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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 （412）   HTML （1537）    PDF（pc） （414KB）（823）       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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Mendelian randomization study to investigate the causal relationship between plasma homocysteine and chronic obstructive pulmonary disease Yanlan Hu, Ping Tan, Juntao Wang, Jun Zeng, Quan Li, Shijiao Yan, Wenjie Hao, Lanfen He, Xingyue Song, Caihong Zhang, Chuanzhu Lyu World Journal of Emergency Medicine    2023, 14 (5): 367-371.   DOI: 10.5847/wjem.j.1920-8642.2023.078 Abstract （133）   HTML （36）    PDF（pc） （233KB）（701）       Knowledge map    Save BACKGROUND: Several observational studies have shown an association between homocysteine (Hcy) levels and chronic obstructive pulmonary disease (COPD), but causal relationships are not clear. Our study aimed to explore the causal relationship between plasma Hcy and COPD by two-sample Mendelian randomization (MR). METHODS: A two-sample MR study was performed to infer the causal link. Genetically predicted plasma Hcy was selected as an instrumental variable (IV) from published genome-wide association study (GWAS) meta-analyses. COPD with different etiologies was extracted as outcome variables from other GWAS meta-analyses. The main MR analysis was performed using the inverse-variance weighted (IVW) method. Additional analyses were further performed using Cochran's Q-test and MR-Egger regression to evaluate the heterogeneity or horizontal pleiotropy of our findings. RESULTS: MR analysis showed no significant association between plasma Hcy and COPD. The results of the groups were consistent with the sensitivity analysis and repeated analysis, without heterogeneity or horizontal pleiotropy. The IVW results showed COPD hospital admissions (odds ratio [OR] 1.06, 95% confidence interval [CI] 0.91-1.24, P=0.42), asthma/COPD (OR 0.97, 95% CI 0.89-1.06, P=0.55), COPD-related chronic infection (OR 1.50, 95% CI 0.57-3.99, P=0.41), COPD/asthma/interstitial lung disease (ILD)-related pneumonia or pneumonia-derived septicemia (OR 0.93, 95% CI 0.86-1.02, P=0.13), and COPD-related respiratory insufficiency (OR 1.00, 95% CI 0.7-1.44, P=0.99). CONCLUSION: There is no direct causal relationship between plasma Hcy and COPD in our study. As Hcy is known to have deleterious effects on endothelial function and vascular homeostasis, further studies are needed to investigate whether additional factors mediate the association between Hcy and COPD. 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 （251）   HTML （481）    PDF（pc） （220KB）（700）       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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Establishment and evaluation of animal models of sepsis-associated encephalopathy Mubing Qin, Yanxia Gao, Shigong Guo, Xin Lu, Qian Zhao, Zengzheng Ge, Huadong Zhu, Yi Li World Journal of Emergency Medicine    2023, 14 (5): 349-353.   DOI: 10.5847/wjem.j.1920-8642.2023.088 Abstract （144）   HTML （32）    PDF（pc） （228KB）（578）       Knowledge map    Save BACKGROUND: Sepsis-associated encephalopathy (SAE) is a critical disease caused by sepsis. In addition to high mortality, SAE can also adversely affect life quality and lead to significant socioeconomic costs. This review aims to explore the development of evaluation animal models of SAE, giving insight into the direction of future research in terms of its pathophysiology and therapy. METHODS: We performed a literature search from January 1, 2000, to December 31, 2022, in MEDLINE, PubMed, EMBASE, and Web of Science using related keywords. Two independent researchers screened all the accessible articles based on the inclusion and exclusion criteria and collected the relevant data of the studies. RESULTS: The animal models for sepsis are commonly induced through cecal ligation and puncture (CLP) or lipopolysaccharide (LPS) injection. SAE can be evaluated using nervous reflex scores and sepsis evaluation during the acute phase, or through Morris water maze (MWM), open-field test, fear condition (FC) test, inhibitory avoidance, and other tests during the late phase. CONCLUSION: CLP and LPS injection are the most common methods for establishing SAE animal models. Nervous reflexs cores, MWM, FC test, and inhibitory avoidance are widely used in SAE model analysis. Future research should focus on establishing a standardized system for SAE development and analysis. Reference | Supplementary Material | 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 （232）   HTML （104）    PDF（pc） （860KB）（555）       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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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 （256）   HTML （215）    PDF（pc） （1057KB）（521）       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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Vagus nerve stimulation protects against cerebral injury after cardiopulmonary resuscitation by inhibiting inflammation through the TLR4/NF-κB and α7nAChR/JAK2 signaling pathways Shuang Xu, Lang Guo, Weijing Shao, Licai Liang, Tingting Shu, Yuhan Zhang, He Huang, Guangqi Guo, Qing Zhang, Peng Sun World Journal of Emergency Medicine    2023, 14 (6): 462-470.   DOI: 10.5847/wjem.j.1920-8642.2023.102 Abstract （126）   HTML （23）    PDF（pc） （1520KB）（505）       Knowledge map    Save BACKGROUND: Our previous research proved that vagus nerve stimulation (VNS) improved the neurological outcome after cardiopulmonary resuscitation (CPR) by activating α7 nicotinic acetylcholine receptor (α7nAChR) in a rat model, but the underlying mechanism of VNS in neuroprotection after CPR remains unclear. METHODS: In vivo, we established a mouse model of cardiac arrest (CA)/CPR to observe the survival rate, and the changes in inflammatory factors and brain tissue after VNS treatment. In vitro, we examined the effects of α7nAChR agonist on ischemia/reperfusion (I/R)-induced inflammation in BV2 cells under oxygen-glucose deprivation/reoxygenation (OGD/R) conditions. We observed the changes in cell survival rate, the levels of inflammatory factors, and the expressions of α7nAChR/Janus kinase 2 (JAK2) and toll-like receptor 4 (TLR4) /nuclear factor-κB (NF-κB). RESULTS: In vivo, VNS preconditioning enhanced functional recovery, improved the survival rate, and reduced hippocampal CA1 cell damage, and the levels of inflammatory mediators after CA/CPR. The application of α7nAChR agonists provided similar effects against cerebral injury after the return of spontaneous circulation (ROSC), while α7nAChR antagonists reversed these neuroprotective impacts. The in vitro results mostly matched the findings in vivo. OGD/R increased the expression of tumor necrosis factor-alpha (TNF-α), TLR4 and NF-κB p65. When nicotine was added to the OGD/R model, the expression of TLR4, NF-κB p65, and TNF-α decreased, while the phosphorylation of JAK2 increased, which was prevented by preconditioning with α7nAChR or JAK2 antagonists. CONCLUSION: The neuroprotective effect of VNS correlated with the activation of α7nAChR. VNS may alleviate cerebral IR injury by inhibiting TLR4/NF-κB and activating the α7nAChR/JAK2 signaling pathway. 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 （175）   HTML （29）    PDF（pc） （2425KB）（486）       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

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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 （208）   HTML （69）    PDF（pc） （402KB）（472）       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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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 （210）   HTML （33）    PDF（pc） （324KB）（452）       Knowledge map    Save Table and Figures | Reference | 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 （179）   HTML （22）    PDF（pc） （283KB）（450）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics

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Effects of mesencephalic astrocyte-derived neurotrophic factor on sepsis-associated acute kidney injury Saifeng Chen, Xuewei Hao, Guo Chen, Guorong Liu, Xiaoyan Yuan, Peiling Shen, Dongfeng Guo World Journal of Emergency Medicine    2023, 14 (5): 386-392.   DOI: 10.5847/wjem.j.1920-8642.2023.077 Abstract （170）   HTML （16）    PDF（pc） （263KB）（414）       Knowledge map    Save BACKGROUND: To determine the protective role of mesencephalic astrocyte-derived neurotrophic factor (MANF) in regulating sepsis-associated acute kidney injury (S-AKI). METHODS: A total of 96 mice were randomly divided into the control group, control+MANF group, S-AKI group, and S-AKI+MANF group. The S-AKI model was established by injecting lipopolysaccharide (LPS) at 10 mg/kg intraperitoneally. MANF (200 μg/kg) was administered to the control+MANF and S-AKI+MANF groups. An equal dose of normal saline was administered daily intraperitoneally in the control and S-AKI groups. Serum and kidney tissue samples were obtained for biochemical analysis. Western blotting was used to detect the protein expression of MANF in the kidney, and enzyme-linked immunosorbent assay (ELISA) was used to determine expression of MANF in the serum, pro-inflammatory cytokines (tumor necrosis factor-α [TNF-α] and interleukin-6 [IL-6]). Serum creatinine (SCr), and blood urea nitrogen (BUN) were examined using an automatic biochemical analyzer. In addition, the kidney tissue was observed for pathological changes by hematoxylin-eosin staining. The comparison between two groups was performed by unpaired Student’s t-test, and statistics among multiple groups were carried out using Tukey’s post hoc test following one-way analysis of variance (ANOVA). A P-value <0.05 was considered statistically significant. RESULTS: At the early stage of S-AKI, MANF in the kidney tissue was up-regulated, but with the development of the disease, it was down-regulated. Renal function was worsened in the S-AKI group, and TNF-α and IL-6 were elevated. The administration of MANF significantly alleviated the elevated levels of SCr and BUN and inhibited the expression of TNF-α and IL-6 in the kidney. The pathological changes were more extensive in the S-AKI group than in the S-AKI+MANF group. CONCLUSION: MANF treatment may significantly alleviate renal injury, reduce the inflammatory response, and alleviate or reverse kidney tissue damage. MANF may have a protective effect on S-AKI, suggesting a potential treatment for S-AKI. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics

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Emergency department approach to monkeypox Catherine V. Levitt, Quincy K. Tran, Hashem Hraky, Maryann Mazer-Amirshahi, Ali Pourmand World Journal of Emergency Medicine    2023, 14 (5): 341-348.   DOI: 10.5847/wjem.j.1920-8642.2023.098 Abstract （122）   HTML （84）    PDF（pc） （203KB）（409）       Knowledge map    Save BACKGROUND: Monkeypox (mpox) is a viral infection that is primarily endemic to countries in Africa, but large outbreaks outside of Africa have been historically rare. In June 2022, mpox began to spread across Europe and North America, causing the World Health Organization (WHO) to declare mpox a public health emergency of international concern. This article aims to review clinical presentation, diagnosis, and prevention and treatment strategies on mpox, providing the basic knowledge for prevention and control for emergency providers. METHODS: We conducted a review of the literature using PubMed and SCOPUS databases from their beginnings to the end of July 2023. The inclusion criteria were studies on adult patients focusing on emerging infections that described an approach to a public health emergency of international concern, systematic reviews, clinical guidelines, and retrospective studies. Studies that were not published in English were excluded. RESULTS: We included 50 studies in this review. The initial symptoms of mpox are non-specific: fever, malaise, myalgias, and sore throat. Rash, a common presentation of mpox, usually occurs 2-4 weeks after the prodrome, but the presence of lymphadenopathy may distinguish mpox from other infections from the Poxviridae family. Life-threatening complications such as pneumonia, sepsis, encephalitis, myocarditis, and death can occur. There are documented co-occurrences of human immunodeficiency virus (HIV) and other sexually transmitted infections that can worsen morbidity. CONCLUSION: The initial presentation of mpox is non-specific. The preferred treatment included tecovirimat in patients with severe illness or at high risk of developing severe disease and vaccination with two doses of JYNNEOS. However, careful history and physical examination can raise the clinicians’ suspicion and point toward a prompt diagnosis. There are different modalities to prevent and treat mpox infection. 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 （199）   HTML （30）    PDF（pc） （738KB）（407）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics

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A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study Jing Yang, Hanqi Tang, Shihuan Shao, Feng Xu, Yangyang Fu, Shengyong Xu, Chen Li, Yan Li, Yang Liu, Joseph Harold Walline, Huadong Zhu, Yuguo Chen, Xuezhong Yu, Jun Xu World Journal of Emergency Medicine    2024, 15 (1): 16-22.   DOI: 10.5847/wjem.j.1920-8642.2023.186 Abstract （138）   HTML （374）    PDF（pc） （235KB）（403）       Knowledge map    Save BACKGROUND: Unsustained return of spontaneous circulation (ROSC) is a critical barrier to survival in cardiac arrest patients. This study examined whether end-tidal carbon dioxide (ETCO2) and pulse oximetry photoplethysmogram (POP) parameters can be used to identify unsustained ROSC. METHODS: We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to 2014. Patients’ general information, ETCO2, and POP parameters were collected and statistically analyzed. RESULTS: The included 105 ROSC episodes (from 80 cardiac arrest patients) comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes. The 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group (29.2% vs. 9.4%, P<0.05). The logistic regression analysis showed that the difference between after and before ROSC in ETCO2 (ΔETCO2) and the difference between after and before ROCS in area under the curve of POP (ΔAUCp) were independently associated with sustained ROSC (odds ratio [OR]=0.931, 95% confidence interval [95% CI] 0.881-0.984, P=0.011 and OR=0.998, 95% CI 0.997-0.999, P<0.001). The area under the receiver operating characteristic curve of ΔETCO2, ΔAUCp, and the combination of both to predict unsustained ROSC were 0.752 (95% CI 0.660-0.844), 0.883 (95% CI 0.818-0.948), and 0.902 (95% CI 0.842-0.962), respectively. CONCLUSION: Patients with unsustained ROSC have a poor prognosis. The combination of ΔETCO2 and ΔAUCp showed significant predictive value for unsustained ROSC. Table and Figures | Reference | Supplementary Material | 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 （202）   HTML （21）    PDF（pc） （387KB）（402）       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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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 （200）   HTML （46）    PDF（pc） （538KB）（396）       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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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 （211）   HTML （23）    PDF（pc） （1073KB）（392）       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 （194）   HTML （44）    PDF（pc） （673KB）（380）       Knowledge map    Save Table and Figures | Reference | Related Articles | Metrics

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Development and validation of an emergency bloodstream infection score for predicting in-hospital mortality in patients with community-acquired bloodstream infections Xinlei Wang, Yao Sun, Xiaoyu Ni, Shu Zhang World Journal of Emergency Medicine    2023, 14 (4): 280-286.   DOI: 10.5847/wjem.j.1920-8642.2023.067 Abstract （170）   HTML （35）    PDF（pc） （418KB）（379）       Knowledge map    Save BACKGROUND: Community-acquired bloodstream infections (CABSIs) are common in the emergency departments, and some progress to sepsis and even lead to death. However, limited information is available regarding the prediction of patients with high risk of death. METHODS: The Emergency Bloodstream Infection Score (EBS) for CABSIs was developed to visualize the output of a logistic regression model and was validated by the area under the curve (AUC). The Mortality in Emergency Department Sepsis (MEDS), Pitt Bacteremia Score (PBS), Sequential Organ Failure Assessment (SOFA), quick Sequential Organ Failure Assessment (qSOFA), Charlson Comorbidity Index (CCI), and McCabe-Jackson Comorbid Classification (MJCC) for patients with CABSIs were computed to compare them with EBS in terms of the AUC and decision curve analysis (DCA). The net reclassification improvement (NRI) index and integrated discrimination improvement (IDI) index were compared between the SOFA and EBS. RESULTS: A total of 547 patients with CABSIs were included. The AUC (0.853) of the EBS was larger than those of the MEDS, PBS, SOFA, and qSOFA (all P<0.001). The NRI index of EBS in predicting the in-hospital mortality of CABSIs patients was 0.368 (P=0.04), and the IDI index was 0.079 (P=0.03). DCA showed that when the threshold probability was < 0.1, the net benefit of the EBS model was higher than those of the other models. CONCLUSION: The EBS prognostic models were better than the SOFA, qSOFA, MEDS, and PBS models in predicting the in-hospital mortality of patients with CABSIs. Table and Figures | Reference | Supplementary Material | Related Articles | Metrics