سال:1399 | دوره: | شماره: |تعداد مقالات:17

Dear Editor, The World Health Organization (WHO) Emergency Committee exclaimed a global health emergency concern based on growing case notification rates of the novel coronavirus in Chinese and other international locations (1). Four weeks have passed from the first reported case of coronavirus disease 2019 (COVID-19) in Iran. During the past month, thousands of patients ran into emergency departments (EDs) due to respiratory complaints. The current outbreak of the novel COVID-19 in Iran is a challenging issue for emergency medicine specialists...

Objective: The purpose of this study was to evaluate a valid model for patients’ admission or discharge from emergency services to improve the health system and reduce costs. Methods: This study was carried out using a prospective cohort method. The study population was patients with limb cellulitis referring to the emergency department of Peymanieh hospital. In this research, the study participants were separated into two groups based on the duration of hospitalization (hospital stay less than 24 hours or longer than 24 hours), then the patients were again separated into 4 groups based on the classification of the the Clinical Resource Efficiency Support Team (CREST) guideline, which in each of these groups the mean age, gender, and the prevalence of underlying diseases were identified and the final outcome for each group was determined after one week from the visit to the hospital. Results: Peripheral vascular disease, history of injection drug use, immunodeficiency and congenital immune deficiency had a significant relationship with the rate of hospitalization and recurrence. There was a significant relationship between class 1 disease and hospitalization for less than 24 hours, classes 2 and 3, and hospitalization for more than 24 hours (P < 0. 001). There was a significant relationship between grade 1 disease and non-recourse, grade 3 and recurrence within one week after initiation of the treatment (P < 0. 001). But there was no relationship between grade 2 and grade 4 and the referral of the patient after treatment. Conclusion: Corset Scale is a reliable scale for assessing the severity of the disease to determine the process of cellulite treatment for outpatient or hospitalization.

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.

Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The purpose of this study is to investigate the relationship between the patient’ s chief complaint and their departure to the emergency room. Methods: From non-traumatic patients referred to the emergency department of Imam Reza Hospital during 2018, about 57 000 patients were selected and enrolled in the study. Then, age, sex, initial diagnosis, time of the final decision, and time of departure from the emergency department as well as hospitalization ward were included in the checklist. Patients whose documentation was incomplete were excluded. Data were entered into SPSS software version 15. 0 and descriptive statistics (normal distribution, average of time, minimum time and maximum time, confidence interval, mode, and median, etc) were used for descriptive analysis and linear regression was used to analyze the correlation among findings. Results: There was a significant relationship between chief complaint and the length of stay in the emergency department (P = 0. 046) and patients with dyspnea due to heart disease, bloody vomit, bloody stool, constipation, jaundice, anemia, decreased level of consciousness, diabetes, complications of diabetes, shortness of breath and kidney injury stayed longer in the emergency room compared to other complaints. Conclusion: The patient’ s manner of expressing and chief complaint has an impact on the length of time they wait to leave the emergency room. Also, most patients with problems related to internal medicine have the longest time in the emergency room; in particular gastrointestinal patients have the longest stay in the emergency room.

Objective: Emergency medical services (EMS) is a critical component of health care system and the forefront of stroke care. The prominent role of EMS in stroke care is timely and accurate diagnosis of acute ischemic stroke and transfer of the patients to stroke centers. The present study aimed to assess the “ awareness” and “ attitude” of EMS personnel concerning prehospital stroke care based on American Stroke Association (ASA) guideline in Rasht town. Methods: This was an analytical cross-sectional study. The participants, consisted of all EMS personnel (n = 115) in Rasht town in 2012, entered the study based on census method. Awareness and attitude of EMS personnel toward prehospital stroke care were assessed using a questionnaire based on ASA guideline. The questionnaire had two sections. The first part contained demographic data and the second part had multiple choice items (Likert-type scale response anchors) to assess awareness and attitude of the personnel. The questionnaires were filled out by the personnel. The collected data were analyzed using descriptive and inferential statistics using SPSS software version 20. P value less than 5% was considered significant. Results: Ninety people participated in this study. The average of age and working experience of participants were 36. 84 ± 8. 02 and 11. 36 ± 5. 71, respectively. Most of the participants had bachelor degree (n = 33, 36. 7%) and majored in medical emergency (n = 43, 47. 8%). Most of them were contract employees (47. 8%). Mean scores of awareness and attitude of the personnel were 26. 68 (the total number of score = 51) and 32. 56 (the total number of score = 80), respectively. Conclusion: Findings revealed poor awareness and attitude of EMS personnel toward prehospital stroke care based on ASA guideline in Rasht Town. We recommended retraining courses to promote awareness of EMS personnel.

Objective: Determination of victim’ s clothes in gunshot wounds is important due to the necessity of immediate workup in the emergency room as well as the legal aspects of cases. The aim of this study is to evaluate the importance of victim’ s clothes in gunshot wounds referred to autopsy hall of legal medicine bureau of Tehran, Iran from 2014 to 2017. Methods: In this analytical comparative study, 202 consecutive cadavers of gunshot victims, referred to Tehran Legal Medical Hall from 2014 to 2017, were enrolled and the effect of shotgun and gunshot wound were determined and compared. Data were collected using a researcher-made questionnaire. The significance level of the tests was considered as P < 0. 05. Spearman correlation coefficient and chi-square tests were used accordingly. The data were analyzed using SPSS software version 22. Results: In this study, all women were killed by gunshot. Also, all of the 26 people who were killed by shotgun were men. The mean of age only in males was 39-48 years for shotgun, and 29-38 years in both genders for gunshot. Evaluation of their clothes in the emergency room and autopsy hall was helpful in 70% of cases in order to determine shot distance and type of gun (P = 0. 0001). Conversely, we did not observe a significant difference between sex (P = 0. 082) and the pattern of death (P = 0. 211). Conclusion: Based on the obtained results, it seems that some characteristics of victim’ s clothes may be useful to differentiate shotgun and gunshot.

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 ICH-related 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.

Objective: Trauma is considered to be a major cause of morbidity and mortality all over the world. This descriptive study has an emphasize on the epidemiology, mechanism and patterns of trauma, with a consideration of why trauma code was activated, and the imaging results in regard to the severity of the trauma. Methods: A descriptive study was conducted in Al Ain Hospital over the year of 2017. Totally 886 patients were included who presented with a trauma and considered dangerous according to hospital guidelines. They underwent a full body trauma CT, and were admitted to the hospital. We looked at the mechanisms, patterns, time of the day and radiological findings. Injury severity score (ISS) and Revised trauma score (RTS) were calculated, and the cause of trauma code activation was evaluated. Results: The study showed that; positive imaging findings were found in 364 (41%) of patients while 522 (59%) had normal radiological tests. The principal mechanism of injury was motor vehicle accident (54. 4%) followed by falls (21. 4%) and pedestrian accidents (10. 2%). Overall, 69. 75% (618 patients) were admitted to the hospital, 22 patients (2. 5%) needed immediate interventions and 36 patients (4%) needed ICU admission. Only 2 patients (0. 25 %) died in the emergency room. Conclusion: The hospital policy in activating a trauma code should be revised, with more care being paid to the mechanisms of injury and the condition of the patient, without missing any injury that could harm the patient. So, the emergency physician should be better prepared to do a detailed physical examination and weigh the risk of radiation against missing a dangerous injury.

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.

Objective: The current study was performed to provide real-time bedside ultrasonography for emergency medical technicians (EMTs) and assess the advantages and disadvantages of its application in dealing with trauma patients in pre-hospital setting from their viewpoints. Methods: This semi-experimental study was conducted in Tehran, Iran. Twenty EMTs were selected purposefully and underwent a training program. Thereafter, they were asked to perform extended focused assessment with sonography in trauma (eFAST) using a handheld ultrasound device on trauma patients, and also filled a questionnaire prepared (in four components including C1: coherence, C2: cognitive participation, C3: collective action, and C4: reflexive monitoring) based on the normalization process theory (NPT). Results: All 20 participants were men and their average age was 37. 8 years (SD = 4. 7). For C1, the median total score was 10. 5 out of a score of 4-20; For C2, the median score was 6 out of 3-15; For C3, the median total score was 18 out of a score of 6-30; and for C4, the median total score was 11 out of a score of 5-25. Conclusion: Overall, it seems that EMTs welcomed using ultrasonography in dealing with trauma patients in pre-hospital setting. Although they thought that it might somewhat lead to an increase in their workload; but they believed that sufficient training was not provided for them yet. The EMTs were uncertain about the viewpoints of the patients and did not know how it could affect patients’ outcome.

The current coronavirus pandemic forces us to realize the significance of the careful utilization of financial and health-care resources. At the same time, it is important to ensure the ability of urologists to function through this crisis to provide essential and emergency services. With regards to urological procedures, a triage of non-emergent operations is hence recommended considering various disease-related factors. Case conduct should also be categorized based on the up-to-date information of the evolving national, regional and local conditions of this pandemic, as marked variation in these conditions can lead to significant differences in decision-making. Over the coming weeks and months, we are bound to face an increasingly difficult task of treating Coronavirus disease 2019 (COVID-19) infected patients presenting with urological ailments. Instituting well-thought plans to perform the un-deferrable urological procedures and emergencies during this pandemic will go a long way in keeping the surgeons and health-care workers safe to perform essential duties.

Introduction: Emerging viral diseases (EVDs) pose a significant threat to public health. There have been a few viral epidemics in the last two decades. Coronavirus disease 2019 (COVID-19) is now a global pandemic. Objective: To provide emergency physicians an update on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its dynamic impact on the emergency department (ED) in terms of preparedness and management of patients presenting to ED with suspected COVID-19 disease. Discussion: COVID-19 has a human-to-human transmission through close contact and even from asymptomatic carriers. Symptoms are similar to a viral respiratory illness. The disease is mild and self-limiting in most patients, but some develop severe illness like pneumonia, acute respiratory distress syndrome (ARDS) and multiorgan failure. Emergency physicians should prioritize early identification of these patients at risk, isolate them and after collaborating with relevant hospital and national authorities, develop clinical pathways to safely evaluate, manage and dispose patients with COVID-19. Various strategies for managing these patients in the ED are discussed. Disposition of these patients depends on symptoms and hemodynamic status and potential to self quarantine versus admission to an isolation facility. Conclusion: This review provides an overview of patients presenting to the ED with suspected COVID-19 and its impact on the ED. It reiterates the fact that emergency physicians, in close collaboration with relevant hospital authorities, play a pivotal role during EVDs. It emphasizes the need for pandemic preparedness, enabling us to better manage such events in the future.

Introduction: Child abuse has been defined as allowing others to cause physical, emotional, and sexual harm, and also physical and emotional pain to a child. The present study was a report on a case of physical and sexual child abuse accompanied by traumatic brain injury (TBI) referred to an emergency department. Case Presentation: A 4-year-old child was rushed into an emergency department by her mother. At the time of hospital admission, the child was feeling confused and drowsy and had symptoms of hemorrhage in the right preperitoneal space as well as bleeding from the mouth. According to the pattern of the child’ s admission to the emergency department, contradictory descriptions by parents, clinical examinations, and TBI pattern; the probability of a case of child abuse was raised. Thus; neurosurgery, legal medicine, gynecology, and surgery consultations were requested. With regard to the brain injury and epidural hematoma, immediate measures (i. e. head lifting, taking Dilantin, blood glucose control, blood pressure control, and maintaining adequate oxygen saturation in the arterial blood) were taken to put a stop to secondary brain injury, and the patient was then transferred to the intensive care unit (ICU) for further treatments. Conclusion: In the present case study, the child was seriously examined and followed up. In conclusion; 20 days later, the case was discharged from the pediatric ward with good medical conditions, and received counseling and psychiatric services for one year.

Objective: Tramadol is a synthetic analgesic with two mechanisms. The opioid and non-opioid mechanisms are responsible for tramadol side effects. Non-opioid side effects of tramadol are due to the reuptake inhibitions of serotonin and norepinephrine. Some of the side effects include anaphylactoid reactions, CNS depression, hypoglycemia, hypotension, respiratory depression, seizures, and serotonin syndrome. Seizure may happen in therapeutic doses. If the frequency of tramadol seizures increases, ischemic brain injury and hypoxic-ischemic encephalopathy can be induced. Case Report: We report a young man with a history of tramadol abuse that was admitted with status epilepticus in Imam Reza hospital in Mashhad, Iran. Due to his altered mental status, he was intubated and antiepileptic agents were prescribed. He was transferred to ICU. After regaining consciousness, he was extubated and with the prescription of rehabilitation support he was discharged. Conclusion: Tramadol is a synthetic analgesic agent with less potential for dependence. It is important to mention that the overdose of this drug is common. This drug has two mechanisms. This paper reports a case that developed generalized tonic clonic seizures due to tramadol and hypoxic ischemic encephalopathy. With adequate treatment and supportive care, patient’ s mental status improves and he/she can be discharged.

Objective: Necrotizing fasciitis of the perinea, referred to as Fournier’ s gangrene, is a necrotizing infection of the perinea. To the best of our knowledge, there is no report on the Fournier’ s gangrene following an ant bite and this is a rare case report of this type. Case Presentation: In this rare case report we describe a 20-year-old man who developed Fournier’ s gangrene following an ant bite which resulted in his death. He sustained numerous ant bites in the perinea. Subsequently, he suffered from itching of the area and had scratched the area frequently leading to dermal ulcers and laceration, pain, and swelling of the scrotal area followed by fever and diminished consciousness. Finally, he presented to the emergency room (ER) after 72 hours of ant bites with a shock. Physical examination revealed extensive necrosis of scrotum. The primary treatments including antibiotic therapy, normal saline solution, and dopamine were not effective. Conclusion: Even a simple nonpoisonous insect bite can lead to Fournier’ s gangrene and death. Paying greater attention to the site of bite, especially in the perinea which is anatomically more susceptible to infection, observing hygienic principles, and quick access to healthcare centers may prevent the patient’ s death.

Objective: Foreign body swallowing is a common pediatric problem. A foreign body in the pharynx is a medical emergency that requires urgent intervention. Evaluation and treatment of pharyngeal foreign bodies is much more difficult in children than in adults and sometimes requires hospitalization and removal of the foreign bodies under general anesthesia due to children’ s lack of cooperation. Fish and chicken bones are the most common swallowed foreign bodies, but an interesting case of a piece of dishwashing steel wool stuck in a child’ s pharynx is reported in this article. Case Presentation: A 10-year old boy was presented with a history of dysphagia from five weeks ago. Oral examination did not reveal anything significant. In lateral neck radiographs of the patient, a metal wire was observed in the hypopharyngeal region opposite the 4th and 5th cervical vertebrae. Endoscopic attempts to remove the foreign body were not successful. Therefore, the foreign body was removed from the patient’ s pharynx in the operating room under general anesthesia. No complications were observed. Conclusion: Despite the prevalence of swallowing foreign bodies in children, ingestion of a piece of dishwashing steel wool not diagnosed for three weeks was considered interesting to report. Pharyngeal foreign bodies are medical emergencies; therefore, it is particularly important to suspect the presence of a foreign body and perform diagnostic procedures.

Objective: Scorpion stings are common in tropical regions of Iran. Hemiscorpius enischnochela are distributed in southern part of Iran. The venom of this scorpion causes severe hemolysis, hemoglobinuria, and occasionally death. Case Presentation: This report describes the clinical manifestations of envenomation by H. enischnochela in a 3-year-old boy from Ruydar city in south of Iran. Conclusion: Special attention should be paid to the painless stings of yellow scorpions and more studies are needed to set out a protocol for the management of these cases in areas with this envenomation to be a common one.