Emergency最新文献

{"title":"Quetiapine versus Haloperidol in Controlling Conversion Disorder Symptoms; a Randomized Clinical Trial","authors":"S. Ghanbarizadeh, Hossein Dinpanah, R. Ghasemi, Yaser Salahshour, Samaneh Sardashti, M. Kamali, S. Khatibi","doi":"10.22037/EMERGENCY.V6I1.22344","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.22344","url":null,"abstract":"Introduction\u0000About 5% of visits to emergency departments are made up of conversion disorder cases. This study was designed with the aim of comparing the effectiveness of quetiapine and haloperidol in controlling conversion disorder symptoms.\u0000\u0000\u0000Methods\u0000The present single-blind clinical trial has been performed on patients with conversion disorder (based on the DSM-IV definition) presenting to emergency department of 9-Day Hospital, Torbat Heydariyeh, Iran, from January 2017 until May 2018.\u0000\u0000\u0000Results\u000073 patients were allocated to haloperidol and 71 to quetiapine group. Mean age of these patients was 32.03 ± 12.80 years (62.50% female). Two groups were similar regarding the baseline characteristics. Within 30 minutes, 90.41% of haloperidol cases and 91.55% of quetiapine cases were relieved (p=0.812). The most common side effects after 30 minutes were extrapyramidal symptoms (9.59%) in the haloperidol group and fatigue and sleepiness (7.04%) in the quetiapine group. Extrapyramidal symptoms was significantly higher than the quetiapine group (p=0.013).\u0000\u0000\u0000Conclusion\u0000The results of the present study showed that although quetiapine and haloperidol have a similar effect in relieving the patients from conversion disorder symptoms, the prevalence of extrapyramidal symptoms is significantly lower in the group under treatment with quetiapine. Therefore, it seems that quetiapine is a safer drug compared to haloperidol.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47728376","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}

{"title":"Quality of Cardiopulmonary Resuscitation in Emergency Department Based on the AHA 2015 Guidelines; a Brief Report","authors":"A. Vafaei, Amin shams akhtari, Kamran Heidari, S. Hosseini","doi":"10.22037/EMERGENCY.V6I1.22233","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.22233","url":null,"abstract":"Introduction: Adhering to existing guidelines on cardiopulmonary resuscitation (CPR) can increase the survival rate of the patients. The present study has been designed with the aim of determining the quality of CPR performed in the emergency department based on the latest protocol by the American heart association (AHA). Methods: In this prospective cross-sectional study CPR process was audited in patients above 18 years old in need of CPR presenting to the emergency departments of 3 teaching hospitals based on the AHA 2015 guidelines. Less than 60% agreement was considered as fail, 60-70% as poor, 70-80% as moderate, 80-90% as good, and 90-100% as excellent. Results: 80 cases of CPR were audited (55% male). Location of arrest was the hospital in 58 (72.5%) cases and 48 (60.0%) of the cases happened during the day. 28 (35.0%) cases had orotracheal intubation before the initiation of CPR. 30 (37.5%) patients had a shockable rhythm at the initiation of CPR. Based on the findings, out of the 31 studied items, 9 (29.03%) had excellent agreement, 10 (32.25%) had good, 4 (12.90%) had moderate, 2 (6.45%) had poor, and 6 (19.35%) had fail agreement rate. Conclusion: Based on the findings of the present study, the quality of applying the principles of basic and advanced CPR in the emergency department of the studied hospital had intermediate, poor and fail agreement with the recommendations of the AHA 2015 in at least one third of the cases.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44653214","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}

{"title":"Hyper Acute Quadriplegia with Chronic Lead Toxicity; a Case Report","authors":"M. Mesri, F. Najari, Ideh Baradaran Kayal, Dorsa Najari","doi":"10.22037/EMERGENCY.V6I1.21609","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21609","url":null,"abstract":"Industrial lead toxicity is more common among miners. This type of toxicity occurs in two forms: acute and chronic. Chronic toxicity is associated with different levels of brain dysfunction, motor impairment, cognitive dysfunction, and neuropsychiatric problems, including depression, anxiety, irritability, and emotional disorders. However, quadriplegia induced by chronic toxicity is very rare. Here we report a 37-year-old male patient with a history of desert hunting, where he used to roll lead bullets in his mouth, who was admitted with sensory impairment, muscle weakness, and quadriplegia and final diagnosis of lead toxicity.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47280329","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}

{"title":"Glasgow Coma Scale and FOUR Score in Predicting the Mortality of Trauma Patients; a Diagnostic Accuracy Study","authors":"Parisa Ghelichkhani, M. Esmaeili, M. Hosseini, K. Seylani","doi":"10.22037/EMERGENCY.V6I1.21068","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21068","url":null,"abstract":"Introduction\u0000Many scoring models have been proposed for evaluating level of consciousness in trauma patients. The aim of this study is to compare Glasgow coma scale (GCS) and Full Outline of UnResponsiveness (FOUR) score in predicting the mortality of trauma patients.\u0000\u0000\u0000Methods\u0000In this diagnostic accuracy study trauma patients hospitalized in intensive care unit (ICU) of 2 educational hospitals were evaluated. GCS and FOUR score of each patient were simultaneously calculated on admission as well as 6, 12 and 24 hours after that. The predictive values of the two scores and their area under the receiver operating characteristics (ROC) curve were compared.\u0000\u0000\u0000Results\u000090 patients were included in the present study (mean age 39.4±17.3; 74.4% male). Comparing the area under the ROC curve of GCS and FOUR score showed that these values were not different at any of the evaluated times: on admission (p=0.68), and 6 hours (p=0.13), 12 hours (p=0.18), and 24 hours (p=0.20) after that.\u0000\u0000\u0000Conclusion\u0000The results of our study showed that, GCS and FOUR score have the same value in predicting the mortality of trauma patients. Both tools had high predictive power in predicting the outcome at the time of discharge.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47152528","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}

{"title":"Intravenous Haloperidol versus Midazolam in Management of Conversion Disorder; a Randomized Clinical Trial","authors":"Mohammadali Jafari, Amir Aliheidari Biuki, M. Hajimaghsoudi, M. Bagherabadi, E. Zarepur","doi":"10.22037/EMERGENCY.V6I1.20888","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.20888","url":null,"abstract":"Introduction\u0000Conversion disorder is a condition in which the patient shows psychological stress in physical ways. This study aimed to compare the effects of haloperidol versus midazolam in patients with conversion disorder.\u0000\u0000\u0000Methods\u0000This double-blind randomized clinical trial was conducted on patients with conversion disorder who had presented to the emergency department, throughout 2015. Patients were randomly divided into two groups and were either treated with 2.5 mg of intravenous (IV) haloperidol or 2.5 mg of IV midazolam. Recovery rate, time to recovery, and side effects of both drugs 1 hour, 24 hours, and 1 week after treatment were compared using SPSS19.\u0000\u0000\u0000Results\u0000140 patients were divided into two groups of 70. There were no significant differences between the groups regarding the baseline characteristics. 12 (17.1%) patients who were treated with IV haloperidol experienced drug side effects within 1 hour and 12 (17.1%) within 24 hours, while only 3 (4.3%) patients in IV midazolam experienced side-effects within 1 hour after drug administration (p = 0.026). The symptoms of the disease subsided in 45 (success rate: 64.3%) patients in midazolam and in 64 (success rate: 91.5%) participants in haloperidol group (P<0.001). Mean recovery time was 31.24 ± 7.03 minutes in IV midazolam and 30.53 ± 7.11 minutes in IV haloperidol group (p = 0.592). Absolute risk reduction (ARR) of treating patients with haloperidol compared to midazolam is about 27%.\u0000\u0000\u0000Conclusion\u0000The response of patients to treatment with haloperidol is clearly better than midazolam. Although more transient and minor side-effects were observed in the group treated with haloperidol compared to midazolam group, serious side-effects were rare for both treatments.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47429791","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}

{"title":"New Molecular Aspects of Cardiac Arrest; Promoting Cardiopulmonary Resuscitation Approaches","authors":"M. Zamanian-Azodi, M. Rezaei Tavirani, M. Rostami-Nejad, Fatemeh Tajik-Rostami","doi":"10.22037/EMERGENCY.V6I1.21467","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21467","url":null,"abstract":"Introduction: Cardiopulmonary resuscitation (CPR) is a method to improve survival of patients with cardiac arrest. This study aimed to identify the key genes affected five minutes after cardiac arrest, hoping to elevate the efficacy of CPR. Methods: In this bioinformatics study differentially expressed genes of six pigs were downloaded from GEO and screened. The significant and characterized genes were analyzed via calculating fold change and protein-protein interaction (PPI) networks. The crucial nodes were determined based on centrality parameters and their related biological processes were investigated via ClueGO. Results: 17 significant up-regulated (LogFC ≥ 2) and 22 down-regulated (LogFC < -0.5) genes were detected. Transthyretin (TTR logFC = 4.59) and Gonadotropin-releasing hormone receptor (GNRHR logFC = 3.84) had higher logFC among up-regulated and down-regulated genes, respectively. The critical genes including four up-regulated and five down-regulated genes were detected from network analysis. GNRHR and Prolactin precursor (PRL) were among the most important down res 5 minutes after cardiac arrest and Beta-2 adrenergic receptor and Cadherin-1 were among the most important up regulated gens. Conclusion: The introduced potential biomarkers could reveal a new molecular aspect for CPR performance and pituitary gland protection was highlighted in this respect.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47666196","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}

{"title":"Evaluation of Airway Management Proficiency in Pre-Hospital Emergency Setting; a Simulation Study","authors":"S. Ghiyasvandian, A. Khazaei, M. Zakerimoghadam, R. Salimi, A. Afshari, Abbas Mogimbeigi","doi":"10.22037/EMERGENCY.V6I1.21973","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21973","url":null,"abstract":"Introduction\u0000Infrequency and low exposure to critically ill patients requiring airway management will lead to reduction in the skills and performance of the Emergency Medical Technicians (EMTs) over time. The present study was conducted primarily aiming to evaluate airway management in stationary ambulance simulations and identify the factors affecting Endotracheal Intubation (ETI) success rate.\u0000\u0000\u0000Method\u0000This is a simulation study. The study population comprised of active EMTs in prehospital emergency bases in Hamadan province. The participants were placed at the back of an ambulance to perform the airway management scenario, which had already been prepared. To investigate the factors affecting the success (≤3 attempts) or failure rate of intubation, both unadjusted and adjusted odds ratios (95% confidence intervals) for univariate and multivariate regressions were reported.\u0000\u0000\u0000Results\u0000184 subjects with the mean age of 33.91+6.25 years and the median work experience of 8 years were studied (54.3% with a history of training in the past year). The median number of previous intubations performed by technicians in the last year was 7 times (IQR 4-9). The total success rate at ventilation, intubation and back-up airway were 50.67%, 53.29%, and 50.0%, respectively. Out of the total 552 attempts for ETI placement, 58.2% of the technicians were able to perform ETI within 3 attempts. Univariate analysis showed that age (OR=1.06, P=0.022), previous number of ETIs (OR=2.49, P<0.001), work experience (OR=1.13, P<0.001), and previous ETI training (OR=1.85, P=0.041) were significantly associated with ETI success rate. After adjustment, previous number of ETIs (OR=2.66, P<0.001) was the most effective factor on ETI success rate.\u0000\u0000\u0000Conclusion\u0000Success rate in airway management, especially ETI, is low. Therefore, improvement in modifiable factors such as increasing the number of ETIs performed and gaining experience in the same conditions as pre-hospital emergency is necessary.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48303971","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}

{"title":"Simultaneous Occurrence of Dysrhythmia and Seizure as a Diagnostic Difficulty; a Case Report","authors":"F. Salehi, H. Riasi, H. Riasi, A. Mirshahi","doi":"10.22037/EMERGENCY.V6I1.21749","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21749","url":null,"abstract":"Torsades de pointes (TdP) is a rare but hazardous ventricular dysrhythmia caused by an increase in the QT interval of the heart rhythm and is categorized into congenital or acquired types. Signs and symptoms of TdP include syncope, seizure, ventricular fibrillation, and even sudden death. According to statistics, among these symptoms, syncope and the seizure can be considered as signs that make the TdP diagnosis difficult. Here, we present an infant referring to Vali-e-Asr Hospital in Birjand with frequent seizures and aspiration pneumonia. She was diagnosed with Torsades de Pointes and a medium-sized patent ductus arteriosus, and subsequently underwent a patent ductus arteriosus ligation.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42159975","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}

{"title":"Intravascular Hemolysis following Acute Zinc Phosphide Poisoning; a Case Report","authors":"Z. Ramezani, A. Babahajian, V. Yousefinejad","doi":"10.22037/emergency.v6i1.21742","DOIUrl":"https://doi.org/10.22037/emergency.v6i1.21742","url":null,"abstract":"Zinc phosphide (ZnP) is low-cost, accessible, and very effective as a rodenticide. It has been used for many human suicide poisonings around the world, including Iran. Nonspecific gastrointestinal symptoms and cardiotoxicity are the most serious complications of ZnP poisoning, which are associated with a high mortality rate. The aim of this paper was to report a poisoned patient that ingested ZnP with suicidal attempt and faced complications due to hemolysis.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45684939","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}

{"title":"Candidemia in Febrile Neutropenic Patients; a Brief Report","authors":"M. Yousefi, D. Yadegarynia, E. Lotfali, Zahra Arab-Mazar, A. Ghajari, A. Fatemi","doi":"10.22037/EMERGENCY.V6I1.20237","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.20237","url":null,"abstract":"Introduction: Febrile neutropenic patients are at risk of serious infections. The aim of the present study is to identify the frequency, species, and susceptibility patterns of candidemia in febrile neutropenic patients. Methods: This cross-sectional study was conducted on febrile neutropenic patients suspected with candidemia who had been referred to 3 educational hospitals during 9 months. Results: The blood samples of 80 febrile neutropenic patients with the mean age of 48±16.6 years were studied (60% female). Five (6.25%) episodes of candidemia were identified. The underlying disease was acute myeloid leukemia in 4 (80%) cases and all 5(100%) cases had central venous catheter and were receiving prophylactic ciprofloxacin and acyclovir. 100% of isolates were found to be susceptible to Voriconazole, 80% to Caspofungin, 60% to Amphotericin B, and 40% to Fluconazole. Conclusion: The frequency of candidemia among the studied febrile neutropenia patients was 6.25%, with 80% mortality rate, and the most frequently identified yeast was Candida albicans (100% susceptible to Voriconazole).","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46608804","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}