Open Access Emergency Medicine

Journal Information
ISSN / EISSN : 11791500 / 11791500
Current Publisher: Dove Medical Press Ltd. (10.2147)
Total articles ≅ 141
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Andrew D Xia, Sara L Dickerson, Andrew Watson, Mika Nokela, Sam Colman, Agota Szende
Open Access Emergency Medicine, Volume 11, pp 229-240; doi:10.2147/OAEM.S214396

Abstract:Inadequate relief of pain is common in prehospital and hospital emergency department (ED) settings. We investigated pain treatments and timelines in patients receiving pre-hospital and hospital ED care to provide insight into potential approaches to reduce the burden of trauma-related pain. In this observational, retrospective chart review, patients had received emergency care for musculoskeletal trauma injuries and analgesic treatment for moderate-to-severe pain in Belgium, France, Germany, Italy, Spain or Sweden. As inhaled low-dose methoxyflurane (LDM) is used extensively in Australia but was not widely available in Europe at the time of this analysis, data from Australia were collated to provide insight into the potential utility of this analgesic in Europe. The primary endpoint was time to administration of first pain relief treatment following arrival of paramedic/ED care. Randomly selected physicians (n=189) collated data from 856 patients (Europe: n=585; Australia: n=271) via an online survey. Time to first pain relief treatment varied between countries and was significantly longer across Europe versus Australia (mean [SD] 38.1 [34.7] vs 29.9 [35.5] mins; P=0.0017). Patients from Australia who received LDM experience a shorter mean (SD) time to first pain treatment following arrival of emergency care versus patients who received other analgesics (propensity score matched [n=85] per group: 21.7 [24.2] vs 39.1 [43.0] mins; P=0.0013). Across all countries, mean (SD) time to first analgesic was shorter when treatment was administered by paramedics versus hospital ED staff (15.7 [14.7] vs 49.1 [38.4] mins). While there was a large variation in analgesia timelines across countries, mean times are shorter in Australia compared with Europe overall. In Australia, use of LDM was associated with a significantly shorter time from emergency assistance to first pain treatment compared with non-LDM treatments. Further studies are needed to investigate the utility of LDM in Europe.
Mohammed Alshahrani, Aisha Alsubaie, Alaa Alshamsy, Bayader Alkhliwi, Hind Alshammari, Maha Alshammari, Nosibah Telmesani, Reem Alshammari, Laila Perlas Asonto
Open Access Emergency Medicine, Volume 11, pp 221-228; doi:10.2147/OAEM.S204110

Abstract:Human H1N1 Influenza A virus was first reported in 2009 when seasonal outbreaks consistently occurred around the world. H1N1 patients present to the emergency departments (ED) with flu-like symptoms extending up to severe respiratory symptoms that require hospital admission. Developing a prediction model for patient outcomes is important to select patients for hospital admission. To date, there is no available data to guide the hospital admission of H1N1 patients based on their initial presentation. The aim of this study was to investigate the predictors of hospital admission of H1N1 patients presenting in the ED. We conducted a retrospective review of all laboratory-confirmed H1N1 cases presenting to the ED of a tertiary university hospital in the Eastern region of Saudi Arabia within the period from November 2015 to January 2016. We retrieved data of the initial triage category, vital signs, and presenting symptoms. Multivariate logistic regression analysis was performed to evaluate risk factors for hospital admission among H1N1patients presented to the ED. We identified 333 patients with laboratory-confirmed H1N1. Patients were classified into two groups: admitted group (n=80; 24%) and non-admitted group (n=253; 76%). Sixty patients (75%) were triaged under category IV. Triage category of level III and less were the most predictive for hospital admission. Multivariate regression analysis showed that of all vital signs, tachypnea was a significant risk factor for hospital admission (OR=1.1; 95% CI 1.02 to 1.13, p<0.01). The association between lower triage category and hospital stay was statistically significant (χ2=6.068, p=0.037). Also, patients with dyspnea were 4.5 times more likely to have longer hospital stay (OR=4.5; 95% CI 1.2 to 17.1, p=0.025). Lower triage category and increased respiratory rate predict the need for hospital admission of H1N1 infected patients; while patients with dyspnea or bronchial asthma are likely to stay longer in the hospital. Further prospective studies are needed to evaluate the accuracy of using the CTAS and other clinical parameters in predicting hospitalization of H1N1 patients during outbreaks.
Open Access Emergency Medicine; doi:10.2147/oaem

Fatemah Buhamed, Maged Edward, Abdullah Shuaib, Fatmah Buhamed
Open Access Emergency Medicine, Volume 11, pp 201-203; doi:10.2147/OAEM.S214161

Abstract:Acute appendicitis and acute cholecystitis are some of the most common surgical emergencies in the emergency department. Both conditions are common causes of abdominal pain. We had a discussion about co-existing acute appendicitis and cholecystitis and if it is a myth. The concurrent presentation of acute appendicitis and cholecystitis is thought to be rare. A PubMed search of MEDLINE was performed using a combination of the keywords “acute appendicitis” and “acute cholecystitis” to obtain case reports. The search returned 11 case reports of co-existent acute appendicitis and acute cholecystitis. The aim of this review is to broaden the prospective of emergency physicians to consider more than one pathology as the cause of abdominal pain. The concurrent presentation of acute appendicitis and cholecystitis is rare but should be considered to avoid complications such as perforation and septicemia.
Erica Koch, Shannon Lovett, Trac Nghiem, Robert A Riggs, Megan A Rech, Robert Riggs
Open Access Emergency Medicine, Volume 11, pp 179-199; doi:10.2147/OAEM.S178358

Abstract:Shock index (SI) is defined as the heart rate (HR) divided by systolic blood pressure (SBP). It has been studied in patients either at risk of or experiencing shock from a variety of causes: trauma, hemorrhage, myocardial infarction, pulmonary embolism, sepsis, and ruptured ectopic pregnancy. While HR and SBP have traditionally been used to characterize shock in these patients, they often appear normal in the compensatory phase of shock and can be confounded by factors such as medications (eg, antihypertensives, beta-agonists). SI >1.0 has been widely found to predict increased risk of mortality and other markers of morbidity, such as need for massive transfusion protocol activation and admission to intensive care units. Recent research has aimed to study the use of SI in patients immediately on arrival to the emergency department (ED). In this review, we summarize the literature pertaining to use of SI across a variety of settings in the management of ED patients, in order to provide context for use of this measure in the triage and management of critically ill patients.
Reza Mosaddegh, Samane Nabi, Sogand Daei, Fatemeh Mohammadi, Gholamreza Masoumi, Samira Vaziri, Mahdi Rezai
Open Access Emergency Medicine, Volume 11, pp 205-210; doi:10.2147/oaem.s207066

Abstract:Combination of liver enzymes, amylase and abdominal ultrasound tests have acceptable diagnostic values as an alternative test for abdominopelvic CT scan in blunt abdominal trauma
Aníbal A Teherán, Luis M Pombo, Vanessa Cadavid, María C Mejía, Jaime F La Rota, Juan C Hernández, Norma Montoya, Thalia S López
Open Access Emergency Medicine, Volume 11, pp 211-219; doi:10.2147/oaem.s197903

Abstract:Cocaine, ethanol, cannabis and benzodiazepines co-consumption among patients assisted at the emergency room
Hadi Khoshmohabat, Shahram Paydar, Alireza Makarem, Mohammad Yasin Karami, Niloofar Dastgheib, Seyed Ali Hossein Zahraei, Rohallah Rezaei, Golnoush Sadat Mahmoudi Nezhad
Open Access Emergency Medicine, Volume 11, pp 171-177; doi:10.2147/OAEM.S205006

Abstract:Planning for management of bleeding in trauma injuries is very important. The initial purpose in emergency situations should be immediate establishment of an efficient hemostasis, principally in its topical application. In this study, we aimed to review the major relevant articles in the case of application of cellulose hemostatic agent on trauma injuries. We searched the online databases such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, and Scopus. Two reviewers independently searched and assessed the titles and abstracts of all articles. Upon screening the titles and abstracts, 24 studies were identified for full-text review. The oxidized cellulose had the best clotting times, while it demonstrated low absorption ability. Surgical and thermosensitive chitosan hemostatic could be valuable for managing hemorrhage from liver injuries in trauma patients. Recently, the application of cellulose hemostatic agents has been one of the main improvements obtained for controlling bleeding in trauma injuries. However, generally according to the literature review, the decision about using each agent should be made on a case-by-case basis. However, it can be mentioned that the perfect hemostatic agent has not been still identified.
Pierluigi Fusco, Angela Iuorio, Mirco Della Valle, Fausto Ferraro
Open Access Emergency Medicine, Volume 11, pp 167-170; doi:10.2147/OAEM.S201079

Abstract:Since its introduction in 1985 with Ciaglia, percutaneous tracheostomy (PT) was contraindicated in emergency settings and obesity. However, several case series in the last 20 years have documented the use of PT in life-threatening airway emergencies. We present a case of severe acute airway obstruction in a 66-year-old woman successfully treated with a placement of an awake PT. The woman’s glottic obstruction was caused by a recurrent laryngeal neoplasia and revealed by nasoendoscopy. This acute condition required a serious effort from the patient to oxygenate and therefore prevented orotracheal intubation as well as the use of any supraglottic device and/or sedation. Blood aspiration after a first attempt to make a quick access to the tracheal lumen with an emergency cricothyroidotomy, and difficulties in the exact identification of tumor infiltration, led us to perform an awake tracheostomy. Due to elevated risk of airway bleeding, we started with a surgical approach to better identify anatomical structures. After the correct inter-tracheal ring space identification, sudden worsening of clinical symptoms required that we complete the procedure quickly with the aid of a Ciaglia Blue Rhino™-Cook (CBR) tracheostomy kit. At the tracheostomy tube placement, the patient quickly resolved her dyspnea and physiological breathing was restored.
Myung Ha Seo, Won Young Sung
Open Access Emergency Medicine, Volume 11, pp 161-166; doi:10.2147/OAEM.S214619

Abstract:Sudden unexpected death in epilepsy (SUDEP) refers to the sudden and unexpected death of an epileptic patient with no other health issues, during normal activity, and for whom no other particular cause of death can be found. The exact cause of SUDEP has not been established yet; however, it is assumed to be caused by multiple organ failure involving the respiratory and cardiovascular systems. Some of the known risk factors are generalized tonic-clonic seizure, frequent epileptic seizure, early onset of epilepsy, long duration of seizure, nocturnal seizure, and combined therapy with antiepileptics. A number of seizure-related cardiac arrhythmia cases have been reported. Arrhythmias are mostly benign tachycardia or bradycardia, and ventricular fibrillation (VF) or asystole is very rare. It is considered that fatal cardiac arrhythmia is a cause of SUDEP. Here, we describe the case of a near-SUDEP patient who was successfully revived without complications by immediate defibrillation with an automated external defibrillator and cardiopulmonary resuscitation, although VF occurred after a convulsive seizure. Based on our experience, when treating a patient with an epileptic seizure, one should always keep in mind the possibility of SUDEP as a seizure-induced emergency situation involving fatal arrhythmia and cardiac arrest, even in young healthy adults.