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Background: The hypertensive crisis is characterized by poorly controlled hypertension, which can lead to unfavorable outcomes and high utilization. The purpose of this study was to examine the prevalence, clinical characteristics, and factors associated with hypertensive emergency. Material and Methods: This cross-sectional study collected data from the hospital information system that included patients greater than or equal to 18 years who were diagnosed with hypertensive crisis (blood pressure ≥180 and/or 120 mmHg) and receiving care from the primary care unit and emergency department from 2020 to 2022. The prevalence and clinical characteristics of these patients were examined. Multiple logistic regression analysis was used to analyze factors associated with hypertensive emergency. Results: Among 3329 patients with hypertension, 17.33% had a hypertensive crisis (16.64 vs. 0.69%, urgency and emergency types). Most patients were female (63.6%), with a median age of 66 years. Almost half the patients (42.2%) with hypertensive crisis presented without specific symptoms, and the most common presenting symptom was vertigo/dizziness (27.7%). The initial and after treatment blood pressures were 203/98 and 174/91 mmHg. In the hypertensive emergency, the most common end-organ damage was ischemic stroke (33.3%), hemorrhagic stroke (25%), and acute heart failure (20.8%). An oral angiotensin-converting enzyme (57.5%) was the most commonly administered medication. Multiple logistic regression was performed but did not reveal any statistically significant. Conclusion: Our result revealed a high prevalence of hypertensive crises; most were of hypertensive urgency. The most common presenting symptom was vertigo/dizziness. There was no factor significantly associated with the hypertensive emergency in this study. Further studies should explore the cause of the hypertensive crisis to improve care delivery to patients with hypertension.
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Objective: To compare the effectiveness of applying the back plate marking method vs the standard method, to a mechanical chest compression device, in regards to reducing the duration of chest compression interruptions during a simulated cardiac arrest. Methods: An experimental study, one group pretest posttest design, conducted in a university-based hospital from November 2020 to October 2021. The study recruited 20 participants including emergency medical residents and paramedics. The participants were randomized into three-person teams and applied the device in both standard and back plate marking methods in sequential order. Teams were required to use a mechanical chest compression device in a manikin-based OHCA simulation to assess performance. Results: The median time pause for the deployment of the upper part of the device was significantly reduced (16 vs 21s, P < 0.01) in the back plate marking method, as was the total pause for device deployment (31.5 vs 38.75s, P = 0.03) and the proportion of total hands-off time attributable to device application interruption (43.08% vs 49.18%, P = 0.02). There was no difference between groups in the duration of all compression interruptions (70.5 vs 82.75s, P = 0.20) and compression fractions (77.85 vs 76.91%, P = 0.19). Conclusion: The back plate marking method was a significantly reduced time of the deployment of the upper part of the device and in regards to the overall pause for device deployment, but there was no difference in CPR quality between the two methods.
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OBJECTIVE: We aimed to identify factors associated with treatment failure in patients with acute exacerbation of COPD (AECOPD) admitted to the emergency department observation unit (EDOU). METHODS: A retrospective cohort study was conducted between January 1, 2013, and October 31, 2019. The electronic medical records were reviewed of patients with AECOPD admitted to the EDOU. The patients were divided into treatment failure and treatment success groups. Treatment failure was defined as prolonged stay at the EDOU (>48 h) or COPD-related ED revisit (within 72 h) or readmission within 1 month. The two groups were compared and analyzed using univariable and multivariable analyses by logistic regression. RESULTS: Of the 220 patients enrolled, 82 (37.3%) developed treatment failure. Factors associated with treatment failure included arrhythmias (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.04-13.9), diabetic mellitus (OR 2.32, 95% CI 1.09-4.95), long-term oxygen therapy (OR 2.89, 95% CI 1.08-7.72), short-acting beta-agonist use (OR 6.06, 95% CI 1.98-18.62), pneumonia findings on chest X-ray (OR 3.24, 95% CI 1.06-9.95), and ED length of stay less than 4 h (OR 2, 95% CI 1.08-3.73). CONCLUSION: Arrhythmias, diabetic mellitus, long-term oxygen therapy, short-acting beta-agonist use, pneumonia findings on chest X-ray, and ED length of stay <4 h were the significant factors associated with treatment failure of AECOPD to which physicians at the ED should pay special attention before the admission of patients to the EDOU.