Frontiers in Emergency Medicine (E-Journal)
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Bidirectional Ventricular Tachycardia in a Women with Dilated Cardiomyopathy: A Case Report
Get PDFIntroduction: Bidirectional ventricular tachycardia (BVT) is a rare arrhythmia characterized by QRS complexes with an axis in the frontal plane alternating polarity in the precordial leads and right bundle branch block (RBBB) morphology. To the best of our knowledge, there is no previous report in dilated cardiomyopathy or in the context of a probable peripartum cardiomyopathy. Case Presentation: A 26-year-old, 9-month female patient, with no significant past medical history (the patient denies medication intake, herbs like aconite, trouble during delivery, any heart issues or family history of sudden death or cardiomyopathies) who presents to the emergency room due to 11 days of dyspnea, exacerbated by daily activities, orthopnea, and paroxysmal nocturnal dyspnea. She presented with ventricular bigeminy and systolic dysfunction with left ventricular ejection fraction (LVEF) <20%. The patient later developed a stable ventricular tachycardia (VT) treated with amiodarone, which resulted in hemodynamic instability and BVT rhythm with VT paroxysms. Without the possibility of ablation, the use of high dose beta blockers and an implantable cardioverter defibrillator resulted in the same rhythm with a lower heart rate, better NYHA functional class, and less episodes of VTs. Conclusion: BVT is a rare type of tachycardia that can be present in dilated cardiomyopathy. In the absence of ablation capabilities, decreasing the heart rate with beta-blockers may reduce the rate of paroxysmal VTs
A Letter on “The Current Status of Genes and Genetic Testing in Emergency Medicine: A Narrative Review”
Get PDFOn August 25, 2019, you published an article titled “The Current Status of Genes and Genetic Testing in Emergency Medicine: A Narrative Review”. I recently read the article and want to both commend the authors for including information on Vascular Ehlers-Danlos Syndrome (vEDS) and expand upon the information provided. Thank you for publishing this article
Efficacy of Half-length vs. Standard-sized Short Arm splint in Soft Tissue Injuries of the Hand and Wrist: a Randomized Controlled Trial
Get PDFIntroduction: Hand and wrist soft tissue injuries are common orthopedic problems that are traditionally treated with short arm splint, which covers the forearm to 1 cm distal to the elbow crease. Objective: The present study was conducted to compare the treatment efficacy of traditional standard-size splint with half-length short arm splint. Method: In this randomized, controlled, clinical trial, patients with hand and wrist soft tissue injuries were randomly assigned to two groups. Group one received standard-sized short arm splints and the other group received half-length short arm splints. The swelling and pain scores were compared between the groups by the end of weeks one, two and three. Results: A total of 256 patients with a mean age of 36.96 ± 12.27 years were enrolled in this study, and 71.9% of them were male. No statistically significant differences were observed in terms of swelling between the two groups after one and two weeks (P=0.41, P=0.18). None of the patients had swelling after three weeks. No statistically significant differences were observed between the two groups in terms of the pain score after one, two and three weeks (P=0.47, P=0.29, P=0.92). Conclusion: In this study, half-length short arm splints were found to be as effective as standard short arm splints
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
A 62-year-old Man with Acute Dizziness, Nausea and Vomiting
Get PDFThe patient was a 62-year-old man presenting to the emergency department 6 hours after the onset of dizziness, nausea and vomiting. The patient complained of numbness of the right side of her body and reported swallowing problems. The initial examination showed the patient was alert and stable. The left side of her face was sweating while the right side was completely dry. The neurological examination revealed the patient was alert, and the right pupil was about 2 mm smaller than the left eye pupil, and both pupils responded to light. A paresis was observed in the right side of the face, tongue and uvula. Uvula was slightly deviated to the right. Other signs included hoarseness and swallowing impairment. The muscle strength of all four limbs was 5/5. Babinski reflex was downward on both sides. The patient could not sit by herself, and leaned to the right. The patient had a history of primary coronary intervention (PCI) and stent placement four years ago. She had smoked a pack of cigarettes for 40 years. She used nitrocontin, pearl, lisinopril, carvedilol and furosemide. Laboratory tests were normal. The first CT scan in the emergency department was normal. As a brain stem infarction was suspected, MRI was performed and revealed an infarct (Figure 1). The patient received neurology consultation and was discharged with stable vital signs and the daily order of aspirin and atorvastatin after five days. The patient was asked to have weekly follow-up visits
Use of Promethazine and Meperidine as Premedicants in Asthmatics before Initiation of Surgery: An Interim Report
Get PDFPatients with bronchial asthma usually land up for surgery and pose a significant challenge as far as their anesthetic management is concerned. Most of these patients either take medicines or else are in a comparatively controlled state. Different protocols have been suggested for such cases such as corticosteroids, long-term β2 agonists, leukotriene receptor antagonists and theophylline sustained-release preparations. 
Silymarin as a Promising Potential Therapeutic Agent for Treatment of Patients with Paraquat Poisoning: An Issue that Merits Further Research
Get PDFHaving an extremely toxic compound for humans and most animals, paraquat (PQ) is known as one of the most frequently used herbicides. Accordingly, PQ poisoning has been recognized as a serious medical problem across the world, with a severe case fatality rate (CFR). In this respect; accidental or intentional ingestion of PQ, even in a small amount, can be significantly associated with poor clinical prognosis and increased mortality. Moreover; inherent toxicity of PQ, absence of specific antidotes, as well as lack of effective treatments have been principally attributed to high fatality of PQ poisoning. Once PQ is ingested, it can be absorbed through skin and the digestive and respiratory system and often progresses to multi-organ failure, particularly the lungs as the main target. In this respect, PQ accumulates predominantly in the lungs and can lead to lung fibrosis, pneumonitis, and consequently respiratory failure and death. Given the nonexistence of specific and widely accepted guidelines for treatment of PQ poisoning, a range of conservative therapeutic modalities have been proposed and administered by clinicians to moderate PQ absorption and to prevent organ failure in these patients. In spite of this, PQ-induced mortality rate is high and disappointing
Approach to Acute Abdominal Pain: Practical Algorithms
Get PDFContext: Acute abdominal pain is one of the most common complaints of patients admitted to emergency units. This study aimed to propose a new approach to abdominal pain by designing a more structured diagnostic workup for physicians. Evidence acquisition: A comprehensive review of relevant articles and algorithms presented in books and websites was conducted. Approaches which were relevant to the study concept, were selected. Results: Seven algorithms were introduced with respect to the site of abdominal tenderness. The mainstay of these algorithms was differential diagnosis of the tenderness site. Conclusion: Based on the findings, the designed approach can prevent confusion among physicians and reduce requests for many unnecessary paraclinical tests, which delay the final diagnosis and impose unacceptable costs on patients and healthcare systems
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
Iranian Emergency Medical Service Response in Disaster; Report of three Earthquakes
Get PDFIntroduction: The earthquake is one of the most natural catastrophic crises that can cause a lot of casualties. Considering an earthquake-prone country, Iran is ranked as one of the world's most dangerous countries. Objective: In this article, we describe the actions taken by emergency medical service (EMS) after the earthquake in Kermanshah, Varzaghan, and Bam and compared the strengths and weaknesses of the emergency response program and the limitations and challenges of this system in dealing with these major crises. Method: This study is a cross-sectional study that compares some of the information and findings related to three earthquakes that occurred in Iran, including Bam, Varzaghan and Sarpol-e-Zahab earthquakes. The data reported in the present article is descriptive and is based on various independent sources such as National Emergency Operation Center, Local Emergency Operations Center (EOC), the EMS of the country, the World Health Organization, the United Nations, the statistics website, the Forensic Data website, the International Institute of Seismology and Earthquake Engineering, conferences and personal interviews. To ensure the credibility of the information, the authors reported data that had been verified by two or more sources. Results: The characteristics of the geographic area of the 3 earthquakes has been described. Post-earthquake response activities were described in details in subheadings including rapid warning and response, surge capacity plan, rapid response teams, emergency medical teams, increasing the capacity of health facilities, increasing transfer capacity, and handling, transportation and distribution of injuries. Conclusion: In the recent earthquake, had been occurred in Sarpol-e-Zahab, the health response of the country was largely satisfactory. The existence of structures such as EOC at various levels, the unified incident command system, emergency operations plan, and Medical Care Monitoring Center are among the most important reasons for satisfactory performance