Advanced Journal of Emergency medicine
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Predictors of In-hospital Mortality after Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction
Get PDFIntroduction: Treatment of myocardial infarction (MI) has been successfully developed, especially after introducing primary percutaneous coronary intervention (PPCI) as it nowadays is the recommended treatment for ST-segment elevation myocardial infarction (STEMI). Objective: This study aimed to evaluate the in-hospital mortality of STEMI patients treated with PPCI according to gender and other likely risk factors. Methods: This cross-sectional study presents a part of the results of a single-center registry in Imam Ali cardiovascular center affiliated to Kermanshah University of medical science (KUMS). From June 2016 to December 2017, 731 consecutive patients undergoing PPCI registered. Data were collected using a case report form developed by European Observational Registry Program (EORP). The relationship between in-hospital mortality and predicting variables was assessed using the Chi-square test, t-test, and univariate and multivariate logistic regression models (Forward LR). Results: Totally, 155 patients (approximately 21%) were female. The mean age of women and men was 65.2 and 57.5, respectively (p=0.001). There were differences between women and men in hypertension (58.1% vs. 30.4%, respectively, p=0.001), diabetes mellitus (26.5% vs. 14.9%; p=0.001), hypercholesterolemia (37.4% vs. 18.6%; p=0.001), and history of prior congestive heart failure (5.2% vs. 2.0%; p=0.016). Although more men were current smokers (58.7% (men) vs. 15.5% (women); p=0.001). Women had a significantly greater incidence of multi-vessel disease, thrombolysis in myocardial infarction (TIMI) flow grade of 0/1 before PPCI, and longer symptom-to-balloon time. In-hospital mortality was higher in women than in men (5.2% vs. 1.9%; p=0.024). Multivariate analysis identified age ≥ 60 years, Killip class≥ II, and post-procedural TIMI flow grade < 3, but not female sex, as independent predictors of in-hospital mortality. Conclusion: In-hospital mortality after PPCI in women was higher than men, though this difference was likely due to the severe clinical profile in women. Also, female gender was not identified as an independent predictor of death
Changes in End-Tidal Carbon Dioxide (ETCO2) vs. Changes in Central Venous Oxygen Saturation (ScvO2) and Lactate Clearance as a Quantitative Goal Parameter in Treatment of Suspected Septic Shock Patients
Get PDFIntroduction: Physiologic indexes for therapeutic assessment of shock were introduced long time ago. Recent studies have evaluated central venous pressure (CVP), central venous oxygen saturation (ScvO2), lactate and end-tidal carbon dioxide (ETCO2) levels in this regard. Objective: To understand the potential diagnostic capability of ETCO2 in comparison with ScvO2, CVP and lactate in patients with suspected septic shock, we aimed to compare these parameters through a quantitative resuscitation treatment approach. Methods: In this cross-sectional study, 84 patients with suspected septic shock were selected randomly. All patients underwent quantitative resuscitation treatment approach. The following parameters were measured and recorded at baseline: ETCO2, CVP, ScvO2, mean arterial pressure (MAP), percentage of arterial oxygen saturation (SatO2), blood lactate levels, heart rate (HR), respiratory rate (RR), and the exact amount of urine output. At the time of treatment, and 3 hours and 6 hours after, all of the tests and measurements were re-implemented and registered by an emergency medicine specialist. Results: There was a significant positive correlation between ETCO2 and ScvO2 at all times (baseline: r=0.566, p<0.001; after 3 hours: r=0.409, p<0.001; after 6 hours: r=0.170, p>0.05). Furthermore, there was a significant inverse correlation between ETCO2 and lactate at all times (baseline: r= -0.538, after 3 hours: r= -0.677, after 6 hours: r= -0.799). There was no significant correlation between ETCO2 and CVP at any time (p>0.05). Conclusions: All parameters significantly changed over time, and the correlation between changes in ETCo2, ScvO2 and lactate clearance was significant
Consider the Options; Can Decontamination and Reuse be the Answer to N95 Respirator Shortage in COVID-19 Pandemic?
Get PDFHealth care workers (HCWs) are heavily involved in the fight against COVID-19 in all over the world. They have the vital role of treating patients and searching for the proper treatment for the disease, while supporting and protecting their families. It is imperative that the systems should try hard to keep them safe and healthy. World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) have recently published guidelines for keeping HCWs safe and protected. The Personal Protective Equipment (PPE) is the cornerstone of recommendations and contains face mask (air purifying respirator), goggles or face shield, gown, and gloves. There is no doubt that a proper mask (e.g. N95) is the most important element of the protective gear when it comes to transmission of COVID-19
Coronavirus Disease (COVID-19): 10 Questions and Discussion Points for Diabetes and COVID-19
Get PDFThe COVID-19 pandemic is now an international concern. COVID-19 is first reported in Wuhan, China on 31 December 2019 and affects different people in different ways. Evidence suggests that people with underlying disease are at higher risk for more severe disease. People with diabetes are not only more likely than the general population to have COVID-19 but also they are among those high-risk categories that can have serious illness if they get the virus
Epidemiology of Fatal Injuries among Patients Admitted at Sina Hospital, the National Trauma Registry of Iran, 2016-2019
No full textIntroduction: Injuries cause high rates of mortality and harm to millions of people annually. Objective: The aims of this study were to assess some characteristics of hospitalized trauma patients and determine the variables which were associated with increased rates of mortality. Methods: Data were extracted from the National Trauma Registry of Iran (NTRI) data bank. Among all trauma patients admitted to Sina Hospital, those who had one of the following were registered in the NTRI: hospitalization for more than 24 hours, death less than 24 hours in the hospital, and transferring from the intensive care unit (ICU) of another hospital. Recorded data relating to the interval between 24 July 2016 and 10 October 2019 were analyzed. Results: A total number of 3430 patients were studied, of whom 78 (0.02%) did not survive. The mean age of survivors was 38.4 (±18.5) and it was 58.1 (±23.7) for non-survivors (p<0.001). The mean Glasgow coma scale (GCS) of survivors was 14.9 (±0.7) and it was 11.7 (±4.4) for non-survivors (p<0.001). The most important predictors of death were ICU admission (OR 4.31; 95% CI 1.65-11.26) and not having surgical operation (OR 6.08; 95% CI 2.30-16.03). The injuries with higher injury severity score (ISS) had higher risks of death (OR 1.20; 95% CI 1.06-1.36). Conclusions: In this study, Road Traffic Crashes (RTCs) were the main cause of injuries. The elder age, lower GCS score, ICU admission, higher ISS and not having surgical operation were the worst factors of death. More studies are needed to reveal other prognostic factors of fatal injuries
Comparing the Analgesic Effect of Aminophylline and Hyoscine with Morphine on Renal Colic: a Randomized Clinical Trial
Get PDFIntroduction: Although narcotics are effective for pain relief in these patients, they have little impact on the underlying cause. Therefore, surveys have been conducted to find more effective agents. Objective: This study conducted to compare the analgesic effect of aminophylline and hyoscine combination with morphine on renal colic patients. Methods: This double-blind clinical trial was conducted on patients with renal colic caused by urinary tract stones. Subjects were selected via convenience sampling method. Patients were randomly divided into two groups based on whether they received aminophylline + hyoscine or morphine. Before drug administration, one researcher was asked to measure the pain of the patients using Graduated Numbered Visual Analogue Scale (GN-VAS). Afterward, 20 mg of hyoscine along with 3 mg/kg of aminophylline in 100 cc normal saline was injected during 10 minutes into patients in the one group, whereas 0.1 mg/kg of morphine was intravenously with 100 cc normal saline to align two groups, administered to the subjects in another group. Half an hour after the administration of drugs, pain was measured for the second time. Vital signs and side effects were all recorded. Results: In this study, 95 patients (47 patients in the aminophylline+hyoscine group and 48 patients in the morphine group) remained in the trial until the end. The difference in sex distribution(p=0.227) and age(p=0.680) of the two groups was not statistically significant. Median of pain intensity was not significantly different between the two study groups (p<0.05), neither before nor after administration of the drugs. The mean time required for pain relief in morphine group was significantly lower than aminophylline+hyoscine group (5.9±1.6 vs. 11.1±1.6 minutes; p<0.001). Conclusion: Overall, our findings indicated that aminophylline + hyoscine combination was effective in reducing renal colic pain and there is no significant difference between this combination and morphine in terms of pain relief
MRI Findings in Children with the First Unprovoked Seizure Presenting to the Emergency Department; Does Developmental Delay Suggest the Importance of Brain MRI Evaluation?
Get PDFIntroduction: The first unprovoked seizure (FUS) in children is a convulsive seizure with an unknown cause, which may be due to an underlying neurological disease or a manifestation of epilepsy. Objective: The aim of this study was to evaluate the findings of brain magnetic resonance imaging (MRI) in pediatric patients with FUS, presenting to the emergency department (ED). Methods: In this cross-sectional study, all children with FUS (age: >1month and<14 years), who were referred to the ED of Qaem Hospital, Mashhad, Iran from 2016 to 2019, were investigated. Medical records, brain MRI findings, electroencephalography (EEG) results, and developmental status of children were reviewed retrospectively. Results: The brain MRI findings of 56 children with FUS were reviewed. The mean age of children was 3.92±6.05 years, and the sex distribution was equal. Seventeen (30.4%) patients had abnormal EEG findings, while 13 (23.2%) patients’ had non-specific EEG findings. Neurological examination of 4 (7.1%) children was abnormal. Overall, 6 (10.7%) patients had non-specific abnormal brain MRI findings for seizure, while 3 (5.4%) patients had specific abnormal findings. A significant relationship was observed between the developmental status of children and abnormal MRI findings (P=0.04). However, MRI findings had no significant relationship with EEG or neurological findings (P>0.05). Conclusion: It may be useful to perform brain MRI for children with FUS presenting to ED, especially those who are suspected of developmental disorders
A Rare Case of Sickle Cell Anemia Crisis Triggered by Plasmodium Falciparum Malaria
Get PDFMalaria is a common public health problem in Sub-Saharan African countries such as Niger and one child dies every two minutes due to this disease. Although the defense mechanism is not clear, sickle cells are 90% protective especially for Plasmodium falciparum malaria. In Niger, malaria is among the first to be considered in patients admitted to the emergency departments (EDs) with high fever. It is important for physicians to resolve the clinical manifestation in a patient who admits due to acute abdominal pain and high fever in a hospital with limited facilities. Failure to provide information about the patient’s history and admission to the ED alone led to a delay of diagnosis and treatment of this rare coexistence
Positive Perspectives of the Predicament of COVID-19
Get PDFAlthough crises such as pandemic can inflict cascading disasters on a health care system, they can provide opportunities for the emergence of new types of potential and their optimal use and manifesting the best kinds of altruism and philanthropy. The COVID-19 crisis will undoubtedly entail great costs that are both economically and emotionally irretrievable; nevertheless, the present study seeks to highlight the new opportunities that are provided during this disaster and the optimal utilization of all capacities to alleviate this seemingly-terrible condition. This paper presents a brief report of the first weeks of the COVID-19 crisis in Imam Khomeini Hospital Complex (IKHC) affiliated to Tehran University of Medical Sciences as the largest hospital in Iran with approximately 1200 active beds. In addition to lots of problems during the battle for maintaining the treatment quality in this crisis, a strategy was devised to mitigate the challenges. The positive perspectives during the fight with the predicament of COVID-19 in this hospital are detailed in the following nine domains
The Effects of the COVID-19 pandemic in the UK- at a Local, National and International level perspective from the Emergency Department
Get PDFContext: There is a significant burden on all emergency services in the management and prevention of the novel COVID-19 transmission. The effects are felt right across the World with certain geographical areas being most affected, it has affected all countries irrespective of their healthcare infrastructure. It has been suggested that certain parts of World that are prone to natural disasters are better prepared for pandemics. However, this is completely unfound as major economies are overwhelmed with the effects of the COVID-19 and it becomes completely irrelevant of any past experiences as these have been in never seen before scale. Evidence acquisition: The national fight against COVID-19 has been dubbed as the greatest fight for the National Health Service (NHS) with the entire United Kingdom under lockdown and the unfamiliar situation not seen before in peacetime. The general understanding of the disease process is that it has profound effects on the elderly and those with significant underlying health conditions such as cardiovascular, respiratory amongst others. However, it has surfaced from time to time that the very young are being affected and at times unfortunately been fatal. Results/Measures: The United Kingdom has been in a lockdown just like several nations across the globe in a desperate measure to limit the spread of the virus. There have been weeks of planning at every level for all possible eventualities with regards to the ongoing COVID-19 pandemic. All routine operations and procedures have been cancelled only procedures that emergency life and limb saving and cancer surgery continue to take place in hospitals all across the hospitals in the NHS. Widespread measures such as social distancing, calling a dedicated helpline for information and advice rather than attending the nearest Emergency Department have led to a significant number of presentations to the Emergency Department. Conclusions: The main concerns that remains for the NHS and other countries that have been affected is that once the lockdown restrictions are slowly eased will lead to a significant resurgence of cases that will overwhelm their respective healthcare infrastructures. From a clinician perspective, the main concern is the potential late presentations of the acutely unwell patients. This is the sentiment that is likely to be felt by many of my critical care colleagues working across NHS hospitals