Frontiers in Emergency Medicine (E-Journal)
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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and the index finger slid caudally with the same pressure as far a distance of four centimeters and the pressure withdrawn slowly.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
Old and New Concepts in Brain Death: A Medico-Legal Overview
Get PDFAlthough brain death has been extensively dealt within the contemporary literature, there does exist some ambiguities regarding its definition, clinical criteria, ethical and religious perspectives. The neurological criteria helped in subduing the much talked about issues of whole brain death and brainstem death to a greater extent, but the recently introduced cardiac or circulation death made the issue of brain death more complicated and indeed a conundrum. We would touch upon brain death issues since the terminology was initially introduced till the present day when the cardiac death connivingly made its way as a means of organ procurement in the so called dead patients. This review article is the authors' own perception and understanding of the conundrum of brain death, and should not be misinterpreted as a narrative or a systematic review of the subject. In conclusion, this review aims at filling the void that exists about the criteria for brain death in the contemporary literature
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
Endotracheal Intubation of COVID-19 Patients
Get PDFThe novel coronavirus (COVID-19) emerged for the first time in China and then rapidly spread and swept the entire world like a tornado killing thousands of patients around the planet. People were advised to stay in-doors to prevent the spread of this deadly disease, and this slogan helped to a greater extent in containing the spread of the virus. Unfortunately, there is no treatment for the disease at present, but extensive research is going on to find a definitive treatment. Regarding endotracheal intubation (ETI) of COVID-19 patients, data are scarce and no randomized clinical trials are available to develop and formulate succinct and acceptable guidelines in tackling the problem of ETI in these highly risky and vulnerable patients
Disruption in Medical Care of Non-COVID Patients in COVID-19 Pandemic
Get PDFIn December 2019, a novel coronavirus (2019-nCoV) was detected in Wuhan Hubei province, China. The virus has caused a global concern because of its high potential for transmission, high morbidity and mortality. COVID-19 spreads so rapidly across an increasing number of countries worldwide that it has been found in more than 200 countries so far. The World Health Organization (WHO) has declared COVID-19 a pandemic and public health threat. In general, COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A case fatality rate of approximately 2.3% has been reported for COVID-19. New fever, cough, lymphopenia and bilateral lung infiltrations are characteristic but not diagnostic for COVID-19. Sore throat, dyspnea, myalgia, diarrhea, and abdominal pain are other presentations of COVID-19. We should also be attentive to the probability of atypical presentations in patients who are immunocompromised. While the majority of cases result in mild respiratory tract symptoms like acute bronchitis, severe cases might end in severe pneumonia, acute respiratory distress syndrome (ARDS), septic shock and death due to multiorgan damage, so early recognition of patients with suspected COVID-19 infection is crucial. The burden of the virus is not limited to physical damage, but it also has a significant impact on the mental health of the public. It can lead to generalized anxiety disorders and depression during COVID-19 pandemic. Now many countries are in a state of crisis worldwide. Whenever the living environment changes, people feel unsafe. People's fear of COVID-19 makes them refrain from going to medical centers, which significantly impacts their access to medical care while they require acute treatment. COVID-19 outbreak in countries has pulled essential medical resources away from regular procedures. This has caused complications for patients who need treatment for other medical conditions that require timely and appropriate care. Cancer patients especially still require attention in curative or palliative settings, and women will still be delivering their infants. How can we care for these patients without exposing them to COVID-19
Do Multiple Sclerosis and Neuromyelitis Optica Patients Have a Lower Chance of Developing Neurological Complications of COVID-19, Compared to Healthy People? The Role of ACE2
Get PDFAs COVID-19 spreads all around the world, it indicates various side effects and complications. Currently, we know that, this disease can affect other organs like brain. The growing number of neurological complications from this disease suggests that, the coronavirus is a neurotropic virus, and this neurotropicity has been attributed to the expression and presence of receptors of angiotensin-converting enzyme 2 (ACE2) in central nervous system (CNS). Unlike ACE itself, ACE2 converts angiotensin 2 to 1, and is present in lung alveolar epithelial cells. In this regard, the coronavirus is likely to use ACE2 as a receptor to enter and infect human cells. The virus causes disease in some other areas such as pancreas and colon with the same mechanism as that of ACE2 receptor. Moreover, the high presence of the corresponding receptor in the CNS has increased the likelihood of neurological involvement in this virus. The binding of the virus to this receptor (Figure 1), which is present in different areas of the brain such as the glial cells, neurons and astrocytes spreads the virus to the CNS and this induces a variety of neurological symptoms. One of the most important areas of the brain that causes high expressions of ACE and ACE2, angiotensinogen, and angiotensin II secretion in the CNS, is perivascular astrocytes. Neuromyelitis optica spectrum disorder (NMOSD) is an astrocytopathy in which a high rate of astrocyte destruction occurs. Some studies have also shown that, these perivascular astrocytes are largely eliminated in multiple sclerosis (MS), especially at chronic stages. This destruction could justify the studies, which have demonstrated the low levels of ACE2 in the cerebrospinal fluid of these patients. Matsushita et al. revealed that, angiotensin II, ACE, and ACE2 levels were lower in the cerebrospinal fluid of the patients with seropositive NMOSD compared to healthy individuals. Accordingly, the same was true for ACE2 levels in MS patients. Another study confirmed the low level of ACE2 concentration in the cerebrospinal fluid of the patients with MS. The destruction of astrocytes and low level of ACE2 concentration could theoretically predict the ACE2 receptor deficiency which might reduce the chance of entering the virus into the CNS, and consequently, decrease the neurological complications. This may suggest that, neurological complications are less likely to occur in the patients with NMOSD and MS in case of developing COVID-19. However, as with all diseases, it is not possible to simply predict the lower degree of neurological complications in these patients on the basis of one factor such as a lower expression of ACE2 in these patients. Thereafter, further investigations are required to shed light on how MS and NMOSD patients develop infectious diseases related to the CNS
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
Clinical Features of Patients Newly Admitted to the Emergency Department of a Psychiatric Hospital with an Emphasis on Physical Examination
Get PDFIntroduction: Many medical diseases and their related signs and symptoms are not identified in routine assessments in emergency departments. Objective: We investigated the prevalence of abnormal findings in physical examination of the patients who were newly admitted to emergency department (ED) of a psychiatric hospital. Methods: We studied 200 patients (143 males, 71.5%) who were recently admitted to the ED of a psychiatric university hospital during a 4-month period in 2018. A thorough physical and neurological examination was performed on each subject. Results: Nearly all of the patients (99.3%) had at least one positive finding in physical (non-neurological) examination and 95% had at least one positive neurological finding. We also found at least one problem in gastrointestinal, respiratory or cardiac system of 22.1%, 24% and 33% of the subjects, respectively. The most frequent findings were in cranial nerve I (30%, more common in substance abuse disorder), and visual acuity (52.6%), as well as recent memory (%68.7), attention (%33.7), orientation to time (%29.5), hypokinetic movements (%28.1, more common in females and psychotic patients), akathisia (41.6%), and skin (%85.1, more common in substance abuse and personality disorders). T wave changes were seen in 31.9% and arrhythmia in 16% of the patients. Conclusions: Abnormal findings in examination of the patients admitted to EDs are very prevalent, but most of the abnormalities are not detected or reported in the routine ward examinations. More emphasis should be placed on the examination of olfactory nerve (especially in patients with substance abuse disorder), cognition (especially in older adults), extrapyramidal system, heart, abdomen and skin (especially in patients with personality disorder) during the first week of admission in a psychiatric emergency setting
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
Epidemiology of Fatal Injuries among Patients Admitted at Sina Hospital, the National Trauma Registry of Iran, 2016-2019
Get PDFIntroduction: 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