Department Of Emergency Research Articles

The loss of the soul and the myth of the living dead. A Jungian approach to a mental health problem in a public hospital in Buenos Aires.

This study is about the intervention carried out by a group of professionals from the Interdisciplinary Mental Health Team of the Emergencies Department in a public hospital in Buenos Aires City between 2017 and 2019. It arose from the need to respond to a public health problem related to the increasing number of patients living in situations involving homelessness, drug abuse, violent behaviour and criminal background. The multiple facets of this problem made us think about the impossibility of addressing it only in the individual sense of each patient. We were forced to admit that we were facing a problem of a complex, collective, social and institutional order, which the predominant medical model had neither been able to handle nor understand. We sought to include a Jungian approach to this contemporary problem found in large Latin American cities. Amplifying a symbolic base allowed us to understand creatively the complexity of the phenomenon, which could not be read in any manner other than the social and collective.

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Unprecedented Training: Experience of Residents During the COVID-19 Pandemic

Особливості перебігу артеріальної гіпертензії, поєднаної з дисплазією сполучної тканини, у практиці сімейного лікаря

Актуальність. Поєднання артеріальної гіпертензії (АГ) та дисплазії сполучної тканини (ДСТ) є одним із недостатньо вивчених питань. ДСТ супроводжується порушеннями структури та функції судин, сприяє розвитку раннього атеросклерозу та серцево-судинних ускладнень. У хворих на АГ, поєднану з ДСТ, часто зустрічаються порушення ритму та провідності серця, значно поширені зміни з боку органів зору, внутрішніх органів та кістково-суглобової системи. Мета. Покращити діагностику та лікування АГ, поєднаної з ДСТ, на основі вивчення клінічного перебігу, вираженості зовнішніх і внутрішніх симптомів ДСТ, ліпідного спектра крові, гострофазових показників, сечової кислоти та інструментальних методів обстеження. Матеріали та методи. Проведено клінічне дослідження, в яке включено 75 хворих на АГ ІІ стадії 1–3-го ступеня з проявами ДСТ, середній вік яких становив 63,5 ± 4,2 року, які перебували на стаціонарному лікуванні в кардіологічному відділенні Комунальної міської клінічної лікарні швидкої медичної допомоги м. Львова. Методи дослідження включали клінічні (огляд, пальпація, перкусія, аускультація), лабораторні (ліпідний спектр крові, С-реактивний протеїн, серомукоїди та сечова кислота), інструментальні (електрокардіографія, ехокардіографія, добове моніторування артеріального тиску, езофагогастродуоденоскопія, ультразвукове дослідження (УЗД) внутрішніх органів і судин нижніх кінцівок, УЗ-дуплексне обстеження сонних і хребтових артерій, рентгенологічне дослідження кістково-суглобової системи), консультації офтальмолога, невропатолога, травматолога, стоматолога. Діагностика недиференційованої ДСТ визначалася за методикою Т.М. Кадуріної та співавт. (2009). Розрахунок діагностичного коефіцієнта для кожної ознаки дисплазії проводили за методикою, розробленою В.М. Яковлевим та співавт. (2008). Пацієнти були розподілені на 3 групи:1-ша група — 12 пацієнтів з АГ II стадії 1-го ступеня, 2-га група — 26 пацієнтів з АГ II стадії 2-го ступеня, 3-тя група — 30 пацієнтів з АГ II стадії 3-го ступеня. Контрольна група — 7 пацієнтів з АГ ІІ стадії 1–3-го ступеня без проявів ДСТ. Результати. При порівняльному аналізі хворих з АГ у 90,67 % спостерігався ряд зовнішніх і внутрішніх симптомів дисплазії сполучної тканини, у 9,33 % були відсутні прояви ДСТ. У 3-й групі хворих спостерігали більше зовнішніх і внутрішніх фенотипових ознак ДСТ та їх вираженість порівняно з 1-ю та 2-ю групами, що прогнозує тяжкість клінічного перебігу захворювання. Висновки. У хворих на АГ спостерігається значне поширення ДСТ: чим більше ознак ДСТ, тим тяжчий клінічний перебіг гіпертонії. У хворих з АГ, поєднаною з ДСТ, поширені зміни з боку серцево-судинної системи, органів зору, внутрішніх органів та кістково-суглобової системи порівняно з групою хворих без ДСТ. При порівнянні групи хворих з АГ і наявністю ДСТ відмічаються вищі показники активності запального процесу та ліпідного спектра крові, ніж у хворих без ДСТ. Своєчасне виявлення АГ, поєднаної з ДСТ, систематичний диспансерний нагляд за хворими, проведення комплексу заходів, спрямованих на покращення структури та функції сполучної тканини, корекція імунодефіциту дозволяють покращити результати перебігу даної патології.

GAMBARAN ASUHAN KEPERAWATAN GAWAT DARURAT PADA PASIEN INFARK MIOKARD AKUT DENGAN NYERI AKUT DI RUANG EMERGENCY CARDIO RSUP SANGLAH DENPASAR

Background: Acute Myocardial Infarction (AMI) is one of the cardiovascular emergency diseases. Sign and symptoms of IMA that accompany patients coming to the Emergency departement are complaints of chest pain. Chest pain is a response that occurs due to ischemia in the myocardium. Untrained chest pain more than 20 minutes will result in irreversible heart damage. The purpose of this case study is to describe emergency nursing care in IMA patients with acute pain Method: The method used in this paper is a descriptive method with a case study approach that describes the condition of two patients suffering from IMA with acute pain. The tools used to retrieve data are IMA observation checklists and interview sheets. The data obtained were analyzed by narrating the data obtained and comparing the existing theory. Results: The IMA patient assessment focused on secondary assessment of SAMPLE. Chest pain data were obtained through the PQRST approach so that the main nursing problem was acute pain. Emergency measures performed by oxygen delivery as nonpharmacological therapy and administration of anti-ischaemic therapy and fibrinolysis as pharmacological therapy. Evaluation performed for 1 hour, the results obtained are reduced pain from the weight scale to moderate. Conclusions: As emergency nurses should pay attention to IMA assessment on secondary assessment and collaborate with medical personnel to reduce pain with pharmacological and nonpharmacological therapies.Keywords: Acute Myocardial Infarction (AMI); Acute Pain; Nursing Care; Emergency

Laser hair removal in the complex treatment of pilonidal cyst in children

Introduction. A pilonidal cyst (PC) in children is a common congenital pathology that manifests in the puberty period.Purpose. To improve outcomes of pilonidal cyst care in children.Materials and methods. The researchers analyzed results of surgical treatment of 156 children with PC who were hospitalized to the department of emergency and purulent surgery in Filatov Children’s City Clinical Hospital (Moscow) and in the surgical department of Republican Children’s Clinical Hospital (Izhevsk) in 2018–2020. All patients were divided into groups depending on the type of preoperative preparation.Results. Cases of 156 children with PC were assessed: 121 boys (77.56%, p 0.05) and 35 girls (22.44%). Patients’ age ranged from 13 to 18. There were two groups. In Group 1 (n = 89, 57.05%), patients had dry shaving as a preoperative preparation; in Group 2 (n = 67, 42.95%), patients’ hair in the sacrococcygeal region was removed with laser technique.Conclusion. A combined technique of surgical treatment of pilonidal cysts in the coccyx in children improves outcomes, , reduces the number of complications and relapses as well as promotes early social rehabilitation and good cosmetic results.

Comparison of paracetamol and hyoscine-N-butylbromide in the treatment of abdominal pain and cramps due to acute gastroenteritis

Background and objective: Hyoscine-N-butyl bromide (HBB) and paracetamol (acetaminophen)are widely used in emergency departments for abdominal pain and cramps. However, there is not enough data on the efficacy, safety, and superiority of each other in treating acute gastroenteritis (AGE) related abdominal pain and cramps. In this study HBB and paracetamol were compared for the treatment of abdominal pain and cramps related to acute gastroenteritis. Materials and methods: The study was conducted in a tertiary university hospital emergency department as a prospective, randomized-controlled, and double-blind study. Intravenous (IV) 1000 mg paracetamol and IV 20 mg hyoscine-N-butyl bromide (HBB) were used to treat abdominal pain and cramps related to AGE. Visual analogue scale (VAS) was used to evaluate the degree of abdominal pain before and after treatment. Results: HBB and paracetamol groups consisted of 123 and 158 cases respectively. In both groups, it was observed that the VAS score gradually decreased from the 0th hour to the 1st and 2nd hours (p<0.001).When comparing each time within itself, it was observed that HBB and paracetamol measurements had similar values (p>0.05). No severe side effects were observed in any of the patients. Conclusion: HBB and paracetamol were used for symptomatic treatment in AGE patients presenting with abdominal pain and cramps. A significant reduction in pain and cramps was achieved in both patient groups. There was no difference between the two drugs in terms of treatment efficacy and side effects. IMC J Med Sci 2022; 16(1): 009 *Correspondence: Hasan Gümüşboğa, Department of Emergency, Şehitkamil State Hospital, Gaziantep, Turkey, Posta code: 27500; Email: profhasan@hotmail.com; ORCID:0000-0003-2097-7102.

Risk factors for pulmonary embolism in ICU patients

Abstract Background: Pulmonary embolism (PE) is a clinical disease of pulmonary hypertension, right heart failure and pulmonary oxygen uptake dysfunction caused by obstruction of pulmonary artery blood flow caused by embolic substances. The incidence rate of acute PE (ATPE) has been increasing year by year in recent years. And ATPE has become a hot topic of common concern in the departments of severe, emergency, respiratory and heart diseases. Research and clinical practice have proved that early thrombolysis and other specific treatment can greatly improve its prognosis. However, the early diagnosis and treatment rate of ATPE is only 7%, for the lack of simple and objective diagnosis and quantitative evaluation of the degree of ATPE. Therefore, the screening of risk factors for PE in intensive care unit (ICU) patients by systematic review and meta-analysis is an important preliminary work to carry out the early diagnosis model of PE. Methods: We will retrieve eight electronic databases from their inception to May 31, 2021, which include PubMed, Cochrane Library, Excerpt Medical Database (Embase), Web of science, China Biology Medicine disc, VIP database (VIP), Wan Fang database, China National Knowledge Infrastructure. Methodological quality of all studies was assessed using the Newcastle-Ottawa scale. We will use STATA V.13.0 software and RevMan5.3 for data analysis, and risk factor effect sizes will be expressed as an odds ratio and their 95% Cl. Results: We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. With this study, we can get the significant risk factors and risk ratio of PE in ICU patients. Conclusion: This study systematically reviewed the existing evidence and determined the risk factors for PE in ICU patients. This study provides a basis for the establishment of early warning and prediction model of PE in ICU patients.

Establishment and evaluation of clinical diagnostic scoring system for septic cardiomyopathy

To establish a clinical diagnostic scoring system for septic cardiomyopathy (SCM) and evaluate its diagnostic efficacy. A prospective cohort study was performed. Patients with sepsis and septic shock admitted to the department of emergency of China Rehabilitation Research Center were enrolled from January 2019 to December 2020. The baseline information, medical history, heart rate (HR), mean arterial pressure (MAP), body temperature and respiratory rate (RR) on admission were recorded. Laboratory indexes such as white blood cell count (WBC), hypersensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and blood lactic acid (Lac) were measured. Transthoracic echocardiography was conducted within 24 hours and on the 7th after admission. Sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II), and nutritional risk screening 2002 scale (NRS2002) were also assessed. The patients were divided into two groups according to whether SCM occurred or not. The risk factors of SCM were screened by univariate and multivariate Logistic regression. The cut-off value of continuous index was determined by receiver operator characteristic curve (ROC curve) and discretized concerning clinical data. The regression coefficient β was used to establish the corresponding score, and the clinical diagnostic score system of SCM was established. The diagnostic value of the model was evaluated by ROC curve. In total, 147 patients were enrolled in the study and the incidence of SCM was 28.6% (42/147). Univariate Logistic regression analysis showed the risk factors of SCM included: (1) continuous indicators: age, NT-proBNP, RR, MAP, Lac, NRS2002, SOFA, APACHE II; (2) discrete indicators: shock, use of vasoactive drugs, history of coronary heart disease, acute kidney injury (AKI). Multivariate Logistic regression analysis after discretization of above continuous index showed that age ≥ 87 years old, NT-proBNP ≥ 3 000 ng/L, RR ≥ 30 times/min, Lac ≥ 3 mmol/L and SOFA ≥ 10 points were independent risk factors for SCM [age ≥ 87 years: odds ratio (OR) = 3.491, 95% confidence interval (95%CI) was 1.371-8.893, P = 0.009; NT-proBNP ≥ 3 000 ng/L: OR = 2.708, 95%CI was 1.093-6.711, P = 0.031; RR ≥ 30 times/min: OR = 3.404, 95%CI was 1.356-8.541, P = 0.009; Lac ≥ 3 mmol/L: OR = 3.572, 95%CI was 1.460-8.739, P = 0.005; SOFA ≥ 10 points: OR = 8.693, 95%CI was 2.541-29.742, P = 0.001]. The clinical diagnostic score system of SCM was established successfully, which was composed of age ≥ 87 years old (1 point), NT-proBNP ≥ 3 000 ng/L (1 point), RR ≥ 30 times/min (1 point), Lac ≥ 3.0 mmol/L (1 point), SOFA ≥ 10 points (2 points), and the total score was 6 points. ROC curve analysis showed the cut-off value of the scoring system for diagnosing SCM was 3 points, the area under ROC curve (AUC) was 0.833, 95%CI was 0.755-0.910, P < 0.001, with the sensitivity of 71.4%, and specificity of 86.7%. The clinical diagnostic scoring system has good diagnostic efficacy for SCM and contributes to early identification of SCM for clinicians.

Feasibility of pulse oxygen saturation for the condition evaluation of acute respiratory distress syndrome patients in the Lijiang region

To explore the feasibility of using pulse oxygen saturation (SpO2) to evaluate the condition of patients with acute respiratory distress syndrome (ARDS) in the Lijiang region. Patients with ARDS who visited the department of emergency of People's Hospital of Lijiang from August to December 2020 were selected as study subjects. Patients were divided by severity into mild ARDS group [200 mmHg (1 mmHg = 0.133 kPa) ≤ oxygenation index (PaO2/FiO2, P/F) ≤ 300 mmHg] and moderate to severe ARDS group (P/F ≤ 200 mmHg). The general condition, clinical diagnosis, arterial blood gas analysis results of the patients were recorded, and the differences of the above indexes between the two groups of ARDS were compared. Spearman correlation analysis was used to analyze the correlation between SpO2 and arterial oxygen saturation (SaO2). SpO2 was carried into the Ellis equation and the Rice equation to calculate the derived P/F and analyze the correlation between the derived P/F and the P/F measured in arterial blood gas analysis; receiver operator characteristic curve (ROC curves) were plotted, the sensitivity and specificity of SpO2/fraction of inspiration oxygen (SpO2/FiO2, S/F) instead of P/F to assess oxygenation in patients with ARDS was calculated. To evaluate the feasibility of SpO2 for the condition evaluation of patients with ARDS in the Lijiang region. Compared with the mild ARDS group, the arterial partial pressure of oxygen (PaO2), SaO2 and hemoglobin (Hb) were significantly decreased in the moderate to severe ARDS group [PaO2 (mmHg): 50.5 (39.3, 56.5) vs. 60.0 (55.0, 67.5), SaO2: 0.86 (0.73, 0.91) vs. 0. 93 (0.90, 0.96), Hb (g/L): 142±27 vs. 156±24, respectively, all P < 0.05]. Correlation analysis revealed a significant positive correlation between SpO2 and SaO2 in ARDS patients residing at high altitude (R = 0.650, P = 0.000). The P/F derived by the Rice formula was significantly and positively correlated with the P/F derived from arterial blood gas analysis (R = 0.802, P = 0.000). The deduced P/F in mild and moderate to severe ARDS groups were all significantly correlated with the measured P/F (R values were 0.562, 0.647, both P = 0.000). The P/F derived using the Ellis formula showed a significant positive correlation with the P/F derived from arterial blood gas analysis (R = 0.822, P = 0.000). The deduced P/F of mild ARDS group and moderate to severe ARDS group were all positively correlated with the measured P/F (R values were 0.556, 0.589, P values were 0.000, 0.010). There was a significant positive correlation between S/F and P/F in ARDS patients (R = 0.828, P = 0.000), and the regression equation was S/F = 1.33 P/F+52.41. ROC curve analysis showed that S/F had some predictive value for patients with mild and moderate to severe ARDS, and area under ROC curve (AUC) and 95% confidence interval (95%CI) were 0.903 (0.829-0.977), 0.936 (0.870-1.000), both P = 0.000. When the cut-off value was 452 mmHg, S/F had a sensitivity of 100% and a specificity of 80.9% for predicting mild ARDS. When the cut-off value was 319 mmHg, S/F predicted moderate to severe ARDS with 95.1% sensitivity and 86.2% specificity. At high altitude, SpO2 and SaO2 have been correlated in patients with ARDS, and P/F derived using SpO2 and measured P/F were significantly correlated in patients with ARDS, especially in those with moderate to severe ARDS. SpO2 may be useful in the assessment of severity of illness in patients with ARDS at high altitude.

Impact of Personal Protective Equipment on Out-of-Hospital Cardiac Arrest Resuscitation in Coronavirus Pandemic.

BackgroundandObjectives: This retrospective study evaluated the clinical impact of enhanced personal protective equipment (PPE) on the clinical outcomes in patients with out-of-hospital cardiac arrest. Moreover, by focusing on the use of a powered air-purifying respirator (PAPR), we investigated the medical personnel’s perceptions of wearing PAPR during cardiopulmonary resuscitation. Materialsand Methods: According to the arrival time at the emergency department, the patients were categorized into a conventional PPE group (1 August 2019 to 20 January 2020) and an enhanced PPE group (21 January 2020, to 31 August 2020). The primary outcomes of this analysis were the return of spontaneous circulation (ROSC) rate. Additionally, subjective perception of the medical staff regarding the effect of wearing enhanced PPE during cardiopulmonary resuscitation (CPR) was evaluated by conducting a survey. Results: This study included 130 out-of-hospital cardiac arrest (OHCA) patients, with 73 and 57 patients in the conventional and enhanced PPE groups, respectively. The median time intervals to first intubation and to report the first arterial blood gas analysis results were longer in the enhanced PPE group than in the conventional PPE group (3 min vs. 2 min; p = 0.020 and 8 min vs. 3 min; p < 0.001, respectively). However, there were no significant differences in the ROSC rate (odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.38–1.67; p = 0.542) and 1 month survival (OR 0.38, 95% CI: 0.07–2.10; p = 0.266) between the two groups. In total, 67 emergent department (ED) professionals responded to the questionnaire. Although a significant number of respondents experienced inconveniences with PAPR use, they agreed that PAPR was necessary during the CPR procedure for protection and reduction of infection transmission. Conclusion: The use of enhanced PPE, including PAPR, affected the performance of CPR to some extent but did not alter patient outcomes. PAPR use during the resuscitation of OHCA patients might positively impact the psychological stability of the medical staff.

Healthcare utilization and psychiatric and physical comorbidities before suicide mortality in patients with methamphetamine use disorder: A nationwide case–control study

BackgroundSince the late 1990s, methamphetamine use has become a considerable public health concern. Despite high suicide rates among methamphetamine users, studies exploring medical utilization and psychiatric and physical comorbidities before suicide are scant. We aim to examine the pattern of medical utilization and distribution of comorbidities shortly before suicide in methamphetamine users who died of suicide and compared these data with those of living methamphetamine users. MethodsFrom Taiwan’s National Health Insurance Research Database, we identified the cohort with methamphetamine use disorder (n = 23,248) between January 1, 2001, and December 31, 2005. We identified 5972 deceased patients (of whom 745 died of suicide) by linking each patient with the national mortality database during the study period. By conducting a nested case–control study with risk-set sampling, from the methamphetamine cohort, we selected four age- and sex-matched controls for each patient who died of suicide (cases). We applied conditional logistic regression to investigate differences in medical utilization and physical and psychiatric comorbidities between cases and controls. ResultsCases had higher medical utilization within 3 months before suicide, particularly in the departments of psychiatry, internal medicine, emergency, and family practice. Cases had higher risks of physical comorbidities, including pneumonia and renal disease, and psychiatric comorbidities, including depressive disorder, sleep disorder, drug-induced mental disorder, schizophrenia, and bipolar disorder. ConclusionsThe findings of increased medical utilization and the higher risks of physical and psychiatric comorbidities in cases are crucial for developing specific interventions to prevent suicide in this patient population.

Expression of F0 ATP synthase C subunit in serum of patients with ischemic heart disease and its clinical implications

To investigate the expression and clinical significance of F0 ATP synthase C subunit (Csub) in patients with ischemic heart disease (IHD). The 101 patients with chest pain admitted to the department of emergency of the People's Hospital of Yuhuan from May 2019 to December 2020 were enrolled, including 59 patients with acute myocardial infarction (AMI) and 42 patients with unstable angina pectoris (UAP). At the same time, 50 age-matched healthy subjects in the health examination center were selected as the healthy control (HC). All patients had completed blood sampling before the intervention of drugs or other intervention measures in the emergency room. The content of serum Csub was detected by enzyme linked immunosorbent assay (ELISA), and the relationship between Csub and clinical characteristics was analyzed. At the same time, the contents of hypersensitivity cardiac troponin T (hs-cTnT) and MB isoenzyme of creatine kinase (CK-MB) in blood were detected by electrochemical luminescence. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the value of Csub, hs-cTnT, and CK-MB in the early diagnosis of IHD. The baseline data such as age, gender, and history of the three groups were balanced. There were significant differences in low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), CK-MB, hs-cTnT and B-type natriuretic peptide (BNP), but there were no significant differences in other biochemical indexes. The Csub content in the AMI group and the UAP group were significantly higher than those in the HC group [8.96% (6.37%, 11.53%), 4.27% (3.23%, 6.49%) vs. 1.56% (1.07%, 2.33%), both P < 0.01]. Moreover, the Csub in the AMI group with more severe myocardial ischemia was higher than UAP group [8.96% (6.37%, 11.53%) vs. 4.27% (3.23%, 6.49%), P < 0.01]. A total of 59 patients with AMI were treated with percutaneous coronary intervention (PCI). According to the median of Csub, AMI patients were subdivided into above-median group (29 cases) and below-median group (30 cases). The results showed that there were no significant differences in the number of coronary artery lesion branches, the number of stent implantation and postoperative medication between the two groups. ROC curve analysis showed that the area under the curve (AUC) and 95% confidence interval (95%CI) of Csub, hs-cTnT and CK-MB in the diagnosis of IHD were 0.98 (0.95-1.00), 0.99 (0.99-1.00), 0.94 (0.89-0.99), respectively. The diagnostic efficacy of Csub was slightly lower than that of hs-cTnT but higher than that of CK-MB. When the cut-off value of Csub was 4.74%, the sensitivity and specificity for the diagnosis of IHD were 100% and 87.0%, respectively. Csub increased significantly in the serum of IHD patients, and further increased with the severity of ischemia. It can be used as a new diagnostic biomarker for the diagnosis and evaluation of the development of myocardial ischemia.

The role of first-aid network construction in the early treatment of patients with critically severe hydrofluoric acid burns

Objective: To explore the role of first-aid network construction in the early treatment of patients with critically severe hydrofluoric acid burns. Methods: Twenty-seven fluorine chemical enterprises distributed in Zhejiang province, Jiangxi Province, Fujian Province, and Inner Mongolia Autonomous Region and 22 hospitals with burn/plastic department or professional burn treatment group in Zhejiang province, including Zhejiang Quhua Hospital, and 5 hospitals outside Zhejiang province were involved in the first-aid network construction as member units. As the main unit, Zhejiang Quhua Hospital was responsible for the daily maintenance and technical guidance of the first-aid network. Zhejiang Quhua Hospital was assigned as the designated emergency hospital for 20 fluorine chemical enterprises, a near emergency hospital to the other 7 fluorine chemical enterprises was assigned as the designated hospital for them. Medical records of 56 patients (all males) with critically severe hydrofluoric acid burns who admitted to 5 first-aid network hospitals from January 2006 to June 2021, meeting the inclusion criteria, were involved in the retrospective cohort study. Based on whether the enterprise belonging to the first-aid network construction or not, the patients were divided into first-aid network group (27 cases, aged (41±9) years) and non first-aid network group (29 cases, aged (42±10) years). After the patients in the first-aid network group were injured, the enterprises and hospitals linked up immediately. The hospital where the patient was treated mobilize the treatment force, equipment, materials, and drugs in advance by the first-aid network, thereby realizing seamless joint between pre-hospital first-aid and in-hospital treatment. The hospital started the first-aid process and temporarily mobilized the rescue forces, equipment, materials, and drug after patients in non first-aid network group arrived at the department of emergency of the hospital. The time from injury to medical service, the first detection time of serum calcium, the time staying in department of emergency, the duration of hypocalcemia and hypomagnesemia, and the treatment outcome of patients in the two groups were recorded. Data were statistically analyzed with chi-square test, Fisher's exact probability test, independent-sample t test, and Wilcoxon rank-sum test. Results: The time from injury to medical service, the first detection time of serum calcium, and the time staying in department of emergency of patients in first-aid network group were 40.0 (30.0, 55.0), 23.0 (17.5, 37.5), and 42.0 (37.0, 53.0) min, which were significantly shorter than 180.0 (120.0, 240.0), 31.0 (22.5, 47.5), 61.0 (52.0, 65.5) min in non first-aid network group (Z=-6.17, -1.98, -4.15, P<0.05 or P<0.01). The duration of hypocalcemia and hypo- magnesemia of patients in first-aid network group were 1.2 (1.1, 1.6) and 1.9 (1.7, 2.1) h, which were significantly shorter than 4.6 (3.1, 6.2) and 3.2 (2.5, 4.6) h in non first-aid network group (Z=-5.80, -4.81, P<0.01). Three patients (11.1%) in first-aid network group died, among whom 2 patients died at 40 min after injury and 1 patient died 9.0 h after injury. Four patients (13.8%) died in non first-aid network group at 3.0, 3.0, 4.5, and 7.0 h after injury, respectively. The mortality rates of patients in the two groups were similar (P>0.05). Conclusions: Critically severe hydrofluoric acid burn is an extremely urgent situation encountered in clinical practice. The construction of a first-aid network creates condition for on-site treatment of patients and improves the first-aid efficiency, thereby gaining time to save lives.

"We All Held Our Own": Job Demands and Resources at Individual, Leader, Group, and Organizational Levels During COVID-19 Outbreak in Health Care. A Multi-Source Qualitative Study.

Background:Interventions tackling COVID-19 impact on health care workers’ mental health would benefit from being informed by validated and integrated assessment frameworks. This study aimed to explore the fitness of integrating the Job Demands-Resources (JD-R) model and the Individual-Group-Leader-Organization (IGLO) framework to investigate the pandemic’s impact on health care workers’ mental health.Methods:Qualitative data were collected via 21 semi-structured interviews with senior and middle managers and four focus groups with employees (doctors, nurses, health care assistants) from three areas (Department of Emergency, Department of Medicine, Research Institute of Neuroscience) of a large health care institution facing the first wave of COVID-19. NVivo deductive content analysis of text data was performed.Findings:Several COVID-19-related job demands and resources were found at IGLO levels. Individual-level demands included emotional load, while resources included resilience and motivation. Group-level demands included social distancing, while resources included team support and cohesion. Leader-level demands included managers’ workload, while resources included leader support. Organizational-level demands included work reorganization, while resources included mental health initiatives.Conclusions/Application to Practice:Integrating JD-R and IGLO proved feasible, as job demands and resources could be categorized according to the individual, group, leader, and organization framework. The findings expand previous studies by filling the lack of knowledge on how job demands and resources might unfold at different workplace levels during a pandemic. Results provide unit-level evidence for designing and implementing multilevel interventions to manage health care workers’ mental health during COVID-19 and future pandemics. Our findings offer occupational health practitioners a suitable approach to perform workplace mental health assessment activities.

Patients presented in emergency department of SRD with headache as symptom of COVID-19

To see the patients presented in the Emergency Department of SRD with headache as a symptom of COVID-19. We have seen frequency and characteristic of headache in 180 patients in an emergency with a test of polymerase chain reaction positive. These patients are presented in period 1 August 2020 until 31 December 2020 with the headache as the first symptom of COVID – 19. The most of cases was reported in man 56% (101 patients) and mid-age of cases were 52.5 years. The most of patients 62% (112 patients) had a very severe intensity of headache and it was diffuse or more in the frontal area (in 90% of these groups). 38% of patients had moderate headache, and a part of all patients 22% (40 patients) had characteristics of migraine with hemicrania and nausea and vomitus and photophobia (this was seen more in patients that had experience migraine before, p < 0.05). In 25% of all patients (45) had continuous headaches without a period of free pain even after administration of analgesic therapy. A part of patients 34% (61 patients) had anosmia as accompanied symptom. All cases had seen by a neurologist that did suggestions for all examinations that were necessary. In our Department of Emergency, we have seen a closed correlation of headaches with COVID-19. The most of patients had headache the only symptom in the first days of covid-19 and it was in general severe, diffuse, and in some patients as a migraine phenotype.

The game of safety behaviors among different departments of the nuclear power plants

To study the developments and variations of unsafe behaviors in nuclear power plants thus reduce the possibility of human-related accidents, this paper, based on the Game Theory, focused on the changes in benefits of the Department of Management, Operational and Emergency in a nuclear power plant, and established the expected revenue functions of these departments. Additionally, the preventive measures of unsafe behaviors in nuclear power plants were also presented in terms of these 3 departments. Results showed that the violations of the Operation Department (OD) and the Emergency Department (ED) were not only relevant with the factors such as their own risks, costs, and the responsibility-sharing due to accidents, but also affected by the safety investments from the Management Department (MD). Furthermore, results also showed that the accident-induced responsibility-sharing of both the OD and the ED would rise, if the MD increased the investments in safety. As a result, the probability of violation behaviors of these 3 departments would be attenuated consciously, which would reduce the unsafe behaviors in the nuclear power plants significantly.

English

BACKGROUND Intestinal obstruction can be defined as the partial or complete blockage of either the small intestine or large intestine or both, causing failure of intestinal contents to pass beyond the point of obstruction. Subacute intestinal obstruction implies incomplete obstruction. It is characterized by continuous passage of flatus and /or feces beyond 6 -12 hours of the onset of symptoms. We wanted to study the conservative management of subacute intestinal obstruction and its outcome. METHODS Data was collected from patients presenting to outpatient Department of General Surgery, SVRRGGH, Tirupati and emergency with the features of subacute intestinal obstruction during the period of March 2019 to April 2020 were included in the study. RESULTS The incidence is high in patients of age group 41-50 years with Male: Female ratio is 2.1:1. The most common presenting symptom is pain abdomen (92 %), followed by vomiting (84 %). In our study, exaggerated bowel sounds (60 %) are the most common physical finding. The most common cause of obstruction is Postoperative adhesions (36 %), followed by obstructed hernias (22 %). Out of 50 cases, 72 % of cases were managed successfully by conservative management. In the patients who were managed conservatively, most of them are due to postoperative adhesions. In the patients who underwent emergency surgical intervention, 50 % of cases operated on the 2nd day of admission. Most commonly done Surgery include Adhesiolysis (28.6 %), Herniorrhaphy (28.6 %) and Resection and anastomosis (21.5 %). CONCLUSIONS Our study showed that conservative management is successful in about 72 % of patients with subacute intestinal obstruction. Not all the patients attending the emergency ward with features of intestinal obstruction need emergency surgical intervention. Conservative management can be tried in selective cases in patients with SAIO, thereby reducing the rate of negative laparotomies and morbidity and mortality. KEYWORDS Sub-Acute, Intestinal, Obstruction Conservative, Outcome

Relationship between 25-hydroxyvitamin D and infarction volume in patients with acute ischemic stroke in anterior circulation

To investigate the correlation between the level of serum 25-hydroxyvitamin D [25(OH)D] and infarction volume in patients with acute ischemic stroke (AIS) with internal carotid artery system (anterior circulation). A prospective cohort study was conducted. Patients with AIS admitted to the department of emergency of Beijing Boai Hospital from October 2017 to September 2019 were enrolled. Nutritional risk screening 2002 (NRS 2002) were assessed in all cases within 24 hours after enrollment. Fasting venous blood was collected for biochemical analysis, including albumin (ALB), homocysteine (HCY), uric acid (UA), hypersensitive C-reactive protein (hs-CRP), etc. Serum 25(OH)D level was detected by electrochemiluminescence immunoassay. Magnetic resonance imaging (MRI) was performed to calculate the volume of cerebral infarction. According to the volume of cerebral infarction, the patients were divided into small volume (≤ 1 cm3) group, medium volume (1 cm3 < infarct volume < 20 cm3) group and large volume (≥ 20 cm3) group. The differences of serum 25(OH)D and other indicators in each group were compared; the influencing factors of infarct volume were analyzed by Logistic regression; and the goodness of fit of regression model was tested by Hosmer-Lemeshow (HL). A total of 224 patients with AIS were enrolled, 92 in small volume group, 90 in medium volume group and 42 in large volume group, and there was no significant difference in serum 25(OH)D level among small, medium and large volume groups [μg/L: 13.21 (7.47, 19.33), 11.20 (7.00, 15.07), 9.19 (6.30, 17.10), H = 4.994, P = 0.082]. There were 124 patients with AIS in anterior circulation, 45, 56 and 23 patients in the small, medium and large volume groups, respectively, with the increase of the cerebral infarction volume, the serum 25(OH)D level in small, medium and large volume groups decreased gradually, and the difference was statistically significant [μg/L: 13.22 (9.00, 19.65), 10.41 (6.72, 14.92), 8.30 (4.70, 11.30), H = 11.068, P = 0.004]. In addition, with the increase of the cerebral infarction volume, the older the patients with AIS in anterior circulation [years old: 63.0 (54.0, 75.5), 76.0 (63.0, 84.0), 82.0 (67.5, 85.0), H = 14.981, P = 0.001], the higher the nutritional risk ratio (35.6%, 53.6%, 73.9%, χ2 = 9.271, P = 0.010), the higher the serum hs-CRP level [mg/L: 1.91 (0.92, 3.40), 4.10 (1.73, 22.42), 19.74 (4.02, 68.81), H = 21.477, P < 0.001], and the lower the ALB level (g/L: 42.30±12, 38.11±5.06, 35.14±5.49, F = 19.347, P < 0.001). After adjusting for age, gender, atrial fibrillation, nutritional risk, hs-CRP and other confounding factors, serum 25(OH)D was an independent protective factor for the infarct volume of AIS in anterior circulation [odds ratio (OR) = 0.962, P = 0.040], For every 10 μg/L decrease of 25(OH)D, the risk of one grade increase in infarction volume was increased by 47.7% respectively (goodness of fit: χ2 = 5.357, P = 0.719). The low serum 25(OH)D level was associated with the increase of infarct volume in the anterior circulation cerebral infarction, and early detection of serum 25(OH)D level can help risk stratification of AIS patients.

A SEVERE STENOSIS OF THE PROXIMAL SEGMENT OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY PRESENTING WITH AN INFERO-LATERO-BASAL ST-ELEVATION MYOCARDIAL INFARCTION : A CASE REPORT

A 57-years-old man presented in our department of emergency with an acute chest pain infarct-like. The electrocardiogram realised showed an ST elevation in the infero-latero-basal leads suggesting an occlusion of the right coronary artery or the left circumflex coronary artery. However, the coronary angiography that was performed showed a subocclusion of the proximal left anterior descending coronary artery, in contrast to the expected results. This case was reported using electrocardiography and coronary angiography data and the electrocardiogram changes after a percutaneous coronary intervention. The particularity of this case lies in the lack of correlation between the electrocardiographic Changes and the Coronary Angiographic Findings.

Web Exclusive. Annals Graphic Medicine - COVID-19 and My Self-made Electronic Stethoscope.

Web ExclusivesAugust 2021Annals Graphic Medicine - COVID-19 and My Self-made Electronic StethoscopeFREEHongguang Ding, MD, Mengting Liu, MB, Yin Wen, MB, Shiying Zhang, MB, and Hongke ZengHongguang Ding, MDGuangdong Provincial People's Hospital, Guangzhou, China (H.D., M.L., Y.W., S.Z., H.Z.)Search for more papers by this author, Mengting Liu, MBGuangdong Provincial People's Hospital, Guangzhou, China (H.D., M.L., Y.W., S.Z., H.Z.)Search for more papers by this author, Yin Wen, MBGuangdong Provincial People's Hospital, Guangzhou, China (H.D., M.L., Y.W., S.Z., H.Z.)Search for more papers by this author, Shiying Zhang, MBGuangdong Provincial People's Hospital, Guangzhou, China (H.D., M.L., Y.W., S.Z., H.Z.)Search for more papers by this author, and Hongke ZengGuangdong Provincial People's Hospital, Guangzhou, China (H.D., M.L., Y.W., S.Z., H.Z.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G21-0027 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Download figure Download PowerPoint Download figure Download PowerPoint Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Guangdong Provincial People's Hospital, Guangzhou, China (H.D., M.L., Y.W., S.Z., H.Z.)Disclosures: The authors have reported no disclosures of interest. The forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G21-0027.Corresponding Author: Hongke Zeng, Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China; e-mail, [email protected]org.cn.Author/Illustrator Information: Hongguang Ding, Mengting Liu, Yin Wen, and Shiying Zhang are all physicians in the Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences.This article was published at Annals.org on 27 July 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics August 2021Volume 174, Issue 8Page: W91-W93 ePublished: 27 July 2021 Issue Published: August 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...