Emergency Cases Research Articles

Quantification of referrals received at two emergency-capable hyperbaric medicine centers

ABSTRACT Sethuraman K, Tom M, Chew KW, Ramon Y, Romero-Casillas J, Hardy K. Quantification of referrals received at two emergency-capable hyperbaric medicine centers. Undersea Hyperb Med. 2024 Second Quarter; 51(2):97-100. Emergency hyperbaric oxygen treatment capability is limited in the United States, and there is little documentation of calls received by centers available 24 hours a day, seven days a week, 365 days a year. Our study aimed to calculate the number of calls received for urgent hyperbaric oxygen (HBO2). We logged calls from two HBO2 chambers on the East Coast of the United States that serve a densely populated region in 2021. The total number of emergency calls was 187 at the University of Maryland (UMD) and 127 at the University of Pennsylvania (UPenn). There were calls on 180/365 (46%) days during the study period at UMD and 239/365 (63%) days at UPenn. The most common indication was carbon monoxide toxicity. The peak month of calls was March. Emergency HBO2 calls are common, and more centers must accept emergency cases. Data from geographically diverse centers would add generalizability to these results and capture more diving-related emergencies.

Particles versus Other Embolic Agents in Emergency Renal Artery Embolization, Various Indications And Techniques

Abstract Background Renal artery embolization (RAE) refers to the occlusion of the renal artery, or some of its branches, by injection of an embolic agent through an endovascular catheter. Aim and Objectives to compare various embolic agents such as metallic microcoils, microspheres (embospheres), polyvinyl alcohol (PVA), gelfoam and histoacryl in emergent indications and techniques for RAE in management of emergency renal diseases. Subjects and Methods This combined retrospective and prospective observational study was conducted at Egyptian Military Hospitals, Radiodiagnosis and Intervention departments, and Ain Shams hospitals. The study included 18 patients with clinical and radiological confirmation of symptomatic indications for urgent RAE from 2019 to 2022. The duration of the study was 3 years. Result small sample sized and emergent cases showing mean embolization time was 12.6 minutes with no detected recanalization nor post embolic syndrome. Conclusion Renal artery embolization has become an effective, versatile therapeutic and adjuvant tool for many urologic conditions, both acute and chronic. It can be applied successfully in improving preoperative management of renal tumors prior to nephrectomy, achieving hemostasis in cases of hemorrhage from trauma or from tumors such as angiomyolipomas, treating complications of renal transplantation and biopsies such as arteriovenous fistulas and pseudoaneurysms, improving symptoms in patients with arteriovenous malformations and certain chronic renal parenchymal diseases, and for treating renal artery aneurysms.

Population-Based Analysis of 6534 Seizure Emergency Cases from Emergency Medical Services Data.

Seizures are common reasons to call an ambulance, and this study aims to analyze the burden of seizures in the prehospital setting based on incidence, hospital admission rate, and costs. This was a population-based, cross-sectional analysis of prehospital emergency medical services (EMS) data on suspected seizure cases from the federal state of Hesse, Germany, in 2019. A total of 6534 suspected seizure cases were identified, of which most were those with a known seizure disorder. Incidence rate for epilepsy-related seizures (ES; pediatric epilepsy, first seizure [1stS], seizure with known seizure disorder [SEPI]) was 205.7 per 100,000 inhabitants and incidence rate for pediatric febrile seizures (PFS) was 36.7 per 100,000 inhabitants, corresponding to 171,275 ES and 28,500 PFS (99.3% < 18years) cases in Germany. A prehospital EMS physician was involved in 40.0% (SEPI) to 54.4% (PFS) of suspected seizure cases. Depending on the type of seizure, 70.7% (SEPI) to 80.9% (1stS) were admitted to hospital for inpatient stay of ≥ 24h. An additional 4% (PFS) to 16% (1stS) of cases needed immediate intervention at hospital. Prehospital EMS staff needed 8:24min:s (SD 7:24; n = 5004) after the emergency call to arrive at the scene of the ES and 10:58min:s (SD 27:39; n = 321) for PFS. ES and PFS cases caused estimated costs of 48.5 and 8.1million euros for Germany in 2019, respectively, not including hospital treatment-related costs. This study identified a high number of suspected seizure-related emergency casesand proportion of patients admitted to hospitals, as well as high associated costs in Germany.

The clinical treatment of laryngotracheal rupture injury

Objective:To investigate the therapeutic effect of laryngotracheal rupture injury and management of related complications. Methods:A retrospective analysis was conducted on 10 patients with laryngotracheal rupture injury caused by trauma, admitted between October 2014 and October 2022. Results:Anti-shock treatment, local debridement, tracheal-cricoid cartilage or tracheal-tracheal anastomosis, laryngeal cartilage reduction and fixation, local transposition flaps repair and phase-Ⅱ airway reconstruction were performed respectively on 10 patients. Nine patients underwent operations of tracheal-cricoid cartilage or tracheal-tracheal anastomosis, with five of these were performed by cartilage broken reduction and fixation, placed with intraluminal stents of iodoform gauze fingerstalls for （8.2±1.6） days. Tracheal reconstruction surgery was performed on 2 cases during phase-Ⅱ and both were placed with T-shaped silicone tube to support for 3 months. Two cases required tracheoesophageal fistula surgical repair, and vocal cord suturing was conducted for three vocal fold injuries. Anti-shock treatment was given to one emergency case and closed thoracic drainage treatment was given to another one. We removed the tracheal cannula from 10 patients after surgery and one case was diagnosed with Ⅰ-level swallowing function of sub-water test. All cases recovered to take food per-orally. Conclusion:Maintenance of circulation and respiration functions is the major target during early treatment of laryngotracheal rupture. It should strive to complete the reconstruction of airway structure on phase-Ⅰ, among which end-to-end anastomosis to reconstruct airway and broken laryngeal cartilage reduction and fixation are the vital methods for airway structure reconstruction to achieve good results. It is suggested that the reconstruction of trachea and esophagus structures should be performed simultaneously to patients with tracheoesophageal fistula.

ANTI-SUICIDE CAMPAIGN STUDY GORONTALO &amp; SOUTH SUMATERA PROVINCIAL HEALTH DEPARTMENT POSTERS 2019

Suicide is the most common cause of death, becoming a humanitarian emergency case, which threatens the survival of the nation's next generation. In the anti-suicide campaign, posters are used as information media. The purpose of the study was to examine the symbolic meaning and visual elements in the design of campaign posters, 2 Health Offices (Gorontalo Province and South Sumatra). The method used was qualitative with Van Zoest's semiotic approach (syntactic, semantic, and pragmatic analysis). The results showed that the posters had visual representations of emotions: darkness, loneliness, or hopelessness; the poster narratives contained motivating quotes and information on aid resources. In conclusion, the visual elements on the poster form a visual message in raising awareness to combat suicide. The impact of the research is that it can educate, reduce the stigma of suicide, and help policy makers and designers design campaign posters with appropriate messages and effective strategies

Social determinants of health and disparities in spine surgery: a 10-year analysis of 8,565 cases using ensemble machine learning and multilayer perceptron

BACKGROUND CONTEXTThe influence of SDOH on spine surgery is poorly understood. Historically, researchers commonly focused on the isolated influences of race, insurance status, or income on healthcare outcomes. However, analysis of SDOH is becoming increasingly more nuanced as viewing social factors in aggregate rather than individually may offer more precise estimates of the impact of SDOH on healthcare delivery. PURPOSEThe aim of this study was to evaluate the effects of patient social history on length of stay (LOS) and readmission within 90 days following spine surgery using ensemble machine learning and multilayer perceptron. STUDY DESIGNRetrospective chart review. PATIENT SAMPLE8,565 elective and emergency spine surgery cases performed from 2013 to 2023 using our institution's database of longitudinally collected electronic medical record information. OUTCOMES MEASURESPatient LOS, discharge disposition, and rate of 90-day readmission. METHODSEnsemble machine learning and multilayer perceptron were employed to predict LOS and readmission within 90 days following spine surgery. All other subsequent statistical analysis was performed using SPSS version 28. To further assess correlations among variables, Pearson's correlation tests and multivariate linear regression models were constructed. Independent sample t-tests, paired sample t-tests, one-way analysis of variance (ANOVA) with post-hoc Bonferroni and Tukey corrections, and Pearson's chi-squared test were applied where appropriate for analysis of continuous and categorical variables. RESULTSBlack patients demonstrated a greater LOS compared to white patients, but race and ethnicity were not significantly associated with 90-day readmission rates. Insured patients had a shorter LOS and lower readmission rates compared to non-insured patients, as did privately insured patients compared to publicly insured patients. Patients discharged home had lower LOS and lower readmission rates, compared to patients discharged to other facilities. Marriage decreased both LOS and readmission rates, underweight patients showcased increased LOS and readmission rates, and religion was shown to impact LOS and readmission rates. When utilizing patient social history, lab values, and medical history, machine learning determined the top 5 most-important variables for prediction of LOS —along with their respective feature importances—to be insurance status (0.166), religion (0.100), ICU status (0.093), antibiotic use (0.061), and case status: elective or urgent (0.055). The top 5 most-important variables for prediction of 90-day readmission—along with their respective feature importances—were insurance status (0.177), religion (0.123), discharge location (0.096), emergency case status (0.064), and history of diabetes (0.041). CONCLUSIONSThis study highlights that SDOH is influential in determining patient length of stay, discharge disposition, and likelihood of readmission following spine surgery. Machine learning was utilized to accurately predict LOS and 90-day readmission with patient medical history, lab values, and social history, as well as social history alone.

Exploring the Clinical Outcomes of End-Organ Damage in Hypertensive Emergency: A National Perspective

Background: The number of emergency department visits for hypertensive emergency has been increasing and was reported to be 496,894 visits in 2013 1. Current recommendations are to admit these patients to the ICU and start on intravenous blood pressure-lowering medications. This study aims to assess the prevalence of each end organ damage and their effects on the outcomes during hospitalization. Methods: This study analyzed data from the 2016-2020 National Inpatient Sample (NIS) database, focusing on adult hospital admissions. We utilized International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes to identify cases of hypertensive emergency (I16.1) and other relevant comorbidities. The primary objective was to assess the prevalence of end-organ damage and its impact on mortality. We employed multivariable logistic regression to adjust for demographics, comorbidities and other potential confounders. Results: Our comprehensive analysis included 1,032,860 hospitalizations due to hypertensive emergencies, with a notable increase in prevalence from 1,149 to 10,255 cases per 1 million patients between 2016 and 2020. The mean age of the cohort was 62.10 (± 15.97 years), with females constituting 50.7% and whites 44.97%. The most common chronic comorbidities identified were chronic kidney disease (CKD) at 44.87%, diabetes mellitus (DM) at 44.22%, coronary artery disease (CAD) at 42.49%, and congestive heart failure (CHF) at 42.46%. Among end-organ damages, acute kidney injury was most prevalent (33.37%), followed by acute heart failure/pulmonary edema (26.38%), Acute Coronary Syndromes (ACS) (15.33%), ischemic stroke (11.55%), hemorrhagic stroke (9.79%), hypertensive encephalopathy (5.30%), and aortic dissection (1.11%). In patients with hypertensive emergencies, the in-hospital mortality rate was 3.9%, and the median length of stay was 5.96 days (range: 5.91 - 6.01). Subgroup analysis revealed the highest mortality rates in patients with hemorrhagic stroke (20.0%), followed by those with aortic dissection (7.1%). Consistently, hemorrhagic stroke (OR 11.45, 95% CI 10.83-12.10, p&lt;0.001) and aortic dissection (OR 3.11, 95% CI 2.54-3.80, p&lt;0.001) emerged as the most significant predictors of increased in-hospital mortality after adjusting for demographics, comorbidities, and various types of end-organ damage. Conclusions: This study highlights a significant ongoing rise in hospital admissions due to hypertensive emergencies from 2016 to 2020, emphasizing the increasing burden of this condition. Our findings demonstrate prevalent comorbidities, end-organ damages and notable mortality rates among patients admitted with hypertensive emergencies. The study emphasizes the need for personalized patient care, underscoring the vital role of early detection and outpatient management of hypertension to prevent the onset of hypertensive emergencies and improve patient outcomes. With the rising incidence of hypertensive emergencies, it is imperative for healthcare systems to evolve, adopting new protocols and refining risk stratification criteria to effectively meet these emerging challenges.

Growing violence against medical professionals: A qualitative analysis of a worrying epidemic

Introduction. Increasing numbers of violent incidents against doctors have made headlines on a regular basis during the last few decades. Research suggests that doctors are disproportionately vulnerable to verbal abuse, threats, physical violence, and cyberbullying at work. As per the Indian Medical Association, verbal or physical abuse is experienced by 75% of doctors, and 43% of them consider it to be a significant cause of concern. Poor communication, overworked and understaffed medical staff, a lack of emergency care and management training, and inefficient grievance redressal procedures are probably contributing reasons. India responded by passing the Health Services Personnel and Clinical Establishments Bill, which is a noteworthy first step in resolving this matter. We must investigate different ways to promote peace, apply systemic adjustments in the provision of healthcare, and avert such unfavorable events in order to guarantee ongoing, excellent services for those who require them. The study set out to determine the likely reasons behind the rise in violence against physicians and to look into ways to make the situation better. Setting and design. Kasturba Medical College in Mangalore served as the study's location. A descriptive qualitative study with two steps is this one. Sorting of piles and free listing. Materials and methodology. Purposive sampling was employed in this investigation. Two interns and two tutors who were employed by Kasturba Medical College in Mangalore's community medicine department participated in one-on-one interviews for the study. The statistical analysis was conducted using Visual Anthropac 4.98.1 software. Results. A total of 28 causes and 19 solutions were found after free listing. A limit of 0.15 for Smith's salience score was set, and after that, 14 causes and 12 solutions were classified into groups of 3-6 and 3-5, respectively. A stronger triage system for emergency situations was the remedy with the highest salience value of 0.25, while undervaluing autonomy was the cause with the highest score of 0.25. Conclusions. In conclusion, one of the main issues we are currently facing is violence against doctors. Favoritism and discrimination among patients were identified as some of the main causes of violence against doctors by using the free listing and pile sorting method, which does not prioritize autonomy. Stricter laws against violence against doctors and an improved triage system for emergency cases were suggested as effective solutions for the aforementioned issue.

Implementasi Layanan Hotline Dan Aplikasi Emergency Button PSC 119 Guna Meningkatkan Akses Dan Mutu Penanganan Kegawatdaruratan Di Kabupaten Tulungagung

Emergency situations are conditions that need attention wherever and whenever they occur. The government has issued regulations regarding the Integrated Emergency Response System (SPGDT), but its implementation is not yet uniform. During emergencies, both medical and non-medical services needed by patients must be provided promptly. The Public Safety Center is a service for emergency cases conducted swiftly, accurately, and carefully for the community. Several regions that have implemented this service continue to develop the services provided to have a greater impact, one of which is the Public Safety Center of Tulungagung Regency, which currently implements the hotline service and the Emergency Button Public Safety Center 119 application, and from the developed services, numerous achievements have been obtained. Apart from the achievements of the developed services, the Public Safety Center of Tulungagung Regency is the first of its kind in Indonesia, thus attracting attention to see in detail how the implementation process of these services is carried out. The implementation analysis conducted in this research is based on Merilee S. Grindle's implementation theory, which consists of two major variables: content of policy and context of implementation, using qualitative research methods. The results show that the implementation process is indeed structured and clear or detailed in each of its indicators, but reinforcement is still needed in several indicators to maximize the implementation process.

Examining Human Rights Derogation in State Emergencies

Safeguarding human rights is the obligation of every nation under international human rights laws. However, some situations require a nation to restrict individual rights to protect public interests. Responding to COVID-19 provided a great example for Vietnam to review its legal ground for regulating limitations on human rights to prevent its expansion. However, the question remains: what are the legal grounds for executive agencies to limit citizens� rights under the international standards on human rights protection? These precautionary measures support the prevention of the risks and damage caused by illegal acts or emergency cases, such as national disasters. Vietnam encounters legal issues, including the absence of comprehensive legal frameworks and delegating legislative authority during state emergencies. It also encounters inefficient mechanisms for reviewing the rationality and viability of preventive measures imposed by executive bodies. Consequently, safeguarding human rights according to international norms poses a significant challenge. This study explores Vietnam's solutions for handling the COVID-19 pandemic and suggests reforms to the country's legal framework regarding preventive measures. Keywords: State Emergency, Enforcement Measures, Legal Issues, Derogation of Human Rights, Vietnam

Statistical machine learning models for prediction of China's maritime emergency patients in dynamic: ARIMA model, SARIMA model, and dynamic Bayesian network model.

Rescuing individuals at sea is a pressing global public health issue, garnering substantial attention from emergency medicine researchers with a focus on improving prevention and control strategies. This study aims to develop a Dynamic Bayesian Networks (DBN) model utilizing maritime emergency incident data and compare its forecasting accuracy to Auto-regressive Integrated Moving Average (ARIMA) and Seasonal Auto-regressive Integrated Moving Average (SARIMA) models. In this research, we analyzed the count of cases managed by five hospitals in Hainan Province from January 2016 to December 2020 in the context of maritime emergency care. We employed diverse approaches to construct and calibrate ARIMA, SARIMA, and DBN models. These models were subsequently utilized to forecast the number of emergency responders from January 2021 to December 2021. The study indicated that the ARIMA, SARIMA, and DBN models effectively modeled and forecasted Maritime Emergency Medical Service (EMS) patient data, accounting for seasonal variations. The predictive accuracy was evaluated using Mean Absolute Error (MAE), Root Mean Squared Error (RMSE), and Coefficient of Determination (R 2) as performance metrics. In this study, the ARIMA, SARIMA, and DBN models reported RMSE of 5.75, 4.43, and 5.45; MAE of 4.13, 2.81, and 3.85; and R 2 values of 0.21, 0.54, and 0.44, respectively. MAE and RMSE assess the level of difference between the actual and predicted values. A smaller value indicates a more accurate model prediction. R 2 can compare the performance of models across different aspects, with a range of values from 0 to 1. A value closer to 1 signifies better model quality. As errors increase, R 2 moves further from the maximum value. The SARIMA model outperformed the others, demonstrating the lowest RMSE and MAE, alongside the highest R 2, during both modeling and forecasting. Analysis of predicted values and fitting plots reveals that, in most instances, SARIMA's predictions closely align with the actual number of rescues. Thus, SARIMA is superior in both fitting and forecasting, followed by the DBN model, with ARIMA showing the least accurate predictions. While the DBN model adeptly captures variable correlations, the SARIMA model excels in forecasting maritime emergency cases. By comparing these models, we glean valuable insights into maritime emergency trends, facilitating the development of effective prevention and control strategies.

Emergency rescue of a patient with hemorrhagic shock caused by superior mesenteric artery rupture: A case report

BACKGROUND Superior mesenteric artery (SMA) injuries rarely occur during blunt abdominal injuries, with an incidence of &lt; 1%. The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation, which progress rapidly and are easily misdiagnosed. Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases. This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture. CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture. On admission, he showed extremely unstable vital signs and was unconscious with a laceration on his head, heart rate of 143 beats/min, shallow and fast breathing (frequency &gt; 35 beats/min), and blood pressure as low as 20/10 mmHg (1 mmHg = 0.133 kPa). Computed tomography revealed abdominal and pelvic hematocele effusion, suggesting active bleeding. The patient was suspected of partial rupture of the distal SMA branch. The patient underwent emergency mesenteric artery ligation, scalp suture, and liver laceration closure. In view of conditions with acute onset, rapid progression, and high bleeding volume, key points of nursing were conducted, including activating emergency protocol, opening of the green channel, and arranging relevant examinations with various medical staff for quick diagnosis. The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time. Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability. Strict measures were taken to avoid intraoperative hypothermia and infection. CONCLUSION After 3.5 h of emergency rescue and medical care, bleeding was successfully controlled, and the patient’s condition was stabilized. Subsequently, the patient was transferred to the intensive care unit for continuous monitoring and treatment. On the sixth day, the patient was weaned off the ventilator, extubated, and relocated to a specialized ward. Through diligent medical intervention and attentive nursing, the patient made a full recovery and was discharged on day 22. The follow-up visit confirmed the patient’s successful recovery.

Introducing AEM-RADS: A novel reporting and data system for abdominal emergencies.

The Reporting and Data System (RADS) has proven successful in various medical settings, but a standardized reporting system for abdominal emergencies is lacking. In this study, the Abdominal Emergency Reporting and Data System (AEM-RADS) for urgent findings on abdominal CT scans is introduced to address the need for consistency in emergency radiology. In this prospective observational study, conducted over a six-month period, the urgency of abdominal CT scans was assessed using the proposed AEM-RADS scoring system. The committee developed a scale ranging from AEM-RADS 1 (normal) to AEM-RADS 5 (urgent disease). Interobserver agreement between two observers with different experience was evaluated, and robust AEM-RADS reference values were established by radiologists who were not observers. Statistical analysis used mean, standard deviations and Kendall's tau analysis for interobserver agreement. Among 2656 patients who underwent CT for abdominal emergencies, the AEM-RADS distribution was 17.50% AEM-RADS 1, 28.57% AEM-RADS 2, 7.22% AEM-RADS 3, 35.61% AEM-RADS 4, and 11.06% AEM-RADS 5. Interobserver agreement was high, especially for urgent and emergent cases (p < 0.0001). Notable discrepancies were observed in AEM-RADS categories 2C-D and 3B-C, emphasizing the influence of radiologists' experience on interpretation. However, the interobserver agreement for both AEM-RADS 2C-D and 3B-C were statistically significant (p < 0.001). AEM-RADS showed promising reliability, particularly in identifying urgent and emergent cases. Despite some inter-observer discrepancies, the system showed potential for standardized emergency workups. AEM-RADS could significantly enhance diagnostic accuracy in abdominal emergencies and provide a structured framework for shared decision-making between clinicians and radiologists.0.

Multi-criteria group emergency decision-making method considering knowledge granularity

Emergencies are typically characterized by abruptness, time urgency, and complexity, which give rise to challenges such as incomplete information, compromised information effectiveness, and reduced efficiency. To address these issues, this study proposes a novel multi-criteria group emergency decision-making (MCGEDM) method considering knowledge granularity. Within the framework of a hierarchical criterion system (HCS), decision makers' (DMs') judgment information is extracted using belief distributions (BDs) on knowledge chunks, based on the conceptualization of knowledge granularity. This enables DMs to make judgments as effectively as possible, thereby improving efficiency in terms of time and enhancing the effectiveness of information. The generalized combination (GC) rule is applied for individual information fusion within basic nests, demonstrating internal revision and complementation of information. Automatic parameter determination methods are proposed to enhance the effectiveness of information and the efficiency of MCGEDM. Finally, the proposed method is demonstrated through a simulative case of an oil spill emergency, and the subsequent sensitivity analysis and comparisons verify its feasibility and effectiveness.

Epidemiological characteristics of spontaneous subarachnoid hemorrhage cases in Shandong province

Objective: To investigate the characteristics and trends of spontaneous subarachnoid hemorrhage (SAH) in Shandong province. Methods: In this study, SAH incidence data of residents from 2012 to 2021 were collected from the chronic disease monitoring information management system of Shandong province, including the basic information of outpatient, emergency or inpatient cases and out-of-hospital deaths (name, gender, ID number, address, etc.) and disease diagnosis information (disease diagnosis, date of onset, date of diagnosis, etc.). The crude incidence rate and age-standardized incidence rate were used as indicators to describe the incidence of SAH in different gender, age groups and regions (urban and rural areas). Joinpoint regression was used to analyze the variation of incidence rate and age by year. The rate difference decomposition method was used to estimate the contribution of population aging to the increase of SAH incidence. Global and local spatial autocorrelation analysis was performed using DeoDa 1.12 software. Results: From 2012 to 2021, a total of 11 629 cases of SAH were reported from 19 provincial monitoring sites in Shandong province. Among them, 54.11% (6 293 cases) were female and 91.87% (10 684 cases) were≥45 years old. The reported crude incidence rate increased from 5.26/100 000 to 9.50/100 000, with an average annual increase of 7.75% (Ztrend=7.30, Ptrend<0.001), and the standardized incidence rate also showed an upward trend (Ztrend=3.92, Ptrend=0.004). The crude incidence rate of women was higher than that of men in all years (all P values<0.05), and the standardized incidence rate of women was higher than that of men in all years except in 2012 and 2021 (all P values<0.05). In 2012, the crude incidence and standardized incidence of urban residents were lower than those in rural areas (P<0.05); from 2013 to 2017, the urban incidence was higher than that in rural areas; and after 2018, the rural incidence exceeded the urban incidence again (all P values<0.05). The median age of onset of SAH increased from 61.9 years in 2012 to 67.2 years in 2021. The age of onset of SAH in men was lower than that in women in all years (all P<0.05), and there was no significant difference between urban and rural residents in most years (P>0.05). The incidence of SAH increased with age (Ptrend<0.001), with a low incidence reported in residents aged<45 years and a rapid increase in residents aged≥45 years. According to the seasonal decomposition, the incidence of SAH had three small peaks in January, March to May and October to November. From 2013 to 2021, the contribution of aging population to the increase of crude incidence of SAH increased from 27.86% to 43.68%. The global spatial autocorrelation analysis showed that the incidence of SAH was in an obvious spatial aggregation distribution (Moran's I>0, P<0.05). Local spatial autocorrelation analysis showed that the counties with high incidence were mainly concentrated in Dezhou City in northwest Shandong Province and Heze city in southwest Shandong province. Conclusions: The crude incidence rate of SAH in Shandong province is increasing, with spatial clustering and seasonal clustering. Residents aged 45 years and older, female residents, and rural residents are at high risk of developing SAH, so targeted prevention and control measures should be taken for high-incidence seasons, high-risk groups, and high-incidence clustered areas.

Intraoperative evaluation for endoleaks using the SCORPION procedure during endovascular aortic repair.

Endoleaks are important complications of endovascular aortic repair. Usually, endoleaks are judged indirectly by aortography or postoperative computed tomography. However, findings from these modalities are difficult to distinguish because of the divergency of endoleaks. Few studies have reported direct visualization of endoleaks. Herein, we introduce a direct procedure for intraoperatively evaluating endoleaks using angioscopy. From April 2023, consecutive patients with an abdominal aortic aneurysm, except emergency cases and those of narrow access, seen at Sunagawa City Medical Center were enrolled in our study. Endoleaks were detected by intraoperative angioscopy using a novel endovascular procedure. Seven patients underwent endovascular aortic repair of an abdominal aortic aneurysm with intraoperative angioscopy. None of the enrolled patients experienced complications. The procedure revealed types 2, 3a, and 4 endoleaks. This is the first study to demonstrate intraoperative visualization of endoleaks using angioscopy. Direct findings observed by this novel procedure might provide information on the velocity and volume of the endoleak, providing comprehensive insights into the intra-sac hemodynamics after the endovascular aortic repair.

Diagnosis and Management of Upper Gastrointestinal Bleeding in Long-Term NSAID Users : Case Report

Upper gastrointestinal bleeding is one of the most frequently encountered emergency cases. For most general practitioners, diagnosing and providing initial management is a challenge in itself. Upper gastrointestinal bleeding is divided into variceal and non-variceal bleeding. Clinical symptoms that can be found include hematemesis or melena. Patients with melena tend to have lower hemoglobin (Hb) levels than hematemesis because clinical manifestations appear more slowly. Drug Induced NSAIDs are also one of the etiologies that can cause upper gastrointestinal bleeding. Endoscopy is the gold standard for diagnosis, but not all health facilities are able to perform it. This case reported a 66-years-old male patient came to the emergency room with complaints of blackish stools with a soft, sticky consistency for 6 days, accompanied by weakness, dizziness, nausea in the stomach and disruption of daily activities. The patient has a history of taking over-the-counter NSAIDs long term to relieve his knee pain. On physical examination, hepatomegaly and splenomegaly were not found and the patient’s hemodynamics is stable. On laboratory examination, Hb was found to be 3.4 g/dl. It was suspected that there was upper gastrointestinal bleeding, then received therapy in the form of PPI injections, antiemetic injections and planned PRC transfusion.

Relationship Between Hemoglobin Levels, Index Severity Score, Leukocytes and Degree of Open Fracture with Surgical Complications (Clavien Dindo Classification) in Long Bone Open Fracture Patients with External Fixation and Internal Fixation at Prof. IGNG Ngoerah Hospital

Introduction: Open bone fractures are an emergency case in the field of orthopedics that must be treated quickly because of its significant morbidity and mortality. Several parameters and classifications are used to assess the impact severity of one open bone fracture. There is no study that has discussed the comparison of each parameter yet. Aims of this study to determine the relationship between hemoglobin levels, injury severity score, leukocytes and the degree of open fracture with the outcome of long bone open fracture patients who are carried out external and internal fixation installation surgery and measured through the degree of Clavien Dindo. Methods: This research was carried out at RSUP Prof I.G.N.G. Ngoerah, Denpasar, Bali with research time from May 2023 to December 2023. Clinical and laboratory data were obtained from secondary data from patient medical records. Data analysis in research uses descriptive analysis and inferential analysis. Results: In this study, a sample of 32 patients was obtained with more males than females with percentages of 65.6% and 34.4%. Based on age, the average is 31 years with the youngest being 16 years and the oldest being 58 years. The Hemoglobin level and leukocyte respectively have an average of 8.51 and 17.7 with score of Gustilo Anderson and ISS 2.73 and 10.06. The results of this study showed a significant relationship (p&lt;0.05) with hemoglobin p = 0.525, leukocytes p = 0.01, gustilo Anderson P = 0.028 and ISS p = 0.022 to the classification of clavein dindo Conclusion: The conclusion of this study is that the Clavien-Dindo has a relationship with several factors such as hemoglobin, leukocyte, ISS and gustilo Anderson which can affect patient condition. Keywords: Open Fracture, Clavien Dindo, Hemoglobin, Leukocyte, Index Severity Score, Gustilo Anderson

FIRST AID EDUCATION DURING INJURY IN CHILDREN WITH RICE METHOD AT SEKOLAH INDONESIA SINGAPURA (SIS)

First Aid is an aid for emergency treatment of victims before help is provided by medical personnel. Injuries can occur anywhere, the location of injuries often occurs especially in the home and school environment. School-age children are a group that is vulnerable to injury, especially when entering celementary school. Injuries can become an emergency case and cause serious injuries and even death if not handled properly. To prevent injuries in children from getting worse, one of the methods that can be used to treat is the RICE (Rest, Ice, Compression, Elevation) method, which can first rest the injured part, apply an ice pack to reduce swelling, bandage the injured skin and elevate the injured area above the height of the heart area. First Aid community service with the RICE method at Sekolah Indonesia Singapura (SIS) is a positive activity that aims to increase children's knowledge and ability to perform first aid when injured or when children know other people are injured. The method used is counseling about first aid for injuries using the RICE method, demonstrating and distributing leaflets. The results of the analysis of children's ability to understand first aid material when injured with the RICE method before and after education is 30 (with an average pre test score of 70 and post test 100). The increase in participants' knowledge proves that with this counseling participants become more aware of what is related to first aid during injuries that can be treated with the RICE method to prevent more severe injuries. Keywords; First Aid, Emergency, RICE, Children

IMPLEMENTASI TERKAIT KESIAPAN PETUGAS PANTI TERHADAP SISTEM PENANGGULANGAN GAWAT DARURAT TERPADU (SPGDT) DI PANTI SOSIAL LANJUT USIA HARAPAN KITA PALEMBANG

Background: The Integrated Emergency Management System (SPGDT) is one of the health service innovations to handle emergency cases at the Harapan Kita Social Institution for the Elderly, Palembang. Residents of the orphanage still have complaints about the implementation of the SPGDT program, complaints are slow to handle, call center access is not easy to contact, the role of case management by the orphanage staff team is still slow. Purpose: to analyze the implementation related to the readiness of the nursing home staff regarding the integrated emergency response system (SPGDT). Methods: qualitative research with in-depth interviews and observation. There were 3 informants in the study consisting of the head of the orphanage, staff and employees at the Harapan Kita Palembang Social Home for the Elderly. The variables used to see the implementation of the readiness of the orphanage officers are communication, resources and infrastructure. The research was carried out for 3 months February-April 2023. Data analysis was processed according to the characteristics of content analysis, namely: data collection, data reduction, verification, data presentation and drawing conclusions. Research results: shows that the implementation related to the readiness of the orphanage staff has not gone as expected, efforts to increase knowledge and access have not been achieved, communication and coordination between teams have not been effective. Conclusion: the integrated emergency management system at Harapan Kita Social Institution Palembang is still not optimal and has not been supported by medical personnel and adequate infrastructure