Advanced Journal of Emergency Medicine最新文献

Introduction: Acute gastric dilation following trauma is an unusual event that can occur in different settings, and can cause gastric necrosis as a rare though fatal condition. The present report involves a case of acute gastric dilation following multiple traumas, which caused gastric necrosis and total gastrectomy.

Case presentation: A 19-year-old morbid obese male presented to the emergency department (ED) following a motor vehicle accident.He had a left lower extremity crash injury. In his serial examinations, he was complaining of upper abdominal pain with epigastric tenderness. After nasogastric tube (NGT) reinsertion, due to detecting coffee ground secretions in the drained fluid, the patient was transferred to the operating room.A midline laparotomy was performed that revealed dilation and discoloration of the stomach. Gastric decompression was performed. All the discoloration then disappeared except for that of certain suspicious areas, which necessitated evaluations. On the following day, given the lack of improvement in the patient`s condition, he was transferred to the operating room for a second laparotomy.

Conclusion: The present report emphasized on the importance of NGT insertion in multiple-trauma patients, which is, however, neglected in many cases. Moreover, acute gastric dilation is recommended to be considered in the differential diagnosis of patients with multiple or abdominal trauma and complaints of vomiting or abdominal pains.

Introduction: Identifying the death reasons amongst elderly, may help prioritizing the research projects and interventions.

Objective: This study purpose was to determine the death pattern and causes, and also its likely associated factors, in a mega hospital in western Iran.

Method: This retrospective cross-sectional study, conducted on elderly died from April 2011 to March 2016, in Imam Reza hospital in Kermanshah, Iran. The data were collected about the demographic characteristics, medical information, and the main death causes. The causes-of-death was classified adopting the International Classification of Diseases, Tenth Revision (ICD-10). The relationships between outcome and predicting variables were assessed by using Chi-square and Tukey's test in SPSS.

Results: Totally, 2415 died elderly were registered during the study period. The participants mean age at the time of their death was 75.35±9.15 years old. The diseases of circulatory system (dominancy of stroke), infectious diseases (leading by septicaemia and septic shock, respectively), and respiratory system diseases were the most common death causes, respectively. Age was the most important associated factor for the all-cause mortality related to the cardiovascular diseases (p=0.001).

Conclusion: The majority of deaths were the premature, which requires paying more attention. Although, cardiovascular diseases were the leading death causes and that is predictable, but the fatality of infectious diseases is still causing concerns.

Introduction: Various strategies could be considered dealing with penetrating thoracic injuries. Thoracoscopy is much less invasive than routine thoracotomy approach for managing such cases in which the sharp object remains in the body. The case presented in this article was managed with thoracoscopy for a penetrating dorsolateral thoracic injury.

Case presentation: A 35-year-old man with a penetrating dorsolateral thoracic injury referred to the emergency department. Despite an elevated pulse rate, the patient has proper blood pressure and O2 saturation. Considering the patient's stability and the results of imaging which did not show any massive vascular injury, the patient was taken to the operation room for thoracoscopy. At thoracoscopy, we saw 4 cm of the blade in the thoracic cavity between the third and fourth intercostal space. There was a mild laceration of lung tissue without any active bleeding. Considering the position of the blade and the absence of active bleeding and vascular injury at the trauma site, we successfully removed the blade by the thoracoscope without any complications.

Conclusion: Our experience of removing a retained knife by thoracoscopy showed that it can be an appropriate alternative for patients with penetrating thoracic injury who are hemodynamically stable and have appropriate conditions for thoracoscopy.

Introduction: In 2010, a national triage train-of-trainer (TOT) workshop was held in Tehran, Iran.

Objective: The present study aimed to assess the validity of the triage performed by the nurses educated by those who participated in TOT workshop.

Method: This cross-sectional study was carried out in 6 teaching hospitals from 4 universities in Iran. Inter-rater and intra-rater reliability of performed triage by participations was measured. Thirteen nurses were randomly selected. Thereafter, at the end of each working shift, patient data recorded in the daily data registry forms were collected. Then, duration of hospital stay, number of cases admitted to general wards or intensive care units, number of cases discharged from the ED within 12 hours and mortality rate were compared with the triage level determined by the nurse.

Results: In total, 30 nurses with a mean age of 28.4 ± 3.7 years were enrolled. In this study, 1491 triage cases (61.6% male) were evaluated, of which 4.2% were triaged as level 1, 18.3% as level 2, 37.1% as level 3, 20.4% as level 4 and 20.0% as level 5. The following outcome was observed: 3.64% were discharged, 6.29% were hospitalized, 3% died and 2.3% were discharged against medical advice without completing treatment. The correlation of determined triage level and patients' duration of hospitalization was significant based on one-way ANOVA test (p = 0.000). The outcome of the patients significantly correlated with the level of triage determined by the study nurses (p = 0.000).

Conclusion: Based on the findings, it appears that triage performed by the study nurses educated by those who participated in TOT workshop through cascade training system had perfect validity.

Introduction: The association between chest compression fraction (CCF) and return of spontaneous circulation (ROSC)has been a controversial issue in literature; and both positive and negative correlations have been reported between CCF and survival rate.

Objective: The present study was conducted to determine the relationship between the rate and outcomes of chest compression and between CCF and ROSC in patients with cardiac arrest.

Method: The present prospective observational study was conducted during 2018 on patients with cardiac arrest aged 18-80 years. Participants with end-stage renal diseases, malignancies and grade IV heart failure were excluded. A stop watch was set upon the occurrence of a code blue in the emergency department, and time was recorded by the observer upon the arrival of the code blue team leader (a maximum permissible duration of 10 minutes). The interruptions in chest compressions were recorded using a stopwatch, and CCF was calculated by dividing the duration of chest compression by the total duration of cardiac arrest observed.

Results: Totally, 45 participants were enrolled. Most of the patients had non-shockable rhythms and underwent CPR based on related algorithm. Hypoxia and hypovolemia were the two probable etiology of cardiac arrest; and coronary artery disease was the most prevalent underlying disease. All patients with ROSC had CCF more than 70%. A CCF below 70% was observed in 21 cases (46.7%), and a fraction of at least 70% in 24 cases. All patients with ROSC had CCF more than 70%. A CCF below 70% was observed in 21 cases (46.7%), and a fraction of at least 70% in 24. A significantly higher duration and fraction of chest compression was observed in the participants who attained ROSC (P<0.001).

Conclusion: Based on the findings of current study, it seems that significantly higher chest compression durations and fractions were found to be associated with ROSC, which was achieved in the majority of the participants with a CCF of at least 80%.

Introduction: Policymaking in order to increase the quality of medical journals needs having accurate data from their current status.

Objective: The present study was designed with the aim of introducing a demographic scheme of Iranian journals in the field of medical sciences.

Method: This cross-sectional study was performed on all the medical journals being published in Iran in 2016. The list of all journal titles was extracted by referring to the medical journals databanks (ministry of health, Magiran, IranMedex, Irandoc and…), and the data required for the study were gathered using journals' homepages or by phone or in person, by attending the journal's office.

Results: Totally, 521 journals were assessed. Publication language used was English in 297 (57%) journals and 515 (98.85%) were open access. 381 (73.1%) journals were published quarterly and the year of starting publication was 2010 onwards in case of 245 (48.0%) of journals. There were 29 (5.56%) journals, which were indexed in all 3 databases of ISI, PubMed and Scopus. Only 4.81% of the journals had an official impact factor announced by Thomson-Reuters or Clarivate Analytics Company. Mean time needed for review of articles was 1.89 ± 1.52 (0.5 - 12) months (n = 146) and mean time interval between accepting an article and its print or electronic publication was 3.63 ± 2.17 (0 - 12) months (n = 144). Rate of membership of these journals in COPE and ICMJE were 40% and 27%, respectively.

Conclusion: Most medical journals being published in Iran were English quarterly journals that were regularly published in the fields of general medicine, open access, with university affiliations, centered in the capital, and more than 80% of them had started publishing from 2000 and afterwards.

Introduction: Hand and wrist soft tissue injuries are common orthopedic problems that are traditionally treated with short arm splint, which covers the forearm to 1 cm distal to the elbow crease.

Objective: The present study was conducted to compare the treatment efficacy of traditional standard-size splint with half-length short arm splint.

Method: In this randomized, controlled, clinical trial, patients with hand and wrist soft tissue injuries were randomly assigned to two groups. Group one received standard-sized short arm splints and the other group received half-length short arm splints. The swelling and pain scores were compared between the groups by the end of weeks one, two and three.

Results: A total of 256 patients with a mean age of 36.96 ± 12.27 years were enrolled in this study, and 71.9% of them were male. No statistically significant differences were observed in terms of swelling between the two groups after one and two weeks (P=0.41, P=0.18). None of the patients had swelling after three weeks. No statistically significant differences were observed between the two groups in terms of the pain score after one, two and three weeks (P=0.47, P=0.29, P=0.92).

Conclusion: In this study, half-length short arm splints were found to be as effective as standard short arm splints.

Introduction: Waiting time in the hospital directly affects the quality of healthcare providing centers. One of the waiting times in hospital is the time spent waiting for receiving various consultations and visits requested by emergency medicine specialists from specialist services.

Objective: The present study was designed and performed to assess the waiting times for receiving specialist visits and consultations requested in the emergency department based on the corresponding service in a referral hospital in Isfahan, Iran.

Method: In the present cross-sectional study, patients presenting to emergency department of Dr. Shariati Hospital, Isfahan, Iran, from October 2017 to March 2018, who were in need of visit or consultation from other specialist services based on the opinion of the emergency medicine specialist, were studied. By attending the patients' bedside, the researcher filled out a checklist consisting of demographic data and waiting time of the patients and other probable related factors. Finally, raw data were entered to the computer and after correction of errors were statistically analyzed via SPSS software.

Results: Overall, 400 patients with the mean age of 53.3 ± 24.3 years were included in the study, 58.8% of which were male. Mean waiting time for receiving a visit or consultation among the studied patients was 242.0 ± 202.4 (min: 5 and max: 1200) minutes. Mean waiting time for a visit or consultation did not significantly correlate with the corresponding physician being resident or on-call. However, it showed a statistically significant correlation with triage level (p = 0.013), work shift (p = 0.000), type of service requested/the specialist service asked for a consultation or visit (p = 0.049), and the consultation or visit being emergent or non-emergent (p = 0.000). In addition, emergent visits or consultations by on-call physicians had been performed significantly faster than those by resident physicians; while non-emergent visits or consultations by resident physicians had been performed significantly faster than those by on-call physicians (p = 0.001).

Conclusion: The results of the present study showed that patients with triage level 2, emergent visit of consultation and a visit or consultation request in the morning or evening shift wait a shorter time for receiving the visit or consultation. In addition, neurosurgery, nephrology, and pediatrics services had the shortest waiting times, while gastroenterology, gynecology, and infectious disease services had the longest waiting times for giving the visit or consultation requested from them.

Introduction: Training is the primary route of attaining required skills among residents in general surgery.

Objective: This study was conducted to evaluate the minimum number of required sessions for attaining basic skills in laparoscopic surgery in a skill-lab among surgical residents.

Method: This cross-sectional study was conducted in Imam-Khomeini Hospital during 2012. A total of 20 surgical residents were enrolled. There were 45-60 mins sessions weekly, which included the following seven elementary skills: first knot tie, second knot tie, peg exchange, peg drop, rope pass, needle pass, and paper cut. These skills were evaluated weekly, and qualitative evaluations were done every 2 weeks.

Results: Mean age of the 20 surgical residents was 32.2 ± 4.7 years, and 55.6% of them were males. The median session counts were as follows: six sessions for first knot tie, six sessions for second knot tie, three sessions for peg exchange, eight sessions for needle pass, and five sessions for paper cut.

Conclusion: Based on the obtained results, it may be concluded that relatively five sessions are required for acquiring basic skills in laparoscopic surgery by surgical residents.