Emergency medicine
Amin Beigzadeh; Elham Sharifpoor; Maryam Maroufi
Volume 10, Issue 1 , January 2024, , Pages 4-6
Abstract
A significant portion of medical students learning is dedicated to clinical education, especially in the field of Emergency Medicine (EM). Clinical rotations in the Emergency Department (ED) are of utmost importance, given the vital role emergency medicine plays within the healthcare system. Emergency ...
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A significant portion of medical students learning is dedicated to clinical education, especially in the field of Emergency Medicine (EM). Clinical rotations in the Emergency Department (ED) are of utmost importance, given the vital role emergency medicine plays within the healthcare system. Emergency departments represent the forefront of medical care, frequently addressing life-threatening circumstances that necessitate swift decision-making, advanced clinical expertise, and the capacity to operate effectively under pressure. Familiarizing medical students with this high-stakes environment provides them with critical competencies, including acute care management, collaborative teamwork, and proficient communication skills, all of which are relevant across various medical disciplines. In this regard, the Society for Academic Emergency Medicine outlines a four-year curriculum for emergency medicine training. First-year students learn basic first aid, CPR, and the local EMS system. Second-year students apply pathophysiology to acute presentations and practice diagnosis skills. Third-year students refine history-taking and examination techniques, working with residents in lower-acuity areas and beginning differential diagnoses. Throughout, students focus on professionalism, communication, and teamwork, preparing them for future roles in emergency medicine.
Emergency medicine
Ehsan Alishapour; Samrad Mehrabi
Volume 10, Issue 1 , January 2024, , Pages 17-21
Abstract
Objective: The epidemiology of drug poisoning is an essential field of study in public health research that explores the many aspects of this urgent problem. Accidental poisoning is the third most common cause of death and the fifth most common reason for hospital visits in several developing countries. ...
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Objective: The epidemiology of drug poisoning is an essential field of study in public health research that explores the many aspects of this urgent problem. Accidental poisoning is the third most common cause of death and the fifth most common reason for hospital visits in several developing countries. Pharmaceutical poisoning is the second most common cause of hospital admissions and deaths in Iran, where unintentional poisoning remains a serious health concern. This research aims to thoroughly investigate all aspects of drug poisoning cases using epidemiological analysis.Methods: This study analyzed the records of 701 consecutive patients at Shiraz Faghihi hospital Medical Emergency Center in Iran between April 1 and September 30, 2022. Poisoning diagnosis was determined based on reports and documents. Data were collected from patient medical records and analyzed using SPSS software, with a significance level set at P < 0.05. The chi-square test was used to compare the means of drug-posing variables and demographic variables.Results: This study reviewed 701 cases, with an average age of 35.02 ± 16.104 (P < 0.001), 45.8% of whom had education levels higher than high school (P = 0.012). The majority (66.6%) had no psychiatric history (P < 0.001), and 55.6% had no history of addiction (P < 0.001). The predominant poisoning agent was opium (48.9%), followed by benzodiazepine poisoning (40.2%). About 10% were attributed to other causes. A mortality rate of 3.4% was observed, and 96.6% of the cases survived.Conclusion: The study underscores the crucial importance of addressing drug usage for both prevention and therapy. Additionally, the revelation that medicines often serve as the primary source of toxicity, particularly in developing countries, emphasizes the high accessibility and potential hazards associated with these medications.
Emergency medicine
Amir Ghaffarzad; Neda Seyedi; Abazar Fathollahzadeh; Homayon Sadeghi Bazargani; Hassan Vaezi; Farzad Rahmani
Volume 10, Issue 1 , January 2024, , Pages 27-32
Abstract
Objective: The vehicle’s heaviness increases the severity of the accident and the probability of death. The study aimed to compare the severity of injuries and the outcome of the injuries caused by accidents between heavy vehicles and light vehicles. The physiological variables of the patients, ...
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Objective: The vehicle’s heaviness increases the severity of the accident and the probability of death. The study aimed to compare the severity of injuries and the outcome of the injuries caused by accidents between heavy vehicles and light vehicles. The physiological variables of the patients, the variables related to the accident, and the patients’ outcomes were evaluated to achieve this goal. The output was based on bivariate analysis.Methods: This cross-sectional descriptive study was conducted in the emergency department of Imam Reza (AS) Hospital of Tabriz between March 2022 and July 2024. Four hundred nine multi-trauma patients related to road traffic accidents (RTAs) were included. The sampling method employed was a full census. Physiologic variables about patients and trauma severity were recorded. All data entered into SPSS 24.0 were compared between two groups using chi-square and independent samples t-tests.Results: This study included 314 (76.8%) patients injured by light-vehicle accidents and 95 (23.2%) patients injured by heavy-vehicle accidents. The mean of trauma severity scores including GAP, RGAP, NTS, RTS, and REMS in heavy-vehicle accidents group were 17.0 ± 5.9, 16.3 ± 6.5, 15.6 ± 6.5, 6.2 ± 1.9, and 5.9 ± 5.6 respectively, and they were 22.4 ± 3.3, 21.8 ± 3.7, 21.8 ± 3.5, 7.6 ± 0.9, and 2.4 ± 3.1, respectively, in light-vehicle accidents. There were significant statistical differences between the two groups concerning the trauma severity scores of patients based on vehicle type (P < 0.001).Conclusion: The study results show that the severity of trauma in heavy-vehicle accidents is higher, and the injured are in more critical conditions. Therefore, it is necessary to identify the factors involved in heavy-vehicle accidents and take measures to reduce them.
Emergency medicine
Daniel AA Umezurike; Aloysius Ugwu-Olisa Ogbuanya; Bieda Fongue Jean Robert; Ifeoma Cecilia Ekwunife
Volume 10, Issue 1 , January 2024, , Pages 65-69
Abstract
Objective: The spleen is the most frequently injured organ in blunt abdominal trauma (BAT). We present an interesting case of traumatic splenic rupture in pregnancy managed successfully by emergency splenectomy in a low-resource setting.Case Presentation: A 27-year old multiparous woman at 23 weeks gestational ...
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Objective: The spleen is the most frequently injured organ in blunt abdominal trauma (BAT). We present an interesting case of traumatic splenic rupture in pregnancy managed successfully by emergency splenectomy in a low-resource setting.Case Presentation: A 27-year old multiparous woman at 23 weeks gestational age presented to the emergency department with a history of BAT following a road traffic accident (RTA). This study was conducted in the Department of Surgery, General Surgery Unit, College of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria, in 2023. A vehicle strayed and hit her from the left side of the abdomen while she was sitting down. She suddenly developed abdominal pain, bruises on the left upper abdomen, andprogressive abdominal distension. The abdominal ultrasound report showed a deep trabecular laceration and massive hemoperitoneum. The fetus was viable from obstetric and ultrasound assessments. The patient was hemodynamically unstable and was subsequently prepared for emergency exploratory laparotomy. Intraoperatively, incomplete hilar avulsion injury and multiple parenchymal lacerations of the spleen were noted. An accessory spleen without injury was also noted. Splenectomy with preservation of the accessory spleen was performed.Postoperatively, the fetus remained viable, and the patient was hemodynamically stable. The mother had no morbidities other than paralytic ileus and fever, and both were amenable to conservative management.Conclusion: Emergency splenectomy is a life-saving procedure in hemodynamically unstable patients with splenic trauma, even in pregnancy.
Emergency medicine
Shiva Salmasi; Sadaf Dilmaqani; Hanieh Ebrahimi Bakhtavar; Alireza Ala; Farzad Rahmani
Volume 9, Issue 2 , July 2023, , Pages 104-108
Abstract
Objective: This study aimed to evaluate the relationship between clavicular fracture and associated injuries in multi-traumatic patients.Methods: In this prospective cohort study, 185 multi-traumatic patients referred to the Emergency Department of Imam Reza (AS) Hospital of Tabriz University of Medical ...
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Objective: This study aimed to evaluate the relationship between clavicular fracture and associated injuries in multi-traumatic patients.Methods: In this prospective cohort study, 185 multi-traumatic patients referred to the Emergency Department of Imam Reza (AS) Hospital of Tabriz University of Medical Sciences were selected between August 2019 and September 2021. The census sampling method was used until the required sample size was achieved. The following patient information was recorded and studied: mechanism of trauma, age, gender, Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), the presence of clavicular fracture, concomitant injuries, hospital outcome, duration ofhospitalization, and severity of trauma. The participants were divided into two groups based on the presence of a clavicular fracture. Data were analyzed using SPSS software.Results: Of all 185 patients, 51 had clavicular fractures. The mean age of the patients was 34.72±12.99. Of all patients, 27.6% had clavicular fractures. There was no statistically significant difference in GCS scores between the two groups (P=0.927). The highest percentage of injuries associated with clavicular traumas was traumatic brain injuries, with rates of 22.4% and 19.6% in the study and control groups, respectively. There were statistically significant differences inconcomitant injuries between the two groups (P
Emergency medicine
Zainab Mehdi; Daljinderjit Kaur; Parv kamra; Nidhi Arora; Narinder kaur; Shivam Bansal
Volume 9, Issue 2 , July 2023, , Pages 138-141
Abstract
Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easy alternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure, predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestion with spontaneous pneumothorax, ...
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Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easy alternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure, predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestion with spontaneous pneumothorax, spontaneous pneumomediastinum, and pneumorrhachis. Aim is to reinforce the importance of a high index of suspicion in early diagnosis when the above findings are present with ARDS in absence of trauma and a history of alleged substance ingestion.Case Presentation: A 35-year-old male presented with loose stool occasionally bloody, oral ulcers, yellow discoloration of eyes with fever, and decreased urine output for three days after consuming some substance with his seafood. On examination, he had yellow discoloration of eyes and oral mucosa along with multiple ulcers on the buccal region as well as the dorsum of the tongue and lateral margins with generalized subcutaneous emphysema. In addition, decreased air entry in the bilateral lung field and muffled heart sounds were present. He had an acute hepatorenal failure and severe metabolic acidosis with respiratory failure. Urine tested positive for myoglobin and muscle enzymes (creatinine kinase and lactate dehydrogenase (LDH)) were raised. He was intubated and shifted to the intensive care unit. Injectable N-acetyl cysteine (NAC) for acute liver failure was started with empirical antibiotics and intravenous fluids. We supplemented thiamine and vitamin K, and hemodialysis was done in view of progressive renal failure. Radiological evaluation showed spontaneous pneumothorax, pneumomediastinum, and pneumorrhachis which were managed conservatively. His respiratory parameters worsened despite maximal ventilatory support. Renal failure and metabolic acidosis worsened in spite of hemodialysis. He succumbed to his illness on day five of admission and seven days after toxin ingestion.Conclusion: We recommend that the sale of paraquat be restricted and regulated to avoid its use for suicidal and homicidal purposes. More research is required to find measures to intervene early and prevent pulmonary fibrosis. We propose that paraquat toxicity be considered early in a patient with the triad in an atraumatic setting with acute respiratory distress syndrome (ARDS).
Emergency medicine
Sadaf Sheikh
Volume 9, Issue 1 , January 2023, , Pages 1-1
Abstract
Cellulitis is treated with antibiotics as routine management and based on the literature the cellulitis hospitalization can be avoided by 11% if appropriate antibiotics are used.1 Randomized clinical trials and Cochrane reviews have suggested that oral antibiotics are non-inferior to intravenous administration ...
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Cellulitis is treated with antibiotics as routine management and based on the literature the cellulitis hospitalization can be avoided by 11% if appropriate antibiotics are used.1 Randomized clinical trials and Cochrane reviews have suggested that oral antibiotics are non-inferior to intravenous administration (1). We would like to highlight here the unrequired use of intravenous antibiotics in cellulitis. Intravenous antibiotics are recommended in patients with sepsis. This is supported by a study done on 1800 patients with cellulitis diagnosis, where one third of patients were hospitalized
Emergency medicine
Marziye Hadian; Alireza Jabbari; Hojjat Sheikhbardsiri
Volume 9, Issue 1 , January 2023, , Pages 4-8
Abstract
Objective: In order to heal burn wounds, many researches have been done, including the use of biological scaffolds due to their ability to achieve the desired properties. Owing to the appropriate biological properties of chitosan such as biocompatibility and antimicrobial properties as well as the promotion ...
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Objective: In order to heal burn wounds, many researches have been done, including the use of biological scaffolds due to their ability to achieve the desired properties. Owing to the appropriate biological properties of chitosan such as biocompatibility and antimicrobial properties as well as the promotion of wound healing in biomedical applications, we aimed to perform a systematic review to investigate the effect of this technology on the treatment of burn hazards victims.Methods: The present research was conducted in 2020 as a systematic review of studies related to the effect of chitosan on burns. In this study, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Critical Appraisal Skills Programme (CASP) guidelines were used to assess the articles. The key words “Chitosan,” “Chitin,” “victim,” “Injury,” “Burn,” “Heal,” “wound” “treat,” “hazard,” and “care” were used in combination with the Boolean operators OR and AND. The ISI web of science, PubMed, Scopus, Science Direct, Ovid, Pro Quest, Wiley and Google Scholar were searched.Results: Recently, chitosan and its derivatives have been proposed as suitable candidates for scaffolding and can be used as temporary scaffolds to modify and stimulate the growth of new tissues. Studies to demonstrate the use of chitosan in the treatment of burns have been limited to research on animal models and have been superior to conventional therapies in terms of time, pain, and efficacy.Conclusion: The effect of chitosan on burns has been positive in animal models and has accelerated wound healing. Since the main ingredient of chit powder is chitosan and due to the limited studies done on humans, it cannot be said with certainty that the use of chitosan and its derivatives to treat burns is better than other ways to treat burns.
Trauma
Shahram Paydar; Armin Akbarzadeh; Ladan Nasermoadeli; Vahid Mohammadkarimi
Volume 9, Issue 1 , January 2023, , Pages 9-12
Abstract
Objective: The adherence of the physicians to guidelines in resuscitation of the patientsis of great importance since it can predict the outcome. To evaluate the adherence of thephysicians of our center in hydration of traumatic patients with crystalloids regarding theAdvanced Trauma Life Support (ATLS) ...
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Objective: The adherence of the physicians to guidelines in resuscitation of the patientsis of great importance since it can predict the outcome. To evaluate the adherence of thephysicians of our center in hydration of traumatic patients with crystalloids regarding theAdvanced Trauma Life Support (ATLS) guidelines.Methods: We designed an algorithm obtained from ATLS guidelines using vital signsand status of bleeding of the traumatic patients to classify them. After categorizing thepatients according to the algorithm, we evaluated the adherence of the physicians to theguideline in hydration of traumatic patients with crystalloids.Results: This is a cross-sectional study in which 998 traumatic patients who were admittedto the emergency ward of Rajaee trauma hospital were enrolled. Most of the patients weremen (89.6%) and the most common causes of traumatic injuries were traffic accidents.Proper hydration was seen in only 14.7% of the patients. Most of the patients were overhydrated (85%) regarding both our algorithm and the patients’ base excess.Conclusion: The present study showed that the adherence of physicians in our centerin resuscitation with crystalloid was low. Also, most of the traumatic patients wereoverhydrated with crystalloids. It is suggested that physicians retrain concerning theside effects of over hydration. In addition, we need a user friendly and more applicableguideline for hydration with crystalloids
Emergency medicine
Mehdi Momeni; Elnaz Vahidi; Neda Karimi Tafti; Zeinab Naderpour; Javad Seyedhosseini; Morteza Saeedi
Volume 9, Issue 1 , January 2023, , Pages 13-18
Abstract
Objective: Hand lacerations are among the most frequent causes of visiting emergencydepartments (EDs). Wound infection is one of its complications. There is still an ongoingdisagreement on the administration of oral versus intravenous (IV) antibiotics (ABs). Theobjective of this study is to compare the ...
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Objective: Hand lacerations are among the most frequent causes of visiting emergencydepartments (EDs). Wound infection is one of its complications. There is still an ongoingdisagreement on the administration of oral versus intravenous (IV) antibiotics (ABs). Theobjective of this study is to compare the effectiveness of oral versus IV ABs in preventingwound infection of hand lacerations.Methods: In this double-blind, randomized clinical trial, we enrolled all patients with handlacerations (based on the inclusion criteria) during 6 months in the EDs of 2 tertiary referralcenters. Convenient sampling was done. Finally, in the first group, 382 patients receivedoral AB (two 500 mg cephalexin capsules) and the other 382 patients in the second groupreceived IV AB (1 gr IV cefazolin) before wound management. Both groups were followedand received oral cephalexin during 48 hours after suturing. Rates of wound infection anddifferent complications were compared between the two groups. T-test, Mann-Whitney Utest, Chi square and Fisher analysis were used.Results: Both groups had the same age and gender distribution rate (79.8% of males withthe mean age of 30.8 years in the first group, and 83.5% of males with the mean age of 32.6years in the second group (P = 0.19 and 0.39, respectively). In our study, wound infectiondeveloped in 2.6% and 1.8% of patients in the first and second groups, respectively (P =0.46).Conclusion: Based on the results of this study, oral and IV ABs were not significantlydifferent in terms of preventing wound infection
Infectious disease
Navid Kalani; Masoud Tavasolian; Khaterh Dehghani; Seyed Reza Mousavi; Erfan Ghanbarzadeh; Masihallah Shakeri; Elahe Rahmanian; Poorya Aryanpoor; Naser Hatami; Zhila Rahmanian; Samaneh Abiri
Volume 9, Issue 1 , January 2023, , Pages 19-24
Abstract
Objective: The goal of our study was to determine the prognostic value of CURB-65,Sequential Organ Failure Assessment (SOFA), pneumonia severity index (PSI), MuLBSTA,and Acute Physiology and Chronic Health Evaluation (APACHE) II upon admission inpatients with coronavirus disease 2019 (COVID-19, as well ...
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Objective: The goal of our study was to determine the prognostic value of CURB-65,Sequential Organ Failure Assessment (SOFA), pneumonia severity index (PSI), MuLBSTA,and Acute Physiology and Chronic Health Evaluation (APACHE) II upon admission inpatients with coronavirus disease 2019 (COVID-19, as well as the prediction cut-off valuefor death regarding these parameters.Methods: This observational retrospective study was performed in COVID-19 triagein Peymaniyeh hospital in Jahrom in 2021. In order to calculate SOFA, APACHE II, PSI,MuLBSTA, and CURB-65, data were collected from patients who were selected by availablesampling method from PCR-confirmed COVID-19 patients. Thirty-day mortality wasassessed as the primary outcome. ROC analysis was conducted using the STATA software toevaluate the prognostic value of the scoring systems. DeLong test was utilized to compareAUC of scores using a web based tool.Results:Ninety-two patients were included in this study with the mean age of 51.02±17.81years (male to female ratio was 1:1). SOFA had an AUC of 0.656 (P=0.130), but other indiceshad statistically significant values of AUC. Based on the comparison of the AUCs, SOFAwas the worst scoring system in COVID-19 as it had significantly lower AUC than PSI andAPACHE II (P<0.05); while its comparison with MULBSTA and CURB65 was not statisticallysignificant (P>0.05).Conclusion: It seems that APACHE II and PSI are the best prognostic factors in our studywith no statistical difference compared together (P>0.05). The sensitivity of APACHE II andPSI was 0.857 with the specificity of 0.927 and 0.976, respectively. The optimal cut-off pointwas 13 and 50 for APACHE II and PSI, respectively
Trauma
Zahra Rahim; Mehrdad MasoudifarI; Behzad Nazemroaya; Mehrdad Norouzi; Amirali Mousavi I
Volume 9, Issue 1 , January 2023, , Pages 25-31
Abstract
Objective: In general, spinal fusion surgery causes heavy bleeding. The purpose of thisstudy was to evaluate the use of two different doses of magnesium sulfate to control thebleeding in lumbar fusion surgery.Methods: This study was carried out as a randomized double-blinded clinical trial in 2020in ...
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Objective: In general, spinal fusion surgery causes heavy bleeding. The purpose of thisstudy was to evaluate the use of two different doses of magnesium sulfate to control thebleeding in lumbar fusion surgery.Methods: This study was carried out as a randomized double-blinded clinical trial in 2020in Al-Zahra hospital in Isfahan. The participants were 60 patients selected using inclusionand exclusion criteria and were randomly allocated into three groups. In the first group,50 mg/kg and in the second group, 40 mg/kg magnesium sulfate was infused. The thirdgroup received normal saline. From the beginning of anesthesia, heart rate, diastolic andsystolic blood pressure, respiratory rate and blood oxygen saturation percentage weremonitored and logged every 30 minutes during the operation and recovery. The volumeof bleeding during the operation was calculated by counting the number of gauzes usedand the amount of suctioned blood during the operation. Other required informationsuch as the duration of operation, duration of anesthesia, time of intubation and the timeperiod of hospitalization and recovery were determined and recorded in all patients. Weused independent t-test and repeated measure ANOVA tests to compare data betweendifferent time lines and also different groups. P value<0.05 was considered as significancethreshold. The collected data were analyzed by using SPSS software version 23.Results: The group receiving 50 mg/kg magnesium sulfate had a significantly lower systolicblood pressure compared to other groups within 15, 30 and 45 minutes after the injections(P=0.04 for all). The pulse rate was significantly lower in the 50 mg/kg magnesium sulfategroup compared to other groups within 15, 30 and 45 minutes after the injections (P<0.05for all). Patients that received 50 mg/kg magnesium sulfate had a lower duration of surgery(P=0.007), lower duration of anesthesia (P=0.007), lower bleeding volume (P<0.001),lower fluid intake (P=0.01) and also lower transfused blood (P=0.01). The surgeons alsohad a significantly higher satisfaction with these patients (P=0.001).Conclusion: Injection of 50 mg/kg magnesium sulfate had a correlation with reducedblood pressure as well as bleeding volume compared to 40 mg/kg magnesium sulfate.
Resuscitation
Javad Seyedhosseini; Rasha Ahmadi; Ehsan Karimialavijeh; Mehrad Aghili
Volume 9, Issue 1 , January 2023, , Pages 32-37
Abstract
Objective: Cardiopulmonary arrest is a devastating outcome of some clinical situationsand requires strict implementation of cardiopulmonary resuscitation (CPR) protocols.Since ultrasound is one of the recommended tools to determine the presence of cardiacmovements and may be a predictor of the outcome, ...
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Objective: Cardiopulmonary arrest is a devastating outcome of some clinical situationsand requires strict implementation of cardiopulmonary resuscitation (CPR) protocols.Since ultrasound is one of the recommended tools to determine the presence of cardiacmovements and may be a predictor of the outcome, this study examined the relationshipbetween echocardiographic findings during CPR with patients’ outcomes.Methods: This cross-sectional prospective observational study was conducted on patientswith cardio-respiratory arrest in the emergency department of Shariaty hospital during2019. sampling method was random. Echocardiography was done at the patient’s bedsideduring the CPR process in accordance with the last advanced cardiac life support (ACLS)guidelines, on two points, after the end of the second and 10th minutes from the start ofCPR. The echocardiography findings (cardiac movement vs standstill) were recorded, andpatient outcomes were followed. Thirty-two patients enrolled in this study with a meanage of 56.9±15.3 years. Chi-square and Mann-Whitney U tests were used to calculate theassociation between heart contractions during resuscitation and the outcomes via SPSSV.22. Fisher’s exact test and Kruskal-Wallis test were used to evaluate the relationshipbetween heart rhythm in the second and tenth minutes with the outcomes of CPR.Results: The presence of cardiac movement in the 10th minute of CPR, in contrast to thefindings of the second minute, had a significant correlation with the success rate of CPRand outcomes (P<0.05). Moreover, patients with ventricular tachycardia (VT)/ventricularfibrillation (VF) cardiac rhythm had a better resuscitation rate, 24-hour survival rate, andbetter outcome than patients with other cardiac rhythms and asystole (P<0.05).Conclusion: Echocardiographic findings in the 10th minute of the CPR process can beused as a prognostic factor for cardiac arrest
Infectious disease
Khadigesadat Kazemi; Hooman Esfahani; Hadis Amiri; Asghar Tavan; Hojjat Farahmandnia
Volume 9, Issue 1 , January 2023, , Pages 38-43
Abstract
Objectives: Pandemics would certainly have a negative impact on mental health. Positivemodifications as well as negative alterations have been documented in earlier viralpandemic according to previous investigations. Teenagers face a variety of challengesduring adolescence. Adolescents may become more ...
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Objectives: Pandemics would certainly have a negative impact on mental health. Positivemodifications as well as negative alterations have been documented in earlier viralpandemic according to previous investigations. Teenagers face a variety of challengesduring adolescence. Adolescents may become more concerned if this time coincides withother worries. This study aims to investigate the positive changes that occur in a youngadolescent’s life after COVID-19 pandemic, and to see how they relate to perceived socialsupport.Methods: This cross-sectional study was performed on adolescents who were randomlyselected from high schools in Kerman, Iran 2020 during the COVID-19. the sample sizewas 108 and for sampling wes used multi-stage random sampling at the end the data wasanalyzed by Pearson correlation test. Demographic information, the MultidimensionalScale of Perceived Social Support (MSPSS) and Posttraumatic Growth Inventory short form(PTGI-SF) were used to collect data. The data were subjected to descriptive and analyticalstatistical tests (Pearson correlation) using SPSS software version 24.Results: Statistically a positive correlation was found between the PTG total score andyoung homeschooled adolescents, parents working remotely, income loss and COVID-19experience. Moreover, during the COVID-19 pandemic, a positive association was foundbetween perceived social support and PTG total scores in young adolescents. There werealso substantial positive connections between the MSPSS subscales and the PTGI overallscore.Conclusion: Based on the findings, an overall growth in all areas of PTG was observedduring the COVID-19 among young adolescents. Perceived social support scores have apositive and significant relationship with COVID-19 effects. In the crises we face throughoutlife, intimate family members and friends play a significant supporting role in adapting tothese situations
Emergency medicine
Mohammad Nikzadian; Sima Hashemi; Reza Beiranvand; Maryam Khormehr
Volume 9, Issue 1 , January 2023, , Pages 44-51
Abstract
Objective: One of the most important indicators used in the evaluation of emergency centers is the chronometric analysis of patients’ workflow. The aim of this study was to provide a chronometric analysis of patients’ workflow (patients’ waiting time in the emergency department) and ...
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Objective: One of the most important indicators used in the evaluation of emergency centers is the chronometric analysis of patients’ workflow. The aim of this study was to provide a chronometric analysis of patients’ workflow (patients’ waiting time in the emergency department) and related factors.Methods: This hospital-based prospective cohort study was carried out in Khatam al-Anbia hospital in Shoushtar in 2020. Random sampling was used and patients referred to the emergency ward in three shifts based on the ESI 5-level triage system. The research tools were the emergency workflow chronometry form and a questionnaire of determining the factors related to the speed of emergency services and using a stopwatch. In order to analyse the data, Stata software version 16 and Weibull model of survival analysis were used.Results: Of 468 participants, the most common cause of referral was trauma with 21.7%. The median ± interquartile range duration of giving the final result was 6.06 ± 4.48 hours, which was more than 0.54 times shorter in clients with level 3. There was a statistically significant difference in the duration of making the final decision based on the request for testing, manner of referring and the type of initial diagnosis (P < 0.05).Conclusion: The duration of service provision in the studied hospital is appropriate for an Iranian hospital, but it should be closer to international standards. At level 2 triage, patients stayed longer. This can be reduced by lessening the time of consultations which can help the emergency ward.
Trauma
Smita Bhat; Amal Suresh; Apeksha Inamdar; Anil Kumar Desai; Gopal Krishnan
Volume 9, Issue 1 , January 2023, , Pages 52-53
Abstract
Objective: Fractures of orbital rims are common and restoration of these fractures back toits normal anatomic form is essential to maintain the function and aesthetics of the eyes.Low profile miniplates are the rigid fixation device of choice for such fractures. But in caseof sagittal and grossly displaced ...
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Objective: Fractures of orbital rims are common and restoration of these fractures back toits normal anatomic form is essential to maintain the function and aesthetics of the eyes.Low profile miniplates are the rigid fixation device of choice for such fractures. But in caseof sagittal and grossly displaced fractures of orbital rims it is difficult to achieve stability byusing miniplate osteosynthesis. The low profile miniplates may not be able to withstandthe forces to reduce this kind if grossly displaced fractures, another stable option needs tobe considered in these situations.Case presentation: This case report presents a simple and effective technique of reductionand fixation of an oblique fracture of infraorbital rim fracture using lag screw principle.A standard titanium screw of 2 mm diameter and 10 mm length is being used in thedescribed technique for stable fixation of fractured segments.Conclusion: The technique is simple, hardware’s are easily available and can be practisedin emergency circumstances where newer advanced technologies are not available
Emergency medicine
Abdolghader Pakniyat; Farzane Jafari; Rojin Ramezani; Mohammad Ghasemi-rad
Volume 9, Issue 1 , January 2023, , Pages 54-57
Abstract
Objective: Orbital emphysema, defined as the presence of air in orbital and periorbital tissues, is a relatively uncommon clinical condition which occurs mostly following facial trauma. It can not only resolve spontaneously without any treatment, but it can also cause life threatening complications such ...
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Objective: Orbital emphysema, defined as the presence of air in orbital and periorbital tissues, is a relatively uncommon clinical condition which occurs mostly following facial trauma. It can not only resolve spontaneously without any treatment, but it can also cause life threatening complications such as pneumomediastinum (PM). PM is an uncommon complication of facial fractures and is defined as the presence of air in the mediastinal space. Developing PM following blunt trauma is commonly considered as a red flag for underlying injuries, such as trachea and esophagus rupture. Therefore, other complementary diagnostic procedures, including bronchoscopy and esophagostomy, are often necessary for patients developing this condition.Case Presentation: A 31-year-old man with a history of facial and neck trauma was presented to the emergency room of our tertiary referral hospital with a complaint of right orbital swelling. On physical examination, vital signs were stable. There was a mild swelling of right upper eyelid, but no proptosis. An hour after admission, following sneezing and blowing his nose, the patient had further swelling of his right face with extension of swelling through the right side of his neck to the nipple. He also complained of dyspnea and acute severe progressive epigastric pain.Conclusion: Orbital emphysema following orbital wall fracture is typically benign and self- limited, but physicians should be aware of serious complications such as PM. Therefore, monitoring the patient is crucial and should be considered in such ct
Trauma
Seyed Ahmad Rasoulinejad
Volume 9, Issue 1 , January 2023, , Pages 58-59
Abstract
Objective: Purtscher’s retinopathy is the retinal damage following trauma or non-traumatic systemic disease, which may contain cotton-wool spots (CWSs), and may cause Purtscher flecken, atrophy of the optic nerve, and hemorrhage of the posterior pole of the eye.Case Presentation: A 28-year-old ...
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Objective: Purtscher’s retinopathy is the retinal damage following trauma or non-traumatic systemic disease, which may contain cotton-wool spots (CWSs), and may cause Purtscher flecken, atrophy of the optic nerve, and hemorrhage of the posterior pole of the eye.Case Presentation: A 28-year-old male patient fell down from a height of 10 m and was admitted with swelling and ecchymosis of the peri-orbit of the right eye. The patient’s vision was at the level of light perception. A mild subconjunctival hemorrhage and hyphema were seen in the right eye. In the fundus, the hemorrhage, edema, and CWS were seen in the posterior pole and around the optic disk. Macular thickness (MT) in Purtscher’s retinopathic eye was 353 μm. Also, the patient had a nose and mandibular fracture and was hospitalized for several days.Conclusion: The findings indicate a decrease in the vision due to Purtscher’s retinopathy caused by trauma. There was no improvement spontaneously
Imaging
Mohammad Rezazadehkermani; Seyed Vahid Hosseini
Volume 9, Issue 1 , January 2023, , Pages 60-63
Abstract
Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinelyvisited in emergency departments. Although most of these patients are managed withendoscopic modalities, some of them are managed with surgical interventions. Most ofemergency surgical interventions are done via ...
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Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinelyvisited in emergency departments. Although most of these patients are managed withendoscopic modalities, some of them are managed with surgical interventions. Most ofemergency surgical interventions are done via laparotomy. With evolution in minimalinvasive surgery, the role of laparoscopic surgeries in emergency settings is on a rise.Case Presentation: In this report we describe a case of lower gastrointestinal bleedingthat was presented with melena and during workups no bleeding lesion was detectedin colon, stomach or duodenum. Further investigations revealed bleeding of proximaljejunum mass that was resected with the laparoscopic approach which is rarely used inthe emergency management of patients with gastrointestinal bleedings. Also, resectionand anastomosis of proximal jejunal loop was challenging in this case.Conclusion: This report is intended to describe the feasibility of laparoscopy in proximalsmall bowel lesion resection in emergency settings as well as the role of CT angiography indetecting the source of obscure gastrointestinal bleeding
Trauma
Alper Alp; Burcu Arslan; Dilek Gibyeli Genek; Bülent Huddam
Volume 9, Issue 1 , January 2023, , Pages 72-75
Abstract
Objective: Rhabdomyolysis is an important etiology for developing acute kidney injury(AKI). Among the many varying reasons for rhabdomyolysis, electrical injury seems to bea lesser-known factor. The clinical presentation of rhabdomyolysis is usually in the formof severe and widespread pain, tenderness, ...
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Objective: Rhabdomyolysis is an important etiology for developing acute kidney injury(AKI). Among the many varying reasons for rhabdomyolysis, electrical injury seems to bea lesser-known factor. The clinical presentation of rhabdomyolysis is usually in the formof severe and widespread pain, tenderness, weakness in the muscles and dark urine. Itis characterized by the disruption of cell integrity in myocytes as a result of widespreaddamage to skeletal muscles and the passage of intracellular components into thecirculation.Case Presentation: Here we presented a case report of a young man who hadrhabdomyolysis induced by electrical injury which is relatively less common among theother etiological factors with preserved renal functions. He had electrical injury relatedwounds on extremities. Urgent intravenous fluid therapy was initiated as soon as hisadmission to the emergency department (ED), without delay.Conclusion: AKI is very common due to the nephrotoxic effect of myoglobinuria and theprerenal status. It is rare that AKI does not develop in patients with a severe increase increatinine kinase. It is a very important point to start effective fluid therapy in a short time.
Ultrasonography
Anton Kasatkin; Aleksandr Urakov; Alekse Shchegolev; Vadim Matreshkin; Ivan Zlobin
Volume 9, Issue 1 , January 2023, , Pages 76-78
Abstract
Objective: Ultrasound assessment of inferior vena cava (IVC) collapsibility is performed todetermine the volume status of critically ill patients. We propose a new acoustic windowfor visualizing a vein in a prone patient.Case Presentation: A healthy volunteer took part in the study. The study protocol ...
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Objective: Ultrasound assessment of inferior vena cava (IVC) collapsibility is performed todetermine the volume status of critically ill patients. We propose a new acoustic windowfor visualizing a vein in a prone patient.Case Presentation: A healthy volunteer took part in the study. The study protocol includestwo stages: 1) performing a magnetic resonance imaging (MRI) examination to determinethe projection of a certain IVC area on the posterior chest surface (holotopy), 2) performingan ultrasound scanning in the area of IVC projection in order to identify it and determineits dimensions.Conclusion: The 11th intercostal space parallel to the paraspinal line allows to visualizethe IVC in the prone position. This gives a potential opportunity to use it to assess the IVCcollapsibility. Its potential advantage is the ability to assess the compressibility of IVC inthe antero-posterior direction
Orthopedics
Ganesh Singh Dharmshaktu; Tanuja Pangtey
Volume 8, Issue 2 , July 2022, , Pages 88-89
Abstract
A 52-year-old male presented with atraumatic left side calf swelling for the last three months. The swelling had acute onset and increased gradually in size. He had a history of rheumatoid arthritis with treatment options limited to physiotherapy sessions and pain medication as he could not continue ...
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A 52-year-old male presented with atraumatic left side calf swelling for the last three months. The swelling had acute onset and increased gradually in size. He had a history of rheumatoid arthritis with treatment options limited to physiotherapy sessions and pain medication as he could not continue disease modifying anti-rheumatic drugs regularly. There was no history of co-morbidities like hypertension, tuberculosis, diabetes mellitus or bleeding diathesis. He neglected the swelling initially due to mild pain and little impact on activities of daily living till swelling increased to be apparent.
Trauma
Raheleh Faramarzi; Mohammad Davood Sharifi; Elnaz Vafadar Moradi; Behnaz Alizadeh
Volume 8, Issue 2 , July 2022, , Pages 95-98
Abstract
Objective: Partial dislocation of radius head (pulled elbow) is the most common trauma observed in out-patient orthopedic treatment of children. The typical mechanism of this trauma includes exertion of longitudinal force along the forearm in a pronation position, causing partial dislocation of the radius ...
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Objective: Partial dislocation of radius head (pulled elbow) is the most common trauma observed in out-patient orthopedic treatment of children. The typical mechanism of this trauma includes exertion of longitudinal force along the forearm in a pronation position, causing partial dislocation of the radius head.Methods: This Retrospective descriptive and cross-sectional study was undertaken on patients referring to the emergency ward of Imam Reza hospital of Mashhad with typical history of partial dislocation of radius head (pulled elbow). The present study was conducted between March 20, 2018 and March 20, 2019. Based on the number of patients at the emergency ward, the sample size was determined to be 80. Descriptive statistics such as mean and standard deviation were used to describe the collected data.Results: From among 80 children diagnosed with partial radius bone dislocation, 66.23% were girls and 33.77% were boys. The age range of patients was 28.08 months for girls and 31.04 months for boys. Findings also showed that 32 patients had a history of recent respiratory infection within 1 week before the pulled elbow incident.Conclusion: Findings revealed that, similar to previous studies, the pulled elbow injury was more common in girls than in boys. Successful reduction in first and second attempts, notwithstanding the maneuvers used indicated that the success rate of first attempts at reduction was 93%. The history of recent respiratory infections during 1 week before the injury was taken into account, where 40% of the children had some history of such respiratory infections.
Infectious disease
Mohammad Mohammadi; Abdolghani Abdollahimohammad; Mohammadreza Firouzkouhi; Maryam Shivanpour
Volume 8, Issue 2 , July 2022, , Pages 99-103
Abstract
Objective: Pre-hospital emergency staff are involved in the front line of care for COVID-19 patients and face many challenges. The aim of this study was to explore the challenges of prehospital emergency staff in the COVID-19 pandemic.Methods: This qualitative research was conducted with a descriptive ...
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Objective: Pre-hospital emergency staff are involved in the front line of care for COVID-19 patients and face many challenges. The aim of this study was to explore the challenges of prehospital emergency staff in the COVID-19 pandemic.Methods: This qualitative research was conducted with a descriptive phenomenological approach. Purposeful sampling was applied and data collection was done through semi-structured interviews. Participants consisted of 16 pre-hospital emergency staff. Data analysis was performed using the Colaizzi approach.Results: Data analysis revealed five main themes including safety against COVID-19, knowledge deficit, fear and worry, challenges of transporting patients to the hospital, and selflessness.Conclusion: Pre-hospital emergency staff face many problems in personal, professional, equipment and cultural fields in the COVID-19 epidemic. In this regard, special attention from health systems is mandatory.
Trauma
Rahul Chaurasia; Naveen Akhtar; Subramanian Arulselvi; Vedanand Arya; Sulekha Karjee
Volume 8, Issue 2 , July 2022, , Pages 104-109
Abstract
Objective: Type and crossmatch (TC) policy is the most common approach for pretransfusion compatibility testing prior to issue of blood for transfusion. As it involvesreserving of the blood units (usually up to 72 hours) prior to issue or un-reserving, it can leadto excessive blood cross matching, inventory ...
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Objective: Type and crossmatch (TC) policy is the most common approach for pretransfusion compatibility testing prior to issue of blood for transfusion. As it involvesreserving of the blood units (usually up to 72 hours) prior to issue or un-reserving, it can leadto excessive blood cross matching, inventory management problems, undue workload,blood outdating and reagent wastage. Type and screen (TS) policy is an alternativeapproach without the need to cross match and reserve blood units prior to issue. The aimof the current study was to retrospectively assess the impact of the implementation of TSpolicy for pre-transfusion compatibility testing on blood transfusion services at an urbanlevel Ι trauma center.Methods: The study was done in two phases in the Department of Transfusion Medicineat Jai Prakash Narayan Apex Trauma Center AIIMS, New Delhi, India. Transfusion data wascollected and compared during two phases: initial phase (Oct 2016-Mar 2017) of TC policyand second phase (Apr 2017-Sept 2017) of TS policy.Results: TS policy resulted in the reduction of C:T ratio from 5.3 to 1.9. Transfusionprobability increased to 29.5% during TS policy from 23.6% during TC policy. Issuable stockindex (ISI) also showed reduction from 12.5 to 11.4 after TS policy. Wastage as percentageof issue (WAPI) was reduced from 2.3% (TC) to 1.3% (TS). TS policy also led to reductionin expenses incurred on pre-transfusion compatibility testing by 35%. No hemolytictransfusion reaction was reported during the study.Conclusion: TS policy was found to be a safe and an efficient alternative approach to TCpolicy for pre-transfusion compatibility at our center. We recommend the implementationof TS policy, but each center should first assess its feasibility based on patient population,blood bank resources and staff knowledge