A randomized controlled trial: Comparing blood pressure reduction in hyperacute phase of spontaneous intracerebral hemorrhage by continuous nicardipine infusion with or without a preceding nicardipine bolus dose.

Objectives: To determine whether addition of an intravenous bolus dose before continuous nicardipine infusion would improve blood pressure reduction in the hyperacute phase in patients with spontaneous intracerebral hemorrhage (ICH). Design: Double-blind randomized controlled trial. Setting: One academic emergency department (ED) in Bangkok, Thailand. Participants: Adult patients with spontaneous ICH presented to the ED between June 30, 2022, and July 15, 2023. Interventions: The bolus group (n = 31) received an intravenous bolus dose of nicardipine before nicardipine continuous infusion, whereas the non-bolus group (n = 31) was given a placebo and nicardipine continuous infusion. Main outcomes: Systolic blood pressure (SBP) within the first hour (being measured every 5 min), neurological deterioration, and infusion dosage at 60 min were assessed. Results: Basic characteristic features including the mean baseline SBP were not significantly different between the two groups. At 10 min after treatment initiation, the bolus group had a significant decrease in SBP (32.1 ± 13.6 vs 22.3 ± 18.5 mmHg; p-value = 0.020). Moreover, the target SBP of 180 mmHg could be achieved within 10 min in the bolus group compared with 15 min in the non-bolus group. However, the overall mean SBPs were not significantly different, with 152 ± 12 mmHg in the bolus group compared with 150 ± 15 mmHg in the non-bolus group (p-value = 0.564). None of the patients in both groups had neurological deterioration over the first hour of the treatment. The infusion dosages of nicardipine at 1 h were 6.2 mg/h (5.9, 7.7 mg/h) and 6.8 mg/h (5.9, 8.4 mg/h) in the bolus and non-bolus groups, respectively (p-value = 0.618). Conclusions: Administering a 1-mg bolus dose of nicardipine before continuous nicardipine infusion notably reduces SBP at 10 min. However, the overall SBP does not exhibit a significant decline during the hyperacute phase of spontaneous intracerebral hemorrhage.

Bradycardia in Older Patients in a Single-Center Emergency Department: Incidence, Characteristics and Outcomes.

Objective: This study aimed to explore data associated with the characteristics, incidence, and outcomes of older patients with symptomatic bradycardia presenting to the emergency department (ED). Methods: We prospectively reviewed data of all patients aged 60 years and older who visited our ED with symptomatic bradycardia during 8AM-12PM between June 4, 2018, and June 10, 2019. The outcomes were the incidence of symptomatic bradycardia and adverse events (recurrent bradycardia, rate of ED revisits, subsequent hospitalization, mortality rate, and composite outcomes) at 30 days and 180 days. Results: A total of 3297 patients visited the ED. Of these, 205 patients had symptomatic bradycardia. The incidence of symptomatic bradycardia was 6.2% (205/3297). One hundred fourteen patients (55.7%) were female, and the mean age was 74.9 (SD, 9) years. One-third of bradycardia patients (80 patients [39.0%]) were admitted to the hospital, 32 of whom because of unstable bradycardia. Ten of these 32 (30%) patients died during hospitalization from causes unrelated to bradycardia. One-third of unstable bradycardia patients had dyspnea (10/32 patients [31.3%]) followed by chest pain and altered mental status, respectively. ED revisit was the most common adverse event after 30 days (10.8%) and 180 days (20.3%). End-stage renal disease with hemodialysis was associated with adverse outcomes at 30 days (odds ratio, 2.34; 95% confidence interval, 1.30-20.87). Conclusion: The incidence of symptomatic bradycardia among older adults was 6.2% in one urban ED. End-stage renal disease with hemodialysis was associated with adverse outcomes at 30 days. Larger studies should confirm this association and investigate methods of minimizing adverse outcomes.

High Incidence of Workplace Violence in Metropolitan Emergency Departments of Thailand; a Cross Sectional Study.

INTRODUCTION: Violence against healthcare workers mostly occurs in emergency departments and is a serious global public health issue. This study aimed to evaluate the prevalence of violence directed towards emergency department healthcare personnel and to ascertain the factors that might be correlated with it. METHODS: In this cross-sectional study, an anonymous questionnaire was used to gather data from healthcare personnel working in the emergency departments under the direction of the Bangkok Metropolitan Administration between 1 August 2019 and 30 November 2019, regarding the experience of violence during the previous year. RESULTS: A total of 258 (87.5%) responses were received from 295 personnel. The results showed that 88.4% (228 personnel) had experienced violence during the past year, of these, 37.6% involved physical abuse that caused minor injuries. Employees with shorter tenures, nurses, and those working in tertiary academic emergency departments in the central business district were found to have increased likelihood of confronting violence. Measures taken to prevent violence had a limited impact on the occurrence rate. The most common impact on employees after experiencing violence was discouragement in their jobs (75.1 %). The key factors that promoted cases of violence were the consumption of alcohol or drugs (81.3%) and long waiting times (73.6%). Most violence tended to occur during non-office hours (95.4%). One-third of emergency healthcare personnel reported facing violence during their work. CONCLUSIONS: Emergency healthcare personnel in metropolitan of Thailand had a high rate of experiencing violence in the previous year. Younger age, lower work experience, being a nurse, and working in the urban academic or tertiary emergency department increased the likelihood of being a victim of workplace violence.

Revisits within 48 Hours to a Thai Emergency Department.

Objective. Emergency department (ED) revisits are a common ED quality measure. This study was undertaken to ascertain the contributing factors of revisits within 48 hours to a Thai ED and to explore physician-related, illness-related, and patient-related factors behind those revisits. Methods. This study was a chart review from one tertiary care, urban Thai hospital from October 1, 2009, to September 31, 2010. We identified patients who returned to the ED within 48 hours for the same or related complaints after their initial discharge. Three physicians classified revisit as physician-related, illness-related, and patient-related factors. Results. Our study included 172 ED patients' charts. 86/172 (50%) were male and the mean age was 38 ±â€Š5.6 (SD) years. The ED revisits contributing factors were physician-related factors [86/172 (50.0%)], illness-related factors [61/172 (35.5%)], and patient-related factor [25/172 (14.5%)], respectively. Among revisits classified as physician-related factors, 40/86 (46.5%) revisits were due to misdiagnosis and 36/86 (41.9%) were due to suboptimal management. Abdominal pain [27/86 (31.4%)] was the majority of physician-related chief complaints, followed by fever [16/86 (18.6%)] and dyspnea [15/86 (17.4%)]. Conclusion. Misdiagnosis and suboptimal management contributed to half of the 48-hour repeat ED visits in this Thai hospital.