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Emerg. Care Med., Volume 1, Issue 4 (December 2024) – 10 articles

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7 pages, 1504 KiB  
Case Report
The Successful Use of Extracorporeal Membrane Oxygenation in a Newly Diagnosed HIV Patient with Acute Respiratory Distress Syndrome (ARDS) Complicated by Pneumocystis and Cytomegalovirus Pneumonia: A Case Report
by Jin Kook Kang, Matthew Acton and Bo Soo Kim
Emerg. Care Med. 2024, 1(4), 428-434; https://doi.org/10.3390/ecm1040042 - 25 Nov 2024
Viewed by 391
Abstract
Background: We report a case of an adult patient with newly diagnosed human immunodeficiency virus (HIV) infection, acquired immune deficiency syndrome (AIDS), and acute respiratory distress syndrome (ARDS) secondary to pneumocystis and cytomegalovirus pneumonia that were present on presentation, which were successfully managed [...] Read more.
Background: We report a case of an adult patient with newly diagnosed human immunodeficiency virus (HIV) infection, acquired immune deficiency syndrome (AIDS), and acute respiratory distress syndrome (ARDS) secondary to pneumocystis and cytomegalovirus pneumonia that were present on presentation, which were successfully managed with venovenous extracorporeal membrane oxygenation (VV-ECMO). Case Presentation: A 40-year-old patient with a past medical history of asthma was admitted to a local hospital due to dyspnea, cough, and wheezing, where the patient was diagnosed with HIV infection, ARDS, and combined pneumocystis and cytomegalovirus pneumonia. Their pulmonary function quickly declined, necessitating mechanical ventilation (MV). After all conventional therapies failed, the patient was transferred to a tertiary medical center for VV-ECMO therapy. The patient was successfully treated with antiretroviral therapy (ART), antibiotics, antivirals, steroids, and 48 days of VV-ECMO support, with complete resolution of their respiratory symptoms. The patient was discharged on hospital day 82. Conclusions: HIV-positive patients with ARDS that is complicated by opportunistic pulmonary infections can be successfully managed with ART, appropriate anti-infective therapies, and VV-ECMO. Full article
(This article belongs to the Special Issue Emergency Medicine Update: Cardiopulmonary Resuscitation)
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11 pages, 223 KiB  
Article
Survivors’ Narratives of the Oklahoma City Bombing Retold Seven Years Post-Disaster
by Elizabeth W. Pollio, Samir Abu-Hamad, Jennifer Wang, Carol S. North and David E. Pollio
Emerg. Care Med. 2024, 1(4), 417-427; https://doi.org/10.3390/ecm1040041 - 20 Nov 2024
Viewed by 455
Abstract
Introduction: A large proportion of the existing voluminous disaster mental health research literature represents the quantitative study of psychopathology, especially posttraumatic stress disorder. Subjective disaster experience is relatively unexplored. Qualitative narratives of surviving a disaster may provide insight into individual experiences of it [...] Read more.
Introduction: A large proportion of the existing voluminous disaster mental health research literature represents the quantitative study of psychopathology, especially posttraumatic stress disorder. Subjective disaster experience is relatively unexplored. Qualitative narratives of surviving a disaster may provide insight into individual experiences of it and efforts to derive meaning from it. Methods: From an initial random sample of 182 survivors of the Oklahoma City bombing, narrative descriptions of this experience were collected 7 years after the bomb blast from 116 of the original sample, for the purpose of examining persistent as well as newly evolving content through qualitative analysis. The narrative content was analyzed for the evolution of thematic content in narrative data also collected at 6 months post-disaster and 1 year later. Results: The thematic content of the bombing experience was structured in a chronological fashion from the bomb blast (sensory, cognitive, and emotional), its immediate aftermath (e.g., escaping danger), and later experiences, (e.g., leaving the bomb site and receiving hospital treatment). During the time between interviews, the focus and general content of the narratives changed minimally, despite considerable compression of detail. Conclusions: The consistency of the material in these narratives over 7 years may reflect the persistence and salience of disaster memories, with the potential for its continuation for the rest of their lives. Full article
6 pages, 1647 KiB  
Case Report
Isolated Distal Tibiofibular Syndesmotic Injury: A Case Series and Proposed Mechanism
by Sydney Asper, Hailey Allen and Maryam Soltanolkotabi
Emerg. Care Med. 2024, 1(4), 411-416; https://doi.org/10.3390/ecm1040040 - 15 Nov 2024
Viewed by 271
Abstract
Objective: To review imaging findings of isolated tibiofibular interosseous membrane (IOM) injury and propose an injury mechanism. Case Report: A retrospective review was conducted on five patients who presented with lower leg pain following a traumatic athletic injury. MRI examinations revealed isolated tibiofibular [...] Read more.
Objective: To review imaging findings of isolated tibiofibular interosseous membrane (IOM) injury and propose an injury mechanism. Case Report: A retrospective review was conducted on five patients who presented with lower leg pain following a traumatic athletic injury. MRI examinations revealed isolated tibiofibular IOM injury without associated fractures or distal syndesmotic disruption. The observed injury patterns, along with the blunt, non-rotational trauma reported in each case, suggest that the mechanism behind this unique presentation may involve sudden traction or direct impact to the lower leg. Conclusion: Isolated tibiofibular IOM injury should be considered in patients with lower leg pain after blunt trauma. MRI of the entire tibia and fibula can be instrumental in characterizing and confirming the injury and should be considered when clinical and injury mechanism indicators are present. Full article
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15 pages, 578 KiB  
Article
Rising Strong: Does Personal Resilience Drive Civic Engagement During Disasters?
by Efrat Blitstein-Mishor
Emerg. Care Med. 2024, 1(4), 396-410; https://doi.org/10.3390/ecm1040039 - 12 Nov 2024
Viewed by 400
Abstract
Background: In the crucible of disasters, civic engagement emerges as a dynamic force that channels individual strength and collective willpower toward the common good. Although it has been recognized as a necessary precondition for community resilience, studies on the motivators for citizens’ activities [...] Read more.
Background: In the crucible of disasters, civic engagement emerges as a dynamic force that channels individual strength and collective willpower toward the common good. Although it has been recognized as a necessary precondition for community resilience, studies on the motivators for citizens’ activities during disasters are relatively limited. This study underscores the interplay of personal resilience, risk perception, and coping strategies in the context of emergency-oriented civic engagement. It provides a robust framework for comprehending the cognitive and emotional processes that drive individuals’ responses to threats and risks to improve knowledge about public behavior, psychological conditions, and mental health during man-made disasters. Method: an online survey was conducted with a sample of 1514 citizens in Israel. A model incorporating both moderation and mediation effects was proposed. Results: The results reveal a consistent positive relationship between personal resilience and emergency-oriented civic engagement and point to the importance of both the intervening role of risk perception and the moderating role of coping strategies. Conclusions: discuss the importance of resilience-building programs and the promotion of positive coping strategies which can empower individuals to navigate the complexities of risk perception and engage actively in civic activities during disasters. Full article
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5 pages, 434 KiB  
Case Report
A Serious Case of Poisoning Caused by Oral Ingestion of Water-Soluble Fertilizer
by Wei Ye, Shirong Lin, Chengquan Zheng and Chunshui Cao
Emerg. Care Med. 2024, 1(4), 391-395; https://doi.org/10.3390/ecm1040038 - 28 Oct 2024
Viewed by 601
Abstract
Current research is mostly focused on the impact of fertilizers on human health when they are ingested through food; the main form of this is chronic damage. Intoxication through oral ingestion of fertilizer is an extremely rare situation. We report a case of [...] Read more.
Current research is mostly focused on the impact of fertilizers on human health when they are ingested through food; the main form of this is chronic damage. Intoxication through oral ingestion of fertilizer is an extremely rare situation. We report a case of a 38-year-old man that attempted to commit suicide by ingesting only 20 mL of a water-soluble fertilizer. Acute kidney injury occurred early, which showed that the toxicity could not be ignored. It was necessary to seek medical attention as soon as possible. In addition, the patient experienced gastrointestinal dysfunction and a severe inflammatory response; inflammatory markers increased rapidly. Physicians implemented antimicrobial stewardship to reduce antimicrobial drug resistance and the risk of hospital infection, and the patient’s inflammatory response was well controlled. Although the damage was severe, the patient quickly recovered to normal after appropriate treatment. The prognosis is very good. This successful case provides guidance for clinical treatment. Full article
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9 pages, 226 KiB  
Article
Outcomes of Open Knee Joint Injuries in Trauma Patients at Tibebe-Ghion Specialized Hospital, Bahir-Dar, Ethiopia
by Getachew Wuhib Shumye, Melatwork Assefa Wolle, Mekuriaw Wuhib Shumye and Leul Mekonnen Zeru
Emerg. Care Med. 2024, 1(4), 382-390; https://doi.org/10.3390/ecm1040037 - 19 Oct 2024
Viewed by 519
Abstract
Background: Open knee joint injury is a deep traumatic laceration violating the joint capsule. This study aimed to assess outcomes and associated factors of open knee joint injuries in trauma patients at Tibebe-Ghion Specialized Hospital, Bahirdar, Ethiopia, 2021. Methods: An institution-based retrospective cross-sectional [...] Read more.
Background: Open knee joint injury is a deep traumatic laceration violating the joint capsule. This study aimed to assess outcomes and associated factors of open knee joint injuries in trauma patients at Tibebe-Ghion Specialized Hospital, Bahirdar, Ethiopia, 2021. Methods: An institution-based retrospective cross-sectional study was conducted by reviewing the medical records of 43 patients treated for open knee joint injuries from January 2019 to July 2021, with an 86% response rate. Data were entered and exported using Epidata Manager Version 4.4 and analyzed using SPSS version 25. Results: Fourteen (32.5%) of the study subjects developed either infections or limping during follow-up due to open knee injuries, with the majority of injuries (58.1%) being caused by car accidents. The presence of associated injuries, wound size, time to wound closure, debridement as a management option, sex, and diagnostic methods showed a significant association with complication outcomes. Among the diagnosed infections, 90% were cases of septic arthritis. During the study period, eight patients (18.6%) developed limping during follow-up. The complication rate among open knee injury patients in the study area was significantly high, with one-third of patients experiencing complications. Targeted public awareness campaigns like car accidents should be conducted to educate the population about orthopedic emergencies and strategies to reduce complication risks, aiming for more favorable outcomes. Full article
14 pages, 11648 KiB  
Article
Insights from a Decade of Optimizing Emergency Medical Services Across Three Major Regions in Switzerland
by Christoph Strauss, Michael Schmid, Daniel Kliem and Martin Müller
Emerg. Care Med. 2024, 1(4), 368-381; https://doi.org/10.3390/ecm1040036 - 17 Oct 2024
Viewed by 665
Abstract
Prehospital care, and especially emergency medical services (EMSs), are facing an increasing demand, while experiencing financial pressure. Strategies aimed at improving prehospital care management emphasize the efficient utilization of resources, but often overlook the long-term implications for the prehospital healthcare system, encompassing emergency [...] Read more.
Prehospital care, and especially emergency medical services (EMSs), are facing an increasing demand, while experiencing financial pressure. Strategies aimed at improving prehospital care management emphasize the efficient utilization of resources, but often overlook the long-term implications for the prehospital healthcare system, encompassing emergency medical services, emergency departments, and healthcare authorities. This paper draws on almost ten years of improvement in EMS’ key performance indicators such as response time or overtime in Switzerland, using Discrete Event Simulation. Three representative simulation studies are used to reflect on the optimization potential of alternative bases and rosters, methodological limitations, and the uptake of the derived recommendations. The results demonstrate that EMSs’ efficiency gains in resource utilization increasingly come into conflict with emergency departments’ and healthcare authorities’ policies, indicating a need to enrich Discrete Event Simulation with a systemic perspective. A new methodology that conceptualizes long-term prehospital care planning as an interdisciplinary and iterative process utilizing a novel combination of System Dynamics and Discrete Event Simulation is proposed. Full article
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18 pages, 614 KiB  
Review
An Evaluation on the Potential of Large Language Models for Use in Trauma Triage
by Kelvin Le, Jiahang Chen, Deon Mai and Khang Duy Ricky Le
Emerg. Care Med. 2024, 1(4), 350-367; https://doi.org/10.3390/ecm1040035 - 12 Oct 2024
Viewed by 688
Abstract
Large Language Models (LLMs) are becoming increasingly adopted in various industries worldwide. In particular, there is emerging research assessing the reliability of LLMs, such as ChatGPT, in performing triaging decisions in emergent settings. A unique aspect of emergency triaging is the process of [...] Read more.
Large Language Models (LLMs) are becoming increasingly adopted in various industries worldwide. In particular, there is emerging research assessing the reliability of LLMs, such as ChatGPT, in performing triaging decisions in emergent settings. A unique aspect of emergency triaging is the process of trauma triaging. This process requires judicious consideration of mechanism of injury, severity of injury, patient stability, logistics of location and type of transport in order to ensure trauma patients have access to appropriate and timely trauma care. Current issues of overtriage and undertriage highlight the potential for the use of LLMs as a complementary tool to assist in more accurate triaging of the trauma patient. Despite this, there remains a gap in the literature surrounding the utility of LLMs in the trauma triaging process. This narrative review explores the current evidence for the potential for implementation of LLMs in trauma triaging. Overall, the literature highlights multifaceted applications of LLMs, especially in emergency trauma settings, albeit with clear limitations and ethical considerations, such as artificial hallucinations, biased outputs and data privacy issues. There remains room for more rigorous research into refining the consistency and capabilities of LLMs, ensuring their effective integration in real-world trauma triaging to improve patient outcomes and resource utilisation. Full article
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9 pages, 2324 KiB  
Project Report
The Experience of the Upu Smurd Floreasca Team during the Earthquakes in Turkey, February 2023
by Bogdan Oprita, Ruxandra Oprita, Teodor-Nicolae Berea, Ionut Olaru and Marian Alexandru Draghici
Emerg. Care Med. 2024, 1(4), 341-349; https://doi.org/10.3390/ecm1040034 - 3 Oct 2024
Viewed by 787
Abstract
Background: The recent earthquakes that occurred in Southern Turkey on the 6th of February 2023, were the most devastating earthquakes that have occurred in Turkey in the modern era. Teams of rescuers from 19 EU states quickly responded and carried out rescue missions [...] Read more.
Background: The recent earthquakes that occurred in Southern Turkey on the 6th of February 2023, were the most devastating earthquakes that have occurred in Turkey in the modern era. Teams of rescuers from 19 EU states quickly responded and carried out rescue missions across the affected area. This article is a report of a case series of rescues performed by the Romanian response team RO-USAR 1, with its aim being to assess the need of an internation consensus regarding immediate first-care in patients that are victims of natural or human-made catastrophes. Operations: A total of five victims were extracted alive from under the debris by our team and transported to the nearest available hospital by ambulance. A total of eight deceased victims were also extracted to facilitate access to the aforementioned alive victims. Conclusions: Quickly recognizing life-threatening situations and rapidly instating rapid fluid resuscitation is an essential step in reducing mortality in patients affected by major natural or human-made disasters. The need for an international consensus for the prehospital care of these patients is needed now more than ever in order to further ameliorate morbidity and mortality that largely occurs due to crush syndrome and its derived complications. Full article
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15 pages, 535 KiB  
Brief Report
A Novel Student-Initiated International Emergency Medicine Competition: A Decade of Experience from the Khon Kaen University International Challenge of Emergency Medicine
by Yui Okamura, Parames Ngeabngamsri, Ami Iwano, Thanachit Krikeerati, Kotaro Yanagisawa, Thanut Jansirirat, Moeko Ohkoshi, Tomonari Shimoda, Thomas Mayers, Praew Kotruchin and Pattarapong Makarawate
Emerg. Care Med. 2024, 1(4), 326-340; https://doi.org/10.3390/ecm1040033 - 26 Sep 2024
Viewed by 1040
Abstract
The global health crisis caused by the COVID-19 pandemic severely restricted in-person international events and clinical exposure opportunities for medical students. As a result, fostering global collaborations and providing hands-on experiences for future healthcare professionals has become increasingly challenging. The Khon Kaen University [...] Read more.
The global health crisis caused by the COVID-19 pandemic severely restricted in-person international events and clinical exposure opportunities for medical students. As a result, fostering global collaborations and providing hands-on experiences for future healthcare professionals has become increasingly challenging. The Khon Kaen University International Challenge of Emergency Medicine (KKU ICEM) is the world’s first international emergency medicine (EM)-focused competition for medical students. Since 2016, it has been held eight times and attracted participation from approximately 500 students across 18 countries spanning Asia, Europe, North America, and Africa. The KKU ICEM not only equips medical students with essential EM knowledge but also cultivates international friendships and cross-cultural competence. Initiatives like the KKU ICEM can play a crucial role in preparing the next generation of healthcare professionals for the challenges ahead. Full article
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