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Emergency Practice and Trauma - Volume:4 Issue: 1, Winter - Spring 2018

Journal of Emergency Practice and Trauma
Volume:4 Issue: 1, Winter - Spring 2018

  • تاریخ انتشار: 1396/10/13
  • تعداد عناوین: 12
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  • Luis Rafael Moscote-Salazar *, Daniel A. Godoy, Amit Agrawal, Andres M. Rubiano Pages 1-2
    Trauma patients are at high risk of cervical and associated injuries. The standard protocol includes immobilization of the cervical spine in a polytrauma as it will help to prevent spinal injuries in the prehospital settings. Hard cervical collar (or alternatives) is routinely used until the cervical spine clearance is obtained .
    In patients with traumatic brain injury avoiding any kind of maneuver may lead to increased intracranial pressure.
    Keywords: Cervical collars, Intracranial pressure, Head neurotrauma
  • Somaye Younesian, Reza Shirvani, Ali Tabatabaey* Pages 3-8
    Objective
    Patient satisfaction (PS) is a major quality assessment index for the emergency department (ED) which affects patient safety, litigation, reimbursements, and consumer satisfaction. In this study we aimed to recognize the factors affecting PS in our center.
    Method
    Random shifts during a week were selected and all patients disposed from the ED were asked to fill out a revised and validated Persian version of the Press-Ganey questionnaire with the help of a research assistant. Results were analyzed using a linear regression model by SPSS software version 21.
    Results
    Findings reaffirmed some of the factors previously described. These included longer door to treatment area times having a negative effect on satisfaction (P
    Conclusion
    Cultural expectations may have an important effect on PS. Thus, every institution should determine and alter the expectations most relevant to them.
    Keywords: Emergency department, Patient satisfaction, Waiting times, Gender
  • Farzad Rahmani, Pegah Sepehri Majd, Haniyeh Ebrahimi Bakhtavar, Farnaz Rahmani * Pages 9-13
    Objective
    Triage refers to the evaluation and categorization of patients for better management to deliver services. A good triage system should be able to accurately specify the patients who require urgent care. Thus, this study aimed to evaluate the accuracy of emergency nurses in correct triage using Emergency Severity Index (ESI) triage.
    Methods
    In this descriptive cross-sectional study 750 patients, who referred to the emergency department (ED) of Sina teaching hospital, participated from 23 July to 22 August in 2015. Participants were selected using convenience sampling method. The patients’ triage level was determined by physicians and nurses separately and the results were compared. To define the level of agreement between two groups (inter-rater agreement), the kappa index was evaluated. Data were analyzed using SPSS version 17.
    Results
    Among 750 patients, 577 patients (76.9%) were classified in correct triage group, 90 patients (12%) in undertriage group and 83 patients (11.1%) in overtriage group. Kappa agreement coefficient between the ESI triage level of physicians and nurses was 0.659 (95% CI: 0.646-0.667). There was statistically significant difference between the triage level of physicians and nurses (P
    Conclusion
    This study showed that there was moderate agreement between the triages of physicians and nurses. It seems that improving nurses’ skills and knowledge might increase the accuracy of emergency nurses in patients’ correct triage. Therefore, planning programs based on training correct triage for emergency nurses is strongly suggested.
    Keywords: Emergency department, Triage, nurses, Physicians
  • Alireza Ala, Farzad Rahmani *, Reza Aslzad, Zahra Parsian Pages 14-17
    Objective
    On account of the widespread use of nuclear energy in different fields, nuclear accidents and disasters have been on a rise. Thus, it is crucial for medical staff especially emergency department personnel to be aware of the nature of these accidents. This study was designed to evaluate the effect of training on the knowledge of physicians and nurses regarding nuclear disasters.
    Methods
    This pre-and post-intervention study was conducted on 97 emergency department personnel including physicians and nurses of educational hospitals in Tabriz University of Medical Sciences. Educational classes and training about nuclear disasters and managing these events were held. A standard questionnaire was used to evaluate the knowledge before and after training, and the effect of education on personnel’s knowledge.
    Results
    Our participants included 41 males and 56 females. The mean age was 32.88 years. The mean score of participants before and after the class was 4.03 ± 1.54 and 7.93 ± 1.55 respectively; which showed a statistically significant difference (P
    Conclusion
    This study showed that the knowledge of medical staff about nuclear disasters is low and educational classes are necessary to increase their knowledge.
    Keywords: Disasters, Nuclear accidents, Education, Emergency Service, Hospital
  • Ali Reza Shafiee Kandjani, Seyed Gholamreza Noorazar *, Saeed Aslanabadi, Nasim Rashedi, Mehrnaz Dadkhah, Mohsen Jafarzadeh Gharehziaaddin Pages 18-23
    Objective

    Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent and impairing levels of inattention, impulsivity and hyperactivity. Evidence shows that adolescents with ADHD are more exposed to trauma. This study aimed to investigate the relationship between ADHD symptom severity and trauma severity.

    Methods

    In this descriptive correlational study, the study population included traumatic adolescents aged 12-18 years referred to Shohada hospital in Tabriz, Iran in 2016. Among this population, 91 subjects were selected. In order to exclude subjects with other psychiatric disorders, a psychiatrist performed clinical interviews with them. In this regard, the short form of Conner’s Comprehensive Behavior Rating Scales Revised Edition (CBRS-R) and Pediatric Trauma Scale were used. For data analysis, Pearson correlation coefficient and independent t test were applied. Data were analyzed using SPSS software version 22.

    Results

    There was a significant positive relationship between trauma severity and ADHD score, hyperactivity, and oppositional/Impulsivity (P

    Conclusion

    Traumas have significant effects on economic and humanistic aspects of life in modern era. Our findings showed that there was a statistically significant relationship between hyperactivity-inattention and trauma intensity in adolescents. Therefore, to prevent traumatic events, ADHD screening at schools is suggested. By the same token, informing parents through mass media can help reduce the consequences of inattention/ hyperactivity disorder in the society.

    Keywords: Hyperactivity, Trauma severity, Attention deficit, Impulsivity, ADHD
  • Farhad Heydari, Shiva Samsam Shariat *, Saeed Majidinejad, Babak Masoumi Pages 24-28
    Objective
    The aim of this study was to use ultrasonography for the diagnosis and confirmation of Pulled Elbow treatment.
    Methods
    This descriptive cross-sectional study initiated in 2014 and continued until 2015. We used simple sampling method and recruited 60 samples among patients aged 4 months to 6 years. The apparatus used in this study was an ultrasonogram with transducer 12 MHz probe. Ultrasound evaluation of both hands was undertaken and after reduction, the physical examination was performed to confirm the diagnosis made by ultrasonography. Then, the results were recorded by a physician in a checklist and entered into SPSS software (version 20) for further analysis.
    Results
    In this study, 60 children with pulled elbow injuries were studied. Of these, 27 patients (45%) were girls (female) and 33 (55%) were boys (male). This indicates the higher incidence of injury among males than females. The highest incidence of pulled elbow injury was observed in children aged 3 (15%). The accuracy of ultrasonography method for the confirmation of treatment was reported to be 92%.
    Conclusion
    This study aimed to confirm the considered therapeutic method based on the result of ultrasonography performed after the treatment. Accordingly, the sensitivity and specificity of ultrasonography in confirming the considered therapeutic method for the treatment of pulled elbow was obtained higher than 90%.
    Keywords: Ultrasonography, X-ray, Pulled elbow injury
  • Morteza Talebi Doluee, Maryam Salehi, Azadeh Mahmoudi Gharaee*, Majid Jalalyazdi, Hamidreza Reihani Pages 29-33
    Objective
    Septic shock is a response to infection and tissue hypoperfusion which does not respond to fluid therapy and eventually leads to organ dysfunction. Aggressive treatment of a broad-spectrum antimicrobial and supportive measures are the cornerstones of successful treatment. In addition to the main treatment, there are adjunctive therapies. Steroids are one of the treatments which have been studied in the management of refractory septic shock. Despite numerous studies on the role of steroids in the mortality of severe sepsis and septic shock, still lots of controversies exist. These conflicts are often about the steroid dose and duration of administration.
    Methods
    This was a prospective, randomized-controlled, two-group assignment study. Patients referred to Imam Reza (AS) hospital in Mashhad who had refractory septic shock criteria were randomly divided into two groups: 80 patients were included in each group. After obtaining the baseline cortisol level and cosyntropin test, one group was treated with intravenous hydrocortisone, and the other group was treated with placebo. The response to hydrocortisone, the return of shock duration, and mortality at 28 days were investigated. The data were analyzed using SPSS version 16. For the normally distributed variables, a t test was used for comparisons. Concerning qualitative variables, the chi-square test or Fisher exact test were applied accordingly.
    Results
    The return of shock duration and mortality in intervention group patients was more than control group, but it was not statistically significant.
    Conclusion
    Despite numerous studies in this field, there are various outcomes (mortality rate, rate of return of shock, time of return of shock). These differences can be attributed to high degree of heterogeneity. Perhaps considering the underlying disease and more differentiation could change the return of shock and mortality rate.
    Keywords: Hydrocortisone, Septic shock, Adrenal insufficiency, cortisol
  • Payman Moharamzadeh, Kavous Shahsavari Nia, Mohammadhossein Somi, Mahboub Pouraghaei, Akbar Fadaeihaghi, Farzad Rahmani * Pages 34-38
    Objective
    In recent years, there has been a great attention concerning red blood cell distribution width (RDW) in clinical decisions as well as determining the severity of diseases. This study was conducted to evaluate the primary level of RDW to predict hospital mortality in pancreatitis.
    Methods
    This was a descriptive analytical study performed on 100 patients with acute pancreatitis in the emergency department of Imam Reza hospital of Tabriz University of Medical Sciences. In this study, the primary level of RDW in patients with acute pancreatitis presenting to the emergency ward was collected and after patients’ admission we followed them. Also, the admission outcome (mortality or discharge) of patients was registered, and finally we evaluated the predictive value of RDW in determining the patient’s outcome in hospital.
    Results
    In our study, 47 patients were male, and 53 patients were female. Mean RDW in patients was 13.82 ± 1.69. Five patients died during the study. Mean RDW in dead patients and other patients was 16.44 ± 4.22 and 13.68 ± 1.37, respectively (P
    Conclusion
    Based on our study results, the initial RDW level is an independent factor for predicting in-hospital mortality in pancreatitis but not for determining the need for surgery or admission to the intensive care unit (ICU).
    Keywords: Pancreatitis, Mortality, prognosis
  • Seyyed Hosein Montazer, Behzad Feizzadeh, Farzad Bozorgi, Seyed Mohammad Hosseininejad, Ayyoub Barzegarnezhad, Iraj Golikatir, Fatemeh Jahanian, Hasan Motamed, Hamed Aminiahidashti * Pages 39-43
    Objective
    The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard.
    Methods
    This double blind clinical trial was conducted on >18 years old renal colic patients in need of pain management in emergency department. Pain severity was recorded as 15, 30, and 60 minutes before injection, and 120 minutes after injection. In addition, side effects were compared between IV acetaminophen and morphine sulfate groups using SPSS version 16.
    Results
    A total of 355 patients were randomly allocated to one of the treatment groups. There were no significant differences between the two groups regarding baseline characteristic of participants. There was no significant difference in the pain intensity of the groups; 15 (P = 0.13) and 30 (P = 0.15) minutes after treatment. Although, the difference in pain severity was statistically significant between the two groups; 60 (P = 0.02) and 120 (P = 0.003) minutes after the infusion. This was not clinically important. The prevalence of side effects in morphine group was higher than the acetaminophen group (RR: 2.14, 95% CI: 1.53-2.98, P
    Conclusion
    Based on the findings, IV morphine sulfate and acetaminophen had equal effectiveness regarding acute renal colic pain management, but considering the significantly higher frequency of side effects, IV acetaminophen seems to be a more reasonable choice in this regard.
    Keywords: Renal colic, Morphine, Acetaminophen, Pain management, Emergency Service
  • Seyedhossein Ojaghihaghighi, Samad Shams Vahdati, Simin Taghavi, Aydin Rahimzade Jahandari, Pegah Sepehri Majd*, Mohammad Mirza-Aghazadeh-Attari Pages 44-47
    Objective
    Pregnancy is an important psychological and biological phenomenon in women’s life. Pregnancy has many complications jeopardizing the well-being of the mother and the child.
    Methods
    In this retrospective study, the data including demographic information, chief complaint, the initial diagnosis, referral decision, final diagnosis, hospitalization outcome and pregnancy outcomes were studied on 239 pregnant women admitted to the emergency departments of the general hospitals of East Azerbaijan province.
    Results
    The average age of patients was 27.54 years. The time period from the initial presentation to completely leave the emergency department was reported to be 3.66 hours on average. In this study, most patients (74.5%) did not have a history of abortion. Exploring the time of admission for all cases, most patients were admitted from 8 pm to 8 am (67.8%), and 32.2% were referred from 8 am to 8 pm. Concerning the time of pregnancy, 46.4% were at their second trimester of pregnancy. Most of the patients were admitted in cold seasons of the year. The most common chief compliant was abdominal pain with 32.2% frequency. In addition, the most frequent primary diagnoses were an acute abdomen and trauma at 25.5% and 14.2% respectively.
    Conclusion
    Abdominal pain and acute abdomen have the most frequency as the chief compliant and initial diagnosis especially during the second trimester of pregnancy. In this regard, appropriate training and skillful staff are needed to deal with the complaints and complications of abdominal pain. More than half of pregnant women referred to the emergency departments were hospitalized or admitted to the intensive care unit (ICU). This signals the necessity of adequate facilities to provide proper care for this group.
    Keywords: Pregnant women, Emergency Service, General hospitals
  • Mohit Kumar Arora *, Ela Madaan Pages 48-50
    Patellar fracture is a relatively uncommon fracture especially the vertical sagittal type. In cases of high energy trauma injury, it is usually associated with fracture of ipsilateral distal femur or proximal tibia. However, the combination of vertical sagittal fracture patella and ipsilateral fracture lateral condyle is very rare. This necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Open reduction and internal fixation is the treatment of choice in managing these types of injuries. This should be followed by gradual mobilization of the affected knee joint. Weight bearing can be started once the fracture starts showing signs of union on X-rays. Literature search shows only one case report describing this pattern. The aim of this case report is to highlight the rarity of this injury, to understand the injury mechanism and surgical approach used for these injuries. The knowledge of this combination will help us manage these injuries so that good functional outcome is achieved
    Keywords: Sagittal, Patella, Ipsilateral, Femoral condyle
  • Mustafa Bolatkale, Muhittin ., , Sever, Ula, Karao, Lu, Ahmet Cagdas Acara *, Mehtap Bulut Pages 51-52
    Statins are commonly used drugs in the treatment of hyperlipidemia (HL), despite some undesirable side effects. These range from mild symptoms such as myopathy, muscle weakness and myalgia to severe muscle weakness associated with chronic myopathy and acute renal failure (ARF) as a result of rhabdomyolysis. The most serious and deadly side effect of statins is rhabdomyolysis. The case presented here is of a patient with rhabdomyolysis due to treatment with the antihyperlipidemic drug, atorvastatin.
    Keywords: Rhabdomyolysis, Atorvastatin, Heart attack, Statin