Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45444220180701Brain multi-infarct and decompression sickness53544632610.15171/jept.2017.17ENLuis RafaelMoscote-SalazarNeurosurgeon-Critical Care, RED LATINO. Latin American Trauma & Intensive Neuro-Care Organization, Bogota, ColombiaGuru DuttaSatyartheeAll India Institute of Medical Sciences, New Delhi, IndiaNidia EscobarHernandezDepartment of Radiology, National Autonomous Universitiy of Mexico, Mexico City, MexicoDepartment of Radiology Hospital, General Dr. Manuel Gea González, Mexico City, MexicoJorge AquinoMatusDepartment of Radiology Hospital, General Dr. Manuel Gea González, Mexico City, MexicoDepartment of Internal Medicine, National Autonomous Universitiy of Mexico, Mexico City, MexicoWillem GuillermoCalderon-MirandaDepartment of Radiology Hospital, General Dr. Manuel Gea González, Mexico City, MexicoDepartment of Internal Medicine, National Autonomous Universitiy of Mexico, Mexico City, MexicoMarco AntonioBlancas-VarasNational Autonomous Universitiy of Mexico, Mexico City, MexicoJohanaMarabyUniversidad de Cartagena, Cartagena de Indias, ColombiaJoulenMo-CarrascalUniversidad de Cartagena, Cartagena de Indias, ColombiaJournal Article20170527Scuba diving is associated with an important risk of developing decompression sickness secondary to formation of gas bubbles inside the body. The latter is formed mainly by nitrogen in the body on the diver’s way to the surface (1,2). In some cases, it might injure the central nervous system. Several decompression cases that have been associated with neurologic symptoms are described in the literature; however, brain multi-infarct with lethal outcome has never been described.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45444220180701The ability of the emergency medical service personnel to take patients’ medical history55615789610.15171/jept.2017.32ENAliSadrollahiDepartment of Nursing Science, Bandar Gaz Branch, Islamic Azad University, Bandar Gaz, IranAdelehGharataghaniDepartment of Clinical Affairs, Golestan University of Medical Sciences, Gorgan, IranMehdiMahmoudiDepartment of Nursing Science, Bandar Gaz Branch, Islamic Azad University, Bandar Gaz, IranFardanehGholipourDepartment of Nursing, Khalkhal Branch, Islamic Azad University, Khalkhal, IranJournal Article20170722Objective: The key point to detect patients’ need in pre-hospital emergency is to have high ability to take medical history. All research findings show that this ability is low. The objective of this research is to investigate the ability to take medical history of patients among the personnel of pre-hospital emergency medical service (EMS) in Golestan province, Iran.<br />Methods: This research was a descriptive cross-sectional study carried in 2016. The population included non-staff technicians and an operator working in the message center (N = 171). The samples were selected using multi-stage cluster sampling. Data were collected by a researcher-developed questionnaire. The collected data were analyzed by SPSS software version 16 conducting descriptive and inferential statistics. All tests were administered at a significance level of P < 0.05.<br />Results: One hundred sixty-five (96.5%) participants were male. The mean score of the ability to take medical history was 58.4 ± 11.1. Therefore, 95 participants (58.3 %) had poor ability and 64 participants (39.3 %) owned moderate ability. The highest score concerning the ability to take medical history was for the aspect of professional knowledge (mean rank = 5). The most influential aspect in the ability was respectively for ‘professional knowledge’ (P = 0.0001, Beta = 0.509). Pearson correlation coefficient indicated a relationship (r=-0.149, P = 0.05) between the ability to take medical history and age.<br />Conclusion: The results of the current study indicated that the ability to take medical history among the personnel of pre-hospital medical emergency of Golestan province was low. Therefore, a thorough review of trainings promoting personnel’s professional knowledge is urgently required.<br /><br />Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45444220180701Effect of oral tizanidine on prolongation of intrathecal lidocaine62666269510.15171/jept.2018.06ENArmanTaheriDepartment of Anesthesiology, Tehran University of Medical Sciences, Tehran, IranMortezaHashemianDepartment of Anesthesiology, Kerman University of Medical Sciences, Kerman, IranMehrdadNorooziDepartment of Anesthesiology, Kerman University of Medical Sciences, Kerman, IranMohammadBakhtiariDepartment of Anesthesiology, Sirjan School of Medicine, Sirjan, IranMohammad RezaDoroodianDepartment of Anesthesiology, Kerman University of Medical Sciences, Kerman, IranShirinSalajeghehDepartment of Anesthesiology, Kerman University of Medical Sciences, Kerman, IranJournal Article20180311Objective: In order to prolong the duration of intrathecal lidocaine, various drugs are used along with it. Due to the promising effects of tizanidine on central nervous system, it can be assumed that tizanidine can have a positive effect on increasing the anesthesia duration too. Thus, we aimed to investigate the effect of oral tizanidine on the duration of lidocaine spinal anesthesia.<br />Methods: This double blind clinical trial was conducted on 40 male patients waiting for elective leg surgery with the age range of 20-60 years in one of the educational hospitals of Kerman University of Medical Sciences, Iran. We used simple random sampling and our participants were assigned into 2 groups (placebo and oral tizanidine receivers). Spinal anesthesia with 1 mg/kg of hyperbaric lidocaine 5% was performed in both groups. In tizanidine group, patients received 4 mg of oral tizanidine one hour before spinal anesthesia. Sensory block was examined by pin prick test and all anesthetic duration including start block until reduction of sensory level was calculated at 2 lower dermatomes.<br />Results: Findings showed that oral tizanidine compared to placebo can cause a 10-15 minute increase in patients’ lidocaine spinal anesthesia. Therefore, the average anesthesia time for tizanidine group increased meaningfully (P = 0.03). In addition, tizanidine can sedate patients during surgery (P = 0.00) or in recovery (P = 0.003).<br />Conclusion: Based on the results, tizanidine increased the duration of lidocaine so oral tizanidine can be used to prolong the duration of lidocaine spinal anesthesia.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45444220180701Abdominal trauma in a semi-urban tertiary health institution67726311710.15171/jept.2018.07ENJulius GbengaOlaogunDepartment of Surgery, Ekiti State University, Ado-Ekiti, Ekiti State, NigeriaDepartment of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, NigeriaOlusoga OlusolaAkuteDepartment of Surgery, Ekiti State University, Ado-Ekiti, Ekiti State, NigeriaDepartment of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, NigeriaAmarachuku ChiduziemEtonyeakuDepartment of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, NigeriaJoshua TayeIgeDepartment of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, NigeriaDavid BrownAjibolaDepartment of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, NigeriaJide MichaelAfolayanDepartment of Anaesthesia, Ekiti State University, Ado-Ekiti, Ekiti State, NigeriaEyitayo EbenezerEmmanuelDepartment of Epidemiology and Community Health, Ekiti State University, Ado-Ekiti, NigeriaJournal Article20180318Objective: There has been a global increase in the incidence of abdominal trauma in surgical patients. We conducted this study to evaluate the pattern of abdominal injuries, patient characteristics and the management outcome in our setting.<br />Methods: It was a descriptive (combined retrospective and prospective) study of all patients with abdominal trauma admitted and managed at Ekiti State University Teaching Hospital, Ado-Ekiti between January 2013 and December 2016. Data on socio-demographics, clinical profile, investigations, treatments and outcome were entered into a spread sheet and analyzed using SPSS version 20.0.<br />Results: A total of 2728 trauma patients presented during the study period. Of these, 68 (2.5%) suffered from abdominal injuries. Their ages ranged from 6 to 72 years (mean 30.3±13.2). Fifty-nine (86.8%) were males while 9 (13.2%) were females (M: F ratio = 6.6:1). Forty-nine (72.1%) sustained blunt trauma while 19 (27.9%) had penetrating injuries. Road traffic incident (RTI) (n=41; 60.3%) was the most common source of trauma, followed by assault: gunshot (n=9; 13.2%), and stab (n=7; 10.3%). Spleen (n=23; 33.8%) was the most common solid organ injured followed by the liver (n=7; 10.3%) while small bowel (n=8; 11.8%) was the most common hollow viscous injured. Forty-seven (69.1%) required operative intervention. Post-operative complication rate was 17% with wound infection (12.5%) predominating. The mortality rate was 4 (5.9%).<br />Conclusion: RTI and assault are major causes of abdominal injury. Measures to reduce RTI, youth restiveness and criminal activities will stem the tide.<br /><br />Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45444220180701Prevalence and pattern of hypertension and effect of body mass index on blood pressure in six communities of Biase LGA In Cross River, Nigeria73766271710.15171/jept.2018.04ENLawsonEkpeDepartment of Chemical Pathology, College of Medical Sciences, University of Calabar, Nigerialawsonekpe2002@yahooKingsleyOsujiDepartment of Chemical Pathology, Irrua Specialist Hospital, Irrua, NigeriaJournal Article20180407Objective: Hypertension is a major risk factor for stroke, renal failure, and heart failure globally. This trend of complications has been seen even among our rural and urban dwellers in the tropics. This study aims at determining the prevalence and pattern of hypertension and body mass index (BMI) in six rural communities in Southern Nigeria.<br />Methods: Adult participants, aged 18-80 years of age from six rural Biase communities who presented for a health screening were recruited. This was a rural community-based cross-sectional study involving 419 adults. Information was obtained from questionnaires which were administered to assess and obtain demographic data. Blood pressure and anthropometric indices were measured from participants to assess the BMI and risk factors associated with hypertension, and pattern of blood pressure.<br />Results: A total of 419 enrolled for the study, but 137 had hypertension (systolic blood pressure ≥140 mm Hg and diastolic blood pressure ≥90 mm Hg) and this was made up of 86 females (62.8%) and 51 males (37.2%). Only 29 of the hypertensives (21.1%) were aware of their condition. The prevalence of hypertension was 32.7%. Moderate hypertension was the commonest presentation. High blood pressure, obesity and overweight was common among the women folk compared to the men that had isolated systolic hypertension (P < 0.05).<br />Conclusion: In recent times, hypertension is seen to be high even in rural settings; hence strict screening should be enhanced to allow for quicker diagnosis and early intervention.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45444220180701Patients’ satisfaction towards medical services at the emergency department of European Gaza Hospital- Gaza Strip77816382110.15171/jept.2018.08ENHammodaAbu-OdahDepartment of Emergency, European Gaza Hospital, Gaza Strip, occupied Palestinian TerritoryAkramAbu SalahPalestine College of Nursing, El-Fukhari, Gaza Strip, occupied Palestinian TerritoryAliEl-KhateebNursing and Health Sciences Department, University Collage of Applied Sciences, Gaza Strip, occupied Palestinian TerritoryKhawlaEl-NemsMedical Military Rafah Clinic, Medical Services Directorate, Gaza Strip, occupied Palestinian TterritoryJournal Article20180619Objective: Patients’ satisfaction (PS) is recognized as an important emergency department service design and it has received a high interest and attention in the health management where many studies have focused on determining factors affecting PS in health-related circumstances. In this study, we aimed to examine PS in emergency department (ED) of the European Gaza Hospital (EGH) in the Gaza Strip (GS).<br />Methods: A descriptive-analytical cross sectional study was performed at ED-EGH between March, 15 and June 20, 2015. Press Ganey questionnaire was used as a tool for data collection. For each patient, a self-administered questionnaire including 22 questions was filled based on a Likert scale. Results were analyzed using SPSS version 22.<br />Results: Overall, 200 respondents were included in the study. About 73% of respondents were satisfied with overall medical services. The term of nurses’ concern provided to patients elicited the highest score (83.1%), followed by physicians’ concern with patients (72.0%) and communication skills with patients (71.4%), while the lowest score was reported in waiting time and security staff. Furthermore, our findings show an association between PS and level of education, gender differences, living area, and work shifts.<br />Conclusion: The study results conclude that areas of medical and nursing care, respects of staff, physical comfort and waiting time ED-EGH is highly acceptable and offer in appropriate manners.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45444220180701Tramadol abuse and shoulder dislocation82854595810.15171/jept.2017.15ENBehnamBehnushDepartment of Forensic Medicine and Toxicology, Tehran University of Medical Sciences, Tehran, IranRoyaKordrostamiDepartment of Forensic Medicine and Toxicology, Iran University of Medical Science, Tehran, IranNahidDadashzadehDepartment of Forensic Medicine and Toxicology, Iran University of Medical Science, Tehran, IranMaryamAmeriDepartment of Forensic Medicine and Toxicology, Iran University of Medical Science, Tehran, IranJournal Article20170225This study aimed to evaluate the shoulder dislocation following tramadol-induced seizure and its potential difference with other shoulder dislocations. We evaluated six cases that used tramadol tablets and some of them had a history of seizure. All of the cases had shoulder dislocation. According to the findings, tramadol use and tramadol-induced seizure may increase the risk of shoulder dislocation.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45444220180701Munchausen syndrome as scorpion biting:a misdiagnosis86884821310.15171/jept.2016.15ENRezaBidakiDepartment of Psychiatry, Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, IranDiabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IranMehrdadRoozbehStudent Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, IranMohamad AminSharifiStudent Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, IranSeyed NaderMostafaviDepartment of Forensic Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, IranMohammad AliAbdolkarimi DavaraniDepartment of Internal Medicine , Rafsanjan University of Medical Sciences, Rafsanjan, IranJournal Article20170710Factitious 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.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45444220180701Traumatic spinal epidural hematoma: an alarming and diagnostic challenge in the ED89916269110.15171/jept.2018.02ENKrishnaPrasadDepartment of Emergency Medicine, Pushpagiri Medical College Hospital, Thiruvalla, Kerala, IndiaSusanTharianDepartment of Emergency Medicine, Pushpagiri Medical College Hospital, Thiruvalla, Kerala, IndiaJebuA ThomasDepartment of Emergency Medicine, Pushpagiri Medical College Hospital, Thiruvalla, Kerala, IndiaJournal Article20180103Traumatic 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.