Hamid Reza Moretza-Bagi, A. Ghaffarzad, Peyman Fathipour, R. Yazdani, Z. Khamnian, Sama Rahnemayan
Objective: Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators in teaching cricothyrotomy skills for emergency medicine residents. Methods: In this pre-post test study, all faculty member of emergency medicine of Tabriz University of medical sciences specialty were invited to participate. After holding an educational and training session for assistants on a teacher-made moulage, all emergency medicine residents performed a tracheostomy on the commercial moulages of the skill lab unit for the second time and their scores were recorded. Results: In this study, 23 emergency medicine residents participated. The mean±standard deviation of age was 35.91±3.57 years. There was a significant difference between the mean duration of cricothyrotomy before and after the training (P value=0.006). There was also a significant difference between the mean scores obtained by residents in the pre-and post-training evaluation (P value<0.001). Conclusion: Findings showed that the moulages constructed by teachers not only can be effective in improving the cricothyrotomy skills in emergency medicine residents but also can reduce the likelihood of failure in performing cricothyrotomy.
{"title":"The effect of teacher-made simulation moulage on learning cricothyrotomy skills in emergency medicine physicians","authors":"Hamid Reza Moretza-Bagi, A. Ghaffarzad, Peyman Fathipour, R. Yazdani, Z. Khamnian, Sama Rahnemayan","doi":"10.34172/JEPT.2021.10","DOIUrl":"https://doi.org/10.34172/JEPT.2021.10","url":null,"abstract":"Objective: Nowadays, simulation of clinical environment in medical education system (simulation-based learning) has led to a huge revolution in the quality of education and has increased the safety of educators and patients. In this study, we investigated the effect of teacher-made neck and lung simulators in teaching cricothyrotomy skills for emergency medicine residents. Methods: In this pre-post test study, all faculty member of emergency medicine of Tabriz University of medical sciences specialty were invited to participate. After holding an educational and training session for assistants on a teacher-made moulage, all emergency medicine residents performed a tracheostomy on the commercial moulages of the skill lab unit for the second time and their scores were recorded. Results: In this study, 23 emergency medicine residents participated. The mean±standard deviation of age was 35.91±3.57 years. There was a significant difference between the mean duration of cricothyrotomy before and after the training (P value=0.006). There was also a significant difference between the mean scores obtained by residents in the pre-and post-training evaluation (P value<0.001). Conclusion: Findings showed that the moulages constructed by teachers not only can be effective in improving the cricothyrotomy skills in emergency medicine residents but also can reduce the likelihood of failure in performing cricothyrotomy.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46688007","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: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations. Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm shaft fracture with ipsilateral DRUJ disruption. Operative intervention in the form of plating was done for both bones forearm shaft fracture and DRUJ was stabilised with one k wire and above elbow plaster splint in full supination was given for 6 weeks. At one-year follow-up, fracture was united and Disabilities of the Arm, Shoulder and Hand (DASH) score was 11.7, and he was well satisfied. Conclusion: DRUJ disruption should be carefully evaluated in all the patients with associated shaft fractures of radius and ulna. Timely diagnosis and optimal intervention may prevent any functional limitations.
{"title":"An unusual case of both bones forearm shaft fracture with ipsilateral distal radio-ulnar joint disruption","authors":"A. Sharma, A. Singhal, Anurag Patil, G. Masih","doi":"10.34172/jept.2021.12","DOIUrl":"https://doi.org/10.34172/jept.2021.12","url":null,"abstract":"Objective: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations. Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm shaft fracture with ipsilateral DRUJ disruption. Operative intervention in the form of plating was done for both bones forearm shaft fracture and DRUJ was stabilised with one k wire and above elbow plaster splint in full supination was given for 6 weeks. At one-year follow-up, fracture was united and Disabilities of the Arm, Shoulder and Hand (DASH) score was 11.7, and he was well satisfied. Conclusion: DRUJ disruption should be carefully evaluated in all the patients with associated shaft fractures of radius and ulna. Timely diagnosis and optimal intervention may prevent any functional limitations.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41734697","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}
Anita Sabzghabaei, Fariba Farahi, Masoud Ghanbari Boroujeni, H. Hatamabadi
Objective: The aim of this study was to determine the effect of an ultrasound training course on the performance of emergency medical technicians (EMTs) in terms of using extended-focused assessment with sonography in trauma (E-FAST) in the pre-hospital setting. Methods: In this quasi-experimental study, 107 EMTs affiliated to Shahid Beheshti and Kashan Universities of Medical Sciences, were randomly selected. At first, the EMTs were given a pre-test of five images concerning normal and abnormal ultrasound views of thoracic and abdominal cavities. Then, 6 hours of theoretical and practical sessions were done by emergency medicine specialists to teach the EMTs to use ultrasound for the detection of pneumothorax and free fluid. The EMTs were tested again in the form of 18 images post-test as well as a 13-item survey to evaluate their skills in taking correct 10 E-FAST. Results: A total of 107 EMTs with the mean age of 27±15.21 and average of 3.5 years work experience participated in this study. The mean of test score increased from 0.57± 0.19 to 0.81±0.08 (with P < 0.001) out of the total score of 100. In the 4-graded survey, 98% of EMTs obtained good to excellent grades in working with ultrasound machine. Also, 50.5% of EMTs were good in taking Morison’s view and 46.6% and 45.6% had medium grades in pericardial and splenorenal views, respectively. In addition, 22.3% had weak grades in taking pericardial views. Conclusion: The results of the present study showed that the implementation of the training course significantly improved the accuracy of free fluid detection in thoracic and abdominal cavities by EMTs.
{"title":"The effect of a short ultrasound training course on the performance of emergency medical technicians in terms of using extended-focused assessment with sonography in trauma (E-FAST) in the pre-hospital setting","authors":"Anita Sabzghabaei, Fariba Farahi, Masoud Ghanbari Boroujeni, H. Hatamabadi","doi":"10.34172/JEPT.2021.09","DOIUrl":"https://doi.org/10.34172/JEPT.2021.09","url":null,"abstract":"Objective: The aim of this study was to determine the effect of an ultrasound training course on the performance of emergency medical technicians (EMTs) in terms of using extended-focused assessment with sonography in trauma (E-FAST) in the pre-hospital setting. Methods: In this quasi-experimental study, 107 EMTs affiliated to Shahid Beheshti and Kashan Universities of Medical Sciences, were randomly selected. At first, the EMTs were given a pre-test of five images concerning normal and abnormal ultrasound views of thoracic and abdominal cavities. Then, 6 hours of theoretical and practical sessions were done by emergency medicine specialists to teach the EMTs to use ultrasound for the detection of pneumothorax and free fluid. The EMTs were tested again in the form of 18 images post-test as well as a 13-item survey to evaluate their skills in taking correct 10 E-FAST. Results: A total of 107 EMTs with the mean age of 27±15.21 and average of 3.5 years work experience participated in this study. The mean of test score increased from 0.57± 0.19 to 0.81±0.08 (with P < 0.001) out of the total score of 100. In the 4-graded survey, 98% of EMTs obtained good to excellent grades in working with ultrasound machine. Also, 50.5% of EMTs were good in taking Morison’s view and 46.6% and 45.6% had medium grades in pericardial and splenorenal views, respectively. In addition, 22.3% had weak grades in taking pericardial views. Conclusion: The results of the present study showed that the implementation of the training course significantly improved the accuracy of free fluid detection in thoracic and abdominal cavities by EMTs.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47295923","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}
L. Bansal, Raja Bhanukiran, P. Chaudhary, Arun Gupta
Objective: Penetrating abdominal trauma secondary to bamboo stick injury is a rare entity in the developed world. Most of such kind of trans abdominal penetrating bamboo stick injury is associated with multiple solid and hollow viscus injuries. In developing countries like India, where nearly 70% of the population reside in rural areas, it is not that uncommon. Aim of this report is to recognition of risk factors and explain optimum surgical management in trans-abdominal bamboo stick injury. Case Presentation: Here we describe a case of penetrating trans abdominal bamboo stick injury resulting due to fall over a branch of bamboo stick with multiorgan damage, which was successfully managed by early surgical exploration in our institute. Conclusion: There are many factors which can prognosticate the penetrating trauma cases. The most important factors include a long interval between injury and surgical exploration, presence or absence of shock, and other associated organ injuries at the time of admission. Early recognition of the severity of injury with surgical management is utmost necessary. These patients have high morbidity and mortality rates due to multiorgan damage and post-operative infection.
{"title":"Penetrating trans-abdominal bamboo stick injury: An unusual case report","authors":"L. Bansal, Raja Bhanukiran, P. Chaudhary, Arun Gupta","doi":"10.34172/JEPT.2021.04","DOIUrl":"https://doi.org/10.34172/JEPT.2021.04","url":null,"abstract":"Objective: Penetrating abdominal trauma secondary to bamboo stick injury is a rare entity in the developed world. Most of such kind of trans abdominal penetrating bamboo stick injury is associated with multiple solid and hollow viscus injuries. In developing countries like India, where nearly 70% of the population reside in rural areas, it is not that uncommon. Aim of this report is to recognition of risk factors and explain optimum surgical management in trans-abdominal bamboo stick injury. Case Presentation: Here we describe a case of penetrating trans abdominal bamboo stick injury resulting due to fall over a branch of bamboo stick with multiorgan damage, which was successfully managed by early surgical exploration in our institute. Conclusion: There are many factors which can prognosticate the penetrating trauma cases. The most important factors include a long interval between injury and surgical exploration, presence or absence of shock, and other associated organ injuries at the time of admission. Early recognition of the severity of injury with surgical management is utmost necessary. These patients have high morbidity and mortality rates due to multiorgan damage and post-operative infection.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45874106","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}
E. Noori, M. Vahedian, S. Rezvan, Neda Minaei, Reihane Tabaraii
Objective: Since the outbreak of coronavirus disease 2019 (COVID-19), the triage of patients diagnosed with corona virus has been a very important issue. The aim of this study was to introduce a triage scoring system according to the clinical and para-clinical findings of patients in order to be admitted or discharged with COVID-19. Methods: After confirming the positive polymerase chain reaction (PCR) test for patients, we used a scoring system which included: the age of patient (less than 40 years and>40 years), early vital signs at the time of admission, lab tests including C-reactive protein (CRP), white blood count (WBC), lactate dehydrogenase (LDH), D-dimer, chest imaging findings, comorbidity and shortness of breath. Results: The clinical score obtained for each variable in this scoring system was a number between 0 and 3. The total score was a minimum of 0 and a maximum of 17. A higher score indicated an increase in the intensity and the need for intensive care. These scores were classified into 3 groups: 0-4, 5-10 and above 10. In the next stage, patients were divided into three groups: mild, moderate and severe. In this regard, patients with mild symptoms were suggested to receive home quarantine and home treatment, patients with moderate symptoms were recommended hospitalization and medical care, and finally patients with severe symptoms were inclined to intensive care. Conclusion: In order to treat and manage patients with COVID-19, it is necessary to pay particular attention to clinical and para-clinical findings and prioritize these findings based on the severity and the condition of patients.
{"title":"The proposed scoring system for hospitalization or discharge of patients with COVID-19","authors":"E. Noori, M. Vahedian, S. Rezvan, Neda Minaei, Reihane Tabaraii","doi":"10.34172/JEPT.2021.08","DOIUrl":"https://doi.org/10.34172/JEPT.2021.08","url":null,"abstract":"Objective: Since the outbreak of coronavirus disease 2019 (COVID-19), the triage of patients diagnosed with corona virus has been a very important issue. The aim of this study was to introduce a triage scoring system according to the clinical and para-clinical findings of patients in order to be admitted or discharged with COVID-19. Methods: After confirming the positive polymerase chain reaction (PCR) test for patients, we used a scoring system which included: the age of patient (less than 40 years and>40 years), early vital signs at the time of admission, lab tests including C-reactive protein (CRP), white blood count (WBC), lactate dehydrogenase (LDH), D-dimer, chest imaging findings, comorbidity and shortness of breath. Results: The clinical score obtained for each variable in this scoring system was a number between 0 and 3. The total score was a minimum of 0 and a maximum of 17. A higher score indicated an increase in the intensity and the need for intensive care. These scores were classified into 3 groups: 0-4, 5-10 and above 10. In the next stage, patients were divided into three groups: mild, moderate and severe. In this regard, patients with mild symptoms were suggested to receive home quarantine and home treatment, patients with moderate symptoms were recommended hospitalization and medical care, and finally patients with severe symptoms were inclined to intensive care. Conclusion: In order to treat and manage patients with COVID-19, it is necessary to pay particular attention to clinical and para-clinical findings and prioritize these findings based on the severity and the condition of patients.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47894369","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: Systemic toxemia with topical anesthetics could be fatal due to the use of anesthetics in various ways (oral, intravenous, intramuscular, or subcutaneous). Nowadays, topical anesthetics are used in inpatient and outpatient treatments. Despite its widespread usage, many physicians are not fully aware of the deadly side effects of lidocaine poisoning and its treatment. The objective of this case report is to highlight the diagnosis and treatment of lidocaine toxicity. Case Presentation: A 21-year-old woman with a history of multiple suicide attempts ingested approximately three 10% w/w lidocaine sprays. The patient was brought to the emergency department of Imam Reza hospital of Mashhad University of Medical Science with cardiac arrest and respiratory failure. After successful cardiopulmonary resuscitation (CPR), she was admitted to the intensive care unit (ICU). She stayed in ICU for 2 days and we administered dobutamine drip and intravenous lipid emulsion for her then she was transferred to the general ward. We discharged her after 8 days. Conclusion: Using BCLS and ACLS in case of cardiac arrest and administration of Lipid Emulsion with proper dosage are recommended treatments for lidocaine toxicity.
{"title":"Oral ingestion of lidocaine for suicide: A case report","authors":"Maryam Adimolmasali, Alireza Teimouri, Hamid Reza Mokhtar, Mahdi Foroughian, Parvin Zohoorian Sadr, Mohammad Hossein Kamaloddini","doi":"10.34172/JEPT.2020.42","DOIUrl":"https://doi.org/10.34172/JEPT.2020.42","url":null,"abstract":"Objective: Systemic toxemia with topical anesthetics could be fatal due to the use of anesthetics in various ways (oral, intravenous, intramuscular, or subcutaneous). Nowadays, topical anesthetics are used in inpatient and outpatient treatments. Despite its widespread usage, many physicians are not fully aware of the deadly side effects of lidocaine poisoning and its treatment. The objective of this case report is to highlight the diagnosis and treatment of lidocaine toxicity. Case Presentation: A 21-year-old woman with a history of multiple suicide attempts ingested approximately three 10% w/w lidocaine sprays. The patient was brought to the emergency department of Imam Reza hospital of Mashhad University of Medical Science with cardiac arrest and respiratory failure. After successful cardiopulmonary resuscitation (CPR), she was admitted to the intensive care unit (ICU). She stayed in ICU for 2 days and we administered dobutamine drip and intravenous lipid emulsion for her then she was transferred to the general ward. We discharged her after 8 days. Conclusion: Using BCLS and ACLS in case of cardiac arrest and administration of Lipid Emulsion with proper dosage are recommended treatments for lidocaine toxicity.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41785018","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}
Saeedeh Derhami, Ehsan Bolvardi, R. Akhavan, Mahdi Foroughian, Behzad Shahi, Arman Hakemi, Z. Rahmanian, S. Abiri
Objective: Acute poisoning is a major health problem and one of the most common causes of emergency visits worldwide. Since most poisoning subjects present with a decreased level of consciousness and due to unreliable disease history, recognizing the etiological cause of the poisoning represents a critical part in arranging the treatment strategy. This study aimed at examining the prevalence of etiological causes of poisoning in Iran in a systematic review and meta-analysis. Method: This systematic review and meta-analysis investigated the cross-sectional studies published from 1990 to 2020, reporting specific poisoning agents among acute poisoning cases in Iran. Persian and English articles on this subject were collected by searching the Scientific Information Database (SID), ScienceDirect, PubMed, Medlib, IranMedex, Scopus, Magiran, and Google Scholar databases. The heterogeneity of the studies was investigated using the I2 index and the probability of bias in the publication was assessed by the Begg and Mazumdar test with a significance level of 0.1. Data analysis was performed by Comprehensive Meta-analysis software version 3 (Biostat, Englewood, NJ, USA). Results: In our review, 19 studies appraising 143,251 cases of poisoning were included. The ranking of the OR of each agent was done; Opium poisoning was the most prevalent poisoning case followed by benzodiazepine, acetaminophen, antipsychotic medications, organophosphates, aluminum phosphide, amphetamine, pesticide, tricyclic antidepressant (TCA), alcohol, chemicals, carbon monoxide (CO), nonsteroidal anti-inflammatory drugs (NSAIDs), and selective serotonin reuptake inhibitors (SSRIs). Conclusion: While proper judgment on the cause of poisoning and selection of suitable treatment manners could be followed by a very good prognosis in patients with acute poisoning; this demands an epidemiological perception of the prevalence of the etiological poisoning agents. Our study ranked the most likely agents leading to the poisoning, to be at the top of the list of differential diagnoses of physicians.
{"title":"Ranking the acute poisoning etiologies in Iran: A systematic review and meta-analysis","authors":"Saeedeh Derhami, Ehsan Bolvardi, R. Akhavan, Mahdi Foroughian, Behzad Shahi, Arman Hakemi, Z. Rahmanian, S. Abiri","doi":"10.34172/JEPT.2020.40","DOIUrl":"https://doi.org/10.34172/JEPT.2020.40","url":null,"abstract":"Objective: Acute poisoning is a major health problem and one of the most common causes of emergency visits worldwide. Since most poisoning subjects present with a decreased level of consciousness and due to unreliable disease history, recognizing the etiological cause of the poisoning represents a critical part in arranging the treatment strategy. This study aimed at examining the prevalence of etiological causes of poisoning in Iran in a systematic review and meta-analysis. Method: This systematic review and meta-analysis investigated the cross-sectional studies published from 1990 to 2020, reporting specific poisoning agents among acute poisoning cases in Iran. Persian and English articles on this subject were collected by searching the Scientific Information Database (SID), ScienceDirect, PubMed, Medlib, IranMedex, Scopus, Magiran, and Google Scholar databases. The heterogeneity of the studies was investigated using the I2 index and the probability of bias in the publication was assessed by the Begg and Mazumdar test with a significance level of 0.1. Data analysis was performed by Comprehensive Meta-analysis software version 3 (Biostat, Englewood, NJ, USA). Results: In our review, 19 studies appraising 143,251 cases of poisoning were included. The ranking of the OR of each agent was done; Opium poisoning was the most prevalent poisoning case followed by benzodiazepine, acetaminophen, antipsychotic medications, organophosphates, aluminum phosphide, amphetamine, pesticide, tricyclic antidepressant (TCA), alcohol, chemicals, carbon monoxide (CO), nonsteroidal anti-inflammatory drugs (NSAIDs), and selective serotonin reuptake inhibitors (SSRIs). Conclusion: While proper judgment on the cause of poisoning and selection of suitable treatment manners could be followed by a very good prognosis in patients with acute poisoning; this demands an epidemiological perception of the prevalence of the etiological poisoning agents. Our study ranked the most likely agents leading to the poisoning, to be at the top of the list of differential diagnoses of physicians.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48308704","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}
Javad Mesbahi, S. Shadnia, H. Hassanian‐Moghaddam, N. Zamani, Peyman Erfan Talab Evini, Delara Hazegh Fetratjoo, A. Kargar, Mitra Rahimi
Objective: Delirium is one of the most common complications in patients admitted to intensive care units (ICUs). Delirium is a definite cause for more extended hospital stays, higher mortality rates, and possibly persistent cognitive decline in the future. Antipsychotics have been frequently evaluated as first drugs of choice, but the most appropriate, evidence-based treatment is yet to be discovered. This study aims to compare the efficacy of haloperidol and olanzapine in patients admitted to our toxicology ICU. Methods: This double-blind, randomized controlled clinical trial was undertaken on 35 ICU admitted patients with delirium in Loghman Hakim hospital in Tehran, Iran. The diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria for delirium, and clinical toxicologists included the patients according to the study’s inclusion and exclusion criteria. Patients received either haloperidol or olanzapine based on computerized randomization. The severity of delirium was measured with the Memorial Delirium Assessment Scale (MDAS) scoring on days 0 and 3 of ICU-admission. Results: The total sample size was 35 in which 16 patients received haloperidol, and 19 patients received olanzapine. The doses of haloperidol and olanzapine were 3 mg three times a day and 5 mg three times a day, respectively. There was no significant difference in baseline characteristics and the scores of MDAS between groups. Conclusion: Olanzapine and haloperidol have the same efficacy in the management of delirium in toxicology ICU-admitted patients. They can be interchangeably used for delirium treatment in these patients.
{"title":"Delirium treatment in intoxicated patients in ICU: A randomized, double-blind clinical trial","authors":"Javad Mesbahi, S. Shadnia, H. Hassanian‐Moghaddam, N. Zamani, Peyman Erfan Talab Evini, Delara Hazegh Fetratjoo, A. Kargar, Mitra Rahimi","doi":"10.34172/JEPT.2020.41","DOIUrl":"https://doi.org/10.34172/JEPT.2020.41","url":null,"abstract":"Objective: Delirium is one of the most common complications in patients admitted to intensive care units (ICUs). Delirium is a definite cause for more extended hospital stays, higher mortality rates, and possibly persistent cognitive decline in the future. Antipsychotics have been frequently evaluated as first drugs of choice, but the most appropriate, evidence-based treatment is yet to be discovered. This study aims to compare the efficacy of haloperidol and olanzapine in patients admitted to our toxicology ICU. Methods: This double-blind, randomized controlled clinical trial was undertaken on 35 ICU admitted patients with delirium in Loghman Hakim hospital in Tehran, Iran. The diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria for delirium, and clinical toxicologists included the patients according to the study’s inclusion and exclusion criteria. Patients received either haloperidol or olanzapine based on computerized randomization. The severity of delirium was measured with the Memorial Delirium Assessment Scale (MDAS) scoring on days 0 and 3 of ICU-admission. Results: The total sample size was 35 in which 16 patients received haloperidol, and 19 patients received olanzapine. The doses of haloperidol and olanzapine were 3 mg three times a day and 5 mg three times a day, respectively. There was no significant difference in baseline characteristics and the scores of MDAS between groups. Conclusion: Olanzapine and haloperidol have the same efficacy in the management of delirium in toxicology ICU-admitted patients. They can be interchangeably used for delirium treatment in these patients.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48074672","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}
Raheleh Faramarzi, M. Sharifi, E. Moradi, B. Alizadeh
Objective: Partial dislocation of radius head (pulled elbow) is the most common trauma observed in out-patient orthopedic treatment of children. The typical mechanism of this trauma includes exertion of longitudinal force along the forearm in a pronation position, causing partial dislocation of the radius head. Methods: This Retrospective descriptive and cross-sectional study was undertaken on patients referring to the emergency ward of Imam Reza hospital of Mashhad with typical history of partial dislocation of radius head (pulled elbow). The present study was conducted between March 20, 2018 and March 20, 2019. Based on the number of patients at the emergency ward, the sample size was determined to be 80. Descriptive statistics such as mean and standard deviation were used to describe the collected data. Results: From among 80 children diagnosed with partial radius bone dislocation, 66.23% were girls and 33.77% were boys. The age range of patients was 28.08 months for girls and 31.04 months for boys. Findings also showed that 32 patients had a history of recent respiratory infection within 1 week before the pulled elbow incident. Conclusion: Findings revealed that, similar to previous studies, the pulled elbow injury was more common in girls than in boys. Successful reduction in first and second attempts, notwithstanding the maneuvers used indicated that the success rate of first attempts at reduction was 93%. The history of recent respiratory infections during 1 week before the injury was taken into account, where 40% of the children had some history of such respiratory infections.
{"title":"Underlying causes of pulled elbow in children: Could there be a physiopathology similar to transient synovitis of the hip?","authors":"Raheleh Faramarzi, M. Sharifi, E. Moradi, B. Alizadeh","doi":"10.34172/JEPT.2020.39","DOIUrl":"https://doi.org/10.34172/JEPT.2020.39","url":null,"abstract":"Objective: Partial dislocation of radius head (pulled elbow) is the most common trauma observed in out-patient orthopedic treatment of children. The typical mechanism of this trauma includes exertion of longitudinal force along the forearm in a pronation position, causing partial dislocation of the radius head. Methods: This Retrospective descriptive and cross-sectional study was undertaken on patients referring to the emergency ward of Imam Reza hospital of Mashhad with typical history of partial dislocation of radius head (pulled elbow). The present study was conducted between March 20, 2018 and March 20, 2019. Based on the number of patients at the emergency ward, the sample size was determined to be 80. Descriptive statistics such as mean and standard deviation were used to describe the collected data. Results: From among 80 children diagnosed with partial radius bone dislocation, 66.23% were girls and 33.77% were boys. The age range of patients was 28.08 months for girls and 31.04 months for boys. Findings also showed that 32 patients had a history of recent respiratory infection within 1 week before the pulled elbow incident. Conclusion: Findings revealed that, similar to previous studies, the pulled elbow injury was more common in girls than in boys. Successful reduction in first and second attempts, notwithstanding the maneuvers used indicated that the success rate of first attempts at reduction was 93%. The history of recent respiratory infections during 1 week before the injury was taken into account, where 40% of the children had some history of such respiratory infections.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45447812","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: To evaluate the predictive and diagnostic accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in acute kidney injury (AKI) and also to predict the renal replacement therapy (RRT) using NGAL as a marker. Methods: This prospective study was conducted among the patients admitted to intensive care units. Plasma samples were collected 24 hours after admission and NGAL was measured using Triage® NGAL test, a specific point of care test which is based on the mechanism of fluorescence immunoassay. The diagnostic accuracy of plasma NGAL (pNGAL) to predict AKI in critically ill patients of ICU was assessed by applying receiver operator curve (ROC) analysis and calculating the area under the curve (AUC). Results: In this study, 100 patients with the mean age of 49.56±19.2 years were included for the period of 18 months. The blood samples were withdrawn from the patients 24 and 44 hours after admission. Totally, 55% (n=55) of ICU patients were diagnosed with AKI. Plasma NGAL level was significantly increased in AKI patients as compared to non-AKI patients (742.65±734.72 vs. 255.62±440.09 μg/L; P<0.01). The sensitivity and specificity of NGAL for diagnosing AKI was 83.6% and 88.9%, respectively. The overall diagnostic accuracy was 86%. Diagnostic accuracy of NGAL for requirement of RRT was 51%. Conclusion: Plasma NGAL is a reliable marker for patients with AKI in ICU, in case the cause of kidney injury is not known. In addition, NGAL also predicts the RRT need based on AKI severity.
目的:评价中性粒细胞明胶酶相关脂钙素(NGAL)对急性肾损伤(AKI)的预测和诊断准确性，并以NGAL为指标预测肾替代治疗(RRT)。方法:本前瞻性研究在重症监护病房住院患者中进行。入院后24小时采集血浆样本，使用Triage®NGAL测试测量NGAL，这是一种基于荧光免疫测定机制的特定护理点测试。应用受试者操作曲线(receiver operator curve, ROC)分析并计算曲线下面积(area under The curve, AUC)，评价血浆NGAL (pNGAL)对ICU危重患者AKI的诊断准确性。结果:本研究纳入100例患者，平均年龄49.56±19.2岁，时间18个月。分别于入院后24小时和44小时抽取患者血样。共有55% (n=55)的ICU患者被诊断为AKI。AKI患者血浆NGAL水平显著高于非AKI患者(742.65±734.72∶255.62±440.09 μg/L;P < 0.01)。NGAL诊断AKI的敏感性和特异性分别为83.6%和88.9%。总体诊断准确率为86%。NGAL对RRT要求的诊断准确率为51%。结论:在肾损伤原因不明的情况下，血浆NGAL是ICU AKI患者的可靠标志物。此外，NGAL还可根据AKI严重程度预测RRT需求。
{"title":"Diagnostic relevance of neutrophil gelatinase-associated lipocalin in early detection of acute kidney injury","authors":"Madhusudhan Mahadevaiah, Murali Mohan Nidasale Thimmaiah, Venu Sashank Yerramsetty, J. Kumar, Ranjith Kumar","doi":"10.34172/JEPT.2020.38","DOIUrl":"https://doi.org/10.34172/JEPT.2020.38","url":null,"abstract":"Objective: To evaluate the predictive and diagnostic accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in acute kidney injury (AKI) and also to predict the renal replacement therapy (RRT) using NGAL as a marker. Methods: This prospective study was conducted among the patients admitted to intensive care units. Plasma samples were collected 24 hours after admission and NGAL was measured using Triage® NGAL test, a specific point of care test which is based on the mechanism of fluorescence immunoassay. The diagnostic accuracy of plasma NGAL (pNGAL) to predict AKI in critically ill patients of ICU was assessed by applying receiver operator curve (ROC) analysis and calculating the area under the curve (AUC). Results: In this study, 100 patients with the mean age of 49.56±19.2 years were included for the period of 18 months. The blood samples were withdrawn from the patients 24 and 44 hours after admission. Totally, 55% (n=55) of ICU patients were diagnosed with AKI. Plasma NGAL level was significantly increased in AKI patients as compared to non-AKI patients (742.65±734.72 vs. 255.62±440.09 μg/L; P<0.01). The sensitivity and specificity of NGAL for diagnosing AKI was 83.6% and 88.9%, respectively. The overall diagnostic accuracy was 86%. Diagnostic accuracy of NGAL for requirement of RRT was 51%. Conclusion: Plasma NGAL is a reliable marker for patients with AKI in ICU, in case the cause of kidney injury is not known. In addition, NGAL also predicts the RRT need based on AKI severity.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45443173","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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