Patients In Emergency Situations Research Articles

Pharmacist administered parenteral medications: A descriptive report of an inpatient training program

AbstractIntroductionParenteral medication administration is a crucial aspect of in‐hospital patient care and has been historically managed by nurses and physicians. Despite pharmacists' extensive training in the medication use process, their underutilization in medication administration stems from various factors, including the lack of formalized training, limited awareness by other healthcare professionals, and unclear legal guidance. This report discusses the implementation and outcomes of a pharmacist medication administration program at a large academic medical center.MethodsThe initiative began by revising hospital policies, enabling pharmacists to administer medications during emergencies. Documentation and communication protocols were established. Training included an online module and hands‐on sessions covering various topics with a focus on parenteral medication administration and medication safety. Following completion of the program, competency of pharmacists was assessed by pharmacists experienced in intravenous administration using simulated patient case scenarios. Following implementation, the frequency and characteristics of pharmacist administered medications were captured and described.ResultsThirty pharmacists, including 11 residents, participated. Seven pharmacists administered 349 doses of medications to 284 patients in emergency situations. Administrations by pharmacists included 227 titratable infusions, 72 intermittent or continuous infusions, 49 intravenous pushes, and 1 intranasal naloxone. Classes of medications included high risk products such as vasopressors, sedatives, antiarrhythmics, and thrombolytics. No extravasations or infiltrations were reported.ConclusionImplementation of the pharmacist medication administration program signifies significant progress in strengthening the pharmacists' role in patient care at the bedside specifically highlighting the competency of pharmacists to administer parenteral products during emergency situations. The absence of adverse events highlights the feasibility and safety of integrating pharmacists into the bedside team. As the landscape of health‐system pharmacy evolves, embracing standardized training programs like ours reemphasize pharmacists' essential contributions to the multidisciplinary healthcare teams, ultimately enhancing patient care and safety.

Organic X‐Ray Image Sensors Using a Medium Bandgap Polymer Donor with Low Dark Current

The development of portable X‐ray detectors is necessary for diagnosing fractures in unconscious patients in emergency situations. However, this is quite challenging because of the heavy weight of the scintillator and silicon photodetectors. The weight and thickness of X‐ray detectors can be reduced by replacing the silicon layer with an organic photodetectors. This study presents a novel bithienopyrroledione‐based polymer donor that exhibits excellent photodetection properties even in a thick photoactive layer (~700 nm), owing to the symmetric backbone and highly soluble molecular structure of bithienopyrroledione. The ability of bithienopyrroledione‐based polymer donor to strongly suppress the dark current density (Jd ~ 10−10 A cm−2) at a negative bias (−2.0 V) while maintaining high responsivity (R = 0.29 A W−1) even at a thickness of 700 nm results in a maximum shot‐noise‐limited specific detectivity of Dsh* = 2.18 × 1013 Jones in the organic photodetectors. Printed organic photodetectors are developed by slot‐die coating for use in X‐ray detectors, which exhibit Dsh* = 2.73 × 1012 Jones with clear rising (0.26 s) and falling (0.29 s) response times upon X‐ray irradiation. Detection reliability is also proven by linear response of the X‐ray detector, and the X‐ray detection limit is 3 mA.

Successful use of extracorporeal membrane oxygenation for life‐threatening macrophage activation syndrome after treatment with tocilizumab in an systemic juvenile idiopathic arthritis patient

AbstractMacrophage activation syndrome (MAS) is a rare, potentially life‐threatening condition in rheumatic diseases. The primary treatments consist of high‐dose corticosteroids and immunosuppressive drugs, although more recently, cytokine inhibitors like anakinra or tocilizumab (TCZ) have been reported. We present a case of a child with systemic juvenile idiopathic arthritis (sJIA). After receiving a single infusion of TCZ, the child developed progressive hypoxia and was subsequently transferred to the pediatric intensive care unit (PICU) after 4 days. An immediate postintubation chest X‐ray revealed a diffuse exudative lesion. Despite continuous efforts to provide mechanical ventilation and respiratory support, the patient's oxygen saturation continued to decline. Moreover, the patient developed hemodynamic compromise, necessitating the administration of norepinephrine. Eventually, vasopressin and dopamine were added to maintain stable hemodynamics. After an intensive but ineffective treatment, extracorporeal membrane oxygenation (ECMO) was initiated in the PICU after 16 h. The patient successfully recovered and was weaned off ECMO support after 60 h. Following discharge from the PICU, given the severe refractory clinical features, we made an attempt to readminister TCZ treatment. However, within half an hour of TCZ infusion, the patient experienced anaphylaxis characterized by palpitations and chest tightness, leading to the discontinuation of TCZ. TCZ, as a biological agent, is commonly used in the treatment of sJIA. Nonetheless, the occurrence of MAS and anaphylaxis following TCZ administration for sJIA may be more prevalent than previously recognized. Pediatric rheumatologists should exercise caution when initiating TCZ for active sJIA. Furthermore, we want to underscore the importance of life‐saving techniques such as ECMO for sJIA patients in emergency situations.

Medical Emergencies in the Pregnant Patient.

This review article provides a comprehensive overview of common medical emergencies that can occur in pregnant patients. We summarize the key diagnostic and management steps for each emergency to assist health care professionals in identifying and treating these potentially life-threatening conditions. The medical emergencies discussed in this article include postpartum hemorrhage; hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome; acute fatty liver of pregnancy; amniotic fluid embolism; pulmonary embolism; acute respiratory distress syndrome; and shock. Each condition is described in detail, with a focus on the clinical presentation, diagnostic workup, and treatment options. The information presented in this review article is based on current best practices and guidelines from leading medical organizations. We hope this article will serve as a valuable resource for health care professionals who care for pregnant patients and help improve outcomes for these patients in emergency situations.

The Effectiveness of Emergency Triage Systems: A Systematic Review

Triage is the first process of assessment and prioritization of all patients who present to emergency departments (EDs) into categories according to their condition and level of urgency. In this study, a systematic review of the literature on the effectiveness of triage systems was conducted in Saudi Arabia. Following PRISMA guidelines, six large databases were searched for relevant articles published between 2003 and 2023. Three authors reviewed the titles, abstracts, and full texts. The databases were searched using the following keywords: triage systems, CTAS, emergency department overcrowding, non-urgent or inappropriate visits to the ED, ED overutilization, and triage and ED overcrowding in the Middle East. A total of 1,051 articles were identified, of which 245 met our inclusion criteria. From the findings of these studies, in relation to the factors that reduce triage efficacy in the Middle East and specifically in Saudi Arabia, it can be argued that there is a need for more studies and solutions to address these issues. Patients are in need of health education, and alternative solutions must be considered to address the high percentage of non-urgent visits to the ED. Emergency department triage is the first screening step that sorts patients in emergency situations by categorizing their urgency levels to prioritize patients for evaluation and treatment. Because the ED is an integral hospital department and a complicated, fast-paced environment, ED healthcare services have evolved to be delivered through effective triage systems to reduce waiting times and overcrowding.

Emergency management of patients with Glanzmann thrombasthenia: consensus recommendations from the French reference center for inherited platelet disorders

Glanzmann thrombasthenia (GT) is a genetic bleeding disorder characterised by severely reduced/absent platelet aggregation in response to multiple physiological agonists. The severity of bleeding in GT varies markedly, as does the emergency situations and complications encountered in patients. A number of emergency situations may occur in the context of GT, including spontaneous or provoked bleeding, such as surgery or childbirth. While general management principles apply in each of these settings, specific considerations are essential for the management of GT to avoid escalating minor bleeding events. These recommendations have been developed from a literature review and consensus from experts of the French Network for Inherited Platelet Disorders, the French Society of Emergency Medicine, representatives of patients’ associations, and Orphanet to aid decision making and optimise clinical care by non-GT expert health professionals who encounter emergency situations in patients with GT.

The The Effectiveness of Poster Media on Increasing Nurses' Knowledge about the Australasian Triage Scale (ATS)

The nurses who working in Emergency Room (ER) are require to be able to provide fast and appropriate treatment according to the priority of the patient's condition. Triage is the process of sorting out patients according to their level of emergency. Australasian Triage Scale (ATS) is one of the triage systems implemented in ER. In practice, sometimes the triage carried out by nurses is not appropriate based on the guidelines, resulting over triage or under triage in patients. The aims of this study is to determine the effectiveness of poster media on increasing nurses knowledge about ATS in Emergency Room Bali Mandara Hospital. This research is a quasi-experimental research design with One Group Pretest-Posttest Design Without Group Control. The number of samples in this study were 26 nurses obtained by total sampling. The instrument in this study used a questionnaire and ATS poster. Data analysis used Paired Sample T-Test. This research obtained the average score of nurses knowledge about ATS on pretest 6,08 and posttest increased to 7,58. Bivariate analysis obtained p-value of <0.001 which means that there is a significant effect of poster media on increasing nurses knowledge about ATS. Nurses should have a good understanding of triage so that they can perform optimal management of the patient in emergency situation.

Related donor platelet transfusion improves platelet transfusion refractoriness in hematological patients.

Transfusion of HLA-matched platelets can reduce the effect of alloimmune responses on platelet transfusion efficacy; however, finding HLA-matched platelets in the population is nearly impossible. Almost all HLA-matched platelets from related are half-matched, but the hemostatic efficacy of related donor platelets is unclear. Our goal was to compare the hemostatic effect of related donated platelets and unrelated donors platelets. In this retrospective cohort study, we included acute leukemia and myelodysplastic syndrome patients with thrombocytopenia after chemotherapy. These patients were all transfused with platelets. This study excluded patients younger than 16 years and older than 65 years, or patients with abnormal coagulation parameters during platelet transfusion. We compared the hemostatic effect of related donated platelets and unrelated donors platelet. The primary outcome was transfusion efficacy after platelet transfusion, and the number of platelet counts and corrected count increments at 24 h after platelet transfusion. We analyzed 31 patients who received platelet transfusions from related donors (Treatment group) and 35 patients who received platelet transfusions from unrelated donors (Comparator group). Except for the relatively small proportion of patients with myelodysplastic syndrome in the treatment group, baseline clinical and laboratory characteristics were similar between the two groups. Hemostasis and prevention of bleeding in the treatment group showed significant superiority; the number of platelets increased 24 h after platelet transfusion in the treatment group was significantly higher than that in the comparator group. After 24 h, the corrected count increments treatment group was also higher than the comparator group; in the treatment group, the transfusion effect was better when the three sites of HLA-A, B, and C were identical, and the different blood types of platelet donors and recipients did not affect the transfusion effect. Related donated platelets have better hemostasis and prevention effects, and no increase in adverse blood transfusion reactions. It may be a better transfusion strategy for platelet refractoriness patients in emergency situations.

The Effects and Challenges Faced by Health Practitioners in Dealing with Emergency Cases

Health practitioners, such as doctors, nurses, and paramedics, play a vital role in our society by providing care to patients in emergency situations. However, they also face a number of challenges in dealing with these cases. Emergency cases represent pivotal moments in healthcare delivery, demanding swift and effective interventions to mitigate life-threatening consequences. Health practitioners, comprising physicians, nurses, paramedics, and other medical personnel, play a critical role in responding to these high-stakes situations. This article delves into the effects and challenges confronting health practitioners when confronted with emergency cases. Emergency situations necessitate immediate medical attention, placing healthcare professionals at the forefront of critical care. However, this role brings about distinctive challenges and repercussions that can influence both patient outcomes and practitioners' well-being. The article examines the emotional and psychological effects on health practitioners, including stress, burnout, psychological impacts, and compassion fatigue. Furthermore, it explores the challenges practitioners face in terms of time pressure, decision-making, resource limitations, ethical dilemmas, communication issues, and physical demands. By understanding and addressing these effects and challenges, healthcare systems can better support practitioners and optimize emergency care.

A Greedy Heuristic Based on Optimizing Battery Consumption and Routing Distance for Transporting Blood Using Unmanned Aerial Vehicles

Unmanned Aerial Vehicles (UAVs) play crucial roles in numerous applications, such as healthcare services. For example, UAVs can help in disaster relief and rescue missions, such as by delivering blood samples and medical supplies. In this work, we studied a problem related to the routing of UAVs in a healthcare approach known as the UAV-based Capacitated Vehicle Routing Problem (UCVRP). This is classified as an NP-hard problem. The problem deals with utilizing UAVs to deliver blood to patients in emergency situations while minimizing the number of UAVs and the total routing distance. The UCVRP is a variant of the well-known capacitated vehicle routing problem, with additional constraints that fit the shipment type and the characteristics of the UAV. To solve this problem, we developed a heuristic known as the Greedy Battery—Distance Optimizing Heuristic (GBDOH). The idea was to assign patients to a UAV in such a way as to minimize the battery consumption and the number of UAVs. Then, we rearranged the patients of each UAV in order to minimize the total routing distance. We performed extensive experiments on the proposed GBDOH using instances tested by other methods in the literature. The results reveal that GBDOH demonstrates a more efficient performance with lower computational complexity and provides a better objective value by approximately 27% compared to the best methods used in the literature.

Medical support of surgical patients in emergency situations in cities

The organization of medical provision of patients of the surgical profile situations in cities is improved by integration of the territorial ambulatory and polyclinic service and republic service of disaster medicine. The measures performed the special emergency surgery to patients in Tatarstan Republic.

Smart Medical Nursing Care Unit based on Internet of Things for Emergency Healthcare

Recently, the development and integration of various sensor control with smart intelligent unit is used in medical field through IoT. However, there is still a lot of space for growth in the medical and health industry's use of new technology. The traditional nurse care unit is managed through medical staffs, and the expanding medical demands creates the hospital’s patients records to be updated inefficiently. Since this is now an urgent need, developing a realistic, smart medical nursing care unit at low cost with a system capable of facilitating the effective and convenient administration of medical staff has taken a new significance. The proposed framework, conducted in the analysis to monitor medical records and activities of the emergency care unit patients, functions as a nurse and gives patients the nurse care satisfaction. The patients' actual location may be obtained for the first time by cloud computing based smart system. The precise location of the patient is critical to rescue the patient in emergency situation. This research work illustrates that the intelligent nurse care unit is the main phase called Smart Medical Nursing Care (SMNC). It contains several sensor units and by the combination of many sensors in the sensor module, it takes very less reaction time to connect or communicate both sides i.e., between patients and medical staffs.

Knowledge of Basic Life Support among Final Year Dental Students of BPKIHS

Introduction: The chance of survival of a victim after cardiac arrest/foreign-body airway obstruction is doubled by early institution of Basic Life Support (BLS). Besides medical doctors, dental doctors might also encounter the patients in emergency situation requiring BLS, especially during peripheral district teaching hospital posting in internship.
 Objectives: The objective of this study was to assess the level of knowledge about BLS among final year dental students of BPKIHS.
 Methodology: In this cross-sectional study, structured questionnaires were distributed to BDS final year students (purposive sampling, sample size=53). Each question responded correctly was awarded as point +1 and total points were calculated by adding all the correct answers. The collected data were entered in Microsoft excel 2010 and descriptive analysis was done by SPSS 16.
 Results: Out of 53 questionnaires distributed, 49 were responded and returned (response rate= 92.45%). Twenty participants were male and twenty-nine were female. Four participants had taken BLS training in the past. Only twenty participants scored ≥ 50% and none of the participant scored ≥75%. Only one question was responded correctly by 100% participants. Ten questions were responded correctly by ≥50% participants. Although 65.3% participants were aware about high quality CPR, only 49% knew the exact location of chest compression. The chest compression to ventilation ratio for each of single rescuer and two rescuers was known by 20 participants (40.8%) and 28 participants (57.1%) respectively.
 Conclusion: Knowledge of BLS is poor among BDS final year students.

Design and Evaluation of a Wearable Smart Blanket System for Monitoring Vital Signs of Patients in an Ambulance

Objectives. Considering the advantages of the wearable systems (such as continuous monitoring, ease of installation, and significant efficiency), they can also be used to monitor patients in emergency situations and, particularly, in the ambulance. This study is aimed at specifying, modeling, and evaluating a wearable smart blanket system for monitoring vital signs in emergency circumstances. Method. At first, all the smart blanket system requirements were specified using an author-made questionnaire, and the essential requirements were specified in the software requirements specification format. Such an anticipated smart wearable blanket is then modeled by Unified Modeling Language. Finally, the most important quality attributes (i.e., the nonfunctional requirements) of the proposed wearable smart blanket system were evaluated using a descriptive-analytical study. Results. Evaluation results of the proposed system show that using the smart blanket system could not only provide the required functionalities, but also, it improved the important quality attributes such as response time and delay in sending data packets (14% improvement), accuracy, energy consumption (18% improvement), reliability and fault-tolerance, and performance (28% improvement) in contrast to the compared related work. Conclusion. Using a smart wearable blanket in an ambulance instead of such in a huge ambulance cabin would be beneficial in terms of time and space, ease of use, and maybe cost while providing the required functionalities besides having proper quality attributes.

A Novel MAC Protocol for Energy Conservation in Wireless Body Area Networks

Body sensor networks are an example of wireless sensor networks. Body Sensor Network is a kind of wireless sensor network for a special purpose that uses wireless sensor nodes to measure a person's biological parameters and monitor his or her health remotely and is available in both wearable and implantable types. These systems also monitor physical activity such as environmental parameters. These systems can provide significant assistance by supplying services such as medical observations and the provision of medicinal and medical information, improving the memory of individuals and controlling home devices and communicating in emergencies. Body wireless sensor network is a wireless technology featuring small, smart devices that connect to the body and monitor it continuously, enhancing early detection of emergency situations in patients at high health risk and providing a wide range of health services, therefore of paramount importance. The most important challenges in wireless sensor networks are sensor nodes, resource constraints, reliability and quality of service, security and routing, and energy consumption constraints. In this article, we focused on energy consumption due to small sensors with limit power resource and latency for emergency data to improve network lifetime, energy consumption, network efficiency and lower latency. This research will provide a way to optimize energy consumption by examining the energy exhaustion and network performance in the MAC layer. It assumed that by improving the access to MAC in wireless body area network can have better operation power and by propound the energy parameter in data transition priority. Optimizing energy consumption and minimizing delays and increasing the latency are the goals of this study by modify the IEEE 802.15.4 superframe structure based on MAC layer protocol.

Considerations on endodontic care in times of SARS CoV-2 pandemic

ABSTRACT The severe acute respiratory syndrome of the new coronavirus, SARS CoV-2, which became a pandemic, was first reported in Wuhan, Hubei, China, in December 2019. It can cause mild symptoms, but in some cases, it can cause serious complications, leading to death. The disease spreads through aerosol droplets and has an estimated incubation period between 2 and 14 days (a period in which the patient has high potential to infect other people). Endodontists have a high risk of exposure to COVID-19 when compared to other health professionals, since most of the work involves the generation of aerosols and care for patients in emergency situations, such as symptomatic irreversible pulpitis, symptomatic apical periodontitis, acute apical abscess and traumatic dental injuries, is imperative. Thus, this critical review addresses considerations about endodontic care in times of pandemic, whose emergencies imply a real need for treatment, as well as the care that must be adopted to minimize risks for both professionals and patients who seek the resolution of their clinical pain conditions.

Effects of COVID-19 pandemic on Turkish private practice dentists' economic well-being

Background/Aim: Coronavirus disease 2019 (COVID-19) is a global health concern. The COVID-19 pandemic has not only health implications but also important social, economic, and political consequences. Dental practices have currently canceled elective procedures and restricted services to the provision of emergency dental care in order to prevent transmission of COVID-19, which has had serious financial implications. Although several reports about the economic consequences of the COVID19 pandemic have been prepared, no study has analyzed the potential impact of a pandemic on the economy of private-practice dentists. In this context, the purpose of this study is to determine how the COVID-19 has shaped the economic behavior of Turkish private-practice dentists and study the underlying mechanisms. Material and Method: A total of 312 private practice dentists were included in the study. The researchers developed a closed-ended questionnaire that contained 10 questions and was divided into three parts. The first part captured demographic information (age, gender, and professional experience of dentists). The second part measured the economic effects of the pandemic. The third part explored the dentists' economic behavior in the post-pandemic period. Results: Over half (52.6%) of the dentists stated that during the pandemic, they only cared for patients in emergency situations. Most (97.4%) of the dentists stated that the pandemic affected their economic situation negatively, and 66.7% of dentists stated that they could not meet their routine clinical expenses during the pandemic. In the post-pandemic period, 52.6% of dentists are considering increasing their treatment fees, and 19.2% of dentists are considering dismissing some of their employees for economic reasons. Conclusions: The significant limitation of clinical and surgical activities in private dental practice caused by the COVID-19 pandemic has had a very significant negative effect on private-practice dentists' economic well-being.

ReSPECT form update: advance care planning

Essential informationAs patients in emergency situations are often unable to make decisions about their priorities for care or treatment choices, advance discussions are essential.

Comparison of clinical outcomes between ABO-incompatible and ABO-compatible pediatric liver transplantation: a systematic literature review and meta-analysis.

ABO-incompatible (ABO-i) liver transplantation (LT) is a life-saving method for pediatric patients in emergency situations that has the potential to expand the pool of liver donors. However, the risks of ABO-i compared to ABO-compatible (ABO-c) LT are unclear. To address this clinical uncertainty, we conducted a systematic review and meta-analysis to compare clinical outcomes between ABO-i and ABO-c LT in pediatric patients. A systematic search for studies comparing outcomes between ABO-i and ABO-c LT was performed in the MEDLINE (PubMed), EMBASE, and Cochrane Library databases through May 2020. Outcomes evaluated included graft survival rate, patient survival rate, rejection, infection, biliary complications, and vascular complications. Quality of evidence was assessed using the Newcastle-Ottawa scale. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using RevMan 5.3. A total of 12 studies involving 7461 patients were included in the review. Meta-analysis of these studies showed significantly lower 1year, 3year, and 5year graft survival rates for ABO-i vs. ABO-c LT (1year: OR = 0.46, 95% CI 0.35-0.59, P < 0.00001; 3years: OR = 0.47, 95% CI 0.36-0.63, P < 0.00001; 5year: OR = 0.48, 95% CI 0.37-0.63, P < 0.00001) as well as significantly lower 1year, 3year, 5year, and 10year patient survival rates for ABO-i vs. ABO-c (1year: OR = 0.34, 95% CI 0.24-0.49, P < 0.00001; 3years: OR = 0.24, 95% CI 0.14-0.40, P < 0.00001; 5years: OR = 0.47, 95% CI 0.35-0.64, P < 0.00001; 10years: OR = 0.59, 95% CI 0.38-0.90, P = 0.02). No significant differences were observed between the groups in incidence of cytomegalovirus infection, acute cellular rejection, acute rejection, biliary complications, or hepatic artery thrombosis. Our systematic review and meta-analysis showed consistently lower patient survival and graft survival in pediatric ABO-i LT compared to ABO-c LT. However, ABO-i LT is still a life-saving emergency option for pediatric patients waiting for a suitable liver source.

Comparison study stapled versus hand sewn method for large bowel anastomosis surgery

Background: Intestinal anastomosis is one of the most commonly performed procedure it required to re-establish gastrointestinal continuity after surgical resection, traumatic disruption or bypass procedures. In last decade, advances in intestinal stapling devices have led to an increased frequency of stapled anastomosis. There are a variety of proposed benefit from a stapled technique: better blood supply, reduced tissue manipulation, less oedema, uniformity of suture, adequate or perhaps wider, lumen at the site of anastomosis, ease and rapidity. Objectives: To compare the relative safety and effectiveness of stapled anastomosis with that of hand sewn anastomosis for large bowel surgery. Patients & Methods: A prospective study was conducted on 103 patients who suffered from benign and malignant disease in addition to trauma patients. They were divided into two groups (SA) group which involved (51) patients where the anastomosis were done by stapler and other group of (52) patients where the anastomosis were done by hand sewing named as (HS) group. All elective cases were prepared for surgery preoperatively by mechanical and chemical preparation while patients in emergency situation had the full criteria for primary anastomosis. Both groups had the same preoperative characters such as age and sex, and the types of outcome analyzed were specific mortality, clinical anastomotic leak, stricture, anastomotic haemorrhage, re-operation, wound infection, anastomotic duration and hospital stay. Results: A total of 9 patients (17.6%) in SA group developed complications compared to 20 patients (38.5%) in H.S group (P. value >0.019). Nine patient developed fistula in HS group (17.3%) compared to two patients (3.9%) in SA group (P. value > 0.035). Mean postoperative hospitalization time for SA group (6.5) days while for HS group (8.8) days (P. value 0.75). There is a significant difference regarding fistula in favours of stapled anastomosis. Conclusions: Staples anastomosis is safe and effective and associated with fewer leak than hand sewn anastomosis.