Emergency Medicine

Acute Toxicity Following Occupational Exposureto Anti-Fouling Marine Paints: A Case Series of Five Adult Patients

Introduction: Anti-fouling marine paints contain toxic components such as copper-based biocides, organotin compounds, and volatile organic solvents. Acute occupational exposure may result in respiratory, gastrointestinal, hepatic, and neurological manifestations; however, clinical data in emergency medicine regarding such exposures remain limited.
Case Presentation: Five male shipyard workers aged 23–39 years presented to the emergency department following acute occupational exposure during anti-fouling paint application. Three patients experienced inhalational exposure and presented with dyspnoea and throat irritation requiring supplemental oxygen therapy. One patient presented with nausea and vomiting and was found to have a two-fold elevation in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. Another patient reported dizziness, throat burning, and palpitations. Other laboratory parameters were within normal limits. All patients were hospitalised for close observation and received supportive treatment, including oxygen therapy, intravenous fluids, and symptomatic management. No severe systemic toxicity or organ failure developed. Clinical and laboratory findings improved within 72 hours, and all patients were discharged without complications.
Conclusion: Acute exposure to anti-fouling marine paints may cause heterogeneous clinical presentations, including respiratory compromise and transient hepatic enzyme elevation. Emergency physicians should recognise this occupational hazard and consider extended observation and supportive management when clinically indicated.

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Adjunctive Atorvastatin for Sepsis in the Acute Medical Unit: A Randomized Controlled Trial

Background: Sepsis, a devastating syndrome of organ dysfunction triggered by a dysregulated host response to infection, remains a leading cause of global mortality. Statins, renowned for lipid-lowering, also exhibit potent anti-inflammatory and endothelial-stabilizing properties, offering a theoretical advantage in the septic milieu. This study investigated whether adjunctive atorvastatin could improve survival and modulate key sepsis-related outcomes.
Methods: In this open-label, randomized controlled trial conducted in the acute medical unit of a tertiary academic center, adult patients with sepsis(defined as suspected infection plus a SOFA score increment of ≥2) were allocated to receive either standard sepsis management plus daily oral atorvastatin 20mg or standard management alone for up to 28 days. The primary endpoint was 28-day all-cause mortality. Secondary endpoints included requirements for organ support, duration of hospitalization, and kinetic changes in C-reactive protein(CRP), procalcitonin(PCT), and lactate. Analysis adhered to intention-to-treat principles.
Results: Sixty-eight patients were randomized(36 atorvastatin, 32 control). While 28-day mortality trended lower in the atorvastatin arm(36% vs. 56% in controls; Risk Difference -20%, 95% CI -45% to 5%), this difference did not achieve statistical significance(p=0.10). Similarly, no significant benefits were observed in organ support needs or hospital stay. Critically, atorvastatin administration led to a significant and more pronounced reduction in both procalcitonin(median change -8 vs 0 ng/ml, p=0.005) and lactate levels(median change -0.95 vs -0.62 mmol/l, p=0.048) by day 7.
Conclusion: While adjunctive atorvastatin did not demonstrably reduce 28-day mortality in this sepsis cohort, its significant impact on attenuating procalcitonin and lactate levels suggests a beneficial modulation of underlying inflammatory and metabolic derangements.

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The effect of antipyretic medication on the relationship between heart rate, respiratory rate and temperature in acutely admitted medical patients: A retrospective study

Research has shown an association between body temperature, heart rate and respiratory rate. We speculated that antipyretics could influence this. We performed this study with the aim of clarifying the association.We included 1,612 acutely admitted medically ill patients and registered their use of antipyretics. We performed crude and adjusted linear regression analyses. In adjusted analysis,...

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Performance of AI-powered chatbots in diagnosing acute pulmonary thromboembolism from given clinical vignettes

Background: Chatbots hold great potential to serve as support tool in diagnosis and clinical decision process. In this study, we aimed to evaluate the accuracy of chatbots in diagnosing pulmonary embolism (PE). Furthermore, we assessed their performance in determining the PE severity.
Method: 65 case reports meeting our inclusion criteria were selected for this study. Two emergency medicine (EM) physicians crafted clinical vignettes and introduced them to the Bard, Bing, and ChatGPT-3.5 with asking the top 10 diagnoses. After obtaining all differential diagnoses lists, vignettes enriched with supplemental data redirected to the chatbots with asking the severity of PE.
Results: ChatGPT-3.5, Bing, and Bard listed PE within the top 10 diagnoses list with accuracy rates of 92.3%, 92.3%, and 87.6%, respectively. For the top 3 diagnoses, Bard achieved 75.4% accuracy, while ChatGPT and Bing both had 67.7%. As the top diagnosis, Bard, ChatGPT-3.5, and Bing were accurate in 56.9%, 47.7% and 30.8% cases, respectively. Significant differences between Bard and both Bing (p=0.000) and ChatGPT (p=0.007) were noted in this group. Massive PEs were correctly identified with over 85% success rate. Overclassification rates for Bard, ChatGPT-3.5 and Bing at 38.5%, 23.3% and 20%, respectively. Misclassification rates were highest in submassive group.
Conclusion: Although chatbots aren’t intended for diagnosis, their high level of diagnostic accuracy and success rate in identifying massive PE underscore the promising potential of chatbots as clinical decision support tool. However, further research with larger patient datasets is required to validate and refine their performance in real-world clinical settings.

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The COVID-19 pandemic has not affected the mortality for patients admitted with pneumonia in Denmark

During the COVID-19 pandemic, several hospital systems observed a reduction in patients with respiratory complaints. Using the Danish national registers, we conducted an observational study on disease severity and 30-day all-cause mortality for acutely admitted pneumonia patients before (3/19-3/20) and during (3/20-2/21) the pandemic. We calculated mortality rate ratios and Cox regression analyses. We identified 54,405 patients and during the pandemic, patients were older, more likely to be male, had more co-morbidity and a lower albumin on admission. Crude mortality was higher during the pandemic (8.4 vs. 6.9%). Adjusted hazard ratio for 30-day all-cause mortality was 1.07 (95%CI 1.01-1.14). We showed a small but significant, increase in mortality risk for patients admitted to hospital during the COVID-19 pandemic in Denmark.

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Evaluation of systemic vasoconstriction and prognosis using thermography: a systematic review

Purpose: This systematic review investigates whether infrared thermography (IRT) can measure systemic vasoconstriction and addresses the value of IRT in assessing circulatory deficiency and prognoses.

Methods: Design was based on the PRISMA criteria and a systematic search of 6 databases was performed.

Results: Of 3,198 records, five articles were included. Three clinical studies were identified; two found significant correlations between IRT obtained temperatures and mortality. An experimental study found an association between peripheral temperature and stroke volume. An animal study found that central-peripheral temperature differences correlated with shock index, mean arterial pressure, and disease progression.

Conclusions: Data from the most valid study suggests that central-peripheral temperature differences should be investigated further, both on its own, and integrated with other variables.

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Higher In-Hospital Mortality in Patients with Nonspecific Complaints Presenting to the Emergency Department

Background: Nonspecific complaints (NSC) at the Emergency Department (ED) are not well researched yet.

Objective: To investigate the number of patients who could be classified as having NSC early after arrival in the ED using an algorithm.

Method: Retrospective cohort study was conducted among all hemodynamically stable non-trauma adult patients with MTS category orange/yellow visiting the ED. Patients who had no specific complaints/signs, predefined on a list, were categorized as NSC.

Results: In total, 2419 patients, of whom 102 (4.2%) presented with NSC. Hospitalization was more prevalent (85.3% vs. 69.0%, p<0.001) and in-hospital mortality was higher in the NSC-group (11.8% vs. 3.5%, adjusted OR 2.0, 95% CI 1.0-3.9, p=0.04). Conclusion: Using an algorithm it is possible to identify NSC patients who have (worse) outcomes than those classified as SC.

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Prediction models for mortality in adult patients visiting the Emergency Department: a systematic review

We provide a systematic overview of literature on prediction models for mortality in the Emergency Department (ED). We searched various databases for observational studies in the ED or similar setting describing prediction models for short-term mortality (up to 30 days or in-hospital mortality) in a non-trauma population. We used the CHARMS-checklist for quality assessment. We found a total of 14.768 articles and included 17 articles, describing 22 models. Model performance ranged from AUC 0.63- 0.93. Most articles had a moderate risk of bias in one or more domains. The full model and PARIS model performed best, but are not yet ready for implementation. There is a need for validation studies to compare multiple prediction models and to evaluate their accuracy.

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Acute Medicine and Emergency Medicine are not (Yet?) The Same

The acquisition of “Level 3” competencies in the setting of the Emergency Room from StR in Acute Medicine raises the question of the boundaries and competences of Acute Medicine and Emergency Medicine. The possibility that phisycians with a training both in Emergency Medicine and Acute Medicine will be involved in the management of Emergency Admission Units and Emergency Medicine Departments in the future is herein considered.

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