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Table of Content

    01 July 2023, Volume 14 Issue 4
    Original Article
    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
    2023, 14(4):  257-264.  doi:10.5847/wjem.j.1920-8642.2023.054
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    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.

    Effect of a low-cost instruction card for automated external defibrillator operation in lay rescuers: a randomized simulation study
    Qiang Zhou, Xuejie Dong, Wei Zhang, Rengyu Wu, Kaizhu Chen, Hongjuan Zhang, Zhijie Zheng, Lin Zhang
    2023, 14(4):  265-272.  doi:10.5847/wjem.j.1920-8642.2023.070
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    BACKGROUND: To evaluate whether a simplified self-instruction card can help potential rescue providers use automated external defibrillators (AEDs) more accurately and quickly.
    METHODS: From June 1, 2018, to November 30, 2019, a prospective longitudinal randomized controlled simulation study was conducted among 165 laypeople (18-65 years old) without prior AED training. A self-instruction card was designed to illuminate key AED operation procedures. Subjects were randomly divided into the card (n=83) and control (n=82) groups with age stratification. They were then individually evaluated in the same simulated scenario to use AED with (card group) or without the self-instruction card (control group) at baseline, post-training, and at the 3-month follow-up.
    RESULTS: At baseline, the card group reached a significantly higher proportion of successful defibrillation (31.1% vs. 15.9%, P=0.03), fully baring the chest (88.9% vs. 63.4%, P<0.001), correct electrode placement (32.5% vs. 17.1%, P=0.03), and resuming cardiopulmonary resuscitation (CPR) (72.3% vs. 9.8%, P<0.001). At post-training and follow-up, there were no significant differences in key behaviors, except for resuming CPR. Time to shock and time to resume CPR were shorter in the card group, while time to power-on AED was not different in each phase of tests. In the 55-65 years group, the card group achieved more skill improvements over the control group compared to the other age groups.
    CONCLUSION: The self-instruction card could serve as a direction for first-time AED users and as a reminder for trained subjects. This could be a practical, cost-effective way to improve the AED skills of potential rescue providers among different age groups, including seniors.

    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
    2023, 14(4):  273-279.  doi:10.5847/wjem.j.1920-8642.2023.066
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    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.

    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
    2023, 14(4):  280-286.  doi:10.5847/wjem.j.1920-8642.2023.067
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    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.

    Heat stroke alters hippocampal and cerebellar transmitter metabonomics
    Guoxin He, Ancong Xu, Xichong Yu, Fan Huang, Lei Su
    2023, 14(4):  287-293.  doi:10.5847/wjem.j.1920-8642.2023.068
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    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.

    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
    2023, 14(4):  294-301.  doi:10.5847/wjem.j.1920-8642.2023.055
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    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.

    Viewpoint
    Research Letter
    COVID-19: Masks do not influence neurocognitive performance during a shift at the emergency department
    Jürgen Grafeneder, Verena Fuhrmann, Katharina Tscherny, Maximilian Niederer, Wolfgang Schreiber, Harald Herkner, Dominik Roth, Calvin Lukas Kienbacher
    2023, 14(4):  317-321.  doi:10.5847/wjem.j.1920-8642.2023.071
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    Case Letter
    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
    2023, 14(4):  322-324.  doi:10.5847/wjem.j.1920-8642.2023.063
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    Venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock induced by adrenal lesions: a case report and review of the literature
    Liping Zhou, Xiaoye Mo, Guoqing Huang, Ping Wu, Changshou She, Shanshan Hu, Ben Liu, Zhen Zhao, Ning Yang
    2023, 14(4):  325-328.  doi:10.5847/wjem.j.1920-8642.2023.064
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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
    2023, 14(4):  329-331.  doi:10.5847/wjem.j.1920-8642.2023.060
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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
    2023, 14(4):  332-334.  doi:10.5847/wjem.j.1920-8642.2023.053
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    Hypoxic-ischemic encephalopathy induced cognitive decline secondary to upper gastrointestinal bleeding: a case report
    Rui Wei, Danyang Jing, Xiangchen Meng, Hongtao Wei
    2023, 14(4):  335-337.  doi:10.5847/wjem.j.1920-8642.2023.065
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    A case of phenibut withdrawal and treatment with baclofen
    Michael Morris, James Espinosa, Alan Lucerna, Robin Lahr
    2023, 14(4):  338-340.  doi:10.5847/wjem.j.1920-8642.2023.059
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