ORIGINAL_ARTICLE
COVID-19 epidemic: What happens to other routine patients admitted in the emergency department?
Four weeks have passed from the first reported case of covid-19 in Iran. During the past month, thousands of patients ran to emergency departments (EDs) due to respiratory complaints. From the beginning of coronavirus disease 2019 (COVID-19) outbreak, EDs have become particular units for admitting patients with respiratory complaints. The question is “what happens to other routine patients of ED?”
http://www.jept.ir/article_90648_fd47fbb9a6986bd0b86fa79065b4a372.pdf
2020-07-01
53
54
10.34172/jept.2020.19
COVID-19
Outbreak
Emergency departments
Shaghayegh
Rahmani
sh79316@yahoo.com
1
Innovated Medical Research Center, Faculty of Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
LEAD_AUTHOR
1. Grouse AI, Bishop RO, Gerlach L, de Villecourt TL, Mallows JL. A stream for complex, ambulant patients
1
reduces crowding in an emergency department. Emerg Med Australas 2014; 26(2): 164-9. doi:
2
10.1111/1742-6723.12204.
3
2. Asplin BR, Magid DJ, Rhodes KV, Solberg LI, Lurie N, Camargo CA Jr. A conceptual model of emergency
4
department crowding. Ann Emerg Med 2003; 42(2):173-80. doi: 10.1067/mem.2003.302.
5
3. Bullard MJ, Villa-Roel C, Guo X, Holroyd BR, Innes G, Schull MJ, et al. The role of a rapid assessment
6
zone/pod on reducing overcrowding in emergency departments: a systematic review. Emerg Med J 2012;
7
29(5): 372-8. doi: 10.1136/emj.2010.103598.
8
4. Baratloo A, Maleki M. Iranian emergency department overcrowding. Journal of Emergency Practice and Trauma 2015; 1(2): 39.
9
5. Knapman M, Bonner A. Overcrowding in mediumvolume emergency departments: Effects of aged
10
patients in emergency departments on wait times for non-emergent triage-level patients. Int J Nurs
11
Pract 2010; 16(3): 310-7. doi: 10.1111/j.1440-172X.2010.01846.x.
12
ORIGINAL_ARTICLE
The investigation of valid criteria for hospitalization and discharge in patients with limb cellulitis: a prospective cohort study
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.
http://www.jept.ir/article_90612_f7a4a525540f376db4ac982908d8591f.pdf
2020-07-01
55
58
10.34172/jept.2020.04
Crest Scale
Cellulitis
Limb
Infection
Samaneh
Abiri
samaneh.abiri@gmail.com
1
Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
AUTHOR
Mahdi
Foroughian
foroughianmh@mums.ac.ir
2
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Hamideh
Akbar
3
Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Neema John
Mehramiz
4
Department of Psychiatry Neurology, Banner University Medical Center, Tucson, AZ, USA
AUTHOR
Naser
Hatami
naserohatami@gmail.com
5
Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
AUTHOR
Abdol Ali
Ameri
abdolaliameri@gmail.com
6
Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
AUTHOR
Navid
Kalani
navidkalani@ymail.com
7
6Anesthesiology, Critical Care, and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
AUTHOR
Esmaeil
Rayat Dost
8
Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
LEAD_AUTHOR
Saeed
Barazandehpour
saeedbarazandehpour@gmaiil.com
9
Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran
LEAD_AUTHOR
1. Sukumaran V, Senanayake S. Bacterial skin and soft tissue infections. Aust Prescr 2016; 39(5): 159-63. doi: 10.18773/austprescr.2016.058.
1
2. Raff AB, Kroshinsky D. Cellulitis: a review. JAMA 2016; 316(3): 325-37. doi:10.1001/jama.2016.8825.
2
3. Collazos J, de la Fuente B, García A, Gómez H, Menéndez C, Enríquez H, et al. Cellulitis in adult patients: a large, multicenter, observational, prospective study of 606 episodes and analysis of the factors related to the response to treatment. PLoS One 2018; 13(9): e0204036. doi: 10.1371/
3
journal.pone.0204036.
4
4. Cranendonk DR, Lavrijsen APM, Prins JM, Wiersinga WJ. Cellulitis: current insights into pathophysiology and clinical management. Neth J Med 2017; 75(9): 366-78.
5
5. Sadick N. Treatment for cellulite. Int J Womens Dermatol 2019; 5(1): 68-72. doi: 10.1016/j.ijwd.2018.09.002.
6
6. Gabillot-Carré M, Roujeau JC. Acute bacterial skin infections and cellulitis. Curr Opin Infect Dis 2007; 20(2):118-23. doi: 10.1097/QCO.0b013e32805dfb2d.
7
7. Rehder PA, Eliezer ET, Lane AT. Perianal cellulitis. Cutaneous group A streptococcal disease. Arch Dermatol 1988; 124(5): 702-4. doi: 10.1001/archderm.1988.01670050046018.
8
8. Volz KA, Canham L, Kaplan E, Sanchez LD, Shapiro NI, Grossman SA. Identifying patients with cellulitis who are likely to require inpatient admission after a stay in an ED observation unit. Am J Emerg Med 2013; 31(2): 360-4. doi:10.1016/j.ajem.2012.09.005.
9
9. Ellis Simonsen SM, van Orman ER, Hatch BE, Jones SS, Gren LH, Hegmann KT, et al. Cellulitis incidence in a defined population. Epidemiol Infect 2006; 134(2): 293-9. doi: 10.1017/s095026880500484x.
10
10. Carratalà J, Rosón B, Fernández-Sabé N, Shaw E, del Rio O, Rivera A, et al. Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. Eur J Clin Microbiol Infect Dis 2003; 22(3): 151-7. doi: 10.1007/s10096-003-0902-x.
11
11. Jenkins TC, Knepper BC, Jason Moore S, Saveli CC, Pawlowski SW, Perlman DM, et al. Comparison of the microbiology and antibiotic treatment among diabetic and nondiabetic patients hospitalized for cellulitis or cutaneous abscess. J Hosp Med 2014; 9(12): 788-94. doi: 10.1002/jhm.2267.
12
12. Njim T, Aminde LN, Agbor VN, Toukam LD, Kashaf SS, Ohuma EO. Risk factors of lower limb cellulitis in a leveltwo healthcare facility in Cameroon: a case-control study. BMC Infect Dis 2017; 17(1): 418. doi: 10.1186/s12879-017-2519-1.
13
13. Goldman RD, Dolansky G, Rogovik AL. Predictors for admission of children with periorbital cellulitis presenting to the pediatric emergency department. Pediatr Emerg Care 2008; 24(5): 279-83. doi: 10.1097/PEC.0b013e31816ecb43.
14
14. Sabbaj A, Jensen B, Browning MA, Ma OJ, Newgard CD. Soft tissue infections and emergency department disposition: predicting the need for inpatient admission. Acad Emerg Med 2009; 16(12): 1290-7. doi: 10.1111/j.1553-2712.2009.00536.x.
15
15. Abiri S. Emergency Medicine Extremity Cellulitis Referring To the Emergency Rooms of Hazrat Rasoul Akram and Sina Hospitals [dissertation]. Iran University of Medical Sciences; 2014.
16
16. Mold J. Goal-directed health care: redefining health and health care in the era of value-based care. Cureus 2017; 9(2): e1043. doi: 10.7759/cureus.1043.
17
17. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood) 2008; 27(3):759-69. doi: 10.1377/hlthaff.27.3.759.
18
ORIGINAL_ARTICLE
Pediatric upper gastrointestinal bleeding in children: etiology and treatment approaches
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.
http://www.jept.ir/article_90623_190f71f4ddc24b0dbbcaea0e5b41698e.pdf
2020-07-01
59
62
10.34172/jept.2020.10
Upper gastrointestinal bleeding
etiology
treatment
Child
Esra
Polat
esrkcdr@gmail.com
1
Department of Pediatrics, Division of Pediatric Gastroenterology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
LEAD_AUTHOR
Nevzat Aykut
Bayrak
2
Department of Pediatrics, Division of Pediatric Gastroenterology, Health Sciences University, Zeynep Kamil Maternity and Children’s Training and Research Hospital, Istanbul, Turkey
AUTHOR
Günsel
Kutluk
gekutluk@gmail.com
3
Department of Pediatrics, Division of Pediatric Gastroenterology, Health Sciences University, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
AUTHOR
Hasret Ayyıldız
Civan
4
Department of Pediatrics, Division of Pediatric Gastroenterology, Health Sciences University, Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
AUTHOR
1. Poddar U. Diagnostic and therapeutic approach to upper gastrointestinal bleeding. Paediatr Int Child Health 2019;39(1): 18-22. doi: 10.1080/20469047.2018.1500226.
1
2. Grimaldi-Bensouda L, Abenhaim L, Michaud L, Mouterde O, Jonville-Béra AP, Giraudeau B, et al. Clinical features and risk factors for upper gastrointestinal bleeding in children: a case-crossover study. Eur J Clin Pharmacol 2010; 66: 831-7. doi: 10.1007/s00228-010-0832-3.
2
3. Colle I, Wilmer A, Le Moine O, Debruyne R, Delwaide J, Dhondt E, et al. Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children. Acta Gastroenterol Belg 2011; 74: 45-66.
3
4. Owensby S, Taylor K, Wilkins T. Diagnosis and management of upper gastrointestinal bleeding in children. J Am Board Fam Med 2015; 28(1): 134-45. doi: 10.3122/jabfm.2015.01.140153.
4
5. Romano C, Oliva S, Martellossi S, Miele E, Arrigo S, Graziani MG, et al. Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology.
5
World J Gastroenterol 2017; 23(8): 1328-37. doi: 10.3748/wjg.v23.i8.1328.
6
6. Banc-Husu AM, Ahmad NA, Chandrasekhara V, Ginsberg GG, Jaffe DL, Kochman ML, et al. Therapeutic endoscopy for the control of nonvariceal upper gastrointestinal bleeding
7
in children: a case series. J Pediatr Gastroenterol Nutr 2017;64(4): e88-e91. doi: 10.1097/mpg.0000000000001457.
8
7. Tringali A, Thomson M, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, et al. Pediatric gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Guideline Executive summary. Endoscopy 2017; 49(1): 83-91. doi: 10.1055/s-0042-111002.
9
8. Jafari SA, Kiani MA, Kianifar HR, Mansooripour M, Heidari E, Khalesi M. Etiology of gastrointestinal bleeding in children referred to pediatric wards of Mashhad hospitals, Iran. Electron Physician 2018; 10(2): 6341-5. doi:10.19082/6341.
10
9. Gimiga N, Olaru C, Diaconescu S, Miron I, Burlea M. Upper gastrointestinal bleeding in children from a hospital center of Northeast Romania. Minerva Pediatr 2016; 68(3):
11
10. Cleveland K, Ahmad N, Bishop P, Nowicki M. Upper gastrointestinal bleeding in children: an 11-year
12
retrospective endoscopic investigation. World J Pediatr 2012; 8(2): 123-8. doi: 10.1007/s12519-012-0350-8.
13
11. Kalyoncu D, Urganci N, Cetinkaya F. Etiology of upper gastrointestinal bleeding in young children. Indian J Pediatr 2009; 76(9): 899-901. doi: 10.1007/s12098-009-0195-x.
14
12. Gultekingil A, Teksam O, Gulsen HH, Ates BB, Saltik- Temizel IN, Demir H. Risk factors associated with clinically significant gastrointestinal bleeding in pediatric ED. Am J Emerg Med 2018; 36(4): 665-8. doi: 10.1016/j.ajem.2017.12.022.
15
13. Mouterde O, Hadji S, Mallet E, Le Luyer B, Métayer P. Les hémorragies digestives chez l’enfant: a propos de 485endoscopies. Ann Pediatr (Paris) 1996; 43(3): 167-76.
16
14. Usta M, Urganci N. Upper gastrointestinal bleeding in children: the role of helicobacter pylori infection and nonsteroidal anti-inflammatory drug use. West Indian MedJ 2015; 64(2): 113-6.
17
15. Singhi S, Jain P, Jayashree M, Lal S. Approach to a child with upper gastrointestinal bleeding. Indian J Pediatr 2013;80(4): 326-33. doi: 10.1007/s12098-013-0987-x.
18
16. Kim SJ, Oh SH, Jo JM, Kim KM. Experiences with endoscopic interventions for variceal bleeding in children with portal hypertension: a single center study. Pediatr Gastroenterol Hepatol Nutr 2013; 16(4): 248-53. doi:10.5223/pghn.2013.16.4.248.
19
17. Nasher O, Devadason D, Stewart RJ. Upper gastrointestinal bleeding in children: a tertiary united kingdom children’s hospital experience. Children (Basel) 2017; 4(11). doi:10.3390/children4110095.
20
18. Zheng W, Jiang L, Jia X, Long G, Shu X, Jiang M. Analysis of risk factors and development of scoring system to predict severity of upper gastrointestinal bleeding in children. J Gastroenterol Hepatol 2019; 34(6): 1035-41. doi: 10.1111/jgh.14548.
21
19. Attard TM, Miller M, Pant C, Kumar A, Thomson M. Mortality associated with gastrointestinal bleeding in children: a retrospective cohort study. World J Gastroenterol 2017; 23(9): 1608-17. doi: 10.3748/wjg.v23.i9.1608.
22
ORIGINAL_ARTICLE
Investigating the relationship between how a chief complaint is expressed and the patient workflow
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.
http://www.jept.ir/article_90650_83c068ffc81f173c44215b45ad6ccddd.pdf
2020-07-01
63
67
10.34172/jept.2020.11
Demography
Initial diagnosis
Chief complaint
Emergency medicine
Sajjad
Ahmadi
1
Emergency Medicine Research Team, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Niloufar
Pouresmaeil
npooresmaeil@gmail.com
2
Emergency Medicine Research Team, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Farima
Najjarian
farima.njrn@gmail.com
3
Emergency Medicine Research Team, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Samad
Shams Vahdati
4
Emergency Medicine Research Team, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
AUTHOR
Maryam
Rahimpour Asenjan
maryam_rahimpour@ymail.com
5
Emergency Medicine Research Team, faculty of Nursing and Midwifery, Tabriz University of Medical Sciences,Tabriz, Iran
AUTHOR
Hamid Reza
Morteza Bagi
hamidm1975@yahoo.com
6
Emergency Medicine Research Team, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
LEAD_AUTHOR
ORIGINAL_ARTICLE
Assessment of awareness and attitude of EMS personnel concerning pre-hospital stroke care based on American Stroke Association Guideline
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
http://www.jept.ir/article_90651_a518a10ca0d745384270604924f89ccf.pdf
2020-07-01
68
72
10.34172/jept.2020.05
awareness
Attitude
Stroke
Prehospital care
Payman
Asadi
1
Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
AUTHOR
Vahid
Monsef Kasmaei
2
Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
AUTHOR
Seyyed Mahdi
Zia Ziabari
3
Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
LEAD_AUTHOR
Shiva
Bakian
4
Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran
LEAD_AUTHOR
Amir
Noyani
a.noyani@shmu.ac.ir
5
Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
LEAD_AUTHOR
1. Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology. 2015;45(3):161-76.
1
2. Truelsen T, Piechowski‐Jóźwiak B, Bonita R, Mathers C, Bogousslavsky J, Boysen G. Stroke incidence and prevalence in Europe: a review of available data. European journal of neurology. 2006;13(6):581-98.
2
3. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(7):2160-236.
3
4. Hsieh M-J, Tang S-C, Chiang W-C, Tsai L-K, Jeng J-S, Ma MH-M. Effect of prehospital notification on acute stroke care: a multicenter study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2016;24(1):57.
4
5. Caceres JA, Adil MM, Jadhav V, Chaudhry SA, Pawar S, Rodriguez GJ, et al. Diagnosis of stroke by emergency medical dispatchers and its impact on the prehospital care of patients. Journal of stroke and cerebrovascular diseases. 2013;22(8):e610-e4.
5
6. Millin MG, Gullett T, Daya MR. EMS Management of Acute Stroke—Out-of-Hospital Treatment andStroke System Development (Resource Document to NAEMSP Position Statement). Prehospital Emergency Care. 2007;11(3):318-25.
6
7. Studnek JR, Asimos A, Dodds J, Swanson D. Assessing the validity of the Cincinnati prehospital stroke scale and the medic prehospital assessment for code stroke in an urban emergency medical services agency. Prehospital emergency care. 2013;17(3):348-53.
7
8. Oostema JA, Konen J, Chassee T, Nasiri M, Reeves MJ. Clinical predictors of accurate prehospital stroke recognition. Stroke. 2015;46(6):1513-7.
8
9. Buck BH, Starkman S, Eckstein M, Kidwell CS, Haines J, Huang R, et al. Dispatcher recognition of stroke using the national academy medical priority dispatch system. Stroke. 2009;40(6):2027-30.
9
10. Clinical Quality & Patient Safty Unit, Q., Clinical Practice Manual (CPM). https://www.ambulance.qld.gov.au/docs/clinical/cpg/CPG_Standard%20cares.pdf. 2017:465-7.
10
11. Frendl DM, Strauss DG, Underhill BK, Goldstein LB. Lack of impact of paramedic training and use of the cincinnati prehospital stroke scale on stroke patient identification and on-scene time. Stroke. 2009;40(3):754-6.
11
12. Brandler ES, Sharma M, McCullough F, Ben-Eli D, Kaufman B, Khandelwal P, et al. Prehospital stroke identification: factors associated with diagnostic accuracy. Journal of Stroke and Cerebrovascular Diseases. 2015;24(9):2161-6.
12
13. Jadidi A, Safarabadi M, Irannejad B, Harorani M. Level of Patients’ Satisfaction from Emergency Medical Services in Markazi Province; a Cross sectional Study. Iranian Journal of Emergency Medicine. 2016;3(2):58-65.
13
ORIGINAL_ARTICLE
The importance of victim’s clothes in gunshot wounds
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.
http://www.jept.ir/article_90652_1aef06407906c7514f3965a20da4b2c4.pdf
2020-07-01
73
76
10.34172/jept.2020.13
Shotgun
Gunshot
Victims
Wounds
Gunshot firearms
Fares
Najari
najari.hospital@sbmu.ac.ir
1
Forensic Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Hadi
Jafari
2
Forensic Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
AUTHOR
Ali Mohammad
Alimohammadi
3
Tehran Legal Medicine Organization, Tehran, Iran
AUTHOR
Dorsa
Najari
dorvv.1998@gmail.com
4
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
AUTHOR
1. Najari F, Mostafazadeh B, Bahrami M, Najari D. Causes and frequency of physical trauma in pregnancy. Tehran University Medical Journal 2019; 77(3): 166-71. [In Persian].
1
2. Knight B. Forensic Pathology. 2nd ed. London: Edward Arnold Ltd; 1996. p. 253-4.
2
3. DiMaio D, DiMaio VJ. Forensic Pathology. 2nd ed. Boca Raton, FL: CRC Press LCC; 2001.
3
4. Miller M, Azrael D, Hemenway D. Firearm availability and unintentional firearm deaths, suicide, and homicide among 5-14 year olds. J Trauma 2002; 52(2): 267-74. doi:10.1097/00005373-200202000-00011.
4
5. Akhlaghi M, Afshar M, Barooni SH, Taghadosi Nejad F, Tofighi Zavareh H, Ghorbani M. General Legal Medicine and Toxicity. Tehran: University of Medical Sciences Press;2009.
5
6. Schmeling A, Strauch H, Rothschild MA. Female suicides in Berlin with the use of firearms. Forensic Sci Int 2001; 124(2-3): 178-81. doi: 10.1016/s0379-0738(01)00594-1.
6
7. Sidel VW. The international arms trade and its impact on health. BMJ 1995; 311(7021): 1677-80. doi: 10.1136/bmj.311.7021.1677.
7
8. Coupland RM. The effect of weapons on health. Lancet 1996; 347(8999): 450-1. doi: 10.1016/s0140 6736(96)90017-3.
8
9. Bowyer GW. Management of small fragment wounds in modern warfare: a return to Hunterian principles? Ann R Coll Surg Engl 1997; 79(3): 175-82.
9
10. Sellier KG, Kneubuehl BP. Wound Ballistics: And the Scientific Background. Amsterdam: Elsevier; 1994.
10
11. Riehl JT, Connolly K, Haidukewych G, Koval K. Fractures due to gunshot wounds: do retained bullet fragments affect union? Iowa Orthop J 2015; 35: 55-61.
11
12. Ali SA, Tahir SM, Makhdoom A, Shaikh AR, Siddique AJ. Aerial firing and stray bullet injuries: a rising tide. Iran Red Crescent Med J 2015; 17(4): e26179. doi: 10.5812/ircmj.17(4)2015.26179.
12
13. Matoso RI, Freire AR, Santos LS, Daruge Junior E, Rossi AC, Prado FB. Comparison of gunshot entrance morphologies caused by. 40-caliber Smith & Wesson, 380-caliber, and 9-mm Luger bullets: a finite element analysis study. PLoS One 2014; 9(10): e111192. doi: 10.1371/journal.pone.0111192.
13
14. Najari F, Imam-Hadi MA, Forghani M, Najari D. Investigation of Bullet Shooting Rresults in Referral Death to the Kahrizak Hall of Legal Medicine Organization from 2010 to 2014. Iranian Journal of Forensic Medicine 2018; 24(1): 53-9. doi: 10.30699/epub.sjfm.24.1.53. [Persian].
14
15. Iflazoglu N, Ureyen O, Oner OZ, Tusat M, Akcal MA. Complications and risk factors for mortality in penetrating abdominal firearm injuries: analysis of 120 cases. Int J Clin Exp Med 2015; 8(4): 6154-62.
15
16. Lustenberger T, Inaba K, Schnüriger B, Barmparas G, Eberle BM, Lam L, et al. Gunshot injuries in the elderly: patterns and outcomes. A national trauma databank analysis. World J Surg 2011; 35(3): 528-34. doi: 10.1007/s00268-010-0920-7.
16
ORIGINAL_ARTICLE
A study of the factors associated with non-traumatic intracerebral hemorrhage (ICH) in patients with chronic systemic hypertension
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.
http://www.jept.ir/article_90653_e2b4771b4ea686b3f58f038ebdafbaf7.pdf
2020-07-01
77
81
10.34172/jept.2020.15
blood pressure
Intracerebral hemorrhage
Stroke
chronic systemic hypertension
patients
Mozhgan
Taghizadeh
mozhgantaghizadeh@gmail.com
1
Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Mahdi
Foroughian
foroughianmh@mums.ac.ir
2
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
AUTHOR
Hamidreza
Vakili
3
Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
AUTHOR
Seyed Reza
Habibzadeh
habibzadehr@mums.ac.ir
4
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
AUTHOR
Reza
Boostani
rezaboostani@gmail.com
5
Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Negar
Morovatdar
6
Clinical Research Unit, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
Ehsan
Bolvardi
7
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
LEAD_AUTHOR
1. An SJ, Kim TJ, Yoon BW. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: an update. J Stroke 2017; 19(1): 3-10. doi: 10.5853/jos.2016.00864.
1
2. Khealani BA, Wasay M. The burden of stroke in Pakistan. Int J Stroke 2008; 3(4): 293-6. doi: 10.1111/j.1747-4949.2008.00214.x.
2
3. Sacco RL. Pathogenesis, classification, and epidemiology of cerebrovascular disease. In: Rowland LP, eds. Merrit’s Textbook of Neurology. Lea & Febiger; 1995. p. 227.
3
4. Iniesta J, Corral J, González-Conejero R, Piqueras C, Vicente V. Polymorphisms of platelet adhesive receptors: do they play a role in primary intracerebral hemorrhage? Cerebrovasc Dis 2003; 15(1-2): 51-5. doi: 10.1159/000067126.
4
5. Ghiasian M, Daneshyar s, Asna-Ashari F, Bagheri Z. Consequences of intracranial hemorrhage and its effective factors. Journal of Mazandaran University of Medical Sciences 2019; 29(174): 42-52. [In Persian].
5
6. Hong KS, Bang OY, Kang DW, Yu KH, Bae HJ, Lee JS, et al. Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the Korean stroke society and clinical research center for stroke. J Stroke 2013; 15(1): 2-20. doi:10.5853/jos.2013.15.1.2.
6
7. Krishnamurthi RV, Moran AE, Forouzanfar MH, Bennett DA, Mensah GA, Lawes CM, et al. The global burden of hemorrhagic stroke: a summary of findings from the GBD 2010 study. Glob Heart 2014; 9(1): 101-6. doi: 10.1016/j.gheart.2014.01.003.
7
8. Sia SF, Tan KS, Waran V. Primary intracerebral haemorrhage in Malaysia: in-hospital mortality and outcome in patients from a hospital based registry. Med J Malaysia 2007; 62(4): 308-12.
8
9. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. Engl J Med 2001; 344(19): 1450-60. doi: 10.1056/nejm200105103441907.
9
10. Wasay M, Yousuf A, Lal D, Awan S. Predictors of the intracerebral hemorrhage volume in hypertensive
10
patients. Cerebrovasc Dis Extra 2011; 1(1): 1-5. doi:10.1159/000323270.
11
11. Flaherty ML, Tao H, Haverbusch M, Sekar P, Kleindorfer D, Kissela B, et al. Warfarin use leads to larger intracerebral hematomas. Neurology 2008; 71(14): 1084-9. doi:10.1212/01.wnl.0000326895.58992.27.
12
12. Nikseresht A, Azin HJ. Hypertension-related primary cerebral hemorrhage in patients referring to hospitals affiliated to Shiraz University of Medical Sciences. Journal of Medical Research (JMR) 2004; 2(2): 40-7. [In Persian].
13
13. Chen G, Ping L, Zhou S, Liu W, Liu L, Zhang D, et al. Early prediction of death in acute hypertensive intracerebral hemorrhage. Exp Ther Med 2016; 11(1): 83-8. doi: 10.3892/etm.2015.2892.
14
14. Zia E, Engström G, Svensson PJ, Norrving B, Pessah- Rasmussen H. Three-year survival and stroke
15
recurrence rates in patients with primary intracerebral hemorrhage. Stroke 2009; 40(11): 3567-73. doi: 10.1161/strokeaha.109.556324.
16
15. Arboix A, Miguel M, Císcar E, García-Eroles L, Massons J, Balcells M. Cardiovascular risk factors in patients aged 85 or older with ischemic stroke. Clin Neurol Neurosurg 2006; 108(7): 638-43. doi: 10.1016/j.clineuro.2005.10.010
17
ORIGINAL_ARTICLE
A look on trauma code activation in a major trauma centre in UAE: a descriptive study
Background:Trauma is considered to be a major cause of morbidity and mortality all over the world. This descriptive study has an emphasize on the epidemiology, mechanism and patterns of trauma, with a consideration of why trauma code was activated, and the imaging results in regard to the severity of the trauma. Method: A descriptive study was conducted in Al Ain Hospital over the year of 2017. Totally 886 patients were included who presented with a trauma and considered dangerous according to hospital guidelines. They underwent a full body trauma CT, and were admitted to the hospital. We looked at the mechanisms, patterns, time of the day and radiological findings. Injury severity score (ISS) and Revised trauma score (RTS) were calculated, and the cause of trauma code activation was evaluated.Results: The study showed that; positive imaging findings were found in 364 (41%) of patients while 522 (59%) had normal radiological tests. The principal mechanism of injury was motor vehicle accident (54.4%) followed by falls (21.4%) and pedestrian accidents (10.2%). Overall, 69.75% (618 patients) were admitted to the hospital, 22 patients (2.5 %) needed immediate interventions and 36 patients (4 %) needed ICU admission. Only 2 patients (0.25 %) died in the emergency room.Conclusion:The hospital policy in activating a trauma code should be revised, with more care being paid to the mechanisms of injury and the condition of the patient, without missing any injury that could harm the patient. So, the emergency physician should be better prepared to do a detailed physical examination and weigh the risk of radiation against missing a dangerous injury.
http://www.jept.ir/article_90654_e87920aa060f83dda2342ea6e8a7b894.pdf
2020-07-01
82
86
10.34172/jept.2020.16
Trauma code
Trauma CT
Radiological findings
Hospital policy
Mustafa
Mahmood Eid
1
Emergency Department, Al Ain Hospital, Al Ain, United Arab Emirates
LEAD_AUTHOR
Maythem
Al-Kaisy
dr.maythem84@yahoo.com
2
Emergency Department, Al Ain Hospital, Al Ain, United Arab Emirates
AUTHOR
ORIGINAL_ARTICLE
Trauma in pregnant women: an experience from a level 1 trauma center
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.
http://www.jept.ir/article_90658_a7f65e90614a70fa0675d7bbee82f090.pdf
2020-07-01
87
91
10.34172/jept.2020.20
Pregnancy
Trauma
Developing country
Road traffic accidents
Pakistan
Mishal
Gillani
mishal.gillani@scholar.aku.edu
1
Medical College, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
LEAD_AUTHOR
Sabah
Uddin Saqib
sabah.saqib@aku.edu
2
Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
AUTHOR
Russell Seth
Martins
3
Medical College, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
AUTHOR
Hasnain
Zafar
hasnain.zafar@aku.edu
4
Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan
AUTHOR
ORIGINAL_ARTICLE
A report on the experience of using ultrasound by emergency medical technicians in dealing with trauma patients in pre-hospital setting: a pilot study
Objective: The current study was performed to provide real-time bedside ultrasonography for emergency medical technicians (EMTs) and assess the advantages and disadvantages of its application in dealing with trauma patients in pre-hospital setting from their viewpoints.Methods: This semi-experimental study was conducted in Tehran, Iran. Twenty EMTs were selected purposefully and underwent a training program. Thereafter, they were asked to perform extended focused assessment with sonography in trauma (eFAST) using a handheld ultrasound device on trauma patients, and also filled a questionnaire prepared (in four components including C1: coherence, C2: cognitive participation, C3: collective action, and C4: reflexive monitoring) based on the normalization process theory (NPT).Results: All 20 participants were men and their average age was 37.8 years (SD = 4.7). For C1, the median total score was 10.5 out of a score of 4-20; For C2, the median score was 6 out of 3-15; For C3, the median total score was 18 out of a score of 6-30; and for C4, the median total score was 11 out of a score of 5-25.Conclusion: Overall, it seems that EMTs welcomed using ultrasonography in dealing with trauma patients in pre-hospital setting. Although they thought that it might somewhat lead to an increase in their workload; but they believed that sufficient training was not provided for them yet. The EMTs were uncertain about the viewpoints of the patients and did not know how it could affect patients’ outcome.
http://www.jept.ir/article_90659_d4284ee84a5be3689b1835846d3c1c47.pdf
2020-07-01
92
97
10.34172/jept.2020.23
Emergency Medical Services
Focused assessment with sonography for trauma
Multiple trauma
Ultrasonography
Pir-Hossein
Kolivand
peirhossein@yahoo.com
1
Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Peyman
Saberian
peymansaberian61@gmail.com
2
Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Mostafa
Sadeghi
sadeghim@tums.ac.ir
3
Anesthesiology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Maryam
Modabber
4
Tehran Emergency Medical Service Center, Tehran, Iran
AUTHOR
Parisa
Hasani-Sharamin
parisahasaniems@gmail.com
5
Tehran Emergency Medical Service Center, Tehran, Iran
AUTHOR
1. Abdolrazaghnejad A, Banaie M, Safdari M. Ultrasonography in emergency department; a diagnostic tool for better examination and decision-making. Adv J Emerg Med 2018; 2(1): e7. doi: 10.22114/AJEM.v0i0.40.
1
2. Heydari F, Ashrafi A, Kolahdouzan M. Diagnostic accuracy of focused assessment with sonography for blunt abdominal trauma in pediatric patients performed by emergency medicine residents versus radiology residents. Adv J Emerg Med 2018; 2(3): e31. doi: 10.22114/AJEM.v0i0.89.
2
3. Samuel AE, Chakrapani A, Moideen F. Accuracy of extended focused assessment with sonography in trauma (e-FAST) performed by emergency medicine residents in a level one tertiary center of India. Adv J Emerg Med 2018; 2(2): e15. doi: 10.22114/ajem.v0i0.69.
3
4. Bagheri‑Hariri S, Bahreini M, Farshidmehr P, Barazandeh S, Babaniamansour S, Aliniagerdroudbari E, et al. The effect of extended-focused assessment with sonography in trauma results on clinical judgment accuracy of the physicians managing patients with blunt thoracoabdominal
4
trauma. Arch Trauma Res 2019;8(4):207-13. doi: 10.4103/atr.atr_57_19.
5
5. Roantree RAG, Furtado CS, Lambert MJ. EMS, Ultrasound Use. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2020.
6
6. El Zahran T, El Sayed MJ. Prehospital ultrasound in trauma:a review of current and potential future clinical applications. J Emerg Trauma Shock 2018; 11(1): 4-9. doi: 10.4103/jets.jets_117_17.
7
7. Price DD, Wilson SR, Murphy TG. Trauma ultrasound feasibility during helicopter transport. Air Med J 2000;19(4): 144-6. doi: 10.1016/s1067-991x(00)90008-7.
8
8. Melanson SW, McCarthy J, Stromski CJ, Kostenbader J, Heller M. Aeromedical trauma sonography by flight crews with a miniature ultrasound unit. Prehosp Emerg Care 2001; 5(4): 399-402. doi: 10.1080/10903120190939607.
9
9. Murray E, Treweek S, Pope C, MacFarlane A, BalliniL, Dowrick C, et al. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med 2010; 8: 63. doi:10.1186/1741-7015-8-63.
10
10. Normalization Process Theory 2020. [Cited 28 May 2019]. Available from: http://www.normalizationprocess.org/resources/.
11
11. Walcher F, Weinlich M, Conrad G, Schweigkofler U, Breitkreutz R, Kirschning T, et al. Prehospital ultrasound imaging improves management of abdominal trauma. Br J Surg 2006; 93(2): 238-42. doi: 10.1002/bjs.5213.
12
12. Byhahn C, Bingold TM, Zwissler B, Maier M, Walcher F. Prehospital ultrasound detects pericardial tamponade in a pregnant victim of stabbing assault. Resuscitation 2008; 76(1): 146-8. doi: 10.1016/j.resuscitation.2007.07.020.
13
13. Heegaard W, Hildebrandt D, Reardon R, Plummer D, Clinton J, Ho J. Prehospital ultrasound diagnosis of
14
traumatic pericardial effusion. Acad Emerg Med 2009; 16(4): 364. doi: 10.1111/j.1553-2712.2009.00379.x.
15
14. Roberts J, McManus J, Harrison B. Use of ultrasonography to avoid an unnecessary procedure in the prehospital combat environment: a case report. Prehosp Emerg Care 2006; 10(4): 502-6. doi: 10.1080/10903120600887023.
16
15. Chin EJ, Chan CH, Mortazavi R, Anderson CL, Kahn CA, Summers S, et al. A pilot study examining the viability of a Prehospital Assessment with UltraSound for Emergencies (PAUSE) protocol. J Emerg Med 2013; 44(1): 142-9. doi:10.1016/j.jemermed.2012.02.032.
17
16. Lyon M, Walton P, Bhalla V, Shiver SA. Ultrasound detection of the sliding lung sign by prehospital critical
18
care providers. Am J Emerg Med 2012; 30(3): 485-8. doi: 10.1016/j.ajem.2011.01.009.
19
17. Krogh CL, Steinmetz J, Rudolph SS, Hesselfeldt R, Lippert FK, Berlac PA, et al. Effect of ultrasound training of physicians working in the prehospital setting. Scand J Trauma Resusc Emerg Med 2016; 24: 99. doi: 10.1186/s13049-016-0289-1.
20
18. Gracias VH, Frankel HL, Gupta R, Malcynski J, Gandhi R, Collazzo L, et al. Defining the learning curve for the Focused Abdominal Sonogram for Trauma (FAST) examination: implications for credentialing. Am Surg 2001; 67(4): 364-8.
21
19. Bobbia X, Hansel N, Muller L, Claret PG, Moreau A, Genre Grandpierre R, et al. Availability and practice of bedside ultrasonography in emergency rooms and prehospital setting: a French survey. Ann Fr Anesth Reanim 2014;33(3): e29-33. doi: 10.1016/j.annfar.2013.12.010.
22
20. Ketelaars R, Reijnders G, van Geffen GJ, Scheffer GJ, Hoogerwerf N. ABCDE of prehospital ultrasonography: a narrative review. Crit Ultrasound J 2018; 10(1): 17. doi:10.1186/s13089-018-0099-y.
23
ORIGINAL_ARTICLE
Urological surgery in the time of coronavirus pandemic
The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to urological procedures, a triage of non-emergent operations is hence recommended considering various disease-related factors. Case conduct should also be categorized based on the up-to-date information of the evolving national, regional and local conditions of this pandemic, as marked variation in these conditions can lead to significant differences in decision-making. Over the coming weeks and months, we are bound to face an increasingly difficult task of treating Coronavirus disease 2019 (COVID-19) infected patients presenting with urological ailments. Instituting well-thought plans to perform the un-deferrable urological procedures and emergencies during this pandemic will go a long way in keeping the surgeons and health-care workers safe to perform essential duties.
http://www.jept.ir/article_90656_b86c044c7078f4848f7172d3b0273b00.pdf
2020-07-01
98
101
10.34172/jept.2020.17
Urology
Surgery
Coronavirus
COVID-19
Pandemic
Manas
Sharma
drmanasmsharma@gmail.com
1
Department of Urology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education & Research, JNMC Campus, Belagavi-590010, Karnataka, India
AUTHOR
Shridhar C.
Ghagane
2
Urinary Biomarkers Research Centre, Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Nehru Nagar, Belagavi-590010, Karnataka, India
AUTHOR
Shubhashree
Muralidhar
3
Department of General Surgery, Jawaharlal Nehru Medical College, KLE Academy of Higher Education & Research, JNMC Campus, Belagavi-590010, Karnataka, India
AUTHOR
Shashank
Patil
drsdp22@gmail.com
4
Department of Urology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education & Research, JNMC Campus, Belagavi-590010, Karnataka, India
AUTHOR
Naina R.
Nerli
5
University Law College & Department of Studies in Law, Bangalore University, Janana Bharati Banaglore, Karnataka, India
AUTHOR
Rajendra B.
Nerli
6
Department of Urology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education & Research, JNMC Campus, Belagavi-590010, Karnataka, India
LEAD_AUTHOR
ORIGINAL_ARTICLE
SARS-CoV-2 and its dynamic impact on emergency department preparedness and management
Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic.Objective: To provide emergency physicians an update on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its dynamic impact on the emergency department (ED) in terms of preparedness and management of patients presenting to ED with suspected COVID-19 disease.Discussion: COVID-19 has a human-to-human transmission through close contact and even from asymptomatic carriers. Symptoms are similar to a viral respiratory illness. The disease is mild and self-limiting in most patients, but some develop severe illness like pneumonia, acute respiratory distress syndrome (ARDS) and multiorgan failure. Emergency physicians should prioritize early identification of these patients at risk, isolate them and after collaborating with relevant hospital and national authorities, develop clinical pathways to safely evaluate, manage and dispose patients with COVID-19. Various strategies for managing these patients in the ED are discussed. Disposition of these patients depends on symptoms and hemodynamic status and potential to self quarantine versus admission to an isolation facility.Conclusion: This review provides an overview of patients presenting to the ED with suspected COVID-19 and its impact on the ED. It reiterates the fact that emergency physicians, in close collaboration with relevant hospital authorities, play a pivotal role during EVDs. It emphasizes the need for pandemic preparedness, enabling us to better manage such events in the future.
http://www.jept.ir/article_90661_368aac4bd48de7833841035e12f6c403.pdf
2020-07-01
102
108
10.34172/jept.2020.25
SARS-CoV-2
COVID-19
Emergency Department
Impact
Preparedness
Sohil
Pothiawala
drsohilpothiawala@yahoo.com
1
Department of Emergency Medicine, Woodlands Health Campus, Singapore
LEAD_AUTHOR
ORIGINAL_ARTICLE
A case report of an unexpected traumatic brain injury following severe child abuse
Introduction: Child abuse has been defined as allowing others to cause physical, emotional, and sexual harm, and also physical and emotional pain to a child. The present study was a report on a case of physical and sexual child abuse accompanied by traumatic brain injury (TBI) referred to an emergency department.Case Presentation: A 4-year-old child was rushed into an emergency department by her mother. At the time of hospital admission, the child was feeling confused and drowsy and had symptoms of hemorrhage in the right preperitoneal space as well as bleeding from the mouth. According to the pattern of the child’s admission to the emergency department, contradictory descriptions by parents, clinical examinations, and TBI pattern; the probability of a case of child abuse was raised. Thus; neurosurgery, legal medicine, gynecology, and surgery consultations were requested. With regard to the brain injury and epidural hematoma, immediate measures (i.e. head lifting, taking Dilantin, blood glucose control, blood pressure control, and maintaining adequate oxygen saturation in the arterial blood) were taken to put a stop to secondary brain injury, and the patient was then transferred to the intensive care unit (ICU) for further treatments.Conclusion: In the present case study, the child was seriously examined and followed up. In conclusion; 20 days later, the case was discharged from the pediatric ward with good medical conditions, and received counseling and psychiatric services for one year.
http://www.jept.ir/article_89537_6d595bbf15a2d1c62e831191d4b3152d.pdf
2020-07-01
109
111
10.34172/jept.2019.16
child abuse
Injury
Trauma
brain
Seyed Reza
Habibzadeh
habibzadehr@mums.ac.ir
1
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
AUTHOR
Ehsan
Bolvardi
bolvardie@mums.ac.ir
2
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
AUTHOR
Esmail
Rayat Dost
e.rayat.dost@gmail.com
3
Department of Emergency Medicine, Faculty of Medicine, Jahrom University of Medical sciences, Jahrom, Iran
AUTHOR
Mahdi
Foroughian
foroughianmh@mums.ac.ir
4
Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran
LEAD_AUTHOR
1. Mills LG, Friend C, Conroy K, Fleck-Henderson A, Krug S, Magen RH, et al. Child protection and domestic violence:
1
Training, practice, and policy issues. Child Youth Serv Rev 2000; 22(5): 315-32. doi: 10.1016/S0190-7409(00)00083-9.
2
2. Sadock BJ, Sadock VA. Kaplan & Sadock’s Comprehensive text book of psychiatry. 7th ed. Philadelphia: Lippincott
3
Williams & Wilkins; 2000.
4
3. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. 2010. Child Maltreatment 2009. Available from: http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can.Accessed May 1, 2011.
5
4. Christian CW, Schwarz DF. Child maltreatment and the transition to adult-based medical and mental health care. Pediatrics 2011; 127(1): 139-45. doi: 10.1542/peds.2010-2297.
6
5. Christopher J, Helga GI, Jane M. Child Abuse and Neglect. 2nd ed. London: Churchill Livingstone; 1999.
7
6. Trokel M, Discala C, Terrin NC, Sege RD. Patient and injury characteristics in abusive abdominal injuries. Pediatr Emerg Care 2006; 22(10): 700-4. doi: 10.1097/01.pec.0000238734.76413.d0.
8
7. Ross CA, Keyes BB, Xiao Z, Yan H, Wang Z, Zou Z, et al. Childhood physical and sexual abuse in China. J Child Sex Abus 2005; 14(4): 115-26. doi: 10.1300/J070v14n04_06.
9
8. Shojaeizadeh D. Child abuse in the family: An analytical study. Iran J Public Health 2001; 30(1-2): 45-8.
10
9. Cairns AM, Mok JY, Welbury RR. The dental practitioner and child protection in Scotland. Br Dent J 2005; 199(8):
11
517-20. doi: 10.1038/sj.bdj.4812809.
12
10. Scher CD, Forde DR, McQuaid JR, Stein MB. Prevalence and demographic correlates of childhood maltreatment in
13
an adult community sample. Child Abuse Negl 2004; 28(2):167-80. doi: 10.1016/j.chiabu.2003.09.012.
14
ORIGINAL_ARTICLE
Hypoxic-ischemic encephalopathy in a young man due to tramadol overdose
Objective: Tramadol is a synthetic analgesic with two mechanisms. The opioid and non-opioid mechanisms are responsible for tramadol side effects. Non-opioid side effects of tramadol are due to the reuptake inhibitions of serotonin and norepinephrine. Some of the side effects include anaphylactoid reactions, CNS depression, hypoglycemia, hypotension, respiratory depression, seizures, and serotonin syndrome. Seizure may happen in therapeutic doses. If the frequency of tramadol seizures increases, ischemic brain injury and hypoxic-ischemic encephalopathy can be induced.Case Report: We report a young man with a history of tramadol abuse that was admitted with status epilepticus in Imam Reza hospital in Mashhad, Iran. Due to his altered mental status, he was intubated and antiepileptic agents were prescribed. He was transferred to ICU. After regaining consciousness, he was extubated and with the prescription of rehabilitation support he was discharged.Conclusion: Tramadol is a synthetic analgesic agent with less potential for dependence. It is important to mention that the overdose of this drug is common. This drug has two mechanisms. This paper reports a case that developed generalized tonic clonic seizures due to tramadol and hypoxic ischemic encephalopathy. With adequate treatment and supportive care, patient’s mental status improves and he/she can be discharged.
http://www.jept.ir/article_89560_8914867313755942fd744731ecde9d18.pdf
2020-07-01
112
114
10.34172/jept.2019.21
Tramadol
Status epilepticus
Hypoxic ischemic encephalopathy
Antiepileptic
Zahra
Ataee
1
Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
LEAD_AUTHOR
Bita
Dadpour
1@gmail.com
2
Medical Toxicology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
AUTHOR
1. American Pain Society (APS). Principles of Analgesic Use. 7th ed. Chicago, IL: APS; 2016.
1
2. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004; 43(13): 879-923. doi: 10.2165/00003088-200443130-00004.
2
3. Raffa RB, Buschmann H, Christoph T, Eichenbaum G, Englberger W, Flores CM, et al. Mechanistic and functional differentiation of tapentadol and tramadol. Expert Opin Pharmacother 2012; 13(10): 1437-49. doi:
3
10.1517/14656566.2012.696097.
4
4. Fournier JP, Azoulay L, Yin H, Montastruc JL, Suissa S. Tramadol use and the risk of hospitalization for hypoglycemia in patients with noncancer pain.JAMA Intern Med 2015; 175(2): 186-93. doi: 10.1001/jamainternmed.2014.6512.
5
5. Shipton EA. Tramadol--present and future. Anaesth Intensive Care 2000; 28(4): 363-74. doi: 10.1177/0310057x0002800403.
6
6. Gasse C, Derby L, Vasilakis-Scaramozza C, Jick H. Incidence of first-time idiopathic seizures in users of
7
tramadol. Pharmacotherapy 2000; 20(6): 629-34. doi:10.1592/phco.20.7.629.35174.
8
7. Rehni AK, Singh I, Kumar M. Tramadol-induced seizurogenic effect: a possible role of opioid-dependent gamma-aminobutyric acid inhibitory pathway. Basic Clin Pharmacol Toxicol 2008; 103(3): 262-6. doi: 10.1111/j.1742- 7843.2008.00276.x.
9
8. Sun C, Mtchedlishvili Z, Erisir A, Kapur J. Diminished neurosteroid sensitivity of synaptic inhibition and altered
10
location of the alpha4 subunit of GABA(A) receptors in an animal model of epilepsy. J Neurosci 2007; 27(46): 12641- 50. doi: 10.1523/jneurosci.4141-07.2007.
11
9. Wightman RS, Perrone J, Erowid F, Erowid E, Meisel ZF, Nelson LS. Comparative analysis of opioid queries on erowid. org: an opportunity to advance harm reduction. Subst Use Misuse 2017; 52(10): 1315-9. doi: 10.1080/10826084.2016.1276600.
12
10. Shadnia S, Soltaninejad K, Heydari K, Sasanian G, Abdollahi M. Tramadol intoxication: a review of 114 cases. Hum ExpToxicol 2008; 27(3): 201-5. doi: 10.1177/0960327108090270.
13
11. Afshari R, Tashakori A. Tramadol overdose as a cause of serotonin syndrome: a case series. Clin Toxicol 2010; 48(4):
14
337-41. doi: 10.3109/15563651003709427.
15
12. Talaie H, Panahandeh R, Fayaznouri MR, Asadi Z, Abdollahi M. Dose-independent occurrence of seizure with tramadol.
16
J Med Toxicol 2009; 5(2): 63-7. doi: 10.1007/BF03161089.
17
13. Kroenke K, Krebs EE, Bair MJ. Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic
18
reviews. Gen Hosp Psychiatry 2009; 31(3): 206-19. doi:10.1016/j.genhosppsych.2008.12.006.
19
14. Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S, Quality Standards Subcommittee of the American Academy
20
of Neurology. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 67(2): 203-10. doi: 10.1212/01.wnl.0000227183.21314.cd.
21
15. Boora K. Tramadol. In: Enna SJ, Bylund DB, eds. xPharm: The Comprehensive Pharmacology Reference. New York:
22
Elsevier; 2007. p. 1-7. doi: 10.1016/B978-008055232-3.62788-6
23
16. Hoffman RS, Howland MA, Lewin NA, Nelson LS, Goldfrank LR. Goldfrank’s Toxicologic Emergencies. 10th ed. US: McGraw-Hill; 2015.
24
17. Musshoff F, Madea B. Fatality due to ingestion of tramadol alone. Forensic Sci Int 2001; 116(2-3): 197-9. doi: 10.1016/s0379-0738(00)00374-1.
25
18. Cock HR. Drug-induced status epilepticus. Epilepsy Behav 2015; 49: 76-82. doi: 10.1016/j.yebeh.2015.04.034.
26
19. Vignatelli L, Tonon C, D’Alessandro R, Bologna Group for the Study of Status Epilepticus. Incidence and shortterm
27
prognosis of status epilepticus in adults in Bologna, Italy. Epilepsia 2003; 44(7): 964-8. doi: 10.1046/j.1528-
28
1157.2003.63702.x.
29
20. Márquez-Romero JM, Zermeño-Pohls F, Soto-Cabrera E. Convulsive status epilepticus associated with a tramadol
30
overdose. Neurologia 2010; 25(9): 583-5. doi: 10.1016/j.nrl.2009.07.001. [In Spanish].
31
21. Mehrpour M. Intravenous tramadol-induced seizure:two case reports. Iranian Journal of Pharmacology and
32
Therapeutics 2005; 4(2): 146-7.
33
22. Boostani R, Derakhshan S. Tramadol induced seizure: A 3-year study. Caspian J Intern Med 2012; 3(3): 484-7.
34
23. Taghaddosinejad F, Mehrpour O, Afshari R, Seghatoleslami A, Abdollahi M, Dart RC. Factors related to seizure in
35
tramadol poisoning and its blood concentration. J Med Toxicol 2011; 7(3): 183-8. doi: 10.1007/s13181-011-0168-0.
36
ORIGINAL_ARTICLE
Fournier’s gangrene following an ant bite in a healthy man: A very rare case report
Objective: Necrotizing fasciitis of the perinea, referred to as Fournier’s gangrene, is a necrotizing infection of the perinea. To the best of our knowledge, there is no report on the Fournier’s gangrene following an ant bite and this is a rare case report of this type.Case Presentation: In this rare case report we describe a 20-year-old man who developed Fournier’s gangrene following an ant bite which resulted in his death. He sustained numerous ant bites in the perinea. Subsequently, he suffered from itching of the area and had scratched the area frequently leading to dermal ulcers and laceration, pain, and swelling of the scrotal area followed by fever and diminished consciousness. Finally, he presented to the emergency room (ER) after 72 hours of ant bites with a shock. Physical examination revealed extensive necrosis of scrotum. The primary treatments including antibiotic therapy, normal saline solution, and dopamine were not effective.Conclusion: Even a simple nonpoisonous insect bite can lead to Fournier’s gangrene and death. Paying greater attention to the site of bite, especially in the perinea which is anatomically more susceptible to infection, observing hygienic principles, and quick access to healthcare centers may prevent the patient’s death
http://www.jept.ir/article_89604_c99aabe8fec9f3afe7aa963d230a8cd5.pdf
2020-07-01
115
117
10.34172/jept.2020.02
Fournier’s gangrene
Necrotizing fasciitis
Fasciitis
Necrotizing
Case report
Abbas
Edalatkhah
e.z200887@yahoo.com
1
Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Mohammad Ali
Jafari
2
School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Sima
Valizadeh
simavalizadeh@gmail.com
3
Trauma Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Alireza
Esmaeili
alirezaesmaeili@gmail.com
4
School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
AUTHOR
Ehsan
Zarepur
ehsanzarepur@gmail.com
5
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
LEAD_AUTHOR
1. Aghaeeafshar M, Shahesmaeili A. Necrotizing fascitis in a 47-year old diabetic man: case Report. Journal of Kerman University of Medical Sciences 2009; 16(4): 405-9. [InPersian].
1
2. Mahdizadeh F, Safari S. Concurrent hand and penile gangrene following prolonged warfarin use; a case report. Emerg (Tehran) 2017; 5(1): e71.
2
3. Jafari M, Biuki AA, Hajimaghsoudi M, Bagherabadi M, Zarepur E. Intravenous haloperidol versus midazolam in management of conversion disorder; a randomized clinical trial. Emerg (Tehran) 2018; 6(1): e43.
3
4. Sasannejad P, Rezaei F, Bidaki R, Zarepur E. Rare presentation of moyamoya disease with sub acute presentation in Iran. Iran J Child Neurol 2018; 12(1): 89- 93.
4
5. Yeniyol CO, Suelozgen T, Arslan M, Ayder AR. Fournier’s gangrene: experience with 25 patients and use of Fournier’s gangrene severity index score. Urology 2004; 64(2): 218-22.doi: 10.1016/j.urology.2004.03.049.
5
6. Korkut M, Içöz G, Dayangaç M, Akgün E, Yeniay L, Erdoğan O, et al. Outcome analysis in patients with
6
Fournier’s gangrene: report of 45 cases. Dis Colon Rectum 2003; 46(5): 649-52. doi: 10.1007/s10350-004-6626-x.
7
7. Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK. Necrotising infections of soft tissues--a
8
clinical profile. Eur J Surg 2002; 168(6): 366-71. doi:10.1080/11024150260284897.
9
8. Aimoni C, Cilione AR, Grandi E, Lombardi L, Merlo R, Pastore A. Cervical necrotizing fasciitis. Eur Arch
10
Otorhinolaryngol 1999; 256(10): 510-3. doi: 10.1007/s004050050201.
11
9. Schmidt GA, Mandel J. Evaluation and management of severe sepsis and septic shock in adults.UpToDate; 2013.Available from: https://www.uptodate.com/contents/evaluation-and-management-of-suspected-sepsis-andseptic-shock-in-adults.
12
10. Imanian M, Ghasemzadeh MJ, Zarepur E, Zarepur A, Sarbandi Farahani R, Sarbandi Farahani R. The Relationship between Pneumonia with parental smoking in children under 10 years old: a case- control study. Int J Pediatr 2018;6(6): 7791-6. doi: 10.22038/ijp.2016.7801.
13
11. Unuigbe EI, Ikhidero J, Ogbemudia AO, Bafor A, Isah AO. Multiple digital gangrene arising from traditional therapy: a case report. West Afr J Med 2009; 28(6): 397-9.
14
12. Verma SB. Necrotizing fascitis induced by mosquito bite. J Eur Acad Dermatol Venereol 2003; 17(5): 591-3. doi:10.1046/j.1468-3083.2003.00819.x.
15
13. Poitelea C, Wearne MJ. Periocular necrotising fasciitis--a case report. Orbit 2005; 24(3): 215-7. doi:
16
10.1080/01676830590930634.
17
14. Jones AE, Brown MD, Trzeciak S, Shapiro NI, Garrett JS, Heffner AC, et al. The effect of a quantitative resuscitation strategy on mortality in patients with sepsis: a metaanalysis. Crit Care Med 2008; 36(10): 2734-9. doi: 10.1097/CCM.0b013e318186f839.
18
ORIGINAL_ARTICLE
Case report of a piece of dishwashing steel wool in a child’s pharynx
Objective: Foreign body swallowing is a common pediatric problem. A foreign body in the pharynx is a medical emergency that requires urgent intervention. Evaluation and treatment of pharyngeal foreign bodies is much more difficult in children than in adults and sometimes requires hospitalization and removal of the foreign bodies under general anesthesia due to children’s lack of cooperation. Fish and chicken bones are the most common swallowed foreign bodies, but an interesting case of a piece of dishwashing steel wool stuck in a child’s pharynx is reported in this article.Case Presentation: A 10-year old boy was presented with a history of dysphagia from five weeks ago. Oral examination did not reveal anything significant. In lateral neck radiographs of the patient, a metal wire was observed in the hypopharyngeal region opposite the 4th and 5th cervical vertebrae. Endoscopic attempts to remove the foreign body were not successful. Therefore, the foreign body was removed from the patient’s pharynx in the operating room under general anesthesia. No complications were observed.Conclusion: Despite the prevalence of swallowing foreign bodies in children, ingestion of a piece of dishwashing steel wool not diagnosed for three weeks was considered interesting to report. Pharyngeal foreign bodies are medical emergencies; therefore, it is particularly important to suspect the presence of a foreign body and perform diagnostic procedures.
http://www.jept.ir/article_90624_f811d76743ca14236558d57d9d6979e7.pdf
2020-07-01
118
120
10.34172/jept.2020.09
Foreign Body
Ingestion
children
Parvin
Aَbbaslou
1
Department of Pediatric, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
AUTHOR
Maryam
Ahmadipour
maryam.ahmadipour5@gmail.com
2
Department of Pediatric, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
LEAD_AUTHOR
1. Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 1995;41(1): 39-51. doi: 10.1016/s0016-5107(95)70274-1.
1
2. Wai Pak M, Chung Lee W, Kwok Fung H, van Hasselt CA. A prospective study of foreign-body ingestion in 311 children. Int J Pediatr Otorhinolaryngol 2001; 58(1): 37-45. doi: 10.1016/s0165-5876(00)00464-x.
2
3. Endican S, Garap JP, Dubey SP. Ear, nose and throat foreign bodies in Melanesian children: an analysis of 1037 cases. Int J Pediatr Otorhinolaryngol 2006; 70(9): 1539-45. doi: 10.1016/j.ijporl.2006.03.018.
3
4. Hesham AKH. Foreign body ingestion: children like to put
4
objects in their mouth. World J Pediatr 2010; 6(4): 301-10. doi: 10.1007/s12519-010-0231-y.
5
5. Mishra A, Shukla GK, Naresh B. Oropharyngeal foreign body. J Laryngol Otol 2000; 114(6): 469-70. doi: 10.1258/0022215001905887.
6
6. Lai AT, Chow TL, Lee DT, Kwok SP. Risk factors predicting the development of complications after foreign body ingestion. Br J Surg 2003; 90(12): 1531-5. doi: 10.1002/bjs.4356.
7
7. Watanabe K, Amano M, Nakanome A, Saito D, Hashimoto S. The prolonged presence of a fish bone in the neck. Tohoku J Exp Med 2012; 227(1): 49-52. doi: 10.1620/tjem.227.49.
8
8. Yang CY, Yang CC. Subjective neck pain or foreign body sensation and the true location of foreign bodies in the pharynx. Acta Otolaryngol 2015; 135(2): 177-80. doi:10.3109/00016489.2014.973532.
9
9. Kim YH, Cho SI, Do NY, Park JH. A case of pharyngeal injury in a patient with swallowed toothbrush: a case report. BMC Res Notes 2014; 7: 788. doi: 10.1186/1756-0500-7-788.
10
10. Kurul S, Kandogan T. Pharyngeal foreign body in a child persisting for three years. Emerg Med J 2002; 19(4): 361-2.doi: 10.1136/emj.19.4.361.
11
11. Sharma RC, Dogra SS, Mahajan VK. Oro-pharyngolaryngeal foreign bodies: some interesting cases. Indian J Otolaryngol Head Neck Surg 2012; 64(2): 197-200. doi:10.1007/s12070-011-0473-6.
12
12. Yadav SP, Chanda R, Malik P, Chanda S. Ingested nail penetrating the neck in an infant. Int J Pediatr
13
Otorhinolaryngol 2002; 65(2): 159-62. doi: 10.1016/s0165- 5876(02)00149-0.
14
13. Landis BN, Giger R. An unusual foreign body migrating through time and tissues. Head Face Med 2006; 2: 30. doi:10.1186/1746-160x-2-30.
15
ORIGINAL_ARTICLE
Severe hemoglobinuria due to Hemiscorpius enischnochela (Scorpiones: Hemiscorpiidae) envenomation from South of Iran
Objective: Scorpion stings are common in tropical regions of Iran. Hemiscorpius enischnochela are distributed in southern part of Iran. The venom of this scorpion causes severe hemolysis, hemoglobinuria, and occasionally death.Case Presentation: This report describes the clinical manifestations of envenomation by H. enischnochela in a 3-year-old boy from Ruydar city in south of Iran.Conclusion: Special attention should be paid to the painless stings of yellow scorpions and more studies are needed to set out a protocol for the management of these cases in areas with this envenomation to be a common one.
http://www.jept.ir/article_90657_9fdec29024fcbde4624d9e4d47c2f7e0.pdf
2020-07-01
121
125
10.34172/jept.2020.22
Hemiscorpius
Scorpion sting
Hemoglobinuria
Iran
Mehran
Shahi
1
Department of Medical Entomology & Vector Control, School of Public Health, Infectious & Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
AUTHOR
Seyed Hamid
Moosavy
2
Department of Internal Medicine, Hormozgan University of Medical Science, Bandar Abbas, Iran
AUTHOR
Hossein
Sanaei-Zadeh
3
Emergency Room, Division of Medical Toxicology, Hazrat Ali-Asghar Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
LEAD_AUTHOR