Anesthesiology
Thushara Madathil; Cassie Carvalho; Sunil Rajan
Volume 10, Issue 1 , January 2024, , Pages 22-26
Abstract
Objective: Fluids are administered to optimize hemodynamics during off-pump coronary artery bypass grafting (CABG), which may lead to a positive fluid balance and increased lung water, lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lung ultrasound can assess ...
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Objective: Fluids are administered to optimize hemodynamics during off-pump coronary artery bypass grafting (CABG), which may lead to a positive fluid balance and increased lung water, lung congestion, hypoxemia, prolonged mechanical ventilation, and longer hospital stays. Lung ultrasound can assess extravascular lung water and help titrate diuretics and fluids, thus preventing hypoxemia. The primary objective of this study was to study the correlation between B-line scores measured by lung ultrasound and the PaO2/FiO2 ratio (the ratio of arterial partial pressure of oxygen to fractional inspired oxygen) after off-pump CABG.Methods: Forty off-pump CABG patients were included in this prospective observational study in a tertiary care center from 2022 to 2023. The correlation coefficient from an earlier study was used and a sample size of 9 was calculated. Random sampling technique was used. A four-sector lung ultrasound was utilized for B-line scoring. B-line scores and PaO2/FiO2 ratios were recorded at three time points: before the surgery commenced and at 24 and 48 hours post-operation. The fluid balance was calculated at 24 and 48 hours post-operation. Pearson correlation coefficient was used to evaluate the correlation between B-line scores and fluid balance with oxygenation, and its significance was assessed through a linear regression test.Results: The PaO2/FiO2 ratio and B-line scores exhibited a statistically significant moderate negative correlation at 24 hours post-surgery (r = -0.44; SD = -0.66, 95% CI = -0.66, -0.15; P = 0.004) and a B-line score exceeding 8 was associated with the lowest PaO2/FiO2 ratio. However, fluid balance and PaO2/FiO2 ratios revealed no correlation at 24 or 48 hours post-surgery. Additionally, fluid balance and B-line scores demonstrated a moderate positive correlation after 48 hours but no correlation at 24 hours post-surgery.Conclusion: B-line scores always negatively correlated with PaO2/FiO2 ratios, and scores greater than eight corresponded to the lowest ratio.
Emergency medicine
Reza Hashemi; Alireza Majidi; Ali Tabatabaey; Sadrollah Mahmoudi
Volume 3, Issue 2 , July 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.
Surgery
Rouzbeh Rajaei Ghafouri; Saeed Shahbazi; Changiz Gholipour; Samad Shams Vahdati; Manouchehr khoshbaten; Amir Ghaffarzad; Respina Jalilian
Volume 2, Issue 2 , July 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.
Trauma
Vahid Abbasi; Abolfazl Atalu; Afshan Sharghi; Fatemeh Taghvatalab
Volume 5, Issue 2 , July 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 , July 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 , July 2020, , Pages 63-67
Abstract
Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The ...
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Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The purpose of this study is to investigate the relationship between the patient’s chief complaint and their departure to the emergency room.Methods: From non-traumatic patients referred to the emergency department of Imam Reza Hospital during 2018, about 57000 patients were selected and enrolled in the study. Then, age, sex, initial diagnosis, time of the final decision, and time of departure from the emergency department as well as hospitalization ward were included in the checklist. Patients whose documentation was incomplete were excluded. Data were entered into SPSS software version 15.0 and descriptive statistics (normal distribution, average of time, minimum time and maximum time, confidence interval, mode, and median, etc.) were used for descriptive analysis and linear regression was used to analyze the correlation among findings.Results: There was a significant relationship between chief complaint and the length of stay in the emergency department (P = 0.046) and patients with dyspnea due to heart disease, bloody vomit, bloody stool, constipation, jaundice, anemia, decreased level of consciousness, diabetes, complications of diabetes, shortness of breath and kidney injury stayed longer in the emergency room compared to other complaints.Conclusion: The patient’s manner of expressing and chief complaint has an impact on the length of time they wait to leave the emergency room. Also, most patients with problems related to internal medicine have the longest time in the emergency room; in particular gastrointestinal patients have the longest stay in the emergency room.
Internal Medicine
Lawson Ekpe; Kingsley Osuji
Volume 4, Issue 2 , July 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.
Ultrasonography
Anita Sabzghabaei; Fariba Farahi; Masoud Ghanbari Boroujeni; Hamidreza Hatamabadi
Volume 7, Issue 2 , July 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.
Anesthesiology
Behzad Nazemroaya; Azim Honarmand; Golshan Mazaheri Tehrani
Volume 9, Issue 2 , July 2023, , Pages 97-103
Abstract
Objective: Etomidate is mentioned as one of the rapid intravenous anesthetic drugs whose unique characteristics include hemodynamic stability, negligible respiratory depression, and brain protection. The most common complication of etomidate is intravenous pain during injection. The purpose of this study ...
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Objective: Etomidate is mentioned as one of the rapid intravenous anesthetic drugs whose unique characteristics include hemodynamic stability, negligible respiratory depression, and brain protection. The most common complication of etomidate is intravenous pain during injection. The purpose of this study was to compare the effectiveness of the Valsalva maneuver and fentanyl in reducing the pain caused by etomidate injection for anesthesia induction.Methods: This clinical trial was performed on 96 patients at Alzahra hospital, affiliated with the Isfahan University of Medical Sciences, from January to June 2021. Patients were divided into two groups of 48 people: the Valsalva maneuver group (group 1) and the fentanyl group (group 2). Blood pressure, heart rate (HR), oxygen saturation, and pain of etomidate injection using the withdrawal response score were graded on a four-point scale (no pain = zero, mild pain = 1, average pain = 2, and severe pain = 3). The collected information was entered into SPSS software version 24. Then, the pain score in the two groups was compared using the chi-square test. The significance level in the present study was P < 0.05.Results: The mean HR (P = 0.07), mean arterial pressure (MAP) (P = 0.33), systolic pressure (P = 0.90), diastolic pressure (P = 0.67), and oxygen saturation level (P = 0.27) at different times between the two groups showed no significant difference (P > 0.05). However, during the etomidate injection, the HR increased and after the injection, the HR decreased in both groups (P = 0.042). The two groups had no significant difference regarding pain frequency.Conclusion: There was no difference in the effect of the Valsalva maneuver and fentanyl on reducing the pain caused by etomidate injection.
Infectious disease
Mohammad Mohammadi; Abdolghani Abdollahimohammad; Mohammadreza Firouzkouhi; Maryam Shivanpour
Volume 8, Issue 2 , July 2022, , Pages 99-103
Abstract
Objective: Pre-hospital emergency staff are involved in the front line of care for COVID-19 patients and face many challenges. The aim of this study was to explore the challenges of prehospital emergency staff in the COVID-19 pandemic.Methods: This qualitative research was conducted with a descriptive ...
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Objective: Pre-hospital emergency staff are involved in the front line of care for COVID-19 patients and face many challenges. The aim of this study was to explore the challenges of prehospital emergency staff in the COVID-19 pandemic.Methods: This qualitative research was conducted with a descriptive phenomenological approach. Purposeful sampling was applied and data collection was done through semi-structured interviews. Participants consisted of 16 pre-hospital emergency staff. Data analysis was performed using the Colaizzi approach.Results: Data analysis revealed five main themes including safety against COVID-19, knowledge deficit, fear and worry, challenges of transporting patients to the hospital, and selflessness.Conclusion: Pre-hospital emergency staff face many problems in personal, professional, equipment and cultural fields in the COVID-19 epidemic. In this regard, special attention from health systems is mandatory.
Trauma
Vikas Bhatia; Suzanne Koshi; Varun Bansal; Uma Debi; Lokesh Singh; Manavjit Singh Sandhu
Volume 8, Issue 1 , January 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 , January 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.
Ultrasonography
Bita Abbasi; Masoud Pezeshki-Rad; Mozhdeh Amini; Mahdi Foroughian; Maryam Sahebari; Sirous Nekooei; Reza Akhvan
Volume 6, Issue 1 , January 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.
Infectious disease
Navid Kalani; Masoud Tavasolian; Khaterh Dehghani; Seyed Reza Mousavi; Erfan Ghanbarzadeh; Masihallah Shakeri; Elahe Rahmanian; Poorya Aryanpoor; Naser Hatami; Zhila Rahmanian; Samaneh Abiri
Volume 9, Issue 1 , January 2023, , Pages 19-24
Abstract
Objective: The goal of our study was to determine the prognostic value of CURB-65,Sequential Organ Failure Assessment (SOFA), pneumonia severity index (PSI), MuLBSTA,and Acute Physiology and Chronic Health Evaluation (APACHE) II upon admission inpatients with coronavirus disease 2019 (COVID-19, as well ...
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Objective: The goal of our study was to determine the prognostic value of CURB-65,Sequential Organ Failure Assessment (SOFA), pneumonia severity index (PSI), MuLBSTA,and Acute Physiology and Chronic Health Evaluation (APACHE) II upon admission inpatients with coronavirus disease 2019 (COVID-19, as well as the prediction cut-off valuefor death regarding these parameters.Methods: This observational retrospective study was performed in COVID-19 triagein Peymaniyeh hospital in Jahrom in 2021. In order to calculate SOFA, APACHE II, PSI,MuLBSTA, and CURB-65, data were collected from patients who were selected by availablesampling method from PCR-confirmed COVID-19 patients. Thirty-day mortality wasassessed as the primary outcome. ROC analysis was conducted using the STATA software toevaluate the prognostic value of the scoring systems. DeLong test was utilized to compareAUC of scores using a web based tool.Results:Ninety-two patients were included in this study with the mean age of 51.02±17.81years (male to female ratio was 1:1). SOFA had an AUC of 0.656 (P=0.130), but other indiceshad statistically significant values of AUC. Based on the comparison of the AUCs, SOFAwas the worst scoring system in COVID-19 as it had significantly lower AUC than PSI andAPACHE II (P<0.05); while its comparison with MULBSTA and CURB65 was not statisticallysignificant (P>0.05).Conclusion: It seems that APACHE II and PSI are the best prognostic factors in our studywith no statistical difference compared together (P>0.05). The sensitivity of APACHE II andPSI was 0.857 with the specificity of 0.927 and 0.976, respectively. The optimal cut-off pointwas 13 and 50 for APACHE II and PSI, respectively
emergency nursing
Mojtaba Samimi; Arash Safaie; Mehran Sotoodehnia; Fatemeh Rasooli; Atefeh Abdollahi
Volume 7, Issue 1 , January 2021, , Pages 22-27
Abstract
Objective: This study was conducted to investigate the role of an emergency nurse coordinator (ENC) in improving patient satisfaction at the emergency department (ED) in Tehran, Iran.Methods: This was an interventional study in the field of ED management. This study was undertaken in the ED of Sina hospital ...
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Objective: This study was conducted to investigate the role of an emergency nurse coordinator (ENC) in improving patient satisfaction at the emergency department (ED) in Tehran, Iran.Methods: This was an interventional study in the field of ED management. This study was undertaken in the ED of Sina hospital in Tehran, Iran, during March 2018 until April 2019. An ENC was assigned to the ED on even days and during the next week. Also, the presence of the ENC was switched to odd days and so on. Patient satisfaction was evaluated by a questionnaire. In order to analyze data, independent T-test was used to assess the mean difference in satisfaction scores. In addition, analysis of covariance (ANCOVA) test was utilized to assess the difference in satisfaction scores after considering age, sex and triage level as confounding variables. Results: Finally, 315 and 291 patients were allocated to the intervention (patients with ENC) and control groups (patients without ENC), respectively. The total satisfaction rate in the intervention and control groups was 63.9% and 59.3%, respectively. The mean score of total satisfaction in the intervention group was significantly higher than the control group [115.1 (SD = 20.0) vs 106.8 (SD = 22.3); P < 0.001]. The ANCOVA analysis showed that age, sex and triage level were not confounding factors affecting the satisfaction score.Conclusion: This study showed that the presence of the ENC in the ED can increase patient satisfaction, especially in domains related to “diagnostic and therapeutic services”, “cleanliness”, “cost and discharge information”, “ethical and privacy issues”, “admission, discharge and management services”.
Emergency medicine
Mohammad Reza Amiresmaili; Mahmood Nekooi Moghadam; Amin Saberi Nia; Rahil Ghorbani Nia
Volume 1, Issue 1 , January 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 , January 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 , January 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
Amir Ghaffarzad; Neda Seyedi; Abazar Fathollahzadeh; Homayon Sadeghi Bazargani; Hassan Vaezi; Farzad Rahmani
Volume 10, Issue 1 , January 2024, , Pages 27-32
Abstract
Objective: The vehicle’s heaviness increases the severity of the accident and the probability of death. The study aimed to compare the severity of injuries and the outcome of the injuries caused by accidents between heavy vehicles and light vehicles. The physiological variables of the patients, ...
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Objective: The vehicle’s heaviness increases the severity of the accident and the probability of death. The study aimed to compare the severity of injuries and the outcome of the injuries caused by accidents between heavy vehicles and light vehicles. The physiological variables of the patients, the variables related to the accident, and the patients’ outcomes were evaluated to achieve this goal. The output was based on bivariate analysis.Methods: This cross-sectional descriptive study was conducted in the emergency department of Imam Reza (AS) Hospital of Tabriz between March 2022 and July 2024. Four hundred nine multi-trauma patients related to road traffic accidents (RTAs) were included. The sampling method employed was a full census. Physiologic variables about patients and trauma severity were recorded. All data entered into SPSS 24.0 were compared between two groups using chi-square and independent samples t-tests.Results: This study included 314 (76.8%) patients injured by light-vehicle accidents and 95 (23.2%) patients injured by heavy-vehicle accidents. The mean of trauma severity scores including GAP, RGAP, NTS, RTS, and REMS in heavy-vehicle accidents group were 17.0 ± 5.9, 16.3 ± 6.5, 15.6 ± 6.5, 6.2 ± 1.9, and 5.9 ± 5.6 respectively, and they were 22.4 ± 3.3, 21.8 ± 3.7, 21.8 ± 3.5, 7.6 ± 0.9, and 2.4 ± 3.1, respectively, in light-vehicle accidents. There were significant statistical differences between the two groups concerning the trauma severity scores of patients based on vehicle type (P < 0.001).Conclusion: The study results show that the severity of trauma in heavy-vehicle accidents is higher, and the injured are in more critical conditions. Therefore, it is necessary to identify the factors involved in heavy-vehicle accidents and take measures to reduce them.
Trauma
Samad Shams Vahdati; Kavous Shahsavari Nia; Sarvin Dalil; Paria Habibollahi; Behzad Yousefi
Volume 3, Issue 2 , July 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.
Trauma
Maryam Ziaee; Amirhossein Mirafzal
Volume 2, Issue 2 , July 2016, , Pages 50-54
Abstract
Objective: To evaluate the association of base deficit (BD) with mortality in traumatized children, and to assess this association in a subgroup of patients with traumatic brain injury (TBI). Methods: In this cross-sectional study performed prospectively on a convenience sample of patients ...
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Objective: To evaluate the association of base deficit (BD) with mortality in traumatized children, and to assess this association in a subgroup of patients with traumatic brain injury (TBI). Methods: In this cross-sectional study performed prospectively on a convenience sample of patients under 16 years of age with trauma presenting to an academic level ІІ trauma center, we obtained venous BD values initially and followed the patients for in-hospital mortality. Initial vital signs were measured and injury severity score (ISS), randomized trauma score (RTS), and pediatric trauma score (PTS) were calculated. Results: A total of 102 patients were included, with 48 patients diagnosed with TBI. Nine patients (8.8%) died during admission, of which 6 were diagnosed with TBI. Based on the univariate analysis, BD was associated with mortality in the whole group (P = 0.01), but not in the TBI subgroup (P = 0.08). In multivariable analysis, RTS was the only variable independently associated with mortality (P = 0.001, odds ratio [OR] = 0.197). Linear regression model showed that BD was predictive of ISS, RTS, and PTS. Receiver operating characteristics (ROC) curve showed a cutoff point of -7 mmol/L for BD, below which there is a 12 fold increased risk for mortality. Conclusion: BD is a useful parameter in mortality prediction in pediatric trauma like in adult age group, but this predictive role in TBI patients is not supported by our results.
Trauma
Mohammad Hasan Lotfi; Hossein Lashkardoost; Andishe Hamedi
Volume 5, Issue 2 , July 2019, , Pages 51-55
Abstract
Objective: The rate of road traffic accidents in Iran per capita and for the number of vehicles is much higher than the average in the world. The present study was conducted to investigate road traffic accidents in Yazd province during 2011-2015.Methods: The present study is a descriptive-analytic study ...
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Objective: The rate of road traffic accidents in Iran per capita and for the number of vehicles is much higher than the average in the world. The present study was conducted to investigate road traffic accidents in Yazd province during 2011-2015.Methods: The present study is a descriptive-analytic study in which data were obtained from data collection forms related to deaths from driving accidents of forensic medicine organizations. Data were entered into SPSS version 23. We calculated the frequency, percentage, and mean indices. We used Fisher exact test for data analysis.Results: In this research, 1437 individuals were studied. The number of deaths in men was three times more than women. Most fatal accidents occurred in the age group of 20-30 years. The most common accident which occurred during these years was the collision of vehicles with each other and in terms of the final cause of death, 1045 people died due to head injuries. In this study, we showed that the incidence decreased from 29.03 in 2011 to 22.03 in 2015.Conclusion: According to the results of this study, the most cases of fatal accidents occurred in the age group of 20-30 years, in people with elementary education and in the summer. Therefore, preventive action is necessary by raising awareness.
Hossein Alimohammadi; Papak Babaie; Hamid Reza Hatamabadi; Anita Sabzghabaei; Hojat Derakhshanfar; Farahnaz Bidari Zerehpoosh
Volume 1, Issue 2 , July 2015, , Pages 56-59
Abstract
Objective: Standardization of hospital emergency units is a major goal in developed countries to decrease the duration of patients stay in these units. The present study was undertaken to evaluate the prevalence of long-term staying in an emergency ward.
Methods: In the present 2-month cross-sectional ...
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Objective: Standardization of hospital emergency units is a major goal in developed countries to decrease the duration of patients stay in these units. The present study was undertaken to evaluate the prevalence of long-term staying in an emergency ward.
Methods: In the present 2-month cross-sectional study, patients referring to the emergency ward of Imam Hossein hospital were assessed. The patients’ demographic data, including age, the presenting symptoms and signs, reasons for delays, and the final outcome in relation to the location of hospitalization and discharge information were recorded. Data were reported as frequencies and percentages. The results were reported as means and standard deviations using SPSS version 20.
Results: Of 10087 patients admitted into the emergency ward during a 2-month period, 75 patients (0.7%) needed to stay and wait for more than 24 hours. The mean ± standard deviation of the patients’ ages was 62.5 ± 20.2 years, with 60% of the patients being over 60 years of age. The most common reason for overcrowding in the emergency ward was a lack of empty beds, with the need for ICU beds as the most important reason for bed deficiency in 59% of the cases. Nervous system problems were the most common reasons for referring to the emergency unit (41%) in patients under study. Finally, 81% of the patients were hospitalized, 10% died, 7% were discharged based on personal request and 1.3% were transferred to another hospital.
Conclusion: The prevalence of patients staying and waiting in the emergency ward for more than 24 hours was 0.7%. Lack of empty ICU beds was the most important reason for such delays; however, paraclinical problems had no role in these delays which were associated with the death of 10% of patients.
Emergency medicine
Payman Asadi; Vahid Monsef Kasmaei; Seyyed Mahdi Zia Ziabari; Shiva Bakian; Amir Noyani
Volume 6, Issue 2 , July 2020, , Pages 68-72
Abstract
Objective: Emergency medical services (EMS) is a critical component of health care system and the forefront of stroke care. The prominent role of EMS in stroke care is timely and accurate diagnosis of acute ischemic stroke and transfer of the patients to stroke centers. The present study aimed to assess ...
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Objective: Emergency medical services (EMS) is a critical component of health care system and the forefront of stroke care. The prominent role of EMS in stroke care is timely and accurate diagnosis of acute ischemic stroke and transfer of the patients to stroke centers. The present study aimed to assess the “awareness” and “attitude” of EMS personnel concerning prehospital stroke care based on American Stroke Association (ASA) guideline in Rasht town.Methods: This was an analytical cross-sectional study. The participants, consisted of all EMS personnel (n = 115) in Rasht town in 2012, entered the study based on census method. Awareness and attitude of EMS personnel toward prehospital stroke care were assessed using a questionnaire based on ASA guideline. The questionnaire had two sections. The first part contained demographic data and the second part had multiple choice items (Likert-type scale response anchors) to assess awareness and attitude of the personnel. The questionnaires were filled out by the personnel. The collected data were analyzed using descriptive and inferential statistics using SPSS software version 20. P-value less than 5% was considered significant.Results: Ninety people participated in this study. The average of age and working experience of participants were 36.84 ± 8.02 and 11.36 ± 5.71, respectively. Most of the participants had bachelor degree (n = 33, 36.7%) and majored in medical emergency (n = 43, 47.8%). Most of them were contract employees (47.8%). Mean scores of awareness and attitude of the personnel were 26.68 (the total number of score = 51) and 32.56 (the total number of score = 80), respectively.Conclusion: Findings revealed poor awareness and attitude of EMS personnel toward prehospital stroke care based on ASA guideline in
Emergency medicine
Hammoda Abu-Odah; Akram Abu Salah; Ali El-Khateeb; Khawla El-Nems
Volume 4, Issue 2 , July 2018, , Pages 77-81
Abstract
Objective: Patients’ satisfaction (PS) is recognized as an important emergency department service design and it has received a high interest and attention in the health management where many studies have focused on determining factors affecting PS in health-related circumstances. In this study, ...
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Objective: Patients’ satisfaction (PS) is recognized as an important emergency department service design and it has received a high interest and attention in the health management where many studies have focused on determining factors affecting PS in health-related circumstances. In this study, we aimed to examine PS in emergency department (ED) of the European Gaza Hospital (EGH) in the Gaza Strip (GS).Methods: A descriptive-analytical cross sectional study was performed at ED-EGH between March, 15 and June 20, 2015. Press Ganey questionnaire was used as a tool for data collection. For each patient, a self-administered questionnaire including 22 questions was filled based on a Likert scale. Results were analyzed using SPSS version 22.Results: Overall, 200 respondents were included in the study. About 73% of respondents were satisfied with overall medical services. The term of nurses’ concern provided to patients elicited the highest score (83.1%), followed by physicians’ concern with patients (72.0%) and communication skills with patients (71.4%), while the lowest score was reported in waiting time and security staff. Furthermore, our findings show an association between PS and level of education, gender differences, living area, and work shifts.Conclusion: The study results conclude that areas of medical and nursing care, respects of staff, physical comfort and waiting time ED-EGH is highly acceptable and offer in appropriate manners.