Articles: emergency-medicine.
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The mortality of severe asthma with cardiac arrest is still close to 100% even if it is treated with conventional cardiopulmonary resuscitation (CCPR). Extracorporeal cardiopulmonary resuscitation (ECPR) has been widely accepted as an alternative method when CCPR is futile. However, the maximum "low-flow" duration has not been well defined. ⋯ He was withdrawn from extracorporeal membrane oxygenator and ventilator at 72 h and 14 days after admission respectively and was discharged without permanent neurologic sequelae. This case illustrates the critical role of ECPR as a last resort in near-fatal asthma. For such patients with bystander, starting ECPR after >60 min of CCPR can still obtain satisfactory prognoses.
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Case Reports
Point of care ultrasound needle guidance to assist diagnosis of acute gluteal compartment syndrome.
Gluteal compartments can be difficult to assess for acute compartment syndrome (ACS) compared to other fascial compartments due to their anatomy and rarity of presentation. Point-of-care ultrasound (POCUS) needle guidance may assist in obtaining accurate compartment pressure measurements within the gluteal compartments. We present a case in which a 69-year-old woman presented following a fall resulting in a superior prosthetic hip dislocation. ⋯ The patient was subsequently taken for emergent fasciotomy and hematoma evacuation. There has been limited investigation into compartment pressure measurement under US guidance versus a palpation/landmark-guided technique. This case shows the feasibility of US needle guidance when assessing compartment pressures for this uncommon diagnosis.
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In June 2022, the United States Supreme Court decision Dobbs v. Jackson Women's Health Organization overturned Roe v. Wade, removing almost 50 years of precedent and enabling the imposition of a wide range of state-level restrictions on abortion access. ⋯ The goal of this paper, therefore, is to describe the impact of the reversal of Roe v. Wade on health equity and reproductive justice, the provision of emergency care education and training, and the specific legal and reproductive consequences for emergency clinicians. Finally, we conclude with specific recommended policy and advocacy responses for emergency medicine clinicians.
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Physicians tend to overestimate patients' pretest probability of having bacteremia. The low yield of blood cultures and contaminants is associated with significant financial cost, as well as increased length of stay and unnecessary antibiotic treatment. ⋯ Scoring systems using only vital signs, NEWS, and SF I showed moderate abilities in predicting bacteremia, whereas qSOFA performed poorly. Scoring systems using both vital signs and laboratory values, mSOFA and especially SF II, showed good abilities in predicting bacteremia.
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Depression and sleep-wake disorders are recognized as one of the major problems among emergency physicians. While depression is more common in females than in males, the associated factors linking depression and sleep-wake disorders in emergency physicians, particularly females, remain unknown. ⋯ Approximately, one-third of EM residents report depression and sleep-wake problems, with female residents showing a higher risk than male residents. Several risk factors were identified, and future strategies should be aimed to address these issues to improve the training environment and overall wellbeing of EM residents.KEY MESSAGESThe prevalence of depression and sleep-related problems were, respectively, 1.95 and 1.81 times higher in female residents compared to their male colleagues.The associated risk factors for depression were flexibility of shift trade, level of training in the emergency medical centre, and frequency of night shifts.Improving the training environment and facilities, as well as offering more flexible duty trading options can provide potential opportunities to reduce the risk.