Emergency最新文献

{"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":"Job Burnout, Stress, and Satisfaction among Emergency Nursing Staff after Health System Transformation Plan in Iran","authors":"N. Tavakoli, S. Shaker, S. Soltani, Mohsen Abbasi, Milad Amini, A. Tahmasebi, Seyed Mohammad Hosseini Kasnavieh","doi":"10.22037/EMERGENCY.V6I1.21410","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21410","url":null,"abstract":"Introduction: Job burnout, stress, and satisfaction are linked to quality of care, patient outcomes and retention of staff. This study was conducted to determine the mentioned issues among emergency nurses. Methods: This cross-sectional study was conducted on all nurses working in the emergency departments of 10 hospitals in Tehran, Iran, in 2017. Standard questionnaires were used for gathering the data of participants regarding job burnout, stress, and satisfaction. Results: 709 (90%) participants returned the completed questionnaires (58.9% female). The mean age of the nurses was 33 (SD = 7) years. The level of job burnout was moderate in 76.1%, low in 22.5%, and high in 1.4% of the nurses. The level of burnout in the married nursing staff was lower than single nurses (3.78 ± 0.98 versus 4.14 ± 0.58, p = 0.049). The level of job satisfaction was moderate in 61.1%, low in 22.2%, and high in 16.7%. There was a significant correlation between age and job satisfaction (p = 0.027, r = 0.3). Job burnout was directly correlated with job stress (p ≤0.001, r = 0.57) and job burnout was negatively correlated with job satisfaction (p = 0.001, r = -0.41). Conclusion: More than 60% of the studied emergency nurses had moderate levels of job burnout, stress, and satisfaction. Job burnout had a direct correlation with job stress and indirect correlation with job satisfaction. Planning to reduce burnout of the emergency nursing staff seems to be necessary.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47606509","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}

{"title":"Awareness of Basic Life Support among Egyptian Medical Students; a Cross-Sectional Study","authors":"E. Ghanem, M. Elgazar, Khaled A. Oweda, H. Tarek, Fathy Assaf, Mostafa Wanees Ahmed El-Husseny, A. Elgebaly, A. Abushouk","doi":"10.22037/EMERGENCY.V6I1.20951","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.20951","url":null,"abstract":"Introduction: It is important for all medical and paramedical staff to be aware of basic life support (BLS) maneuvers. In this study, we aimed to evaluate the level of BLS awareness among Egyptian medical students. Methods: The level of BLS knowledge was assessed using a validated questionnaire and the results were analyzed using an answer key, prepared from the Advanced Cardiac Life Support (ACLS) manual. We used the Student's t-test to analyze the association between awareness level and year of study, previous BLS training and practical experience. Results: A total of 823 medical students with the mean age of 20.3 ± 2.7 years, from Al-Azhar medical schools completed the questionnaire (463 and 360 in academic and clinical years, respectively). About 72% and 84% of students failed to recognize the proper point of chest compression in adults and infants, respectively. Moreover, the majority (80%) did not know how to give rescue breathing in infants. Only 18% of students correctly identified early signs of shock and only 22% knew how to help patients with myocardial infarction. Being in clinical years, previous BLS training or practical experience were significantly associated with higher BLS knowledge scores (p < 0.001). Conclusion: The level of BLS awareness among Egyptian medical students is generally poor. Introduction of regular BLS courses into the undergraduate curriculum is a must to increase the level of BLS knowledge among Egyptian future physicians.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45385646","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":"Examination of References in Rosen’s Emergency Medicine Text Book, 8th Edition; an Observational Study","authors":"R. Güven","doi":"10.22037/EMERGENCY.V6I1.20259","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.20259","url":null,"abstract":"Introduction: This study aims to analyze the references that the authors and editors used during the writing of Rosen’s Emergency Medicine, 8th edition. Methods: 15,209 references, which were used in 197 chapters of Rosen’s Emergency Medicine, 8th edition, were examined regarding the distribution of countries, journals, publication year, and the department of the affiliation of the first author. Results: A total of 63.1% (n = 9591) of the references were led by authors from the United States (US). US-based journals were mostly used, and Annals of Emergency Medicine was the journal from which the references were most frequently extracted, with a percentage of 5.2% (n = 756). The studies conducted by emergency physicians have increased in recent years, and emergency physicians, with a percentage of 17.8% (n = 351), were the leading authors of studies conducted between 2010 and 2013, which were cited in the references of Rosen’s Emergency Medicine, 8th edition. Conclusion: US-based studies make up a significantly bigger portion of the references used in Rosen’s Emergency Medicine, 8th edition. If Europe and other countries give due importance to emergency medicine, they will have the capability to produce studies that can be used as references in textbooks as much as the US.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45807075","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}