Point-of-care ultrasound (POCUS) is a rapidly developing technology that has the potential to revolutionize emergency and critical care medicine. The use of POCUS can improve patient care by providing real-time clinical information. However, appropriate usage and proper training are crucial to ensure patient safety and reliability. This article discusses the various applications of POCUS in emergency and critical care medicine, the importance of training and education, and the future of POCUS in medicine.

Objective Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ.Methods This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis.Results Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746–9.240).Conclusion Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.

The COVID-19 pandemic has highlighted the significant infection risks posed by aerosol-generating procedures (AGPs), such as intubation and cardiopulmonary resuscitation (CPR). Despite existing protective measures, high-risk environments like these require more effective safety solutions. In response, our research team has focused on developing a novel respiratory barrier enclosure designed to enhance the safety of healthcare workers and patients during AGPs. We developed a hood that covers the patient’s respiratory area, incorporating a negative pressure system to contain aerosols. Using computational fluid dynamics (CFD) analysis, we optimized the hood’s design and adjusted the negative pressure levels based on simulations of droplet dispersion. To test the design, Polyalphaolefin (PAO) particles were generated inside the hood, and leakage was measured every 10 s for 90 s. The open side of the hood was divided into nine sections for consistent leakage measurements, and a standardized structure was implemented to ensure accuracy. Our target was to maintain a leakage rate of less than 0.3%, in line with established filter-testing criteria. Through iterative improvements based on leakage rates and intubation efficiency, we achieved significant results. Despite reducing the hood’s size, the redesigned enclosure showed a 36.2% reduction in leakage rates and an approximately 3204.6% increase in aerosol extraction efficiency in simulations. The modified hood, even in an open configuration, maintained a droplet leakage rate of less than 0.3%. These findings demonstrate the potential of a CFD-guided design in developing respiratory barriers that effectively reduce aerosol transmission risks during high-risk medical procedures. This approach not only improves the safety of both patients and healthcare providers but also provides a scalable solution for safer execution of AGPs in various healthcare settings.

Objective This study aimed to introduce a novel negative pressure aerosol box (Carrycure Isolator) and to test its efficiency and limitations, with the hope of suggesting improvements and further directions.Methods A novel aerosol box (Carrycure Isolator) was invented. A single-center, randomized, crossover simulation study of 28 emergency medicine physicians was designed. Three trials of each participant using an intubation manikin were conducted, including intubation without the aerosol box (trial A), intubation with the aerosol box (trial B), and intubation with the aerosol box after familiarization (trial C). The primary endpoint was the time to intubation. The secondary endpoints were first-attempt success, number of attempts, percentage of glottic opening score, and Cormack-Lehane view. Collected data were statistically analyzed for their significance.Results The median times to intubation of trials A, B, and C were 30.5 (interquartile range [IQR], 28.0–40.0 seconds), 59.0 (IQR, 50.0–75.5 seconds), and 34.0 seconds (IQR, 30.5–47.0 seconds), respectively. Post hoc analysis showed that the time to intubation in trial B was significantly longer than that in trial A (P<0.05), while that the time to intubation in trial C was significantly shorter than that in trial B (P<0.05). Results concerning secondary endpoints showed similar patterns. Participants reported performing intubation with Carrycure Isolator to be relatively difficult, necessitating significant arm movement and view restrictions while increasing their time to intubation.Conclusion Physicians took a longer time to intubate a manikin using the Carrycure Isolator, a novel negative pressure aerosol box. However, the time was improved after a period of familiarization.

Objective The efficacy of previously developed respiratory barrier enclosures to limit healthcare workers’ exposure to aerosols from COVID-19 patients remains unclear; in addition, the design of these devices is unsuitable for transportation or other emergency procedures. Therefore, we developed a novel negative pressure respiratory isolator to improve protection from patient-generated aerosols and evaluated its protective effect in conversion to systemic isolator. Methods This in vitro study simulated droplets by nebulizing 1% glycerol + 99% ethanol solution. We performed cardiopulmonary resuscitation (CPR) and converted a respiratory barrier enclosure into a systemic isolator with a respiratory barrier as well as a respiratory barrier with negative pressure generator (NPG), which were compared with control and room air. During the procedure, particles were counted for 30 seconds and the count was repeated 10 times. Results During CPR, the total number of particles in the respiratory barrier with NPG (280,529; interquartile range [IQR], 205,263–359,195; P=0.970) was similar to that in the control (308,789; IQR, 175,056–473,276). Using NPG with a respiratory barrier reduced the number of particles to 27,524 (IQR, 26,703– 28,905; P=0.001). Particle number during conversion of the respiratory barrier into a systemic isolator was also lower than in the control (25,845; IQR, 19,391– 29,772; P=0.001). Conclusion The novel isolator was converted to a systemic isolator without air leakage. The aerosol-blocking effect of the isolator was quantified using a particle counter during CPR. Further studies comparing the barrier effect of isolators within various pressure differentials are warranted.

Healthcare providers performing aerosol-generating procedures (AGPs) face significant infection risks, emphasizing the critical need for effective aerosol containment systems. In this study, we developed and validated a negative pressure chamber enhanced with an innovative aerodynamic cap structure designed to optimize aerosol containment. Initially, computational fluid dynamics (CFD) simulations were performed to evaluate multiple structural improvement ideas, including air curtains, bidirectional suction, and aerodynamic cap structures. Among these, the aerodynamic cap was selected due to its superior predicted containment performance, practical feasibility, and cost-effectiveness. The CFD analyses employed realistic transient boundary conditions, precise turbulence modeling using the shear stress transport (SST) k–ω model, and detailed droplet evaporation dynamics under realistic humidity conditions. A full-scale prototype incorporating the selected aerodynamic cap was fabricated and evaluated using physical polyalphaolefin (PAO) particle leakage tests and biological aerosol validation with aerosolized Bacillus subtilis. For the physical leakage tests, the chamber opening was divided into nine sections, and the aerosol dispersion was tested in three distinct directions: ceiling-directed, toward the suction hole, and opposite the suction hole. These tests demonstrated significantly stabilized airflow and substantial reductions in aerosol leakage, consistently maintaining containment levels below the critical threshold of 0.3%, especially under transient coughing conditions. The biological aerosol experiments, conducted in a simulated emergency department environment, involved aerosolizing bacteria continuously for one hour. The results confirmed the effectiveness of the aerodynamic cap structure in achieving at least a one millionth (10⁻⁶) reduction in the aerosolized bacterial leakage compared to the control conditions. These findings highlight the importance and effectiveness of advanced CFD modeling methodologies in accurately predicting aerosol dispersion and improving containment strategies. Although further studies assessing the structural durability, long-term operational ease, and effectiveness against pathogenic microorganisms are required, the aerodynamic cap structure presents a promising, clinically practical infection control solution for widespread implementation during aerosol-generating medical procedures.