Advanced Journal of Emergency Medicine最新文献

{"title":"A 58-Year-Old Woman with Weakness and Shortness of Breath.","authors":"Mehran Sotoodehnia, Pooya Payandemehr","doi":"10.22114/AJEM.v0i0.41","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.41","url":null,"abstract":"","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 1","pages":"e12"},"PeriodicalIF":0.0,"publicationDate":"2017-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/23/31/AJEM-2-e12.PMC6548110.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37310049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fever and Flank Pain in a Diabetic Woman; a Case of Emphysematous Pyelonephritis.","authors":"Mahbube Ebrahimpur, Mahnaz Pejman-Sani, Zeinab Naderpour","doi":"10.22114/AJEM.v0i0.38","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.38","url":null,"abstract":"Case presentation: A 55–year-old diabetic woman presented to the emergency department with a complaint of nausea, vomiting, right upper abdominal pain, and fever with chills since 10 days. She revealed a 10-year history of poorly controlled diabetes on oral agent and kidney stones. On examination, the patient was found to be febrile (39 ℃) with tenderness in the right renal angle. Laboratory data has revealed the following findings: blood sugar (BS: 480 mg/dl), HbA1C: 13%, complete blood count (white blood cells (WBC): 13,900; polymorphonuclear leukocytes (PMN): 80%; lymphocytes: 18%; hemoglobin: 12 g/dl; and platelet: 118,000), blood urea nitrogen (BUN): 79 mg/dl, creatinine (Cr): 2.3 mg/dl, and erythrocyte sedimentation rate (ESR): 103 mm in 1 h. The urine analysis revealed 12–13 WBCs, 7–8 red blood cells (RBCs), and several bacteria. Urgent ultrasound indicated a heterogeneous mass in with focal echoes suggesting intraparenchymal gas, along with gross hydronephrosis and numerous stones, in the right kidney. The patient was treated with hydration, insulin, and intravenous imipenem 500 mg twice daily (adjusted with her creatinine). After 48 h, blood culture report was negative, whereas urine culture revealed presence of imipenem sensitive Citrobacter. Computed tomography (CT) scan without contrast indicated an enlarged, edematous right kidney with multiple air bubbles and air fluid levels. Based on the clinical and radiological findings, diagnosis was confirmed and right urgent nephrectomy was performed after 36 h of admission. The histopathology of the removed kidney revealed acute or chronic inflammation and necrosis, extending to the perinephric fat. The patient was discharged without any major complication after a 14-day hospital stay. \u0000Learning points: Emphysematous pyelonephritis (EPN) is an acute, severe, and gas producing necrotizing bacterial infection that affects the renal parenchymal and surrounding tissues. The predisposing factors include: diabetes mellitus, urinary tract obstructions, and immune incompetence. Diabetes mellitus is the most commonly associated factor and up to 90% of the patients report uncontrolled diabetes mellitus. Bilateral renal involvement and obstruction has been observed in 5% and 30% of the patients, respectively. The most common pathogen causing EPN is Escherichia coli. Other pathogens have been reported including Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa. Several factors contribute in the pathogenesis of EPN including high levels of glucose inside the tissues, gas forming bacterial infection, impaired vascular blood supply, reduced host immunity, and obstruction in the urinary system. Clinical manifestations are similar to acute pyelonephritis, including fever, nausea, vomiting, and flank pain; however, often they do not respond to the medical treatment. Laboratory investigations often reveal leukocytosis with a shift to the left, thrombocytopenia, and elevation of the serum cre","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 1","pages":"e11"},"PeriodicalIF":0.0,"publicationDate":"2017-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/b5/AJEM-2-e11.PMC6548100.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37310048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Very General Overview of the Development Pediatric Emergency Medicine as a Specialty in the United States and Advocacy for Pediatric Healthcare; the Charge to Other Countries.","authors":"Ron D Waldrop","doi":"10.22114/AJEM.v0i0.39","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.39","url":null,"abstract":"","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 1","pages":"e1"},"PeriodicalIF":0.0,"publicationDate":"2017-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/ca/AJEM-2-e1.PMC6548101.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37308090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 27-years-old Man with Abdominal Pain; Lead Toxicity.","authors":"Maryam Kia, Rokhsareh Aghili, Seyed Mojtaba Aghili","doi":"10.22114/AJEM.v0i0.36","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.36","url":null,"abstract":"Case presentation: A 27-year-old man came to our emergency department with chief complaints of abdominal pain, nausea and vomiting, colicky pain in all area of abdomen without any radiation and generalized myalgia. In his background, he had no previous medical problem. In his social history he had worked in an automobile battery-reclaiming factory for 5 years. During his physical examination, his appearance was pale with perioral priority, ill and agitated but not toxic with a blood pressure of 127/85 mmHg and a pulse of 80 beats/min, respiratory rate of 14 breaths/min and oral temperature of 37.3 °C, mild generalized abdominal tenderness without rebound. No obvious signs of sensory and motor neuropathy were found. In the head and neck examination, we found lead-lined teeth. \u0000Learning points: The most common cause of chronic metal poisoning is lead. Exposure occurs through inhalation or ingestion. Both inorganic and organic forms of lead that exist naturally produce clinical toxicity. Gastrointestinal manifestations occur more frequently with acute rather than with chronic poisoning, and concurrent hemolysis may cause the colicky abdominal pains. Patients may have complained of a metallic taste and, with long-term exposure, have bluish-gray gingival lead lines. In addition, constitutional symptoms, including arthralgia, generalized weakness, and weight loss raises the possibility of lead toxicity.","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 2","pages":"e22"},"PeriodicalIF":0.0,"publicationDate":"2017-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f1/07/AJEM-2-e22.PMC6549056.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40550305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 58-year-old Man with Abdominal Pain; Acute Appendicitis due to an Appendicolith.","authors":"Seyed Mojtaba Aghili, Maryam Kia, Rokhsareh Aghili","doi":"10.22114/AJEM.v0i0.35","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.35","url":null,"abstract":"","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 1","pages":"e10"},"PeriodicalIF":0.0,"publicationDate":"2017-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/7c/AJEM-2-e10.PMC6548106.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37310047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Implementation of the Standard Clinical Practice Guideline (CPG) for Management of Multiple Trauma Patients Admitted to an Emergency Department.","authors":"Farhad Heydari,&nbsp;Mohammad-Hosein Maghami,&nbsp;Mehrdad Esmailian,&nbsp;Majid Zamani","doi":"10.22114/AJEM.v0i0.37","DOIUrl":"10.22114/AJEM.v0i0.37","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of triage in the standard Clinical Practice Guide (CPG) for multiple trauma patients is to perform the primary and secondary evaluations in the quickest and shortest possible time with minimal errors and the best quality in the emergency department (ED).</p><p><strong>Objective: </strong>In this study, a practical program for a coordinated management of multiple trauma patients in the ED has been provided by using the CPG guide. The impact of its implementation on the multiple trauma patients' management was evaluated.</p><p><strong>Methods: </strong>This is a cross-sectional study conducted in 2014 and 2015 in Isfahan's Al-Zahra hospital ED. Administration and management of multiple trauma patients had been prepared before the implementation of the plan based on standard clinical methods of implementation in a way that used a 12-step protocol for the practical guide. This protocol was designed as a flowchart and the results before and after its implementation were evaluated.</p><p><strong>Results: </strong>In this study, 100 multiple trauma patients before and after the implementation of the protocol were studied. The mean age of the patients and other baseline characteristics of studied patients in the two periods before and after implantation of the CPG were not significantly different (p > 0.05). The frequency of intubation (p = 0.016) and sent to the operating room (p < 0.001) were different in the two study periods. However, hospitalization in the ICU (p = 0.35) and death (p = 0.73) before and after implementation of the protocol were not statistically different. The time before examination by the EM physicians was significantly lower in all triage levels after CPG implementation. Meanwhile, no change in time elapsed occurred for the surgeons except for the patients in level 2 of triage.</p><p><strong>Conclusion: </strong>Implementation of the strategic plan of CPG lead to a significant reduction in waiting time for visits by emergency medicine services and other specialized services, increased the deployment of patients needing surgery, and reducing the time spent in the ED.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 1","pages":"e5"},"PeriodicalIF":0.0,"publicationDate":"2017-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0e/1c/AJEM-2-e5.PMC6548104.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37308094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasonography in Emergency Department; a Diagnostic Tool for Better Examination and Decision-Making.","authors":"Ali Abdolrazaghnejad,&nbsp;Mohsen Banaie,&nbsp;Mohammad Safdari","doi":"10.22114/AJEM.v0i0.40","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.40","url":null,"abstract":"<p><strong>Context: </strong>The aim of this study is to evaluate the applications of ultrasonography (US) as a diagnostic tool in emergency settings.</p><p><strong>Evidence acquisition: </strong>In the present review article, search engines and scientific databases of Google Scholar, Science Direct, PubMed, Medline, Scopus, and Cochrane were searched for the applications of US in emergencies. Finally, related articles which were published between 2000 and 2017, were selected and by reviewing them an attempt was made to evaluate various applications of US for examining and facilitating decision-making in emergency department (ED).</p><p><strong>Results: </strong>As a diagnostic tool, US can be of diagnostic help in emergency settings for the specialists and the treatment team regarding trauma, measuring intracranial pressure (ICP), hemothorax pneumothorax, abscess and its drainage, deep vein thrombosis (DVT), dyspnea, acute abdomen, appendicitis and biliary problems, renal colic and renal stones, shock, foreign object, bone fracture, peripheral nerve block, establishing central and peripheral venous access, lumbar puncture (LP), and confirmation of nasogastric tube (NGT) and endotracheal tube (ETT) placement.</p><p><strong>Conclusion: </strong>The results of this review study showed that US can be of help to EMPs as a diagnostic tool in a wide range of diseases and clinical conditions, which in turn can result in a decrease in the time needed for diagnosis and treatment, and therefore improve both the quality and quantity of the service provided in ED.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 1","pages":"e7"},"PeriodicalIF":0.0,"publicationDate":"2017-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/bb/AJEM-2-e7.PMC6548109.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37308096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Patients with Chest Pain Benefit from Installing Triage System in Emergency Department?","authors":"Seyedhossein Seyedhosseini-Davarani,&nbsp;Hossein Asle-Soleimani,&nbsp;Hooman Hossein-Nejed,&nbsp;Reza Jafarbaghdadi","doi":"10.22114/AJEM.v0i0.33","DOIUrl":"10.22114/AJEM.v0i0.33","url":null,"abstract":"<p><strong>Introduction: </strong>Chest pain, which can be cardiac or non-cardiac and either benign or life-threatening, needs appropriate diagnosis and treatment in emergency department (ED).</p><p><strong>Objective: </strong>The aim of this study was to compare delivery time of primary care for patients with chest pain before and after applying triage system in ED.</p><p><strong>Methods: </strong>Medical records were reviewed of thirty patients (group one) with chief complaint of chest pain who referred to ED between April and July 2008 (before installing triage system) and thirty-five patients (group two) with the same chief complaint who referred between August and September 2009 (after installing triage system). Time between patients' arrival and beginning of diagnostic and therapeutic interventions including cardiac monitoring, first physician visit time, intravenous line insertion, and electrocardiogram performance were compared between the two groups.</p><p><strong>Results: </strong>Based on the findings, the mean age and sex ratio of studied patients in the two groups were not significantly different (p>0.05). Door to ECG performance, Door to intravenous line insertion, and Door to cardiac monitoring were significantly shorter in post triage installing period than previously (p<0.001). Door to first visit by physician was not statistically different in the two study periods (p=0.421).</p><p><strong>Conclusion: </strong>It is likely that patients with chest pain who referred to ED benefit from installing triage system in terms of performing some nursing care including ECG performance, starting cardiac monitoring, and IV insertion.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 1","pages":"e8"},"PeriodicalIF":0.0,"publicationDate":"2017-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/de/bb/AJEM-2-e8.PMC6548102.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37308097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain Relieving Effect of Sublingual Glycerol Trinitrate in Renal Colic: a Randomized Placebo-Controlled Trial.","authors":"Leyla Nasehi,&nbsp;Reza Taslimi,&nbsp;Ahmadreza Dehpour,&nbsp;Javad Seyedhosseini","doi":"10.22114/AJEM.v0i0.3","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.3","url":null,"abstract":"<p><strong>Introduction: </strong>Renal colic is caused by colicky spasms of ureters. As has been shown in previous experiments, glycerol trinitrate (TNG) can inhibit these muscular spasms.</p><p><strong>Objective: </strong>This study was performed to assess the pain relieving effect of TNG among patients referred due to renal colic pain to the emergency department (ED).</p><p><strong>Methods: </strong>This study is a randomized, placebo-controlled study on 60 patients with renal colic who were referred to the ED, who were diagnosed clinically to have renal colic, and their pain was more than 5 based on a visual analogue scale (VAS). The patient's pain was recorded at the moment of clinical diagnosis, and each one received one capsule, either 0.4 mg TNG or placebo, plus a 100 mg indomethacin suppository. The pain score was re-assessed after 5 and 30 min. The values were recorded and compared using SPSS-16 software.</p><p><strong>Results: </strong>Sixty patients with a mean age of 35.75 ± 11.99 years were enrolled (73.3% male). Patients in the two groups were matched for age (p = 0.290), sex (p = 0.559), and the presence of microscopic hematuria (p = 0.292). Pain relief from the start point until the end of the intervention was statistical different in all studied patients (p < 0.05); but the comparison between the two groups showed no significant difference in this regard (p = 0.440).</p><p><strong>Conclusion: </strong>It is likely that adding TNG to an indomethacin suppository had no significant effects on better pain management of patients referred with renal colic to the ED.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 1","pages":"e2"},"PeriodicalIF":0.0,"publicationDate":"2017-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.22114/AJEM.v0i0.3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37308091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Overcrowding Impact on the Quality of Care of Patients Presenting with Acute Stroke.","authors":"Mehdi Momeni,&nbsp;Elnaz Vahidi,&nbsp;Javad Seyedhosseini,&nbsp;Alemeh Jarchi,&nbsp;Zeinab Naderpour,&nbsp;Morteza Saeedi","doi":"10.22114/AJEM.v0i0.25","DOIUrl":"https://doi.org/10.22114/AJEM.v0i0.25","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency overcrowding is defined as when the amount of care required for patients overcomes the available amount. This can cause delays in delivering critical care in situations like stroke.</p><p><strong>Objective: </strong>The aim of this study was to assess the possible impact of emergency department (ED) crowding on the quality of care for acute stroke patients.</p><p><strong>Methods: </strong>In this cross-sectional prospective study, all patients with symptoms of acute stroke presenting to the ED of educational hospitals were enrolled. All patients were assessed and examined by the emergency medicine (EM) residents on shift and a questionnaire was filled out for them. The amount of time that passed from the first triage to performing the required interventions and delivering health services were recorded by the triage nurse. ED crowding was measured by the occupancy rate. Then, the correlation between all of the variables and ED crowding level were calculated.</p><p><strong>Results: </strong>The average daily bed occupancy rate was 184.9 ± 54.3%. The median time passed from the first triage to performing the interventions were as follows: the first EM resident visit after 34 min, the first neurologic visit after 138 min, head CT after 134 min, ECG after 104 min and ASA administration after 210 min. There was no statistically significant relationship between the ED occupancy rate and the time elapsed before different required health services in the management of stroke patients either throughout an entire day or during each 8-hour interval (p > 0.05).</p><p><strong>Conclusion: </strong>In the current study, the ED occupancy rate was not significantly correlated with the time frame associated with management of admitted acute stroke patients.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"2 1","pages":"e3"},"PeriodicalIF":0.0,"publicationDate":"2017-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6f/db/AJEM-2-e3.PMC6548098.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37308092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}