Trauma
Julius Gbenga Olaogun; Olusoga Olusola Akute; Amarachuku Chiduziem Etonyeaku; Joshua Taye Ige; David Brown Ajibola; Jide Michael Afolayan; Eyitayo Ebenezer Emmanuel
Volume 4, Issue 2 , Summer and Autumn 2018, , Pages 67-72
Abstract
Objective: There has been a global increase in the incidence of abdominal trauma in surgical patients. We conducted this study to evaluate the pattern of abdominal injuries, patient characteristics and the management outcome in our setting.Methods: It was a descriptive (combined retrospective and prospective) ...
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Objective: There has been a global increase in the incidence of abdominal trauma in surgical patients. We conducted this study to evaluate the pattern of abdominal injuries, patient characteristics and the management outcome in our setting.Methods: It was a descriptive (combined retrospective and prospective) study of all patients with abdominal trauma admitted and managed at Ekiti State University Teaching Hospital, Ado-Ekiti between January 2013 and December 2016. Data on socio-demographics, clinical profile, investigations, treatments and outcome were entered into a spread sheet and analyzed using SPSS version 20.0.Results: A total of 2728 trauma patients presented during the study period. Of these, 68 (2.5%) suffered from abdominal injuries. Their ages ranged from 6 to 72 years (mean 30.3±13.2). Fifty-nine (86.8%) were males while 9 (13.2%) were females (M: F ratio = 6.6:1). Forty-nine (72.1%) sustained blunt trauma while 19 (27.9%) had penetrating injuries. Road traffic incident (RTI) (n=41; 60.3%) was the most common source of trauma, followed by assault: gunshot (n=9; 13.2%), and stab (n=7; 10.3%). Spleen (n=23; 33.8%) was the most common solid organ injured followed by the liver (n=7; 10.3%) while small bowel (n=8; 11.8%) was the most common hollow viscous injured. Forty-seven (69.1%) required operative intervention. Post-operative complication rate was 17% with wound infection (12.5%) predominating. The mortality rate was 4 (5.9%).Conclusion: RTI and assault are major causes of abdominal injury. Measures to reduce RTI, youth restiveness and criminal activities will stem the tide.
Clinical Toxicology
Javad Mesbahi; Shahin Shadnia; Hossein Hassanian-Moghaddam; Nasim Zamani; Peyman Erfan Talab Evini; Delara Hazegh Fetratjoo; Alireza Kargar; Mitra Rahimi
Volume 7, Issue 2 , Summer and Autumn 2021, , Pages 93-96
Abstract
Objective: Delirium is one of the most common complications in patients admittedto intensive care units (ICUs). Delirium is a definite cause for more extended hospitalstays, higher mortality rates, and possibly persistent cognitive decline in the future.Antipsychotics have been frequently evaluated as ...
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Objective: Delirium is one of the most common complications in patients admittedto intensive care units (ICUs). Delirium is a definite cause for more extended hospitalstays, higher mortality rates, and possibly persistent cognitive decline in the future.Antipsychotics have been frequently evaluated as first drugs of choice, but the mostappropriate, evidence-based treatment is yet to be discovered. This study aims to comparethe efficacy of haloperidol and olanzapine in patients admitted to our toxicology ICU.Methods: This double-blind, randomized controlled clinical trial was undertaken on 35 ICUadmitted patients with delirium in Loghman Hakim hospital in Tehran, Iran. The diagnosiswas based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-V) criteria for delirium, and clinical toxicologists included the patients accordingto the study’s inclusion and exclusion criteria. Patients received either haloperidol orolanzapine based on computerized randomization. The severity of delirium was measuredwith the Memorial Delirium Assessment Scale (MDAS) scoring on days 0 and 3 of ICUadmission.Results: The total sample size was 35 in which 16 patients received haloperidol, and 19patients received olanzapine. The doses of haloperidol and olanzapine were 3 mg threetimes a day and 5 mg three times a day, respectively. There was no significant difference inbaseline characteristics and the scores of MDAS between groups.Conclusion: Olanzapine and haloperidol have the same efficacy in the managementof delirium in toxicology ICU-admitted patients. They can be interchangeably used fordelirium treatment in these patients
Emergency medicine
Seyyed Meysam Amini; Mehriyar Yoldashkhan; Sima Zohari; Malihe Nasiri; Zahra Mousavi; Seyed Mohammad Amini
Volume 8, Issue 1 , Winter and Spring 2022, , Pages 8-12
Abstract
Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase ...
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Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase activity and reduces pain and inflammation. It can be considered as the strongest analgesic drug in this category. The aim of this study was to evaluate the effectiveness of ketorolac in pain management of traumatic injuries in a prehospital setting.Methods: This descriptive cross-sectional study was undertaken to evaluate the effectiveness of a treatment method in the pain management of traumatic injuries in the prehospital environment of Lorestan province in Iran. We included 134 injured patients from road emergency bases of Lorestan province. In order to control the pain of these injured patients, 30 mg of ketorolac was injected slowly intravenously in one minute. Pain was measured in the time interval of zero minutes (before injection), 15 minutes, 30 minutes, and 45 minutes by visual acuity scale (VAS). The analysis of the obtained data was performed by SPSS software version 23.Results: The mean age of participants was 37.42±23.6. There were 47 female injuries (35.1%) and 87 male injuries (64.9%). In terms of pain intensity, 49 patients (36.6%) had moderate pain (VAS = 4-6) and 85 patients (63.4%) had severe pain (VAS = 7-10). The average of pain relief in the injured group with severe and moderate pain 15 minutes after the injection was 0.471 and 0.878 (P = 0.001), respectively. In addition, the mean of pain relief in the injured group with severe and moderate pain 30 minutes after the injection was 1.124 and 1.796, respectively (P = 0.001). Pain reduction in the group of severely injured patients with moderate pain in the first 30 minutes was statistically significant.Conclusion: Findings revealed that ketorolac is a suitable drug in pain management for trauma patients with moderate and severe pain in trauma patients. On the other hand, due to the peak effect (more than 30 minutes), it is not an effective drug for trauma patients with severe pain in a short period transferred to the prehospital environment.
emergency nursing
Farzad Rahmani; Pegah Sepehri Majd; Haniyeh Ebrahimi Bakhtavar; Farnaz Rahmani
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 9-13
Abstract
Objective: Triage refers to the evaluation and categorization of patients for better management to deliver services. A good triage system should be able to accurately specify the patients who require urgent care. Thus, this study aimed to evaluate the accuracy of emergency nurses in correct triage ...
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Objective: Triage refers to the evaluation and categorization of patients for better management to deliver services. A good triage system should be able to accurately specify the patients who require urgent care. Thus, this study aimed to evaluate the accuracy of emergency nurses in correct triage using Emergency Severity Index (ESI) triage. Methods: In this descriptive cross-sectional study 750 patients, who referred to the emergency department (ED) of Sina teaching hospital, participated from 23 July to 22 August in 2015. Participants were selected using convenience sampling method. The patients’ triage level was determined by physicians and nurses separately and the results were compared. To define the level of agreement between two groups (inter-rater agreement), the kappa index was evaluated. Data were analyzed using SPSS version 17. Results: Among 750 patients, 577 patients (76.9%) were classified in correct triage group, 90 patients (12%) in undertriage group and 83 patients (11.1%) in overtriage group. Kappa agreement coefficient between the ESI triage level of physicians and nurses was 0.659 (95% CI: 0.646-0.667). There was statistically significant difference between the triage level of physicians and nurses (P < 0.001). Conclusion: This study showed that there was moderate agreement between the triages of physicians and nurses. It seems that improving nurses’ skills and knowledge might increase the accuracy of emergency nurses in patients’ correct triage. Therefore, planning programs based on training correct triage for emergency nurses is strongly suggested.
Emergency medicine
payman Asadi; Vahid Monsef Kasmaei; Seyyed Mahdi Zia Ziabari; Behzad Zohrevandi
Volume 2, Issue 1 , Winter and Spring 2016, , Pages 11-15
Abstract
Objective: Low back pain is the most common skeletal disorder worldwide that 50% to 80% of people experience it at least once in their lifetime. Physical and psychological factors in the work environment can relatively contribute to low back pain. In this study, we examined the prevalence of low back ...
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Objective: Low back pain is the most common skeletal disorder worldwide that 50% to 80% of people experience it at least once in their lifetime. Physical and psychological factors in the work environment can relatively contribute to low back pain. In this study, we examined the prevalence of low back pain and influential factors in its development among nursing staff. Methods: In this cross-sectional study we assessed the prevalence of low back pain among nurses working in Poursina hospital, Rasht, Iran, during March and April 2012. Demographic data and information on the status of skeletal pain, as well as, associated factors were collected using a pre-designed check list. Data were analyzed using SPSS version 16. Results: A total of 350 nurses with a mean age of 32.00 ± 8.24 years (minimum 22 and maximum 56 years) were studied (90.3% female). 246 participants (70.3%) had a history of low back pain. There was no significant difference between gender and the incidence of low back pain, (P = 0.286). 96 participants (27.4%) aged 27 to 31 had the highest rate of low back pain and 11 participants (3.1%) aged 52 to 56 were the least frequent age group. Low back pain significantly differed by age (P = 0.001), body mass index (BMI) (P = 0.222), and physical activity (P = 0.050). Conclusion: The results of this study showed a prevalence of 70% for low back pain among nurses working in Poursina hospital in Rasht, in Gilan province. Age, BMI, and physical activity were significantly associated with the prevalence of low back pain. However, gender, occupation, marital status, smoking, family history, frequency of lifting heavy things, work experience, and workplace did not show a significant relationship
Infectious disease
Hamid Zamani Moghadam; Fatemeh Maleki; Mohsen Ebrahimi; Mahdi Foroughian
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 13-17
Abstract
Objective: The purpose of this study is to evaluate the diagnostic value of nitrite test in comparison with urine culture (U/C) results in patients with Urinary tract infection (UTI) symptoms.Methods: This cross-sectional study was performed on 203 patients with UTI symptoms. Middle urine sample was ...
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Objective: The purpose of this study is to evaluate the diagnostic value of nitrite test in comparison with urine culture (U/C) results in patients with Urinary tract infection (UTI) symptoms.Methods: This cross-sectional study was performed on 203 patients with UTI symptoms. Middle urine sample was taken into sterile plastic containers, and simultaneously the urine sample and the nitrite test were done by the use of urine dipstick test. Data were analyzed using SPSS software version 23.Results: The results of the urine culture test indicated that the highest excreted organisms in both sexes were E. coli (58.8%), Candida (17.6%), Klebsiella (8.8%), E. coli (MDR) (5.9%), Pseudomonas (2.9%), Enterococcus (2.9%) and Acinetobacter (2.9%). The results showed that there was a significant correlation between U/C and urine analysis (U/A) test results (P = 0.01), and in U/C positive results, U/A results were significantly positive for UTI. Other findings showed a significant relationship between the results of nitrite one and nitrite two tests (P = 0.001). There was a significant correlation between urinary, and nitrite1 levels (P = 0.04). Also, in this study, the sensitivity and specificity of diagnostic tests for U/A and nitrite 1 and 2 with U/C were calculated as the Golden Standard method.Conclusion: Overall, the results of this study showed that the negative nitrite test and urine dipstick test could be performed in emergency cases to prevent ectopic dysfunction and inadequate diagnosis. Also, it can reduce the unreasonable expenses for U/A.
Emergency medicine
Majid Zamani; Maliheh Mazaheri; Farhad Heydari; Babak Masoumi
Volume 7, Issue 1 , Winter and Spring 2021, , Pages 17-21
Abstract
Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional ...
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Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional study, 214 patients (over 18 years) presenting to the emergency department (ED) with suspicion of traumatic calcaneus fracture following acute blunt trauma, were enrolled. Bedside ultrasonography was performed and interpreted by emergency physicians. After that, plain radiography was performed. Furthermore, all the patients were assessed by computed tomography (CT) scan as the gold standard. Results: Finally, 193 patients were enrolled with a mean age of 29.4±15.7 years (85.5% male). Fractures in the calcaneus were detected in 49 patients. The sensitivity and specificity of ultrasonography in the detection of calcaneal fractures were 83.6%, (confidence interval (CI), 69.7 –92.2) and 100% (95% CI, 96.7 –100), while the sensitivity and specificity of X-ray were 87.7% (95% CI, 74.5 –94.9) and 100% (95% CI, 96.7 –100). There was no false positive result for X-ray and US. Conclusion: Our findings suggest that bedside US with an acceptable sensitivity and specificity can be used as a promising alternative for the diagnosis of calcaneal fracture in ED.
OB/GYN
Aboutaleb Beigi; Alireza Mazinanian; Mansour Ashrafinia; Alireza Baratloo; Saeed Safari
Volume 1, Issue 1 , Winter and Spring 2015, , Pages 19-21
Abstract
Objective: There are major differences in neonatal and obstetrics outcomes of labour among different ethnicities. The present study compared the neonatal and obstetrics outcomes of labour between the Iranian and Afghan ethnicities. Methods: Neonatal and obstetrics problems were evaluated in Iranian ...
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Objective: There are major differences in neonatal and obstetrics outcomes of labour among different ethnicities. The present study compared the neonatal and obstetrics outcomes of labour between the Iranian and Afghan ethnicities. Methods: Neonatal and obstetrics problems were evaluated in Iranian and Afghan pregnant women, who had referred to Arash Educational/Treatment Center for labour during a year. Results: 3020 (93.7%) Iranian and 202 (63%) Afghan women were evaluated. There were no significant differences between the two ethnicities in relation to a need for Neonatal Intensive Care Unit (NICU), the rate of live births, infant birth weight, congenital anomalies and premature births (P>0.05). The rate of Caesarian section was higher in Iranian women (P=0.001). Conclusion: It seems that the differences in neonatal problems and outcomes of labour obstetrics between Iranians and Afghans can be attributed to different cultural, economic, and social conditions in comparison to different ethnicities.
Surgery
Nasser Malekpour Alamdari; Samad Shams Vahdati; Barmak Gholizadeh; Shima Nayebian
Volume 5, Issue 1 , Winter and Spring 2019, , Pages 19-22
Abstract
Objective: Chronic kidney disease (CKD) is a complicated kidney defect causing permanent failure in renal function in progressive stages. Hemodialysis is the most accepted treatment to maintain body’s fluid/electrolyte homeostasis at the terminal stages of the disease. Permanent hemodialysis catheter ...
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Objective: Chronic kidney disease (CKD) is a complicated kidney defect causing permanent failure in renal function in progressive stages. Hemodialysis is the most accepted treatment to maintain body’s fluid/electrolyte homeostasis at the terminal stages of the disease. Permanent hemodialysis catheter (permicath) may be inserted blindly or by fluoroscopic guidance. This study aimed to compare the early function and complications between fluoroscopic guidance and blindly insertion of permanent hemodialysis catheter.Methods: This prospective randomized clinical trial was undertaken in the emergency department of Modarres hospital in Tehran, Iran during 2014 and 2015. Patients who needed catheter due to renal failure entered the study. Patients who needed emergency dialysis and those who could not wait for permicath were excluded. Patients were randomly assigned into 2 groups, under fluoroscopic guidance and blindly catheter insertion. Data were collected using a questionnaire and a checklist related to function (after 24 hours and 1 month), a need to exchange the catheter and the early adverse effects such as pneumothorax, hemothorax, and vascular injury.Results: A total of 101 patients were enrolled in this trial. Early dysfunction (blind group = 5), a need for catheter exchange (blind group = 2), pneumothorax (blind group = 2), vascular injury (blind group = 1) were recorded but the difference between the two groups was not statistically significant (P > 0.05).Conclusion: We did not observe a significant difference between the placement of permicath by fluoroscopic or blind method. However, more studies with larger groups are recommended.
Emergency medicine
Ali Arhami Dolatabadi; Elham Memari; Majid Shojaee; Hossein Alimohammadi; Hamid Kariman; Ali Shahrami; Abdelrahman Ibrahim Abushouk3
Volume 3, Issue 1 , Winter and Spring 2017, , Pages 22-25
Abstract
Objective: Cardiopulmonary resuscitation (CPR) has been known in its present form since 1960. Different studies have reported variable outcomes among different countries. Therefore, the purpose of this study was to assess the rate of CPR success and the survival rate in managing cardiac arrest among ...
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Objective: Cardiopulmonary resuscitation (CPR) has been known in its present form since 1960. Different studies have reported variable outcomes among different countries. Therefore, the purpose of this study was to assess the rate of CPR success and the survival rate in managing cardiac arrest among patients in an educational medical center.
Methods: This cross-sectional study was performed at Imam Hosein hospital, Tehran, Iran. All patients, admitted to the emergency department with cardiac arrest between March 2007 and January 2008 were included. We used a formerly designed registration form and hospital documentation to retrieve the data of included patients. The main outcomes were the rate of CPR success and the survival rate of these patients.
Results: Totally 855 patients were included, from which 510 (59.64%) were males. The mean age of included patients was 63 ± 17.6. The CPR process was successful among 364 (42.58%) patients. A total number of 101 (11.82%) patients were discharged from the hospital. Different factors as the cause of cardiac arrest and past medical problems affected the probability of CPR success and the survival of patients with cardiac arrest.
Conclusion: Survival rate at hospital discharge was less than one-third of patients and nearly half of the patients received successful CPR. More intensive care unit (ICU) facilities and educational interventions for the emergency staff and the community can enhance the survival of cardiac arrest patients in our health system.
Emergency medicine
Reza Hashemi; Alireza Majidi; Ali Tabatabaey; Sadrollah Mahmoudi
Volume 3, Issue 2 , Summer and Autumn 2017, , Pages 42-45
Abstract
Objective: Chloride is the major plasma anion. There are several methods available for the determination of serum chloride levels. Unfortunately these methods are sometimes not available in the urgent setting where values are needed. Here we describe a formula for estimating plasma chloride levels. Methods: ...
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Objective: Chloride is the major plasma anion. There are several methods available for the determination of serum chloride levels. Unfortunately these methods are sometimes not available in the urgent setting where values are needed. Here we describe a formula for estimating plasma chloride levels. Methods: Fifty-two consecutive patients were enrolled for which serum chloride levels were estimated using the formula CL- = (Na+ + 10 –TBB), and also measured directly through the colorimetric method. Correlation between the two values was analyzed using Pearson correlation coefficient and agreement was shown in the Bland-Altman plot. Results: Comparing the values achieved through estimation and laboratory determination of plasma chloride revealed a significant correlation (r = 0.97). Consistent agreement was described within -4.8 and +6.6 on the Bland-Altman plot throughout the measurements. Conclusion: The formula presented here may be a reliable alternative to direct measurement of serum chloride when direct results are not available.
Emergency medicine
Rouzbeh Rajaei Ghafouri; Saeed Shahbazi; Changiz Gholipour; Samad Shams Vahdati; Manouchehr khoshbaten; Amir Ghaffarzad; Respina Jalilian
Volume 2, Issue 2 , Summer and Autumn 2016, , Pages 46-49
Abstract
Objective: Acute mesenteric ischemia (IMA) is a vascular emergency with broad variability of clinical presentations and non-specific laboratory findings. Therefore, there is a significant need for reliable serological markers of ischemia. Various laboratory studies may be performed for suspected AMI, ...
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Objective: Acute mesenteric ischemia (IMA) is a vascular emergency with broad variability of clinical presentations and non-specific laboratory findings. Therefore, there is a significant need for reliable serological markers of ischemia. Various laboratory studies may be performed for suspected AMI, but in general, such studies will not establish the diagnosis.Methods: In a prospective, non-interventional study, from October 2012 to October 2013, we investigated 70 patients with probable diagnosis of AMI. Blood samples were taken from patients and analyzed for complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), urea, creatinine (Cr), sodium (Na), potassium (K), D-dimer, lactate, amylase, PH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3). Finally the results were compared with AMI diagnosis confirmed by computed tomography (CT) angiography.Results: Seventy patients with acute severe abdominal pain were studied. Thirty-nine patients (55.7%) were male and 31 patients (44.3%) were female. The average age was 68.01 ± 14.67 (±SD). Based on CT-angiography results, 27 (38.6%) patients had AMI and 43 (61.4%) patients did not have AMI. Chi-squire test showed P values of 0.606 and 0.986 for relations between sex and risk factors with AMI correspondingly. One-sample Kolmogorov-Smirnov revealed white blood cell (WBC), hemoglobin (Hb), platelets (Plt), urea, Cr, Na, K, PCO2 and HCO3 as normally distributed parameters (P > 0.05). Moreover PT, PTT, INR, D-dimer, lactate, amylase, and PH were non-normally distributed (P < 0.05).Conclusion: We found a significant relation between increased serum lactate level and definitive AMI diagnosis. We recommend rising serum lactate as a finding in AMI.
Emergency medicine
Vahid Abbasi; Abolfazl Atalu; Afshan Sharghi; Fatemeh Taghvatalab
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 47-50
Abstract
Objective: Currently, treating ischemic stroke by intravenous thrombolytic therapy has acceptable results in patients with stroke. This study aimed to evaluate the three months prognosis of patients treated with recombinant tissue plasminogen activator (rt-PA).Methods: This cross-sectional prospective ...
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Objective: Currently, treating ischemic stroke by intravenous thrombolytic therapy has acceptable results in patients with stroke. This study aimed to evaluate the three months prognosis of patients treated with recombinant tissue plasminogen activator (rt-PA).Methods: This cross-sectional prospective study was conducted on 30 patients with cerebral ischemic stroke with the National Institutes of Health Stroke Scale (NIHSS) >5. Data such as demographic information, signs and symptoms, medical history, risk factors, focused neurological examination, and the NIHSS were collected for all patients. Then, all patients received 0.9 mg/kg of rt-PA as intravenous bolus doses and intravenous infusion under close monitoring in the emergency department. All patients were checked for necessary outcomes and also disability at the admission time, 7 days later and after three months all patients were checked again. All collected data were analyzed by appropriate tests using SPSS version 22.Results: Of all patients, 63.3% were males and 36.7% were females. The mean age of the patients was 62.37 ± 12.62 years with a range of 40-91 years. The mean of NIHSS was 12.46 ± 4.28 at admission time, in day seven it was 8.06 ± 3.72 and in month three after treatment it was 3.62 ± 2.31. There was a significant relationship between age, place of residence and NIHSS. Thirty percent of patients had NIHSS more than 15 at admission time and after 7 days this rate reached to 10% and three months later it declined to 6.7%. These differences were statistically significant.Conclusion: Intravenous thrombolytic therapy is associated with proper short term results in most patients with ischemic stroke.
emergency nursing
Ramin Azhough; Samad Shams Vahdati; Fariba Faraji; Malihe Faraji; Maryam Ghorbanian; Ali Ramouz; Shahrad Tajoddini
Volume 1, Issue 2 , Summer and Autumn 2015, , Pages 52-55
Abstract
Objective: Triage procedure is one of the most important aspects of emergency departments as it has an undeniable role on the management of patients. It includes 5 categories based on the Emergency Severity Index (ESI) according to the condition of severity. For better decision making and management, ...
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Objective: Triage procedure is one of the most important aspects of emergency departments as it has an undeniable role on the management of patients. It includes 5 categories based on the Emergency Severity Index (ESI) according to the condition of severity. For better decision making and management, it is important to have skillful and experienced nursing staff. In the current study, we aimed to investigate the effectiveness of a one-day workshop on participants in terms of their triage knowledge improvement.
Methods: This is a pre- and post-test trial study. In this study all the nursing staff of Sina hospital participated. The workshop was conducted in a single day for 6 hours. During the one-day workshop, topics such as emergency triage and hospital triage were covered according to START and ESI. In order to evaluate triage knowledge, each participant completed a pre-test before the workshop, and a post-test after the workshop (15 questions). Data were analyzed with SPSS 15.0. Paired t test was applied for data analysis.
Results: Fifty-five nurses with the mean age of 35.72 ± 7.35 participated in the workshop. The analysis of the data, using paired t test based on the pre-test and post-test results, did not show any significant differences (P > 0.05).
Conclusion: This study suggests that a one-day workshop is not really effective and reliable for triage knowledge improvement. We propose longer planned workshops in order to train more skillful staff.
Emergency medicine
Sajjad Ahmadi; Niloufar Pouresmaeil; Farima Najjarian; Samad Shams Vahdati; Maryam Rahimpour Asenjan; Hamid Reza Morteza Bagi
Volume 6, Issue 2 , Summer and Autumn 2020, , Pages 63-67
Abstract
Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The ...
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Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The purpose of this study is to investigate the relationship between the patient’s chief complaint and their departure to the emergency room.Methods: From non-traumatic patients referred to the emergency department of Imam Reza Hospital during 2018, about 57000 patients were selected and enrolled in the study. Then, age, sex, initial diagnosis, time of the final decision, and time of departure from the emergency department as well as hospitalization ward were included in the checklist. Patients whose documentation was incomplete were excluded. Data were entered into SPSS software version 15.0 and descriptive statistics (normal distribution, average of time, minimum time and maximum time, confidence interval, mode, and median, etc.) were used for descriptive analysis and linear regression was used to analyze the correlation among findings.Results: There was a significant relationship between chief complaint and the length of stay in the emergency department (P = 0.046) and patients with dyspnea due to heart disease, bloody vomit, bloody stool, constipation, jaundice, anemia, decreased level of consciousness, diabetes, complications of diabetes, shortness of breath and kidney injury stayed longer in the emergency room compared to other complaints.Conclusion: The patient’s manner of expressing and chief complaint has an impact on the length of time they wait to leave the emergency room. Also, most patients with problems related to internal medicine have the longest time in the emergency room; in particular gastrointestinal patients have the longest stay in the emergency room.
Internal Medicine
Lawson Ekpe; Kingsley Osuji
Volume 4, Issue 2 , Summer and Autumn 2018, , Pages 73-76
Abstract
Objective: Hypertension is a major risk factor for stroke, renal failure, and heart failure globally. This trend of complications has been seen even among our rural and urban dwellers in the tropics. This study aims at determining the prevalence and pattern of hypertension and body mass index (BMI) in ...
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Objective: Hypertension is a major risk factor for stroke, renal failure, and heart failure globally. This trend of complications has been seen even among our rural and urban dwellers in the tropics. This study aims at determining the prevalence and pattern of hypertension and body mass index (BMI) in six rural communities in Southern Nigeria.Methods: Adult participants, aged 18-80 years of age from six rural Biase communities who presented for a health screening were recruited. This was a rural community-based cross-sectional study involving 419 adults. Information was obtained from questionnaires which were administered to assess and obtain demographic data. Blood pressure and anthropometric indices were measured from participants to assess the BMI and risk factors associated with hypertension, and pattern of blood pressure.Results: A total of 419 enrolled for the study, but 137 had hypertension (systolic blood pressure ≥140 mm Hg and diastolic blood pressure ≥90 mm Hg) and this was made up of 86 females (62.8%) and 51 males (37.2%). Only 29 of the hypertensives (21.1%) were aware of their condition. The prevalence of hypertension was 32.7%. Moderate hypertension was the commonest presentation. High blood pressure, obesity and overweight was common among the women folk compared to the men that had isolated systolic hypertension (P < 0.05).Conclusion: In recent times, hypertension is seen to be high even in rural settings; hence strict screening should be enhanced to allow for quicker diagnosis and early intervention.
Emergency medicine
Anita Sabzghabaei; Fariba Farahi; Masoud Ghanbari Boroujeni; Hamidreza Hatamabadi
Volume 7, Issue 2 , Summer and Autumn 2021, , Pages 97-100
Abstract
Objective: The aim of this study was to determine the effect of an ultrasound training course on the performance of emergency medical technicians (EMTs) in terms of using extended-focused assessment with sonography in trauma (E-FAST) in the pre-hospital setting.Methods: In this quasi-experimental study, ...
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Objective: The aim of this study was to determine the effect of an ultrasound training course on the performance of emergency medical technicians (EMTs) in terms of using extended-focused assessment with sonography in trauma (E-FAST) in the pre-hospital setting.Methods: In this quasi-experimental study, 107 EMTs affiliated to Shahid Beheshti and Kashan Universities of Medical Sciences, were randomly selected. At first, the EMTs were given a pre-test of five images concerning normal and abnormal ultrasound views of thoracic and abdominal cavities. Then, 6 hours of theoretical and practical sessions were done by emergency medicine specialists to teach the EMTs to use ultrasound for the detection of pneumothorax and free fluid. The EMTs were tested again in the form of 18 images post-test as well as a 13-item survey to evaluate their skills in taking correct 10 E-FAST.Results: A total of 107 EMTs with the mean age of 27±15.21 and average of 3.5 years work experience participated in this study. The mean of test score increased from 0.57± 0.19 to 0.81±0.08 (with P < 0.001) out of the total score of 100. In the 4-graded survey, 98% of EMTs obtained good to excellent grades in working with ultrasound machine. Also, 50.5% of EMTs were good in taking Morison’s view and 46.6% and 45.6% had medium grades in pericardial and splenorenal views, respectively. In addition, 22.3% had weak grades in taking pericardial views.Conclusion: The results of the present study showed that the implementation of the training course significantly improved the accuracy of free fluid detection in thoracic and abdominal cavities by EMTs.
Emergency medicine
Vikas Bhatia; Suzanne Koshi; Varun Bansal; Uma Debi; Lokesh Singh; Manavjit Singh Sandhu
Volume 8, Issue 1 , Winter and Spring 2022, , Pages 13-18
Abstract
Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective ...
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Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective evaluation of the CT records of patients over a period of 5 years was done at our institute. A total of 1519 patients who had undergone contrast-enhanced abdominal CT at a 64-slice Multidetector CT for abdominal trauma were included in this study. Inclusion criteria were: 1) History of blunt abdominal trauma, 2) Patients who had undergone a biphasic CECT abdomen scan. Exclusion criteria were: 1) Patients with penetrating injury, 2) Patients with incomplete data set/records. Results: Liver was the most common injured organ in both adult (38.8%) and paediatric population (40.9%). Significant higher incidence of mesenteric injury, bladder injury, spinal and rib fractures were seen in adult patients. Significant association of anorectal injuries (P=0.003) and bladder/urethral injuries with pelvic fractures was also seen (P <0.001). Conclusion: Our study provided important insights about the pattern, severity and association between the various abdominal injuries based on imaging findings in a large patient population. Larger studies with incorporation of clinical outcome in such patients can help in formulating appropriate management strategies.
Emergency Medical Services
Alireza Ala; Farzad Rahmani; Reza Aslzad; Zahra Parsian
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 14-17
Abstract
Objective: On account of the widespread use of nuclear energy in different fields, nuclear accidents and disasters have been on a rise. Thus, it is crucial for medical staff especially emergency department personnel to be aware of the nature of these accidents. This study was designed to evaluate the ...
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Objective: On account of the widespread use of nuclear energy in different fields, nuclear accidents and disasters have been on a rise. Thus, it is crucial for medical staff especially emergency department personnel to be aware of the nature of these accidents. This study was designed to evaluate the effect of training on the knowledge of physicians and nurses regarding nuclear disasters. Methods: This pre-and post-intervention study was conducted on 97 emergency department personnel including physicians and nurses of educational hospitals in Tabriz University of Medical Sciences. Educational classes and training about nuclear disasters and managing these events were held. A standard questionnaire was used to evaluate the knowledge before and after training, and the effect of education on personnel’s knowledge. Results: Our participants included 41 males and 56 females. The mean age was 32.88 years. The mean score of participants before and after the class was 4.03 ± 1.54 and 7.93 ± 1.55 respectively; which showed a statistically significant difference (P < 0.001). Among medical staff, physicians had better knowledge compared with the other group. Conclusion: This study showed that the knowledge of medical staff about nuclear disasters is low and educational classes are necessary to increase their knowledge.
Emergency medicine
Bita Abbasi; Masoud Pezeshki-Rad; Mozhdeh Amini; Mahdi Foroughian; Maryam Sahebari; Sirous Nekooei; Reza Akhvan
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 18-22
Abstract
Objective: This study was designed to evaluate the clinical symptoms and sonographic characteristics of femoral trochlear cartilage in patients with knee joint osteoarthritis (OA). Methods: This cross-sectional study was conducted on 94 patients with painful primary knee OA according to the American ...
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Objective: This study was designed to evaluate the clinical symptoms and sonographic characteristics of femoral trochlear cartilage in patients with knee joint osteoarthritis (OA). Methods: This cross-sectional study was conducted on 94 patients with painful primary knee OA according to the American College of Rheumatology criteria with a visual analog scale pain score of 30 mm or more. Clinical features were evaluated by a rheumatologist according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) criteria, and a radiologist performed ultrasonography within a week. The thickness and echogenicity grade of three cartilage regions were evaluated. Other findings such as meniscal extrusion, effusion, and Baker’s cyst were recorded. Results: The average age of patients was 60 years. The linear regression model showed a significant association of grades II and III trochlear cartilage injury with the pain index, physical activity, and WOMAC overall index. However, there was no significant association between the trochlear cartilage thickness in these three regions and the WOMAC indexes (including pain, physical activity, and the overall index). There was also no significant association between Baker’s cyst and the WOMAC indexes, but a significant association was found between meniscal extrusion and the WOMAC index (P≤0.001). Conclusion: According to our study, the echogenicity grade determined by ultrasonography of femoral trochlear cartilage affects the clinical symptoms of patients including pain. These findings indicate the role of this diagnostic device in understanding changes due to the disease, and it can help physicians focus on the pathology in order to control clinical symptoms in patients.
Emergency medicine
Mojtaba Samimi; Arash Safaie; Mehran Sotoodehnia; Fatemeh Rasooli; Atefeh Abdollahi
Volume 7, Issue 1 , Winter and Spring 2021, , Pages 22-27
Abstract
Objective: This study was conducted to investigate the role of an emergency nurse coordinator (ENC) in improving patient satisfaction at the emergency department (ED) in Tehran, Iran.Methods: This was an interventional study in the field of ED management. This study was undertaken in the ED of Sina hospital ...
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Objective: This study was conducted to investigate the role of an emergency nurse coordinator (ENC) in improving patient satisfaction at the emergency department (ED) in Tehran, Iran.Methods: This was an interventional study in the field of ED management. This study was undertaken in the ED of Sina hospital in Tehran, Iran, during March 2018 until April 2019. An ENC was assigned to the ED on even days and during the next week. Also, the presence of the ENC was switched to odd days and so on. Patient satisfaction was evaluated by a questionnaire. In order to analyze data, independent T-test was used to assess the mean difference in satisfaction scores. In addition, analysis of covariance (ANCOVA) test was utilized to assess the difference in satisfaction scores after considering age, sex and triage level as confounding variables. Results: Finally, 315 and 291 patients were allocated to the intervention (patients with ENC) and control groups (patients without ENC), respectively. The total satisfaction rate in the intervention and control groups was 63.9% and 59.3%, respectively. The mean score of total satisfaction in the intervention group was significantly higher than the control group [115.1 (SD = 20.0) vs 106.8 (SD = 22.3); P < 0.001]. The ANCOVA analysis showed that age, sex and triage level were not confounding factors affecting the satisfaction score.Conclusion: This study showed that the presence of the ENC in the ED can increase patient satisfaction, especially in domains related to “diagnostic and therapeutic services”, “cleanliness”, “cost and discharge information”, “ethical and privacy issues”, “admission, discharge and management services”.
Emergency medicine
Mohammad Reza Amiresmaili; Mahmood Nekooi Moghadam; Amin Saberi Nia; Rahil Ghorbani Nia
Volume 1, Issue 1 , Winter and Spring 2015, , Pages 23-27
Abstract
Objective: Emergency department is the most important part of a hospital and it seems that 24-hour presence of emergency medicine specialist can be effective in improving the performance of this ward. Therefore, the present study was performed with the aim of studying the effect of 24-hour presence of ...
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Objective: Emergency department is the most important part of a hospital and it seems that 24-hour presence of emergency medicine specialist can be effective in improving the performance of this ward. Therefore, the present study was performed with the aim of studying the effect of 24-hour presence of emergency medicine specialists in the emergency department of Shahid Bahonar hospital, Kerman/Iran.
Methods: In this mixed methods study, data collection was done through studying various related documents and semi-structured interview. Data analysis was performed using descriptive statistics and qualitative content analysis.
Results: The presence of emergency medicine specialists resulted in a decrease in waiting time, hospital’s revenue growth, increase in number of requested laboratory tests, improvement of decision-making for patients and decrease of first 24-hour mortality rate. Economic benefits, improvement of the quality of services and emergency department management were among qualitative results of the present study.
Conclusion: In whole, 24-hour presence of emergency medicine specialists in the emergency department of Kerman Shahid Bahonar hospital has been effective in improving the performance and quality of services.
Clinical Toxicology
Mohammad Rafiqul Islam; Sarmistha Biswas; Syed Zakir Hossain; Nafizul Islam; Gourab Dewan; Mohammad Robed Amin
Volume 5, Issue 1 , Winter and Spring 2019, , Pages 23-28
Abstract
Objective: Acute poisoning is a common cause of hospital admission in Bangladesh. But, risk factors and characteristics of victims of different modes of poisoning have not been evaluated for possible intervention strategies. So, in this study we aimed to describe the pattern of acute poisoning in central ...
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Objective: Acute poisoning is a common cause of hospital admission in Bangladesh. But, risk factors and characteristics of victims of different modes of poisoning have not been evaluated for possible intervention strategies. So, in this study we aimed to describe the pattern of acute poisoning in central Bangladesh as well as identifying risk factors for various mode of poisoning.Methods: A prospective observational study was undertaken in Dhaka Medical College Hospital in 2015. Consenting adult acute poisoning victims were included as study subjects. A pretested structured case record form was used to systematically record the cases. The poisoning cases were defined by clinical toxidrome (sympathomimetic, antimuscarinic, opioids, cholinergic, sedative, etc) during acute presentation with suspected poisoning and groups accordingly. SPSS 20 was used for data analysis and statistical tests including mean ± standard division (SD), percentage, t test and chi-square were used accordingly.Results: Total poisoning cases were 1155. Suicidal (62.25%, n = 719), commuter poisoning (24.16%, n = 279) and accidental poisoning (12.38%, n = 143) were main types of poisoning. Risk factors of suicidal poisoning were young females of 11 to 30 years, married, housewives and students (P < 0.0001). Stressful relationship was the commonest reason of suicidal poisoning. Pesticides and sedatives were frequently chosen for easy availability. Commuter poisoning was common in males and urban areas (P < 0.0001). Accidental poisoning was more in males and rural areas (P < 0.0001) and snake envenomation was the main cause.Conclusion: Poisoning burden is high in central Bangladesh. Identified risk factors will help develop poisoning prevention strategies.
Emergency medicine
Shiva Salmasi; Navideh Robai; Hanieh Ebrahimi Bakhtavar; Farzad Rahmani; Farnaz Rahmani
Volume 3, Issue 1 , Winter and Spring 2017, , Pages 26-29
Abstract
Objective: According to the definition of World Health Organization (WHO), attempting suicide is an act that a person intentionally and without others’ interference shows an abnormal behavior (such as harming themselves or eating a drug higher than treatment dose) and his objective is realizing ...
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Objective: According to the definition of World Health Organization (WHO), attempting suicide is an act that a person intentionally and without others’ interference shows an abnormal behavior (such as harming themselves or eating a drug higher than treatment dose) and his objective is realizing his expected changes. The purpose of this study was to investigate the demographic characteristics of married women with suicidal attempt and a variety of methods used to suicide among them who referred to the emergency department of Sina hospital in Tabriz.
Methods: In a cross-sectional study 472 married female patients with suicide attempt who referred to the emergency department of Sina hospital in Tabriz in 2014 entered the study and relevant information was collected. Obtained information was analyzed using SPSS version 17.0.
Results: Findings showed that the most frequent method of suicide was drug use (99.8%). A significant relationship was found between the type of drug used and seasons of the year. The majority of the population (90.5%) lived in urban areas and based on statistical analyses, a significant relationship was found between residency and type of drug used.
Conclusion: According to the results of this study it can be concluded that drug use is the most frequent method of suicide that is done with a higher frequency in summer. Thus, rational prescription of drugs by physicians can be considered as one of the factors that can prevent suicide.
Emergency medicine
Samad Shams Vahdati; Kavous Shahsavari Nia; Sarvin Dalil; Paria Habibollahi; Behzad Yousefi
Volume 3, Issue 2 , Summer and Autumn 2017, , Pages 46-48
Abstract
Objective: Trauma is a disease of modern societies and one of the reasons for the deaths of all ages in those societies. It is estimated that each year about 8.5 million people worldwide lose their lives as a result of trauma. Among the types of injuries around the world, road accidents are more common. ...
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Objective: Trauma is a disease of modern societies and one of the reasons for the deaths of all ages in those societies. It is estimated that each year about 8.5 million people worldwide lose their lives as a result of trauma. Among the types of injuries around the world, road accidents are more common. We conducted this study to compare types of trauma in different seasons in patients referred to Imam Reza hospital trauma center in 2013. Methods: In this cross-sectional study, all trauma patients admitted to Trauma Emergency Department of Imam Reza hospital in Tabriz entered the study. As this study did not focus on the diagnosis and treatment of diseases, we used epidemiological data from history and physical examination as a source. Descriptive statistics such as frequency, percentage, mean and standard deviation were used for data analysis. All data were analyzed using SPSS version 15.0. Results: Of all 23 876 patients, 18 044 patients (75.6%) were male and 5832 (24.4%) were female. The prevalence of majority of trauma cases was 11.2% (2671) and occurred in September. Traffic accidents were the most common cause of trauma in patients with a prevalence of 33.9% (8095). Head injury had a prevalence of 38.6%. We did not find any correlation between age of patients, gender, type of injuries and the affected limb. Conclusion: Findings showed that trauma is more prevalent among males and younger people. Thus, proper planning and stringent traffic rules can reduce accident rate.