Journal of Emergency Practice and Trauma

Journal of Emergency Practice and Trauma

Basic info

  • Publisher: Kerman University of Medical Sciences
  • Country of publisher: iran, islamic republic of
  • Date added to EuroPub: 2019/Sep/29

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  • Time from submission to publication: weeks

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  • Waiver policy for charges? No

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  • Open Access Statement: No
  • Year open access content began: 2015
  • Does the author retain unrestricted copyright? False
  • Does the author retain publishing rights? False

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This journal has '20' articles

Brain multi-infarct and decompression sickness

Brain multi-infarct and decompression sickness

Authors: Luis Rafael Moscote Salazar
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Abstract

Scuba diving is associated with an important risk of developing decompression sickness secondary to formation of gas bubbles inside the body. The latter is formed mainly by nitrogen in the body on the diver’s way to the surface (1,2). In some cases, it might injure the central nervous system. Several decompression cases that have been associated with neurologic symptoms are described in the literature; however, brain multi-infarct with lethal outcome has never been described.

Keywords:
Effect of oral tizanidine on prolongation of intrathecal
lidocaine

Effect of oral tizanidine on prolongation of intrathecal lidocaine

Authors: Arman Taheri, Morteza Hashemian, Mohammad Bakhtiari, Mohammad Reza Doroodian, Shirin Salajegheh
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Abstract

Objective: In order to prolong the duration of intrathecal lidocaine, various drugs are used along with it. Due to the promising effects of tizanidine on central nervous system, it can be assumed that tizanidine can have a positive effect on increasing the anesthesia duration too. Thus, we aimed to investigate the effect of oral tizanidine on the duration of lidocaine spinal anesthesia. Methods: This double blind clinical trial was conducted on 40 male patients waiting for elective leg surgery with the age range of 20-60 years in one of the educational hospitals of Kerman University of Medical Sciences, Iran. We used simple random sampling and our participants were assigned into 2 groups (placebo and oral tizanidine receivers). Spinal anesthesia with 1 mg/kg of hyperbaric lidocaine 5% was performed in both groups. In tizanidine group, patients received 4 mg of oral tizanidine one hour before spinal anesthesia. Sensory block was examined by pin prick test and all anesthetic duration including start block until reduction of sensory level was calculated at 2 lower dermatomes. Results: Findings showed that oral tizanidine compared to placebo can cause a 10-15 minute increase in patients’ lidocaine spinal anesthesia. Therefore, the average anesthesia time for tizanidine group increased meaningfully (P= 0.03). In addition, tizanidine can sedate patients during surgery (P= 0.00) or in recovery (P= 0.003). Conclusion: Based on the results, tizanidine increased the duration of lidocaine so oral tizanidine can be used to prolong the duration of lidocaine spinal anesthesia.

Keywords: Tizanidine, Intrathecal lidocaine, Spinal anesthesia
Abdominal trauma in a semi-urban tertiary health
institution

Abdominal trauma in a semi-urban tertiary health institution

Authors:
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Abstract

Objective: There has been a global increase in the incidence of abdominal trauma in surgical patients. We conducted this study to evaluate the pattern of abdominal injuries, patient characteristics and the management outcome in our setting. Methods: It was a descriptive (combined retrospective and prospective) study of all patients with abdominal trauma admitted and managed at Ekiti State University Teaching Hospital, AdoEkiti between January 2013 and December 2016. Data on socio-demographics, clinical profile, investigations, treatments and outcome were entered into a spread sheet and analyzed using SPSS version 20.0. Results: A total of 2728 trauma patients presented during the study period. Of these, 68 (2.5%) suffered from abdominal injuries. Their ages ranged from 6 to 72 years (mean 30.3±13.2). Fiftynine (86.8%) were males while 9 (13.2%) were females (M: F ratio = 6.6:1). Forty-nine (72.1%) sustained blunt trauma while 19 (27.9%) had penetrating injuries. Road traffic incident (RTI) (n=41; 60.3%) was the most common source of trauma, followed by assault: gunshot (n=9; 13.2%), and stab (n=7; 10.3%). Spleen (n=23; 33.8%) was the most common solid organ injured followed by the liver (n=7; 10.3%) while small bowel (n=8; 11.8%) was the most common hollow viscous injured. Forty-seven (69.1%) required operative intervention. Post-operative complication rate was 17% with wound infection (12.5%) predominating. The mortality rate was 4 (5.9%). Conclusion: RTI and assault are major causes of abdominal injury. Measures to reduce RTI, youth restiveness and criminal activities will stem the tide

Keywords: Abdominal trauma, Semi-urban tertiary institution, Treatment outcome
Prevalence and pattern of hypertension and effect of
body mass index on blood pressure in six communities
of Biase LGA In Cross River, Nigeria

Prevalence and pattern of hypertension and effect of body mass index on blood pressure in six communities of Biase LGA In Cross River, Nigeria

Authors:
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Abstract

Objective: Hypertension is a major risk factor for stroke, renal failure, and heart failure globally. This trend of complications has been seen even among our rural and urban dwellers in the tropics. This study aims at determining the prevalence and pattern of hypertension and body mass index (BMI) in six rural communities in Southern Nigeria. Methods: Adult participants, aged 18-80 years of age from six rural Biase communities who presented for a health screening were recruited. This was a rural community-based cross-sectional study involving 419 adults. Information was obtained from questionnaires which were administered to assess and obtain demographic data. Blood pressure and anthropometric indices were measured from participants to assess the BMI and risk factors associated with hypertension, and pattern of blood pressure. Results: A total of 419 enrolled for the study, but 137 had hypertension (systolic blood pressure ≥140 mm Hg and diastolic blood pressure ≥90 mm Hg) and this was made up of 86 females (62.8%) and 51 males (37.2%). Only 29 of the hypertensives (21.1%) were aware of their condition. The prevalence of hypertension was 32.7%. Moderate hypertension was the commonest presentation. High blood pressure, obesity and overweight was common among the women folk compared to the men that had isolated systolic hypertension (P<0.05). Conclusion: In recent times, hypertension is seen to be high even in rural settings; hence strict screening should be enhanced to allow for quicker diagnosis and early intervention.

Keywords: Hypertension, Rural, Blood pressure, Prevalence, Nigeria
Patients’ satisfaction towards medical services at the
emergency department of European Gaza HospitalGaza Strip

Patients’ satisfaction towards medical services at the emergency department of European Gaza HospitalGaza Strip

Authors:
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Abstract

Objective: Patients’ satisfaction (PS) is recognized as an important emergency department service design and it has received a high interest and attention in the health management where many studies have focused on determining factors affecting PS in health-related circumstances. In this study, we aimed to examine PS in emergency department (ED) of the European Gaza Hospital (EGH) in the Gaza Strip (GS). Methods: A descriptive-analytical cross sectional study was performed at ED-EGH between March, 15 and June 20, 2015. Press Ganey questionnaire was used as a tool for data collection. For each patient, a self-administered questionnaire including 22 questions was filled based on a Likert scale. Results were analyzed using SPSS version 22. Results: Overall, 200 respondents were included in the study. About 73% of respondents were satisfied with overall medical services. The term of nurses’ concern provided to patients elicited the highest score (83.1%), followed by physicians’ concern with patients (72.0%) and communication skills with patients (71.4%), while the lowest score was reported in waiting time and security staff. Furthermore, our findings show an association between PS and level of education, gender differences, living area, and work shifts. Conclusion: The study results conclude that areas of medical and nursing care, respects of staff, physical comfort and waiting time ED-EGH is highly acceptable and offer in appropriate manners

Keywords: Patients’ Satisfaction, Emergency care, Emergency department, European Gaza Hospital
Tramadol abuse and shoulder dislocation

Tramadol abuse and shoulder dislocation

Authors:
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Abstract

This study aimed to evaluate the shoulder dislocation following tramadol-induced seizure and its potential difference with other shoulder dislocations. We evaluated six cases that used tramadol tablets and some of them had a history of seizure. All of the cases had shoulder dislocation. According to the findings, tramadol use and tramadolinduced seizure may increase the risk of shoulder dislocation.

Keywords: Tramadol, Seizure, Shoulder dislocation
Munchausen syndrome as scorpion biting:
a misdiagnosis

Munchausen syndrome as scorpion biting: a misdiagnosis

Authors:
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Abstract

Factitious disorder as Munchausen syndrome is a time and money consuming condition that is presented with different signs and symptoms. In emergent situations, it is not a differential diagnosis with high priority, but when it becomes recurrent with atypical symptoms, factitious disorder and malingering should be considered as well. In this survey, we report an odd and interesting presentation of a factitious disease as a scorpion sting which misled some professional healthcare providers until the patient finally confessed that she used turmeric to mimic the signs of a scorpion sting. She exaggerated her symptoms when asked about the details of the mechanism of the scorpion bite. When encountering an emergent condition, after ruling out the critical conditions especially when the symptom is recurrent, factitious disorders should be considered. Consultation with a psychiatrist help the team manage the patient properly.

Keywords: Factitious disorder, Scorpion sting, Turmeric
Traumatic spinal epidural hematoma: an alarming and
diagnostic challenge in the ED

Traumatic spinal epidural hematoma: an alarming and diagnostic challenge in the ED

Authors:
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Abstract

Traumatic spinal epidural hematoma (TSEH) is a neurosurgical emergency which is considered as one of the rare causes of back pain. The onset of symptoms presentation can vary especially following a trauma. Here, we report a case where a young girl had a trivial fall and presented symptoms of back pain three days later. She developed abrupt onset of lower limb weakness during her stay in the emergency department (ED). X-ray and computed tomography (CT) imaging of the spine did not show any obvious abnormality whereas, Magnetic resonance imaging (MRI) imaging revealed hyper-intense lesions in the thoracic spinal segment which led to the diagnosis of TSEH. Our case highlights the importance of the atypical and varied nature of presentation and the choice of investigation which would help in the early diagnosis of this entity

Keywords: Traumatic spinal epidural hematoma, Back pain, Paraperesis, Emergency department
Effect of cervical collars on intracranial pressure in
patients with head neurotrauma

Effect of cervical collars on intracranial pressure in patients with head neurotrauma

Authors:
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Abstract

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 (1-4). In patients with traumatic brain injury avoiding any kind of maneuver may lead to increased intracranial pressure (5).

Keywords: cervical collars, intracranial pressure, intracranial pressure, neurotrauma
Factors predicting patient satisfaction in the
emergency department: a single-center study

Factors predicting patient satisfaction in the emergency department: a single-center study

Authors:
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Abstract

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. Methods: 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<0.001), and providing vivid discharge information improving PS (P<0.001). Other important factors were also found that had not previously been focused on, namely cleanliness of the area (P<0.0001) and courtesy of the staff in charge of patient transfer (P=0.03). We also found that men had a more satisfying ED experience (P=0.002). 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
Evaluating the accuracy of emergency nurses in correct
triage using emergency severity index triage in Sina
hospital of Tabriz: a cross-sectional analysis

Evaluating the accuracy of emergency nurses in correct triage using emergency severity index triage in Sina hospital of Tabriz: a cross-sectional analysis

Authors:
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Abstract

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<0.001). 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
The effect of training on the management of nuclear
disasters by emergency department nurses and
physicians

The effect of training on the management of nuclear disasters by emergency department nurses and physicians

Authors:
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Abstract

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 < 0.001). Among medical staff, physicians had better knowledge compared with the other group. 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
The relationship between attention-deficit/
hyperactivity disorder and trauma in adolescents

The relationship between attention-deficit/ hyperactivity disorder and trauma in adolescents

Authors:
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Abstract

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<0.01). Conversely, no statistical significance was observed between attention deficiency and trauma severity. The severity of trauma was higher among ADHD group than normal individuals. There were also correlations between socioeconomic status (SES) and oppositional/impulsive patients. In this regard, higher scores of oppositional/impulsivity were observed among patients with lower SES. 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
The use of ultrasonography for the confirmation of
pulled elbow treatment

The use of ultrasonography for the confirmation of pulled elbow treatment

Authors:
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Abstract

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
The effect of physiologic dose of intravenous
hydrocortisone in patients with refractory septic
shock: a randomized control trial

The effect of physiologic dose of intravenous hydrocortisone in patients with refractory septic shock: a randomized control trial

Authors:
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Abstract

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 chisquare 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

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