The latest medical research on Emergency Medicine

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about emergency medicine gathered by our medical AI research bot.

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Burn-Induced Coagulopathies: A Comprehensive Review.

Shock

Burn-induced coagulopathy is not well understood, and consensus on diagnosis, prevention, and treatments are lacking. In this review, literature on...

The Impact of Selecting Specific Cohorts for Benchmarking and Interpretation of Emergency Department Patient Satisfaction Scores.

Academic Emergency Medicine

Emergency Departments (EDs) patient satisfaction metrics are highly valued by hospitals, health systems and payers, yet these metrics are challenging to analyze and interpret. Accurate interpretation involves selection of the most appropriate peer group for benchmark comparisons. We hypothesized that the selection of different benchmark peer groups would yield different interpretations of Press Ganey (PG) patient satisfaction scores.

ED PG summary ratings of "Doctors Section" and "Likelihood to Recommend" raw scores and corresponding percentiles were derived for three benchmark peer groups from three academic years (2016, 2017, and 2018). The three benchmarks are; 1) the PG Large database, 2) the PG University HealthSystem Consortium (UHC) database and 3) the Academy of Administrators in Academic Emergency Medicine (AAAEM) database which is comprised only of EDs from academic health centers with emergency medicine residency training programs. Raw scores were converted to percentile ranks for each distribution and then compared using Welch's ANOVA and Games-Howell pairwise comparisons.

For both patient satisfaction raw scores evaluated, the AAAEM database was noted to have significantly higher percentile ranks when compared to the PG Large and PG UHC databases. These results were consistent for all three time frames assessed.

Benchmarking with different peer groups provides different results; with similar patient satisfaction raw scores resulting in higher percentile ranks using the AAAEM database compared to the two PG databases. The AAAEM database should be considered the most appropriate peer group for benchmarking academic EDs.

The Burn Victim.

Academic Emergency Medicine

Even in the safety of my stiff EMT uniform that night I couldn't help but feel I was grossly invading your privacy.

Pardon Me for Being a Wallflower.

Academic Emergency Medicine

Emergency medicine physicians are supposed to be outgoing gregarious risk takers, right? That's the perception of our specialty when you watch tele...

Outcome, quality of life and direct costs after out-of-hospital cardiac arrest in an urban region of Switzerland.

Scandinavian Journal of

This trial was registered with www.clinicaltrials.gov under NCT02625883.

Eighty eight patients older than 18 years of age that were resuscitated by the EMS Winterthur in the year 2013 were included and retrospective analysis of EMS-protocols was performed. For patients alive at follow-up, 2 years after the event, a structured interview with quality of life questionnaires was conducted. This study was accepted by the local Ethics Committee.

Thirty five percent (n = 31) of resuscitated patients were admitted alive to the hospital following out-of-hospital cardiac arrest. This incidence was as high as 60%, if the patients had a shockable rhythm as first rhythm. Survival to follow-up was 16% (n = 14). These patients had an excellent quality of life overall, with little to no limitations in daily life. There was no significant difference in survival for patients in outlying regions with comparatively longer timespans until arrival of EMS. Median EMS-costs for deceased patients were CHF 1731 (inter-quartile range 346), for survivors CHF 2'169 (inter-quartile range CHF 444) and median hospital-costs were CHF 27'707 (inter-quartile range CHF 62'783).

Quality of care for patients with out-of-hospital cardiac arrest in the region of Winterthur is high, including patients in outlying regions. The associated costs are similar to other European countries.

Impact of rewarming rate on the mortality of patients with accidental hypothermia: analysis of data from the J-Point registry.

Scandinavian Journal of

Accidental hypothermia (AH) is defined as an involuntary decrease in core body temperature to < 35 °C. The management of AH has been progressing over the last few decades, and numerous techniques for rewarming have been validated. However, little is known about the association between rewarming rate (RR) and mortality in patients with AH.

This was a multicentre chart review study of patients with AH visiting the emergency department of 12 institutions in Japan from April 2011 to March 2016 (Japanese accidental hypothermia network registry, J-Point registry). We retrospectively registered patients using the International Classification of Diseases, Tenth Revision code T68: 'hypothermia'. We excluded patients whose body temperatures were unknown or ≥ 35 °C, who could not be rewarmed, whose rewarmed temperature or rewarming time was unknown, those aged < 18 years, or who or whose family members had refused to join the registry. RR was calculated based on the body temperature on arrival at the hospital, time of arrival at the hospital, the documented temperature during rewarming, and time of the temperature documentation. RR was classified into the following five groups: ≥2.0 °C/h, 1.5-< 2.0 °C/h, 1.0-< 1.5 °C/h, 0.5-< 1.0 °C/h, and < 0.5 °C/h. The primary outcome of this study was in-hospital mortality. The association between RR and in-hospital mortality was evaluated using multivariate logistic regression analysis.

During the study, 572 patients were registered in the J-Point registry, and 481 patients were included in the analysis. The median body temperature on arrival to the hospital was 30.7 °C (interquartile range [IQR], 28.2 °C-32.4 °C), and the median RR was 0.85 °C/h (IQR, 0.53 °C/h-1.31 °C/h). The in-hospital mortality rates were 19.3% (11/57), 11.1% (4/36), 14.4% (15/104), 20.1% (35/175), and 34.9% (38/109) in the ≥2.0 °C/h, 1.5-< 2.0 °C/h, 1.0-< 1.5 °C/h, 0.5-< 1.0 °C/h, and < 0.5 °C/h groups, respectively. Multivariate regression analysis revealed that in-hospital mortality rate increased with each 0.5 °C/h decrease in RR (adjusted odds ratio, 1.49; 95% confidence interval, 1.15-1.94; Ptrend < 0.01).

This study showed that slower RR is independently associated with in-hospital mortality.

Comment on epinephrine during resuscitation of traumatic cardiac arrest and increased mortality: a post hoc analysis of prospective observational study.

Scandinavian Journal of

The aim of this Letter to the Editor was to report some important biases in a recently published Article. We agreed with the notion by Yamamoto et ...

Regional hypothermia attenuates secondary-injury caused by time-out application of tourniquets following limb fragments injury combined with hemorrhagic shock.

Scandinavian Journal of

Tourniquet is the most widely used and effective first-aid equipment for controlling hemorrhage of injured limb in battlefield. However, time-out application of tourniquets leads to ischemic-necrosis of skeletal muscles and ischemia-reperfusion injury. Regional hypothermia (RH) on wounded limb can relieve the injury on local tissue and distant organs. We aimed to investigate the protective effects of RH on rabbits' limbs injured by a steel-ball combined with hemorrhagic-shock, and then employed tourniquet over-time, tried to identify the optimal treatment RH.

Thirty rabbits were randomly divided into 5 groups. All rabbits were anesthetized, intubated femoral artery and vein in right-hind limbs. Sham operation group (Sham): only femoral arteriovenous cannula in right-hind limb. None RH group (NRH): rabbits were intubated as Sham group, then the soft tissues of rabbits' left-hinds were injured by a steel-ball shooting, and were exsanguinated until shock, then bundled with rubber tourniquets for 4 h. Three RH subgroups: rabbits were injured as mentioned above, the injured limbs were bundled with rubber tourniquets and treated with different temperature (5 ± 1 °C, 10 ± 1 °C, and 20 ± 1 °C, respectively) for 4 h. The injury severity of lung and regional muscle was assessed by histologic examination. Activity of adenosine triphosphatase (ATPase) and content of malondialdehyde (MDA) in muscle, inflammatory cytokines, myoglobin, creatine kinase-MM (CK-MM), Heme, Heme oxygenase 1 (HO-1), lactic acid (Lac), and lectrolyte ion in serum were detected.

Following with RH treatment, the injury of lung and local muscle tissue was alleviated evidencing by mitigation of histopathological changes, significant decrease of water-content and MDA content, and increase of ATPase activity. Lower level of Lac, Potassium (K+), inflammatory cytokines, Heme, CK-MM, myoglobin content, and higher level of Calcium (Ca2+), HO-1 content were shown in RH treatment. 10 °C was the most effective RH to increase ATPase activity, and decrease MDA, myoglobin, CK-MM content.

Transient RH (4 h) had a "long-term mitigation effects" (continued for 6 h) on time-out application of tourniquet with the fluid resuscitation and core temperature maintenance, and the most effective temperature for reducing the side effects on tourniquet time-out application was 10 °C.

Peptidylarginine Deiminase 2 Knockout Improves Survival in Hemorrhagic Shock.

Shock

The peptidylarginine deiminase (PAD) family converts arginine into citrulline through protein citrullination. PAD2 and PAD4 inhibitors can improve survival in hemorrhagic shock (HS). However, the impact of isoform specific PAD inhibition in improving survival has not been studied. In this study, we utilize selective Pad2 knockout (KO) mice to elucidate loss of function of PAD2 leads to pro-survival effect in HS.

HS: Pad2 and wild type (WT) mice (n = 5/group) were subjected to lethal HS (55% volume hemorrhage). Survival was monitored over seven days. Myocardial infarction (MI): Pad2 and WT mice (n = 9/group) were subjected to MI by permanent LAD ligation to examine the effect of ischemia on the heart. After 24 hours cardiac function and infarct size were measured.

HS: Pad2 mice demonstrated 100% survival compared to 0% for WT mice (p = 0.002). In a sub-lethal HS model, cardiac β-catenin levels were higher in Pad2 compared to WT after 24 hours. MI: WT mice demonstrated larger MI (75%) compared to Pad2 (60%) (p < 0.05). Pad2 had significantly higher ejection fraction and fractional shortening compared to WT (p < 0.05).

Pad2 improves survival in lethal HS. Possible mechanisms by which loss of PAD2 function improve survival include the activation of cell survival pathways, improved tolerance of cardiac ischemia and improved cardiac function during ischemia. PAD2 is promising as a future therapeutic target for the treatment of HS and cardiac ischemia.

Impaired B-Cell Maturation Contributes to Reduced B Cell Numbers and Poor Prognosis in Sepsis.

Shock

Reduced B cell numbers plays a critical role in sepsis immunosuppression. The role of B-cell maturation regulated by T follicular helper (Tfh) cells in reduced B cell numbers during sepsis remains unclear. We tested the hypothesis that impaired B-cell maturation contributes to reduced B cell numbers.

To identify the exact lymphocyte counts that affect the prognosis of sepsis, we firstly conducted a retrospective study. Then in the prospective cohort study, differences in B-cell maturation, B cell death and numbers of circulating Tfh (cTfh) cell were compared between 28-day survivors and 28-day non-survivors, mainly by flow cytometry and enzyme-linked immunosorbent assay.

In retrospective study (n = 123), we found patients with lymphocyte counts less than 0.4 × 10 cells/L had higher mortality than patients with lymphocyte counts above 0.4 × 10 cells/L. In observational prospective cohort study (n = 40), compared to survivors, non-survivors had fewer numbers of mature B cell and circulating Tfh (cTfh) cell (sepsis onset: memory B cells: 3.44% vs. 4.48%, antibody-secreting cells: 4.53% vs. 6.30%, cTfh cells: 3.57% vs. 4.49%; 24 h after sepsis onset: memory B cells: 4.05% vs. 7.20%, antibody-secreting cells: 5.25% vs. 8.78%, cTfh cells: 3.98% vs. 6.15%), while there were no differences in cell death of mature B cells between them. We further noticed the numbers of cTfh cell positively correlated with the numbers of mature B cell and immunoglobulin concentrations.

Impaired B-cell maturation contributes to reduced B cell numbers, while the numbers of cTfh cell, acting as a warning indicator for sepsis prognosis, may be a new therapeutic target for treating sepsis.

Dynamic Autoregulation is Impaired in Circulatory Shock.

Shock

Circulatory shock is a life-threatening disorder that is associated with high mortality, with a state of systemic and tissue hypoperfusion that can lead to organ failure, including the brain, where altered mental state is often observed. We hypothesized that cerebral autoregulation (CA) is impaired in patients with circulatory shock.

Adult patients with circulatory shock and healthy controls were included. Cerebral blood flow velocity (CBFV, transcranial Doppler ultrasound) and arterial blood pressure (BP, Finometer or intra-arterial line) were continuously recorded during 5-minutes in both groups. Autoregulation Index (ARI) was estimated from the CBFV response to a step change in BP, derived by transfer function analysis; ARI ≤ 4 was considered as impaired CA. The relationship between organ dysfunction, assessed with the Sequential Organ Failure Assessment (SOFA) score and the ARI was assessed with linear regression.

Twenty-five shock patients and 28 age-matched healthy volunteers were studied. The mean ± SD SOFA score was 10.8 ± 4.3. Shock patients compared to control subjects had lower ARI values (4.0 ± 2.1 vs. 5.9 ± 1.5, p = 0.001). Impaired CA was more common in shock patients (44.4% vs. 7.1%, p = 0.003). There was a significant inverse relationship between the ARI and the SOFA score (R = -0.63, p = 0.0008).

These results suggest that circulatory shock is often associated with impaired CA and that the severity of CA alterations are correlated with the degree of multiple organ failure, reinforcing the need to monitor cerebral hemodynamics in patients with circulatory shock.

The Consequences of Aging on the Response to Injury and Critical Illness.

Shock

Changing demographic trends have led to an increase in the overall geriatric trauma patient volume. Furthermore, the intersection of aging and inju...