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Emerg. Care Med., Volume 1, Issue 1 (March 2024) – 8 articles

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2 pages, 161 KiB  
Editorial
Traumatic Cardiac Arrest: Navigating the Spectrum of Fundamentals and Advances
by Francisco Epelde
Emerg. Care Med. 2024, 1(1), 59-60; https://doi.org/10.3390/ecm1010008 - 13 Mar 2024
Viewed by 771
Abstract
Traumatic Cardiac Arrest (TCA) arises from severe trauma, both blunt and penetrating, leading to the sudden cessation of cardiac activity [...] Full article
13 pages, 1448 KiB  
Review
Resuscitative Endovascular Balloon Occlusion of the Aorta in Non-Traumatic Out-of-Hospital Cardiac Arrest: A State-of-the-Art Review
by Andrea Breglia, Pietro Pettenella, Laura Cervino, Claudio Fossa and Mirko Zanatta
Emerg. Care Med. 2024, 1(1), 46-58; https://doi.org/10.3390/ecm1010007 - 1 Mar 2024
Viewed by 1279
Abstract
Out-of-hospital cardiac arrest (OHCA) is one of the most important causes of death worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an interesting new device that has been developed as a bridge therapy to treat trauma patients with non-compressible torso hemorrhage. [...] Read more.
Out-of-hospital cardiac arrest (OHCA) is one of the most important causes of death worldwide. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an interesting new device that has been developed as a bridge therapy to treat trauma patients with non-compressible torso hemorrhage. REBOA has also been tested in non-traumatic OHCA, but the results are inconclusive. The aim of this review is to describe the state of the art in the use of REBOA for the management of non-traumatic out-of-hospital cardiac arrest. We performed a state-of-the-art review of the literature, searching for the therapeutic role of REBOA in the management of non-traumatic OHCA. We interviewed PubMed, Central, and Embase, and searched for citations before May 2023 using these criteria: “non-traumatic out-of-hospital cardiac arrest” and “resuscitative endovascular balloon occlusion of the aorta”. We selected only observational studies because controlled trials have not been published yet. All studies demonstrated the feasibility of REBOA placement in the management of non-traumatic OHCA and the improvement of all perfusion markers. Although some important uncertainties still remain, REBOA has the potential to become a new cornerstone in the therapy of OHCA and change the management of cardiac arrest, especially in remote locations which require a long time for scene arrival and an even longer time for metropolitan hospital arrival, where an ECPR is available. Full article
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7 pages, 690 KiB  
Case Report
Asymptomatic Intestinal Ischemia Secondary to Thrombosis of the Spleno-Mesenteric Portal Axis: Usefulness of Laparoscopic Approach for Diagnosis and Therapeutical Decisions—Case Report and Review of the Literature
by Simone Gianazza, Marika Morabito, Davide Inversini, Sabrina Garbarino, Marta Ripamonti, Giuseppe Ietto and Giulio Carcano
Emerg. Care Med. 2024, 1(1), 39-45; https://doi.org/10.3390/ecm1010006 - 7 Feb 2024
Viewed by 824
Abstract
Mesenteric Venous Thrombosis (MVT) is a rare but often lethal form of ischemia. The diagnosis may be difficult for the clinician due to its mild symptoms with a great discrepancy between the pain suffered by the patients and the clinical observation. The non-specificity [...] Read more.
Mesenteric Venous Thrombosis (MVT) is a rare but often lethal form of ischemia. The diagnosis may be difficult for the clinician due to its mild symptoms with a great discrepancy between the pain suffered by the patients and the clinical observation. The non-specificity of the laboratory tests and the challenge in computed tomography (CT) scan in distinguishing when an ischemia is occurring lead to the risk of an unrecognized diagnosis, especially considering that an early onset of treatment is largely fundamental for better outcomes. Also, the choice between the surgical approach and the anticoagulation may be a pitfall for the clinicians. The treatment choice requires a multidisciplinary approach. Emergency exploration by laparoscopy allows clinicians to reach the correct diagnosis and the real-time assessment of the intestinal infarction extension, playing a double diagnostic and therapeutic role in those doubtful and tricky cases. Here, a 77-year-old male with a completely asymptomatic bowel ischemia secondary to a Mesenteric Venous Thrombosis was submitted to a laparoscopic approach. Full article
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8 pages, 815 KiB  
Brief Report
A Ten-Year before–after Study on the Impact of the Affordable Care Act Health Insurance Expansion on Emergency Department Visits in California, U.S.
by Theodore C. Chan, Jesse J. Brennan and Edward M. Castillo
Emerg. Care Med. 2024, 1(1), 31-38; https://doi.org/10.3390/ecm1010005 - 29 Jan 2024
Viewed by 1152
Abstract
The Affordable Care Act (ACA) implemented in the U.S. aimed to improve healthcare access by expanding insurance coverage. To study the impact of ACA on Emergency Departments (Eds), we conducted a multi-center observational retrospective study of ED visits from all nonfederal acute care [...] Read more.
The Affordable Care Act (ACA) implemented in the U.S. aimed to improve healthcare access by expanding insurance coverage. To study the impact of ACA on Emergency Departments (Eds), we conducted a multi-center observational retrospective study of ED visits from all nonfederal acute care hospitals in California over a 10-year period (2009 and 2018), 5 years before and after ACA implementation. Primary outcome measures included total ED visits, health insurance, disposition, and diagnoses, including ambulatory-care-sensitive conditions (ACSCs), and were analyzed each year to assess for trends during the 10-year study period. Overall, ED visits increased from 8,475,330 (30,791/100,000 population) in 2009 to 11,389,384 in 2018 (37,255/100,000 population), an increase of 21.0%, with the largest increase in 2014, the first year of ACA. The payer mix also dramatically changed, with a significant drop in uninsured patient visits (21.5% to 7.8%) and an increase in government-funded Medicaid visits (18.9% to 35.7%). There was a slight decrease in visits resulting in hospitalization or transfer (21.2% to 18.1% of all D visits) and ASCS visits (173.2 to 144.3 per 1000 ED visits). In conclusion, ED visits increased significantly in California following ACA, with a decrease in uninsured patients and small decreases in both hospitalizations/transfers. Full article
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7 pages, 1489 KiB  
Case Report
Ischemic-Hemorrhagic Stroke in New Onset Type 1 Diabetes Mellitus with Diabetic Ketoacidosis in a Two-Year-Old Toddler: The First Reported Case in Indonesia
by Anita Halim, Felicia Harsono, Sisilia Orlin and Gilbert Sterling Octavius
Emerg. Care Med. 2024, 1(1), 24-30; https://doi.org/10.3390/ecm1010004 - 27 Dec 2023
Viewed by 1402
Abstract
Cerebral edema accounts for 90% of intracerebral complications in diabetic ketoacidosis (DKA). Stroke has been reported to account for 10% of intracerebral complications of DKA in children. It may be underrecognized because its presentation may be subtle. This case report aims to raise [...] Read more.
Cerebral edema accounts for 90% of intracerebral complications in diabetic ketoacidosis (DKA). Stroke has been reported to account for 10% of intracerebral complications of DKA in children. It may be underrecognized because its presentation may be subtle. This case report aims to raise awareness of stroke presentation and risk factors in pediatric DKA. A previously healthy two-year-old female presented to the emergency department one day before admission with loss of consciousness and was diagnosed with DKA. The recognition of left hemiparesis was on the 9th day of hospitalization. After 14 days of hospitalization, the patient had recurrent seizures. Computed tomography and angiography revealed subacute ischemic transformative to subacute hemorrhagic stroke. During the follow-up, the symptoms of hemiparesis improved with routine physiotherapy, with some partial palsy of the third cranial nerve remaining. Risk factors for stroke in the patient were the severity of dehydration during DKA, younger age of onset, delayed DKA treatment, and iron deficiency anemia. Suspicion of stroke is necessary even if a subtle neurologic deficit occurs. Full article
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13 pages, 236 KiB  
Review
Addressing Challenges in EMS Department Operations: A Comprehensive Analysis of Key Issues and Solution
by Abdullah Basnawi
Emerg. Care Med. 2024, 1(1), 11-23; https://doi.org/10.3390/ecm1010003 - 20 Dec 2023
Viewed by 4011
Abstract
Background: Emergency medical services (EMS) are essential in providing timely medical attention and transportation to people in need during times of crisis. Effective EMS operations are crucial for delivering prompt and effective healthcare. However, the landscape of EMS operations is constantly evolving, posing [...] Read more.
Background: Emergency medical services (EMS) are essential in providing timely medical attention and transportation to people in need during times of crisis. Effective EMS operations are crucial for delivering prompt and effective healthcare. However, the landscape of EMS operations is constantly evolving, posing a number of challenges that require rigorous research and innovative solutions. Objectives: To highlight the key challenges facing EMS departments in their daily operations and discuss potential solutions. Methods: A narrative literature review was conducted. Relevant studies were identified by searching electronic databases, such as PubMed, MEDLINE, CINAHL, and Google Scholar. Results: The main challenges facing EMS departments include an increasing demand for services, limited resources, aging infrastructure, technological advancements, and regulatory compliance. Operational-level solutions that can be used to address these challenges include investing in technology, cross-training personnel, developing contingency plans, and partnering with other organizations. Conclusion: EMS departments today face a variety of challenges. However, there are a number of approaches that can be taken to address these challenges. By investing in technology, cross-training personnel, developing contingency plans, and partnering with other organizations, EMS departments can improve their operations and provide the best possible care to patients. Full article
8 pages, 237 KiB  
Article
Knowledge of and Attitude towards First Aid Measures among Drivers in Sharjah
by Amjad Mohamadiyeh, Mohammed Ra’a Said, Banan Al-Dabbagh, Rana Saeed, Furqan Al-Haboobi, Maitha AlJuwaied, Sarra Shorbagi and Amal Hussein
Emerg. Care Med. 2024, 1(1), 3-10; https://doi.org/10.3390/ecm1010002 - 8 Dec 2023
Cited by 1 | Viewed by 2435
Abstract
Injury is an important cause of mortality and morbidity. First aid is the immediate assistance provided to a suddenly injured or sick person until professional help arrives or that person has recovered. Many lives would be saved if proper first aid was provided [...] Read more.
Injury is an important cause of mortality and morbidity. First aid is the immediate assistance provided to a suddenly injured or sick person until professional help arrives or that person has recovered. Many lives would be saved if proper first aid was provided early. In the Middle East, there are limited studies that explore knowledge and practices towards first aid needed during RTA. The aim of this study is to investigate the knowledge and attitude towards first aid among drivers in Sharjah. A cross-sectional study was conducted through a self-administered questionnaire written in Arabic and the English language. Participants were 18 years or older holding a driving license in the city of Sharjah. Paramedics and certified participants with a certification from authorized organizations were excluded. A non-proportional convenient sampling method was used. A total of 343 participants completed the questionnaires. The majority of the study participants were less than 40 years old, and (56.76%) were males. Most participants (94.2%) indicated that they know the term ‘First Aid’. However, (49.7%) of the participants knew the number to call for an ambulance, and (52.43%) of the participants indicated that the victim should be moved to the hospital without an ambulance. With regard to attitude, (34.86%) were not willing to provide first aid in the case of RTA. The main reason was lack of knowledge, followed by fear of legal consequences. Most participants (83.78%) were willing to participate in first aid classes to improve their knowledge and attitude. Most participants are aware of the basic terms of first aid; however, they are not willing to provide first aid in cases of RTA due to lack of knowledge and fear of legal consequences. Based on these findings, we recommend providing first aid classes to new drivers so that they can obtain certification. Full article
2 pages, 380 KiB  
Editorial
Emergency Care and Medicine, 2023
by Raimundas Lunevicius
Emerg. Care Med. 2024, 1(1), 1-2; https://doi.org/10.3390/ecm1010001 - 5 Sep 2023
Viewed by 2247
Abstract
The most recent global emergency medicine 56-question survey highlighted challenges and gaps in providing emergency care [...] Full article
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