Advanced Journal of Emergency medicine
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Psychological Impact of the COVID-19 on Health Care Workers in the Emergency Department
Get PDFThe ongoing global pandemic of the Coronavirus disease 2019 (COVID-19) is a public health emergency. It has not only affected the general population, but has also caused psychological distress in the frontline health care workers (HCWs). It is crucial to understand the psychological impact of the COVID-19 on the frontline HCWs. The overall well-being and resilience of HCWs are key determinants to maintain an optimal healthcare response for appropriate patient management as well as to achieve good patient outcomes. This article summarizes the various risk factors as well as strategies that can be adopted to reduce the impact of stress on these frontline HCWs. This will help guide institutional as well as national policies and interventions to maintain their psychological well-being
A Primer on COVID-19 for Clinicians: Clinical Manifestation and Natural Course
Get PDFContext: COVID-19 is a new pandemic in the world and data in the various aspect of this disease are evolving. In this review, the authors try to cover different aspects of clinical manifestations and the natural course of the disease. Evidence acquisition: For data gathering, the authors searched through MEDLINE, Cochrane library, google scholar and Scopus. The key phrases for search were "clinical presentation of COVID-19", "clinical features of COVID-19", "natural course of COVID-19", "neurologic manifestation of COVID-19", "cardiovascular manifestation of COVID-19" and "gastrointestinal manifestation of COVID-19". Results: After screening of titles and abstracts, the authors finally enrolled 55 articles. Then the full texts of the selected articles were read carefully to determine eligibility and extracting relevant information. Conclusion: The most common presentations of COVID-19 patients were fever, non-producing cough and dyspnea but a considerable amount of patients may seek heath care without these complaints. Asymptomatic patients and patients with only gastrointestinal and neurologic symptoms remain a significant challenge for medical practitioners
Clinical Performance of RT-PCR and Chest CT Scan for Covid-19 Diagnosis; A Systematic Review
Get PDFContext: Due to their availability and rapid turnaround time, the supplemental role of chest computed tomography (CT) scan and real-time polymerase chain reaction (RT-PCR) is growing for early diagnosis of patients with COVID-19. However, due to the low efficiency of viral nucleic acid detection as well as low specificity of chest CT scan for detecting COVID-19 pneumonia, both methods show incomplete clinical performance for proper COVID-19 disease diagnosis. The purpose of this review was to compare the clinical performance of two methods and to evaluate the diagnostic values of chest CT scan and RT-PCR for suspected COVID-19 patients. Evidence acquisition: We systemically searched PubMed, Cochrane, from December 2019 to the end of April 2020. Clinical research papers in goal fields that reviewed COVID-19 patients, whom chest CT scan, and PCR testing were performed together were included. Results: In total, we found 536 studies; and finally168 studies were shortlisted. Following title and abstract screening, we reached 83 studies based on the inclusion and exclusion criteria. Conducted screen by the full text covered 28 studies, which led to data extraction. By the full-text assessment of 28 included studies, we found 4486 assessed patients. Totally, 3164 patients had positive chest CT scans, and 3014 patients had positive PCR results. The finding showed that recent studies on the diagnostic performance of RT-PCR and chest CT scan have commonly been reported from China. Conclusion: The results from this review indicate that the chest CT scan should be used for symptomatic and hospitalized patients. Moreover, chest CT scan should not be used as a primary screening tool for diagnosing COVID-19. Application of RT-PCR as the first line diagnosis is still recommended
A New Technique Employing Direct Tactile Pressure on the common Carotid Artery to Relieve Acute Episode Attack of Migraine Headache: A Single-Arm Interventional Study
Get PDFIntroduction: Migraine, is a common neurological disorder, and its pathology and acute treatment has not been determined so far. In the contemporary literature, there is no remedy that can abort an acute episode of migraine. Objective: We aimed to evaluate the effect of transient presser on the middle part of common carotid artery for terminating an acute attack of migraine headache. Methods: It is an interventional study without a control limb, performed on patients within age range of 18-45 years. Patients with established migraine headache based on International Classification of Headache Disorders (ICHD) guidelines, who had no atheromatous plaque in their common carotid arteries were included. Pain intensity was evaluated by Universal Pain Assessment Tools (UPAT). In safe position, applying vital signs monitoring and ipsilateral of headache, a gentle pressure was applied on the common carotid artery, lateral to the cricothyroid membrane and medial border of the Sterno-Cleido-Mastoid (SCM) muscle, by using both index and middle fingers, till the headache was relieved, following which the pressure was maintained for a period of 15 seconds. Then the middle finger was maintained at its position and the index finger slid caudally with the same pressure as far a distance of four centimeters and the pressure withdrawn slowly. After 2 minutes, patients were asked to report any change in headache which was recorded. Results: Totally, 215 patients entered this study. The mean of pain score before and after using the technique regarding to UPAT, was 6.28±1.34 and 0.4±0.64, respectively; Also, the pain decreases equal 5.88 score was significant, special by according sex (p<0.001). No side effect was seen. Conclusions: It seems that pressure on the common carotid artery and extending the pressure caudally, helped a rapid, safe and significant reduction in pain score for patients with acute attack of migraine headache
The Effects of Different Doses of Submucosal vs. Intravenous Ketamine for Conscious-sedation in Children Candidates for Diagnostic-Therapeutic Procedures in Emergency Department
Get PDFIntroduction: Ketamine is a commonly used medicine for reducing pain and stress in patients, including children in emergency department (ED). The intravenous (IV) injection of ketamine is gold standard though difficult in children, but other routes are also possible. Objective: This study was conducted to compare the effects of the submucosal at different doses versus IV injections of ketamine on sedation with proper consciousness in children candidates for diagnostic-therapeutic procedures in ED. Methods: This randomized clinical trial was conducted with 4 groups; groups 1, 2 and 3 respectively received 4, 3 and 2 mg/kg of submucosal ketamine and group four 1.5 mg/kg of IV ketamine. Eligible subjects selected from 46 patients of children’s age as the candidates for subcutaneous wound healing were randomly assigned to the four groups and followed up 5, 10, 15 and 30 minutes after the injection. The Ramsay score was obtained by measuring the heart rate, the breathing rate, the time to start affecting and duration of the effect. The data were ultimately analyzed in SPSS and Excel. Results: The baseline data were matched and confounding variables eliminated included age, gender, weight and hemodynamics. Compared to other doses of submucosal ketamine, 4 mg/kg was found to exert its effect the fastest (4.08±1.01 minutes) (p<0.05) and for the longest duration (23.09±1.12 minutes) (p<0.05). The Ramsay score in groups 1 and 4, i.e. 5.9, was significantly higher than that in groups 2 and 3 (p<0.05). Conclusions: The results showed that 4 mg/kg and 3 mg/kg of submucosal ketamine are appropriate alternatives to IV ketamine. Although the time to start affecting was shorter in the intravenous group compared to in the other groups, the duration of the effect was the longest with 4 mg/kg of submucosal ketamine. Surgeon satisfaction scores were found to be very good and not significantly different between groups 1, 2 and 4. Vomiting was also prevalent with no significant differences between the four groups
The Effect of Oral Tamsulosin vs. Oral Tamsulosin and Oral Isosorbide Dinitrate in Acute Urinary Retention Patients Due to Benign Prostatic Hyperplasia: A Double-Blind Clinical Trial Study
Get PDFIntroduction: Acute urinary retention due to benign prostatic enlargement is one of the clinical complaints that patients refer to the emergency department. Selective α-blockers are used after urinary catheterization. Recently, the use of nitrate compounds has been shown to relieve bladder neck and to treat acute urinary retention. Objective: The aim of this study was to survey the addition of Isosorbide di nitrate to tamsulosin in the treatment of acute urinary retention in patients with benign prostatic hyperplasia. Methods: This is a randomized, double-blind placebo-controlled clinical trial. In all, 78 patients with benign prostatic hyperplasia-related acute urinary retention referred to the emergency department were divided into two groups and randomly assigned to receive either 0.4 mg tamsulosin plus placebo or 0.4 mg tamsulosin plus isosorbide dinitrate 40 mg extended-release tablets daily for 3 days. At the same first visit, the catheter was removed and the ability to void in same time and 1 month later was assessed in each group. Results: After catheter removal, 27 (67.5%) patients in the tamsulosin plus placebo group and 31 (81.6%) in the tamsulosin plus isosorbide dinitrate group voided successfully after 3 days (p = 0.155). After 1 month, 20 (50.0%) patients taking tamsulosin plus placebo and 23 (60.5%) taking tamsulosin plus isosorbide dinitrate could void, yet indicating no significant difference (p = 0.350). Conclusions: Addition of isosorbide dinitrate to α-blockers has advantage in improving benign prostatic hyperplasia-related acute urinary retention versus tamsulosin alone, although was not statistically significant
Spontaneous Rupture of Urinary Bladder Diagnosed by Bedside Ultrasound; a Case Report
Get PDFIntroduction: Spontaneous rupture of the urinary bladder (SRUB) is rare condition. It is often difficult to diagnose particularly in busy emergency department (ED). SRUB is usually secondary to an underlying pathology, but in extremely rare condition, it can be idiopathic. Significant morbidity and mortality can result from a missed or delayed diagnosis. Case presentation: We report a case of idiopathic SRUB in a young male presented with inability to pass urine and abdominal pain in the absence of prior trauma or alcohol intoxication. A bedside ultrasound was performed by the emergency physician (EP) to confirm his suspicion, which demonstrated free intra-peritoneal fluid. This expedited further workup and management. Emergency consultation to urologist on call was initiated, the diagnosis was confirmed by CT scan and the patient was taken to the theatre. Conclusion: We report this case as it is unique in presentation, very rare in occurrence and bedside US had expedited further workup and management
Rationale and Design of a Registry in a Referral and Educational Medical Center in Tehran, Iran: Sina Hospital Covid-19 Registry (SHCo-19R)
Get PDFCoronavirus disease 2019 (Covid-19) is caused by the novel coronavirus resulting in a highly contagious respiratory tract infection with an increased risk of acute respiratory distress syndrome (ARDS), which was first seen in Wuhan, China. Thus far, this virus has spread to many countries worldwide, including Iran. Multiple studies have assessed disease characteristics, viral genetics, and complications of Covid-19 in the Chinese population. However, there is limited data regarding patient characteristics and outcomes of infected cases outside of China. Besides, risk factors of adverse outcomes are poorly identified in different populations. Due to limited data in the Iranian population affected by the virus, we aimed to design a registry of patients with Covid-19 at Sina Hospital in Tehran, Iran [Sina Hospital Covid-19 Registry (SHCo-19R)] in this regard, to assess patient characteristics, imaging features, laboratory findings, management strategies, and adverse outcomes of Iranian patients with Covid-19 and their differences with other populations
A Case Series of Patients with COVID-19 Infection Admitted to a Secondary Care Center in Turkey
Get PDFIntroduction: COVID-19 is a zoonotic viral infection that first emerged in Wuhan, China, the source of which is thought to be a seafood market, and then spread rapidly from China to the world. Objective: The aim of this observational study was to analyze cases with COVID-19 admitted to a single secondary care center in Turkey. Methods: This is a descriptive study performed during the period from March 22 to 30, 2020, in Kars Harakani State Hospital, Kars, Turkey. We evaluated all patients with reverse transcription polymerase chain reaction (RT-PCR) to confirm COVID-19. Demographic characteristics, clinical signs and symptoms, comorbidities, blood tests results, chest computed tomography (CT) scan findings and outcomes including hospitalization, intensive care unit (ICU) admission and survival of the patients were recorded. Results: During the one week study period, we took 435 nasopharyngeal swabs from suspicious cases and found 22 patients (4 females, 18 males) whose COVID-19 infection was confirmed via RT-PCR. Their ages ranged from 18 to 86 years, with an average of 45.59±25.02. Ten (45%) of the cases were current smokers. The body temperature of the cases ranged from 36.1 to 38.4 oC, with an average of 36.78 ± 0.65. Four cases were asymptomatic and the most common complaint was cough (82%). Hypertension (23%) and chronic obstructive pulmonary disease (COPD) (23%) were the most common coexisting diseases. In chest CT scan, ground glass densities were detected in 7 (32%) patients and infiltration was observed in 8 (36.3%). The mortality rate of the cases was 9% (n=2). Conclusion: The most common complaint of patients was cough. Hypertension and COPD were the most prevalent comorbidities among patients
The Role of Chest CT Scan in Diagnosis of COVID-19
Get PDFAs the number of patients infected by COVID-19 increases worldwide, and in the absence of appropriate therapeutic drugs or vaccines, it is essential to detect patients with COVID-19 pneumonia at its early stages, in order to isolate the patients from healthy population. Computed tomography (CT) scan seems to be promising in detection of COVID-19 as shown in some studies