A prospective study assessing the efficacy of abdominal computed tomography scan without bowel preparation in diagnosing intestinal wall and luminal lesions in patients presenting to the emergency room with abdominal complaints

AIM: To evaluate the positive predictive value of abdominal non-prepared computed tomography (CT) for diagnosing intestinal lumen or wall lesions in patients presenting to the emergency room (ER) with abdominal complaints.METHODS: For 1-year we prospectively evaluated all ER patients hospitalized after abdominal CT scan detected either intraluminal or intestinal wall lesions. These patients underwent colonoscopy serving as gold standard. Patients with prior abdominal pathology or CT findings of appendicitis or diverticulitis were excluded.RESULTS: Five hundred and sixty-eight abdominopelvic CT scans were performed in the ER, 96 had positive colonic findings. Sixty-two patients were excluded, 46 because of diverticulitis or appendicitis, 16 because of prior abdominal pathology. Of the remaining 34 patients, 14 did not undergo colonoscopy during hospitalization.Twenty eligible patients were included in the study. The positive predictive value of the CT scans performed in the ER was calculated to be 45% (95% CI 25-67).CONCLUSION: CT findings correlated with colonoscopic findings only in approximately half of the cases. Relying on non-prepared CT scan findings in planning patient management and colonoscopy may lead to unnecessary diagnostic work-ups.

Diurnal Temperature Range and Daily Emergency Room Admissions among the Elderly in Beijing,China

In recent years, more attentions have been paid to the association between climate change and human health. Increasing and more variable global surface temperature is one of the key climatic change factors which have been consistently reported about the effect on human health. So far, more researches have revealed that temperature lead not only to direct deaths and illnesses but also to aggravation of cardiovascular and respiratory diseases. Typically, the relationship between temperature and mortality or morbidity is V-, U-, or J- shaped, with optimum temperature corresponding to the lowest point in the temperature mortality curve.

Trends in hospital readmissions and emergency room visits 60 days after robotic-assisted and laparoscopic hysterectomy

Objective:Hospital readmission after surgery is one of the major contributors to the increased healthcare cost.Robotic-assisted hysterectomy(RAH)is an innovative surgical procedure most commonly performed within the last decade.The purpose of this study was to analyze the effects on hospital readmission patterns and emergency room(ER)visits within 60 days of discharge for women who had RAH versus laparoscopic hysterectomy(LH)in an academic community hospital in Texas.Method:We performed a retrospective study of women with RAH or LH.We used the univariate and multivariate logistic regression to examine the impact of patients'risk factors,the type of surgery,age,number of comorbidities,and duration of surgery on the 60-day hospital readmissions and ER visits.Results:A total of 291 cases with RAH or LH for benign and malignant indications were examined.The number of comorbidities and duration of surgery were similar between the two treatment groups(p>0.05).Patients in the RAH group were younger than the LH group(RAH:45.4±9.9 y,LH:49.8±11.5 y,p<0.05).No significant difference neither in hospital readmission or ER visits between the two groupswas observed(p?0.544 and p=0.109,respectively).Younger age and longer duration of surgery were significantly associated with a higher risk of ER visits(p<0.05).Conclusion:RAH is comparable with LH in hospital readmissions and ER visits.The younger age and longer operation time could lead to ER visits.

Association of emergency room visits for respiratory diseases with sources of ambient PM2.5

Previous studies have reported associations of short-term exposure to different sources of ambient fine particulate matter(PM2.5)and increased mortality or hospitalizations for respiratory diseases.Few studies,however,have focused on the short-term effects of source-specific PM2.5 on emergency room visits(ERVs)of respiratory diseases.Source apportionment for PM2.5 was performed with Positive Matrix Factorization(PMF)and generalized additive model was applied to estimate associations between source-specific PM2.5 and respiratory disease ERVs.The association of PM2.5 and total respiratory ERVs was found on lag4(RR=1.011,95%CI:1.002,1.020)per interquartile range(76μg/m3)increase.We found PM2.5 to be significantly associated with asthma,bronchitis and chronic obstructive pulmonary disease(COPD)ERVs,with the strongest effects on lag5(RR=1.072,95%CI:1.024,1.119),lag4(RR=1.104,95%CI:1.032,1.176)and lag3(RR=1.091,95%CI:1.047,1.135),respectively.The estimated effects of PM2.5 changed little after adjusting for different air pollutants.Six primary PM2.5 sources were identified using PMF analysis,including dust/soil(6.7%),industry emission(4.5%),secondary aerosols(30.3%),metal processing(3.2%),coal combustion(37.5%)and traffic-related source(17.8%).Some of the sources were identified to have effects on ERVs of total respiratory diseases(dust/soil,secondary aerosols,metal processing,coal combustion and traffic-related source),bronchitis ERVs(dust/soil)and COPD ERVs(traffic-related source,industry emission and secondary aerosols).Different sources of PM2.5 contribute to increased risk of respiratory ERVs to different extents,which may provide potential implications for the decision making of air quality related policies,rational emission control and public health welfare.

Factors influencing the length of emergency room stay and hospital stay in non-fatal bicycle accidents:A retrospective analysis

Purpose:Lengthy hospitalization places a burden on patients and healthcare resources.However,the factors affecting the length of hospital stay(LHoS)and length of emergency room stay(LERS)in non-fatal bicycle accidents are currently unclear.We investigated these factors to inform efforts to minimize hospitalization.Methods:We performed a retrospective analysis of data from non-fatal injured bicyclists admitted to the Emergency and Critical Care Center at Kyoto Medical Center between January 2012 and December 2016.We measured LHoS,LERS,mechanism of injury,head injury prevalence,polytrauma,operations performed,injury severity score(ISS),abbreviated injury scale(AIS)score,maximum AIS score,and trauma and injury severity score probability of survival.We conducted multiple regression analysis to determine predictors of LHoS and LERS.Results:Within the study period,82 victims met the inclusion and exclusion criteria and were included.Mean age was(46.0±24.7)years.Overall mean LHoS was(16.8±25.2)days,mean LERS was(10.6±14.7)days,median ISS was 9(interquartile range(IQR):3-16),median maximum AIS was 3(IQR:1-4),and median trauma and injury severity score probability of survival was 98.0%(IQR:95.5%-99.6%).Age,maximum AIS,ISS,and prevalence of surgery were significantly greater in long LHoS and LERS group compared with short LHoS and LERS group(p<0.05).Performance of surgery independently explained LHoS(p=0.0003)and ISS independently explained LERS(p=0.0009).Conclusion:Surgery was associated with long hospital stays and ISS was associated with long emergency room stays.To improve the quality life of the bicyclists,preventive measures for reducing injury severity or avoiding injuries needing operation are required.

Concept Analysis: Emergency Department Crowding and Length of Stay before and after an Increase in Catchment Area

Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher rates of patient mortality, and greater harm to hospitals due to financial losses are some of these problems. Collaboration is crucial in the healthcare industry since it determines the team’s hourly performance in managing patient care. By using Walker and Avant’s (2011) concept analysis method, the author reviewed the literature to better understand ED crowding, to ensure that patients receive safe treatment in a timely manner, and to highlight best practices that can be identified through concept analysis and practice evaluations. In conducting this concept analysis, Walker and Avant’s framework was applied to examine the nature of the findings selected for the advancement of the concept. Everyone working in the ED, from those who determine policy to those on the front lines continually encounter new obstacles, but has little or no time to formulate fresh concepts or reconsider how ED treatment is provided. Overcrowding occurs when the number of patients requiring attention, awaiting transfer, or undergoing diagnosis and treatment exceeds the physical capacity of ED staff. If a clear plan is not in place to increase and improve services in proportion to a growing population, this situation will persist.

Drug dependence and its risk factors in emergency department patients:A retrospective cross-sectional study

Objective:To determine the characteristics and risk factors of drug dependence among patients who were administered drugs with addictive potential(DAP)in an emergency department(ED).Methods:This retrospective cross-sectional study included patients who were administered DAP 3 or more times in the emergency room between September 1,2019 and March 1,2020.The demographic and baseline information were recorded.All the prescibed DAP,the reasons to use these drugs,secondary drug dependence,the department where DAP were first prescribed,types of doctors who preferred to prescribed DAP,and the risk factors for the development of drug dependence were determined.Results:A total of 3000 patients were screened from medical records,and among them,80 patients developed drug dependence.Drug dependence only developed for tramadol(n=57,71.3%),diazepam(n=11,13.8%),and biperiden(n=12,15.0%).Tramadol was the most frequently prescribed drug(n=57,71.3%).The most common reason for drug dependence was psychiatric disorders(n=29,36.3%).Drug dependence developed in renal colic patients due to the administration of tramadol(n=7,100%).On the contrary,dependence to biperiden were mainly developed in patients with psychiatric complaints(n=12,41.4%).The rate of secondary drug dependence was 15%(n=12).Of the Biperiden users,41.7%developed secondary drug dependence on diazepam.Most DAP were first prescribed in the ED(n=52,65%),and the specialist preferred to prescribe DAP(n=43,53.8%).For the development of dependence,the presence of renal colic(OR:3.387,95%confidence interval(CI):1.473-7.788,P=0.004)and low back pain(OR:5.778,95%CI:2.779-12.014,P<0.001)were the risk factors.Conclusions:Most DAP were first prescribed in the ED compared to other departments,and specialist are preferred to use DAP.Tramadol is the most commonly used drugs caused drug dependence.Psychiatric disorder patients are easier to develope drug dependence.Furthermore,renal colic and low back pain patients needs more attention to avert drug dependence.

Appendectomy in patient with suspected COVID-19 with negative COVID-19 results: A case report

BACKGROUND Even at present,we are in the middle of the novel coronavirus disease 2019(COVID-19)pandemic and are facing challenges in trial and error.Presently,emergency surgery for patients with suspected COVID-19 is burdensome not only for patients but also for healthcare workers.Therefore,we established a surveillance system in the emergency room and established principles for managing patients suspected of COVID-19 who require emergency surgery.CASE SUMMARY A 67-year-old man was diagnosed with appendicitis in March 2020.His wife was diagnosed with COVID-1910 d earlier,and the patient was in close contact with her.The patient tested negative twice on an upper respiratory COVID-19 reverse transcription–polymerase chain reaction screening test,but chest X-ray and chest computed tomography revealed patchy ground-glass opacity in both upper lobes of the patient’s lungs.The same emergency surgery procedure for patients with confirmed COVID-19 was applied to this patient suspected of having the disease to ensure that surgery was not delayed while waiting for the reverse transcription–polymerase chain reaction results.A few hours after surgery,the upper respiratory tract specimen taken in the emergency room was negative for COVID-19 but the lower respiratory tract specimen was found to be positive for the disease.CONCLUSION When COVID-19 is suspected,emergency surgery should be performed as for confirmed COVID-19 without delay.

Gastric ultrasound-assisted diagnosis of undifferentiated shock:A case report

Rationale:Peptic ulcer disease and variceal bleeding are two of the most common causes of gastrointestinal(GI)bleeding.GI bleeding can present with symptoms of hemodynamic instability such as tachycardia and shock.Patient’s Concern:A 33-year-old man with confusion and hypotension(blood pressure:70/40 mmHg and pulse rate:140/min)was brought by emergency medical services from home to the emergency department without any companion.The patient was in undifferentiated shock.His hypotension was assessed with inferior vena cava(IVC)size and collapsibility,and rapid ultrasound in shock and hypotension(RUSH)protocol was used to investigate the cause of his shock.Following the RUSH protocol when scanning the IVC,parts of the stomach were seen in its vicinity and suspended heterogeneous particles were observed in the fluid.After seeing these particles,we suspected GI bleeding.Diagnosis:Endoscopy confirmed GI bleeding.Interventions:After placing an orogastric tube and suction,about 2 L of coffee-ground fluid with clots was removed.We started intravenous proton-pump inhibitors 80 mg bolus,followed by a continuous infusion of 8 mg/h.The patient received about 2 L of normal saline and 2 units of packed red blood cells to correct his hypotension.Outcomes:After being admitted to the GI ward and treated for three days,the patient was discharged from the hospital with a hemoglobin level of 11 g/dL and continued to have an outpatient follow-up at the clinic.Lessons:The use of gastric ultrasound in conjunction with the RUSH protocol can help to diagnose undifferentiated hypotensive shock.The components of the RUSH exam are the heart(H),IVC(I),Morrison’s/FAST abdominal views with the aorta(MA),and pulmonary and pipes scanning(P),and can be memorized with the mnemonic:HI-MAP.We would like to introduce a new mnemonic:Hi-MAPS,adding stomach(S)to the RUSH protocol in undifferentiated hypotension and shock to evaluate upper GI bleeding.

Seasonality of ER Admissions in Northwestern Pennsylvania: A Cross-Sectional Study

Seasonality, in the context of emergency room (ER) admissions, can be described as the periodic incidence of disease, corresponding to seasons, or other pre-established calendar periods. Respiratory diseases, in general, show a seasonal pattern with incidence peak at the winter season, however research still presents a considerable amount of inconsistency. Incidence of cardiovascular diseases (CVD) is also very well linked to the cold season. Gastrointestinal, genitourinary and neurological diseases are poorly studied in regards their seasonal patterns. This study aimed to assess seasonality of the five categories of diseases–respiratory, cardiovascular, gastrointestinal, genitourinary, and neurological-using data from a community hospital in northwestern PA. We analyzed 14 years (2000-2014) of data from the Meadville Medical Center (MMC) ER admissions. For each ER admission case, we had information about ICD-9 code, sex, insurance, race, age and date, time and year of admission. Statistical analyses were performed using SAS 9.4 University version software. We found significantly fewer cases of respiratory diseases in spring (OR = 0.757), summer (OR = 0.579), and fall (OR = 0.741), when comparing to the winter season;however, seasonal differences were not found for cardiovascular, genitourinary, and neurological diseases. The implications of these results will primarily be used to improve Meadville’s public health policies for cold seasons, and more specifically, implement programs that prepare the ER to receive and treat respiratory cases more efficiently in the cold season.

Surgical first aid and nursing care of a parturient with massive hemorrhage in natural delivery

Objective:To summarize the first aid and nursing of the operating room due to serious complications caused by postpartum massive bleeding.Methods:One case of emergency hemorrhage was ineffective in emergency hysterectomy.Results:The uterus was successfully removed and the bleeding was successfully stopped.It was transferred to the ICU under general anesthesia.Conclusion:For pregnant women with postpartum massive bleeding and hemorrhagic shock and diffuse intravascular coagulation(DIC),targeted surgical treatment and complete operating room emergency care are of great significance to save maternal lives.

Youth’s Role in Peace Building:A Case Study of Gadarif State

This study in Gadarif State,Sudan,analyzes the crucial role of youth in conflict resolution and peace building efforts amidst the ongoing crisis.Findings reveal that youth,facing economic,environmental,and security challenges,actively engage in peacemaking through initiatives,emergency rooms,and cultural programs,contributing to social cohesion and combatting hate speech.Despite their willingness to build peace,they encounter obstacles like the lack of training programs,limited support,and marginalization in policy-making processes.Recommendations emphasize the necessity of empowering youth through training programs,enhancing government support,and addressing negative perceptions from older generations towards youth contributions.Conclusively,prioritizing youth issues and fostering their participation in peace building initiatives are essential for sustainable peace and social harmony in Gadarif State.