Hypertensive emergency is one of the most challenging conditions to treat in the emergency department (ED). From previous studies, about 1%–3% of hypertensive individuals experienced hypertensive emergencies. Its prevalence varied by country and region throughout Asia. Asian populations have more different biological and cultural backgrounds than Caucasians and even within Asian countries. However, there is a scarcity of research on clinical features, treatment, and outcomes in multinational Asian populations. The authors aimed to review the current evidence about epidemiology, clinical characteristics and outcomes, and practice guidelines in Asia. Five observational studies and nine clinical practice guidelines across Asia were reviewed. The prevalence of hypertensive emergencies ranged from .1% to 1.5%. Stroke was the most common target organ involvement in Asians who presented with hypertensive emergencies. Although most hypertensive emergency patients required hospitalization, the mortality rate was low. Given the current lack of data among Asian countries, a multinational data repository and Asian guidelines on hypertensive emergency management are mandatory.

BACKGROUND: The use of point-of-care ultrasound (POCUS) has recently proposed the integration of ultrasound into undergraduate medical education. However, the evidence of learning tool for this integration has not been well studied. AIM: The aim of this study was to compare the levels of knowledge improvement of the 6th year medical students before and after receiving the POCUS training in two ways: By employing the traditional methods and by utilizing the new learning tool. METHODS: The practical ultrasound flashcards were developed by a Thai physician. In the study, the 6th year medical students were enrolled and randomized to become members of either the flashcard group or the control group. Participants in both groups attended a 4-week ultrasound training course. Before and after the training course, all students were evaluated using the multiple-choice questions. In addition, the subjects’ attitudes and perceptions about the flashcards were evaluated using a questionnaire. RESULTS: A total of 46 students participated in this study and were randomly assigned to either the flashcard group (n = 23) or the control group (n = 23). It was discovered that the students in the flashcard group had performed better on the POCUS knowledge post-test than those in the control group had. Most students had been satisfied with the flashcards (mean 5 Likert scores = 4.48). However, the students had rated their confidence score to perform POCUS at 3.96 out of 5.0. CONCLUSIONS: Medical students who used the ultrasound flashcards to learn POCUS had resulted in better knowledge scores rather than the others who attended the standard ultrasound training course only. However, it was not possible to evaluate the practical skills and the clinical decision-making processes in this study.

Introduction: The atypical presentation of acute coronary syndromes (ACS) was a risk factor of unfavorable outcomes. It is not uncommon for chronic kidney disease (CKD) patients with ACS to present atypically. Hypothesis: We hypothesized that the atypical presentation of non-ST-segment elevation ACS (NSTE-ACS) in CKD patients might associate with poor clinical outcomes. Methods: This was a retrospective cohort study in Srinagarind hospital, Thailand, from 2014 to 2017. The CKD patients with NSTE-ACS were enrolled. Clinical data including presenting symptoms, laboratory results, treatments, and outcomes were collected from an electronic database. The atypical presentation was defined as nausea and/or vomiting, dyspepsia, confusion, dyspnea, or no chest pain. The outcome was a composite of all-cause mortality, the over 30-day length of stay, and recurrent ACS underwent PCI or CABG. Results: There were 147 patients enrolled, of those, 77 (52.3%) presented with atypical symptoms. The atypical presentation group had a faster heart rate (HR) compared with those who presented with typical symptoms (87 vs. 78 beats per minute, P=0.005), however, both groups had comparable age, sex, and echocardiographic parameters. The determinant of the atypical presentation was HR (Odds ratio (OR) 1.03, 95%CI: 1.01-1.05). Atypical symptoms and diabetes mellitus were associated with the outcome, adjusted OR 2.62, 95%CI: 1.21-5.67, and adjusted OR 3.54, 95%CI: 1.56-8.03, respectively. Conclusions: ACS should be one of the differential diagnoses in the CKD patients who presented with nausea and/or vomiting, dyspepsia, confusion, dyspnea, or no chest pain. Considered that the atypical presentation was associated with poorer outcomes.

Background: High-sensitivity cardiac troponin T (hs-cTnT) is recommended for diagnosing non-ST segment elevation acute coronary syndromes (NSTE-ACS). While the guidelines recommend using the 0,1-hour (hr) and 0,3-hr hs-cTnT algorithms, their efficacy has not been clearly established in chronic kidney disease (CKD) patients. We aimed to assess the differential associations between the two algorithms mentioned above with significant coronary stenosis in CKD patients. Methods: This was a retrospective cohort study. Patients aged ≥18 years who were diagnosed with NSTE-ACS and had undergone coronary angiogram were recruited. The differential association between significant coronary stenosis and being ruled in based on the 0,1-hr and 0,3-hr hs-cTnT algorithm was analyzed and reported. Results: There were 158 and 160 patients in the CKD and normal renal function groups. Among CKD patients, determinants of significant coronary stenosis were hypertension (OR = 2.68; 95% CI 1.10-6.50) and being ruled in by the 0,3-hr algorithm (OR = 3.65; 95% CI 1.27-10.52). In the normal renal function group, age (OR = 1.04; 95% CI 1.01-1.06), male sex (OR = 2.15; 95% CI 1.09-4.22), and being ruled in by the 0,1-hr algorithm (OR = 3.12; 95% CI 1.20-8.10) were associated with significant coronary stenosis. Conclusion: Being ruled in according to the 0,3-hr algorithm was significantly associated with coronary stenosis in CKD patients, making this a likely algorithm of choice in these patients.

BACKGROUND: To improve survival rate, the main focus of adult cardiac arrest management includes rapid recognition, prompt administration of cardiopulmonary resuscitation (CPR), defibrillation for shockable rhythms, post-return of spontaneous circulation (ROSC) care, and identification and treatment of underlying causes. This study aimed to identify the determinants of unrecognized cardiac arrest, and to study the recognition rate of out-of-hospital cardiac arrest (OHCA) by emergency medical services call handlers. METHODS: We included OHCA patients who were transferred to hospital via Emergency Medical Services (EMS) of Srinagarind hospital, Khon Kaen, Thailand, from 1st January 2020 to 31st December 2020. The primary outcome was to identify symptoms that lead to an unrecognized cardiac arrest by the EMS call handlers. Secondary outcomes were to identify the recognition rate of OHCA by emergency medical services call handlers, and assess the outcome of CPR performed on OHCA patients. RESULTS: There were a total of 58 patients in the present study, 26 patients (44.8%) and 32 patients (55.2%) belonged to the unrecognized and recognized cardiac arrest groups, respectively. The most common symptoms that led to unrecognized cardiac arrest were a state of unconsciousness (46.2%), major trauma (15.4%), and seizure-like activity (11.5%). The rate of ROSC was higher in the unrecognized cardiac arrest group (34.6% vs. 15.6%) but the rate of survival to hospital discharge was higher in the recognized cardiac arrest group (6.3% vs 0%). CONCLUSIONS: Falling unconscious is the most common symptom of unrecognized OHCA cases seen by EMS in Thailand. Basic life support, especially an immediate assessment of a patient’s respiratory status should be taught in health programs in school or through public service channels.

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Faculty of Medicine Khon Kaen University Background High-sensitivity cardiac troponin T (hs-cTnT) is recommended for diagnosing non-ST segment elevation acute coronary syndromes (NSTE-ACS). While the standard practice guidelines recommend using the 0,1-hour (hr) and 0,3-hr hs-cTnT algorithms, their efficacy has been not clearly established in chronic kidney disease (CKD) patients.  Purpose We aimed to assess the differential associations between the two algorithms mentioned above with significant coronary stenosis in CKD patients. Methods This was a retrospective cohort study. Patients aged ≥18 years (yr) who were diagnosed with NSTE-ACS and had undergone coronary angiogram were recruited. The differential association between significant coronary stenosis and being ruled in based on the 0,1-hr and 0,3-hr hs-cTnT algorithm in both CKD patients and those normal renal function was analyzed and reported. Results There were 158 and 160 patients in the CKD group and the normal renal function group, respectively. The prevalence of significant coronary stenosis was higher in the CKD group (70.4% vs. 57.8%, P =0.028). Among CKD patients, factors associated with significant coronary stenosis were hypertension (OR =2.68; 95%CI 1.10-6.50) and being ruled in by the 0,3-hr algorithm (OR =3.65; 95%CI 1.27-10.52). In the normal renal function group, age (OR =1.04; 95%CI 1.01-1.06), male sex (OR =2.15; 95%CI 1.09-4.22), and being ruled in by the 0,1-hr algorithm (OR =3.12; 95%CI 1.20-8.10) were associated with significant coronary stenosis. Conclusions Being ruled in according to the 0,3-hr algorithm was significantly associated with coronary stenosis in CKD patients, making this a likely algorithm of choice in these patients. Abstract Figure. Adjusted OR of a coronary stenosis

BACKGROUND: Concerning the COVID-19 outbreak in Thailand, the number of patients has been increasing. Emergency medical services (EMS) operating duration differs from normal services due to equipment preparation, number of personnel, and on-board ambulance procedures. Notably, there have been no studies examining EMS duration regarding COVID-19 patients. AIM: The aim of this study was to compare the EMS time for COVID-19 patients and routine services. METHODS: This cross-sectional study was conducted in a tertiary university hospital in Khon Kaen, Thailand. Information gathering was carried out by employing the Srinagarind Hospital EMS database throughout January 1, 2020, and February 10, 2021. RESULTS: A total of 2420 EMS operations were examined, of which five tested positive for COVID-19 (0.21%). The mean age of the COVID-19 patients was 35.6 ± 7.2 years, with the activation interval for COVID-19 and routine services at 64.20 ± 10.14 and 1.42 ± 0.42 min, respectively (p < 0.001). The on-scene time for COVID-19 and routine services was 3.20 ± 0.44 and 5.20 ± 2.20 min, respectively. CONCLUSIONS: EMS operating time amid the activation interval for COVID-19 patients was significantly longer than in the normal group. However, on-scene time for COVID-19 patients was less time than in normal operations.