{"title":"Quiz in Emergency Medicine","authors":"","doi":"10.5005/njem-11015-0007","DOIUrl":"https://doi.org/10.5005/njem-11015-0007","url":null,"abstract":"","PeriodicalId":508269,"journal":{"name":"Journal of the Association of Physicians of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139186320","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}
Ankur Verma, Sanjay Jaiswal, Amit Batra, Abbas A Khatai, Nilesh Prasad, Saumya Khard, Shivani Sarda
Acute aortic dissection (AAD) masquerading as ischaemic stroke can be a challenging diagnosis for clinicians and can pose complications for the patient. Type A dissections extending into the vessels of the brain and neck can cause cerebral hypoperfusion leading to strokes or stroke-like symptoms. Thrombolysis of ischaemic strokes caused due to aortic dissection can be catastrophic for the patient. We present a series of two cases of aortic dissection presenting as strokes which were thrombolysed and underwent surgical intervention for dissection but did not suffer catastrophic complications. We do not recommend to rule out dissection in acute stroke patients before thrombolysis.
伪装成缺血性中风的急性主动脉夹层（AAD）对临床医生来说是一个具有挑战性的诊断，并可能给患者带来并发症。延伸至脑部和颈部血管的 A 型夹层可引起脑灌注不足，导致中风或类似中风的症状。主动脉夹层导致的缺血性中风的溶栓治疗对患者来说可能是灾难性的。我们介绍了两例以中风为表现的主动脉夹层病例，这两例患者均接受了溶栓治疗，并因主动脉夹层接受了手术干预，但没有出现灾难性并发症。我们不建议急性中风患者在溶栓前排除夹层。
{"title":"Aortic Dissection Presenting as Acute Ischaemic Stroke and Thrombolysed: A Case Series","authors":"Ankur Verma, Sanjay Jaiswal, Amit Batra, Abbas A Khatai, Nilesh Prasad, Saumya Khard, Shivani Sarda","doi":"10.5005/njem-11015-0010","DOIUrl":"https://doi.org/10.5005/njem-11015-0010","url":null,"abstract":"Acute aortic dissection (AAD) masquerading as ischaemic stroke can be a challenging diagnosis for clinicians and can pose complications for the patient. Type A dissections extending into the vessels of the brain and neck can cause cerebral hypoperfusion leading to strokes or stroke-like symptoms. Thrombolysis of ischaemic strokes caused due to aortic dissection can be catastrophic for the patient. We present a series of two cases of aortic dissection presenting as strokes which were thrombolysed and underwent surgical intervention for dissection but did not suffer catastrophic complications. We do not recommend to rule out dissection in acute stroke patients before thrombolysis.","PeriodicalId":508269,"journal":{"name":"Journal of the Association of Physicians of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139186309","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}
{"title":"Emergency Medicine Academics in India: A Roadmap for Future","authors":"S. Ts","doi":"10.5005/njem-11015-0008","DOIUrl":"https://doi.org/10.5005/njem-11015-0008","url":null,"abstract":"","PeriodicalId":508269,"journal":{"name":"Journal of the Association of Physicians of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139186622","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}
Aortic dissection (AD) is a relatively uncommon, rare disorder and potentially misdiagnosed disease. Early diagnosis and treatment is required for the patient's survival. Aortic dissection can be fatal if misdiagnosed. A 50-year-old adult male presented to emergency with acute chest pain and having a medical history of aortic stenosis post-aortic valve replacement 9 months back and a family history of ischaemic heart disease. Pain was relieved by analgesics. After further investigations by echocardiography and CT Angiography, it was diagnosed as AD Standford type A and DeBakey type 1, in view of the critical nature of illness, patient attenders wanted only medical management. The patient was declared dead after 2 days of diagnosis.
主动脉夹层（AD）是一种相对不常见的罕见疾病，也是一种可能被误诊的疾病。为了患者的生存，必须及早诊断和治疗。如果被误诊，主动脉夹层可能会致命。一名 50 岁的成年男性因急性胸痛急诊就诊，病史为主动脉瓣置换术后主动脉瓣狭窄 9 个月，家族史为缺血性心脏病。止痛药缓解了疼痛。经过超声心动图和 CT 血管造影的进一步检查，诊断为 AD Standford A 型和 DeBakey 1 型，鉴于病情危重，病人的主治医生只希望进行药物治疗。患者在确诊两天后宣告死亡。
{"title":"What May Stand Behind Chest Pain: A Case Report on Aortic Dissection","authors":"Aishwarya A, Nilu Sunil","doi":"10.5005/njem-11015-0004","DOIUrl":"https://doi.org/10.5005/njem-11015-0004","url":null,"abstract":"Aortic dissection (AD) is a relatively uncommon, rare disorder and potentially misdiagnosed disease. Early diagnosis and treatment is required for the patient's survival. Aortic dissection can be fatal if misdiagnosed. A 50-year-old adult male presented to emergency with acute chest pain and having a medical history of aortic stenosis post-aortic valve replacement 9 months back and a family history of ischaemic heart disease. Pain was relieved by analgesics. After further investigations by echocardiography and CT Angiography, it was diagnosed as AD Standford type A and DeBakey type 1, in view of the critical nature of illness, patient attenders wanted only medical management. The patient was declared dead after 2 days of diagnosis.","PeriodicalId":508269,"journal":{"name":"Journal of the Association of Physicians of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139186415","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}
Background: Cardiopulmonary resuscitation (CPR) is one of the most evolving areas of saving actions that improve the survival rates following cardiac arrest and educating high school students can play a dynamic role in case of emergencies in society. Education of school students in CPR is a strategic goal for the improvement of bystander CPR in rural society. If adolescents were trained to perform CPR during school physical education hours, this may be a cost-effective approach to CPR training. This study is conducted to assess the effectiveness of health education in the improvement of knowledge of CPR among school-going adolescents. Aim: To assess the effect of a training program on students’ knowledge of CPR. Objective: (A) To determine the background knowledge of high school students about cardiac arrest and basic life support in adult victims of cardiac arrest. (B) To determine the association between knowledge of cardiopulmonary resuscitation and skills with selected demographic variables. Materials and methods: This is a quasi-experimental study conducted among adolescents aged 13–15 years attending schools in rural areas of South India. The study was conducted between Jan 2022 and Jan 2023. 680 students were included in this study. The universal sampling method was used to enumerate the participants to reduce the impact of the dropout rate. The data was collected using a pre-tested semi-structured questionnaire by interview method. Basic teaching of CPR for the participants included 2 hours of oral teaching using lecture method, question and answer discussion method as well as 2 hours of practical session using demonstration, practice on a manikin, provision of feedback and correction of errors. Results: A total of 680 participants were grouped into three categories according to their knowledge scores: (A) fair, (B) Moderate, and (C) Good scores obtained in pre-training observation and post-training observation. Initially, there were 666 (97.9%) in the fair category, most of them improved after training as seen in the post-training observation results, with 97 (14.3%) persons in the fair (A) category. There was not a single student in the good category of the score before intervention, which increased to 665 (45.6%) in the good category of knowledge. The mean score of pre-training is 2.55, and the post-training score is significantly increased to 9.5. Conclusion: An improvement is observed in knowledge of CPR post-training with planned teaching and demonstration. Hence, this method can be considered a logical solution for improving knowledge about CPR in cases of emergency life-saving skills in a particular group of society.
{"title":"Effectiveness of Teaching and Demonstration in Improvement of Knowledge and Skill on CPR among School-going Adolescents: A Quasi-experimental Study","authors":"Rajadurai Meenakshisundaram, Anand Raj Ramavel, Nayyara Banu, Akmal Areeb, Esther Monica Jared Premkumar, Salman Saeed","doi":"10.5005/njem-11015-0009","DOIUrl":"https://doi.org/10.5005/njem-11015-0009","url":null,"abstract":"Background: Cardiopulmonary resuscitation (CPR) is one of the most evolving areas of saving actions that improve the survival rates following cardiac arrest and educating high school students can play a dynamic role in case of emergencies in society. Education of school students in CPR is a strategic goal for the improvement of bystander CPR in rural society. If adolescents were trained to perform CPR during school physical education hours, this may be a cost-effective approach to CPR training. This study is conducted to assess the effectiveness of health education in the improvement of knowledge of CPR among school-going adolescents. Aim: To assess the effect of a training program on students’ knowledge of CPR. Objective: (A) To determine the background knowledge of high school students about cardiac arrest and basic life support in adult victims of cardiac arrest. (B) To determine the association between knowledge of cardiopulmonary resuscitation and skills with selected demographic variables. Materials and methods: This is a quasi-experimental study conducted among adolescents aged 13–15 years attending schools in rural areas of South India. The study was conducted between Jan 2022 and Jan 2023. 680 students were included in this study. The universal sampling method was used to enumerate the participants to reduce the impact of the dropout rate. The data was collected using a pre-tested semi-structured questionnaire by interview method. Basic teaching of CPR for the participants included 2 hours of oral teaching using lecture method, question and answer discussion method as well as 2 hours of practical session using demonstration, practice on a manikin, provision of feedback and correction of errors. Results: A total of 680 participants were grouped into three categories according to their knowledge scores: (A) fair, (B) Moderate, and (C) Good scores obtained in pre-training observation and post-training observation. Initially, there were 666 (97.9%) in the fair category, most of them improved after training as seen in the post-training observation results, with 97 (14.3%) persons in the fair (A) category. There was not a single student in the good category of the score before intervention, which increased to 665 (45.6%) in the good category of knowledge. The mean score of pre-training is 2.55, and the post-training score is significantly increased to 9.5. Conclusion: An improvement is observed in knowledge of CPR post-training with planned teaching and demonstration. Hence, this method can be considered a logical solution for improving knowledge about CPR in cases of emergency life-saving skills in a particular group of society.","PeriodicalId":508269,"journal":{"name":"Journal of the Association of Physicians of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139186686","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}
{"title":"From Crisis to Care: The Spectacular Evolution of Emergency Medicine in India","authors":"Saravana Kumar","doi":"10.5005/njem-11015-0005","DOIUrl":"https://doi.org/10.5005/njem-11015-0005","url":null,"abstract":"","PeriodicalId":508269,"journal":{"name":"Journal of the Association of Physicians of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139186479","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}
Aim and objectives: Analysis of blood cultures taken from patients attending emergency departments is an important exercise in determining the common pathogens prevalent in the region. The distribution of these infective pathogens keeps changing over time, and the rise in antimicrobial-resistant pathogens makes it difficult to routinely conduct effective empirical broad-spectrum antimicrobial therapy. This study aimed to analyse the results of blood cultures obtained from patients presenting to the Emergency Department of a Tertiary Healthcare Hospital in Mumbai and provide updated and detailed information on the distribution of causative pathogens in adult sepsis and study their antibiotic-susceptibility pattern. Materials and methods: A hospital-based prospective cross-sectional study of 121 positive blood culture reports was conducted at the Department of Emergency Medicine, Fortis Hospital Mulund, Mumbai, which included all adult (age > 18 yrs) suspected sepsis patients arriving to the Emergency Department whose blood cultures were sent from the Emergency Department from January 2021 to December 2021. Results: The study showed that mean age of the study cases was 59.3 years with 59.5% cases that belonged to the elderly age group with a male predominance (56.2% males–43.8% females). Overall, Gram-negative isolates were seen in 95% cases, while Gram-positive isolates were seen in only 1.7% cases. The most common organism isolated from cases with sepsis was Escherichia coli (45.5%) followed by Klebsiella (13.2%), Salmonella (10.7%), Stenotrophomonas (7.4%) and Pseudomonas (5%). Among Gram-positive organisms, Staphylococcus aureus was the most common organism isolated (1.7%). Escherichia coli isolates showed poor sensitivity towards fluoroquinolones and cephalosporins while good sensitivity towards aminoglycosides, carbapenems and combination drugs like Cefoperazone and Sulbactam and Piperacillin and Tazobactam. These findings suggest that Gram-negative organisms are the most common isolates observed in this study, with E. coli being the predominant pathogen followed by Klebsiella. High-level antimicrobial resistance was observed in sepsis cases for commonly used antimicrobials like fluoroquinolones and cephalosporins.
{"title":"Analysis of Blood Cultures of Patients Presenting to the Emergency Department in a Tertiary Healthcare Hospital in Mumbai","authors":"Deepak Kishor Sharma, Sandeep B Gore","doi":"10.5005/njem-11015-0006","DOIUrl":"https://doi.org/10.5005/njem-11015-0006","url":null,"abstract":"Aim and objectives: Analysis of blood cultures taken from patients attending emergency departments is an important exercise in determining the common pathogens prevalent in the region. The distribution of these infective pathogens keeps changing over time, and the rise in antimicrobial-resistant pathogens makes it difficult to routinely conduct effective empirical broad-spectrum antimicrobial therapy. This study aimed to analyse the results of blood cultures obtained from patients presenting to the Emergency Department of a Tertiary Healthcare Hospital in Mumbai and provide updated and detailed information on the distribution of causative pathogens in adult sepsis and study their antibiotic-susceptibility pattern. Materials and methods: A hospital-based prospective cross-sectional study of 121 positive blood culture reports was conducted at the Department of Emergency Medicine, Fortis Hospital Mulund, Mumbai, which included all adult (age > 18 yrs) suspected sepsis patients arriving to the Emergency Department whose blood cultures were sent from the Emergency Department from January 2021 to December 2021. Results: The study showed that mean age of the study cases was 59.3 years with 59.5% cases that belonged to the elderly age group with a male predominance (56.2% males–43.8% females). Overall, Gram-negative isolates were seen in 95% cases, while Gram-positive isolates were seen in only 1.7% cases. The most common organism isolated from cases with sepsis was Escherichia coli (45.5%) followed by Klebsiella (13.2%), Salmonella (10.7%), Stenotrophomonas (7.4%) and Pseudomonas (5%). Among Gram-positive organisms, Staphylococcus aureus was the most common organism isolated (1.7%). Escherichia coli isolates showed poor sensitivity towards fluoroquinolones and cephalosporins while good sensitivity towards aminoglycosides, carbapenems and combination drugs like Cefoperazone and Sulbactam and Piperacillin and Tazobactam. These findings suggest that Gram-negative organisms are the most common isolates observed in this study, with E. coli being the predominant pathogen followed by Klebsiella. High-level antimicrobial resistance was observed in sepsis cases for commonly used antimicrobials like fluoroquinolones and cephalosporins.","PeriodicalId":508269,"journal":{"name":"Journal of the Association of Physicians of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139186292","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}
Seetharaman Nagasubbu, Sai Surendar Mohan, Ramkumar Selvam
A case report of oral anticoagulant—acenocoumarol Induced Ecchymosis. Acenocoumarol is a coumarin derivative and vitamin K antagonist. Adverse effects like ecchymosis that is potentially fatal if not noticed with an altered coagulation profile. Initiation of safer anticoagulants for mid to long-term treatment under the supervision of coagulation profile.
口服抗凝剂--醋硝香豆素诱发瘀斑的病例报告。醋硝香豆素是一种香豆素衍生物和维生素 K 拮抗剂。其不良反应包括瘀斑，如果不注意凝血功能的改变，瘀斑有可能致命。在凝血功能检查的监督下，开始使用更安全的抗凝剂进行中长期治疗。
{"title":"Anticoagulants Induced Ecchymosis","authors":"Seetharaman Nagasubbu, Sai Surendar Mohan, Ramkumar Selvam","doi":"10.5005/njem-11015-0003","DOIUrl":"https://doi.org/10.5005/njem-11015-0003","url":null,"abstract":"A case report of oral anticoagulant—acenocoumarol Induced Ecchymosis. Acenocoumarol is a coumarin derivative and vitamin K antagonist. Adverse effects like ecchymosis that is potentially fatal if not noticed with an altered coagulation profile. Initiation of safer anticoagulants for mid to long-term treatment under the supervision of coagulation profile.","PeriodicalId":508269,"journal":{"name":"Journal of the Association of Physicians of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139186418","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}
Snakebite is a major health issue in India and developing nations across the globe. Common krait bites are associated with delayed paralysis and locked-in syndrome. Locked-in syndrome has been documented among patients of snakebite. Our case is unique due to the confounding effect of hypokalaemia which may confuse the physician as hypokalaemic periodic paralysis (HPP), a rare genetic condition which can also be precipitated by a stressful event such as snakebite. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. As krait bite are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP. We urge our fellow researchers to look out for similar findings in their patients. Key messages: Locked-in syndrome in snakebites can be due to the effect of the venom in blood onto the ventral pons. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. We presume this hypokalaemia to be nutritional in origin. As krait bites are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP. Keywords: Case report, Hypokalaemia, Neurotoxic, Snake envenomation
{"title":"Delayed Neurotoxic Paralysis with Confounding Hypokalaemia","authors":"Utsav Anand Mani, Mukesh Kumar, Haider Abbas, Pranay Gupta","doi":"10.5005/njem-11015-0002","DOIUrl":"https://doi.org/10.5005/njem-11015-0002","url":null,"abstract":"Snakebite is a major health issue in India and developing nations across the globe. Common krait bites are associated with delayed paralysis and locked-in syndrome. Locked-in syndrome has been documented among patients of snakebite. Our case is unique due to the confounding effect of hypokalaemia which may confuse the physician as hypokalaemic periodic paralysis (HPP), a rare genetic condition which can also be precipitated by a stressful event such as snakebite. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. As krait bite are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP. We urge our fellow researchers to look out for similar findings in their patients. Key messages: Locked-in syndrome in snakebites can be due to the effect of the venom in blood onto the ventral pons. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. We presume this hypokalaemia to be nutritional in origin. As krait bites are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP. Keywords: Case report, Hypokalaemia, Neurotoxic, Snake envenomation","PeriodicalId":508269,"journal":{"name":"Journal of the Association of Physicians of India","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139186523","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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