Emergency medicine
Harish Kodisiddaiah Shivanna; Aruna Chala Ramesh; Keshava Murthy M Rangaswamy
Volume 8, Issue 1 , January 2022, , Pages 43-48
Abstract
Objective:To implement the 5-level Emergency Severity Index (ESI) triage tool into nursingpractice in the emergency department (ED) and validate it with a population-based cohortusing hospitalization and length of stay (LOS) as outcome measures.Methods: The study included 850 patients, irrespective of ...
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Objective:To implement the 5-level Emergency Severity Index (ESI) triage tool into nursingpractice in the emergency department (ED) and validate it with a population-based cohortusing hospitalization and length of stay (LOS) as outcome measures.Methods: The study included 850 patients, irrespective of age and gender, reporting tothe ED of a tertiary care hospital. Each patient was assessed by the triage nurse as perthe 5-level ESI triage tool and categorized. The number and type of resources used by thepatient, LOS in the ED and the outcome were noted. Data were statistically analyzed byusing RStudio Team software, 2015. A P value of < 0.05 was considered to be statisticallysignificant.Results: The majority of patients belonged to ESI-4 (46.82%), followed by ESI-1 (19.41%),ESI-2 (17.06%), ESI-3 (10.35%), and ESI-5 (6.35%). In most patients, the LOS in the ED was<120 minutes (55.65%). ESI showed a statistically significant association with all the clinicalcharacteristics, as well as resources used, interventions needed, maximum time allowedbefore initiating physician assessment, duration of stay in ED, and patient outcomes(P=0.000). ESI was found to have a sensitivity of 100% and specificity of 78%.Conclusion: ESI is a useful and valid tool for the emergency triage and has the potential tobecome the standard triage acuity assessment in EDs in India.
Emergency Medical Services
Seyedhossein Ojaghihaghighi; Samad Shams Vahdati; Simin Taghavi; Aydin Rahimzade Jahandari; Pegah Sepehri Majd; Mohammad Mirza-Aghazadeh-Attari
Volume 4, Issue 1 , January 2018, , Pages 44-47
Abstract
Objective: Pregnancy is an important psychological and biological phenomenon in women’s life. Pregnancy has many complications jeopardizing the well-being of the mother and the child. Methods: In this retrospective study, the data including demographic information, chief complaint, the initial ...
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Objective: Pregnancy is an important psychological and biological phenomenon in women’s life. Pregnancy has many complications jeopardizing the well-being of the mother and the child. Methods: In this retrospective study, the data including demographic information, chief complaint, the initial diagnosis, referral decision, final diagnosis, hospitalization outcome and pregnancy outcomes were studied on 239 pregnant women admitted to the emergency departments of the general hospitals of East Azerbaijan province. Results: The average age of patients was 27.54 years. The time period from the initial presentation to completely leave the emergency department was reported to be 3.66 hours on average. In this study, most patients (74.5%) did not have a history of abortion. Exploring the time of admission for all cases, most patients were admitted from 8 pm to 8 am (67.8%), and 32.2% were referred from 8 am to 8 pm. Concerning the time of pregnancy, 46.4% were at their second trimester of pregnancy. Most of the patients were admitted in cold seasons of the year. The most common chief compliant was abdominal pain with 32.2% frequency. In addition, the most frequent primary diagnoses were an acute abdomen and trauma at 25.5% and 14.2% respectively. Conclusion: Abdominal pain and acute abdomen have the most frequency as the chief compliant and initial diagnosis especially during the second trimester of pregnancy. In this regard, appropriate training and skillful staff are needed to deal with the complaints and complications of abdominal pain. More than half of pregnant women referred to the emergency departments were hospitalized or admitted to the intensive care unit (ICU). This signals the necessity of adequate facilities to provide proper care for this group.
Education
Amin Beigzadeh; Nikoo Yamani; Elham Sharifpoor; Kambiz Bahaadinbeigy; Peyman Adibi
Volume 7, Issue 1 , January 2021, , Pages 46-55
Abstract
Objective: Literature on the obstacles of clinical rounds is dispersed and has not been well established under a unified systematic investigation. Teaching and learning in clinical rounds, where a variety of skills important for the medical profession, cannot be augmented if barriers related to main ...
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Objective: Literature on the obstacles of clinical rounds is dispersed and has not been well established under a unified systematic investigation. Teaching and learning in clinical rounds, where a variety of skills important for the medical profession, cannot be augmented if barriers related to main factors in the clinical environment are not identified. Methods: A systematic review of English articles using Web of Science, PubMed, Embase, Scopus and Cochrane library were conducted. Relevant keywords and their synonyms were used for the domains “medical students/clinical teachers/barriers and clinical round”. Additional studies were identified by searching reference lists of retrieved articles. All searches for English language articles were conducted within a 10-day period from 25 May to 3 June 2017. No time limit was considered for article searching. We contacted Kerman University of Medical Sciences to locate some studies due to access limitation. In this systematic review, studies on the subject of barriers to clinical rounds from clinical teachers’ and medical students’ perspectives were identified. Our search strategy yielded 600 articles. After title and abstract review, 43 of these were obtained and finally 20 were included in the study. All data were abstracted from the included studies. Two authors independently screened the studies. We used inductive content analysis and categories of barriers were derived from the data. MAXQDA software version 10 was used for data analysis. Results: A total of 20 articles were included and analyzed in depth. Content analysis yielded identification of 320 codes concerning barriers to clinical rounds in six categories classified as system-, climate-, teacher-, student-, patient-, and personnel-related factors. Conclusion: Our investigation depicts primarily main barriers in teaching on rounds. In this regard, effective teaching in clinical rounds is not obtained unless barriers concerning the learning triad and its environment are explored and necessary actions are adopted accordingly
Surgery
Mohit Kumar Arora; Ela Madaan; Rajnand Kumar
Volume 6, Issue 1 , January 2020, , Pages 47-49
Abstract
Objective: Patella is a sesamoid bone which develops in the quadriceps tendon. It is an uncommon site for neoplasms. The most common primary tumors which involve patella are benign. These include chondroblastoma, giant cell tumor (GCT) and aneurysmal bone cyst. Malignant lesions are less common in patella. ...
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Objective: Patella is a sesamoid bone which develops in the quadriceps tendon. It is an uncommon site for neoplasms. The most common primary tumors which involve patella are benign. These include chondroblastoma, giant cell tumor (GCT) and aneurysmal bone cyst. Malignant lesions are less common in patella. These encompass metastasis, osteosarcoma and hemangioendothelioma. The most common complaint in patients of GCT patella is anterior knee pain. Early diagnosis and optimal management are necessary for improving survival rate in these patients.Case Presentation: The authors present a case report of GCT of patella in a 16-year old child. Incisional biopsy was done to confirm the diagnosis. Further radiological examination showed that the tumor involved almost whole of the patella. Hence, surgical management in the form of patellectomy and extensor mechanism repair was done to improve the outcome of the disease. The patient did not have any clinical or radiological symptoms at the end of the final follow up of 22 months.Conclusion: Primary tumor of patella is a rare entity. Benign tumors like GCT present only with anterior knee pain and should be included in the differential diagnosis of anterior knee pain. MRI is useful to determine the extent of involvement of tumor in the patella. Treatment may vary from curettage and bone grafting to total patellectomy with extensor mechanism repair
Emergency medicine
Abdolghader Pakniyat; Farzane Jafari; Rojin Ramezani; Mohammad Ghasemi-rad
Volume 9, Issue 1 , January 2023, , Pages 54-57
Abstract
Objective: Orbital emphysema, defined as the presence of air in orbital and periorbital tissues, is a relatively uncommon clinical condition which occurs mostly following facial trauma. It can not only resolve spontaneously without any treatment, but it can also cause life threatening complications such ...
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Objective: Orbital emphysema, defined as the presence of air in orbital and periorbital tissues, is a relatively uncommon clinical condition which occurs mostly following facial trauma. It can not only resolve spontaneously without any treatment, but it can also cause life threatening complications such as pneumomediastinum (PM). PM is an uncommon complication of facial fractures and is defined as the presence of air in the mediastinal space. Developing PM following blunt trauma is commonly considered as a red flag for underlying injuries, such as trachea and esophagus rupture. Therefore, other complementary diagnostic procedures, including bronchoscopy and esophagostomy, are often necessary for patients developing this condition.Case Presentation: A 31-year-old man with a history of facial and neck trauma was presented to the emergency room of our tertiary referral hospital with a complaint of right orbital swelling. On physical examination, vital signs were stable. There was a mild swelling of right upper eyelid, but no proptosis. An hour after admission, following sneezing and blowing his nose, the patient had further swelling of his right face with extension of swelling through the right side of his neck to the nipple. He also complained of dyspnea and acute severe progressive epigastric pain.Conclusion: Orbital emphysema following orbital wall fracture is typically benign and self- limited, but physicians should be aware of serious complications such as PM. Therefore, monitoring the patient is crucial and should be considered in such ct
emergency nursing
Sahar Mirbaha; Parvin Kashani; Ali Arhami Dolatabadi; Afshin Amini; Farahnaz Meschi; Alireza Baratloo
Volume 3, Issue 2 , July 2017, , Pages 59-63
Abstract
Objective: Personality disorder is a multi-factorial condition in which workplace stress plays a significant role. This study was undertaken due to scarcity of information regarding the role of workplace stress which can cause personality disorder among nurses. We aimed to evaluate the prevalence of ...
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Objective: Personality disorder is a multi-factorial condition in which workplace stress plays a significant role. This study was undertaken due to scarcity of information regarding the role of workplace stress which can cause personality disorder among nurses. We aimed to evaluate the prevalence of personality disorders in nurses working in different hospital departments and assess factors affecting its onset. Methods: In this cross-sectional study the personality disorders of nurses working in various hospital departments were evaluated based on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) test. After the completion of questionnaires, data were entered to MMPI-2 test’s special software and the final result was interpreted based on the opinion of a clinical psychologist. Finally, multivariate logistic regression model was used to assess the independent effect of the mentioned factors on prevalence of personality disorders in nurses. Results: We gathered data from 2 groups of participants (n = 206). These groups included nurses in emergency departments and nurses in other hospital units. The mean of age was 32.5 ± 6.9 years. Overall, 54.3% (n = 38) of non-emergency nurses and 45.7% (n = 32) of emergency nurses showed symptoms of personality disorders respectively. Multivariate logistic regression analysis showed that history of a serious accident or trauma increased the odds of detecting personality disorders up to 3.8 times (odds ratio [OR] = 3.84; 95% CI: 1.33-11.06; P = 0.01). In addition, an unpleasant incident in the past year increased it up to 2.2 times (OR = 2.23; 95% CI: 1.18 – 4.22; P = 0.01) in both groups. Conclusion: The present study showed that there was no significant difference between emergency departments and other units of hospitals regarding the prevalence of personality disorders among nurses. Overall, somatization, hysteria, and pollyannaish were the most common personality disorders among the studied population
Emergency medicine
Daniel AA Umezurike; Aloysius Ugwu-Olisa Ogbuanya; Bieda Fongue Jean Robert; Ifeoma Cecilia Ekwunife
Volume 10, Issue 1 , January 2024, , Pages 65-69
Abstract
Objective: The spleen is the most frequently injured organ in blunt abdominal trauma (BAT). We present an interesting case of traumatic splenic rupture in pregnancy managed successfully by emergency splenectomy in a low-resource setting.Case Presentation: A 27-year old multiparous woman at 23 weeks gestational ...
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Objective: The spleen is the most frequently injured organ in blunt abdominal trauma (BAT). We present an interesting case of traumatic splenic rupture in pregnancy managed successfully by emergency splenectomy in a low-resource setting.Case Presentation: A 27-year old multiparous woman at 23 weeks gestational age presented to the emergency department with a history of BAT following a road traffic accident (RTA). This study was conducted in the Department of Surgery, General Surgery Unit, College of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria, in 2023. A vehicle strayed and hit her from the left side of the abdomen while she was sitting down. She suddenly developed abdominal pain, bruises on the left upper abdomen, andprogressive abdominal distension. The abdominal ultrasound report showed a deep trabecular laceration and massive hemoperitoneum. The fetus was viable from obstetric and ultrasound assessments. The patient was hemodynamically unstable and was subsequently prepared for emergency exploratory laparotomy. Intraoperatively, incomplete hilar avulsion injury and multiple parenchymal lacerations of the spleen were noted. An accessory spleen without injury was also noted. Splenectomy with preservation of the accessory spleen was performed.Postoperatively, the fetus remained viable, and the patient was hemodynamically stable. The mother had no morbidities other than paralytic ileus and fever, and both were amenable to conservative management.Conclusion: Emergency splenectomy is a life-saving procedure in hemodynamically unstable patients with splenic trauma, even in pregnancy.
Trauma
Seyyed Mahdi Mirhamidi; Davood Soroosh; Alireza Abadi; Elahe Fahimi
Volume 5, Issue 2 , July 2019, , Pages 75-77
Abstract
Compartment syndrome is a rare vascular disorder and an orthopedic emergency caused by high intramuscular pressure following bone fractures and some other etiologies. It mostly involves extremities, but can affect other parts of the body. The syndrome is diagnosed based on extensively varying signs and ...
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Compartment syndrome is a rare vascular disorder and an orthopedic emergency caused by high intramuscular pressure following bone fractures and some other etiologies. It mostly involves extremities, but can affect other parts of the body. The syndrome is diagnosed based on extensively varying signs and symptoms including feeling pain, pallor, pulselessness, and some other signs among patients. It causes irreversible complications that may even lead to death in some cases. If not treated promptly, muscle and nerve necrosis, myoglobinuria, and ultimately extremity gangrene and renal failure may occur. Timely diagnosis requires close attention to patient’s signs and symptoms and repeated measurements of pressure in the compartment. The reported case was an 11-year-old girl suffering from a closed double fracture in her forearm following blunt trauma. Inappropriate treatment done by a local therapist resulted in compartment syndrome. The aim of this study was to obtain an accurate knowledge on it and to do timely action when facing with this syndrome.
Surgery
Manas Sharma; Shridhar C. Ghagane; Shubhashree Muralidhar; Shashank Patil; Naina R. Nerli; Rajendra B. Nerli
Volume 6, Issue 2 , July 2020, , Pages 98-101
Abstract
The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to ...
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The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to urological procedures, a triage of non-emergent operations is hence recommended considering various disease-related factors. Case conduct should also be categorized based on the up-to-date information of the evolving national, regional and local conditions of this pandemic, as marked variation in these conditions can lead to significant differences in decision-making. Over the coming weeks and months, we are bound to face an increasingly difficult task of treating Coronavirus disease 2019 (COVID-19) infected patients presenting with urological ailments. Instituting well-thought plans to perform the un-deferrable urological procedures and emergencies during this pandemic will go a long way in keeping the surgeons and health-care workers safe to perform essential duties.
Emergency medicine
Seyed Reza Habibzadeh; Samaneh Abiri; Saeed Barazandehpour; Mohammad Javad Zarei; Mahdi Foroughian; Hamideh Akbari; Navid Kalani; Esmaeil Rayat Dost; Seyed Hamed Hojati
Volume 7, Issue 2 , July 2021, , Pages 130-132
Abstract
Objective: Brugada syndrome (BrS) is a disorder in which the electrical activity in the heart is abnormal and affects individuals with cardiac dysrhythmia. In the present study, we introduce a case diagnosed with BrS, admitted to intensive care unit (ICU) and received treatments following sudden cardiac ...
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Objective: Brugada syndrome (BrS) is a disorder in which the electrical activity in the heart is abnormal and affects individuals with cardiac dysrhythmia. In the present study, we introduce a case diagnosed with BrS, admitted to intensive care unit (ICU) and received treatments following sudden cardiac arrest. Case Report: The patient was a male 25-year-old medical student enrolled in the sixth academic year who suffered from loss of consciousness due to sudden cardiac arrest. The patient immediately received cardiopulmonary resuscitation (CPR) measures, was visited by a cardiologist and a neurologist, and was consequently treated with medications. After an 8-day stay in the coronary care unit (CCU), the patient regained his level of consciousness and he was transferred to the ICU of Faghihi hospital in the city of Shiraz, Iran. Being diagnosed with BrS and following pulmonary aspiration treatments, he finally implanted with an implantable cardioverter defibrillator (ICD). Conclusion: Fortunately, necessary measures had been taken on time for the introduced patient and he was discharged with full recovery after 6 days
Cardiology
Asghar Mohamadi; Nazanin Davari; Elham Sepahvand; Maryam Aliramezany
Volume 9, Issue 2 , July 2023, , Pages 134-137
Abstract
Objective: Dyspnea is a common symptom of heart disease that can also be related to otherdisorders, such as liver disease. In this case report, we aim to describe a rare case of metastatic livermass that presented with heart failure.Case Presentation: A 50-year-old woman without a past medical history ...
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Objective: Dyspnea is a common symptom of heart disease that can also be related to otherdisorders, such as liver disease. In this case report, we aim to describe a rare case of metastatic livermass that presented with heart failure.Case Presentation: A 50-year-old woman without a past medical history arrived at our hospitalwith a history of dyspnea and swelling in the lower extremities. She did not complain of pain,arthralgia, trauma, or chest pain but complained of exertional dyspnea and fatigue that had startedone month before and had aggravated two days before. Her laboratory test indicated anemia. Inechocardiography, we saw mild right ventricle enlargement and dysfunction, but the left heart wasnormal with acceptable systolic and diastolic function. In the subcostal view, the inferior vena cava(IVC) was dilated but under compression of a large liver mass. According to our literature review, thisis the first case in which a metastatic liver mass had presented with heart failure.Conclusion: In patients presenting with dyspnea, despite normal echocardiographic findings, theexact evaluation of the IVC should be considered.
Infectious disease
Mohsen Eshraghi; Enayatollah Noori; Ahmad Kachoie; Moien Zolmafakher
Volume 8, Issue 2 , July 2022, , Pages 141-144
Abstract
Objective: Bronchopleural fistula (BPF) is a pathological communication between thebronchial tree and pleural space. BPFs are commonly seen after lung surgery, and are lesscommon in trauma, lung abscess, and radiation therapy. In this study, we describe theclinical course and surgery of a case of pulmonary ...
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Objective: Bronchopleural fistula (BPF) is a pathological communication between thebronchial tree and pleural space. BPFs are commonly seen after lung surgery, and are lesscommon in trauma, lung abscess, and radiation therapy. In this study, we describe theclinical course and surgery of a case of pulmonary necrosis and BPF in a patient infectedwith coronavirus disease 2019 (COVID-19).Case Presentation: The patient was a 54-year-old man with multiple myeloma and endstagerenal disease from the last 8 years. He had a history of coronary artery bypass graftingfrom the last 3 years. He also suffered from progressive shortness of breath and dry coughsince March 2019.Conclusion: The results of this study showed that BPF is one of the most severecomplications after thorax surgery, and there is no effective prevention methodparticularly in this patient who had COVID-19 pneumonia. Therefore, early intervention,especially when diagnosed at an early stage, by strengthening the stump inside the thoraxor thoracotomy in the open window may eventually accelerate the closure of the BPF andimprove the survival.
Disaster
Simin Salehinejad; Nazanin Jannati; Roghayeh Ershad Sarabi; Kambiz Bahaadinbeigy
Volume 7, Issue 1 , January 2021, , Pages 56-62
Abstract
Objective: Both natural and man-made disasters need near-term and long-term interventions to reduce morbidity and mortality among the affected population. Recently, telemedicine has been effectively used in both man-made and natural disasters and showed its effectiveness in eliminating the adverse consequences ...
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Objective: Both natural and man-made disasters need near-term and long-term interventions to reduce morbidity and mortality among the affected population. Recently, telemedicine has been effectively used in both man-made and natural disasters and showed its effectiveness in eliminating the adverse consequences of disasters. Therefore, the purpose of this study was to identify the application of telehealth in different phases of disaster. Methods: We systematically searched all English papers regarding the use of telemedicine in different phases of disaster indexed in PubMed, Embase, and Web of Science databases until June 2020. A data collection form was designed to extract the required data such as types of systems, telecommunication technologies, and phases of disaster. Results: In this study, 16 out of 4490 retrieved articles were selected as relevant and reviewed by the authors. Findings indicated that the majority of studies highlighted the use of telemedicine in natural disasters (n=12), and only four discussed it in a man-made disaster like war and terrorist attacks. In 6 studies out of 16, telemedicine was used to treat and assess mental disorders among the affected population. And the internet was the most common technology for telemedicine development. Conclusion: Providing health care during a disaster is necessary, and telemedicine is important for such care. This systematic review helps define the components and application of telemedicine in disaster as a new technology in recent days, but we need to consider it and develop this technology in all phases of disaster management, especially during the response phase.
Trauma
Seyed Ahmad Rasoulinejad
Volume 9, Issue 1 , January 2023, , Pages 58-59
Abstract
Objective: Purtscher’s retinopathy is the retinal damage following trauma or non-traumatic systemic disease, which may contain cotton-wool spots (CWSs), and may cause Purtscher flecken, atrophy of the optic nerve, and hemorrhage of the posterior pole of the eye.Case Presentation: A 28-year-old ...
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Objective: Purtscher’s retinopathy is the retinal damage following trauma or non-traumatic systemic disease, which may contain cotton-wool spots (CWSs), and may cause Purtscher flecken, atrophy of the optic nerve, and hemorrhage of the posterior pole of the eye.Case Presentation: A 28-year-old male patient fell down from a height of 10 m and was admitted with swelling and ecchymosis of the peri-orbit of the right eye. The patient’s vision was at the level of light perception. A mild subconjunctival hemorrhage and hyphema were seen in the right eye. In the fundus, the hemorrhage, edema, and CWS were seen in the posterior pole and around the optic disk. Macular thickness (MT) in Purtscher’s retinopathic eye was 353 μm. Also, the patient had a nose and mandibular fracture and was hospitalized for several days.Conclusion: The findings indicate a decrease in the vision due to Purtscher’s retinopathy caused by trauma. There was no improvement spontaneously
Trauma
Em Thong Huynh; Khai Duong; Duy Khai Lam; Tung Thanh Thach; Duoc Minh Le; Bao Tu Thai Nguyen
Volume 10, Issue 1 , January 2024, , Pages 70-73
Abstract
Objective: This case report aims to demonstrate an instance of superficial femoral artery (SFA) rupture after an open femoral shaft fracture.Case Presentation: Our patient was a 22-year-old man admitted to the emergency department after a motorbike accident with a deformity at the distal third of the ...
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Objective: This case report aims to demonstrate an instance of superficial femoral artery (SFA) rupture after an open femoral shaft fracture.Case Presentation: Our patient was a 22-year-old man admitted to the emergency department after a motorbike accident with a deformity at the distal third of the thigh and an open wound on the medial side. Radiographs and computed tomography angiography revealed a left distal third femoral fracture with ipsilateral SFA injury. We performed fracture reduction external fixation following SFA reconstruction using a 5-cm saphenous vein autograft. Prophylaxis fasciotomy was not performed. At a 6-month follow-up, the wound was well-healed, the Doppler ultrasound showed good blood flow at the reconstructed artery, and a rigid callus entirely covered the fracture.At 1-year follow-up, the patient could walk with full weight-bearing. Maximum knee range of motion was restored, and the patient could return to daily activities.Conclusion: Vascular injury after femoral shaft fracture is rare, and accurate diagnosis with timely and appropriate surgery plays a crucial role in achieving limb salvage, reducing the risk of complications, and improving the overall quality of patient life.
Trauma
Mohit Kumar Arora; Ela Madaan; Sandeep Kumar
Volume 5, Issue 2 , July 2019, , Pages 78-80
Abstract
Simultaneous fracture of lateral condyle and medial epicondyle of humerus along with elbow dislocation is very rare injury in adults. Only a few cases have been reported in literature in pediatric age groups. The authors describe a case report of fracture of lateral condyle and medial epicondyle of humerus ...
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Simultaneous fracture of lateral condyle and medial epicondyle of humerus along with elbow dislocation is very rare injury in adults. Only a few cases have been reported in literature in pediatric age groups. The authors describe a case report of fracture of lateral condyle and medial epicondyle of humerus along with elbow dislocation in a young adult. The patient sustained injury in the form of fall from bike. Clinically the patient had swelling and deformity of the elbow joint. There were contusions present in the skin around the elbow joint. There was no distal neuro-vascular deficit. Appropriate radiological investigations were done. The elbow joint was then reduced and found to be unstable. Hence, patient was taken up for surgery in the form of open reduction and internal fixation. The functional outcome of the surgery is presented in the case report. Open reduction and internal fixation are the treatment of choices in these types of cases.
Infectious disease
Sohil Pothiawala
Volume 6, Issue 2 , July 2020, , Pages 102-108
Abstract
Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic.Objective: To provide emergency physicians an update on severe acute respiratory syndrome ...
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Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic.Objective: To provide emergency physicians an update on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its dynamic impact on the emergency department (ED) in terms of preparedness and management of patients presenting to ED with suspected COVID-19 disease.Discussion: COVID-19 has a human-to-human transmission through close contact and even from asymptomatic carriers. Symptoms are similar to a viral respiratory illness. The disease is mild and self-limiting in most patients, but some develop severe illness like pneumonia, acute respiratory distress syndrome (ARDS) and multiorgan failure. Emergency physicians should prioritize early identification of these patients at risk, isolate them and after collaborating with relevant hospital and national authorities, develop clinical pathways to safely evaluate, manage and dispose patients with COVID-19. Various strategies for managing these patients in the ED are discussed. Disposition of these patients depends on symptoms and hemodynamic status and potential to self quarantine versus admission to an isolation facility.Conclusion: This review provides an overview of patients presenting to the ED with suspected COVID-19 and its impact on the ED. It reiterates the fact that emergency physicians, in close collaboration with relevant hospital authorities, play a pivotal role during EVDs. It emphasizes the need for pandemic preparedness, enabling us to better manage such events in the future.
Infectious disease
Shaghayegh Rahmani; Kosar Deldar; Sara Hemati Ali
Volume 7, Issue 2 , July 2021, , Pages 133-134
Abstract
Objective: Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic.Case ...
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Objective: Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic.Case Presentation: We report 5 cases that missed triage or received delayed diagnosis because of COVID-19 suspicion. Some cases are life threatening.Conclusion: Although COVID-19 is the main health concern these days, other critical conditions should be considered. Stabilizing patients before transferring them between hospitals should be the essential goal of emergency department whether the patient is Corona virus infected or not. And before any intervention, the safety of healthcare workers must be ensured.
Emergency medicine
Zainab Mehdi; Daljinderjit Kaur; Parv kamra; Nidhi Arora; Narinder kaur; Shivam Bansal
Volume 9, Issue 2 , July 2023, , Pages 138-141
Abstract
Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easy alternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure, predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestion with spontaneous pneumothorax, ...
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Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easy alternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure, predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestion with spontaneous pneumothorax, spontaneous pneumomediastinum, and pneumorrhachis. Aim is to reinforce the importance of a high index of suspicion in early diagnosis when the above findings are present with ARDS in absence of trauma and a history of alleged substance ingestion.Case Presentation: A 35-year-old male presented with loose stool occasionally bloody, oral ulcers, yellow discoloration of eyes with fever, and decreased urine output for three days after consuming some substance with his seafood. On examination, he had yellow discoloration of eyes and oral mucosa along with multiple ulcers on the buccal region as well as the dorsum of the tongue and lateral margins with generalized subcutaneous emphysema. In addition, decreased air entry in the bilateral lung field and muffled heart sounds were present. He had an acute hepatorenal failure and severe metabolic acidosis with respiratory failure. Urine tested positive for myoglobin and muscle enzymes (creatinine kinase and lactate dehydrogenase (LDH)) were raised. He was intubated and shifted to the intensive care unit. Injectable N-acetyl cysteine (NAC) for acute liver failure was started with empirical antibiotics and intravenous fluids. We supplemented thiamine and vitamin K, and hemodialysis was done in view of progressive renal failure. Radiological evaluation showed spontaneous pneumothorax, pneumomediastinum, and pneumorrhachis which were managed conservatively. His respiratory parameters worsened despite maximal ventilatory support. Renal failure and metabolic acidosis worsened in spite of hemodialysis. He succumbed to his illness on day five of admission and seven days after toxin ingestion.Conclusion: We recommend that the sale of paraquat be restricted and regulated to avoid its use for suicidal and homicidal purposes. More research is required to find measures to intervene early and prevent pulmonary fibrosis. We propose that paraquat toxicity be considered early in a patient with the triad in an atraumatic setting with acute respiratory distress syndrome (ARDS).
Ultrasonography
Khosro Ayazi; Parham Nikraftar; Hamidreza Hatamabadi; Fatemeh Shojaeian; Shervan Family
Volume 8, Issue 2 , July 2022, , Pages 145-147
Abstract
Objective: One of the most prevalent surgical emergencies is appendicitis, caused by different factors. However, its relation to trauma has not been well-known yet. Here we have described three cases with blunt abdominal trauma and a secondary diagnosis of appendicitis that were transferred to the operation ...
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Objective: One of the most prevalent surgical emergencies is appendicitis, caused by different factors. However, its relation to trauma has not been well-known yet. Here we have described three cases with blunt abdominal trauma and a secondary diagnosis of appendicitis that were transferred to the operation room.Case Presentation: Three patients suffering from blunt trauma and abdominal pain were referred to the emergency department (ED). Of these patients, one of them was transferred to the operation room (OR) with a peritonitis diagnosis and the other two patients had appendicitis signs and symptoms. The abdominal pain and related signs and symptoms of these three patients were due to appendicitis. All three patients were discharged from the hospital with normal vital signs.Conclusion: Traumatic appendicitis might be regarded as one of the differential diagnoses of the patients referred to the ED with blunt abdominal trauma and abdominal pain; hence, appendicitis and blunt abdominal trauma have some unknown relations.
Trauma
Mohit Kumar Arora; Ela Madaan
Volume 4, Issue 1 , January 2018, , Pages 48-50
Abstract
Patellar fracture is a relatively uncommon fracture especially the vertical sagittal type. In cases of high energy trauma injury, it is usually associated with fracture of ipsilateral distal femur or proximal tibia. However, the combination of vertical sagittal fracture patella and ipsilateral fracture ...
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Patellar fracture is a relatively uncommon fracture especially the vertical sagittal type. In cases of high energy trauma injury, it is usually associated with fracture of ipsilateral distal femur or proximal tibia. However, the combination of vertical sagittal fracture patella and ipsilateral fracture lateral condyle is very rare. This necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Open reduction and internal fixation is the treatment of choice in managing these types of injuries. This should be followed by gradual mobilization of the affected knee joint. Weight bearing can be started once the fracture starts showing signs of union on X-rays. Literature search shows only one case report describing this pattern. The aim of this case report is to highlight the rarity of this injury, to understand the injury mechanism and surgical approach used for these injuries. The knowledge of this combination will help us manage these injuries so that good functional outcome is achieved
Emergency medicine
Shyam lal; Vinod Kumar Singh; Suhas Agarwal
Volume 8, Issue 1 , January 2022, , Pages 49-54
Abstract
Objective: Perforation peritonitis is a common surgical emergency which is treated bysurgery and antibiotics. Candida isolation in peritoneal fluid and antifungal treatment isnot a norm. The aim of this study was to determine the incidence of Candida in peritonealfluid and its role in the outcome of ...
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Objective: Perforation peritonitis is a common surgical emergency which is treated bysurgery and antibiotics. Candida isolation in peritoneal fluid and antifungal treatment isnot a norm. The aim of this study was to determine the incidence of Candida in peritonealfluid and its role in the outcome of patients with perforation peritonitis.Methods: This prospective observational study was conducted on 70 patients withperforation peritonitis from October 2016 to February 2018. Intraoperatively, peritonealfluid was taken and sent for microbiological culture and sensitivity. Perforation wasmanaged according to the site of perforation and condition of bowel.Results: The mean age of the patients was 38.74 years with male predominance (58,82.85%). Forty-seven (67.14%) patients had positive peritoneal cultures. Escherichia coliwas the most common bacteria (n=29), while Candida was found to be the most commonfungi and was found in 18 patients. The incidence of Candida was higher in upper gastroduodenal perforation (30, 42.85%). Patients found positive for Candida had APACHE IIseverity score 10 or more which was higher than the rest of the patients. The mortality washigher in patients with positive peritoneal cultures (10/47) as compare to negative ones(2/23, P<0.001). The mortality in mixed bacterial and fungal-positive cultures (7/18) wasalso higher as compared to isolated bacterial culture (3/29, P <0.001). The overall mortalityrate was 17.14%.Conclusion: Patients with Candida positive peritoneal culture had a significant mortalityand morbidity as compared to Candida negative. Peritoneal fluid culture and sensitivity forbacterial and fungal were helpful in the early diagnosis and treatment
Imaging
Mohammad Rezazadehkermani; Seyed Vahid Hosseini
Volume 9, Issue 1 , January 2023, , Pages 60-63
Abstract
Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinelyvisited in emergency departments. Although most of these patients are managed withendoscopic modalities, some of them are managed with surgical interventions. Most ofemergency surgical interventions are done via ...
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Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinelyvisited in emergency departments. Although most of these patients are managed withendoscopic modalities, some of them are managed with surgical interventions. Most ofemergency surgical interventions are done via laparotomy. With evolution in minimalinvasive surgery, the role of laparoscopic surgeries in emergency settings is on a rise.Case Presentation: In this report we describe a case of lower gastrointestinal bleedingthat was presented with melena and during workups no bleeding lesion was detectedin colon, stomach or duodenum. Further investigations revealed bleeding of proximaljejunum mass that was resected with the laparoscopic approach which is rarely used inthe emergency management of patients with gastrointestinal bleedings. Also, resectionand anastomosis of proximal jejunal loop was challenging in this case.Conclusion: This report is intended to describe the feasibility of laparoscopy in proximalsmall bowel lesion resection in emergency settings as well as the role of CT angiography indetecting the source of obscure gastrointestinal bleeding
Trauma
Ganesh Singh Dharmshaktu
Volume 3, Issue 2 , July 2017, , Pages 64-65
Abstract
Simultaneous combination of fracture of the lateral condyle and postero-medial elbow dislocation is a rare event and limited to few reports or case series in the literature. Rarity of the injury also necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Various ...
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Simultaneous combination of fracture of the lateral condyle and postero-medial elbow dislocation is a rare event and limited to few reports or case series in the literature. Rarity of the injury also necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Various authors have reported about the condition including the management which mostly includes surgical intervention. A report of one such injury pattern in an 8 years old male child with operative management and satisfactory outcome is presented to highlight the presence of this rare combination and adherence to standard treatment protocols to address them. The report is an addition to the limited resources available on similar fractures and highlights the importance of ruling out possible associated injuries in cases of elbow dislocations. A good fixation of lateral condyle fracture is instrumental to avoid late complications leading to poor functional outcome. The early and supervised rehabilitation also plays a role in ensuring successful return to activities of daily living.
Orthopedics
Marcus vinicius Bianchi; Leonardo Comerlatto; Cristina Vicioli; Ramesses Akamefula; Marcio Balbinotti Ferrari
Volume 10, Issue 1 , January 2024, , Pages 74-76
Abstract
Objective: Quadriceps tendon ruptures are rare injuries affecting the knee extensor mechanism, typically occurring in middle-aged patients with underlying pathologies. Bilateral simultaneous quadriceps tendon ruptures are even more uncommon, and almost all reported cases in the literature are associated ...
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Objective: Quadriceps tendon ruptures are rare injuries affecting the knee extensor mechanism, typically occurring in middle-aged patients with underlying pathologies. Bilateral simultaneous quadriceps tendon ruptures are even more uncommon, and almost all reported cases in the literature are associated with an underlying disease.Case Presentation: A 62-year-old Caucasian male presented complaining of pain in the anterior-superior aspect of both knees following a fall while walking that same day, during which his knees were in a semi-flexed position. Physical examination revealed a loss of active knee extension in both limbs and a palpable gap between the superior pole of the patella and the quadriceps tendon. MRI of both knees was performed two days after the injury, confirming bilateral quadriceps tendon ruptures. Twelve days after the initial injury, the patient underwent surgical intervention, and both injuries were addressed simultaneously using a transosseous tunnel technique. The transosseous technique consisted of three longitudinal and parallel tunnels drilled into the patella, and a modified Kessler suture was used to secure and reattach the quadriceps tendon back to the superior pole of the patella. At the patient’s eight-month follow-up, the patient was asymptomatic, ambulating normally, and had full knee extension with 120° flexion bilaterally. However, hypotrophy of the quadriceps muscle was noted bilaterally.Conclusion: Proper evaluation and treatment of these injuries are crucial to achieving good outcomes, as they can lead to significant knee pain and disabilities.