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: Patient admissions beyond the capacity of emergency departments (EDs) have been reported since the coronavirus disease (COVID-19) pandemic. Thus, laboratory parameters to predict the readmission of patients discharged from the ED are needed. For this purpose, we investigated whether C-reactive protein (CRP) level and neutrophil-to-lymphocyte ratio (NLR) could predict the readmission of patients with COVID-19. Methods: Patients aged ＞18 years who visited the ED in October 2020 and had positive polymerase chain reaction test results were evaluated. Among these patients, those who were not hospitalized and were discharged from the ED on the same day were included in the study. The patients' readmission status within 14 days after discharge, age, sex, complaint on admission, comorbidity, systolic blood pressure, diastolic blood pressure, fever, pulse, oxygen saturation level, CRP level, blood urea nitrogen level, creatinine level, neutrophil count, lymphocyte count, and NLR were recorded. Data were compared between the groups. Results: Of the 779 patients who were included in the study, 359 (46.1%) were male. The median age was 41 years (range, 31-53 years). Among these patients, those who were not hospitalized and were discharged from the ED on logistic regression analysis, age, CRP level, NLR, loss of smell and taste, and hypertension had odds ratios of 2.494, 2.207, 1.803, 0.341, and 1.879, respectively. Conclusions: The strongest independent predictor of readmission within 14 days after same-day ED discharge was age ＞ 50 years. In addition, CRP level and NLR were the laboratory parameters identified as independent predictors of ED readmission.
- 期刊
- OpenAccess
Background: High-quality cardiopulmonary resuscitation (HQ-CPR) focuses on improving heart and brain blood perfusion. The evaluation of HQ-CPR included depth, frequency, rate of chest compressions, and the occurrence of chest recoil between two chest compressions. Staff performing CPR may not be performing HQ-CPR since it is influenced by individual stamina, physical strength, and lack of target marker. We aimed to study the impact of 100 times per minute rate vs. 120 times per minute CPR rate on the depth and percentage of depth-on-target done by trained staff on a manikin. Methods: This was a cross-over randomized control study. The subjects were anesthesiology and intensive care residents in a tertiary teaching hospital in Indonesia, all certified to perform advanced life support. The subject was asked to perform both CPR of 100 and 120 times per minute after a period of one-day rest. The standardized adult manikin was used, and the depth of CPR was measured using a pad-sensor attached to the manikin, and the results were transferred to recording software. Analysis was done using the chi-square analysis, and p ＜ 0.05 was considered statistically significant. Results: A total of 35 subjects were included. The results showed that the average compression depth at 100 times/minute was more statistically superficial than the 120 times/minute treatment (5.210 ± 0.319 vs. 5.430 ± 0.283, p = 0.007). In contrast, the compression depth-on-target percentage was significantly higher at a speed of 100 times per minute (37.130 ± 10.233 vs. 18.730 ± 7.224, p = 0.0001). Conclusion: One hundred times per minute CPR resulted in a statistically significant lower compression depth, although not clinically significant, with a statistically significant higher percentage of compression depth-on-target than 120 times per minute CPR.
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- OpenAccess
Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in substantial impacts on all aspects of medical education. Modern health systems must prepare for a wide variety of catastrophic scenarios, including emerging infectious disease outbreaks and human and natural disasters. During the COVID-19 pandemic, while the use of traditional teaching methods has decreased, the use of online-based teaching methods has increased. COVID-19 itself and the accompanying infection control measures have restricted full-scale practice. Therefore, we developed an adapted hybrid model that retained adequate hands-on practice and educational equality, and we applied it with a group of undergraduate medical students participating in a mandatory disaster education course in a military medical school. Methods: The course covered the acquisition of skills used in emergency and trauma scenarios through designated interdisciplinary modules on disaster responses. Several asynchronous and synchronous online webinars were used in this one-credit mandatory disaster and military medicine education course. To allow opportunities for hands-on practice and ensure education equality, the students were divided into 15 groups, with 12 students in each group. The hands-on practice exercises were also recorded and disseminated to the students in the designated area for online learning. Results: A total of 164 3rd-year medical students participated in this mandatory disaster and military medicine course during the COVID-19 pandemic. The satisfaction survey response rate was 96.5%. The students were satisfied with the whole curriculum (3.8/5). Most of the free-text comments regarding the course represented a high level of appreciation. The students felt more confident in the knowledge and skills they gained in hands-on exercises than they did in the knowledge and skills they gained in online exercises. The students showed significant improvements in knowledge after the course. Conclusions: We demonstrated that this adapted hybrid arrangement provided an enhanced learning experience, but we also found that medical students were more confident in their knowledge and skills when they had real hands-on practice.
- 期刊
- OpenAccess
Dentures dislodged into throat on bilevel positive airway pressure (BiPAP) ventilation can be overlooked and potentially compromise airway patency. An 81-year-old man with a history of chronic obstructive pulmonary disease (COPD) presented with increased shortness of breath and productive cough for 1 week. Inhaled bronchodilators, parenteral steroids, and BiPAP ventilation were administered for acute exacerbation of COPD complicated with acute hypercapnic respiratory failure. Fifty minutes after receiving BiPAP ventilation, his respiratory condition improved; however, he started to complain of neck pain. The patient remained intolerant to the device 3 hours later, despite receiving assurance that the discomfort might be caused by air pressure through mask ventilation. His throat did not exhibit any abnormality during visual examination. Neck radiographs were subsequently obtained and demonstrated a denture impacted in the hypopharynx. His neck pain resolved after the removal of the dislodged maxillary denture. Denture dislodgement can occur in mask ventilation and compromise airway patency if stuck in the hypopharynx or respiratory tract. Such adverse events may be overlooked on the coexistence of respiratory and pulmonary diseases. A precisely pharyngolaryngeal inspection and complete imaging studies must be performed to facilitate early identification and further retrieval intervention.