Frontiers in Emergency Medicine (E-Journal)
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Life Threatening Transverse-Lying Vegetable Foreign Body in the Larynx; A Case Report
Get PDFIntroduction: Foreign body (FB) in throat is one of the common presentations in emergency departments (ED). The foreign body may be stuck in the neck region through ingestion or due to iatrogenic injury. FB ingestion is rare in adults but still occurs. The ED treatment plan for patients suspected to have ingested a foreign body depends on the type and location of the FB, as well as the patient’s condition. In adults, the most common FBs ingested are chicken bone and fishbone. The ingested FB often gets lodged in the oropharynx and cricopharyngeal muscle regions. Case presentation: We report a 15-year-old female patient who presented with a foreign body in the throat. Lateral neck radiograph (LNR) revealed a radio-dense vegetable foreign body in the supraglottic region, lying transversely above the vocal cord. This is an unusual clinical and radiological presentation. A 4-cm long piece of beetroot was removed successfully via direct laryngoscopy under safe procedural sedation. Post-procedure, the patient recovered well, discharged within a few hours. Conclusion: Even though foreign body in throat is a common presentation, we report this case due to its anatomical position, type, size, and the unusual radiological appearance of the FB
Predisposing Factors of Seizure in Patients Presenting to the Emergency Department; a Brief Report
Get PDFIntroduction: Identifying predisposing factors of seizure can be somewhat helpful in preventing it from occurring. Objective: The present study has been designed aiming to assess the frequency of predisposing factors of seizure in patients visiting the emergency department (ED). Methods: The present prospective cross-sectional study was performed on adult patients presenting to ED following seizure during 1 year. Known or probable predisposing risk factors for seizure were extracted from various studies and were asked from patients or their relatives during history taking and clinical examination. Results: Finally, 246 seizure patients with the mean age of 38.8 ± 18.3 (18 – 92) years were included (68.7% male). Most patients were in the 18–29 years age group (41.1%), had an educational level less than high school diploma (59.8%), and were unemployed (47.8%). Among the predisposing factors of seizure, emotional stress with 107 (43.7%) cases, insomnia with 44 (17.9%), and irregular use of antiepileptic medications with 36 (14.6%) cases were the most common predisposing factors, respectively. In 43.5% of the patients, no identified predisposing factor was found. Insomnia (p = 0.002), stress (p < 0.001), and substance abuse (p < 0.001) were the most important predisposing factors of seizure in individuals less than 60 years old. In addition, being in the menstruation period was also shown to be a predisposing risk factor for women aged less than 60 years (p = 0.002). Conclusion: Emotional stress, insomnia, and irregular use of antiepileptic medication were the most important predisposing factors of seizure in the studied patients. In more than 40% of patients presenting to ED following seizure, no predisposing factor was found
Necessary Indicators for Developing a Hazmat Response Team of the Iranian Health System
Get PDFIntroduction: Although some countries have set up predetermined programs and specialized teams to deal with hazardous materials (Hazmat) induced events, in other countries including Iran there are many weaknesses in this regard. Objective: We aimed to develop the necessary indicators for the formation of teams to deal with Hazmat accidents in the health system based on existing standards and resources as well as the indigenous conditions of Iran. Methods: This cross-sectional study was carried out in two stages from 2018 to 2020. In the first stage, the literature review was performed and the current guidelines, standards, and models presented in other countries were reviewed and related items were extracted. In the second stage, semi-structured and purposeful interviews by managers and physicians specialized in Hazmat incidents working in Iran, were conducted. The interviews were recorded and later the recordings were transcribed and simultaneously the categorizing and coding of the interviews were performed. Results: In the first stage, searching through the available resources for the present study identified 12 published references through which 10 indicators to develop a Hazmat team were ultimately extracted. In the second stage, a total of 10 interviews were conducted and data saturation occurred. Based on the results of the content analysis for the main indicators of designing and developing teams, 8 categories and 19 sub-categories were developed. Conclusions: By interviewing and localizing the 10 main indicators that were achieved in the first stage, we finally reached the 8 indicators including: Training hazmat team’s members, required equipment for team, response plan, medical surveillance program, hazmat team structure, incident command system, hazmat team qualification of different levels, certification and maintenance of the certificate
Ethical Issues in Responding to the COVID-19 Pandemic; A Narrative Review
Get PDFAt present, the biggest challenge to health and economic systems around the world is the emergence of COVID-19 pandemic. Several ethical questions have been raised at the macro-, meso- and micro-levels with respect to proper management and control of this pandemic. The most important factor in creating fear and public anxiety and disturbances of social functions is the fatalities caused by the epidemic by an unknown pathogen in most countries. Decisions for epidemic control measures are made among many uncertainties, and prioritize public health over individual rights. People's trust and compliance with recommendations play a decisive role in public actions. Therefore, during an epidemic, necessities such as adherence to the values of honesty, respect, human dignity, solidarity, justice, reciprocity, transparency, and responsiveness in the response system need to be considered. The major ethical considerations in macro and micro levels of decision-making responding to the COVID-19 will be reviewed in this paper. Ethical dilemmas arise in different domains of a pandemic such as restriction on freedom of movement, individual’s refusal of preventive or therapeutic interventions, health care workers’ rights and duty to care, the allocation of scarce resources, off-label use of diagnostic and therapeutic measures and research. The purpose of this article is to pay attention to ethical principles in solving these challenges and does not necessarily respond to all ethical problems; however, it draws the reader's attention and moral sensitivity to the issues raised in this area
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
Six min Walk Test as a Criterion for going to the Hospital in Suspected COVID-19 Patients; Is it Practical, Safe and Scientifically Justified?
Get PDFThe current outbreak of the novel coronavirus SARS‐CoV‐2 (COVID-19) has rapidly spread worldwide, which greatly endangers the global health and economy. Due to vast limitations in hospital resources, some countries have encountered serious problems for fair access to hospital beds. An interesting letter in this journal recommended 6-minute walk test (6MWT) as a proper clinical test to determine the necessity for going to the hospital in patients with suspected COVID-19. 6MWT is a field exercise test in which, patient should walk for 6 minutes as far as possible. It is usually used to compare pre- and post-treatment conditions in many pulmonary and cardiac disorders or to estimate functional status of individuals with some pulmonary and cardiovascular diseases. This test may be applied as a predictor of morbidity and mortality in these patients. Although the idea of finding an applicable and feasible clinical test to do at home is valuable by itself, but in our opinion, there are great concerns to use 6MWT for this purpose. Here, we will discuss about some serious concerns about the practical, judicious and scientifically justified use of this test in patients with suspected COVID-19
A Limited Self-Claimed Web-Based Survey COVID-19 Contamination among Iranian Healthcare Workers
Get PDFIntroduction: It is likely that high rate of healthcare workers (HCWs) infection has occurred in Iran, but there is not any proof yet. Objective: This study was conducted to highlight the rate of Iranian HCWs infected by COVID-19 and some of its surrounding points. Methods: This cross-sectional study was conducted in Tehran, Iran. Using web-based applications including WhatsApp, Telegram, Instagram and Facebook, the link to the questionnaire was sent and exposed to the eligible ones. The target population of the study was HCWs who were diagnosed as approved cases of COVID-19. They were asked about their baseline characteristics and also possible source of infection, symptoms onset, hospitalization and etc. All findings presented by frequency and percent. Results: From March 29, 2020 to April 5, 2020, a total of 452 HCWs had completed the online questionnaire of whom 50.9% were women; mostly were in the age range of 25-29 years old. Among the participants, physicians had the largest population with 312 people (69.0%). The most frequent clinical symptoms were fatigue, fever and myalgia, respectively. The highest frequency with 85 cases (18.8%) was reported their symptoms onset within 20-24th February, 2020. The most commonly used piece of equipment was gloves, which was used in 57.3% of the cases, followed by simple surgical mask, which was used by 47.1% of the participants. In 21.9% cases no personal protective equipment was used. Totally, 348 cases (91.6%) were treated in an outpatient setting and only 36 cases (9.5%) needed to be hospitalized. In 160 cases (35.4%), at least one other person was infected with COVID-19 in their household. Conclusions: Considerable number of participants that declared their infection in this study, emphasizes on the considerable rate of Iranian HCWs infected by COVID-19
Epidemiological Characteristics, Clinical Features, and Outcome of COVID-19 Patients in Northern Tehran, Iran; a Cross-Sectional Study
Get PDFIntroduction: Following the widespread pandemic of the novel coronavirus diseases (COVID-19), this study has reported demographic and laboratory findings and clinical outcomes of patients with COVID-19 admitted to a tertiary educational hospital in 99 days in Iran. Objective: We aimed to investigate in-hospital death risk factors including underlying diseases and describe the signs, symptoms, and demographic features of COVID-19 patients. Methods: All confirmed COVID-19 cases admitted from 22 February to 30 May 2020 were extracted from hospital records. A follow-up telephone survey was conducted 30 days after discharge to acquire additional data such as survival status. Distribution of demographic and clinical characteristics was presented based on survival status during hospitalization. All analyses were performed using STATA version 14 with a level of significance below 5%. Results: Among 1083 recorded patients, the rate of survival and death was 89.2% (n=966) and 10.8% (n=117), respectively. 62% of the cases (n=671) were male. The mean recovery time was 1.90 (3.4) days in survived cases, which was significantly lower than that in deceased cases 4.5 (5.2) days, p<0.001). A significantly higher rate of death was observed among patients above the age of 60 years (24.8%, p<0.001), cases with hypertension (25.4%, P<0.001) and cases without cough (17 %, p=0.002) but with shortness of breath (16.5%, p=0.001). Conclusions: Our study emphasized the significant effect of different underlying conditions as mortality factors among COVID-19 patients, namely older age spectrum, hypertension, and ischemic heart disease. By acknowledging the epidemiologic pattern and mortality factors, we have more tools to prioritize and make better judgments, and more lives can be saved
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
Besides other Signs, Can a 6-min Walk Test be Applied as a Criterion for Going to the Hospital with a Diagnosis of COVID-19?
Get PDFRecently the pandemic of Covid-19 challenges countries’ medical health services systems. While some patients experience acute and devastating symptoms, others may only have mild myalgia and fever. Due to the high amounts of hospital referrals, some countries’ health systems have asked patients to stay at home and go to the hospital when they feel that the symptoms are severe. Some symptoms, such as fever, myalgia, diarrhea, and headache, have been offered as Covid-19 symptoms. However, is there any clinical test that helps patients themselves to detect the severity of symptoms? A six-minute walk test is a clinical test to investigate the function of the cardiorespiratory system. In this test, a physician asks a patient to walk for 6 minutes in a 30-meter walking course. Some studies have shown its relation with short term survival, especially in patients who complete less than 300 meters. Based on the walked distance, results can be used in the two following formats. First, the Vo2 max could be estimated via an equation; second, the distance can be compared at different times. Considering that Covid-19 affects the respiratory tract, it seems that it could affect 6-min walk test results. Due to the particular situation, the health system can ask people who have mild symptoms to check their 6-min walk test results for several consecutive days besides the other symptoms. If patients’ walking distance decreased due to breath shortness at this time, they should go to the hospital. Even if their walking distance is less than 300 meters, maybe they need a chest CT scan. With the application of this approach, we can decrease the load of referrals to the hospitals and also prevent patients with mild symptoms from being contacted to the high load of virus in the hospitals