Hasil untuk "Medical emergencies. Critical care. Intensive care. First aid"

Rahel Naef

Ricardo X. Noriega, Juan Nañez, Emily Hartmann et al.

Introduction: Past patient data from health information exchanges (HIE) can enhance physician-patient interactions, although how and how often is unclear. We sought to determine how and how often past medical records provided by an HIE impacts current decision-making by emergency physicians. Methods: We identified qualifying emergency department (ED) visits between September 24–26, 2022. The primary feature of a qualifying visit was a separate ED visit within three days prior at a separate hospital system. Fifty-five charts with essential details of each patient’s most recent visit were reviewed in duplicate by 22 emergency medicine residents. Reviewers accessed prior medical records for each patient via an HIE clinical viewer. The primary outcome was the influence of knowledge from prior records on interactions during the most recent visit, measured with 11 Likert-scale ratings. Reviewer agreement was used as an indicator of confidence. Results: Reviewers most frequently agreed that the information from the prior visit was valuable “a moderate amount” (25% of all reviewer pairs) and agreed that the information would cause them to change their approach (69%). They would adjust treatment protocols because of understanding what had been tried previously (67%) and ask the patient different questions (78%). There was also agreement that they would further compare laboratory tests or imaging between visits (67%) and better understand patient behavioral patterns (73%). Conclusion: Access to patients’ previous medical records (diagnoses, imaging reports, discharge reports, etc) via HIEs impacts how emergency physicians communicate with patients, evaluate cases, and make medical decisions.

Charlotte Njua Mbuh, Ian Jones, Ian Steed et al.

Background: The need to provide children affected by the armed conflict between Russia and Ukraine with mental health and psychosocial support (MHPSS) services outweighs available support. In 2024, a certificate peer learning program on Psychological First Aid (PFA) equipped educators, social workers, and health professionals to extend initial psychosocial care to children and the individuals accompanying them. Methods: Sequential mixed methods explored the program’s impact through the lens of organizational learning theory. Correlation examined organizational learning culture, knowledge, and mission performance. Mean learning culture scores were compared to similar studies. Logistic regression assessed program completion variables to develop a predictive model. Content analysis explored contextual needs and participant-valued program features. Constant comparison between MHPSS outcomes analyzed core areas to systematically document and assess PFA impact.  Results: Significant correlations were found between learning culture and changes in organizational knowledge and missional performance. Mean learning culture scores were significantly higher than in similar quantitative studies. Peer review and gender analysis showed significant associations with program completion. Findings revealed common learning patterns and ways the program improved continuous learning opportunities. Participants found peer learning activities to be inclusive and motivational. MHPSS outcomes included improvements in functioning, subjective well-being, coping, social behavior, social connectedness, and severe reactions.  Conclusion: Results support large-scale programming using digital peer learning strategies to fill network gaps and promote continuous learning. Future PFA learning activities should incorporate group discussions and a PFA-evaluation tool to document MHPSS outcomes systematically. Strong learning systems, as demonstrated in this study, correlate with higher performance.  Анотація Передумови: Потреба в наданні послуг психічного здоров’я та психосоціальної підтримки (ПЗПСП) дітям, які постраждали від збройного конфлікту між Росією та Україною, переважає наявну підтримку. У 2024 році сертифікатна програма навчання з першої психологічної допомоги (ППД) дозволила освітянам, соціальним працівникам та медичним працівникам надавати початкову психосоціальну допомогу дітям та особам, які їх супроводжують. Методи: Послідовно використані змішані методи досліджували вплив програми крізь призму теорії організаційного навчання. Кореляційний метод досліджував культуру організаційного навчання, знання та цільову діяльність. Середні бали культури навчання порівнювалися з аналогічними дослідженнями. Логістична регресія оцінювала змінні завершення програми для розробки прогностичної моделі. Контент-аналіз досліджував контекстуальні потреби та оцінювані учасниками характеристики програми. Постійне порівняння результатів психічного здоров'я, соціального забезпечення та соціальної підтримки аналізувало основні області для систематичного документування та оцінки впливу ППД. Результати: Було виявлено значну кореляцію між культурою навчання та змінами в організаційних знаннях і цільовій діяльності. Середні бали культури навчання були значно вищими, ніж у аналогічних кількісних дослідженнях. Експертна оцінка та гендерний аналіз показали значний зв'язок із завершенням програми. Результати виявили спільні моделі навчання та способи, якими програма покращила можливості для безперервного навчання. Учасники вважали, що заходи з навчання за участю колег є інклюзивними та мотивуючими. Результати, повʼязані з ПЗПСП, включали покращення функціонування, суб'єктивного благополуччя, подолання труднощів, соціальної поведінки, соціальних звʼязків та складних реакцій. Висновок: Результати підтверджують ефективність масштабних програм з використанням стратегій цифрового навчання за принципом «рівний — рівному» для заповнення прогалин у професійних мережах та сприяння безперервному навчанню. Майбутні навчальні заходи з ППД повинні включати групові дискусії та інструмент оцінювання ППД для систематичного документування результатів, повʼязаних з ПЗПСП. Як показано в цьому дослідженні, сильні системи навчання корелюють з вищою ефективністю. Résumé de l'article Contexte : Le besoin de fournir des services de soutien en santé mentale et psychosociale (SMSPS) aux enfants touchés par le conflit armé entre la Russie et l'Ukraine est supérieur aux ressources disponibles. En 2024, un programme de certification sur l’apprentissage par les pairs en premiers secours psychologiques a permis de former des éducateurs, des travailleurs sociaux et des professionnels de la santé afin qu'ils puissent apporter un soutien psychosocial initial aux enfants et aux personnes qui les accompagnent. Méthodes : Une approche mixte séquentielle a permis d’explorer l’impact du programme à travers le prisme de la théorie de l’apprentissage organisationnel. Une corrélation a examiné la culture d’apprentissage organisationnel, les connaissances et la performance de la mission. Les scores moyens de la culture d’apprentissage ont été comparés à ceux d’études similaires. Une régression logistique a évalué les variables liées à l’achèvement du programme afin d’élaborer un modèle prédictif. Une analyse de contenu a exploré les besoins contextuels et les caractéristiques du programme appréciées par les participants. Une comparaison constante des résultats en matière de santé mentale et de soutien psychosocial a permis d’analyser les domaines clés afin de documenter et d’évaluer systématiquement l’impact des premiers secours psychologiques. Résultats : Des corrélations significatives ont été observées entre la culture d'apprentissage et les changements en matière de connaissances organisationnelles et à la performance de la mission. Les scores moyens relatifs à la culture d'apprentissage se sont révélés significativement plus élevés que ceux des études quantitatives similaires. La revue par les pairs et l'analyse selon le genre ont montré des associations significatives avec la réussite du programme. Les conclusions ont mis en évidence des schémas d’apprentissage communs ainsi que la manière dont le programme a amélioré les occasions d’apprentissage continu. Les participants ont trouvé les activités d'apprentissage entre pairs inclusives et motivantes. Les résultats en matière de santé mentale et de soutien psychosocial comprenaient des améliorations concernant le fonctionnement, le bien-être subjectif, les capacités d'adaptation, le comportement social, les liens sociaux et les réactions sévères. Conclusion : Les résultats confirment l'efficacité des programmes à grande échelle utilisant des stratégies d'apprentissage par les pairs pour combler les lacunes des réseaux et promouvoir la formation continue. Les futures activités d’apprentissage aux premiers secours psychologiques devraient intégrer des discussions de groupe et un outil d'évaluation spécifique afin de documenter systématiquement les résultats en matière de santé mentale et soutien psychosocial. Des systèmes d'apprentissage performants, comme le démontre cette étude, sont corrélés à de meilleures performances.

M. Cesari, Marco Proietti

TheWorld Health Organization declared the COVID-19 situation as a pandemic onMarch 11, 2020.1 To date, Italy is the country after China that has beenmost severely hit by this humanitarian and public health tsunami. Projections are even suggesting that the number of deaths due to SARS-CoV-2 in Italy will continue to increase in the near future, leaving us the sad world record of casualties. What has happened in Italy during these last few weeks? On February 22, a “red zone” was defined by the government to quarantine a group of several towns in the Lombardy region, just a few hours after the diagnosis of the first case in Italy. This area, where about 50,000 persons live, included Codogno (where patient 1 was identified), Castiglione D’Adda, and Casalpusterlengo. On March 8, the red zone was extended to the entire region of Lombardy (about 10 million people) and several surrounding provinces in a new attempt to prevent the uncontrolled diffusion of the virus to the rest of the country. The following day, the entire country was transformed into a “red zone.” OnMarch 21, a complete lockdown of Italy was ordered by the government as a drastic and unprecedented countermeasure against the coronavirus. Behind this story of the Italian crisis is the drama of a health care system close to collapse. The exponential increase of patients admitted to emergency departments with fever and/or respiratory symptoms resembled themountingwave of a tsunami. It soon became evident how inadequate the availability of beds was to face the continuous flow of patients. The situationwas aggravated by the need to isolate patients with COVID-19, given the high contagiousness of the virus. At the same time, intensive care units started to saturate, and the number of devices for ventilating patients suddenly appeared insufficient to address the growing demand. Furthermore, health care professionals started falling sick (sometimes even dying) as consequence of their untiringwillingness to serve the community, as well as the infrastructural unpreparedness for the enormity of the outbreak. Our world was completely subverted by the emergency. No plans or protocols had the time to be tested and verified, at least on a large scale. The rapidity of the evolving scenario made it necessary to adopt easy and pragmatic solutions even for critical and delicate matters. Not surprisingly, the usual, despicable age criterion started to be

Omid Ahmadi, Mehdi Motififard, Farhad Heydari et al.

Objective Musculoskeletal ultrasound is increasingly used as the modality of choice in diagnosing many medical situations. The present study aimed to compare the accuracy of point-of-care ultrasonography (POCUS) and magnetic resonance imaging (MRI) to detect acute medial meniscus tears in knee. Methods The prospective study was conducted on patients with suspected medial meniscus tears in knee in the emergency department. In the absence of a knee fracture on x-ray, POCUS on the knee was performed. All patients underwent POCUS and MRI of the knee followed by arthroscopy. POCUS findings were then compared to MRI findings to diagnose medial meniscus tears. Results A final total of 157 patients with a mean age of 25.04±7.41 years was included. Out of 157 patients, 94 (59.9%) were male. Medial meniscus tears were detected in 89 patients (56.7%) using arthroscopy as the gold standard. The sensitivity, specificity, positive and negative predictive values, and accuracy of POCUS to detect medial meniscus tears were 88.8% (95% confidence interval [CI], 80.3%–94.5%), 89.7% (95% CI, 79.9%–95.8%), 91.9% (95% CI, 84.8%–95.8%), 85.9% (95% CI, 77.2%–91.7%), and 89.2% (95% CI, 83.3%–93.6%), respectively. The diagnostic accuracy of MRI to detect medial meniscus injury was 93.0% (95% CI, 87.8%–96.4%). Conclusion The present study demonstrated that POCUS is an accurate and reliable diagnostic tool alternative to MRI in detecting medial meniscal tears. POCUS had acceptable sensitivity, specificity, and accuracy in detecting meniscal injuries and could be performed as an effective immediate investigation to guide further modalities in patients with acute knee trauma.

Mahsa Behnemoon, Mojdeh Mehrno, Naser Gharebaghi et al.

Objective: To investigate cardiovascular risk factors affecting COVID-19 outcomes in a tertiary referral hospital. Methods: This prospective cohort study analyzed 269 participants with COVID-19. The primary outcomes were ICU admission, prolonged hospital stay duration, and in-hospital death. The secondary outcomes included death, chronic symptoms, and NYHA functional class during follow-up periods. Results: A total of 412 patients with COVID-19 symptoms were enrolled in the study, and out of which 269 patients had complete medical records and positive SARS-CoV-2 PCR test results, fulfilling the study criteria were analyzed. The patients were divided into two groups, with cardiovascular comorbidities (group A, n=122), such as established cardiovascular disease, diabetes mellitus, and hypertension, and without cardiovascular comorbidities (group B, n=147). Binary logistic regression analysis showed that patients with underlying hypertension, diabetes, and established cardiovascular disease had a 1.55 (95% CI: 1.28-2.26), 1.62 (95% CI: 1.34-2.13), and 1.63 (95% CI: 1.07-5.34)-fold risk of mortality, respectively in the adjusted model. Conclusions: Hospitalized COVID-19 patients with predisposing cardiovascular risk factors are more susceptible to develop worse outcomes. More attention should be paid to the management and follow-up of these patients.

Agnese Accogli, Marco Vergano

Nusret Xhaferi, Antonio Gavrilovski, Marija Jakimova et al.

Abstract: A parasitic disease called actinomycosis occurs when bacteria spread through body tissues, causing abscesses, inflammation, and pain. It affects the skin or deeper parts of the body and can sometimes affect the blood.[1]  The symptoms of actinomycosis may mimic those of other diseases or even neoplasms. Remission and exacerbation of symptoms occurring in parallel sequence with the initiation and cessation of therapy is a phenomenon that should increase suspicion of actinomycosis in any of its manifestations. [2] Microbiology, histopathology, and MRI revealed the presence of an unusual infectious agent, Actinomyces spp., which is also known as Madura foot [3] This implies a serious difficulty in getting a bactericidal concentration of the effective drug into areas of active infection and seriously questions the possibility of restoring the involved tissues [4, 8] The diagnosis was confirmed by isolation of the organisms by anaerobic culture giving typical molar tooth colonies. Final confirmation was done by histopathological examination. Case report; The patient's condition dates back 5 years before the operative treatment when for the first time the patient reported that she was stabbed with a foreign body in the area of ​​the left foot. The patient was treated at home and in the beginning, did not go to the doctor. She occasionally complained of pain and swelling but the pain was not distressing, with no fever and no swelling of the foot…

Chan Hee Park, Jeong Woo Lee

Penetrating abdominal injuries are rare in countries that do not allow legal possession of firearms by the public. We report a case of a 27-year-old male patient with a penetrating liver injury caused by metal fragments released in a blast accident. On the day of the accident, there was a metal explosion, and multiple fragments of the metal lodged in the patient’s abdomen. The metal fragments were widely distributed over the abdomen and limited to the subcutaneous layer. A computed tomography scan showed that one metal fragment had penetrated near the right upper quadrant. First, we tried exploratory laparoscopy to accurately locate and remove the presumed metal fragment under the liver, on the side of the gallbladder, and near the duodenum. However, we could not find the metal fragment and converted the procedure to open laparotomy. The metal fragment was found to be completely lodged in segment 4, the quadrate lobe to the left of the gallbladder. To remove the fragment, a 2-cm incision was made on the liver surface where the metal fragment was found. The patient's general postoperative condition was satisfactory, with no findings of bile leakage or bleeding. In conclusion, clinicians who do not have experience with these injuries can still provide adequate treatment by selecting a treatment method based on the patient's condition as well as the velocity of trauma. The laparoscopic approach, as a less invasive procedure, may be worthwhile for treating penetrating trauma. Additionally, laparoscopic exploratory laparotomy may be considered in selected cases.

M. A. Balalaeva, L. V. Selivanova, O. V. Dymova et al.

Patients with nosocomial infections stay in the hospital 2–3 times longer than patients without signs of infection.It results in 3–4-fold increase of costs and 5–7-fold elevated risk of death. The choice of rational regimes of antimicrobial therapy in such cases is very difficult.The objective: to demonstrate the efficacy of a combination of prolonged intravenous infusion of meropenem and inhaled sodium colistimethate in the treatment of the patient with the pulmonary infection caused by Kl. pneumoniae and Ac. baumanii, which were resistant to a wide range of antibiotics.

S.M. Nedashkivskyi, D.O. Dzuba, M.M. Kalysh et al.

The article considers the causes of carbon monoxide poisoning, the main symptoms of mild, moderate, and severe poisoning. The article describes the pathophysiology of poisoning, the effect of carboxyhemoglobin on various organs and systems of the victim’s body. Preventive measures to prevent possible poisoning are highlighted. The principles of providing medical care to victims both at the pre-hospital stage and during inpatient treatment are given.

Manon C. Vanbellinghen, MD, Burak Atasever, MD, PhD, Hans J. I. van der Spoel, MD, PhD et al.

Objectives:. To evaluate the yield of mini-bronchoalveolar lavage compared with that of directed bronchoalveolar lavage in critically ill patients with suspected coronavirus disease 2019–associated pulmonary aspergillosis. Design:. A retrospective cohort study. Setting:. The ICU of the Amsterdam University Medical Centers. Patients:. Patients with confirmed coronavirus disease 2019 screened for coronavirus disease 2019–associated pulmonary aspergillosis. INTERVENTIONS:. Mini-bronchoalveolar lavage and/or directed bronchoalveolar lavage. Measurements and Main Results:. In total, 76 patients were included, 20 of whom underwent bronchoalveolar lavage, 40 mini-bronchoalveolar lavage, and 16 both mini-bronchoalveolar lavage and bronchoalveolar lavage. The percentage of samples with one or more positive Aspergillus detecting test (galactomannan, culture, polymerase chain reaction) did not differ significantly between bronchoalveolar lavage and mini-bronchoalveolar lavage (16.7% vs 21.4%). However, in mini-bronchoalveolar lavage samples, this was more frequently driven by a positive polymerase chain reaction than in bronchoalveolar lavage samples (17.9% vs 2.8%; p = 0.030). In 81% of patients (13/16) with both mini-bronchoalveolar lavage and bronchoalveolar lavage, the test results were in agreement. In 11 of 12 patients (92%) with first a negative mini-bronchoalveolar lavage, the subsequent bronchoalveolar lavage sample was also negative. Conclusions:. We found a similar percentage of positive test results in mini-bronchoalveolar lavage and bronchoalveolar lavage samples in patients with suspected coronavirus disease 2019–associated pulmonary aspergillosis. Our findings indicate that mini-bronchoalveolar lavage could be a useful tool for coronavirus disease 2019–associated pulmonary aspergillosis screening in ICU patients.

M. Christian, N. Kissoon

Pediatric Critical Care Medicine www.pccmjournal.org 679 In 2011, we led the Pediatric Emergency Mass Critical Care Task Force (1) which recommended that hospitals which provide care exclusively to adults be prepared to provide care for pediatric patients in a pandemic or disaster which impacts children proportionally to adults. In the 2014 Task Force for Mass Critical Care (2), we highlighted the need for a systems-level approach for the provision of critical care in pandemics or disasters where pediatric patients are not considered a “special population” but rather are entitled to an equitable share of critical care resources. These recommendations were driven by the significant lower critical care capacity for pediatric patients within the population compared to that of adults. Although these recommendations remain valid today, we did not envision a pandemic, such as the coronavirus disease 2019 (COVID-19), which so disproportionately affect adults that pediatric intensive care clinicians are being asked to accommodate critically ill adults in their ICUs (3). In this issue of Pediatric Critical Care Medicine, Remy et al (4) comprised dual trained adult and pediatric intensive care physicians provide timely advice primarily aimed at pediatric intensive care physicians regarding key differences in the medical management of critically ill adults. This practical information is timely and much needed by pediatric intensivist caring for adults suffering from COVID-19. However, effective and safe care can only be delivered if a structured framework in place as an enabler. Thus, thoughtful preparation beyond the information provided by Remy et al (4) is necessary to prepare pediatric units to care for adult patients. Issues of ethics, justice, and societal considerations are important in determining whether pediatric critical care beds should be made available for adults. It is widely accepted that there are finite critical care resources and the process to allocate these resources ethically must include considerations of equity of all patients in need (5–7). However, there is very limited practical guidance to assist providers facing the ethical challenges of considering both adults and pediatric patients together vying for a single pool of resources (8). Although there is certainly a strong basis to argue that allowing adults to die while ventilators sit unused in a PICU is unethical, healthcare systems must have a process in place for making decisions regarding the allocation of critical care resources that can address the ethical and medical complexities of allocating resources that takes into account the differences within and between these populations (9). Caring for COVID-19–infected adults in ICUs at pediatric hospitals (which do not normally care for adults) should be considered equivalent to providing adult critical care in an alternate care facility. Commensurate with published recommendations (2, 10–12), this should only occur during a crisis surge response after the strategies for conventional and contingency responses (2, 13), including maximally expanding critical care capacity within adult hospitals such as recruiting pediatric critical care staff and expertise to adult units. In order to successfully provide the care outlined by Remy et al (4) to adults in a pediatric hospital, the enablers of care such as staff, “stuff,” space, and systems must be arranged a priori. Successful delivery of care also depends on a robust “3Cs” (command, control, and communication) system (2, 11, 14).

H. Corwin, A. Gettinger, R. Pearl et al.

Francesco Mojoli, Silvia Mongodi, Anita Orlando et al.

Shunichiro Nakao, Yusuke Katayama, Atsushi Hirayama et al.

Abstract Background There is a paucity of information for predicting patient outcomes other than the American Association for the Surgery of Trauma (AAST) renal injury scale. The aim of this study was to evaluate the association between the patient characteristics and outcomes of patients with blunt renal trauma using a nationwide database in Japan. Methods We performed a retrospective analysis of the Japan Trauma Data Bank (JTDB) from 2004 to 2018. We identified patients with blunt renal trauma by AIS codes converted to AAST grades. We evaluated trends in patient characteristics and management and assessed factors associated with mortality and nephrectomy using a multivariable logistic regression analysis. Results We identified 3550 patients with blunt renal trauma. Their median age was 43 years and 74.2% were male. Nephrectomy was performed in 3.8%, and the overall mortality rate was 9.5%. We found increasing trends in age and emergency abdominal angiography and decreasing trends in nephrectomy and mortality over the 15-year period. The following factors were associated with mortality: age ≥ 65 years (adjusted OR 3.36); pedestrian accident (adjusted OR 1.94); fall from height (adjusted OR 1.91); shock on arrival (adjusted OR 4.02); concomitant injuries to the head/neck (adjusted OR 3.14), pelvis/lower-extremity (adjusted OR 1.59), liver (adjusted OR 1.68), spleen (adjusted OR 1.45), and gastrointestinal tract (adjusted OR 1.90); AAST grades III–V (adjusted ORs 1.42, 2.16, and 5.55); and emergency abdominal angiography (adjusted OR 0.70). The following factors were associated with nephrectomy: shock on arrival (adjusted OR 1.98), concomitant injuries to the thorax (adjusted OR 0.46) and spleen (adjusted OR 2.07), AAST grades III, IV, and V (adjusted ORs 18.40, 113.89, and 468.17), and emergency abdominal angiography (adjusted OR 0.28). Conclusions We demonstrated that the AAST grade and emergency angiography were associated with mortality and nephrectomy in blunt renal trauma in the Japanese population.

P. Carli, François Pons, J. Levraut et al.

M. Peters, K. Woolfall, I. Khan et al.

BackgroundFever improves pathogen control at a significant metabolic cost. No randomized clinical trials (RCT) have compared fever treatment thresholds in critically ill children. We performed a pilot RCT to determine whether a definitive trial of a permissive approach to fever in comparison to current restrictive practice is feasible in critically ill children with suspected infection.MethodsAn open, parallel-group pilot RCT with embedded mixed methods perspectives study in four UK paediatric intensive care units (PICUs) and associated retrieval services.Participants were emergency PICU admissions aged > 28 days to < 16 years receiving respiratory support and supplemental oxygen.Subjects were randomly assigned to permissive (antipyretic interventions only at ≥ 39.5 °C) or restrictive groups (antipyretic interventions at ≥ 37.5 °C) whilst on respiratory support. Parents were invited to complete a questionnaire or take part in an interview. Focus groups were conducted with staff at each unit. Outcomes were measures of feasibility: recruitment rate, protocol adherence and acceptability, between group separation of temperature and safety.ResultsOne hundred thirty-eight children met eligibility criteria of whom 100 (72%) were randomized (11.1 patients per month per site) without prior consent (RWPC). Consent to continue in the trial was obtained in 87 cases (87%). The mean maximum temperature (95% confidence interval) over the first 48 h was 38.4 °C (38.2–38.6) in the restrictive group and 38.8 °C (38.6–39.1) in the permissive group, a mean difference of 0.5 °C (0.2–0.8). Protocol deviations were observed in 6.8% (99/1438) of 6-h time periods and largely related to patient comfort in the recovery phase. Length of stay, duration of organ support and mortality were similar between groups. No pre-specified serious adverse events occurred. Staff (n = 48) and parents (n = 60) were supportive of the trial, including RWPC. Suggestions were made to only include invasively ventilated children for the duration of intubation.ConclusionUncertainty around the optimal fever threshold for antipyretic intervention is relevant to many emergency PICU admissions. A more permissive approach was associated with a modest increase in mean maximum temperature. A definitive trial should focus on the most seriously ill cases in whom antipyretics are rarely used for their analgesic effects alone.Trial registrationISRCTN16022198. Registered on 14 August 2017.