Life-threatening Emergency Condition Research Articles

Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes: Systematic Review and Meta-Analysis

Acute aortic syndrome is a life-threatening emergency condition. Previous systematic reviews of D-dimer diagnostic accuracy for acute aortic syndrome have been contradictory and based on limited data, but recently published studies offer potential for a more definitive overview. We aimed to perform a systematic review and meta-analysis to determine the diagnostic accuracy of D-dimer for diagnosing acute aortic syndrome. We searched MEDLINE, EMBASE, and the Cochrane Library from inception to February 2024. Additionally, the reference lists of included studies and other systematic reviews were thoroughly searched. All diagnostic cohort studies (prospective or retrospective) that assessed the use of D-dimer for diagnosing acute aortic syndrome compared with a reference standard test (eg, computed tomographic angiography (CTA), ECG-gated CTA, echocardiography, magnetic resonance angiography, operation, or autopsy) were included. Two independent reviewers completed study selection, data extractions and quality assessment using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Data were synthesized using a bivariate meta-analysis model. Of 2017 potentially relevant citations, 25 cohort studies met the inclusion criteria, and 18 reporting the 500 ng/mL threshold were included in the primary meta-analysis. Risk of bias domains were mostly unclear due to limited study reporting. The summary sensitivity was 96.5% (95% credible interval [CrI] 94.8% to 98%) and summary specificity was 56.2% (95% CrI, 48.3% to 63.9%). Study specificity varied markedly from 33% to 86%, indicating substantial heterogeneity. Sensitivity analysis including the 7 studies reporting other thresholds showed summary sensitivity of 95.7% (95% CrI, 93.2% to 97.5%) and summary specificity of 57.5% (95% CrI, 50.1% to 64.6%). D-dimer concentration has high sensitivity (96.5%) and moderate specificity (56.2%) for acute aortic syndrome, with some uncertainty around estimates due to risk of bias and heterogeneity. Previous meta-analysis reporting higher specificity may be explained by inclusion of case-control studies that may overestimate accuracy.

Diclofenac sodium and Allopurinol induced Stevens Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs

One of the life-threatening multi-organ emergency conditions is Stevens-Johnson Syndrome (SJS). Although this is a rare disease and manifests as drug reactions, this condition can cause death.We present a case of a 63-year-old male with Diclofenac sodium and Allopurinol induced Stevens_Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs.The patient was undergoing outpatient TB treatment at the end of the first month. The patient comes to the emergency department of the hospital because of shortness of breath, fever, blistered skin, nasal and oral mucosa, cracks and wounds, visible pus, red eyes accompanied by erythematous rash all over the body after previously taking diclofenac sodium and allopurinol given by the doctor because felt joint pain all over body and uric acid increased. On physical examination of the lungs, crackles and wheezing were heard in both lung fields. The chest radiograph shows infiltrates in both lung fields. Laboratory results showed leukocytosis and the results of other blood laboratory tests were still within normal limits. Patient diagnosed Stevens-Johnson Syndrome based on clinical, laboratory, and radiology examination results. The patient was given treatments using nasal canule oxygen of 5 litres/minute, intravenous fluid dehydration D5% : NaCl 0.9%, ceftriaxone injection, gentamicin injection, dexamethasone injection, cetirizine ranitidine injection, compresses with 0.9% NaCl liquid, 2.5% hydrocortisone ointment. The patient was treated in the Intensive Care Unit for 8 days. The patient had no history of previous drug allergies. In this case, the likelihood of Diclofenac sodium and Allopurinol induced Stevens_Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs, needs to be a concerned, as well as the importance of evaluation and strict follow-up to prevent Stevens Johnson Syndrome disease.

Fetomaternal Outcome in Eclampsia at Tertiary Care Centre: A Descriptive Cross-Sectional Study

Introduction: Eclampsia is a life threatening emergency condition that remains a leading cause of maternal and perinatal mortality. It is one of the causes of preventable maternal mortality. There are specific risks for the mother as this condition lead to seizure and may cause woman to lose consciousness and if the fetus is not delivered, this condition can cause the death of the mother and or the fetus. This study was conducted to evaluate the fetomaternal outcome in eclampsia. Materials and Methods: This is a descriptive cross sectional study done at National Medical College Teaching Hospital from 1st February 2021 to 31st January 2022. Ethical approval was obtained from IRC (regd no. F-NMC/518/076-77). During the study period 1496 women delivered. Out of this, 44 patients with generalized tonic-clonic convulsions during pregnancy / labour / within 7 days of delivery were included in the study criteria. The data analyzed included various maternal parameters, fetal parameters and pregnancy outcomes. Result: Among 1496, 44 patients (2.94%) developed eclampsia, 38.63% in age group of < 20 years, 59.09% were primigravida, 84.09% unbooked, 63.63% presented with antepartum eclampsia, delivered by caesarean 63.63%. There was 2.26% maternal mortality due to cerebrovascular accident. Perinatal mortality was 11.36% which included stillbirth 6.81%nand neonatal death 4.54%. Conclusion: Regular antenatal checkup, early detection of disease, timely referral, and early initiation and treatment in patients with eclampsia improve outcomes. Treatment of these patients should be carried out in tertiary care centers where intensive care units, NICU facilities, and multidisciplinary units are available.

192: OUTCOME IMPROVEMENTS IN AORTIC DISSECTION PATIENTS WITH INTENSIVE CARE UNIT USE OF STATIN

Introduction: Aortic dissection is a life-threatening emergency condition that requires immediate interventions and therapies. The in-hospital mortality rate varies from 10% to 20%, depending on the type, location, and severity of dissection. Clinical data further highlight the association between oxidation, inflammation, and in-hospital mortality in aortic dissection patients. Statin possesses potent anti-oxidation and anti-inflammation capacity. We conjectured that use of statin in intensive care unit (ICU) may improve the outcomes of aortic dissection patients. To explicate this matter in question, we performed this retrospective cohort study analyzing data retrieved from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Methods: Through exploring the MIMIC-IV database, we identified aortic dissection patients admitted to ICU and retrieved relevant data for analysis. The Chi square test was performed to compare the between-group differences in the in-hospital mortality and overall mortality rates. Moreover, logistic regression analysis was performed to elucidate the impacts of ICU statin use on in-hospital mortality and overall mortality. Results: A total of 432 subjects were included. Among them, 223 subjects (51.62%) received statin after ICU admission (the Statin group) and 209 subjects (48.38%) did not use statin during hospitalization (the no-Statin group). Our data revealed that the in-hospital mortality rate and overall mortality rate in the Statin group (5.38% and 8.97%, respectively) were significantly lower than those in the non-Statin group (18.66% and 22.97%, respectively) (both p < 0.001). Data of logistic regression analysis further demonstrated that, comparing to the non-Statin group, the risks of in-hospital mortality (odd’s ratio [OR]: 0.25, 95% confidence intervals [CI]: 0.13~0.49, p < 0.001) and overall mortality (OR: 0.33, 95% CI: 0.19~0.58, p < 0.001) in the Statin group were significantly lower. Conclusions: Data from this retrospective cohort study support the relationship between use of statin in ICU and outcome improvements in aortic dissection patients.

Long Standing Foreign Body lodged in the Right Bronchial Tree – A Case Report

Foreign body inhalation is a life threatening emergency condition that commonly occur in children. A foreign body (FB) can be lodged in either the upper or lower airway or cause either a partial or complete airway obstruction. Complete obstruction of upper airway is a potentially life-threatening situation that causes severe respiratory distress and suffocation. Lower airway FB typically manifests with sudden-onset coughing and choking, followed by wheezing and dyspnea. We are presenting a case report of 3years old female child with a foreign body in the right bronchus intermediacy over one year. Patient was managed by performing thoracotomy after failed rigid bronchoscopy. This case is importance as to reduce the frequency of prescribing without throughout investigations.

'Back-and-Forth Stomach' CT Imaging Findings of a Pathophysiologic Entity Causing Acute Gastric Volvulus.

Background: Gastric volvulus (GV) is a life-threatening emergency condition that prompts emergent surgical management. With the advent of high-resolution computed tomography (CT), the role of radiologists in its diagnosis has become essential. Although many cases of GV have been described in the literature, its pathophysiology is still poorly understood. In addition, there is substantial terminological confusion with associated entities such as paraesophageal hernia, upside-down stomach, organo-axial or chronic GV. Methods: We conducted a retrospective review of clinical, radiological findings and other relevant data for seven patients with previous radiological diagnoses of a large hiatus hernia who presented with acute GV to the emergency department of our institution. We report data on age, sex, medical history, clinical presentation, imaging, treatment and outcomes for each case. Results: The CT findings at acute presentation showed the antrum lying above the diaphragm and dilated fundus below the diaphragm. By comparing the position of the stomach at acute presentation with previous imaging examinations, we confirmed a hypothesis put forward by a few authors decades ago that re-herniation of the gastric fundus into the abdomen is a common pathophysiologic trigger leading to acute GV. This hypothesis has not been supported by modern imaging examinations. Conclusions: We have provided imaging evidence supporting that the pathophysiology of many GVs is based on caudal re-descent of hiatal hernia into the abdominal cavity. Given the terminological disparity used in the literature in this context, we believe it appropriate to introduce and extend the term ‘back-and-forth stomach’ to refer to this type of GV.

Kounis syndrome: from an unexpected case in the Emergency Room to a review of the literature.

Kounis syndrome (KS) is a coronary syndrome in the setting of allergic/anaphylactic reactions and can be classified in three variants: vasospastic allergic angina (type I), allergic myocardial infarction (type II) and stent thrombosis (type III). The early diagnosis is of paramount importance for the correct management and the prognosis, being KS a life-threatening emergency condition. KS is not uncommon, but it is frequently unrecognized or undiagnosed in virtue of its broad clinical manifestations. The diagnosis should be based on the combination of cardiovascular and allergic/anaphylactic clinical symptoms and signs, as well as on laboratory, electrocardiographic, echocardiographic, and angiographic evidence. ECG monitoring, cardiac enzymes and troponin are mandatory to confirm or exclude KS in a patient with subclinical or clinical, acute, or chronic allergic reactions. Nevertheless, the treatment is a real challenge for the emergency clinicians because guidelines have not been established yet, and the therapy is based on the variant type. We herein report the case of type I KS in a woman with no prior history of allergy, admitted to our emergency department for abdominal pain, nausea and hematochezia. Starting from this case we conducted a systematic search of the following databases: PubMed, Google Scholar, Science Direct, Medline, using the keywords of “Kounis syndrome”, “coronary spams”, “cardiac arrest”, “sudden death”, “allergy”, and “anaphylaxis”. The main purpose of this review is to remind emergency clinicians to keep a high index of suspicion regarding KS when dealing with patients with allergic reactions or anaphylaxis to promptly identify and correctly manage KS. (www.actabiomedica.it)

Parental Readiness in Caring for Low Birth Weight: Pediatric Nursing Intervention

Background: low birth weight babies (LBW) weighing less than 2500 are babies at high risk because in general, they are smaller than normal birth weight babies and immature organ function. LBW requires special care to anticipate life-threatening emergency conditions. The care process for meeting the special needs of LBW requires the involvement of parents during the hospital and after discharge from the hospital. Nurses as educators have an important role in preparing parents to care for LBW after returning from the hospital. Purpose: This study aims to determine the effect of child nursing interventions through the education of LBW infant care with parents' readiness to care for LBW. Methods: This research is a quantitative study, using a quasi-experimental design with a pre-post-test with control. The population of this study was parents who had LBW babies in Kendal District Hospital with the sampling technique using accidental sampling, the total sample was 40 parents with LBW babies. The sample was classified into two groups, namely, 20 respondents as the intervention group and 20 respondents as the control group. Results: The results of this study indicate that there was a significant differences in parent readiness scores in caring for LBW between those who were given and not given education with a P value of 0.000, used an independent sample t-test and there was an effect of education on the readiness of parents in caring for LBW used the Chi-square test with a p value of 0.002. Conclusion: Providing education to parents with LBW is one of the implementations of pediatric nursing to prepare parents to care for LBW.

BILATERAL SPONTANEOUS PNEUMOTHORAXES ASSOCIATED WITH VAPING

TOPIC: Tobacco Cessation and Prevention TYPE: Medical Student/Resident Case Reports INTRODUCTION: Electronic cigarette or vaping product use associated lung injury (EVALI) has received increasing attention by the Centers for Disease Control and Prevention (CDC) within the last year due to a recent increase of cases of acute lung injury associated with vaping. The CDC has established criteria for EVALI: 1) the patient must have vaped within 90 days prior to symptom onset;2) there is evidence of pulmonary infiltrate on chest radiographs or chest CT;3) absence of pulmonary infection on initial work-up;4) no evidence alternative diagnoses.Spontaneous pneumothoraces (SPs) are often idiopathic in nature, classically in tall, thin males between the ages of 15-34 years old, as well as underlying lung or connective tissue diseases. There are few reported cases of SPs in association with vaping or e-cigarette use, with bilateral pneumothoraces being nearly unseen. CASE PRESENTATION: A 26-year-old Caucasian male with past medical history of polysubstance abuse presented to the emergency department with a one-day history of shortness of breath and chest pain. He was an active daily vaper. On arrival, he endorsed dyspnea, hemoptysis, presyncope, and pleuritic pain. Vitals showed hypotension, tachycardia, and tachypnea. Physical exam shows no trauma or tracheal deviation. Lung sounds were decreased at both apices. Chest X-ray showed bilateral apical pneumothoraces. Workup for respiratory virus panel and COVID were negative. CBC and CMP lab values were largely unremarkable, only with lactic acidosis to 4.4 mmol/L. Toxicology was positive for cocaine, THC, and opiates. A left sided thoracostomy was performed, resulting in resolution of the left sided pneumothorax. Shortly after placement, the patient traumatically removed his thoracostomy tube. 100% oxygen resulted in resolution of the right sided pneumothorax. The patient was downgraded from the ICU and discharged on hospital day three with resolution of symptoms. DISCUSSION: Spontaneous pneumothorax is a potentially life-threatening emergency condition. This patient's concerning presentation with spontaneous bilateral secondary pneumothoraces (SBSP) and multifocal opacities on the chest x-ray in the setting of vape use, without a prior or family history of lung disease, created a concerning clinical picture. EVALI is already a concerning condition. Per the CDC as of January 14, 2020, there were 2,668 cases of EVALI requiring hospitalization, with 68 cases resulting in mortality CONCLUSIONS: This case is highlighted in order to add to increasing evidence of the dangerous effects of vaping. Patients should be counseled on the wide variety of risks of vaping. Furthermore, cases of SBSP are quite rare, and this patient's history makes vaping and marijuana use the most likely contributing factors to his presentation. Patients with a history of spontaneous pneumothorax should be monitored over time for recurrences and counseled on vaping cessation. REFERENCE #1: Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html REFERENCE #2: Graf-Deuel E, Knoblauch A: Simultaneous bilateral spontaneous pneumothorax. Chest. 1994, 105:1142-1146. 10.1378/chest.105.4.1142 DISCLOSURES: No relevant relationships by Riley Ewen, source=Web Response No relevant relationships by Gilad Guez, source=Web Response no disclosure on file for Brijesh Patel;no disclosure on file for Farhan Shah;

The Effect of Normovolemic versus Decreasing Maintenance Fluids on Critically Ill Multiple Trauma Patient’s Clinical Outcomes

Background: Major trauma is a life-threatening emergency condition that requires immediate intervention. Resuscitation of low volume fluid or decreasing maintenance fluids maintains tissue perfusion and decreases the negative consequences of early vigorous resuscitation. Aim of the study was to evaluate the effect of normovolemic versus decreasing maintenance fluids on ICU multiple trauma patient’s clinical outcomes. Method: A quasi experimental comparative research design was utilized in this study, purposive sample of 40 adult critically ill patients with multiple traumas would be enrolled sequentially into two groups, each group consists of (20) patients. This study was carried out in trauma intensive care unit at Emergency Hospital affiliated to Tanta University Hospitals, Egypt .Three tools were used to conduct the study. Tool I: social- demographic and clinical data sheet, Tool II: injury severity score, Tool III: patients' outcome sheet. Results: There were sixty percent of patients in control group had age more than 30 years compared to 45% of patients in the study group. The male patient represents the highest percentage in this both groups. It was observed 90.0% of the study groups had injury severity score between (17-25) score. While 80.0% of the control groups has < 25 injury severity score level. a significant improvement regarding mean scores of pulse rate, respiratory rate, and Fio2 on discharge. The mean score of sodium, urea and creatinine was improved significantly among study groups compared with control groups on discharge where P= 0.022 and 0.00 respectively. Seventy percent of patients in control group had long duration of stay in ICU more than 20 days compared to (55.0%) of patients in the study group. Conclusion: It can be concluded that trauma patients in the ICU who received decreasing maintenance fluids at 30 mL/h in normotensive trauma patients had improved physiological parameters, decreased ICU stay and days on ventilator. Recommendations: Emergency hospital should include decreasing maintenance fluids for trauma patients admitted to the ICU if not contraindicated. Nursing and medical staff should be informed with the updated protocols of fluid resuscitation therapy and its application in clinical practice for emergency and critically ill patients.

Successful management of status epilepticus with yoga prana vidya healing as a complementary therapy: A case study of atypical febrile seizure

: Epilepsy is one of the most common disorders of the nervous system and affects people of all ages, races, and ethnic backgrounds, and seen more commonly in children. Atypical febrile seizure with Status epilepticus is a disorder known for significant morbidity and mortality. Despite newer antiepileptic drugs, 30 % of subjects are refractory to the conventional treatment with a risk of recurrence and neuro-developmental disorder. This paper presents one such case of a child handled successfully by Yoga Prana Vidya (YPV) Energy healing complementarily to conventional therapy. This is a prospective case study of a 2-month-old infant, an emergency case of atypical febrile seizures with status epilepticus, where YPV Healing intervention was done from the beginning while admitting doctors had given a guarded prognosis. This case study reports the normal physical, mental &amp; psychological development of the subject following YPV Healing with 3-year follow up, and the subject was observed to be normal without any recurrence of the disease or neuro-developmental abnormality.: Although the use of Complementary and Alternative Medicine (CAM) has been evaluated globally, there are few studies available on the use of Energy healing in various ailments. YPV Healing has been emerging as an effective modality of treatment for various physical, psychological ailments without any side effects. It can be effectively used from distance even without physically examining the subject. It has been used as a complementary or alternative modality of treatment in some severe life-threatening emergency conditions, and further studies may be conducted with appropriate sample sizes.

Evaluating delays for emergent CT scans from a rural British Columbia hospital.

Computed Tomography (CT) scans help diagnose and triage life-threatening and time-sensitive emergency conditions, but most rural hospitals in British Columbia do not have access to a local CT scanner. We investigate how many transfers from a rural British Columbia hospital were for CT scans and describe the time delays to emergent CT imaging. This was a prospective cohort study, over a 1-year period, on all patients requiring a transfer from the Golden and District Hospital, located 247km from the closest CT scanner. Data collection forms were completed prospectively and the main measurements included age, transport triage level, reason for transfer, referral hospital, transfer request time, and CT scan time. The time interval between the CT request and CT imaging was calculated and represents the 'delay to CT scan' interval. The study hospital received 8672 emergency department (ED) visits and 220 were transferred to referral centres (2.5%). 61% of all transfers received a CT scan. Transfers for time-sensitive emergencies took an average of 6h 52min. Patients with acute stroke experienced a 4h 44min time interval. Less urgent and non-urgent conditions entailed an even greater time delay. This study highlights that the lack of a rural CT scanner is associated with increased transfers and significant time delays. Improving access to CT scanners for rural communities may be one of the many steps in addressing healthcare disparities between rural and urban communities.

Preparedness of pre-intern medical graduates of three universities in Sri Lanka to diagnose and manage anaphylaxis

BackgroundEarly recognition and the optimal management of anaphylaxis saves lives but studies from different countries have demonstrated gaps in knowledge and practices between healthcare workers. There is a paucity of such data from Sri Lanka. We assessed knowledge, perception and self-confidence in the diagnosis and management of anaphylaxis amongst pre-intern medical graduates who would soon become first-contact doctors attending emergencies.MethodsThis cross-sectional study included pre-interns who graduated with Bachelor of Medicine, Bachelor of Surgery (MBBS) degrees in 2019 from three Sri Lankan universities with differing undergraduate curricula. Using consecutive sampling data were collected within four months of the final-MBBS examinations with a self-administered questionnaire and the answers on case diagnosis and management were used as the basis of outcome scores.Results385 participants responded (response rate: 91.5%). 16.4% correctly identified all anaphylaxis triggers. Only 7.3% correctly diagnosed all ten case scenarios and 34.5% all seven cases of anaphylaxis. 98.2 and 97.9% correctly identified 1:1000 adrenaline as the first-line treatment and the intramuscular route. 9.9% would preferentially but incorrectly use the intravenous route if access was available. Only 79.2 and 55.6% knew the correct adult and paediatric doses of adrenaline and 50% agreed that follow-up care was needed. The mean scores for case diagnosis and management of anaphylaxis were 7.7/10 ± 1.4 and 16.9/20 ± 1.9, respectively. Multiple linear regression indicated that the final MBBS results classification (class of degree or no class indicated) was a positive predictor of case diagnosis score [class vs no class: B = 0.662 (95% CI 0.347–0.978), p < 0.001] and being a graduate of University 2 [B = 1.568 (95% CI 1.182–1.953), p < 0.001] and passing with a class at final MBBS [B = 0.716 (95% CI 0.319–1.113), p < 0.001] were positive predictors of management score. Self confidence in diagnosing and managing anaphylaxis were rated as 79.7 and 62.1% and there was a positive correlation between knowledge and perception scores and self-confidence (case-diagnosis: rpb = 0.111, p = 0.03; management: rpb = 0.164, p = 0.001).ConclusionsKnowledge, perception and self confidence in the diagnosis and management of anaphylaxis was sub optimal amongst pre-interns and we identified areas that need improvement. A higher MBBS qualification classification was a predictor for correct diagnosis and management and confidence in diagnosis and management positively correlated with knowledge and perception scores. Further and enhanced educational and training strategies are needed for this life threatening emergency condition.

Assessment of final-year medical students' performance in diagnosing critical findings on chest X-ray.

PurposeDue to the recently emerging shortage in medical staff during the novel corona virus pandemic, several countries have rushed their undergraduate medical students into the emergency department. The accuracy of diagnosing critical findings on X-rays by senior medical students is not well assessed. In this study, we aim to assess the knowledge and accuracy of undergraduate final-year medical students in diagnosing life-threatening emergency conditions on chest x-ray.MethodThis is a cross-sectional nationwide survey across all medical schools in Jordan. Through an electronic questionnaire, participants were sequentially shown a total of six abnormal X-rays and one normal. For each X-ray, participants were asked to choose the most likely diagnosis, and to grade the degree of self-confidence regarding the accuracy of their answer in a score from 0 (not confident) to 10 (very confident).ResultsWe included a total of 530 participants. All participants answered at least six out of seven questions correctly, out of them, 139 (26.2%) participants answered all questions correctly. Pneumoperitoneum was the highest correct answer (93.8%), whereas flail chest was the least correctly answered case with only 310 (58.5%) correct answers. Regarding self-confidence for each question, 338 participants (63.8%) reported very high overall self-confidence level. Answers related to tension pneumothorax had the highest confidence level.ConclusionSenior Jordanian medical students showed good knowledge with high confidence levels in diagnosing life-threatening conditions on chest x-rays, supporting their incorporation in the emergency department during pandemics and confirming the reliability of information they can extract.

The Effect of Pet Insurance on Presurgical Euthanasia of Dogs With Gastric Dilatation-Volvulus: A Novel Approach to Quantifying Economic Euthanasia in Veterinary Emergency Medicine.

Euthanasia of companion animals in veterinary emergency medicine is a common cause of death. Euthanasia is economic when it is the consequence of the pet owner's inability to afford essential treatment while a viable medical alternative to euthanasia exists. Gastric dilatation-volvulus (GDV) is an acute life-threatening emergency condition of dogs; if left untreated, rapid death is highly likely. Surgical treatment leads to survival of around 80-90% of dogs; however, such treatment is costly. Therefore, pre-surgical euthanasia may be largely economically motivated. Having pet insurance, a financial instrument to reduce the burden of unforeseen veterinary medical costs on pet owners, would be expected to abolish the risk for pre-surgical economic euthanasia. We therefore aimed to determine whether pet insurance attenuates the risk of pre-surgical economic euthanasia in dogs with GDV. Non-referred dogs (n = 260) with GDV and known insurance status seen at 24 emergency clinics over a 2-year period were included. Relevant data (e.g., insurance status, age, comorbidities, outcome) were retrospectively extracted from a pet insurer's claim records (insured animals) or from electronic medical records of participating hospitals (non-insured animals). Forty-one percent of dogs (106 of 260 dogs) did not survive to hospital discharge; 82 (77%) of non-survivors died before surgery, all through euthanasia. The pre-surgical euthanasia rate was 10% in insured and 37% in non-insured dogs (p < 0.001). When adjusted for the effect of age, deposit size, comorbidities, and blood lactate concentration, the absence of insurance increased the odds of pre-surgical euthanasia by a factor of 7.4 (95% CI 2.0 to 37; p = 0.002). Of dogs undergoing surgery, 86% survived to hospital discharge. Overall, 80% of insured animals and 53% of non-insured animals survived to hospital discharge (p < 0.001). Thus, insurance was associated with a marked decrease in risk of pre-surgical euthanasia indicating that the cause of pre-surgical euthanasia of dogs with GDV is predominantly economic in nature. The rate of pre-surgical euthanasia in dogs with GDV may emerge as a suitable marker to quantify economic decision making of pet owners and to measure the impact of financial interventions aimed at mitigating economic duress associated with cost of veterinary emergency care.

Preparedness of non-hospital health centers to manage patients with life-threatening emergency conditions: findings from a qualitative study

BackgroundManagement of Life-threatening Emergency (LTE) patients in urban and rural areas is an important challenge, which can affect pre-hospital mortality rate. Therefore, Non-hospital Health Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The aim of this study was to explore domains related to the preparedness of NHHCs to manage LTE patients through resorting to healthcare providers’ and experts’ perspectives.MethodsA qualitative exploratory study was applied using Semi-Structured Interviews (SSIs) and Focus Group Discussions (FGDs). Prior to beginning data collection, the study and its objectives were explained to the participants and their informed consents were obtained. Then, SSIs and FGDs were conducted by two trained researchers using an interview guide, which was developed through literature review and consulting experts. In total, 12 SSIs were done with the providers at different NHHCs in Tabriz. In addition, 2 FGDs were conducted with the specialists in Emergency Medicine (EM) and Primary Health Care (PHC), and the executives of health centers, with over 5 years of work experience, and Emergency Medical Services (EMS) experts. Purposive sampling method was used in this study. All SSIs and FGDs were audio recorded and subsequently transcribed. Framework Analysis was employed to manually analyze the interview transcripts from all the SSIs and FGDs.ResultsThe interview transcripts analysis resulted in the emergence of 3 themes and 11 sub-themes, categorized according to Donabedian’s triple model. 5 sub-themes were related to input, including medical equipment and supplies, environmental infrastructures of the centers, emergency medicines, human resource, and protocols, guidelines and policies. 4 sub-themes were related to process, including providing clinical services, medicine storage capacity, maintenance of equipment, and management process. Finally, 2 sub-themes were related to outcome, which were patients’ satisfaction with the quality of care and improved survival of LTE patients.ConclusionsThe results of this study can provide a new perspective for health managers and policy makers on how to evaluate the preparedness of NHHCs in managing LTE patients. In addition, it will be used to develop instruments to measure the preparedness of these centers.

In-vivo efficacy of biodegradable ultrahigh ductility Mg-Li-Zn alloy tracheal stents for pediatric airway obstruction

Pediatric laryngotracheal stenosis is a complex congenital or acquired airway injury that may manifest into a potentially life-threatening airway emergency condition. Depending on the severity of obstruction, treatment often requires a combination of endoscopic techniques, open surgical repair, intraluminal stenting, or tracheostomy. A balloon expandable biodegradable airway stent maintaining patency while safely degrading over time may address the complications and morbidity issues of existing treatments providing a less invasive and more effective management technique. Previous studies have focused on implementation of degradable polymeric scaffolds associated with potentially life-threatening pitfalls. The feasibility of an ultra-high ductility magnesium-alloy based biodegradable airway stents was demonstrated for the first time. The stents were highly corrosion resistant under in vitro flow environments, while safely degrading in vivo without affecting growth of the rabbit airway. The metallic matrix and degradation products were well tolerated by the airway tissue without exhibiting any noticeable local or systemic toxicity.

A narrative review of the challenges and countermeasures in hepatoblastoma management during COVID-19 epidemic.

An infectious disease named “coronavirus disease 2019” (COVID-19) currently has brought a threat to global health security and trends to be more and more severe in many countries. It also has introduced great challenges to the diagnosis and management of children with hepatoblastoma (HB). During the COVID-19 pandemic, pediatric surgeons should not only develop personalized treatment plans for HB therapy, but also emphasize the diagnosis, prevention, and treatment of this virus. Children with both HB and COVID-19 are recommended to undertake multidisciplinary assessment. Anti-SARS-CoV-2 therapy may be a preferred treatment for the infected without presenting a surgical emergency. However, emergent operation may be necessary for HB children with concurrent COVID-19 who developed a life-threatening surgical emergency condition. Otherwise, for children with negative virus examination results, treatment advice should be based on the impact of the epidemic and regional economic considerations. A “wait and see” strategy is recommended for children with resectable tumors after new adjuvant chemotherapy treatment (NACT). Assessment of liver transplantation is recommended for children with HB whose tumors cannot be resected after NACT. Children with HB with pulmonary metastasis may have abnormal findings on chest imaging due to COVID-19. Besides, the detailed therapeutic regimens may vary for children with HB with or without an emergency presentation. Based on previous consensus, current research, and the experiences of our hospital, we aim to offer available management plans for the above-mentioned concerns.

No Benefit of Hemostatic Drugs on Acute Upper Gastrointestinal Bleeding in Cirrhosis.

Background and Aims Acute upper gastrointestinal bleeding (AUGIB) is one of the most life-threatening emergency conditions. Hemostatic drugs are often prescribed to control AUGIB in clinical practice but have not been recommended by major guidelines and consensus. The aim of this study was to investigate the therapeutic effect of hemostatic drugs on AUGIB in cirrhosis. Methods All cirrhotic patients with AUGIB who were admitted to our hospital from January 2010 to June 2014 were retrospectively included. Patients were divided into hemostatic drugs and no hemostatic drug groups. A 1 : 1 propensity score matching (PSM) analysis was performed by adjusting age, gender, etiology of liver disease, Child-Pugh score, MELD score, hematemesis, red blood cell transfusion, vasoactive drugs, antibiotics, proton pump inhibitors, and endoscopic variceal therapy. Primary outcomes included 5-day rebleeding and in-hospital mortality. Results Overall, 982 cirrhotic patients with AUGIB were included (870 in hemostatic drugs group and 112 in no hemostatic drug group). In overall analyses, hemostatic drugs group had a significantly higher 5-day rebleeding rate (18.10% versus 5.40%, P = 0.001) than no hemostatic drug group; in-hospital mortality was not significantly different between them (7.10% versus 4.50%, P = 0.293). In PSM analyses, 172 patients were included (86 patients in each group). Hemostatic drugs group still had a significantly higher 5-day rebleeding rate (15.10% versus 5.80%, P = 0.046); in-hospital mortality remained not significantly different (7.00% versus 3.50%, P = 0.304) between them. Statistical results remained in PSM analyses according to the type of hemostatic drugs. Conclusions The use of hemostatic drugs did not improve the in-hospital outcomes of cirrhotic patients with AUGIB.

Cut throat gashes: emergency tracheostomy as a relief

&lt;p class="abstract"&gt;Cut throat injury accounts for about 5 to 10 percent of all traumas. It is a life-threatening emergency condition. Cut throat injuries are challenging in terms of management as it necessitates close collaboration by otolaryngologists, anaesthetists, psychiatrists, speech therapists and general surgeons. Securing airway by emergency tracheostomy is always of prime concern to prevent impending complications such as haemorrhage, shock and asphyxia followed by closure of wound. This paper shares our experience with three patients who presented in emergency department with cut throat injuries of varying etiology who were treated diligently with a multidisciplinary approach. This paper is to emphasize the importance of securing airway by emergency tracheostomy under local anaesthesia.&lt;/p&gt;