Objective: To demonstrate the significance of fused cervical vertebrae in emergency medicine practice. Case Presentation: A 35-year-old male was brought to the emergency department (ED) who attempted suicide by hanging and was later found to have congenital fusion of cervical vertebra C2 and C3, a condition referred to as - vertebra critica. This is the only case report of a patient with vertebra critica admitted for near hanging. The patient was intubated with a Portex® North Polar endotracheal tube (ETT) through the nasal route. This proved to be a critical decision as it helped early airway control avoiding any complication. Conclusion: As the victims of near-hanging should have cervical spine restriction, judicious use of flexible portex® ETT may help in early intubation and resuscitation without aggravating the neurological injuries. It must be noted that nasal intubation is contraindicated in base of skull fractures and it should be avoided in patients with obvious traumatic injury to the neck including laryngeal trauma, tracheal disruption and vessel injuries.
{"title":"Vertebra critica in a case of near-hanging","authors":"Z. Shaikh, V. Shinde, S. R. Shinde, J. Ughade","doi":"10.34172/jept.2022.21","DOIUrl":"https://doi.org/10.34172/jept.2022.21","url":null,"abstract":"Objective: To demonstrate the significance of fused cervical vertebrae in emergency medicine practice. Case Presentation: A 35-year-old male was brought to the emergency department (ED) who attempted suicide by hanging and was later found to have congenital fusion of cervical vertebra C2 and C3, a condition referred to as - vertebra critica. This is the only case report of a patient with vertebra critica admitted for near hanging. The patient was intubated with a Portex® North Polar endotracheal tube (ETT) through the nasal route. This proved to be a critical decision as it helped early airway control avoiding any complication. Conclusion: As the victims of near-hanging should have cervical spine restriction, judicious use of flexible portex® ETT may help in early intubation and resuscitation without aggravating the neurological injuries. It must be noted that nasal intubation is contraindicated in base of skull fractures and it should be avoided in patients with obvious traumatic injury to the neck including laryngeal trauma, tracheal disruption and vessel injuries.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42518988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shahram Paydar, A. Akbarzadeh, Ladan Nasermoadeli, Vahid Mohammadkarimi
Objective: The adherence of the physicians to guidelines in resuscitation of the patients is of great importance since it can predict the outcome. To evaluate the adherence of the physicians of our center in hydration of traumatic patients with crystalloids regarding the Advanced Trauma Life Support (ATLS) guidelines. Methods: We designed an algorithm obtained from ATLS guidelines using vital signs and status of bleeding of the traumatic patients to classify them. After categorizing the patients according to the algorithm, we evaluated the adherence of the physicians to the guideline in hydration of traumatic patients with crystalloids. Results: This is a cross-sectional study in which 998 traumatic patients who were admitted to the emergency ward of Rajaee trauma hospital were enrolled. Most of the patients were men (89.6%) and the most common causes of traumatic injuries were traffic accidents. Proper hydration was seen in only 14.7% of the patients. Most of the patients were overhydrated (85%) regarding both our algorithm and the patients’ base excess. Conclusion: The present study showed that the adherence of physicians in our center in resuscitation with crystalloid was low. Also, most of the traumatic patients were overhydrated with crystalloids. It is suggested that physicians retrain concerning the side effects of over hydration. In addition, we need a user friendly and more applicable guideline for hydration with crystalloids.
{"title":"Adherence to guideline in hydrating traumatic patients with crystalloid fluids: A single center experience from Southern Iran","authors":"Shahram Paydar, A. Akbarzadeh, Ladan Nasermoadeli, Vahid Mohammadkarimi","doi":"10.34172/jept.2022.22","DOIUrl":"https://doi.org/10.34172/jept.2022.22","url":null,"abstract":"Objective: The adherence of the physicians to guidelines in resuscitation of the patients is of great importance since it can predict the outcome. To evaluate the adherence of the physicians of our center in hydration of traumatic patients with crystalloids regarding the Advanced Trauma Life Support (ATLS) guidelines. Methods: We designed an algorithm obtained from ATLS guidelines using vital signs and status of bleeding of the traumatic patients to classify them. After categorizing the patients according to the algorithm, we evaluated the adherence of the physicians to the guideline in hydration of traumatic patients with crystalloids. Results: This is a cross-sectional study in which 998 traumatic patients who were admitted to the emergency ward of Rajaee trauma hospital were enrolled. Most of the patients were men (89.6%) and the most common causes of traumatic injuries were traffic accidents. Proper hydration was seen in only 14.7% of the patients. Most of the patients were overhydrated (85%) regarding both our algorithm and the patients’ base excess. Conclusion: The present study showed that the adherence of physicians in our center in resuscitation with crystalloid was low. Also, most of the traumatic patients were overhydrated with crystalloids. It is suggested that physicians retrain concerning the side effects of over hydration. In addition, we need a user friendly and more applicable guideline for hydration with crystalloids.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45054795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Balaji RajaRam, Sayan Nath, Supreet Kaur, D. Bagaria, R. Subramaniam, V. Rewari
{"title":"Late presentation of isolated caecal perforation following blunt abdominal trauma: The utility of point-of-care ultrasound","authors":"Balaji RajaRam, Sayan Nath, Supreet Kaur, D. Bagaria, R. Subramaniam, V. Rewari","doi":"10.34172/jept.2022.20","DOIUrl":"https://doi.org/10.34172/jept.2022.20","url":null,"abstract":"","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45124787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madhushri Vadhone Dinesh, A. Ramesh, Keshava Murthy M Rangaswamy, Hariprasad Kanakapura Veerendranath
Objective: Chest pain is amongst the most frequently occurring symptoms in patients presenting to the emergency department (ED). Accurate and fast risk stratification is paramount for identification of patients with immediate risk of acute coronary syndrome (ACS). The present study has compared different scoring systems like HEART (History, ECG, Age, Risk factors, Troponin), Thrombolysis in Myocardial Infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores and their efficacy in predicting incidence of major adverse cardiac events (MACE). Methods: The present prospective observational study was conducted on 199 patients who presented in the ED with complaint of chest pain. HEART, GRACE and TIMI scores were calculated with collected patient data which was further evaluated for efficacy by calculating area under ROC curves (AUCs). Data were analyzed by using R statistical software version 4.0.3 and Microsoft Excel. P value less than or equal to 0.05 indicates statistical significance. Results: In the current study, 76 (38%) patients reported MACE. The HEART score identified the largest number of patients as high risk 74 (37%) and among them 69 patients developed a MACE. The AUC of HEART score was the highest with 0.96 (95% CI: 0.93-0.98), followed by TIMI score with 0.815 (95% CI: 0.75-0.873) and the GRACE score with 0.814 (95% CI: 0.75- 0.813). The sensitivity of HEART score of ≥7 for MACE was found to be 90.78%, specificity was 95.96%, positive predictive value (PPV) was 93.24% and negative predictive value (NPV) was 94.4%. The sensitivity of GRACE score was 39.4%, specificity was 95.16%, PPV was 83.3% and NPV was 71.95%. The sensitivity of TIMI score was 30.2%, specificity was 95.96%, PPV was 82.14% and NPV was 69.18%. Conclusion: The HEART score showed higher efficacy in predicting risk levels in patients and incidence of MACE in comparison with GRACE and TIMI scores in the included study cohort.
{"title":"A prospective risk stratification and validation of HEART, GRACE and TIMI scores for chest pain patients presenting to the emergency department","authors":"Madhushri Vadhone Dinesh, A. Ramesh, Keshava Murthy M Rangaswamy, Hariprasad Kanakapura Veerendranath","doi":"10.34172/jept.2022.16","DOIUrl":"https://doi.org/10.34172/jept.2022.16","url":null,"abstract":"Objective: Chest pain is amongst the most frequently occurring symptoms in patients presenting to the emergency department (ED). Accurate and fast risk stratification is paramount for identification of patients with immediate risk of acute coronary syndrome (ACS). The present study has compared different scoring systems like HEART (History, ECG, Age, Risk factors, Troponin), Thrombolysis in Myocardial Infarction (TIMI), and Global Registry of Acute Coronary Events (GRACE) scores and their efficacy in predicting incidence of major adverse cardiac events (MACE). Methods: The present prospective observational study was conducted on 199 patients who presented in the ED with complaint of chest pain. HEART, GRACE and TIMI scores were calculated with collected patient data which was further evaluated for efficacy by calculating area under ROC curves (AUCs). Data were analyzed by using R statistical software version 4.0.3 and Microsoft Excel. P value less than or equal to 0.05 indicates statistical significance. Results: In the current study, 76 (38%) patients reported MACE. The HEART score identified the largest number of patients as high risk 74 (37%) and among them 69 patients developed a MACE. The AUC of HEART score was the highest with 0.96 (95% CI: 0.93-0.98), followed by TIMI score with 0.815 (95% CI: 0.75-0.873) and the GRACE score with 0.814 (95% CI: 0.75- 0.813). The sensitivity of HEART score of ≥7 for MACE was found to be 90.78%, specificity was 95.96%, positive predictive value (PPV) was 93.24% and negative predictive value (NPV) was 94.4%. The sensitivity of GRACE score was 39.4%, specificity was 95.16%, PPV was 83.3% and NPV was 71.95%. The sensitivity of TIMI score was 30.2%, specificity was 95.96%, PPV was 82.14% and NPV was 69.18%. Conclusion: The HEART score showed higher efficacy in predicting risk levels in patients and incidence of MACE in comparison with GRACE and TIMI scores in the included study cohort.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49471440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Dehghani, Nasrullah Rastegar Pouyani, Shahrad Tajaddini, Masoomeh Varzandeh
Objective: Snakes are among the predators of any ecosystem and have been seen in different parts of Iran. The report on their distribution in Isfahan province was taken into consideration because of the importance of regional knowledge of these animals. Case report: During this survey, a sample of snakes was collected from north of Isfahan province, Kashan city, the University site of Medical Sciences and the sample was studied. The snake was identified by morphological and habitat characteristics and compared to other photos and data. The specimen belonged to the Colubridae family and non-venomous snakes. This species is distributed in the tropical climatic zone of the province. The species of the tropical region of Kashan city was identified as Platyceps karelini. or spotted snake Conclusion: We identified the habitat of this animal in Kashan city in Isfahan province. By identifying the species of Spotted Desert Racer from the Colubridae family, the number of non-venomous snakes in Kashan reached eight species.
{"title":"Platyceps karelini a nonvenomous snake (Ophidia: Colubridae) from Kashan county (Isfahan–Iran)","authors":"R. Dehghani, Nasrullah Rastegar Pouyani, Shahrad Tajaddini, Masoomeh Varzandeh","doi":"10.34172/jept.2022.18","DOIUrl":"https://doi.org/10.34172/jept.2022.18","url":null,"abstract":"Objective: Snakes are among the predators of any ecosystem and have been seen in different parts of Iran. The report on their distribution in Isfahan province was taken into consideration because of the importance of regional knowledge of these animals. Case report: During this survey, a sample of snakes was collected from north of Isfahan province, Kashan city, the University site of Medical Sciences and the sample was studied. The snake was identified by morphological and habitat characteristics and compared to other photos and data. The specimen belonged to the Colubridae family and non-venomous snakes. This species is distributed in the tropical climatic zone of the province. The species of the tropical region of Kashan city was identified as Platyceps karelini. or spotted snake Conclusion: We identified the habitat of this animal in Kashan city in Isfahan province. By identifying the species of Spotted Desert Racer from the Colubridae family, the number of non-venomous snakes in Kashan reached eight species.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44868705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinely visited in emergency departments. Although most of these patients are managed with endoscopic modalities, some of them are managed with surgical interventions. Most of emergency surgical interventions are done via laparotomy. With evolution in minimal invasive 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 bleeding that was presented with melena and during workups no bleeding lesion was detected in colon, stomach or duodenum. Further investigations revealed bleeding of proximal jejunum mass that was resected with the laparoscopic approach which is rarely used in the emergency management of patients with gastrointestinal bleedings. Also, resection and anastomosis of proximal jejunal loop was challenging in this case. Conclusion: This report is intended to describe the feasibility of laparoscopy in proximal small bowel lesion resection in emergency settings as well as the role of computed tomography (CT) angiography in detecting the source of obscure gastrointestinal bleeding.
{"title":"Minimal invasive management of proximal small bowel bleeding: A case report and reviewing the evidences","authors":"M. Rezazadehkermani, S. Hosseini","doi":"10.34172/jept.2022.12","DOIUrl":"https://doi.org/10.34172/jept.2022.12","url":null,"abstract":"Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinely visited in emergency departments. Although most of these patients are managed with endoscopic modalities, some of them are managed with surgical interventions. Most of emergency surgical interventions are done via laparotomy. With evolution in minimal invasive 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 bleeding that was presented with melena and during workups no bleeding lesion was detected in colon, stomach or duodenum. Further investigations revealed bleeding of proximal jejunum mass that was resected with the laparoscopic approach which is rarely used in the emergency management of patients with gastrointestinal bleedings. Also, resection and anastomosis of proximal jejunal loop was challenging in this case. Conclusion: This report is intended to describe the feasibility of laparoscopy in proximal small bowel lesion resection in emergency settings as well as the role of computed tomography (CT) angiography in detecting the source of obscure gastrointestinal bleeding.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46385248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Awareness of the severity of trauma and the outcome of patients can help physicians decide how long to treat patients. The objective of this study is to design a new score (R-GAP: Revised-GCS, Age, Pressure) for multi-trauma patients and determine its predictive value concerning in-hospital outcome of these patients. Methods: This cross-sectional study was performed in the emergency ward of Imam Reza (AS) and Shohada hospitals (referral centers for trauma patients) affiliated to Tabriz University of Medical Sciences from 2019 to 2020. The sample size of this study was estimated to be 2000 people. Required information was collected and the final diagnosis of the patients was recorded. The hospital outcome was recorded at the time of discharge. Patients’ outcome was also recorded using the Glasgow Outcome Scale (GOS) system. Based on the obtained data, GAP, R-GAP, new trauma score (NTS) scores were also collected and their results were compared with the designed model. Receiver operating characteristic (ROC) curve and logistic regression were used to analyze the predictive value of the scores. Results: The mean age of the subjects was 34.09 (± 15.23) years. The highest outcome of patients based on the GOS system was recovery, moderate disability, and severe disability with 1309 cases (54.9%), 743 cases (31.2%), and 212 cases (8.9%), respectively. The mean of GAP, R-GAP, and NTS scores were 21.83 (± 3.1), 21.47 (± 3.4), and 21.27 (± 3.3), respectively. The intensity of GAP, R-GAP, and NTS in most subjects was low with 2143 cases (89.9%), 1994 cases (83.6%), and 2138 cases (89.7%). Among the significant variables included in the regression model, O2sat, primary GCS, GAP, R-GAP, and NTS with modulation on other variables, significantly equalized the mortality chance by 0.416, 0.622, 0.595, 0.601, 0.637, respectively (P value<0.001). Conclusion: According to the study results, it seems that GAP, R-GAP, and NTS respectively, have the highest strength of predictive value in the survival of patients with multiple traumas. It is suggested that a comprehensive study be conducted to better estimate this issue.
{"title":"A new method to predict the in-hospital outcome of multi-trauma patients: R-GAP","authors":"Pegah Sepehri Majd, Amirhossein Alimohammadi Siyabani, Haniyeh Ebrahimi Bakhtavar, F. Rahmani","doi":"10.34172/jept.2022.15","DOIUrl":"https://doi.org/10.34172/jept.2022.15","url":null,"abstract":"Objective: Awareness of the severity of trauma and the outcome of patients can help physicians decide how long to treat patients. The objective of this study is to design a new score (R-GAP: Revised-GCS, Age, Pressure) for multi-trauma patients and determine its predictive value concerning in-hospital outcome of these patients. Methods: This cross-sectional study was performed in the emergency ward of Imam Reza (AS) and Shohada hospitals (referral centers for trauma patients) affiliated to Tabriz University of Medical Sciences from 2019 to 2020. The sample size of this study was estimated to be 2000 people. Required information was collected and the final diagnosis of the patients was recorded. The hospital outcome was recorded at the time of discharge. Patients’ outcome was also recorded using the Glasgow Outcome Scale (GOS) system. Based on the obtained data, GAP, R-GAP, new trauma score (NTS) scores were also collected and their results were compared with the designed model. Receiver operating characteristic (ROC) curve and logistic regression were used to analyze the predictive value of the scores. Results: The mean age of the subjects was 34.09 (± 15.23) years. The highest outcome of patients based on the GOS system was recovery, moderate disability, and severe disability with 1309 cases (54.9%), 743 cases (31.2%), and 212 cases (8.9%), respectively. The mean of GAP, R-GAP, and NTS scores were 21.83 (± 3.1), 21.47 (± 3.4), and 21.27 (± 3.3), respectively. The intensity of GAP, R-GAP, and NTS in most subjects was low with 2143 cases (89.9%), 1994 cases (83.6%), and 2138 cases (89.7%). Among the significant variables included in the regression model, O2sat, primary GCS, GAP, R-GAP, and NTS with modulation on other variables, significantly equalized the mortality chance by 0.416, 0.622, 0.595, 0.601, 0.637, respectively (P value<0.001). Conclusion: According to the study results, it seems that GAP, R-GAP, and NTS respectively, have the highest strength of predictive value in the survival of patients with multiple traumas. It is suggested that a comprehensive study be conducted to better estimate this issue.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42779889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Hypothyroidism has many causes and manifestations in children. One of the causes is autoimmunity, which is known as autoimmune thyroiditis or Hashimoto thyroiditis. Pseudotumor cerebri is a rare manifestation of Hashimoto thyroiditis. Here we report a 10-year-old girl with asymptomatic papillary edema who was treated with levothyroxine and acetazolamide. Case Presentation: A 10-year-old girl suffered from left eye trauma while playing volleyball and went to an ophthalmology center due to redness in the same eye. During the examination, they noticed a bilateral optic disc swelling without ocular inflammation and the other eye examination was within normal limits. Encephalopathy may rarely occur during autoimmune thyroiditis, which is known as Hashimoto encephalopathy, and it is stated that the autoimmune disorder is not related to the thyroid dysfunction characterized by the symptoms of decreased level of consciousness and seizures. Conclusion: The diagnosis of hypothyroidism in children is usually made by examining the thyroid-stimulating hormone (TSH), and T4 in which TSH is elevated and T4 is decreased as in our patient.
{"title":"A 10-year-old girl with red eyes and hypothyroidism","authors":"Z. Ataee, Saeed Shokoohi-rad, S. Soleimanpour","doi":"10.34172/jept.2022.17","DOIUrl":"https://doi.org/10.34172/jept.2022.17","url":null,"abstract":"Objective: Hypothyroidism has many causes and manifestations in children. One of the causes is autoimmunity, which is known as autoimmune thyroiditis or Hashimoto thyroiditis. Pseudotumor cerebri is a rare manifestation of Hashimoto thyroiditis. Here we report a 10-year-old girl with asymptomatic papillary edema who was treated with levothyroxine and acetazolamide. Case Presentation: A 10-year-old girl suffered from left eye trauma while playing volleyball and went to an ophthalmology center due to redness in the same eye. During the examination, they noticed a bilateral optic disc swelling without ocular inflammation and the other eye examination was within normal limits. Encephalopathy may rarely occur during autoimmune thyroiditis, which is known as Hashimoto encephalopathy, and it is stated that the autoimmune disorder is not related to the thyroid dysfunction characterized by the symptoms of decreased level of consciousness and seizures. Conclusion: The diagnosis of hypothyroidism in children is usually made by examining the thyroid-stimulating hormone (TSH), and T4 in which TSH is elevated and T4 is decreased as in our patient.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43929401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abbas Edalatkhah, Fatemeh Samadi Khorshidi, Hamidreza Mohammadi, R. Hassannejad, Faezeh Jafari, Mohammad Lame, Amirhossein Zarepur, E. Zarepur
Objective: An outbreak of coronavirus disease 2019 (COVID-19) occurred in late 2019. A better understanding of this disease will help us in preventing and managing it. This study evaluated the risk factors and clinical and laboratory characteristics of patients admitted to Shahid Sadoughi hospital in Yazd with a diagnosis of COVID-19. Methods: This cross-sectional study was conducted on patients with the diagnosis of COVID-19 admitted to Shahid Sadoughi hospital in Yazd in May 2020, Iran. Patients’ clinical information, including their symptoms at admission, history of smoking or drug/ alcohol abuse, history of Td (tetanus, diphtheria) vaccine, radiographic/computed tomography (CT) scan findings, and blood oxygen saturation, was recorded. The patients were also asked about their previous history of diabetes, hypertension, autoimmune disorder, and cancer or history of diseases in heart, lung, liver, and thyroid. Laboratory findings, height, weight and body mass index of the patients were also recorded. Statistical analyses were performed using SPSS 21. Results: The mean age of 86 patients enrolled in the study was 61.40±17.37 years, of which 56 (65.11%) had mild pulmonary involvement and 30 (34.89%) had severe pulmonary involvement, according to CT scan results. Also, 26 (30.2%) of all patients had diabetes and about 30 (36%) had high blood pressure, but current smokers (6%) were rare. In patients with severe pulmonary involvement, the level of neutrophil, creatinine, and lactate dehydrogenase (LDH) was higher than patients with mild pulmonary involvement. Out of 56 patients with mild pulmonary involvement, 47 patients had a history of Td vaccination in the last 5 years. Only one patient in the severe group had a history of Td vaccination. Conclusion: A lower percentage of blood lymphocytes as well as higher levels of neutrophils, creatinine, and LDH were observed in patients with severe pulmonary involvement. Numerous factors, especially more prominent laboratory abnormalities, determine the severity of the disease, and a better understanding of these factors can help physicians know the severity of the disease and its prognosis. These findings help us to further clarify the characteristics of COVID-19. Also, the effect of Td vaccine should be investigated in future studies.
{"title":"Risk factors, clinical, and laboratory characteristics of patients with a diagnosis of COVID-19","authors":"Abbas Edalatkhah, Fatemeh Samadi Khorshidi, Hamidreza Mohammadi, R. Hassannejad, Faezeh Jafari, Mohammad Lame, Amirhossein Zarepur, E. Zarepur","doi":"10.34172/jept.2022.13","DOIUrl":"https://doi.org/10.34172/jept.2022.13","url":null,"abstract":"Objective: An outbreak of coronavirus disease 2019 (COVID-19) occurred in late 2019. A better understanding of this disease will help us in preventing and managing it. This study evaluated the risk factors and clinical and laboratory characteristics of patients admitted to Shahid Sadoughi hospital in Yazd with a diagnosis of COVID-19. Methods: This cross-sectional study was conducted on patients with the diagnosis of COVID-19 admitted to Shahid Sadoughi hospital in Yazd in May 2020, Iran. Patients’ clinical information, including their symptoms at admission, history of smoking or drug/ alcohol abuse, history of Td (tetanus, diphtheria) vaccine, radiographic/computed tomography (CT) scan findings, and blood oxygen saturation, was recorded. The patients were also asked about their previous history of diabetes, hypertension, autoimmune disorder, and cancer or history of diseases in heart, lung, liver, and thyroid. Laboratory findings, height, weight and body mass index of the patients were also recorded. Statistical analyses were performed using SPSS 21. Results: The mean age of 86 patients enrolled in the study was 61.40±17.37 years, of which 56 (65.11%) had mild pulmonary involvement and 30 (34.89%) had severe pulmonary involvement, according to CT scan results. Also, 26 (30.2%) of all patients had diabetes and about 30 (36%) had high blood pressure, but current smokers (6%) were rare. In patients with severe pulmonary involvement, the level of neutrophil, creatinine, and lactate dehydrogenase (LDH) was higher than patients with mild pulmonary involvement. Out of 56 patients with mild pulmonary involvement, 47 patients had a history of Td vaccination in the last 5 years. Only one patient in the severe group had a history of Td vaccination. Conclusion: A lower percentage of blood lymphocytes as well as higher levels of neutrophils, creatinine, and LDH were observed in patients with severe pulmonary involvement. Numerous factors, especially more prominent laboratory abnormalities, determine the severity of the disease, and a better understanding of these factors can help physicians know the severity of the disease and its prognosis. These findings help us to further clarify the characteristics of COVID-19. Also, the effect of Td vaccine should be investigated in future studies.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42119214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Intoxication is among the most common causes of emergency department (ED) visits. Activated charcoal is one of the useful treatments preventing poison absorption. However, nausea caused by using charcoal has made this substance less acceptable among patients. This study aims at investigating the influence of using cold charcoal on reducing the nausea among poisoned patients. Methods: This clinical experimental trial study approved by the Medical Ethics Committee of Regional School of Medicine of Mashhad University of Medical Sciences with the code 930106. Randomization was provided by Sealed Envelope. Accordingly, the experimental group received cold charcoal (4ᵒC), while the control group received room temperature charcoal (23ᵒC). We used the coding method in order to double blind the study. After half and one hour, nausea was checked in patients by visual numeric scale (VNS). Data were described by using descriptive and analytic test indices including frequency, mean ± standard deviation and suitable charts and tables. Results: The average age of participants was 25.83±7.05. The severity of nausea half an hour after consuming charcoal in cold charcoal group and experimental group was 1.3 and 2.73, respectively (P<0.001). One hour after consuming charcoal, the severity of nausea in cold charcoal group and experimental group was 0.39 and 1.38 (P<0.001). As indicated by the results of the study and after investigating the changing trend of nausea severity, nausea severity decreased in both groups by passing time from half to one hour (P<0.001). Conclusion: Cold charcoal can reduce the rate of nausea and make it more acceptable among patients.
{"title":"The influence of cold versus room temperature charcoal on reducing nausea of poisoned patients: A randomized clinical trial","authors":"Morteza Talebi Doluee, Bita Dadpoor, Behrang Rezvani Kakhki, V. Vakili, Elahe Barati, Elnaz Vafadar Moradi","doi":"10.34172/jept.2022.14","DOIUrl":"https://doi.org/10.34172/jept.2022.14","url":null,"abstract":"Objective: Intoxication is among the most common causes of emergency department (ED) visits. Activated charcoal is one of the useful treatments preventing poison absorption. However, nausea caused by using charcoal has made this substance less acceptable among patients. This study aims at investigating the influence of using cold charcoal on reducing the nausea among poisoned patients. Methods: This clinical experimental trial study approved by the Medical Ethics Committee of Regional School of Medicine of Mashhad University of Medical Sciences with the code 930106. Randomization was provided by Sealed Envelope. Accordingly, the experimental group received cold charcoal (4ᵒC), while the control group received room temperature charcoal (23ᵒC). We used the coding method in order to double blind the study. After half and one hour, nausea was checked in patients by visual numeric scale (VNS). Data were described by using descriptive and analytic test indices including frequency, mean ± standard deviation and suitable charts and tables. Results: The average age of participants was 25.83±7.05. The severity of nausea half an hour after consuming charcoal in cold charcoal group and experimental group was 1.3 and 2.73, respectively (P<0.001). One hour after consuming charcoal, the severity of nausea in cold charcoal group and experimental group was 0.39 and 1.38 (P<0.001). As indicated by the results of the study and after investigating the changing trend of nausea severity, nausea severity decreased in both groups by passing time from half to one hour (P<0.001). Conclusion: Cold charcoal can reduce the rate of nausea and make it more acceptable among patients.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48369074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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