Journal of Emergency Practice and Trauma

Abstract Every journal finds its fundamentals in the course of time by the validity and originality of its published literature. This is validated if authors keep diligence and honesty when they conduct their research and submit their work in a journal. But at times what comes out of a scientific research is not always valid and reliable because there has not been an appropriate control on the work or researchers did not thoroughly conduct and report the results. Thus, it is very important that journals keep an increasingly close eye for the detection of scientific misconduct.  

Abstract Objective: Renal colic is a common cause of emergency room visits. Due to the spontaneous passage of more than 90% of kidney stones, treatment in the emergency department (ED) is limited to pain control. Analgesics currently used are selected based on physician experiences and various theories from different sources. The aim of this study was to compare the common drugs (pethidine and diclofenac) used for renal colic in Iran.  Methods: In this single-blinded randomized clinical trial, 90 patients with renal colic who referred to the ED of Imam Reza hospital in Kermanshah were randomly assigned to each of 3 treatments including pethidine suppository (50 mg, iv), diclofenac suppository (50 mg), and a combination of pethidine and diclofenac suppository. In this regard, the response to treatment and duration of hospitalization were compared.  Results: The best medicine to relieve pain intensity in patients under 25 years was diclofenac suppository. In patients in the age range of 25-45 years, pethidine and diclofenac were the best choice. Conversely, in patients older than 45 years, pethidine was the best treatment. We could also observe a decrease in the length of hospitalization in patients who received pethidine.   Conclusion: It can be concluded that morphine is more appropriate to control pain and reduce the length of hospitalization in patients with renal colic.   Clinical Trial Registration: irct.ir Identifier: IRCT20101214538  

Abstract Objective: To evaluate the capability of ascitic fluid dipstick results for pH, glucose, and protein in order to predict a low serum-ascites albumin gradient (SAAG) at the bedside of the patient in the emergency department (ED).
Methods: This prospective cross-sectional study was conducted during one year in the ED of Afzalipour hospital in Kerman, Iran. All patients with diagnostic or therapeutic paracentesis of ascitic fluid were considered as eligible patients. Exclusion criteria included clinical suspicion for spontaneous bacterial peritonitis (SBP), any contraindications to paracentesis, and patients’ refusal to participate in the study. Dipstick values were obtained at the bedside, and SAAG was calculated after the determination of serum and ascitic fluid albumin by laboratory. A low SAAG ascitic fluid was defined as the study outcome. We also used our study population as a test group to evaluate an equation proposed in one previous study: K = 0.012 Protein−0.012 Glucose−3.329 pH+23.498
Results: A total of 50 patients were enrolled in the study. Based on multivariate regression analysis, dipstick values for protein and glucose were independently predictive of a low SAAG ascitic fluid (P = 0.23, OR = 1.04; and P = 0.001, OR = 0.81, respectively). The formula proposed in one of the previous studies was tested by our data set, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at 84%, 83%, 84%, and 80%, respectively.
Conclusion: Dipstick test of ascitic fluid for pH, glucose, and protein has an acceptable sensitivity and specificity as a point of care test, but it cannot be recommended as a substitute for SAAG determination based on the current findings.

Abstract Objective: Low back pain is the most common skeletal disorder worldwide that 50% to 80% of people experience it at least once in their lifetime. Physical and psychological factors in the work environment can relatively contribute to low back pain. In this study, we examined the prevalence of low back pain and influential factors in its development among nursing staff.  
Methods: In this cross-sectional study we assessed the prevalence of low back pain among nurses working in Poursina hospital, Rasht, Iran, during March and April 2012. Demographic data and information on the status of skeletal pain, as well as, associated factors were collected using a pre-designed check list. Data were analyzed using SPSS version 16.  
Results: A total of 350 nurses with a mean age of 32.00 ± 8.24 years (minimum 22 and maximum 56 years) were studied (90.3% female). 246 participants (70.3%) had a history of low back pain. There was no significant difference between gender and the incidence of low back pain, (P = 0.286). 96 participants (27.4%) aged 27 to 31 had the highest rate of low back pain and 11 participants (3.1%) aged 52 to 56 were the least frequent age group. Low back pain significantly differed by age (P = 0.001), body mass index (BMI) (P = 0.222), and physical activity (P = 0.050).  
Conclusion: The results of this study showed a prevalence of 70% for low back pain among nurses working in Poursina hospital in Rasht, in Gilan province. Age, BMI, and physical activity were significantly associated with the prevalence of low back pain. However, gender, occupation, marital status, smoking, family history, frequency of lifting heavy things, work experience, and workplace did not show a significant relationship  

Abstract Objective:  Patient satisfaction is one of the most important indicators for measuring the quality of emergency services and health care. The purpose of this study was to evaluate the patients’ satisfaction in the emergency department (ED) of Sina hospital.
Methods: This descriptive, cross-sectional study was performed during one month in Sina hospital in 2014. Data were collected by a questionnaire which its validity and reliability were confirmed in previous studies. The questionnaire consisted of 2 parts. Part 1 included the demographic characteristics and part 2 encompassed the scales of satisfactory. Data analysis was conducted by SPSS version 15.
Results: Totally, 425 patients participated in this study. The mean age of patients was 41.6±17.6 years. The mean total score of patient satisfaction was 17.43±1.56. The maximum satisfaction was related to the knowledge of physicians and the minimum satisfaction was related to the remaining period in the ED. Additionally, there was a desirable satisfaction for nurses’ performances. In terms of satisfaction regarding the physical environment and the workflow of the ED, the results were moderate. There was a significant statistical difference regarding nurses and physicians behavior in the ED during different working shifts, vacation days, and workdays. Conclusion: Based on the results obtained, patients had good satisfaction for the received services in the ED. It is necessary to develop physical spaces and improve the workflow of patients in the ED.

Abstract Objective: One of nonsteroidal anti-inflammatory drugs (NSAIDs) named as ketorolac is frequently used to relieve acute pain. Current study was conducted with the aim of ketorolac efficacy measurement as a pain killer agent for controlling the primary headache in emergency departments.
Methods: In this study, we enrolled 50 patients with primary headache who received 60 mg ketorolac intravenously as a slow infusion in about 10 minutes. Pain scores were evaluated with visual analog scale (VAS) on arrival and also 1 hour and 2 hours after ketorolac infusion. Statistical analysis was performed on collected data by using Wilcoxon and Mann-Whitney tests to assess the differences in VAS pain scores. Results: Decreasing the VAS more than 3 points from the arrival until 1 hour (P < 0.001), and more than 5 points from the arrival until 2 hours after ketorolac administration (P < 0.001) were seen. Those with history of analgesic use before admission in emergency department in comparison with the others did not accompany with more decline in pain score after 1 hour (P = 0.34) or 2 hours (P = 0.92).
Conclusion: It seems that ketorolac is assured, safe and well tolerated agent for pain control in patients presented with primary headache to the emergency departments. Based on the results achieved in this study, ketorolac illustrates its perceptible effects within 1 hour after administration that even more prominent after 2 hours.

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 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.

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 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.