Background:Parotitis, inflammation of the parotid gland, is most commonly attributed to infection, salivary duct obstruction, or autoimmune disease; trauma-induced parotitis is uncommon, and blunt-trauma cases are reported less frequently than penetrating injury. Case presentation:We describe a 4-year-old boy who presented to the emergency department with left-sided facial swelling one day after a low-velocity slap to the cheek during play. Examination showed tender left parotid swelling without bruising, pain-limited trismus, and no facial nerve, otologic, oral cavity, or temporomandibular joint abnormalities; a whole-body skin survey and a formal social-work assessment for non-accidental injury were unremarkable. Computed tomography, obtained because the mechanism of injury required clarification and mandibular fracture could not initially be excluded on clinical grounds, showed parotid enlargement with adjacent fat stranding and no fracture. Markedly elevated serum amylase, with normal inflammatory markers and negative viral serology, supported a diagnosis of traumatic parotitis after systematic exclusion of infectious, obstructive, and suppurative causes. The child was managed conservatively and recovered fully within two weeks. Conclusion:This case adds to the limited literature on post-traumatic parotitis by illustrating that even a low-velocity, everyday mechanism such as a slap can produce isolated parotid swelling in children, an association not previously emphasized outside higher-energy blunt trauma. It highlights the value of a structured differential work-up, judicious imaging, and routine safeguarding assessment in this presentation.
Introduction:Water-related emergencies are a major urban public health concern, particularly along Bangkok's heavily trafficked Chao Phraya River. Between 2019 and 2023, Bangkok reported the third-highest drowning mortality rate in Thailand. Although advanced water-based emergency medical service (EMS) units have operated for more than three decades, their operational characteristics have not been systematically evaluated. Objective:To describe the operational characteristics and system structure of advanced water-based EMS units operating along the Chao Phraya River in Bangkok. Methods:A retrospective descriptive study analyzed operational data from January 1, 2021, to December 31, 2023, using mission report databases from the Bangkok Metropolitan Administration EMS Center and three designated advanced water-based EMS units. Key variables included annual incident notifications, mission characteristics, operational outcomes, and system structure. Results:Descriptive evaluation identified several system limitations across all units, including inadequate docking infrastructure, shortages of specialized medical equipment, and the absence of standardized clinical protocols and performance monitoring. Comprehensive quantitative analysis was not possible for Units 2 and 3 because of incomplete operational records. Unit 1 recorded 28, 71, and 52 incident notifications in 2021, 2022, and 2023, respectively, resulting in 11, 50, and 18 EMS missions. Medical assistance was provided in 1, 11, and 9 cases, respectively. These findings are presented descriptively and should not be interpreted as comparisons between units because comparable operational data were unavailable for Units 2 and 3. Conclusion:Available data indicate important gaps in infrastructure, documentation, standardized reporting, and performance monitoring within Bangkok's water-based EMS system. Strengthening the system will require improved docking infrastructure, standardized medical equipment, digitized reporting systems, and the implementation of continuous quality improvement processes.
This commentary examines cyberwarfare targeting healthcare supply chains as an underrecognized threat to emergency medical services (EMS) in the United States, using the March 2026 Stryker cyberincident as a case study. We argue that in the context of prehospital settings, cybersecurity is inseparable from patient safety, operational continuity, and equipment readiness.
Background:Emergency department shock rooms provide immediate care for critically ill patients requiring life-saving interventions. Rapid diagnosis and treatment are crucial determinants of survival, yet factors predicting outcomes in this population remain poorly understood. This study evaluated factors associated with survival among patients hospitalized after shock room treatment in a tertiary medical center. Methods:In this retrospective cohort study, medical records of patients treated in the emergency department shock room of a tertiary referral center were reviewed. Patients were categorized according to hospital survival. Variables analyzed included age, sex, comorbidities, etiology of the acute event, vital signs at admission and discharge from the SR (including blood pressure, heart rate, respiratory rate, body temperature, and oxygen saturation), out-of-hospital mechanical ventilation, and laboratory values including creatinine, hemoglobin, lactate, electrolytes, and coagulation parameters. Results:A total of 101 patients treated over 24 consecutive months were included. The cohort comprised 50 men and 51 women with a mean age of 68±20 years (range 18-100). The mean shock room stay was 4.69±4.3 hours. Sixteen patients (16%) arrived following out-of-hospital resuscitation and were invasively ventilated. Overall, 60 patients (60%) died during hospitalization. Approximately half of all admissions were related to respiratory system morbidity. Mortality was significantly higher among patients aged >65 years than among those aged ≤65 years (75% vs 34%, p=0.046). Oncological disease as a comorbidity was significantly more prevalent in deceased patients (38% vs 10%, p=0.001). Admission creatinine was higher in deceased patients (1.5 vs 0.9 mg/dL, p=0.004) and hemoglobin was lower (11.9 vs 12.9 g/dL, p=0.044). Respiratory rate was significantly higher (18 vs 12 breaths/min, p=0.002) and diastolic blood pressure lower (67.5 vs 79.0 mmHg, p=0.011) in patients who died. Diastolic blood pressure remained significantly lower at shock room discharge in deceased patients (p=0.010). Shock room stay duration (≤4 vs >4 hours) was not significantly associated with mortality (OR 0.66, p=0.320). Conclusion:Age over 65, elevated creatinine, low hemoglobin, high respiratory rate, and low diastolic blood pressure at admission were associated with in-hospital mortality. Persistent diastolic hypotension at shock room discharge was a novel finding. Shock room stay duration was not independently associated with mortality. These findings are exploratory and prospective validation in larger cohorts is needed.
Background:Communication failures in the emergency department (ED) can delay consultations and worsen crowding. Hospitals now use phone-based systems, EMR-integrated secure chat, and EMR-adjacent messaging platforms for consultant communication, but few studies describe ED clinician experience with these workflows. Objective:To describe ED clinicians' perceived acceptability of, and experience with, an EMR-adjacent Microsoft Teams-based consultation workflow used alongside a telephone-based consultation pathway. Methods:We conducted a single-center post-implementation survey of clinicians who used a Microsoft Teams consultation workflow in an academic ED. The primary analysis focused on ED clinician responses; consulting clinician responses were reported descriptively because of the low estimated non-ED response rate. Results:Of 121 respondents, 82 were ED clinicians, and 39 were consulting clinicians. Among ED clinicians, 78.0% reported high acceptability of the Teams consultation workflow, 85.4% perceived improvements in the workflow, and 89.0% perceived a positive impact on patient care. Delays remained common, with 24.4% of ED clinicians reporting that responses were often delayed. Consulting clinician responses are reported descriptively only because of the low estimated non-ED response rate. Conclusion:ED clinicians reported high perceived acceptability of an EMR-adjacent Microsoft Teams consultation workflow used alongside a telephone-based consultation pathway. These results reflect post-implementation clinician perceptions and do not establish improved consultation timeliness, patient flow, or clinical outcomes.
