Emergency最新文献

{"title":"Predictive Factors of Mortality in Acute Amphetamine Type Stimulants Poisoning; a Review of 226 Cases.","authors":"Mitra Rahimi,&nbsp;Somaieh Lookzadeh,&nbsp;Roxana Sadeghi,&nbsp;Kambiz Soltaninejad,&nbsp;Shahin Shadnia,&nbsp;Abdolkarim Pajoumand,&nbsp;Hossein Hassanian-Moghaddam,&nbsp;Nasim Zamani,&nbsp;Masoud Latifi-Pour","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Amphetamine type stimulants (ATS) such as amphetamine and methamphetamine (MA) are one of the most important causes of poisoning in the world. In this study we aimed to define the predictive factors of mortality in acute ATS poisoning patients.</p><p><strong>Methods: </strong>This is a retrospective cross-sectional study on all cases with acute ATS poisoning who were referred to a referral center for poisoning, Tehran, Iran, from April 2011 to March 2014. Using patients^' medical records, demographic data, route of exposure, type and amount of ATS, the cause of poisoning, clinical presentations, and electrocardiogram (ECG) and laboratory findings, as well as patient's outcomes were collected and analyzed regarding the independent predictive factors of mortality.</p><p><strong>Results: </strong>226 cases with the mean age of 32.9 ± 10.9 years were studied (77% male). MA was the most abused ATS (97.4%) and the most frequent route of exposure was oral (55.3%). The mortality rate was 5.4%. There was a significant association between agitation (p = 0.002), seizure (p = 0.001), loss of consciousness (p < 0.001), creatine phosphokinase level (p = 0.002), serum pH (p = 0.002), serum HCO₃ (p = 0.02), and PCO₂ (p = 0.01) with mortality. However, serum HCO₃ [OR=1.27 (95% CI: 1.07-1.50); p value=0.005], PCO₂ [OR=0.89 (95% CI: 0.84-0.96); p value=0.002], and loss of consciousness [OR=0.019 (95% CI: 0.003-0.106); p value=0.000] were the only independent predictive factors of mortality.</p><p><strong>Conclusion: </strong>PCO₂ ≥ 51 mmHg, serum bicarbonate ≤ 22.6 mEq/L, and loss of consciousness on admission could be considered as prognostic factors of mortality in acute ATS poisoning cases presenting to emergency department.</p>","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"6 1","pages":"e1"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35882605","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}

{"title":"Applications of End-Tidal Carbon Dioxide (ETCO2) Monitoring in Emergency Department; a Narrative Review.","authors":"Hamed Aminiahidashti,&nbsp;Sajad Shafiee,&nbsp;Alieh Zamani Kiasari,&nbsp;Mohammad Sazgar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Capnograph is an indispensable tool for monitoring metabolic and respiratory function. In this study, the aim was to review the applications of end-tidal carbon dioxide (ETCO2) monitoring in emergency department, multiple databases were comprehensively searched with combination of following keywords: \"ETCO2\", \"emergency department monitoring\", and \"critical monitoring\" in PubMed, Google Scholar, Scopus, Index Copernicus, EBSCO and Cochrane Database.</p>","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"6 1","pages":"e5"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35882609","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}

{"title":"Intravenous versus Subcutaneous Midazolam Using Jet-injector in Pediatric Sedation; a Randomized Clinical Trial.","authors":"Majid Hajimaghsoudi,&nbsp;Mehdi Bagherabadi,&nbsp;Ehsan Zarepur,&nbsp;Vahid Ahmadi Hanzaei","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The quality of interventions in children is largely dependent on their control. Hence, this study compared the sedative effects of subcutaneous (SC) and intravenous (IV) Midazolam in pediatric sedation induction.</p><p><strong>Methods: </strong>This randomized clinical trial was conducted on children aged 1-6 years presenting to emergency departments of Shahid Sadoughi and Shahid Rahnemoon Hospitals, Yazd, Iran. Participants were randomly assigned to IV or SC midazolam using a jet injector and success rate, degree of sedation, and satisfaction of parents and physician were compared between groups.</p><p><strong>Results: </strong>60 cases with the mean age of 3.15±1.43 (1-6) years were randomly assigned to the SC (30 cases) or IV (30 cases) groups (56.7% female). SC and IV groups were similar regarding the mean age (p = 0.165) and sex (p = 0.121). Depth of sedation (p=0.900), control of child (p=0.711), in-charge physician's satisfaction (p=0.467), successful sedation and need for rescue dose (p=0.519) were not different between groups. IV midazolam group had a significantly shorter recovery time (about 10 minutes; p=0.040) and SC midazolam group had a significantly higher level of parent satisfaction (p=0.001).</p><p><strong>Conclusion: </strong>The findings indicate no significant difference in depth of sedation, control of child, in-charge physician's satisfaction, successful sedation (reaching stage 1 of sedation or higher), and need for rescue dose of SC and IV midazolam. Parents' satisfaction was significantly greater with SC administration and IV injection had shorter recovery time.</p>","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"6 1","pages":"e53"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/d8/emerg-6-e53.PMC6289147.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36813534","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}

{"title":"Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin C in Early Detection of Pediatric Acute Kidney Injury; a Diagnostic Accuracy Study.","authors":"Neamatollah Ataei, Sonbol Ameli, Mahmoud Yousefifard, Alireza Oraei, Fatemeh Ataei, Behnaz Bazargani, Arash Abbasi, Mostafa Hosseini","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>There is a controversy regarding accuracy of neutrophil gelatinase-associated lipocalin (NGAL) and Cystatin C in early detection of acute kidney injury (AKI). The present study aimed to compare the diagnostic value of two biomarkers in this regard.</p><p><strong>Method: </strong>In the present diagnostic accuracy study, all children between the ages of 1 month to 14 years were entered. Pediatric Risk, Injury Failure, Loss, End-stage renal disease (pRIFLE) criteria was used for identification of children with AKI as the reference test. Blood samples were taken from all patients at baseline and 48 hours after admission to assess serum creatinine and Cystatin C level. In addition, a urine sample was obtained within 6 hours of admission in order to measure NGAL level. In the end, area under the receiving operating characteristics (ROC) curve, sensitivity, and specificity of urine NGAL (uNGAL) and Cystatin C in early detection of AKI were compared.</p><p><strong>Results: </strong>Data from 96 children with the mean age of 27.31±36.24 months were entered (56.25% girls). Area under the ROC curve of uNGAL level in diagnosis of AKI in children was 0.91 (95% CI: 0.80 to 1.00) and area under the ROC of Cystatin C was 0.90 (95% CI: 0.77 to 1.00). Both tests had the same value in diagnosis of AKI (p=0.89). The best cut-off point of uNGAL for diagnosing AKI was 125 mg/L. uNGAL had a sensitivity and specificity of 0.92 (0.62 to 0.99) and 0.69 (0.57 to 0.78), respectively. The best cut-off point of serum Cystatin C level was 0.4 mg/L. Cystatin C had a sensitivity and specificity of 0.92 (0.62 to 0.99) and 0.64 (0.52 to 0.74), respectively.</p><p><strong>Conclusion: </strong>The present study showed that uNGAL level has the same value as serum Cystatin C level in early diagnosis of AKI.</p>","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"6 1","pages":"e2"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35882606","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}

{"title":"Accuracy of Neck stiffness, Kernig, Brudzinski, and Jolt Accentuation of Headache Signs in Early Detection of Meningitis.","authors":"Alireza Ala,&nbsp;Farzad Rahmani,&nbsp;Sima Abdollahi,&nbsp;Zahra Parsian","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnostic value of clinical signs in early diagnosis of meningitis has been evaluated but the existing results are contradicting. The present study aimed to evaluate the accuracy of Kernig, Brudzinski, neck stiffness, and Jolt Accentuation of Headache (JAH) signs in this regard.</p><p><strong>Methods: </strong>In this diagnostic accuracy study, patients with suspected meningitis who were referred to the emergency department were examined regarding presence or absence of the mentioned clinical signs and screening performance characteristics of the signs were calculated. Cerebrospinal fluid analysis was used as the reference test.</p><p><strong>Results: </strong>120 cases with mean age of 48.79 ± 21.68 years (18 - 93) were studied (63.3% male). Diagnosis of meningitis was confirmed for 45 (37.5%) cases. Neck stiffness (p < 0.001), Kernig (p < 0.001), Brudzinski (p < 0.001), and JAH (p < 0.001) had significantly higher frequency among patients with meningitis. The accuracy of neck stiffness, Kernig, Brudzinski, and JAH signs in early detection of meningitis were 0.676 (95% CI: 0.575-0.776), 0.667 (95% CI: 0.552-0.782), 0.720 (95% CI: 0.619-0.821), 0.749 (95% CI: 0.659-839), respectively.</p><p><strong>Conclusions: </strong>It seems that diagnostic value of JAH is higher than other clinical signs but the accuracy of all signs is in poor to fair range. JAH had the highest sensitivity and Kernig and Brudzinski had the highest specificity.</p>","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"6 1","pages":"e8"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5827054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35882086","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}

{"title":"Loss of Guide Wire as an Important Complication of Central Venous Catheterization; a Case Report.","authors":"Fares Najari,&nbsp;Mohamadjavad Amirian,&nbsp;Sara Sadjadi,&nbsp;Ideh Baradaran Kayal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Many critically ill patients need aggressive procedures, such as central venous catheterization. The complication rate of central venous line placement is estimated to be 15%. Common complications include arterial puncture, hematoma, pneumothorax, hemothorax, arrhythmia, thoracic duct injury, infection, and thrombosis. Cardiac tamponade, pericardial effusions, pleural effusions, air or guidewire embolisms, and lost guide wires are rare but severe complications. Here we report a case of lost guide wire following central venous line insertion.</p>","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"6 1","pages":"e17"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/64/56/emerg-6-e17.PMC6036527.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36311541","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}

{"title":"A Simple Device to Control Valsalva Manoeuvre Strain Pressure; a Letter to Editor.","authors":"Isabel FitzGerald,&nbsp;Andrew Appelboam","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"6 1","pages":"e22"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/5a/emerg-6-e22.PMC6036539.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36311546","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}

{"title":"Epidemiology and Outcome of Patients with Acute Kidney Injury in Emergency Department; a Cross-Sectional Study.","authors":"Saeed Safari,&nbsp;Behrouz Hashemi,&nbsp;Mohammad Mehdi Forouzanfar,&nbsp;Mehrnoush Shahhoseini,&nbsp;Meysam Heidari","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Elimination of preventable deaths due to acute kidney injury (AKI) in low-income countries by 2025 is an important healthcare goal at the international level. The present study was designed with the aim of evaluating the prevalence and outcome of AKI in patients presenting to emergency department.</p><p><strong>Methods: </strong>The present cross-sectional, retrospective study was performed on patients that presented to the emergency departments of 3 major teaching hospitals, Tehran, Iran, between 2005 and 2015 and were diagnosed with AKI. Patient selection was done using consecutive sampling and required data for this study was extracted by referring to the medical profiles of the patients and filling out a checklist designed for the study.</p><p><strong>Results: </strong>770 AKI patients with the mean age of 62.72 ± 19.79 (1 - 99) years were evaluation (59.1% male). 690 (89.61%) cases of AKI causes were pre-renal or renal. Among the pre-renal causes, 74 (73.3%) cases were due to different types of shock (p < 0.001). The most common etiologic causes of AKI in pre-renal group were hypotension (57.3%) and renal vascular insufficiency (31.6%). In addition, regarding the renal types, rhabdomyolysis (35.0%), medication (17.5%) and chemotherapy (15.3%) and in post-renal types, kidney stone (34.5%) were the most common etiologic causes. 327 (42.5%) patients needed dialysis and 169 (21.9%) patients died. Sex (p = 0.001), age over 60 years (p = 0.001), blood urea nitrogen level (p < 0.001), hyperkalemia (p < 0.001), metabolic acidosis (p < 0.001), cause of failure (p = 0.001), and type of failure (p = 0.009) were independent risk factors of mortality.</p><p><strong>Conclusion: </strong>The total prevalence of AKI in emergency department was 315 for each 1000000 population and preventable mortality rate due to AKI was estimated to be 28.2 cases in each 1000000 population. The most important preventable AKI causes in the pre-renal group included shock, sepsis, and dehydration; in the renal group they included rhabdomyolysis and intoxication; and stones in the post-renal group.</p>","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"6 1","pages":"e30"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/50/48/emerg-6-e30.PMC6036528.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36313801","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}

{"title":"Anaphylaxis as a Rare Side Effect of Pantoprazole; a Case Report.","authors":"Gholamreza Faridaalaee,&nbsp;Javad Ahmadian Heris","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Anaphylaxis is a serious life-threatening allergic reaction. Any medication may potentially trigger anaphylaxis, but reaction to pantoprazole is rare. Our case is a 21 year-old girl with anaphylactic reaction to pantoprazole a short time after prescription.</p>","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"6 1","pages":"e34"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3e/dc/emerg-6-e34.PMC6036523.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36313805","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}

{"title":"Correlation of Hyperchloremic Metabolic Acidosis and Renal Function in Critically ill Patients of Emergency Department: an Observational Study.","authors":"Mauro Giordano,&nbsp;Tiziana Ciarambino,&nbsp;Pietro Castellino,&nbsp;Lorenzo Malatino,&nbsp;Giuseppe Signoriello,&nbsp;Giuseppe Paolisso,&nbsp;Luigi Elio Adinolfi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Early detection is crucial for prompt management of acute kidney injury (AKI) patients in emergency department (ED). This study aimed to investigate the usefulness of hyperchloremic metabolic acidosis (HCMA) levels in this regard.</p><p><strong>Methods: </strong>In this retrospective observational study, > 18 years old critically ill patients presenting to ED of Marcianise Hospital, Italy, were divided into non-AKI and AKI group according to KDIGO guideline. The level of HCMA ((arterial pH x bicarbonate)/chloride) was compared between groups and correlation of HCMA with estimated glomerular filtration rate (e-GFR) in ARF patients was evaluated.</p><p><strong>Results: </strong>134 patients with the mean age of 76.5 ± 3.1 years were enrolled (64 non-AKI and 70 AKI; 64% female). Two groups were similar regarding mean age (p = 0.251), sex (p = 0.091), APACHII score (p = 0.215), Charlson Comorbidity Index (p= 0.187), and body mass index (p = 0.129). The mean HCMA level was 1.98 ± 0.09 in the non-AKI group and 1.56 ± 0.07 in the AKI group (p=0.039). There was a positive correlation between HCMA and e-GFR levels in AKI group (r: 0.467, p=0.0092).</p><p><strong>Conclusions: </strong>If confirmed and validated in a future study, ABG derived formula for HCMA may be a useful tool for early detection of AKI patients in emergency department.</p>","PeriodicalId":11681,"journal":{"name":"Emergency","volume":"6 1","pages":"e52"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/44/8d/emerg-6-e52.PMC6289160.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36813533","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}