Frontiers in Emergency Medicine (E-Journal)
Not a member yet
430 research outputs found
Sort by
The diagnostic value of the field assessment stroke triage for emergency destination tool in identifying the obstruction of large cerebral vessels; a systematic review and meta-analysis
Get PDFObjective: In this study, we investigate the diagnostic value of the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) tool in the diagnosis of large vessels occlusion (LVO) in a systematic review and meta-analysis. Methods: We conducted a search in Medline (PubMed), Embase, Scopus and Web of Science databases until the 21st of September 2022, as well as a manual search in Google and Google scholar to find related articles. Studies of diagnostic value in adult population were included. Screening, data collection and quality control of articles were done by two independent researchers. The data were entered and analyzed in STATA 17.0 statistical program. Results: The data from 30 articles were entered. The best cut-off points for FAST-ED were 3 or 4. The sensitivity and specificity of FAST-ED at cut-off points 3 were 0.77 (95% CI: 0.73-0.80) and 0.76 (95% CI: 0.72-0.80), respectively. These values for cut-off point 4 were 0.72 (95% CI: 0.65-0.78) and 0.79 (95% CI: 0.75-0.82), respectively. Meta-regression showed that the sensitivity and specificity of FAST-ED performed by a neurologist was more accurate compared to emergency physician (p for sensitivity=0.01; p for specificity<0.001) and emergency medical technicians (p for sensitivity=0.03; p for specificity<0.001). Finally, it was found that the sensitivity of FAST-ED performed by the emergency physician and the emergency medical technician has no statistically significant difference (p=0.76). However, the specificity of FAST-ED reported by the emergency physician is significantly higher (p<0.001). The false negative rate of this tool at cut-off points 3 and 4 is 22.5% and 28.8%, respectively. Conclusion: Although FAST-ED has an acceptable sensitivity in identifying LVO, its false negative rate varies between 22.5% and 28.8%. A percentage this high is unacceptable for a screening tool to aide in the diagnosis of strokes considering it has a high rate or morbidity and mortality. Therefore, it is recommended to use another diagnostic tool for the stroke screening
Emergency department management for an unusual case of penile entrapment and strangulation
Get PDFA 11-year-old boy was seen at our pediatric emergency department (PED) for evaluation of a swollen and painful penis. He had placed a glass ring over his penis fourteen days prior. This resulted in straining with micturition and a fleshy circumferential non healing wound at the base of the penis with serosanguinous discharge. The glass ring eroded into the deep subcutaneous layer of the skin at the base of the penis. The distal penis was swollen and tender with no changes in skin color, texture or blurring of sensation. The glans was viable with appropriate capillary refill. Urine stream was unaffected, and the amount of serosanguinous discharge was not related to the act of voiding. Emergency measures were conducted including administration of analgesia, antiemetics, active immunization against tetanus, systemic antibiotic therapy (cefazolin), and urology consultation. Due to extensive damage, urology deferred ring removal in the PED and recommended removal in the operating room to control the probable damages better, post removal of ring. The patient was transferred as our facility did not have an inpatient unit for post operative management. The ring was successfully removed using a bone cutter under general anesthesia. Surgical exploration revealed minimal erosion into the cavernosal bodies without any injuries to the dorsal veins, dorsal and deep artery, and nerves. Intra-op cystoscopy showed no injuries to the urethra. Primary closure was done circumferentially in two layers (Buck’s fascia and skin) with an absorbable vicryl 5-0 interrupted suture, followed by pressure bandage. The case was presented to a social worker considering the clinical features of the case. The social service experts and providing physicians were reassured there was no concerns for child abuse, sexual abuse, neglect, behavioral or psychiatric disorders. The patient was discharged with Bactrim and analgesics for one week after he was able to void independently. One month follow up at the urology clinic revealed that the patient had good skin preservation, wound healing, and micturition. The patient had no difficulties with anxiety, depression, or post-traumatic stress at his follow up appointments with a behavioral health therapist
Reviewing brachial plexus injury in a trauma registry center
Get PDFDear editor
We read with interest Abdolrazaghi and his colleague’s paper entitled ‘’ Brachial plexus injury following blunt trauma; an anatomical variation in electrodiagnostic findings’’ and enjoyed it a lot. They presented a brachial plexus injury (BPI) case, which was rare in clinical practice because blunt traumas did not commonly cause BPI. There is ample evidence that most cases are men and adolescents aged 15 to 25 years, and the main mechanism of injury (70%) is motor vehicle accidents. As BPI is increasing, we will provide some epidemiologic and clinical characteristics of our cases registered at Sina Hospital, affiliated with the National Trauma Registry of Iran (NTRI). The Sina Trauma and Surgery Research Center launched the NTRI in 2016 and first recorded the related data from Sina Hospital. As the registry expanded, the NTRI included some other Iranian hospitals from different cities in the next step. The inclusion criteria were discussed elsewhere. We have registered 10 cases of BPI since 2016 at Sina Hospital. All of them were men, ranging from 19 to 45 years. The cause of injury was cut/stab in nine and road traffic accidents in one patient; seven were intentional, and most were due to interpersonal violence. Five of the injuries happened outdoors, three cases in commercial and service departments, and two at homes. Furthermore, the median injury severity score (ISS) was 5.0 (IQR=1). All of the patients had surgical operations. No death or need for ventilators was reported. Only one patient needed intensive care unit (ICU) admission and stayed for three days in the ward. We hope this information can be helpful for the Frontiers in Emergency Medicine’s readers to know more about BPI and can compare similarities and differences between our cases and the others included in the literature
Does emergency medicine clerkship change students' misconceptions towards this specialty? Pre- and post-clerkship perceptions
Get PDFObjective: This study aims to understand students' skills based on their self-assessment and their perceptions regarding emergency medicine (EM) physicians, EM patients, and choosing EM as a future career. Methods: This study employed prospective observational design. It was conducted from 2 October to 2 November 2022 in Saudi Arabia. The study participants were senior medical students at King Faisal University. Senior students who finished a four-week EM rotation were involved as post-cases, and senior students who had not finished their EM rotation were involved as pre-cases. An online survey was administrated to all students who met out criteria. Results: A total of 161 students were included in the study; 65.2% had not yet done their EM clerkship, while 34.8% had completed their EM clerkship. Among them, 48.4% were male, and 51.6% were female. On average, post-EM clerkship students showed greater confidence in their skills of conducting an initial assessment of a patient (p=0.027), developing a management plan (p=0.007), explaining the principles of EM to others (p<0.001), presenting patient cases formally (p=0.049), interpreting electrocardiogram (p=0.006), and applying medical resuscitation (p=0.041). No significant differences were found between the average confidence in the skills and abilities of male and female students. Post-EM clerkship and male students were more likely to choose EM as a career when compared with pre-EM clerkship (p<0.001) and female students (p=0.006). Conclusion: It seems that, after completing a four-week rotation, students exhibited significant advances in knowledge, illness management, and procedural skills. It is likely that the EM clerkship significantly improved students' perceptions of the EM specialty
Psychological problems and associated factors during COVID-19 pandemic in Ethiopia
Get PDFObjective: Psychological problems like depression, anxiety, and stress are common in the general population and they have a negative impact on the well-being of the community as well as the country. Pandemic diseases like COVID-19 increase the prevalence of psychological problems in the community. Studying psychological problems and associated factors in the community is very crucial for community mental health management. However, evidence is scarce in Ethiopia. Therefore, this study aimed to assess the prevalence of psychological problems and factors in the community during the COVID-19 pandemic in Shashemene Town, Oromia, Ethiopia. Methods: A community-based cross-sectional study was conducted from February 01,2012 to February 28, 2021. A structured, pretested, and interviewer-administered questionnaire was used to collect data from 889 study participants selected through a simple random sampling technique. The data was collected using the depression, anxiety, and stress scale (DASS-21) questionnaire and analyzed using SPSS version 25.0. Bivariable and multivariable logistic regression was done to determine factors associated with DAS. Adjusted odds ratio with their 95% confidence intervals were calculated to identify the presence and strength of an association, while statistical significance was reported at P<0.05. Results: The prevalence of psychological problems was 96.6% [95% Cl: 95.9,98.1]. The overall prevalence of depression and anxiety were 30% and 43.5% respectively. Having COVID-19 symptoms in the past two weeks before the survey (AOR=0.34; 95% Cl: 0.15,0.77) and having known medical problems (AOR=0.28; 95% Cl: 0.13,0.59) were factors significantly associated with a psychological problem in response to COVID-19 pandemic. Conclusion: The prevalence of psychological problems in response to the COVID-19 pandemic infection was very high in the study area. It needs immediate action to alleviate this psychological problem crisis in the community
The crisis, disasters and catastrophes afflicting Yemen and its people
Get PDFIt would be inaccurate to state that Yemen’s difficulties began with the current civil war in September of 2014. While the war brought about its own list of insurmountable tribulations, it also exacerbated already present disasters. This article explores the many dynamics that have led to what has been referred to as the world’s worst humanitarian crisis (1). These include war, internal displacement, economic disaster, healthcare collapse, outbreaks in refugee camps, vaccination concerns, malnutrition, food insecurity, water sparsity, and infectious disease catastrophes. Along with accurate depictions of what is happening on the ground, this article suggests a few potential solutions worth investigating further, ranging from national and international efforts. With an ever-changing climate, this article serves to provide the most up to date impression of the current crisis and disasters
Intraoperative administration of methadone reduced postoperative pain and opioid consumption following cadaveric renal transplantation: a randomized controlled trial
Get PDFObjective: In this randomized clinical trial study, the impact of prophylactic administration of methadone during surgery on postoperative pain and analgesic requirement following cadaveric renal transplantation was assessed. Methods: Ninety patients were randomized to receive either methadone 0.15 mg/kg or 0.15mg/kg morphine after tracheal intubation. Both groups were treated with acetaminophen 1 gr before extubation. Protocol of anesthesia was the same in both groups and the anesthetist was blinded to the study groups. The primary outcome was defined as total opioid consumption during recovery and first day after surgery. Secondary outcomes were pain scores and level of patients’ sedation during the recovery period and first postoperative day as well as opioid-related complications. Results: Data of eighty-five eligible patients were analyzed. The mean pain and sedation scores were lower in the methadone group compared to the morphine group during recovery and the first 24 hours after surgery. The time of first rescue analgesic requirement was later in the methadone group (10.4 vs 6.3 hours). Also, postoperative morphine consumption was significantly less in the methadone group compared to patients receiving morphine (3.5 vs. 6.9 mg; P < 0.001). Conclusion: Intraoperative administration of methadone decreased postoperative pain scores, reduced opioid consumption after surgery and improved level of sedation during the first 24 hours after surgery
Diagnostic accuracy of inverted grayscale mode in radiographs: a systematic review and meta-analysis
Get PDFX-rays are routinely utilized for different diagnostic purposes but there is always the risk of an inaccurate diagnosis. This systematic review was designed to investigate whether inverse grayscale mode increased diagnostic accuracy. From inception to February 2022, MEDLINE, Embase, Scopus, Web of Science, and CENTRAL were searched for studies comparing grayscale inversion diagnostic accuracy to the conventional method. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2) tool. Eighteen studies were included with an overall patient population of 1704. The number of studies investigating each lesion are as follows, lung masses: 13, pneumothoraces: 4, bony lesions: 3, interstitial lung diseases: 3, orthopedic studies: 2, bullous lung disease: 1, pleural effusion: 1, urinary calculus: 1, and large vascular occlusion: 1. Two studies had an overall moderate risk of bias and the remainders had low risk. The combined mode, featuring the conventional mode with the addition of the inverse grayscale, demonstrated better performance or insignificant difference in comparison with the conventional mode in all studies except one, which showed lower sensitivity in detecting pulmonary nodules. Also, meta-analysis of 250 patients in four pulmonary nodule studies showed better area under the ROC curve (AUC) of inverse mode (0.83, 95% CI: 0.75,0.90) in comparison with conventional mode (0.80, 95% CI: 0.72,0.88). Application of inverse mode when using radiography for detection of pulmonary nodules might improve diagnostic accuracy. Also, the inverse/combined mode showed better performance for lesions other than pulmonary nodule in some studies. However, there was insufficient evidence to draw a consistent conclusion
Effect of vitamin C on coagulation factors and endothelium function in patients with sepsis
Get PDFObjective: Sepsis is one of the leading causes of mortality in intensive care unit. Despite advances in its management, its mortality rate remains high. Recently, high dose of vitamin C in sepsis treatment has attracted the attention of researchers. In the current study, the impacts of 25 mg/kg of vitamin C every 6 hours as a bolus for 3 days were assessed in septic patients in intensive care unit (ICU). Methods: This was a prospective cohort study that was performed on adult patients with diagnosis of sepsis. Patients were assigned to control group (administration of placebo) or intervention group, i.e., those receiving a 25 mg/kg dose of vitamin C every 6 hours as a bolus for 3 days. Clinical data were recorded before and after the experiment. Also, plasma levels of antithrombin III, syndecan-1, fibrin degradation product (FDP), D-dimer, and C-reactive protein (CRP) were measured at 0, 24, 48, and 72 hours. Results: In septic patients receiving vitamin C, a significant upregulation of antithrombin III and significant decreases in the levels of syndecan-1 (at 48 hours; P-value=0.046 and at 72 hours; P-value=0.007), D-dimer and CRP were observed compared to the control. Reductions in sequential organ failure assessment (SOFA) score, in-hospital mortality, and ICU length of stay were seen in septic patients receiving vitamin C. Conclusion: Prescribing high dose of intravenous vitamin C can reduce the mortality of sepsis patients and reduce the length of stay in the ICU
Comparison of three methods of cardiopulmonary resuscitation training in terms of improving the skills of emergency medical technicians; a pretest–posttest study
Get PDFObjective: There are several methods for teaching emergency medical technicians (EMTs) cardiopulmonary resuscitation (CPR); but choosing the most effective option depends on several factors. This study was designed to compare the effectiveness of three different CPR training methods, including traditional, peer, and virtual methods, for EMTs. Methods: This study was a pretest-posttest study, which was performed from March to September 2020 in Tehran, Iran. Participants were EMTs working in the operations department of the EMS center. In the first step, for the pretest evaluation, an Objective Structured Clinical Evaluation (OSCE) exam was held for all participants. Thereafter, the subjects were divided into 3 groups including master-centered traditional collective education, peer training, and virtual courses. Then the participants underwent educational intervention and after that, another OSCE exam was held about 1 week after the sessions to evaluate the effect of interventions. Results: At first, 156 volunteers entered the study and participated in the pretest OSCE exam, of which 125 volunteers participated in the posttest OSCE exam. Of these, 51 volunteers participated in the peer education group, 35 volunteers were in the virtual education group, and 39 volunteers in the classic education group. The mean score of the participants in all 4 assessed skills, including endotracheal intubation, laryngeal mask airway insertion, basic life support, and advanced life support, increased significantly after educational intervention in all 3 groups (p<0.05); and this increase was higher in the virtual group compared to the other two groups (p<0.05). Conclusion: We found that virtual training was more effective than classic and peer training for CPR training of EMTs