Articles: emergency-medicine.
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The growing prevalence of heat stroke as a public health issue, exacerbated by climate change and increasing global temperatures, demands an immediate and strategic response to prevent weather-related morbidity and mortality. Heat stroke results from the body's inability to cope with excessive heat, leading to systemic inflammatory responses, cellular apoptosis, and potential multiorgan dysfunction or failure. However, little information explicitly outlines how to perform cold-water immersion in the emergency department (ED), including potential patient selection, how much water or ice to use, target temperatures, when to stop, and complications or challenges with the process. ⋯ Additionally, the article addresses challenges and lessons learned during the protocol's implementation, emphasizing the importance of multidisciplinary collaboration, staff education, and the adaptation of ED infrastructure to support this lifesaving treatment based on its use during the last 3 years. The successful resolution of the presented cases, along with the protocol's potential for widespread adoption, illustrates the critical role of cold-water immersion in enhancing ED responses to heat stroke, offering a blueprint for future research and the development of similar protocols across health care settings. This work contributes to the evolving landscape of emergency medicine and aligns with the global effort to combat the adverse health effects of climate change.
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Comparative Study Observational Study
Comparative Analysis of Frailty Scales in Emergency Department: Highlighting the Strengths of the Triage Frailty and Comorbidity Tool.
Currently, there is uncertainty about which frailty scale is most appropriate and valid for use in the emergency department. The objective of this study was to compare the most commonly used frailty scales in triage and evaluate their performance. ⋯ The findings of this study suggest that the Triage Frailty and Comorbidity tool is a valid instrument for assessing frailty in the emergency department. Moreover, among the scales used, it is the only 1 that considers the entire adult population, not just those aged >65 years, making it more inclusive for a setting such as the emergency department.
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Though the disease burden addressable by prehospital and out-of-hospital emergency care(OHEC) spans communicable diseases, maternal conditions, chronic conditions and injury, the single largest disability-adjusted life year burden contributor is injury, primarily driven by road traffic injuries(RTIs). Establishing OHEC for RTIs and other common emergencies in low- and middle-income countries(LMICs) where the injury burden is disproportionately greatest is a logical first step toward more comprehensive emergency medical services(EMS). However, with limited efforts to formalize and expand existing informal bystander care networks, there is a lack of consensus on how to develop and maintain bystander-driven Tier-1 EMS systems in LMICs. Resultantly, Tier-1 EMS development is fragmented among non-governmental organizations and the public sector globally. ⋯ Consensus is necessary to avoid duplicative and disorganized efforts due to the fragmented nature of parallel Tier-1 EMS efforts globally. A Delphi-like multi-round expert discussion among the members of the largest collaboration between organizations directing Tier-1 EMS programs globally generated relevant priorities to direct future efforts.
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Band neutrophil count greater than 10 % of the white blood cell differential (bandemia) has been associated with severe infections in emergency department (ED) patients. In January 2023, our ED instituted a critical alert for bandemia. We performed a retrospective chart review of two cohorts of emergency department patients, before and after initiation of critical alert. After critical alert initiation for bandemia, there was a 4.6-fold higher incidence of bandemia with similar baseline patient characteristics.