Advanced Journal of Emergency Medicine最新文献

{"title":"Bidirectional Ventricular Tachycardia in a Women with Dilated Cardiomyopathy: A Case Report.","authors":"Dalton Argean Norwood,&nbsp;Lucia Belem Dominguez,&nbsp;Ricardo Leonel Dominguez,&nbsp;Walter Tyler Winders","doi":"10.22114/ajem.v0i0.287","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.287","url":null,"abstract":"<p><strong>Introduction: </strong>Bidirectional ventricular tachycardia (BVT) is a rare arrhythmia characterized by QRS complexes with an axis in the frontal plane alternating polarity in the precordial leads and right bundle branch block (RBBB) morphology. To the best of our knowledge, there is no previous report in dilated cardiomyopathy or in the context of a probable peripartum cardiomyopathy.</p><p><strong>Case presentation: </strong>A 26-year-old, 9-month female patient, with no significant past medical history (the patient denies medication intake, herbs like aconite, trouble during delivery, any heart issues or family history of sudden death or cardiomyopathies) who presents to the emergency room due to 11 days of dyspnea, exacerbated by daily activities, orthopnea, and paroxysmal nocturnal dyspnea. She presented with ventricular bigeminy and systolic dysfunction with left ventricular ejection fraction (LVEF) <20%. The patient later developed a stable ventricular tachycardia (VT) treated with amiodarone, which resulted in hemodynamic instability and BVT rhythm with VT paroxysms. Without the possibility of ablation, the use of high dose beta blockers and an implantable cardioverter defibrillator resulted in the same rhythm with a lower heart rate, better NYHA functional class, and less episodes of VTs.</p><p><strong>Conclusion: </strong>BVT is a rare type of tachycardia that can be present in dilated cardiomyopathy. In the absence of ablation capabilities, decreasing the heart rate with beta-blockers may reduce the rate of paroxysmal VTs.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"4 1","pages":"e12"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/7c/AJEM-4-e12.PMC6955033.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37544874","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":"Accuracy of Ultrasonography in Diagnosis of Shoulder Dislocation: A Systematic Review.","authors":"Pouya Entezari,&nbsp;Mohammad Jalili,&nbsp;Javad Seyedhosseini,&nbsp;Amin Doosti-Irani,&nbsp;Hadi Mirfazaelian","doi":"10.22114/ajem.v0i0.285","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.285","url":null,"abstract":"<p><strong>Context: </strong>This systematic review of clinical trials was conducted to compare the diagnostic accuracy of ultrasound in comparison to plain radiography in shoulder dislocation.</p><p><strong>Evidence acquisition: </strong>MEDLINE, Cochrane Database of Systematic Reviews, clinicaltrials.gov, Google scholar, and Scopus were searched for clinical trials. Diagnosis of shoulder dislocation and confirmation of shoulder reduction were the outcomes of interest. Sensitivity, specificity, positive predictive value and negative predictive value of included clinical trials were calculated.</p><p><strong>Results: </strong>Seven studies met our inclusion criteria and were analyzed. All included studies except two had a sensitivity and specificity of 100% for ultrasound (one with a sensitivity of 54% and one with a specificity of 60%).</p><p><strong>Conclusion: </strong>It can be suggested that ultrasound can be used as a reliable alternative diagnostic method for detection of both dislocation and reduction in shoulder joint. This may decrease the delay in treatment, cost, radiation exposure, and need for repeated sedation.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"4 1","pages":"e9"},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d7/3c/AJEM-4-e9.PMC6955034.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37544871","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":"Animal Injuries; a Case Series of Bull Induced Injuries in India.","authors":"Sushma Vijaykumar Shriyan,&nbsp;Utsav Anand Mani,&nbsp;Firdaus B Bhot,&nbsp;Elizabeth C Sada,&nbsp;Rajesh Ursekar,&nbsp;Digvijay Adake","doi":"10.22114/ajem.v0i0.244","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.244","url":null,"abstract":"<p><strong>Introduction: </strong>Bull injuries are common in India. An injury by a bull is more common in rural and agriculture dependent regions of the country. The incident causing injury by a bull can be sports related or work related. Work related injuries are almost mostly seen in farmers.</p><p><strong>Case presentation: </strong>We would like to present six cases of bull injury over a period of three years who reported to our EM. All six patients were admitted. Five out of six patients survived the hospital stay.</p><p><strong>Conclusion: </strong>Trauma sustained due to being hit by a large animal should be treated akin to a high velocity trauma and such a patient definitely warrants a period of observation even if the injuries are not life threatening. A high index of suspicion is needed for suspecting occult injuries. Fluid resuscitation and age of the patient are important considerations.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"4 1","pages":"e5"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/b8/AJEM-4-e5.PMC6955030.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37542905","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 Review on the Etiology and Management of Pediatric Traumatic Spinal Cord Injuries.","authors":"Amira Benmelouka, Laila Salah Shamseldin, Anas Zakarya Nourelden, Ahmed Negida","doi":"10.22114/ajem.v0i0.256","DOIUrl":"10.22114/ajem.v0i0.256","url":null,"abstract":"<p><strong>Context: </strong>Pediatric traumatic spinal cord injury (SCI) is an uncommon presentation in the emergency department. Severe injuries are associated with devastating outcomes and complications, resulting in high costs to both the society and the economic system.</p><p><strong>Evidence acquisition: </strong>The data on pediatric traumatic spinal cord injuries has been narratively reviewed.</p><p><strong>Results: </strong>Pediatric SCI is a life-threatening emergency leading to serious outcomes and high mortality in children if not managed promptly. Pediatric SCI can impose many challenges to neurosurgeons and caregivers because of the lack of large studies with high evidence level and specific guidelines in terms of diagnosis, initial management and of in-hospital treatment options. Several novel potential treatment options for SCI have been developed and are currently under investigation. However, research studies into this field have been limited by the ethical and methodological challenges.</p><p><strong>Conclusion: </strong>Future research is needed to investigate the safety and efficacy of the recent uprising neurodegenerative techniques in SCI population. Owing to the current limitations, there is a need to develop novel trial methodologies that can overcome the current methodological and ethical limitations.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"4 2","pages":"e28"},"PeriodicalIF":0.0,"publicationDate":"2019-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/bd/AJEM-4-e28.PMC7163256.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37861364","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 Quality of the Maternity Triage Process: a Qualitative Study.","authors":"Farzaneh Rashidi-Fakari,&nbsp;Masoumeh Simbar,&nbsp;Saeed Safari,&nbsp;Shahrzad Zadeh-Modares,&nbsp;Hamid Alavi-Majd","doi":"10.22114/ajem.v0i0.242","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.242","url":null,"abstract":"<p><strong>Introduction: </strong>There is no consensus on what the bases and criteria are for the dynamic process of maternity triage. Properly performing the maternity triage process requires reliable data to ensure the correct implementation of this process and the identification of existing deficiencies, and find strategies to modify, improve and enhance the quality of this process.</p><p><strong>Objective: </strong>The present study was conducted to explain the quality of the maternity triage process.</p><p><strong>Methods: </strong>The present qualitative study performed a directed content analysis on 19 maternity triage service providers and key informants selected through purposive sampling. The data were collected through semi-structured interviews in 2018 and analyzed using directed content analysis based on the Donabedian's model. The accuracy and rigor of the qualitative data were then investigated and confirmed.</p><p><strong>Results: </strong>The participants identified the most important factors affecting the quality of the services provided in maternity triage as two categories of measures and care, and interactions and communication. The category of measures and care included two subcategories of examinations and obtaining a medical history.</p><p><strong>Conclusion: </strong>The present study comprehensively identified different dimensions of the quality of maternity triage services at different levels. The participants identified the quality of the maternity triage process as a multi-dimensional and important concept. Different dimensions of the maternity triage process are recommended that be addressed when designing and implementing maternity triage guidelines and instructions so as to maintain the quality of this process and satisfy their needs.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"4 1","pages":"e6"},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/8b/AJEM-4-e6.PMC6955035.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37542906","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":"Silymarin as a Promising Potential Therapeutic Agent for Treatment of Patients with Paraquat Poisoning: An Issue that Merits Further Research.","authors":"Zakaria Zakariaei","doi":"10.22114/ajem.v0i0.266","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.266","url":null,"abstract":"","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"4 2","pages":"e16"},"PeriodicalIF":0.0,"publicationDate":"2019-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/8a/AJEM-4-e16.PMC7163272.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37862984","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":"Jellyfish Stings Rarely Induced Infectious Cellulitis: First Aid Remedies as Double-Edged Sword.","authors":"Minoosh Shabani,&nbsp;Ali Saffaei,&nbsp;Mohammadali Asghari,&nbsp;Zahra Sahraei","doi":"10.22114/ajem.v0i0.260","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.260","url":null,"abstract":"A 27-year-old woman was presented with a burning like lesion. The skin lesion was developed after a jellyfish stings (Rhizostomae) while she was swimming in Pattaya Sea in Thailand, five days prior to her presentation. Instantly after jellyfish stings, she was taken into the ship for rescue operations. The ship personnel applied lemon juice and baking soda to the injured area believing that this remedy is efficient in this situation. The next day, she referred to a local hospital at Pattaya because she was suffering from a horrible pain in her arm and then she was discharged on oral Dicloxacillin and topical Hydrocortisone. The edema was extended the next days which intensified her pain. At this time, she was transferred to Loghman Hakim Hospital, Tehran, Iran. At admission, erythematous edematous patch with centrally grouped vesicles on the left arm was observed (Figure 1). The patient had a high-grade fever (38.1 °C) and was agitated due to her intolerable pain. Other vital signs were normal. In the sonography imaging, soft tissue edema was seen without any collection. According to the clinical and imaging findings, the diagnosis of soft tissue cellulitis due to jellyfish stings was made. The patient admitted to infections ward and intravenous antibiotics including Cefazolin at dose of 2000 mg every eight hours and Vancomycin at dose of 1000 mg every 12 hours initiated. After five days of hospitalization, the patient was recovered from left arm edema. Also, her pain decreased gradually and no obvious erythema was seen. The patient was finally discharged with a satisfactory clinical response","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"4 2","pages":"e33"},"PeriodicalIF":0.0,"publicationDate":"2019-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/69/40/AJEM-4-e33.PMC7163266.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37861368","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":"Electrical Storm in the Absence of a Structural Heart Disease in a Young Girl.","authors":"Suhas Rao,&nbsp;Anoop T Chakrapani,&nbsp;Ashok Kumar Uppiretla,&nbsp;Donnel Don Bosco","doi":"10.22114/ajem.v0i0.221","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.221","url":null,"abstract":"A 14-year-old girl presented to the emergency department (ED) with a history of three episodes of seizure-like activity and no comorbidities at 2 am. The first episode had occurred at 6 am, the second at 12 pm and the third two hours before presenting to the ED. Each episode lasting less than 5 minutes, was associated with the limb and spinal rigidity and extension, the up-rolling of eyeballs and urinary incontinence. The patient reported no history of fever, recent trauma, previous febrile seizures, prodromal symptoms, tongue bite, headache or physical excretion before the episodes. No postictal confusion or tonic-clonic movements and significant family history were also reported. The initial examination found her to be conscious, oriented and hemodynamically stable, and the results of her systemic examinations were normal without any significant positive findings. \u0000Evaluation of the patient initiated with the provisional diagnosis of new-onset seizures, followed by performing a computed tomography (CT) scan of the head, which was normal and ruled out any intra-cranial pathology. The results of the blood test involving serum electrolytes, calcium and magnesium were also normal. \u0000Abrupt polymorphic ventricular tachycardia (VT) was identified on the monitor (figure 1) as a few second-episodes of posturing and stretching of the body with no peripheral and central pulses during the examination in the ED. The patient came around after undergoing cardiopulmonary resuscitation immediately followed by defibrillation at 200 J and reverting the rhythm to sinus. The patient had recurrent episodes of pulseless polymorphic VT, which required ten times of defibrillation for one hour and antiarrhythmic drug therapy with IV bolus of 300 mg and then again 150 mg amidaraone, and then infusion of 1 mg of magnesium sulfate diluted in 10 ml of D5W and also administration of 1 mg/kg of lidocaine. \u0000The patient was electively intubated and ventilated under deep sedation, and transferred to the cardiac care unit (CCU). The two-dimensional echocardiography findings were revealed normal-sized heart chambers and good left ventricular function. Blood levels of high-sensitivity troponin I and CK-MB were also in their normal range. Despite performing repeated defibrillation and anti-arrhythmic therapy, the patient showed repeated episodes of pulseless VT. She was therefore referred to a higher-level center to be administered with left stellate ganglion block (LSGB). She withstood the procedure, and discharged from the hospital after a ten-day follow-up. An implantable cardioverter-defibrillator (ICD) was later planned for the patient, and she continued with taking oral antiarrhythmic drugs.","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"4 1","pages":"e14"},"PeriodicalIF":0.0,"publicationDate":"2019-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/70/AJEM-4-e14.PMC6955023.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37544876","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 Case Report of a Huge Mesenteric Cyst in a 5-Year-Old Girl: A Rare and Challenging Finding in Radiological Assessment.","authors":"Ahmad Rezaee-Azandaryani,&nbsp;Manouchehr Ghorbanpour,&nbsp;Mehrdad Taghipour,&nbsp;Ali Yamini","doi":"10.22114/ajem.v0i0.201","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.201","url":null,"abstract":"Introduction: Mesenteric cysts are rare benign intra-abdominal vesicles with various clinical presentations. They almost located in the mesentery of the small intestine. The selective therapeutic method is complete surgical excision, however more than half need resection and bowel anastomosis. Case presentation: Here, we presented a 5-year-old girl with a huge mesenteric cyst (15×14cm2) mesenteric cyst that was excised surgically., which the diagnosis confirmed by computed tomography scan and managed through surgical excision. Conclusion: Acute abdominal pain may be due to the presence of mesenteric cysts, but it is not always possible to differentiate and diagnose it preoperatively, and this challenge especially exists in the case of bulky masses. it is recommended to choose primary radical, surgical treatment in case of intra-abdominal cystic mass in the pediatric age.","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"4 2","pages":"e31"},"PeriodicalIF":0.0,"publicationDate":"2019-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/23/50/AJEM-4-e31.PMC7163255.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37861366","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 21-year-old Pregnant Trauma Patient with Asymptomatic Fat Embolism; a Case Report.","authors":"Niloofar Ayoobi-Yazdi,&nbsp;Faeze Salahshour,&nbsp;Mehran Arab-Ahmadi,&nbsp;Samira Hemati,&nbsp;Mohammad Amiri","doi":"10.22114/ajem.v0i0.254","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.254","url":null,"abstract":"<p><strong>Introduction: </strong>Fat embolism syndrome (FES) is most often associated with orthopedic trauma that typically presents 24-72 hours after the trauma with a classic triad. Only few cases of fat embolism due to lower extremity venous system had been reported.</p><p><strong>Case presentation: </strong>The current case report presents a pregnant woman who was referred to our emergency department with bilateral femoral open fracture. After detecting fetal demise by abdominopelvic ultrasound, an area of fat density in right external iliac vein was detected in abdominopelvic contrast enhanced computed tomography (CT) scan which was considered as the probable diagnosis of fat embolism. While the patient did not show signs and symptoms of FES, the fat embolism was confirmed in further evaluations.</p><p><strong>Conclusion: </strong>In summary, although detection of fat embolus in CT scan in the emergency department is very rare, evaluation of lower extremity venous system in a posttraumatic patient seems to be crucial because early diagnosis of fat embolism can help the clinicians to prevent FES.</p>","PeriodicalId":7290,"journal":{"name":"Advanced Journal of Emergency Medicine","volume":"4 2","pages":"e32"},"PeriodicalIF":0.0,"publicationDate":"2019-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/50/21/AJEM-4-e32.PMC7163263.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37861367","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}