South Asian Journal of Emergency Medicine最新文献

{"title":"DNAR decisions in Pakistan, Middle East and UK: An emergency physician's perspective","authors":"I. Qureshi","doi":"10.5455/SAJEM.020107","DOIUrl":"https://doi.org/10.5455/SAJEM.020107","url":null,"abstract":"Although resuscitation aims to preserve life and restore health, it is sometimes at the expense of increased suffering and disability to the receiving patient. In this situation, the treating physicians often end up in the dilemma of whether resuscitation is appropriate for the patient and have discussions with the patient and/or family. This may lead to a decision to “Do Not Attempt Resuscitation” (DNAR). In western societies, the patients have an option to opt out of Cardiopulmonary Resuscitation (CPR) if they are in the situation, and at times, the medical team can make a clinical decision when the efforts are deemed futile. This is supported in the legislation of those countries, and as an example, the UK law states, There is no obligation to give treatment that is futile or burdensome.1 As the preservation of life in Muslim countries is of paramount importance due to religious reasons as well as cultures and traditions, a similar blanket approach to DNAR in Muslim countries is rarely seen. One of the earliest Fatwa (Islamic law) on this topic by Shaykh ‘Abd al-‘Azeez ibn ‘Abd-Allaah ibn Baaz and Shaykh ‘Abd al-Razzaaq ‘Afeefi in the year 1986, states “if reviving the heart and lungs is of no benefit and not appropriate because of a certain situation, according to the opinion of three trustworthy specialist doctors, then there is no need to use resuscitation equipment, and no attention should be paid to the opinions of the patient’s next of kin concerning the use of resuscitation equipment or otherwise, because this is not their specialty.” 2 This has led to physicians in Saudi Arabia being empowered to make DNAR decisions for their terminal patients and allow dignified death. The lack of similar legislation in Pakistan often places physicians in the unenviable situation of having to explain to patients and their families why CPR would be futile, and, in the absence of consensus, having to provide expensive, futile treatment, at the expense of the family, and other patients who may benefit from the resources used up. When possible, these discussions should be had by the treating speciality and the patient/families, but emergency physicians often find themselves in the awkward and undesirable situation of initiating these difficult conversations. The area to discuss and investigate here is about the ethical, religious, and legal implications of such a decision, and how an emergency physician can continue to act in the patient’s best interest while keeping themselves safe.","PeriodicalId":389251,"journal":{"name":"South Asian Journal of Emergency Medicine","volume":"303 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114443424","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":"Hirayama Disease: A Rare Clinical Entity","authors":"S. Mansoor, K. Murphy, M. Adenan, E. Joyce, O. Hardiman, Michael J. Hennessey, S. Kelly","doi":"10.5455/sajem.020204","DOIUrl":"https://doi.org/10.5455/sajem.020204","url":null,"abstract":"Hirayama disease is a rare neurological entity which can present in any setting emergency departments included. These cases are usually diagnosed after carefully excluding other conditions. Intraspinal lesions (eg, syringomyelia, syringobulbia, or tumor) can present with symptoms that can mimic hirayama disease. We report the case of a 23-year old man who presented with an 18 month history of numbness, tingling and painless curling of the 4th and 5th digits. The symptoms did not progress beyond the 12 month period. The right side and bulbar function remained unaffected throughout. Based on the age of onset, arrest of progression after a period of deterioration, imaging features and neurophysiological findings a diagnosis of Hirayama Disease was made.","PeriodicalId":389251,"journal":{"name":"South Asian Journal of Emergency Medicine","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129655637","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":"Vasogenic Shock Secondary to an Intentional Overdose of Multiple Antihypertensives in a patient with Hypertrophic\u0000Cardiomyopathy","authors":"M. Ghani","doi":"10.5455/SAJEM.020106","DOIUrl":"https://doi.org/10.5455/SAJEM.020106","url":null,"abstract":"We are reporting a case of intentional polypharmacy with beta blockers, calcium channel blockers, alpha adrenergic blockers and centrally acting antihypertensive agents in a young male with HCM. This unique presentation resulted in shock which didn't respond to all known interventions including intralipid. The patient finally responded to HIET and Vasopressin and after adrenaline was tapered and finally stopped. We feel early initiation of pure alpha agonist like vasopressin or phenylephrine could have been more successful in this scenario of hypotension and outflow obstruction. \u0000 \u0000In our literature search we came across a case report of combined B blocker/calcium channel blocker and amiodarone toxicity in a patient with HCM which responded well to intralipid. However, to our knowledge this is the first case report of life threatening overdose of B blocker, calcium channel blocker, alpha blocker and centrally acting antihypertensives in a patient with HCM.","PeriodicalId":389251,"journal":{"name":"South Asian Journal of Emergency Medicine","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125450751","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":"Clinical Profile of Pediatric Tuberculosis, Presenting to the Emergency Department of Tertiary Care Hospital in Karachi, Pakistan.","authors":"Emad Siddiqui, Tooba Siddiqui, A. Khan","doi":"10.5455/sajem.040212","DOIUrl":"https://doi.org/10.5455/sajem.040212","url":null,"abstract":"Abstract\u0000Background\u0000Tuberculosis (TB), a preventable airborne infectious disease, early detection is essential to improve health outcomes. Extent of childhood tuberculosis is unknown and is estimated to be around 6% of all incidences. \u0000Diagnosis of pediatric tuberculosis is always difficult and no age is spared, however, children <5 years are more at risk. Children frequently admitted through emergencies of hospitals with different working diagnoses and later diagnosed as tuberculous. Despite multiple studies from Pakistan; the complex and multifaceted ED presentation of childhood tuberculosis was not looked in.\u0000Primary objective was to assess the clinical profile of tuberculosis patients presenting to ED, the secondary objective was to evaluate the relation of BCG vaccination, history of contact, and measles. \u0000\u0000Methods\u0000This was a retrospective chart review of children admitted to the study center with the discharge diagnosis of Childhood Tuberculosis from June 2010 to June 2015 as per WHO criteria. \u0000Patient demographic characters, medical history, and physical examination findings in ED along with vital signs and laboratory variables will be recorded from the charts. CXR, CBC, ESR, sputum analysis, and lab other parameters were recorded from an electronic database. \u0000Results\u0000We enrolled 264 children, majority, 139 (53%) were below 5 years of age, 152 (58%) males, 112 (42%) females. BCG vaccination was given to 81 (30%) male and, 60 (23%) female children. \u0000183 (69%) children had pulmonary symptoms, 81 (31%) had extra extrapulmonary tuberculosis. The commonest extrapulmonary manifestation was GIT 34 (13%), followed by CNS 27 (10%) cases. Cough was found in 54 (31%) followed by respiratory distress 49 (27%), almost all of them were below 5 years of age. \u0000CXR was performed in all cases, 85 (32%) didn’t have radiological findings. The frequency of BCG vaccination status, history of contact, measles about age gender, and systemic involvement was also analyzed and found significant results. \u000023 children, had a history of contact and measles both. Miliary was found in 6 (26%) cases, however, 22 (99%) of 23 didn’t have BCG vaccination. \u0000History of weight loss was found in 46 (33%) who either didn’t get BCG vaccination or didn’t remember (no BCG scar, 123), out of 92 children with weight loss 31 (34%) have contact history. \u0000\u0000Conclusion\u0000Diagnosing childhood tuberculosis in emergency with vague/overlapping clinical presentations is a dilemma. Clinical scoring system may not identify most cases, hence suspicion must be high in all suspected cases with prolonged history, contact tracing methods, weight loss or failure to gain weight, etc.","PeriodicalId":389251,"journal":{"name":"South Asian Journal of Emergency Medicine","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133929021","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":"Validating the National Early Warning Score(NEWS) in Emergency Department of a tertiary care hospital in Pakistan.","authors":"A. Khan, A. Sattar, S. Ghauri, H. Hasnain, H. Khan","doi":"10.5455/sajem.020212","DOIUrl":"https://doi.org/10.5455/sajem.020212","url":null,"abstract":"BACKGROUND \u0000National Early Warning Score has been studied well in indoor settings of developed countries but hasn’t been tested before in the Emergency Department of developing countries with fewer resources. Our objective was to determine whether the emergency department (ED) NEWS can be associated with Triage, admission, disposition, length of emergency/hospital stay, reappearance and mortality. \u0000 \u0000METHODOLOGY \u0000A random sample of 1000 patients’ first encounter in the ED was extracted in the study period (between November 2018 and April 2019). Statistical analysis was done to analyze whether ED NEWS severity category can be associated with Triage, admission, disposition, length of emergency stay, length of hospital stay, reappearance in two weeks and mortality. \u0000 \u0000RESULTS \u0000ED NEWS Score is associated with triage as shown by mean 2.68 (SD ± 0.6, p=0.01). Also, a high NEWS score also had impact on admission including 75 (66.4%) patients in severe and 55(74.3%) in moderate NEWS severity category respectively. NEWS score is also associated with Critical care admission and length of Emergency stay likely hood ratio of 26.0(p=0.038). Reappearance \u0000in emergency within next two weeks of discharge had no relation to NEWS severity. On the other hand both ED mortality and Hospital mortality were related to High NEWS. It correlates weakly with Length of Stay in emergency or with Length of Stay in Hospital. \u0000 \u0000CONCLUSION \u0000NEWS Score can be used in the emergency department to identify and predict adverse outcome of patients presenting to ED. NEWS \u0000can be used as a triage tool when deciding whether and where patients should be admitted.","PeriodicalId":389251,"journal":{"name":"South Asian Journal of Emergency Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131835806","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":"“Hello, Jack of all Specialties”","authors":"Amber Zohaib Jafferi","doi":"10.5455/sajem.020202","DOIUrl":"https://doi.org/10.5455/sajem.020202","url":null,"abstract":"I write today as a human, who happens to be a mother of three, wife of a non-medical person, an emergency physician and a writer who loves her field of work, who is confident of her expertise but gets second thoughts at least once every week. Who would ask herself every month, at least once, is this what you want to face all your life?","PeriodicalId":389251,"journal":{"name":"South Asian Journal of Emergency Medicine","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129014495","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":"Radiological Delay and the Impact of Radiological Delay on Emergency department Throughput","authors":"M. Bangash, Samra Haroon, H. Khan","doi":"10.5455/sajem.040105","DOIUrl":"https://doi.org/10.5455/sajem.040105","url":null,"abstract":"","PeriodicalId":389251,"journal":{"name":"South Asian Journal of Emergency Medicine","volume":"148 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132056764","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":"Bedside lung ultrasonography as a triaging tool for suspected COVID-19 patients in the emergency department","authors":"Moeed Ahmed","doi":"10.5455/sajem.040202","DOIUrl":"https://doi.org/10.5455/sajem.040202","url":null,"abstract":"","PeriodicalId":389251,"journal":{"name":"South Asian Journal of Emergency Medicine","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122961129","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":"Risk Factors of Post-Traumatic Stress Disorder and Coping Strategies of Emergency Medicine Physicians During the COVID - 19 Pandemic","authors":"P. Luna, F. Gaerlan, J. Luna, Zoila Fortes","doi":"10.5455/sajem.040109","DOIUrl":"https://doi.org/10.5455/sajem.040109","url":null,"abstract":"Asthma is a heterogeneous chronic condition of the airways characterized by respiratory symptoms such as airflow obstruction, inflammation, and hyper bronchial responsiveness. The symptoms present in different ways in different patients but the most common include shortness of breath, limitations in expiratory airflow, wheeze, chest tightness, and cough with varying intensity.(1) The occurrence of these symptoms determines the severity of asthma and the clinical manifestation. Asthma is a global health issue. It is listed among the top health conditions in developed countries. In the United Kingdom of Saudi Arabia, more than 25 percent of the Saudi Arabians were diagnosed with physician reported in 2004.(2) Saudi Arabia is a developed country with an average burden of more than 10%. At the time, in other developed countries, asthma prevalence fell below twenty-five percent. For instance, United Kingdom’s asthma prevalence was less than 15%.(3) A recent survey reports an increasing occurrence of asthma where it accounts for 20 percent of the total ER visits.","PeriodicalId":389251,"journal":{"name":"South Asian Journal of Emergency Medicine","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117346061","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":"Septic Shock Secondary to Emphysematous Splenic Abscess","authors":"Saad Jawaid, W. Khan","doi":"10.5455/SAJEM.020102","DOIUrl":"https://doi.org/10.5455/SAJEM.020102","url":null,"abstract":"Splenic abscess is rarely encountered nowadays and the most common predisposing factor is bacteremia. Classically, endocarditis is seen to be associated with splenic abscess but any cause of bacteremia, ranging from enteric fever, to intravenous line infection, to urinary tract infection, may result in splenic abscess. Since, urinary tract infection (UTI) is common in females and bacteremia complicating this infection is frequently seen. Here, we present a case of septic shock secondary to emphysematous splenic abscess caused by Escherichia coli (E. coli) bacteremia complicating urinary tract infection (UTI). It was presented in emergency department with complaint of abdominal pain associated with fever and vomiting, which was diagnosed with the help of ultrasound and computed tomography (CT) scan of abdomen and managed with intravenous antibiotic and splenectomy was performed.","PeriodicalId":389251,"journal":{"name":"South Asian Journal of Emergency Medicine","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129612831","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}