An 85-year-old female patient was brought to emergency department (ED) from a nursing home with altered mental status (GCS: 12/15) and hypotension (90/60 mmHg). Bilateral fine crackles in lungs and severe cachexia were obvious in her physical examination. The ECG showed only sinus tachycardia. Several attempts at peripheral vein cannulation failed due to poor visualization of severely atrophied and contracted subcutaneous veins. Therefore, on two attempts, a central venous catheter (CVC) was inserted into the right internal jugular vein (IJV) using the Seldinger technique. After securing and taping the central line, fluid infusion started with no difficulty and a portable chest x-ray was ordered.
{"title":"An 85-year-old Woman with Altered Mental Status and Hypotension","authors":"Mehran Sotoodehnia, A. Abdollahi, Maryam Khodayar","doi":"10.22114/ajem.v0i0.144","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.144","url":null,"abstract":"An 85-year-old female patient was brought to emergency department (ED) from a nursing home with altered mental status (GCS: 12/15) and hypotension (90/60 mmHg). Bilateral fine crackles in lungs and severe cachexia were obvious in her physical examination. The ECG showed only sinus tachycardia. Several attempts at peripheral vein cannulation failed due to poor visualization of severely atrophied and contracted subcutaneous veins. Therefore, on two attempts, a central venous catheter (CVC) was inserted into the right internal jugular vein (IJV) using the Seldinger technique. After securing and taping the central line, fluid infusion started with no difficulty and a portable chest x-ray was ordered.","PeriodicalId":94293,"journal":{"name":"Advanced journal of emergency medicine","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74940543","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}
Although the ideal treatment route for management of patients with ST-segment elevation myocardial infarction (STEMI) is rapid diagnosis and direct transfer to the catheterization unit and undergoing primary angioplasty, using thrombolytic still has its place in cases that the equipment are not available or there is not enough time for performing angioplasty. Of course these drugs are associated with specific side effects such as probability of gastrointestinal (GI) and cerebral bleeding, allergic reactions and etc. Therefore, finding drugs with fewer side effects and limitations for use has always been interesting in this regard. The drug which has been used all around the world since 1970 and is also traditionally used in Iran for managing patients with STEMI is streptokinase. This drug is a protein extracted from beta hemolytic streptococci, which combines with plasminogen and facilitates transformation of plasminogen to plasmin. However, recently fibrin specific drugs or recombinant tissue plasminogen activators (rtPA) such as alteplase, urokinase, tenecteplase, reteplase and etc. have become available to emergency medicine physicians and cardiologists. Having longer half-lives, fewer side effects, and easier method of use, these drugs have opened a new door for physicians regarding use of thrombolytic drugs in treatment of STEMI and brain stroke. Studies regarding comparison of safety and effectiveness of these drugs are ongoing. In a systematic review and meta-analysis, Tourani et al. showed that the safety and effectiveness of streptokinase and tenecteplase were in the same level. Reteplase is an rtPA peptide, which converts endogenous plasminogen to plasmin. Plasmin causes destruction of the fibrin present in the clot and the clot disappears. In a prospective case-control study in Amiralmomenin Hospital, Tehran, Iran, we divided 152 patients with STEMI and the mean age of 56.41 ± 10.40 (27 – 85) years who were candidates for receiving thrombolytic therapy into 2 groups receiving either streptokinase (from CSL Behring GmbH Co, Germany) or reteplase (from Reliance Life Sciences Co, India) (83.6% male). Then we compared outcomes such as GI bleeding, mortality, hypotension, arrhythmia, and etc. between the 2 groups. The 2 groups were in a similar condition regarding sex (p = 0.331) and age distribution (p = 0.393), blood pressure on admission (p = 0.378), and the rate of positive troponin on admission (p = 0.113). Overall, 61 (40.1%) patients showed at least one of the outcomes that we studied (13 cases in the streptokinase group and 48 cases in the reteplase group; p < 0.0001). In this study, all 20 cases of GI bleeding observed following thrombolytic prescription were in the reteplase group. Additionally, out of the 19 cases of death observed, 14 were in reteplase group and 5 had received streptokinase. One case of arrhythmia and 2 cases of hypotension were seen in streptokinase group. Based on the findings of this study, it seems that desp
虽然st段抬高型心肌梗死(STEMI)患者的理想治疗途径是快速诊断并直接转入置管室并进行初级血管成形术，但在设备不具备或时间不够进行血管成形术的情况下，溶栓治疗仍有其作用。当然，这些药物有特定的副作用，如胃肠道(GI)和脑出血的可能性，过敏反应等。因此，在这方面，寻找副作用和使用限制较少的药物一直很有趣。自1970年以来，全世界都在使用这种药物，传统上在伊朗也用于治疗STEMI患者，这种药物是链激酶。该药物是从溶血性链球菌中提取的蛋白质，与纤溶酶原结合，促进纤溶酶原向纤溶酶的转化。然而，近年来，纤维蛋白特异性药物或重组组织型纤溶酶原激活剂(rtPA)如阿替普酶、尿激酶、替奈特普酶、雷替普酶等已成为急诊科医生和心脏病专家可用的药物。这些药物具有半衰期长、副作用少、使用方法简单等特点，为医生在STEMI和脑中风治疗中使用溶栓药物打开了新的大门。有关这些药物的安全性和有效性比较的研究正在进行中。Tourani等在一项系统综述和荟萃分析中发现，链激酶和替奈普酶的安全性和有效性处于同一水平。Reteplase是一种rtPA肽，可将内源性纤溶酶原转化为纤溶酶。纤溶酶会破坏凝块中的纤维蛋白，凝块就会消失。在伊朗德黑兰Amiralmomenin医院的一项前瞻性病例对照研究中，我们将152例STEMI患者，平均年龄56.41±10.40(27 - 85)岁，作为接受溶栓治疗的候选患者分为两组，接受链激酶(来自德国CSL Behring GmbH Co .)或reteplase(来自印度Reliance Life Sciences Co .)(83.6%男性)。比较两组患者消化道出血、死亡率、低血压、心律失常等情况。两组患者在性别(p = 0.331)、年龄分布(p = 0.393)、入院时血压(p = 0.378)、入院时肌钙蛋白阳性率(p = 0.113)等方面差异无统计学意义。总体而言，61例(40.1%)患者表现出至少一种我们研究的结果(链激酶组13例，雷替普酶组48例;P < 0.0001)。本研究中，溶栓处方后观察到的20例消化道出血均为瑞替普酶组。另外，19例死亡病例中，雷替普酶组14例，链激酶组5例。链激酶组心律失常1例，低血压2例。根据本研究结果，尽管存在血清半衰期较长、使用方便等因素，但在使用前应仔细考虑该药的副作用率。根据现有的一些研究，似乎在最乐观的情况下，这两组具有相似的副作用和有效性。为了对伊朗人种进行更准确的评估，至少需要更大样本量的更准确的研究。这个话题在发达国家可能受到的关注较少，因为考虑到这些国家设备的可用性，治疗方案主要基于血管成形术，而不是使用溶栓药物。当我们意识到这些新药的治疗费用较高时，这个问题变得更加重要，因为保险不包括这些药物。建议在未来的研究中进行成本/效益研究和评估治疗的安全性。
{"title":"Reteplase versus Streptokinase in Management of ST-segment Elevation Myocardial Infarction; a Letter to the Editor","authors":"","doi":"10.22114/ajem.v0i0.143","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.143","url":null,"abstract":"Although the ideal treatment route for management of patients with ST-segment elevation myocardial infarction (STEMI) is rapid diagnosis and direct transfer to the catheterization unit and undergoing primary angioplasty, using thrombolytic still has its place in cases that the equipment are not available or there is not enough time for performing angioplasty. Of course these drugs are associated with specific side effects such as probability of gastrointestinal (GI) and cerebral bleeding, allergic reactions and etc. Therefore, finding drugs with fewer side effects and limitations for use has always been interesting in this regard. The drug which has been used all around the world since 1970 and is also traditionally used in Iran for managing patients with STEMI is streptokinase. This drug is a protein extracted from beta hemolytic streptococci, which combines with plasminogen and facilitates transformation of plasminogen to plasmin. However, recently fibrin specific drugs or recombinant tissue plasminogen activators (rtPA) such as alteplase, urokinase, tenecteplase, reteplase and etc. have become available to emergency medicine physicians and cardiologists. Having longer half-lives, fewer side effects, and easier method of use, these drugs have opened a new door for physicians regarding use of thrombolytic drugs in treatment of STEMI and brain stroke. Studies regarding comparison of safety and effectiveness of these drugs are ongoing. In a systematic review and meta-analysis, Tourani et al. showed that the safety and effectiveness of streptokinase and tenecteplase were in the same level. Reteplase is an rtPA peptide, which converts endogenous plasminogen to plasmin. Plasmin causes destruction of the fibrin present in the clot and the clot disappears. In a prospective case-control study in Amiralmomenin Hospital, Tehran, Iran, we divided 152 patients with STEMI and the mean age of 56.41 ± 10.40 (27 – 85) years who were candidates for receiving thrombolytic therapy into 2 groups receiving either streptokinase (from CSL Behring GmbH Co, Germany) or reteplase (from Reliance Life Sciences Co, India) (83.6% male). Then we compared outcomes such as GI bleeding, mortality, hypotension, arrhythmia, and etc. between the 2 groups. The 2 groups were in a similar condition regarding sex (p = 0.331) and age distribution (p = 0.393), blood pressure on admission (p = 0.378), and the rate of positive troponin on admission (p = 0.113). Overall, 61 (40.1%) patients showed at least one of the outcomes that we studied (13 cases in the streptokinase group and 48 cases in the reteplase group; p < 0.0001). In this study, all 20 cases of GI bleeding observed following thrombolytic prescription were in the reteplase group. Additionally, out of the 19 cases of death observed, 14 were in reteplase group and 5 had received streptokinase. One case of arrhythmia and 2 cases of hypotension were seen in streptokinase group. Based on the findings of this study, it seems that desp","PeriodicalId":94293,"journal":{"name":"Advanced journal of emergency medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80713341","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: The concept, family-centered care (FCC), is used to describe the way families are involved in the health care of hospitalized children. In developing countries, most paediatric wards claim to be ‘family-centered’, which means that the wards adopt a philosophy where parents are acknowledged as being central to their children’s existence. Despite substantial investments in researchers, dissemination and advocacy, huge gap exist between what is known about effective health services and what is done in real world practice. There is no common agreement between health care workers on provision of FCC in Iran. Objectives: To identify the effect of educational intervention on Family-Centered Care model on attitude, intention and behaviour of pediatric nurses. Methods: Participants were randomly assigned to complete a questionnaire assessing paediatric nurses’ attitude towards providing FCC in Iran. Results: There is no significant relationship between socio-demographic characteristics and attitude towards provision of FCC for both intervention and control groups (p>0.05). The mean of behaviour in the intervention group (1.57 unit) increased and difference among pre- and post-tests in behaviour score in the intervention group was significant (P<0.05). Conclusion: The findings have important theoretical implication as theory of planned behaviour verified that nurses’ behaviours changed after educational intervention.
{"title":"Effect of Educational Intervention on Nurses’ Attitude, Intention and Behaviour Towards Family-Centered Care in Pediatric Wards in Iran: A Randomized Control Trial Utilizing Prospect Theory","authors":"F. Rostami","doi":"10.18686/AEM.V8I1.144","DOIUrl":"https://doi.org/10.18686/AEM.V8I1.144","url":null,"abstract":"Background: The concept, family-centered care (FCC), is used to describe the way families are involved in the health care of hospitalized children. In developing countries, most paediatric wards claim to be ‘family-centered’, which means that the wards adopt a philosophy where parents are acknowledged as being central to their children’s existence. Despite substantial investments in researchers, dissemination and advocacy, huge gap exist between what is known about effective health services and what is done in real world practice. There is no common agreement between health care workers on provision of FCC in Iran. Objectives: To identify the effect of educational intervention on Family-Centered Care model on attitude, intention and behaviour of pediatric nurses. Methods: Participants were randomly assigned to complete a questionnaire assessing paediatric nurses’ attitude towards providing FCC in Iran. Results: There is no significant relationship between socio-demographic characteristics and attitude towards provision of FCC for both intervention and control groups (p>0.05). The mean of behaviour in the intervention group (1.57 unit) increased and difference among pre- and post-tests in behaviour score in the intervention group was significant (P<0.05). Conclusion: The findings have important theoretical implication as theory of planned behaviour verified that nurses’ behaviours changed after educational intervention.","PeriodicalId":94293,"journal":{"name":"Advanced journal of emergency medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90024722","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}
Cancer vaccination projects are on trial worldwide and the results are far-off being a remarkable success. Albeit, thousands of clinical trials are taking place, only a several of those are producing a significant result to increase the survival rate of the patients. Four vaccines (Human papillomavirus - HPV vaccines, Hepatitis B virus - HBV vaccines, Sipuleucel-T and Oncophage) are approved for market in the United States and Russia so far. Most of the prototype vaccines are yielding at phase III clinical trials after being successful at phase I and II. Apparently, new visions and approaches are required to guide these projects to harvest better results.
{"title":"The Looming Success in Cancer Vaccination","authors":"S. Rahman","doi":"10.18686/AEM.V8.137","DOIUrl":"https://doi.org/10.18686/AEM.V8.137","url":null,"abstract":"Cancer vaccination projects are on trial worldwide and the results are far-off being a remarkable success. Albeit, thousands of clinical trials are taking place, only a several of those are producing a significant result to increase the survival rate of the patients. Four vaccines (Human papillomavirus - HPV vaccines, Hepatitis B virus - HBV vaccines, Sipuleucel-T and Oncophage) are approved for market in the United States and Russia so far. Most of the prototype vaccines are yielding at phase III clinical trials after being successful at phase I and II. Apparently, new visions and approaches are required to guide these projects to harvest better results.","PeriodicalId":94293,"journal":{"name":"Advanced journal of emergency medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73716793","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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