首页期刊导航|The American journal of emergency medicine
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The American journal of emergency medicine
Centrum Philadelphia]
The American journal of emergency medicine

Centrum Philadelphia]

0735-6757

The American journal of emergency medicine/Journal The American journal of emergency medicine
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    Prehospital time for patients with acute cardiac complaints: A rural health disparity

    Ashburn N.P.Snavely A.C.Angi R.M.Scheidler J.F....
    5页
    查看更多>>摘要：? 2021 Elsevier Inc.Objective: Delays in care for patients with acute cardiac complaints are associated with increased morbidity and mortality. The objective of this study was to quantify rural and urban differences in prehospital time intervals for patients with cardiac complaints. Methods: The ESO Data Collaborative dataset consisting of records from 1332 EMS agencies was queried for 9–1-1 encounters with acute cardiac problems among adults (age ≥ 18) from 1/1/2013–6/1/2018. Location was classified as rural or urban using the 2010 United States Census. The primary outcome was total prehospital time. Generalized estimating equations evaluated differences in the average times between rural and urban encounters while controlling for age, sex, race, transport mode, loaded mileage, and patient stability. Results: Among 428,054 encounters, the median age was 62 (IQR 50–75) years with 50.7% female, 75.3% white, and 10.3% rural. The median total prehospital, response, scene, and transport times were 37.0 (IQR 29.0–48.0), 6.0 (IQR 4.0–9.0), 16.0 (IQR 12.0–21.0), and 13.0 (IQR 8.0–21.0) minutes. Rural patients had an average total prehospital time that was 16.76 min (95%CI 15.15–18.38) longer than urban patients. After adjusting for covariates, average total time was 5.08 (95%CI 4.37–5.78) minutes longer for rural patients. Average response and transport time were 4.36 (95%CI 3.83–4.89) and 0.62 (95%CI 0.33–0.90) minutes longer for rural patients. Scene time was similar in rural and urban patients (0.09 min, 95%CI -0.15-0.33). Conclusion: Rural patients with acute cardiac complaints experienced longer prehospital time than urban patients, even after accounting for other key variables, such as loaded mileage.
      原文链接:
    • NSTL
    • Elsevier

    Methanol poisoning during COVID-19 pandemic; A systematic scoping review

    Mousavi-Roknabadi R.S.Arzhangzadeh M.Safaei-Firouzabadi H.Sharifi M....
    16页
    查看更多>>摘要：? 2021 Elsevier Inc.Objective: In this systematic scoping review, it was aimed to assess the epidemiology of methanol poisoning, clinical findings and patients' management, causes, and recommendations regarding prevention or reduction of methanol poisoning during COVID-19 pandemic. Methods: Three Electronic databases [Medline (accessed from PubMed), Scopus, and Science Direct] were searched systematically from December 01, 2019 to September 10, 2020, using MESH terms and the related keywords in English language. Considering the titles and abstracts, unrelated studies were excluded. The full texts of the remained studies were evaluated by authors, independently. Then, the studies' findings were assessed and reported. Results: Total of 86 articles were obtained within the first step of searching, and 64 ones remained after removing the duplications. Through the title and abstract screening, 35 were removed. Finally, after reading the full text of the remained articles, 15 ones included in data extraction. Most of the previous reported evidence (13/15) were letter to editor, commentary and short reports. None of them were interventional, and none of them followed the patients. Findings were summarized in four categories: 1) epidemiology; 2) clinical findings and patients' management; 3) causes; and 4) recommendation regarding prevention or reduction of methanol poisoning during COVID-19 pandemic. Conclusion: The recent outbreak is the largest methanol mass poisoning outbreak throughout Iran and the world in recent decades. The causes of methanol poisoning during the COVID-19 pandemic are intertwined, and most of them are modifiable by health policy makers. Building trust, educating and warning, as well as controlling and monitoring are three main recommendation for prevention or reduction of methanol poisoning.
      原文链接:
    • NSTL
    • Elsevier

    Dispelling myths and misconceptions about the treatment of acute hyperkalemia

    Gupta A.A.Self M.Mueller M.Wardi G....
    7页
    查看更多>>摘要：? 2021 The AuthorsHyperkalemia represents a widespread and potentially lethal condition that affects millions of people across their lives. Despite the prevalence and severity of the condition, there are no consensus guidelines on the treatment of hyperkalemia or even a standard definition. Herein, we provide a succinct review of what we believe to be the most significant misconceptions encountered in the emergency care of hyperkalemia, examine current available literature, and discuss practical points on several modalities of hyperkalemia treatment. Additionally, we review the pathophysiology of the electrocardiographic effects of hyperkalemia and how intravenous calcium preparations can antagonize these effects. We conclude each section with recommendations to aid emergency physicians in making safe and efficacious choices for the treatment of acute hyperkalemia.
      原文链接:
    • NSTL
    • Elsevier

    The association between the degree of fever as measured in the emergency department and clinical outcomes of hospitalized adult patients

    Marcusohn E.Gibory I.Miller A.Lipsky A.M....
    7页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: Fever is a physiologic response to a wide range of pathologies and one of the most common complaints and clinical signs in the emergency medicine department (ED). The association between fever magnitude and clinical outcomes has been evaluated in specific populations with inconsistent results. Objectives: In this study we aimed to investigate the association between the degree of fever in the ED and clinical outcomes of hospitalized febrile adult patients. Methods: This was a retrospective single-center cohort study of all the patients with maximal body temperature (BT) ≥ 38.0 °C, as recorded during the ED evaluation, who were hospitalized between January 2015 and December 2020. Patients with heatstroke were excluded. The primary outcome was 30-day all-cause mortality and secondary outcomes were intensive care unit (ICU) admission and development of acute kidney injury (AKI). Results: Fever was recorded among 8.1% of patients evaluated in the ED. Elevated BT was associated with increased risk of hospital admission (70.3% vs. 49.4%, p < 0.001), 30-day mortality (12.3% vs. 2.6%, p < 0.001), ICU admission (5.7% vs. 2.8%, p < 0.001), and AKI 11.7% vs. 3.8%, p < 0.001). After exclusion of nine patients with heatstroke, 21,252 hospitalized febrile patients were included in the final analysis. BT > 39.7 °C was progressively associated with increased mortality (OR 1.64–2.22, 95% CI 1.16–2.81, p < 0.005) as compared to BT 38.0–38.1 °C. More AKI events were observed in patients with BT > 39.5 °C (OR 1.48–2.91, 95% CI 1.11–3.66, p < 0.007). Temperature between 39.2 and 39.5 °C was associated with lower mortality (OR 0.62–0.71, 95% CI 0.51–0.87, p < 0.001). In a multiple logistic regression analysis BT > 39.9 °C was independently associated with increased mortality and AKI. BT > 39.7 °C was progressively associated with an increased risk of ICU admission. Conclusion: Among febrile patients admitted to the hospital, BT > 39.5 °C was associated with adverse clinical course, as compared to patients with lower-grade fever (38.0–38.1 °C). These patients should be flagged on arrival to the ED and likely warrant more aggressive evaluation and treatment.
      原文链接:
    • NSTL
    • Elsevier

    Secondary traumatic stress, anxiety, and depression among emergency healthcare workers in the middle of the COVID-19 outbreak: A cross-sectional study

    Ilhan B.Kupeli I.
    6页
    查看更多>>摘要：? 2021 Elsevier Inc.Background: This study aims to determine the secondary traumatic stress (STS), anxiety, and depression levels of the emergency healthcare workers (HCWs) and to identify the factors associated with the mental health of the emergency HCWs. Methods: This prospective cross-sectional study was performed between April 1 and May 1, 2021. Emergency nurses and auxiliary staff who gave informed consent were included in the study. Participants who answered the questions incompletely were excluded from the study. Demographic information, working and living conditions, STS, anxiety, depression scores, and coping strategies were recorded. Results: A total of 363 HCWs were included in the study. STS was detected in 261 (71.9%) of the participants, anxiety in 148 (40.8%), and depression in 203 (55.9%) participants. Vaccination against COVID-19 was not associated with STS, anxiety, and depression among emergency HCWs (p > 0.05). Having financial difficulties was the most important factor in the development of anxiety, depression, and STS (OR: 3.68 (95% CI 1.96–6.90), p < 0.001; OR: 4.36 (95% CI 2.52–7.53), p < 0.001; OR: 5.35 (95% CI 3.06–9.37), p < 0.001, respectively). We found significantly reduced levels of STS, anxiety, and depression among participants reporting coping strategies that engaging in hobbies, healthy nutrition, and reading books. Conclusion: High levels of STS, anxiety, and depression were determined among emergency nurses and auxiliary staff during the pandemic. Poor job satisfaction and financial difficulties were associated with the mental health of emergency HCWs. The mental health of the emergency HCWs should be evaluated regularly. In addition to professional psychological support, social and financial support should be provided as well.
      原文链接:
    • NSTL
    • Elsevier

    Impact of crowding in local ambulance demand on call-to-ambulance scene arrival in out-of-hospital cardiac arrest

    Kim D.K.Kim T.H.Shin S.D.Ro Y.S....
    5页
    查看更多>>摘要：? 2021Background: Rapid emergency medical service (EMS) response is an important prognostic factor in out-of-hospital cardiac arrest (OHCA). This study aims to evaluate the association between local hourly EMS demand and ambulance response in OHCA. Methods: OHCA occurring in 24 districts of Seoul from 2013 to 2018 was analyzed. Hourly ambulance demand per ambulance in each local district of patient location at the hour of cardiac arrest was calculated as the crowding index. The crowding index was categorized according to quartiles (1Q: ≤0.43, 2Q: 0.44–0.67, 3Q: 0.68–0.99, 4Q: ≥1.0 calls/h\r/ambulance). The primary outcome was ambulance dispatched within 1 km of the OHCA scene. Multivariable logistic regression analysis was performed to test the association between the local hourly ambulance demand and outcomes. Results: A total of 26,479 patients were analyzed. The rate of ambulance dispatched within 1 km decreased according to the crowding quartile (1Q: 31.3%, 2Q: 30.0%, 3Q: 28.8%, and 4Q: 26.6%). Compared to 1Q, adjusted odds ratios (95% CIs) of dispatch distance within 1 km in 2Q, 3Q, and 4Q were 0.92 (0.86–0.99), 0.86 (0.80–0.94), and 0.77 (0.71–0.84), respectively. Conclusion: Crowding in local ambulance demand was associated with less ambulance dispatched within 1 km and delayed response to the scene in OHCA. Strategies to mitigate and adjust to ambulance demand crowding may be considered for better EMS response performance.
      原文链接:
    • NSTL
    • Elsevier

    The potential use of Google reviews to assess patient satisfaction in the emergency department

    Derdzakyan N.Pourmand A.Shesser R.Ganguli S....
    4页
      原文链接:
    • NSTL
    • Elsevier

    Predicting scale of delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning: A retrospective study

    Yang S.Liu H.Peng Q.Li J....
    5页
    查看更多>>摘要：? 2021Objective: To establish and validate a predictive formula for calculating the possibility of developing delayed neurological sequelae (DNS) after acute carbon monoxide (CO) poisoning to facilitate better decision-making about treatment strategies. Methods: This study retrospectively enrolled 605 consecutive patients who had been newly diagnosed with CO poisoning from the Central Hospital of Enshi Prefecture between January 1, 2015 and December 31, 2020. The cohort was randomly divided into two subgroups: the development cohort (n = 104) and validation cohort (n = 44). Univariate analysis and backward elimination of multivariate logistic regression were used to identify predictive factors, and a predictive formula was established. The performance was assessed using the area under the curve (AUC), the mean AUC of five-fold cross-validation, and calibration plots. Results: The formula included four commonly available predictors: initial GCS score, duration of exposure, CK, and abnormal findings on MRI. We next created a formula to calculate the risk score for developing DNS: Risk score = ?4.54 + 3.35 * (Abnormal findings on MRI = yes) - 0.51 * (Initial GCS score) + 0.65 * (Duration of exposure) + 0.01 * (CK). Then, the probability of developing DNS could be calculated: Probability of DNS = 1/(1 + e Risk score). The model revealed good discrimination with AUC, and mean AUC of fivefold cross-validation in two cohort, and the calibration plots showed good calibration. Conclusions: This study established a prediction predictive formula for predicting developing of DNS, which could facilitate better decision-making about treatment strategies.
      原文链接:
    • NSTL
    • Elsevier

    Traumatic brain injury and intraparenchymal hemorrhage progression: Blood pressure variability matters

    Tran C.Frederick H.Baqai H.Fairchild M....
    9页
    查看更多>>摘要：? 2021 Elsevier Inc.Introduction: Blood pressure variability (BPV) has been shown to correlate with intraparenchymal hematoma progression (HP) and worse outcomes in patients with spontaneous intracerebral hemorrhage (sICH). However, this association has not been elucidated in patients with traumatic intraparenchymal hemorrhage or contusion (tIPH). We hypothesized that 24 h-BPV from time of admission is associated with hemorrhagic progression of contusion or intraparenchymal hemorrhage (HPC), and worse outcomes in patients with tIPH. Method: We performed a retrospective observational analysis of adult patients treated at an academic regional Level 1 trauma center between 01/2018–12/2019. We included patients who had tIPH and ≥ 2 computer tomography (CT) scans within 24 h of admission. HP, defined as ≥30% of admission hematoma volume, was calculated by the ABC/2 method. We performed stepwise multivariable logistic regressions for the association between clinical factors and outcomes. Results: We analyzed 354 patients' charts. Mean age (Standard Deviation [SD]) was 56 (SD = 21) years, 260 (73%) were male. Mean admission hematoma volume was 7 (SD =19) cubic centimeters (cm3), 160 (45%) had HP. Coefficient of variation in systolic blood pressure (SBPCV) (OR 1.03, 95%CI 1.02–1.3, p = 0.026) was significantly associated with HPC among patients requiring external ventricular drain (EVD). Difference between highest and lowest systolic blood pressure (SBPmax-min) (OR 1.02, 95%CI 1.004–1.03, p = 0.007) was associated with hospital mortality. Conclusion: SBPCV was significantly associated with HP among patients who required EVD. Additionally, increased SBPmax-min was associated with an increase in mortality. Clinicians should be cautious with patients' blood pressure until further studies confirm these observations.
      原文链接:
    • NSTL
    • Elsevier

    Chest compression quality during CPR of potential contagious patients wearing personal protection equipment

    Cekmen B.Bildik B.Atis S.E.Koksal M....
    4页
    查看更多>>摘要：? 2021Aim of the study: In this study we aimed to investigate whether changing rescuers wearing N95 masks every 1 min instead of the standard CPR change over time of 2 min would make a difference in effective chest compressions. Methods: This study was a randomized controlled mannequin study. Participants were selected from healthcare staff. They were divided into two groups of two people in each group. The scenario was implemented on CPR mannequin representing patient with asystolic arrest, that measured compression depth, compression rate, recoil, and correct hand position. Two different scenarios were prepared. In Scenario 1, the rescuers were asked to change chest compression after 1 min. In Scenario 2, standard CPR was applied. The participants' vital parameters, mean compression rate, correct compression rate/ratio, total number of compressions, compression depth, correct recoil/ratio, correct hand position/ratio, mean no-flow time, and total CPR time were recorded. Results: The study hence included 14 teams each for scenarios, with a total of 56 participants. In each scenario, 14 participants were physicians and 14 participants were women. Although there was no difference in the first minute of the cycles starting from the fourth cycle, a statistically significant difference was observed in the second minute in all cycles except the fifth cycle. Conclusion: Changing the rescuer every 1 min instead of every 2 min while performing CPR with full PPE may prevent the decrease in compression quality that may occur as the resuscitation time gets longer.
      原文链接:
    • NSTL
    • Elsevier