Emergency medicine
Nazanin Jannati; Vahid Yazdi-Feyzabadi; Roghayeh Ershad Sarab; Simin Salehinejad
Volume 7, Issue 2 , July 2021, , Pages 127-129
Abstract
The coronavirus disease (COVID-19) pandemic is a global health crisis of our time. The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently. In addition, the COVID-19 pandemic has disrupted or halted critical mental health ...
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The coronavirus disease (COVID-19) pandemic is a global health crisis of our time. The mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently. In addition, the COVID-19 pandemic has disrupted or halted critical mental health services in many countries worldwide. One way to overcome this situation is to use Telemental health services and people can take advantage of these services to meet their mental health needs. However, there are some barriers to provide Telemental health services, which should be considered by policymakers before the crisis.
Emergency medicine
Seyed Reza Habibzadeh; Samaneh Abiri; Saeed Barazandehpour; Mohammad Javad Zarei; Mahdi Foroughian; Hamideh Akbari; Navid Kalani; Esmaeil Rayat Dost; Seyed Hamed Hojati
Volume 7, Issue 2 , July 2021, , Pages 130-132
Abstract
Objective: Brugada syndrome (BrS) is a disorder in which the electrical activity in the heart is abnormal and affects individuals with cardiac dysrhythmia. In the present study, we introduce a case diagnosed with BrS, admitted to intensive care unit (ICU) and received treatments following sudden cardiac ...
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Objective: Brugada syndrome (BrS) is a disorder in which the electrical activity in the heart is abnormal and affects individuals with cardiac dysrhythmia. In the present study, we introduce a case diagnosed with BrS, admitted to intensive care unit (ICU) and received treatments following sudden cardiac arrest. Case Report: The patient was a male 25-year-old medical student enrolled in the sixth academic year who suffered from loss of consciousness due to sudden cardiac arrest. The patient immediately received cardiopulmonary resuscitation (CPR) measures, was visited by a cardiologist and a neurologist, and was consequently treated with medications. After an 8-day stay in the coronary care unit (CCU), the patient regained his level of consciousness and he was transferred to the ICU of Faghihi hospital in the city of Shiraz, Iran. Being diagnosed with BrS and following pulmonary aspiration treatments, he finally implanted with an implantable cardioverter defibrillator (ICD). Conclusion: Fortunately, necessary measures had been taken on time for the introduced patient and he was discharged with full recovery after 6 days
Infectious disease
Shaghayegh Rahmani; Kosar Deldar; Sara Hemati Ali
Volume 7, Issue 2 , July 2021, , Pages 133-134
Abstract
Objective: Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic.Case ...
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Objective: Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic.Case Presentation: We report 5 cases that missed triage or received delayed diagnosis because of COVID-19 suspicion. Some cases are life threatening.Conclusion: Although COVID-19 is the main health concern these days, other critical conditions should be considered. Stabilizing patients before transferring them between hospitals should be the essential goal of emergency department whether the patient is Corona virus infected or not. And before any intervention, the safety of healthcare workers must be ensured.
Emergency medicine
Maryam Adimolmasali; Ali Teimouri; Hamid Reza Mokhtar; Mahdi Foroughian; Parvin Zohoorian Sadr; Mohammad Hossien Kamaloddini
Volume 7, Issue 2 , July 2021, , Pages 135-136
Abstract
Systemic toxemia with topical anesthetics could be fatal due to the use of anesthetics in various ways (oral, intravenous, intramuscular, or subcutaneous). Nowadays, topical anesthetics are used in inpatient and outpatient treatments. Despite its widespread usage, many physicians are not fully aware ...
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Systemic toxemia with topical anesthetics could be fatal due to the use of anesthetics in various ways (oral, intravenous, intramuscular, or subcutaneous). Nowadays, topical anesthetics are used in inpatient and outpatient treatments. Despite its widespread usage, many physicians are not fully aware of the deadly side effects of lidocaine poisoning and its treatment. The objective of this case report is to highlight the diagnosis and treatment of lidocaine toxicity. A 21-year-old woman with a history of multiple suicide attempts ingested approximately three 10% w/w lidocaine sprays. The patient was brought to the emergency department of Imam Reza hospital of Mashhad University of Medical Science with cardiac arrest and respiratory failure. After successful cardiopulmonary resuscitation (CPR), she was admitted to the intensive care unit (ICU). She stayed in ICU for 2 days and we administered dobutamine drip and intravenous lipid emulsion for her then she was transferred to the general ward. We discharged her after 8 days.
Trauma
Lalit Kumar Bansal; Raja Bhanukiran; Poras Chaudhary; Arun Kumar Gupta
Volume 7, Issue 2 , July 2021, , Pages 137-139
Abstract
Objective: objectives: Penetrating abdominal trauma secondary to bamboo stick injury is a rare entity in the developed world. Most of such kind of trans abdominal penetrating bamboo stick injury is associated with multiple solid and hollow viscus injuries. In developing countries like India, where nearly ...
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Objective: objectives: Penetrating abdominal trauma secondary to bamboo stick injury is a rare entity in the developed world. Most of such kind of trans abdominal penetrating bamboo stick injury is associated with multiple solid and hollow viscus injuries. In developing countries like India, where nearly 70% of the population reside in rural areas, it is not that uncommon. Aim of this report is to recognition of risk factors and explain optimum surgical management in trans-abdominal bamboo stick injury.Case Presentation: Here we describe a case of penetrating trans abdominal bamboo stick injury resulting due to fallover a branch of bamboo stick with multiorgan damage, which was successfully managedby early surgical exploration in our institute.Conclusion: There are many factorswhich can prognosticate the penetrating trauma cases. The most important factors includea long interval between injury and surgical exploration, presence or absence of shock, andother associated organ injuries at the time of admission. Early recognition of the severity ofinjury with surgical management is utmost necessary. These patients have high morbidityand mortality rates due to multiorgan damage and post-operative infection
Emergency medicine
Mustafa Mahmood Eid
Volume 7, Issue 2 , July 2021, , Pages 140-142
Abstract
Objective: Numerous drugs and medications from various pharmacological classes can lead to seizures as an unwanted side effect. Midwakh is a pipe commonly used to smoke tobacco blend in small quantities. Midwakh use is increasing, especially among young people. Case Presentation: A 17-year-old patient ...
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Objective: Numerous drugs and medications from various pharmacological classes can lead to seizures as an unwanted side effect. Midwakh is a pipe commonly used to smoke tobacco blend in small quantities. Midwakh use is increasing, especially among young people. Case Presentation: A 17-year-old patient with a history of seizures was provoked by smoking midwakh, despite having no previous disease history. Conclusion: Although the patient had a negative workup for epilepsy, midwakh should be classified as an epileptogenic drug. More studies need to be conducted on the effects of midwakh on the neurological system
Emergency medicine
Ganesh Singh Dharmshaktu; Tanuja Pangtey
Volume 7, Issue 2 , July 2021, , Pages 146-148
Abstract
Introduction: Inflammation of the infrapatellar bursa results from various causes like trauma, infection and overuse. Superficial skin or soft tissue infection can also lead to occasional septic bursitis. Infrapatellar bursa has two parts, superficial and deep bursae. Superficial bursa inflammation reactive ...
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Introduction: Inflammation of the infrapatellar bursa results from various causes like trauma, infection and overuse. Superficial skin or soft tissue infection can also lead to occasional septic bursitis. Infrapatellar bursa has two parts, superficial and deep bursae. Superficial bursa inflammation reactive to adjacent superficial skin infection may occasionally lead to secondary bursitis.Case Presentation: We report a rare finding of acute right knee pain with extraordinary amount of fluid collection within superficial part of infrapatellar bursa in an elderly male patient. A secondary, septic and massive superficial infrapatellar bursitis was unusual in its appearance mimicking neoplastic lesion. Judicious use of clinical assessment and imaging helped to diagnose the condition.Conclusion: Early diagnosis and treatment of bursitis can ensure optimal outcome and it can be used to check further complications. Atypical presentation of any bursitis should be acknowledged and the judici
Trauma
Harshit Shah; Bhavin P Vadodariya; Vibhuti Jaju; Sanjay Nagral; Nitin Borle; Manoj Jain
Volume 7, Issue 1 , January 2021, , Pages 7-11
Abstract
Objective: To study the demographic profile and outcomes of pediatric trauma victims.Methods: A prospective observational study was performed at a secondary care centre in urban India over 15 months. Permission from the local ethics body was obtained prior to the commencement of the study. Children under ...
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Objective: To study the demographic profile and outcomes of pediatric trauma victims.Methods: A prospective observational study was performed at a secondary care centre in urban India over 15 months. Permission from the local ethics body was obtained prior to the commencement of the study. Children under the age of 12 years admitted with trauma to the General Surgical department were included. Demographic data, history of events leading to trauma, clinical findings and treatment were recorded. Pediatric Trauma Score (PTS), Functional Independence Measure (FIM) and Pediatric Quality of Life Index (PQLI) were used to assess the outcomes.Results: A total of 178 patients were included in the study. Preschool age group (3-5 years) (45%) was the most commonly affected. Majority of traumas occurred at home (75%). These homes were informal slum houses where children stayed in lofts. Fall from height (49%) due to fall from lofts (44%) was observed to be the most common mode of injury at home. Majority of patients had minor trauma with PTS (9-12) presenting with head injury (88%). However, only 35% had positive radiologic findings. There was a significant difference in PQLI of all patients and in FIM of preschool age group patients, irrespective of severity of trauma before admission and at one month of follow up.Conclusion: Child’s home was found as the most common site of trauma. Physical, psychosocial and cognitive impairment were seen in all pediatric trauma patients and functional impairment was seen mainly in preschool age. Majority of pediatric injuries are preventable.
Ultrasonography
Behrang Rezvani Kakhki; Mohsen Ebrahimi; Mahdi Foroughian; Samaneh Khajeh Nasiri; Vahid Eslami; Saeideh Anavri Ardakani; Sayyed Reza Ahmadi
Volume 7, Issue 1 , January 2021, , Pages 12-16
Abstract
Objective: The purpose of the current study was to assess the success rate of posterior tibial nerve block in the ankle with and without ultrasound guidance for pain management in emergency departments. Methods: This clinical trial was conducted on 80 individuals who needed posterior tibial nerve block ...
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Objective: The purpose of the current study was to assess the success rate of posterior tibial nerve block in the ankle with and without ultrasound guidance for pain management in emergency departments. Methods: This clinical trial was conducted on 80 individuals who needed posterior tibial nerve block in the ankle at the emergency department of Hashemi Nejad hospital and Edalatian emergency center in Mashhad, Iran. The eligible individuals were randomly assigned to one of two groups, designated the control (landmark-based nerve block) and the case group (ultrasound-guided nerve block). The two groups were compared in terms of the main measurable outcomes. The data were analyzed using SPSS software (version 20) by nonparametric tests. Results: According to the findings, the mean and median of nerve block success in the landmark-based and ultrasound-guided methods were significantly different between the two groups, both 15 (P=0.02) and 30 (P=0.001) min post-intervention. In this regard, nerve block with ultrasound guidance had a higher success rate compared to the landmark method. However, no significant difference between the two interventions was found in terms of the mean and median of the procedure duration (P=0.8) and injection frequency (P=0.4). On the other hand, the two groups were significantly different regarding the median and mean of patient satisfaction (P=0.00), duration of analgesia (P=0.004), and nerve block-related complications (P=0.03). Conclusion: The findings revealed that the relatively new technique of nerve block by ultrasound-guide resulted in better outcomes than the landmark-based method. Consequently, this method could be adopted to control acute pain in the emergency departments and improve patient care.
Ultrasonography
Majid Zamani; Maliheh Mazaheri; Farhad Heydari; Babak Masoumi
Volume 7, Issue 1 , January 2021, , Pages 17-21
Abstract
Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional ...
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Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional study, 214 patients (over 18 years) presenting to the emergency department (ED) with suspicion of traumatic calcaneus fracture following acute blunt trauma, were enrolled. Bedside ultrasonography was performed and interpreted by emergency physicians. After that, plain radiography was performed. Furthermore, all the patients were assessed by computed tomography (CT) scan as the gold standard. Results: Finally, 193 patients were enrolled with a mean age of 29.4±15.7 years (85.5% male). Fractures in the calcaneus were detected in 49 patients. The sensitivity and specificity of ultrasonography in the detection of calcaneal fractures were 83.6%, (confidence interval (CI), 69.7 –92.2) and 100% (95% CI, 96.7 –100), while the sensitivity and specificity of X-ray were 87.7% (95% CI, 74.5 –94.9) and 100% (95% CI, 96.7 –100). There was no false positive result for X-ray and US. Conclusion: Our findings suggest that bedside US with an acceptable sensitivity and specificity can be used as a promising alternative for the diagnosis of calcaneal fracture in ED.
emergency nursing
Mojtaba Samimi; Arash Safaie; Mehran Sotoodehnia; Fatemeh Rasooli; Atefeh Abdollahi
Volume 7, Issue 1 , January 2021, , Pages 22-27
Abstract
Objective: This study was conducted to investigate the role of an emergency nurse coordinator (ENC) in improving patient satisfaction at the emergency department (ED) in Tehran, Iran.Methods: This was an interventional study in the field of ED management. This study was undertaken in the ED of Sina hospital ...
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Objective: This study was conducted to investigate the role of an emergency nurse coordinator (ENC) in improving patient satisfaction at the emergency department (ED) in Tehran, Iran.Methods: This was an interventional study in the field of ED management. This study was undertaken in the ED of Sina hospital in Tehran, Iran, during March 2018 until April 2019. An ENC was assigned to the ED on even days and during the next week. Also, the presence of the ENC was switched to odd days and so on. Patient satisfaction was evaluated by a questionnaire. In order to analyze data, independent T-test was used to assess the mean difference in satisfaction scores. In addition, analysis of covariance (ANCOVA) test was utilized to assess the difference in satisfaction scores after considering age, sex and triage level as confounding variables. Results: Finally, 315 and 291 patients were allocated to the intervention (patients with ENC) and control groups (patients without ENC), respectively. The total satisfaction rate in the intervention and control groups was 63.9% and 59.3%, respectively. The mean score of total satisfaction in the intervention group was significantly higher than the control group [115.1 (SD = 20.0) vs 106.8 (SD = 22.3); P < 0.001]. The ANCOVA analysis showed that age, sex and triage level were not confounding factors affecting the satisfaction score.Conclusion: This study showed that the presence of the ENC in the ED can increase patient satisfaction, especially in domains related to “diagnostic and therapeutic services”, “cleanliness”, “cost and discharge information”, “ethical and privacy issues”, “admission, discharge and management services”.
Emergency medicine
Siamak Mousazadeh; Iraj Feizi; Khatereh Isazadeh
Volume 7, Issue 1 , January 2021, , Pages 28-31
Abstract
Objective: Inguinal hernia surgery is one of the most commonly used surgical procedures in the world. The aim of this study was to compare the recurrence and postoperative complications between a new mesh implant technique in the floor of the inguinal canal with limited tissue repair on it and Liechtenstein ...
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Objective: Inguinal hernia surgery is one of the most commonly used surgical procedures in the world. The aim of this study was to compare the recurrence and postoperative complications between a new mesh implant technique in the floor of the inguinal canal with limited tissue repair on it and Liechtenstein technique for inguinal hernia repair.Methods: In this cross-sectional study, patients were studied by Liechtenstein technique and a new technique of insertion of mesh at the foam of the inguinal canal with a limited tissue repair on it. Data were collected by interview and we assessed the recurrence rate, urinary retention and post-operative pain. Data were analyzed using SPSS software version 24. Chi-square test and t test were used for quantitative data and P value less than 0.05 was considered significant.Results: The mean age of patients was 49.28 ± 15.84. The mean age and sex ratio between the two groups were similar. Recurrence was seen in 11 (1.83%) of all patients and the difference between the two groups was not significant. Of all patients, 28 (4.7%) had urinary retention after surgery and the difference between the two groups was significant (p=0.01). Of all patients, 91 (15.2%) had pain after three weeks and 29 (4.8%) had pain after six months.Conclusion: The results showed that the new method had less complications concerning post-operative pain and urinary retention in comparison with the Liechtenstein method as an acceptable method for inguinal hernia repair in future.
Infectious disease
Mulla Mahammad Rafi; Mohammed Ismai Nizami; Uppaluri Sarath Chandra; Ashima Sharma; Gaddam Dharani Reddy; Lubna Tarannum
Volume 7, Issue 1 , January 2021, , Pages 36-40
Abstract
Objective: COVID-19 has become a major public health concern in recent times with detrimental effects on health and economy of the nation exerting unbearable pressure on health care personnel. It is vital for the caretakers and the people accompanying those patients to be aware of the ongoing pandemic ...
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Objective: COVID-19 has become a major public health concern in recent times with detrimental effects on health and economy of the nation exerting unbearable pressure on health care personnel. It is vital for the caretakers and the people accompanying those patients to be aware of the ongoing pandemic and its impact on the society and to realize their responsibility towards curbing the spread of the disease. The aim of this study is to assess the awareness of COVID-19 among the attendants accompanying the patients at emergency department (ED) and to determine their perception of the disease. Methods: A questionnaire was prepared and the attendants were approached with it. The attendants responded to the questionnaire by choosing the appropriate answers. Illiterates were explained about the questions in the language they understood and the responses were recorded. The survey was conducted from May 25th, 2020 to June 10th, 2020. Descriptive analysis was done to represent the study characters. Results: A total of 509 participants responded to the questionnaire with the mean age between 30 to 50 years. Participants were fairly conversant of the preventive measures but a significant portion lacked the knowledge of transmission and the impact of COVID-19. Education was observed to have a positive correlation with the correct responses given. Conclusion: Public education for the spread of awareness is yet to reach the illiterate section of the society. The need exists for educating the attendants of the patients as well who actually are potential candidates for contracting and also for spreading the disease
Trauma
Fardin Shahbazzadeh; Sajjad Narimani; Shiva Ahmadi; Zahra Anvari; Mehdi Khezeli
Volume 7, Issue 1 , January 2021, , Pages 41-45
Abstract
Objective:This study aimed to determine the motivation to helmet use among motorcyclists in Ardabil city using the trans-theoretical model (TTM) motivational interview. Methods: Random cluster sampling was used for this study. Five gas stations were selected from the crowded areas of Ardabil city and ...
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Objective:This study aimed to determine the motivation to helmet use among motorcyclists in Ardabil city using the trans-theoretical model (TTM) motivational interview. Methods: Random cluster sampling was used for this study. Five gas stations were selected from the crowded areas of Ardabil city and motorcyclists who came to these places were randomly interviewed. In this descriptive cross-sectional study, 350 motorcyclists in Ardabil were selected and interviewed by TTM Motivational questionnaire. We used one-way analysis of variance (ANOVA) and linear regression for analysis of data in SPSS software version 20. Results: Findings revealed that 12.6% of respondents consistently wore a helmet when they rode a motorcycle, while 45.2% of helmet non-wearers were uncertain about wearing a helmet in the future. Decisional balance (pros), self-efficacy (decreasing the negative affect situation score), and behavioral process of change can motivate participants to helmet use. Conclusion: Reducing negative social situations and increasing positive emotional states can motivate people to use helmet.
Trauma
Seyed Reza Habibzadeh; Hamid Zamani Moghadam; Neema John Mehramiz; Mahdi Foroughian
Volume 7, Issue 1 , January 2021, , Pages 63-65
Abstract
Objective: Anterior teeth are of utmost importance with regard to chewing, speaking, and beauty. Therefore, any traumatic dental injury has psychologically undesirable effects on children and their parents. The present study reported a case of a traumatic dental injury induced by falling ...
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Objective: Anterior teeth are of utmost importance with regard to chewing, speaking, and beauty. Therefore, any traumatic dental injury has psychologically undesirable effects on children and their parents. The present study reported a case of a traumatic dental injury induced by falling off a bike and referral to an emergency department as well as measures taken for dental reconstruction and patient’s improvement.Case Presentation: An 8-year-old child was taken to an emergency department due to falling off a bike following imbalance, while suffering from dental pain in his upper jaw due to dental subluxation. Afterwards, dental retaining paste along with a fixer wire was used to maintain the position of the teeth. The patient also received oral non-steroidal analgesia (acetaminophen) for proper control of the pain and was subsequently referred to a dentist to repair the teeth. The initial examinations revealed that the child was fully conscious. Considering the patient’s severe pain and intrusion of the superior left primary first tooth and the subluxation of the superior right primary first tooth. Local anesthesia was performed using 1% lidocaine in the location of the given teeth using infiltration technique. Then they were brought into an alignment by extracting the plunged tooth and the child was referred to a dentist for advanced dental trauma care.Conclusion: Dentists are not always present in hospital emergency departments; therefore, an emergency medicine specialist should be able to diagnose common traumatic dental injuries in order to manage them appropriately at the early stages, and if necessary, refer patients to dentists for further complementary treatments. This important fact will bedone after full examination and ruling out critical causes of trauma in the emergency department.
Emergency medicine
Seyed Reza Habibzadeh; Esmaeil Rayat Dost; Saeed Barazandehpour; Mahdi Foroughian
Volume 7, Issue 1 , January 2021, , Pages 69-70
Abstract
Introduction: Unilateral and bilateral tongue cyanosis usually occurs due to the Raynaud syndrome and in the underlying severe types of vasculitis and rheumatology.Case Presentation: The present study was conducted on a 54-year-old woman who referred to the emergency department with complaints of ...
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Introduction: Unilateral and bilateral tongue cyanosis usually occurs due to the Raynaud syndrome and in the underlying severe types of vasculitis and rheumatology.Case Presentation: The present study was conducted on a 54-year-old woman who referred to the emergency department with complaints of sudden and painless discoloration of the left half of the tongue. The patient had no history of disease other than diabetes controlled with glibenclamide. Clinical examination of the head and neck revealed evidence of unilateral cyanosis in the left half of the tongue without pain, whose discoloration did not improve with warming of the tongue.Conclusion: Cyanosis in the emergency department can be managed appropriately by considering some parameters including history taking, history of cyanosis occurrence, history of cardiopulmonary disease, cold sensitivity and history of rheumatologic diseases, presence or absence of nail clubbing, arterial blood oxygen saturation and arterial blood gas test results. These parameters can be effective in designing a treatment regimen, while differentiating the causes of central from peripheral cyanosis.
Emergency medicine
Esmaeal Rayat Dost; Saeed Barazandehpour; Navid Kalani; Samaneh Abiri
Volume 7, Issue 1 , January 2021, , Pages 71-73
Abstract
Objective: Aortic dissection is an uncommon disorder with a high mortality rate, especially if misdiagnosis and mistreatment are not considered. Case Presentation: We present a 67-year old female with slurred speech and left sided plegia during her brother’s funeral. The patient did not have ...
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Objective: Aortic dissection is an uncommon disorder with a high mortality rate, especially if misdiagnosis and mistreatment are not considered. Case Presentation: We present a 67-year old female with slurred speech and left sided plegia during her brother’s funeral. The patient did not have any chest pain. she was referred to our emergency department by EMS due to being suspicious of cerebrovascular accident (CVA) )as code 724). However, owing to low blood pressure and atypical symptoms of the patient, we did RUSH exam in the emergency department to detect aortic dissection. After doing the Computed tomography (CT) angiography, the diagnosis of aortic dissection was confirmed. As the vascular surgeon was not present in our surgery department, we transferred the patient to Namazi hospital by air ambulance to undergo the surgery. She was discharged from hospital with complete recovery.Conclusion: Aortic dissection symptoms can be manifested in different ways such as pulmonary embolism, ACS, and CVA. Therefore, clinicians must always have the differential diagnosis of aortic dissection in their mind and be aware of its various manifestations.
Emergency medicine
Mustafa Mahmood Eid
Volume 7, Issue 1 , January 2021, , Pages 77-79
Abstract
Objective: Epidural anesthesia is one of the famous, generally safe, and most requestedpain relief measures in labor. Nevertheless, it can have some complications thoughpneumocephalus and subdural effusion are very rare complications.Case Presentation: A 32-year-old woman presented with a severe persistent ...
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Objective: Epidural anesthesia is one of the famous, generally safe, and most requestedpain relief measures in labor. Nevertheless, it can have some complications thoughpneumocephalus and subdural effusion are very rare complications.Case Presentation: A 32-year-old woman presented with a severe persistent headacheafter a vaginal delivery, where epidural anesthesia was used for pain control. Her braincomputerized tomography (CT) scan confirmed pneumocephalus and subdural effusionas a complication of the procedure.Conclusion: Although headache can be present in many women post-delivery,investigations should run in susceptible women with alerting signs.
Emergency medicine
Samaneh Abiri; Mahdi Foroughian; Hamideh Akbar; Neema John Mehramiz; Naser Hatami; Abdol Ali Ameri; Navid Kalani; Esmaeil Rayat Dost; Saeed Barazandehpour
Volume 6, Issue 2 , July 2020, , Pages 55-58
Abstract
Objective: The purpose of this study was to evaluate a valid model for patients’ admission or discharge from emergency services to improve the health system and reduce costs.Methods: This study was carried out using a prospective cohort method. The study population was patients with limb cellulitis ...
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Objective: The purpose of this study was to evaluate a valid model for patients’ admission or discharge from emergency services to improve the health system and reduce costs.Methods: This study was carried out using a prospective cohort method. The study population was patients with limb cellulitis referring to the emergency department of Peymanieh hospital. In this research, the study participants were separated into two groups based on the duration of hospitalization (hospital stay less than 24 hours or longer than 24 hours), then the patients were again separated into 4 groups based on the classification of the the Clinical Resource Efficiency Support Team (CREST) guideline, which in each of these groups the mean age, gender, and the prevalence of underlying diseases were identified and the final outcome for each group was determined after one week from the visit to the hospital.Results: Peripheral vascular disease, history of injection drug use, immunodeficiency and congenital immune deficiency had a significant relationship with the rate of hospitalization and recurrence. There was a significant relationship between class 1 disease and hospitalization for less than 24 hours, classes 2 and 3, and hospitalization for more than 24 hours (P < 0.001). There was a significant relationship between grade 1 disease and non-recourse, grade 3 and recurrence within one week after initiation of the treatment (P < 0.001). But there was no relationship between grade 2 and grade 4 and the referral of the patient after treatment.Conclusion: Corset Scale is a reliable scale for assessing the severity of the disease to determine the process of cellulite treatment for outpatient or hospitalization.
Pediatrics
Esra Polat; Nevzat Aykut Bayrak; Günsel Kutluk; Hasret Ayyıldız Civan
Volume 6, Issue 2 , July 2020, , Pages 59-62
Abstract
Objective: Upper gastrointestinal bleeding (UGB) is one of the most important and serious cause of emergency admission in childhood. The aim of the study was to evaluate the etiological factors and the treatment approaches in patients with UGB.Methods: In this retrospective study, children with UGB admitted ...
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Objective: Upper gastrointestinal bleeding (UGB) is one of the most important and serious cause of emergency admission in childhood. The aim of the study was to evaluate the etiological factors and the treatment approaches in patients with UGB.Methods: In this retrospective study, children with UGB admitted to emergency clinics of Istanbul Health Sciences University Kanuni Sultan Suleyman Research and Training Hospital, Istanbul Bakirkoy Sadi Konuk Research and Training Hospital and Diyarbakir Children’s Hospital were evaluated between January 2014 and August 2017.Results: Of the 198 children, 14.6% had non-steroid anti-inflammatory drug (NSAID) history, and 12.6% had chronic liver disease. We detected esophagitis, esophagus varices and peptic ulcer with upper gastrointestinal endoscopic evaluation (47%, 11.1%, 18.1%, respectively). Helicobacter pylori was found in 61.6% of patients. Endoscopic therapeutic procedures (band ligation therapy, sclerotherapy, and adrenaline injection) were appied in 11.1% of patients. Eighty-four (42.4%) patients were hospitalized, and erythrocyte transfusion (ET) was ordered in 29 (14.6%) patients.Conclusion: Approximately in 20% of the pediatric patients, the source of gastrointestinal bleeding is the upper gastrointestinal system. The cause of UGB varies with age. Appropriate diagnostic and therapeutic approaches are very important for management and to reduce mortality.
Emergency medicine
Sajjad Ahmadi; Niloufar Pouresmaeil; Farima Najjarian; Samad Shams Vahdati; Maryam Rahimpour Asenjan; Hamid Reza Morteza Bagi
Volume 6, Issue 2 , July 2020, , Pages 63-67
Abstract
Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The ...
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Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The purpose of this study is to investigate the relationship between the patient’s chief complaint and their departure to the emergency room.Methods: From non-traumatic patients referred to the emergency department of Imam Reza Hospital during 2018, about 57000 patients were selected and enrolled in the study. Then, age, sex, initial diagnosis, time of the final decision, and time of departure from the emergency department as well as hospitalization ward were included in the checklist. Patients whose documentation was incomplete were excluded. Data were entered into SPSS software version 15.0 and descriptive statistics (normal distribution, average of time, minimum time and maximum time, confidence interval, mode, and median, etc.) were used for descriptive analysis and linear regression was used to analyze the correlation among findings.Results: There was a significant relationship between chief complaint and the length of stay in the emergency department (P = 0.046) and patients with dyspnea due to heart disease, bloody vomit, bloody stool, constipation, jaundice, anemia, decreased level of consciousness, diabetes, complications of diabetes, shortness of breath and kidney injury stayed longer in the emergency room compared to other complaints.Conclusion: The patient’s manner of expressing and chief complaint has an impact on the length of time they wait to leave the emergency room. Also, most patients with problems related to internal medicine have the longest time in the emergency room; in particular gastrointestinal patients have the longest stay in the emergency room.
Emergency medicine
Payman Asadi; Vahid Monsef Kasmaei; Seyyed Mahdi Zia Ziabari; Shiva Bakian; Amir Noyani
Volume 6, Issue 2 , July 2020, , Pages 68-72
Abstract
Objective: Emergency medical services (EMS) is a critical component of health care system and the forefront of stroke care. The prominent role of EMS in stroke care is timely and accurate diagnosis of acute ischemic stroke and transfer of the patients to stroke centers. The present study aimed to assess ...
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Objective: Emergency medical services (EMS) is a critical component of health care system and the forefront of stroke care. The prominent role of EMS in stroke care is timely and accurate diagnosis of acute ischemic stroke and transfer of the patients to stroke centers. The present study aimed to assess the “awareness” and “attitude” of EMS personnel concerning prehospital stroke care based on American Stroke Association (ASA) guideline in Rasht town.Methods: This was an analytical cross-sectional study. The participants, consisted of all EMS personnel (n = 115) in Rasht town in 2012, entered the study based on census method. Awareness and attitude of EMS personnel toward prehospital stroke care were assessed using a questionnaire based on ASA guideline. The questionnaire had two sections. The first part contained demographic data and the second part had multiple choice items (Likert-type scale response anchors) to assess awareness and attitude of the personnel. The questionnaires were filled out by the personnel. The collected data were analyzed using descriptive and inferential statistics using SPSS software version 20. P-value less than 5% was considered significant.Results: Ninety people participated in this study. The average of age and working experience of participants were 36.84 ± 8.02 and 11.36 ± 5.71, respectively. Most of the participants had bachelor degree (n = 33, 36.7%) and majored in medical emergency (n = 43, 47.8%). Most of them were contract employees (47.8%). Mean scores of awareness and attitude of the personnel were 26.68 (the total number of score = 51) and 32.56 (the total number of score = 80), respectively.Conclusion: Findings revealed poor awareness and attitude of EMS personnel toward prehospital stroke care based on ASA guideline in
Emergency medicine
Fares Najari; Hadi Jafari; Ali Mohammad Alimohammadi; Dorsa Najari
Volume 6, Issue 2 , July 2020, , Pages 73-76
Abstract
Objective: Determination of victim’s clothes in gunshot wounds is important due to the necessity of immediate workup in the emergency room as well as the legal aspects of cases. The aim of this study is to evaluate the importance of victim’s clothes in gunshot wounds referred to autopsy hall ...
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Objective: Determination of victim’s clothes in gunshot wounds is important due to the necessity of immediate workup in the emergency room as well as the legal aspects of cases. The aim of this study is to evaluate the importance of victim’s clothes in gunshot wounds referred to autopsy hall of legal medicine bureau of Tehran, Iran from 2014 to 2017.Methods: In this analytical comparative study, 202 consecutive cadavers of gunshot victims, referred to Tehran Legal Medical Hall from 2014 to 2017, were enrolled and the effect of shotgun and gunshot wound were determined and compared. Data were collected using a researcher-made questionnaire. The significance level of the tests was considered as P < 0.05. Spearman correlation coefficient and chi-square tests were used accordingly. The data were analyzed using SPSS software version 22.Results: In this study, all women were killed by gunshot. Also, all of the 26 people who were killed by shotgun were men. The mean of age only in males was 39-48 years for shotgun, and 29-38 years in both genders for gunshot. Evaluation of their clothes in the emergency room and autopsy hall was helpful in 70% of cases in order to determine shot distance and type of gun (P = 0.0001). Conversely, we did not observe a significant difference between sex (P = 0.082) and the pattern of death (P = 0.211).Conclusion: Based on the obtained results, it seems that some characteristics of victim’s clothes may be useful to differentiate shotgun and gunshot.
Emergency medicine
Mozhgan Taghizadeh; Mahdi Foroughian; Hamidreza Vakili; Seyed Reza Habibzadeh; Reza Boostani; Negar Morovatdar; Ehsan Bolvardi
Volume 6, Issue 2 , July 2020, , Pages 77-81
Abstract
Objective: Intracerebral hemorrhage (ICH) following systemic and chronic hypertension is one of the main causes of acute stroke leading to disability and death. Identifying the risk factors in ICH patients can be effective in reducing bleeding and the rates of mortality and disability in these patients. ...
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Objective: Intracerebral hemorrhage (ICH) following systemic and chronic hypertension is one of the main causes of acute stroke leading to disability and death. Identifying the risk factors in ICH patients can be effective in reducing bleeding and the rates of mortality and disability in these patients. This study was carried out to investigate the factors associated with ICH.Methods: A total of 134 patients with chronic systemic hypertension who had ICH were enrolled in this study. The amount of ICH was measured through computed tomography (CT scan). The subjects were divided into two groups of high (>30 mL) and low (Results: The mean age of the subjects was 66.04± 14.15 years, and 71 (52.99%) individuals were females. The mean volume of ICH was 24.47 mL, with 29.10% of the subjects (39 patients) having >30 mL and 70.90% (95 patients) having Conclusion: The results of this study showed that less than 30% of the subjects had high volumes of bleeding, and the co-existence of IHD was considered as a strong independent risk factor affecting the volume of ICH associated with worse prognosis.
Trauma
Mishal Gillani; Sabah Uddin Saqib; Russell Seth Martins; Hasnain Zafar
Volume 6, Issue 2 , July 2020, , Pages 87-91
Abstract
Objective: Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger. It is expected to complicate around 1 in 12 pregnancies and accounts for 46% of such deaths. In this study, we present our experience of trauma during pregnancy at a tertiary care hospital ...
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Objective: Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger. It is expected to complicate around 1 in 12 pregnancies and accounts for 46% of such deaths. In this study, we present our experience of trauma during pregnancy at a tertiary care hospital in Karachi.Methods: A standardized form was used to extract data from online records for all pregnant women who presented with traumatic injuries to the Aga Khan University Hospital from 2014 to 2019.Results: A total of 48 pregnant females with a mean age of 28.80 (SD: 6.50) years were included in this study. Road traffic accidents (RTA) accounted for the commonest cause of injury in the first (66.7%) and second (65%) trimesters. However, fall (45.5%) followed by RTA (27.3%) was the most frequent mechanism of injury during the third trimester. Gunshot injuries were seen in 4 patients only. Overall, fetal ultrasound was the most commonly performed imaging (87.5%) followed by limb X-ray and focused abdominal sonography for trauma (FAST) ultrasound. Out of total, 52.1% of the patients were surgically managed. Fetal demise in utero and spontaneous abortion was reported in 2 patients only.Conclusion: Road traffic accidents and falls comprise a significant burden of maternal and fetal morbidity and mortality. In terms of prevention, several policies and interventions at the government level need to be introduced in order to reduce the incidence of traumatic events.