Emergency Medicine Department Research Articles

Status and perception of point-of-care ultrasound education in Korean medical schools: A national cross-sectional study.

As point-of-care ultrasound (POCUS) is increasingly being used in clinical settings, ultrasound education is expanding into student curricula. We aimed to determine the status and awareness of POCUS education in Korean medical schools using a nationwide cross-sectional survey. In October 2021, a survey questionnaire consisting of 20 questions was distributed via e-mail to professors in the emergency medicine (EM) departments of Korean medical schools. The questionnaire encompassed 19 multiple-choice questions covering demographics, current education, perceptions, and barriers, and the final question was an open-ended inquiry seeking suggestions for POCUS education. All EM departments of the 40 medical schools responded, of which only 13 (33%) reported providing POCUS education. The implementation of POCUS education primarily occurred in the third and fourth years, with less than 4 hours of dedicated training time. Five schools offered a hands-on education. Among schools offering ultrasound education, POCUS training for trauma cases is the most common. Eight schools had designated professors responsible for POCUS education and only 2 possessed educational ultrasound devices. Of the respondents, 64% expressed the belief that POCUS education for medical students is necessary, whereas 36%, including those with neutral opinions, did not anticipate its importance. The identified barriers to POCUS education included faculty shortages (83%), infrastructure limitations (76%), training time constraints (74%), and a limited awareness of POCUS (29%). POCUS education in Korean medical schools was limited to a minority of EM departments (33%). To successfully implement POCUS education in medical curricula, it is crucial to clarify learning objectives, enhance faculty recognition, and improve the infrastructure. These findings provide valuable insights for advancing ultrasound training in medical schools to ensure the provision of high-quality POCUS education for future healthcare professionals.

Clinical audit on management of suspected meningoencephalitis patients at lady reading Hospital, Peshawar

Objective: The purpose of this study was to observe management and empiric treatment of meningitis/encephalitis without doing initial investigation CSF-RE or delaying it, at Department of Emergency Medicine, General Medicine and Neurology wards. Method: It is an observational retrospective study this study was carried out at the General medicine, Neurology and Emergency units from July 2023 to Dec 2023.Total of 54 patients were included. Before conduction of study Ethical Review Committee permission was sought to access patient Data. We studied their hospital stored data on HMIS such as admission Date, start of empiric antibiotics, CT Scans, Blood Culture and CSF-REs. Results: 98% of patients were started on empiric Antibiotics without doing CSF-RE/LP on initial presentation at the hospital. In 64% patients CSF-RE was delayed and subsequently performed. In 34% CSF-RE was never carried out. Conclusion: We did presentations, Information campaigns, to follow standard Guidelines for Suspected meningitis /encephalitis to limit potential side effects, Development of Resistance to Antibiotics and to limit treatment costs.

Evaluation of the diagnostic efficacy of computed tomography imaging in trauma patients

Aims: The objective of this study was to assess the efficacy of computed tomography imaging tests ordered for trauma patients in the emergency medicine service and to identify pathologies in the imaging. Methods: A retrospective evaluation was conducted on trauma patients who applied to our hospital's Emergency Medicine Department between 01 January 2023 and 01 October 2023 and underwent diagnostic computed tomography imaging (CT). Results: A total of 4193 CT scans were analysed in 3641 patients. Falls were the most common etiological cause (n=3451, 82.3%). Pathology was detected in 25.87% of CT orders. The most frequently used CT type was cranial CT (n=1687, 40.22%). The highest rate of pathology was found in scapula CT (75%), while the lowest rate was observed in cervical spine CT (13%). The most common pathology was detected in cranial CT (n=457). The highest rate of pathology was found in scapula CT (75%), while the lowest rate was observed in cervical spine CT (13%). Conclusion: The accessibility of relevant specialists to emergency physicians reduces the number of unnecessary CT imaging orders. In the emergency department, physicians should adhere to internationally accepted guidelines when ordering advanced imaging studies.

Requirements of geriatric population for Emergency Medicine Department of The County of Split-Dalmatia in year before Covid-19 pandemic and in year of Covid-19 pandemic

Requirements of geriatric population for Emergency Medicine Department of The County of Split-Dalmatia in year before Covid-19 pandemic and in year of Covid-19 pandemic

A logic framework for addressing medical racism in academic medicine: an analysis of qualitative data

BackgroundDespite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design.MethodsWe interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism.ResultsParticipant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism.ConclusionsOrganizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism.

Toddler fractures immobilisation and complications: A retrospective review

BackgroundA Toddler's Fracture (TF) is classically an isolated, nondisplaced, distal-third diaphyseal tibial spiral fracture in younger children. A TF is stable and has a low risk of complication. There is lack of uniformity as to the optimal treatment for TF. Immobilisation with full above knee casting, below knee casting, splinting, controlled ankle motion boots and no immobilisation are all strategies currently in use. There is limited data from European centres regarding those treated without immobilisation. MethodsA retrospective review of electronic medical and radiology records was performed to identify all children presenting to a multisite department of paediatric emergency medicine in Ireland from January to December 2022. Those with radiologically confirmed TF or a presumptive diagnosis of TF were included. Data retrieved for each child included initial treatment and the number of and reason for ED reattendances relating to the injury in the 6-month period following the injury. Results166 children were identified, 96 with radiologically confirmed TF and 70 with presumptive diagnosis TF. Girls accounted for 47 % of presentations. Fall from a standing height (33 %) was the most common mechanism. 13 % (22/166) children were managed without immobilisation. Those with radiologically confirmed fracture (91/96) were significantly more likely to be immobilised than those with a presumptive diagnosis (53/70) (p = 0.001). In total 28 patients (17 % of total) represented to the ED within 6 months. The representation rate in those immobilised was 17 %, while in those not immobilised was 13 % (p = 0.66). ConclusionIn this cohort, those with no radiological evidence of fracture are more likely to be managed without immobilisation. There was no significant difference in PED representations between those immobilised and not immobilised.

Development and psychometric evaluation of a 360-degree evaluation instrument to assess medical students’ performance in clinical settings at the emergency medicine department in Iran: a methodological study

In the Iranian context, no 360-degree evaluation tool has been developed to assess the performance of prehospital medical emergency students in clinical settings. This article describes the development of a 360-degree evaluation tool and presents its first psychometric evaluation. There were 2 steps in this study: step 1 involved developing the instrument (i.e., generating the items) and step 2 constituted the psychometric evaluation of the instrument. We performed exploratory and confirmatory factor analyses and also evaluated the instrument’s face, content, and convergent validity and reliability. The instrument contains 55 items across 6 domains, including leadership, management, and teamwork (19 items), consciousness and responsiveness (14 items), clinical and interpersonal communication skills (8 items), integrity (7 items), knowledge and accountability (4 items), and loyalty and transparency (3 items). The instrument was confirmed to be a valid measure, as the 6 domains had eigenvalues over Kaiser’s criterion of 1 and in combination explained 60.1% of the variance (Bartlett’s test of sphericity [1,485]=19,867.99, P<0.01). Furthermore, this study provided evidence for the instrument’s convergent validity and internal consistency (α=0.98), suggesting its suitability for assessing student performance. We found good evidence for the validity and reliability of the instrument. Our instrument can be used to make future evaluations of student performance in the clinical setting more structured, transparent, informative, and comparable.

Outcome of early emergency intubation and early emergency dialysis in deliberate self-harm with formic acid in a tertiary care center in South India: A retrospective cohort study

OBJECTIVE: The objective is to evaluate the outcome of early emergency intubation and early dialysis in formic acid (FA) poisoning and to determine the clinical features associated with its mortality. METHODS: It is a retrospective cohort study of 78 patients who presented to the emergency medicine department from July 2008 to June 2015 with alleged history and clinical features of FA poisoning. The outcome of early intubation and early dialysis was studied in terms of 7-day and 30-day mortality. The outcome was compared in severe and not severe groups separately. Severity was graded according to Med-Tu chart used for corrosive poisoning. RESULTS: In the severe group (n = 53), early dialysis was done in 15 patients. There was 53% (n = 8) 30-day mortality. In the group where early dialysis was not done there was a significant increase in mortality 92.1% (n = 35). This was statistically significant with a P = 0.003. In a similar fashion 7-day mortality was analyzed in the severe group where mortality was higher when early dialysis was not done. In not severe group early dialysis has minimally decreased the mortality. Early intubation in severe group did not demonstrate any mortality benefit. Patients who were intubated early and not intubated early had equally high mortality. In not severe group, intubation could not make any significant difference in mortality. CONCLUSION: In this retrospective study, we observed that early dialysis in the severe group has a better outcome in terms of 7-day and 30-day mortality.

Managing STEMIs without a Catheterization Lab: A Simulated Scenario to Improve Emergency Clinician Recognition and Execution of Thrombolysis in the Setting of Rural STEMI Management.

The targeted audience for this simulation is Emergency Medicine (EM) residents. Medical students, advanced practice providers, and staff physicians could all also find educational merit in this scenario. Cardiovascular disease is the leading cause of death in the United States according to the CDC.1 Coronary artery disease caused 375,000 deaths 2021 alone, and about 5% of all adult patients have a prior history of coronary artery disease.2 Furthermore, chest pain itself is a common chief complaint encountered in the ED, with nearly 8 million visits annually occurring throughout the United States, with 10-20% of those patients ultimately being diagnosed with an acute coronary syndrome3, including ST-elevation myocardial infarction (STEMI). Given this, it is essential that EM residents are well prepared to care for all patients presenting with chest pain, regardless of the acute care or emergency setting.Throughout their training, most EM residents typically learn and evaluate patients at a large tertiary or quaternary medical center with 24-hour catheterization laboratory availability. For patients presenting with electrocardiogram (EKG) findings consistent with STEMI, the standard of care is for the patient to undergo cardiac catheterization and stent placement within 90 minutes of arrival. Unfortunately, only half of patients living in rural areas have a cardiac catheterization-capable facility available to them within a 60-minute driving radius, making it difficult for those patients to undergo cardiac catheterization within the desired time frame.4 These patients remain candidates for thrombolytic therapy, but given infrequent opportunities to learn about and deploy thrombolytic agents during residency training, graduating EM residents may be unfamiliar with indications, dosing, and contraindications before they begin practice. Furthermore, the recent EM workforce data suggests that although there may be an oversupply of 8,000 emergency physicians by 2030, robust practice opportunities for emergency physicians remain in rural settings.5 Although historically EM graduates have not selected rural areas for practice, with only approximately 8% of emergency physicians practicing in rural areas,6 it is likely that given the opportunities present and perceived saturation in many non-rural settings, more EM graduates will pursue practice in a rural setting. With these changing practice dynamics in mind, this simulation provides the opportunity for residents and medical students to experience the management of a STEMI in the rural setting, with a focus upon the indications, contraindications, dosing, and disposition of a patient receiving thrombolytics. By the end of this simulation, learners will be able to:Diagnose ST elevation myocardial infarction accurately and initiate thrombolysis in the rural setting without timely access to cardiac catheterization.Engage the simulated patient in a shared decision-making conversation, clearly outlying the benefits and risks of thrombolysis.Identify the indications and contraindications for thrombolysis in ST elevation myocardial infarction.Arrange for transfer to a tertiary care center following completion of thrombolysis. This scenario is a simulated encounter in a rural emergency department setting requiring the diagnosis of a STEMI, a discussion with the patient regarding the risks and benefits of thrombolysis prior to administration, administration of thrombolysis, and transfer of patient to a higher level of care. The educational content of this simulation as a teaching instrument was evaluated by the learner utilizing an internally developed survey after case completion. This survey was reviewed for precision of language and assessment of learning objectives by our simulation faculty and other members of our West Virginia University Emergency Medicine Department of Medical Education. The learner was asked to specify any prior experience with rural STEMI management as well as quantify via a five-point Likert Scale, where 1 = very uncomfortable and 5 = very comfortable, their level of comfort with thrombolysis before and after the scenario as well as their comfort with having a shared decision-making conversation with patients with regards to thrombolysis. Learners were also asked to rank the helpfulness of this simulation in preparing them for administering thrombolytics for STEMI in a rural setting on a five-point Likert scale, where 1 = not helpful and 5 =very helpful. An open response section was also provided to allow learners the opportunity to comment directly on any aspect of the simulation. Data was collected anonymously from 16 PGY1-3 resident learners via surveys with a 100% response rate. Overall, the feedback received regarding the simulation was positive. There was a low average comfort level with administering thrombolytics and having a shared decision-making conversation regarding administering thrombolytics. There was a high average rating of the helpfulness of this simulation in preparing residents for this conversation as well as managing STEMIs in a rural setting. Subjective comments regarding the simulation were universally positive. The management of STEMI in the rural emergency department differs significantly from the environment in which many EM residents train. As a leading cause of death in the United States, STEMI management is a vital component of EM resident education. Although the concept of thrombolysis in the rural setting is discussed, the opportunity for real-world experience in its execution is often limited despite many graduates ultimately working in rural emergency departments. This simulation sought to provide a realistic patient encounter to promote familiarity and comfort in the identification, patient discussion and execution of thrombolysis in the treatment of a STEMI. The educational content was shown to be effective via learner survey completion.

Clinico-Epidemiological Profile of COVID-19 of Patients Presenting to Emergency Department of a Tertiary Medical College of Central Nepal

Background Clinico-epidemiological profile of COVID-19 includes varied clinical symptoms like fever, cough, and fatigue, with a potential for rapid community spread through respiratory droplets. Understanding the clinical characteristics of patients is crucial for planning human resources and logistics support. This study aims to identify the clinical characteristics observed in patients suspected of having COVID-19 presenting to emergency department of College of Medical Sciences and Teaching Hospital. MethodsThis is a retrospective cross-sectional study conducted at Department of General Practice and Emergency Medicine of College of Medical Sciences, Bharatpur, Nepal from April 2020 to February 2021. Ethical approval was taken from institutional review committee of College of Medical Sciences. Data was collected from record file of emergency department. Data was entered and analyzed by using descriptive statistical tools in SPSS-20.ResultsMajority (25.2%) of them were in the age group 50-60 years. Mean±SD of age was 55.2±16.5 years. Majority (54.3%) respondents were male. In presenting complaints 71.42% had cough, 69.5% had fever, 62.9% had shortness of breath. Also, 34.28% had severe symptoms, and 33.34% had moderate symptoms, 20% were asymptomatic and 12.38% had mild symptoms. Finding showed that 69.52% of patients required oxygen supplementation. The motility of COVID-19 patients during emergency stay was 6.67% while 36.19% were admitted in ward and 31.43% were admitted in ICU, 20% patients were sent for home isolation.Conclusions Young adults were the most commonly affected age group and males showed a higher incidence of COVID-19. Since many patients were symptomatic with fever and cough as the typical presentations in the emergency department. Majority of patients during presentation had moderate and severe symptoms and needed oxygen supplementation.

Computed Tomography to Exclude Cardiac Thrombus in Atrial Fibrillation-An 11-Year Experience from an Academic Emergency Department.

Computed tomography (CT) could be a suitable method for acute exclusion of left atrial appendage thrombus (LAAT) prior to cardioversion of atrial fibrillation (AF) and atrial flutter (AFL) at the emergency department. Our aim was to present our experiences with this modality in recent years. This registry-based observational study was performed at the Department of Emergency Medicine at the Medical University of Vienna, Austria. We studied all consecutive patients with AF and AFL who underwent CT between January 2012 and January 2023 to rule out LAAT before cardioversion to sinus rhythm was attempted. Follow-ups were conducted by telephone and electronic medical records. The main variables of interest were the rate of LAAT and ischemic stroke at follow-up. A total of 234 patients (143 [61%] men; median age 68 years [IQR 57-76], median CHA2DS2-VASc 2 [IQR 1-4]) were analyzed. Follow-up was completed in 216 (92%) patients after a median of 506 (IQR 159-1391) days. LAAT was detected in eight patients (3%). A total of 163 patients (72%) in whom LAAT was excluded by CT were eventually successfully cardioverted to sinus rhythm. No adverse events occurred during their ED stay. All patients received anticoagulation according to the CHA2DS2-VASc risk stratification, and no patient had suffered an ischemic stroke at follow-up, resulting in an incidence risk of ischemic strokes of 0% (95% CI 0.0-1.2%). LAAT was rare in patients admitted to the ED with AF and AFL who underwent cardiac CT prior to attempted cardioversion. At follow-up, no patient had suffered an ischemic stroke. Prospective studies need to show whether this strategy is suitable for the acute treatment of symptomatic AF in the emergency setting.

"They were very very nice but just not very good": The interplay between resident-supervisor relationships and assessment in the emergency setting.

Clinical supervisors hesitate to report learner weaknesses, a widely documented phenomenon referred to as "failure to fail." They also struggle to discuss weaknesses with learners themselves. Their reluctance to report and discuss learner weaknesses threatens the validity of assessment-of-learning decisions and the effectiveness of assessment for learning. Personal and interpersonal factors have been found to act as barriers to reporting learners' difficulties, but the precise role of the resident-supervisor relationship remains underexplored, specifically in the emergency setting. This study aims to better understand if and how factors related to the resident-supervisor relationship are involved in assessment of and for learning in the emergency setting. We conducted a qualitative study, using semistructured interviews of 15 clinical supervisors in emergency medicine departments affiliated with our institution. Transcripts were independently coded by three members of the team using an iterative mixed deductive-inductive thematic analysis approach. The team then synthesized the coding and discussed analysis following guidelines for thematic analysis. Participating emergency medicine supervisors valued resident-supervisor relationships built on collaboration and trust and believed that such relationships support learning. They described how these relationships influenced assessment of and for learning and how in turn assessment influenced the relationship. Almost all profiles of resident-supervisor relationships in our study could hinder the disclosing of resident weaknesses, through a variety of mechanisms. To protect residents and themselves from the discomfort of disclosing weaknesses and to avoid deteriorating the resident-supervisor relationship, many downplayed or even masked residents' difficulties. Supervisors who described themselves as able to provide negative assessment of and for learning often adopted a more distant or professional stance. This study contributes to a growing literature on failure to fail by confirming the critical impact that the resident-supervisor relationship has on the willingness and ability of emergency medicine supervisors to play their part as assessors.

Emergency medicine residency pathways for MD/PhD trainees: A national cross-sectional study of physician-scientist training programs.

Combined clinical and research training is common in residency programs outside emergency medicine (EM), and these pathways are particularly valuable for combined MD/PhD graduates planning to pursue a career as a physician-scientist. However, EM departments may not know what resources to provide these trainees during residency to create research-focused, productive, future faculty, and trainees may not know which programs support their goal of becoming a physician-scientist in EM. The objective of this study was to describe research training and resources available to MD/PhD graduates in EM residency training with a focus on dedicated research pathways. This study was a cross-sectional inventory conducted through an electronic survey of EM residency program directors. We sought to identify dedicated MD/PhD research training pathways, with a focus on both resources and training priorities. Descriptive statistics were used to summarize survey responses. We collected 192 survey responses (69.6% response rate). Among respondents, 41 programs (21.4%) offered a research pathway/track, 52 (27.4%) offered a research fellowship, 22 (11.5%) offered both a residency research pathway/track and a research fellowship, and two (1.0%) offered a dedicated EM physician-scientist training pathway. Most programs considered research a priority and were enthusiastic about interviewing applicants planning a research career, but recruitment of physician-scientist applicants was not generally prioritized. Some EM residency programs offer combined clinical and mentored research training for prospective physician-scientists, and nearly all residency programs considered research important. Future work will focus on improving the EM physician-scientist pipeline by optimizing pathways available to trainees during residency and fellowship.

Clinical duties and compensation for U.S. emergency medicine fellows at academic centers: A descriptive, cross-sectional survey.

Fellowship training is increasingly popular among residency graduates and critical to the advancement of academic emergency medicine (EM). Little is known about the clinical hours worked and financial compensation received by fellows during training. We sought to describe the clinical duties and financial compensation of EM fellows at U.S. academic centers. This cross-sectional study surveyed U.S. academic EM department administrators who were members of the Society for Academic Emergency Medicine's Academy of Administrators in Academic Emergency Medicine (AAAEM) regarding their fellowship programs and fellows. We electronically distributed the validated survey instrument to 73 member sites between October 2022 and January 2023. Survey domains included fellow and fellowship demographics, base and total annual clinical hours, and base and total annual compensation. We calculated descriptive statistics and compared fellows by accreditation (Accreditation Council for Graduate Medical Education [ACGME] or non-ACGME) using chi-square and Wilcoxon rank-sum testing. We conducted a secondary analysis of base and total salary by gender and accreditation using Wilcoxon rank-sum testing. We received 38 institutional responses (response rate 52%), which represented 217 individual fellows. Nearly three-fourths (n = 158, 72.8%) of fellows enrolled in non-ACGME fellowships, worked 33% more base hours annually than ACGME fellows (median 571 h vs. 768 h, p < 0.001), and received base compensation 20% higher than ACGME fellows ($88,540 vs. $70,777, p < 0.001). Accounting for additional compensation, the median total annual compensation for non-ACGME fellows remained 11% higher than ACGME fellows ($105,000 vs. $93,853, p = 0.004). We observed no significant differences salary when stratified by gender. Most EM fellows at U.S. academic institutions enrolled in non-ACGME fellowships with significantly higher base hours and financial compensation than ACGME fellowships. These results represent the first description of the clinical hours and financial compensation of academic EM fellows and should be considered in ongoing benchmarking efforts by AAAEM.

Identifying the prevalence and characteristics of diversity, equity, and inclusion leaders in academic emergency medicine.

Our study aims to better understand and describe the current state of diversity, equity, and inclusion (DEI) leadership in emergency medicine (EM) by identifying the prevalence of department DEI leadership positions, their demographics, and their job duty characteristics. We disseminated an electronic survey from April to July 2022 to Society for Academic Emergency Medicine (SAEM) Association of Academic Chairs of Emergency Medicine, Academy for Diversity and Inclusion in Emergency Medicine, and the Equity and Inclusion Committee to identify department DEI leads. From July to August 2022, a 45-question survey was sent to all identified DEI leaders on individual characteristics, DEI experience, and DEI lead job description. We received a response from 79 out of 120 academic EM departments identified (65.8%). Of the responding institutions, 59 (74.7%) reported a DEI leader. A total of 74.6% of these DEI leaders responded at least partially to our survey and 57.6% responded in full. The most common titles were vice/associate chair of DEI (34.4%), director of DEI (28.1%), and DEI committee chair (18.8%). Most respondents (84.4%) were the inaugural DEI lead in their department and 84.4% of respondents did not have a formal DEI role in their department previously. On average, respondents have had their DEI title for 2 years (range 0-7 years) with an average of 7 years (range 0-30 years) of experience performing DEI work. Many (63.4%) do not receive any funded effort for their DEI roles. Most DEI leads were not tenure track (72.2%) and most commonly at the rank of assistant professor (47.2%) followed by associate professor (33.3%), full professor (16.7%), and instructor (2.8%). This is the first known study to assess the characteristics of DEI department leaders in EM. EM DEI leadership positions are new, common, and led by diverse personal identities and are often not funded. Future directions could gain qualitative insight into this workforce to guide best practices in EM DEI leadership.

Comparative analysis of codes white given by the emergency departments of two different third level hospitals in Ankara

Aims: In our study, we aimed to compare the codes white given by the emergency services of two tertiary hospitals in Ankara, to reveal the significant differences between them and to discuss the reasons that may lead to these differences. Methods: In our study, we compared the codes white data given from the Emergency Medicine Department of Bilkent Ankara City Hospital (ABCH) and Ankara Training and Research Hospital (ATRH) between 01.01.2021 and 31.12.2022. We classified the data according to the gender, occupation, working hours of the violence, the person who caused the violence, and the type of violence. For research analysis, we grouped the data using Windows-based Microsoft 365 Excel, and for statistical analysis, we used IBM SPSS version 26. Results: The gender that was exposed to violence more in ABCH was women, the most frequent perpetrators were the relatives of the patients, and the type of violence experienced was verbal violence. In ATRH, male health workers were the most frequently exposed to violence, while the most frequent perpetrator was the patient himself, and more cases of physical violence were reported. Conclusion: There are significant differences between the incidents of violence in the emergency departments of the two hospitals, which have different socio-cultural environments due to their location.

Extreme heat impacts on acute care: Examining emergency department visits and hospital admissions during the 2021 British Columbia heatwave

IntroductionEmergency department (E.D.) visits and hospitalization patterns shifted dramatically during the 2021 extreme heat event (EHE) across the Greater Vancouver Area of southern British Columbia, Canada. MethodsIn this ecological timeseries study we analyze E.D. visits (n=36,432) and hospitalizations (n=18,624) between June 4th, 2021, and July 29th, 2021, using data from two administrative databases: (1) the Canadian National Ambulatory Care Reporting System; and (2) and the Canadian Discharge Abstract Database data. Using Mann-U Whitney tests, we compared how E.D. visits, hospitalizations, and patient diagnoses changed during a seven-day EHE and two subsequent lag periods compared to the surrounding baseline period. We also use a distributed lag non-linear model to analyze the relationship between daily maximum temperatures and daily E.D. visits during the study period. ResultsWe observed a statistically significant increase in overall E.D. visits during the EHE and during the week following the EHE, and a positive relationship between daily maximum temperature and relative risk of an E.D. visit. Further, there were significant increases in critically ill patients presenting to the E.D. during the EHE, based on Canadian Triage Acuity Scale (CTAS) and increases in key diagnoses, including acute kidney failure, heatstroke, and dehydration. ConclusionsHeatwaves have significant impacts on public health and acute care systems beyond heat-related deaths. Complications associated with heat exposure and surges in patient volume have implications for internal medicine, emergency medicine, and psychiatry departments. Better understanding the disease patterns associated with extreme heat events is essential to health system planning and response.

Prehospital Factors Associated with Delayed Hospital Arrival of Stroke Patients: A Regional Single-Center Study from India

Background: Only a small percentage of patients with acute stroke are currently eligible for thrombolysis, partly due to severe delays in hospital arrival. We had previously conducted the first regional study to assess the factors delaying acute stroke care in India. The present study aims to understand and describe in depth the variables associated with prehospital delay among patients admitted with an acute ischemic stroke. Methods: Data were prospectively collected by conducting an in-depth interview of 470 acute ischemic stroke patients and their bystanders, aged above 18 years, presenting to the Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur. Patients who arrived within 4.5 h of symptom onset were considered as “early arrival” and those who arrived after 4.5 h were considered as “delayed arrival.” Univariate and multivariate analyses were undertaken to determine associations between variables of interest and delays to hospital presentation. Results: Of the 470 patients who met the inclusion criteria, 73 patients reached within 4.5 h (15.5%), whereas 397 patients arrived after 4.5 h. The mean age of acute stroke patients who reached within 4.5 h was 63 ± 13.7 years, whereas the mean age of those who reached after 4.5 h was 63 ± 12.1 years. Binary logistic regression performed to quantify the associations of prehospital factors showed an increased risk of prehospital delay among individuals with lack of awareness (odds ratio [OR] = 5.16 [3.040–8.757], P &lt; 0.001), followed by those for whom a vehicle was not available at the site of event (OR = 3.745 [1.864–7.522], P &lt; 0.001). Within the predefined socioeconomic strata, compared to lower class, upper middle class had less risk (OR = 0.135 [0.018–1.035], P = 0.054), whereas the distance from first medical contact to emergency department contributed moderate risk (OR = 1.071 [1.028–1.116], P &lt; 0.001) for prehospital delay. Conclusions: Health promotion techniques that increase public knowledge about the early signs of stroke, transferring patients directly to hospitals with thrombolysis capabilities, and making ambulance services more widely available are appropriate measures to reduce prehospital delay.

[Application of high flow nasal canula in patients with pulmonary edema caused by seawater drowning].

To investigate the therapeutic effect of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive positive pressure ventilation (NPPV) on patients with pulmonary edema caused by seawater drowning. A retrospective analysis method was used. Based on the Utstein database of emergency drowning in the First Hospital of Qinhuangdao, the clinical data of patients with seawater drowning pulmonary edema admitted to the emergency medicine department of the First Hospital of Qinhuangdao from January 1, 2019 to December 31, 2022 were collected. The patients were divided into NPPV group and HFNC group according to different ventilation methods. The general data, endotracheal intubation rate in 7 days, arterial blood gas analysis indexes [arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), arterial oxygen saturation (SaO2)] and hemodynamic indexes (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, blood lactic acid) before and after treatment, length of stay in intensive care unit (ICU), oxygen therapy comfort of the two groups were compared. A total of 54 patients were enrolled, including 21 patients in the NPPV group and 33 patients in the HFNC group. There were no significant differences in gender, age, state of consciousness and other general information between the two groups. Compared with NPPV group, the rate of endotracheal intubation in HFNC group within 7 days was significantly lower [24.2% (8/33) vs. 33.3% (7/21), P < 0.05]. Before treatment, there were no significant differences in arterial blood gas analysis and hemodynamics between the two groups. After treatment, the above indexes in both groups were significantly improved compared with those before treatment, and PaO2, SaO2, systolic blood pressure, diastolic blood pressure and mean arterial pressure in HFNC group were significantly higher than those in NPPV group [PaO2 (mmHg, 1 mmHg≈0.133kPa): 93.56±6.37 vs. 82.14±6.25, SaO2: 1.02±0.09 vs. 0.95±0.11, systolic blood pressure (mmHg): 117.37±8.43 vs. 110.42±8.38, diastolic blood pressure (mmHg): 79.43±7.61 vs. 72.21±4.32, mean arterial pressure (mmHg): 92.34±6.32 vs. 85.12±5.38], PaCO2, heart rate and blood lactic acid were significantly lower than those in NPPV group [PaCO2 (mmHg) : 34.26±5.63 vs. 37.24±6.22, heart rate (times/min): 73.38±7.56 vs. 86.25±5.41, blood lactic acid (mmol/L): 1.38±0.36 vs. 2.25±1.14], and the differences were statistically significant (all P < 0.05). In addition, the length of ICU stay in HFNC group was significantly shorter than that in NPPV group (days: 13.30±2.38 vs. 16.27±4.26), and the comfort rate of oxygen therapy was significantly higher than that in NPPV group [66.7% (22/33) vs. 42.8% (9/21)], with statistical significance (all P < 0.05). HFNC can improve the oxygenation of patients with pulmonary edema caused by seawater drowning, improve hemodynamics, reduce the rate of tracheal intubation, shorten the length of ICU stay, and improve the comfort of oxygen therapy, which has certain clinical application value.

Evaluation of Thoracic Trauma Severity Score (TTSS) in Assessing and Predicting Severity of Chest Trauma

Introduction: Chest trauma, which is frequently caused by road traffic accidents (RTAs), is a major public health concern worldwide. The Thoracic Trauma Severity Score (TTSS) provides a standardized method for assessing the severity of chest injuries, which aids in treatment decisions and outcome prediction. Material and Methods: This observational study aimed to determine the effectiveness of the TTSS in predicting the outcomes of chest trauma patients. The study, which conducted from September 2019 to May 2021 at the Department of Emergency Medicine, Apollo BGS Hospital in Mysore, included 65 adult patients who presented with chest injuries. Data on demographics, injury types, clinical characteristics, and outcomes has been collected and analyzed. Results: The majority of patients (70.8%) were male, with a mean age of 46.1 years. Road traffic accidents accounted for 80% of injuries. Rib fractures (95.4%) and lung contusions (75.4%) were the most common thoracic injuries observed. Patients with higher TTSS had prolonged hospital and ICU stays and increased need for mechanical ventilation. Mortality rates increased with higher TTSS, with 6.2% overall mortality. Conclusion: The TTSS proved effective in predicting outcomes of chest trauma patients, with higher scores associated with poorer outcomes. The findings highlight the value of TTSS in guiding early assessment and management strategies for chest trauma, ultimately aiding in reducing morbidity and mortality.