Emergency Medical Conditions Research Articles

Cross sectional observational study to assess the knowledge of drugs utilized in emergency medical conditions amongst medical interns and residents in tertiary care teaching hospital

Background: Medical interns and residents are future medical professionals and as first-line responders, they may confront any type of emergency. Knowledge of pharmacotherapeutics (PTs) is the backbone of emergency care. Therefore, this study is designed to assess PTs’ knowledge and identify the lacunae in handling various medical emergencies among medical interns and residents.Methods: This was a cross-sectional, observational, questionnaire-based study. A self-structured questionnaire containing 30 close-ended questions, assessing the knowledge of drugs utilized in various medical emergency conditions was prepared and circulated in the form of a Google form. A credit score of “1” was given for each correct response. Grading of knowledge was done as “poor” (≤50%), “average” (>50-70%), and “adequate” (>70%-100%) The student’s unpaired t-test was used to analyse the data.Results: A total of 282 candidates responded, with 148 (52.48 %) interns and 134 (47.52%) residents. Participants had the least knowledge of PTs for anaphylactic shock. Participants’ knowledge of PTs was found to be adequate regarding the central nervous system and electrolyte disorders while average regarding toxicology, immunization, and endocrine system. Results suggested that residents (mean score: 21.42±5.06) were significantly (p=0.0165) more knowledgeable than interns (mean score: 19.96±5.08). Among respondents, 17.6% of interns and 13.4% of residents had poor performance while 45.9% of interns and 53.7% of residents had adequate performance.Conclusions: The current study provides valuable information regarding the state of PTs’ knowledge in medical emergencies among interns and residents, which can be used to improve undergraduate as well as postgraduate training.

Guest editorial: Decision making and control for connected and automated vehicles

Guest editorial: Decision making and control for connected and automated vehicles

Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses.

BackgroundApart from infecting a large number of people around the world and causing the death of many people, the COVID-19 pandemic seems to have changed the healthcare processes of other diseases by changing the allocation of health resources and changing people’s access or intention to healthcare systems.ObjectiveTo compare the incidence of endpoints marking delayed healthcare seeking in medical emergencies, before and during the pandemic.MethodsBased on a PICO model, medical emergency conditions that need timely intervention was selected to be evaluated as separate panels. In a systematic literature review, PubMed was quarried for each panel for studies comparing the incidence of various medical emergencies before and during the COVID-19 pandemic. Markers of failure/disruption of treatment due to delayed referral were included in the meta-analysis for each panel.ResultThere was a statistically significant increased pooled median time of symptom onset to admission of the acute coronary syndrome (ACS) patients; an increased rate of vasospasm of aneurismal subarachnoid hemorrhage; and perforation rate in acute appendicitis; diabetic ketoacidosis presentation rate among Type 1 Diabetes Mellitus patients; and rate of orchiectomy among testicular torsion patients in comparison of pre-COVID-19 with COVID-19 cohorts; while there were no significant changes in the event rate of ruptured ectopic pregnancy and median time of symptom onset to admission in the cerebrovascular accident (CVA) patients.ConclusionsCOVID-19 has largely disrupted the referral of patients for emergency medical care and patient-related delayed care should be addressed as a major health threat.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12992-022-00836-2.

Attitudes and Beliefs of Patients With Left-Ventricular Assist Devices Toward COVID-19 Vaccination and Willingness to Seek Care During the Pandemic.

Given the stalling improvement in vaccine hesitancy rates in the United States (US), it is important to understand why a chronically ill group, patients with left-ventricular assist devices (LVADs), might not get vaccinated and to delineate the barriers they may face in seeking care. We conducted an online survey to characterize the attitudes of patients with LVADs toward COVID-19 vaccination, identify their willingness to seek care during the pandemic, and characterize barriers to doing so. Our survey showed that the rate of vaccine hesitancy among LVAD patients is similar to that of the general population in the US. This rate is higher than expected for a chronically ill group at risk of severe COVID-19 infection. We also found that LVAD patients perceive barriers to seeking care during the pandemic. We recommend that LVAD care teams emphasize that patients should seek care for emergency medical conditions despite their fears of contracting COVID-19. Based on our results, we also recommend vaccine uptake education for this population focused on patients' concerns about serious side effects and not enough research done on the vaccine.

A qualitative study of an undergraduate online emergency medicine education program at a teaching Hospital in Kampala, Uganda

BackgroundGlobally, half of all years of life lost is due to emergency medical conditions, with low- and middle-income countries (LMICs) facing a disproportionate burden of these conditions. There is an urgent need to train the future physicians in LMICs in the identification and stabilization of patients with emergency medical conditions. Little research focuses on the development of effective emergency medicine (EM) medical education resources in LMICs and the perspectives of the students themselves. One emerging tool is the use of electronic learning (e-learning) and blended learning courses. We aimed to understand Uganda medical trainees’ use of learning materials, perception of current e-learning resources, and perceived needs regarding EM skills acquisition during participation in an app-based EM course.MethodsWe conducted semi-structured interviews and focus groups of medical students and EM residents. Participants were recruited using convenience sampling. All sessions were audio recorded and transcribed verbatim. The final codebook was approved by three separate investigators, transcripts were coded after reaching consensus by all members of the coding team, and coded data were thematically analyzed.ResultsTwenty-six medical trainees were included in the study. Analysis of the transcripts revealed three major themes: [1] medical trainees want education in EM and actively seek EM training opportunities; [2] although the e-learning course supplements knowledge acquisition, medical students are most interested in hands-on EM-related training experiences; and [3] medical students want increased time with local physician educators that blended courses provide.ConclusionsOur findings show that while students lack access to structured EM education, they actively seek EM knowledge and practice experiences through self-identified, unstructured learning opportunities. Students value high quality, easily accessible EM education resources and employ e-learning resources to bridge gaps in their learning opportunities. However, students desire that these resources be complemented by in-person educational sessions and executed in collaboration with local EM experts who are able to contextualize materials, offer mentorship, and help students develop their interest in EM to continue the growth of the EM specialty.

Evaluating spatial accessibility to healthcare services from the lens of emergency hospital visits based on floating car data

ABSTRACT Public medical facilities that are closely related to the health of residents have been recognised as one of the most crucial elements in sustainable urban planning. For the sake of social equality of medical services (especially for emergency medical conditions), the spatial distributions of medical resources need to be accurately measured and continuously optimized. This study presents an effective method to examine night emergency hospital visit and analyse its spatiotemporal characteristics using float car data (FCD). By extracting the hospital service areas, the two-step floating catchment area (2SFCA) methodology was improved to calculate hospital accessibility. Then, the balance between hospital accessibility and population density was analysed. In addition, we investigated the relationship between individual hospital choice preferences and hospital level and analysed several factors that affect individual choices. These results help us understand the special requirements and need of emergency hospital travel in cities and identify areas where medical resources are scarce. They can be used as guidance for urban hospital planning and construction. And the approach of hospital access behaviour investigation and the improved 2SFCA method can also provide insights for other activity-based travel behaviour research.

Role of mHealth applications for emergency medical system activation in reducing mortality in low-income and middle-income countries: a systematic review protocol

IntroductionPrehospital care is an essential component in reducing mortality for patients presenting with emergency medical conditions. Prehospital systems tend to be underdeveloped or non-existent in these areas, with less than...

Signal from the noise: A mixed graphical and quantitative process mining approach to evaluate care pathways applied to emergency stroke care

ObjectiveMapping real-world practice patterns vs. deviations from intended guidelines and protocols is necessary to identify and improve the quality of care for emergent medical conditions like acute ischemic stroke. Most status-quo process identification relies on expert opinion or direct observation, which can be biased or limited in scalability. We propose a mixed graphical and quantitative process mining approach to Electronic Health Record (EHR) event log data as a unique opportunity not only to more easily identify practice patterns, but also to compare real-world care processes and measure their conformance or variability. MaterialsData was obtained from the event log of a major EHR vendor (Epic) for Stanford Health Care Hospital patients aged 18 years and older presenting to the ED from January 1, 2010 through December 31, 2018 and receiving tPA (tissue plasminogen activator) within 4.5 h of presentation. MethodsWe developed an unsupervised process-mining algorithm to create a process map from clinical event logs. The method first identifies the most common events across the cohort. Then, all possible ordered events are recorded, and a summarized vector of nodes (events) and edges (events occurring in series) are mapped by their timing and probability. The highest probability ordered pairs are used to identify the most common path. We define measures for individual pathways conformity and average conformity across all encounters. ResultsAutomatically generated process mining graphs, and specifically it’s the most common path, mimicked our institutions recommended “code stroke” clinical pathway. The average conformity score for our cohort was 0.36 (i.e. paths had an average of 36% overlap with all possible paths), with a range from high of 0.64 and low of 0.20. DiscussionThis method allows for unsupervised visualization of the current state of common processes as well as their most common path, which can then be used to calculate the conformity of individual pathways through this process. These results may be used to evaluate the consistency of quality care at a given institution. It may also be extended to other common processes like sepsis or myocardial infarction care or even those which currently lack standardized clinical pathways. ConclusionOur mixed graphical and quantitative process mining approach represents an essential data analysis step to improve complex care processes by automatically generating qualitative and quantitative process measures from existing event log data which can then be used to target quality improvement initiatives.

The status and future of emergency care in the Republic of Kenya.

Kenya is a rapidly developing country with a growing economy and evolving health care system. In the decade since the last publication on the state of emergency care in Kenya, significant developments have occurred in the country's approach to emergency care. Importantly, the country decentralized most health care functions to county governments in 2013. Despite the triple burden of traumatic, communicable, and non-communicable diseases, the structure of the health care system in the Republic of Kenya is evolving to adapt to the important role for the care of emergent medical conditions. This report provides a ten-year interval update on the current state of the development of emergency medical care and training in Kenya, and looks ahead towards areas for growth and development. Of particular focus is the role emergency care plays in Universal Health Coverage, and adapting to challenges from the devolution of health care.

Understanding factors impacting global priority of emergency care: a qualitative policy analysis

IntroductionThe high burden of emergency medical conditions has not been met with adequate financial and political prioritisation especially in low and middle-income countries. We examined the factors that have shaped...

EMERGENCY CONDITIONS AS SIMULATION MEDICAL SCENARIOS FOR APPLICANTS OF EDUCATION

Emergency conditions are very life-threatening situations and require fast actions and immediate intervention from medical stuff. For young doctors without extensive experience in the treatment of these important diseases, it is very crucial to know and timely apply modern treatment algorithms. Simulation medical scenarios are a good approach and can help to improve knowledge and practical skills. Authors provide frequent trainigs for students and interns for emergency medical conditions according to world standards and University syllabus. The main idea is to create new and improve old practical skills and competencies for students and interns.

Neuroradiological emergency consultations during the first year of the COVID-19 pandemic

BackgroundMeasures taking aim at minimizing the risk of coronavirus transmission and fear of infection may affect decisions to seek care for other medical emergency conditions. The purpose of this analysis was to analyze intermediate-term effects of the COVID-19 pandemic on neuroradiological emergency consultations (NECs).MethodsWe conducted an ambispective study on NEC requests to a university hospital from a teleradiological network covering 13 hospitals in Germany. Weekly NEC rates for prepandemic calendar weeks (CW) 01/2019–09/2020 were compared with rates during first COVID-19 wave (CW 10–20/2020), first loosening of restrictions (CW 21–29/2020), intensified COVID-19 testing (CW 30–39/2020) and second COVID-19 wave (CW 40–53/2020), and contrasted with COVID-19 incidence in Germany.ResultsA total of n = 10 810 NECs were analyzed. Prepandemic NEC rates were stable over time (median: 103, IQR: 97–115). Upon the first COVID-19 wave in Germany, NEC rates declined sharply (median: 86, IQR: 69–92; p < 0.001) but recovered within weeks. Changes in NEC rates after first loosening of restrictions (median: 109, IQR: 98–127; p = 0. 188), a phase of intensified testing (median: 111, IQR: 101–114; p = 0.434) and as of a second COVID-19 wave (median: 102, IQR: 94–112; p = 0. 462) were not significant. Likewise, patient age and gender distribution remained constant.ConclusionUpon the first pandemic COVID-19 wave in Germany, NEC rates declined but recovered within weeks. It is unknown whether this recovery reflects improved medical care and test capabilities or an adjustment of the patients’ behaviour.

Modular Platform for the Development of Recombinant Hemoglobin Scavenger Biotherapeutics.

Cell-free hemoglobin (Hb) is a driver of disease progression in conditions with intravascular or localized hemolysis. Genetic and acquired anemias or emergency medical conditions such as aneurysmal subarachnoid hemorrhage involve tissue Hb exposure. Haptoglobin (Hp) captures Hb in an irreversible protein complex and prevents its pathophysiological contributions to vascular nitric oxide depletion and tissue oxidation. Preclinical proof-of-concept studies suggest that human plasma-derived Hp is a promising therapeutic candidate for several Hb-driven diseases. Optimizing the efficacy and safety of Hb-targeting biotherapeutics may require structural and functional modifications for specific indications. Improved Hp variants could be designed to achieve the desired tissue distribution, metabolism, and elimination to target hemolytic disease states effectively. However, it is critical to ensure that these modifications maintain the function of Hp. Using transient mammalian gene expression of Hp combined with co-transfection of the pro-haptoglobin processing protease C1r-LP, we established a platform for generating recombinant Hp-variants. We designed an Hpβ-scaffold, which was expressed in this system at high levels as a monomeric unit (mini-Hp) while maintaining the key protective functions of Hp. We then used this Hpβ-scaffold as the basis to develop an initial proof-of-concept Hp fusion protein using human serum albumin as the fusion partner. Next, a hemopexin-Hp fusion protein with bispecific heme and Hb detoxification capacity was generated. Further, we developed a Hb scavenger devoid of CD163 scavenger receptor binding. The functions of these proteins were then characterized for Hb and heme-binding, binding of the Hp-Hb complexes with the clearance receptor CD163, antioxidant properties, and vascular nitric oxide sparing capacity. Our platform is designed to support the generation of innovative Hb scavenger biotherapeutics with novel modes of action and potentially improved formulation characteristics, function, and pharmacokinetics.

A Survey on Knowledge of Medical Emergencies and Its Management among the Under-Graduate (UG) Clinical Students of a Dental College in Pondicherry, India

Introduction: Dentist can encounter a medical emergency during any phase of the dental treatment. It isessential for the clinician to accurately identify and manage a life threatening situation in patients undergoingdental treatment. The aim of the present study is to assess the knowledge on medical emergencies and itsmanagement among dental clinical students of a dental college in Pondicherry.Materials and Methods: A retrospective questionnaire study was conducted among 135 under-graduate(UG) students to assess their knowledge on various medical emergency conditions and its management fromtheir level of perception in clinical postings.Results: The overall knowledge regarding identification and management of medical emergencies amongthe study population was found to be inadequate.Conclusion: Every dentist must be prepared for an emergency and believing it can be a real possibilityis of paramount importance. It cannot be completely prevented but efficiently managed with appropriateknowledge of signs, symptoms and management techniques.

Assessing the validity of an OSCE developed to assess rare, emergent or complex clinical conditions in endocrinology & metabolism

BackgroundAssessment of emergent, rare or complex medical conditions in Endocrinology and Metabolism (E&M) is an integral component of training. However, data is lacking on how this could be best achieved. The purpose of this study was to develop and administer an Objective Structured Clinical Examination (OSCE) for E&M residents, and to gather validity evidence for its use.MethodsA needs assessment survey was distributed to all Canadian E&M Program Directors and recent graduates to determine which topics to include in the OSCE. The top 5 topics were selected using a modified Delphi technique. OSCE cases based on these topics were subsequently developed. Five E&M residents (PGY4-5) and five junior Internal Medicine (IM) residents participated in the OSCE. Performance of E&M and IM residents was compared and results were analyzed using a Generalizability study. Examiners and candidates completed a survey following the OSCE to evaluate their experiences.ResultsThe mean score of IM and E&M residents was 41.7 and 69.3 % (p < 0.001), respectively, with a large effect size (partial η2 = 0.75). Overall reliability of the OSCE was 0.74. Standard setting using a borderline regression method resulted in a pass rate of 100 % of E&M residents and 0 % of IM residents. All residents felt the OSCE had high value for learning as a formative exam.ConclusionsThe E&M OSCE is a feasible method for assessing emergent, rare and complex medical conditions and this study provides validity evidence to support its use in a competency-based curriculum.

Comparative profile of refractory status epilepticus models following exposure of cholinergic agents pilocarpine, DFP, and soman

Status epilepticus (SE) is a medical emergency condition with continuous seizure activity that lasts at least 5 min and causes profound neuronal damage, morbidity, or death. SE incidents can arise spontaneously, but mostly are elicited by seizurogenic triggers. Chemoconvulsants such as the muscarinic agonist pilocarpine and organophosphates (OP) such as the pesticide diisopropylfluorophosphate (DFP) and the nerve agent soman can induce persistent seizures and SE. Pilocarpine, DFP, and soman share a common feature of cholinergic crisis that transitions into a state of refractory SE, but their comparative profiles remain unclear. Here, we evaluated the comparative convulsant profile of pilocarpine, DFP, and soman to produce refractory SE and brain damage in rats. Behavioral and electrographic seizures were monitored after agent exposure and the extent of brain injury was determined by histological markers of neuronal injury and degeneration. Seizures were elicited about 10-15 min slower after pilocarpine as compared to DFP or soman, which caused rapid onset of spiking at 8-10 min after challenges that swiftly developed into persistent SE lasting for hours. Time-course of SE activity after DFP was comparable to that after soman, a potent neurotoxic chemical agent. Diazepam controlled pilocarpine-induced SE, but it was ineffective in reducing DFP- and soman-induced SE. All three agents produced 35-45% neuronal injury and neurodegeneration in the brain. These results reveal distinct convulsant and neuronal injury patterns following exposure to cholinergic agonists, OP pesticides, and nerve agents. A battery of SE models is essential to identify novel anticonvulsants or combination therapies that can effectively control refractory SE.

Stevens Johnson Syndrome in Babylon

SJS and TEN are emergency medical conditions, rare but with high mortality rate. They start as flu like illnesswith high fever. They are mucocutaneous disorders Affect mainly the skin, eye, nose, mouth and genitalia,with characteristics rash, blistering, peeling of the skin. Two accused as a cause: certain drugs, and infectionslike Mycoplasma pneumonia. In order to overcome the lack of informative studies about these syndromes,and to lower the high mortality rate associated, we followed the occurrence, diagnosis, management andprognosis of these syndromes in one year field study in the province of Babylon, Iraq from the 1st of March2018 to the 1st of March 2019. The data were taken from the medical records of 4 major hospital in thecenter of AL Hilla city, Iraq (Al Hilla teaching hospital , Merjan teaching hospital Babil teaching hospital,and Al Noor pediatric hospital). Five cases of this syndrome where reported, 3 males and 2 females with agerange 23-30 years. One female survived. Four patients died. Full typical autopsy with necessary laboratorytests where achieved in the department of Forensic Medicine in Babylon. The occurrence of this syndromewas 5 /2 million /year, the diagnosis was delayed and accordingly the management and lines of treatmentwere delayed too, leading to bad prognosis (four deaths, one survival). The mortality rate was 80%. Thedirect causes of death were pneumonia and encephalitis associated with Stevens Johnson Syndrome. Thissyndrome should be kept in mind when prescribing a medication. Early management is leading to goodprognosis

"We are left with nothing to work with"; challenges of nurses working in the emergency unit at a secondary referral hospital: A descriptive qualitative study.

In recent times, there has been an increasing burden in traumatic, medical, and surgical emergency conditions, placing more emphasis on the need for quality emergency care. This study aimed to explore the challenges experienced by nurses working in the emergency unit of a secondary referral hospital. The study used an exploratory qualitative research design with a constructivist approach and a grounded theory method. Data were collected through in-depth interviews lasting between 30 to 45 minutes using a semi-structured interview guide. Inductive content analysis was used to analyse data. Eleven (11) participants were interviewed. The majority were female (9), aged between 31-40 years. From the inductive content analysis, four themes emerged. These were; 1) overcrowding in the emergency unit, 2) understaffing at the emergency unit, 3) lack of emergency equipment, 4) inadequate managerial support. The study identified several major challenges confronting nurses working in the emergency unit which are linked with managerial processes and inadequate managerial support. These challenges need to be addressed to promote quality emergency nursing care. To foster a positive working environment, hospital management should validate and address the aforementioned concerns of the Emergency Department nurses.

Drug Use Review of Intravenous Levetiracetam in Patients with Epilepsy, Tertiary Care Hospital

Background: Epilepsy is a current important health problem. Status epilepticus is a medical emergency condition which may be lifethreatening, increased mortality rate and hospitalization. However, some patients with epilepsy could not control their symptoms and anticonvulsant medications have some adverse effects. Intravenous levetiracetam (ivLEV) is a new antiepileptic drug which its use tends to be increased. Objective: To study the prescription pattern of ivLEV and its adverse drug reactions (ADRs) in hospitalized patients and to define the efficacy of iv LEV as first line treatment for status epilepticus. Materials and Methods: This was a descriptive retrospective study to review medical records of all inpatients receiving ivLEV at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University during January 1st 2010 to December 31st 2014. Results: During the study period, there were 406 hospital visits that met the study criteria. The average age of the patients was 54.32+20.36 years with nearly equal sex distribution. The indications of ivLEV were status epilepticus (22.4%), previous treatment with oral levetiracetam (9.6%), perioperative craniectomy/craniotomy (8.6%), and acute seizure with non-status epilepticus (59%). Most of the patients (63.3%) received ivLEV as first line treatment antiepileptic drug and the most loading dose range of ivLEV that the patients received was 500 to 1,000 mg/day (78.3%). All of the patients had been followed vital signs and plasma electrolytes. 98.5% and 45.8% of hospital visits had been monitored liver/kidney function and electroencephalogram (EEG), respectively. Adverse effects during the treatment of ivLEV occurred 0.98%, which were hypotension, drowsiness, and maculopapular rash. No major ADRs were detected in any patients after the ivLEV treatment. Regarding process indicators, overall seizure control rate was 76.4%, of which 35.2% and 85.9% were for the patients with status epilepticus and acute seizure with non-status epilepticus, respectively. ivLEV could be used as first line treatment effectively in patients with status epilepticus (80.2%). In the patients with renal impairment receiving adjusted dosage regimen ivLEV could be control seizure 73.1%. Conclusion: The treatment of ivLEV was effective and safe for control seizure, including status epilepticus and acute seizure with non-status epilepticus. Thus, ivLEV could be the first line antiepileptic drug for the treatment of status epilepticus and brain surgery prevention. However, due to the high cost of the drug and the treatment course, there would be further study of cost-effectiveness. Keywords: Levetiracetam, Epilepsy, Acute seizure, Status epilepticus, Drug use review, Inpatient

Perforated Appendicitis: An Unintended Consequence During the Coronavirus-19 Pandemic.

ABSTRACTBackgroundThe coronavirus disease 2019 (COVID-19) pandemic has had major clinical impact across the globe. Delayed presentation for medical emergencies has been noted by the medical community. There has been limited reporting on the impact for the care for emergent surgical conditions. We sought to describe the effect of the global pandemic on the presentation and outcomes for the most common urgent general surgery disease process, acute appendicitis.MethodsWe performed a retrospective review of patients admitted to the United States Naval Hospital Okinawa during the COVID-19 pandemic, from January 2020 to May 2020 (COVID cohort), and compared them to a historical cohort (pre-COVID cohort) over the prior 2 years. Demographics, clinical presentation data, and interventions were collected.ResultsOf the 80 patients with appendicitis, 20% presented perforated. Most patients were male (71%), presented with 1 day of symptoms and had a length of stay of 1 to 2 days. Comparing groups, 13% of the pre-COVID group vs. 31% of the COVID cohort presented perforated (P = .04), with a symptom duration of 1.6 vs. 2.7 days before presentation (P = .075), respectively.ConclusionsThe COVID-19 pandemic and the global systematic response has impacted unrelated medical and surgical conditions. At our overseas military hospital with minimal disease burden, we observed a delay in presentation for acute appendicitis with a higher incidence of perforation. Patients should be empowered to continue to seek care for urgent and emergent medical and surgical conditions so that they are not harmed by fear of COVID-19 rather than by COVID-19 itself.