Inter-rater variability in the interpretation of the head impulse test results.
Clinical and Experimental Emergency Medicine.2018;5(1):69-70. doi:10.15441/ceem.17.284
Clinical and Experimental Emergency Medicine
2014 (1, 1) to Present ISSN: 2383-4625
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A novel method to cease traumatic urethral bleeding.
Clinical and Experimental Emergency Medicine.2018;5(1):66-68. doi:10.15441/ceem.17.230
Urethral bleeding due to trauma is a well-studied and often self-limiting condition. However, existing evidence regarding effective management of massive hemorrhage is limited. Intermittent penile compression and continuous perineal pressure are methods commonly used to control urethral bleeding. Nevertheless, these methods are not mentioned in the literature as specific treatment for this condition, and are rather learned by physicians via word of mouth. Sometimes these methods are ineffective and difficult for the patient to tolerate. This paper explains a new method implemented on a young man with massive urethral bleeding due to iatrogenic trauma, which was unresponsive to standard management. For this patient, the bleeding was controlled by gradually inflating the balloon of the catheter up to 4 mL. Given its safety and efficiency in controlling bleeding in this patient, it seems this new technique should be considered in cases of massive hemorrhage unresponsive to routine treatment.
Catheters ; Hemorrhage* ; Humans ; Methods* ; Mouth ; Urethral Stricture ; Urinary Catheters
Catheters ; Hemorrhage* ; Humans ; Methods* ; Mouth ; Urethral Stricture ; Urinary Catheters
Clinical and Experimental Emergency Medicine.2018;5(1):60-65. doi:10.15441/ceem.16.190
Delayed massive hemothorax requiring surgery is relatively uncommon and can potentially be life-threatening. Here, we aimed to describe the nature and cause of delayed massive hemothorax requiring immediate surgery. Over 5 years, 1,278 consecutive patients were admitted after blunt trauma. Delayed hemothorax is defined as presenting with a follow-up chest radiograph and computed tomography showing blunting or effusion. A massive hemothorax is defined as blood drainage >1,500 mL after closed thoracostomy and continuous bleeding at 200 mL/hr for at least four hours. Five patients were identified all requiring emergency surgery. Delayed massive hemothorax presented 63.6±21.3 hours after blunt chest trauma. All patients had superficial diaphragmatic lacerations caused by the sharp edge of a broken rib. The mean preoperative chest tube drainage was 3,126±463 mL. We emphasize the high-risk of massive hemothorax in patients who have a broken rib with sharp edges.
Chest Tubes ; Diaphragm* ; Drainage ; Emergencies ; Follow-Up Studies ; Hemorrhage ; Hemothorax* ; Humans ; Lacerations ; Radiography, Thoracic ; Rib Fractures* ; Ribs* ; Thoracic Injuries ; Thoracostomy ; Thorax
Chest Tubes ; Diaphragm* ; Drainage ; Emergencies ; Follow-Up Studies ; Hemorrhage ; Hemothorax* ; Humans ; Lacerations ; Radiography, Thoracic ; Rib Fractures* ; Ribs* ; Thoracic Injuries ; Thoracostomy ; Thorax
Clinical and Experimental Emergency Medicine.2018;5(1):51-59. doi:10.15441/ceem.17.260
OBJECTIVE: The aim of this study was to investigate the effectiveness of a quality improvement activity for pain management in patients with extremity injury in the emergency department (ED). METHODS: This was a retrospective interventional study. The patient group consisted of those at least 19 years of age who visited the ED and were diagnosed with International Classification of Diseases codes S40–S99 (extremity injuries). The quality improvement activity consisted of three measures: a survey regarding activities, education, and the triage nurse’s pain assessment, including change of pain documentation on electronic medical records. The intervention was conducted from January to April in 2014 and outcome was compared between May and August in 2013 and 2014. The primary outcome was the rate of analgesic prescription, and the secondary outcome was the time to analgesic prescription. RESULTS: A total of 1,739 patients were included, and 20.3% of 867 patients in the pre-intervention period, and 28.8% of 872 patients in the post-intervention period received analgesics (P < 0.001). The prescription rate of analgesics for moderate-to-severe injuries was 36.4% in 2013 and 44.5% in 2014 (P=0.026). The time to analgesics prescription was 116.6 minutes (standard deviation 225.6) in 2013 and 64 minutes (standard deviation 75.5) in 2014 for all extremity injuries. The pain scoring increased from 1.4% to 51.6%. CONCLUSION: ED-based quality improvement activities including education and change of pain score documentation can improve the rate of analgesic prescription and time to prescription for patients with extremity injury in the ED.
Analgesics ; Education ; Electronic Health Records ; Emergencies* ; Emergency Service, Hospital* ; Extremities* ; Humans ; International Classification of Diseases ; Pain Management* ; Pain Measurement ; Prescriptions ; Quality Improvement* ; Retrospective Studies ; Triage
Analgesics ; Education ; Electronic Health Records ; Emergencies* ; Emergency Service, Hospital* ; Extremities* ; Humans ; International Classification of Diseases ; Pain Management* ; Pain Measurement ; Prescriptions ; Quality Improvement* ; Retrospective Studies ; Triage
Clinical and Experimental Emergency Medicine.2018;5(1):43-50. doi:10.15441/ceem.17.216
OBJECTIVE: Patients with nonvalvular atrial fibrillation (AF) and renal disease (RD) who receive anticoagulation therapy appear to be at greater risk of major bleeding (MB) than AF patients without RD. As observed in past studies, anticoagulants are frequently withheld from AF patients with RD due to concerns regarding bleeding. The objective of this study was to evaluate the incidence and pattern of MB in those with RD, as compared to those without RD, in a population of rivaroxaban users with nonvalvular AF. METHODS: Electronic medical records of over 10 million patients from the Department of Defense Military Health System were queried to identify rivaroxaban users with nonvalvular AF. A validated algorithm was used to identify MB-related hospitalizations. RD was defined through diagnostic codes present within 6 months prior to the bleeding date for MB cases and end of study participation for non-MB patients. Data were collected on patient characteristics, comorbidities, MB management, and outcomes. RESULTS: Overall, 44,793 rivaroxaban users with nonvalvular AF were identified. RD was present among 6,921 patients (15.5%). Patients with RD had a higher rate of MB than those without RD, 4.52 per 100 person-years versus 2.54 per 100 person-years, respectively. The fatal bleeding outcome rate (0.09 per 100 person-years) was identical between those with and without RD. CONCLUSION: In this post-marketing study of 44,793 rivaroxaban users with nonvalvular AF, RD patients experienced a higher MB rate than those without RD. The higher rate of MB among those with RD may be due to the confounding effects of comorbidities.
Anticoagulants ; Atrial Fibrillation* ; Comorbidity ; Electronic Health Records ; Hemorrhage* ; Hospitalization ; Humans ; Incidence* ; Military Personnel ; Rivaroxaban*
Anticoagulants ; Atrial Fibrillation* ; Comorbidity ; Electronic Health Records ; Hemorrhage* ; Hospitalization ; Humans ; Incidence* ; Military Personnel ; Rivaroxaban*
Clinical and Experimental Emergency Medicine.2018;5(1):35-42. doi:10.15441/ceem.16.192
OBJECTIVE: Many studies have proposed reducing unnecessary use of computed tomography (CT), and ongoing studies in pediatric populations are aiming to decrease radiation dosages whenever possible. We aimed to evaluate the long-term changes in the utilization patterns of CT and ultrasound (US) in pediatric emergency departments (PEDs). METHODS: This retrospective study reviewed the electronic medical data of patients who underwent CT and/or US in the PED of a tertiary referral hospital from 2000 to 2014. We compared the changes in utilization patterns of brain and abdominal CT scans in pediatric patients and analyzed changes in abdominal US utilization in the PED. RESULTS: During the study period, 196,371 patients visited the PED. A total of 12,996 brain and abdominal CT scans and 12,424 abdominal US were performed in the PED. Comparison of CT use in pediatric patients before and after 2007 showed statistically decreasing trends after 2007, expressed as the coefficient values of the differences in groups. The numbers of brain and abdominal CT scans showed a significant decreasing trend in children, except for abdominal CT in adolescents. The abdominal US/CT ratio in the PED showed a statistically significant increase (2.68; 95% confidence interval, 1.87 to 3.49) except for the adolescent group (5.82; 95% confidence interval, -2.06 to 13.69). CONCLUSION: Overall, CT use in pediatric patients has decreased since 2007. Pediatric US use has also shown a decreasing trend; however, the abdominal US/CT ratio in pediatric patients showed an increasing trend, except for adolescents.
Adolescent ; Brain ; Child ; Diagnostic Imaging ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Radiation Dosage ; Retrospective Studies ; Tertiary Care Centers ; Tomography, X-Ray Computed ; Ultrasonography*
Adolescent ; Brain ; Child ; Diagnostic Imaging ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Radiation Dosage ; Retrospective Studies ; Tertiary Care Centers ; Tomography, X-Ray Computed ; Ultrasonography*
Pre-hospital i-gel blind intubation for trauma: a simulation study.
Clinical and Experimental Emergency Medicine.2018;5(1):29-34. doi:10.15441/ceem.16.188
OBJECTIVE: This study aimed to evaluate the efficacy of i-gel blind intubation (IGI) as a rescue device for definitive airway management in ground intubation for pre-hospital trauma patients. METHODS: A prospective randomized crossover study was conducted with 18 paramedics to examine intubation performance of two blind intubation techniques through a supraglottic airway devices (IGI and laryngeal mask airway Fastrach), compared with use of a Macintosh laryngoscope (MCL). Each intubation was conducted at two levels of patient positions (ground- and stretcher-level). Primary outcomes were the intubation time and the success rate for intubation. RESULTS: The intubation time (sec) of each intubation technique was not significantly different between the two positions. In both patient positions, the intubation time of IGI was shortest among the three intubation techniques (17.9±5.2 at the ground-level and 16.9±3.8 at the stretcher-level). In the analysis of cumulative success rate and intubation time, IGI was the fastest to reach 100% success among the three intubation techniques regardless of patient position (all P < 0.017). The success of intubation was only affected by the intubation technique, and IGI achieved more success than MCL (odds ratio, 3.6; 95% confidence interval, 1.1 to 11.6; P=0.03). CONCLUSION: The patient position did not affect intubation performance. Additionally, the intubation time with blind intubation through supraglottic airway devices, especially with IGI, was significantly shorter than that with MCL.
Airway Management ; Allied Health Personnel ; Cross-Over Studies ; Emergency Medical Technicians ; Humans ; Intubation* ; Laryngeal Masks ; Laryngoscopes ; Prospective Studies ; Simulation Training
Airway Management ; Allied Health Personnel ; Cross-Over Studies ; Emergency Medical Technicians ; Humans ; Intubation* ; Laryngeal Masks ; Laryngoscopes ; Prospective Studies ; Simulation Training
Cervical collar makes difficult airway: a simulation study using the LEMON criteria.
Clinical and Experimental Emergency Medicine.2018;5(1):22-28. doi:10.15441/ceem.16.185
OBJECTIVE: Endotracheal intubation is extremely difficult to perform in patients wearing a cervical collar for a head and neck injury. Therefore, we analyzed actual measurements using the look externally, evaluate 3-3-2, Mallampati score, obstruction, and neck mobility (LEMON) criteria before and after cervical collar application to investigate the causes of a difficult airway. METHODS: This simulation study was performed in 76 healthy volunteers. We measured the mouth opening, modified Mallampati classification, and neck extension before and after cervical collar application. RESULTS: The mean inter-incisor distance significantly decreased from 4.3 to 2.6 cm (P < 0.001). Fifty-seven participants classified as I and II were newly classified as III and IV according to the modified Mallampati classification after cervical collar application (16% to 91%). The angles of neck extension significantly decreased from 44° to 22° after cervical collar application (P < 0.001). Before cervical collar application, our simulations predicted that 14 of 76 participants (18%) would have a difficult airway, whereas after cervical collar application, 76 of 76 (100%) were predicted to have a difficult airway. CONCLUSION: All values for the LEMON criteria (mouth opening, modified Mallampati classification, and neck extension) worsened significantly after cervical collar application. Additionally, a difficult airway was predicted in all participants after cervical collar application.
Airway Management ; Classification ; Head ; Healthy Volunteers ; Humans ; Intubation, Intratracheal ; Mouth ; Neck ; Neck Injuries
Airway Management ; Classification ; Head ; Healthy Volunteers ; Humans ; Intubation, Intratracheal ; Mouth ; Neck ; Neck Injuries
Clinical and Experimental Emergency Medicine.2016;3(4):197-203. doi:10.15441/ceem.15.109
OBJECTIVE: The aim of this study was to evaluate the effect of adding bedside ultrasonography to the diagnostic algorithm for nephrolithiasis on emergency department (ED) length of stay. METHODS: A prospective, randomized, controlled pilot study was conducted from October 2014 to December 2014 with patients with acute flank pain. In the non-ultrasonography group (NUSG), non-contrast computed tomography was selected based on clinical features and hematuria in the urinalysis. In the ultrasonography group (USG), non-contrast computed tomography was selected based on clinical features and hydronephrosis on bedside ultrasonography. The primary outcome was ED length of stay. The secondary outcomes were radiation exposure, amount of analgesics, proportion of patients with diseases other than ureteral calculus, and proportion of patients with unexpected ED revisits within 7 days from the index visit. RESULTS: A total of 103 patients were enrolled (NUSG, 51; USG, 52). The ED length of stay for the USG (89.0 minutes) was significantly shorter than that for the NUSG (163.0 minutes, P<0.001). There were no significant differences between the two groups in the radiation exposure dose (5.29 and 5.08 mSv, respectively; P=0.392), amount of analgesics (P=0.341), proportion of patients with diseases other than ureteral calculus (13.0% and 6.8%, respectively; P=0.486), and proportion of patients with unexpected ED revisits within 7 days from the index visit (7.8% and 9.6%, respectively; P=1.000). CONCLUSION: The use of early bedside ultrasonography for patients with acute flank pain could reduce the ED length of stay without increasing unexpected ED revisits.
Analgesics ; Emergencies* ; Emergency Service, Hospital* ; Flank Pain ; Hematuria ; Humans ; Hydronephrosis ; Length of Stay* ; Nephrolithiasis ; Pilot Projects* ; Prospective Studies ; Radiation Exposure ; Renal Colic* ; Ultrasonography* ; Ureteral Calculi ; Ureterolithiasis ; Urinalysis
Analgesics ; Emergencies* ; Emergency Service, Hospital* ; Flank Pain ; Hematuria ; Humans ; Hydronephrosis ; Length of Stay* ; Nephrolithiasis ; Pilot Projects* ; Prospective Studies ; Radiation Exposure ; Renal Colic* ; Ultrasonography* ; Ureteral Calculi ; Ureterolithiasis ; Urinalysis
Clinical and Experimental Emergency Medicine.2016;3(4):213-218. doi:10.15441/ceem.16.148
OBJECTIVE: The aim of this study was to assess the success rate of the GlideScope video laryngoscope (GVL) and direct laryngoscope (DL) over ten years in two academic emergency departments. METHODS: We used adult intubation data using DL and GVL collected from airway management registries at two academic emergency departments. We analyzed changes in first-pass success (FPS) rate by device and operator training level. We conducted a multivariate logistic regression analysis to predict the FPS according to time period. RESULTS: Over the study period (2006 to 2010, season I; 2013-2015, season II) the DL usage rate dropped from 91.6% to 45.0% while the GVL usage rate increased from 8.4% to 55.4%. The FPS rate using DL also declined from 90.8% in 2007 to 75.5% in 2015. On the other hand, the FPS rate using GVL increased from 87.8% to 95.2%. With DL, all operators’ FPS rate declined by approximately 10% in season II compared to season I. The FPS rate with GVL was significantly higher in the providers of postgraduate year over 3 years (P=0.043). Multivariate logistic regression analysis revealed an adjusted odds ratio for GVL FPS of 0.799 during season I (P=0.274). However, the adjusted odds ratio for GVL FPS was 3.744 during season II (P<0.001). CONCLUSION: We found that the FPS rates of GVL have slightly increased but DL’s FPS rate has significantly decreased during the last ten years.
Adult ; Airway Management ; Emergencies* ; Emergency Service, Hospital* ; Hand ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes* ; Laryngoscopy ; Logistic Models ; Observational Study* ; Odds Ratio ; Registries ; Seasons
Adult ; Airway Management ; Emergencies* ; Emergency Service, Hospital* ; Hand ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes* ; Laryngoscopy ; Logistic Models ; Observational Study* ; Odds Ratio ; Registries ; Seasons
Country
Republic of Korea
Publisher
Korean Society of Emergency Medicine
ElectronicLinks
http://ceemjournal.org/Editor-in-chief
Adam J. Singer
office@ceemjournal.org
Abbreviation
Clin Exp Emerg Med
Vernacular Journal Title
ISSN
2383-4625
EISSN
2383-4625
Year Approved
2017
Current Indexing Status
Currently Indexed
Start Year
2014
Description
It launched in 2014, published quarterly on the last day of March, June, September, and December. This journal focuses on both basic and clinical research of emergency medicine including pathophysiology, epidemiology, diagnosis, prognosis, treatment, and simulation. It is the member journal of the Korean Society of Emergency Medicine.
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