Letter to Editor
Clinical Toxicology
Mojtaba Miladinia; Elham Mousavi Nouri
Articles in Press, Accepted Manuscript, Available Online from 17 June 2021
Abstract
Medication errors (MEs) are considered the most common medical errors and as one of the major challenges threatening the health system, which can be also reduced. MEs threaten patients' safety and may increase the length of hospital stay, lead to unexpected complications, mortality and side costs. In ...
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Medication errors (MEs) are considered the most common medical errors and as one of the major challenges threatening the health system, which can be also reduced. MEs threaten patients' safety and may increase the length of hospital stay, lead to unexpected complications, mortality and side costs. In 2017, the World Health Organization launched Medication without Harm to reduce severe avoidable medication-related damage by 50%, globally in the next 5 years. Emergency Departments (EDs) are stressful care environments which making EDs more prone to MEs. Therefore, EDs need to be seriously considered to reduce MEs and increase patients' safety. In this regard, it is of great significance to know about the most common stage of error in pharmacotherapy, the most common type of medication error and the most common causes of MEs in the emergency department practice setting. in conclusion, the most common types of MEs in EDs include drug omission error, wrong dose and strong infusion rate. In addition, the administration and prescribing are the most common stages of MEs in EDs. Also, the most common causes of MEs in EDs in Iran include nursing shortage (fatigue) and poor medication knowledge .
Review Article
Infectious disease
Mojtaba Miladinia; Farhad Abolnezhadian; Joachim G. Voss; Kourosh Zarea; Naser Hatamzadeh; Mandana Ghanavati
Articles in Press, Corrected Proof, Available Online from 23 September 2020
Abstract
Objective: Final patient triage determines which patients can be home-isolated andwhich patients require hospitalization on the basis to predict the patient’s prognosismost accurately. Final triage is an important link in the clinical management chain of thecoronavirus disease 2019 (COVID-19) pandemic, ...
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Objective: Final patient triage determines which patients can be home-isolated andwhich patients require hospitalization on the basis to predict the patient’s prognosismost accurately. Final triage is an important link in the clinical management chain of thecoronavirus disease 2019 (COVID-19) pandemic, and a comprehensive review of variouspatient triage methods is very important to guide decision making and triage efficiency.Decision by clinicians about hospitalization or home-discharge is one of the main challengesin places with limited hospital facilities compared to the high volume of COVID-19 patients.This review was designed to guide clinicians on how to address this challenge.Methods: In this mini review we searched scientific databases to obtain the final triagemethods of COVID-19 patients and the important criteria in each method. In order toconducted searches a period from December 2019 to July 2020 was considered. All searcheswere done in electronic databases and search engines.Results: Findings revealed four current methods for final triage (decision-making regardinghome-isolation or hospitalization of COVID-19 patients). These methods included 1)demographic and background information, 2) clinical information, 3) laboratory indicatorsand 4) initial chest CT-scan. Each of the aforementioned methods encompassed significantcriteria according to which decisions on the patient’s prognosis and final triage were made.Finally, by evaluating each final triage method, we found that each method had somelimitations.Conclusion: An effective and quick final triage requires simultaneous complementary useof all four methods to compensate for each other’s weaknesses and add to each other’sstrengths. It is therefore suggested to assure that clinicians are trained in all four COVID-19patient’s triage methods and their useful criteria in order to achieve evidence-basedperformance for better triage (decision between home-isolation versus hospitalization).
Original Article
Emergency medicine
Raheleh Faramarzi; Mohammad Davood Sharifi; Elnaz Vafadar Moradi; Behnaz Alizadeh
Articles in Press, Corrected Proof, Available Online from 20 October 2020
Abstract
Objective: Partial dislocation of radius head (pulled elbow) is the most common trauma observed in out-patient orthopedic treatment of children. The typical mechanism of this trauma includes exertion of longitudinal force along the forearm in a pronation position, causing partial dislocation of the radius ...
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Objective: Partial dislocation of radius head (pulled elbow) is the most common trauma observed in out-patient orthopedic treatment of children. The typical mechanism of this trauma includes exertion of longitudinal force along the forearm in a pronation position, causing partial dislocation of the radius head.Methods: This Retrospective descriptive and cross-sectional study was undertaken on patients referring to the emergency ward of Imam Reza hospital of Mashhad with typical history of partial dislocation of radius head (pulled elbow). The present study was conducted between March 20, 2018 and March 20, 2019. Based on the number of patients at the emergency ward, the sample size was determined to be 80. Descriptive statistics such as mean and standard deviation were used to describe the collected data.Results: From among 80 children diagnosed with partial radius bone dislocation, 66.23% were girls and 33.77% were boys. The age range of patients was 28.08 months for girls and 31.04 months for boys. Findings also showed that 32 patients had a history of recent respiratory infection within 1 week before the pulled elbow incident.Conclusion: Findings revealed that, similar to previous studies, the pulled elbow injury was more common in girls than in boys. Successful reduction in first and second attempts, notwithstanding the maneuvers used indicated that the success rate of first attempts at reduction was 93%. The history of recent respiratory infections during 1 week before the injury was taken into account, where 40% of the children had some history of such respiratory infections.
Original Article
Education
Hamid Reza Moretza Bagi; Amir Ghaffarzad; Peyman Fathipour; Reza Yazdani; Zhila Khamnian; Sama Rahnemayan
Articles in Press, Corrected Proof, Available Online from 09 April 2021
Abstract
Objective: Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators ...
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Objective: Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators in teaching cricothyrotomy skills for emergency medicine residents.Methods: In this pre-post test study, all faculty member of emergency medicine of Tabriz University of medical sciences specialty were invited to participate. After holding an educational and training session for assistants on a teacher-made moulage, all emergency medicine residents performed a tracheostomy on the commercial moulages of the skill lab unit for the second time and their scores were recorded.Results: In this study, 23 emergency medicine residents participated. The mean ± standard deviation of age was 35.91 ± 3.57 years. There was a significant difference between the mean duration of cricothyrotomy before and after the training (P value = 0.006). There was also a significant difference between the mean scores obtained by residents in the pre- and post-training evaluation (P value < 0.001).Conclusion: Findings showed that the moulages constructed by teachers not only can be effective in improving the cricothyrotomy skills in emergency medicine residents but also can reduce the likelihood of failure in performing cricothyrotomy.
Original Article
Emergency medicine
Seyyed Meysam Amini; Mehriyar Yoldashkhan; Sima Zohari; Malihe Nasiri; Zahra Mousavi; Seyed Mohammad Amini
Articles in Press, Accepted Manuscript, Available Online from 23 April 2021
Abstract
Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase ...
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Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase activity and reduces pain and inflammation. It can be considered as the strongest analgesic drug in this category. The aim of this study was to evaluate the effectiveness of ketorolac in pain management of traumatic injuries in a prehospital setting.Methods: This descriptive cross-sectional study was undertaken to evaluate the effectiveness of a treatment method in the pain management of traumatic injuries in the prehospital environment of Lorestan province in Iran. We included 134 injured patients from road emergency bases of Lorestan province. In order to control the pain of these injured patients, 30 mg of ketorolac was injected slowly intravenously in one minute. Pain was measured in the time interval of zero minutes (before injection), 15 minutes, 30 minutes, and 45 minutes by visual acuity scale (VAS). The analysis of the obtained data was performed by SPSS software version 23.Results: The mean age of participants was 37.42±23.6. There were 47 female injuries (35.1%) and 87 male injuries (64.9%). In terms of pain intensity, 49 patients (36.6%) had moderate pain (VAS = 4-6) and 85 patients (63.4%) had severe pain (VAS = 7-10). The average of pain relief in the injured group with severe and moderate pain 15 minutes after the injection was 0.471 and 0.878 (P = 0.001), respectively. In addition, the mean of pain relief in the injured group with severe and moderate pain 30 minutes after the injection was 1.124 and 1.796, respectively (P = 0.001). Pain reduction in the group of severely injured patients with moderate pain in the first 30 minutes was statistically significant.Conclusion: Findings revealed that ketorolac is a suitable drug in pain management for trauma patients with moderate and severe pain in trauma patients. On the other hand, due to the peak effect (more than 30 minutes), it is not an effective drug for trauma patients with severe pain in a short period transferred to the prehospital environment.
Original Article
Emergency medicine
Articles in Press, Accepted Manuscript, Available Online from 17 June 2021
Abstract
Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective ...
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Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective evaluation of the CT records of patients over a period of 5 years was done at our institute. A total of 1519 patients who had undergone contrast-enhanced abdominal CT at a 64-slice Multidetector CT for abdominal trauma were included in this study. Inclusion criteria were: 1) History of blunt abdominal trauma, 2) Patients who had undergone a biphasic CECT abdomen scan. Exclusion criteria were: 1) Patients with penetrating injury, 2) Patients with incomplete data set/records. Results: Liver was the most common injured organ in both adult (38.8%) and paediatric population (40.9%). Significant higher incidence of mesenteric injury, bladder injury, spinal and rib fractures were seen in adult patients. Significant association of anorectal injuries (P=0.003) and bladder/urethral injuries with pelvic fractures was also seen (P <0.001). Conclusion: Our study provided important insights about the pattern, severity and association between the various abdominal injuries based on imaging findings in a large patient population. Larger studies with incorporation of clinical outcome in such patients can help in formulating appropriate management strategies.
Original Article
elnaz vahidi; Ahmad Abbasian; Maryam Beladi
Articles in Press, Accepted Manuscript, Available Online from 23 July 2021
Brief Report
Infectious disease
Enayatollah Noori; Mostafa Vahedian; Sajjad Rezvan; Neda Minaei; Reihane Tabaraii
Articles in Press, Accepted Manuscript, Available Online from 30 January 2021
Abstract
Objective: Since the outbreak of coronavirus disease 2019 (COVID-19), the triage ofpatients diagnosed with corona virus has been a very important issue. The aim of thisstudy was to introduce a triage scoring system according to the clinical and para-clinicalfindings of patients in order to be admitted ...
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Objective: Since the outbreak of coronavirus disease 2019 (COVID-19), the triage ofpatients diagnosed with corona virus has been a very important issue. The aim of thisstudy was to introduce a triage scoring system according to the clinical and para-clinicalfindings of patients in order to be admitted or discharged with COVID-19.Methods: After confirming the positive polymerase chain reaction (PCR) test for patients,we used a scoring system which included: the age of patient (less than 40 years and >40years), early vital signs at the time of admission, lab tests including C-reactive protein (CRP),white blood count (WBC), lactate dehydrogenase (LDH), D-dimer, chest imaging findings,comorbidity and shortness of breath.Results: The clinical score obtained for each variable in this scoring system was a numberbetween 0 and 3. The total score was a minimum of 0 and a maximum of 17. A higher scoreindicated an increase in the intensity and the need for intensive care. These scores wereclassified into 3 groups: 0-4, 5-10 and above 10. In the next stage, patients were dividedinto three groups: mild, moderate and severe. In this regard, patients with mild symptomswere suggested to receive home quarantine and home treatment, patients with moderatesymptoms were recommended hospitalization and medical care, and finally patients withsevere symptoms were inclined to intensive care.Conclusion: In order to treat and manage patients with COVID-19, it is necessary to payparticular attention to clinical and para-clinical findings and prioritize these findings basedon the severity and the condition of patients.
Case Report
Clinical Toxicology
Elham Pishbin; Hamidreza Reihani; Bahram Zarmehri; Mahdi Foroughian
Articles in Press, Corrected Proof, Available Online from 11 April 2021
Abstract
Objective: Methanol poisoning is a dangerous life-threatening event, manifested withvarious symptoms, sometimes very rare ones, that all should be addressed to preventmisdiagnosis of the methanol-poisoned patients.Case Presentation: A 21-year-old young man was brought to the emergency department(ED) ...
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Objective: Methanol poisoning is a dangerous life-threatening event, manifested withvarious symptoms, sometimes very rare ones, that all should be addressed to preventmisdiagnosis of the methanol-poisoned patients.Case Presentation: A 21-year-old young man was brought to the emergency department(ED) with a generalized tonic-clonic (GTC) seizure and he was diagnosed with methanolintoxication. A non-contrast computed tomography (NCCT) of the brain demonstratedfindings similar to subarachnoid hemorrhage (SAH). After the brain CT, he had a GlasgowComa Score (GCS) of 3 and all brainstem reflexes were absent. Neurology consultantagreed with the diagnosis of pseudo-SAH. Brain death was confirmed by a positive apneatest within 24 hours of presentation.Conclusion: It is suggested that compression of dural sinuses due to severe brain edema,reduces the venous drainage and leads to venous engorgement, which appears highattenuated in the background of low-density edematous brain matter.
Case Report
Infectious disease
Mohsen Eshraghi; Enayatollah Noori; Ahmad Kachoie; Moien Zolmafakher
Articles in Press, Corrected Proof, Available Online from 23 April 2021
Abstract
Objective: Bronchopleural fistula (BPF) is a pathological communication between thebronchial tree and pleural space. BPFs are commonly seen after lung surgery, and are lesscommon in trauma, lung abscess, and radiation therapy. In this study, we describe theclinical course and surgery of a case of pulmonary ...
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Objective: Bronchopleural fistula (BPF) is a pathological communication between thebronchial tree and pleural space. BPFs are commonly seen after lung surgery, and are lesscommon in trauma, lung abscess, and radiation therapy. In this study, we describe theclinical course and surgery of a case of pulmonary necrosis and BPF in a patient infectedwith coronavirus disease 2019 (COVID-19).Case Presentation: The patient was a 54-year-old man with multiple myeloma and endstagerenal disease from the last 8 years. He had a history of coronary artery bypass graftingfrom the last 3 years. He also suffered from progressive shortness of breath and dry coughsince March 2019.Conclusion: The results of this study showed that BPF is one of the most severecomplications after thorax surgery, and there is no effective prevention methodparticularly in this patient who had COVID-19 pneumonia. Therefore, early intervention,especially when diagnosed at an early stage, by strengthening the stump inside the thoraxor thoracotomy in the open window may eventually accelerate the closure of the BPF andimprove the survival.