Thai Journal of Emergency Medicine

Star Fruits (Averrhoa carambola); Persistent Hiccups and Severe Metabolic Acidosis in An End-Stage Renal Disease Patient

2024-01-25T21:10:30+07:00

We encountered a man in his 70’s with end-stage renal disease (ESRD) who experienced a persistent hiccup. The hiccup was unresponsive to various standard medications, including metoclopramide, chlorpromazine, baclofen, and phenytoin. The patient developed dyspnea due to severe lactic acidosis 7 hours later. After ruling out possible causes of the persistent hiccups and lactic acidosis, a toxicologist discovered that the patient had taken four star fruits 4 hours before the onset of the symptoms.

Accuracy of Recognition of Out of Hospital Cardiac Arrest by Narenthorn Emergency Medical service Center’s Call Handlers

2023-12-04T12:25:31+07:00

Introduction Sudden cardiac arrest is an emergency medical condition requiring immediate resuscitation. Early recognition of cardiac arrest and proper resuscitation are important factors to increase survival rate of OHCA

Objectives To evaluate accuracy of recognition of OHCA in unconscious patients and factors that associate with recognition of OHCA patients by Narenthorn Emergency Medical dispatcher center

Method This retrospective, diagnostic study includes 453 unconscious patients who were reported to Narenthorn Emergency Medical service Center and treated by emergency medical personnel in Bangkok from 1/1/2018 – 31/12/2021. Data was analysed to identify accuracy of recognition of OHCA by kappa coefficient and factors associated diagnosis of OHCA patients by multiple logistic regression analysis.

Results Accuracy between pre-arrival recognition of OHCA and actual OHCA is substantial with kappa coefficient 0.74 (95%CI: 0.674 - 0.806). Patients who were unconscious and apnea have greater risk of actual OHCA with adjusted odd ratio of 0.21 (95%CI: 0.09 - 0.50, p-value < 0.001) compared to patients who were only unconscious with no other symptoms.

Conclusion Accuracy of recognition of unconsciousness and OHCA is substantial. Reports of ‘unsciousness and apnea’ and, ‘unconsciousness’ were highly diagnosed OHCA.

A Comparison Study of Acute Stroke Prognostication between Full Outline of UnResponsiveness Score Coma Scale, Glasgow Coma Scale and Glasgow Coma Scale-Pupils Score in Emergency Department, Siriraj Hospital

2024-03-27T15:42:29+07:00

Introduction The consciousness scoring systems are good predictors for defining mortality in acute stroke. However, there is no study comparing between Full Outline of UnResponsiveness (FOUR), Glasgow Coma Scale (GCS), and Glasgow Coma Scale-Pupils (GCS-P) score.

Objectives To compare the accuracy of FOUR, GCS-P, and GCS scores for predicting in-hospital mortality. The other objectives are the prognostication of these scores for 30-day and 90-day mortality and poor neurological outcome.

Method The prospective cohort study was conducted in the emergency department of Siriraj Hospital, between August 2019 and October 2020. Acute stroke patients were evaluated by the scoring systems before definitive treatment. The telephone interview was done at 30 and 90 days after onset of acute stroke.

Results From 315 participants, 33 (10.47%) were died in the hospital. The best scoring system for predicting in-hospital mortality was the GCS-P score with the area under the curve (AUC) 0.932 (95% CI 0.885-0.976). The AUC of GCS and FOUR scores were 0.930 and 0.895 respectively. GCS-P score was also the best coma score for predicting the 30 and 90-day mortality (AUC of 0.913 and 0.891). Although there was a poor relationship between the Modified Rankin Scale, Cerebral Performance Score, and coma scoring systems, the patients with low GCS-P, GCS, or FOUR scores tended to have poor neurological outcomes.

Conclusion GCS-P score is the best prognostication for in-hospital, 30-day, and 90-day mortality in acute stroke patients in the emergency department.

Comparison of Returning of Spontaneous Circulation between Mechanical Ventilation and Manual Ventilation among Patients with Cardiac Arrest

2024-04-03T17:21:44+07:00

Backgrounds During the coronavirus outbreak situation, cardiopulmonary resuscitation (CPR) has the potential to cause the spread of the coronavirus from the distribution of droplets, secretions from the mouth and nose of the patient. We recommended to reduce the diffusion of aerosols, secretions from the mouth and nose of patients by using a mechanical ventilator after intubation instead of manual ventilation.

Objectives This research aimed to determine the difference in resuscitation outcomes, vital signs, and post-resuscitation laboratory results in cardiac arrest patients receiving mechanical ventilation compared to those receiving manual ventilation.

Methods The study period was from 2019-2022. We studied 106 patients who were ventilated by mechanical ventilation during the coronavirus outbreak (ventilator setup FiO 2 1.0, respiratory rate 10 bpm, low tidal volume) compared to a group of 96 patients receiving manual ventilation.

Results The researchers conducted an analysis by dividing patients into two groups : cardiac arrest patients who were ventilated by mechanical ventilation and those who were ventilated by manual ventilation. We found that the median CPR duration (30.00±10.812 minute, 30.00±11.600 minute, P value 0.458), systolic blood pressure (0.00±52.867 mmHg, 0.00±57.780 mmHg, P value 0.332), diastolic blood pressure (0.00±30.981mmHg, 0.00±36.219mmHg, P value 0.293), heart rate (0.00±56.079 beat/minute, 0.00±54.772 beat/ minute, P value 0.806), O 2 saturation (0.00±46.941%, 0.00±54.772%, P value 0.806) were no statistical significant difference, and venous blood gas results PvO 2 (34.00±60.29mmHg, 23.00±16.971mmHg, P value 0.319), PvCO 2 (7.810±3.272mmHg, 4.930±9.617mmHg, P value 0.076), lactate (6.760±5.738mmol/L, 5.095±0.784mmol/L, P value 0.884) were no statistical significant difference. But the researchers found that venous blood gas pH (6.914±0.231, 7.210±0.069, P value 0.047) were statistical significant different. There was no difference in the results of resuscitation including return of spontaneous circulation (ROSC) odds ratio(OR) 1.262(95%CI 0.709-2.247, P value = 0.429) and use of blood pressure stimulating drugs OR 0.870(95%CI 0.456- 1.660, P value = 0.672).

Conclusions Return of spontaneous circulation, there was no difference between patients receiving mechanical ventilation and manual ventilation.

Comparison of the treatment outcomes between Hour – 1 Bundle and usual care among septic shock patients at Emergency Room, Rajavithi hospital

2024-04-03T17:07:55+07:00

Background Sepsis and septic shock stand as a preeminent medical emergency, wherein prompt and accurate initial interventions within the critical early hours have demonstrated potential for enhancing patient outcomes. The Hour-1 Bundle has garnered endorsement within the recent iteration of the Surviving Sepsis Campaign. However, no statistical evidence regarding the mortality rate of patients when using Hour-1 Bundle for treating sepsis.

Objectives A comparative analysis of 28-day mortality among patients diagnosed with septic shock admitted to the emergency department of Rajavithi hospital: A study of the Hour-1 Bundle care versus usual care cohorts.

Methods A retrospective observational cohort study of septic patients from January to December 2018 for usual care, and from January to December 2022 for patients managed in accordance with the Hour-1 bundle protocol.

Results Enroll 300 patients who diagnosed sepsis shock categorized into two distinct groups: the Hour-1 bundle group (N=149) and the usual care group (N=151). The 28-day mortality is 97 out of 151 patients (64.23%) within the usual care group, and 70 out of 149 patients (46.62%) within the Hour-1 bundle group (P=0.003; OR 2.03; 95%CI 1.28 – 3.22). An expeditious resolution of shock within the initial hour of admission was notable in the Hour-1 bundle group with 119 out of 149 patients (79.86%) in contrast, the usual care group saw 25 out of 151 patients (16.56%) achieving such prompt resolution (P<0.001 ; OR 19.99 ; 95%CI 11.11 – 35.95).

Conclusion The implementation of the Hour-1 bundle protocol in septic shock patients demonstrated a discernible enhancement in the rates of 28-day mortality as well as success shock resuscitation within the initial hour.