فهرست مطالب mohammadreza farnia

Blood product over-requesting and wasting are the biggest concerns for the health community in providing the patients' blood needs. This study aimed to investigate the blood request and transfusion status and related factors to non-transfusion and their wastage in Imam Reza Hospital, Kermanshah.

This descriptive-analytical study was conducted on 1045 patients who were candidates for receiving blood products in Imam Reza Hospital. Demographic characteristics, clinical data, and reserved blood product outcomes (Transfusion/non-transfusion) were extracted from the patients' clinical documents. The C/T index was used for the calculation of the reserved and transfusion blood products ratio. The multivariate logistic regression test was conducted to explore the predictors for blood product wastage.

Of 1045 patients with a mean age of 41.45 ± 22.32 years who were candidates for blood products, 57% received blood transfusion. The C/T index was 1.75. The patients' frequency distribution regarding gender, marital status, education, diagnosis, and blood product type between two groups of patients with and without blood transfusion showed no statistically significant difference (P>0.05). However, the frequency distribution of the person ordering blood products and age in the two groups had a statistically significant difference (P<0.05).

The request-consume blood products index in Imam Reza Hospital of Kermanshah showed a favorable condition. The younger age and the reservation by the first-year resident were independent predictors for requested blood product wastage.

Procedural sedation and anesthesia (PSA) is a common practice in the emergency department (ED). We reporta case of seizure after ketamine and propofol administration for procedural sedation. Seizure is not a commonside effect of ketamine nor propofol. A 60 years old man admitted to the emergency department with complaintof right shoulder pain caused by the blunt trauma. Simple X-Ray revealed anterior dislocation. After adminis-tration of 30 mg ketamine and propofol (1:1) intravenously, closed shoulder reduction was performed. After 2minutes, the patient experienced a generalized tonic-clonic seizure with upward gaze and urinary incontinence.The clonic movements resolved after about 1 minute with supportive care and without anti epilepsy drugs, thenthe patient entered the post-ictal phase. 45 minutes later, the patient was completely awake and after 6 hoursobservation, he was sent home with discharge instructions. Seizure is not a common complication of any of theadministered drugs. Nevertheless, rare possibilities may also occur, and thus emergency clinicians and otherswho perform procedural sedation, should be ready for any possible complications to treat them appropriately.

Atropine is not recommended in organophosphorus (OPs) poisoning cases without any obvious clinical signs. This study aimed to evaluate the clinical utility of Atropine challenge test in screening OPs poisoning cases with atypical presentation. In this prospective cross sectional study, after primary supportive care, patients with atypical pretentions of OPs poisoning underwent Atropine challenge test (1 mg intravenously) and demographic parameters, clinical presentations, and serum level of cholinesterase enzyme were compared between cases with positive and negative test results. 20 patients with the mean age of 47.60 ± 13.25 years were studied. The mean time since exposure and initial symptoms was 6.17 ± 2.99 hours. The most common clinical presentations were tachycardia (55%) and flushing (35%). The atropine challenge test was positive in 3 (15.00%) cases. The two groups were the same regarding gender distribution (p = 0.582), mean age (p = 0.957), clinical presentation (p > 0.05), and mean PR interval (p = 0.729). The level of cholinesterase was 220.00 ± 15.52 U/mL and 332.17 ± 143.99 U/mL in patients with positive and negative Atropine challenge test, respectively (p = 0.006). Patients with positive Atropine challenge test had a significantly lower level of serum cholinesterase and response to Atropine in their therapeutic management. Hence, Atropine challenge test could be considered as a useful clinical test in the setting of acute OPs poising.