Acute Life-threatening Conditions Research Articles

Onboarding in intensive care and emergency medicine in Germany

The treatment of acute life-threatening conditions in intensive care and emergency medicine requires in-depth training and education, with initial training playing akey role. What is the structure and quality of the initial training of physicians and nurses in intensive care units and emergency departments in Germany? With the help of survey software, an online questionnaire comprising 40questions in German on the aforementioned topic was designed. It was distributed via the website of the German Society for Internal Intensive Care and Emergency Medicine (DGIIN) and via pertinent social media channels. In total, 103 nurses and 125 physicians participated in the survey. The average work experience of the participating nurses and physicians was 8.5 ± 5.1 and 3.0 ± 3.1years, respectively. The majority of participants worked primarily in intensive care units (59%) or in emergency departments (22%). On average, the initial training lasted 45 ± 27 and 13 ± 13days for nurses and physicians, respectively. Only 20% of the initial training comprised seminars or hands-on workshops taught outside of routine clinical care. In all, 47% of the participants stated that they were not able to complete the entire initial training period. Only 49% had been officially certified for usage of the technical equipment in their department. Atotal of 35% reported feeling confident or somewhat confident in handling predictable tasks after initial training, but only 15% in handling acute emergencies. The present study revealed that initial training in intensive care and emergency medicine is frequently incomplete, unstructured, as well as inadequate and bears both safety and liability risks. New concepts are needed to improve the initial training across clinics.

The Role of Chest Radiology in Traumatic Injuries: A Comprehensive Narrative Review

Chest trauma is a critical medical condition that encompasses a range of injuries and can result from various causes. Prompt and accurate diagnosis is crucial in managing chest trauma patients and radiology plays a pivotal role in this aspect. Imaging modalities in chest trauma aid in precise diagnosis and treatment planning. Especially, X-rays remain the initial imaging modality of choice due to their accessibility, speed, and ability to detect acute life-threatening conditions. Computed Tomography (CT) Scan offers detailed cross- sectional images allowing for comprehensive evaluation of chest trauma and surgical planning when necessary. Ultrasound (US) is increasingly valuable tool due to its portability and real-time imaging capabilities, aiding in rapid assessment at the bedside. Magnetic Resonance Imaging (MRI) is less commonly used due to time constraints and limited availability. Radiological imaging serves various purposes in the diagnosis and management of chest trauma such as early detection and triage, characterization and severity assessment, surgical planning, follow-up and monitoring of chest trauma. Reduction of radiation exposure, advancements in imaging technology (dual-energy CT, contrastenhanced imaging) and Artificial Intelligence (AI) algorithms are crucial challenges and deserve attention. A multidisciplinary approach integrating radiological expertise remains fundamental in ensuring optimal outcomes for patients with chest trauma.

Thoracic Aorta: Anatomy and Pathology

The aorta is the largest elastic artery in the human body and is classically divided into two anatomical segments, the thoracic and the abdominal aorta, separated by the diaphragm. The thoracic aorta includes the aortic root, the ascending aorta, the arch, and the descending aorta. The aorta’s elastic properties depend on its wall structure, composed of three distinct histologic layers: intima, media, and adventitia. The different aortic segments show different embryological and anatomical features, which account for their different physiological properties and impact the occurrence and natural history of congenital and acquired diseases that develop herein. Diseases of the thoracic aorta may present either as a chronic, often asymptomatic disorder or as acute life-threatening conditions, i.e., acute aortic syndromes, and are usually associated with states that increase wall stress and alter the structure of the aortic wall. This review aims to provide an update on the disease of the thoracic aorta, focusing on the morphological substrates and clinicopathological correlations. Information on anatomy and embryology will also be provided.

Factors affecting post-mortem production of equine ICSI blastocysts

In vitro fertilization of equine oocytes by intracytoplasmic sperm injection (ICSI) has enabled post-mortem production of equine embryos. This procedure makes it possible to secure one last offspring from mares that must be suddenly euthanized. Currently, little is known about how clinical factors influence the outcome. The aim of this study was to evaluate the effect of the following clinical factors on the chance of a successful session (≥1 embryo) and blastocyst rates after post-mortem ICSI: Mare age, number of collected oocytes per mare, location of euthanasia (at our clinic/in the field), duration of ovary transport, method of ovary removal (during anaesthesia, after pentobarbital, after bolt gun), reason for euthanasia (acute life-threatening conditions requiring immediate euthanasia vs. non-acute conditions, where euthanasia could be postponed). The study was performed retrospectively and included ovaries from 65 euthanized mares in the period between 2019-2022. The mares, mainly Warmbloods, were aged between 1 to 26 years old (average 14.4 years old). If euthanasia was performed in the field, the ovaries were transported to our clinic (0.5 to 14 hours) in sterile saline at 22-32⁰C. The oocytes were collected by scraping each follicle. After overnight holding, the oocytes were matured for 30 hours. The mature metaphase II oocytes were inseminated by ICSI with the desired semen and after7-10 days of culture, blastocysts were vitrified. In total, 842 oocytes were collected from 65 mares (range: 1 to 47 oocytes per mare, average = 13), 744 oocytes were placed in maturation medium and the remaining degenerated oocytes were discarded. A total of 65% (481/744) of the oocytes reached the MII stage and were injected, and 11.4% (55/481) of these reached the blastocyst stage within 10 days after ICSI. The proportion of successful sessions was 37%. The factors that were shown to affect the chance of a successful session, were the number of collected oocytes per mare and the reason for euthanasia (acute vs. non-acute; multiple logistic regression, p < 0.05). The other examined factors did not affect the chance of a successful session (multiple logistic regression, p > 0.05). When comparing mares euthanized for non-acute reasons to mares euthanized for acute reasons, there was a higher chance of a successful session (50%, 16/38 vs. 20.7%, 6/29, respectively, p = 0.02, Fisher's exact test) and a higher blastocyst rate (16.2%, 44/272 vs. 5.3%, 11/209, p = 0.0001, Fisher's exact test) in mares euthanized for non-acute reasons. This study reports that post-mortem, in vitro embryo production can be performed on mares euthanized both in the field and at the ICSI clinic, but with a lower chance of a successful session for mares euthanized due to acute life-threatening conditions.

Imparting knowledge is no more considered a paramount contribution.

I have been practising medicine in an under-served rural setting since 1976, and have published around 109 papers in PubMed-indexed journals - including The Lancet, BMJ, NEJM and several tropical medicine journals - on scorpion and snakebite cases causing acute life-threatening conditions. I have researched in detail, with restricted resources, the acute clinical effects of envenomation and management of scorpion and snakebite cases [1, 2]. In Mahad, the fatality rate due to refractory heart failure arising from autonomic storm evoked by scorpion venom was previously 30% [3]. Since the advent of prazosin and scorpion antivenom, it has dropped to less than 1% [4]. Similarly, fatalities due to snakebite poisoning have been reduced from 18% to 5.

Managing chronic disease with individualized metabolomics &amp; artificial intelligence

Managing chronic disease with individualized metabolomics &amp; artificial intelligence Christopher Gerner from the Joint Metabolome Facility at the University of Vienna, Austria, walks us through what we need to know about managing chronic disease by individualized metabolomics &amp; artificial intelligence. Gerner discusses both the promise and challenge of developing such biomedical methods, a new methodology termed Metabo-tip, and what the future holds for managing chronic disease. Many acute life-threatening conditions, such as severe injury or bacterial infections, have remained well under control for almost a century. However, chronic diseases such as type 2 diabetes, inflammatory bowel diseases, endometriosis, chronic fatigue syndrome, etc. and the increasing numbers of patients suffering from them still pose a major challenge.

Doctors’ experiences of providing care in rural hospitals in Southern New Zealand: a qualitative study

ObjectiveTo explore rural hospital doctors’ experiences of providing care in New Zealand rural hospitals.DesignThe study had a qualitative design, using qualitative content analysis.SettingThe study was conducted in South Island, New...

Nitrobenzene Induced Methemoglobinemia with Paroxysmal Atrial Fibrillation Treated with Single Volume Exchange Transfusions

Methemoglobinemia is a potentially fatal condition if left untreated. Conventional treatment of nitrobenzene induced methemoglobinemia dictates the use of methylene blue, which is the antidote of choice. However, its availability in our setting is limited only to the laboratory use. We present a case of a 21-year-old female with intentional ingestion of nitrobenzene. Clinical history and supportive investigations revealed methemoglobinemia and it was successfully managed with single volume exchange transfusions in absence of specific antidote. While exchange transfusions are indicated for severe cases, it may be useful as an alternative treatment in acute life-threatening conditions where methylene blue is not available.

Prioritization versus rationing of healthcare – elective surgery is not optional surgery

Prioritization versus rationing of healthcare – elective surgery is not optional surgery

Redeployment of psychiatrist trainees during the COVID-19 pandemic: evaluation of attitude and preparedness.

Background: The coronavirus disease-2019 (COVID-19) pandemic has imposed an unprecedented strain on healthcare systems worldwide. In response, psychiatrist trainees were redeployed from their training sites to help manage patients with COVID-19. This study aimed to examine the attitude of psychiatrist trainees toward redeployment to COVID-19 sites and their perceived preparedness for managing physical health conditions during redeployment. Methods: A cross-sectional researcher-developed online survey was administered among psychiatrist trainees in May 2020 at the Department of Psychiatry, Hamad Medical Corporation, Qatar. Results: Of the 45 psychiatrist trainees, 40 (88.9%) responded to the survey. Most trainees reported being comfortable dealing with chronic medical conditions, but less so with acute life-threatening medical conditions. Half reported feeling anxious about redeployment, and most felt the need for additional training. We found that trainees’ perceived redeployment preparedness was significantly associated with their level of postgraduate training and the time since and duration of their last medical or surgical training. Conclusion: Adequate preparation and training of psychiatrist trainees is important before redeployment to COVID-19 sites to ensure that they can effectively and safely manage patients with COVID-19.

Computed Tomography Imaging in Simulated Ongoing Cardiopulmonary Resuscitation: No Need to Switch Off the Chest Compression Device during Image Acquisition.

Computed tomography (CT) represents the current standard for imaging of patients with acute life-threatening diseases. As some patients present with circulatory arrest, they require cardiopulmonary resuscitation. Automated chest compression devices are used to continue resuscitation during CT examinations, but tend to cause motion artifacts degrading diagnostic evaluation of the chest. The aim was to investigate and evaluate a CT protocol for motion-free imaging of thoracic structures during ongoing mechanical resuscitation. The standard CT trauma protocol and a CT protocol with ECG triggering using a simulated ECG were applied in an experimental setup to examine a compressible thorax phantom during resuscitation with two different compression devices. Twenty-eight phantom examinations were performed, 14 with AutoPulse® and 14 with corpuls cpr®. With each device, seven CT examinations were carried out with ECG triggering and seven without. Image quality improved significantly applying the ECG-triggered protocol (p < 0.001), which allowed almost artifact-free chest evaluation. With the investigated protocol, radiation exposure was 5.09% higher (15.51 mSv vs. 14.76 mSv), and average reconstruction time of CT scans increased from 45 to 76 s. Image acquisition using the proposed CT protocol prevents thoracic motion artifacts and facilitates diagnosis of acute life-threatening conditions during continuous automated chest compression.

Early in-hospital course of critically ill nontrauma patients in aresuscitation room of aGerman emergency department (OBSERvE2 study).

BackgroundManagement of critically ill nontrauma (CINT) patients in the resuscitation room of the emergency department (ED) is very challenging. Detailed data describing the patient characteristics and management of this population are lacking. This observational study describes the epidemiology, management and outcome in CINT ED patients in the resuscitation room.MethodsThis prospective, single center observational study included all adult patients who were consecutively admitted to the ED resuscitation room during 2 periods of 1 year (September 2014–August 2015 vs. September 2017– August 2018). Patient characteristics, out-of-hospital/in-hospital treatment, admission-related conditions, time intervals for diagnostics and interventions and outcome were recorded using a self-developed questionnaire.ResultsA total of 34,303 patients in the first and 35,039 patients in the second study period were admitted to the ED, of whom 532 and 457 patients, respectively, were admitted to the nontrauma resuscitation room due to acute life-threatening conditions. The patient characteristics did not differ significantly between the study periods (male: 58% vs. 59%, age: 68 ± 17 years vs. 65 ± 17 years). Time intervals for diagnostic and therapeutic interventions were similar. The CINT patients during the second study period were treated faster compared to the first study period (end of ED management: 53 ± 33 min vs. 41 ± 24 min, p < 0.0001). The 30-day all-cause mortality was comparable (34.0% vs. 36.3%).ConclusionObservation of critically ill patient management in the ED resuscitation room showed reliable results between both study periods. Structured ED management guidelines for CINT patients may provide comparable results at one institution.Supplementary InformationThe online version of this article (10.1007/s00101-021-00962-3) contains an additional table and the evaluation chart. The article and the supplementary material are available at www.springermedizin.de.Please enter the article title in the search box; the supplementary material is available with the article under “Supplementary Information”.

Rapid Multianalyte Microfluidic Homogeneous Immunoassay on Electrokinetically Driven Beads.

The simplicity of homogeneous immunoassays makes them suitable for diagnostics of acute conditions. Indeed, the absence of washing steps reduces the binding reaction duration and favors a rapid and compact device, a critical asset for patients experiencing life-threatening diseases. In order to maximize analytical performance, standard systems employed in clinical laboratories rely largely on the use of high surface-to-volume ratio suspended moieties, such as microbeads, which provide at the same time a fast and efficient collection of analytes from the sample and controlled aggregation of collected material for improved readout. Here, we introduce an integrated microfluidic system that can perform analyte detection on antibody-decorated beads and their accumulation in confined regions within 15 min. We employed the system to the concomitant analysis of clinical concentrations of Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin C in serum, two acute kidney injury (AKI) biomarkers. To this end, high-aspect-ratio, three-dimensional electrodes were integrated within a microfluidic channel to impart a controlled trajectory to antibody-decorated microbeads through the application of dielectrophoretic (DEP) forces. Beads were efficiently retained against the fluid flow of reagents, granting an efficient on-chip analyte-to-bead binding. Electrokinetic forces specific to the beads’ size were generated in the same channel, leading differently decorated beads to different readout regions of the chip. Therefore, this microfluidic multianalyte immunoassay was demonstrated as a powerful tool for the rapid detection of acute life-threatening conditions.

Interventions to increase patient and family involvement in escalation of care for acute life-threatening illness in community health and hospital settings.

Interventions to increase patient and family involvement in escalation of care for acute life-threatening illness in community health and hospital settings.

Amniocele after laparoscopic myomectomy: is expectant management acceptable?

Amniocele after laparoscopic myomectomy: is expectant management acceptable?

Potential Indirect Effects of the COVID-19 Pandemic on Use of Emergency Departments for Acute Life-Threatening Conditions - United States, January-May 2020.

On March 13, 2020, the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, states enacted stay-at-home orders to slow the spread of SARS-CoV-2, the virus that causes COVID-19, and reduce the burden on the U.S. health care system. CDC* and the Centers for Medicare & Medicaid Services (CMS)† recommended that health care systems prioritize urgent visits and delay elective care to mitigate the spread of COVID-19 in health care settings. By May 2020, national syndromic surveillance data found that emergency department (ED) visits had declined 42% during the early months of the pandemic (1). This report describes trends in ED visits for three acute life-threatening health conditions (myocardial infarction [MI, also known as heart attack], stroke, and hyperglycemic crisis), immediately before and after declaration of the COVID-19 pandemic as a national emergency. These conditions represent acute events that always necessitate immediate emergency care, even during a public health emergency such as the COVID-19 pandemic. In the 10 weeks following the emergency declaration (March 15-May 23, 2020), ED visits declined 23% for MI, 20% for stroke, and 10% for hyperglycemic crisis, compared with the preceding 10-week period (January 5-March 14, 2020). EDs play a critical role in diagnosing and treating life-threatening conditions that might result in serious disability or death. Persons experiencing signs or symptoms of serious illness, such as severe chest pain, sudden or partial loss of motor function, altered mental state, signs of extreme hyperglycemia, or other life-threatening issues, should seek immediate emergency care, regardless of the pandemic. Clear, frequent, highly visible communication from public health and health care professionals is needed to reinforce the importance of timely care for medical emergencies and to assure the public that EDs are implementing infection prevention and control guidelines that help ensure the safety of their patients and health care personnel.

Accuracy of procalcitonin in detecting severe bacterial infections among critically ill children

Objectives: The aims of this study are to determine the accuracy of serum procalcitonin (PCT) in the early detection of severe bacterial infections among critically ill children and to establish the correlation between PCT changes and clinical outcomes. Design: This was a prospective, observational study at Queen Sirikit National Institute of Child Health, Bangkok, Thailand, between March 2014 and December 2014. Materials and Methods: Children aged between 1 month and 15 years with acute severe life-threatening conditions were included. Microbiologic specimens were sent for multiplex polymerase chain reaction and bacterial culture on day 1 of hospitalization. PCT was obtained on days 1, 2, 3, and 5. Measurement and Main Results: A total of 61 patients with a mean age of 21.2 months were enrolled. Microbiologic specimens were sent for multiplex polymerase chain reaction and bacterial culture on day 1 of hospitalization. PCT was obtained on days 1, 2, 3, and 5. The medians of PCT levels on days 1 and 2 from the bacterial infections group were significantly higher than those from the viral infections group and the mixed infections group. The sensitivity, specificity, and area under the PCT curve (cutoff value ≥1.1 ng/ml) employed to predict bacterial infections were 67.7%, 73.7%, and 0.72, respectively. The percentage changes of PCT levels on days 2–5 correlated with those of pediatric logistic organ dysfunction (PELOD) scores on days 1–5 but did not correlate significantly with the lengths of PICU stay. Conclusions: PCT is a moderately accurate option for the early detection of bacterial infections among children with acute severe life-threatening conditions since there is a correlation between the percentage changes of PCT levels and PELOD scores but no significant correlation between the percentage changes of PCT levels and the length of PICU stay.W

Quality of emergency nursing care in two tertiary healthcare settings in a developing Sub-Saharan African Country

IntroductionThe quality of care received by patients during the first few hours following an accident and/or acute life-threatening conditions can significantly affect the overall outcome of treatment. This study, therefore, assessed the quality of emergency nursing care in two tertiary healthcare settings in a developing Sub-Saharan African Country.MethodsThe study was conducted in two renowned tertiary hospitals in Southwest Nigeria. Four hundred and twenty-eight patients selected by purposive sampling technique from the two hospitals formed the sample. The Donabedian three-pronged approach of structure, process and outcome domains was employed for data collection. Two instruments; an adapted validated structured questionnaire and an observation checklist were used for data collection and data collected were analysed with the aid of Statistical Package for Social Sciences (SPSS 24) using mainly descriptive statistics such as frequency counts and percentages.ResultsResults showed that a majority (62.6%) rated the quality of emergency nursing care as high though observation revealed glaring differences in the structure, process and outcome domains of quality in selected hospitals.Discussion/ConclusionThe study, therefore, concluded that while the quality of emergency nursing care in the selected hospitals can be described in general as average, a lot still needs to be done to address the identified deficiencies in emergency nursing care.

Single-best Choice Between Intermittent Versus Continuous Renal Replacement Therapy: A Review.

Critically ill patients often develop multiorgan dysfunction syndrome. Acute kidney injury (AKI) is part of it. Renal replacement therapy (RRT) remains the primary choice of treatment in severely ill patients who develop AKI. Recent data have shown increased use of RRT in AKI patients. Therefore, the right choice of RRT plays an important role in the renal recovery of such patients. The question of which mode of RRT to apply has been the topic of study in the last two decades. Whether RRT should be conducted in intermittent mode, as intermittent hemodialysis (IHD), or in continuous mode, as continuous renal replacement therapy (CRRT), is still being investigated. CRRT has a hypothetical advantage when compared to IHD, as it involves a process in which there is gradual removal of fluids, better control of urea, better maintenance of the acid/base balance, and hemodynamic stability. However, IHD is more practical, cost-effective, does not require anticoagulation, decreases the bleeding risk, and removes the solute efficiently and rapidly in acute life-threatening conditions.Other modalities of RRT like sustained low-efficiency daily dialysis (SLEDD) and prolonged intermittent renal replacement therapy (PIRRT) have shown to encompass the benefits of both CRRT in terms of hemodynamic stability and IHD in terms of cost-efficiency. Although SLEDD is progressively being used as an alternative to CRRT and IHD, very few studies have shown to support it. In this article, we try to summarize the advantages and disadvantages of the different techniques used in RRT. With SLEDD gaining more popularity among the different modalities of RRT, we want to assess the possibility of its routine implementation as the single-best choice for RRT.

High-Value Multidetector CT Angiography of the Superior Mesenteric Artery: What Emergency Medicine Physicians and Interventional Radiologists Need to Know.

The superior mesenteric artery (SMA) provides vital blood supply to the midgut, and an acute abnormality can rapidly precipitate bowel ischemia and infarction and lead to morbidity and mortality. Vascular diseases that acutely compromise the SMA threaten its tributaries and include occlusion, dissection, aneurysm rupture, pseudoaneurysm, vasculitis, and SMA branch hemorrhage into the bowel. Emergency medicine physicians rely on the radiologist to identify SMA abnormalities, to characterize them, and to detail findings that guide the appropriate triage of these patients. As such, radiologists must be cognizant of the features that influence patient treatment to assist vascular surgeons and interventional radiologists in decision making. Some patients can be treated medically, while clinical and radiographic findings may suggest the need for interventional or surgical repair of the artery. In the latter case, multidetector CT findings aid in determining which of the various surgical and endovascular treatment options is optimal, and both vascular and gastrointestinal sequelae of acute SMA abnormalities contribute to these determinations. The authors review acute life-threatening conditions involving the SMA including acute occlusion, dissection, aneurysm, pseudoaneurysm, and hemorrhage and discuss the vascular and gastrointestinal multidetector CT findings in each of these conditions that help to guide surgical and interventional management. ©RSNA, 2019.