davood farsi

Orthopedic procedures are one of the most common medical procedures in the emergency department (ED) and are also among the most painful procedures performed on the conscious patient. This study aimed to compare different doses of ketofol in procedural sedation and analgesia (PSA) in patients referred to the EDs.

In this double-blinded clinical trial, 296 patients aged 18 years or over who presented with the need for orthopedic procedures in the three academic EDs in 2020 were studied. After completing the written consent, the patients were randomly assigned to four treatment groups. Demographic information, underlying diseases, patients' physical condition, type of orthopedic injuries requiring intervention, and patients' vital signs were recorded in a checklist for each patient.

In this study, the mean age, gender, level of education, addiction, patients' physical condition, type of procedures performed, apnea, hypoventilation, bradycardia, hypotension, and agitation in all four treatment groups were not statistically different, but hallucination and hypoxia in group C (propofol 1 mg/kg plus ketamine 0.33 mg/kg) were much less than other groups; thus, oxygen administration was more common in other groups.

By testing different doses of ketamine, we concluded that doses of 1 mg and 0.5 mg were associated with more side effects. A dose of 0.33 mg of ketamine has fewer side effects while causing analgesia and sedation as in the above doses. A dose of 0.25 mg of ketamine increases thelikelihood of requiring subsequent doses. Therefore, it seems that 0.33 mg of ketamine is the best dose of choice.

Distal radius fractures are one of the most common upper extremity fractures, and their incidence continues to increase due to an aging population and an increase in osteoporosis. Various methods of analgesia for distal radius fractures have been described—including hematoma blocks and nerve blocks. Hematoma blocks are a simple and effective method of providing analgesia; nonetheless, their efficacy may be limited in some cases. On the other hand, nerve blocks provide more targeted analgesia and may be more effective in reducing pain during fracture reduction. This study aimed to compare the analgesic effectiveness of radial and median nerve blocks with hematoma blocks under ultrasound guidance in treating distal radius fractures. Also, this study aimed to compare the analgesia of radial and median nerve blocks with hematoma blocks under ultrasound guidance to reduce distal radius fractures.

In this prospective trial, patients with distal radius fractures referring to 2 academic centers were placed into 2 randomized groups, including hematoma block, and radial median block, both of which were ultrasound-guided. The patient's pain levels were measured and recorded based on the visual analog scale before the block, 5, 10, and 15 minutes after the block, at the start of reduction, during reduction, and 5, 10, and 15 minutes after reduction. Patient satisfaction and physician satisfaction rates were assessed, and side effects were also observed for 1 week. Quantitative variables were reported as mean ± standard deviation, and number and frequency percentages were reported for qualitative variables. The Student t test and the chi-square test were used on a case-by-case basis. The significance level was set at P ˂ 0.05.

In this study, 120 patients were included. The groups had no significant differences in pain reduction during the procedure. Analgesic medication was needed during the procedure for 17 patients; nerve blocks were applied for 6 patients, and hematoma blocks for 11 patients, which was statistically significant (P = 0.041). Satisfaction rates for patients and physicians performing the procedure were significantly higher in the nerve block group than in the hematoma block group (P = 0.001; P ˂ 0.001, respectively).

The results of this study suggest that ultrasound-guided radial and median nerve blocks can be used as alternative methods of analgesia with other techniques in the reduction of distal radius fractures in emergency departments.

Traffic accidents are considered a major public health problem in many parts of the world. This study aimed to investigate the epidemiology of the accidents leading to pedestrians’ death in Ahvaz, Iran, in 2015-2017. This descriptive cross-sectional study was conducted in 2015-2017. The statistical population was pedestrians who died in traffic accidents in Ahvaz city. The data collection source was the Forensic Medicine Organization. The data were analyzed using the SPSS 16 software using descriptive statistics and chisquare test. Among the 165 pedestrians who died in traffic accidents, 72.1% (119 people) were male and 27.9% (46) female. The mean age of the deceased subjects was 38.38±2.44. The highest frequencies of death in the age groups over 65, under 7, and 25-34 years old were 19.4% (32 people), 14.5% (24 people), and 14.5% (24 people), respectively. Most of the deceased were illiterate (34.5% (57 people)), self-employed (24.2% (40 people)). The final cause of death in more than half of the pedestrians was head trauma (64.8%) (107 people), and most of the deceased had died in hospitals (71.5%) (118 people). Considering that young and older people are two high-risk groups in car accidents, training safety and improving pedestrian safety by creating a safer environment can play a significant role in reducing deaths.

Health care workers (HCWs) are heavily involved in the fight against COVID-19 in all over the world. They have the vital role of treating patients and searching for the proper treatment for the disease, while supporting and protecting their families. It is imperative that the systems should try hard to keep them safe and healthy. World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) have recently published guidelines for keeping HCWs safe and protected. The Personal Protective Equipment (PPE) is the cornerstone of recommendations and contains face mask (air purifying respirator), goggles or face shield, gown, and gloves. There is no doubt that a proper mask (e.g. N95) is the most important element of the protective gear when it comes to transmission of COVID-19.

Ascites is characterized by excess fluid accumulation in the peritoneal cavity. In assessing a patient with ascites, it is necessary to determine the cause due to the very different causes of ascites, the importance of knowing its causes and finally the unknown status of the disease in the area. In order to determine the causes ascites and the role of age, sex, and other causes we reviewed the causes and the reasons for the visit patients with ascites admitted to the emergency department of Rasoul Akram and Firoozgar Hospitals.

This is a descriptive cross-sectional study. In this study, the files of all patients referred to Firoozgar and Rasoul Akram hospitals during 5 years from 2010 to 2015 were evaluated. Data including demographic information, such as age, sex, etc., and clinical information such as cause, drug use, number of years of illness and etc were collected using a pre-designed checklist. Data were analyzed using SPSS version 21 software.

A total of 427 participants with ascites (48% male and 42% female) were enrolled. The most common cause of referral to hospital was abdominal pain (36.8%) and then increased abdominal girth (20.8%). The most common complication in hospitalized patients with ascites was SBP.

Since SBP can be a life-threatening complication, early diagnosis and prompt treatment should be ensured. Further large-scale studies are suggested.

Although pain management in EDs has been fully addressed in clinical trials, prehospital settings have rarely been investigated.

The present study was conducted to compare the effectiveness of intravenous acetaminophen with that of ketorolac in pre-hospital pain control.

This randomized clinical trial (RCT) was performed at a prehospital setting during EMS missions in Tehran, Iran. The eligible candidates comprised all patients over the age of 7 years with a complaint of moderate to severe pain. The patients were randomly assigned to two groups, one receiving 30 mg of intravenous (IV) ketorolac and the other 1 g of IV acetaminophen. The pain intensity was measured using a visual analog scale (VAS) before administering the analgesic and upon admission to the ED.

The present study was conducted on 150 patients aged 8-81 years with a mean age of 40.4 ± 17.7, including 84 (56%) males. The mean reduction in the pain score was 14.9±8.6 in the acetaminophen group and 16.0±8.8 in the ketorolac group. Univariate analyses suggested no statistically significant differences between the two groups in terms of delta pain score (pain reduction) (P=0.429).

Based on the obtained findings, both ketorolac and acetaminophen could be administered for pain management in prehospital settings in both traumatic and non-traumatic patients in case their contraindications are considered.

Professionalism is a core competency in the medical profession. In this paper, we aimed to confirm the validity, reliability and acceptability of the Professionalism Mini-Evaluation Exercise (P-MEX) instrument for the emergency medicine (EM) residency program. Twenty-two EM attending physicians completed 383 P-MEX forms (the Persian version) for 90 EM residents. Construct validity was assessed via structural equation modeling (SEM). The reliability coefficient was estimated by the generalizability theory, and acceptability was assessed using two researcher-made questionnaires to evaluate the perspectives of residents and assessors. There was a consensus among the participants regarding the content of P-MEX. According to the results of SEM, the first implementation of the original model was associated with a moderate fit and high item loadings. The model modified with correlated error variances for two pairs of items showed an appropriate fit. The reliability of P-MEX was 0.81 for 14 occasions. The perception survey indicated high acceptability for P-MEX from the viewpoint of the residents and increasing satisfaction with P-MEX among the assessors over time. According to the results of the research, P-MEX is a reliable, valid, and acceptable instrument for assessing professionalism in EM residents.

Pneumothorax is a life-threatening complication and the most common cause of which is trauma. Early diagnosis and treatment of Pneumothorax are very important. The aim of this study was to compare the diagnostic values of four-point and double-point ultrasound versus CT scan in determining pneumothorax in Rasul-Akram and Hafte-Tir Hospitals during the years 2015 - 2016.

This cross-sectional study was performed on 880 trauma patients that selected randomly from the emergency department. The study information was completed based on two-point US and four-point US and the patients’ file records. CT scan, as the gold standard for the diagnosis of pneumothorax, was used for all patients. The crosstab test was used for evaluating the accuracy of two methods and to determine the Kappa coefficient level of agreement. Data were analyzed using SPSS v.16 software.

The sensitivity of ultrasonography in the diagnosis of pneumothorax in the two-point technique group was 91.1%, with a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 97.7%. The accuracy in this method was 95.5%. In the four-point technique, the sensitivity was 98.9%, with a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 99.7%. The accuracy in this method was 99.4%.

The four-point chest ultrasound is a high accuracy method for the bedside diagnosis of pneumothorax in patients with trauma.

Various training methods such as lecture-based and media-aided methods are employed to train focused assessment with sonography for trauma (FAST) technique during internship period. The current study aimed at comparing the efficacy of lecture-based and CD-based approaches among medical interns in emergency wards. The current comparative study was conducted on 128 interns randomly assigned into two training groups. The first group (n = 64) was trained through a one-hour training program based on CD in a single session, and the other group (n = 64) was trained through a one-hour face-to-face slide-based session. Before and immediately after the training sessions, the participants were asked to answer the questions about the FAST technique. Also, the questionnaires were emailed to the participants one month later. The mean assessment score was significantly higher in the group trained through the lecture-based method compared with the ones trained with the CD-based method immediately (P <0.001) and one month (P = 0.003) after training. With regard to practical training, the subjects trained through the lecture-based method achieved higher assessment scores than the ones trained through the CD-based method (P = 0.042). A significant increase in the mean assessment score was noted immediately after training (P = 0.023), while a significant reduction in the mean score was found one month after training (P = 0.015) in both groups. The use of the lecture-based approach for FAST training was more effective than the CD-based approach among emergency ward interns.

Chest ultrasonography is routinely used in evaluation of chest trauma for diagnosis of pulmonary injury. This study aimed to evaluate the accuracy of B-Lines for diagnosing lung contusion in patients with blunt trauma of the chest. Trauma patients who met the inclusion criteria were enrolled in the study and underwent ultrasonography by trained emergency medicine residents. Ultrasound results were recorded in terms of number of B-lines and the existence of peripheral parenchymal lesion (PPL). After ultrasound, the patient underwent chest x-ray and chest CT scan (as reference test) and screening performance of B-lines and PPL were evaluated. 147 patients underwent chest ultrasound. The mean age of the patients was 40.74 ± 18.6 (78.9% male). B-lines˃3 had 94.0% (95% CI: 83.45-98.75) sensitivity and 57.7% (95% CI: 47.3-67.7) specificity, B-lines˃6 had 90.0% (95% CI: 78.2-96.7) sensitivity and 93.81% (95% CI: 87.0-97.7) specificity, and PPL had 34.0% (95% CI: 21.2-48.8) sensitivity and 100% (95% CI: 96.3-100.0) specificity. Composite findings of B-lines˃6 + PPL had 92.0% (95% CI: 80.8-97. 8) sensitivity and 93.8% (95% CI: 87.0-97.7) specificity in the diagnosis of lung contusion. PPL and B-Lines˃6 had the highest accuracy in detecting lung contusion. B-Line˃6 had high sensitivity and specificity and was easy to perform; thus, it seems that B-Line˃6 could be considered as an alternative screening tool in detection of lung contusion.

Seizure is one of the important reasons for referral to the emergency department, which sometimes indicates serious damage to the brain parenchyma. Since in patients without a history, awareness of the medium-term course of the disease helps the diagnosis, thus, in this study, definition of 6-month prognosis without taking medication, was investigated after the first seizure attack.
This study is an observational cohort study. The sample population included 125 patients, who referred to the emergency of Rasoul Akram Hospital after the first seizure attack, and had no recent history of consumption of anticoagulants, alcohol, narcotics, and psychotropic drugs. Sampling method was consecutive sampling. Data were analyzed using Chi-square, independent t-, and logistic regression analytical tests. The significance level was considered as p During the 6-month follow-up, 30.4% of the patients had seizure recurrence. Among the patients referred to the emergency department with first seizure, the number of men was significantly higher than women. Also, a significant difference was observed between two genders and family history or seizure recurrence in the follow-up period.
The results of this study indicated that factors, such as gender, presence of status epilepticus and, first-grade family history of seizures can be considered as the risk factors for seizure recurrence in the 6-month period after the first seizure without taking medication. Therefore, considering these variables and appropriate treatment, the incidence rate of seizures significantly decreases after discharge from hospital.

Ketamine, as an opium alternative, has been proposed for pain relief in the emergency department (ED).
This study was carried out to compare low dose ketamine (LDK) with morphine for pain relief in trauma patients.
In this randomized double-blinded clinical trial, 300 trauma patients from the ED of 2 teaching hospitals in Tehran, Iran were enrolled and randomly divided into 2 equal groups. The 1st group received 0.2 mg/kg of ketamine while the 2nd group received 0.1 mg/kg of intravenous morphine. The pain intensity and complications were measured and compared every 15 minutes to 1 hour.
Fifteen minutes after drug injection in both groups, a significant reduction was found in average pain intensity compared to the initial pain (P = 0.01). At 15 minutes, no significant difference was found in both groups in regards to average pain intensity (P = 0.23). The average pain intensity at 30, 45, and 60 minutes in the group receiving morphine was lower than the ketamine group (P = 0.01, P The results of this study suggest that LDK, at a dose of 0.2 mg/kg, in the earlier minutes leads to significant reduction of pain when compared to that of intravenous morphine. It also created fewer complications than morphine.

Scorpion sting is an important public health problem in some countries, including Iran. This study aimed to describe the demographics of a large number of these victims in some endemic areas of Iran.

This cross-sectional study evaluated baseline characteristics, clinical findings, management, and disposition of scorpion stung cases in 26 cities of 4 provinces in the southwest quarter of Iran, during one year.

3008 cases of scorpion sting with mean age of 27.07 § 16.58 years were studied (51.3% female). The mean time from sting to hospital was 1.89 § 1.04 hours. No first aid measures had been taken in 96.6% of cases. Lower (39.5%) and upper (35.7%) extremities were stung most frequently. Midnight to 6:00 am was the period of time most of stings occurred (34.2%). Local pain (77.2%) and erythema (63.5) were among the most common signs and symptoms. 2026 (67.3%) victims had been discharged; 326 (10.8%) were admitted or referred to other hospitals and 5 (0.2%) cases died.

It seems that demographic characteristics of scorpion sting in Iran are not so different fromthose reported fromother sites of theworld, as signs and symptoms of local and systemic envenomations. Victims, companions, and healthcare providers perform many futile and maybe harmful measures and there is a need to educate all about all of these details.

To determine the effects of pre-injury consumption of anti-platelet agents on the 30-day outcomes of patients with mild traumatic brain injury (TBI).
This prospective cohort study was conducted at three general hospitals in Tehran, Iran between July 2013 and July 2014. The study population included all patients with mild TBI aged over 18 years that medicated with aspirin or clopidogrel before occurring trauma. Within hospitalization, all patients were assessed with respect to in-hospital conditions especially complications and adverse events. After discharge, the individuals were followed for 30 days by telephone to assess mortality and disability using the Glasgow outcome scale (GOS).
Of 1140 patients with mild TBI, only 135 had previously received aspirin and/or clopidogrel. The mean age was dramatically higher in those who were taking aspirin or clopidogrel (p 0.001). The patients with previously use of anti-platelets were more transferred by ambulance when compared to another group (p=0.006). The patients on anti-platelets had significantly lower GCS on admission when compared to others (p The premedication by anti-platelets (aspirin and/or clopidogrel) in patients with mild TBI leads to prolonged hospital stay, and increase rate of disability. Age and on admission GCS are the independent risk factors for predicting the outcome in patients with mild TBI receiving anti-platelet agents.

Many systems are being applied to predict mortality of the patients in ICUs. In this study, the patients admitted to EICU were compared to those of MICU and SICU using APACHE-II scoring system to predict their mortality.
In this retrospective cohort study, the files of 290 patients admitted toEICU, MICU, and SICU of RasoulAkram Hospital in Tehran, were evaluated in a 6 month period. The outcome of every patient wascollected, patients’ APACHE-II scores were calculated, and the departments were compared each other.
There was no statistically meaningful difference among the patients of departments evaluated for age and sex. APACHE-II scoresof patients of EICU were meaningfully lower than two other wards.The stay length and mortality rate of patients admitted to EICU were meaningfully lower than two other wards.
The results of this research showed that in the hospital studied, the disease severity of the patients admitted to MICU and SICU were higher than the patients of EICU. On the other hand, the patients admitted to EICU, had lower length of stay and mortality compared to the two other wards.

Blunt abdominal injury is a leading cause of death in trauma patients. A reliable test predicting intra-abdominal hemorrhage would be a novel method. The study objective was to assess the diagnostic accuracy of plasma ammonia in detection of intra-abdominal bleeding in patients with blunt abdominal trauma (BAT). In this observational study, all patients suffering from BAT, referred to our university teaching hospital included. The levels of ammonia were measured at the time of emergency department admission and 1 h after initial treatment. Demographic data, vital signs, and venous blood gas reports were recorded. Findings of contrast-enhanced abdominopelvic computed tomography scan and laparotomy were assumed as a gold standard for abdominal injuries. A total of 104 patients was enrolled in the study. 15 patients (14.4%) had intra-abdominal hemorrhage and the mean plasma ammonia level in this group was significantly higher than the other patients on admission time (101.73 ± 5.41? g/dL vs. 47.36 ± 26.31? g/dL, P < 0.001). On receiver-operator characteristic curve analysis, in cutoff point of 89? g/dL, the sensitivity, specificity, positive and negative likelihood ratios were 100% (95% confidence interval [CI], 79.6-100), 93.26% (95%CI, 86-96.8), 14.83 (95% CI, 6.84-32.12), and 0, respectively. The study findings suggest the measurement of ammonia level at the time of admission in the patients with BAT would be a useful test predicting intra-abdominal hemorrhage. Furthermore,decrease in the ammonia level could be a useful marker for monitoring response to treatment in these patients.

Accidental exposure to blood and body secretions is frequent among health care workers (HCWs). They are at risk of acquiring blood-borne diseases. In this study, we have investigated the prevalence and risk factors of occupational exposure among the HCWs of the Emergency Departments (ED) at three teaching hospitals in Tehran. We conducted this observational, descriptive, cross-sectional study using a self-reporting 25-question survey, related to occupational exposures, in February 2010. It was carried out among 200 HCWs (specialist physicians, residents, medical interns, nurses, laboratory personnel, housekeepers, cleaners, and others), who were working in the EDs of the three teaching hospitals of the Tehran University of Medical Sciences. The age, sex, and job category of the HCWs suffering from the injury were determined, as also the risk factors responsible for the exposure of the HCWs. One hundred and fifteen (57.5%) of the 200 HCWs had had at least one episode of blood or body fluid exposure in their professional life. Hollow-bore needles accounted for the highest amount of injuries, with 41.5%, followed by suture needles (18.5%). The most prevalent procedures associated with injuries were suturing (17.5%) and recapping used syringes (16.5%), respectively. All the specialist doctors in this study reported at least one exposure. The percentage of exposure in the other participants of our study was 74.3% for ED residents, 61.1% for laboratory technicians, 51.9% for nurses, and 51% for medical interns. Binary logistic regression analysis revealed that male gender, recapping needles, and job profession were independently associated with exposure to blood or body fluids. High prevalence of occupational exposure in this study emphasized the importance of promoting awareness, training, and education for the HCWs, for preventive strategies, and also reporting of occupational exposure to blood and body secretions.