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Current Medical Journalism Needs Major Revisions. 当前的医学新闻需要重大修订。
Pub Date : 2018-05-13 eCollection Date: 2018-01-01 DOI: 10.22114/AJEM.v0i0.90
Alireza Baratloo
Medical journalism commenced during early nineteenth century as an impressive adjunct for medical education. It is considered as a platform to share the results of the research studies and to disseminate medical information that could impact the present concept and practice of the medicine field. Medical journalism gained immense attention over the years; however, the present scenario revealed certain limitations. A rise in the number of researchers, by interest or forcefully, has led to an increase in the journal count, resulting in several fake research articles being published in the journals. This leads to inappropriate research and low quality of journals, where the data appearing in the research articles is not authentic; thus, the journals publishing such articles face several issues while verifying the authenticity of the data provided. All journals, in particular, the recent ones strive to achieve immense importance in regards to the impact factor, h-index, and similar quality assessments; however, attaining similar scores as that of the well-known journals is impossible. Hence, as a futile effort, the editorial team of the new or latest journals consider adding more references in their articles in order to achieve a higher score; however, certain references from the previously published papers, may decode as a conflict of interest. Based on an unwritten and unavailable rule, all new journals try to publish papers in same format as publishing in famous journals, and do not dare to deconstruct it. It seems that deconstruction should also be performed by the old journals founded the current style! In order to avoid the aforementioned issues, the Advanced Journal of Emergency Medicine emerged with the concept of being different, deconstructive, and without any futile competition with the other journals. Accordingly, we consider a large audience with several degrees of medical education to participate in the field of research, make the journal a unique one aim to augment of medical education through medical research charm.  To the best of our knowledge, at present, we do not have appropriate solutions to aforementioned problems. We request the authors, directors, and editorial members of the journals to have a detailed discussion on this topic, and we are ready to publish articles on the topic that is briefly discussed in this article.
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引用次数: 1
Diagnostic Accuracy of Focused Assessment with Sonography for Blunt Abdominal Trauma in Pediatric Patients Performed by Emergency Medicine Residents versus Radiology Residents. 急诊内科住院医师与放射科住院医师对儿科患者钝性腹部创伤超声聚焦评估的诊断准确性。
Pub Date : 2018-05-08 eCollection Date: 2018-01-01 DOI: 10.22114/AJEM.v0i0.89
Farhad Heydari, Ayoub Ashrafi, Mohsen Kolahdouzan

Introduction: Focused assessment with sonography for trauma (FAST) has been shown to be useful to detect intraperitoneal free fluid in patients with blunt abdominal trauma (BAT).

Objective: We compared the diagnostic accuracy of FAST performed by emergency medicine residents (EMRs) and radiology residents (RRs) in pediatric patients with BAT.

Method: In this prospective study, pediatric patients with BAT and high energy trauma who were referred to the emergency department (ED) at Al-Zahra and Kashani hospitals in Isfahan, Iran, were evaluated using FAST, first by EMRs and subsequently by RRs. The reports provided by the two resident groups were compared with the final outcome based on the results of the abdominal computed tomography (CT), operative exploration, and clinical observation.

Results: A total of 101 patients with a median age of 6.75 ± 3.2 years were enrolled in the study between January 2013 and May 2014. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. A good diagnostic agreement was noted between the results of the FAST scans performed by EMRs and RRs (κ = 0.865, P < 0.001). The sensitivity, specificity, positive and negative predictive values, and accuracy in evaluating the intraperitoneal free fluid were 72.2%, 85.5%, 52%, 93.3%, and 83.2%, respectively, when FAST was performed by EMRs and 72.2%, 86.7%, 54.2%, 93.5%, and 84.2%, respectively, when FAST was performed by RRs. No significant differences were seen between the EMR- and RR-performed FAST.

Conclusion: In this study, FAST performed by EMRs had acceptable diagnostic value, similar to that performed by RRs, in patients with BAT.

引言:创伤超声聚焦评估(FAST)已被证明有助于检测钝性腹部创伤(BAT)患者的腹腔游离液。目的:我们比较急诊医学住院医师(EMRs)和放射学住院医师(RR)对患有BAT的儿科患者进行FAST的诊断准确性。方法:在这项前瞻性研究中,在伊朗伊斯法罕的Al-Zahra和Kashani医院,转诊至急诊科的BAT和高能创伤儿科患者使用FAST进行评估,首先通过EMR,然后通过RR。根据腹部计算机断层扫描(CT)、手术探查和临床观察的结果,将两个住院组提供的报告与最终结果进行比较。结果:在2013年1月至2014年5月期间,共有101名中位年龄为6.75±3.2岁的患者参与了该研究。这些患者使用FAST进行评估,首先通过EMR进行评估,然后通过RR进行评估。EMRs和RR的FAST扫描结果之间存在良好的诊断一致性(κ=0.865,P<0.001)。当EMRs进行FAST时,评估腹膜内游离液的敏感性、特异性、阳性和阴性预测值以及准确性分别为72.2%、85.5%、52%、93.3%和83.2%,当FAST由RR执行时。结论:在本研究中,EMR和RR进行的FAST对BAT患者具有可接受的诊断价值,与RR相似。
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引用次数: 1
A 69-year-old Man with Sudden Loss of Consciousness, Non-reactive Pupils, and a Bilateral Positive Babinski Sign. 69岁男性,突然失去意识,瞳孔无反应,双侧巴宾斯基征阳性。
Pub Date : 2018-04-30 eCollection Date: 2018-01-01 DOI: 10.22114/AJEM.v0i0.86
Mehran Sotoodehnia, Mehrnoosh Aligholi-Zahraie
LEARNING POINTS: Pathologic findings In figure 1, the basilar artery appears homogenously hyperdense in comparison with the adjacent left middle cerebral artery (MCA), using brain parenchyma as a reference point; thus indicating a hyperdense basilar artery sign (HBAS) (Figure 2, white arrow). Also, the right superior cerebellar artery and left posterior cerebral artery appear to be hyperdense (Figure 2, the red and green arrows, respectively). This is called a hyperdense artery sign (HAS). The artery becomes hyperdense because the intra-arterial clotted blood has a higher Hounsfield unit (80 HU) than the non-clotted flowing blood (40 HU) and thus appears white on non-contrast computed tomography (CT) scan. Pathologically, high hematocrit levels and calcium deposits in the vessel wall (due to arteriosclerotic disease) can result in an incorrect diagnosis of HAS. Sometimes, infections or tumors can make the brain parenchyma surrounding the vessel hypodense, which can give the false impression of a hyperdense vessel (1). To avoid misdiagnosis, these considerations are useful:  Ensure the attenuation value (Hounsfield units) of all intracranial arteries and veins are nearly the same when there are high hematocrit levels.  Calcifications are usually located at the periphery of the vessels.  In contrast to atheromatous calcifications, a hyperdensity thought to be a HAS is reversible (2).  Koo et al. defined hyperdensity as an absolute density of > 43 HU and a MCA ratio (the ratio of the dense MCA to the contralateral MCA) of > 1.2. He showed that using a combination of these two parameters had 100% specificity for the HAS for acute ischemic stroke cases (3). Importance Acute basilar artery occlusion (BAO) is a rare catastrophic form of stroke, roughly causing around 1% of all strokes (4). BAO occurs usually due to an embolus with a cardiac or large vessel origin, or the formation of a local atherosclerotic thrombosis. In this patient, BAO occurred soon after myocardial infarction. Depending on the location and extent of occlusion and on the degree of collateral flow, BAO has quite variable clinical and imaging manifestations. The clinical presentation of BAO ranges from nonspecific symptoms such as headache, neck pain, or vertigo to severe disabilities such as decreased consciousness, hemiplegia or quadriplegia, extensor plantar sign, dysarthria, dysphagia, aphagia, ataxia, nuclear oculomotor nerve palsy, bilateral ptosis, anisocoria, non-reactive pupils, Figure 1: Axial non-enhanced computed tomography scan of the patient’s brain Mehran Sotoodehnia*, Mehrnoosh Aligholi-Zahraie
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引用次数: 0
Non-ST-Elevation Myocardial Infarction in a Case of Von Willebrand Disease: a Case Report. Von Willebrand病非ST段抬高型心肌梗死1例报告。
Pub Date : 2018-04-30 eCollection Date: 2018-01-01 DOI: 10.22114/AJEM.v0i0.85
Anees Abdul, Arpith Easo Samuel, Fabith Moideen, Jayasree Nambiar

Introduction: Studies have shown that patients with Von Willebrand disease (VWD) have decreased prevalence of thrombotic events like myocardial infarction (MI). Here we describe a case of VWD with acute non-ST-elevation MI with ongoing bleeding manifestations.

Case presentation: A 37-year-old female patient presented to the emergency department with a complaint of central chest pain since 7 days. She also had a history of hemoptysis since 8 days. Electrocardiogram (ECG) revealed ST-segment depression in leads I, aVL, II, III, aVF, and V4-V6 compatible with diagnosis of Non-ST-Elevation Myocardial Infarction (Non STEMI). She was started on nitroglycerine infusion, angiotensin II receptor blockers, and calcium channel blockers along with trimetazidine. Her chest pain and ECG changes settled after 2 days, and she was discharged in a stable condition.

Conclusion: There are limited studies available regarding the management of acute MI in VWD patients with acute bleeding manifestations. Further studies have to be carried out to determine successful ways of managing thrombotic events like MI in this subset of patients.

研究表明,血管性血友病(VWD)患者的血栓性事件(如心肌梗死(MI))发生率降低。我们在此报告一例VWD合并急性非st段抬高型心肌梗死,伴有持续出血表现。病例介绍:一名37岁女性患者,因中枢性胸痛7天前来急诊科就诊。患者有咯血病史8天。心电图显示I、aVL、II、III、aVF、V4-V6导联st段下降,符合非st段抬高型心肌梗死(Non STEMI)的诊断。她开始使用硝酸甘油输注、血管紧张素受体阻滞剂、钙通道阻滞剂和曲美他嗪。2天后胸痛及心电图改变消退,出院时病情稳定。结论:有急性出血表现的VWD患者急性心肌梗死的处理研究有限。必须进行进一步的研究,以确定在这类患者中管理血栓性事件(如心肌梗死)的成功方法。
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引用次数: 0
An Interesting Case of Isolated Pancreatic Transection Following Blunt Abdominal Trauma in Emergency Department. 急诊科钝性腹部创伤后孤立胰腺横断一例。
Pub Date : 2018-04-30 eCollection Date: 2018-01-01 DOI: 10.22114/AJEM.v0i0.87
Devendra Richhariya, Vivekanshu Verm, Yatin Mehta

Introduction: Traumatic injury to the pancreas is not common, but if the diagnosis is delayed or misdiagnosed in the emergency department (ED), the condition is associated with high morbidity and mortality and raises a question about the quality of emergency care. Here, we describe a rare case of blunt abdominal trauma resulted in isolated pancreas injury.

Case presentation: A 25-year-old young male came to our emergency room (ER) in a conscious, anxious state from a nearby town with a history of roadside trauma. Further investigations revealed an isolated pancreatic injury due to trauma with no other major injuries, which occurred due to a sudden high-speed impact of the steering wheel to the epigastrium of a driver while driving the car, severely compressing the pancreas between the backbone and steering wheel. The patient was admitted to the intensive care unit for close observation and monitoring. He was managed conservatively on intravenous fluids, antibiotics, analgesics, and vasopressors. He was discharged after five days in a hemodynamically stable and afebrile condition, on a normal diet.

Conclusion: Isolated pancreatic injury following blunt abdominal trauma is rare, and the symptoms are difficult to analyze early due to its retroperitoneal anatomy. Early detection and early intervention are important in the ED, and if left unrecognized, could result in a poor outcome.

外伤性胰腺损伤并不常见,但如果在急诊科(ED)诊断延误或误诊,这种情况与高发病率和死亡率相关,并引起对急诊护理质量的质疑。在这里,我们描述一个罕见的病例钝性腹部创伤导致孤立的胰腺损伤。病例介绍:一名25岁的年轻男性从附近城镇来到我们的急诊室,他意识清醒,焦虑不安,有路边创伤史。进一步的调查显示,这是一例孤立的胰腺损伤,是由于驾驶员在驾驶汽车时突然高速撞击方向盘到上腹部,严重挤压了骨干和方向盘之间的胰腺,没有其他重大损伤。患者被送入重症监护病房密切观察和监测。他接受了保守的静脉输液、抗生素、镇痛药和血管加压药治疗。5天后出院,患者血流动力学稳定,无发热症状,饮食正常。结论:钝性腹部创伤后孤立性胰腺损伤较为罕见,且由于其腹膜后解剖结构,早期症状难以分析。早期发现和早期干预对急症很重要,如果不加以认识,可能会导致不良后果。
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引用次数: 0
Pituitary Macroprolactinoma with Mildly Elevated Serum Prolactin: Hook Effect. 垂体大泌乳素瘤伴轻度血清泌乳素升高:钩效应。
Pub Date : 2018-04-28 eCollection Date: 2018-01-01 DOI: 10.22114/AJEM.v0i0.84
Mahnaz Pejman Sani, Mahbube Ebrahimpur, Mohammad Reza Mohajeri-Tehrani
A 45-year-old man was admitted in our department with complaints of severe headache for over 6 months period. He also suffered from several problems such as visual field defect, decreased energy and libido, body hair loss, cold intolerance, decreased appetite and dry skin. On physical examination, he was afebrile: BP (blood pressure): 110/70 mm/Hg, PR (pulse rate) :65 beat/min, BMI (body mass index): 24. He had no terminal hair on face or chest and subcutaneous adipose tissue mass had been decreased substantially. Laboratory tests revealed; Hb: 12 g/dL (N: 14–17 g/dL), Total testosterone: 1.2 ng/mL (N:–-10 ng/mL), Luteinizing hormone (LH):3.3MIU/mL (N:1–8 MIU/mL), Follicle Stimulating hormone (FSH):1.3 MIU/mL (N:1–7 MIU/mL), T4:3.4 micg/dL (N:4–12 micg/dL), TSH:0.6 MIU/mL (N:0.5–5 MIU/mL), Prolactin:100 ng/mL (2–24 ng/mL), serum cortisol:6 MIU/mL (N:4–21 MIU/mL), IGF1:162 ng/mL (50–245). Pituitary MRI showed macroadenoma (29*16*14 mm) in left side of sella turcica which bulged to suprasellar cistern with pressure effect on left optic nerve (Figure 1, 2). Visual field examination revealed mild temporal hemianopia. These findings are consistent with macroadenoma and mild prolactin elevation. We also observed a discrepancy between pituitary tumor size and prolactin level. The correct estimate of serum prolactin was obtained after serial dilutional measurement. Serum prolactin after dilution was 6470 ng/mL. With these findings pituitary macroadenoma was diagnosed and treatment with cabergoline (dopamine agonist) 0.5 mg/week was started. After one month follow-up he had no symptoms, visual field defect was improved and pituitary MRI showed significant shrinkage of tumor.
{"title":"Pituitary Macroprolactinoma with Mildly Elevated Serum Prolactin: Hook Effect.","authors":"Mahnaz Pejman Sani,&nbsp;Mahbube Ebrahimpur,&nbsp;Mohammad Reza Mohajeri-Tehrani","doi":"10.22114/AJEM.v0i0.84","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.84","url":null,"abstract":"A 45-year-old man was admitted in our department with complaints of severe headache for over 6 months period. He also suffered from several problems such as visual field defect, decreased energy and libido, body hair loss, cold intolerance, decreased appetite and dry skin. On physical examination, he was afebrile: BP (blood pressure): 110/70 mm/Hg, PR (pulse rate) :65 beat/min, BMI (body mass index): 24. He had no terminal hair on face or chest and subcutaneous adipose tissue mass had been decreased substantially. Laboratory tests revealed; Hb: 12 g/dL (N: 14–17 g/dL), Total testosterone: 1.2 ng/mL (N:–-10 ng/mL), Luteinizing hormone (LH):3.3MIU/mL (N:1–8 MIU/mL), Follicle Stimulating hormone (FSH):1.3 MIU/mL (N:1–7 MIU/mL), T4:3.4 micg/dL (N:4–12 micg/dL), TSH:0.6 MIU/mL (N:0.5–5 MIU/mL), Prolactin:100 ng/mL (2–24 ng/mL), serum cortisol:6 MIU/mL (N:4–21 MIU/mL), IGF1:162 ng/mL (50–245). Pituitary MRI showed macroadenoma (29*16*14 mm) in left side of sella turcica which bulged to suprasellar cistern with pressure effect on left optic nerve (Figure 1, 2). Visual field examination revealed mild temporal hemianopia. These findings are consistent with macroadenoma and mild prolactin elevation. We also observed a discrepancy between pituitary tumor size and prolactin level. The correct estimate of serum prolactin was obtained after serial dilutional measurement. Serum prolactin after dilution was 6470 ng/mL. With these findings pituitary macroadenoma was diagnosed and treatment with cabergoline (dopamine agonist) 0.5 mg/week was started. After one month follow-up he had no symptoms, visual field defect was improved and pituitary MRI showed significant shrinkage of tumor.","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 4","pages":"e49"},"PeriodicalIF":0.0,"publicationDate":"2018-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/44/b0/AJEM-2-e49.PMC6548154.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40539929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Rare Case of Gorlin-Goltz Syndrome Presented to the Emergency Department as Facial Swelling. 罕见的Gorlin-Goltz综合征以面部肿胀出现在急诊科。
Pub Date : 2018-04-21 eCollection Date: 2018-01-01 DOI: 10.22114/AJEM.v0i0.83
Suha N Aloosi, Kawa A Mahmood, Shakhawan M Ali, Payman Kh Mahmud, Seerwan O Hasan, Hawbash O Muhamed

Introduction: Gorlin-Goltz syndrome (GGS), also known as basal cell nevus syndrome, is a very rare autosomal dominant inherited disorder that is characterized by the development of numerous basal cell carcinoma. This article reports a case of GGS, emphasizing its clinical and radiographic manifestations.

Case presentation: We report here the case of a 35-year-old man who visited the maxillofacial emergency department due to left facial swelling. According to his clinical and radiographic examination we diagnosed him with GGS with no family history. The patient has multiple odontogenic keratocysts, rib anomalies, calcifications of the falx cerebri, lower jaw prognathism, frontal bossing, macrocephaly, and thick eyebrows.

Conclusion: A definitive diagnosis of GGS should be made by a multidisciplinary team including a maxillofacial surgeon and medical specialists. Early diagnosis, treatment, and regular follow up are important to decrease complications, including oromaxillofacial deformation and destruction, and possible malignancy.

简介:Gorlin-Goltz综合征(GGS),也被称为基底细胞痣综合征,是一种非常罕见的常染色体显性遗传疾病,其特征是发展为许多基底细胞癌。本文报告1例GGS,强调其临床和影像学表现。病例介绍:我们在此报告一例35岁男性因左面部肿胀到颌面急诊科就诊。根据他的临床和影像学检查,我们诊断他为无家族史的GGS。患者有多发牙源性角化囊肿、肋骨异常、大脑镰钙化、下颌前突、额部隆起、大头畸形和粗眉。结论:GGS的明确诊断应由包括颌面外科医生和医学专家在内的多学科团队做出。早期诊断、治疗和定期随访对于减少并发症,包括口颌面变形和破坏,以及可能的恶性肿瘤是重要的。
{"title":"A Rare Case of Gorlin-Goltz Syndrome Presented to the Emergency Department as Facial Swelling.","authors":"Suha N Aloosi,&nbsp;Kawa A Mahmood,&nbsp;Shakhawan M Ali,&nbsp;Payman Kh Mahmud,&nbsp;Seerwan O Hasan,&nbsp;Hawbash O Muhamed","doi":"10.22114/AJEM.v0i0.83","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.83","url":null,"abstract":"<p><strong>Introduction: </strong>Gorlin-Goltz syndrome (GGS), also known as basal cell nevus syndrome, is a very rare autosomal dominant inherited disorder that is characterized by the development of numerous basal cell carcinoma. This article reports a case of GGS, emphasizing its clinical and radiographic manifestations.</p><p><strong>Case presentation: </strong>We report here the case of a 35-year-old man who visited the maxillofacial emergency department due to left facial swelling. According to his clinical and radiographic examination we diagnosed him with GGS with no family history. The patient has multiple odontogenic keratocysts, rib anomalies, calcifications of the falx cerebri, lower jaw prognathism, frontal bossing, macrocephaly, and thick eyebrows.</p><p><strong>Conclusion: </strong>A definitive diagnosis of GGS should be made by a multidisciplinary team including a maxillofacial surgeon and medical specialists. Early diagnosis, treatment, and regular follow up are important to decrease complications, including oromaxillofacial deformation and destruction, and possible malignancy.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 4","pages":"e46"},"PeriodicalIF":0.0,"publicationDate":"2018-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b4/f8/AJEM-2-e46.PMC6548149.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40561495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A 24-year-old Female Traumatic Patient Following a Car Accident. 车祸后的24岁女性创伤患者。
Pub Date : 2018-04-12 eCollection Date: 2018-01-01 DOI: 10.22114/AJEM.v0i0.82
Atousa Akhgar, Seyed-Hasan Imami-Razavi, Shervin Farahmand, Seyedhossein Seyedhosseini-Davarani, Shahram Bagheri-Hariri, Ali Labaf, Mohammad Reza Keramati, Mohammad Zarei, Morteza Noparast, Hadi Mirfazaelian
{"title":"A 24-year-old Female Traumatic Patient Following a Car Accident.","authors":"Atousa Akhgar,&nbsp;Seyed-Hasan Imami-Razavi,&nbsp;Shervin Farahmand,&nbsp;Seyedhossein Seyedhosseini-Davarani,&nbsp;Shahram Bagheri-Hariri,&nbsp;Ali Labaf,&nbsp;Mohammad Reza Keramati,&nbsp;Mohammad Zarei,&nbsp;Morteza Noparast,&nbsp;Hadi Mirfazaelian","doi":"10.22114/AJEM.v0i0.82","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.82","url":null,"abstract":"","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 3","pages":"e38"},"PeriodicalIF":0.0,"publicationDate":"2018-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/d7/AJEM-2-e38.PMC6549202.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40550275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gender-Based Violence Causing Severe Multiple Injuries; a Case Report. 造成多重严重伤害的性别暴力;一份病例报告。
Pub Date : 2018-04-11 eCollection Date: 2018-01-01 DOI: 10.22114/AJEM.v0i0.80
Adalard Falschung

Introduction: Gender-based violence (GBV) against women has been identified as a global health and development issue. We reported a case of GBV causing sever, multiple injuries in a middle-aged female.

Case report: A 47-year-old woman presented to emergency room with disturbed level of consciousness, shortness of breath and multiple patches of skin discoloration. On examination, the patient was semi-conscious, with multiple ecchymosis and bilateral decreased air entry. Computed tomography scan of the neck and chest showed six rib fractures on the left side, and eight rib fractures on the right side, sternal fracture, manubriosternal dislocation, bilateral hemothorax, fracture of body of 11th thoracic vertebra, and fracture of cervical spine of 5th and 7th vertebrae. The patient was intubated and admitted to intensive care unit. She was discharged with good health condition after 23 days of hospital admission.

Conclusion: GBV is still a cause of severe trauma that puts the patient's life at risk.

导言:基于性别的暴力侵害妇女行为已被确定为一个全球性的健康和发展问题。我们报告了一例GBV造成严重的,多处伤害的中年女性。病例报告:一名47岁女性因意识紊乱、呼吸短促和多处皮肤变色而被送往急诊室。检查时,患者半清醒,多发瘀斑,双侧空气进入减少。颈胸部ct示左侧6根肋骨骨折,右侧8根肋骨骨折,胸骨骨折,胸骨柄胸骨脱位,双侧血胸,第11胸椎体骨折,第5、7椎颈椎骨折。病人插管后住进加护病房。住院23天后出院,身体状况良好。结论:性别暴力仍然是严重创伤的一个原因,使患者的生命处于危险之中。
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引用次数: 1
Outcome-Based Validity and Reliability Assessment of Raters Regarding the Admission Triage Level in the Emergency Department: a Cross-Sectional Study. 急诊科入院分诊等级评分者基于结果的有效性和可靠性评估:一项横断面研究。
Pub Date : 2018-04-08 eCollection Date: 2018-01-01 DOI: 10.22114/AJEM.v0i0.76
Seyedhossein Seyedhosseini-Davarani, Amir Nejati, Hooman Hossein-Nejad, Seyed-Mohammad Mousavi, Mojtaba Sedaghat, Mona Arbab, Shahram Bagheri-Hariri

Introduction: Emergency department (ED) is usually the first line of healthcare supply to patients in non-urgent to critical situations and, if necessary, provides hospital admission. A dynamic system to evaluate patients and allocate priorities is necessary. Such a structure that facilitates patients' flow in the ED is termed triage.

Objective: This study was conducted to investigate the validity and reliability of implementation of Emergency Severity Index (ESI) system version 4 by triage nurses in an overcrowded referral hospital with more than 80000 patient admissions per year and an average emergency department occupancy rate of more than 80%.

Method: This prospective cross-sectional study was conducted in a tertiary care teaching hospital and trauma center with an emergency medicine residency program. Seven participating expert nurses were asked to assess the ESI level of patients in 30 written scenarios twice within a three-week interval to evaluate the inter-rater and intra-rater reliability. Patients were randomly selected to participate in the study, and the triage level assigned by the nurses was compared with that by the emergency physicians. Finally, based on the patients' charts, an expert panel evaluated the validity of the triage level.

Results: During the study period, 527 patients with mean age of 54 ± 7 years, including 253 (48%) women and 274 (52%) men, were assessed by seven trained triage nurses. The degree of retrograde agreement between the collaborated expert panel's evaluation and the actual triage scales by the nurses and physicians for all 5 levels was excellent, with the Cohen's weighted kappa being 0.966 (CI 0.985-0.946, p < 0.001) and 0.813 (CI 0.856-0.769, p<0.001), respectively. The intra-rater reliability was 0.94 (p < 0.0001), and the inter-rater reliability for all the nurses was in perfect agreement with the test result (Cohen's weighted kappa were as follows: 0.919, 0.956, 0.911, 0.955, 0.860, 0.956, and 0.868; p < 0.001).

Conclusion: The study findings showed that there was perfect reliability and, overall, almost perfect validity for the triage performed by the studied nurses.

引言:急诊科(ED)通常是为非紧急到危重情况下的患者提供医疗服务的第一线,必要时提供住院服务。有必要建立一个动态系统来评估患者并分配优先级。这种便于患者在急诊室流动的结构被称为分诊。目的:本研究旨在调查一家过度拥挤的转诊医院的分诊护士实施紧急情况严重程度指数(ESI)系统第4版的有效性和可靠性,该医院每年有80000多名患者入院,急诊科平均入住率超过80%教学医院和创伤中心的急诊医学住院计划。七名参与的专家护士被要求在三周内两次评估30个书面场景中患者的ESI水平,以评估评分者之间和评分者内部的可靠性。随机选择患者参与研究,并将护士分配的分诊级别与急诊医生分配的分检级别进行比较。最后,根据患者的图表,专家小组评估了分诊水平的有效性。结果:在研究期间,527名平均年龄为54±7岁的患者,包括253名(48%)女性和274名(52%)男性,由7名受过培训的分诊护士进行了评估。协作专家小组的评估与护士和医生对所有5个级别的实际分诊量表之间的逆向一致程度非常好,Cohen加权kappa分别为0.966(CI 0.985-0.946,p<0.001)和0.813(CI 0.856-0.769,p结论:研究结果表明,研究护士进行的分诊具有完全的可靠性,总体而言,几乎完全的有效性。
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引用次数: 2
期刊
Advanced Journal of Emergency Medicine
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