Emergency Medical Services
Samaneh Alizadeh; Samad Shams Vahdati; Alehe Seyyed Rasooli; Mohammad Asghari Jafarabadi; Saba Amir Farhangi; Shahrad Tajoddini
Volume 1, Issue 2 , July 2015, , Pages 40-43
Abstract
Objective: Trauma is a major health problem worldwide regardless of regional socioeconomic and healthcare status. As a leading cause of death, trauma results in severe socioeconomic damages, which could be highly prevented by optimal care. As nurses are the major professional groups involved in patient ...
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Objective: Trauma is a major health problem worldwide regardless of regional socioeconomic and healthcare status. As a leading cause of death, trauma results in severe socioeconomic damages, which could be highly prevented by optimal care. As nurses are the major professional groups involved in patient care, improvement of their knowledge and practical skill leads to more qualified healthcare staff. Nowadays, traditional methods of education cannot meet students’ needs and modern methods of training are recommended to be applied. This study, therefore, aimed to compare the effects of two methods of teaching (electronic education and teacher-based education) on students’ learning and the efficacy rate of each method on the knowledge of fourth year students of nursing and midwifery faculty in Tabriz University of Medical Sciences.
Methods: In this study, the participants were randomly assigned into 2 educational groups of electronic (experimental group) and teacher-based (control group) method. All participants took a pre-test. Then each group attended the same course in a different method. Finally, post-test was taken by the participants and data were analyzed.
Results: A comparison of the mean knowledge score of both groups showed that electronic education was more effective than teacher-based education.
Conclusion: The electronic training will result in more effective learning in comparison to teacher-based method and can be applied as an appropriate and efficient method of education
Surgery
Mustafa Bolatkale; Çağdaş Can; Ahmet Çağdaş Acara; Mustafa Topuz
Volume 3, Issue 2 , July 2017, , Pages 40-41
Abstract
In emergency department, physicians can diagnose pulseless electrical activity, asystole, pericardial effusions, ischemic heart disease, wall motion abnormalities, valvular cardiac disease volume status or global cardiac function evaluating with electrocardiographic findings or using bedside cardiac ...
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In emergency department, physicians can diagnose pulseless electrical activity, asystole, pericardial effusions, ischemic heart disease, wall motion abnormalities, valvular cardiac disease volume status or global cardiac function evaluating with electrocardiographic findings or using bedside cardiac ultrasonography. But these two methods are not always sufficient to explain the underlying another pathologies such as pancreatitis and acute cholecystitis which can mimick acute cardiac events. Patients who are followed up with a preliminary diagnosis of acute coronary syndrome in the emergency department, might have underlying biliary or pancreatic pathologies, or even more, these might be the sole reason of the clinical picture. So bedside abdomen ultrasonography and liver enzymes may be requested in all patients with suspected cardiac pathology with a normal cardiac ultrasonography when a patient presented with acute chest or abdominal pain. Physicians must be aware for coexisting pathophysiologies and take into account the differential diagnosis of all life-threatening causes such as cardiac ischemia or acute abdominal situations. So the diagnostic tests for gallbladder pathology could be added to cardiac ultrasonography.
Infectious disease
Shaghayegh Rahmani
Volume 6, Issue 2 , July 2020, , Pages 53-54
Abstract
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 ...
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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?”
Emergency Medical Services
Ali Sadrollahi; Adeleh Gharataghani; Mehdi Mahmoudi; Fardaneh Gholipour
Volume 4, Issue 2 , July 2018, , Pages 55-61
Abstract
Objective: The key point to detect patients’ need in pre-hospital emergency is to have high ability to take medical history. All research findings show that this ability is low. The objective of this research is to investigate the ability to take medical history of patients among the personnel ...
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Objective: The key point to detect patients’ need in pre-hospital emergency is to have high ability to take medical history. All research findings show that this ability is low. The objective of this research is to investigate the ability to take medical history of patients among the personnel of pre-hospital emergency medical service (EMS) in Golestan province, Iran.Methods: This research was a descriptive cross-sectional study carried in 2016. The population included non-staff technicians and an operator working in the message center (N = 171). The samples were selected using multi-stage cluster sampling. Data were collected by a researcher-developed questionnaire. The collected data were analyzed by SPSS software version 16 conducting descriptive and inferential statistics. All tests were administered at a significance level of P < 0.05.Results: One hundred sixty-five (96.5%) participants were male. The mean score of the ability to take medical history was 58.4 ± 11.1. Therefore, 95 participants (58.3 %) had poor ability and 64 participants (39.3 %) owned moderate ability. The highest score concerning the ability to take medical history was for the aspect of professional knowledge (mean rank = 5). The most influential aspect in the ability was respectively for ‘professional knowledge’ (P = 0.0001, Beta = 0.509). Pearson correlation coefficient indicated a relationship (r=-0.149, P = 0.05) between the ability to take medical history and age.Conclusion: The results of the current study indicated that the ability to take medical history among the personnel of pre-hospital medical emergency of Golestan province was low. Therefore, a thorough review of trainings promoting personnel’s professional knowledge is urgently required.
Clinical Toxicology
Rouhullah Dehghani; Shahrad Tajaddini; masoomeh varzandeh
Volume 9, Issue 2 , July 2023, , Pages 81-86
Abstract
Objective: Arthropod bites and stings have always been of interest to humans; therefore, researchers have always been interested in their prevention and timely treatment. Considering the brilliance of ancient Iranian physicians, especially Avicenna, this study was conducted based on their views on diagnosing ...
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Objective: Arthropod bites and stings have always been of interest to humans; therefore, researchers have always been interested in their prevention and timely treatment. Considering the brilliance of ancient Iranian physicians, especially Avicenna, this study was conducted based on their views on diagnosing and treating venomous arthropod bites and stings.Methods: This study is a narrative review conducted by surveying sources, especially The Canon of Medicine, and searching for the keywords “bites,” “stings,” “poisonous,” “venomous arachnids,” and“insects” as well as the diagnosis and treatment of bites and stings .The study was conducted in 2022 and in Kashan and Kerman universities of medical sciences. Sampling method was based onthe study objective.The collected data was then summarized.Results: To diagnose the bite or sting, the clinical manifestations of the patient, local symptoms in the bite or sting site, and the classification of the venomous arthropods, such as spiders, wasps, scorpions, etc., are used. Venom suction and using medicinal plants and ointments of mineral compounds were proposed as treatment methods.Conclusion: Therapeutic methods and the use of herbal and mineral compounds are widely mentioned in The Canon. There are a lot of connections and harmony between modern and conventional medicine, in the clinical description of bites and stings as well as their diagnosis, but more research is suggested on treatment methods
Clinical Toxicology
Saeedeh Derhami; Ehsan Bolvardi; Reza Akhavan; Mahdi Foroughian; Behzad Shahi; Arman Hakemi; Zhila Rahmanian; Samaneh Abiri
Volume 7, Issue 2 , July 2021, , Pages 82-87
Abstract
Objective: Acute poisoning is a major health problem and one of the most common causes of emergency visits worldwide. Since most poisoning subjects present with a decreased level of consciousness and due to unreliable disease history, recognizing the etiological cause of the poisoning represents a critical ...
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Objective: Acute poisoning is a major health problem and one of the most common causes of emergency visits worldwide. Since most poisoning subjects present with a decreased level of consciousness and due to unreliable disease history, recognizing the etiological cause of the poisoning represents a critical part in arranging the treatment strategy. This study aimed at examining the prevalence of etiological causes of poisoning in Iran in a systematic review and meta-analysis. Method: This systematic review and meta-analysis investigated the cross-sectional studies published from 1990 to 2020, reporting specific poisoning agents among acute poisoning cases in Iran. Persian and English articles on this subject were collected by searching the Scientific Information Database (SID), ScienceDirect, PubMed, Medlib, IranMedex, Scopus, Magiran, and Google Scholar databases. The heterogeneity of the studies was investigated using the I2 index and the probability of bias in the publication was assessed by the Begg and Mazumdar test with a significance level of 0.1. Data analysis was performed by Comprehensive Meta-analysis software version 3 (Biostat, Englewood, NJ, USA). Results: In our review, 19 studies appraising 143,251 cases of poisoning were included. The ranking of the OR of each agent was done; Opium poisoning was the most prevalent poisoning case followed by benzodiazepine, acetaminophen, antipsychotic medications, organophosphates, aluminum phosphide, amphetamine, pesticide, tricyclic antidepressant (TCA), alcohol, chemicals, carbon monoxide (CO), nonsteroidal anti-inflammatory drugs (NSAIDs), and selective serotonin reuptake inhibitors (SSRIs). Conclusion: While proper judgment on the cause of poisoning and selection of suitable treatment manners could be followed by a very good prognosis in patients with acute poisoning; this demands an epidemiological perception of the prevalence of the etiological poisoning agents. Our study ranked the most likely agents leading to the poisoning, to be at the top of the list of differential diagnoses of physicians.
Orthopedics
Ganesh Singh Dharmshaktu; Tanuja Pangtey
Volume 8, Issue 2 , July 2022, , Pages 88-89
Abstract
A 52-year-old male presented with atraumatic left side calf swelling for the last three months. The swelling had acute onset and increased gradually in size. He had a history of rheumatoid arthritis with treatment options limited to physiotherapy sessions and pain medication as he could not continue ...
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A 52-year-old male presented with atraumatic left side calf swelling for the last three months. The swelling had acute onset and increased gradually in size. He had a history of rheumatoid arthritis with treatment options limited to physiotherapy sessions and pain medication as he could not continue disease modifying anti-rheumatic drugs regularly. There was no history of co-morbidities like hypertension, tuberculosis, diabetes mellitus or bleeding diathesis. He neglected the swelling initially due to mild pain and little impact on activities of daily living till swelling increased to be apparent.
Clinical Toxicology
Ali Taherinia; Soodeh Shahsavari; Azadeh Heidarpour; Seyyed Mohammad Tabatabaii; Afsson Vahdat
Volume 2, Issue 1 , January 2016, , Pages 3-6
Abstract
Objective: Renal colic is a common cause of emergency room visits. Due to the spontaneous passage of more than 90% of kidney stones, treatment in the emergency department (ED) is limited to pain control. Analgesics currently used are selected based on physician experiences and various theories from different ...
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Objective: Renal colic is a common cause of emergency room visits. Due to the spontaneous passage of more than 90% of kidney stones, treatment in the emergency department (ED) is limited to pain control. Analgesics currently used are selected based on physician experiences and various theories from different sources. The aim of this study was to compare the common drugs (pethidine and diclofenac) used for renal colic in Iran.
Methods: In this single-blinded randomized clinical trial, 90 patients with renal colic who referred to the ED of Imam Reza hospital in Kermanshah were randomly assigned to each of 3 treatments including pethidine suppository (50 mg, iv), diclofenac suppository (50 mg), and a combination of pethidine and diclofenac suppository. In this regard, the response to treatment and duration of hospitalization were compared.
Results: The best medicine to relieve pain intensity in patients under 25 years was diclofenac suppository. In patients in the age range of 25-45 years, pethidine and diclofenac were the best choice. Conversely, in patients older than 45 years, pethidine was the best treatment. We could also observe a decrease in the length of hospitalization in patients who received pethidine.
Conclusion: It can be concluded that morphine is more appropriate to control pain and reduce the length of hospitalization in patients with renal colic. Clinical Trial Registration: irct.ir Identifier: IRCT20101214538
Emergency medicine
Mohammad Paravar; Somaye Safavi; Razie Eghtesadi; Mahdi Mohamadzade; Mojtaba Sehat; Mohammadreza Fazel; Esmaeil Fakharian; Mohammadhosein Makki; Mahzad Erami; Tayebeh Taghipor; Abdolreza dayani najafabadi
Volume 6, Issue 1 , January 2020, , Pages 3-6
Abstract
Objective: Emergency medical services systems are at the first line of dealing with patients who suffer from various infections. Conducting investigations on the bacterial contamination of emergency ambulances play a crucial role to improve the occupational health of staff as well as the quality of patient ...
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Objective: Emergency medical services systems are at the first line of dealing with patients who suffer from various infections. Conducting investigations on the bacterial contamination of emergency ambulances play a crucial role to improve the occupational health of staff as well as the quality of patient care. Therefore, the aim of the present study was to investigate the presence of Staphylococcus aureus and other life treating bacteria in the urban and rural ambulances and their on-call emergency medical service personnel.Methods: This descriptive cross-sectional study was conducted on 12 front line pre-hospital emergency urban and rural ambulances in Kashan, Iran, in 2015. A total of 18 sites were sampled in each ambulance and from the nose of personnel. Grown colonies were confirmed based on colony morphology on mannitol salt agar plates, gram stain reaction and biochemical characteristics reactions.Results: The S. aureus contamination was only isolated from the nose of on-call emergency medical service providers of 12 urban and road ambulances, while no sign of contamination was found in 18 sampling sites of these front-line ambulances. Also, further evaluation of these sampling sites revealed the contamination with coagulase-negative staphylococci in all of them and oxygen tank was introduced as the most contaminated site inside the ambulances. Moreover, the prevalence of equipment contamination was significantly higher in urban ambulances.Conclusion: Identifying the rate of pathogens in clinical settings like the pre-hospital ambulance setting is an important issue which should be carefully considered.
Emergency medicine
Marziye Hadian; Alireza Jabbari; Hojjat Sheikhbardsiri
Volume 9, Issue 1 , January 2023, , Pages 4-8
Abstract
Objective: In order to heal burn wounds, many researches have been done, including the use of biological scaffolds due to their ability to achieve the desired properties. Owing to the appropriate biological properties of chitosan such as biocompatibility and antimicrobial properties as well as the promotion ...
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Objective: In order to heal burn wounds, many researches have been done, including the use of biological scaffolds due to their ability to achieve the desired properties. Owing to the appropriate biological properties of chitosan such as biocompatibility and antimicrobial properties as well as the promotion of wound healing in biomedical applications, we aimed to perform a systematic review to investigate the effect of this technology on the treatment of burn hazards victims.Methods: The present research was conducted in 2020 as a systematic review of studies related to the effect of chitosan on burns. In this study, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Critical Appraisal Skills Programme (CASP) guidelines were used to assess the articles. The key words “Chitosan,” “Chitin,” “victim,” “Injury,” “Burn,” “Heal,” “wound” “treat,” “hazard,” and “care” were used in combination with the Boolean operators OR and AND. The ISI web of science, PubMed, Scopus, Science Direct, Ovid, Pro Quest, Wiley and Google Scholar were searched.Results: Recently, chitosan and its derivatives have been proposed as suitable candidates for scaffolding and can be used as temporary scaffolds to modify and stimulate the growth of new tissues. Studies to demonstrate the use of chitosan in the treatment of burns have been limited to research on animal models and have been superior to conventional therapies in terms of time, pain, and efficacy.Conclusion: The effect of chitosan on burns has been positive in animal models and has accelerated wound healing. Since the main ingredient of chit powder is chitosan and due to the limited studies done on humans, it cannot be said with certainty that the use of chitosan and its derivatives to treat burns is better than other ways to treat burns.
Education
Hamidreza Reihani; Niazmohammad Jafari; Mohsen Ebrahimi; Elham Pishbin; Ehsan Bolvardi; Veda Vakili
Volume 1, Issue 1 , January 2015, , Pages 7-11
Abstract
Objective: In this trial, we intend to assess the effect of simulation-based education approach on advanced cardiovascular life support skills among medical students.
Methods: Through convenient sampling method, 40 interns of Mashhad University of Medical Sciences in their emergency medicine rotation ...
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Objective: In this trial, we intend to assess the effect of simulation-based education approach on advanced cardiovascular life support skills among medical students.
Methods: Through convenient sampling method, 40 interns of Mashhad University of Medical Sciences in their emergency medicine rotation (from September to December 2012) participated in this study. Advanced Cardiovascular Life Support (ACLS) workshops with pretest and post-test exams were performed. Workshops and checklists for pretest and post-test exams were designed according to the latest American Heart Association (AHA) guidelines.
Results: The total score of the students increased significantly after workshops (24.6 out of 100 to 78.6 out of 100). This demonstrates 53.9% improvement in the skills after the simulation-based education (P< 0.001). Also the mean score of each station had a significant improvement (P< 0.001).
Conclusion: Pretests showed that interns had poor performance in practical clinical matters while their scientific knowledge, such as ECG interpretation was acceptable. The overall results of the study highlights that Simulation based-education approach is highly effective in Improving ACLS skills among medical students.
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.
Surgery
Vishnu Vardhan P. Reddy; Srujan Dharap; Reyaz Ahmad; Ajeet Pratap Maurya; Meena Kumari; Bharati Pandya
Volume 10, Issue 1 , January 2024, , Pages 7-16
Abstract
Objective: COVID-19 caused one of the most prolonged global pandemics, disturbing the routine of hospital protocols beyond measure, especially affecting surgical specialties, emergencies, and cancer care.Methods: This observational study was conducted on 129 patients of pediatric and adult age groups ...
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Objective: COVID-19 caused one of the most prolonged global pandemics, disturbing the routine of hospital protocols beyond measure, especially affecting surgical specialties, emergencies, and cancer care.Methods: This observational study was conducted on 129 patients of pediatric and adult age groups who presented with abdominal emergencies from March 1, 2020 to March 31, 2022 and were recruited for the study from the department of General Surgery, All India Institute of Medical Sciences, Bhopa. The analysis done using the chi-square or Fisher’s exact test. P values < 0.05 were considered significant. The outcomes were compared with the pre-existing standard protocols using SPSS.Results: Among the 129 patients, 104 were COVID-19-negative and 15 were COVID-19-positive, and in 10 cases, the results were inconclusive. The abdominal presentations observed in the study were as follows: two patients with hemorrhagic and five with septic shock. Emergency surgeries were done in 80 (62.1%) patients, and conservative approaches were used in 49 (37.9%) patients; of the 80 patients who underwent operation, 30 (37.5%) required deviation from standard established protocols. The ICU admitted a larger number of COVID-19-positive patients as compared to COVID-19-negative patients [8 (57%) vs. 24 (25%)] who needed operations, and 18 (13.9%) patients were treated conservatively in the ICU. Mortality was higher in COVID-19-positive as compared to COVID-19-negative patients [4 (28%) vs. 9 (8%)].Conclusion: The present study demonstrated the definite negative impact of COVID-19 on emergencies but provided useful lessons for emergency surgeons. A high standard of care, such as evaluating if a procedure can be postponed till the patient is less infectious or at a lesser risk of morbidity and mortality, is warranted during COVID-19 or similar pandemics. Ensuring adequate safety measures in the operating theatre is essential. We recommend a careful and judicious evaluation of every surgical indication.
Emergency medicine
Ali Imani; Jalal Borna; Ali Alami; Shahla Khosravan; Hadi Hasankhani; Mostafa Bafandeh Zende
Volume 5, Issue 1 , January 2019, , Pages 8-13
Abstract
Objective: Low back pain is one of the most important job injuries among emergency medical personnel. This study was carried out to investigate the prevalence of low back pain as well as its physical, mental and managerial predisposing factors among emergency medical personnel in Iran.Methods: In this ...
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Objective: Low back pain is one of the most important job injuries among emergency medical personnel. This study was carried out to investigate the prevalence of low back pain as well as its physical, mental and managerial predisposing factors among emergency medical personnel in Iran.Methods: In this analytical cross-sectional study we recruited 298 pre-hospital emergency medical personnel based on census sampling. Data were gathered using Nordic and a research-made questionnaire related to physical, mental and managerial back pain factors. Data were analyzed using SPSS version 20. Descriptive and analytical tests including chi-square test were used appropriately. P value less than 0.05 was considered as the level of significance.Results: Findings showed that 46.3% of pre- hospital emergency technicians had a history of low back pain with different intensities. We observed a significant relationship between age, work experience, occupational-physical factors with low back pain (P > 0.001). However, there was no significant relationship between occupational-managerial factors and mental-occupational factors with low back pain (P > 0.05).Conclusion: Results show that the prevalence of back pain among emergency medical personnel is high. Identifying the factors associated with back pain can help the managers as well as the personnel to control the problem of back pain and increase employees’ productivity.
Orthopedics
Felice Mucilli; Pierpaolo Camplese; Guiseppe Cipollone; Decio Di Nuzzo; Luigi Guetti; Marco Perioletta; Mirko Barone
Volume 3, Issue 1 , January 2017, , Pages 11-17
Abstract
Objective: Thoracic trauma may be a life-threatening condition. Flail chest is a severe chest injury with high mortality rates. Surgery is not frequently performed and, in Literature, data are controversial. The authors report their experience in the treatment of flail chest by an extracortical internal-external ...
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Objective: Thoracic trauma may be a life-threatening condition. Flail chest is a severe chest injury with high mortality rates. Surgery is not frequently performed and, in Literature, data are controversial. The authors report their experience in the treatment of flail chest by an extracortical internal-external stabilization technique with Kirshner’s wires (K-wires).
Methods: From 2010 to 2015, 137 trauma patients (109 males and 28 females) with an average age of 58.89 ±19.74 years were observed. Seventeen (12.41%) patients presented a flail chest and of these, 13 (9.49%) with an anterior one. All flail chest patients underwent early chest wall surgical stabilization (within 48 hours from the injury).
Results: In the general population, an overall morbidity of 21.9% (n = 30 of 137) and a 30-day mortality rate of 5.1% (n = 7 of 137) were observed. By clustering the population according to the treatment (medical or interventional vs surgical), significant statistically differences between the two cohorts were found in morbidity (12.65% vs. 34.48%, P = 0.002) and mortality rates (1.28% vs. 10.34%, P = 0.017). In patients undergoing chest wall surgical stabilization, with an average Injury Severity Score of 28.3 ± 5.2 and Abbreviated Injury Score (AIS) of 8.4 ± 1.7, an overall morbidity rate of 52.9% (n = 9) and a mortality rate of 17.6% (n = 3) were found. Post-surgical device removal, in local anesthesia or mild sedation, was performed 42.8 ± 2.9 days after chest wall stabilization and no cases of wound infection, dislodgment of the wires or osteosynthesis failure were reported. Moreover, in these patients, an early postoperative improvement in pulmonary ventilation (ΔpaO2 and ΔpCO2: +9.49 and -5.05, respectively) was reported.
Conclusion: Surgical indication for the treatment of flail chest remains controversial and debated both due to an inadequate training and the absence of comparative prospective studies between various strategies. Our technique for the surgical treatment of the anterior flail chest seems to be anachronistic, but the aspects described, both in terms of technical features and of outcome and benefits (health, economic), allow to evaluate the effectiveness of this approach.
Emergency Medical Services
Afsaneh Esmaeili Ranjbar; Masoud Mayel; Mitra Movahedi; Faezeh Emaeili Ranjbar; Amirhossein Mirafzal
Volume 2, Issue 2 , July 2016, , Pages 37-41
Abstract
Objective: Most previous retrospective studies failed to show a consistent association between pre-hospital time intervals and mortality in trauma patients, bringing the recommendation of “transport fast to increase survival” under question. The aim of this study was to evaluate the association ...
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Objective: Most previous retrospective studies failed to show a consistent association between pre-hospital time intervals and mortality in trauma patients, bringing the recommendation of “transport fast to increase survival” under question. The aim of this study was to evaluate the association of response time, scene time, and transport time with 24-hour in-hospital mortality.Methods: In this cross-sectional study data were collected In the emergency department (ED). Time intervals were obtained from emergency medical service (EMS) central system. All traumatized patients presented to an urban academic hospital by EMS with Emergency Severity Index (ESI) levels 1 or 2 were included in the study. Exclusion criteria were age under 16 or above 65, being transported from outside of the city, severe underlying medical illness, life threatening intoxications, and randomized trauma score (RTS) of more than 10. Patients were followed in the hospital for 24-hour mortality.Results: A total of 2884 patients were enrolled in the study. Response time, scene time, transport time, and total out of hospital time were all associated with mortality in univariate analysis (P = 0.02, 0.01, <0.001, and 0.001, respectively). In multivariate regression analysis, transport time was associated with 24-hour mortality (P < 0.001, OR [95% CI]: 1.20 [1.16-1.24]).Conclusion: Although time intervals in most previous studies did not show association with mortality, there is no recommendation such as “pre-hospital time intervals in traumatized patients should not be limited,” since limiting time intervals for taking a traumatized patient to the hospital still seems to be prudent. Our findings support the recommendation of decreasing the transportation and total out of hospital time in the present condition in Kerman city EMS system.
Emergency medicine
Fereshteh Jamali; Haniyeh Ebrahimibakhtavar; Mahbubeh Zomordi Torkdari; Farzad Rahmani
Volume 5, Issue 2 , July 2019, , Pages 37-40
Abstract
Objective: Assessing patients’ satisfaction with emergency medical services (EMSs) is an important managerial point of view. The present study aimed to assess the patients’ satisfaction with EMS in Tabriz, Iran.Methods: This is a descriptive-analytic study that was done in the prehospital ...
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Objective: Assessing patients’ satisfaction with emergency medical services (EMSs) is an important managerial point of view. The present study aimed to assess the patients’ satisfaction with EMS in Tabriz, Iran.Methods: This is a descriptive-analytic study that was done in the prehospital emergency and disaster management center of Tabriz University of Medical Sciences. In this study, from May to December 2017, we included 659 patients who were transferred to hospitals with our prehospital emergency services. A valid and reliable questionnaire was used to evaluate the satisfaction of patients about the performance of prehospital EMSs.Results: Data of 659 patients were evaluated. Trauma was the most common cause of contact with 115 and help request (33.83%). The results indicated that patients’ level of satisfaction was good and very good. The highest level of satisfaction was related to the treatment of patients and use of medical equipment in the ambulance (n=578 patients, 87.7%) as well as the treatment practiced by the emergency medical technicians (EMTs) (n=575 patients, 87.24%). However, the lowest level of satisfaction was related to the absence of an active EMT in the rear cabin when transferring patients to the hospital (n=337 patients, 51.14%) and transfer of the patient from the accident scene to the ambulance (n=410 patients, 62.21%).Conclusion: Patients’ satisfaction with EMS was optimal. The minimum and maximum satisfaction rates were related to the absence of an active EMT in the rear cabin, treatment of the patient, and use of medical equipment.
Critical Care
Mahboob Pouraghaei; Behzad Mohammadi; Ali Taghizadeh; Paria Habibollahi; Payman Moharamzadeh
Volume 1, Issue 2 , July 2015, , Pages 44-47
Abstract
Objective: Congestive heart failure (CHF) has become one of the most important health care problems in western countries. This article focuses on the outpatient diagnosis and management of heart failure. We want to compare the outcome of patients who were treated with high dose diuretics in the emergency ...
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Objective: Congestive heart failure (CHF) has become one of the most important health care problems in western countries. This article focuses on the outpatient diagnosis and management of heart failure. We want to compare the outcome of patients who were treated with high dose diuretics in the emergency department (ED) without admission with patients who were admitted to hospital for standard treatment.
Methods: This was a randomized prospective clinical trial study. The patients who came to the ED from March 20, 2008 up to August 20, 2008 were divided into two groups randomly. The length of ED stay in the experimental group was documented. Also, readmission and mortality in 6 months and satisfaction in both groups were taken into consideration. All data were analyzed using SPSS 15.0.
Results: In experimental group, the rate of recurrent admission, expiration, discharge, clinic visit, and clinic admission was 8%, 4%, 29%, 18%, and 0% respectively. On the other hand, in control group it was 16%, 40%, 18%, 22%, and 2% respectively. Additionally, there was a significant difference between these groups (P = 0.00).
Conclusion: This study is the first regional prospective trial to comprehensively examine the therapeutic management in patients with CHF. This study, comparing the high dose diuretic efficacy in the decreasing of hospital stay and readmission; and decreasing mortality rate with routine therapy, showed that there was a significant difference between these two strategies in the mortality rate, readmission, and length of hospital stay (P = 0.00).
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.
Anesthesiology
Arman Taheri; Morteza Hashemian; Mehrdad Noroozi; Mohammad Bakhtiari; Mohammad Reza Doroodian; Shirin Salajegheh
Volume 4, Issue 2 , July 2018, , Pages 62-66
Abstract
Objective: In order to prolong the duration of intrathecal lidocaine, various drugs are used along with it. Due to the promising effects of tizanidine on central nervous system, it can be assumed that tizanidine can have a positive effect on increasing the anesthesia duration too. Thus, we aimed to investigate ...
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Objective: In order to prolong the duration of intrathecal lidocaine, various drugs are used along with it. Due to the promising effects of tizanidine on central nervous system, it can be assumed that tizanidine can have a positive effect on increasing the anesthesia duration too. Thus, we aimed to investigate the effect of oral tizanidine on the duration of lidocaine spinal anesthesia.Methods: This double blind clinical trial was conducted on 40 male patients waiting for elective leg surgery with the age range of 20-60 years in one of the educational hospitals of Kerman University of Medical Sciences, Iran. We used simple random sampling and our participants were assigned into 2 groups (placebo and oral tizanidine receivers). Spinal anesthesia with 1 mg/kg of hyperbaric lidocaine 5% was performed in both groups. In tizanidine group, patients received 4 mg of oral tizanidine one hour before spinal anesthesia. Sensory block was examined by pin prick test and all anesthetic duration including start block until reduction of sensory level was calculated at 2 lower dermatomes.Results: Findings showed that oral tizanidine compared to placebo can cause a 10-15 minute increase in patients’ lidocaine spinal anesthesia. Therefore, the average anesthesia time for tizanidine group increased meaningfully (P = 0.03). In addition, tizanidine can sedate patients during surgery (P = 0.00) or in recovery (P = 0.003).Conclusion: Based on the results, tizanidine increased the duration of lidocaine so oral tizanidine can be used to prolong the duration of lidocaine spinal anesthesia.
Critical Care
Moloud Balafar; Mahboub Pouraghaei; Mahnaz Ranjkesh; Mahshid Dehghan; Ali Delkhorrami; Samad Shams Vahdati
Volume 9, Issue 2 , July 2023, , Pages 87-91
Abstract
Objective: According to the most recent guidelines, the recommended imaging approaches for the diagnosis of pneumonia are chest X-ray (CXR) and computed tomography (CT) scan. However, there are limitations to these approaches. Lung ultrasound (LUS) has attracted a lot of attention in intensive care units ...
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Objective: According to the most recent guidelines, the recommended imaging approaches for the diagnosis of pneumonia are chest X-ray (CXR) and computed tomography (CT) scan. However, there are limitations to these approaches. Lung ultrasound (LUS) has attracted a lot of attention in intensive care units (ICUs) and emergency departments. Considering the importance of the timely diagnosis and proper treatment of pneumonia, this study aimed to determine the diagnostic value of bedside LUS in comparison to chest CT scans in patients with suspected pneumonia or unspecified CXR findings in the emergency department.Methods: This prospective descriptive-analytic study was conducted in the emergency department of Imam Reza hospital. Patients aged 3 years and older with early diagnosis of pneumonia or any unspecified CXR findings with an indication of CT scan were included in the study. LUS was performed with a deep curved and linear surface probe. The results obtained from the chest ultrasound were compared with the results obtained by CT scan as the diagnostic gold standard.Results: A total of 175 patients were included in this study. According to the results, the sensitivity and specificity of LUS in the diagnosis of subpleural consolidation were 94.1% and 100%, respectively, and the positive predictive value and the negative predictive value were 100% and 33.3%, respectively. The sensitivity and specificity of LUS in diagnosing pleural effusion were 69.2% and 100%, respectively, and the positive predictive value and the negative predictive value were 100% and 90.7%, respectively. Furthermore, the sensitivity of LUS in diagnosing dynamic airbronchogram was 98%.Conclusion: According to the findings of the present study, in patients suspected of pneumonia, LUS is more sensitive and specific in the diagnosis of pneumonia and is less time-intensive and costly. Additionally, the ultrasound device is easily portable and accessible. It can be widely used and does not have the secondary side effects of ionizing radiation in patients. However, the technician’s skill in performing ultrasound is a matter of importance.
Emergency medicine
Madhusudhan Mahadevaiah; Murali Mohan Nidasale Thimmaiah; Venu Sashank Yerramsetty; Jeevan Kumar; Ranjith Kumar
Volume 7, Issue 2 , July 2021, , Pages 88-92
Abstract
Objective: To evaluate the predictive and diagnostic accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in acute kidney injury (AKI) and also to predict the renal replacement therapy (RRT) using NGAL as a marker.Methods: This prospective study was conducted among the patients admitted to intensive ...
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Objective: To evaluate the predictive and diagnostic accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in acute kidney injury (AKI) and also to predict the renal replacement therapy (RRT) using NGAL as a marker.Methods: This prospective study was conducted among the patients admitted to intensive care units. Plasma samples were collected 24 hours after admission and NGAL was measured using Triage® NGAL test, a specific point of care test which is based on the mechanism of fluorescence immunoassay. The diagnostic accuracy of plasma NGAL (pNGAL) to predict AKI in critically ill patients of ICU was assessed by applying receiver operator curve (ROC) analysis and calculating the area under the curve (AUC).Results: In this study, 100 patients with the mean age of 49.56 ± 19.2 years were included for the period of 18 months. The blood samples were withdrawn from the patients 24 and 44 hours after admission. Totally, 55% (n = 55) of ICU patients were diagnosed with AKI. Plasma NGAL level was significantly increased in AKI patients as compared to non-AKI patients (742.65 ± 734.72 vs. 255.62 ± 440.09 μg/L; P < 0.01). The sensitivity and specificity of NGAL for diagnosing AKI was 83.6% and 88.9%, respectively. The overall diagnostic accuracy was 86%. Diagnostic accuracy of NGAL for requirement of RRT was 51%.Conclusion: Plasma NGAL is a reliable marker for patients with AKI in ICU, in case the cause of kidney injury is not known. In addition, NGAL also predicts the RRT need based on AKI severity.
Infectious disease
Mojtaba Miladinia; Farhad Abolnezhadian; Joachim G. Voss; Kourosh Zarea; Naser Hatamzadeh; Mandana Ghanavati
Volume 8, Issue 2 , July 2022, , Pages 90-94
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).
Emergency Medical Services
Somaye Younesian; Reza Shirvani; Ali Tabatabaey
Volume 4, Issue 1 , January 2018, , Pages 3-8
Abstract
Objective: Patient satisfaction (PS) is a major quality assessment index for the emergency department (ED) which affects patient safety, litigation, reimbursements, and consumer satisfaction. In this study we aimed to recognize the factors affecting PS in our center. Method: Random shifts during a week ...
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Objective: Patient satisfaction (PS) is a major quality assessment index for the emergency department (ED) which affects patient safety, litigation, reimbursements, and consumer satisfaction. In this study we aimed to recognize the factors affecting PS in our center. Method: Random shifts during a week were selected and all patients disposed from the ED were asked to fill out a revised and validated Persian version of the Press-Ganey questionnaire with the help of a research assistant. Results were analyzed using a linear regression model by SPSS software version 21. Results: Findings reaffirmed some of the factors previously described. These included longer door to treatment area times having a negative effect on satisfaction (P < 0.001), and providing vivid discharge information improving PS (P < 0.001). Other important factors were also found that had not previously been focused on, namely cleanliness of the area (P < 0.0001) and courtesy of the staff in charge of patient transfer (P = 0.03). We also found that men had a more satisfying ED experience (P = 0.002). Conclusion: Cultural expectations may have an important effect on PS. Thus, every institution should determine and alter the expectations most relevant to them.
Emergency medicine
Hamid Reza Moretza Bagi; Amir Ghaffarzad; Peyman Fathipour; Reza Yazdani; Zhila Khamnian; Sama Rahnemayan
Volume 8, Issue 1 , January 2022, , Pages 3-7
Abstract
Objective: Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators ...
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Objective: Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators in teaching cricothyrotomy skills for emergency medicine residents.Methods: In this pre-post test study, all faculty member of emergency medicine of Tabriz University of medical sciences specialty were invited to participate. After holding an educational and training session for assistants on a teacher-made moulage, all emergency medicine residents performed a tracheostomy on the commercial moulages of the skill lab unit for the second time and their scores were recorded.Results: In this study, 23 emergency medicine residents participated. The mean ± standard deviation of age was 35.91 ± 3.57 years. There was a significant difference between the mean duration of cricothyrotomy before and after the training (P value = 0.006). There was also a significant difference between the mean scores obtained by residents in the pre- and post-training evaluation (P value < 0.001).Conclusion: Findings showed that the moulages constructed by teachers not only can be effective in improving the cricothyrotomy skills in emergency medicine residents but also can reduce the likelihood of failure in performing cricothyrotomy.