Journal of Critical Care & Emergency Medicine
Editor-in-Chief Maimaiti Yisireyili Assistant Professor Department of Cardiology Nagoya University Graduate School of Medicine Nagoya, Japan ORCID: 0000-0002-9313-7107 Journal of Critical Care & Emergency Medicine is an international, peer-reviewed, open-access journal published by SRC Publishers. The journal provides a platform for physicians, researchers, academicians, healthcare professionals, and emergency care specialists to share high-quality research and clinical advancements in Critical Care and Emergency Medicine. Call for Papers: Special Issue on Emerging Technologies in Emergency and Intensive Care Medicine The journal promotes the dissemination of scientific and clinical knowledge across emergency care, intensive care, acute medicine, trauma, resuscitation, and related specialties. You can submit your articles through online https://srcpublishers.com/critical-care-emergency-medicine/user/register (or) can send through an e-mail with attachment for: emergencymedicine@onlinescientificresearch.info 0.5 Impact Factor 84.5% Citations 90% Acceptance
Lifelong Health Education within the Framework of Medicine for Years
I want to begin with a broad overview, moving from the general to the specific. My reflections concern the condition of today’s world, our societies, families, educational systems, the mental health of younger generations, and the growing social challenges we all face. Everything I discuss concerns every one of us, including children and young people.
Copyright (c) 2026 Journal of Critical Care & Emergency Medicine
Community-Based Metabolic Prevention and Health Education: A Conceptual Framework Integrating Digital Wellness Platforms with Lessons from Blue Zone Longevity Populations
Metabolic disorders, including obesity, type 2 diabetes mellitus, hypertension, cardiovascular disease, and chronic low-grade inflammation, remain leading contributors to global morbidity, mortality, and healthcare expenditure. Although substantial evidence supports lifestyle-based prevention, many healthcare systems remain predominantly reactive rather than prevention-oriented. This manuscript presents a conceptual framework integrating digital wellness platforms with behavioural and environmental patterns described in longevity-associated populations commonly referred to as Blue Zones. Blue Zone regions—including Okinawa (Japan), Sardinia (Italy), Ikaria (Greece), Nicoya Peninsula (Costa Rica), and Loma Linda (California, USA)—have been associated with favourable aging outcomes and lower chronic disease burden. Commonly reported patterns include routine physical activity, predominantly plant-forward dietary intake, strong social cohesion, stress-mitigating rituals, and purpose-driven living. While these findings are largely observational and subject to methodological limitations, they align with established evidence in lifestyle medicine and behavioural epidemiology. Digital wellness platforms may offer scalable mechanisms to reinforce preventive behaviours through self-monitoring, education, feedback loops, social accountability, and sustained engagement. Prysm io is discussed as an example of a digital wellness engagement platform that may operationalize these principles at the individual and community level. However, prospective controlled studies are required to determine effectiveness in improving metabolic and behavioural outcomes.
Metabolic Prevention, Digital Health, Lifestyle Medicine, Blue Zones, Chronic Disease Prevention, Community Health, Behaviour Change
The Pink Curtain: Rapid Identification of Retinal Detachment Using Point-of-Care Ultrasound
A 76-year-old male with known history of hypertension patient presented to the ED with 5 days of new floaters in the right eye followed by sudden visual loss on the day of presentation. He described a “pink curtain” with greenish edges obscuring about 75% of his right visual field. There was no eye pain, redness, discharge, headache, or systemic symptoms. His history was notable for a retinal detachment repair in the other eye 20 years earlier. On exam, right eye visual acuity was markedly reduced (≈6/30) versus 6/6 in the left eye. Pupils were equal and reactive, with no afferent pupillary defect. Extraocular movements were full and there were no external signs of inflammation or infection.
Assessment of Heavy Metals in Shallow Aquifer Boreholes and Possible Links to Chronic Kidney Disease (CKD) In Maiduguri and Environs, Borno State, Nigeria
Groundwater contamination by heavy metals is a global environmental and public health concern. In Maiduguri and environs, northeastern Nigeria, groundwater from the shallow unconfined aquifer is the principal source of drinking water and is highly vulnerable to pollution due to poor sanitation and waste disposal practices in the area. This study assessed heavy metal concentrations in groundwater from 300 shallow aquifer boreholes to evaluate potential health risks, particularly in relation to Chronic Kidney Disease (CKD). Water samples were collected during a 2022 field campaign and analysed for Mercury (Hg), Copper (Cu), Arsenic (As), Cadmium (Cd), Lead (Pb), and Chromium (Cr) using Atomic Absorption Spectrophotometry (AAS, Buck Scientific 210 VGP) following APHA standard methods. Results show that Hg concentrations were below both World Health Organization (WHO) and Nigerian Standards for Drinking Water Quality (NSDWQ) guideline values in all the borehole samples. Cu concentrations exceeded the WHO and NSDWQ in only one borehole sample. Thus, the level of Hg and Cu concentrations in the borehole samples do not appear to pose health concern. However, the concentrations of As, Cd, Pb and Cr in the borehole samples show variable percentages above the WHO/NSDWQ guideline from As-18%; Cd-23%; Pb-48%; and Cr-56%. These indicate significant health risks from exposure to these metals, because Pb and Cd are known nephrotoxicants, while As and Cr (particularly hexavalent chromium) have been reported to have links to kidney diseases. Therefore, consumption of water from these boreholes with elevated As, Cd, Pb and Cr may contribute to long-term adverse health outcomes, including increased CKD risk. Mitigation measures may include: implementing appropriate water treatment technologies on the affected boreholes; use of alternative treated surface water; and drilling to deeper aquifers free from these contaminants. In addition, there is the need to strengthen waste management practices, continuous groundwater monitoring and public education campaigns, which can reduce exposure to these risks and safeguard community health.
Maiduguri, Chad Basin, Shallow Aquifer, Heavy Metals, Groundwater, Risk
Gamified Simulation in Medical Education: Do Escape Room–Based Interventions Improve Clinical Decision-Making UnderTime Pressure and Cognitive Load? A Systematic Review
Background: Escape room–based simulation has emerged as an innovative approach in medical education, integrating gamification, time pressure, and collaborative problem-solving. While its effects on engagement and teamwork are increasingly recognized, its influence on clinical decision-making under cognitive load remains unclear. Objective: To systematically evaluate the impact of escape room–based simulation on clinical decision-making, cognitive load, and educational outcomes in medical training. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were searched for studies published between 2018 and 2025 examining escape room–based interventions in medical education. Eligible studies included undergraduate and postgraduate learners. Due to heterogeneity in study designs and outcome measures, a structured narrative synthesis was performed. Outcomes were categorized into cognitive, affective, and behavioral domains. Results: Twenty-six studies met inclusion criteria. Escape room–based learning was consistently associated with high levels of engagement, motivation, and learner satisfaction. Improvements in teamwork, communication, and collaborative problem-solving were frequently reported. Gains in knowledge acquisition were observed across several disciplines; however, direct assessment of clinical reasoning and decision-making under pressure was limited. Few studies evaluated cognitive load using validated measures, and most relied on descriptive or quasi-experimental designs. Conclusions: Escape room–based simulation represents a promising educational strategy that enhances engagement and team-based competencies. However, its impact on higher-order cognitive processes, particularly decision-making under pressure and cognitive load, remains insufficiently defined. Future research should prioritize rigorous study designs and the integration of objective, theory-informed assessment tools to better elucidate its role in medical training.
Student Perceptions in Psychiatric Nursing: A Before and After Qualitative Study
Introduction: Negative perceptions and stereotypes of patients suffering from mental health disorders can have a significant impact on the quality of care that they receive. By eliminating these ill-conceived rhetorics, undergraduate nursing students can focus on providing safe, empathetic, and competent care. AIM/Question: The goal of this qualitative study was to determine what perceptions sophomore undergraduate nursing students had towards psychiatric nursing before their psychiatric nursing course rotation, compared to after their course completion, using a 3-question open-ended pre- and post-survey. Method: An open-ended 3-question pre- and post-survey was used for this study. Forty-five students participated. A thematic analysis was conducted after all pre- and post-submissions were collected. Results: The pre-course survey revealed some negative perceptions towards psychiatric patients. The post-survey indicated that negative perceptions following didactic and clinical learning had been mostly eradicated, but they are still present within the clinical atmosphere. Discussion: The findings of this research indicate that bias does exist and continues to exist within the healthcare field. Eradicating these perceptions will help healthcare professionals empathize with patients and, therefore, provide more effective care. Limitations: This study involved a small sample group and therefore does not represent the entire nursing student body. Implications: This study’s findings focused on the perceptions of nursing students before and after didactic and clinical psychiatric course completion, as identified through comparisons between pre- and post-course surveys.
Why we Should use the Neuromuscular Blockers in Critical Care?!
Certain disease states may produce an up-regulation in acetylcholine skeletal muscle receptors, leading to higherthan-normal doses of the NMBA (e.g., musclet rauma, muscle atrophy, burns).
Kidney Replacement Therapy in a Shocked Brain: CRRT or IHD: Who’s the Real Brain-Saver in the Dialysis Arena?
Acute brain injury disrupts the Blood-Brain Barrier (BBB), impairs autoregulation, and leads to cerebral oedema and Increased Intracranial Pressure (ICP). ABI can be Traumatic (TBI, SAH) or Non-Traumatic (AIS, ICH), and studies show that up to 89% of these patients develop dysfunction in at least one non-neurological organ—most notably the kidneys
Assessment of Adapted Clavien-Dindo Classification (ACDiT) as aTool for Reporting and Grading Negative Outcomes in Acute CareSurgical Patients: A Prospective Study at a Tertiary Care Centre
Background: Acute care surgery (ACS) encompasses emergency general surgery, trauma, surgical rescue, and critical care, all of which carry significant risk of complications. Mortality rates have declined with modern resuscitation and damage-control strategies, making non-fatal complications more meaningful outcome measures. The traditional Clavien-Dindo classification (CDC) has limitations in ACS, especially in non-operative management. The Adapted Clavien-Dindo in Trauma (ACDiT) scale addresses these gaps by incorporating trauma-specific modifications. Aim: To assess the feasibility of using ACDiT for grading non-mortality complications across the spectrum of acute care surgical patients, and to evaluate its correlation with outcomes and critical care scoring systems. Methods: A prospective observational study was conducted in the Department of Traumatology and Surgery at a tertiary care hospital. All ACS patients admitted during the study period, both trauma and non-trauma, were included. Complications were graded using the ACDiT system. Outcomes measured included hospital stay, ICU stay, and correlation with critical care scores. Statistical analyses were performed to determine associations between ACDiT grade and patient outcomes. Ethical clearance was obtained. Results: A significant proportion of patients developed complications that could be systematically classified using ACDiT. Increasing ACDiT grades correlated with longer ICU stay, prolonged hospitalization, and adverse outcomes. The classification was applicable to both operative and non-operative cases, demonstrating feasibility in the heterogeneous ACS population. Higher complication grades were consistent with worse outcomes when compared with critical care scoring systems. Conclusion: ACDiT is a feasible and reliable tool for grading complications in acute care surgery. It provides a standardized framework applicable to trauma and non-trauma cases, allows meaningful comparison of outcomes, and complements critical care scoring systems. Adoption of ACDiT can improve reporting quality, facilitate benchmarking across centres, and enhance quality improvement initiatives.
The Health Benefits of Walking 200 Steps Every 2–3 Hours: A Simple Strategy to Prevent Cardiovascular, Renal, and MetabolicDisorders in the Workplace
Background: Prolonged sitting has been linked to numerous adverse health effects, particularly for individuals in sedentary work environments. This study aimed to explore the health benefits of incorporating walking breaks, specifically walking 200 steps every 2–3 hours, among employees engaged in prolonged sitting during office hours. The primary focus was on cardiovascular health, kidney function, metabolic improvements, and musculoskeletal flexibility. Methods: A total of 300 employees working from 08:00 to 16:00 in Parepare, Indonesia, participated in this study, which was conducted from January 2024 to December 2024. The participants were instructed to take walking breaks of 200 steps every 2–3 hours throughout their workday. Health outcomes were measured, including blood pressure, heart rate, serum creatinine, blood urea nitrogen (BUN), waist circumference, body mass index (BMI), fasting blood glucose, lower back pain, and urine output. Data were analyzed using paired t-tests, with a significance level set at p < 0.05. Results: The results showed significant improvements in multiple health indicators. Systolic blood pressure decreased by 10 mmHg (p = 0.03), and diastolic blood pressure reduced by 6 mmHg (p = 0.02). Heart rate and pulse pressure decreased by 6 beats per minute (p = 0.04) and 4 mmHg (p = 0.04), respectively. Kidney function improved as serum creatinine decreased by 0.2 mg/dL (p = 0.01), and BUN levels reduced by 3 mg/dL (p = 0.02). Urine output increased by 300 mL/day (p = 0.03). Additionally, waist circumference decreased by 6 cm (p = 0.04), BMI reduced by 2 kg/m² (p = 0.04), and fasting blood glucose decreased by 10 mg/dL (p = 0.03). Musculoskeletal health showed improvement, with lower back pain decreasing by 3 points on the Visual Analog Scale (VAS) (p = 0.01). Conclusion: This study demonstrated that walking breaks significantly contributed to improvements in cardiovascular health, kidney function, metabolic health, and musculoskeletal flexibility. The findings support the integration of short walking breaks into daily work routines as an effective strategy for enhancing employee well-being and mitigating the negative health effects of prolonged sitting. Future studies should explore the long-term effects and practical implementation strategies of walking breaks in various occupational settings.
Acute Compartment Syndrome is a rare but potentially devastating condition that demands immediate intervention. Failure to diagnose and manage compartment syndrome promptly is associated with long term disability and litigation. Ongoing research looks set to introduce new techniques for compartment pressure monitoring and both the diagnosis and treatment of the condition are now the subject of national guidelines. In writing this, clinical review, we performed a Pub Med and Med Line Search using the words Compartment Syndrome and cited key papers historical papers in the field.
Clinical Management Strategies for Lymphedema Secondary to Breast Cancer Treatment in Selected Hospitals in Western Region,Kenya
Background: Globally breast cancer remains the most diagnosed cancer with approximately 2.3 million cases in both sexes, about, 28% to 38% develop lymphedema following breast cancer treatment affecting one in five patients, when severe, Lymphedema significantly impact the person’s ability to perform tasks and without treatment the condition progresses to serious complications. In Sub-Saharan Africa reported comorbidities associated with lymphedema showed it is on the increase. Kenya has no data on the prevalence of lymphedema, although reports exist on different types of lymphedema treatment. In western Kenya, no studies have examined lymphedema. This study evaluated clinical management strategies for lymphedema secondary to breast cancer treatment in selected hospitals in the Western Region of Kenya. Material and Methods: This was a cross sectional analytic study. Simple random sampling was used to select health care facilities offering cancer screening and treatment. HealthCare providers were randomly selected from five health facilities depending on the number required at each health facility. 192 health care providers were selected to participate in the study. Data collection was by structured questionnaires, observation checklist and focus group discussion, analysed by SPSS version 23.1 and Qualitative data thematically analysed guided by questions on knowledge, skills and management strategies. Results: The results showed healthcare providers knowledge ranging from low to average with deficit in important areas of practice such as skincare (OR=0.56, p=0.01). stocking pressure (OR=1.841, P=0.004, positive stemmer’s sign test (OR=2.217, p=0.001) with over 50% getting incorrect answers. Good history and assessment Skills were demonstrated (0R=1.6;CI;1.0-24;P=0.037) but patient education was poorly done. Findings from focus group discussion showed deficit in knowledge by failure to clearly define lymphedema. Conclusion: Structured education of lymphedema is needed to increase the knowledge of healthcare providers and improving knowledge may fill the gaps in knowledge and demonstrate good practical skills in patient management.
The Relationship Between Knowledge and Attitudes of Reproductive-Age Women in Choosing Contraceptive Pills at the IndependentPractice of Midwife “WA” Sidakarya in 2024
Understanding the relationship between knowledge and attitudes is crucial for making informed and effective contraceptive decisions, preventing unplanned pregnancies, and complications resulting from inappropriate contraceptive use. This study aims to explore the relationship between knowledge and attitudes of reproductiveage women in selecting contraceptive pills at the Independent Practice of Midwife WA Sidakarya in 2024. The research employs a correlational analysis design with a cross-sectional approach to investigate this relationship. Primary data were collected through questionnaire responses from 51 participants. The study findings indicate varying levels of knowledge about contraceptive pills among women aged 20-24 years, with a significant 71% correlation
Impact of Supply Chain Management Practices on Surgical Outcomes at Mpilo Central Hospital
Background: Efficient Supply Chain Management (SCM) is critical for ensuring timely and safe surgical care, particularly in resource-constrained settings. This study investigated the impact of SCM practices, including inventory management, procurement efficiency, demand planning, and logistics and distribution, on surgical outcomes at Mpilo Central Hospital, Zimbabwe. Methods: A cross-sectional survey was conducted among 83 healthcare professionals, including surgeons, nurses, anesthetists, and inventory managers, achieving a 92% response rate. Data were analyzed using descriptive statistics, chi-square tests, ANOVA, and Partial Least Squares Structural Equation Modelling (PLS-SEM) to examine relationships between SCM practices and surgical outcomes. Reliability of the survey instrument was confirmed with a Cronbach’s alpha of 0.705. Results: Respondents reported significant challenges in SCM: 91% indicated that surgical delays were due to missing supplies, and 95% reported surgery cancellations resulting from supply shortages. Poor inventory management, procurement inefficiencies, inadequate demand planning, and ineffective logistics were all negatively associated with surgical outcomes. Chi-square analyses revealed significant associations between demographic variables (age, length of employment, and department) and perceptions of SCM impact. PLS-SEM confirmed that inventory management (β = -0.175, p = 0.0195), procurement efficiency (β = -0.192, p = 0.015), and logistics and distribution (β = -0.121, p = 0.04) significantly influenced surgical outcomes, whereas demand planning was not statistically significant (β = -0.00674, p = 0.959). Conclusion: Deficiencies in SCM practices at Mpilo Central Hospital negatively impact surgical outcomes, contributing to delays, cancellations, and compromised patient care. Strengthening inventory control, procurement processes, and logistics systems, alongside targeted training and resource allocation, is essential to enhance surgical efficiency and patient outcomes in similar low-resource settings.
Deliberate Simulation Training with a Geriatric Focus
The global increase in older adults poses immense challenges for both the healthcare system and social perspectives. They often have multiple long-term health-related issues, complex healthcare needs requiring tailored and anticipatory approaches. In this paper, we share our deliberate focus on geriatric simulation for training our healthcare providers and staff. This is with the intent to deliver patient-centred care for these older patients, who are both fragile and vulnerable. They also come with a multitude of medical conditions and co-morbidities which need to be managed in a customized fashion. These older persons are extremely dynamic in their needs and have atypical as well as complex presentations, which will differ from the younger patients. Incorporating simulation-based education into the geriatric curriculum for Emergency Department staffs not only enhances clinical competence, interprofessional coordination, and decision-making in the acute care of older adults; it also aligns with the preparation to face the super-aged society Singapore is transforming into.
From Hierarchy to Integration: The ‘Hierarchy of Intervention Effectiveness’ to the ‘Framework for Effective Integration and Adoption’
At work and in organizations, hierarchy often does not apply equally. Education and training is never a “one-size-fit-all”. The boundaries between systems-focused and people-focused interventions are becoming increasingly blurred today. The Hierarchy of Intervention Effectiveness (HIE) popularized by Lucian Leape and illustrated by Cassie McDaniel represents a risk management theory, with hierarchical ranks given to interventions; depicting that systems-focused interventions are more impactful and effective than human-focused ones. We are proposing that the HIE be evolved to “The Framework for Effective Integration and Adoption”, for a variety of reasons, discussed in this paper. It aligns with the state of education and training today against the background of technological advancements.
Reducing NSAID Prescriptions in Patients Receiving ACE Inhibitors/ARBs and Diuretics: A Quality Improvement Initiative
Background: Concurrent prescribing of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) to patients taking an ACE inhibitor or Angiotensin Receptor Blocker (ARB) together with a diuretic (“triple whammy”) increases Acute Kidney Injury (AKI) risk. This Quality Improvement (QI) initiative sought to reduce avoidable NSAID prescribing among high-risk patients in primary care. Objective: To reduce NSAID prescriptions by 50% among adults concurrently receiving ACEI/ARB and a diuretic over a 3-month period (May–July 2024). Methods: Using the Institute for Healthcare Improvement Model for Improvement, we implemented prescriber education, pharmacist counseling, and monthly electronic medical record (EMR) audits. The primary outcome was the monthly proportion of high-risk patients receiving an NSAID; 95% Confidence Intervals (CI) were calculated and a chi-square test assessed change across months. Results: NSAID prescribing decreased from 31.0% (9/29) in May to 21.7% (5/23) in June and 14.3% (3/21) in July. This represented a 54.0% relative reduction. Chi-square test of independence: χ²=1.96, p=0.376. Two-proportion (May vs July) z-test: z=1.37, p=0.171. Balancing measures included qualitative patient feedback on pain control. Conclusions: A structured QI approach integrating prescriber education, pharmacist counseling, and EMR audit feedback achieved a substantial reduction in NSAID prescribing among patients at elevated AKI risk.
Reimagining the Delivery of Emergency Medicine
Introduction: Emergency departments are experiencing higher volumes of patients, where overcrowding and boarding have become a normal everyday occurrence. These barriers force hospitals and specifically emergency departments to think differently when it comes to caring for patients. The old split flow model of care is no longer sufficient to move patients safely, effectively, and timely through the continuum of emergency care. This project focuses on innovating emergency department throughput and identifies new road maps to decrease the time a patient spends in the emergency department. Methods: A multi-disciplinary team was created including nurses, physicians, patient care assistants, transporters, radiology, and patient liaisons. The team was tasked to completely reimagine a new innovative emergency care model. Go-live would be in 60 days. The challenge was to create superior emergency department throughput strategies that did not rely on the hospital having capacity. Post-implementation metrics were measured for eight months. Results: Vast improvement was noted in nearly every emergency department metric upon go-live. Length of stay decreased by nearly 25%, left without being seen decreased to nearly 0%, left before treatment complete decreased to below 1%, and patient satisfaction more than doubled. Conclusion: Using data analysis as the foundation for creating an innovative emergency care model was able to improve throughput inefficiencies experienced with the previous split flow model at an overcrowded urban hospital. Contribution to Emergency Nursing Practice: This quality improvement project developed a new care delivery model for emergency departments which are experiencing overcrowding related throughput inefficiencies. • Key implications for emergency nursing practice found in this article are that interdisciplinary collaboration is key to improving emergency department throughput. • This article places an emphasis on utilizing data analysis to drive emergency department throughput decision making.
Rethinking Vascular Access in the Emergency Department
Many studies have concluded that implementing a vascular access program in inpatient units can reduce central line rates. However, there are limited studies on the effects of implementing these programs within the emergency department, where efforts to reduce central line rates should begin. This quality improvement project examined the effects of an ultrasound-guided peripheral access program in the emergency department has on inpatient central line rates. An ultrasound-guided peripheral IV access program was implemented at a community hospital with an annual volume of 40,000 patients. Eight Emergency Department (ED) nurse champions were trained in various ultrasound-guided peripheral IV insertions. Central line data were compared for 8 weeks pre- and post-intervention. The study site experienced a 39% reduction in the total number of inpatient central lines inserted during project implementation despite a 12% increase in the average daily hospital census. The project implementation resulted in a 46% reduction in the total number of patient days per central line. The study concluded that implementing an ultrasound-guided peripheral vascular access program in the ED was able to reduce inpatient central line use.
When Time is of the Essence: Comparing Infusion Rates by Gravity, “Push-Pull” Technique and Pressure Bag Delivery
Background: Rapid infusion is a fundamental component of resuscitation in trauma, conditions such as shock, perioperative bleeding and sepsis. The ability to deliver fluids and blood products swiftly and safely often determines the outcome of critical cases. Rapid fluid administration will help to restore volume, augment cardiac output and reverse shock. It represents one of the early interventions that can help reduce mortality and morbidity. In most emergency situations, peripheral intravenous (IV) access provides the fastest and most practical route for initial resuscitation when central access or automated rapid infusers are not yet available. However, infusion rate through a peripheral line is affected by multiple mechanical and physical factors, such as bag height, tubing length, cannula gauge, external pressure, and fluid viscosity. Objective: To compare the flow rates via three peripheral infusion techniques gravity flow, pressure-bag assistance, and push–pull syringe method, using both normal saline and simulated blood at two pole heights (1.85 m and 1.50 m). Methods: Thirty-six bench-simulation trials were conducted in a controlled laboratory using an 18-gauge cannula, standard transfusion tubing, and a mannequin arm. Each combination of method, pole height, and fluid type was tested in triplicate (250 mL per run). Mean infusion times (seconds) and flow rates (mL/min) were recorded. Results: Pressure-bag infusion produced the highest flow rate (118 ± 27 mL/min), significantly outperforming gravity (36 ± 7 mL/min) and push–pull syringe techniques (31 ± 2 mL/min) (p < 0.001). Raising the pole from 1.50 m to 1.85 m increased flow by 14–25%, depending on method. Saline infused faster than simulated blood (mean +23 mL/min, p < 0.05). The fastest combination was Pressure Bag + High Pole + Saline (139.7 mL/min), and the slowest was Gravity + Low Pole + Blood (26.7 mL/min). Conclusion: External pressure and greater hydrostatic height substantially enhance infusion speed. Pressure-bag assistance offers a simple, effective solution when rapid infusion is required, particularly in emergency or low-resource settings.
Copyright (c) 2025 Journal of Critical Care & Emergency Medicine
Evaluation of Brain-Derived Neurotrophic Factor Nano Therapies to Treat Alzheimer’s Diseases
Alzheimer’s disease is a neurodegenerative disorder affecting millions across the world. It is caused by the progressive build-up of Amyloid-β plaques and tau tangles resulting in inflammation in neurons, followed by apoptosis. This paper aims to synthesize the findings of various researchers on Alzheimer’s Diseases to shed light on a treatment using molecules that promote the survival and proliferation of neurons - neurotrophic factors. Each family of neurotrophic factors has different functions and after evaluating each one, brain-derived neurotrophic factor (BDNF) was shown to have the most potential in treating Alzheimer’s disease. Nano therapy was considered as a carrier for BDNF to cross the blood-brain barrier. PolyPGLA was found to be the most effective nanocarrier for BDNF
Copyright (c) 2023 Journal of Critical Care & Emergency Medicine
Rare Diseases and the Unseen Burden: A Patient-Centered Perspective
Background: Rare diseases affect millions worldwide and pose substantial challenges to patients, healthcare providers, and researchers. Definitions of rarity vary geographically, complicating coordinated global responses. Patients often face prolonged diagnostic delays, limited treatment options, and significant social barriers. Main Body: This perspective explores the multi-dimensional burden faced by rare disease patients, highlighting key issues such as diagnostic odysseys marked by misdiagnoses and emotional distress. Treatment availability is constrained by high costs and lack of approved therapies, especially in low- and middle-income countries. Clinical trials, central to advancing therapies, remain difficult to access for many due to geographic and logistical barriers. Decentralized Clinical Trials (DCTs) emerge as a promising innovation, leveraging telemedicine and remote monitoring to increase inclusivity and trial participation. Beyond medical challenges, patients and caregivers experience social isolation, stigma, and significant psychosocial strain. Addressing these gaps requires coordinated efforts to raise awareness, improve healthcare infrastructure, foster patient-centric and decentralized research models, and implement supportive policies promoting equitable access to care. Conclusion: The rare disease community urgently needs integrated action combining early diagnosis, expanded therapeutic research, inclusive clinical trial designs, and social support mechanisms. Amplifying patient voices and fostering partnerships in research and policy are critical to developing effective, meaningful solutions. This comprehensive approach promises to transform the rare disease landscape, ensuring no patient remains unseen or underserved.
Behavior of Perfusion Variables in Adult Patients Undergoing Cardiac Surgery in the Hospital Cardiovascular Del Niño De Cundinamarca Descriptive Cohort
Introduction: Blood lactate levels during extracorporeal circulation (ECC) have been the method used to monitor the state of microcirculation. New studies recommend the central venous oxygen saturation (SvcO2) and the central venous - arterial difference of CO2 (Cv-aCO2 ) as innovative tools to evaluate such state in this group of patients. Aim: To describe the levels of tissue perfusion biomarkers (SvcO2, Cv-aCO2 and lactate) of adult patients undergoing ECC cardiac surgery, at the Hospital Cardiovascular del Niño, from April 1 to July 31, 2019. Methodology: Historical descriptive cohort study. A review of the medical records of adult patients undergoing cardiac surgery of any etiology under ECC was carried out, evaluating the variables to be studied intraoperatively and postoperatively at 6, 12 and 24 hours in the Intensive Care Unit. Descriptive statistics were used. Results: 54 patients undergoing different types of cardiac surgery with ECC were included. The most frequent one was myocardial revascularization in 24 patients (44,4%). The duration of ECC in 30 cases (55,5%) ranged between 60-120 minutes. During the intraoperative period, a progressive rise in the medians of the Lactate variables was observed, being greater towards the end of the ECC and being reestablished outside the ECC and in the first 24 hours of ICU stay. Conclusions: This study allowed the integration of 3 tissue perfusion variables and findings that are relevant from the clinical perspective for the perioperative management of patients undergoing cardiac surgery in ECC.
Venous-toArterial Carbon Dioxide Difference
Prevalence, Severity, and Persistence of Chemotherapy-Induced Peripheral Neuropathy in Early-Stage Breast Cancer Patients Treated with Paclitaxel: an Observational Study in a Referral Hospital in Latin America
Chemotherapy-induced peripheral neuropathy (CIPN) is one of the main adverse effects of antitumor treatment. The aim of our study was to examine the prevalence and severity of CIPN in breast cancer patients treated with paclitaxel. The association with specific patient-, tumour- and treatment-related variables was also explored. Thus, 45 patients with early-stage breast cancer were evaluated at a referral hospital in Argentina. Patient-reported CIPN-related symptoms were assessed using an abbreviated version of EORTC QLQ-CIPN20 questionnaire. Additional variables analyzed included age, weight, body mass index, tumor phenotype, and chemotherapy regimen. The study population included women aged 25-71 years. Most tumors were ER/PR-positive, and the most frequently used chemotherapy regimen was adjuvant anthracycline-based therapy. The prevalence of clinical CIPN, defined by the presence of at least one symptom experienced ‘quite a bit’ or ‘very much’, was 62%. In contrast, clinical records showed a prevalence of 24%. No significant associations were observed between patient-, tumor- or treatment-related variables and CIPN development. Among patients with neuropathy, mean CIPN score was 26,25. Of these patients, 50% presented both sensory and motor symptoms, 29% only motor and 18% only sensory symptoms. Two years after finishing chemotherapy, 46% of CIPN-patients still experienced at least one symptom. All patients with persistent symptoms had experienced motor disturbances during chemotherapy, with significantly higher motor scores. Our results indicate a high prevalence of CIPN-related symptoms during and after paclitaxel administration in our population. The presence and/or the severity of motor symptoms during chemotherapy could be postulated as possible predictors of CIPN persistence. Clinical underreporting and symptom persistence emphasize the need to incorporate patient-reported measures into clinical practice to better detect symptoms and guide interventions to improve patient’s quality of life.
Chemotherapy-Induced Peripheral Neuropathy
Sympathetic Crashing Acute Pulmonary Edema (SCAPE): A Race Against Time in the Emergency Department
Sympathetic Crashing Acute Pulmonary Edema (SCAPE) represents the extreme end of the heart failure spectrum, characterised by hemodynamic instability and severe respiratory distress. Prompt recognition and intervention are crucial to reducing morbidity and mortality in patients with SCAPE. High-Dose Nitroglycerin (HDN) and Non-Invasive Ventilation (NIV) are pivotal in managing these cases. We present a case of a 56-year-old man who presented to our Emergency Department (ED) with SCAPE. He was successfully managed with HDN at a dosage of 100 µg/min and positive pressure ventilation. This case underscores the importance of early recognition and aggressive intervention in SCAPE, highlighting the effectiveness of HDN and NIV in stabilising hemodynamics and improving outcomes.
Sympathetic Crashing Acute Pulmonary Edema (SCAPE)
Blunt Abdominal Trauma with an open Book Pelvic Fracture and a retrohepatic caval injury in a patient with cirrhosis
A 42-year-old male was involved in a high-speed motor vehicle collision. He was intubated at the scene and transported to a Level 2 trauma center.
Utilization of Immediate Energy Resources in Critical Care, Emphasis on Phosphocreatine
Modern societies heavily rely on sophisticated energy resources, likewise human baseline daily and stress related activity commencing on the molecular and cellular level is essentially dependent on properly functioning energy producing, rebooting and storage conditions. Adenosine triphosphate (ATP) assumes the role of universal energy currency stored in high energy phosphate bounds, with immediate availability for biochemical processes requiring fuel resources. The intrinsic resources for ATP are mitochondria providing synthesis from ADP mediated by ATPase, and ATP is recycled in significant amounts from high ATP containing organs, like muscles. ICU patients are characterized by low ATP reserves. The reasons are conceivably multifactorial, including increased requirements, mitochondrial damage, catabolism and muscle breakdown, leading to impaired availability and increased demand. Phosphocreatine (PCr) provides the high energy substrate to promote regeneration of ATP rendering an immediate energy resource bypassing the largely oxygen dependent oxidative phosphorylation. Currently, phosphocreatine substitution is available therapeutically, offering a transient supportive tool to the organism during conditions when demand is enhanced, production may suffer and endogenous resources of creatine or phosphocreatine are relatively low. Exogenous phosphocreatine supplementation may be beneficial during critical care illness, when energy resource processing and utilization may be dampened by ischemic and inflammatory pathological processes. The significance of supplementary immediate energy substitution is demonstrated on case reports during inflammatory conditions.
Treatment by Ozone and a Parasympathomimetic Drug in Liposome Cream on Knee after Surgery or Trauma
Verify the pain relief by applying a parasympathomimetic drug in liposomes cream distributed supra cute males, in-group of patients suffering from painful knee, after surgery or trauma. This study was carried out in double blind. Material and Methods: From 2022 to 2023, the authors, on double blind method, of which 34 females and 84 males, average age, studied 118 patients 49 years old, suffering from painful knee, after surgery or trauma. by application of a parasympathomimetic drug diluted in liposomes cream, at a dose of 20 mg in 150 ml of cream, for 20 session, after ozone by 10 ml for each treatment. For each patient, the intensity of pain was assessed by the visual analogue scale (VAS) and the assessment of functional impotence with the 5 levels of the semantic scale: A = Absent AA = Almost Absent M =Mild R = Remarkable T = Total Detection occurred at T0’, T10’, T20’, T60’ after each medicated session. Results: Of118 patients, 34 females and 84 males, therefore 85,00% of the total obtained a good pain control with restoration of functional activity (See poster’s graphic).
Dual Burden: Radiologically Confirmed Neurocysticercosis Complicated by Infective Endocarditis in a Young Patient: Case Report
We report the case of a 17-year-old male who presented with progressive headache, fever, vomiting, and neck stiffness. On admission, he was febrile, tachycardic, tachypneic, hypoxic, and severely anemic, with conjunctival hemorrhages and new cardiac murmurs. Neurologically, he had reduced consciousness, left-sided weakness, hypertonia, and meningeal signs. Echocardiography revealed large vegetations on the aortic and mitral valves with moderate regurgitations and pulmonary hypertension, confirming native-valve infective endocarditis. Neuroimaging demonstrated a left parietal mass extending from the choroid plexus with multiple subarachnoid and scalp cystic lesions, consistent with racemose neurocysticercosis, complicated by severe vasogenic edema, obstructive hydrocephalus, subfalcine herniation, and intraparenchymal hemorrhages. The patient underwent burr-hole decompression (yielding mainly blood) and was treated with albendazole, praziquantel, corticosteroids, and antiepileptics for neurocysticercosis, alongside intravenous vancomycin and ceftriaxone for six weeks for infective endocarditis. This case highlights the rare coexistence of infective endocarditis and racemose neurocysticercosis with intracerebral hemorrhage, underscoring the importance of multidisciplinary care in managing overlapping infectious and neurological pathologies.
Comparison of Hematological Indices in Patients before and After Coronary Artery Bypass Grafting (CABG)
Subject: Clinically, a reduction in hematocrit (Hct) or hemoglobin (Hb) levels is a notable condition commonly observed in patients undergoing coronary artery bypass grafting (CABG). Postoperative anemia is a risk factor for mortality in patients undergoing CABG, affecting both the early and late stages of recovery. However, the underlying mechanisms remain incompletely elucidated. We aimed to investigate the relation between the hematologic indices with two surgery methods (on-pump & off-pump). Methods: Fifty consecutive CABG cases were randomly assigned to group I (On-pump, n= 24) and group II (Off-pump, n = 26). General clinical and surgery parameters, hematologic incidence were measured in two blood samples, the first sample was taken from each patient on the morning of the day of surgery after 12-hr fasting, and the second sample on the first postoperative day at 24-hr after surgery. Statistically assessing serum levels pre- and post-CABG and comparing between the two groups was analyzed and the correlation between parameters was evaluated. Result: In the baseline, there were significant differences between the on-pump and off-pump groups regarding heart rate (HR) (p = 0.002). Investigation after surgery showed that the difference in HR and urea levels in pre- and post-CABG was significant when compared between the two groups. A significant difference was observed in the white blood cell, it became less after the operation. The decrease in platelet and PT level in patients who underwent the on-pump and off-pump surgery (diff = -23.5 and diff = -0.62, respectively) was shown and this difference remained significant between the two groups. Conclusion: We achieve the on-pump method places greater stress on blood cells, resulting in reduced levels of white blood cell in patient outcomes. It can be suggested that it should be adjusted for patients undergoing both on-pump and off-pump surgeries.