Frontiers in Emergency Medicine (E-Journal)
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Reliability of Platelet Indices for Diagnosing Pulmonary Embolism; a Brief Report
Get PDFIntroduction: Early diagnosis of pulmonary thromboembolism (PTE) is crucial in clinical medicine. Many para-clinical measurements are used to diagnose PTE. Objective: The present study was conducted to evaluate platelet indices in terms of diagnosing PTE. Methods: The present case-control study was conducted between September 2015 and September 2016 with 173 patients suspected of PTE in the emergency wards of Shahid Madani Hospital and Imam Reza Hospital affiliated to Tabriz University of Medical Sciences, Iran. The patients’ platelet indices were checked upon admission and they were evaluated in terms of diagnosing PTE. Platelet indices included mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PL-CR). PTE was diagnosed in 125 out of the 173 patients. Platelet indices were also compared between two groups. Results: No statistically significant differences were observed between the two groups in term of demographic variables (P>0.05). MPV was found to be 10.38±8.59 in the case group and 9.46±1.11 in the controls (P˃0.05). PDW was also found to be 12.86±5.57 in the case group and 12.32±2.48 in the controls (P>0.05). Moreover, PL-CR was found to be 22.59±7.32 in the case group and 21.97±8.16 in the controls (P>0.05). Conclusion: According to the obtained results, platelet indices do not increase in PTE. They cannot be therefore used to diagnose PTE in suspected patients
Food-borne Botulism Caused by Clay Cheese: A Case Report
Get PDFIntroduction: Recently, the use of metal and plastic containers instead of clay containers in producing this type of cheese has provided the anaerobic condition for growing the bacterium and producing the botulinum toxin. In this case report was to introduce "clay cheese dug in the ground" as a source of botulinum toxin for the first time. Case Report: A 34-year-old man with dizziness, asthma, and inability to swallow for four days referred to the hospital emergency department. He had diplopia and ptosis for two days. During admission to the emergency, the patient was conscious without fever, but with dysarthria and bilateral ptosis, an impaired gag reflex, slow right papillary reaction to light, a decreased eye movement, and a decreased power of facial muscles and limbs. The patient reported the use of clay cheese in a week before referring to the emergency. Hematological, biochemical, electrocardiogram, magnetic resonance imaging, and chest X-ray assays were normal. According to the Centers for Disease Control and Prevention classification, these symptoms were related to botulism. The evaluation of serum samples, emission, and gastric juice confirmed botulism by type A toxin. Conclusion: Considering the clinical results of this case study, clay cheese, which is produced in the west of Iran, can be introduced as a new source of the botulinum toxin
Reliability and Recalibration of the Persian Version of Cumberland Ankle Instability Tool Cut-off Score in Athletes with Functional Ankle Instability
Get PDFIntroduction: The Cumberland Ankle Instability Tool (CAIT) is a valid instrument for determining the presence and severity of functional ankle instability. This questionnaire was recently cross-culturally adapted into Persian; however, the reliability of the Persian version has not been examined in athletes. CAIT has also been used with various independently-selected cut-off scores to determine instability. Objective: The present study was conducted to evaluate the psychometric properties of the Persian version of CAIT and to determine its optimal cut-off score in athletic populations. Method: One-hundred and sixteen athletes (volleyball, basketball and track and field players) over 18 years old both with and without ankle instability completed the Persian version of the CAIT. The internal consistency, test-retest reliability and discriminative ability of the tool were assessed. A receiver operating characteristic (ROC) curve was drawn to confirm the cut-off point of the Persian version of CAIT using the Youden index. Results: The average CAIT score was 25.14±4.98 for the right and 25.76±4.94 for the left ankle. The Persian version of CAIT had a good internal consistency (Cronbach's α of 0.78 for the right ankle and 0.79 for the left ankle) and substantial reliability (ICC2, 1 = 0.88; 95% CI: 0.86 – 0.90) in athletes. No ceiling or floor effects were observed. The optimal cut-off score for discriminating between athletes with and without FAI was 24. Conclusion: The Persian version of CAIT was shown to be a reliable tool for assessing functional ankle instability among Iranian athletes
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
Challenges of Utilizing the Primary Health Safety Index Tool for Assessing the Vulnerability of Healthcare Centers to Disasters
Get PDFAs important infrastructures in every community, hospitals and healthcare centers are required to continue their operation during normal and disastrous situations and respond to the situation and provide services for the injured. In 2008, the hospital safety index (HSI) was proposed by the Pan American Health Organization (PAHO) for evaluating the safety of hospitals and healthcare facilities in potential hazardous situations. The hazards threatening these facilities can be identified using a checklist, and categorized as structural, non-structural and functional vulnerability while considering their likelihood of occurrence, frequency, harmful outcomes and numerical estimate of damage. In 2016, risk and safety assessments in disasters were performed in 280 healthcare centers affiliated to Ilam University of Medical Sciences, Ilam, Iran, including 204 medical homes, 66 comprehensive urban and rural health centers and 10 district health centers. The present research was conducted using the hazard assessment guidelines developed by the Iranian Ministry of Health. The results revealed that geologic hazards, climatologic threats, epidemics and traffic accidents were respectively the most frequent hazards threatening healthcare centers in Ilam province. Moreover, the levels of the structural, non-structural and functional safety of the healthcare centers were respectively found to be 20.34%, 27.67% and 21.53%. The overall safety of the health centers was also estimated at 22.79%. In fact, the safety level received a score of 3 out of 10. Hatami et al. obtained a safety index of 4 out of 10, and found the level of functional safety to be 51.48%, that of structural safety 33.97%, that of non-structural safety 54.82% and that of overall safety 43.72%. Moreover, an evaluation of the safety level of Iranian health centers in the face of disasters in 2015 reported a functional safety level of 29%, a structural safety level of 36%, a non-structural safety level of 21% and an overall safety level of 29%. The safety levels of healthcare centers in Ilam province were therefore lower than those reported as the national mean safety indices. In addition, the present results were expressed through their root cause analysis. The unsatisfactory preparedness level of healthcare centers in Ilam province on a national scale based on the hazard assessment guidelines developed by the Ministry of Health can be attributed to the following factors:
The very old building structures of the health centers contributing to lower safety and higher risks
Failing to complete the checklists according to the instructions provided for national assessment tools; the checklists should have been completed by skilled, well-educated experts who were informed of how to use the instruments and how to complete the checklists.
The invalidity of the obtained results associated with completing the checklists by experts of the Deputy of Health and subsidiary units, who lacked knowledge about structural engineering and building architecture. In fact, the intrinsic features of some of the instruments required asking for assistance from engineering experts such as architects, civil engineers and urban engineers to complete the checklists; nevertheless, financial limitations prevented the use of specialist expertise.
Failing to take the necessary measures to promote the safety and efficiency of the healthcare centers despite the neglect reflected in the annually-completed preparedness assessment tools; the annual status of safety and preparedness of healthcare centers in Ilam was reported to be unsatisfactory.
As a major component of management, control is a combination of actions required for identifying strengths, weaknesses, threats and opportunities through monitoring and evaluating the processes and solving the system problems by performing appropriate intervention. The improvement of the status quo is not guaranteed unless controls lead to interventions. The results obtained through assessing the preparedness and safety of hospitals appear to have not affected the strategic programs, policies and procedures of the health system authorities in a way that safety levels are enhanced in healthcare facilities. The policy makers are therefore recommended to revise the methods used to take advantage of this information
An Unusual Case of Accidental Ingestion of a Toothbrush
Get PDFIntroduction: Foreign body ingestion is a common presenting complaint in the emergency department. While ingestion of small foreign bodies like coins and button batteries is not uncommon, ingestion of long and rigid foreign bodies like toothbrush is very rare. Case presentation: We describe a 36-year-old man who presented to us after accidental ingestion of a toothbrush. The patient underwent urgent endoscopic removal; Psychiatric evaluation revealed an acute and transient psychotic disorder in him. Conclusion: Ingestion of long and rigid foreign bodies like a toothbrush is an uncommon entity. Such foreign bodies when ingested find it difficult to maneuver through the GI tract, which makes their spontaneous passage almost impossible. Their ingestion is associated with increased risk of impaction, perforation and, bleeding. Therefore, early removal of the ingested toothbrush is recommended before complications develop
Accuracy of Ultrasonography in Diagnosis of Shoulder Dislocation: A Systematic Review
Get PDFContext: This meta-analysis of clinical trials was conducted to compare the diagnostic accuracy of ultrasound in comparison to plain radiography in shoulder dislocation. Evidence acquisition: MEDLINE, Cochrane Database of Systematic Reviews, clinicaltrials.gov, Google scholar, and Scopus were searched for clinical trials. Diagnosis of shoulder dislocation and confirmation of shoulder reduction were the outcomes of interest. Sensitivity, specificity, positive predictive value and negative predictive value of included clinical trials were calculated. Results: Seven studies met our inclusion criteria and were analyzed. All included studies except two had a sensitivity and specificity of 100% for ultrasound (one with a sensitivity of 54% and one with a specificity of 60%). Conclusion: It can be suggested that ultrasound can be used as a reliable alternative diagnostic method for detection of both dislocation and reduction in shoulder joint. This may decrease the delay in treatment, cost, radiation exposure, and need for repeated sedation
Waiting Time for Specialist Consultation and Visit Requested in the Emergency Department; a Cross-Sectional Study
Get PDFIntroduction: Waiting time in the hospital directly affects the quality of healthcare providing centers. One of the waiting times in hospital is the time spent waiting for receiving various consultations and visits requested by emergency medicine specialists from specialist services. Objective: The present study was designed and performed to assess the waiting times for receiving specialist visits and consultations requested in the emergency department based on the corresponding service in a referral hospital in Isfahan, Iran. Method: In the present cross-sectional study, patients presenting to emergency department of Dr. Shariati Hospital, Isfahan, Iran, from October 2017 to March 2018, who were in need of visit or consultation from other specialist services based on the opinion of the emergency medicine specialist, were studied. By attending the patients’ bedside, the researcher filled out a checklist consisting of demographic data and waiting time of the patients and other probable related factors. Finally, raw data were entered to the computer and after correction of errors were statistically analyzed via SPSS software. Results: Overall, 400 patients with the mean age of 53.3 ± 24.3 years were included in the study, 58.8% of which were male. Mean waiting time for receiving a visit or consultation among the studied patients was 242.0 ± 202.4 (min: 5 and max: 1200) minutes. Mean waiting time for a visit or consultation did not significantly correlate with the corresponding physician being resident or on-call. However, it showed a statistically significant correlation with triage level (p = 0.013), work shift (p = 0.000), type of service requested/the specialist service asked for a consultation or visit (p = 0.049), and the consultation or visit being emergent or non-emergent (p = 0.000). In addition, emergent visits or consultations by on-call physicians had been performed significantly faster than those by resident physicians; while non-emergent visits or consultations by resident physicians had been performed significantly faster than those by on-call physicians (p = 0.001). Conclusion: The results of the present study showed that patients with triage level 2, emergent visit of consultation and a visit or consultation request in the morning or evening shift wait a shorter time for receiving the visit or consultation. In addition, neurosurgery, nephrology, and pediatrics services had the shortest waiting times, while gastroenterology, gynecology, and infectious disease services had the longest waiting times for giving the visit or consultation requested from them
An 85-year-old Woman with Altered Mental Status and Hypotension
Get PDFAn 85-year-old female patient was brought to emergency department (ED) from a nursing home with altered mental status (GCS: 12/15) and hypotension (90/60 mmHg). Bilateral fine crackles in lungs and severe cachexia were obvious in her physical examination. The ECG showed only sinus tachycardia. Several attempts at peripheral vein cannulation failed due to poor visualization of severely atrophied and contracted subcutaneous veins. Therefore, on two attempts, a central venous catheter (CVC) was inserted into the right internal jugular vein (IJV) using the Seldinger technique. After securing and taping the central line, fluid infusion started with no difficulty and a portable chest x-ray was ordered
A New Formula for Confirmation of Proper Endotracheal Tube Placement with Ultrasonography
Get PDFBackground Endotracheal intubation is an important procedure in critical care and emergency medicine settings. Optimal depth of the tube placement has been a serious concern because of several complications associated with its malposition. Objective: The aim of the current study was to find a new formula to estimate the proper endotracheal tube depth when using ultrasonography or lighted stylet device in order to increase the accuracy of determining Endotracheal tube (ETT) depth and decrease the side effects of ETT misplacement. Method: Patients older than 18 years of age admitted to Imam emergency department who needed tracheal intubation were included. Tube’s length at the angle of the mouth while the tube passed the suprasternal notch, ETT depth after insertion and the distance from ETT’s tip to carina were recorded. Ultrasonography and portable chest x-ray were used as tools for measuring these lengths. Results: A total number of 91 patients including 55 men and 36 women were eligible for inclusion in the study. Not placing the tube at proper depth was considered as failure of intubation. This failure rate was 9.9% in the standard method which would have been 1.1% if our proposed formula was used. Conclusion: The findings of this study suggest that the use of this new formula may help in predicting the proper intubation tube placement. Further studies are warranted to confirm these findings