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The impact of prehospital blood sampling on the emergency department process of patients with chest pain: a pragmatic non-randomized controlled trial Johan L. van Nieuwkerk, M. Christien van der Linden, Rolf J. Verheul, Merel van Loon-van Gaalen, Marije Janmaat, Naomi van der Linden World Journal of Emergency Medicine    2023, 14 (4): 257-264.   DOI: 10.5847/wjem.j.1920-8642.2023.054 Abstract （407）   HTML （1537）    PDF（pc） （414KB）（812）       Knowledge map    Save BACKGROUND: In patients with chest pain who arrive at the emergency department (ED) by ambulance, venous access is frequently established prehospital, and could be utilized to sample blood. Prehospital blood sampling may save time in the diagnostic process. In this study, the association of prehospital blood draw with blood sample arrival times, troponin turnaround times, and ED length of stay (LOS), number of blood sample mix-ups and blood sample quality were assessed. METHODS: The study was conducted from October 1, 2019 to February 29, 2020. In patients who were transported to the ED with acute chest pain with low suspicion for acute coronary syndrome (ACS), outcomes were compared between cases, in whom prehospital blood draw was performed, and controls, in whom blood was drawn at the ED. Regression analyses were used to assess the association of prehospital blood draw with the time intervals. RESULTS: Prehospital blood draw was performed in 100 patients. In 406 patients, blood draw was performed at the ED. Prehospital blood draw was independently associated with shorter blood sample arrival times, shorter troponin turnaround times and decreased LOS (P<0.001). No differences in the number of blood sample mix-ups and quality were observed (P>0.05). CONCLUSION: For patients with acute chest pain with low suspicion for ACS, prehospital blood sampling is associated with shorter time intervals, while there were no significant differences between the two groups in the validity of the blood samples. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Unmanned aerial vehicle based intelligent triage system in mass-casualty incidents using 5G and artificial intelligence Jiafa Lu, Xin Wang, Linghao Chen, Xuedong Sun, Rui Li, Wanjing Zhong, Yajing Fu, Le Yang, Weixiang Liu, Wei Han World Journal of Emergency Medicine    2023, 14 (4): 273-279.   DOI: 10.5847/wjem.j.1920-8642.2023.066 Abstract （254）   HTML （214）    PDF（pc） （1057KB）（509）       Knowledge map    Save BACKGROUND: Rapid on-site triage is critical after mass-casualty incidents (MCIs) and other mass injury events. Unmanned aerial vehicles (UAVs) have been used in MCIs to search and rescue wounded individuals, but they mainly depend on the UAV operator’s experience. We used UAVs and artificial intelligence (AI) to provide a new technique for the triage of MCIs and more efficient solutions for emergency rescue. METHODS: This was a preliminary experimental study. We developed an intelligent triage system based on two AI algorithms, namely OpenPose and YOLO. Volunteers were recruited to simulate the MCI scene and triage, combined with UAV and Fifth Generation (5G) Mobile Communication Technology real-time transmission technique, to achieve triage in the simulated MCI scene. RESULTS: Seven postures were designed and recognized to achieve brief but meaningful triage in MCIs. Eight volunteers participated in the MCI simulation scenario. The results of simulation scenarios showed that the proposed method was feasible in tasks of triage for MCIs. CONCLUSION: The proposed technique may provide an alternative technique for the triage of MCIs and is an innovative method in emergency rescue. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers Rashed Alremeithi, Quincy K. Tran, Megan T. Quintana, Soroush Shahamatdar, Ali Pourmand World Journal of Emergency Medicine    2024, 15 (1): 3-9.   DOI: 10.5847/wjem.j.1920-8642.2023.085 Abstract （246）   HTML （481）    PDF（pc） （220KB）（679）       Knowledge map    Save BACKGROUND: Traumatic cardiac arrest (TCA) is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system. Although there have been advances in treatment modalities, survival rates for TCA patients remain low. This narrative literature review critically examines the indications and effectiveness of current therapeutic approaches in treating TCA. METHODS: We performed a literature search in the PubMed and Scopus databases for studies published before December 31, 2022. The search was refined by combining search terms, examining relevant study references, and restricting publications to the English language. Following the search, 943 articles were retrieved, and two independent reviewers conducted a screening process. RESULTS: A review of various studies on pre- and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm. There were conflicting results regarding other prognostic factors, such as witnessed arrest, bystander cardiopulmonary resuscitation (CPR), and the use of prehospital or in-hospital epinephrine. Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock. When implemented in the setting of aortic occlusion, emergency thoracotomy and REBOA resulted in comparable mortality rates. Veno-venous extracorporeal life support (V-V ECLS) and veno-arterial extracorporeal life support (V-A ECLS) are viable options for treating respiratory failure and cardiogenic shock, respectively. In the context of traumatic injuries, V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS. CONCLUSION: TCA remains a significant challenge for emergency medical services due to its high morbidity and mortality rates. Pre- and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures. Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment efficacy and ameliorate survival outcomes. Table and Figures | Reference | Related Articles | Metrics

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Blood gas analysis as a surrogate for microhemodynamic monitoring in sepsis Jingyi Wang, Li Weng, Jun Xu, Bin Du World Journal of Emergency Medicine    2023, 14 (6): 421-427.   DOI: 10.5847/wjem.j.1920-8642.2023.093 Abstract （229）   HTML （104）    PDF（pc） （860KB）（533）       Knowledge map    Save BACKGROUND: Emergency patients with sepsis or septic shock are at high risk of death. Despite increasing attention to microhemodynamics, the clinical use of advanced microcirculatory assessment is limited due to its shortcomings. Since blood gas analysis is a widely used technique reflecting global oxygen supply and consumption, it may serve as a surrogate for microcirculation monitoring in septic treatment. METHODS: We performed a search using PubMed, Web of Science, and Google scholar. The studies and reviews that were most relevant to septic microcirculatory dysfunctions and blood gas parameters were identified and included. RESULTS: Based on the pathophysiology of oxygen metabolism, the included articles provided a general overview of employing blood gas analysis and its derived set of indicators for microhemodynamic monitoring in septic care. Notwithstanding flaws, several parameters are linked to changes in the microcirculation. A comprehensive interpretation of blood gas parameters can be used in order to achieve hemodynamic optimization in septic patients. CONCLUSION: Blood gas analysis in combination with clinical performance is a reliable alternative for microcirculatory assessments. A deep understanding of oxygen metabolism in septic settings may help emergency physicians to better use blood gas analysis in the evaluation and treatment of sepsis and septic shock. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Hemorrhagic pancreatitis from fenofibrate and metformin toxicity: a case report Marcus Aik Beng Lee, Mingwei Ng, Paul Yugendra, Yiju Yao, R Ponampalam, Boon Kiat Kenneth Tan World Journal of Emergency Medicine    2023, 14 (6): 495-498.   DOI: 10.5847/wjem.j.1920-8642.2023.106 Abstract （208）   HTML （33）    PDF（pc） （324KB）（444）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics

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Use of VA-ECMO successfully rescued a trauma patient with fat embolism syndrome complicated with acute heart failure and acute respiratory distress syndrome Pengchao Guo, Taiwen Rao, Wen Han, Licai Liang, Hongjue Ji, Hong Liu, Qin Lu World Journal of Emergency Medicine    2023, 14 (4): 332-334.   DOI: 10.5847/wjem.j.1920-8642.2023.053 Abstract （207）   HTML （23）    PDF（pc） （1073KB）（383）       Knowledge map    Save Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Acute hemolytic anemia in a 34-year-old man after inhalation of a volatile nitrite “popper” product Xiang Peng, Liuyang Cheng, Huanhuan Gong, Jie Wang, Xiaowei Ke, Xiangmin Li World Journal of Emergency Medicine    2023, 14 (5): 414-415.   DOI: 10.5847/wjem.j.1920-8642.2023.075 Abstract （202）   HTML （18）    PDF（pc） （131KB）（246）       Knowledge map    Save Reference | Supplementary Material | Related Articles | Metrics

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Does a fall from a standing height warrant computed tomography in an elderly patient with polytrauma? Debkumar Chowdhury World Journal of Emergency Medicine    2023, 14 (4): 302-306.   DOI: 10.5847/wjem.j.1920-8642.2023.040 Abstract （201）   HTML （27）    PDF（pc） （438KB）（362）       Knowledge map    Save Reference | Related Articles | Metrics

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Knowledge of radiation exposure associated with common trauma imaging modalities among orthopaedic surgeons, emergency medicine physicians, and general surgeons in the United States Fady Y. Hijji, Andrew D. Schneider, Matthew D. Thomas, Joseph G. Lyons, Daniel D. Bohl, Jennifer L. Jerele, Michael J. Prayson World Journal of Emergency Medicine    2023, 14 (4): 294-301.   DOI: 10.5847/wjem.j.1920-8642.2023.055 Abstract （199）   HTML （46）    PDF（pc） （538KB）（388）       Knowledge map    Save BACKGROUND: Few contemporary studies have assessed physicians’ knowledge of radiation exposure associated with common imaging studies, especially in trauma care. The purpose of this study was to assess the knowledge of physicians involved in caring for trauma patients regarding the effective radiation doses of musculoskeletal (MSK) imaging studies routinely utilized in the trauma setting. METHODS: An electronic survey was distributed to United States orthopaedic surgery, general surgery, and emergency medicine (EM) residency programs. Participants were asked to estimate the radiation dose for common imaging modalities of the pelvis, lumbar spine, and lower extremity, in terms of chest X-ray (CXR) equivalents. Physician estimates were compared to the true effective radiation doses. Additionally, participants were asked to report the frequency of discussing radiation risk with patients. RESULTS: A total of 218 physicians completed the survey; 102 (46.8%) were EM physicians, 88 (40.4%) were orthopaedic surgeons, and 28 (12.8%) were general surgeons. Physicians underestimated the effective radiation doses of nearly all imaging modalities, most notably for pelvic computed tomaography (CT) (median 50 CXR estimation vs. 162 CXR actual) and lumbar CT (median 50 CXR estimation vs. 638 CXR actual). There was no difference between physician specialties regarding estimation accuracy (P=0.133). Physicians who regularly discussed radiation risks with patients more accurately estimated radiation exposure (P=0.007). CONCLUSION: The knowledge among orthopaedic and general surgeons and EM physicians regarding the radiation exposure associated with common MSK trauma imaging is lacking. Further investigation with larger scale studies is warranted, and additional education in this area may improve care. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Prevalence and risk factors for acquired long QT syndrome in the emergency department: a retrospective observational study Diogo de Almeida Fernandes, Guilherme de Freitas Camões, Diana Ferreira, Carolina Queijo, Carlos Fontes-Ribeiro, Lino Gonçalves, Rui Pina, Natália António World Journal of Emergency Medicine    2023, 14 (6): 454-461.   DOI: 10.5847/wjem.j.1920-8642.2023.104 Abstract （199）   HTML （24）    PDF（pc） （401KB）（328）       Knowledge map    Save BACKGROUND: Long QT syndrome (LQTS) is a heterogeneous syndrome that may be congenital or, more frequently, acquired. The real-world prevalence of acquired LQTS (aLQTS) in the emergency department (ED) remains to be determined. The aim of this study was to determine prevalence of aLQTS and its impact on symptoms on ED admissions. METHODS: Electrocardiograms (ECG) of 5,056 consecutively patients admitted in the ED of a tertiary hospital between January 28th and March 17th of 2020 were reviewed. All patients with aLQTS were included. Clinical data with a focus on QT prolonging drugs and clinical factors were recorded. Statistical comparison was made between the groups with and without corrected QT (QTc) interval greater than 500 ms (value that is considered severely increased). RESULTS: A total of 383 ECGs with prolonged QTc were recognized, corresponding to a prevalence of aLQTS at admission of 7.82%. Patients with aLQTS were more commonly men (53.3%) with an age of (73.49±14.79) years old and QTc interval of (505.3±32.4) ms. Only 20.4% of these patients with aLQTS were symptomatic. No ventricular arrhythmias were recorded. Patients with QT interval greater than 500 ms were more frequently female (59.5%; P<0.001) and were more frequently on QT prolonging drugs (77.3%; P=0.025). Main contributing factor was intake of antibiotics (odds ratio [OR] 4.680) followed by female gender (OR 2.473) and intake of antipsychotics (OR 1.925). CONCLUSION: aLQTS is particularly prevalent in the ED. Female patients on antibiotics and antipsychotics are at particularly high risk. Efforts must be made to avoid, detect and treat aLQTS as early as possible. Table and Figures | Reference | Related Articles | Metrics

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Emergency department management of acute agitation in the reproductive age female and pregnancy Ariella Gartenberg, Kayla Levine, Alexander Petrie World Journal of Emergency Medicine    2024, 15 (2): 83-90.   DOI: 10.5847/wjem.j.1920-8642.2024.011 Abstract （198）   HTML （68）    PDF（pc） （402KB）（433）       Knowledge map    Save BACKGROUND: Agitation is a common presentation within emergent departments (EDs). Agitation during pregnancy should be treated as an obstetric emergency, as the distress may jeopardize both the patient and fetus. The safety of psychotropic medications in the reproductive age female has not been well established. This review aimed to explore a summary of general agitation recommendations with an emphasis on ED management of agitation during pregnancy. METHODS: A literature review was conducted to explore the pathophysiology of acute agitation and devise a preferred treatment plan for ED management of acute agitation in the reproductive age or pregnant female. RESULTS: While nonpharmacological management is preferred, ED visits for agitation often require medical management. Medication should be selected based on the etiology of agitation and the clinical setting to avoid major adverse effects. Adverse effects are common in pregnant females. For mild to moderate agitation in pregnancy, diphenhydramine is an effective sedating agent with minimal adverse effects. In moderate to severe agitation, high-potency typical psychotropics are preferred due to their neutral effects on hemodynamics. Haloperidol has become the most frequently utilized psychotropic for agitation during pregnancy. Second generation psychotropics are often utilized as second-line therapy, including risperidone. Benzodiazepines and ketamine have demonstrated adverse fetal outcomes. CONCLUSION: While randomized control studies cannot be ethically conducted on pregnant patients requiring sedation, animal models and epidemiologic studies have demonstrated the effects of psychotropic medication exposure in utero. As the fetal risk associated with multiple doses of psychotropic medications remains unknown, weighing the risks and benefits of each agent, while utilizing the lowest effective dose remains critical in the treatment of acute agitation within the EDs. Table and Figures | Reference | Related Articles | Metrics

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The effect of prophylactic antibiotics in acute upper gastrointestinal bleeding patients in the emergency department Miao Gan, Liang Zong, Xuezhong Yu, Jun Xu World Journal of Emergency Medicine    2023, 14 (6): 442-447.   DOI: 10.5847/wjem.j.1920-8642.2023.062 Abstract （197）   HTML （21）    PDF（pc） （387KB）（391）       Knowledge map    Save BACKGROUND: Currently, prophylactic antibiotics are recommended only for cirrhotic patients with acute upper gastrointestinal bleeding (AUGIB); however, the benefit for other AUGIB patients remains undetermined. We aimed to compare the clinical outcomes between patients with AUGIB with and without prophylactic antibiotics to identify the population that requires this therapy. METHODS: Patients with AUGIB admitted between 1st January 2019 and 31st December 2021 in the Emergency Department of Peking Union Medical College Hospital were enrolled. Patients were divided into the antibiotic and non-antibiotic groups. The primary outcome was in-hospital mortality, and the secondary outcome was the onset of new infection. The risk factors for mortality and infection were analyzed, and stratification analysis of prophylactic antibiotics was performed. Continuous data were analyzed using the t-test or nonparametric rank sum test, and categorical data were analyzed using the Chi-square test or Fisher’s exact test. Indicators with significant differences between the groups were included for logistic regression analysis. A P-value <0.05 was considered statistically significant. RESULTS: A total of 392 individuals were included, among them, 281 patients received prophylactic antibiotics, and 111 patients did not receive prophylactic antibiotics. The mortality rates were significantly lower in the antibiotic group than in the non-antibiotics group (6.41% vs. 17.12%, P=0.001). The risk factors for infection were varicose veins (P=0.045) and endotracheal intubation (P=0.005) in the prophylactic antibiotic group, and endoscopic treatment (P=0.010) in the non-prophylactic antibiotic group. Stratified analyses showed that patients with age ≥ 65 years, endotracheal intubation, endoscopic treatment, and AUGIB of variceal etiologies benefited from prophylactic antibiotics. CONCLUSION AUGIB patients may benefit from prophylactic antibiotics to decrease mortality, especially those aged ≥ 65 years and those with endotracheal intubation, endoscopic treatment, and variceal etiologies. Table and Figures | Reference | Related Articles | Metrics

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Hypertensive emergency versus preeclampsia in a patient with sickle cell disease: a case report Jigar Patel, Juan A Reyes, Ivan Berezowski, Quincy K Tran, Sarah E Frasure, Ali Pourmand World Journal of Emergency Medicine    2023, 14 (4): 329-331.   DOI: 10.5847/wjem.j.1920-8642.2023.060 Abstract （196）   HTML （30）    PDF（pc） （738KB）（398）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics

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Recurrent malignant hyperthermia after scoliosis correction surgery Junfeng Su, Man Huang World Journal of Emergency Medicine    2024, 15 (1): 70-72.   DOI: 10.5847/wjem.j.1920-8642.2024.006 Abstract （196）   HTML （17）    PDF（pc） （181KB）（315）       Knowledge map    Save Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Legionella pneumonia complicated with rhabdomyolysis and acute kidney injury diagnosed by metagenomic next-generation sequencing: a case report Bin Deng, Junjie Hua, Yufei Zhou, Duoxian Zhan, Lijuan Zhu, Yixing Zhan, Yumin Fang, Yun Ji, Libin Li World Journal of Emergency Medicine    2023, 14 (4): 322-324.   DOI: 10.5847/wjem.j.1920-8642.2023.063 Abstract （190）   HTML （43）    PDF（pc） （673KB）（370）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics

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Severe disseminated intravascular coagulation complicated by acute renal failure during pregnancy Yuqun Pu, Jingping Zhu, Baihui Zhao, Mengmeng Yang, Qiong Luo World Journal of Emergency Medicine    2023, 14 (5): 411-413.   DOI: 10.5847/wjem.j.1920-8642.2023.072 Abstract （183）   HTML （12）    PDF（pc） （152KB）（307）       Knowledge map    Save Reference | Related Articles | Metrics

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Clinical characteristics, pathogenesis, treatment and prognosis of osteomyelitis in children: a retrospective study from a single center Shuang Wang, Ming Wang, Botao Ning, Wanglin Zhang World Journal of Emergency Medicine    2023, 14 (4): 312-316.   DOI: 10.5847/wjem.j.1920-8642.2023.069 Abstract （181）   HTML （27）    PDF（pc） （458KB）（285）       Knowledge map    Save Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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A case of phenibut withdrawal and treatment with baclofen Michael Morris, James Espinosa, Alan Lucerna, Robin Lahr World Journal of Emergency Medicine    2023, 14 (4): 338-340.   DOI: 10.5847/wjem.j.1920-8642.2023.059 Abstract （178）   HTML （22）    PDF（pc） （283KB）（431）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics

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Key elements and checklist of shared decision-making conversation on life-sustaining treatment in emergency: a multispecialty study from China Shu Li, Jing Xie, Ziyi Chen, Jie Yan, Yuliang Zhao, Yali Cong, Bin Zhao, Hua Zhang, Hongxia Ge, Qingbian Ma, Ning Shen World Journal of Emergency Medicine    2023, 14 (5): 380-385.   DOI: 10.5847/wjem.j.1920-8642.2023.076 Abstract （174）   HTML （17）    PDF（pc） （234KB）（329）       Knowledge map    Save BACKGROUND: Shared decision-making (SDM) has broad application in emergencies. Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice. This study is to investigate the optimal application of SDM to guide life-sustaining treatment (LST) in emergencies. METHODS: This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education. Participants were identified based on their expertise in medicine, law, administration, medical education, or patient advocacy. All individual items and questions in the questionnaire were scored using a 5-point Likert scale, with responses ranging from “very unimportant” (a score of 1) to “extremely important” (a score of 5). The percentages of the responses that had scores of 4-5 on the 5-point Likert scale were calculated. A Kendall’s W coefficient was calculated to evaluate the consensus of experts. RESULTS: A two-level framework consisting of 4 domains and 22 items as well as a ready-to-use checklist for the informed consent process for LST was established. An acceptable Kendall’s W coefficient was achieved. CONCLUSION: A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions, research studies, medical education, and policy initiatives. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Heat stroke alters hippocampal and cerebellar transmitter metabonomics Guoxin He, Ancong Xu, Xichong Yu, Fan Huang, Lei Su World Journal of Emergency Medicine    2023, 14 (4): 287-293.   DOI: 10.5847/wjem.j.1920-8642.2023.068 Abstract （173）   HTML （29）    PDF（pc） （2425KB）（477）       Knowledge map    Save BACKGROUND: The mechanisms underlying heat stroke (HS)-induced hippocampal injury remain unclear. This study aimed to evaluate the HS-induced metabonomics of hippocampal and cerebellar transmitters. METHODS: The HS model was established with male Sprague-Dawley rats subjected to heat exposure of up to 42 °C at a humidity of (55.0±5.0)%. The hippocampal and cerebellar transmitters and metabolites of rats were tested via ultra-high-performance liquid chromatography-mass spectrometry (UPLC-MS/MS). The primary transmitters and metabolites were identified by principal component analysis (PCA) and orthogonal partial least square-discriminant analysis (OPLS-DA). The major metabolic pathways for HS were selected after enrichment. The brain injury was evaluated by histological tests. RESULTS: HS induced hippocampal and cerebellar injuries in rats. HS upregulated the protein levels of hippocampal glutamate, glutamine, gamma-aminobutyric acid, L-tryptophan (Trp), 5-hydroxy-indoleacetic acid, and kynurenine; however, it downregulated asparagine, tryptamine, 5-hydroxytryptophan, melatonin, 3,4-dihydroxyphenylalanine (L-DOPA), and vanillylmandelic acid. HS also sharply elevated the protein levels of cerebellar methionine and Trp, and decreased the levels of serotonin, L-alanine, L-asparagine, L-aspartate, cysteine, norepinephrine, spermine, spermidine, and tyrosine. Hippocampal glutamate, monoamine transmitters, cerebellar aspartate acid, and catecholamine transmitters’ metabolic pathways were identified as the main metablic pathways in HS. CONCLUSION: The hippocampus and cerebellum were injured in rats with HS, possibly induced the disorder of hippocampal glutamate and serotonin metabolism, cerebellar aspartate acid and catecholamine transmitter metabolism, and related metabolic pathways. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics