Emergency Medical Services
Mohammad Hossein Kamaloddini; Anahita Alizadeh Ghamsari; Bita Dadpour
Articles in Press, Accepted Manuscript, Available Online from 27 November 2019
Abstract
The Clinical Toxicology Center in Imam Reza hospital in Mashhad is the referral center of poisonings in the East of Iran and many cases of poisoned children are referred to this center and some cases are admitted.In this letter we report some specific, strange and unusual poisonings in children admitted ...
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The Clinical Toxicology Center in Imam Reza hospital in Mashhad is the referral center of poisonings in the East of Iran and many cases of poisoned children are referred to this center and some cases are admitted.In this letter we report some specific, strange and unusual poisonings in children admitted in our center.
Trauma
Seyed Reza Habibzadeh; Hamid Zamani Moghadam; Neema John Mehramiz; Mahdi Foroughian
Articles in Press, Accepted Manuscript, Available Online from 09 October 2019
Abstract
Objective: Anterior teeth are of utmost importance with regard to chewing, speaking, and beauty. Therefore, any traumatic dental injury has psychologically undesirable effects on children and their parents. The present study reported a case of a traumatic dental injury induced by falling ...
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Objective: Anterior teeth are of utmost importance with regard to chewing, speaking, and beauty. Therefore, any traumatic dental injury has psychologically undesirable effects on children and their parents. The present study reported a case of a traumatic dental injury induced by falling off a bike and referral to an emergency department as well as measures taken for dental reconstruction and patient’s improvement.Case Presentation: An 8-year-old child was taken to an emergency department due to falling off a bike following imbalance, while suffering from dental pain in his upper jaw due to dental subluxation. Afterwards, dental retaining paste along with a fixer wire was used to maintain the position of the teeth. The patient also received oral non-steroidal analgesia (acetaminophen) for proper control of the pain and was subsequently referred to a dentist to repair the teeth. The initial examinations revealed that the child was fully conscious. Considering the patient’s severe pain and intrusion of the superior left primary first tooth and the subluxation of the superior right primary first tooth. Local anesthesia was performed using 1% lidocaine in the location of the given teeth using infiltration technique. Then they were brought into an alignment by extracting the plunged tooth and the child was referred to a dentist for advanced dental trauma care.Conclusion: Dentists are not always present in hospital emergency departments; therefore, an emergency medicine specialist should be able to diagnose common traumatic dental injuries in order to manage them appropriately at the early stages, and if necessary, refer patients to dentists for further complementary treatments. This important fact will bedone after full examination and ruling out critical causes of trauma in the emergency department.
Emergency Medical Services
Peyman Saberian; Mostafa Sadeghi; Parisa Hasani-Sharamin; Maryam Modaber; Amirreza Farhoud; Mehrad Aghili
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 38-42
Abstract
Objective: This study aimed to compare the efficacy of rescue blankets with conventional blankets in terms of preventing hypothermia in the pre-hospital setting. Methods: In this randomized clinical trial, patients older than 18 years old with Cold Discomfort Scale (CDS) > 2, and those who were transferred ...
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Objective: This study aimed to compare the efficacy of rescue blankets with conventional blankets in terms of preventing hypothermia in the pre-hospital setting. Methods: In this randomized clinical trial, patients older than 18 years old with Cold Discomfort Scale (CDS) > 2, and those who were transferred to the emergency department (ED) by emergency medical service entered the study. Patients were randomly divided into two groups based on the type of transfer. In this regard, one group was transferred with rescue blankets and the other group was transferred with conventional blankets. The tympanic temperature in patients and CDS were recorded before the use of blanket (primary) and at the time of arrival in the ED (secondary). Results: Finally, 161 patients with the mean age of 45.31±19.8 years were included (63.4% were male). Totally, 88 cases (54.7%) were transferred with rescue blankets and 73 cases (45.3%) with conventional blankets. The mean of the primary tympanic temperatures in the rescue and conventional blanket groups were 36.20±0.84°C and 36.34±0.65°C, respectively (P=0.23). The mean of the primary CDS in rescue and conventional blanket groups were 6.55±1.95 and 5.89±2.29, respectively (P=0.05). Also, the mean of the secondary tympanic temperatures in the rescue and conventional blanket groups were 36.59±0.47°C and 36.76±0.48 °C, respectively (P=0.03). Besides, the mean of the secondary CDS in the rescue and conventional blanket groups were 2.64±2.80 and 2.41±1.29, respectively (P=0.48). Conclusion: According to the results, there is no significant difference in the tympanic temperature and CDS of the patients transferred with the rescue blanket compared with the conventional blanket
Trauma
Ramin Shahbad; Mohsen Mortazav; Fereshteh Alizadeh-Fard; Zeinab Mohammadi; Fatemeh Alavi; Mohammed N. Ashtiani
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 28-32
Abstract
Objective: Femur is the strongest, longest and heaviest bone in the human body. Due to the great importance of femur in human body, its injury may cause large numbers of disabilities and mortality. Considering various effective parameters such as mechanical properties, geometry, loading configuration, ...
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Objective: Femur is the strongest, longest and heaviest bone in the human body. Due to the great importance of femur in human body, its injury may cause large numbers of disabilities and mortality. Considering various effective parameters such as mechanical properties, geometry, loading configuration, etc. can propel the study to the trustable results.. Methods: A 3D finite element model of the femur was subjected to different impact loading and orientations and also material properties. In addition to a reference healthy model of analysis, a total of 14 cases including four different loading conditions, six different bone density conditions and four different load orientations were considered. Results: Findings showed that the models with higher bone density cannot considerably reduce the stress under the impact loadings but porous models receive high mechanical stress which the bone prone to injury. The stress and displacement of the bone model received more values distributed through the femoral neck. Conclusion: Porous bone models had greater stress values under an impact load. Higher and faster impacts may create multi-fracture breaks of the femur. The inferior femoral neck regions are the most vulnerable part in response to the impacts.
Emergency Medical Services
Surendar Ravipragasam; Deepika Chandar; Vinay R Pandit
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 23-27
Abstract
Objective: Survival-to-discharge rates following in-hospital cardiac arrest (IHCA) patients remain significantly low. The use of initial documented cardiac rhythm as predictor of Survival-to-discharge is still unclear. This study aimed to assess whether the initial documented rhythm can be used as a ...
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Objective: Survival-to-discharge rates following in-hospital cardiac arrest (IHCA) patients remain significantly low. The use of initial documented cardiac rhythm as predictor of Survival-to-discharge is still unclear. This study aimed to assess whether the initial documented rhythm can be used as a predictor of survival-to-discharge following IHCA in an emergency department of the tertiary care referral institute, south India. Methods: This observational study was conducted for six months from January to June 2017 among all patients above 12 years, with witnessed cardiac arrest after arrival at the emergency department. After obtaining informed consent from the patients’ caregivers, data of socio-demographic details, previous relevant medical history, initial documented rhythm, neurologic status and survival-to-discharge were collected and analyzed. Results: The mean age of participants was 50 ± 17.15 years. Of the 252 study participants, 77.4% had non-shockable and 22.6% had shockable rhythm as initial documented rhythm. The overall survival-to-discharge rate was 17.5% (n=44) in our study. The overall proportion of participants who survived to discharge after IHCA was higher among participants with shockable rhythm (16/57, 28%) in comparison to participants with non-shockable rhythm (28/195, 14.3%). These differences were found to be statistically significant. Among the patients with shockable rhythm, 61.1% had good cerebral performance. Conclusion: Survival-to-discharge rates after IHCA can be predicted based on the initial documented cardiac rhythm. Early identification of patients with impending cardiac arrest and providing prompt management of patients with cardiac arrest will improve the survival rates significantly
Emergency Medical Services
Julius Gbenga Olaogun; Amarachukwu Chiduziem Etonyeaku; Joshua Taye Ige; Obafemi Kayode Wuraola
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 7-12
Abstract
Objective: There has been a worldwide rise in the prevalence of penetrating abdominal injury (PAI), and there are both inter-country and intra-country variations in frequencies. This study evaluates the mechanisms and pattern of penetrating abdominal injuries and the treatment outcome in our center.Methods: ...
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Objective: There has been a worldwide rise in the prevalence of penetrating abdominal injury (PAI), and there are both inter-country and intra-country variations in frequencies. This study evaluates the mechanisms and pattern of penetrating abdominal injuries and the treatment outcome in our center.Methods: This descriptive study of adult patients managed for PAI was conducted at the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti from January 2015 to December 2018. Data were prospectively collected and analyzed by using descriptive statistics from Statistical Package for Social Sciences (SPSS) version 20.0.Results: There were 96 patients managed for abdominal injuries during the study period. Forty-six (47.9%) of them had PAI, while 50 (52.1%) others sustained blunt trauma. Patients ages ranged from 17-72 years (mean = 34.2±10.8 years; median = 34 years). Majority, 42 (91.3%), were males, while 4 (8.7%) were females (M: F=11:1). The most afflicted age group was in the 4th decade. Majority of the injuries were due to gunshot (60.9%) followed by stab (26.1%), unsafe abortion (6.5%), road traffic injury (4.3%) and fall (2.2%). Gastrointestinal injuries were the most common with small bowel perforations predominating. Solid organ injuries were only seen in 3 (7.9%) patients. Eight (17.4%) had associated extra-abdominal injuries. Thirty-eight (82.6%) patients required exploratory laparotomy, while 8 (17.4%) were managed non-operatively. The negative laparotomy rate was 2.6%. Seven (15.2%) patients developed complications which were mostly wound infection (10.8%). The duration of hospital stay was 1-58 days (mean 12.7±10.5). Three patients (6.5%) with gunshot injuries died.Conclusion: Gunshot wounds were the major variant of PAI, and the highest cause of mortality from it. Gut injuries were most common, and exploratory laparotomy remains the main-stay of treatment, while non-operative management is practicable in carefully selected cases.
Emergency Medical Services
Sahar Mirbaha; Mohammadmehd Forouzanfar; Amin Saberinia; Amir Salimi; Hamid Kariman; Mozhgan Farmahini Farahani
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 43-46
Abstract
Objective: Each imaging technique has a special application and usage, and should be used in the right situation. Physicians choose the type of imaging technique by considering the type of tissue and the benefits and disadvantages of the imaging method as well as its financial burden on the patient. ...
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Objective: Each imaging technique has a special application and usage, and should be used in the right situation. Physicians choose the type of imaging technique by considering the type of tissue and the benefits and disadvantages of the imaging method as well as its financial burden on the patient. The aim of this study was to estimate the cost of imaging tests performed in the emergency department (ED) of an educational hospital and determine their financial burden on both the patients and the healthcare system of the country. Methods: This retrospective descriptive cross-sectional single-center study was conducted in Shohadaye Tajrish, an educational hospital, during one year. The study population consisted of all patients who had undergone some type of imaging (CT scan, ultrasound, radiography, magnetic resonance imaging [MRI]) in the ED. The information was collected using a predesigned checklist. The costs of a variety of imaging methods for patients referred to the ED were calculated using different types of accounting units and PACS system. Results: The number of patients who visited the ED of the studied hospital during a one year period was 63507. The total cost of performing different types of imaging methods in the studied center throughout the one-year target period was 44018695695 Rials (≃$US 423745) (59.27% of which was spent on CT scan, 16.09% on ultrasound, 13.75% on plain radiography and 10.87% on MRI). Conclusion: According to the collected data, the total cost of radiology was 44018695695 Rials. The highest cost was related to CT scan modality, and the lowest belonged to MRI.
Trauma
Rosanna Varutti; Alessandro Mosca; Nicola Latronico
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 50-52
Abstract
Objective: One of the most frequent causes of death and acquired disability in the pediatric population is the Traumatic Brain Injury (TBI). TBI is secondary to falls, road traffic and vehicle collisions, child abuse and assaults. Penetrating brain injury is a severe form of traumatic brain injury. Blunt ...
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Objective: One of the most frequent causes of death and acquired disability in the pediatric population is the Traumatic Brain Injury (TBI). TBI is secondary to falls, road traffic and vehicle collisions, child abuse and assaults. Penetrating brain injury is a severe form of traumatic brain injury. Blunt head injury is more frequent than TBI in children, but the second one carries a poor prognosis and a worse outcomes.Case Presentation: We report a pediatric case of penetrating craniofacial trauma, caused by a pencil in to the eye, and the successful of multidisciplinary management.Conclusion: Traumatic head injuries in children are frequently seen in the emergency ward, but the penetrating head injuries are unusual in young children. This case shows the importance of the ‘first golden hour’ after head trauma. The collaboration between team members, added to a promptly and invasive strategy, allowed to reduce neurological sequelae.
Emergency Medical Services
Mohammad Paravar; Somaye Safavi; Razie Eghtesadi; Mahdi Mohamadzade; Mojtaba Sehat; Mohammadreza Fazel; Esmaeil Fakharian; Mohammadhosein Makki; Mahzad Erami; Tayebeh Taghipor; Abdolreza dayani najafabadi
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 3-6
Abstract
Objective: Emergency medical services systems are at the first line of dealing with patients who suffer from various infections. Conducting investigations on the bacterial contamination of emergency ambulances play a crucial role to improve the occupational health of staff as well as the quality of patient ...
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Objective: Emergency medical services systems are at the first line of dealing with patients who suffer from various infections. Conducting investigations on the bacterial contamination of emergency ambulances play a crucial role to improve the occupational health of staff as well as the quality of patient care. Therefore, the aim of the present study was to investigate the presence of Staphylococcus aureus and other life treating bacteria in the urban and rural ambulances and their on-call emergency medical service personnel.Methods: This descriptive cross-sectional study was conducted on 12 front line pre-hospital emergency urban and rural ambulances in Kashan, Iran, in 2015. A total of 18 sites were sampled in each ambulance and from the nose of personnel. Grown colonies were confirmed based on colony morphology on mannitol salt agar plates, gram stain reaction and biochemical characteristics reactions.Results: The S. aureus contamination was only isolated from the nose of on-call emergency medical service providers of 12 urban and road ambulances, while no sign of contamination was found in 18 sampling sites of these front-line ambulances. Also, further evaluation of these sampling sites revealed the contamination with coagulase-negative staphylococci in all of them and oxygen tank was introduced as the most contaminated site inside the ambulances. Moreover, the prevalence of equipment contamination was significantly higher in urban ambulances.Conclusion: Identifying the rate of pathogens in clinical settings like the pre-hospital ambulance setting is an important issue which should be carefully considered.
Trauma
Hassan Amiri; Mojtaba Chardoli; Maryam Sarvari; Samad Shams Vahdati; Niloufar Ghodrati; Roshan Fahimi
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 56-60
Abstract
Objective: This study investigates the possible magnetic resonance imaging (MRI) findings in patients with cervical trauma having a normal level of consciousness and normal CT reports. These patients have tenderness or an uncomfortable feeling in the traumatized area as well.Methods: In this cross-sectional ...
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Objective: This study investigates the possible magnetic resonance imaging (MRI) findings in patients with cervical trauma having a normal level of consciousness and normal CT reports. These patients have tenderness or an uncomfortable feeling in the traumatized area as well.Methods: In this cross-sectional anterograde study, cases were selected among patients referred to the emergency department of Hafte Tir, Iran University of Medical Sciences from 2012 to 2014. Inclusion criteria to select cases were: age above 15, blunt neck trauma, GCS=15, normal CT scan reports of neck, no past medical history of cervical vertebral surgery, and no persistent neurologic lesions. In order to analyse qualitative data, chi-square test was used and for quantitative data t test was applied accordingly.Results: Two hundred eighty patients with chief complaints of neck pain due to trauma entered our study. Among this batch, 264 of them had normal CT scan reports and MRI was done for all of them. According to the results, the maximum injury in MRI was related to intervertebral disc injury (38 cases), ligamentous edema (35 cases), and muscle edema (22 cases), respectively. Neck tenderness from the beginning of the accident and transient neurologic signs had a significant role in MRI results (P < 0.05).Conclusion: In patients with acute cervical trauma having normal CT reports, MRI must be done in those with the average age of 45 or more, tenderness in the neck area, and in those with neurologic transient symptoms.
Emergency Medical Services
Fereshteh Jamali; Haniyeh Ebrahimibakhtavar; Mahbubeh Zomordi Torkdari; Farzad Rahmani
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 37-40
Abstract
Objective: Assessing patients’ satisfaction with emergency medical services (EMSs) is an important managerial point of view. The present study aimed to assess the patients’ satisfaction with EMS in Tabriz, Iran.Methods: This is a descriptive-analytic study that was done in the prehospital ...
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Objective: Assessing patients’ satisfaction with emergency medical services (EMSs) is an important managerial point of view. The present study aimed to assess the patients’ satisfaction with EMS in Tabriz, Iran.Methods: This is a descriptive-analytic study that was done in the prehospital emergency and disaster management center of Tabriz University of Medical Sciences. In this study, from May to December 2017, we included 659 patients who were transferred to hospitals with our prehospital emergency services. A valid and reliable questionnaire was used to evaluate the satisfaction of patients about the performance of prehospital EMSs.Results: Data of 659 patients were evaluated. Trauma was the most common cause of contact with 115 and help request (33.83%). The results indicated that patients’ level of satisfaction was good and very good. The highest level of satisfaction was related to the treatment of patients and use of medical equipment in the ambulance (n=578 patients, 87.7%) as well as the treatment practiced by the emergency medical technicians (EMTs) (n=575 patients, 87.24%). However, the lowest level of satisfaction was related to the absence of an active EMT in the rear cabin when transferring patients to the hospital (n=337 patients, 51.14%) and transfer of the patient from the accident scene to the ambulance (n=410 patients, 62.21%).Conclusion: Patients’ satisfaction with EMS was optimal. The minimum and maximum satisfaction rates were related to the absence of an active EMT in the rear cabin, treatment of the patient, and use of medical equipment.
Trauma
Esmaeil Fakharian; Zahra Sehat; Mojtaba Sehat
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 65-70
Abstract
Objective: Traumatic spine injuries are seriously important and are associated with considerable morbidity and mortality. The goal of this study is to determine the epidemiology of the traumatic spine injuries in Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS), the main trauma ...
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Objective: Traumatic spine injuries are seriously important and are associated with considerable morbidity and mortality. The goal of this study is to determine the epidemiology of the traumatic spine injuries in Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS), the main trauma center in Kashan, Iran.Methods: This cross-sectional study was undertaken on all cases of traumatic spinal injuries that were admitted to Shahid Beheshti hospital of KAUMS from 2014 to 2017. A checklist was used to collect demographic characteristics (age, gender, education, marital) and mechanism of the injury of the spine. According to ICD-10, the level of the injury was detected by diagnostic tests such as radiologic imaging and magnetic resonance imaging and computed tomography scans, and also multi-trauma final outcome of the patients with traumatic spine injury (TSI) and rate of the spinal cord injury (SCI), hospital length of stay and surgery treatment was investigated.Results: The number of patients with traumatic spine injuries was 986. Among this batch, 77% were males. The mean age of the patients was 39.5 years. Most injuries occurred in the age group of 15 to 30 years. Traffic accident was the most common mechanism of the trauma (35.2%) followed by the falls (26.95%) motorcycle accident (17.9%), assault by a sharp object or an unspecified object (10.13%) and other reasons (5.6%). The most common site of injury was in lumbar section (24.41%). Patients with traffic accident injury had the longest hospitalization. The rate of SCI was 2.63% and the rate of mortality was 2.3%.Conclusion: The TSI is an important and serious public health problem and a major cause of disability. Understanding the epidemiology can help us contrive appropriate preventative measures.
Trauma
Manoel Francisco de Campos Neto; Vidal Haddad Junior
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 81-84
Abstract
This communication describes two attacks by domestic and wild carnivores in Caceres County, localized in the Pantanal area, an extensive flooded plain in Mato Grosso State, Midwest region of Brazil. The first attack took place in an urban area and was caused by a Rottweiler dog (Canis lupus familiaris) ...
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This communication describes two attacks by domestic and wild carnivores in Caceres County, localized in the Pantanal area, an extensive flooded plain in Mato Grosso State, Midwest region of Brazil. The first attack took place in an urban area and was caused by a Rottweiler dog (Canis lupus familiaris) created by the family of the victim. Another attack occurred in a rural area, caused by a jaguar (Panthera onca), which was disturbed while feeding, characterizing an unprovoked attack. Both the patients were wounded in the forearm, with different severity of the wounds. The lesions restricted to the forearm were the consequence of the victims using their arms as a shield, featuring the “defense” injuries, but the severity of the wounds were proportional to the strength of the attacking carnivore. Health staffs and emergency centers should be alert for soft tissue and bone injuries in the observed body regions after domestic and wild animal attacks.
Trauma
Nahid Zamanimehr; Samad Shams Vahdati; Hamed Hojjatpanah
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 61-64
Abstract
Objective: Fluid resuscitation is necessary in almost all critical patients. The central venous pressure (CVP) is a well-established method of assessing resuscitation. Recently, there have been attempts to investigate less invasive methods like the diameters of inferior vena cava (IVC) or the jugular ...
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Objective: Fluid resuscitation is necessary in almost all critical patients. The central venous pressure (CVP) is a well-established method of assessing resuscitation. Recently, there have been attempts to investigate less invasive methods like the diameters of inferior vena cava (IVC) or the jugular vein. We aimed to investigate this method in our research.Methods: Seventy eight critical patients admitted to the emergency department from April 2018 to December 2018 were studied. The CVP was measured along with the diameters of the two mentioned veins before and during resuscitation. The urinary output was also recorded after administering the fluid. The minimum p-value that would illustrate a significant association was equal to 0.05.Results: Findings showed that 53.8% of patients were males and 46.2% were females with an average age of 71.48 years. The causes of the critical state were 25.6% hemorrhagic shocks, 30.8% septic shocks and 43.6% hypovolemic shocks. The mean diameter of the jugular vein before and during resuscitation was 27.21 mm and 25.38 mm, respectively (P = 0.1). The mean of IVC diameter before and during resuscitation was 63.33 mm and 57.98 mm, respectively (P <0.001). The CVP was 4.23 mmHg before resuscitation and 5.61 mmHg after resuscitation (P <0.001). With an average urine output of 201.28 cc, a significant correlation was observed with the increase in the CVP, while no such correlations were observed with the decreasing state of the diameters of the IVC or the jugular vein.Conclusion: Both the IVC diameter and the jugular vein diameter are unable to assess fluid resuscitation independently from respiratory factors
Emergency Medical Services
Samuel Olufemi Bolarinde; Isaiah Oyewole; Adesola Felix Abobarin
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 41-46
Abstract
Objective: Musculoskeletal disorders (MSDs) are one of the major complaints in the work place. This study investigated the prevalence and pattern of work-related MSDs, risk factors and the strategies of management among nurses working in various specialty areas in a tertiary health institution in Nigeria.Methods: ...
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Objective: Musculoskeletal disorders (MSDs) are one of the major complaints in the work place. This study investigated the prevalence and pattern of work-related MSDs, risk factors and the strategies of management among nurses working in various specialty areas in a tertiary health institution in Nigeria.Methods: This cross-sectional survey recruited 150 nurses working in various specialty areas of a government own tertiary institution in South-west, Nigeria. Data were obtained on demographic characteristics, occupational profile, work-related musculoskeletal symptoms, perceptions on job risk factors and management strategies. Data were presented using descriptive statistics of percentages and frequency tables.Results: The most common MSD among the respondents was low back pain (LBP) (60.0%), followed by neck pain (48.0%), while elbow pain was the lowest work-related musculoskeletal pain (5.3%). Findings indicated that respondents working in Intensive Care Unit (100.0%), Dental Unit (100.0%), Accident and Emergency (77.8%), Orthopaedics (75.0%), Ear Nose and Throat (75.0%) and Medicine (72.7%) suffered from LBP more than other respondents in other specialty areas. Results also revealed that frequent bending (64.0%), prolonged standing (49.3%) and frequent lifting of patients (48.0%) were major factors that contributed to LBP among the respondents. Rest (56.0%), pain killer drugs (50.7%), and exercise (36.0 %) were the most preferred pain management strategies among the respondents, while only 12.0% preferred physiotherapy management.Conclusion: A great percentage of Nigerian nurses suffer from work-related MSDs in their professions with the low back being the most injured body part. Nurses working in Intensive Care Unit, Dental, Accident and Emergency and Orthopedics are more prone to work-related LBP. Education programs on back care and workplace ergonomics are recommended for reduction and prevention of occupational hazards among nurses.
Emergency Medical Services
Bontha V Babu; Yogita Sharma
Volume 5, Issue 1 , Winter and Spring 2019, , Pages 2-7
Abstract
Road traffic injuries (RTIs) are the sixth leading cause of deaths in India and about 400 deaths take place every day due to road traffic accidents. The present paper analyses the data of the India’s National Crime Record Bureau (NCRB) to assess the burden of RTI. In addition, it reports the health ...
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Road traffic injuries (RTIs) are the sixth leading cause of deaths in India and about 400 deaths take place every day due to road traffic accidents. The present paper analyses the data of the India’s National Crime Record Bureau (NCRB) to assess the burden of RTI. In addition, it reports the health systems research initiated by the Indian Council of Medical Research (ICMR). As per NCRB data, in 2015, 6.3 million persons (50 persons per 10 million population) injured and out of them 1.4 million (11 persons per 10 million population) died in India. Except the NCRB data, there are no nation-wide data on RTI and the data remain poorly collected and sporadic in India. Hence, ICMR has initiated a multi-centric study to establish an electronic-based comprehensive and integrated RTI surveillance system. The second issue on which ICMR undertake research is timely and quality care of RTI patients as many deaths occur either at the scene or en route to the hospital. There is a clear survival and functional benefit for critically injured patients to receive appropriate care within the first 60 minutes of injury (‘golden hour’). Hence, this multi-centric study has been initiated to standardize structured evidence-based intervention for safety, efficacy and quality of post-crash pre-hospital and in-hospital trauma care services to improve the outcome in RTI victims. An android-based trauma registry is being built and will be used to assess the impact of interventions. These studies will provide first comprehensive estimates on various epidemiological issues related to RTI. Also, an evidence of improvement through quality post-crash prehospital and in-hospital trauma care services will emerge. These results will contribute to the setting of research and investment priorities and to formulate policies and guidelines.
Emergency Medical Services
Ali Sadrollahi; Adeleh Gharataghani; Mehdi Mahmoudi; Fardaneh Gholipour
Volume 4, Issue 2 , Summer and Autumn 2018, , Pages 55-61
Abstract
Objective: The key point to detect patients’ need in pre-hospital emergency is to have high ability to take medical history. All research findings show that this ability is low. The objective of this research is to investigate the ability to take medical history of patients among the personnel ...
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Objective: The key point to detect patients’ need in pre-hospital emergency is to have high ability to take medical history. All research findings show that this ability is low. The objective of this research is to investigate the ability to take medical history of patients among the personnel of pre-hospital emergency medical service (EMS) in Golestan province, Iran.Methods: This research was a descriptive cross-sectional study carried in 2016. The population included non-staff technicians and an operator working in the message center (N = 171). The samples were selected using multi-stage cluster sampling. Data were collected by a researcher-developed questionnaire. The collected data were analyzed by SPSS software version 16 conducting descriptive and inferential statistics. All tests were administered at a significance level of P < 0.05.Results: One hundred sixty-five (96.5%) participants were male. The mean score of the ability to take medical history was 58.4 ± 11.1. Therefore, 95 participants (58.3 %) had poor ability and 64 participants (39.3 %) owned moderate ability. The highest score concerning the ability to take medical history was for the aspect of professional knowledge (mean rank = 5). The most influential aspect in the ability was respectively for ‘professional knowledge’ (P = 0.0001, Beta = 0.509). Pearson correlation coefficient indicated a relationship (r=-0.149, P = 0.05) between the ability to take medical history and age.Conclusion: The results of the current study indicated that the ability to take medical history among the personnel of pre-hospital medical emergency of Golestan province was low. Therefore, a thorough review of trainings promoting personnel’s professional knowledge is urgently required.
Clinical Toxicology
Luis Rafael Moscote-Salazar; Guru Dutta Satyarthee; Nidia Escobar Hernandez; Jorge Aquino Matus; Willem Guillermo Calderon-Miranda; Marco Antonio Blancas-Varas; Johana Maraby; Joulen Mo-Carrascal
Volume 4, Issue 2 , Summer and Autumn 2018, , Pages 53-54
Abstract
Scuba diving is associated with an important risk of developing decompression sickness secondary to formation of gas bubbles inside the body. The latter is formed mainly by nitrogen in the body on the diver’s way to the surface (1,2). In some cases, it might injure the central nervous system. ...
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Scuba diving is associated with an important risk of developing decompression sickness secondary to formation of gas bubbles inside the body. The latter is formed mainly by nitrogen in the body on the diver’s way to the surface (1,2). In some cases, it might injure the central nervous system. Several decompression cases that have been associated with neurologic symptoms are described in the literature; however, brain multi-infarct with lethal outcome has never been described.
Trauma
Reza Bidaki; Mehrdad Roozbeh; Mohamad Amin Sharifi; Seyed Nader Mostafavi; Mohammad Ali Abdolkarimi Davarani
Volume 4, Issue 2 , Summer and Autumn 2018, , Pages 86-88
Abstract
Factitious disorder as Munchausen syndrome is a time and money consuming condition that is presented with different signs and symptoms. In emergent situations, it is not a differential diagnosis with high priority, but when it becomes recurrent with atypical symptoms, factitious disorder and malingering ...
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Factitious disorder as Munchausen syndrome is a time and money consuming condition that is presented with different signs and symptoms. In emergent situations, it is not a differential diagnosis with high priority, but when it becomes recurrent with atypical symptoms, factitious disorder and malingering should be considered as well. In this survey, we report an odd and interesting presentation of a factitious disease as a scorpion sting which misled some professional healthcare providers until the patient finally confessed that she used turmeric to mimic the signs of a scorpion sting. She exaggerated her symptoms when asked about the details of the mechanism of the scorpion bite. When encountering an emergent condition, after ruling out the critical conditions especially when the symptom is recurrent, factitious disorders should be considered. Consultation with a psychiatrist help the team manage the patient properly.
Emergency Medical Services
Hammoda Abu-Odah; Akram Abu Salah; Ali El-Khateeb; Khawla El-Nems
Volume 4, Issue 2 , Summer and Autumn 2018, , Pages 77-81
Abstract
Objective: Patients’ satisfaction (PS) is recognized as an important emergency department service design and it has received a high interest and attention in the health management where many studies have focused on determining factors affecting PS in health-related circumstances. In this study, ...
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Objective: Patients’ satisfaction (PS) is recognized as an important emergency department service design and it has received a high interest and attention in the health management where many studies have focused on determining factors affecting PS in health-related circumstances. In this study, we aimed to examine PS in emergency department (ED) of the European Gaza Hospital (EGH) in the Gaza Strip (GS).Methods: A descriptive-analytical cross sectional study was performed at ED-EGH between March, 15 and June 20, 2015. Press Ganey questionnaire was used as a tool for data collection. For each patient, a self-administered questionnaire including 22 questions was filled based on a Likert scale. Results were analyzed using SPSS version 22.Results: Overall, 200 respondents were included in the study. About 73% of respondents were satisfied with overall medical services. The term of nurses’ concern provided to patients elicited the highest score (83.1%), followed by physicians’ concern with patients (72.0%) and communication skills with patients (71.4%), while the lowest score was reported in waiting time and security staff. Furthermore, our findings show an association between PS and level of education, gender differences, living area, and work shifts.Conclusion: The study results conclude that areas of medical and nursing care, respects of staff, physical comfort and waiting time ED-EGH is highly acceptable and offer in appropriate manners.
Emergency Medical Services
Seyedhossein Ojaghihaghighi; Samad Shams Vahdati; Simin Taghavi; Aydin Rahimzade Jahandari; Pegah Sepehri Majd; Mohammad Mirza-Aghazadeh-Attari
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 44-47
Abstract
Objective: Pregnancy is an important psychological and biological phenomenon in women’s life. Pregnancy has many complications jeopardizing the well-being of the mother and the child. Methods: In this retrospective study, the data including demographic information, chief complaint, the initial ...
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Objective: Pregnancy is an important psychological and biological phenomenon in women’s life. Pregnancy has many complications jeopardizing the well-being of the mother and the child. Methods: In this retrospective study, the data including demographic information, chief complaint, the initial diagnosis, referral decision, final diagnosis, hospitalization outcome and pregnancy outcomes were studied on 239 pregnant women admitted to the emergency departments of the general hospitals of East Azerbaijan province. Results: The average age of patients was 27.54 years. The time period from the initial presentation to completely leave the emergency department was reported to be 3.66 hours on average. In this study, most patients (74.5%) did not have a history of abortion. Exploring the time of admission for all cases, most patients were admitted from 8 pm to 8 am (67.8%), and 32.2% were referred from 8 am to 8 pm. Concerning the time of pregnancy, 46.4% were at their second trimester of pregnancy. Most of the patients were admitted in cold seasons of the year. The most common chief compliant was abdominal pain with 32.2% frequency. In addition, the most frequent primary diagnoses were an acute abdomen and trauma at 25.5% and 14.2% respectively. Conclusion: Abdominal pain and acute abdomen have the most frequency as the chief compliant and initial diagnosis especially during the second trimester of pregnancy. In this regard, appropriate training and skillful staff are needed to deal with the complaints and complications of abdominal pain. More than half of pregnant women referred to the emergency departments were hospitalized or admitted to the intensive care unit (ICU). This signals the necessity of adequate facilities to provide proper care for this group.
Emergency Medical Services
Alireza Ala; Farzad Rahmani; Reza Aslzad; Zahra Parsian
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 14-17
Abstract
Objective: On account of the widespread use of nuclear energy in different fields, nuclear accidents and disasters have been on a rise. Thus, it is crucial for medical staff especially emergency department personnel to be aware of the nature of these accidents. This study was designed to evaluate the ...
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Objective: On account of the widespread use of nuclear energy in different fields, nuclear accidents and disasters have been on a rise. Thus, it is crucial for medical staff especially emergency department personnel to be aware of the nature of these accidents. This study was designed to evaluate the effect of training on the knowledge of physicians and nurses regarding nuclear disasters. Methods: This pre-and post-intervention study was conducted on 97 emergency department personnel including physicians and nurses of educational hospitals in Tabriz University of Medical Sciences. Educational classes and training about nuclear disasters and managing these events were held. A standard questionnaire was used to evaluate the knowledge before and after training, and the effect of education on personnel’s knowledge. Results: Our participants included 41 males and 56 females. The mean age was 32.88 years. The mean score of participants before and after the class was 4.03 ± 1.54 and 7.93 ± 1.55 respectively; which showed a statistically significant difference (P < 0.001). Among medical staff, physicians had better knowledge compared with the other group. Conclusion: This study showed that the knowledge of medical staff about nuclear disasters is low and educational classes are necessary to increase their knowledge.
Emergency Medical Services
Somaye Younesian; Reza Shirvani; Ali Tabatabaey
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 3-8
Abstract
Objective: Patient satisfaction (PS) is a major quality assessment index for the emergency department (ED) which affects patient safety, litigation, reimbursements, and consumer satisfaction. In this study we aimed to recognize the factors affecting PS in our center. Method: Random shifts during a week ...
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Objective: Patient satisfaction (PS) is a major quality assessment index for the emergency department (ED) which affects patient safety, litigation, reimbursements, and consumer satisfaction. In this study we aimed to recognize the factors affecting PS in our center. Method: Random shifts during a week were selected and all patients disposed from the ED were asked to fill out a revised and validated Persian version of the Press-Ganey questionnaire with the help of a research assistant. Results were analyzed using a linear regression model by SPSS software version 21. Results: Findings reaffirmed some of the factors previously described. These included longer door to treatment area times having a negative effect on satisfaction (P < 0.001), and providing vivid discharge information improving PS (P < 0.001). Other important factors were also found that had not previously been focused on, namely cleanliness of the area (P < 0.0001) and courtesy of the staff in charge of patient transfer (P = 0.03). We also found that men had a more satisfying ED experience (P = 0.002). Conclusion: Cultural expectations may have an important effect on PS. Thus, every institution should determine and alter the expectations most relevant to them.
Trauma
Ali Reza Shafiee-Kandjani; Seyed Gholamreza Noorazar; Saeed Aslanabadi; Nasim Rashedi; Mehrnaz Dadkhah; Mohsen Jafarzadeh-Gharehziaaddin
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 18-23
Abstract
Objective: Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent and impairing levels of inattention, impulsivity and hyperactivity. Evidence shows that adolescents with ADHD are more exposed to trauma. This study aimed to investigate the relationship between ADHD symptom severity ...
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Objective: Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent and impairing levels of inattention, impulsivity and hyperactivity. Evidence shows that adolescents with ADHD are more exposed to trauma. This study aimed to investigate the relationship between ADHD symptom severity and trauma severity. Methods: In this descriptive correlational study, the study population included traumatic adolescents aged 12-18 years referred to Shohada hospital in Tabriz, Iran in 2016. Among this population, 91 subjects were selected. In order to exclude subjects with other psychiatric disorders, a psychiatrist performed clinical interviews with them. In this regard, the short form of Conner’s Comprehensive Behavior Rating Scales Revised Edition (CBRS-R) and Pediatric Trauma Scale were used. For data analysis, Pearson correlation coefficient and independent t test were applied. Data were analyzed using SPSS software version 22. Results: There was a significant positive relationship between trauma severity and ADHD score, hyperactivity, and oppositional/Impulsivity (P < 0.01). Conversely, no statistical significance was observed between attention deficiency and trauma severity. The severity of trauma was higher among ADHD group than normal individuals. There were also correlations between socioeconomic status (SES) and oppositional/impulsive patients. In this regard, higher scores of oppositional/impulsivity were observed among patients with lower SES. Conclusion: Traumas have significant effects on economic and humanistic aspects of life in modern era. Our findings showed that there was a statistically significant relationship between hyperactivity-inattention and trauma intensity in adolescents. Therefore, to prevent traumatic events, ADHD screening at schools is suggested. By the same token, informing parents through mass media can help reduce the consequences of inattention/ hyperactivity disorder in the society.
Emergency Medical Services
Seyyed Hosein Montazer; Behzad Feizzadeh; Farzad Bozorgi; Seyed Mohammad Hosseininejad; Ayyoub Barzegarnezhad; Iraj Golikatir; Fatemeh Jahanian; Hasan Motamed; Hamed Aminiahidashti
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 39-43
Abstract
Objective: The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard.
Methods: This double blind clinical trial was conducted on >18 ...
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Objective: The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard.
Methods: This double blind clinical trial was conducted on >18 years old renal colic patients in need of pain management in emergency department. Pain severity was recorded as 15, 30, and 60 minutes before injection, and 120 minutes after injection. In addition, side effects were compared between IV acetaminophen and morphine sulfate groups using SPSS version 16.
Results: A total of 355 patients were randomly allocated to one of the treatment groups. There were no significant differences between the two groups regarding baseline characteristic of participants. There was no significant difference in the pain intensity of the groups; 15 (P = 0.13) and 30 (P = 0.15) minutes after treatment. Although, the difference in pain severity was statistically significant between the two groups; 60 (P = 0.02) and 120 (P = 0.003) minutes after the infusion. This was not clinically important. The prevalence of side effects in morphine group was higher than the acetaminophen group (RR: 2.14, 95% CI: 1.53-2.98, P< 0.0001).
Conclusion: Based on the findings, IV morphine sulfate and acetaminophen had equal effectiveness regarding acute renal colic pain management, but considering the significantly higher frequency of side effects, IV acetaminophen seems to be a more reasonable choice in this regard.