Patients In Emergency Situations Research Articles

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.

Bailout subclavian artery stenting in a sick child with iatrogenic subclavian artery perforation: a case report

BackgroundSubclavian artery injury during internal jugular vein catheterization is a rare yet potentially life-threatening complication leading to hemothorax and exsanguination. The percutaneous endovascular approach offers a less invasive and effective alternative to the high-risk surgical repair in emergent situations.Case presentationWe present a case of a 6-year-old child suffering from hemolytic uremic syndrome requiring urgent hemodialysis, for which IJV (internal jugular vein) cannulation was attempted. This procedure led to iatrogenic subclavian arterial perforation causing massive hemothorax with hemodynamic compromise. CT angiogram showed a through and through perforation in the first part of right subclavian artery between common carotid and vertebral artery. A definitive assessment of the extent of ongoing leak was made through an invasive angiogram in the catheterization laboratory. The perforation was successfully closed percutaneously with a covered stent without compromising any branch vessels.ConclusionArterial injury although rare is a potentially life-threatening complication of IJV cannulation which warrants immediate attention and corrective measures. Ultrasound guidance can reduce the risk of such life-threatening complications. Percutaneous management offers a less invasive, less time consuming, and effective alternative in critically ill patients in emergency situations.

Smart Hospitals With the Use of 'Internet of Things' and Artificial Intelligence

The Internet of Things is an intelligently devices and systems which comprised of smart machines interacting and communicating with other machines, environments and objects and infrastructures and the Radio Frequency Identification (RFID) and sensor network technologies will rise to meet this new challenge. This paper presents the design and implementation of smart health help system using Internet of Things and Artificial Intelligence with the help of Android Technology. It will provide an innovative technical support for helping patients in emergency situations providing a rescue by nurses and doctors with low investments. This project is designed especially for government funded hospitals where there are lots of patients and is somewhat difficult for doctors and nurses to take care of them.

On triage system

Introduction: Triage is the process of categorizing patients in emergency situation according to the severity of their injuries or sickness. This is done in order to give medical attention to those who need it first, to minimize loss of life from injuries. Aims: This article aims to create an electronic triage system based on the Raspberry Pi computer and Arduino microcontroller. The Raspberry Pi computer wirelessly receives data measured by the Arduino and analyses the data after which it automatically categorizes patients with minimal human intervention. Results: The Raspberry Pi runs a graphical user interface-based system that is used to display results and allow for users to input data into the database. The system contains two functionalities, emergency mode (MODE 1) and emergency department mode (MODE 2). MODE 1 is used for urgent outdoor emergency scenarios such as motor vehicle accident with multiple casualties, to determine the seriously injured victims. MODE 2 can be integrated in a medical center where it is used to determine which patient needs immediate attention in a scenario where there are so many patients waiting. In MODE 2, patient's recent vitals readings can be graphically viewed for further analysis and medical doctors can comment on each patient's progress for future reference. This data is then uploaded to an online server. Conclusion: The article focuses on the design and implementation of triage system which is based on Raspberry Pi.

Position Paper of the Task Force for Obstetrics and Prenatal Medicine (AGG - Section Preterm Birth) on the Placement, Removal and Surveillance of the Arabin Cervical Pessary in Patients at Risk for Spontaneous Preterm Birth.

This position paper describes clinically important, practical aspects of cervical pessary treatment. Transvaginal ultrasound is standard for the assessment of cervical length and selection of patients who may benefit from pessary treatment. Similar to other treatment modalities, the clinical use and placement of pessaries requires regular training. This training is essential for proper pessary placement in patients in emergency situations to prevent preterm delivery and optimize neonatal outcomes. Consequently, pessaries should only be applied by healthcare professionals who are not only familiar with the clinical implications of preterm birth as a syndrome but are also trained in the practical application of the devices. The following statements on the clinical use of pessary application and its removal serve as an addendum to the recently published German S2-consensus guideline on the prevention and treatment of preterm birth.

Emergency management in patients with haemophilia A and inhibitors on prophylaxis with emicizumab: AICE practical guidance in collaboration with SIBioC, SIMEU, SIMEUP, SIPMeL and SISET.

Emicizumab has been approved in several countries for regular prophylaxis in patients with congenital haemophilia A and FVIII inhibitors because it substantially reduces their bleeding risk and improves quality of life. However, although significantly less frequent, some breakthrough bleeds may still occur while on emicizumab, requiring treatment with bypassing or other haemostatic agents. Thrombotic complications have been reported with the associated use of activated prothrombin complex concentrates. In addition, when surgery/invasive procedures are needed while on emicizumab, their management requires multidisciplinary competences and direct supervision by experts in the use of this agent. Given this, and in order to expand the current knowledge on the use of emicizumab and concomitant haemostatic agents, and reduce the risk of complications in this setting, the Italian Association of Haemophilia Centres (AICE) here provides guidance on the management of breakthrough bleeds and surgery in emergency situations in patients with haemophilia A and inhibitors on emicizumab prophylaxis. This paper has been shared with other National Scientific Societies involved in the field.

Idarucizumab administration in emergency situations: the Munich Registry of Reversal of Pradaxa® in clinical routine (MR REPAIR).

To evaluate daily life management and functional outcome of Idarucizumab administration in case of emergency situations in patients with Dabigatran treatment. Multicenter observational registry study. All hospitals with full neurological departments (n = 6) in Munich, Germany INCLUDED PATIENTS: All patients treated with Idarucizumab from 01/2016 to 03/2019. Indication and application of Idarucizumab, demographics and clinical parameters, and further interventions and treatments; clinical outcome was assessed with the modified Rankin scale (mRS) at 3months after Idarucizumab administration RESULTS: Idarucizumab was administered to 32 patients for severe bleeding complications and ischemic strokes, more precisely for the following specific indications: intracranial bleeding (17 patients, 53%), ischemic stroke (8 patients, 25%), gastrointestinal bleeding (3 patients, 9%), femoral fracture, aortic dissection, and abdominal trauma and ileus (1 patient each, 3%). Additional coagulation management was performed in 7 patients (22%). Nine patients (28%) underwent emergency surgery. Seven patients (22%) received Idarucizumab before intravenous thrombolysis due to ischemic stroke and 4 of these 7 patients (13%) received mechanical thrombectomy in addition. Indication was mainly based on the history of Dabigatran intake and was irrespective of laboratory testing. At follow-up, 25% of the investigated patients had a mRS 0-2, while 25% had an unfavorable outcome (mRS 4-5). Mortality was 31%. In our study, we have shown that the administration of Idarucizumab is a rare intervention and restricted to patients with severe bleeding complications or ischemic stroke. The clinical outcome of patients who received Idarucizumab in emergency situations was poor.

Does medical training in Thailand prepare doctors for work in community hospitals? An analysis of critical incidents

BackgroundCompulsory 3-year public service was implemented in 1967 as a measure to tackle the maldistribution of doctors in Thailand. Currently, therefore, most medical graduates work in rural community hospitals for their first jobs. This research explored doctors’ perceptions of preparedness for practice using a critical incident technique.MethodsA self-administered critical incident questionnaire was developed. Convenient samples were used, i.e. Family Medicine residents at Ramathibodi Hospital who had worked in a community hospital after graduation before returning to residency training. Participants were asked to write about two incidents that had occurred while working in a community hospital, one in which they felt the knowledge and skills obtained in medical school had prepared them for managing the situation effectively and the other in which they felt ill-prepared. Data were thematically analysed.ResultsFifty-six critical incidents were reported from 28 participants. There were representatives from both normal and rural tracks of undergraduate training and community hospitals of all sizes and all regions. Doctors felt well-prepared to provide care for patients in emergency situations and as in-patients, but under-prepared for obstetric and paediatric emergencies, out-patient care, and palliative care. Moreover, they felt poorly prepared to deal with difficult patients, hospital administration and quality assurance.ConclusionsLong-term solutions are needed to solve the rural doctor shortage. Medical graduates from both normal and rural tracks felt poorly prepared for working effectively in community hospitals. Medical training should prepare doctors for rural work, and they should be supported while in post.KeywordsPreparedness for practice, Community hospital, Critical incident, Rural doctor, Rural practice, Undergraduate medical training

GNSS-based navigation systems of autonomous drone for delivering items

This paper presents our research on the development of navigation systems of autonomous drone for delivering items that uses a GNSS (Global Navigation Satellite System) and a compass as the main tools in drone. The grand purpose of our research is to deliver important medical aids for patients in emergency situations and implementation in agriculture in Indonesia, as part of the big mission of Society 5.0 and related with big data. In sending process, drone must be able to detect object and reach goal position and go back safely using GPS. We proposed a navigation algorithm for drone including the usage of course-over-ground information to help drone in doing autonomous navigation. In the experiment that we did, the average of positional deviation of landing position between the actual landing position and the desired landing position in the flight tests of flying from start to goal is 1.1125 m and for the tests that use the algorithm which uses course-over-ground, the positional deviation has average of 2.39 m. Navigation using course-over-Ground algorithm is not more reliable than the navigation algorithm with GNSS and Compass at a navigation distance of less than 1 m.

Optimization of Nurse Scheduling Problem using Genetic Algorithm: A Case Study

Nurse scheduling problem is an essential problem in hospital, especially in emergency department. Emergency department is very busy unit in hospital because it receives patients in emergency situation, therefore nurses in this department are obliged to be ready for 24 hours. Working hours allocation of nurses in this department is not equally, so nurse’s preferences cannot be fulfilled yet. In this study, genetic algorithms are used to minimize unfulfilled preferences of nurse that called violations. Genetic algorithm represents solution candidate using random chromosomes. The selection used is elitist, the crossover used is one point cut crossover, and mutation used is reciprocal exchange mutation. Based on experiment, the optimal parameters are obtained, size of population is 80, mutation rate is 0.01, and iteration is 10000. Result is schedule of nurses for 30 days in emergency department that generated 74 violations.

Implementation of an Evidence-Based Hemorrhage Protocol at a Birth Center

Maternal morbidity and mortality are on the rise in the United States. Postpartum hemorrhage is the leading cause of postpregnancy complications; however, early detection and management can minimize the effects of hemorrhage. To improve maternity care in the United States, evidence-based postpartum hemorrhage protocols and care bundles need to be implemented. On the basis of a risk analysis performed at a midwife-led birth center in Austin, Texas, staff determined that a comprehensive postpartum hemorrhage protocol needed to be developed and implemented. Based on the resources and limitations of the birth center environment, a care bundle was created. Postpartum hemorrhage kits were created that held all of the necessary materials needed in the event of a hemorrhage. The kits included intravenous catheters and fluids, lab drawing supplies, and a scale for accurately measuring blood loss. An easy-to-read reference list of uterotonic medications was created and placed on top of the kits for easy access. An evidence-based algorithm for interventions was created and placed on top of the kit as well. Last, a flowsheet was created for staff to document interventions. After implementation of the care bundle, staff evaluated its success by determining the amount of blood loss that occurred in postintervention hemorrhages. They also tracked the number of posthemorrhage complications and number of medically necessary transfers from the birth center that were related to hemorrhage, with the goal of complete elimination of complications and transfers. Comprehensive care protocols empower nurses to provide quality care for their patients in emergency situations. Quality improvement in hospital and birth center environments is necessary to improve maternity care. Development of evidence-based postpartum hemorrhage protocols is an essential step for quality improvement and can be a positive, nurse-driven change.

Application of interventional ultrasound in emergency medicine conditions

ULTRASONOGRAPHY is a modern diagnostic tool both in intensive care and emergency medicine. Small, portable and simple ultrasound devices have been introduced due to technological advances. The image quality, size, and weight of portable ultrasound devices are improving. Prehospital point-of-care ultrasonog- raphy may have an impact on the decision making in prioritizing initial treatment. First aid at the scene of the accident and transporting the patient to the hospital is a key element, which in the case of appropriate diagnostics allows you to fight life-threatening injuries. The intention of using ultrasound protocols is to shorten and simplify the ultrasound examination allowing to eliminate or find complications of an injury as soon as possible. The protocols used include elements of ultrasonography and echocardiography of the lung tissue, abdominal cavity, pelvis, large vessels or the eyeball. The intention of the authors of the article was to present to the reader the basic ultrasound protocols applicable to patients in emergency situations.

Clinical characteristics of internal carotid artery pseudoaneurysms in the sphenoid sinus

BackgroundInternal carotid artery (ICA) pseudoaneurysms are associated with high mortality if lack of proper management. Patients with ICA pseudoaneurysms in the sphenoid sinus often visit a hospital's ear, nose and throat (ENT) department due to nasal bleeding. In such cases, simple examination and therapy will lead to misdiagnosis. ObjectiveThis study sought to investigate the clinical characteristics, diagnostic methods and treatment of ICA pseudoaneurysms in the sphenoid sinus. MethodsVarious data, including clinical features, imaging examination results, and treatment and prognosis information, were collected and analyzed for 8 patients who visited the Department of Otolaryngology, Head & Neck Surgery of West China Hospital from March 2008 to January 2017. ResultsThe patients included 6 males and 2 females (ages 16 to 56 years). Repeated epistaxis was a common symptom in six of the eight patients (6/8), whereas monocular blindness and binocular blindness were observed in the other two patients. Head trauma was found to play a role in the induction of ICA pseudoaneurysms, given that five patients (5/8) exhibited a specific history of head injury. CT examination tended to result in misdiagnosis, whereas MRI and digital subtraction angiography (DSA) were helpful for obtaining a definite diagnosis with all diagnoses were confirmed via DSA. Coated stent intervention was performed in five patients, while carotid artery ligation was performed in two patients in emergency situations: one of whom exhibited paraplegia, but recovery was ultimately observed after rehabilitation. Moreover, failure of coated stent intervention in one patient was resolved via additional unilateral common carotid artery ligation. Furthermore, one patient with vision loss experienced vision restoration. One patient discontinued treatment for personal reasons and was lost to follow-up. No recurrence was observed in the other 7 patients. ConclusionICA pseudoaneurysms in the sphenoid sinus are uncommon. To accurately identify ICA pseudoaneurysms, collaboration between otolaryngologists and imaging specialists is essential. On the other hand, both surgical and interventional treatments can achieve good results; therefore, otolaryngologists should enhance their cooperation with neurosurgery and intervention departments. Accurate diagnosis and rapid treatment are keys to managing ICA pseudoaneurysms.

Is It Time to Reconsider the Concepts of "Universal Donor" and "ABO Compatible" Transfusions?

Is It Time to Reconsider the Concepts of "Universal Donor" and "ABO Compatible" Transfusions?

Emergency Sleep Medicine.

AbstractSleep is a tranquil process that contributes substantially to our overall health and well-being. Yet sleep creates certain vulnerabilities. These sometimes require urgent management decisions for prehospital emergency medical services and on-call medical providers alike. Some of these emergencies may be directly due to sleep itself, whereas others may result from sleep disorders or a lack of sleep. And then some medical emergencies may occur during sleep by chance. Yet for some of these emergencies, sleep does not necessarily play a benign role. Sleep can mask the emergency—causing a delay in detection, confusion in the diagnosis, or even impede treatment. Finally, some disorders will mimic sleep and thus elude detection. Understanding these core principles will enable medical practitioners to optimize care for patients in emergency situations.

Return of experience on the initial audit of Cofrac and projects for the release of results of emergency biological tests.

Legislation and ISO 15189 international standard provide that the clinical laboratories shall organize the communication of the biological assay results, especially with the establishment of a list of critical assays, whose results shall be reported during doctor's on call period but also through restricting result transmission to biologically validated results. Actually continuous validation and immediate procession of the medical records belonging to patients in emergency situation are not always possible, because of the biologist's workload and the other activities he is responsible for. Based on the modified version of SH REF 04, we intend to export on the servers the results of critical assays during both the day time and doctor's on call period, as they are validated by the authorized technician, under the responsibility of the biologist in charge of validation. With this project, it will be possible at the same time to respond to the clinical requirements, and, for the biologist, to perform all his functions that are important to ensure the smooth running and the development of the laboratory.

Endovascular treatment of genetically linked aortic diseases.

BackgroundThe most important structural proteins of the vascular wall are collagen and elastin. Genetically linked connective tissue diseases lead to degeneration, aneurysm formation and spontaneous dissection or rupture of arteries. The most well-known are Marfan syndrome, vascular Ehlers-Danlos syndrome (type IV), Loeys-Dietz syndrome and familial aortic aneurysms and dissections.ObjectiveThis review article addresses the current status of endovascular treatment options for important connective tissue diseases.Material and methodsEvaluation of currently available randomized studies and registry data.ResultsThe treatment of choice for patients that are mostly affected at a young age is primarily conservative or open repair. There is only limited evidence for endovascular aortic repair (EVAR) of abdominal aneurysms or thoracic endovascular aortic repair (TEVAR).ConclusionThe progression of the disease with dilatation leads to secondary endoleaks and high reintervention rates with uncertain long-term results. For this reason, there is currently consensus that EVAR and TEVAR should be limited to justified exceptional cases and emergency situations in patients with genetically linked aortic diseases.

The PJ Nicholoff Steroid Protocol for Duchenne and Becker Muscular Dystrophy and Adrenal Suppression.

Duchenne muscular dystrophy (DMD or Duchenne) is a progressive, life-limiting muscle-wasting disease that requires comprehensive, multidisciplinary care. This care, at minimum, should include neuromuscular, respiratory, cardiac, orthopedic, endocrine and rehabilitative interventions that address both the primary and secondary manifestations of the disease. The care needs of patients evolve over the cdourse of the disease and as they transition from childhood into young adulthood. In the past two decades, life expectancy has increased significantly by the use of corticosteroids and enhanced clinical management. Nevertheless, each year, patients with Duchenne muscular dystrophy are admitted to emergency departments and intensive care units where medical expertise thrives, but where expertise in rare diseases, such as Duchenne, may not. Emergency care for patients with Duchenne can be as complex as the disease process itself. While any illness or injury may occur in a person with Duchenne, some acute scenarios are much more common in the context of the disease. Making decisions about the clinical care of a person with Duchenne who presents with an acute illness can be quite difficult — in part, because of the extensive use of corticosteroids, which can lead to adrenal suppression. The life of a person with Duchenne needing emergency care may therefore depend upon the ability of the clinician on duty in the emergency department to recognize and mitigate adrenal suppression resulting from corticosteroid dependence. With this in mind, and drawing from expertise and experience with other steroid-dependent diseases, the ‘PJ Nicholoff Steroid Protocol’ was developed. The purpose of this protocol is to provide clinicians information regarding the safe management of corticosteroid during emergency situations in patients who may have accompanying adrenal suppression. The protocol explains how to recognize the signs and symptoms of acute adrenal crisis, how to prevent it with supplemental stress doses of corticosteroids, and how to taper doses after emergency care in order to prevent corticosteroid withdrawal.

How to manage patients on rivaroxaban in the emergency department: a statement of the Italian society of emergency medicine advisory board.

Rivaroxaban, a new oral anticoagulant, has been approved in many countries and its everyday use in clinical practice is increasing. Thus, the chances for an emergency physician to encounter rivaroxaban-treated patients in emergency situations have increased. Here, the authors address the main issues in terms of the prescription of rivaroxaban and the management of these patients in cases of minor or major bleeding, urgent surgery, atrial fibrillation requiring cardioversion, acute ischemic stroke, ST-elevation myocardial infarction, and new onset of atrial fibrillation in recent ST-elevation myocardial infarction. The recommendations reached are based on a literature review and a panel discussion of the advisory board of SIMEU, the Italian Society of Emergency Medicine.

Computer-Assisted 3-D Ultrasound Probe Placement for Emergency Healthcare Applications

In this paper, a new computer-assisted ultrasound probe placement system is introduced to guide paramedics and first responders to conduct abdominal ultrasound imaging for diagnosing trauma patients in emergency situations where specialists are not present. Recently, telesonography has been employed to supervise paramedics by remote experts to perform ultrasound scan for triaging, although its utility is limited by unavailability of fast internet connectivity in remote regions. In the proposed solution of this paper, a paramedic is first instructed to place the ultrasound probe on an initial placement for imaging an organ of interest. Then, a three-dimensional (3-D) ultrasound image is acquired and processed to determine the organ's shape misalignment with respect to a reference alignment. Afterward, the organ's shape misalignment is used to estimate the probe misalignment, and then, a probe placement command is generated to guide the paramedic. This process iterates until a correct organ's view of interest is obtained. As the advantage of the proposed solution over the existing technique, the proposed solution does not require a fast Internet connectivity and a dedicated remote specialist to conduct ultrasound imaging by a paramedic. The utility of the proposed solution is evaluated for a case study on the right upper quadrant (RUQ) view, which has a paramount importance in triaging trauma patients. Accuracy and robustness of the proposed solution is verified using actual and simulated 3-D ultrasound images of the RUQ view.