Emergency medicine
Fatemeh Keighobadi Khajeh; Gholamreza Fareedalaee; Fatemeh Abbasalizadeh
Volume 3, Issue 1 , Winter and Spring 2017, , Pages 32-33
Abstract
The first time Weinstein in 1982 described patients with the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP) in pregnant preeclamptic and eclamptic patients. This syndrome is a severe form of preeclampsia or eclampsia. Usually HELLP syndrome occurs at the third trimester ...
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The first time Weinstein in 1982 described patients with the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP) in pregnant preeclamptic and eclamptic patients. This syndrome is a severe form of preeclampsia or eclampsia. Usually HELLP syndrome occurs at the third trimester and only 15% occur before the 27th week of pregnancy and rarely before the 20th week of pregnancy. We want to present a 30- year old parity 2, gravidity 1 pregnant patient who was pregnant for 20 weeks with preeclampsia and HELLP syndrome. Two hours before arriving to the emergency unit, she felt chest discomfort and went to the nearest clinic to visit a physician. She was then referred to the hospital because of high blood pressure (BP). When she arrived to the emergency unit, she had right upper quadrant and epigastric pain, headache, vomiting, dyspnea, and high BP (185/100). Finally the diagnosis of HELLP syndrome was made. As maternal and fetus mortality and morbidity of HELLP syndrome is high, immediate recognition and treatment is vital to save the lives of both the mother and the fetus.
Critical Care
Ataman Köse; Akif Yarkaç; Gülten Bozali; Seyran Bozkurt Babuş; Ersin Altınsoy
Volume 5, Issue 1 , Winter and Spring 2019, , Pages 32-34
Abstract
Anaphylaxis is a serious clinical condition that can affect all ages and many systems (skin, gastrointestinal system, respiratory and cardiovascular systems). There are a few case reports of cardiac and cerebrovascular complications due to the anaphylaxis and/or the treatment with epinephrine. A 69-year-old ...
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Anaphylaxis is a serious clinical condition that can affect all ages and many systems (skin, gastrointestinal system, respiratory and cardiovascular systems). There are a few case reports of cardiac and cerebrovascular complications due to the anaphylaxis and/or the treatment with epinephrine. A 69-year-old female patient with known coronary artery disease (CAD), coronary artery bypass graft (CABG), and diabetes mellitus (DM) was admitted to the emergency department. She was brought to the emergency service with the complaints of shortness of breath, swelling of the tongue and lip, widespread itching and nausea after the use of amoxicillin-clavulonic acid due to soft tissue infection. The patient was considered as having anaphylaxis. 0.5 mg intramuscular (IM) epinephrine was administered. Following the emergency electrocardiography (ECG), the rate was 140/min and the rhythm was evaluated as atrial fibrillation. We present a case of cardiovascular complications and acute ischemia stroke following intramuscular epinephrine administration with anaphylactic diagnosis in this study. As a result, anaphylaxis management is extremely important in elderly patients with preexisting cardiovascular conditions.
Clinical Toxicology
Fares Najari; Seyed Mojtaba Abolbagaei; Babak Mostafazadeh; Dorsa Najari
Volume 7, Issue 1 , Winter and Spring 2021, , Pages 32-35
Abstract
Objective: Due to the rapid pace of industrialization and the high prevalence of addiction, toxicity caused by heavy metals, especially lead, has become one of the major health problems associated with high morbidity and mortality. Therefore, reliable information is critical to manage this condition. ...
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Objective: Due to the rapid pace of industrialization and the high prevalence of addiction, toxicity caused by heavy metals, especially lead, has become one of the major health problems associated with high morbidity and mortality. Therefore, reliable information is critical to manage this condition. Methods: This descriptive cross-sectional study was performed on 30 cadavers, suspected of lead poisoning. The hospital records and the results of anatomical investigations were studied. Data were collected in a researcher-made questionnaire and analyzed in SPSS Version 22. Results: The results showed a significant correlation between the pathological results of pulmonary autopsy and the duration of drug use (P= 0.01). Also, the pathological results of cardiac autopsy had significant correlations with age (P= 0.006) and blood lead level (P= 0.03). Moreover, significant correlations were found between the pathological results of liver autopsy and age (P=0.00), between the pathological results of brain autopsy and the route of drug administration (P=0.01), and between the pathological results of kidney autopsy and age (P=0.00). Most pathological changes were observed in the brain and kidney tissues. Conclusion: Lead poisoning does not cause any specific pathological changes in the liver, heart, brain, lung, or kidney tissues; however, these non-specific changes, alone or together, can lead to death
Cardiology
Alireza Baratloo; Pauline Haroutunian; Alaleh Rouhipour; Saeed Safari; Farhad Rahmati
Volume 1, Issue 1 , Winter and Spring 2015, , Pages 35-38
Abstract
Background: Potassium, as an extracellular ion, plays an important role in the electrophysiologic function of the myocardium and any change in extracellular concentration of this ion might have a marked impression upon myocyte electrophysiologic gain. High serum potassium levels are thought to impair ...
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Background: Potassium, as an extracellular ion, plays an important role in the electrophysiologic function of the myocardium and any change in extracellular concentration of this ion might have a marked impression upon myocyte electrophysiologic gain. High serum potassium levels are thought to impair pulse conduction in Purkinje fibers and ventricles more than that in the Atrioventricular (AV) node. Therefore, although complete AV block can occur, it is a rare initial presentation.
Case Report: We describe a 62-year-old man with a history of diabetes mellitus, ischemic heart disease and previous Coronary Artery Bypass Graft (CABG), who came to our emergency department due to generalized weakness starting 2 days before admission. The patient also had decreased force in lower limbs, exacerbating from the morning, and was finally diagnosed as a hyperkalemia-induced Complete Heart Block (CHB). It should also be noted that the patient responded dramatically to the administration of 10 mL of 10% calcium gluconate along with external pacing until potassium level correction became effective. Conclusion: In spite of the fact that Hyperkalemia can be associated with frequent Electrocardiogram (ECG) abnormality, advanced heart blocks (second- and third-degree AV blocks) are usually found only in patients with pre-existing heart failure, conduction abnormalities, or other cardiac diseases. Institution of effective treatment rapidly and forgiveness of traditional non-effective, time consumptive and sometimes risking full-adjustment modalities, such as sodium bicarbonate infusion or exchange resins that prevent their use in the emergent phase, can help minimize patient morbidity and mortality.
Emergency Medical Services
Mirko Barone; Marco Prioletta; Giuseppe Cipollone; Decio Di Nuzzo; Pierpaolo Camplese; Felice Mucilli
Volume 3, Issue 2 , Summer and Autumn 2017, , Pages 53-58
Abstract
Objective: Cardiac tamponade is a life-threatening clinical entity that requires an emergency treatment. Cardiac tamponade can be caused both by benign and malignant diseases. A variety of methods have been described for the treatment of these cases from needle-guided pericardiocentesis, balloon-based ...
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Objective: Cardiac tamponade is a life-threatening clinical entity that requires an emergency treatment. Cardiac tamponade can be caused both by benign and malignant diseases. A variety of methods have been described for the treatment of these cases from needle-guided pericardiocentesis, balloon-based techniques to surgical pericardiotomy. The Authors report their experience in surgical management of cardiac tamponade and an exhaustive review of literature. Methods: This study involved 61 patients (37 males and 24 females) with an average age of 61.80 ± 16.32 years. All patients underwent emergency surgery due to the presence of cardiac tamponade. Results: Cardiac tamponade was caused by a benign disease in 57.40% of patients. In cancer patients group, lung cancer, breast cancer and malignant pleural mesothelioma were the most common neoplasms (17-27, 87%). The average preoperative size of pericardial effusion at M-2D echocardiography was 30.15 ± 5.87 mm. Postoperative complications were observed in 11 patients (18%). The reoperation rate was 3.3% (2 patients) due to relapsed cardiac tamponade. 30-day mortality rate was 3.3%. Overall cumulative survival was 29.9 ± 20.1 months. Twenty-nine patients (47.5%) died during the follow up period. By dividing the population into two groups, group B (benign) and group M (malignant), there was a statistically significant difference (P < 0.001) in terms of survival. Conclusion: In conclusions, anterior minithoracotomy for surgical treatment of cardiac tamponade has to be held into account in patients both with benign diseases and malignancies.
Clinical Toxicology
Gholamreza Faridaalaee; Seyed Hesam Rahmani; Amin Mahboubi
Volume 2, Issue 2 , Summer and Autumn 2016, , Pages 58-61
Abstract
Cisplatin was the first of the platinum drugs. Second-generation platinum derivative was carboplatin that its efficacy in the treatment of many malignancies is equal to cisplatin, and its toxicity profile is more favorable. Here we report on a 50-year-old woman with a history of cervix cancer who developed ...
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Cisplatin was the first of the platinum drugs. Second-generation platinum derivative was carboplatin that its efficacy in the treatment of many malignancies is equal to cisplatin, and its toxicity profile is more favorable. Here we report on a 50-year-old woman with a history of cervix cancer who developed a severe hypersensitivity reaction (HSR) to carboplatin. She was admitted to the emergency department (ED) with shortness of breath, tachypnea, restless, agitation, and lethargy. On arrival, the patient was hemodynamically unstable; we initiated treatment immediately with hydration, oxygen therapy with mask, hydrocortisone, midazolam, and adrenalin. After 1 hour, BP and O2 sat improved to 100/70 mm Hg and 92% respectively, but there was not any significant improvement in tachycardia as well as tachypnea and she was still lethargic and agitated. Her symptoms improved gradually after 18 hours of admission. She was discharged after 36 hours. HSRs to cisplatin and carboplatin can be potentially life-threatening. The symptoms can range from a mild rash to severe anaphylaxis. Doctors should be aware of these reactions, determine appropriate treatment, and know the cross-reactivity among these drugs.
Emergency medicine
Nahid Zamanimehr; Samad Shams Vahdati; Hamed Hojjatpanah
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 61-64
Abstract
Objective: Fluid resuscitation is necessary in almost all critical patients. The central venous pressure (CVP) is a well-established method of assessing resuscitation. Recently, there have been attempts to investigate less invasive methods like the diameters of inferior vena cava (IVC) or the jugular ...
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Objective: Fluid resuscitation is necessary in almost all critical patients. The central venous pressure (CVP) is a well-established method of assessing resuscitation. Recently, there have been attempts to investigate less invasive methods like the diameters of inferior vena cava (IVC) or the jugular vein. We aimed to investigate this method in our research.Methods: Seventy eight critical patients admitted to the emergency department from April 2018 to December 2018 were studied. The CVP was measured along with the diameters of the two mentioned veins before and during resuscitation. The urinary output was also recorded after administering the fluid. The minimum p-value that would illustrate a significant association was equal to 0.05.Results: Findings showed that 53.8% of patients were males and 46.2% were females with an average age of 71.48 years. The causes of the critical state were 25.6% hemorrhagic shocks, 30.8% septic shocks and 43.6% hypovolemic shocks. The mean diameter of the jugular vein before and during resuscitation was 27.21 mm and 25.38 mm, respectively (P = 0.1). The mean of IVC diameter before and during resuscitation was 63.33 mm and 57.98 mm, respectively (P <0.001). The CVP was 4.23 mmHg before resuscitation and 5.61 mmHg after resuscitation (P <0.001). With an average urine output of 201.28 cc, a significant correlation was observed with the increase in the CVP, while no such correlations were observed with the decreasing state of the diameters of the IVC or the jugular vein.Conclusion: Both the IVC diameter and the jugular vein diameter are unable to assess fluid resuscitation independently from respiratory factors
Clinical Toxicology
Samad Shams Vahdati; Reza Shahab Moghadam; Pouya Paknejad; Zahra Vandrajabpour; Shahrad Tajoddini
Volume 1, Issue 2 , Summer and Autumn 2015, , Pages 67-68
Abstract
Aluminum phosphide (ALP) is a potent lethal substance, that use for agriculture purpose, as a pesticide. this substance may use for suicide, and it will kill the patient rapidly. we want to report a patient who use ALP for suicide purpose and was managed quickly in the emergency department and ...
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Aluminum phosphide (ALP) is a potent lethal substance, that use for agriculture purpose, as a pesticide. this substance may use for suicide, and it will kill the patient rapidly. we want to report a patient who use ALP for suicide purpose and was managed quickly in the emergency department and he became alive.
Emergency medicine
Mozhgan Taghizadeh; Mahdi Foroughian; Hamidreza Vakili; Seyed Reza Habibzadeh; Reza Boostani; Negar Morovatdar; Ehsan Bolvardi
Volume 6, Issue 2 , Summer and Autumn 2020, , Pages 77-81
Abstract
Objective: Intracerebral hemorrhage (ICH) following systemic and chronic hypertension is one of the main causes of acute stroke leading to disability and death. Identifying the risk factors in ICH patients can be effective in reducing bleeding and the rates of mortality and disability in these patients. ...
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Objective: Intracerebral hemorrhage (ICH) following systemic and chronic hypertension is one of the main causes of acute stroke leading to disability and death. Identifying the risk factors in ICH patients can be effective in reducing bleeding and the rates of mortality and disability in these patients. This study was carried out to investigate the factors associated with ICH.Methods: A total of 134 patients with chronic systemic hypertension who had ICH were enrolled in this study. The amount of ICH was measured through computed tomography (CT scan). The subjects were divided into two groups of high (>30 mL) and low (Results: The mean age of the subjects was 66.04± 14.15 years, and 71 (52.99%) individuals were females. The mean volume of ICH was 24.47 mL, with 29.10% of the subjects (39 patients) having >30 mL and 70.90% (95 patients) having Conclusion: The results of this study showed that less than 30% of the subjects had high volumes of bleeding, and the co-existence of IHD was considered as a strong independent risk factor affecting the volume of ICH associated with worse prognosis.
Trauma
Reza Bidaki; Mehrdad Roozbeh; Mohamad Amin Sharifi; Seyed Nader Mostafavi; Mohammad Ali Abdolkarimi Davarani
Volume 4, Issue 2 , Summer and Autumn 2018, , Pages 86-88
Abstract
Factitious disorder as Munchausen syndrome is a time and money consuming condition that is presented with different signs and symptoms. In emergent situations, it is not a differential diagnosis with high priority, but when it becomes recurrent with atypical symptoms, factitious disorder and malingering ...
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Factitious disorder as Munchausen syndrome is a time and money consuming condition that is presented with different signs and symptoms. In emergent situations, it is not a differential diagnosis with high priority, but when it becomes recurrent with atypical symptoms, factitious disorder and malingering should be considered as well. In this survey, we report an odd and interesting presentation of a factitious disease as a scorpion sting which misled some professional healthcare providers until the patient finally confessed that she used turmeric to mimic the signs of a scorpion sting. She exaggerated her symptoms when asked about the details of the mechanism of the scorpion bite. When encountering an emergent condition, after ruling out the critical conditions especially when the symptom is recurrent, factitious disorders should be considered. Consultation with a psychiatrist help the team manage the patient properly.
Emergency medicine
Aloysius Ugwu-Olisa Ogbuanya; Nonyelum Benedett Ugwu
Volume 7, Issue 2 , Summer and Autumn 2021, , Pages 111-117
Abstract
Objective: Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great ...
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Objective: Recently, emergency and essential surgical and anesthesia care at district hospitals is increasingly gaining recognition as a critical, though neglected element of health care system in Africa and other developing nations. Emergency laparotomy is a versatile procedure that can cure a great deal of acute abdominal conditions. The aim of this study was to document the indications and outcomes of laparotomy for emergency abdominal surgical conditions in our district hospitals.Methods: This retrospective study was undertaken in district hospitals from January 2009 to December 2018. Associations between different variables were measured and compared using statistical tests of significance.Results: Of the 879 patients evaluated, appendicitis (n=361, 41.1%) was the most frequent indication for emergency laparotomy followed by complicated external hernias (n=120, 13.7%). Other indications were adhesive intestinal obstruction (n=111, 12.6%), typhoid perforation (n=98, 11.1%), perforated peptic ulcer (n=89, 10.1%), trauma (n=58, 6.6%), colorectal cancer (CRC) (n=18, 2.0%) and others (n=24, 2.8%). The vast majority of patients (n=726, 82.6%) were presented after 24 hours of the onset of disease. Approximately, one-third of patients (n=278, 31.6%) had comorbidities, 867 (98.6%) had high ASA scores (III and IV) and 105 (11.9%) received intestinal resection with or without stoma. The main independent predictors of mortality were late presentation (P=0.003), generalized peritonitis (P=0.001), bowel resection (P=0.000) and high ASA (III and IV) scores (P=0.000). Overall, the mortality rate was 10.6%. The commonest complication was wound infection (39.7%), followed by intra-abdominal collection (10.0%).Conclusion: The most common indication for emergency laparotomy was appendicitis followed by complicated hernias. The major independent predictors of mortality included bowel resection, high ASA score, late presentation and generalized peritonitis.
Education
Amin Beigzadeh; Bahareh Bahmanbijri; Elham Sharifpoor; Masoumeh Rahimi
Volume 2, Issue 1 , Winter and Spring 2016, , Pages 25-28
Abstract
In order to equip medical students with all the necessary skills in dealing with patients to provide optimal treatment, the need for the use of real patients in educational settings has become prominent. But all the required skills cannot be practiced on real patients due to patients’ safety and ...
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In order to equip medical students with all the necessary skills in dealing with patients to provide optimal treatment, the need for the use of real patients in educational settings has become prominent. But all the required skills cannot be practiced on real patients due to patients’ safety and well-being. Thus, the use of standardized patients (SPs) or simulated patients (SiPs) as a substitute for real patients signifies their importance in simulation-based medical education. One question raised in regard to using SPs or SiPs in order to enhance medical students’ tangible and intangible skills in a safe controlled environment is whether these two terminologies are the same or different? Various studies use these terms interchangeably and do not consider a difference between them. Based on our literature review, there seems to be differences between these two modalities. We also try to highlight the advantages of these modalities in clinical encounters.
Emergency medicine
Morteza Talebi Doluee; Maryam Salehi; Azadeh Mahmoudi Gharaee; Majid Jalalyazdi; Hamidreza Reihani
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 29-33
Abstract
Objective: Septic shock is a response to infection and tissue hypoperfusion which does not respond to fluid therapy and eventually leads to organ dysfunction. Aggressive treatment of a broad-spectrum antimicrobial and supportive measures are the cornerstones of successful treatment. In addition to the ...
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Objective: Septic shock is a response to infection and tissue hypoperfusion which does not respond to fluid therapy and eventually leads to organ dysfunction. Aggressive treatment of a broad-spectrum antimicrobial and supportive measures are the cornerstones of successful treatment. In addition to the main treatment, there are adjunctive therapies. Steroids are one of the treatments which have been studied in the management of refractory septic shock. Despite numerous studies on the role of steroids in the mortality of severe sepsis and septic shock, still lots of controversies exist. These conflicts are often about the steroid dose and duration of administration.Methods: This was a prospective, randomized-controlled, two-group assignment study. Patients referred to Imam Reza (AS) hospital in Mashhad who had refractory septic shock criteria were randomly divided into two groups: 80 patients were included in each group. After obtaining the baseline cortisol level and cosyntropin test, one group was treated with intravenous hydrocortisone, and the other group was treated with placebo. The response to hydrocortisone, the return of shock duration, and mortality at 28 days were investigated. The data were analyzed using SPSS version 16. For the normally distributed variables, a t test was used for comparisons. Concerning qualitative variables, the chi-square test or Fisher exact test were applied accordingly.Results: The return of shock duration and mortality in intervention group patients was more than control group, but it was not statistically significant.Conclusion: Despite numerous studies in this field, there are various outcomes (mortality rate, rate of return of shock, time of return of shock). These differences can be attributed to high degree of heterogeneity. Perhaps considering the underlying disease and more differentiation could change the return of shock and mortality rate.
Emergency medicine
Ali Delirrooyfard; Maria Cheraghi; Mehdi Sayyah; Zahra Farahbakhsh
Volume 8, Issue 1 , Winter and Spring 2022, , Pages 32-36
Abstract
Objective: People with a significant childhood history of abuse may exhibit emotionaldysregulations and psychiatric disorders and, in some cases, present suicidal ideation.Methods: In this descriptive-analytical and cross-sectional study data were collectedfrom suicidal patients referred to two grand ...
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Objective: People with a significant childhood history of abuse may exhibit emotionaldysregulations and psychiatric disorders and, in some cases, present suicidal ideation.Methods: In this descriptive-analytical and cross-sectional study data were collectedfrom suicidal patients referred to two grand hospitals in 2019. One hundred ninetyfive participants were evaluated concerning child abuse and neglect history. Data werereported as mean, SD, frequency, and percent. T-test and chi-square tests were used forstatistical analyses accordingly.Results: Child abuse regarding suicidal people were to the following order, neglect(n=103), child emotional abuse (n=102), child physical abuse (n=101), malnutrition (n=96),and child sexual abuse (n=87). Suicide was different between the two genders, but it wasnot different based on parents’ education and marital status.Conclusion: The harassed child is not equipped with proper behavioral skills and issubjected to low self-esteem due to incorrect training. Therefore, he/she may commitsuicide in adolescence by facing some problems and failures. In this regard, communityplays an important role, parents must be informed and use the right culture to reward thechild.
Ali Reza Shafiee-Kandjani; Shahrokh Amiri; Nima Sarihi; Elham Hossein; Salman Safikhanlou; Mohsen Jafarzadeh-Ghareziaaddin
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 33-37
Abstract
Objective: Two temperamental components that are mostly associated with suicide are high novelty seeking (NS) and high harm avoidance (HA). This study aimed to evaluate the temperament and character personality dimensions of self-poisoning in suicidal attempters in an Iranian population.Methods: A descriptive-analytic ...
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Objective: Two temperamental components that are mostly associated with suicide are high novelty seeking (NS) and high harm avoidance (HA). This study aimed to evaluate the temperament and character personality dimensions of self-poisoning in suicidal attempters in an Iranian population.Methods: A descriptive-analytic study was conducted with random sampling in which 77 self-poisoning patients and equal normal counterparts were selected. Cloninger’s Temperament and Character Inventory (TCI) and clinical interview were used as study procedures. Data were analyzed by SPSS software version 18 using chi-square, Mann-Whitney U and regression. P values<0.05 were considered statistically significant.Results: Findings showed that people attempting suicide were significantly different from general population in terms of character and temperament. NS and HA yielded high scores in the suicide group, while reward dependence (RD), self-directedness (SD), cooperativeness (CO) and self-transcendence (ST) variables revealed significantly higher scores in the healthy group. No significant difference was observed among suicide attempters in terms of gender.Conclusion: The results confirm the difference between non-suicidal individuals and suicide attempters in terms of character and temperament in a way that suicidal patients have high harm-avoidance and introversion. In addition, the history of attempts and early alcohol consumption might be considered as suicide re-attempt predictors.
Critical Care
Mahesh Chand Meena; Kuldeep Panchal; Mukta Rani
Volume 3, Issue 1 , Winter and Spring 2017, , Pages 34-37
Abstract
Oculocardiac reflex (OCR) sometimes occurs as a result of pressure on the eye or traction of the intraorbital surrounding structures during ophthalmic surgery. This can result in bradycardiac arrhythmia and cardiac arrest. A 45-year-old female was undergoing an elective squint correction surgery of one ...
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Oculocardiac reflex (OCR) sometimes occurs as a result of pressure on the eye or traction of the intraorbital surrounding structures during ophthalmic surgery. This can result in bradycardiac arrhythmia and cardiac arrest. A 45-year-old female was undergoing an elective squint correction surgery of one eye under local anaesthesia in a private hospital in December 2013. The patient was preoperatively examined, investigated and admitted to the hospital one day prior to operation. There was no previous history of any chronic illnesses. The patient collapsed during surgery and declared dead. Doctors attempting strabismus surgery under local anaesthesia should be familiar with this phenomenon.
Emergency medicine
Mulla Mahammad Rafi; Mohammed Ismai Nizami; Uppaluri Sarath Chandra; Ashima Sharma; Gaddam Dharani Reddy; Lubna Tarannum
Volume 7, Issue 1 , Winter and Spring 2021, , Pages 36-40
Abstract
Objective: COVID-19 has become a major public health concern in recent times with detrimental effects on health and economy of the nation exerting unbearable pressure on health care personnel. It is vital for the caretakers and the people accompanying those patients to be aware of the ongoing pandemic ...
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Objective: COVID-19 has become a major public health concern in recent times with detrimental effects on health and economy of the nation exerting unbearable pressure on health care personnel. It is vital for the caretakers and the people accompanying those patients to be aware of the ongoing pandemic and its impact on the society and to realize their responsibility towards curbing the spread of the disease. The aim of this study is to assess the awareness of COVID-19 among the attendants accompanying the patients at emergency department (ED) and to determine their perception of the disease. Methods: A questionnaire was prepared and the attendants were approached with it. The attendants responded to the questionnaire by choosing the appropriate answers. Illiterates were explained about the questions in the language they understood and the responses were recorded. The survey was conducted from May 25th, 2020 to June 10th, 2020. Descriptive analysis was done to represent the study characters. Results: A total of 509 participants responded to the questionnaire with the mean age between 30 to 50 years. Participants were fairly conversant of the preventive measures but a significant portion lacked the knowledge of transmission and the impact of COVID-19. Education was observed to have a positive correlation with the correct responses given. Conclusion: Public education for the spread of awareness is yet to reach the illiterate section of the society. The need exists for educating the attendants of the patients as well who actually are potential candidates for contracting and also for spreading the disease
Emergency medicine
Esmaeil Fakharian; Zahra Sehat; Mojtaba Sehat
Volume 5, Issue 2 , Summer and Autumn 2019, , Pages 65-70
Abstract
Objective: Traumatic spine injuries are seriously important and are associated with considerable morbidity and mortality. The goal of this study is to determine the epidemiology of the traumatic spine injuries in Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS), the main trauma ...
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Objective: Traumatic spine injuries are seriously important and are associated with considerable morbidity and mortality. The goal of this study is to determine the epidemiology of the traumatic spine injuries in Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS), the main trauma center in Kashan, Iran.Methods: This cross-sectional study was undertaken on all cases of traumatic spinal injuries that were admitted to Shahid Beheshti hospital of KAUMS from 2014 to 2017. A checklist was used to collect demographic characteristics (age, gender, education, marital) and mechanism of the injury of the spine. According to ICD-10, the level of the injury was detected by diagnostic tests such as radiologic imaging and magnetic resonance imaging and computed tomography scans, and also multi-trauma final outcome of the patients with traumatic spine injury (TSI) and rate of the spinal cord injury (SCI), hospital length of stay and surgery treatment was investigated.Results: The number of patients with traumatic spine injuries was 986. Among this batch, 77% were males. The mean age of the patients was 39.5 years. Most injuries occurred in the age group of 15 to 30 years. Traffic accident was the most common mechanism of the trauma (35.2%) followed by the falls (26.95%) motorcycle accident (17.9%), assault by a sharp object or an unspecified object (10.13%) and other reasons (5.6%). The most common site of injury was in lumbar section (24.41%). Patients with traffic accident injury had the longest hospitalization. The rate of SCI was 2.63% and the rate of mortality was 2.3%.Conclusion: The TSI is an important and serious public health problem and a major cause of disability. Understanding the epidemiology can help us contrive appropriate preventative measures.
Radiology
Mustafa Mahmood Eid; Maythem Al-Kaisy
Volume 6, Issue 2 , Summer and Autumn 2020, , Pages 82-86
Abstract
Background:Trauma is considered to be a major cause of morbidity and mortality all over the world. This descriptive study has an emphasize on the epidemiology, mechanism and patterns of trauma, with a consideration of why trauma code was activated, and the imaging results in regard to the severity of ...
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Background:Trauma is considered to be a major cause of morbidity and mortality all over the world. This descriptive study has an emphasize on the epidemiology, mechanism and patterns of trauma, with a consideration of why trauma code was activated, and the imaging results in regard to the severity of the trauma. Method: A descriptive study was conducted in Al Ain Hospital over the year of 2017. Totally 886 patients were included who presented with a trauma and considered dangerous according to hospital guidelines. They underwent a full body trauma CT, and were admitted to the hospital. We looked at the mechanisms, patterns, time of the day and radiological findings. Injury severity score (ISS) and Revised trauma score (RTS) were calculated, and the cause of trauma code activation was evaluated.Results: The study showed that; positive imaging findings were found in 364 (41%) of patients while 522 (59%) had normal radiological tests. The principal mechanism of injury was motor vehicle accident (54.4%) followed by falls (21.4%) and pedestrian accidents (10.2%). Overall, 69.75% (618 patients) were admitted to the hospital, 22 patients (2.5 %) needed immediate interventions and 36 patients (4 %) needed ICU admission. Only 2 patients (0.25 %) died in the emergency room.Conclusion:The hospital policy in activating a trauma code should be revised, with more care being paid to the mechanisms of injury and the condition of the patient, without missing any injury that could harm the patient. So, the emergency physician should be better prepared to do a detailed physical examination and weigh the risk of radiation against missing a dangerous injury.
Emergency medicine
Krishna Prasad; Susan Tharian; Jebu A Thomas
Volume 4, Issue 2 , Summer and Autumn 2018, , Pages 89-91
Abstract
Traumatic spinal epidural hematoma (TSEH) is a neurosurgical emergency which is considered as one of the rare causes of back pain. The onset of symptoms presentation can vary especially following a trauma. Here, we report a case where a young girl had a trivial fall and presented symptoms of back pain ...
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Traumatic spinal epidural hematoma (TSEH) is a neurosurgical emergency which is considered as one of the rare causes of back pain. The onset of symptoms presentation can vary especially following a trauma. Here, we report a case where a young girl had a trivial fall and presented symptoms of back pain three days later. She developed abrupt onset of lower limb weakness during her stay in the emergency department (ED). X-ray and computed tomography (CT) imaging of the spine did not show any obvious abnormality whereas, Magnetic resonance imaging (MRI) imaging revealed hyper-intense lesions in the thoracic spinal segment which led to the diagnosis of TSEH. Our case highlights the importance of the atypical and varied nature of presentation and the choice of investigation which would help in the early diagnosis of this entity.
Emergency medicine
Mahnaz Yadollahi; sarina sahmeddini
Volume 7, Issue 2 , Summer and Autumn 2021, , Pages 118-122
Abstract
Objective: The purpose of the current study is to determine the prevalence and pattern of maxillofacial trauma.Methods: This is a cross sectional study of maxillofacial trauma cases treated in the referral trauma center of south of Iran. Data of 264 patients were extracted from patients’ records ...
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Objective: The purpose of the current study is to determine the prevalence and pattern of maxillofacial trauma.Methods: This is a cross sectional study of maxillofacial trauma cases treated in the referral trauma center of south of Iran. Data of 264 patients were extracted from patients’ records and analyzed. Data included patient’s demographics, injury mechanism, types of maxillofacial injuries, Injury Severity Score (ISS), associated injuries, length of hospital stay and outcome. Binary logistic regression by backward method was applied to determine the effects of independent variables on mortality odds ratio.Results: 85.23% of patients were males and of all patients 87.5% survived. The mean of age was 34.95 ± 16.51. The commonest cause of maxillofacial injury was road traffic accidents (86.31%). The median of ISS was 20.39± 10.24 and patients aged 30-39 years had the highest ISS. Overall, the most common maxillofacial injuries were orbital (59.47%, n=157) followed by maxillary (48.11%, n=127); common associated injuries were related to head (81.44%, n=215) followed by thorax (58.33%, n=154). Age and gender (being male) increased the odds ratio of mortality. An increase in ISS decreased the odds ratio of mortality, but it was not significant.Conclusion: Most of maxillofacial trauma patients suffered from orbital injuries and there were a huge percentage of associated injuries. Gender (male), age and length of hospital stay were the significant variables of mortality in maxillofacial patients. The findings of the current study sheds light on further investigation to treat these patients and enforce road traffic legislation and public education to prevent these traumas.
Clinical Toxicology
Gholamreza Faridaalaee; Seyed Hesam Rahmani; Sajjad Ahmadi; Amin Mahboubi
Volume 2, Issue 1 , Winter and Spring 2016, , Pages 29-30
Abstract
Ingestion and inhalation of phosphine are 2 forms of toxicity and their clinical manifestation is extremely wide. A 22-year-old girl was admitted with complaints of nausea, vomiting and epigastric pain after eating lunch. She had a history of celiac disease. On arrival, she was alert and hemodynamically ...
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Ingestion and inhalation of phosphine are 2 forms of toxicity and their clinical manifestation is extremely wide. A 22-year-old girl was admitted with complaints of nausea, vomiting and epigastric pain after eating lunch. She had a history of celiac disease. On arrival, she was alert and hemodynamically stable. There was not any abdominal tenderness or guarding. Food poisoning treatment initiated but after 1 hour her condition deteriorated with hypotension, tachycardia, and epigastric pain. Venous blood gas (VBG) showed severe metabolic acidosis. She denied any drug ingestion again. New Electrocardiogram (ECG) showed extensive inferolateral ST elevation myocardial infarction (STEMI). Bicarbonate plus dopamine was initiated. After 8 hours of admission, rhythm became ventricular fibrillation (VF) and cardiopulmonary resuscitation (CPR) began. Peritoneal dialysis was performed. Next morning frequent VF occurred again but CPR was unsuccessful. Family found aluminum phosphide (AIP) tablets in her purse. Early diagnosis and supportive treatment may be effective but the most important factor is the dose of ingestion.
Emergency medicine
Payman Moharamzadeh; Kavous Shahsavari Nia; Mohammadhossein Somi; Mahboub Pouraghaei; Akbar Fadaeihaghi; Farzad Rahmani
Volume 4, Issue 1 , Winter and Spring 2018, , Pages 34-38
Abstract
Objective: In recent years, there has been a great attention concerning red blood cell distribution width (RDW) in clinical decisions as well as determining the severity of diseases. This study was conducted to evaluate the primary level of RDW to predict hospital mortality in pancreatitis.
Methods: ...
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Objective: In recent years, there has been a great attention concerning red blood cell distribution width (RDW) in clinical decisions as well as determining the severity of diseases. This study was conducted to evaluate the primary level of RDW to predict hospital mortality in pancreatitis.
Methods: This was a descriptive analytical study performed on 100 patients with acute pancreatitis in the emergency department of Imam Reza hospital of Tabriz University of Medical Sciences. In this study, the primary level of RDW in patients with acute pancreatitis presenting to the emergency ward was collected and after patients’ admission we followed them. Also, the admission outcome (mortality or discharge) of patients was registered, and finally we evaluated the predictive value of RDW in determining the patient’s outcome in hospital.
Results: In our study, 47 patients were male, and 53 patients were female. Mean RDW in patients was 13.82 ± 1.69. Five patients died during the study. Mean RDW in dead patients and other patients was 16.44 ± 4.22 and 13.68 ± 1.37, respectively (P < 0.001). The cut-off point of 14.55 for RDW with 80% sensitivity and 85% specificity was determined for predicting mortality in patients.
Conclusion: Based on our study results, the initial RDW level is an independent factor for predicting in-hospital mortality in pancreatitis but not for determining the need for surgery or admission to the intensive care unit (ICU).
Emergency medicine
Peyman Saberian; Mostafa Sadeghi; Parisa Hasani-Sharamin; Maryam Modaber; Amirreza Farhoud; Mehrad Aghili
Volume 6, Issue 1 , Winter and Spring 2020, , Pages 38-42
Abstract
Objective: This study aimed to compare the efficacy of rescue blankets with conventional blankets in terms of preventing hypothermia in the pre-hospital setting. Methods: In this randomized clinical trial, patients older than 18 years old with Cold Discomfort Scale (CDS) > 2, and those who were transferred ...
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Objective: This study aimed to compare the efficacy of rescue blankets with conventional blankets in terms of preventing hypothermia in the pre-hospital setting. Methods: In this randomized clinical trial, patients older than 18 years old with Cold Discomfort Scale (CDS) > 2, and those who were transferred to the emergency department (ED) by emergency medical service entered the study. Patients were randomly divided into two groups based on the type of transfer. In this regard, one group was transferred with rescue blankets and the other group was transferred with conventional blankets. The tympanic temperature in patients and CDS were recorded before the use of blanket (primary) and at the time of arrival in the ED (secondary). Results: Finally, 161 patients with the mean age of 45.31±19.8 years were included (63.4% were male). Totally, 88 cases (54.7%) were transferred with rescue blankets and 73 cases (45.3%) with conventional blankets. The mean of the primary tympanic temperatures in the rescue and conventional blanket groups were 36.20±0.84°C and 36.34±0.65°C, respectively (P=0.23). The mean of the primary CDS in rescue and conventional blanket groups were 6.55±1.95 and 5.89±2.29, respectively (P=0.05). Also, the mean of the secondary tympanic temperatures in the rescue and conventional blanket groups were 36.59±0.47°C and 36.76±0.48 °C, respectively (P=0.03). Besides, the mean of the secondary CDS in the rescue and conventional blanket groups were 2.64±2.80 and 2.41±1.29, respectively (P=0.48). Conclusion: According to the results, there is no significant difference in the tympanic temperature and CDS of the patients transferred with the rescue blanket compared with the conventional blanket
Emergency medicine
Fardin Shahbazzadeh; Sajjad Narimani; Shiva Ahmadi; Zahra Anvari; Mehdi Khezeli
Volume 7, Issue 1 , Winter and Spring 2021, , Pages 41-45
Abstract
Objective:This study aimed to determine the motivation to helmet use among motorcyclists in Ardabil city using the trans-theoretical model (TTM) motivational interview. Methods: Random cluster sampling was used for this study. Five gas stations were selected from the crowded areas of Ardabil city and ...
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Objective:This study aimed to determine the motivation to helmet use among motorcyclists in Ardabil city using the trans-theoretical model (TTM) motivational interview. Methods: Random cluster sampling was used for this study. Five gas stations were selected from the crowded areas of Ardabil city and motorcyclists who came to these places were randomly interviewed. In this descriptive cross-sectional study, 350 motorcyclists in Ardabil were selected and interviewed by TTM Motivational questionnaire. We used one-way analysis of variance (ANOVA) and linear regression for analysis of data in SPSS software version 20. Results: Findings revealed that 12.6% of respondents consistently wore a helmet when they rode a motorcycle, while 45.2% of helmet non-wearers were uncertain about wearing a helmet in the future. Decisional balance (pros), self-efficacy (decreasing the negative affect situation score), and behavioral process of change can motivate participants to helmet use. Conclusion: Reducing negative social situations and increasing positive emotional states can motivate people to use helmet.