Frontiers in Emergency Medicine (E-Journal)
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Acute dyspnea following knee joint total endoprosthesis – a diagnostic surprise
Get PDFAcute dyspnea, sometimes dramatic, is most often caused by cardiovascular or respiratory disease. However, although rare, thyroid dysfunction may present a similar clinical picture with equally serious and life-threatening consequences. Therefore, every occurrence of acute dyspnea represents a special medical challenge in diagnosis and treatment. We present a case of 81-year-old male admitted to the rehabilitation department five days after a knee joint total endoprosthesis and developed acute dyspnea two days later. An emergency diagnostic was performed and confirmed an airway stenosis through a previously undiagnosed enlarged thyroid gland. Although in most cases an acute life-threatening postoperative dyspnea indicates a cardiac or pulmonary problem, other diseases must be taken into consideration
Determination of emergency department patient utilization and staffing at the University of the Philippines-Philippine General Hospital (UP-PGH)
Get PDFObjective: In developing staffing plans for emergency departments (EDs), a multifaceted approach must be considered without compromising quality of care, patient safety and personnel satisfaction. This study aims to determine the temporal trend of patient attendance and staffing in a major tertiary hospital ED to assist in establishing an optimal staffing pattern. Methods: A 1-year retrospective ED census review of adult patients at the University of the Philippines-Philippine General Hospital (UP-PGH) was undertaken. One-way analysis of variance (ANOVA) with post hoc Fisher-Hayter pairwise comparisons were utilized to determine if the ED consults and admissions were significantly (P<0.05) associated with the month of the year and day of the week. Results: A total 43,632 consults at the UP-PGH ED, averaging of 3,636 per month or 121 per day, were seen in 2019. Results indicated statistically significant differences between monthly [F (11,353) =16.45; P<0.0001] and between daily means [F (6,358) =4.19; P=0.0004]. The most number of consults occur during August, September, October and November while admissions were highest during April and October. It was busiest during Mondays and afternoon shifts (1400-2200 hours) with majority arriving as urgent in acuity. Mortality was also highest during the afternoon shifts. Conclusion: The temporal variations in patient visits and acuity described in our study can be used as a template for workforce scheduling and resource allocation to meet the demands in the provision of care at the ED
Early clinical experience with a new video laryngoscope (SANYAR®) for tracheal intubation in adults: a comparison clinical study
Get PDFObjective: SANYAR® video laryngoscope (S-VL) is a new video laryngoscope. We conducted a comparative clinical study to assess its ability to provide laryngeal exposure and facilitate endotrachetal intubation (ETI) in adult patients. Methods: This comparison clinical study was conducted on adult patients undergoing elective general anesthesia. The patients were randomly divided into two groups of direct laryngoscopy (DL) or S-VL. The primary outcome was the time required for performing ETI. The glottic view and successful ETI on the first attempt was also compared between the two groups. Results: Full and partial glottic visualization was achieved in 100% of the patients in the S-VL group, while the corresponding figure in the DL group was 90%. Cormack-Lehane III was observed in 5 patients of the DL group, and ETI was successfully carried out with S-VL. The first-pass success rate of ETI was significantly higher in S-VL group compared to the DL group (94% vs. 78%; P = 0.034). The mean times to ETI were 38.32±6.4 and 35.31±8.4 seconds in DL and S-VL groups, respectively (P = 0.650). Conclusions: During ETI for general anesthesia, SANYAR® video laryngoscope compared with direct laryngoscopy improved glottic visualization and first-pass ETI rate
Cardiac dysrhythmia in COVID-19 patients; occurrence and risk factors
Get PDFObjective: In this study, we have evaluated the occurrence and risk factors of cardiac dysrhythmia on admission and during hospitalization in COVID-19 patients. Methods: This study was conducted as a retrospective cohort in which 893 electrocardiograms (ECGs) taken at the time of admission and 328 ECGs taken during hospitalization were evaluated. These ECGs were assessed for cardiac dysrhythmias by a cardiologist. Finally, relationships between clinical characteristics and the occurrence of cardiac dysrhythmias in patients were assessed. Results: Most common cardiac dysrhythmias on admission were sinus tachycardia (64.8%), atrial fibrillation (13.5%), and sinus bradycardia (11.3%). Multivariate regression analysis showed that a history of metformin use (RR=0.83; p=0.042) was independently associated with reduced risk of cardiac dysrhythmias on admission, while male sex (RR=1.16; p=0.018), history of cardiovascular diseases (RR=1.16; p=0.017), history of cancer (RR=1.40; p=0.004) and QT prolongation on ECG (RR=1.18; p=0.017) were associated with a higher risk of cardiac dysrhythmias on admission. Also, from the 328 patients that had a second ECG, 185 (56.4%) experienced cardiac dysrhythmias during their hospitalization. Multivariate analysis showed that presence of cardiac dysrhythmias on admission (RR=1.85; 95% CI; 1.49-2.35; p<0.001) was the only independent prognostic factor for the occurrence of cardiac dysrhythmias during hospitalization. no significant relationships were observed between treatment regimens and the incidence of cardiac dysrhythmias. Conclusion: The present study showed that more than half of COVID-19 patients have cardiac dysrhythmias on admission. Our analyses illustrated that a history of metformin use was associated with a lower risk of cardiac dysrhythmias on admission, while male sex, history of cardiovascular diseases, history of cancer, and QT prolongation were associated with a higher rate of cardiac dysrhythmias. Hydroxychloroquine use along with azithromycin and Kaletra (Lopinavir-Ritonavir) had no association with the development cardiac dysrhythmias during hospitalization
Eye emergency during wars; Take-home message for soldiers
Get PDFWar is an organized and prolonged armed dispute between states or nations. It is characterized by high mortality, violence, and social or economic costs. There are multiple causes of war and conflict, including extreme poverty, high unemployment, and social, political, or economic disparities. The incidence of wars has increased since 1950, especially between states. Small Arms Survey reports that warfare kills nearly 133,750 persons, yearly. The rates of disability and death caused by war are more than many major diseases globally. It destroys the healthcare systems and public health services of the included states or societies, which results in more diseases and deaths
Increased prevalence of bloodstream infection with Klebsiella species in patients with recent COVID-19 infection
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In viral pandemics, the possibility of accompanied bacterial infections is always a serious challenge for health care providers. In the recent pandemic with COVID-19, studies showed an increase in bacterial infections in patients with COVID-19, especially those requiring intensive care unit (ICU) admission. Various meta-analyses have shown that the prevalence of some secondary bacterial infections, especially infection with Mycoplasma pneumoniae, Gram-negative germs like extended-spectrum beta-lactamase, and Klebsiella pneumoniae, has increased significantly. Recent studies have also shown that the pathogens that cause bloodstream infections have changed during the COVID-19 pandemic for a variety of reasons, including the widespread use of antibiotics, the effects of COVID-19 on the immune system, and so on. Increased prevalence of bloodstream infections with Gram-negative bacteria that are resistant to third generation of cephalosporins and carbapenems in patients with COVID-19 has been reported in several studies. Studies have also shown increased isolation of pathogens such as members of the Enterobacteriaceae family, including Klebsiella and Escherichia specimens, from blood cultures of patients hospitalized due to COVID-19
Spontaneous renal subcapsular hematoma; a case report and reviewing management options
Get PDFSpontaneous subcapsular renal hematoma is a rare complication with potentially fatal effects in clinical practice. We discuss a case of a patient who arrived at the emergency room with abrupt onset flank discomfort and hematuria. The damaged kidney was effectively embolized by interventional radiology, and the patient quickly recovered. Follow-up tests revealed that the hematoma had shrunk in size. We believe that early arterial embolization should be explored in the care of patients with renal bleeding because it may enhance outcomes
Developing and validating a checklist for assessing the performance of air ambulance services
Get PDFObjective: The purpose of this study was to develop a checklist for assessing the performance of air ambulance services. Method: This is a qualitative study. The first phase involved a review of existing documentation about air emergency standards to create a checklist of the most critical factors and components affecting the performance of air ambulance services. The second phase required experts to complete a performance evaluation checklist from the previous phase. The third phase utilized the Delphi technique to validate the performance evaluation checklist for air ambulance services. The experts in this study were 24 pundits with a vested interest in the subject. Results: A total of 31 items exist in the area of helipad-related facilities, 17 items in the area of process requirements for medical centers with helicopter landing areas, 15 items in the category of human resources for air ambulances, 10 items in the category of human resources for receiving or delivering patients from air ambulances to medical centers, 27 items in the area of base equipment, 17 items in the area of helicopter equipment, and requirements, 14 items in the category of technical, communication, and safety equipment for use inside the helicopter, 1o items dealing with time standards, 11 items dealing with road and urban base requirements for air ambulance operations. Experts approved two items in the area of utilizing other rescue and law enforcement agencies to assist and cooperate with air emergency flights and two items in the area of comfort for conscious patients to alleviate stress during flight. Conclusion: A performance evaluation checklist is an effective tool for evaluating the quantity and quality of emergency helicopter services provided and measuring their performance
Acute kidney injury after successful cardiopulmonary resuscitation: risk factors and prognosis
Get PDFObjectives: Acute kidney injury (AKI) is an independent risk factor in critically ill patients. This study aimed to evaluate the prevalence of AKI in resuscitated cardiac arrest (CA) patients, its potential risk factors, and outcomes of AKI in cardiac arrest survivors. Methods: A hundred and forty-nine cases of post-CA that survived for at least 24 hours, were admitted to three hospitals between 2016 and 2020, were studied. AKI was defined by the RIFLE (Risk, Injury, Failure, Loss, and End-stage) criteria. Baseline demographic data, resuscitation variables, the prevalence of AKI, in-hospital and six-month mortality were collected. Logistic regression evaluated the factors associated with AKI occurrence and mortality. Results: AKI occurred in 59 (39.6%) of the patients. Of these, nine patients (15.3%) required renal replacement therapy (RRT) during their hospital stay. There were 47 (52.2%) in-hospital mortality in patients without AKI and 41 (69.5%) in patients with AKI (P=0.036). Post-CA AKI was significantly associated with six-month mortality (OR 1.65 [1.39-2.88]; p = 0.029). Older age, the higher cumulative dosage of epinephrine during cardiopulmonary resuscitation, post-CA shock, in-hospital CA, PEA/asystole rhythm, longer duration of cardiac arrest, as well as higher admission creatinine and lactate levels were independently associated with AKI, in contrast, higher admission Base Excess level was negatively associated with AKI. Conclusion: AKI occurred in nearly 40% of CA patients. AKI was associated with a higher in-hospital and six-month mortality rates
The value of predictive instruments in the screening of acute stroke: an umbrella review on previous systematic reviews
Get PDFObjective: Although various predictive instruments have been introduced for early stroke diagnosis, there is no consensus on their performance. Therefore, we decided to assess the value of predictive instruments in the detection of stroke by conducting an umbrella review. Methods: A search was performed in the Medline, Embase, Scopus and Web of Science databases by the end of August 2021 for systematic reviews and meta-analyses. Original articles included in the systematic reviews were retrieved, summarized and pooled sensitivity, specificity and diagnostic odds ratio were calculated. The level of evidence was divided into five groups: convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV) and non-significant. Results: The value of 33 predictive instruments was evaluated. The sample size included in these scoring systems’ assessments varied between 182 and 47072 patients. The level of evidence was class I in one tool, class II in 18 tools, class III in 2 tools, class IV in 11 tools, and non-significant in one tool. Apart from Med PACS, which had a low diagnostic value, other tools appeared to be able to detect a stroke. The optimum performance for diagnosis of stroke was for ROSIER, NIHSS, PASS, FAST, LAMS, RACE and CPSS. Conclusion: Convincing to suggestive evidence shows that ROSIER, NIHSS, PASS, FAST, LAMS, RACE and CPSS have the optimum performance in identifying stroke. Since ROSIER’s calculation is simple and has the highest sensitivity and specificity among those predictive instruments, it is recommended for stroke diagnosis in pre-hospital and in-hospital settings