Emergency最新文献

{"title":"Systemic Fibrinolytic Therapy in the Presence of Absolute Contraindication; a Case Series","authors":"Mahdi Pishgahi, Toktam Alirezaei, B. Hajimoradi, S. Nekooghadam, Shima Shahi","doi":"10.22037/EMERGENCY.V6I1.21162","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21162","url":null,"abstract":"In massive pulmonary embolism (PE), fibrinolytic therapy is a potential lifesaving treatment; therefore, if other treatments are not available, the physicians encounter this question: can we accept the risk of complications from fibrinolytic therapy, especially intracranial hemorrhage, in the presence of absolute contraindication, in order to save the patient’s life? Here, we describe three cases of massive PE with absolute contraindication for fibrinolytic therapy who presented to emergency department following dyspnea. Since, surgical or catheter embolectomy were not available and patients were very high risk for transferring to another hospital, systemic fibrinolytic was administered. The patients improved clinically and were discharged from hospital. It seems that, if no other acceptable treatments are available, physicians could consider fibrinolytic therapy, even at the presence of contraindication, to save the patient’s life.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46049109","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":"Hopkins Syndrome in a 14 Year Old Boy; a Case Report","authors":"A. Majidi, S. Saket, Zohreh Nabizadeh Gharghozar, Ehsan Akrami, Seyed Mohsen Fayyazi","doi":"10.22037/EMERGENCY.V6I1.18287","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.18287","url":null,"abstract":"Hopkins syndrome (HS) is a flaccid paralysis resembling poliomyelitis that has been seen in some children who are recovering from an acute episode of asthma. This syndrome should be suspected based on clinical findings even before the occurrence of characteristic breathing patterns and epilepsy. We report a 14-year-old boy who had experienced an episode of HS.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49304618","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":"Lidocaine-Midazolam-Fentanyl Combination in Controlling Pain for Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial","authors":"Ali Arhami Dolatabadi, Aida Mohammadian, Hamid Kariman","doi":"10.22037/EMERGENCY.V6I1.21069","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.21069","url":null,"abstract":"Introduction: Finding a fast-acting compound with minimal side-effects to induce a safe and efficient analgesia with short or medium duration of action is of great interest in the emergency department. The present study has been designed with the aim of comparing the effect of midazolam + fentanyl + lidocaine combination with midazolam + fentanyl + placebo in pain management of anterior shoulder dislocation reduction. Methods: The present two-arm parallel double-blind randomized controlled trial was performed on patients who presented to emergency department with anterior shoulder dislocation. Patients were randomly allocated to the 2 treatment groups of midazolam + fentanyl + placebo (double-drug group) and midazolam + fentanyl + intravenous (IV) lidocaine (triple-drug group). Then outcomes such as treatment success rate and side-effects following prescription of drugs were compared between the 2 groups. Results: 100 patients were included in the present study (50 patients in each group; mean age of the studied patients 27.3±8.9 years; 93.0% male). Using the double-drug regimen led to 35 (70%) cases of complete analgesia, while this rate in the triple-drug group was 41 (82%) cases (p=0.16). The calculated number needed to treat was 9 cases. This means that about one in every 9 patients in treatment arm will benefit from the treatment. The most important side-effects observed included dysrhythmia (1 patient in double drug and 1 patient in triple-drug group), apnea (2 patients in each group) and SPO2<90% (2 patients in triple-drug group) (p=0.78). Number needed to harm was 25 cases. In other words, for each 25 patients treated with the triple drug regimen, 1 case of SPO2<90% is observed. Conclusion: Findings of the present study showed that adding IV lidocaine to IV midazolam + fentanyl drug combination does not provide additional analgesia in sedation for anterior shoulder reduction.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48708361","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":"A Simple Device to Control Valsalva Manoeuvre Strain Pressure; a Letter to Editor","authors":"I. Fitzgerald, A. Appelboam","doi":"10.22037/EMERGENCY.V6I1.19885","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.19885","url":null,"abstract":"We read with interest the article by Motamedi and colleagues about the use of a hand held manometer to measure strain pressure during Valsalva manoeuvre (VM) treatment of supraventricular tachycardia (SVT).  We also used a manometer in our study (REVERT) of a postural modification of the VM and are currently investigating the use of a simple, single patient use device to control VM strain pressure, NCT number: NCT03298880. Such a device would be useful as blood pressure manometers are not always available and cannot be left with patients and other methods of generating the recommended strain such as syringes have been shown to be unreliable. We note that Motamedi’s study demonstrated a cardioversion rate of 14.8% in supine participants, which was similar to the rate achieved in the REVERT trial by control participants in the semi recumbent position (17%). In contrast, participants randomised to the modified VM in the REVERT trial, had a markedly improved cardioversion rate of 43%. This modification required participants to perform a 40 mmHg pressure strain for 15 seconds in a semi recumbent position but with supine repositioning and passive leg raise immediately after the Valsalva strain. To our knowledge this is the first trial to study this modification and was not described in the ‘new modified version’ quoted and referenced in Motamedi’s paper. To achieve the best cardioversion rates, we recommend use of a modified VM as described above with the strain controlled by a manometer where possible. A simple, single patient use device designed to deliver the recommended pressure may be helpful to facilitate this in practice and could be kept by patients for future use.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46430154","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":"The Effect of Low-Dose Ketamine in Treating Acute Asthma Attack; a Randomized Clinical Trial","authors":"Mehrdad Esmailian, Mahboubeh Koushkian Esfahani, Farhad Heydari","doi":"10.22037/EMERGENCY.V6I1.20997","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.20997","url":null,"abstract":"Introduction: Efficient treatment of asthma can play an important role in controlling asthma attacks, rapid recovery and decrease of patient mortality. Therefore, in the present study the therapeutic effect of low-dose ketamine is evaluated in patients with acute asthma attack. Methods: In the present single-blind, randomized clinical trial with placebo control, the effect of low-dose intravenous ketamine in treating 18 to 85 year-old asthmatic patients who presented to the emergency department was evaluated. Peak expiratory flow rate (PEFR) and the patients’ response to treatment were measured before and 1 hour after treatment. Additionally, using SPSS 22.0, effectiveness of ketamine with 0.3, 0.4, and 0.5 mg/kg doses followed by infusion of the same dose during 30 minutes were compared with placebo. Results: 92 patients were enrolled (59.8% female, mean age 48.5 ± 13.9 years). 15 (16.3%) patients were treated with 0.3 mg/kg ketamine, 14 (15.2%) with 0.4 mg/kg, and 16 (17.4%) with 0.5 mg/kg doses. Mean PEFR was 336.2 ± 101.5 liters in the placebo group and 345.8 ± 84.7 liters in the ketamine group before intervention (p = 0.6), while after intervention, they were 352.1 ± 101.2 and 415.8 ± 76.2 liters, respectively (p = 0.001). Ketamine treatment with 0.4 and 0.5 mg/kg doses led to a higher increase in PEFR compared to 0.3mg/kg dose (df: 3, 88; F = 23.8; p < 0.001). Conclusion: It seems that administration of 0.4 - 0.5 mg/kg doses of intravenous ketamine followed by infusion of the same dose during 30 minutes can be effective for rapid recovery of PEFR in patients with mild to moderate asthma.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.22037/EMERGENCY.V6I1.20997","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46559082","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":"Sudden Death due to Hydatid Cyst Emboli; a Case Report","authors":"Mohammad Ali Emam Hadi, F. Najari, Leila Soleimani","doi":"10.22037/EMERGENCY.V6I1.19764","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.19764","url":null,"abstract":"Echinococcosis is an infection caused in human by complex parasites that causes cystic hydatid disease. These infections are prevalent in most areas where livestock is raised in association with dogs. These parasites are found in all continents. Slowly enlarging cysts generally remain asymptomatic until their size has expanded. Here we present a case of sudden death following cyst emboli to the large veins and right heart of a young adult female.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43292572","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":"Prevalence of Mycoplasma Pneumoniae Infection in Patients with COPD Exacerbation; a Letter to the Editor","authors":"A. Amiri, K. Ghazvini, Hamid Zamani Moghadam","doi":"10.22037/EMERGENCY.V6I1.20788","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.20788","url":null,"abstract":"Dear editor; Currently, control and prevention of respiratory illnesses is considered a health priority in most developed countries and managing the risk factors is necessary for improving the population’s health. Chronic obstructive pulmonary disease (COPD) is the 5 th cause of death around the world and estimations have indicated that due to an increase in environmental pollution, this disease will become the 3 rd cause of death in the future. In previous studies, pulmonary infection with mycoplasma pneumoniae has been introduced as one of the causes for COPD exacerbation. Mycoplasma pneumoniae affects the upper and lower respiratory tract and its clinical manifestation is trachea-bronchitis accompanied by restlessness and dry coughs. The pathogenesis spectrum of this bacterium ranges from mild pharyngitis and trachea-bronchitis to acute pneumonia. Epidemiologic studies have shown that this bacterium is responsible for more than 20% of community acquired pneumonias. In a cross-sectional study by the authors of the present letter, 66 patients over the age of 18 years who had presented to the emergency department of Imam Reza Hospital, Mashhad, Iran, with diagnosis of COPD exacerbation were evaluated. Sputum sample of the patients was obtained and sent to the laboratory for performing polymerase chain reaction (PCR). Mean age of the patients participating in this study was 67.28 ± 13.68 years (60.6% male). The result of PCR was positive in 6 patients out of the total of 66 patients (9.1%). The results of the present study showed that there was no correlation between age (p=0.18), sex (p=0.25), duration of being affected with COPD (p=0.20), consumption of antibiotics (p=0.35), smoking (p=0.62), opioid abuse (p=0.44), corticosteroid use (p=0.57), underlying illness (p=0.94) and health care—associated pneumonia (HCAP) (p=0.46) with mycoplasma infection. However, prevalence of leukocytosis (p=0.01) and myalgia (p=0.02) was significantly higher in the mycoplasma group. Numerous studies have confirmed the presence of mycoplasma pneumoniae in exacerbation of COPD using serologic diagnosis. For instance, in a study by Lieberman et al. prevalence of mycoplasma pneumoniae in patients with COPD exacerbation was reported as 14.2% and in Meloni et al. study the prevalence of this infection was expressed to be 6.7%. These rates were reported between 5% and 14% in other studies. Thus, it seems that prevalence of mycoplasma is high in COPD exacerbation, but there is still no answer to the question if this infection results in exacerbation of COPD or not and there is controversy between the studies in this regard. Therefore, it is suggested to design case-control or cohort studies to find the answer to this question.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43271618","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":"Emergency Medicine Resident versus Radiologist in Detecting the Ultrasonographic Signs of Acute Cholecystitis; a Diagnostic Accuracy Study","authors":"Javad Tootian Tourghabe, H. R. Arabikhan, A. Alamdaran, Hamid Zamani Moghadam","doi":"10.22037/EMERGENCY.V6I1.20790","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.20790","url":null,"abstract":"Introduction: Dependence of ultrasonography on the operator’s skill plays a major role in the differences between various studies in reporting its diagnostic accuracy. Therefore, the present study was done with the aim of comparing the ultrasonography findings performed by emergency medicine resident and radiologist in evaluation of acute cholecystitis. Methods: The present diagnostic accuracy study has been carried out on patients presenting to the emergency department with complaint of pain in the right upper quadrant of abdomen suspected with acute cholecystitis. All the patients underwent gallbladder ultrasonography by a trained emergency medicine resident and a radiologist and their findings were compared with surgical and pathology findings regarding gallstone and increased gallbladder wall thickness. Results: 51 patients with the mean age of 42.3±15.8 (17-81) years were analyzed (82.4% female). The overall agreement between emergency medicine resident and radiologist in ultrasonographic diagnosis of cholecystitis was 0.421 (95% CI: 0.118-0.724). Based on the pathology and surgical findings, acute cholecystitis was confirmed for all 51 (100%) patients. Meanwhile, based on the ultrasonographic report of radiologist and emergency medicine resident only 45 (88.2%) and 34 (66.7%) patients, respectively, were diagnosed with cholecystitis. Screening performance characteristics of ultrasonography by radiologist for detection of gallbladder stone (p = 0.010) and gallbladder wall thickness (p < 0.0001) were significantly better than emergency medicine resident. Conclusion: The screening performance characteristics of ultrasonography by radiologist in detection of gallstones and increased wall thickness of gallbladder were significantly better.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46920124","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":"Loss of Guide Wire as an Important Complication of Central Venous Catheterization; a Case Report","authors":"F. Najari, Mohamadjavad Amirian, Sara Sadjadi, Ideh Baradaran Kayal","doi":"10.22037/EMERGENCY.V6I1.19466","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.19466","url":null,"abstract":"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.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47778839","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":"Sudden Death Following Oral Intake of Metal Objects (Acuphagia): a Case Report","authors":"M. Emamhadi, F. Najari, M. Hedayatshode, Shokoufeh Sharif","doi":"10.22037/EMERGENCY.V6I1.19676","DOIUrl":"https://doi.org/10.22037/EMERGENCY.V6I1.19676","url":null,"abstract":"According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), pica is described as eating one or more non-nutritive, non-food substances over a period of at least 1 month that is severe enough to warrant clinical attention. The present case is a 44-year-old man who was brought to emergency department following severe abdominal pain, but died before admission or receiving any treatments. On the autopsy, 64 bolts and metal fittings (3700 grams) were found in the esophagus, stomach, small intestine, and large intestine of the patient.","PeriodicalId":11681,"journal":{"name":"Emergency","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.22037/EMERGENCY.V6I1.19676","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45114307","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}