Life-threatening Situations Research Articles

Lived Experiences of Women after Emergency Peripartum Hysterectomy: A Qualitative study in Peshawar, Pakistan.

Background: Emergency Peripartum Hysterectomy (EPH) is a type of hysterectomy which is performed in emergency and life-threatening situations like postpartum hemorrhage. Aim: To explore the lived experiences of women after EPH. Methods: A qualitative phenomenological study was conducted in Lady Reading Hospital (LRH) Peshawar, Khyber Pakhtunkhwa (KP) to explore the lived experiences of women after EPH. A total of 10 participants were included in the study. Data were collected using interview guide, audio and written data were recorded. Thematic analysis was done using thematic analysis techniques. Results: Overall, ten participants were included in the study. 117 codes were generated from the data which helps in creating five themes about the experiences of women after EPH. The women experience profound grief, needs for support, needs for information, bonding and fear. Conclusion: The findings of the study concluded that women after EPH experience profound grief, need of support, need of information, bonding, and fear. Keywords: Women, Emergency peripartum hysterectomy, lived experiences, Qualitative Study

Evaluation of Non-fatal Forensic Vascular Injuries

In the forensic report, whether the injury includes "vascular injury" or not, the life-threatening situation is important for the investigation. In this study, it was aimed to evaluate the vascular injury status and share the data with the literature in cases related to forensic traumatology, which were reflected in the Forensic Medicine Department of Eskişehir Osmangazi University Faculty of Medicine. In the 5-year period between 2015 and 2019, the cases with vascular injury, who applied to the Eskişehir Osmangazi University Faculty of Medicine, Department of Forensic Medicine, were retrospectively analyzed. Report contents and demographic data of the cases were evaluated. It was determined that 52 (1.2%) of 4378 forensic cases evaluated within the scope of the study had vascular injury. 90.3% of the patients with vascular injury were male, they were most frequently in the 19-29 age group, 69.3% of the cases were stab wounds, and the most commonly injured vessel was a.femoralis and its branches (n=11, %21.2). The data obtained in the study were found to be compatible with the literature. It was thought that in-service trainings on this subject were important, especially for emergency room doctors to be more attentive in issuing forensic reports, to take necessary measures to prevent them from being held responsible in cases of vascular injury and other forensic cases, to protect the legal rights of victims.

Lower cerebello-cortical functional connectivity in veterans with reactive aggression symptoms: A pilot study

A significant number of veterans experience irritability and aggression symptoms as a result of being exposed to extremely stressful and life-threatening situations. In addition to the well-established involvement of the brain's cortico-subcortical circuit in aggression-related behaviours, a role of the deep cerebellar nuclei (DCN) in reactive aggression has been suggested. In the present study, seed-based resting-state functional connectivity between the DCN and cortico-subcortical areas was explored in veterans with and without reactive aggression symptoms. Nineteen male veterans with reactive aggression symptoms and twenty-two control veterans without reactive aggression symptoms underwent 3T resting-state functional MRI scans. Region-of-interest (ROI) analyses that included the amygdala, hypothalamus and periaqueductal grey as ROIs did not yield significant group-related differences in resting-state functional connectivity with the DCN. However, exploratory whole-brain analysis showed that veterans with reactive aggression symptoms exhibited lower functional connectivity between the DCN and the orbitofrontal cortex compared to control veterans. Our findings provide preliminary evidence for the possible involvement of a cerebello-prefrontal pathway in reactive aggression in male veterans.

Omgaan met zorgweigering bij een persoon met een ernstige psychiatrische aandoening en een levensbedreigende ziekte: een casusbespreking

Dealing with refusal of care by patients with a severe psychiatric disorder in combination with a life-threatening condition: a case report Providing good care for persons with a severe psychiatric disorder in combination with a life-threatening condition is a major challenge for health care providers. By means of a case report, the authors analyze the situation of a 65-year-old woman with Korsakov’s disease, depressive symptoms and aplastic anemia. She refuses to be examined and treated, despite many efforts on the part of the caregivers and relatives, as well as the seriousness of the situation. The team has to switch from a curative to a palliative approach in a short space of time. Various areas of tension are assessed: appraising the decision-making capacity of the person requesting care, dealing with refusal of care in a life-threatening situation, and involving and coordinating the various parties concerned, including the psychiatric and somatic care providers, administrator and family. The case uniquely illustrates the challenges described in international literature and recent local studies. The authors plead for the importance of the liaison function between psychiatric and somatic care and the central role of the general practitioner associated with the psychiatric facility. The careful clarification of the legal capacity of the patient who refuses life-saving care, the added value of ethical consultation in order to come to a supported approach and to channel moral distress, and the involvement of a palliative support team within a psychiatric setting are also crucial elements in the approach.

Premedication before laryngoscopy in neonates: Evidence-based statement from the French society of neonatology (SFN).

Laryngoscopy is frequently required in neonatal intensive care. Awake laryngoscopy has deleterious effects but practice remains heterogeneous regarding premedication use. The goal of this statement was to provide evidence-based good practice guidance for clinicians regarding premedication before tracheal intubation, less invasive surfactant administration (LISA) and laryngeal mask insertion in neonates. A group of experts brought together by the French Society of Neonatology (SFN) addressed 4 fields related to premedication before upper airway access in neonates: (1) tracheal intubation; (2) less invasive surfactant administration; (3) laryngeal mask insertion; (4) use of atropine for the 3 previous procedures. Evidence was gathered and assessed on predefined questions related to these fields. Consensual statements were issued using the GRADE methodology. Among the 15 formalized good practice statements, 2 were strong recommendations to do (Grade 1+) or not to do (Grade 1-), and 4 were discretionary recommendations to do (Grade 2+). For 9 good practice statements, the GRADE method could not be applied, resulting in an expert opinion. For tracheal intubation premedication was considered mandatory except for life-threatening situations (Grade 1+). Recommended premedications were a combination of opioid + muscle blocker (Grade 2+) or propofol in the absence of hemodynamic compromise or hypotension (Grade 2+) while the use of a sole opioid was discouraged (Grade 1-). Statements regarding other molecules before tracheal intubation were expert opinions. For LISA premedication was recommended (Grade 2+) with the use of propofol (Grade 2+). Statements regarding other molecules before LISA were expert opinions. For laryngeal mask insertion and atropine use, no specific data was found and expert opinions were provided. This statement should help clinical decision regarding premedication before neonatal upper airway access and favor standardization of practices.

Should the family be permitted to accompany the patient during resuscitation?

Family is considered to be an essential part of support, especially during difficult times. Similarly, during life-threatening situations, the presence of family is considered a controversial issue in healthcare settings. It has been observed that family members are often requested to wait outside the patient's room throughout the resuscitation process. On the one hand, their presence can assist in making decisions and accepting reality, which therefore eases their grieving process, while on the other hand, watching the resuscitation process can also make them emotionally unstable and may also lead to post-traumatic stress disorder in the future. The purpose of this literature review is to identify and analyze the various barriers and facilitators associated with the presence of family members during resuscitation procedures. A review of studies published between 2013 and 2022 was taken using databases such as CINAHL, PubMed, Google Scholar Search Engine, and Science Direct. "Family support", "family presence during resuscitation," and "family presence during CPR" were the keywords used during the search. In this review, a total of 22 studies were included based on their relevant titles, abstracts, and backgrounds.

Evaluation of a critical incident management system on mental health in lifeguard organisations: a retrospective study

BackgroundLifeguards may face many life-threatening situations during their careers and may be at increased risk of post-traumatic stress disorder (PTSD). Minimal evidence concerning critical incident management systems in lifeguard organisations...

Neurological complication during pregnancy, delivery and puerperium requiring intensive therapy management

Neurological complications during pregnancy, delivery and puerperium are relatively rare, but can lead to serious consequences and life-threatening situations. Clinical symptoms such as headache, weakness, seizures, sudden neurological deficits, or decreased level of consciousness should be the reasons for a prompt and careful consideration and neuroimaging to confirm the diagnosis and initiate treatment. In this article, we aim to describe the diseases and clinical situations that may manifest as neurological symptoms during pregnancy, delivery and puerperium. We also provide a more comprehensive descriptions of certain pregnancy-specific diseases and latest findings in literature and improvement in diagnostic approaches and treatment. Our primary objective is to emphasise the urgent need for prompt and accurate diagnosis and treatment in order to prevent life-threatening situations, not only for the mother, but also for the baby.

Perceptions of mental health services among the children who are in conflict with the law in Jammu and Kashmir.

Background: Due to the Jammu and Kashmir conflict, many teenagers are involved in disputes with the law. The conflict made generations suffer for decades. Such children made the mobs; being involved in life-threatening situations and the risk they confront develop psychiatric disorders. As a result of the various tense conditions when applied in multiple anti-social activities, aberrant children sent to correctional homes have to encounter numerous psychological disorders. Aim: The motive of the study is to explore the level of awareness, availability of services, stigma and obstacles to seeking assistance. Method: Due to the open-ended interview questions and a small sample size of 15 respondents, this study employed a qualitative methodology - a thematic analysis was done. Results: The findings revealed that, although the stigma is not publicly acknowledged, children who break the law and seek mental health services (MHS) are stigmatised. It was also shown that minor offenders fear that when they receive services provided by the staff of the observation home (OH), there will be a violation of their privacy and fear unforeseen repercussions. Conclusion: Collaborative action must proactively raise appropriate awareness to lessen the stigma linked with mental health problems, especially regarding MHS among these teenagers.

A Cloud-Based Deep Learning Framework for Early Detection of Pushing at Crowded Event Entrances

Crowding at the entrances of large events may lead to critical and life-threatening situations, particularly when people start pushing each other to reach the event faster. Automatic and timely identification of pushing behavior would help organizers and security forces to intervene early and mitigate dangerous situations. In this paper, we propose a cloud-based deep learning framework for automatic early detection of pushing in crowded event entrances. The proposed framework initially modifies and trains the EfficientNetV2B0 Convolutional Neural Network model. Subsequently, it integrates the adapted model with an accurate and fast pre-trained deep optical flow model with the color wheel method to analyze video streams and identify pushing patches in real-time. Moreover, the framework uses live capturing technology and a cloud-based environment to collect video streams of crowds in real-time and provide early-stage results. A novel dataset is generated based on five real-world experiments and their associated ground truth data to train the adapted EfficientNetV2B0 model. The experimental setups simulated a crowded event entrance, while the ground truths for each video experiment was generated manually by social psychologists. Several experiments on the videos and the generated dataset are carried out to evaluate the accuracy and annotation delay time of the proposed framework. The experimental results show that the proposed framework identified pushing behaviors with an accuracy rate of 87% within a reasonable delay time.

Huu S. TIEU’s Predicting Outcome of Severe Acute Respiratory Syndrome (SARS) and Preparing the Treatment for COVID-19 (Coronavirus) and Other Viral Pandemics

This project paper is to give a prediction for the future of other viral pandemics and to provide recommendations for preparing therapies that could help in the success of effective treatments and benefits for patients in life-threatening situations. The theory of prediction was proposed by Huu S. TIEU on March 25, 2019, and he hypothesized that any malfunctioning cell in the body could have a damaging effect. This paper discusses the prediction that Localized Oxygen Deprivation could be a contributing factor for a future epidemic or other viral pandemics that could affect body function. This paper is based on opinion and does not have sufficient evidence to support the claims made. Therefore, further in-depth study is needed to prove the findings. The author cites Hypoxia to support his idea, but he is not claiming that Hypoxia-Inducible Factor (HIF) has worked on his predictions. The author also tested a theory using cow blood curd for body function, but this test was not a structured test and the findings were not supported by other evidence. To further prove the idea or theory, further study into the subject should be conducted.

Acute Kidney Injury Following Naphthalene (Mothball) Poisoning.

Naphthalene is a widely available moth repellant in the Asian subcontinent. Toxicity can occur either accidentally or intentionally as a suicide attempt. An overdose can lead to a variety of clinical symptoms, including intravascular hemolysis, and can sometimes lead to life-threatening clinical situations. A young male was admitted to our center with an alleged history of ingesting an unknown quantity of naphthalene balls (mothballs). He developed methemoglobinemia, intra-vascular hemolysis, anuria, and acute kidney injury (AKI), followed by cardiorespiratory arrest. He was treated successfully with intravenous methylene blue and dialysis. Naphthalene toxicity can lead to methemoglobinemia and intravascular hemolysis. This can result in AKI caused by pigment nephropathy.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Activation of GPR81 aggravated intestinal ischemia/reperfusion injury-induced acute lung injury via HMGB1-mediated neutrophil extracellular traps formation.

Intestinal ischemia/reperfusion (II/R) injury is a life-threatening situation accompanied by severe organ injury, especially acute lung injury (ALI). A great body of evidence indicates that II/R injury is usually associated with hyperlactatemia. G-protein-coupled receptor 81 (GPR81), a receptor of lactate, has been recognized as a regulatory factor in inflammation, but whether it was involved in II/R injury-induced ALI is still unknown. To establish the II/R injury model, the superior mesenteric artery of the mice was occluded gently by a microvascular clamp for 45min to elicit intestinal ischemia and then a 90-min reperfusion was performed. Broncho-alveolar lavage fluid (BALF) and lung tissues were obtained to evaluate the lung injury after II/R. The pulmonary histopathological alteration was evaluated by H&E staining. The concentration of proteins, the number of infiltrated cells, and the level of IL-6 were measured in BALF. The formation of neutrophil extracellular traps (NETs) was evaluated by the level of double-stranded DNA (dsDNA) and myeloperoxidase- double-stranded DNA (MPO-dsDNA) complex in BALF, and the content of citrullinated histone H3 (Cit-H3) in lung tissue. The level of HMGB1 in the BALF and plasma was measured by enzyme linked immunosorbent assay (ELISA). Administration of the GPR81 agonist 3,5-dihydroxybenzoic acid (DHBA) aggravated II/R injury-induced lung histological abnormalities, upregulated the concentration of proteins, the number of infiltrated cells, and the level of IL-6 in BALF. In addition, DHBA treatment increased the level of dsDNA and MPO-dsDNA complex in BALF, and promoted the elevation of Cit-H3 in lung tissue and the release of HMGB1 in BALF and plasma. After induction of ALI by II/R, the administration of DHBA aggravated ALI through NETs formation in the lung.

Use of bedside echocardiography in the care of critically ill patients - a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência, and Sociedade Brasileira de Medicina Hospitalar. Part 1 - Competence in bedside echocardiography.

The use of echocardiography by physicians who are not echocardiographers has become common throughout the world across highly diverse settings where the care of acutely ill patients is provided. Echocardiographic evaluation performed in a point-of-care manner can provide relevant information regarding the mechanism of causes of shock, for example, increasing the rates of correct diagnosis and allowing for faster informed decision-making than through evaluation methods. Considering that the accurate diagnosis of life-threatening situations is essential for professionals working with acutely ill patients, several international associations recommend that physicians responsible for critically ill patients acquire and develop the ability to perform bedside ultrasound examinations, including echocardiographic examinations. However, there is no consensus in the literature regarding which specific applications should be included in the list of skills for nonechocardiographer physicians. Taking into account the multiplicity of applications of echocardiography in different scenarios related to acutely ill patients; the differences in the published protocols, with regard to both the teaching methodology and competence verification; and the heterogeneity of training among highly diverse specialties responsible for their care at different levels, this consensus document aimed to reflect the position of representatives of related Brazilian medical societies on the subject and may thus serve as a starting point both for standardization among different specialties and for the transmission of knowledge and verification of the corresponding competencies.

Treatment of acute diabetic metabolic crises in adults (Update2023) : Hyperglycemic hyperosmolar state and ketoacidotic metabolic disorder

Diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS) represent potentially life-threatening situations in adults. Therefore, rapid comprehensive diagnostic and therapeutic measures with close monitoring of vital and laboratory parameters are required. The treatment of DKA and HHS is essentially the same and replacement of the mostly substantial fluid deficit with several liters of aphysiological crystalloid solution is the first and most important step. Serum potassium concentrations need to be carefully monitored to guide its substitution. Regular insulin or rapid acting insulin analogues can be initially administered as an i.v. bolus followed by continuous infusion. Insulin should be switched to subcutaneous injections only after correction of the acidosis and stable glucose concentrations within an acceptable range.

Notfälle in der pädiatrischen Sportmedizin

Acute medical emergencies also occur in children and adolescents who participate in sports. Should a life-threatening situation arise, it is important that supporting supervisors are familiar with the correct application of resuscitation measures and regularly update their knowledge. Due to anatomical and physiological characteristics, children and adolescents sometimes show various injury patterns than adults and react differently to medical interventions. Knowledge of these differences helps in diagnosis as well as in therapy.

Emergency Management of Traumatic Brain Injuries Current Guideline and New Developments

Annually, traumatic brain injury keeps afflicting millions of individuals around the world. Traumatic brain injury may manifest in various forms from minor changes in consciousness to persistent comatoseness and death. The entirety of the brain is impacted by a diffused type of injury and edema in the most severe form of traumatic brain injury. Depending on the degree of the injury, there are many different treatment options, ranging from regular cognitive therapy sessions to invasive surgical procedures like bilateral decompressive craniectomies. Clinical practice guidelines have been developed to standardize assessment, discharge education, and referral of traumatic brain injury patients in order to achieve best practice management. Guidelines are described as propositions derived from research and used to direct clinicians and patients in making decisions about the highest degree of care and best practices in clinical practice. In order to minimise the risk of secondary brain injury and maximise the prognosis, early detection and therapy of severe traumatic brain injury are essential. The methodical evaluation and management of life-threatening situations that result from this is followed by invasive steps to control the airway, respiratory physiology, and hemodynamics, all with the main objective of maintaining a sufficient level of cerebral perfusion. Preventing secondary injury is the fundamental goal of early therapy of severe traumatic brain injury, specifically by preventing hypotension and hypoxia. The purpose of this research is to review the available information about the emergency management of traumatic brain injury current guideline and new developments

Kada kiseonik prestaje da bude lek?

Oxygen has been considered a potentially life-saving drug in life-threatening situations for decades. It is crucial in the perioperative period, where it is used daily by millions of surgical patients of all ages. Iatrogenic hyperoxia is as damaging as hypoxia, especially in young children and neonates. There is a growing awareness about this problem. Significant discoveries about the effect of oxygen on oxidative stress and cellular damage due to oxygen intoxication must contribute to developing hyperoxia monitoring, oxygen dosing guidelines, and revising the safe limits of hyperoxia. The consequences of hyperoxia can be irreversible damage to the vulnerable organs (lungs and brain), which mainly affects developing organisms.

Uso da ecocardiografia à beira do leito no cuidado do paciente grave - um documento conjunto de consenso da Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência e Sociedade Brasileira de Medicina Hospitalar. Parte 1 - Competência em ecocardiografia à beira do leito

The use of echocardiography by physicians who are not echocardiographers has become common throughout the world across highly diverse settings where the care of acutely ill patients is provided. Echocardiographic evaluation performed in a point-of-care manner can provide relevant information regarding the mechanism of causes of shock, for example, increasing the rates of correct diagnosis and allowing for faster informed decision-making than through evaluation methods. Considering that the accurate diagnosis of life-threatening situations is essential for professionals working with acutely ill patients, several international associations recommend that physicians responsible for critically ill patients acquire and develop the ability to perform bedside ultrasound examinations, including echocardiographic examinations. However, there is no consensus in the literature regarding which specific applications should be included in the list of skills for nonechocardiographer physicians. Taking into account the multiplicity of applications of echocardiography in different scenarios related to acutely ill patients; the differences in the published protocols, with regard to both the teaching methodology and competence verification; and the heterogeneity of training among highly diverse specialties responsible for their care at different levels, this consensus document aimed to reflect the position of representatives of related Brazilian medical societies on the subject and may thus serve as a starting point both for standardization among different specialties and for the transmission of knowledge and verification of the corresponding competencies.