Urgent Conditions Research Articles

Effects of integrated takeover request warning with personal portable device on takeover time and post-takeover performance in level 3 driving automation

Introduction: Level 3 driving automation defined by the Society of Automotive Engineers (SAE) requests human drivers to drive manually when the vehicle cannot perform the driving task. In this regard, researchers have studied the integrated takeover request (TOR) which provides visual and auditory TOR warning in both vehicle interface (e.g., dashboard, windshield (head-up display) and personal portable device (PPD) (e.g., cell phone, tablet). However, these studies neither used auditory TOR warning in PPD nor examined the effect of use of headphone on takeover. Thus, this study evaluates the effects of the integrated TOR with the use of headphones on the takeover time and the post-takeover performance. Method: The behavior of 60 drivers was observed in the driving simulator experiment. During the experiment, the drivers watched a video on a tablet in automated driving, received the TOR warning, and manually drove in the lane change and pullover scenarios. The survey was also conducted to ask drivers’ experience and preference for TOR warning. Results: The integrated TOR significantly reduced the takeover time compared to the conventional TOR which provides the TOR warning in vehicle interface only. The integrated TOR also improved the post-takeover performance as indicated by more stable steering operation and safer driving behavior after TOR warning. However, the use of headphones did not significantly reduce the takeover time or improve the post-takeover performance for the integrated TOR. The participants generally perceived higher subjective comfort and safety level with the integrated TOR than the conventional TOR. Conclusions: The integrated TOR with auditory warning in PPD can significantly reduce the takeover time and improve the post-takeover performance in both urgent and less urgent conditions. Practical applications: The integrated TOR with auditory warning in PPD can be applied to SAE Level 3 driving automation for safe transition from automated to manual driving.

Data-driven insights to increase utilization of an oncology acute care clinic.

342 Background: Cancer patients often use the emergency department (ED) for acute symptoms. Because of the frequency of non-emergent acute care, many practices have created non-ED sites of care, such as Oncology Acute Care (OAC). OAC clinics can manage urgent conditions, and have been shown to reduce ED visits, however, patient and practice factors may lead to underuse of these clinics. We aimed to increase OAC utilization at our safety-net system. Methods: Parkland Health is the safety-net system for Dallas County, caring for a primarily uninsured (70.0% Medicaid/charity care), minority population (60.4% Hispanic, 24.2% Black). We established an OAC in 2017: patients can call a dedicated triage line staffed by English and Spanish-speaking nurses, who schedule OAC visits as appropriate. Subsequent quantitative and qualitative research found that OAC was underused, but that many patients were simply unaware of the OAC. In early 2023, a monthly 20-member multidisciplinary workgroup was formed, including many frontline staff. Findings and ideas for improvement were reviewed with our Patient and Family Advisory Council. Implementation strategies were aimed at raising staff/provider awareness, streamlining patient education, and developing relevant process measures. Results: By Q1 2024, nurse call volume rose to 235, from 110 calls in Q3 of 2023. Patients began to call sooner upon symptom onset (50% of symptoms were more than 3 days old, compared to 55%); 51% were scheduled to the OAC on the same day. Nurses managed 34% of calls through telehealth. Lack of OAC availability resulted in ED referral for 4% of calls. There was an early downward trend in potentially avoidable ED visits (15% of chemotherapy infusions with an ED visit in 30 days in Q4 2023, down to 12.5% in Q1 2024). Conclusions: A data-driven, delivery research collaboration has been established to reduce avoidable ED care among adults receiving chemotherapy. This collaborative has been marshalling existing resources to serve a patient population that faces many challenges in optimizing their care. By piloting these implementation strategies, we are improving patient symptom management, and have created a platform for ongoing delivery innovation.

Gastric Volvulus in Association with Bockdalekhernia in Adult Patient (Case Report)

Purpose: Bochdalek hernia (BH) in adulthood is rare. Symptomatic BH in adults is rarer, but may lead to fatal complications. Patients with acute gastric volvulus on diaphragmatic hernia are a diagnostic and therapeutic emergency.Materials and Methods: A 22-year-old male patient presented to our emergency department with a two-day history of severe epigastric pain. The pain was dull in nature with dyspnea on lying supine. Findings: The stomach was within the thorax on the left side due to left diaphragmatic hernia of a nontraumatic cause, diagnosed by chest radiograph, and computed tomography (CT). The patient was prepared for the open surgical repair, to close the defect. The patient recovered with accepted general condition and was discharged 5 days later. In conclusion, in our case, we report this rare presentation of BH with gastric volvulus as an urgent condition that needs to be diagnosed as early as possible to prevent fatal complications. Implications to Theory, Practice and Policy: A diagnosis of an adult diaphragmatic hernia should always be kept in mind in patients with overlapping abdominal and respiratory symptoms with or without a history of trauma.

Cytomegalovirus infection in gastroenterology

To highlight the relevance of gastrointestinal manifestations of cytomegalovirus infection (CMVI), to highlight the main risk factors for the development of this pathology, current trends in diagnosis and treatment. CMVI is one of the most common opportunistic diseases, characterized by a variety of manifestations from asymptomatic to severe generalized forms affecting internal organs and body systems. The prevalence of CMVI worldwide ranges from 20 to 95%. Particular attention is paid to timely diagnosis, treatment and prevention of CMVI. The "gold standard" in the diagnosis of digestive diseases associated with CMVI is immunohistochemical examination and detection of cytomegalovirus (CMV) DNA in tissues using the polymerase chain reaction (PCR). Of undoubted interest in the diagnosis of CMV is the detection of CMV DNA in stool using digital PCR. Compared to quantitative PCR, digital PCR has higher accuracy and sensitivity. As first-line therapy, the drugs of choice are ganciclovir and valganciclovir. Maribavir has been successfully used to treat patients with CMV infection refractory to one or more previous therapies. One of the promising directions in the treatment of cytomegalovirus colitis in patients with ulcerative colitis is fecal microbiota transplantation. Timely identification of risk factors for the development of CMV infection, the introduction of innovative methods and approaches in diagnosis, and the use of effective methods for treating diseases of the digestive system associated with CMV infection can improve the prognosis of the underlying disease and reduce the risk of developing urgent conditions in gastroenterology.

Emergency department service utilisation of older patients with urgent conditions: a cross-sectional observational study

BackgroundAs with many countries worldwide, Singapore is experiencing a rapidly ageing population. Presentation of older persons for urgent but non-emergent conditions to the Emergency Department (ED) represents a growing group of patients utilising public healthcare emergency services and puts a strain on current ED resources. The medical conditions vary, and resources used has been poorly characterized.MethodsThis is a single-center cross-sectional observational study of patients aged 55 to 75 years old who visited the ED with urgent conditions, Patient Acuity Category Scale (PACS) P2 or P3, who were subsequently discharged. The patients visited a public hospital in Singapore on four randomly selected weekdays in April 2023. The utilisation of hospital resources and manpower was studied. A formulated criteria was used to determine the appropriate site of care, such as an Urgent Care Centre (UCC), Primary Care Providers (PCP) clinic or the ED.ResultsThere were 235 eligible patients during the study period, with a mean age of 65.1 years of which a majority, 183 (77.9%) were allocated to patient acuity category scale P2. Most of the patients were walk-in patients with no referrals (169 (71.9%)). Based on the criteria, the majority of 187 (79.6%) of these patient may be safely managed at an outpatient setting; 71 (30.2%) patients by PCP, 116 (49.4%) patients may be managed by an UCC, with the remaining 48 (20.4%) requiring ED care.ConclusionOur findings indicate that a significant portion of discharged older ED adults with urgent but non-emergent conditions may be adequately managed at outpatient medical services that are appropriately resourced. More research is needed on healthcare initiatives aimed at developing the capabilities of outpatient medical services to manage mild to moderate acute conditions to optimise ED resource allocation.

Aortic dissection presenting with respiratory failure: case report and literature

Due to its nonspecific symptoms, in several cases, Acute Aortic Dissection (AAD) is a difficult-to-diagnose urgent condition. The torn intimal layer initiates a false lumen, which can potentially propagate and cause life-threatening ruptures or organ ischemia. Intramural hematoma can rarely develop inside the false lumen, resulting in compression of surrounding structures and worsening the patient’s prognosis. We report a case of AAD - Stanford Type A complicated by an intramural hematoma compressing the pulmonary artery, accompanied by a discussion of relevant literature. This patient presented to the emergency department with acute respiratory distress; clinical and initial diagnostic findings mimicked pulmonary embolism. However, a systematic differential evaluation supported by point-of-care ultrasound allowed a prompt diagnosis of AAD and avoided fixation errors.

Analysis of the waitlist performance and post-transplant outcomes of lung transplant in elderly recipients in Korea: A nationwide cohort study.

There is a lack of information on the waitlist performance and post-transplant outcomes of lung transplants in elderly recipients in Korea. We retrospectively reviewed and analyzed data from the Korean Network for Organ Sharing database between March 2010 and August 2023. In total, 2574 patients were listed for lung transplantation during the study period, with 511 (19.9%) of them being over 65 years of age. Among these, 188 patients (36.8%) underwent transplantation, while 184 patients (36%) passed away without undergoing transplantation at the time of data extraction. The most prevalent underlying disease on the waitlist was idiopathic pulmonary fibrosis, accounting for 68.1%. The 1-year survival rate was significantly lower in the elderly compared to that in the nonelderly (65.4vs. 75.4%; p=.004). In the multivariate Cox analysis, elderly (hazard ratio [HR], 1.49; 95% CI, 1.14-1.97; p=.004) and a high urgent status at registration (HR, 1.83; 95% CI, 1.40-2.40; p<.001) were significantly associated with post-transplant 1-year mortality. Kaplan-Meier curves demonstrated a significant difference in post-transplant mortality based on the urgency status at enrollment (χ2=8.302, p=.016). Even with the same highly urgent condition at the time of transplantation, different prognoses were observed depending on the condition at listing (χ2=9.056, p=.029). The elderly exhibited worse transplant outcomes than nonelderly adults, with a highly urgent status at registration identified as a significant risk factor. Unprepared, highly urgent transplantation was associated with poor outcomes.

A Clinical Review on Spinal Epidural Abscess: Epidemiology, Pathophysiology, Diagnosis, and Management for Emergency Medicine and Hospitalist Physicians.

Description Spinal epidural abscess (SEA), a critical surgical emergency, demands prompt recognition and intervention to prevent severe complications and fatalities. The incidence of SEA is notably increasing, particularly among individuals with diabetes, intravenous drug use, or a history of invasive spinal procedures. Although SEA can manifest through various clinical symptoms, the presence of its classic triad-back pain, fever, and neurological deficits-is noteworthy despite its occurrence in only 10% to 13% of cases. Identifying this triad is vital due to its high specificity for SEA, which is essential to guiding swift diagnostic and therapeutic actions in a condition where early intervention is critical. Magnetic resonance imaging is pivotal in diagnosing SEA, offering unmatched sensitivity and specificity compared to other imaging techniques. Immediate empirical antibiotic therapy and timely neurosurgical consultation, when required, form the foundation of SEA treatment. The prognosis significantly depends on the patient's initial neurological status, underlying health conditions, and the timeliness of their presentation, diagnosis, and treatment initiation. Given the complexity of SEA and the high risk of diagnostic delays, managing this condition involves substantial medicolegal considerations. Enhanced comprehension of SEA is imperative for improving patient outcomes and reducing health care resource burdens. Prompt and accurate diagnosis and appropriate interventions are essential for effectively managing this urgent condition.

Pattern of pediatric emergency dental care during COVID-19 pandemic in Saudi Arabia

ObjectiveAt the beginning of the COVID-19 pandemic, it was recommended to provide emergency dental care and avoid aerosol-generating procedures (AGPs) when possible. This study aimed to determine how Saudi Arabian pediatric patients utilized emergency dental services at the national level at the beginning of the COVID-19 pandemic and what situations required an AGP. MethodsData was collected from all Ministry of Health dental facilities in Saudi Arabia between March and May 2020. All pediatric dental patients who received emergency dental care during the COVID-19 lockdown were included in this study. ResultsThe majority of the 1,544 pediatric dental patients who received emergency dental care during this period received treatment for caries (77.9 %). AGPs were predominant in the treatment of urgent dental conditions (51.5 %). About 64 % of cases with pulpal inflammation and 52.4 % with abscesses underwent an AGP. ConclusionEmergency and urgent dental conditions were the main reason for seeking dental care during the pandemic (75.8 %), while only 24.2 % of cases were considered non-urgent. Despite the recommendations, AGPs were required for some urgent conditions to relieve the associated pain, and this comprised 46.8 % of dental treatment provided.

Accuracy of Patient-Collected Vital Signs.

Introduction: Telehealth has emerged as an important clinical setting for managing acute respiratory tract infections (ARIs), potentially reducing emergency department and urgent care overcrowding, and reducing nosocomial transmission. Many current algorithms for ARI management incorporate information on patient vital signs. However, the accuracy of vital signs collected by patients using readily available home devices and techniques has not been studied. Methods: A cross-sectional sample of patients seen for urgent conditions at a hospital emergency and urgent care center were given instructions and low-cost, readily available devices to collect their vital signs. A trained research coordinator collected a parallel set of vital signs using standard hospital equipment, serving as the gold standard. We analyzed the performance of patient-collected vital signs compared with vital signs collected by a trained research coordinator. Results: A total of 300 patients completed the study. Patient-collected vital signs were highly specific for traditional levels of abnormalities (HR >100 beats per min, RR >24 breaths per min, temperature >100.4 degrees Fahrenheit, oxygen saturation <94 percent); however, sensitivity was poor for elevated heart rate by pulse estimation (25%) and elevated respiratory rate (60%). Heart rate and oxygen saturation by pulse oximeter and oral temperature had higher sensitivity. Conclusions: Vital signs measured and provided by patients are not uniformly accurate, particularly when using manual techniques rather than automated devices. Telehealth algorithms that rely on these values could provide incorrect triage and management advice.

Anterior Displacement of the Eyeball in a Patient with Uncontrolled Schizophrenia

Purpose: To report a case in which vision improvement was achieved following surgery for anterior displacement of the eyeball resulting from self-mutilation in a patient with schizophrenia.Case summary: A 37-year-old female patient with schizophrenia was admitted following an attempt at self-mutilation, which led to anterior displacement of her right eyeball. Initial evaluation revealed that reduction was not feasible and visual acuity was finger count at 20 cm in the right eye. Orbital computed tomography indicated 26-mm anterior displacement of the eyeball from the center of the cornea to the interzygomatic line along with a small retrobulbar hemorrhage and edema in the superior rectus muscle. Surgical intervention, consisting of lateral canthotomy, cantholysis, and tarsorrhaphy, was performed for correction. The surgical site was reconstructed 6 days after surgery. A fundus examination conducted 1 month later revealed no abnormalities and best-corrected visual acuity improved to 20/20.Conclusions: Globe subluxation due to self-mutilation is a very rare and urgent condition in both ophthalmic and psychiatric contexts that requires immediate surgical intervention. This case demonstrates that immediate anatomical reduction when there is no direct suspicion of optic nerve damage can be beneficial for the recovery of visual acuity and may lead to a favorable prognosis.

A home healthcare routing-scheduling optimization model considering time-balancing and outsourcing

Home care services have a significant role in lowering healthcare expenditure. Supply chain management in home healthcare (HHC) ensures efficient delivery of medical supplies and equipment to patients' homes, improving overall quality of care and patient outcomes. This study proposes a routing and scheduling optimization model for HHC by prioritizing patients, developing an effective delivery strategy, and considering home care logistics and services. The model primarily concerns reducing logistics activities’ overall expenses while considering patients’ priorities. A bi-objective optimization model for a multi-period HHC problem is developed by prioritizing patients with urgent critical needs. The best-worst method (BWM) and technique for order of preference by similarity to ideal solution (TOPSIS) are used to prioritize patients using a linear programming metric (Lp-metric). The BWM and TOPSIS have been uniquely used in this study for routing and scheduling in HHC. Eventually, the applicability of the proposed method is demonstrated through a real-life case study with a series of numerical examples and sensitivity analysis. For instance, by analyzing privilege, we see patients are carefully matched with caregivers possessing advanced skills, leading to increased patient satisfaction. Based on assigned routes, caregivers prioritize patients with higher weight and emergency conditions at the start of each path, followed by patients with less urgent conditions. This ensures that patients with more severe conditions are serviced first.

The profile of patients attending to the general emergency department with ocular complaints within the last year: is it a true ocular emergency?

PurposeOcular emergencies require immediate intervention to prevent rapid vision loss or functional impairment. The aim of this study was to determine the proportion of true ocular emergencies among patients who presented to the general emergency department with ocular complaints and were referred to the Eye Clinic.MethodsIn a retrospective cross-sectional study in a tertiary hospital in Istanbul, patients aged 0–100 years who presented to the general emergency department with ocular complaints between January and December 2022 were included. Inconclusive diagnoses and incomplete records were excluded. Patients were divided into three groups: top eye emergencies (TE), relative eye emergencies (REE), and non-emergency eyes (NEE).ResultsAmong the 652,224 individuals seeking care, 9,982 (1.5%) were referred to the Eye Emergency Clinic. Of these, 2,788 (27.9%) were female, and 7,194 (72.1%) were male, with ages ranging from 0 to 98 years. TopEye Emergencies (TEE), Relative Eye Emergencies (REE), and Non-Eye Emergencies (NEE) accounted for 13%, 60%, and 27% of the cases, respectively. Common top-eye emergencies (TEE) include chemical injuries, orbital-preseptal cellulitis, and orbital fractures. Relative eye emergencies (REEs) commonly feature corneal foreign bodies, corneal erosion, and conjunctivitis. Nonemulsion eye (NEE) methods involve simple eye redness, trauma without eye involvement, and subconjunctival haemorrhage.ConclusionsConsistent with the literature, 1.5% of patients presenting to the general emergency department had eye complaints.However, 27% of those referred to the ophthalmological clinic did not have an urgent eye condition. This is partly due to the high proportion of patients presenting to the emergency department with ocular complaints and the lack of knowledge of ophthalmological diseases by emergency physicians, leading to unnecessary referrals to the ophthalmology clinic, resulting in a loss of the workforce and reduced time allocated to patients with true ocular emergencies.

Kualitas Jaringan Operator Selular Coverage Indoor dan Outdoor di Lingkungan Universitas Warmadewa

Telecommunications technology is growing rapidly, and telecommunications providers are now in the 5G technology phase. Providing very fast speed and data transfer. However, in the development of cellular technology in Indonesia, especially in Bali, the distribution of provider signal coverage areas is not evenly distributed. Although many BTS (Base Transceiver Station) have been scattered and built in the Denpasar city area, there are still locations that are not well covered. In this study the location chosen was the campus area at Warmadewa University. The method used was survey and sample interviews among students, lecturers, and staff. The number of data samples is 100 people. The survey results obtained are the findings of the signal coverage of Telkomsel, Indosat, XL-Axiata providers including coverage ranging from very poor to very good, while the Smartfren and 3 providers include good and very good signal coverage received in the Warmadewa University area. The use of phone calls (pulses) is rarely used because data packages are more flexible and efficient, the selection of calls (pulses) is usually used when urgent conditions.

Videolaryngoscopy during Urgent Cesarean Delivery: Association with Neonatal Intensive Care Unit Admission.

Parturients are at increased risk for difficult airway management with subsequent fetal complications. Videolaryngoscopy was opined to be the new standard of airway care to facilitate orotracheal intubation under urgent care conditions. We examined in parturients requiring general anesthesia for urgent cesarean delivery the association of the type of laryngoscopy technique and time required to facilitate orotracheal intubation with the incidence of subsequent neonatal intensive care unit (NICU) admission. Following institutional review board approval, 431 parturients aged 18 years and older who underwent urgent cesarean section requiring general anesthesia were entered into this study. Patient characteristics, maternal comorbidities, and indications for urgent cesarean delivery were collected from the electronic medical records from January 2013 to November 2018. Orotracheal intubation times by type of laryngoscopy (video or direct) and NICU admission rates also were collected. A measure of effect size, risk differences with 95% confidence intervals (CIs), were calculated for the likelihood of NICU admission by difficult orotracheal intubation and by type of laryngoscopy used to secure the airway. Videolaryngoscopy as the primary type of laryngoscopy was used in 24.1% (95% CI 20.3%-28.3%) of general anesthetics. The incidence of difficult orotracheal intubation was 4.4% (95% CI 2.8%-6.7%), with a higher incidence observed with videolaryngoscopy (8.7%) than with direct laryngoscopy (3.1%) and a risk difference of 5.6% (95% CI 0.001%-11.3%). The incidence of NICU admission was 38.4% (95% CI 34.0%-43.1%). Times for successful orotracheal intubation were longer with videolaryngoscopy. Videolaryngoscopy had a higher association for NICU admission (47%) than for direct laryngoscopy (36%), with a risk difference of 11.4% (95% CI 0.01%-22.3%). Videolaryngoscopy did not decrease the incidence of difficult orotracheal intubation, and it did not decrease the time associated with orotracheal intubation. Videolaryngoscopy was associated with a higher association of NICU admission. These results suggest that videolaryngoscopy does not supplant direct laryngoscopy as the standard of care for orotracheal intubation under urgent care conditions of general anesthesia for cesarean section.

Clinical and Epidemiological Profile of Patients Presenting With Acute Abdomen to the Emergency Department of a Tertiary Care Hospital.

Acute abdomen is a common and urgent clinical condition requiring prompt diagnosis and treatment. This study determines the clinical and epidemiological profile of patients presenting with acute abdomen at a tertiary care hospital. To describe the demographic characteristics, provisional diagnoses, treatment modalities, and pain management effectiveness in patients with acute abdomen. This prospective observational study was conducted in the Emergency Medicine department at Dr. D. Y. Patil Medical College, Hospital & Research Center, Pimpri, Pune, over a specified period. The study included patients presenting with acute abdomen, aged above 14 years, excluding those with traumatic acute abdomen and pregnant patients. A sample size of 146 was calculated based on the proportion of ureteric colic cases, with a 95% confidence interval and a 6% margin of error; however, a total of 176 patients were included in the study. Data collection involved recording demographic details, clinical features, provisional diagnoses, and pain scores, as well as performing required blood investigations and ultrasonography. Pain scores were assessed before and after treatment. Patients will be given non-steroidal anti-inflammatory drugs(NSAIDs) or opioid analgesia, depending on the clinical severity. Emergency medicine residents, in consultation with the on-call consultant, determined the disposition of patients, deciding if they required surgical or conservative management. The study found that the majority of patients, n = 130 (73.86%), were aged 26-50 years, with cases n = 103 (58.52%) being males and cases n = 73 (41.48%) females. Acute appendicitis was the most common diagnosis, n = 41 (24.43%), followed by urolithiasis n = 33 (18.75%). Surgical interventions were required for n = 78 (45.08%) of patients, highlighting the urgent nature of these conditions. Pain management was effective, with significant reductions in pain scores post-treatment (mean visual analog score (VAS) decreased from 6.22 to 2.33, and mean numerical rating score (NRS) from 6.05 to 2.10; p < 0.001). The study underscores the high prevalence of gastrointestinal and renal conditions in patients with acute abdomen, particularly in middle-aged adults. The high rate of surgical interventions reflects the urgent nature of these conditions. Significant reductions in pain scores demonstrated effective pain management. Comprehensive care strategies are essential for optimizing patient outcomes. Future research with larger sample sizes and multi-center participation is recommended to validate these findings and enhance management protocols for acute abdomen.

A distributed economic model predictive control-based FPPT scheme for large-scale solar farm

Increasing solar-photovoltaic-power penetration necessitates the implementation of flexible power point tracking (FPPT) in solar farms. However, coordinating multiple solar photovoltaic (PV) power generation systems (SPVPGSs) poses a significant challenge due to their inherent intermittency and varying dynamic characteristics, complicating FPPT implementation. To overcome this challenge, this paper proposes a distributed economic model predictive control (DEMPC) scheme to achieve FPPT, while simultaneously enhancing overall economic performance in solar farms. By integrating solar farm control and local control into one optimal control framework, this scheme eliminates the need for power allocation, PV voltage reference calculation, and pulse width modulation. Leveraging the SPVPGS model and soft power constraint, DEMPC controllers are designed to achieve the economic targets of solar farms, which cooperate through a communication network to realize FPPT and economic optimization. Additionally, the strong nonlinearity of SPVPGS causes a non-convex mixed integer nonlinear programming (MINLP) problem, solved by a MINLP algorithm using finite converter switching states. Simulations under step-changed irradiance and power reference, as well as urgent maintenance conditions, demonstrate that the DEMPC-based FPPT scheme significantly outperforms the traditional hierarchical model predictive control-based FPPT scheme, presenting both superior dynamic response and enhanced economic performance in FPPT implementation.

INTENSIVE TREATMENT OF SEPTIC SHOCK IN PEDIATRIC PRACTICE

In pediatric practice, septic shock (SS) is a serious, urgent condition with a high incidence and increased risk of death. Intensive therapy in this condition is based on provision of volume-expansion fluid management, prescription of antibiotic medications, and vasopressor support. Urgent care for children is provided in an intensive care unit and includes mandatory determination of the aetiology of SS (by inoculation of blood samples for sterility), provision of venous access and continuous monitoring of vital signs with measurement of lactate levels. The intensity of respiratory support changes according to the following stepwise logic: oxygen therapy – non-invasive ventilation – mechanical ventilation. When providing fluid management to a patient with SS, preference is given to crystalloid solutions. Antibacterial therapy is devised empirically and must be administered within the first hour of ICU admission. If fluid management proves insufficient to ensure stable hemodynamic parameters, vasopressor support is provided by administering inotropic agents, vasodilators and inodilators (norepinephrine, epinephrine, dopamine and dobutamine). Evidence on the effectiveness of corticosteroids in children and adolescents with SS is lacking. Knowledge of the latest algorithms of intensive treatment of SS in pediatric practice will enhance the quality of care and improve the therapeutic prognosis in this category of patients.

A case with respiratory failure caused from iatrogenic hypercalcemic crisis

Hypercalcemia is a critical and urgent clinical condition that can lead to death, related to blood calcium levels. We present a case of a 69-year-old female who presented with respiratory and renal failure, depression due to iatrogenic hypercalcemia developing in a patient using uncontrolled calcium and vitamin D.

Artificial Intelligence-Based Electrocardiographic Biomarker for Outcome Prediction in Patients With Acute Heart Failure: Prospective Cohort Study.

Although several biomarkers exist for patients with heart failure (HF), their use in routine clinical practice is often constrained by high costs and limited availability. We examined the utility of an artificial intelligence (AI) algorithm that analyzes printed electrocardiograms (ECGs) for outcome prediction in patients with acute HF. We retrospectively analyzed prospectively collected data of patients with acute HF at two tertiary centers in Korea. Baseline ECGs were analyzed using a deep-learning system called Quantitative ECG (QCG), which was trained to detect several urgent clinical conditions, including shock, cardiac arrest, and reduced left ventricular ejection fraction (LVEF). Among the 1254 patients enrolled, in-hospital cardiac death occurred in 53 (4.2%) patients, and the QCG score for critical events (QCG-Critical) was significantly higher in these patients than in survivors (mean 0.57, SD 0.23 vs mean 0.29, SD 0.20; P<.001). The QCG-Critical score was an independent predictor of in-hospital cardiac death after adjustment for age, sex, comorbidities, HF etiology/type, atrial fibrillation, and QRS widening (adjusted odds ratio [OR] 1.68, 95% CI 1.47-1.92 per 0.1 increase; P<.001), and remained a significant predictor after additional adjustments for echocardiographic LVEF and N-terminal prohormone of brain natriuretic peptide level (adjusted OR 1.59, 95% CI 1.36-1.87 per 0.1 increase; P<.001). During long-term follow-up, patients with higher QCG-Critical scores (>0.5) had higher mortality rates than those with low QCG-Critical scores (<0.25) (adjusted hazard ratio 2.69, 95% CI 2.14-3.38; P<.001). Predicting outcomes in patients with acute HF using the QCG-Critical score is feasible, indicating that this AI-based ECG score may be a novel biomarker for these patients. ClinicalTrials.gov NCT01389843; https://clinicaltrials.gov/study/NCT01389843.