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Final triage methods to decide on home-isolation versus hospitalization in COVID-19 pandemic: a challenge for clinicians 在COVID-19大流行期间决定家庭隔离还是住院的最终分类方法:对临床医生的挑战
Q3 Nursing Pub Date : 2020-09-23 DOI: 10.34172/JEPT.2020.37
Mojtaba Miladinia, F. Abolnezhadian, J. Voss, Kourosh Zarea, N. Hatamzadeh, Mandana, Ghanavati
Objective: Final patient triage determines which patients can be home-isolated and which patients require hospitalization on the basis to predict the patient’s prognosis most accurately. Final triage is an important link in the clinical management chain of the coronavirus disease 2019 (COVID-19) pandemic, and a comprehensive review of various patient triage methods is very important to guide decision making and triage efficiency. Decision by clinicians about hospitalization or home-discharge is one of the main challenges in places with limited hospital facilities compared to the high volume of COVID-19 patients. This review was designed to guide clinicians on how to address this challenge. Methods: In this mini review we searched scientific databases to obtain the final triage methods of COVID-19 patients and the important criteria in each method. In order to conducted searches a period from December 2019 to July 2020 was considered. All searches were done in electronic databases and search engines. Results: Findings revealed four current methods for final triage (decision-making regarding home-isolation or hospitalization of COVID-19 patients). These methods included 1) demographic and background information, 2) clinical information, 3) laboratory indicators and 4) initial chest CT-scan. Each of the aforementioned methods encompassed significant criteria according to which decisions on the patient’s prognosis and final triage were made. Finally, by evaluating each final triage method, we found that each method had some limitations. Conclusion: An effective and quick final triage requires simultaneous complementary use of all four methods to compensate for each other’s weaknesses and add to each other’s strengths. It is therefore suggested to assure that clinicians are trained in all four COVID-19 patient’s triage methods and their useful criteria in order to achieve evidence-based performance for better triage (decision between home-isolation versus hospitalization).
目的:在最准确预测患者预后的基础上,最终患者分诊确定哪些患者可以居家隔离,哪些患者需要住院治疗。最终分诊是2019冠状病毒病(新冠肺炎)大流行临床管理链中的重要一环,全面回顾各种患者分诊方法对于指导决策和分诊效率非常重要。与大量新冠肺炎患者相比,临床医生关于住院或家庭出院的决定是医院设施有限的地方面临的主要挑战之一。这篇综述旨在指导临床医生如何应对这一挑战。方法:在这篇小型综述中,我们搜索了科学数据库,以获得新冠肺炎患者的最终分诊方法以及每种方法中的重要标准。为了进行搜索,考虑了2019年12月至2020年7月的时间段。所有搜索都是在电子数据库和搜索引擎中进行的。结果:研究结果揭示了目前最终分诊的四种方法(关于新冠肺炎患者居家隔离或住院的决策)。这些方法包括1)人口统计学和背景信息,2)临床信息,3)实验室指标和4)初步胸部CT扫描。上述每一种方法都包含了重要的标准,根据这些标准来决定患者的预后和最终分诊。最后,通过评估每种最终分诊方法,我们发现每种方法都有一些局限性。结论:有效快速的最终分诊需要同时互补使用所有四种方法,以弥补彼此的弱点,增加彼此的优势。因此,建议确保临床医生接受新冠肺炎患者的所有四种分诊方法及其有用标准的培训,以实现循证表现,从而更好地进行分诊(在家庭隔离与住院之间做出决定)。
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引用次数: 1
Medical errors during COVID-19 pandemic: the role of emergency medicine 新冠肺炎大流行期间的医疗差错:急诊医学的作用
Q3 Nursing Pub Date : 2020-09-10 DOI: 10.34172/JEPT.2020.28
S. Rahmani, Kosar Deldar, Sara Hemati Ali
Objective: Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic. Case Presentation: We report 5 cases that missed triage or received delayed diagnosis because of COVID-19 suspicion. Some cases are life threatening. Conclusion: Although COVID-19 is the main health concern these days, other critical conditions should be considered. Stabilizing patients before transferring them between hospitals should be the essential goal of emergency department whether the patient is Corona virus infected or not. And before any intervention, the safety of healthcare workers must be ensured.
目的:目前,世界上许多国家都与新冠肺炎有关,新增病例和死亡人数都在上升。急诊医学和医生主导的分诊在这一时期的作用非常重要。我们在我们的学术中心报告了一些与此次疫情有关的未遂病例。病例介绍:我们报告了5例因怀疑新冠肺炎而错过分诊或延迟诊断的病例。有些病例会危及生命。结论:尽管新冠肺炎是目前主要的健康问题,但应考虑其他严重情况。无论患者是否感染了冠状病毒,在医院之间转移患者之前稳定患者应该是急诊科的基本目标。在进行任何干预之前,必须确保医护人员的安全。
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引用次数: 1
Trauma in pregnant women: an experience from a level 1 trauma center 孕妇的创伤:来自一级创伤中心的经验
Q3 Nursing Pub Date : 2020-06-16 DOI: 10.34172/jept.2020.20
M. Gillani, S. Saqib, R. Martins, H. Zafar
Objective: Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger. It is expected to complicate around 1 in 12 pregnancies and accounts for 46% of such deaths. In this study, we present our experience of trauma during pregnancy at a tertiary care hospital in Karachi. Methods: A standardized form was used to extract data from online records for all pregnant women who presented with traumatic injuries to the Aga Khan University Hospital from 2014 to 2019. Analysis was performed using SPSS v. 21. Chi-squared tests were performed for comparison of categorical data. Results: A total of 48 pregnant females with a mean age of 28.80 ± 6.50 years were included in this study. Road traffic accidents (RTA) accounted for the commonest cause of injury in the first (66.7%) and second (65%) trimesters. However, fall (45.5%) followed by RTA (27.3%) was the most frequent mechanism of injury during the third trimester. Gunshot injuries were seen in 4 patients only. Overall, fetal ultrasound was the most commonly performed imaging (87.5%) followed by limb X-ray and focused abdominal sonography for trauma (FAST) ultrasound. Out of total, 52.1% of the patients were surgically managed. Fetal demise in utero and spontaneous abortion was reported in 2 patients only. Conclusion: Road traffic accidents and falls comprise a significant burden of maternal and fetal morbidity and mortality. In terms of prevention, several policies and interventions at the government level need to be introduced in order to reduce the incidence of traumatic events.
目的:创伤是35岁及以下妇女孕产妇死亡的重要非产科原因。预计这将使大约1/12的妊娠复杂化,占此类死亡的46%。在这项研究中,我们介绍了我们在卡拉奇一家三级护理医院怀孕期间的创伤经历。方法:使用标准化表格从2014年至2019年在阿加汗大学医院出现创伤性损伤的所有孕妇的在线记录中提取数据。使用SPSS v.21进行分析。进行卡方检验以比较分类数据。结果:本研究共纳入48名孕妇,平均年龄28.80±6.50岁。道路交通事故(RTA)是上半年(66.7%)和下半年(65%)最常见的伤害原因。然而,跌倒(45.5%)和RTA(27.3%)是妊娠晚期最常见的损伤机制。只有4名患者出现枪伤。总体而言,胎儿超声是最常见的影像学检查(87.5%),其次是肢体X光检查和腹部聚焦超声检查(FAST)。在总数中,52.1%的患者接受了手术治疗。仅2例患者报告了胎儿宫内死亡和自然流产。结论:道路交通事故和跌倒是孕产妇和胎儿发病率和死亡率的重要负担。在预防方面,需要在政府一级采取一些政策和干预措施,以减少创伤事件的发生率。
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引用次数: 1
A study of the factors associated with non-traumatic intracerebral hemorrhage (ICH) in patients with chronic systemic hypertension 慢性全身性高血压患者非外伤性脑出血(ICH)相关因素研究
Q3 Nursing Pub Date : 2020-06-02 DOI: 10.34172/jept.2020.15
Mozhgan Taghizadeh, Mahdi Foroughian, Hamidreza Vakili, Seyed Reza Habibzadeh, R. Boostani, N. Morovatdar, Ehsan Bolvardi
Objective: Intracerebral hemorrhage (ICH) following systemic and chronic hypertension is one of the main causes of acute stroke leading to disability and death. Identifying the risk factors in ICH patients can be effective in reducing bleeding and the rates of mortality and disability in these patients. This study was carried out to investigate the factors associated with ICH. Methods: A total of 134 patients with chronic systemic hypertension who had ICH were enrolled in this study. The amount of ICH was measured through computed tomography (CT scan). The subjects were divided into two groups of high (>30 mL) and low (<30 mL) ICH volume, and the related risk factors in the two groups were studied and compared using SPSS software version 21. Results: The mean age of the subjects was 66.04 years, and 71 (52.99%) individuals were females. The mean volume of ICH was 24.47 mL, with 29.10% of the subjects (39 patients) having >30 mL and 70.90% (95 patients) having <30 mL of ICH. The results of studying ICHrelated factors in the multiple logistic regression showed that ischemic heart disease (IHD) (odds ratio [OR] = 2.243, P value <0.05) and cardiovascular disease (OR = 3.294, P value <0.05) were the co-existing diseases that increased the odds of developing ICH. Conclusion: The results of this study showed that less than 30% of the subjects had high volumes of bleeding, and the co-existence of IHD was considered as a strong independent risk factor affecting the volume of ICH associated with worse prognosis.
目的:脑出血(ICH)是引起全身和慢性高血压的急性脑卒中致残和死亡的主要原因之一。确定脑出血患者的危险因素可有效减少出血,降低这些患者的死亡率和致残率。本研究旨在探讨脑出血的相关因素。方法:对134例合并脑出血的慢性全身性高血压患者进行研究。通过计算机断层扫描(CT)测量脑出血的量。将受试者分为脑出血高(30ml)和低(30ml)两组,70.90%(95例)患者脑出血< 30ml。多元logistic回归分析ICH相关因素的结果显示,缺血性心脏病(IHD)(比值比[OR] = 2.243, P值<0.05)和心血管疾病(OR = 3.294, P值<0.05)是增加ICH发生几率的共存疾病。结论:本研究结果显示,不到30%的受试者存在高出血量,IHD的共存被认为是影响ICH出血量的一个较强的独立危险因素,且预后较差。
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引用次数: 0
Painless aortic dissection with slurred speech (Neurologic symptom) 无痛性主动脉夹层伴口齿不清(神经系统症状)
Q3 Nursing Pub Date : 2020-05-27 DOI: 10.34172/JEPT.2020.18
E. R. Dost, Saeed Barazandehpour, N. Kalani, S. Abiri
Objective: Aortic dissection is an uncommon disorder with a high mortality rate, especially if misdiagnosis and mistreatment are not considered. Case Presentation: We present a 67-year old female with slurred speech and left sided plegia during her brother’s funeral. The patient did not have any chest pain. she was referred to our emergency department by EMS due to being suspicious of cerebrovascular accident (CVA) )as code 724). However, owing to low blood pressure and atypical symptoms of the patient, we did RUSH exam in the emergency department to detect aortic dissection. After doing the Computed tomography (CT) angiography, the diagnosis of aortic dissection was confirmed. As the vascular surgeon was not present in our surgery department, we transferred the patient to Namazi hospital by air ambulance to undergo the surgery. She was discharged from hospital with complete recovery.Conclusion: Aortic dissection symptoms can be manifested in different ways such as pulmonary embolism, ACS, and CVA. Therefore, clinicians must always have the differential diagnosis of aortic dissection in their mind and be aware of its various manifestations.
目的:主动脉夹层是一种罕见的疾病,死亡率很高,尤其是在不考虑误诊和误治的情况下。案例介绍:我们介绍一位67岁的女性,她在哥哥的葬礼上口齿不清,左侧瘫痪。病人没有任何胸痛。由于怀疑脑血管意外(CVA),她被EMS转诊到我们的急诊科(代码724)。然而,由于患者血压低,症状不典型,我们在急诊科做了RUSH检查,以检测主动脉夹层。在做了计算机断层扫描(CT)血管造影术后,确认了主动脉夹层的诊断。由于血管外科医生不在我们的外科,我们用空中救护车将患者转移到Namazi医院接受手术。她出院后完全康复。结论:主动脉夹层症状可表现为肺栓塞、急性冠脉综合征和CVA。因此,临床医生必须时刻牢记主动脉夹层的鉴别诊断,并意识到其各种表现。
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引用次数: 1
COVID-19 epidemic: What happens to other routine patients admitted in the emergency department? 新冠肺炎疫情:急诊科收治的其他常规患者会发生什么?
Q3 Nursing Pub Date : 2020-05-27 DOI: 10.34172/jept.2020.19
S. Rahmani
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引用次数: 2
Pediatric upper gastrointestinal bleeding in children: etiology and treatment approaches 儿童上消化道出血:病因和治疗方法
Q3 Nursing Pub Date : 2020-04-13 DOI: 10.34172/jept.2020.10
E. Polat, Nevzat Aykut Bayrak, G. Kutluk, H. Civan
Objective: Upper gastrointestinal bleeding (UGB) is one of the most important and serious cause of emergency admission in childhood. The aim of the study was to evaluate the etiological factors and the treatment approaches in patients with UGB. Methods: In this retrospective study, children with UGB admitted to emergency clinics of Istanbul Health Sciences University Kanuni Sultan Suleyman Research and Training Hospital, Istanbul Bakirkoy Sadi Konuk Research and Training Hospital and Diyarbakir Children’s Hospital were evaluated between January 2014 and August 2017. Results: Of the 198 children, 14.6% had non-steroid anti-inflammatory drug (NSAID) history, and 12.6% had chronic liver disease. We detected esophagitis, esophagus varices and peptic ulcer with upper gastrointestinal endoscopic evaluation (47%, 11.1%, 18.1%, respectively). Helicobacter pylori was found in 61.6% of patients. Endoscopic therapeutic procedures (band ligation therapy, sclerotherapy, and adrenaline injection) were appied in 11.1% of patients. Eighty-four (42.4%) patients were hospitalized, and erythrocyte transfusion (ET) was ordered in 29 (14.6%) patients. Conclusion: Approximately in 20% of the pediatric patients, the source of gastrointestinal bleeding is the upper gastrointestinal system. The cause of UGB varies with age. Appropriate diagnostic and therapeutic approaches are very important for management and to reduce mortality.
目的:上消化道出血(UGB)是儿童急诊入院最重要、最严重的原因之一。本研究的目的是评估UGB患者的病因和治疗方法。方法:在这项回顾性研究中,对2014年1月至2017年8月期间入住伊斯坦布尔卫生科学大学Kanuni Sultan Suleyman研究与培训医院、伊斯坦布尔Bakirkoy Sadi Konuk研究与训练医院和迪亚巴克尔儿童医院急诊室的UGB儿童进行了评估。结果:198名儿童中,14.6%有非甾体抗炎药(NSAID)病史,12.6%有慢性肝病。我们在上消化道内镜评估中发现了食道炎、食道静脉曲张和消化性溃疡(分别为47%、11.1%和18.1%)。幽门螺杆菌检出率为61.6%。11.1%的患者采用了内镜治疗程序(结扎带治疗、硬化治疗和肾上腺素注射)。84名(42.4%)患者住院,29名(14.6%)患者要求进行红细胞输注。结论:大约在20%的儿科患者中,胃肠道出血的来源是上消化道系统。UGB的病因因年龄而异。适当的诊断和治疗方法对于管理和降低死亡率非常重要。
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引用次数: 0
Non-visible penetrating brain trauma: a case report 不可见穿透性脑外伤1例报告
Q3 Nursing Pub Date : 2019-11-13 DOI: 10.15171/jept.2019.20
R. Varutti, A. Mosca, N. Latronico
Objective: One of the most frequent causes of death and acquired disability in the pediatric population is the Traumatic Brain Injury (TBI). TBI is secondary to falls, road traffic and vehicle collisions, child abuse and assaults. Penetrating brain injury is a severe form of traumatic brain injury. Blunt head injury is more frequent than TBI in children, but the second one carries a poor prognosis and a worse outcomes. Case Presentation: We report a pediatric case of penetrating craniofacial trauma, caused by a pencil in to the eye, and the successful of multidisciplinary management. Conclusion: Traumatic head injuries in children are frequently seen in the emergency ward, but the penetrating head injuries are unusual in young children. This case shows the importance of the ‘first golden hour’ after head trauma. The collaboration between team members, added to a promptly and invasive strategy, allowed to reduce neurological sequelae.
目的:外伤性脑损伤(TBI)是儿童死亡和获得性残疾最常见的原因之一。创伤性脑损伤仅次于跌倒、道路交通和车辆碰撞、虐待儿童和袭击。穿透性脑损伤是一种严重的创伤性脑损伤。钝性脑损伤在儿童中比TBI更常见,但后者预后较差,预后更差。病例介绍:我们报告了一例小儿穿透性颅面外伤,由铅笔进入眼睛引起,并成功地进行了多学科治疗。结论:儿童创伤性颅脑损伤在急诊科较为常见,但穿透性颅脑损伤在幼儿中并不常见。这个案例显示了头部创伤后“第一个黄金小时”的重要性。团队成员之间的合作,加上迅速和侵入性的策略,可以减少神经系统后遗症。
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引用次数: 0
A case report of an isolated traumatic dental injury in an 8-year-old child 个案报告一个孤立的创伤性牙齿损伤在一个8岁的孩子
Q3 Nursing Pub Date : 2019-10-09 DOI: 10.15171/JEPT.2019.18
Seyed Reza Habibzadeh, Hamid Zamani Moghadam, N. Mehramiz, Mahdi Foroughian
Objective: Anterior teeth are of utmost importance with regard to chewing, speaking, and beauty. Therefore, any traumatic dental injury has psychologically undesirable effects on children and their parents. The present study reported a case of a traumatic dental injury induced by falling off a bike and referral to an emergency department as well as measures taken for dental reconstruction and patient’s improvement.Case Presentation: An 8-year-old child was taken to an emergency department due to falling off a bike following imbalance, while suffering from dental pain in his upper jaw due to dental subluxation. Afterwards, dental retaining paste along with a fixer wire was used to maintain the position of the teeth. The patient also received oral non-steroidal analgesia (acetaminophen) for proper control of the pain and was subsequently referred to a dentist to repair the teeth. The initial examinations revealed that the child was fully conscious. Considering the patient’s severe pain and intrusion of the superior left primary first tooth and the subluxation of the superior right primary first tooth. Local anesthesia was performed using 1% lidocaine in the location of the given teeth using infiltration technique. Then they were brought into an alignment by extracting the plunged tooth and the child was referred to a dentist for advanced dental trauma care.Conclusion: Dentists are not always present in hospital emergency departments; therefore, an emergency medicine specialist should be able to diagnose common traumatic dental injuries in order to manage them appropriately at the early stages, and if necessary, refer patients to dentists for further complementary treatments. This important fact will bedone after full examination and ruling out critical causes of trauma in the emergency department.
目的:前牙对于咀嚼、说话和美容至关重要。因此,任何创伤性牙齿损伤都会对儿童及其父母产生不良的心理影响。本研究报告1例因骑脚踏车而导致的外伤性牙齿损伤,转诊至急诊科,并采取措施重建牙齿及改善病人的情况。病例介绍:一名8岁儿童因不平衡而从自行车上摔下,同时由于牙齿半脱位而导致上颌牙痛,被送往急诊室。然后,使用牙固定膏和固定线来保持牙齿的位置。患者还接受了口服非甾体镇痛药(对乙酰氨基酚)以适当控制疼痛,随后转介给牙医修复牙齿。初步检查显示孩子完全清醒。考虑到患者疼痛严重,左上第一乳牙侵入,右上第一乳牙半脱位。用1%利多卡因局部麻醉,采用牙浸润法。然后,他们通过拔牙来矫正牙齿,孩子被转到牙医那里进行高级牙齿创伤护理。结论:牙医并不总是出现在医院急诊科;因此,急诊医学专家应该能够诊断常见的创伤性牙齿损伤,以便在早期阶段适当地处理它们,并在必要时将患者转介给牙医进行进一步的补充治疗。这一重要事实将在急诊科进行全面检查并排除创伤的关键原因后才能确定。
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引用次数: 0
A brief review of some strange and unusual poisoning in children 简要回顾一些奇怪和不寻常的儿童中毒
Q3 Nursing Pub Date : 2019-10-03 DOI: 10.15171/JEPT.2019.17
Mohammad Hossein Kamaloddini, A. Ghamsari, B. Dadpour
The Clinical Toxicology Center in Imam Reza hospital in Mashhad is the referral center of poisonings in the East of Iran and many cases of poisoned children are referred to this center and some cases are admitted.In this letter we report some specific, strange and unusual poisonings in children admitted in our center.
马什哈德伊玛目礼萨医院的临床毒理学中心是伊朗东部的中毒转诊中心,许多中毒儿童病例被转诊到该中心,有些病例被收治。在这封信中,我们报告了一些特殊的,奇怪的和不寻常的中毒在我们中心入院的儿童。
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引用次数: 0
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Journal of Emergency Practice and Trauma
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