Life-threatening Situations Research Articles

Auditing the status of prioritization of nursing actions in the trauma emergency department

IntroductionPatient assessment is considered as one of the key actions of nurses to provide professional services. Prioritizing the care needs based on the assessment could save patients' lives. Nurses should be able to prioritize patients' care needs and then, based on this prioritization, plan for patient life-threatening situations one after the other. The aim of this study was to audit the status of prioritization of nursing care for trauma patients in the trauma emergency department of Kowsar Hospital in Sanandaj. MethodsThis study was a quasi-experimental study (pre- and post-training) conducted using simple random sampling during the February to June 2021, in the emergency department of Kowsar Hospital in Sanandaj. The data collection tool was a standardized checklist for prioritizing nursing care, which contained a total of 53 items. At the beginning of the study, 64 nurses (32 in the experimental group and 32 in the control group) entered the study and the experimental group was evaluated based on a standardized prioritization checklist. Then, the data were collected and after statistical analysis, based on the obtained results and examining the weaknesses, the intervention group nurses participated in an educational course for one month. The checklist assessment was performed again and the results were compared with the results of the first assessment (before the intervention). ResultsThe number of items requiring training in the experimental group before the intervention was 258 cases which decreased to 53 cases after training and this decrease was statistically significant (p < 0.05). However, in the control group, the number of measures requiring training in the first stage was 220 cases, which in the second stage of assessment fell to 213, but this decrease was not statistically significant (p > 0.05). ConclusionBy auditing the status of nursing care prioritization in the trauma emergency department and providing training related to focusing on the identified weaknesses, nurses' skills to prioritize patients' care needs as well as the quality of nursing care delivery increased.

The Risks of Using Trimethoprim/Sulfamethoxazole in Patients with Renal and Cardiac Compromise.

The purpose of this article is to familiarize physicians with the risks of prescribing trimethoprim/sulfamethoxazole (TMP/SMX) for patients who have kidney or cardiac pathology, have hyperkalemia, or take other interacting medications. Although TMP/SMX is a drug that is frequently used to treat skin and soft-tissue infections of the leg and foot, particularly if methicillin-resistant Staphylococcus aureus is identified, it is not an innocuous antibiotic. Literature documenting the many adverse effects of TMP/SMX is reviewed. A case history is presented illustrating the association of TMP/SMX with the development of a life-threatening situation. Ways of avoiding these adverse events are discussed, and the use of safer antibiotics is recommended.

Using natural language processing in facilitating pre-hospital telephone triage of emergency calls.

Natural language processing (NLP) is an area of computer science that involves the use of computers to understand human language and semantics (meaning) and to offer consistent and reliable responses. There is good evidence of significant advancement in the use of NLP technology in dealing with acutely ill patients in hospital (such as differential diagnosis assistance, clinical decision-making and treatment options). Further technical development and research into the use of NLP could enable further improvements in the quality of pre-hospital emergency care. The aim of this literature review was to explore the opportunities and potential obstacles in implementing NLP during this phase of emergency care and to question if NLP could contribute towards improving the process of nature of call screening (NoCS) to enable earlier recognition of life-threatening situations during telephone triage of emergency calls. A systematic search strategy using two electronic databases (CINAHL and MEDLINE) was conducted in December 2021. The PRISMA systematic approach was used to conduct a review of the literature, and selected studies were identified and used to support a critical review of the actual and potential use of NLP for the call-taking phase of emergency care. An initial search offered 204 records: 23 remained after eliminating duplicates and a consideration of title and abstracts. A further 16 full-text articles were deemed ineligible (not related to the subject under investigation), leaving seven included studies. Following a thematic review of these studies two themes emerged, that are considered individually and together: (i) use of NLP for dealing with out-of-hospital cardiac arrest and (ii) responding to increased accuracy of NLP. NLP has the potential to reduce or eliminate human bias during the emergency triage assessment process and contribute towards improving triage accuracy in pre-hospital decision-making and an early identification and categorisation of life-threatening conditions. Evidence to date is mostly linked to cardiac arrest identification; this review proposes that during the call-taking phase NLP should be extended to include further medical emergencies (including fracture/trauma, stroke and ketoacidosis). Further research is indicated to test the reliability of these findings and a proportionate introduction of NLP simultaneous with increased quality and reliability.

SOFIA: An automated framework for early soft error assessment, identification, and mitigation

The occurrence of radiation-induced soft errors in electronic computing systems can either affect non-essential system functionalities or violate safety–critical conditions, which might incur life-threatening situations. To reach high safety standard levels, reliability engineers must be able to explore and identify efficient mitigation solutions to reduce the occurrence of soft errors at the initial design cycle. This paper presents SOFIA, a framework that integrates: (i) a set of fault injection techniques that enable bespoke inspections, (ii) machine learning methods to correlate soft error results and system architecture parameters, and (iii) mitigation techniques, including: full and partial triple modular redundancy (TMR) as well as a register allocation technique (RAT), which allocates the critical code (e.g., application’s function, machine learning layer) to a pool of specific processor registers. The proposed framework and novel variations of the RAT are validated through more than 1739k fault injections considering a real Linux kernel, benchmarks from different domains and a multi-core Arm processor.

Ecological analysis of Pavlovian fear conditioning in rats

Pavlovian fear conditioning, which offers the advantage of simplicity in both the control of conditional and unconditional stimuli (CS, US) presentation and the analysis of specific conditional and unconditional responses (CR, UR) in a controlled laboratory setting, has been the standard model in basic and translational fear research. Despite 100 years of experiments, the utility of fear conditioning has not been trans-situationally validated in real-life contexts. We thus investigated whether fear conditioning readily occurs and guides the animal’s future behavior in an ecologically-relevant environment. To do so, Long-Evans rats foraging for food in an open arena were presented with a tone CS paired with electric shock US to their dorsal neck/body that instinctively elicited escape UR to the safe nest. On subsequent test days, the tone-shock paired animals failed to exhibit fear CR to the CS. In contrast, animals that encountered a realistic agent of danger (a looming artificial owl) paired with a shock, simulating a plausible predatory strike, instantly fled to the nest when presented with a tone for the first time. These results highlight the possibility of a nonassociative, rather than standard associative, fear process providing survival function in life-threatening situations that animals are likely to encounter in nature.

Understanding darkness: age, sex, and tech-proficiency in knowledge and perceptions of technology-mediated abuse

Abstract This article examines how people understand technology-mediated abuse (TMA) between adult romantic partners. Because knowledge and attitudes regarding sensitive issues are created and shaped via technology, users’ interpretations are crucial to understanding life-threatening relational situations such as TMA. In this study, 551 individuals were recruited via community-based chain-referral sampling and asked to describe TMA (e.g., online stalking, hacking, verbal attack, etc.). To varying degrees, age, sex, and technological proficiency each and also, interactively predicted TMA perceptions. Findings showed that older (vs. younger) and male (vs. female) individuals understood different technology-mediated behaviors as harmful when used by adult romantic partners.

Testing P2Y12 platelet inhibitors generics beyond bioequivalence: a parallel single-blinded randomized trial

Cardiovascular diseases are the leading cause of death worldwide. Ticagrelor is an oral antiplatelet drug used in acute coronary syndrome. Although generic drugs are approved for their bioequivalence to the original product, they are not necessarily to be therapeutically equivalent. This study was conducted to prove the efficacy and safety of ticagrelor generically named Ticaloguard® compared to its brand Brilique® in healthy volunteers. A loading dose of 180 mg ticagrelor named Brilique® or Ticaloguard® followed by a 90 mg twice daily regimen as maintenance dose was given to 14 and 15 volunteers in Tica and Brili groups, respectively. The platelet aggregation on the ADP agonist was assessed at baseline and repeated 1 h and 3 h after the loading dose, on day 4 (after reaching steady-state), 12 and 24 h after discontinuation of the antiplatelet drug. Adverse effects from trial medications were noted by direct questions. It was shown that generic Ticaloguard® provides a similar therapeutic effect and safety as its branded Brilique® (p > 0.05). This will permit safe and trusted use of the generic Ticaloguard® when treating it in the same manner as Brilique®. Testing generic drug effects rather than simple bioequivalency, especially for drugs that are used in critical life-threatening situations, is crucial. We advocate applying this form of a clinical trial to test surrogate clinical efficacy for generics used in critical indications before having real-world data whenever possible.

Difficult Ventilation in an Infant After Successful Intubation.

Manufacturing defects in the connector of the endotracheal tube are not frequently encountered in emergency and planned intubations. In cases where they are encountered, however, they may cause partial or complete airway obstruction in sick infants with limited reserves, giving rise to a life-threatening situation following the intubation. For this reason, endotracheal tubes must be checked carefully before use. To this end, a stylet can be passed through the tube to check for a defect in the tube lumen or tube connector as part of a routine check of an endotracheal tube. This report features a patient who experienced a complete airway obstruction following intubation due to a manufacturing defect in the connector of the endotracheal tube.

An artificial intelligence model to identify snakes from across the world: Opportunities and challenges for global health and herpetology.

BackgroundSnakebite envenoming is a neglected tropical disease that kills an estimated 81,000 to 138,000 people and disables another 400,000 globally every year. The World Health Organization aims to halve this burden by 2030. To achieve this ambitious goal, we need to close the data gap in snake ecology and snakebite epidemiology and give healthcare providers up-to-date knowledge and access to better diagnostic tools. An essential first step is to improve the capacity to identify biting snakes taxonomically. The existence of AI-based identification tools for other animals offers an innovative opportunity to apply machine learning to snake identification and snakebite envenoming, a life-threatening situation.MethodologyWe developed an AI model based on Vision Transformer, a recent neural network architecture, and a comprehensive snake photo dataset of 386,006 training photos covering 198 venomous and 574 non-venomous snake species from 188 countries. We gathered photos from online biodiversity platforms (iNaturalist and HerpMapper) and a photo-sharing site (Flickr).Principal findingsThe model macro-averaged F1 score, which reflects the species-wise performance as averaging performance for each species, is 92.2%. The accuracy on a species and genus level is 96.0% and 99.0%, respectively. The average accuracy per country is 94.2%. The model accurately classifies selected venomous and non-venomous lookalike species from Southeast Asia and sub-Saharan Africa.ConclusionsTo our knowledge, this model’s taxonomic and geographic coverage and performance are unprecedented. This model could provide high-speed and low-cost snake identification to support snakebite victims and healthcare providers in low-resource settings, as well as zoologists, conservationists, and nature lovers from across the world.

Adrenal bleeding due to pheochromocytoma - A call for algorithm

BackgroundAdrenal hemorrhage is a rare, usually life-threating complication. The most common neoplasm resulting in spontaneous adrenal bleeding is pheochromocytoma and it accounts for nearly 50% of cases. Currently, the recommendations for the diagnosis and management of patients with adrenal bleeding due to pheochromocytoma are unavailable.Materials and methodsWe performed a database search for all pheochromocytoma patients, diagnosed and treated from 2005 to 2021 in tertiary endocrinology center. 206 patients were identified, 183 with complete data were included in the analysis. We investigated clinicopathological characteristics, treatment and outcomes of hemorrhagic pheochromocytoma cases and characterize our approach to perioperative diagnosis and medical management. Finally our experiences and data from previously published articles concerning adrenal hemorrhage were analyzed to propose a diagnostic and therapeutic algorithm for hemorrhagic pheochromocytomas.ResultsIn the whole group, seven patients (4 men and 3 women) with adrenal bleeding were found, (3.8%). Median patient’s age was 49 years (range: 36-78 years). The most common manifestation of adrenal bleeding was acute abdominal pain (5/7). Two patients developed shock. Hormonal assessment was performed in five patients, based on 24-hour urinary fractionated metanephrines with urinary 3-methoxytyramine. Normetanephrine was elevated in all patients, metanephrine and 3-methoxytyramine - in four cases (4/5). Most patients (6/7) had symptoms suggesting pheochromocytoma before hemorrhage – most commonly paroxysmal hypertension (4/7). One patient died, before the diagnosis of adrenal bleeding was made. Diagnostic imaging performed in six out of seven patients revealed adrenal tumor, with median largest diameter equal to 7.4 cm (range: 5-11 cm). Five patients had elective surgery, in one case an urgent surgery was performed. In all cases the diagnosis of pheochromocytoma was confirmed in postoperative histopathology or in autopsy. The perioperative survival rate was 85.7%.ConclusionsDiagnosis of pheochromocytoma should be always considered in patients with adrenal bleeding, especially with accompanying abdominal pain, hemodynamic shock and previous history of pheochromocytoma-associated symptoms. Lack of proper diagnosis of pheochromocytoma before surgery is associated with an additional perioperative risk. To improve the decision making in this life-threatening clinical situation, based on our results and literature data, we proposed a diagnostic and treatment algorithm.

A Holistic Approach to a Dizzy Patient: A Practical Update.

Dizziness is one of the most common symptoms encountered by physicians daily. It is divided into four categories: vertigo, disequilibrium, presyncope, and psychogenic dizziness. It is essential to distinguish these four symptoms because the causes, prognosis, and treatment differ. Vertigo constitutes a disease of the central or peripheral nervous system. Central origin vertigo may be a life-threatening situation and must be detected as soon as possible because it includes diseases such as stroke, hemorrhage, tumors, and multiple sclerosis. Peripheral origin vertigo includes benign diseases, which may be fully treatable such as vestibular migraine, benign paroxysmal positional vertigo, vestibular neuritis, Ménière’s disease, and cervical vertigo. The HINTS (head impulse, nystagmus, test of skew) examination is essential to distinguish central from peripheral causes. A detailed history including the duration of vertigo (episodic or continuous), its trigger, and a clinical examination step by step following the appropriate protocol could help to make a definite and accurate diagnosis and treatment. Due to a lack of expertise in dizziness and inappropriate treatment, many patients are admitted to dizziness clinics with long-standing dizziness. A holistic treatment combining medications, vestibular rehabilitation, physiotherapy, and psychotherapy should be initiated to improve the quality of life of these patients. So, this review aims to recommend a clinical protocol for approaching a dizzy patient with vertigo and to present in detail the epidemiology, pathophysiology, symptoms, diagnosis, and contemporary treatments of all causes of vertigo.

Extracorporeal hemoadsorption with the CytoSorb device as a potential therapeutic option in severe intoxications: Review of the rationale and current clinical experiences.

Many severe intoxications occur with substances with no specific antidote, which is why methods of extracorporeal elimination represent a particularly useful and even critical component in their management. The purpose of this review is to summarize the accumulating evidence and clinical results from the application of CytoSorb hemoadsorption therapy in patients with severe intoxications. The technology represents a promising technique with an increasing number of publications in a variety of severe intoxication scenarios suggesting that early intervention might provide rapid substance removal with subsequent overall clinical improvement. Given the tremendous challenges in performing prospective, randomized trials in this field, the strong safety profile of the device and the high acuity of these life-threatening situations, CytoSorb should be considered as a therapeutic option in severe intoxications, particularly when direct antidotes are not available. However, further clinical data are desirable to provide precise recommendations.

Anesthesia management in patients with abnormally invasive placenta: A single-center experience

Aim: Postpartum hemorrhage is a life-threatening obstetric emergent clinical situation accompanied by blood loss of more than 500 ml after vaginal delivery and more than 1000 ml after cesarean section. This situation, frequently encountered in placental adhesion anomalies, is essential in terms of follow-up, treatment, and multidisciplinary management. We aimed to retrospectively evaluate the perioperative anesthesia management, transfusion requirement, and postoperative intensive care unit requirement of patients diagnosed with placental invasion anomaly who had an intraoperative hemorrhage&#x0D; Methods: In our single-center study, a total of 58 female patients diagnosed with of placental invasion anomaly with a cesarean section between 2017-2020 were examined. Patients under 18 years of age and missing data were excluded from the study. Demographic data of patients (age, American Society of Anesthesiologists score (ASA)), diagnosis, duration of operation, perioperative laboratory findings, anesthesia type, perioperative hemodynamics (highest heart rate, lowest mean arterial pressure, shock index), amount of bleeding, blood products, and fluids used, surgical interventions (B-Lynch, Bacri balloon application, uterine artery ligation, hysterectomy), intraoperative vasopressor/inotrope use, ICU stay, laboratory results in the first 24 hours postoperatively, and total hospital stay were recorded.&#x0D; Results: In the preoperative evaluation, 27 (46.5%) patients were diagnosed with placenta accreta, and placenta previa was diagnosed in 19 (32.7%) patients. Perioperatively mean of 3.08 ± 1.7 units of Red blood cell was used. In patients with postoperative intensive care unit hospitalization, the highest intraoperative lactate value was 3.5±1.8 mmol/L, shock index was 1.3±0.3 (0.6-1.8). In patients given intraoperative fibrinogen concentrate, the intraoperative shock index was 1.5±0.2 (0.9-1.8), the amount of intraoperative bleeding was 2575±302.2 ml, and the fibrinogen levels measured in the first 24 hours after surgery were 294.7±79.7 mg/dl.&#x0D; Conclusions: Anesthesia management of patients diagnosed with abnormal placental invasion is important because of significant hemorrhage. Due to unstable hemodynamics, preoperative blood product preparation with a multidisciplinary approach and a postoperative intensive care unit plan should be made for these patients.

IOT BASED REMOTE MEDICAL DIAGNOSIS SYSTEM USING NODE MCU

Internet of things (IoT) can help us better our lives in many ways by rendering real time Information over the internet collected from a smart network of devices. In this paper, we have discussed about Remote Medical Diagnosis System (RMDS), which can come to aid for humans in many life-threatening situations. Often, people fall sick in locations where there are no hospitals or healthcare facility nearby, in such cases people sometimes even die due to lack of proper treatment and diagnosis. In rural areas of third-world countries, this problem is even more intense. For demonstration purpose, heartrate and body temperature of a person is determined and rendered over the internet. Health data is uploaded in real-time and can be viewed through a web browser. The aim of RMDS is to remotely provide health information of a patient to a healthcare professional in life-threatening situations. It can also be used for remote patient monitoring of regular patients of a doctor.

Peri-Traumatic Dissociation and Tonic Immobility as Severity Predictors of Posttraumatic Stress Disorder After Rape.

Some individuals show abnormal reactions to extreme fear and life-threatening situations, including tonic immobility (TI) and peri-traumatic dissociation (PTD). We aimed to investigate the association of TI and PTD with posttraumatic stress disorder (PTSD) in women who experienced sexual violence and the risk factors for PTD occurrence. We compared PTSD severity in 86 young adult women with PTSD after a sexual violence exposure grouped according to the presence of PTD and TI. In addition, we investigated whether PTD is associated with depression and anxiety symptoms and assessed potential risk factors for PTD reaction. We found a significant positive correlation between PTSD severity and PTD occurrence (R2 = .132; p = .001). PTD was also positively correlated with all clusters of PTSD symptoms except the Clinician-Administered PTSD Scale avoidance cluster (p = .058). PTD was strongly correlated with anxiety (R2 = .619; p < .001) and depressive symptoms (R2 = .547; p < .001). Multiple logistic regression showed that history of physical abuse (odds ratio [OR]: 1.386; p = .011) and sexual abuse (OR: 1.947; p = .004) during childhood were associated with PTD occurrence. Other risk factors for PTD were having less years of study (OR: 0.216; p = .016) and lower income (OR: 7.403; p = .028). TI measures were available for a subsample of 29 women. We found no association between TI and PTSD severity. PTD, but not TI, is significantly associated with more severe PTSD, depressive, and anxiety symptoms. Less-educated women with a history of childhood abuse and a lower income are at risk of PTD occurrence during a sexual violence episode.

Expandable carboxymethyl chitosan/cellulose nanofiber composite sponge for traumatic hemostasis

Uncontrolled hemorrhage poses a severe life-threatening situation. However, traditional hemostats still have various limitations. It is urgent to develop a material with excellent biocompatibility and hemostatic ability. Evidence has shown that carboxymethyl chitosan (CMCS) has hemostatic properties and good compatibility. Herein, we develop an expandable hemostatic sponge by modifying CMCS with cellulose nanofibrils (CNFs) through the CO-NH cross-linking method. We verified its potential as a hemostatic agent both in vivo and in vitro. The results demonstrated that the prepared carboxymethyl chitosan/cellulose nanofiber composite (CNF-CMCS) sponges could absorb blood, quickly expand to exert pressure in the wound, and exhibit an excellent coagulation ability. The CNF-CMCS sponges significantly decreased the bleeding time and blood loss in several hemorrhage models and possessed a significant advantage in treating the deep penetrating injury hemorrhage. Therefore, the sponges provide a unique application prospect and potential as a penetrating trauma hemostatic agent.

Effects of cardiovascular health, musculoskeletal health and physical fitness on occupational performance of firefighters: protocol for a systematic review and meta-analysis

IntroductionFirefighting is a hazardous occupation, where firefighters are involved in life-threatening situations, being placed under tremendous physical strain, while wearing heavy and insulated equipment to protect them from chemicals, fumes...

Trauma Resuscitation Training: An Evaluation of Nurses' Knowledge.

Trauma resuscitation in the emergency department involves coordinated, well-equipped, and trained health care providers to make essential, prudent, and expedient management decisions. During resuscitation, health care providers' knowledge and skills are critical in minimizing the potential risks of mortality and morbidity. This study aimed to evaluate the impact of training on nurses' knowledge and confidence regarding trauma resuscitation and whether there was any difference between participants with and without previous trauma training. This study used a pre- and posttraining test study design to evaluate the effects of an intensive 8-hr trauma resuscitation training program on nurses' knowledge from January 2018 to August 2021. The training program consisted of lectures and patient scenarios covering initial assessment, resuscitation, and management priorities for trauma patients in life-threatening situations, stressing the principles of the trauma team approach. A total of 128 nurses participated in 16 courses conducted during the study period. This study found significant improvement in nurses' knowledge after the training (pre- and posttraining median [interquartile range, IQR] test scores 5 [4-6] vs. 9 [8-9], p < .001). There was no significant difference in pretraining test scores between the participants with previous trauma training and those without training (median [IQR] test scores 5 [4-6] vs. 4 [4-5], p = .751). Trauma resuscitation training affects nurses' knowledge improvement, emphasizing the need for training trauma care professionals to provide adequate care.

Role of Nurses in Intensive Care Unit

Critical care nurses provide most of the direct care to patients in life-threatening situations within the intensive care unit. ICU nurses commonly provide care to patients suffering from cardiac disease, brain injuries, accident victims, and patients recovering from complex surgeries that need frequently nursing care. The ICU nurse is the primary responsible for the care taking and treatment of patient’s within an unstable and/or critical clinical situation. The nurse manages and coordinates nursing care through an in-depth and ongoing assessment, therapies and high-intensity interventions. In the Intensive Care Unit, a nurse takes crucial clinical decisions based on the best available scientific evidence, clinical experience and patient preferences.&#x0D; Intensive care unit nurses work very closely with physicians and other members of the health care team. They need to be skilled to assess patients’ problems quickly and capable to use high-tech equipment. They use their advanced skills to care for patients who are critically ill and at high risk for life-threatening health problems.&#x0D; Critical care nurses or ICU nurses must be physically, mentally, and emotionally strong to work with seriously ill patients and their loved ones. Most patients in a critical care unit are physically and mentally unstable and they require respiratory and heart monitoring as well as treatment adjustments. The nurse is equipped with advanced skills that enable him to carry out specific, autonomous or complementary interventions of a technical-scientific, managerial, relational and educational nature; she/he plans healthcare assistance through scientifically validated tools; she/he identifies, analyzes, calculates and treats risks related to care provision by systematically evaluating healthcare outcomes. In this complicated environment, the individual clinical act acquires substantial importance in the overall care process and must be based on continuous education to ensure a safe and quality treatment.&#x0D; They are responsible for all care given to the patient, from medication administration to tracheotomy and other ventilator care, as well as constant monitoring of the patient for any alterations in their status. Responsibilities include monitoring, assessment, vital sign monitoring, ventilator management, medication administration, intravenous insertion and infusion, central line care, Swan-Ganz catheters, and maintenance of a running record of the patient’s status. He or she must be prepared at all times to perform cardiopulmonary resuscitation and other lifesaving techniques.

Paediatric Deep Neck Infection-The Risk of Needing Intensive Care.

Deep neck infections are potentially dangerous complications of upper respiratory tract or odontogenic infections. The pathophysiology, clinical presentation, and potential spreading depend on the complex anatomy of the neck fascia. These infections can lead to severe pathological conditions, such as mediastinitis, sepsis, and especially airway impairment with difficult management. Because of the risk of life-threatening emergency situations and the possible impacts on the overall health status of affected children, their early recognition is of utmost importance. Torticollis, drooling, and stridor are the most common signs of advancing disease. Children presenting with these symptoms should be admitted to the paediatric intensive care unit for vital function monitoring, where the airway could be readily secured if function is compromised.