Advanced journal of emergency medicine最新文献

{"title":"An 85-year-old Woman with Altered Mental Status and Hypotension","authors":"Mehran Sotoodehnia, A. Abdollahi, Maryam Khodayar","doi":"10.22114/ajem.v0i0.144","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.144","url":null,"abstract":"An 85-year-old female patient was brought to emergency department (ED) from a nursing home with altered mental status (GCS: 12/15) and hypotension (90/60 mmHg). Bilateral fine crackles in lungs and severe cachexia were obvious in her physical examination. The ECG showed only sinus tachycardia. Several attempts at peripheral vein cannulation failed due to poor visualization of severely atrophied and contracted subcutaneous veins. Therefore, on two attempts, a central venous catheter (CVC) was inserted into the right internal jugular vein (IJV) using the Seldinger technique. After securing and taping the central line, fluid infusion started with no difficulty and a portable chest x-ray was ordered.","PeriodicalId":94293,"journal":{"name":"Advanced journal of emergency medicine","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74940543","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":"Reteplase versus Streptokinase in Management of ST-segment Elevation Myocardial Infarction; a Letter to the Editor","authors":"","doi":"10.22114/ajem.v0i0.143","DOIUrl":"https://doi.org/10.22114/ajem.v0i0.143","url":null,"abstract":"Although the ideal treatment route for management of patients with ST-segment elevation myocardial infarction (STEMI) is rapid diagnosis and direct transfer to the catheterization unit and undergoing primary angioplasty, using thrombolytic still has its place in cases that the equipment are not available or there is not enough time for performing angioplasty. Of course these drugs are associated with specific side effects such as probability of gastrointestinal (GI) and cerebral bleeding, allergic reactions and etc. Therefore, finding drugs with fewer side effects and limitations for use has always been interesting in this regard. The drug which has been used all around the world since 1970 and is also traditionally used in Iran for managing patients with STEMI is streptokinase. This drug is a protein extracted from beta hemolytic streptococci, which combines with plasminogen and facilitates transformation of plasminogen to plasmin. However, recently fibrin specific drugs or recombinant tissue plasminogen activators (rtPA) such as alteplase, urokinase, tenecteplase, reteplase and etc. have become available to emergency medicine physicians and cardiologists. Having longer half-lives, fewer side effects, and easier method of use, these drugs have opened a new door for physicians regarding use of thrombolytic drugs in treatment of STEMI and brain stroke. Studies regarding comparison of safety and effectiveness of these drugs are ongoing. In a systematic review and meta-analysis, Tourani et al. showed that the safety and effectiveness of streptokinase and tenecteplase were in the same level. Reteplase is an rtPA peptide, which converts endogenous plasminogen to plasmin. Plasmin causes destruction of the fibrin present in the clot and the clot disappears. In a prospective case-control study in Amiralmomenin Hospital, Tehran, Iran, we divided 152 patients with STEMI and the mean age of 56.41 ± 10.40 (27 – 85) years who were candidates for receiving thrombolytic therapy into 2 groups receiving either streptokinase (from CSL Behring GmbH Co, Germany) or reteplase (from Reliance Life Sciences Co, India) (83.6% male). Then we compared outcomes such as GI bleeding, mortality, hypotension, arrhythmia, and etc. between the 2 groups. The 2 groups were in a similar condition regarding sex (p = 0.331) and age distribution (p = 0.393), blood pressure on admission (p = 0.378), and the rate of positive troponin on admission (p = 0.113). Overall, 61 (40.1%) patients showed at least one of the outcomes that we studied (13 cases in the streptokinase group and 48 cases in the reteplase group; p < 0.0001). In this study, all 20 cases of GI bleeding observed following thrombolytic prescription were in the reteplase group. Additionally, out of the 19 cases of death observed, 14 were in reteplase group and 5 had received streptokinase. One case of arrhythmia and 2 cases of hypotension were seen in streptokinase group. Based on the findings of this study, it seems that desp","PeriodicalId":94293,"journal":{"name":"Advanced journal of emergency medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80713341","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":"Effect of Educational Intervention on Nurses’ Attitude, Intention and Behaviour Towards Family-Centered Care in Pediatric Wards in Iran: A Randomized Control Trial Utilizing Prospect Theory","authors":"F. Rostami","doi":"10.18686/AEM.V8I1.144","DOIUrl":"https://doi.org/10.18686/AEM.V8I1.144","url":null,"abstract":"Background: The concept, family-centered care (FCC), is used to describe the way families are involved in the health care of hospitalized children. In developing countries, most paediatric wards claim to be ‘family-centered’, which means that the wards adopt a philosophy where parents are acknowledged as being central to their children’s existence. Despite substantial investments in researchers, dissemination and advocacy, huge gap exist between what is known about effective health services and what is done in real world practice. There is no common agreement between health care workers on provision of FCC in Iran. Objectives: To identify the effect of educational intervention on Family-Centered Care model on attitude, intention and behaviour of pediatric nurses. Methods: Participants were randomly assigned to complete a questionnaire assessing paediatric nurses’ attitude towards providing FCC in Iran. Results: There is no significant relationship between socio-demographic characteristics and attitude towards provision of FCC for both intervention and control groups (p>0.05). The mean of behaviour in the intervention group (1.57 unit) increased and difference among pre- and post-tests in behaviour score in the intervention group was significant (P<0.05). Conclusion: The findings have important theoretical implication as theory of planned behaviour verified that nurses’ behaviours changed after educational intervention.","PeriodicalId":94293,"journal":{"name":"Advanced journal of emergency medicine","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90024722","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 Looming Success in Cancer Vaccination","authors":"S. Rahman","doi":"10.18686/AEM.V8.137","DOIUrl":"https://doi.org/10.18686/AEM.V8.137","url":null,"abstract":"Cancer vaccination projects are on trial worldwide and the results are far-off being a remarkable success. Albeit, thousands of clinical trials are taking place, only a several of those are producing a significant result to increase the survival rate of the patients. Four vaccines (Human papillomavirus - HPV vaccines, Hepatitis B virus - HBV vaccines, Sipuleucel-T and Oncophage) are approved for market in the United States and Russia so far. Most of the prototype vaccines are yielding at phase III clinical trials after being successful at phase I and II. Apparently, new visions and approaches are required to guide these projects to harvest better results.","PeriodicalId":94293,"journal":{"name":"Advanced journal of emergency medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73716793","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}