Advanced Journal of Emergency medicine
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Causes and Predictors of Hospital-Death among Elderly Patients in Western Iran; a Hospital-Based Cross-Sectional Study
Get PDFIntroduction: Identifying the death reasons amongst elderly, may help prioritizing the research projects and interventions. Objective: This study purpose was to determine the death pattern and causes, and also its likely associated factors, in a mega hospital in western Iran. Method: This retrospective cross-sectional study, conducted on elderly died from April 2011 to March 2016, in Imam Reza hospital in Kermanshah, Iran. The data were collected about the demographic characteristics, medical information, and the main death causes. The causes-of-death was classified adopting the International Classification of Diseases, Tenth Revision (ICD–10). The relationships between outcome and predicting variables were assessed by using Chi-square and Tukey's test in SPSS. Results: Totally, 2415 died elderly were registered during the study period. The participants mean age at the time of their death was 75.35±9.15 years old. The diseases of circulatory system (dominancy of stroke), infectious diseases (leading by septicaemia and septic shock, respectively), and respiratory system diseases were the most common death causes, respectively. Age was the most important associated factor for the all-cause mortality related to the cardiovascular diseases (p=0.001). Conclusion: The majority of deaths were the premature, which requires paying more attention. Although, cardiovascular diseases were the leading death causes and that is predictable, but the fatality of infectious diseases is still causing concerns
Sample Size Calculation Guide - Part 5: How to calculate the sample size for a superiority clinical trial
Get PDFIn the previous educational articles, we explained how to calculate the sample size for a rate or a single proportion, for an independent cohort study, for an independent case-control study, and for a diagnostic test accuracy study. In this article, we explain how to calculate the sample size for a superiority clinical trial
Red Cell Distribution Width (RDW) Index as a Predictor of Severity of Acute Ischemic Stroke: A Correlation Study
Get PDFIntroduction: Globally, stroke is one of the leading causes of death and disability-adjusted life-years (DALYs). The red cell distribution width (RDW) is a readily available and inexpensive test which is done routinely as a part of complete blood count in these patients. Objective: In this study, we tried to correlate the RDW with severity of acute ischemic stroke (AIS). Methods: Patients presenting to emergency department (ED) within 24 hours of the onset of clinical signs and symptoms suggestive of AIS were assessed for Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) score followed by non-contrast computed tomography (NCCT) scan. RDW value for all the patients who were included in the study were co-related with the severity of the stroke. Results: The median (IQR) RDW in the patients with minor stroke on the basis of GCS was 13.5 (13.3-13.5), moderate stroke was 13.8 (13.5-14.4) and with severe stroke was 15.4 (15.1- 15.6) (p < 0.001). The median (IQR) RDW in the patients with minor stroke on the basis of NIHSS score was 13.4 (13.2 – 13.6), moderate stroke was 13.8 (13.5-14.3), and moderate to severe stroke was 14.7 (14.5-15.3) and with severe stroke was 15.5 (15.1-15.7) (p < 0.001). The median RDW in patients who were alive was 13.8 (13.5 -15.1) and in patients who expired was 15.5 (14.5 -15.7) (p = 0.048). Conclusion: Based on the findings of this study, RDW index has statistically significant correlation with the severity of AIS. So it can potentially be an important parameter to predict the prognosis of AIS patients
The Correlation between Ultrasonographic Gastric Antral Area and Vomiting in Patients undergoing Procedural Sedation and Analgesia
Get PDFIntroduction: Aspiration of gastric contents is one of the most important complications during procedural sedation and analgesia (PSA). It seems that gastric ultrasonography could be a suitable tool for qualitative and quantitative measurement of gastric contents before PSA. Objective: In the present study, efforts were made to assess the correlation between ultrasonographic gastric antral area and incidence of vomiting in patients underwent PSA. Methods: In the present cross-sectional study, using a convex 4MHz probe in supine position, ultrasonographic evaluation of gastric antral area was done for 100 participants in need of PSA. The evaluations were done from the outer layer of the gastric wall and 3 images were recorded between peristaltic contractions. Finally, the rate of vomiting incidence in patients were recorded and compared with the results of patients’ ultrasonography. Results: The findings showed that anteroposterior diameter (AP), craniocaudal diameter (CC), and cross-sectional area (CSA) had a statistically significant correlation with incidence of vomiting in patients (p ≤ 0.0001). The odds ratio of these variables show that increase in antral diameter leads to increase incidence of vomiting. Based on these findings, 1 unit rise in AP increases the odds of vomiting by 7.45 times, 1 unit increase in CC increases the odds by 7.20 times, and finally, 1 unit increase in CSA increases the odds of vomiting by 1.32 times. Conclusion: Gastric antrum ultrasonography can be used as a proper diagnostic tool for assessing the risk of vomiting in patients undergoing PSA
Twenty Years with a Retained Foreign Body after Hysterectomy: A Case Report
Get PDFIntroduction: Unintentionally retained foreign bodies (RFBs) can be accompanied with acute reactions such as inflammatory responses, infections and abscesses within a few days or weeks after surgery with adverse consequences for patients and surgeons. Case Report: An 84-year-old woman was admitted to hospital with weakness, lethargy and infectious secretions of the umbilicus. The patient had undergone hysterectomy 21 years before. Clinical examinations and accurate umbilicus explorations found a 0.5-mm fibrin and smelly umbilical secretions. Dragging found the fibrin to be a surgical gauze thread. The patient was therefore identified as a candidate for laparotomy, which revealed a long gauze attached to a band and a metal ring in the umbilicus and hypogastric regions as well as a large abscess containing 200 ml of infectious secretions, severe adhesions of the intestines to each other and to the abdominal wall, a 10×10 cm cavity and an approximately 1-cm fistula or laceration in the Ileum due to the foreign body (long gauze). The patient was discharged from the hospital in good health conditions after the final surgery. Conclusion: Given the possibility of leaving foreign bodies in the surgery site, surgical teams are required to precisely control surgical instruments after surgery
Acute Gastric Dilation Following Trauma: A Case Report
Get PDFIntroduction: Acute gastric dilation following trauma is an unusual event that can occur in different settings, and can cause gastric necrosis as a rare though fatal condition. The present report involves a case of acute gastric dilation following multiple traumas, which caused gastric necrosis and total gastrectomy. Case presentation: A 19-year-old morbid obese male presented to the emergency department (ED) following a motor vehicle accident. He had a left lower extremity crash injury. In his serial examinations, he was complaining of upper abdominal pain with epigastric tenderness. After nasogastric tube (NGT) reinsertion, due to detecting coffee ground secretions in the drained fluid, the patient was transferred to the operating room. A midline laparotomy was performed that revealed dilation and discoloration of the stomach. Gastric decompression was performed. All the discoloration then disappeared except for that of certain suspicious areas, which necessitated evaluations. On the following day, given the lack of improvement in the patient`s condition, he was transferred to the operating room for a second laparotomy. Conclusion: The present report emphasized on the importance of NGT insertion in multiple-trauma patients, which is, however, neglected in many cases. Moreover, acute gastric dilation is recommended to be considered in the differential diagnosis of patients with multiple or abdominal trauma and complaints of vomiting or abdominal pains
The Correlation of Serum Chloride Level and Hospital Mortality in Multiple Trauma Patients
Get PDFIntroduction: Electrolyte disorder is a prevalent complication in multiple trauma patients; nevertheless, the role of chloride has been rarely addressed in literature when evaluating serum electrolytes. Objective: The present study was conducted to determine the correlation between serum chloride changes and hospital mortality in multiple trauma patients. Method: The present cross-sectional study measured serum chloride levels in 100 multiple trauma patients upon their admission to the emergency department and 24 hours later. All these patients were followed up in terms of hospital mortality using their medical records. Exact logistic regression was used to measure the effects of independent variables on hospital mortality in the patients. Results: Hospital mortality was found to be 15 (15%), and the mean serum chloride level to be 106.37±4.53 mmol/l upon admission and 112.18±6.16 mmol/l 24 hours later. Although the univariate analysis suggested that serum chloride levels were independently associated with mortality 24 hours after admission (P=0.005), this correlation was insignificant in the multivariate analysis. Conclusion: The present study rejected the hypothesis suggesting the potential role of serum chloride levels in predicting hospital mortality in multiple trauma patients
Radiation Exposure in Patients with Multiple Trauma in Level 2 and 3 Triage During first 48 Hours of Admission; a Cross-Sectional Study
Get PDFIntroduction: Recently, radiological imaging could be help to diagnose injury in the patients with multiple trauma in the emergency department (ED). Objective: In this study, we aimed to compare the radiation exposure within 48 hours, in patients with multiple trauma in level 2 and 3 triage admitted to ED. Method: This cross-sectional study was conducted on patients with multiple trauma of Level 2 and 3 triage who were referred during 2014-2015 to the EDs of Imam Khomeini Hospital of Tehran and Alzahra hospital of Isfahan, Iran. Radiation exposure of radiographies and computed tomography (CT) scans in patients were calculated during the first 48 hours of admission. Results: In this study, 220 patients with the mean age of 35.41±15.04 years were studied of whom 120 patients (54.5%) were male. The mean radiation exposure was 3.43±3.12 mSv. The mean radiation exposure of CT-scan in level 2 was significantly higher than level 3 (p<0.001). On the other hand, the mean radiation exposure of radiography in level 3 was significantly higher than level 2 (p=0.022). Also, the mean radiation exposure of total radiation in level 2 was significantly higher than level 3 (p<0.001). Conclusion: In 48 hours admitting to emergency department, patients with multiple trauma in Level 2 had more radiation exposure than Level 3
Use of Health Information Technology in Patient Care Management: a Mixed Method Study in Iran
Get PDFIntroduction: New computerized system, including health information technologies (HITs), plays an important role in the efficacy of management and nursing care services. Objective: This study was aimed to determine the use of HIT in patient care management, in a case study in Iran. Methods: This mixed method study was conducted in 2018 at the Kowsar Hospital of Semnan, Iran. Data collection was performed, using an observational checklist, and a questionnaire, including two main parts, one demographic and other assessment of information technology (IT) application in the care management of inpatients. The researcher prepared the questionnaire and its validity was verified. The data were organized and analyzed in the form of a descriptive analytic report. In the process of data collection 10 participants, including nurses, head nurses, physicians, radiology experts and IT managers were interviewed, and data analysis was performed, using conventional content analysis. Results: Nurses were satisfied with the computerized system and believed it can expedite the job. From the nurse’s viewpoint, the most common use of the HIT was to have access (observation) to patient admission and discharge information (100%), providing medicine and equipment, and transfer of patients (92.3%). The least use of IT was the retrieval of evidence in the care process (0%), and judgment and analysis related to radiological diagnostic procedures (0%). The potential of electronic record is still not applicable. Conclusion: Use of modern information and communication technology in hospitals facilitates access and transfer of information, and also accelerates patient’s admission and discharge process, relation between hospital units, simplifying the administration of current affairs and providing the necessary medical supplies and diagnostic procedures. However, modifying organizational policies improves the infrastructure, and enhances nurses' motivation in documentation of nursing reports, which can be effective in increasing the impact of IT in care management processes, especially in electronic record and nurse’s clinical judgment and evidence-based care
Comparison of Analgesic Effects of Nebulized Morphine with Fentanyl Transdermal Patch and Oral Methadone for Cancer Patients in Terminal Stages; a Double-blind Randomized Controlled Study
Get PDFIntroduction: Recent years have witnessed widespread reports on the effectiveness of nebulized morphine for dyspnea, yet there is no evidence for its effectiveness in analgesic therapy. Objective: This study aims to compare effectiveness and side effects of inhalation morphine with oral methadone and transdermal fentanyl in sequential days in end stage cancer patients. Method: This double-blind, randomized controlled study conducted between April and September 2017. Ninety eligible cancer patients presenting to Sayed al-Shohada Hospital were selected non-randomly according to inclusion criteria and then divided to 3 groups in random order. Pain severity was scored by Visual Analog Scale (VAS). Patients were followed up for 3 days and then data were analyzed by SPSS. The benchmark of success was set as marking 4 or below on VAS and a reduction ratio of 50 percent. Results: Pain severity was equal for 3 groups before the first administration (p>0.05), but it decreased significantly from 8.45 (range 6-10) at baseline to 2.46 (range 1-4) at the end of the 3rd day in the nebulized group. The decrease ratio was equal to 70.8% after three days (p<0.05). Pain severity reduced from 8.45 (range 7-10) to 1.8 (range 1-3) (p<0.05) in the methadone group, and reduced from 8.5 (range 6-10) to 2.13 (range 1-3) in the fentanyl group. Conclusion: Our study showed that nebulized morphine, just like oral methadone and transdermal fentanyl, is effective, safe, and well-tolerated for pain management in patients with cancer