Emergency Conditions Research Articles

Predictability of adult patient medical emergency condition from triage vital signs and comorbidities: a single-center, observational study

BackgroundVital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). In most EDs, triage of patients takes place with vital signs and admission complaints only. Comorbidities are generally underestimated when determining the patient’s status at the triage area. This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED.MethodsThis prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 h, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 h, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered “medical emergency conditions”. The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression.ResultsA total of 10,022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. Six hundred four patients presented with an MEC. All vital signs -except diastolic hypertension and tachycardia- and comorbidities were found statistically significant. Hypoxia (Odd’s Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, an MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities.ConclusionAmong the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of an MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs.

Influence of lithodynamics of coastal area on the safety of railway operation on the Tuapse-Adler section of the North Caucasus Railway

The present paper considers the railroad bed on the Tuapse-Adler section of the North Caucasus Railway (Black Sea coast) in terms of its protection from wave scouring. Aim. To evaluate the influence of coastal lithodynamics on the safety of the railway operation on the section under consideration. The paper describes lithodynamic processes in the sea coastal zone and demonstrates the influence of coastal protection structures produced on lithodynamics in general and on adjacent sections, as exemplified by a specific section of the coast (1907–1910 km). The study involves a retrospective analysis of the step-by-step construction of trapping structures, and sea groins without full-fledged dumping of beach-forming material into the inter-groin compartments. The investigation and analysis of satellite images of 1907–1910 km coast within the Vodopadny-Lazarevskoye section indicate that lithodynamic processes remained unconsidered during the intensive construction of bank protection structures, which led to the beach erosion and the emergency condition of the seawalls along 1909–1910 km section. The paper provides recommendations for considering lithodynamic processes in the construction of railway protection structures, thereby increasing the safety of the railway operation.

Access to Healthcare for Appendicitis Patients in the United States Based on Insurance Coverage.

Health insurance plays a crucial role in ensuring access to healthcare services, addressing affordability concerns.Insurance options have varying wait times and acceptance challenges, which can greatly impact patients in emergency conditions, such as appendicitis. This study aims to find out the healthcare access disparities for appendicitis patients in states with low Medicaid coverage. A three-week virtual cross-sectional study (Oct 20-Nov 10, 2023) evaluated healthcare accessibility for appendicitis symptoms in North Dakota, Utah, Wyoming, and New Hampshire. Using www.healthgrades.com, data on general surgeons within 10 milesprioritizing new patients with three stars or above were collected and then analyzed with StataCorp 2023. The study was done among 81 physicians among whom, 61 (75.31%) were maleand 20 (24.69%) were female, mostly MD (76, 93.83%), DO (3, 3.70%), and APRN (2, 2.47%). Cigna (n=77) is mostly accepted by more physicians than Medicaid (n=33) across the states. The average waiting period for Cigna (9.45±10.54 days) is mostly longer than Medicaid (4.71± 9.63 days). Our findings of P-values >0.05reveal no significant associations in insurance acceptance or waiting times. Although varying wait times were observed across states, no significant disparities were found in appointment waiting periods based on insurance types.

Acute Approach to Central Nervous System Infections in Kazakhstan

Background Neuroinfections in children are a socially significant problem of our time, as they can lead to disability and death of the patient, which actualizes the need for their early clinical diagnosis. The purpose of the study: to identify patterns of clinical manifestations of central nervous system lesions in children with neuroinfections. Materials and methods The cases of neuroinfections in 101 children treated at the “City Clinical Infectious Diseases Hospital” (Shymkent) in the period from 2018 to 2022 were analyzed, of which 37 patients with viral neuroinfections, 64 with bacterial ones. Results The predominance of bacterial neuroinfections over viral ones was revealed, with a predominance among young boys. Headache or its equivalents (in children under one year old) were observed in 72.5%; most often in children with viral infections of the nervous system (81.2%), less often in patients with bacterial infections (65.4%), p 0.01. In most cases, the disease manifested with the phenomena of fever and vomiting. When assessing the neurological status, the duration of preservation of two frequently occurring meningeal signs (rigidity of the occipital muscles, Kernig’s symptom) was taken into account, which was 6 ± 1.3 days and 5 ± 1.1 days in the group with bacterial neuroinfections, and 4 ± 1.8 and 5 ± 1.7 days, respectively, in the group with viral neuroinfections (p 0.05). With pneumococcal etiology, the most severe and protracted cases of the course of neuroinfections are recorded. Frequent emergency conditions in infectious lesions of the central nervous system in the form of cerebral edema, septic shock, which occur more often in bacterial neuroinfections, have been identified. Conclusion Neuroinfections are characterized by a symptom complex of clinical manifestations, which should be interpreted by doctors in a timely and correct manner in order to diagnose early and minimize adverse outcomes of the disease. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1206-1212

Hyperbaric Oxygen Therapy: An Evidence-Based Primer for Emergency Physicians

BackgroundHyperbaric medicine is a subspecialty that many emergency physicians may not encounter frequently in their daily practice. As such, we hope to provide a review, where we present an overview of hyperbaric oxygen therapy, complications from the therapy, and a description of how the treatments are administered. We also discuss seven emergency indications that may benefit from transfer to a hyperbaric facility for treatment. Objective of the ReviewOur aim is to provide an overview of hyperbaric oxygen therapy as it pertains to an emergency physician. We hope that this review will help emergency physicians identify conditions that may benefit from transfer to a hyperbaric facility. DiscussionWe discuss seven emergency conditions that may benefit from transfer to a hyperbaric facility for management – decompression sickness, arterial gas embolism, central retinal artery occlusion, carbon monoxide poisoning, crush injury, necrotizing soft tissue infection, and symptomatic anemia. We also describe special considerations for how to transfer patients needing evaluation by a hyperbaric physician. ConclusionsThis review aims to describe hyperbaric oxygen therapy, identify conditions that may benefit from treatment with hyperbaric oxygen, and discuss management of patients with those conditions as it pertains to an emergency physician.

Performance measurement systems in an era of complexity, uncertainty and grand challenges

The current uncertain and emergency environment is challenging business man-agement like never before. Companies are called to face many complex and wicked problems affecting society on a global scale. Climate change, global pan-demics, social inequalities, war conflicts, digital transformation, and energy supply shortages are only a few of the critical issues companies must deal with daily. Per-formance measurement systems and management control practices can have a key role in addressing such a turbulent environment. Accordingly, the literature has recently started investigating their role in supporting companies facing societal "Grand Challenges". The scientific debate on this topic is intense but still in its in-fancy leaving open wide research areas that need to be further explored and inves-tigated. The articles included in this volume fuel the ongoing debate by analysing the role of performance measurement systems and management control tools in several contexts and under uncertain and emergency conditions.

Laparoscopic Versus Open Closure of Duodenal Perforations: A Retrospective Comparative Study in a Rural Hospital, Andhra Pradesh, India

Abstract Introduction: Evidence on the outcomes of laparoscopic surgeries, especially in emergency conditions such as peptic ulcer, remains unknown. A retrospective study was conducted in a rural surgical unit in Andhra Pradesh to compare morbidity, mortality, and duration of hospital admission in patients undergoing laparoscopic (Group L) and open (Group O) closure of duodenal perforations. Methods: Retrospective data of adult patients with peptic ulcer perforation treated by surgical approach during January 2012 and December 2017 were scrutinized. Pre- and postoperative records were abstracted for clinical conditions. Mortality was compared between the two groups with appropriate statistical tests. Results: A total of 120 patients, 60 in each group, were recruited for the study. The preoperative clinical characteristics of the two groups were similar. The mean duration of surgery was significantly higher in Group L (212.8 ± 29 min) compared to Group O (107 ± 16 min) (P < 0.001). Wound discharge (n = 3, 5%) and postoperative leak (n = 2, 3.3%) were the only complications noted in the L group. Several complications were noted in the O group including wound discharge (n = 51, 85%), wound dehiscence (n = 12, 20.0%), postoperative leak (n = 8, 13.3%), pneumonia (n = 1, 1.7%), and need for ventilation (n = 6, 10.0%). Three (5%) patients died in the hospital in Group O while none died in Group L. The average duration of hospital admission was 7.1 days (standard deviation [SD] =1.0 days) for Group L and 11.7 days (SD = 2.2 days) for Group O (mean difference: 4.6 days; 95% confidence interval: 4.6–5.2 days). Conclusion: Laparoscopic correction of duodenal ulcer perforation is both feasible and effective in reducing morbidity and mortality and overall treatment duration at peripheral centers.

Simplified Calculation Method for the Critical Load Bearing of Market-based Profile Emergency Steel Pier

A novel emergency steel pier, assembled from market-available profiles, has been developed to address the challenges associated with the "regular stockpiling and rapid emergency deployment" of bridge pier repair equipment. These challenges often involve significant labor and financial costs for manufacturing and maintenance. The buckling modes of the columns and pier-girder connections were considered. Using energy methods and plate-shell theory, an analytical formula for the critical load-bearing capacity of the steel pier under emergency conditions was derived. Numerical simulations were conducted for comparison and validation, resulting in an optimized and simplified method for calculating the critical load capacity, which is suitable for engineering applications.The study shows that the critical load-bearing capacity of the emergency steel pier exhibits distinct patterns under the influence of column buckling modes and pier-girder connection methods. In cases where the column is fixed at one end and hinged at the other, or fixed at both ends, the critical load for axisymmetric buckling is affected by factors such as elastic modulus, Poisson’s ratio, height, radius, wall thickness, and the number of buckling waves. When considering non-axisymmetric buckling, the number of circumferential buckling waves becomes an additional factor. A simplified method for calculating the critical load-bearing capacity was developed. The simplified formula depends only on a correction factor, modified buckling stress, the number of columns, and cross-sectional area. This makes it highly practical for emergency engineering applications.

349 Evaluating the Efficacy of ChatGPT in Generating Discharge Instructions for Common Pediatric Emergency Conditions

349 Evaluating the Efficacy of ChatGPT in Generating Discharge Instructions for Common Pediatric Emergency Conditions

Reinforcement of the steel columns structure of the industrial hall weakened by intense corrosion

Owing to the severe impact of the corrosive environment associated closely with the technological process, steel structures, including the columns described in the study, which constitute the main framework of the industrial hall, are prone to corrosion due to inadequate protection. This corrosion has resulted in emergency conditions. The paper presents proposals for strengthening these columns, preceded by expert assessments of their technical condition, geodetic measurements, load-bearing capacity analysis, and an evaluation of the technical feasibility of conducting repairs during continuous industrial operations. The results of these analyses are detailed in this paper

Prosthesis applications and challenges in children with earthquake-related amputations

BackgroundAmputations are among the most important traumatic injuries caused by earthquakes. However, data on amputee children and prosthesis application is quite limited in the literature. The aim of the study is to evaluate the injury-related data, stump problems, prosthesis application, difficulties and complications experienced with prosthesis during follow-up of children with 2023 Kahramanmaraş earthquake-related limb loss. Patients and methodsSociodemographic and injury-related data, pre-amputation and post-amputation interventions, prosthesis application, current prosthetic problems, and revision surgeries of the amputee children were recorded. ResultsMedian age of patients (n = 102) admitted to our center was 13.0 years. 67.6 % of patients had one or more concomitant injuries. Median time and number of amputations were 4 (0–57) days and 1 (1–4), respectively. Of the total 120 amputations, 67.5 % (n = 81) were lower extremity amputations. Most common amputation levels were transtibial (29.1 %, n = 35), transfemoral (22.5 %, n = 27), and transhumeral (15.8 %, n = 19). Most amputees (56.8 %) underwent revision surgery after initial amputation. Median duration of time from amputation to prosthesis application was 184 (28–314) days. For 25 prostheses, a socket revision was required. Six patients had surgical revision of the stumps to allow prosthetic fit and mobility (due to bone overgrowth, soft tissue failure, heterotopic ossification). ConclusionLimited healthcare facilities, surgeries performed under emergency conditions, accompanying multiple traumas, inadequate follow-up conditions, and additional difficulties arising from the pediatric patient group lead to difficulties in the care of pediatric amputee patients. Our results will guide the care of this vulnerable patient population in the event of a similar unfortunate disaster.

Enhancing Student Engagement: Technology Acceptance in Higher Education During Covid-19

COVID-19 has caused institutions across the sector to transition from conventional teaching and learning environments into virtual environments. Amidst this paradigm shift, academics have adopted a range of technology-based strategies to support the online learner. However, low attendance, engagement, and participation continue to challenge the execution of eLearning across the higher education (HE) sector. Within this narrative, there has been an interest in understanding the acceptance and adoption of technologies in education from the learners’ perspective. As a result, there has been an increased focus on technology acceptance models as a theoretical lens to unpack attitudes and beliefs relating to eLearning. Motivated by these environmental shifts, this study aims to capture themes and perspectives considered in educational literature worldwide to present future considerations for studied and practitioners as we emerge from the pandemic. By systematically reviewing global educational literature, the study aims to provide valuable insights and future considerations for both studied and practitioners as the HE sectors transitions out of the pandemic. The study is guided by the central study question: What influences the learners’ acceptance and continuation of use of education technologies during forced emergency conditions such as the COVID-19 pandemic? Based on these findings, we then share recommendations for education technology adoption in the HE sector.

Scientific Achievements of The Department of Phthisiology and Pulmonology of the Bogomolets National Medical University (on the Occasion of the 100th Anniversary of the Founding of the Department)

Department of Phthisiology and Pulmonology of O.O. Bogomoletsa was founded in the distant past (1924). The department was initially established as an associate professorship in tuberculosis at the Kyiv Medical Institute (KMI), later became a course on tuberculosis, and eventually developed into a full department of tuberculosis. During its existence, the department changed its name several times (Department of Phthisiology, Department of Phthisiology with a Course of Pulmonology, Department of Phthisiology and Pulmonology).The direction of the work of the associate professorship on tuberculosis of the KMI (head A.I. Sobkevych) is the scientific analysis of the symptoms of tuberculosis and the development of recommendations for the rational nutrition of patients. The direction of the tuberculosis course (head D.Ya. Epshtein) is to improve the method of treating tuberculosis with the help of an artificial pneumothorax.The field of work of the Department of Tuberculosis (head V.P. Rudin) is the analysis of age-related reactivity of the body of tuberculosis patients, features of pathogenesis, clinic, diagnosis and treatment of tuberculosis in young people and the elderly; study of tuberculous meningitis and new methods of climate therapy for tuberculosis.The field of work of the Department of Phthisiology (head M.S. Pylypchuk) is the development of methods of diagnosis and improvement of treatment of patients with tuberculosis and non-specific lung diseases (use of heparin, donors of sulfhydryl groups, galascorbin and proteolytic enzymes; establishment of hemosorption, endolymphotherapy, aerosol therapy and intravenous administration of antituberculosis drugs drugs, lung resection with pneumoperitoneum) and treatment of tuberculosis patients with chronic alcoholism. Study of the surfactant system of the lungs, the mucociliary apparatus and the aerogematic barrier; animal lung transplantation experiments.The field of work of the department of phthisiology and pulmonology since 1997 (head — V.I. Petrenko) — improvement of existing and development of new methods of antimycobacterial and pathogenetic therapy (Tri-vi-plus, Dufalak®, Kagocel®, Glutargin, ademethionine, Livolin Forte and Immunofan) in patients with pulmonary tuberculosis; application of biocorrective technologies in emergency conditions in pulmonology and the latest technologies in diagnostics (dopplerography) and treatment (information-wave therapy «IHT-Threshold») of tuberculosis; environmental problems in phthisiology and pulmonology (cigarette smoking, ionizing radiation).The student circle at the Department of Phthisiology and Pulmonology has been operating since 1960. Students have been actively engaged in scientific research. They take part in the implementation of the Department’s National Development Program and make presentations at scientific and practical conferences, congresses and forums (they receive diplomas and certificates). Active student participation is noted during the «April Student Scientific Sessions» (Ukraine) and Olympiads (Ukraine, Uzbekistan).

Characteristics of Obstructive Ileus: Literature Review

Obstructive ileus or often called bowel obstruction is one of the pathological processes that cause abdominal distress. Abdominal distress is an emergency condition in the abdominal cavity. This condition usually arises suddenly with the main complaint of pain. This study aims to see the characteristics of obstructive ileus. The research design used in this study is a literature review using Google scholar in finding previous related articles. The criteria for related articles used were those published from 2021-2024 and 20 journals were collected. Based on these 20 journals, it was found that the characteristics of obstructive ileus were mostly in adulthood and the elderly, based on gender, many were found in men due to lifestyle, while based on the cause of postoperative adhesions and based on symptoms that abdominal pain, nausea, vomiting, and abdominal distension were clinical features of obstructive ileus sufferers.

Experience in Team Multidisciplinary Training of an Ambulance Station Using a Physical Model of the City

The most difficult part of training young professionals is the skills of decision-making, communication, and role allocation. To develop these skills, Kursk State Medical University conducts business games simulating the operation of an ambulance and disaster medicine station. Starting with oral exercises and board games, the authors aim to diversify the mechanics of the game and increase engagement. The result was a model of an entire region with a city, villages, enterprises and natural areas, where participants physically move by special transport and fully provide the entire pre-hospital stage in normal and emergency conditions.

Training of Skills of Providing Assistance in Emergency Conditions to Dentists Using Anthropomorphic Simulation Robots

In the daily work of a dentist, situations often arise that require emergency care for urgent indications. According to researchers (Al-Turki O, Al-Hussyeen A, Al-Hammad N, Alhowaish L, Almaflehi N. Medical Emergencies In Dental Practice. J Dent Med Sci), emergency medical situations at a dental appointment occur on average once every two years. In addition, in recent years, there have been fatal cases during the provision of dental care, which certainly makes the problem relevant.

Support network: the challenges of ensuring myocardial infarction patients comfort in the critical care unit: a qualitative study

IntroductionMyocardial infarction (MI) is a critical emergency condition that affects all aspects of health. Patients with MI need specialized care in the Coronary care unit (CCU). The main goal of care is to ensure their comfort, which can be significantly affected by their illness and hospitalization. This study aims to explore MI patients’ perceptions of support network challenges to ensure comfort in the CCU.MethodsA qualitative approach was adopted, and semi-structured interviews and notes were used for collecting data between 2020 and mid-2021. The participants were 27 MI patients in our country who had been hospitalized in the CCU of the University Heart Hospital. They were selected using purposive sampling. The data were analyzed using conventional content analysis by Graneheim and Lundman.FindingsThe results of this research were revealed in the form of a “support network” theme comprising five categories: “Physical support”, “Mental occupations”, “Presence of peers”, “relatives support “and “Spiritual strategies”.ConclusionThe study results showed that MI patients, in critical condition, receiving care, and hospitalized in the CCU require continuity in their support network to ensure comfort. The inconsistency between the components of each dimension leads to the challenge of ensuring comfort.

Probabilistic co‐expansion planning for natural gas and electricity energy systems with wind curtailment mitigation considering uncertainties

AbstractIn response to growing reliance on electricity and gas systems, this paper introduces a stochastic bi‐level model for the optimized integration of these systems. This integration is achieved through sizing and allocating of power‐to‐gas (P2G) and gas‐to‐power (G2P) units. The first level of the model focuses on decisions related to P2G and G2P unit installations, while the second level addresses optimal system operation considering decisions made from first level and stochastic scenarios. The primary aim is to enhance energy‐sharing capabilities through coupling devices and mitigate wind generation curtailment. An economic evaluation assesses the model's effectiveness in reducing costs. N − 1 contingency analysis gauges the integrated system's ability to supply load under emergency conditions. Two new indices, performance of the electricity system and performance of the natural gas system, are proposed for N − 1 contingency analysis. These indices quantify the proportion of the supplied load to the total load, thereby illustrating the system's capacity to meet demand. For numerical investigation, the proposed model is applied to a modified IEEE 14‐bus power system and a 10‐node natural gas system. Numerical results demonstrate a 9.426% reduction in investment costs and a significant 10.6% reduction in wind curtailment costs through proposed planning model.

Passive Rom Therapy to Improve Muscle Strength in Post-Op Upper/Lower Extremity Patients: a Case Study

Fractures are emergency conditions that must be treated quickly and accurately and in accordance with fracture management procedures. In general, clients with fractures must undergo surgery which in addition to causing pain also affects activity. After surgery, rehabilitation is needed to prevent contractures. Nursing care for patients with upper/lower extremity fractures must be prioritized and focused on providing comfort, preventing complications, and achieving optimal rehabilitation in rehabilitation. Patients are taught mobilization or movement exercises, namely Passive Range of Motion (ROM). Purpose: To determine the Effectiveness of Passive ROM Exercise in Postoperative Patients with Upper/Lower Extremity Fractures on Length of Stay at Sukoharjo Regional General Hospital. Design: This researcher studied the type of experimental research. The method used is a case study. Results: the results of the study showed that the majority of Active ROM respondents were treated for 2 days with a frequency of 5 respondents. Then the results showed that there was a difference in the effect of passive ROM on the length of stay for fracture patients at Sukoharjo Regional General Hospital.

Emergency surgery influences oncological outcome in small intestinal neuroendocrine tumors.

Patients with small intestinal neuroendocrine tumors (siNETs) frequently present emergently due to bowel ischemia or bowel obstruction. The influence of emergency surgery on the prognosis of siNET remains controversial. The aim of this study was to investigate the association between type of presentation (emergency/elective) and oncological outcome. Clinicopathological data of patients who underwent bowel resection and were treated due to siNET at the Charité - Universitätsmedizin Berlin, Germany were analyzed retrospectively. A total of 165 patients underwent bowel resection for siNET. Of these, 22.4% (n = 37) were emergency and 77.6% (n = 128) were elective procedures. A preoperative known diagnosis was less common in patients with emergency surgery (48.6% vs 85.2%; p < 0.001) and complete resections of all tumor manifestations were performed less often (32.4% vs 50.8%; p = 0.049), while more completion operations had to be performed (24.3% vs 11.1%; p = 0.049). Overall survival (OS) and progression-free survival (PFS) of emergently operated patients were reduced (5-year OS: 85.2% vs 89.5% (p = 0.023); 5-year PFS: 26.7% versus 52.5% (p = 0.018)). In addition, emergency surgery was negatively associated with OS after multivariable regression analysis. Emergency surgery in siNET patients is associated with adverse oncological outcomes including shorter OS and PFS. Prevention of emergency conditions should be emphasized in advanced disease.