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Case Report
Neurology
Abducens paralysis—a rare complication of spinal anesthesia at an emergency department: a case report
Mustafa Korkut, Cihan Bedel
Received December 4, 2021  Accepted January 28, 2022  Published online July 5, 2022  
DOI: https://doi.org/10.4266/acc.2021.01697    [Epub ahead of print]
  • 3,239 View
  • 53 Download
  • 1 Crossref
AbstractAbstract PDF
The sixth cranial nerve (CN VI) is a rare site of complication associated with spinal anesthesia and can produce secondary symptoms of ocular muscle palsy. A 38-year-old man was admitted to the emergency department with complaint of diplopia and limited lateral gaze in the first week after endoscopic urological surgery under spinal anesthesia. Isolated unilateral CN VI palsy was considered after excluding differential diagnoses. Ocular palsy and diplopia regressed with conservative treatment during follow-up, and the patient was discharged. This article aims to show that CN VI palsy is a rare complication of spinal anesthesia, which can be observed in the emergency department.

Citations

Citations to this article as recorded by  
  • Cranial Nerve Six Palsy After Vaginal Delivery with Epidural Anesthesia: A Case Report
    Jennifer Olivarez, Scott Gutovitz, Caylyne Arnold
    The Journal of Emergency Medicine.2024; 66(3): e338.     CrossRef
Original Article
Infection
Incidence and risk factors associated with early death in patients with emergency department septic shock
Matthew S. Reaven, Nigel L. Rozario, Maggie S. J. McCarter, Alan C. Heffner
Acute Crit Care. 2022;37(2):193-201.   Published online February 11, 2022
DOI: https://doi.org/10.4266/acc.2021.00857
  • 4,706 View
  • 269 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract PDF
Background
Limited research has explored early mortality among patients presenting with septic shock. The objective of this study was to determine the incidence and factors associated with early death following emergency department (ED) presentation of septic shock.
Methods
A prospective registry of patients enrolled in an ED septic shock clinical pathway was used to identify patients. Patients were compared across demographic, comorbid, clinical, and treatment variables by death within 72 hours of ED presentation.
Results
Among the sample of 2,414 patients, overall hospital mortality was 20.6%. Among patients who died in the hospital, mean and median time from ED presentation to death were 4.96 days and 2.28 days, respectively. Death at 24, 48, and 72 hours occurred in 5.5%, 9.5%, and 11.5% of patients, respectively. Multivariate regression analysis demonstrated that the following factors were independently associated with early mortality: age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.03–1.05), malignancy (OR, 1.53; 95% CI, 1.11–2.11), pneumonia (OR, 1.39; 95% CI, 1.02–1.88), urinary tract infection (OR, 0.63; 95% CI, 0.44–0.89), first shock index (OR, 1.85; 95% CI, 1.27–2.70), early vasopressor use (OR, 2.16; 95% CI, 1.60–2.92), initial international normalized ratio (OR, 1.14; 95% CI, 1.07–1.27), initial albumin (OR, 0.55; 95% CI, 0.44–0.69), and first serum lactate (OR, 1.21; 95% CI, 1.16–1.26).
Conclusions
Adult septic shock patients experience a high rate of early mortality within 72 hours of ED arrival. Recognizable clinical factors may aid the identification of patients at risk of early death.

Citations

Citations to this article as recorded by  
  • Early Prediction of Mortality for Septic Patients Visiting Emergency Room Based on Explainable Machine Learning: A Real-World Multicenter Study
    Sang Won Park, Na Young Yeo, Seonguk Kang, Taejun Ha, Tae-Hoon Kim, DooHee Lee, Dowon Kim, Seheon Choi, Minkyu Kim, DongHoon Lee, DoHyeon Kim, Woo Jin Kim, Seung-Joon Lee, Yeon-Jeong Heo, Da Hye Moon, Seon-Sook Han, Yoon Kim, Hyun-Soo Choi, Dong Kyu Oh, S
    Journal of Korean Medical Science.2024;[Epub]     CrossRef
  • Predicting sepsis at emergency department triage: Implementing clinical and laboratory markers within the first nursing assessment to enhance diagnostic accuracy
    Ugo Giulio Sisto, Stefano Di Bella, Elisa Porta, Giorgia Franzoi, Franco Cominotto, Elena Guzzardi, Nicola Artusi, Caterina Anna Giudice, Eugenia Dal Bo, Nicholas Collot, Francesca Sirianni, Savino Russo, Gianfranco Sanson
    Journal of Nursing Scholarship.2024;[Epub]     CrossRef
  • Red cell distribution width and in‐hospital mortality in septic shock: A public database research
    Qiong Ding, Yingjie Su, Changluo Li, Ning Ding
    International Journal of Laboratory Hematology.2022; 44(5): 861.     CrossRef
Review Article
CPR/Resuscitation
Critical emergency medicine and the resuscitative care unit
Maria Mermiri, Georgios Mavrovounis, Dimitrios Chatzis, Ioannis Mpoutsikos, Aristea Tsaroucha, Maria Dova, Zacharoula Angelopoulou, Dimitrios Ragias, Athanasios Chalkias, Ioannis Pantazopoulos
Acute Crit Care. 2021;36(1):22-28.   Published online January 28, 2021
DOI: https://doi.org/10.4266/acc.2020.00521
  • 7,633 View
  • 278 Download
  • 9 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Critical emergency medicine is the medical field concerned with management of critically ill patients in the emergency department (ED). Increased ED stay due to intensive care unit (ICU) overcrowding has a negative impact on patient care and outcome. It has been proposed that implementation of critical care services in the ED can negate this effect. Two main Critical Emergency Medicine models have been proposed, the “resource intensivist” and “ED-ICU” models. The resource intensivist model is based on constant presence of an intensivist in the traditional ED setting, while the ED-ICU model encompasses the notion of a separate ED-based unit, with monitoring and therapeutic capabilities similar to those of an ICU. Critical emergency medicine has the potential to improve patient care and outcome; however, establishment of evidence-based protocols and a multidisciplinary approach in patient management are of major importance.

Citations

Citations to this article as recorded by  
  • Inhaled anaesthetic gas for severe bronchospasm at the emergency department
    Osman Adi, Farah Nuradhwa Apoo, Chan Pei Fong, Azma Haryaty Ahmad, Nurul Liana Roslan, Faheem Ahmed Khan, Shahridan Fathil
    The American Journal of Emergency Medicine.2024; 75: 179.     CrossRef
  • Patients’ Expectations in Emergency Department at King Abdulaziz University Hospital: A Cross-Sectional Survey-Based Study
    Ahmad H Bakhribah, Ghaida A. Eissa, Dania W Alsulami, Marah A Alotaibi, Htoun M Abdulmannan, Imad M Khojah
    Cureus.2024;[Epub]     CrossRef
  • CRP/Albumin Ratio and NLR in Recognizing Critically Ill Patients
    Abuzer Özkan
    Eurasian Journal of Critical Care.2024; 6(1): 38.     CrossRef
  • Rearranging the furniture: A blueprint for reappropriating fixed resources to create an emergency department resuscitative care unit
    Angela Barskaya, Liliya Abrukin, Christopher McStay
    Journal of the American College of Emergency Physicians Open.2024;[Epub]     CrossRef
  • The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study
    Ahmed Faidh Ramzee, Ayman El-Menyar, Mohammad Asim, Ahad Kanbar, Khalid Ahmed, Bahaa Daoud, Saji Mathradikkal, Ahmad Kloub, Hassan Al-Thani, Sandro Rizoli
    World Journal of Emergency Medicine.2023; 14(2): 96.     CrossRef
  • Value of Intensive Nursing Detail Management in Intensive Care Unit Nursing
    Yansong Li, Lehong Zhou, Qin Wei, Zhaoqi Dong
    Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1.     CrossRef
  • Effect of Early Low-Calorie Enteral Nutrition Support in Critically Ill Patients: A Systematic Review and Meta-analysis
    Qidong Jiang, Tao Xu, Dinesh Rokaya
    BioMed Research International.2022; 2022: 1.     CrossRef
  • Is the Critical Care Resuscitation Unit Sustainable: A 5-Year Experience of a Beneficial and Novel Model
    Elizabeth Powell, Iana Sahadzic, Daniel Najafali, Emilie Berman, Katie Andersen, Leenah Z. Afridi, Zoe Gasparotti, Erin Niles, Jeffrey Rea, Thomas Scalea, Daniel J. Haase, Quincy K. Tran, Edward A. Bittner
    Critical Care Research and Practice.2022; 2022: 1.     CrossRef
Original Articles
How to Decrease the Malposition Rate of Central Venous Catheterization: Real-Time Ultrasound-Guided Reposition
Hongjoon Ahn, Gundong Kim, Byulnimhee Cho, Wonjoon Jeong, Yeonho You, Seung Ryu, Jinwoong Lee, Seungwhan Kim, Insool Yoo, Yongchul Cho
Korean J Crit Care Med. 2013;28(4):280-286.
DOI: https://doi.org/10.4266/kjccm.2013.28.4.280
  • 2,858 View
  • 41 Download
  • 3 Crossref
AbstractAbstract PDF
BACKGROUND
The purpose of this retrospective and prospective study is to evaluate the efficiency of ultrasound (US) guidance as a method of decreasing the malposition rate of central venous catheterization (CVC) in the emergency department (ED).
METHODS
We retrospectively enrolled 379 patients who underwent landmark-guided CVC (Group A) and prospectively enrolled 411 patients who underwent US-guided CVC (Group B) in the ED of a tertiary hospital. Malposition of the CVC tip is identified when the tip is not located in the superior vena cava (SVC). In Group B, we performed US-guided intravascular guide-wire repositioning and then confirmed the location of the CVC tip with chest radiography when the guide-wire was visible in any three other vessels rather than in the approached vessel. In the case of a guide-wire inserted into the right subclavian vein (SCV), the left SCV and both internal jugular veins (IJV) were referred to as the three other vessels. The two subject groups were compared in terms of the malposition rate using Fisher's exact test (significance = p < 0.05).
RESULTS
There were 38 malposition cases out of a total of 790 CVCs. The malposition rates of Groups A and B were 5.5% (21) and 4.1% (17), respectively, and no statistically significant difference in malposition rate between the two groups was found. In Group B, the malposition rate was decreased from 4.1% (17) to 1.2% (5) after the guide-wire was repositioned with US guidance, which led to a statistically significant difference in malposition rate (p < 0.01).
CONCLUSIONS
The authors concluded that repositioning the guide-wire with US guidance increased correct placement of central venous catheters toward the SVC.

Citations

Citations to this article as recorded by  
  • Safety and Feasibility of Ultrasound-guided Peripherally Inserted Central Catheterization for Chemo-Delivery
    Tak-Joong Song, Shin-Seok Yang, Woo-Sung Yoon
    Journal of Surgical Ultrasound.2019; 6(1): 14.     CrossRef
  • Single Center Experience of Ultrasonography-guided Bedside Procedures for Surgical Patients
    Dooreh Kim, Dae Hyun Cho, Yun Tae Jung, Jae Gil Lee
    Journal of Surgical Ultrasound.2018; 5(2): 61.     CrossRef
  • Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter
    Byeong jun Ahn, Sung Uk Cho, Won Joon Jeong, Yeon Ho You, Seung Ryu, Jin Woong Lee, In Sool Yoo, Yong chul Cho
    The Korean Journal of Critical Care Medicine.2015; 30(4): 280.     CrossRef
Analysis of Prognostic Factors Early in Emergency Department (ED) and Late in Intensive Care Unit (ICU) of the Critically Ill Patients Admitted in the ICU via ED
Ru Bi Jeong, Jung Hwan An, Hyun Min Jun, Sung Min Jeong, Tae Yong Shin, Young Sik Kim, Young Rock Ha
Korean J Crit Care Med. 2012;27(4):237-248.
DOI: https://doi.org/10.4266/kjccm.2012.27.4.237
  • 2,492 View
  • 18 Download
AbstractAbstract PDF
BACKGROUND
Many critically ill patients in the ED are hospitalized to the ICU, but most prognosis predicting systems have been developed based on the physiochemical variables of the critically ill in the ICU. The objective of this study is to identify prognostic predictors early in the ED when compared with well-known predictors in the ICU and estimate their predictive abilities.
METHODS
An observational prospective study was performed in an urban ED. Information of all the critically ill patients admitted to the ICU via the ED including vital signs, laboratory results, and physiochemical scoring systems were checked during 6 months and divided into the early stage for the ED and the late stage in the ICU. Poor outcome was defined as 28-days mortality. After checking for significant predictors among them through univariate analysis, we identified the most discriminating predictors in each stage using logistic regression and a decision tree analysis.
RESULTS
A total of 246 patients were enrolled. In univariate analysis, the significant predictors including central venous pressure, fraction of inspired oxygen (FiO2), pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2), albumin, mortality in emergency department sepsis, acute physiology and chronic health evaluation II, simplified acute physiology score II, and sequential organ failure assessment scores were identified in the early stage, while PaO2/FiO2, base excess, unmeasured anion, albumin, anion gap, albumin-corrected anion gap, APACHEII, SAPSII, SOFA, and rapid emergency medicine score were identified in the late stage. Through a decision tree analysis, PaO2/FiO2 and SAPSII were revealed as the most discriminating predictors in the ED and ICU, respectively.
CONCLUSIONS
The prognosis discriminating predictor in critical patients was different between the ED and ICU. Emergency physicians should pay more attention to the critical patients having low PaO2/FiO2.
The Effect of Emergency Department Treatment Time on Outcomes in Acute Stroke Patients
Dong Wook Lee, Eui Chung Kim, Ok Jun Kim, Sung Wook Choi, Young Tae Park, Yun Kyung Cho
Korean J Crit Care Med. 2010;25(2):76-82.
DOI: https://doi.org/10.4266/kjccm.2010.25.2.76
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AbstractAbstract PDF
BACKGROUND
Stroke is a disease that leads to a long period of disability and death. Accordingly, the initial treatment is so influential on the prognosis of a patient that shortening the time to initial treatment after hospital admission has a very important role in the entire treatment regimen. This study aimed to demonstrate the effect of the Emergency Department treatment time at Bundang CHA Hospital for acute stroke patients to improve the treatment regimen through six sigma activities.
METHODS
The outcomes for 246 patients with suspected acute strokes who were admitted to the Emergency Department of Bundang CHA Hospital, the flow of the emergency department process divided into 11 phases, and the duration of each phase were determined. Patients were classified as before and after six sigma activities and compared.
RESULTS
The five phases statistically demonstrated the effect of meaningful improvement in the duration of visit-receiving CT prescriptions, visit-receiving lab prescriptions, consult request-arriving to the emergency department, visit-CT angiography results, and visit-the issue of hospital admissions. In the next 2 phases, the sigma level also improved by 0.71sigma and 0.06sigma. However, the total emergency department stay time was not statistically meaningful. The time required time was increased and the sigma level was decreased by 0.19sigma.
CONCLUSIONS
The result of six sigma activities showed the effect of the treatment system improvement with a partial decrease in the duration of each phase, but the total emergency department stay time was not improved owing to environmental factors. For better results, continuous improvement of the treatment system and expansion of hospital facilities will be required.

ACC : Acute and Critical Care