Emergency medicine
Sadaf Sheikh
Articles in Press, Accepted Manuscript, Available Online from 27 April 2022
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
Articles in Press, Accepted Manuscript, Available Online from 20 December 2021
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.
Emergency medicine
Abdolghader Pakniyat
Articles in Press, Corrected Proof, Available Online from 29 May 2022
Emergency medicine
Seyed Ahmad Rasoulinejad
Articles in Press, Corrected Proof, Available Online from 02 June 2022
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
Emergency medicine
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.
Emergency medicine
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.
Emergency medicine
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.
Emergency medicine
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
Clinical Toxicology
Morteza Talebi Doluee; Bita Dadpoor; Behrang Rezvani Kakhki; Veda Vakili; Elahe Barati; Elnaz Vafadar Moradi
Volume 8, Issue 2 , July 2022, , Pages 122-127
Abstract
Objective: Intoxication is among the most common causes of emergency department (ED) visits. Activated charcoal is one of the useful treatments preventing poison absorption. However, nausea caused by using charcoal has made this substance less acceptable among patients. This study aims at investigating ...
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Objective: Intoxication is among the most common causes of emergency department (ED) visits. Activated charcoal is one of the useful treatments preventing poison absorption. However, nausea caused by using charcoal has made this substance less acceptable among patients. This study aims at investigating the influence of using cold charcoal on reducing the nausea among poisoned patients.Methods: This clinical experimental trial study approved by the Medical Ethics Committee of Regional School of Medicine of Mashhad University of Medical Sciences with the code 930106. Randomization was provided by Sealed Envelope. Accordingly, the experimental group received cold charcoal (4ᵒC), while the control group received room temperature charcoal (23ᵒC).We used the coding method in order to double blind the study. After half and one hour, nausea was checked in patients by visual numeric scale (VNS). Data were described by using descriptive and analytic test indices including frequency, mean ± standard deviation and suitable charts and tables.Results: The average age of participants was 25.83±7.05. The severity of nausea half an hour after consuming charcoal in cold charcoal group and experimental group was 1.3 and 2.73, respectively (P < 0.001). One hour after consuming charcoal, the severity of nausea in cold charcoal group and experimental group was 0.39 and 1.38 (P < 0.001). As indicated by the results of the study and after investigating the changing trend of nausea severity, nausea severity decreased in both groups by passing time from half to one hour (P < 0.001).Conclusion: Cold charcoal can reduce the rate of nausea and make it more acceptable among patients.
Emergency medicine
Pegah Sepehri Majd; Amirhossein Alimohammadi Siyabani; Haniyeh Ebrahimi Bakhtavar; Farzad Rahmani
Volume 8, Issue 2 , July 2022, , Pages 128-133
Abstract
Objective: Awareness of the severity of trauma and the outcome of patients can help physicians decide how long to treat patients. The objective of this study is to design a new score (R-GAP: Revised-GCS, Age, Pressure) for multi-trauma patients and determine its predictive value concerning in-hospital ...
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Objective: Awareness of the severity of trauma and the outcome of patients can help physicians decide how long to treat patients. The objective of this study is to design a new score (R-GAP: Revised-GCS, Age, Pressure) for multi-trauma patients and determine its predictive value concerning in-hospital outcome of these patients.Methods: This cross-sectional study was performed in the emergency ward of Imam Reza (AS) and Shohada hospitals (referral centers for trauma patients) affiliated to Tabriz University of Medical Sciences from 2019 to 2020. The sample size of this study was estimated to be 2000 people. Required information was collected and the final diagnosis of the patients was recorded. The hospital outcome was recorded at the time of discharge. Patients’ outcome was also recorded using the Glasgow Outcome Scale (GOS) system. Based on the obtained data, GAP, R-GAP, new trauma score (NTS) scores were also collected and their results were compared with the designed model. Receiver operating characteristic (ROC) curve and logistic regression were used to analyze the predictive value of the scores.Results: The mean age of the subjects was 34.09 (± 15.23) years. The highest outcome of patients based on the GOS system was recovery, moderate disability, and severe disability with 1309 cases (54.9%), 743 cases (31.2%), and 212 cases (8.9%), respectively. The mean of GAP, R-GAP, and NTS scores were 21.83 (± 3.1), 21.47 (± 3.4), and 21.27 (± 3.3), respectively. The intensity of GAP, R-GAP, and NTS in most subjects was low with 2143 cases (89.9%), 1994 cases (83.6%), and 2138 cases (89.7%). Among the significant variables included in the regression model, O2sat, primary GCS, GAP, R-GAP, and NTS with modulation on other variables, significantly equalized the mortality chance by 0.416, 0.622, 0.595, 0.601, 0.637, respectively (P value < 0.001).Conclusion: According to the study results, it seems that GAP, R-GAP, and NTS respectively, have the highest strength of predictive value in the survival of patients with multiple traumas. It is suggested that a comprehensive study be conducted to better estimate this issue.
Emergency medicine
Madhushri Vadhone Dinesh; Aruna Chala Ramesh; Keshava Murthy M Rangaswamy; Hariprasad Kanakapura Veerendranath
Volume 8, Issue 2 , July 2022, , Pages 134-140
Abstract
Objective: Chest pain is amongst the most frequently occurring symptoms in patientspresenting to the emergency department (ED). Accurate and fast risk stratification isparamountforidentification of patients with immediate risk of acute coronary syndrome(ACS). The present study has compared different ...
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Objective: Chest pain is amongst the most frequently occurring symptoms in patientspresenting to the emergency department (ED). Accurate and fast risk stratification isparamountforidentification of patients with immediate risk of acute coronary syndrome(ACS). The present study has compared different scoring systems like HEART (History,ECG,Age,Risk factors, Troponin), ThrombolysisinMyocardial Infarction (TIMI), andGlobalRegistryofAcuteCoronaryEvents(GRACE)scores andtheir efficacyinpredicting incidenceof major adverse cardiac events(MACE).Methods: The present prospective observational study was conducted on 199 patientswho presented in the ED with complaint of chest pain. HEART, GRACE and TIMI scoreswere calculated with collected patient data which was further evaluated for efficacy bycalculating area under ROC curves (AUCs). Data were analyzed by using R statisticalsoftware version 4.0.3 and Microsoft Excel. P value less than or equal to 0.05 indicatesstatistical significance.Results:Inthecurrentstudy,76(38%)patientsreportedMACE.TheHEARTscoreidentifiedthelargestnumberofpatientsashighrisk74(37%)andamongthem69patientsdevelopedaMACE.TheAUCofHEART scorewasthehighestwith0.96(95%CI:0.93-0.98),followedbyTIMIscore with 0.815 (95% CI: 0.75-0.873) and the GRACE score with 0.814 (95% CI: 0.75-0.813). The sensitivity of HEART score of ≥7 for MACE wasfound to be 90.78%,specificitywas 95.96%, positive predictive value (PPV) was 93.24% and negative predictive value(NPV) was 94.4%. The sensitivity of GRACE score was 39.4%, specificity was 95.16%, PPVwas 83.3% and NPV was 71.95%. The sensitivity of TIMI score was 30.2%, specificity was95.96%, PPV was 82.14% and NPV was 69.18%.Conclusion:TheHEARTscoreshowedhigherefficacyinpredictingrisklevelsinpatientsandincidenceofMACE incomparisonwithGRACE andTIMIscoresintheincludedstudy cohort.
Emergency medicine
Khosro Ayazi; Parham Nikraftar; Hamidreza Hatamabadi; Fatemeh Shojaeian; Shervan Family
Volume 8, Issue 2 , July 2022, , Pages 145-147
Abstract
Objective: One of the most prevalent surgical emergencies is appendicitis, caused by different factors. However, its relation to trauma has not been well-known yet. Here we have described three cases with blunt abdominal trauma and a secondary diagnosis of appendicitis that were transferred to the operation ...
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Objective: One of the most prevalent surgical emergencies is appendicitis, caused by different factors. However, its relation to trauma has not been well-known yet. Here we have described three cases with blunt abdominal trauma and a secondary diagnosis of appendicitis that were transferred to the operation room.Case Presentation: Three patients suffering from blunt trauma and abdominal pain were referred to the emergency department (ED). Of these patients, one of them was transferred to the operation room (OR) with a peritonitis diagnosis and the other two patients had appendicitis signs and symptoms. The abdominal pain and related signs and symptoms of these three patients were due to appendicitis. All three patients were discharged from the hospital with normal vital signs.Conclusion: Traumatic appendicitis might be regarded as one of the differential diagnoses of the patients referred to the ED with blunt abdominal trauma and abdominal pain; hence, appendicitis and blunt abdominal trauma have some unknown relations.
Critical Care
Sadaf Sheikh; Umair Javed
Volume 8, Issue 2 , July 2022, , Pages 159-161
Abstract
Objective: Renal infarction which is a rare phenomenon can be missed on the patient’s work up making its incidence low.Case Presentation: We report a 68-year-old lady with known history of hypertension presented with epigastric pain and vomiting for 4 days. During her stay in the emergency room, ...
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Objective: Renal infarction which is a rare phenomenon can be missed on the patient’s work up making its incidence low.Case Presentation: We report a 68-year-old lady with known history of hypertension presented with epigastric pain and vomiting for 4 days. During her stay in the emergency room, she developed sudden onset of left-sided weakness. Electrocardiogram was normal sinus rhythm. Computed tomography scan of the abdomen showed acute pancreatitis with partial impingement of superior mesenteric vein.Conclusion: Imaging s showed cholelithiasis without evidence of cholecystitis and lower pole right renal infarct likely secondary to obstruction of the right lower renal artery due to calcified plaques at their origin from the aorta. Subsequently, the patient was kept on antiplatelets and planned for discharge uneventfully.
Clinical Toxicology
Mojtaba Miladinia; Elham Mousavi Nouri
Volume 8, Issue 1 , January 2022, , Pages 1-2
Abstract
Medication errors (MEs) are considered the most common medical errors and as one of the major challenges threatening the health system, which can be also reduced. MEs threaten patients' safety and may increase the length of hospital stay, lead to unexpected complications, mortality and side costs. In ...
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Medication errors (MEs) are considered the most common medical errors and as one of the major challenges threatening the health system, which can be also reduced. MEs threaten patients' safety and may increase the length of hospital stay, lead to unexpected complications, mortality and side costs. In 2017, the World Health Organization launched Medication without Harm to reduce severe avoidable medication-related damage by 50%, globally in the next 5 years. Emergency Departments (EDs) are stressful care environments which making EDs more prone to MEs. Therefore, EDs need to be seriously considered to reduce MEs and increase patients' safety. In this regard, it is of great significance to know about the most common stage of error in pharmacotherapy, the most common type of medication error and the most common causes of MEs in the emergency department practice setting. in conclusion, the most common types of MEs in EDs include drug omission error, wrong dose and strong infusion rate. In addition, the administration and prescribing are the most common stages of MEs in EDs. Also, the most common causes of MEs in EDs in Iran include nursing shortage (fatigue) and poor medication knowledge .
Education
Hamid Reza Moretza Bagi; Amir Ghaffarzad; Peyman Fathipour; Reza Yazdani; Zhila Khamnian; Sama Rahnemayan
Volume 8, Issue 1 , January 2022, , Pages 3-7
Abstract
Objective: Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators ...
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Objective: Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators in teaching cricothyrotomy skills for emergency medicine residents.Methods: In this pre-post test study, all faculty member of emergency medicine of Tabriz University of medical sciences specialty were invited to participate. After holding an educational and training session for assistants on a teacher-made moulage, all emergency medicine residents performed a tracheostomy on the commercial moulages of the skill lab unit for the second time and their scores were recorded.Results: In this study, 23 emergency medicine residents participated. The mean ± standard deviation of age was 35.91 ± 3.57 years. There was a significant difference between the mean duration of cricothyrotomy before and after the training (P value = 0.006). There was also a significant difference between the mean scores obtained by residents in the pre- and post-training evaluation (P value < 0.001).Conclusion: Findings showed that the moulages constructed by teachers not only can be effective in improving the cricothyrotomy skills in emergency medicine residents but also can reduce the likelihood of failure in performing cricothyrotomy.
Emergency medicine
Seyyed Meysam Amini; Mehriyar Yoldashkhan; Sima Zohari; Malihe Nasiri; Zahra Mousavi; Seyed Mohammad Amini
Volume 8, Issue 1 , January 2022, , Pages 8-12
Abstract
Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase ...
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Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase activity and reduces pain and inflammation. It can be considered as the strongest analgesic drug in this category. The aim of this study was to evaluate the effectiveness of ketorolac in pain management of traumatic injuries in a prehospital setting.Methods: This descriptive cross-sectional study was undertaken to evaluate the effectiveness of a treatment method in the pain management of traumatic injuries in the prehospital environment of Lorestan province in Iran. We included 134 injured patients from road emergency bases of Lorestan province. In order to control the pain of these injured patients, 30 mg of ketorolac was injected slowly intravenously in one minute. Pain was measured in the time interval of zero minutes (before injection), 15 minutes, 30 minutes, and 45 minutes by visual acuity scale (VAS). The analysis of the obtained data was performed by SPSS software version 23.Results: The mean age of participants was 37.42±23.6. There were 47 female injuries (35.1%) and 87 male injuries (64.9%). In terms of pain intensity, 49 patients (36.6%) had moderate pain (VAS = 4-6) and 85 patients (63.4%) had severe pain (VAS = 7-10). The average of pain relief in the injured group with severe and moderate pain 15 minutes after the injection was 0.471 and 0.878 (P = 0.001), respectively. In addition, the mean of pain relief in the injured group with severe and moderate pain 30 minutes after the injection was 1.124 and 1.796, respectively (P = 0.001). Pain reduction in the group of severely injured patients with moderate pain in the first 30 minutes was statistically significant.Conclusion: Findings revealed that ketorolac is a suitable drug in pain management for trauma patients with moderate and severe pain in trauma patients. On the other hand, due to the peak effect (more than 30 minutes), it is not an effective drug for trauma patients with severe pain in a short period transferred to the prehospital environment.
Emergency medicine
Vikas Bhatia; Suzanne Koshi; Varun Bansal; Uma Debi; Lokesh Singh; Manavjit Singh Sandhu
Volume 8, Issue 1 , January 2022, , Pages 13-18
Abstract
Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective ...
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Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective evaluation of the CT records of patients over a period of 5 years was done at our institute. A total of 1519 patients who had undergone contrast-enhanced abdominal CT at a 64-slice Multidetector CT for abdominal trauma were included in this study. Inclusion criteria were: 1) History of blunt abdominal trauma, 2) Patients who had undergone a biphasic CECT abdomen scan. Exclusion criteria were: 1) Patients with penetrating injury, 2) Patients with incomplete data set/records. Results: Liver was the most common injured organ in both adult (38.8%) and paediatric population (40.9%). Significant higher incidence of mesenteric injury, bladder injury, spinal and rib fractures were seen in adult patients. Significant association of anorectal injuries (P=0.003) and bladder/urethral injuries with pelvic fractures was also seen (P <0.001). Conclusion: Our study provided important insights about the pattern, severity and association between the various abdominal injuries based on imaging findings in a large patient population. Larger studies with incorporation of clinical outcome in such patients can help in formulating appropriate management strategies.
Cardiology
elnaz vahidi; Maryam Beladi; Ahmad Abbasian; Amirhosein Jahanshir; Javad Seyedhosseini
Volume 8, Issue 1 , January 2022, , Pages 19-25
Abstract
Objective: Disposition in acute coronary syndrome (ACS) is pivotal in an emergency department (ED). HEART score is a recent scoring system for finding primary endpoints in undetermined ACS. This study aimed at evaluating the predictive value of HEART score in ACS outcome and disposition.Methods: In this ...
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Objective: Disposition in acute coronary syndrome (ACS) is pivotal in an emergency department (ED). HEART score is a recent scoring system for finding primary endpoints in undetermined ACS. This study aimed at evaluating the predictive value of HEART score in ACS outcome and disposition.Methods: In this prospective study, all patients with chest pain presentation compatible with our inclusion criteria referring to ED were enrolled during one year. Demographic data, triage level, hospital length of stay, admission ward, coronary angiography result, HEART score, thrombolysis in myocardial infarction (TIMI) score, 1-month primary ACS endpoints and major adverse cardiac events (MACE) were evaluated.Results: In our studied population (200 cases), 49 patients (24.5%) had at least one score for MACE. Comparing the prognostic values of TIMI vs HEART score in MACE revealed that the HEART had a larger AUC. The best cut-off point of HEART score in MACE prediction was calculated to be ≥5. There was a statistically significant relation between HEART score and hospital length of stay. The higher the HEART score, the more probability of patients being admitted to either hospital cardiac ward or coronary care unit (CCU). There was a significant relationship between the triage level and HEART score. Patients with higher HEART score had more acuity (lower triage level 1 or 2).Conclusion: HEART predicted MACE better than TIMI in low risk ACS. Patients with higher HEART score were more admitted to the hospital with longer hospital stay and patients with lower HEART score had higher triage level with less acuity.
Clinical Toxicology
Malek Moradi; Amir Motamedi; Adele Pouyafard; Mostafa Gavahi; Mohsen Barzegar
Volume 8, Issue 1 , January 2022, , Pages 26-31
Abstract
Objective: Narcotic and alcohol use are recognized as the two important underlying factors in all types of trauma. In this study, the prevalence of opium consumption was investigated in traumatic patients who referred to Shahid Rahnemoon hospital in Yazd in 2018.Methods: In this descriptive cross-sectional ...
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Objective: Narcotic and alcohol use are recognized as the two important underlying factors in all types of trauma. In this study, the prevalence of opium consumption was investigated in traumatic patients who referred to Shahid Rahnemoon hospital in Yazd in 2018.Methods: In this descriptive cross-sectional study, 252 patients with trauma admitted to Shahid Rahnemoon Hospital from October to December 2018 were studied. In order to collect the data, a checklist was administered including the patients’ demographic information (age and gender), opium consumption, location of trauma, day of occurrence of trauma and cause of trauma.Results: The mean of patients’ age was 31.33 ± 19.46 years ranging from 2 to 90 years and 71.4% of them were males. The most common causes of trauma included accidents with motor vehicles (56%), falls from height (19.8%), and intimate partner violence (6%), respectively. Regarding opium consumption, 87.3% of patients did not use it, while 10.3% consumed opium. Narcotic abuse was significantly different with regard to the patients’ gender (P = 0.000) and age (P = 0.000).Conclusion: Opium consumption increases the risk of error and accident while driving. People on methadone treatment also show high-risk behaviors and are at greater risk of accidents.
Emergency medicine
Ali Delirrooyfard; Maria Cheraghi; Mehdi Sayyah; Zahra Farahbakhsh
Volume 8, Issue 1 , January 2022, , Pages 32-36
Abstract
Objective: People with a significant childhood history of abuse may exhibit emotionaldysregulations and psychiatric disorders and, in some cases, present suicidal ideation.Methods: In this descriptive-analytical and cross-sectional study data were collectedfrom suicidal patients referred to two grand ...
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Objective: People with a significant childhood history of abuse may exhibit emotionaldysregulations and psychiatric disorders and, in some cases, present suicidal ideation.Methods: In this descriptive-analytical and cross-sectional study data were collectedfrom suicidal patients referred to two grand hospitals in 2019. One hundred ninetyfive participants were evaluated concerning child abuse and neglect history. Data werereported as mean, SD, frequency, and percent. T-test and chi-square tests were used forstatistical analyses accordingly.Results: Child abuse regarding suicidal people were to the following order, neglect(n=103), child emotional abuse (n=102), child physical abuse (n=101), malnutrition (n=96),and child sexual abuse (n=87). Suicide was different between the two genders, but it wasnot different based on parents’ education and marital status.Conclusion: The harassed child is not equipped with proper behavioral skills and issubjected to low self-esteem due to incorrect training. Therefore, he/she may commitsuicide in adolescence by facing some problems and failures. In this regard, communityplays an important role, parents must be informed and use the right culture to reward thechild.
Emergency medicine
Harish Kodisiddaiah Shivanna; Aruna Chala Ramesh; Keshava Murthy M Rangaswamy
Volume 8, Issue 1 , January 2022, , Pages 43-48
Abstract
Objective:To implement the 5-level Emergency Severity Index (ESI) triage tool into nursingpractice in the emergency department (ED) and validate it with a population-based cohortusing hospitalization and length of stay (LOS) as outcome measures.Methods: The study included 850 patients, irrespective of ...
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Objective:To implement the 5-level Emergency Severity Index (ESI) triage tool into nursingpractice in the emergency department (ED) and validate it with a population-based cohortusing hospitalization and length of stay (LOS) as outcome measures.Methods: The study included 850 patients, irrespective of age and gender, reporting tothe ED of a tertiary care hospital. Each patient was assessed by the triage nurse as perthe 5-level ESI triage tool and categorized. The number and type of resources used by thepatient, LOS in the ED and the outcome were noted. Data were statistically analyzed byusing RStudio Team software, 2015. A P value of < 0.05 was considered to be statisticallysignificant.Results: The majority of patients belonged to ESI-4 (46.82%), followed by ESI-1 (19.41%),ESI-2 (17.06%), ESI-3 (10.35%), and ESI-5 (6.35%). In most patients, the LOS in the ED was<120 minutes (55.65%). ESI showed a statistically significant association with all the clinicalcharacteristics, as well as resources used, interventions needed, maximum time allowedbefore initiating physician assessment, duration of stay in ED, and patient outcomes(P=0.000). ESI was found to have a sensitivity of 100% and specificity of 78%.Conclusion: ESI is a useful and valid tool for the emergency triage and has the potential tobecome the standard triage acuity assessment in EDs in India.
Emergency medicine
Shyam lal; Vinod Kumar Singh; Suhas Agarwal
Volume 8, Issue 1 , January 2022, , Pages 49-54
Abstract
Objective: Perforation peritonitis is a common surgical emergency which is treated bysurgery and antibiotics. Candida isolation in peritoneal fluid and antifungal treatment isnot a norm. The aim of this study was to determine the incidence of Candida in peritonealfluid and its role in the outcome of ...
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Objective: Perforation peritonitis is a common surgical emergency which is treated bysurgery and antibiotics. Candida isolation in peritoneal fluid and antifungal treatment isnot a norm. The aim of this study was to determine the incidence of Candida in peritonealfluid and its role in the outcome of patients with perforation peritonitis.Methods: This prospective observational study was conducted on 70 patients withperforation peritonitis from October 2016 to February 2018. Intraoperatively, peritonealfluid was taken and sent for microbiological culture and sensitivity. Perforation wasmanaged according to the site of perforation and condition of bowel.Results: The mean age of the patients was 38.74 years with male predominance (58,82.85%). Forty-seven (67.14%) patients had positive peritoneal cultures. Escherichia coliwas the most common bacteria (n=29), while Candida was found to be the most commonfungi and was found in 18 patients. The incidence of Candida was higher in upper gastroduodenal perforation (30, 42.85%). Patients found positive for Candida had APACHE IIseverity score 10 or more which was higher than the rest of the patients. The mortality washigher in patients with positive peritoneal cultures (10/47) as compare to negative ones(2/23, P<0.001). The mortality in mixed bacterial and fungal-positive cultures (7/18) wasalso higher as compared to isolated bacterial culture (3/29, P <0.001). The overall mortalityrate was 17.14%.Conclusion: Patients with Candida positive peritoneal culture had a significant mortalityand morbidity as compared to Candida negative. Peritoneal fluid culture and sensitivity forbacterial and fungal were helpful in the early diagnosis and treatment
Emergency medicine
Atul Rai Sharma; Akash Singhal; Anurag Patil; Gladson David Masih
Volume 8, Issue 1 , January 2022, , Pages 66-68
Abstract
Objective: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations.Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm ...
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Objective: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations.Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm shaft fracture with ipsilateral DRUJ disruption. Operative intervention in the form of plating was done for both bones forearm shaft fracture and DRUJ was stabilised with one k wire and above elbow plaster splint in full supination was given for 6 weeks. At one-year follow-up, fracture was united and Disabilities of the Arm, Shoulder and Hand (DASH) score was 11.7, and he was well satisfied.Conclusion: DRUJ disruption should be carefully evaluated in all the patients with associated shaft fractures of radius and ulna. Timely diagnosis and optimal intervention may prevent any functional limitations.
Emergency medicine
Chui King Wong; Glen Chiang Hong Tan; Mohd Johar Jaafar
Volume 8, Issue 1 , January 2022, , Pages 74-76
Abstract
Objective: ST-elevations in electrocardiogram (ECG) secondary to an acute myocarditis may mimic ST-elevation myocardial infarction (STEMI). It is vital to distinguish between the two entities to avoid inappropriate clinical management and complications.Case Presentation: A previously well 19-year-old ...
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Objective: ST-elevations in electrocardiogram (ECG) secondary to an acute myocarditis may mimic ST-elevation myocardial infarction (STEMI). It is vital to distinguish between the two entities to avoid inappropriate clinical management and complications.Case Presentation: A previously well 19-year-old male presented with two episodes of central chest pain which were resolved spontaneously. His presentation was preceded by multiple episodes of vomiting, diarrhoea and abdominal pain. Physical examination was unremarkable except for a low-grade temperature of 37.7°C. The first ECG revealed ST-segment elevations in anterior leads without reciprocal changes. Serial ECGs showed increasing ST elevations and his cardiac markers were significantly raised. As the initial clinical presentation was potentially an acute coronary syndrome, he was instinctively treated with anti-platelets. Fortunately, this patient was not given thrombolysis as there were clinical suspicions of an acute myocarditis due to his young age, presence of viral symptoms, and absence of cardiac risk factors. Subsequent cardiac MRI confirmed the diagnosis of an acute myocarditis.Conclusion: An acute myocarditis is well known but less common presentation of viral infections. ST-segment elevations in ECG of any young patients with chest pain but without risk factors for acute coronary syndrome should always raise the suspicion of acute myocarditis especially in the presence of viral symptoms. Investigations such as cardiac magnetic resonance imaging (MRI) should be carried out emergently to distinguish both conditions.
Emergency medicine
Garima Sharma; Sanya Vermani; Anjum Syed
Volume 8, Issue 1 , January 2022, , Pages 77-79
Abstract
Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should ...
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Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should be utilized and all potential sites of injuries must be reviewed.Case Presentation: We present a case of a 40-year-old male patient with a history of trauma (fall from height), presenting to the emergency department with loss of consciousness and ear bleed. Chest radiographs showed pneumomediastinum. On cross-sectional imaging, pneumomediastinum and pneumoretroperitoneum were seen, however no esophageal, tracheal and skeletal injuries could be identified. On careful evaluation, fractures involving the base of skull were identified as a source of ectopic air.Conclusion: This case represents a situation where the fascial connections between various compartments of the body were utilized to find the site of injury and hence the source of ectopic air. Base of skull fractures are important to be identified since these require surgical attention at an early stage.