Emergency最新文献

{"title":"Performance of Local Anesthesia with Lidocaine among Opium Addicts and Non-Addicts; a Case Control Study","authors":"A. Majidi, Tala Shahhosseini, Sadrollah Mahmoudi","doi":"10.22037/EMERGENCY.V6I1.21690","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21690","url":null,"abstract":"Introduction: Compared to ordinary people, addicts usually have a lower pain threshold. The current work attempts to compare the performance of local analgesia with lidocaine among opium addicts and non-addicts. Methods: In this case-control study, opium addicts and healthy patients with skin laceration referring to emergency departments of two educational hospitals were compared regarding the response to local anesthesia with lidocaine, as well as side effects. Results: 197 cases with the mean age of 43.44 ± 20.12 years were studied (72.1% male). 98 (49.8%) cases were addicts and 99 (50.2%) were healthy people. Two groups were similar regarding age (p = 0.281), sex (p = 0.666), and wound size (p = 0.272). The amount of pain reduction 5 (df =1.5, F=0.38, p = 0.88) and 10 (df =1.5, F=0.58, p = 0.72) minutes after lidocaine injection was not different between the groups. Subgroup analysis based on sex and age of patient did not show any differences between the groups (p > 0.1 for all analysis). The mean duration of analgesia was 16.4 ± 5.37 minutes in addicts and 16.95±1.79 in control group (p = 0.334). Conclusion: Lidocaine, as a commonly used local anesthetic agents, does not show different effects in addicts and non-addicts in repairing skin laceration.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45839122","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":"Medical Errors in Emergency Department; a Letter to Editor","authors":"P. Asadi, E. Modirian, Nazanin Dadashpour","doi":"10.22037/EMERGENCY.V6I1.21486","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21486","url":null,"abstract":"Medical error is the third leading cause of death in the United States of America and almost 100000 patients lose their life due to medical errors every year.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45358654","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":"Anaphylaxis as a Rare Side Effect of Pantoprazole; a Case Report","authors":"G. Faridaalaee, Javad Ahmadian Heris","doi":"10.22037/EMERGENCY.V6I1.20541","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.20541","url":null,"abstract":"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.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41345637","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":"Introducing a Device for Measuring Pain Intensity; a Letter to Editor","authors":"Keshvad Hedayatyanfard, S. Sadeghi, Iman Habibi","doi":"10.22037/EMERGENCY.V6I1.21450","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21450","url":null,"abstract":"Pain is defined as an unpleasant feeling caused by a real or potential tissue injury and is classified into neuropathic, somatic and visceral types. Characteristics such as severity, location, duration and site of pain referral are very helpful in correct diagnosis and treatment of the disease. Pain control in the emergency department is one of the first measures that should be taken for the patients and for this purpose, a wide range of analgesic drugs such as NSAIDs, opioids, and corticosteroids are used. For evaluating the success rate as well as determining the best medication required for controlling the patient’s pain, being aware of the pain severity is of great importance. Therefore, a device or a method that can monitor pain severity and therefore, the process of patient treatment with high accuracy is very interesting. Currently, various methods exist for assessing pain severity. One way is to ask the patient (self-report) for determining pain severity. Among the most important methods based on self-report of the patient, numerical rating scales (NRS) and verbal rating scales (VRS) can be mentioned. In cases that self-report by the patient is not possible, methods such as Behavioral pain scale (BPS) and critical care pain observation tool (CPOT) can be used. One of the common methods for assessing pain severity and threshold in animal studies is using monofilaments. These monofilaments are made from polyethylene and the base of their function is the bend that occurs at the time of applying pressure on the surface of the intended organ. A wide range of these filaments is available, each of which apply a pre-determined force depending on the bend. Results of a study were indicative of 41% to 93% sensitivity and 68% to 100% specificity of monofilaments in determining pain threshold. However, temperature and humidity of the environment can affect the bending and therefore, the accuracy of the monofilaments. Considering the aforementioned points, researchers of the present study attempted to design a digital device for assessing pain severity and threshold with characteristics such as accuracy, reproducibility, sensitivity, specificity, and ease of use. Among the most important uses of this device, quantitative measurement of response to the external stimulant, pain threshold, and assessing the trend of response to treatment with various analgesic drugs can be pointed out. The device is made up of 2 parts of body and probe, the body includes an LCD with touch screen and internal memory for recording the performed tests. Its accuracy in measurement is about 100 mg and it can show a maximum of 1000 g. The device can record the maximum force inflicted on the desired organ and can be connected to the computer and data can be printed out. In addition, the trend of force inflicted on the organ of the animal or human can be observed as a curve on the graph. Inside the probe there is a load cell with high sensitivity for measuring the inflicted forc","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48742140","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":"Full and Modified Glasgow-Blatchford Bleeding Score in Predicting the Outcome of Patients with Acute Upper Gastrointestinal Bleeding; a Diagnostic Accuracy Study","authors":"Ali Shahrami, Saba Ahmadi, Saeed Safari","doi":"10.22037/EMERGENCY.V6I1.21449","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21449","url":null,"abstract":"Introduction: Screening of high risk patients and accelerating their treatment measures can reduce the burden of the disease caused by acute upper gastrointestinal (GI) bleeding. This study aimed to compare the full and modified Glasgow-Blatchford Bleeding Score (GBS and mGBS) in prediction of in-hospital outcomes of upper GI bleeding. Methods: In the present retrospective cross-sectional study, the accuracy of GBS and mGBS models were compared in predicting the outcome of patients over 18 years of age with acute upper GI bleeding confirmed via endoscopy, presenting to the emergency departments of 3 teaching hospitals during 4 years. Results: 330 cases with the mean age of 59.07 ± 19.00 years entered the study (63.60% male). Area under the curve of GBS and mGBS scoring systems were 0.691 and 0.703, respectively, in prediction of re-bleeding (p = 0.219), 0.562 and 0.563 regarding need for surgery (p = 0.978), 0.549 and 0.542 for endoscopic intervention (p = 0.505), and 0.767 and 0.770 regarding blood transfusion (p = 0.753). Area under the ROC curve of GBS scoring system regarding need for hospitalization in intensive care unit (0.589 vs. 0.563; p = 0.035) and mortality (0.597 vs. 0.564; p = 0.011) was better but the superiority was not clinically significant. Conclusion: GBS and mGBS scoring systems have similar accuracy in prediction of the probability of re-bleeding, need for blood transfusion, surgery and endoscopic intervention, hospitalization in intensive care unit, and mortality of patients with acute upper GI bleeding.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42172360","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":"Epidemiology and Outcome of Patients with Acute Kidney Injury in Emergency Department; a Cross-Sectional Study","authors":"Saeed Safari, B. Hashemi, M. Forouzanfar, Mehrnoush Shahhoseini, Meysam Heidari","doi":"10.22037/EMERGENCY.V6I1.21334","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21334","url":null,"abstract":"Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46920872","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":"Rectus Muscle Hematoma as a Rare Differential Diagnosis of Acute Abdomen; a Case Report","authors":"Mohammadreza Maleki Verki, H. Motamed","doi":"10.22037/EMERGENCY.V6I1.21261","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21261","url":null,"abstract":"Rectus sheath hematoma is a rare but well-known problem. Exercise, pregnancy, subcutaneous injection of insulin, abdominal surgery and severe coughs can be predisposing factors of hemorrhage in the mentioned muscle sheath. Here, we will discuss a case of rectus sheath hematoma in a 28 year-old female patient who presented to emergency department with complaint of abdominal pain and improved in 1 week with palliative care.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44577474","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":"Post-Traumatic Pulmonary Pseudocyst following Blunt Chest Trauma; a Case Report","authors":"Nasim Ghafourian, F. Mahdizadeh, M. Zavareh, M. Ahmadi, M. Askarzadeh, F. Jalili","doi":"10.22037/EMERGENCY.V6I1.20596","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.20596","url":null,"abstract":"Traumatic pulmonary pseudocyst is a rare complication of chest trauma that has been poorly documented and usually resolves without specific treatment. Here, we present a case of pulmonary pseudocyst in a child with chest trauma without obvious symptoms. It is important to consider this diagnosis in patients with chest trauma to avoid unnecessary invasive procedures.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44463618","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":"Prehospital Emergency Medical Services Challenges in Disaster; a Qualitative Study","authors":"M. Sorani, S. Tourani, H. Khankeh, Sirous Panahi","doi":"10.22037/EMERGENCY.V6I1.20465","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.20465","url":null,"abstract":"Introduction: Prehospital Emergency Medical Care (EMC) is a critical service in disaster management. The aim of this study was to explore the challenges of prehospital Emergency Medical Services (EMS) during disaster response in Iran. Methods: A qualitative study was conducted from April 2015 to March 2017. Data were collected through in-depth, semi-structured interviews with 23 experienced individuals in the field of disaster that were selected using purposeful sampling. Data were analyzed using content analysis approach. Results: Fifteen sub-themes and the following six themes emerged in the analysis: challenges related to people, challenges related to infrastructure, challenges related to information management systems, challenges related to staff, challenges related to managerial issues and challenges related to medical care. Conclusions: Iran’s prehospital EMS has been chaotic in past disasters. Improvement of this process needs infrastructure reform, planning, staff training and public education.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43315520","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":"Vagus Nerve Stimulation and External Defibrillation during Resuscitation; a Letter to Editor","authors":"M. Wittstock, J. Buchmann, U. Walter, J. Rösche","doi":"10.22037/emergency.v6i1.20752","DOIUrl":"https://doi.org/10.22037/emergency.v6i1.20752","url":null,"abstract":"Dear Editor; External defibrillation in patients with implanted neuromodulatory devices is a crucial therapeutic challenge. We report a 63-year-old male patient with refractory epilepsy (RE) after recurrent ischaemic strokes in the middle cerebral artery and in the anterior cerebral artery territory 26 and 23 years ago. He received various therapeutic interventions to achieve seizure control with insufficient success. Therefore, vagus nerve stimulation (VNS) (model Pulse 102, Aspire SR, Cyberonics Inc, Houston, Texas) was applied via insertion of a pulse generator in the left upper chest in 2011. VNS stimulation settings were: output current 1.0 mA, pulse width 500 µs, frequency 30 Hz, 30s ON, 3.0 minute OFF. A reduction of seizure frequency was achieved. Last antiepileptic therapy consisted of levetiracetam 1500 mg td, valproate 1000 mg td, and eslicarbazepine 800 mg td. In 2016, he was admitted because of generalized seizure and aspiration pneumonia.  During hospital stay he suffered a cardiac arrest (CA) with pulseless ventricular tachycardia (VT) caused by fulminant pulmonary artery embolism. After successful resuscitation, the patient experienced return of spontaneous circulation (ROSC). During resuscitation, biphasic electric shocks were applied using 150 Joule and subsequently 360 Joule with patches placed approximately 10 cm parasternal and at the left chest below the VNS. After successful ROSC the VNS was checked again and no malfunction could be detected. Stimulation settings were not changed. Impedance was normal. Seizures were not observed during the remaining day. Unfortunately, the patient died within one day after successful resuscitation and ROSC because of therapy refractory circulatory insufficiency. VNS is an established therapeutic approach in treatment of TRE in children and adults to achieve reduction of seizure frequency with proven safety and efficacy. The safety of VNS in emergency situations like cardiac arrest due to VF with need of external defibrillation and application of large amounts of electrical energy is not clear. External defibrillation in VNS patients may potentially be harmful. The literature concerning external defibrillation during resuscitation or external cardioversion (EC) in patients with implanted electronic devices in neurological disorders is sparse. In patients with cardiac pacemakers external defibrillation may damage the cardiac device. EC applied to deep brain stimulation (DBS) patients may cause thalamotomy or DBS failure. Application of electroconvulsive therapy in psychiatric disorders seems to be safe. Two cases of electroconvulsive therapy (ECT) in VNS have been reported by Sharma et al. The first patient was a 66-year old female with major depression and the second one, a 57-year-old male with a history of bipolar disorder. Both had VNS for therapy refractory psychiatric illness. ECT was applied because of further worsening of the mental state without malfunction of the VNS device. To our ","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47180234","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}