Background: Emergency department cardiac arrests (EDCA) account for approxi-mately 10% of all in-hospital cardiac arrest (CA) events. However, data regarding EDCA remain scarce. Since EDCA has unique characteristics, etiologies, and outcomes, it should be considered distinct from out-of-hospital and in-hospital cardiac arrest. Methods: This study included adult patients who received cardiopulmonary resuscitation in our emergency department for EDCA between 01 January 2019, and 30 June 2023. Patients with a do-not-resuscitate order and those with trauma were excluded. On the basis of the assessment performed by emergency physicians, we divided the patients into unexpected and expected EDCA groups. Results: This study included 266 patients, of whom 93 had experienced an unexpected EDCA. Shockable initial rhythm was observed in 21.05% of the overall cohort. The incidence of initial shockable rhythms and the prevalence of end-stage renal disease were higher in the unexpected EDCA group (40.86% and 22.58%, respectively). The predominant etiologies of EDCA in the expected and unexpected EDCA groups were sepsis (24.86%) and shockable fatal dysrhythmia (40.86%), respectively. The overall probabilities of survival to hospitalization, survival to hospital discharge, and favorable neurological outcomes were 49.62%, 27.44%, and 12.41%, respectively. A trend toward better neurological outcomes was observed in the unexpected EDCA group. Conclusions: Expected and unexpected EDCA events differ in terms of characteristics, etiologies, and outcomes. To enhance care quality and prognosis, these differences should be considered when treatment is being planned for patients with EDCA.

Background: Despite the critical importance of emergency response, there are currently no dedicated resuscitation guidelines for managing cardiac arrest in dentistry. Existing international cardiopulmonary resuscitation (CPR) protocols, such as those from the American Heart Association (AHA) and the European Resuscitation Council (ERC), are designed for general life-threatening situations and may not be directly applicable in dental clinics. In cases of cardiac arrest in dental patients, it is often recommended to move the patient to the floor to facilitate effective chest compressions. However, most dental clinics in Japan have a limited staff, often predominantly female, with unique challenges in transferring patients, especially overweight male patients. These challenges include confined space, limited personnel, obstructive equipment, and the physical size of the patient. This study examined several factors that affect female staff members’ ability to transfer male patients from a dental chair to the floor. Methods: A randomized crossover study was conducted involving four male and nine female rescuers using two types of dental chairs (with and without side tables). Variables such as the number of female rescuers, transfer time, changes in vital signs, and perceived fatigue were assessed. Results: Depending on patient size and chair type, a minimum of five female staff members and approximately 20 seconds were needed for a safe transfer. Conclusions: If the dental clinic does not have adequate staff and sufficient floor space, transferring the patient from the dental chair to the floor for CPR may not be a feasible or an effective procedure. Clinical Trial Registration: The study was registered retrospectively with UMIN Individual Case Data Sharing System (https://www.umin.ac.jp/) as UMIN000060182.

Oesophageal intubation is dangerous if not promptly identified and managed. It often results from human error and inadequate education. An advanced technologies can mitigate the risk of this serious complication and enhance patient safety. This narrative review evaluated contemporary publications concerning unrecognised oesophageal intubation in the surgical theatre. PubMed, Scopus, and the Cochrane Library were searched for relevant articles published from 2010 to 2025, excluding non-English manuscripts, case reports, and studies lacking pertinent data. The effectiveness of capnography, video laryngoscopy, and simulation training was analysed to determine intubation rates across various clinical settings. The narrative review indicated that the rates of unrecognised oesophageal intubation range from 2.9% to 16.7%, and are associated with increased mortality. The implementation of video laryngoscopy reduced these rates by approximately 50%, while simulation training improved first-attempt intubation success. The findings underscore the necessity of incorporating advanced monitoring systems and simulation-based training into anaesthesia protocols to reduce the risks associated with overlooked oesophageal intubation. This fosters a safety-oriented culture and utilises technological innovations to significantly improve patient outcomes and decrease the incidence of this severe complication.

Background: Agricultural injuries caused by hand-held tools, such as sickles, remain an underrecognized yet preventable public health challenge. Despite increased mechanization, hand-held tools are still widely used, especially in rural areas in low- and middle-income countries, where significant injuries are reported. Sickle injuries, in particular, frequently lead to amputations, tendon disruptions, and permanent neurovascular damage. This study examined the demographic, seasonal, and clinical patterns of sickle-related injuries and their treatment outcomes at a tertiary care center in South India. Methods: A retrospective observational study was conducted at a tertiary care teaching hospital in South India; patient records from January 2021 to December 2023 were reviewed to identify sickle-related injuries receiving surgical or nonsurgical treatment in the Emergency Department. Demographic details, injury patterns, seasonal trends, clinical interventions, and treatment outcomes were collected and analyzed quantitatively through descriptive and inferential statistics. Results: The study included 108 patients, predominantly males (78%), with the majority of the injuries occurring among the middle-aged population (40–60 years). Most injuries occurred in the morning and peaked during the crop harvest season (September–December). Upper limb injuries, particularly to the left hand, were most common, with lacerations being the predominant type of injury. Surgical interventions were required for 68% of the patients, and a significant correlation was observed between injury severity and length of hospital stay. Conclusions: Sickle-related injuries are a significant occupational hazard among agricultural workers in rural India, often resulting in disability and financial hardship. Middle-aged male farmers are disproportionately affected, with a clear seasonal and temporal pattern linked to agricultural activity. Upper limb trauma, particularly lacerations and neurovascular damage, is common. Despite existing legislation, policy gaps persist regarding nonpowered tool safety. Our findings highlight a persistent, underrecognized public health issue and the urgent need for targeted safety training, ergonomic tool redesign, and policy reform.

Background: This study aimed to characterize the clinical features, morbidity, and in-hospital mortality of patients admitted to the intensive care unit (ICU) following the Turkey–Syria earthquakes, with particular attention to the prevalence of Crush Syndrome (CS) and the identification of prognostic factors influencing its development and patient outcomes. Methods: Clinical data from 108 patients who were admitted to the ICU for earthquake-related trauma were retrospectively reviewed to assess their demographic characteristics, clinical presentation, duration of entrapment under rubble, treatment measures, blood gas parameters, laboratory results, ICU length of stay, occurrence of CS, and hospital mortality. Results: Among the 108 patients (mean age, 37 ± 18 years), the in-hospital mortality rate was 29%. Mortality was found to be significantly associated with higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, lower Glasgow Coma Scale scores, and increased levels of aspartate aminotransferase, alanine aminotransferase, creatine kinase (CK), peak CK, creatinine, troponin I, and red cell distribution width, as well as with decreased pH and bicarbonate levels (p < 0.05 for all). Troponin I exhibited the highest prognostic performance, with an area under the curve of 0.85, sensitivity of 83%, and specificity of 78% at a cut-off value of 257 ng/L. CS was diagnosed in 81 patients (75%), with a median CK level of 44,915 U/L (interquartile range, 15,000–122,250). Male sex and younger age were significantly associated with the development of CS (p < 0.05). Conclusions: Elevated troponin I levels at admission could be strongly associated with in-hospital mortality among earthquake victims requiring ICU care. CS was highly prevalent, particularly among younger and male patients, indicating the need for early recognition and targeted management strategies in this population.

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can improve survival and neurological outcomes in patients with cardiac arrest. This study aimed to evaluate the association between the interval from cardiopulmonary resuscitation (CPR) initiation to VA-ECMO cannulation and in-hospital mortality in adult patients. Methods: Data from 279 adult patients who received VA-ECMO during CPR were retrospectively collected and the CPR-to-ECMO interval was stratified into tertiles: ≤14 minutes, 15–29 minutes, and >30 minutes. A multivariable logistic regression examined the relationship between the interval and in-hospital mortality, adjusting for potential confounders. Results: Among the 279 patients who underwent VA-ECMO, 179 died during hospitalization. VA-ECMO was initiated within 14 minutes in 44 patients, between 15 and 29 minutes in 52 patients, and after more than 30 minutes in 83 patients. A longer interval was independently associated with a higher risk of in-hospital mortality. Each additional minute of delay was associated with a 3% increase in mortality risk (adjusted odds ratio (aOR) 1.03; 95% confidence interval (CI), 1.01–1.04; p = 0.002). Compared to patients in the lowest tertile, those in the highest tertile had a 4.07-fold increased risk of death (aOR 4.07; 95% CI, 1.90–8.73; p < 0.001). Conclusions: In patients undergoing CPR, a shorter interval between CPR initiation and VA-ECMO cannulation was significantly associated with lower in-hospital mortality. These findings underscore the importance of minimizing delays in VA-ECMO initiation to improve survival outcomes following cardiac arrest.

Background: Percutaneous balloon compression (PBC) and radiofrequency thermoco-agulation (RFT) are widely used minimally invasive treatments for trigeminal neuralgia (TN). However, controversies persist regarding their comparative long-term efficacy, recurrence rates, postoperative physiological stress and inflammatory responses. This study is to analyze the efficacy of PBC and RFT in the treatment of patients with TN. Methods: This retrospective, single center, cohort study included 165 patients with primary TN, treated from January 2017 to December 2022, after failure or intolerance to medical therapy. The PBC group (n = 85), underwent percutaneous microballoon compression of the Gasserian ganglion, and the RFT group (n = 80) underwent radiofrequency thermocoagulation. The primary outcomes were pain relief, assessed using the Barrow Neurological Institute (BNI) pain intensity score, and pain recurrence rates at one and three years postoperatively. Secondary outcomes comprised pain relief rate at 24 hours post-surgery, serum inflammatory markers (Tumor Necrosis Factor-alpha (TNF-α), Interleukin-1β (IL-1β), and Interleukin-6 (IL-6)) at 7 days post-surgery, and levels of stress hormones (norepinephrine (NE) and cortisol (Cor)) at 1-and 2-days post-surgery. Results: At 24 hours postoperatively, no significant difference was observed in the pain relief effect between the two groups (p > 0.05). However, at 7 days post-operation, TNF-α, IL-1β, and IL-6 levels were significantly lower in the PBC group compared to the RFT group (p < 0.05). Similarly, at 1- and 2-day post-operation, norepinephrine and cortisol levels were significantly lower in the PBC group (p < 0.05). At 1, 3 years post-operation, the PBC group demonstrated significantly better pain relief and lower recurrence rates than the RFT group (p < 0.05). Conclusions: For the treatment of trigeminal neuralgia, PBC of the trigeminal ganglion provides effective pain relief with reduced postoperative inflammatory and stress responses. Compared with radiofrequency thermocoagulation, PBC might offer superior long-term efficacy and lower recurrence rates.

Mechanical circulatory support (MCS) is frequently used in patients with cardiogenic shock to restore adequate organ perfusion, improve hemodynamic, reduce catecholamine-related adverse events, and prevent development of organ failure. Intra-aortic balloon pump (IABP) is usually the first line device used among currently available MCS systems, it is easily inserted at bedside, and associated with low complications rate. Despite its widespread use, a recent small, randomized study suggested that early implantation of IABP does not improve short-term outcomes in patients with Society of Cardiovascular Angiography Class B to D heart-failure related cardiogenic shock. In this article, we discuss possible limitations of recent studies on IABP, as well as updated evidence on effects on outcome and optimal patient selection for IABP support in patients with heart-failure related cardiogenic shock.

Background: Socioeconomic status may influence survival after out-of-hospital cardiac arrest (OHCA). This study is the first to assess the association between village-level income quartiles and survival to hospital discharge after OHCA in a mid-sized Asian city where EMS delivery is standardized and geographic variation in access is minimal. Methods: We conducted a retrospective analysis of 209 adult residential OHCA cases recorded in the Chiayi City EMS registry in 2024. Income quartiles (Q1–Q4) were defined by case-level distribution as ≤New Taiwan (NT)$823,000, NT$823,001–868,000, NT$868,001–931,000, and >NT$931,000. Three multivariable logistic regression models, each meeting the events-per-variable threshold of ≥10:1, were constructed: discharge (2 covariates: income, shockable rhythm), Return of spontaneous circulation (ROSC) >24 h (4 covariates), and ROSC >2 h (6 covariates). Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were reported, along with model performance metrics (area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit). Results: Survival to discharge increased from 3.8% in Q1 to 13.5% in Q4 (p = 0.10). ROSC >24 h ranged from 11.3%in Q1 to 26.9% in Q4 (p = 0.09). ROSC >2 h peaked in Q2 (40.4%) compared with 18.9% in Q1 (p = 0.02). Shockable rhythm was a strong predictor of survival (adjusted OR = 17.4, 95% CI 4.2–71.7, p < 0.01). EMS response time differed significantly by income quartile (p = 0.03), with Q2 showing the shortest times. Model AUCs ranged from 0.78 to 0.80. Conclusions: In small urban environments, socioeconomic status appears to influence OHCA outcomes in a non-linear manner, with moderate-income areas demonstrating higher early ROSC rates, potentially due to a greater prevalence of shockable rhythms and favorable community factors. These findings contrast with patterns observed in larger cities and suggest that targeted interventions may help reduce survival disparities.

Background: Postoperative nausea and vomiting (PONV) are distressing symptoms that considerably diminish postoperative satisfaction. We are conducting a double-blind, randomised, controlled trial to evaluate the efficacy of a novel G-protein-biased µ-opioid receptor agonist, oliceridine, in preventing PONV after general anaesthesia in high-risk patients. The study also seeks to determine whether traditional opioids, such as fentanyl, can be replaced during tracheal intubation and for postoperative analgesia. The objectives of this trial include assessing the impact of oliceridine on PONV. Methods: In this study, 280 adult female patients (aged 18–65 years) undergoing elective laparoscopic gynaecological under general surgery who meet the inclusion criteria will be randomly assigned to an experimental group (oliceridine) and a control group (fentanyl) in a 1:1 ratio. The primary outcome indicator is the incidence of nausea and vomiting within 48 hours after surgery. The secondary outcome indicators are the analgesic effect in the perioperative period (anaesthesia induction period, intraoperative period, and 48 hours post-surgery), the overall incidence of severe complications post-surgery, length of hospital stay, and time of food and drink intake. Conclusions: This trial demonstrates that oliceridine provides comparable analgesia to fentanyl in high-risk surgical patients, positioning it as a promising alternative with a superior PONV profile. Clinical Trial Registration: ChiCTR2400089121.