Frontiers in Emergency Medicine (E-Journal)
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The Diagnosis and Management of Toxic Alcohol Poisoning in the Emergency Department: A Review Article
Get PDFContext: This review discusses the range of clinical presentations seen with poisonings by the major toxic alcohols--methanol, ethylene glycol, and isopropyl alcohol. It outlines a straightforward diagnostic strategy and discusses in detail the current treatment recommendations. Evidence acquisition: The authors conducted a literature search of primary and secondary sources related to the topic. For treatment recommendations, search restrictions included articles published between 2008 and 2019. For background information, search restrictions included articles written from 1990 – present. Results: This review discusses in detail how the diagnosis can be made via clinical signs, symptoms, and laboratory values as well as the most recent treatment recommendations. This paper will also discuss the limitations of the emergency department workup and how the absence of particular laboratory findings does not necessarily rule out the diagnosis. Conclusion: Poisoning with methanol, ethylene glycol, and isopropanol present diagnostic and therapeutic challenges to emergency physicians. Toxic alcohol poisonings lead to an elevated osmolar gap and, with the exception of Isopropanol, a metabolic acidosis. In order for the timely initiation of life-saving treatment, emergency physicians need a solid understanding of the pathophysiology, clinical presentation, laboratory workup, and treatment. Laboratory assays for these compounds are send-out tests in most hospitals and are therefore of no value in the acute clinical setting
Teaching Approach to Tachycardia and Bradycardia in Medical Students: A Quasi-Experimental Study to Compare Team-Based Learning and Lecture Method
Get PDFIntroduction: It is crucial to find ways to improve the durability of learning in clinical units. One of these methods is team-based learning (TBL). This learning method is active and students must study the subject before the session. Objective: This study examined TBL and compared it with conventional lecture method (LM) in an educational approach to tachycardia and bradycardia in adult patients. Method: In this quasi-experimental study, medical students (interns) were randomly divided into two groups of TBL and LM. Two faculty members of emergency medicine were responsible for teaching in both LM and TBL groups. Data collection tool was a checklist including demographic information and a researcher-made questionnaire for assessing knowledge about tachycardia and bradycardia in adult patients. Two sets of questions with the same difficulty were designed to be used for pre-test and post-test. Both groups completed pre-test and post-test, which were finally compared. Results: Totally 65 medical interns with the mean age of 28.75±2.26 years were participated of whom 37 persons (56.9%) were female. There was no significant difference in terms of the mean age of the participants in the two groups (p=0.914). The two groups were also matched in terms of male/female ratio (p=0.416). There was no significant difference between TBL and LM groups regarding pre-test score (p=0.935). However, they were significantly different in post-test (p=0.001) when TBL group scored higher than the LM group. Conclusion: Based on the research findings, it seems that TBL was more effective than LM on students' understanding of approach to tachycardia and bradycardia in adult patients
Chronic Back Pain Diagnosed as Giant Osteoid Osteoma of the Thoracic Vertebra: A Case Report
Get PDFIntroduction: Diagnosing an osteoid osteoma as a benign tumor can be challenging owing to its different presentation patterns, ambiguous radiological findings and unusual sites of involvement. The present case report involves a 30-year-old female patient with a large osteoid osteoma of the thoracic vertebrae as an uncommon site of its presentation. Case Presentation: The patient presented with a one-year history of progressive right-sided upper back and interscapular pains. She was identified as a candidate for surgery using the whole body bone scan and a multiple detector computed tomography (MDCT) scan. A large 25-mm osteoid osteoma of the lamina of the third thoracic vertebra (T3) was also diagnosed through histopathology. Conclusion: As a potential cause of persistent back pain in young adults, an osteoid osteoma may be easily missed by routine radiographs. The CT scan is an effective tool in the investigation of the size and location of this tumor. Surgical excision can also be used for treating spinal lesions
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
A Review on the Etiology and Management of Pediatric Traumatic Spinal Cord Injuries
Get PDFContext: Pediatric traumatic spinal cord injury (SCI) is an uncommon presentation in the emergency department. Severe injuries are associated with devastating outcomes and complications, resulting in high costs to both the society and the economic system. Evidence acquisition: The data on pediatric traumatic spinal cord injuries has been narratively reviewed. Results: Pediatric SCI is a life-threatening emergency leading to serious outcomes and high mortality in children if not managed promptly. Pediatric SCI can impose many challenges to neurosurgeons and caregivers because of the lack of large studies with high evidence level and specific guidelines in terms of diagnosis, initial management and of in-hospital treatment options. Several novel potential treatment options for SCI have been developed and are currently under investigation. However, research studies into this field have been limited by the ethical and methodological challenges. Conclusion: Future research is needed to investigate the safety and efficacy of the recent uprising neurodegenerative techniques in SCI population. Owing to the current limitations, there is a need to develop novel trial methodologies that can overcome the current methodological and ethical limitations
Development and Implementation of Integrated Road Traffic Injuries Surveillance – India (IRIS-India): A Protocol
Get PDFRoad traffic accidents stand as one of the leading causes of mortality and morbidity across the globe. The reasons for the high burden of road traffic injuries (RTIs) in developing countries are increasing in the number of motor vehicles, poor enforcement of traffic safety regulations, inadequacy of health infrastructure and poor transport facility. However, the systematic collection of road traffic data is not well developed in many developing countries including India and under-reporting of RTIs and deaths are common. Hence, surveillance of RTIs is recommended to assess the burden, to identify high-risk groups, to establish an association with probable risk factors and to plan interventions to control the RTIs. The broad objective of this study is to establish an electronic-based comprehensive and integrated RTI surveillance system, to assess the burden of RTIs, its risk factors and outcomes across rural and urban settings in India. This study with the support of the Indian Council of Medical Research (ICMR) is progressing in three cities (Chennai, Delhi and Jaipur) and two rural areas (Chittoor and Tehri-Garhwal). At each centre, major sources of data can be categorized under two categories including health facilities and community. In urban areas, one trauma centre, one private hospital and a community of 10000-population are included in the study. In rural areas, a district hospital, a private nursing home and two sub-centres areas of different primary health centres at each site are included for the surveillance. Passive surveillance is done at the trauma centres/district hospitals, while active surveillance is done in private hospitals/nursing homes, sub-centres and communities. Before establishing the surveillance system, situational analysis has been undertaken. Surveillance-related software was developed during the preparatory stage. This electronic surveillance platform allowed to gather data electronically across multiple sites. This internet-enabled surveillance platform has several modules to capture and analyse the data. The present study provides a model of surveillance including both passive and active surveillance to cover maximum number of RTIs. This study further provides the first comprehensive epidemiology of RTIs. The results of these studies will contribute to the setting of research and investment priorities to tackle the burden of RTIs
The Effect of Language Barrier and Non-professional Interpreters on the Accuracy of Patient-physician Communication in Emergency department
Get PDFIntroduction: Patients’ relatives commonly play the role of interpreters in medical interviews. These non-professional interpreters are prone to potentially-dangerous translation errors. Objective: The present study was conducted to evaluate these errors in the emergency department (ED). Method: Twenty interviews with Azeri patients were recorded. They were unable of speaking Persian and therefore accompanied by a relative as a Persian interpreter. These records were presented to two physicians as native Azeri speakers to determine the clinical importance of the interpreters' errors according to their medical expertise. Results: The total omission and addition errors observed in Azeri to Persian translation were significantly more than in Persian to Azeri translation, while mistranslation errors were almost the same. The relatives with higher levels of education made fewer errors, and those living with the patients made significantly more addition errors. Conclusion: Non-professional interpreters cannot effectively facilitate patient-physician communication, as their translation is error-prone, especially in terms of translating their native language into official languages. These errors can have important clinical ramifications
Validity of Triage Performed by Nurses Educated by Train-of-Trainer Workshop Participants; a Cross-sectional Study for Assessment of Cascade Training System
Get PDFIntroduction: In 2010, a national triage train-of-trainer (TOT) workshop was held in Tehran, Iran. Objective: The present study aimed to assess the validity of the triage performed by the nurses educated by those who participated in TOT workshop. Method: This cross-sectional study was carried out in 6 teaching hospitals from 4 universities in Iran. Inter-rater and intra-rater reliability of performed triage by participations was measured. Thirteen nurses were randomly selected. Thereafter, at the end of each working shift, patient data recorded in the daily data registry forms were collected. Then, duration of hospital stay, number of cases admitted to general wards or intensive care units, number of cases discharged from the ED within 12 hours and mortality rate were compared with the triage level determined by the nurse. Results: In total, 30 nurses with a mean age of 28.4 ± 3.7 years were enrolled. In this study, 1491 triage cases (61.6% male) were evaluated, of which 4.2% were triaged as level 1, 18.3% as level 2, 37.1% as level 3, 20.4% as level 4 and 20.0% as level 5. The following outcome was observed: 3.64% were discharged, 6.29% were hospitalized, 3% died and 2.3% were discharged against medical advice without completing treatment. The correlation of determined triage level and patients’ duration of hospitalization was significant based on one-way ANOVA test (p = 0.000). The outcome of the patients significantly correlated with the level of triage determined by the study nurses (p = 0.000). Conclusion: Based on the findings, it appears that triage performed by the study nurses educated by those who participated in TOT workshop through cascade training system had perfect validity
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
The Role of Ultrasonography in Patients Referring to the Emergency Department with Acute Abdominal Pain
Get PDFContext: Acute abdominal pain is a common clinical problem in emergency and non-emergency cases accounting for 5 to 10% of all referrals to the emergency department. Studies have indicated that these widely differentiated diagnoses are common to these complaints. Considering the high prevalence of this complaint in the patients and the wide range of its differential diagnosis, this review study was designed and evaluated aiming at investigating the causes of acute abdominal pain with a focus on assessing the position of ultrasound as a diagnostic tool in the emergency department. Evidence acquisition: This article was conducted as a narrative review of 106 articles from 2005 through 2019. By comparing them, a comprehensive review of ultrasonographic status was conducted in patients with acute abdominal pain referring to the emergency department. Results: In this review study, we attempted to use the articles of the clinical approach, the required laboratory tests, the disadvantages and advantages of each imaging technique, the differential diagnosis for acute abdominal pain according to the location of the pain, and the position of ultrasound as a diagnostic aid tool. Eventually, the proposed protrusion will be considered in dealing with a patient with acute abdominal pain. Conclusion: Regarding the wide range of causes providing multiple differential diagnosis, as well as the limited time of the health team in the emergency department for diagnostic and therapeutic measures, particularly in time-sensitive clinical conditions, ultrasound offered by emergency medicine specialists as a diagnostic aid is considered to improve the overall diagnosis and treatment of patients, thereby reducing complications