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.
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
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
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
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
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
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.2023;[Epub] 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
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
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.
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.