Wookjin Choi, Young Soon Cho, Young Rock Ha, Je Hyeok Oh, Heekyung Lee, Bo Seung Kang, Yong Won Kim, Chan Young Koh, Ji Han Lee, Euigi Jung, Youdong Sohn, Han Bit Kim, Su Jin Kim, Hohyun Kim, Dongbum Suh, Dong Hyun Lee, Ju Young Hong, Won Woong Lee, on behalf of the Society Emergency and Critical Care Imaging (SECCI)
Clin Exp Emerg Med 2023;10(4):363-381. Published online December 29, 2023
Point-of-care ultrasound (POCUS) is a rapidly developing technology that has the potential to revolutionize emergency and critical care medicine. The use of POCUS can improve patient care by providing real-time clinical information. However, appropriate usage and proper training are crucial to ensure patient safety and reliability. This article discusses the various applications of POCUS in emergency and critical care medicine, the importance of training and education, and the future of POCUS in medicine.
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Objective Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ.
Methods This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis.
Results Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746–9.240).
Conclusion Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.
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Objective The efficacy of previously developed respiratory barrier enclosures to limit healthcare workers’ exposure to aerosols from COVID-19 patients remains unclear; in addition, the design of these devices is unsuitable for transportation or other emergency procedures. Therefore, we developed a novel negative pressure respiratory isolator to improve protection from patient-generated aerosols and evaluated its protective effect in conversion to systemic isolator. Methods This in vitro study simulated droplets by nebulizing 1% glycerol + 99% ethanol solution. We performed cardiopulmonary resuscitation (CPR) and converted a respiratory barrier enclosure into a systemic isolator with a respiratory barrier as well as a respiratory barrier with negative pressure generator (NPG), which were compared with control and room air. During the procedure, particles were counted for 30 seconds and the count was repeated 10 times. Results During CPR, the total number of particles in the respiratory barrier with NPG (280,529; interquartile range [IQR], 205,263–359,195; P=0.970) was similar to that in the control (308,789; IQR, 175,056–473,276). Using NPG with a respiratory barrier reduced the number of particles to 27,524 (IQR, 26,703– 28,905; P=0.001). Particle number during conversion of the respiratory barrier into a systemic isolator was also lower than in the control (25,845; IQR, 19,391– 29,772; P=0.001). Conclusion The novel isolator was converted to a systemic isolator without air leakage. The aerosol-blocking effect of the isolator was quantified using a particle counter during CPR. Further studies comparing the barrier effect of isolators within various pressure differentials are warranted.
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Objective This study aimed to introduce a novel negative pressure aerosol box (Carrycure Isolator) and to test its efficiency and limitations, with the hope of suggesting improvements and further directions.
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Results The median times to intubation of trials A, B, and C were 30.5 (interquartile range [IQR], 28.0–40.0 seconds), 59.0 (IQR, 50.0–75.5 seconds), and 34.0 seconds (IQR, 30.5–47.0 seconds), respectively. Post hoc analysis showed that the time to intubation in trial B was significantly longer than that in trial A (P<0.05), while that the time to intubation in trial C was significantly shorter than that in trial B (P<0.05). Results concerning secondary endpoints showed similar patterns. Participants reported performing intubation with Carrycure Isolator to be relatively difficult, necessitating significant arm movement and view restrictions while increasing their time to intubation.
Conclusion Physicians took a longer time to intubate a manikin using the Carrycure Isolator, a novel negative pressure aerosol box. However, the time was improved after a period of familiarization.
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