Journal of Emergency Practice and Trauma最新文献

{"title":"The role of ProBNP in differentiation of cardiogenic and non-cardiogenic syncope: A diagnostic accuracy study","authors":"A. Amini, Maryam Ahmadi Chegeni, Zahra Soltanzadeh Khasraghi, Mohammad Parsa Mahjoob, S. Shool, Amir Ghabousian, Rozita Khatamian Oskooi, Saeed Safari","doi":"10.34172/jept.2022.11","DOIUrl":"https://doi.org/10.34172/jept.2022.11","url":null,"abstract":"Objective: The significance of diagnosing the root reason for syncope and taking the required preventive or treatment measures cannot be overlooked when it comes to outcome prediction. This study endeavors to examine the role of proBNP in differentiating cardiogenic and non-cardiogenic syncope in patients presenting to the emergency department (ED). Methods: We prospectively performed a cross-sectional study on patients presenting with acute syncope. All the patients for this investigation were followed up until the definite cause of their syncope (cardiac or non-cardiac) was diagnosed and the screening performance characteristics of proBNP in differentiation of cardiogenic and non-cardiogenic syncope were evaluated. Results: Three hundred patients with syncope were studied (64.7% male). In the end, the cause of syncope was determined to be cardiogenic in 133 cases (44.3%). The area under the ROC curve of proBNP in the differentiation of cardiogenic syncope from non-cardiogenic was estimated to be 78.9 (95% CI: 73.5 – 84.3). The optimal cut-off point for proBNP in this regard was 143.5 pg/mL point. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of proBNP in the mentioned cut-off point were 75.39% (95% CI: 67.61–82.73), 75.44% (95% CI: 68.07–81.62), 71.12% (95% CI: 62.82–78.26), 79.74% (95% CI: 72.46–85.54), 2.46 (95% CI: 1.86–3.25), and 0.25 (95% CI: 0.18–0.34), respectively. Conclusion: The accuracy of proBNP in differentiation of cardiogenic and non-cardiogenic syncope is fair. ProBNP concentration equals to or higher than 143.5 pg/mL can differentiate cardiogenic syncope from non-cardiogenic with 75% sensitivity and 76% specificity. It seems that its use for this purpose should be considered with caution and along with other tools.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43498342","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":"Seizure after a massive infusion of N-acetylcysteine and successful treatment with a good outcome","authors":"Khadijeh Saravani, P. Ramezannezhad, Mohammad Hossein Kamaloddini, Mohammadmahdi Akbari, Tayebeh Shahraki","doi":"10.34172/jept.2022.07","DOIUrl":"https://doi.org/10.34172/jept.2022.07","url":null,"abstract":"Objective:N-acetylcysteine is frequently used as an efficacious antidote for acetaminophen toxicity. It prevents liver injury induced by paracetamol and in most cases the overdose of acetylcysteine produces mild clinical effects. Case Presentation: Here we describe a patient who self-treated himself by acetylcysteine after acetaminophen toxicity. Approximately 5 hours after receiving 140 g of acetaminophen, the patient developed confusion, hypotension as well as seizures and also had coagulopathy and acute kidney injury. Other causes of these symptoms were overdose of acetaminophen and amoxicillin. Finally, the patient was treated by extensive supportive therapy and got healed. Conclusion: This case suggests that massive IV acetylcysteine overdose can cause serious life-threatening conditions. The purpose of reporting this case is to increase the awareness among medical staff concerning adverse reactions revealed after a massive overdose of N-acetylcysteine and their arrangement as well as describing the way of management of such problems. The seizure was one of the manifestations in our case and it is so rare. This indicates that massive dosing of acetylcysteine could form irreversible damages in the brain, so it is very important to start the management as soon as possible and monitor patients precisely.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43484112","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":"Purtscher’s retinopathy following trauma: A case report","authors":"S. A. Rasoulinejad","doi":"10.34172/jept.2022.10","DOIUrl":"https://doi.org/10.34172/jept.2022.10","url":null,"abstract":"Objective: Purtscher’s retinopathy is the retinal damage following trauma or non-traumatic systemic disease, which may contain cotton-wool spots (CWSs), and may cause Purtscher flecken, atrophy of the optic nerve, and hemorrhage of the posterior pole of the eye. Case Presentation: A 28-year-old male patient fell down from a height of 10 m and was admitted with swelling and ecchymosis of the peri-orbit of the right eye. The patient’s vision was at the level of light perception. A mild subconjunctival hemorrhage and hyphema were seen in the right eye. In the fundus, the hemorrhage, edema, and CWS were seen in the posterior pole and around the optic disk. Macular thickness (MT) in Purtscher’s retinopathic eye was 353 µm. Also, the patient had a nose and mandibular fracture and was hospitalized for several days. Conclusion: The findings indicate a decrease in the vision due to Purtscher’s retinopathy caused by trauma. There was no improvement spontaneously.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47957683","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 calf swelling and pseudo-thrombophlebitis in rheumatoid arthritis: an uncommon emergency spot diagnosis","authors":"G. Dharmshaktu, T. Pangtey","doi":"10.34172/jept.2022.09","DOIUrl":"https://doi.org/10.34172/jept.2022.09","url":null,"abstract":"Dear Editor, A 52-year-old male presented with atraumatic left side calf swelling for the last three months. The swelling had acute onset and increased gradually in size. He had a history of rheumatoid arthritis with treatment options limited to physiotherapy sessions and pain medication as he could not continue disease modifying anti-rheumatic drugs regularly. There was no history of co-morbidities like hypertension, tuberculosis, diabetes mellitus or bleeding diathesis. He neglected the swelling initially due to mild pain and little impact on activities of daily living till swelling increased to be apparent. The swelling was mildly tender, fluctuant and more noticeable in prone position (Figure 1) with no overlying raised temperature, intact distal neurovascular status and normal knee joint movements. The magnetic resonance imaging (MRI) bi-compartmental knee arthritis and also revealed hyperintense fluidfilled swelling on T2 weighted images with large fluid collection over the calf region (Figure 1c). The collection was noted to be communicating with the posterior knee joint and corresponded with common location of popliteal cyst. His color Doppler and duplex scan reports were normal and provisional diagnosis of ruptured Baker’s cyst was made and knee aspiration was performed both for sampling and therapeutic relief. A straw-colored collection of about 800 mL was aspirated resulting in apparent subsidence of swelling. A two-week period of compression bandage and knee immobilizer was advised with daily follow up. No infective organism was isolated in culture and a milder recurrence of swelling after two days required the second aspiration and reapplication of compression bandage. There was no recurrence noted in a follow up of 8 months. Popliteal cyst (or Baker’s cyst) is a swelling resulting from distension of gastrocnemiussemimembranosus bursa that communicates with the knee joint (1). Mostly these are present as asymptomatic lesion with mild pain or clinically notable lumps. The cyst may be associated with conditions like osteoarthritis, medial meniscus tear or inflammatory arthritis. The prevalence of complicated cyst is 6.8% with rupture reported as common complication (2). Ruptured cyst may occasionally lead to resultant calf swelling making it one of the differential diagnosis of an acute or chronic calf swelling and should be investigated accordingly (3). Acute pain and swollen as well as tender calf may mimic deep vein thrombosis (DVT) or compartment syndrome and results from cyst rupture with its contents seeping into inter-muscular spaces (1,4). MRI is excellent in demarcation of fluid within musculofascial spaces and also helps to rule out mimicking disorders like DVT, rupture of medial gastrocnemius head or plantaris muscle, intramuscular hematoma, vascular disorders or neoplastic growths among others (1,3,4). The clinical presentation of a sudden pain at back of the knee with or without erythema, and ecchymoses at calf and ankle a","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46085720","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":"Periorbital emphysema and pneumomediastinum following blunt orbital fracture: A case report and review of the literature","authors":"A. Pakniyat, F. Jafari, Rojin Ramezani, M. Ghasemi-rad","doi":"10.34172/jept.2022.04","DOIUrl":"https://doi.org/10.34172/jept.2022.04","url":null,"abstract":"Objective: Orbital emphysema, defined as the presence of air in orbital and periorbital tissues, is a relatively uncommon clinical condition which occurs mostly following facial trauma. It can not only resolve spontaneously without any treatment, but it can also cause life threatening complications such as pneumomediastinum (PM). PM is an uncommon complication of facial fractures and is defined as the presence of air in the mediastinal space. Developing PM following blunt trauma is commonly considered as a red flag for underlying injuries, such as trachea and esophagus rupture. Therefore, other complementary diagnostic procedures, including bronchoscopy and esophagostomy, are often necessary for patients developing this condition. Case Presentation: A 31-year-old man with a history of facial and neck trauma was presented to the emergency room of our tertiary referral hospital with a complaint of right orbital swelling. On physical examination, vital signs were stable. There was a mild swelling of right upper eyelid, but no proptosis. An hour after admission, following sneezing and blowing his nose, the patient had further swelling of his right face with extension of swelling through the right side of his neck to the nipple. He also complained of dyspnea and acute severe progressive epigastric pain. Conclusion: Orbital emphysema following orbital wall fracture is typically benign and selflimited, but physicians should be aware of serious complications such as PM. Therefore, monitoring the patient is crucial and should be considered in such conditions.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44787631","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":"Subcutaneous emphysema and pneumomediastinum in COVID -19 patients: ICU course of four cases and review of literature","authors":"O. Nazir, Rana Pratap Singh, Amit Kumar","doi":"10.34172/jept.2022.03","DOIUrl":"https://doi.org/10.34172/jept.2022.03","url":null,"abstract":"Objective: Since April 2021, there has been significant increase in number of COVID-19 cases in India. As the caseload increased, so did the complications like pneumomediastinum (PM) and subcutaneous emphysema (SE). Case Presentation: We present clinical course of 4 patients as case series of COVID-19 pneumonia who developed PM and SE during their management. Two cases with the need of non-invasive ventilation (NIV) recovered and two cases that needed invasive mechanical ventilation (IMV) ultimately expired. Conclusion: This case series highlights the importance of positive pressure ventilation via NIV and IMV as a predisposing factor for PM and SE as well as the need of strict vigilance by clinicians managing COVID-19 patients in IMV.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41616253","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":"Cellulitis: When to say its treatment failure","authors":"Sadaf Sheikh","doi":"10.34172/jept.2022.06","DOIUrl":"https://doi.org/10.34172/jept.2022.06","url":null,"abstract":"","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47944088","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":"Renal infarction mimicking cholecystitis: a case report of a patient presenting with stroke","authors":"Sadaf Sheikh, U. Javed","doi":"10.34172/jept.2022.05","DOIUrl":"https://doi.org/10.34172/jept.2022.05","url":null,"abstract":"Objective: Renal infarction which is a rare phenomenon can be missed on the patient’s work up making its incidence low. Case Presentation: We report a 68-year-old lady with known history of hypertension presented with epigastric pain and vomiting for 4 days. During her stay in the emergency room, she developed sudden onset of left-sided weakness. Electrocardiogram was normal sinus rhythm. Computed tomography scan of the abdomen showed acute pancreatitis with partial impingement of superior mesenteric vein. Conclusion: Imaging s showed cholelithiasis without evidence of cholecystitis and lower pole right renal infarct likely secondary to obstruction of the right lower renal artery due to calcified plaques at their origin from the aorta. Subsequently, the patient was kept on antiplatelets and planned for discharge uneventfully.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44257727","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":"Case report of unusual presentation of COVID-19 in a patient with pulmonary hypertension","authors":"M. Moazenzadeh, Maryam Aliramezany","doi":"10.34172/jept.2022.02","DOIUrl":"https://doi.org/10.34172/jept.2022.02","url":null,"abstract":"Objective: COVID-19 has now become a worldwide health problem with many new cases diagnosed every day. people with underlying heart diseases are more likely to get infected and have poor prognosis. Of them, adult patients with congenital heart disease need special attention due to their different symptoms and course of the disease. Case Presentation: Here, we report the unusual presentation and course of COVID-19 disease with rapid progression of right ventricle failure and pulmonary hypertension in patient who was infected with new SARS-CoV-2 virus. She is a 39-year-old woman, known case of ventricular septal defect and pulmonary hypertension with a history of open-heart surgery at the age of seven that arrived to our clinic due to exacerbation of dyspnea; progressive lower extremity edema and mild ascites from 10-days ago. Conclusion: Any changes in the condition of adult patients with congenital heart disease in this epidemic should be considered as a potential infection by this virus and the necessary and accurate evaluation should be done.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46167415","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":"Clubfoot management during COVID-19 times: An Indian scenario","authors":"A. Singhal, Anil Kapoor","doi":"10.34172/jept.2022.01","DOIUrl":"https://doi.org/10.34172/jept.2022.01","url":null,"abstract":"The coronavirus disease 2019 (COVID-19) pandemic has been universal and swift in its spread. As orthopaedic surgeons, for the most of us this timeframe has reduced our activity to emergency and trauma cases only, with virtual outpatient clinics and no elective surgeries. With some of the common deformity problems including clubfoot etc, which comprises a large number of children in the developing world, the management has been deferred, without any regional and national guidelines being framed. Updated guidelines relating to the management of clubfoot patients, in which parents can safely consult with the orthopaedic surgeon and physical rehabilitation specialists will allow them to cope with this unprecedented situation. We revisit the current scenario and the possible management protocol in the context of COVID-19 pandemic.","PeriodicalId":36499,"journal":{"name":"Journal of Emergency Practice and Trauma","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48294621","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}