Open Journal of Emergency Medicine

Journal Information
ISSN / EISSN : 2332-1806 / 2332-1814
Published by: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 113
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Junnan Wang, Wenjing Lu, Jiating Hu, Wang Xi, Jibin Xu, Zhinong Wang, Yufeng Zhang
Open Journal of Emergency Medicine, Volume 10, pp 124-137; https://doi.org/10.4236/ojem.2022.102011

Abstract:
Victims are usually overwhelmed by local medical system in an unexpected mass casualty incident (MCI). Triage systems originate from wartime necessity to achieve the greatest efficiency to the maximum number of victims. In peacetime, the triage systems are applied to allocate constrained medical resources for the victims in MCI. There are several kinds of triage systems in different countries, such as Simple Triage and Rapid Treatment (START), Sort, Assess, Life-saving interventions, Treatment and/or Transport (SALT), Sacco Triage Method (STM), Careflight triage and Triage Sieve (TS). The START system is widely used in developed countries, especially in USA. The SALT is formulated by a work group of the Centers for Disease Control and Prevention (CDC) based on scientific data. STM is a triage algorithm designed for resource-constrained condition. Besides, the other triage systems show their power in managing the victims in MCI. However, the data of theses popular triage tools are mainly based on simulated tests, lacking of validity and reliability of triage systems. Therefore, the application, reliability, sensitivity and specificity of existing triage tools require to be validated in the real condition of MCI. Furthermore, due to the difference among triage tools used in different countries, international cooperation is demanded for a more highly organized mass-casualty medical response.
Matthew F. Ryan
Open Journal of Emergency Medicine, Volume 10, pp 138-147; https://doi.org/10.4236/ojem.2022.102012

Abstract:
Introduction: The prevalence of obesity and obesity-related diseases continues to rise. A key aspect of prevention and treatment of these disorders requires clear communication about weight and health between patients and healthcare providers. Objective: We sought to examine the prevalence rate of obesity and associated comorbid illnesses in an emergency department (ED) population. A second aim was to assess patients’ perceptions of their weight and their overall health. Methods: This is a cross-sectional study performed in an academic tertiary-care center using a representative sample of patients (≥18 yr) who presented to the ED. Pregnant patients, patients who were medically unstable, cognitively impaired or who were unable or unwilling to provide informed consent were excluded. Anthropometric measurements were taken which include BMI (the ratio of a patient’s weight and height expressed as kg/m2) and waist circumference. In addition, the prevalence rates of all enrolled patients who 1) feel their health is affecting their weight and 2) who have had or recall discussions about their health and weight with their provider were examined by using a two-question validated survey. Results: The overall prevalence rate of obesity in this study was 38.6%. Only 71.8% (95% CI, 63.2% - 80.6%) of overweight patients (BMI = 25.0 - 29.9) and 28.4% (95% CI, 21.6% - 35.2%) of obese patients (BMI ≥ 30.0) believe their present weight is damaging to their health. Further, only 15.5% (95% CI, 8.5% - 22.6%) and 59.4% (95% CI, 53% - 67%) of those overweight and obese, respectively, recall being informed by their healthcare provider they are overweight. For morbidly obese patients (BMI ≥ 40.0), 79.6% (95% CI, 12.2 - 28.6) feel their weight is damaging their health and 83.7% (95% CI, 9.4 - 23.2) recall having a conversation about weight with their healthcare provider. Conclusion: Many obese and overweight patients believe their weight does not impact their health and have not had discussion about weight and health with their healthcare provider.
Youssef Saleem Abboud, Sreya Varanasi
Open Journal of Emergency Medicine, Volume 10, pp 80-84; https://doi.org/10.4236/ojem.2022.102007

Abstract:
Cardiopulmonary resuscitation-induced consciousness (CPRIC) is increasingly being reported across the world. High quality cardiopulmonary resuscitation (CPR) may transiently generate sufficient cerebral perfusion to cause signs of consciousness during CPR which disappears on cessation of CPR. Here we present the case of a 56-year-old male presenting with myocardial infarction that led to cardiac arrest and initiation of CPR during which he showed signs of consciousness. This led to multiple disruptions in delivering high quality CPR. CPR providers are often unaware and inexperienced in managing these patients. However, CPRIC has an association with improved survival. Hence, more research needs to be conducted in this field and guidelines need to be developed to better manage CPRIC.
Antigona Ukëhaxhaj, Drita Zogaj, Naser Ramadani, Bekim Sejdiu, Besart Gashi, Besarta Pelaj, Vanesa Tanushi, Faton Hoxha
Open Journal of Emergency Medicine, Volume 10, pp 85-99; https://doi.org/10.4236/ojem.2022.102008

Abstract:
Introduction: Healthcare workers across the world have been raised to the demands of treating COVID-19 patients, potentially at significant cost to their own health and wellbeing. The coronavirus disease 2019 (COVID-19) pandemic has caused an increasing of challenges for healthcare professionals not only in Kosovo but globally. However, the psychological impact and change behavior, of the coronavirus disease 2019 pandemic, among healthcare workers, are still unknown. Aim: The purpose of this paper is to know the reality and challenges of healthcare workers in Kosovo during the current COVID-19 outbreak. Methodology: This is a cross-sectional, online survey which was conducted from 15 March 2020 to 30 July 2020 on 309 healthcare workers at three hospitals in Kosovo. An online survey questionnaire was used to collect data on participants’ characteristics, questions about gel hand sanitizer, disposable gloves, masks, facial protective shields, including questions such as: Do they have any chronic disease? Do they have fear from infection? Were they getting information about COVID-19? Do they have a stress during their work? Do they carry about public health measures and policies? The study protocol was approved by the ethical commission of our university. Findings: A total of 309 healthcare workers and medical practices completed the online survey. Most participants were female (n = 233; 75.4%), and live in city (n = 174; 56.3%). Based on their income (n = 250; 80.9%), by having a middle income and (n = 44; 14.2%) low income. Regarding provide services to people with COVID-19, 69.3% of participants were directly with infected patients, and during this time those who were worried to get infected with coronavirus were 31.4%, who said that they were afraid of becoming infected. The frustration was that if they become infected, the possibility of transmitting the virus to other family members will increase, where 35% stated that they are very scared and extremely scared 21.4%. Conclusion: Our study highlighted the importance of taking into consideration the experiences and concerns on front-line staff during pandemic. Factors such as older age, being female, chronic diseases and trainings may protect healthcare workers from fear during pandemic.
Sayani Banerjee
Open Journal of Emergency Medicine, Volume 10, pp 8-18; https://doi.org/10.4236/ojem.2022.101002

Abstract:
Deep vein thrombosis (DVT) is one or more blood clots formed inside the deep vein in the body resulting in complete or partial blockage of blood flow through the affected vein. Upper Extremity DVT (UEDVT) accounts for 5% - 10% of all cases of DVTs. Previously it was thought to be a rare disorder. However in recent years with the advent of various indwelling intravenous devices, hypercoagulable state like COVID-19, secondary UEDVT did not remain infrequent presentation anymore. Though primary UEDVT, also known as Effort Thrombosis, that takes place without any underlying obvious pathology is a rare form till now. We presented a case of 46 years female who presented to the emergency with complaints of progressively increasing pain (7 days) and swelling (3 days) of her right forearm since last 7 days following strenuous and heavy work by her dominant/ right hand during the period of festival. She initially ignored her condition because of the Durga Puja festival. As her symptoms deteriorated she eventually had to attend the emergency department. Eventually an urgent ultrasonography color Doppler was done on emergency basis which diagnosed underlying DVT of her right brachial vein. She was managed with low molecular weight heparin, urgent fasciotomy owning to her impending compartment syndrome. Other tests ruled out any secondary underlying pathology. She improved and discharged without any complications on oral anticoagulant. Exigent events in her history were trauma followed by fall on her right elbow 2 months back and then presenting signs & symptoms commencing at the same region following strenuous, tedious activities over 7 days and consequential effort thrombosis of her right brachial vein. All of that compelled us to ruminate on rare differentials of her presentation and eventually come to this rare diagnosis. The author hence brought this pedagogic case to the readers, especially emergency & primary care physicians and emphasised the importance of being intuitive about rare but deadly differentials which come from proficiency & experience in the field of medicine.
Youssouf Sogoba, Drissa Kanikomo, Quenum Kouassi Jean Marie Kisito, Moussa Diallo, Bakary Dembélé, Boubacar Sogoba, Djènè Kourouma, Izoudine Blaise Koumaré, Seybou Hassane Diallo, Hamidou Almeimoune, et al.
Open Journal of Emergency Medicine, Volume 10, pp 48-53; https://doi.org/10.4236/ojem.2022.101004

Abstract:
Background: Traumatic Brain Injury (TBI) is a major health problem worldwide. It is the main cause of trauma mortality. Acute subdural hematoma (ASDH) has a reputation for being the most serious of all posttraumatic head injuries. Its frequency is estimated to be 1% to 5% of all head injuries and 22% of severe head injuries. The aim of this study was to assess the epidemiological, clinical and prognosis aspects of ASDH in our department. Material and Methods: This prospective study, from January to December 2019, included 57 patients admitted to the Gabriel Touré Teaching Hospital for ASDH. Patients underwent detailed clinical and radiological evaluation and ASDH was diagnosed by non-contrast computed tomography (CT) scan. Functional outcome was evaluated 6 months after injury by Glasgow Outcome Scale. Results: During the study period, 662 patients were admitted for TBI including 57 (8.61%) cases of ASDH. The mean age was 34 years with extremes of 2 and 77 years. There was a male predominance with 52 (91.2%). The main cause of trauma was motor vehicle accidents in 38 (66.6%) patients. According to the Glasgow coma scale (GCS), 33 (57.9%) patients were classified mild (Table 2). The thickness of the hematoma was more than 1 cm in 13 (22.8%) patients and less than 1 cm in 44 (77%) patients. Surgical treatment was performed in 13 (22.8%) patients. The outcome was favorable in 30 (52.6%) patients and the mortality rate was 33.3%. Conclusion: ASDH remains a difficult challenge because of the high mortality. The mortality rate remains high particularly in patient with poor GCS score at admission.
Masanobu Kishimoto, Kenji Maejima, Takashi Muroya, Kentaro Kajino, Hitoshi Ikegawa, Yasuyuki Kuwagata
Open Journal of Emergency Medicine, Volume 10, pp 149-156; https://doi.org/10.4236/ojem.2022.103013

Abstract:
Contrast-enhanced computed tomography (CT) and colonoscopy are very useful for the diagnosis and treatment of colonic diverticular bleeding. However, the timing of CT has been reported in few cases. The aim of this study was to demonstrate the usefulness of contrast-enhanced CT on arrival in colonic diverticular bleeding. We conducted a review of the data of patients that were diagnosed with colonic diverticular bleeding between July 2010 and December 2021. Eighty-two patients (51 males, 31 females, average age 69.1 years) were admitted with diagnosis of colonic diverticular bleeding after undergoing contrast-enhanced CT. We retrospectively investigated the relationship between the initial diagnosis by contrast-enhanced CT on arrival at the hospital and the results of endoscopic identification. Contrast-enhanced CT showed extravasation of contrast medium in 30 cases. The time from the onset of bloody stool to the implementation of contrast-enhanced CT was significantly shorter in cases with extravasation images in the CT (average 7.9 hours) than in cases without extravasation images in the CT (average 15.3 hours). The identification rate of diverticular bleeding sites with colonoscopy was significantly higher in cases with extravasation images in the CT (83%) than in cases without extravasation images in the CT (36.5%). The final treatment methods were endoscopic hemostasis in 46 cases, medical treatment alone in 26 cases, transcatheter arterial embolization (TAE) in 8 cases, and surgery in 2 cases. For patients suspected of colonic diverticular bleeding, performing contrast-enhanced CT early and estimating the bleeding site before colonoscopy may lead to the success of endoscopic hemostasis. To identify and treat successfully colonic diverticular bleeding by colonoscopy, the early use of contrast-enhanced CT before colonoscopy is highly recommended.
Sayani Banerjee, Aishwarya Nandy, Santosh Kumar Singh
Open Journal of Emergency Medicine, Volume 10, pp 111-123; https://doi.org/10.4236/ojem.2022.102010

Abstract:
Cerebral Venous Sinus Thrombosis (CVST/CSVT) is occlusion of cerebral veins and venous sinuses of brain secondary to blood clot formation resulting in hindrance in the blood drainage system in brain, leading to disturbances the internal homeostasis of brain, raised intracranial pressure, cerebral edema, and 50% of cases will have venous infarction or venous hemorrhage (stroke). CVST although being a Rare disorder but may be more common in children than adults with greater risk in neonatal period i.e. first 28 days of life. Here we are discussing a case of Pediatric CVST in a 7-month-old baby boy who presented to Emergency Room (ER) with recurrent discrete episodes of vomiting, fever, seizures, drowsiness and respiratory distress. The fatal outcome in our child was attributed to delayed presentation in a tertiary care center, hence missed early diagnosis and treatment. In this child the CVST could be result of amalgamation of complex underlying ongoing multiple pathological processes: an acute systemic illness like sepsis, severe dehydration, undiagnosed and untreated complex congenital heart disease, tetralogy of fallot with osteum secondum atrial septal defect, worsening the coagulopathy. It takes this case even more unique. This discussion is to bring focus on the importance of knowledge about CVST amongst emergency physicians and primary care physicians, specially managing this rare disorder with flummox presentation mimicking other more common disorders, especially in pediatric and neonatal population where definitive history and chief complaints are often vague and difficult to obtain, making it more difficult to diagnose. We the authors hence reporting this case with intent to spread awareness of CVST, how to doubt it, detect it and then manage it, especially in places like Chhattisgarh, India, where CVST is not so uncommon. We believe early diagnosis, early presentation to tertiary care center with aggressive early treatment can significantly reduce the mortality. Should the parents brought the baby early to any tertiary care center owing to his complex deteriorating symptoms like high grade fever progressed to drowsiness and seizure episodes, could there be a different outcome for this child as well as his parents.
Luiz Gonzaga Francisco De Assis Barros D’Elia Zanella
Open Journal of Emergency Medicine, Volume 10, pp 19-47; https://doi.org/10.4236/ojem.2022.101003

Abstract:
Background: COVID-19 brought challenges that did not end after a two-year pandemic. From more straightforward changes in habits to studying to understand the enigmatic parasite-host relationship, we can better manage the patient infected with SARS-CoV-2 even with a vaccine full of doubts and antivirals that do not correctly cover the viral period. SARS-CoV-2 brought the chronic inflammation now called “The Long COVID-19 Syndrome” (LCS), something still little talked about, but we already see deaths due to non-identification of this inflammatory syndrome that can lead to shock. Theory: LCS Shock is due to a long period of metabolic stress, reflecting the shift from inflammation to oxidative stress and innate immunity, and does not respond to antimicrobials, as its main component is inflammatory, although there may be conjoined bacterial translocation. Thus, we are losing patients to a new syndrome confused with sepsis and septic shock. While septic shock (SS) responds to antimicrobials, Inflammatory Shock (ISc) does not respond to antimicrobials alone, requiring high doses of corticosteroids. Review: This study shows that we need to differentiate SS and ISC, as the treatment is different. The review shows that Lactate, LDH and the presence of new/recent cardiac changes and bradycardia in the face of a status where there should be tachycardia as the usual response can differ ISC from SS. Maybe the main responsible for high LDH is Warburg Effect. Conclusion: We have a dilemma that requires clinical studies that routinely match high doses of corticosteroids (until there is something better to be done) and bring laboratory and imaging differences to diagnose SS vs ISc better.
Keatlaretse Siamisang, Kago Mokute, Bonolo Bonnie Mhaladi, John Thato Tlhakanelo
Open Journal of Emergency Medicine, Volume 10, pp 54-65; https://doi.org/10.4236/ojem.2022.101005

Abstract:
Background: Mortality and morbidity due to trauma are a significant public health challenge. There is paucity of data on the waiting times and length of stay (LOS) of trauma patients in emergency departments in Botswana. The aim of this study was to determine the Emergency Department (ED) waiting times and LOS of trauma patients at Princess Marina Hospital in Gaborone, Botswana. Methods: This was a retrospective medical records review of waiting times (time from triage to review by ED medical officer) and LOS (time from triage to disposition from the emergency department). The waiting times for the different assigned acuities were assessed against the South African Triage System (SATS) standards. All trauma patients seen from 19/11/2018 to 18/12/2018 were included in the study. Prolonged length of stay was defined as duration > 6 hours. Categorical data was summarized with frequencies while numeric data was summarized with medians and interquartile ranges. Results: A total of 187 trauma patients’ files were analyzed. Of these, 72 (38.5%) were females. The median waiting time was 3.8 hours and the maximum was 19.2 hours. The median length of stay (LOS) was 8.8 hours with a maximum of 37.2 hours. Only 53 (28.3%) of the participants had a LOS of less than 6 hours. None of the emergent patients were seen immediately. Only 5 (4.0%) of the very urgent patients were seen within the target of 10 minutes. Finally, only 10 (20.4%) of urgent patients were seen within the target time of 1 hour. Conclusion: The waiting times and length of stay in Princess Marina Hospital were mostly above the recommended standards. Urgent interventions are needed to reduce waiting times and length of stay for trauma patients. More studies are needed to explore the sources of delay and investigate possible solutions to this public health challenge.
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