Journal of Acute Medicine
- OpenAccess
台灣急診醫學會 & Ainosco Press,正常發行
選擇卷期
- 期刊
- OpenAccess
Background: Few studies have tested the role of the internal jugular vein (IJV) ultrasonographic (US) diameters in the assessment of central venous pressure (CVP) in spontaneously breathing patients. No review or meta-analysis is currently available on the role of IJV assessment in this setting. The aim of this systematic review is to check the reliability and accuracy of IJV US diameters in predicting CVP and to evaluate its correlation with CVP in spontaneously breathing patients. Methods: This systematic review was based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We included studies on the accuracy and reliability of the IJV ultrasound measures and studies exploring its correlation with CVP in adult spontaneously breathing patients. The studies' report quality was assessed by Standards for Reporting of Diagnostic Accuracy (STARD) and Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 scales. Results: A total of five studies was eligible for final analysis. The studies on IJV ultrasound measures showed a good quality in reporting. The anterior-posterior diameter maximum of IJV (AP-IJV Dmax) showed the best correlation with the CVP with a good inter-rater reliability and validity in predicting CVP. All measures showed good inter-rater reliability and validity in predicting CVP, but only the AP-IJV Dmax showed good correlation with CVP. Conclusions: The AP-IJV Dmax could be a potential surrogate of CVP because of its good reliability and validity in predicting CVP value and its fair-moderate correlation with CVP. Anyway, further research should confirm these conclusions.
- 期刊
- OpenAccess
Background: To evaluate whether the frequency variation of ventricular fibrillation (VF) helps to predict successful defibrillation in a rat model of cardiac arrest. Methods: VF was induced in rats followed by cardiopulmonary resuscitation and then defibrillation. The electrocardiographic signals of 30 rats with first-shock success were obtained from our previous animal experiments, and 300 rats without first-shock success were selected as control. The VF waveform immediately before the first defibrillation was analyzed. Results: Eighty-eight percentages of the frequency variations of an electrocardiogram (ECG) record falling in the range -9.5-9.5 Hz was selected with sensitivity of 0.8, specificity of 0.583, and area under curve (AUC) of 0.708. Compared with amplitude spectrum area (AMSA) (sensitivity = 0.767, specificity = 0.547, and AUC = 0.678), combining frequency variation and AMSA significantly increases the predictability with sensitivity of 0.933, specificity of 0.493, and AUC of 0.732 (p = 0.005). Conclusions: The frequency variation of VF may serve a useful parameter to predict defibrillation success.
- 期刊
- OpenAccess
Background: Infection and necrosis are common acute complications of diabetic foot ulcer (DFU). Amputation is the last resort treatment to control severe diabetic foot infection. Many risk factors for progression of infection that lead to amputation are disclosed. However, the prediction for the amputation necessity is clinically important to stratify risk and target intervention for limb salvage. Accordingly, this study investigates the predictive risk factors for amputation need in diabetic patients with foot ulcer. Methods: We retrospectively studied the medical records of the DFU patients from January to December in 2017. The patients were classified as the non-amputation and amputation groups. Patient characteristics, clinical features of vasculopathy and neuropathy (ankle brachial index [ABI] and monofilament test), and laboratory features (hemoglobin A1C [HbA1C], C-reactive protein [CRP], and white blood cell [WBC] counts) were analyzed, using the univariate and multivariate analyses. Results: Of the eligible 73 cases (age 41 to 76 years), 14 (19.2%) underwent lower limb amputation. Using the multivariate model, significate risk factors included low ABI (＜ 0.8; adjusted odds ratio [OR] = 17.9; p = 0.003), the presence of neuropathy (adjusted OR = 5.6; p = 0.005), and HbA1C ＞ 8.0% (adjusted OR = 4.7; p = 0.016). Conclusions: Several predictors, such as vasculopathy, neuropathy, higher HbA1C and CRP, were associated with amputation necessities in DFU patients. Of note, the vasculopathy was found to be the most important powerful. Therefore, identification and correction of these predictors would improve the quality care and patient prognosis.
- 期刊
- OpenAccess
New-Onset Massive Ascites With Acute Kidney Injury Due to Spontaneous Rupture of the Urinary Bladder
Spontaneous rupture of the urinary bladder (SRUB) is a rare urological emergency associated with urinary ascites and apparent acute kidney injury. The clinical course can be severe or lethal if no early diagnosis is achieved. We present a 44-year-old woman with type 2 diabetes mellitus had progressive abdominal fullness, poor appetite, dyspnea, and lower legs edema for two days. Laboratory studies present as acute kidney injury. Abdominal sonogram and computed tomogram (CT) revealed massive ascites. Her ascites relieved dramatically after Foley catheter indwelling, and daily urine amount was about 5,000 mL. Urinary bladder rupture was found after CT cystography. She received surgical repair of the ruptured urinary bladder, and cystometry revealed detrusor areflexia. Then she was discharged uneventfully.
- 期刊
- OpenAccess
Retained guidewire is a major complication of central line placement. We present a patient with infective endocarditis caused by a retained guidewire. A young man admitted to our emergency department complained of debilitating weakness, productive cough, and fever for seven days. Chest radiography showed some lesions in both lungs as well as a retained guidewire. Past history revealed a thermal burn injury one month before, during which an internal jugular central venous line was inserted. Echocardiography showed multiple large vegetations in right atrium and right ventricle. Thus, infective endocarditis and multiple embolic lung lesions were treated with empirical antibiotics. Guidewire was removed by vascular surgery service. Unfortunately, the patient died before undergoing open-heart surgical intervention. It is believed that central vein catheterization requires special attention to perform through the Seldinger technique skillfully and under supervision to avoid preventable complications.
- 期刊
- OpenAccess
In recent decades, morbidity in road traffic accidents has declined in Western Europe, mainly due to the enforcement of road safety policies and innovations in car engineering. In classic cars-so called ＂oldtimers＂ in Switzerland-these innovations in car engineering and often even seat belts are lacking, leading to a greater risk of morbidity after accidents. Thus, we reviewed our own series of victims of accidents with oldtimers who were admitted to our Level 1 Trauma Centre in Switzerland over the last 18 years. Within the 18-year study period and a total of 500,000 consultations, six documented oldtimer accidents were included in this case series. In three of the six oldtimer accidents and in all high-speed accidents, the car was overturned. In one case, the reason for this was unknown, in another a tire had suddenly burst and in a third this was triggered by evading an obstacle. Four reports contained information about a missing airbag and/or seat belt. Injuries included blunt abdominal injuries (laceration, mesenteric vessel injury), chest trauma (pneumothorax, rip fracture, scapula fracture), brain injury, and contusions. None of the patients died. In conclusion, oldtimer accidents are rare. However, pre-clinicians and clinicians treating patients after oldtimer car accidents should be aware of the specific risks-such as steering wheel injuries and consequences of trauma, i.e., extensive injuries to the head, chest and abdomen.