Frontiers in Emergency Medicine
Year:2022 | Volume:6 | Issue:3|Papers Count:15

Objective: We aimed to investigate the extent of pulmonary involvement and adverse outcomes in patients receiving angiotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blocker (ARB) versus who did not, in hospitalized coronavirus infectious disease 2019 (COVID-19) patients. Method: All COVID-19 patients with a positive polymerase chain reaction (PCR) test, who were admitted to our tertiary referral hospitals in Tehran, Iran between January 2021 and May 2021, and had an on-admission chest computed tomography (CT) scan, were included. The patients were divided into two groups (receiving ACEI/ARB and who did not) for further analysis. The outcomes of interest in our study were the extent of pulmonary involvement, intensive care unit (ICU) admission, and death. Results: A total of 893 participants (mean age of 58. 6±, 15. 4 years,female, 522 (58. 4%)) were enrolled. Among them, 368 (41. 2%) participants had hypertension, and use of ACEI/ARB was reported in 183 (20. 5%) participants. Of all, 409 (45. 8%) participants required ICU admission, and 259 (29%) participants succumbed to death. We found that participants who received ACEI/ARB were less likely to progress critical disease and experienced significantly lower ICU admission (P=0. 022) and death (P<0. 001). On multivariable analysis adjusting for age, sex, and comorbidities, this relationship remained statistically significant for death (odds ratio (OR): 0. 23 [0. 14-0. 38], P<0. 001) and ICU admission (OR: 0. 49 [0. 32-0. 73], P=0. 001). Conclusion: Our findings showed that COVID-19 patients who receiving ACEI/ARB prior to hospitalization vs. those who did not, had more favorable outcomes.

1. Introduction Since the emergence of Coronavirus Disease 2019 (COVID-19), critically ill childrenwithCOVID-19 made up a small proportion of the patients. Still, recent records of coronavirus infection in children and adolescents have been accompanied by multisystem inflammatory syndrome and Kawasaki-like symptoms (1-3). This new phenomenon, called Multisystem Inflammatory Syndrome in children (MIS-C), seems to be a kind of post-viral inflammatory disease rather than a remitting infection. The most common manifestations of this disease are fever, gastrointestinal symptoms, rash, conjunctivitis, and shock. Myocarditis and myocardial dysfunction have also been reported by performing echocardiography (4-6). It should be noted that there are differences between viral myocarditis and myocarditis following MIS-C in COVID-19. In viral myocarditis, signs and symptoms are due to viral penetration and the immune response,however, in these inflammatory diseases and MIS-C, the manifestations are mainly due to inflammatory infiltration and cytokine stormin interstitial myocardial tissue (5, 7). Even so, myocarditis with severe restrictive diastolic dysfunction is considered a rare presentation of this disease among children. . .

Objective: The aim of this study was to evaluate the influence of adding a 10-day course of levamisole (LVM) to the standard care compared with standard care alone, on the clinical status of COVID-19 patients with mild to moderate disease. Methods: In this randomized open-label trial, we enrolled non-hospitalized patients with mild to moderate COVID-19 at nine health centers in Tehran province, Iran, in 2021. Patients were randomly assigned to receive a 10-day course of LVM with standard care (n=185) or standard care alone (n=180) in a 1: 1 ratio. On days 1 to 10, LVM was administered orally at a dosage of 50 mg. The participants were called and followed on days 1, 3, 5, 7, 9, and 14. The measured parameters were general health condition, hospitalization rate, signs and symptoms, and adverse events. The generalized estimating equationsmodel was used for analysis. Results: Among 507 randomized patients, 473 patients started the experiment and received LVM plus standard care or received the standard care alone,385 patients included in the analysis,346 (98%) patients completed the trial. The median age of the patients was 40 years [IQR: 32-50. 75],and 201 (55. 1%) patiens were male. The mean age, sex ratio, and frequency of the underlying diseases of the patients in the two study groups had no statistically significant differences (P>0. 05). Compared to the control group, LVM improved the general health condition of the patients (B=-0. 635,95% CI:-0. 041,-0. 329,P<0. 001). Patients receiving LVM compared with standard care group had significantly lower odds of developing fever (OR=0. 260,95% CI: 0. 113, 0. 599,P=0. 002), chills (OR=0. 223,95% CI: 0. 076, 0. 648,P=0. 006), fatigue (OR=0. 576,95% CI: 0. 346, 0. 960,P=0. 034), and myalgia (OR=0. 544,95% CI: 0. 317, 0. 932,P=0. 027). No significant difference was observed in the rate of hospitalization. Although the intervention group had greater adverse effects than the control group, the difference was not statistically significant. Conclusion: Findings of this study suggest that LVMhas clinical benefits in improving patients’,health condition with mild to moderate COVID-19.

1. Case presentation The patient was a 30-year-old female. She had developed dysphagia three days prior to admission. Initially, she only had problem swallowing solids but later the problem progressed to liquids, and after that dysphonia was added. She was visited by a first-level doctor who diagnosed her problem as pharyngotonsillitis and treated her with amoxicillin + clavulanate without improvement. Two days later, diplopia was added, which led her to come to our hospital. Upon arrival, the vital signs were recorded as blood pressure 120/70 mmHg, respiratory rate 18 breaths per minute, temperature 35. 7 °, C, and O2 saturation 98% in roomair. She was alert, oriented in three spheres, normoreflexic, had isochoric pupils with ptosis when making a pathetic look, and had preserved motor and sensory function of the facial nerve. She also had dysphonia, inability to swallow, with difficulty to manage secretions. She had normal thorax with adequate ventilatory mechanics, lung fields with adequate air entry and exit, rhythmic precordium without aggregated auscultator phenomena, globular abdomen at the expense of panniculus adiposus, preserved peristalsis, pelvic limbs with 1/5 bilateral loss of strength, preserved sensitivity, bilateral areflexia, thoracic limbs strength 3/5 bilateral, and ataxic gait. . .

This is the third installment in the electrocardiogram (ECG) interpretation series by Jerry W. Jones MD FACEP FAAEM for this journal. In the first installments, he discussed simple atrioventricular (AV) dissociation versus AV dissociation caused by third degree AV block (1),and in the second one, he shares some very important pearls regarding ECG interpretation (2). . .

Objective: In this study, we have evaluated the occurrence and risk factors of cardiac dysrhythmia on admission and during hospitalization in COVID-19 patients. Methods: This study was conducted as a retrospective cohort in which 893 electrocardiograms (ECGs) taken at the time of admission, and 328 ECGs taken during hospitalization were evaluated. These ECGs were assessed for cardiac dysrhythmias by a cardiologist. Finally, relationships between clinical characteristics and the occurrence of cardiac dysrhythmias in patients were assessed. Results: Most common cardiac dysrhythmias on admission were sinus tachycardia (64. 8%), atrial fibrillation (13. 5%), and sinus bradycardia (11. 3%). Multivariate regression analysis showed that a history ofmetformin use (RR=0. 83,P=0. 042) was independently associated with reduced risk of cardiac dysrhythmias on admission, while male sex (RR=1. 16,P=0. 018), history of cardiovascular diseases (RR=1. 16,P=0. 017), history of cancer (RR=1. 40,P=0. 004) and QT interval prolongation on ECG (RR=1. 18,P=0. 017) were associated with a higher risk of cardiac dysrhythmias on admission. Also, among the 328 patients that had a second ECG, 185 (56. 4%) experienced cardiac dysrhythmias during their hospitalization. Multivariate analysis showed that presence of cardiac dysrhythmias on admission (RR=1. 85,95% CI: 1. 49, 2. 35,P<0. 001) was the only independent prognostic factor for the occurrence of cardiac dysrhythmias during hospitalization. No significant relationships were observed between treatment regimens and the incidence of cardiac dysrhythmias. Conclusion: The present study showed that more than half of COVID-19 patients have cardiac dysrhythmias on admission. Our analyses illustrated that a history of metformin use was associated with a lower risk of cardiac dysrhythmias on admission, while male sex, history of cardiovascular diseases, history of cancer, andQT interval prolongation were associated with a higher rate of cardiac dysrhythmias. Hydroxychloroquine use along with azithromycin and kaletra (lopinavir-ritonavir) had no association with the development of cardiac dysrhythmias during hospitalization.

Non-convulsive seizures (NCS) and non-convulsive status epilepticus (NCSE) are of the acute complications of patients admitted to the intensive care unit (ICU), which lead to increased mortality and morbidity. In these cases, immediate treatment with antiepileptic drugs (AEDs) is important to prevent further damage to the brain. AEDs are the first line of treatment, however, most of these medications have many side effects. In the recent years, significant advances have been made in this area and lacosamide is one of the therapeutic options. The intravenous formulation of this drug is most popular due to the lack of drug-drug interaction and properly designed studies which have been conducted in this field. In this review, the latest findings on the effect of lacosamide on acute non-convulsive and generalized-convulsive seizures (G-CS) are evaluated in critically ill patients admitted to the ICU.

Objective: SANYAR®, video laryngoscope (S-VL) is a new video laryngoscope. We conducted a comparative clinical study to assess its ability to provide laryngeal exposure and facilitate endotrachetal intubation (ETI) in adult patients. Method: This comparison clinical study was conducted on adult patients undergoing elective general anesthesia. The patients were randomly divided into two groups of direct laryngoscopy (DL) or S-VL. The primary outcome was the time required for performing ETI. The glottic view and successful ETI on the first attempt was also compared between the two groups. Results: Full and partial glottic visualization was achieved in 100% of the patients in the S-VL group, while the corresponding figure in the DL group was 90%. Cormack-Lehane III was observed in 5 patients of the DL group, and ETI was successfully carried out with S-VL. The first-pass success rate of ETI was significantly higher in S-VL group compared to the DL group (94% vs. 78%,P = 0. 034). The mean times to ETI were 38. 32±, 6. 4 and 35. 31±, 8. 4 seconds in DL and S-VL groups, respectively (P = 0. 650). Conclusion: During ETI for general anesthesia, SANYAR®,video laryngoscope compared with direct laryngoscopy improved glottic visualization and first-pass ETI rate.

Objective: The simulation strategy is so important for appropriate responses and preparedness of hospital emergency department staff in emergencies to strengthen team building and care focused on the interdisciplinary community. Therefore, this study aimed to identify the factors affecting the hospital emergency department’, s simulators during emergencies and disasters. Methods: This conventional content analysis study was conducted in 2021. Participants were selected from Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis. Results: Analysis of the data results through semi-structured interviews showed 4 main categories and 11 subcategories includingmanagement and leadership (the structure, casualty management, command, interactions and coordination, communications and information, as well as human resources), and increasing the capacity (resources (physical resources, and financial resources)), modern technology approaches (information technology), laws and policies (policies, guidelines, and rules). Conclusion: The simulation technology use can be effective in preparing the hospital emergency department in the event of disasters, strengthening management and leadership, proper planning, appropriate organizational culture, organizational learning, interactions and coordination, casualty management, as well as providing resources, equipment, items, processes, and instructions. So, the use of these new technological training is recommended to improve responses in times of emergencies and disasters.

Healthcare services have entered a new era in the last three decades in Turkey. Inauguration of the specialty of emergency medicine (EM) modified the sector in an unprecedented way to be called “, like never before”, . Following the birth of EM specialty in USA in the sixties, Israel, United Kingdom, Australia, and Turkey have conceptualized and launched necessary steps in this regard (1, 2). EM, a fledgling specialty in 1994, has now evolved into an energetic new profession with more than 4000 dedicated members and experiencing its early age of maturity. EM is currently the clinical branch that carries out the most educational activities in our country. . .

Objective: Although various predictive instruments have been introduced for early stroke diagnosis, there is no consensus on their performance. Therefore, we decided to assess the value of predictive instruments in the detection of stroke by conducting an umbrella review. Method: A search was performed in the Medline, Embase, Scopus and Web of Science databases by the end of August 2021 for systematic reviews and meta-analyses. Original articles included in the systematic reviews were retrieved, summarized and pooled sensitivity, specificity and diagnostic odds ratio were calculated. The level of evidence was divided into five groups: convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV) and non-significant. Results: The value of 33 predictive instruments was evaluated. The sample size included in these scoring systems’,assessments varied between 182 and 47072 patients. The level of evidence was class I in one tool, class II in 18 tools, class III in 2 tools, class IV in 11 tools, and non-significant in one tool. Apart from Med PACS, which had a low diagnostic value, other tools appeared to be able to detect a stroke. The optimum performance for diagnosis of stroke was for ROSIER, NIHSS, PASS, FAST, LAMS, RACE and CPSS. Conclusion: Convincing to suggestive evidence shows that ROSIER, NIHSS, PASS, FAST, LAMS, RACE and CPSS have the optimum performance in identifying stroke. Since ROSIER’, s calculation is simple and has the highest sensitivity and specificity among those predictive instruments, it is recommended for stroke diagnosis in pre-hospital and in-hospital settings.

Objective: We aimed to evaluate the performance of ultrasonography (US) versus computed tomography (CT) scan in detecting intra-abdominal injury among pediatric patients with blunt abdominal trauma. Methods: Pediatric patients aged<18, who were admitted to the emergency department (ED) due to blunt abdominal trauma and underwent both US and CT scan were evaluated retrospectively. Results: A total of 732 pediatric patients were included in this study. Pathology was detected on US of 418 (57. 1%) cases, whereas, intra-abdominal pathology was detected in CT scan of 359 (48. 7%) cases. The sensitivity of US in detecting pathology (fluid and/or organ injury) was 95. 3%, and its specificity was 79. 6%. The sensitivity of US in detecting free fluid was 94. 9%, and its specificity was 80. 5%. In hemodynamically unstable and stable patients, the sensitivities of US in detection of pathology (fluid and/or organ injury) were 97. 6% and 91. 6%, and its specificities were 74. 3% and 80. 9%, respectively. Conclusion: In our study, the sensitivity of US in terms of detecting pathology in pediatrics with blunt abdominal trauma was high, whereas the specificity of US was low.

1. Case presentation: The patient was a 71-year-old woman who was referred to the general surgery clinic due to a severe colonic dilatation and a fecal mass that was found in her abdominopelvic CT scan, which was ordered by a nephrologist for approaching her right flank pain. The patient had experienced bloating and progressive abdominal distension in the year prior to the current visit. The last defecation had occurred approximately 20 days prior to the visit, and the last gas passage had occurred the day before the visit...

1. Introduction: Although most of the patients who get infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develop respiratory symptoms similar to an upper respiratory tract infection, complications in body organs other than the respiratory system are far from exception (1-3). Vasculitis is a rare complication of COVID-19, resulting in a poor prognosis if left untreated (4, 5). Since there is no specific curative treatment available for COVID-19 and its complications, preventive strategies such as vaccination are considered the only effective way of controlling the pandemic. Although the available COVID-19 vaccines are considered safe with minimal adverse reactions, vaccinationmay have rare and even lethal adverse effects in some individuals. Overall, it has been reported that the most common side effects of COVID-19 vaccines are local reactions at the injection site and the dermatologic side effects vary from morbidiform rashes to erythema multiforme and pityriasis rosea (6-8). A growing number of reports suggest vasculitis as a complication of COVID-19 vaccines in different populations, including those with underlying chronic liver or dermatologic diseases (9-12). The following report discusses the lethal outcome of a vasculitis case following COVID-19 mRNA vaccination in a female patient with underlying SARS-CoV-2 infection...

Objective: The purpose of this study was to develop a checklist for assessing the performance of air ambulance services. Method: This is a qualitative study. The first phase involved a review of existing documentation about air emergency standards to create a checklist of the most critical factors and components affecting the performance of air ambulance services. The second phase required experts to complete a performance evaluation checklist from the previous phase. The third phase utilized the Delphi technique to validate the performance evaluation checklist for air ambulance services. The experts in this study were 24 pundits with a vested interest in the subject. Results: A total of 31 items exist in the area of helipad-related facilities, 17 items in the area of process requirements for medical centers with helicopter landing areas, 15 items in the category of human resources for air ambulances, 10 items in the category of human resources for receiving or delivering patients from air ambulances to medical centers, 27 items in the area of base equipment, 17 items in the area of helicopter equipment, and requirements, 14 items in the category of technical, communication, and safety equipment for use inside the helicopter, 1o items dealing with time standards, 11 items dealingwith road and urban base requirements for air ambulance operations. Experts approved two items in the area of utilizing other rescue and law enforcement agencies to assist and cooperate with air emergency flights and two items in the area of comfort for conscious patients to alleviate stress during flight. Conclusion: A performance evaluation checklist is an effective tool for evaluating the quantity and quality of emergency helicopter services provided and measuring their performance.