Advanced Journal of Emergency medicine
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Traumatic Brain Injury in Older Adults Presenting to the Emergency Department: Epidemiology, Outcomes and Risk Factors Predicting the Prognosis
Get PDFIntroduction: The continuing-to-grow number of older adults with traumatic brain injury (TBI) presenting to emergency departments (EDs) and hospitals necessitates the investigation of TBI in these patients. Objective: The present study was conducted to investigate the epidemiology of TBI and the factors affecting intracranial lesions and patient outcomes in older adults. Method: The present retrospective cross-sectional study was performed between March 2016 and March 2018. The study population comprised all TBI patients with a minimum age of 60 years presenting to the ED. The eligible candidates consisted of patients presenting to the ED within 24 hours of the occurrence of traumas and requiring head CT scan as part of their examination. The patients’ baseline information was also recorded. Results: A total of 306 older adult patients with a mean age of 70.61±8.63 years, of whom 67.6% were male, underwent CT scan for TBI during the study period. Falls were the major cause of head injuries, and intracranial lesions were observed in 22.9% (n=70) of the patients. Subdural hematoma (SDH) was observed as the most prevalent injury in 27.6% of the patients, 22.9% (n=16) were transferred to the operating room, and 7.5% (n=23) died. Moreover, the severity of trauma was significantly different between the two genders (P=0.029). Midline shift, SDH, subarachnoid hemorrhage (SAH) and moderate-to-severe head injuries were also significantly associated with poor outcomes (p<0.05). Conclusion: Death from TBIs was more likely in the patients with SDH, SAH and midline shift or in those with an initial Glasgow coma scale (GCS) of below 13. These predictions are clinically relevant, and can help improve the management of older adults with TBI
Accuracy of Mean Platelet Volume (MPV) and Red Cell Distribution Width (RDW) for the Diagnosis of Acute Appendicitis: Evaluation of Possible New Biomarkers
Get PDFIntroduction: Acute appendicitis is the most common cause of the abdominal pain in surgery. Despite its significant prevalence, the diagnosis is associated with many problems in some cases, which leads to false appendectomy. Objective: The aim of this study was to determine the validity of diagnostic tests of mean platelet volume (MPV) and red cell distribution width (RDW), as a new possible tool in the diagnosis of acute appendicitis. Methods: In this study, all patients who referred to the emergency department of Besat Hospital, Hamadan, Iran, in 2015, with abdominal pain and first impression of acute appendicitis, undergone appendectomy, were evaluated. The diagnostic markers of pre-operative and post-operative pathology and the validity of MPV and RDW were determined in diagnosis of acute appendicitis. Results: Laboratory and clinical data from 438 patients, presenting the signs and symptoms of acute appendicitis with the mean age of 26.51±13.9 years, were examined (55.6% men). The sensitivity, specificity, positive and negative predictive value of MPV in the diagnosis of acute appendicitis were 59.77, 98.66, 99.5 and 34.26 percent, and for the RDW were 57.79, 56.00, 86.07 and 21.98 percent, respectively. The area under the receiver operating characteristic (ROC) curve for RDW and MPV was 0.61and 0.90, respectively. The mean of MPV in patients with normal pathologic outcome was 9.52±1.60 and in patients with acute appendicitis was 7.51±1.22. There was a significant difference between the mean MPV in both groups (p<0.001). The mean of RDW in patients with normal pathology were 13.42±1.97 and 13.05±1.09, in patients with acute appendicitis. There was a significant difference between the mean RDW of the two groups (p=0.009). Conclusion: MPV and RDW indexes have the potential to be used by the surgeons in diagnosis of acute and perforated appendicitis, especially in adults, in order to reduce unnecessary appendectomy, but MPV is more valid in screening acute appendicitis, compared to the RDW
Large Laryngeal Lipoma with Extra Laryngeal Component Mimics Mixed Form Laryngocele: A Case Report
Get PDFIntroduction: Lipomas are the most common benign neoplasms, occurring in any part of the body where fat is present. Their occurrence in the head and neck is not common. Here, we report a large laryngeal lipoma with extra laryngeal component, mimicking mixed form of laryngocele. Case presentation: A 47-year-old man presented with a 3-year history of hoarseness, intermittent dyspnea and mass sensation in the neck. The patient was submitted to indirect laryngoscopy; a large submucosal mass obliterating the left side of the supraglottic larynx and partially obstructing the airway was found. Enhanced computed tomography (CT) scan demonstrated non-enhancing homogeneous hypodense fat density mass lesion measured 55*45*32 mm, extending through the thyroid membrane to parapharyngeal space and showing extra laryngeal component with an intact laryngeal mucosa lesion. Open surgery of the submucosal mass was performed. Pathology examination confirmed the diagnosis of lipoma. Conclusion: Neck lipomas are also typically asymptomatic, but can compress nearby structures, causing symptoms such as hoarseness, dyspnea and dysphagia. When symptomatic, they should be removed via surgery
Epidemiological Features of Injured Patients Examined by Tehran Emergency Medical Service Technicians
Get PDFIntroduction: Knowledge of epidemiological aspects can be a useful guide in determining the resources for better prevention and management of injuries. There are some performed studies on this topic in Iran, based on the limited hospital database. However, to the best of our knowledge, there is not any survey based on the pre-hospital database. Objective: The purpose of this study was to assess baseline characteristics of the traumatic patients according to the records of Tehran Emergency Medical Service (EMS) Center to present descriptive statistics of their epidemiological features. Method: This cross-sectional study was conducted retrospectively, using Tehran EMS center data registry. All traumatic patients examined by EMS in Tehran, Iran following call to emergency medical dispatcher were included. By reviewing the EMS technicians’ mission forms, required data were extracted. The mission form contains information such as age, sex, injured location, damage mechanism, accident location (home, workplace, street), time of call, the outcome of the patient's ambulance mission and the results of the assessment of the technician, etc. Results: Totally, 56612 injured cases with the mean age of 33.1±15.6 years were examined by EMS during one-year study period of whom 80.4% were male. Crude Incidence Rate was 10.5 and 2.5 per 1000 in male and female, respectively. Traffic accident and then fall were the two most prevalent mechanism of injuries. All types of injuries were significantly more prevalent in males (P<0.001). Most injuries were in winter season with 15570 cases (27.5%). Car accident was prevalent in winter and other injuries were significantly prevalent in spring (P<0.001). The most frequent places of injuries occurred on main roads and streets (55.7%). All of the road-related injuries was prevalent in winter, whereas injuries in other places were prevalent in spring (P<0.001). Most of the cases (78.3%) were transferred to the health centers, but 20.7% did not consent to treatment and transmission. Only 222 cases (0.4%) died, that 95% was due to traffic accident. there was a significant relationship between the number of injured organs and the death; So that the highest death rate occurred for those with more than 5 injured organs (P <0.001). Conclusion: Based on the findings, traffic accident was the most frequent cause of trauma that led to visiting a traumatic patient by an EMS technician in Tehran, Iran. Injuries in all age groups were more prevalent in males, and the involvement of 5 or more injured organ had a significant relationship with mortality
Chronic Back Pain Diagnosed as Giant Osteoid Osteoma of the Thoracic Vertebra: A Case Report
Get PDFIntroduction: Diagnosing an osteoid osteoma as a benign tumor can be challenging owing to its different presentation patterns, ambiguous radiological findings and unusual sites of involvement. The present case report involves a 30-year-old female patient with a large osteoid osteoma of the thoracic vertebrae as an uncommon site of its presentation. Case Presentation: The patient presented with a one-year history of progressive right-sided upper back and interscapular pains. She was identified as a candidate for surgery using the whole body bone scan and a multiple detector computed tomography (MDCT) scan. A large 25-mm osteoid osteoma of the lamina of the third thoracic vertebra (T3) was also diagnosed through histopathology. Conclusion: As a potential cause of persistent back pain in young adults, an osteoid osteoma may be easily missed by routine radiographs. The CT scan is an effective tool in the investigation of the size and location of this tumor. Surgical excision can also be used for treating spinal lesions
Animal Injuries; a Case Series of Bull Induced Injuries in India
Get PDFIntroduction: 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. Case presentation: 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. Conclusion: 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
Intranasal versus Intramuscular/Intravenous Naloxone for Pre-hospital Opioid Overdose: A Systematic Review and Meta-analysis
Get PDFContext: The present systematic review and meta-analysis aims to perform an extensive search in databases to compare the efficacy of the intranasal administration of naloxone with its intramuscular/intravenous administration in the pre-hospital management of opioid overdose. Evidence acquisition: This meta-analysis included controlled trials conducted on the efficacy of naloxone administration in the pre-hospital management of opioid overdose. A search was carried out in electronic databases on relevant articles published by the end of 2018. After data collection, analyses were performed in STATA 14.0 software and the efficacy and side-effects of the two administration routes of naloxone, i.e. intranasal and intramuscular/intravenous, were compared. An overall effect size with 95% confidence interval (95% CI) was provided for each section. Results: Eventually, data from six studies were included in this meta-analysis. The success rate of the intranasal and intramuscular/intravenous administration of naloxone in the management of opioid overdose in pre-hospital settings was 82.54% (95% CI: 57.97 to 97.89%) and 80.39% (95% CI: 57.38 to 96.04%), respectively. There was no difference between injectable (intramuscular/intravenous) naloxone and intranasal naloxone in the pre-hospital management of opioid overdose (Odds Ratio=1.01; 95% CI: 0.42 to 2.43; P=0.98). The onset of action of intranasal naloxone, however, was slightly longer than injectable naloxone (Standardized Mean Difference=0.63; 95% CI: 0.07 to 1.19; P=0.03). Additionally, the odds of needing a rescue dose was 2.17 times higher for intranasal naloxone than intramuscular/intravenous naloxone (OR=2.17; 95% CI: 1.53 to 3.09; P<0.0001). The prevalence of major side-effects was non-significant for both intranasal (0.00%) and intramuscular/intravenous (0.05%) routes of naloxone administration and there was no difference in the prevalence of major (OR=1.18; 95% CI: 0.38 to 3.69; P=0.777) and minor (OR=0.64; 95% CI: 0.17 to 2.34; P=0.497) side-effects between the two routes. Conclusion: The present meta-analysis demonstrated that intranasal naloxone is as effective as injectable naloxone in the pre-hospital management of opioid overdose complications. Consequently, intranasal naloxone may be an appropriate alternative to injectable naloxone
Efficacy of Half-length vs. Standard-sized Short Arm splint in Soft Tissue Injuries of the Hand and Wrist: a Randomized Controlled Trial
Get PDFIntroduction: Hand and wrist soft tissue injuries are common orthopedic problems that are traditionally treated with short arm splint, which covers the forearm to 1 cm distal to the elbow crease. Objective: The present study was conducted to compare the treatment efficacy of traditional standard-size splint with half-length short arm splint. Method: In this randomized, controlled, clinical trial, patients with hand and wrist soft tissue injuries were randomly assigned to two groups. Group one received standard-sized short arm splints and the other group received half-length short arm splints. The swelling and pain scores were compared between the groups by the end of weeks one, two and three. Results: A total of 256 patients with a mean age of 36.96 ± 12.27 years were enrolled in this study, and 71.9% of them were male. No statistically significant differences were observed in terms of swelling between the two groups after one and two weeks (P=0.41, P=0.18). None of the patients had swelling after three weeks. No statistically significant differences were observed between the two groups in terms of the pain score after one, two and three weeks (P=0.47, P=0.29, P=0.92). Conclusion: In this study, half-length short arm splints were found to be as effective as standard short arm splints
Spinocerebellar Atrophy Type-3 with Chiari Malformation in a Young Man: A Case Report
Get PDFIntroduction: Chiari malformations are a group of congenital anomalies which involve the hindbrain and the cervical spinal canal. Case presentation: Here, we describe a patient who presented with acute diplopia and gait unsteadiness which was first deigned with Chiari malformation type-1. However due to progression of the ataxia the full neurologic evaluation was considered which established the diagnosis of spinocerebellar ataxia type 3 (Machado-Joseph-Disease). Conclusion: We aim to highlight the importance of careful examination in order to avoid misdiagnosis of even rare diseases
The Patency Rate of Endovascular Procedure in Patients with Superior Vena Cava Syndrome Caused by Intravenous Catheterization: A Case Series and Longitudinal Study
Get PDFIntroduction: Different methods have been well addressed in literature in terms of treating superior vena cava (SVC) syndrome; nevertheless, the patency of endovascular treatment has rarely been investigated in patients with SVC syndrome in patients with central venous access. Objectives: The present study was performed to assess the patency rate of endovascular procedure in patients with SVC syndrome caused by intravenous catheterization. Methods: The present case series and longitudinal study was conducted on patients with SVC syndrome in presence of central venous catheter who underwent venoplasty. Computed tomography (CT) venography was performed 1, 6 and 12 months after venoplasty. Facial swelling, facial discomfort, extremity edema, arteriovenous fistula (AVF) dysfunction, impairment in dialysis and SVC stenosis were measured at baseline and 1, 6 and 12 months after venoplasty. Results: Out of 20 investigated patients, 11 (55%) were male. Significantly decreases were observed in the median grades of facial swelling and extremity edema in the follow-up (P<0.001). The decrease in facial discomfort was statistically insignificant (P=0.129), and the median grade of SVC stenosis significantly decreased from 1.5 to zero in the follow-up (P<0.001). A statistically-significant decrease was observed in AVF dysfunction (P=0.007), and impairment in dialysis significantly decreased after the intervention during the follow-up (P<0.001). Conclusion: Findings of the present study revealed the appropriate patency rate of endovascular treatment in patients with SVC syndrome in presence of central venous catheter