Emergency Medicine – Open Journal

Emergency Medicine – Open Journal

Basic info

  • Publisher: Openventio Publishers
  • Country of publisher: india
  • Date added to EuroPub: 2019/Nov/15

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  • Language of fulltext: english

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  • Article Processing Charges (APCs): No
  • Submission charges: No
  • Waiver policy for charges? No

Editorial information

Open access & licensing

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  • Open Access Statement: No
  • Year open access content began: 2014
  • Does the author retain unrestricted copyright? False
  • Does the author retain publishing rights? False

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This journal has '68' articles

Lost in Translation

Lost in Translation

Authors: Francesco Vetri
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Abstract

As anesthesiologists, in whatever part of the world we live in, it is very common to be exposed to different cultures and languages. In some hospitals it happens on a daily basis, in others seldom, but the challenge of dealing with the “other” remains.

Keywords: Anesthesiologists. Language. Medical translator
Cost-Effectiveness of the Sucralfate
Technetium 99m isotope Labelled
Esophageal Scan to Assessesophageal
Injury in Children after Caustic Ingestion

Cost-Effectiveness of the Sucralfate Technetium 99m isotope Labelled Esophageal Scan to Assessesophageal Injury in Children after Caustic Ingestion

Authors: Arjan Sebastiaan
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Abstract

Background: Ingestion of caustic material by children is a considerable health problem. The 99mTc-labelled sucralfate esophageal scan proved to be an accurate method to identify injury to the esophagus after caustic substance ingestion. The purpose of this study was to calculate the cost-effectiveness of a sucralfate scan as compared to the gold standard of using endoscopy under general anesthesia. A secondary outcome was to assess the positive predictive value of the sucralfate scan. Methods: A 10-year retrospective medical folder audit was conducted of all children admitted to our hospital with a history of caustic ingestion who underwent a sucralfate scan to identify evidence of caustic esophageal injury/inflammation. The patients who had a negative sucralfate scan were assessed as having no significant injury and were discharged without further investigation or management. The patients with a positive result went for a subsequent endoscopy. Results: 234 patients were included. The total costs saved by performing a sucralfate scan only were R 446, 964.00 (South African Rand) in 234 patients. The positive predictive value of performing a sucralfate scan is 47.3%. Conclusion: A sucralfate scan as primary diagnostic method for caustic injury proved to be cost-effective and with less chance of complications.

Keywords: Sucralfate. Caustic.Esophageal Injury.Cost-Benefit Analysis.
Hemostasis Management during Adult
Extracorporeal Membrane Oxygenation:
A Shot in the Dark?

Hemostasis Management during Adult Extracorporeal Membrane Oxygenation: A Shot in the Dark?

Authors: Michael Mazzeffi
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Abstract

Extracorporeal membrane oxygenation (ECMO) has been used increasingly in adult patients with cardiopulmonary failure.1 According to the Extracorporeal Life Support Organization’s (ELSO’s) 2012 report over 51,000 patients have received ECMO. Most cases are for neonates; however, an increasing proportion is for adults.2 ECMO is a unique life saving therapy, but many patients experience complications including: hemolysis, systemic thromboembolism, neurologic complications, and bleeding.3 We previously reported that up to 56% of patients experience at least one significant bleeding event during ECMO and the rate of serious bleeding events is approximately 10 per 100 ECMO days.4 Our data also suggest that bleeding events and the amount of transfusion on ECMO are associated with decreased survival.

Keywords: Bleeding. Coagulation. Extracorporeal membrane oxygenation (ECMO)
Strengthening Community Based Health
Care Provision Capacity is Critical for
Emergency Preparedness – Lessons from
Iraq and Uganda

Strengthening Community Based Health Care Provision Capacity is Critical for Emergency Preparedness – Lessons from Iraq and Uganda

Authors: Rumishael Shoo
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Abstract

Women, children and the poor constitute the most vulnerable groups in emergencies. Continuity of delivery of services at the community level is critical in preventing morbidity and mortality. Insecurity and other disasters reduce access to public health services. Conventional emergency preparedness emphasizes community capacity development after a disaster to build resilience and thereby mitigate against effects of a similar occurrence in the future. Lessons from Iraq and Uganda seem to indicate that this should be addressed as part of preparedness. Our review of the context in two completely different settings supports this view. We present here, work undertaken in Iraq to strengthen community level Maternal Newborn and Child Health (MNCH) provision before the insecurity following the invasion by Islamic State of Iraq and Syria (ISIS) and experiences from Northern Uganda during the insecurity caused by the Lord’s Resistance Army and Ebola Disease outbreaks.

Keywords: Community. Health Care.Emergency Preparedness.
Pediatric Emergence Agitation

Pediatric Emergence Agitation

Authors: Mehtap Honca
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Abstract

Emergence Agitation (EA) is still remaining as a major problem during the early stage of recovery from general anesthesia in children. EA was first reported in 1960’s and it has been considered as a mental disturbance during recovery from general anesthesia which consists of hallucinations, delusions and confusion manifested by moaning, restlessness, involuntary physical activity and thrashing about in the bed.1 The incidence of EA is variable and can reach to 80%.

Keywords: Emergence Agitation. General anesthesia. Preoperative anxiety
Positioning and Anesthesia Challenges
In a Morbidly Obese Patient Undergoing
Cervical Spine Surgery

Positioning and Anesthesia Challenges In a Morbidly Obese Patient Undergoing Cervical Spine Surgery

Authors: Keyuri Popat
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Abstract

Background Context: By itself, the perioperative anesthesia management of morbidly obese patients is challenging; this task is further complicated when such patients have to be placed in the prone position for surgery. In these cases, challenges may include positioning, intubation and ventilation. Purpose: Herein, we describe the safe perioperative anesthesia care of a morbidly obese patient undergoing cervical spine surgery for an enlarging schwannoma. Study Setting: Morbidly obese patient care at a tertiary cancer institute. Patient Sample: Single case report. Methods: Describing the preparation and planning for this complex case and the perioperative care of a patient with several comorbidities. No conflict of interest to report for any of the authors. Results: Good patient outcome. Conclusion: Careful multi-disciplinary planning facilitates, good patient outcome, given the challenging nature of the case. Highlighting the use of a trial run in the operating prior to the day of surgery.

Keywords: Obesity. Surgical complications. Cervical Spine Surgery
Isolated Prolonged Activated Partial
Thromboplastin Time and Contact Factor
Deficiencies: Case Series and
Management Review

Isolated Prolonged Activated Partial Thromboplastin Time and Contact Factor Deficiencies: Case Series and Management Review

Authors: Majed A. Refaai
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Abstract

Background: Contact factor deficiencies are rare disorders that can cause grossly prolonged activated partial thromboplastin time (aPTT) and activated clotting time (ACT) while rarely affecting in vivo hemostasis. This in vitro laboratory phenomenon poses a particular challenge in surgical procedures that require anticoagulation monitoring. Case: Here we report two cases of contact factor deficiencies; a 67-year-old morbidly obese female with factor XII deficiency requiring revascularization of a graft and a 58-year-old female with prekallikrein (PK) deficiency undergoing routine muscle biopsy. Conclusion: Peri-operative anticoagulation monitoring poses a significant challenge in contact factor deficiency patients. Awareness of the challenges of contact factor deficiencies allows for optimal peri-operative management. Emerging literature supports that contact factors play a role in fibrinolysis. Increased surveillance of thrombotic events as well as avoidance of fibrinolytics may be necessary in these patients.

Keywords: Prekallikrein (PK). Factor XII, Activated partial thromboplastin time (aPTT). Contact factors. Fibrinolysis. Anticoagulation. Prolonged clotting time. Thrombosis.
Case Report in Anesthesiology: Essential
Pulmonary Hypertension in a Primigravida

Case Report in Anesthesiology: Essential Pulmonary Hypertension in a Primigravida

Authors: Charles Youngblood
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Abstract

A 21-year old gravida 1, para 0, female with a past medical history of Pulmonary Hypertension (PH) secondary to a congenital heart disease (patent foramen ovale), diaphragmatic hernia status post repair, asthma, and attention-deficit/hyperactivity disorder presented to a tertiary care hospital at 30 weeks gestation for a right heart catheterization. The catheterization was completed without complications and it was found that the patient’s Pulmonary Arterial Pressure (PAP) was 54/32 with a mean value of 39. The PAP was only minimally improved to 46/30 with a mean of 35 after nitric oxide administration.

Keywords: Primigravida. Pulmonary Hypertension. DVT prophylaxis
A Comparative Study of Ropivacaine
Alone Versus Ropivacaine With
Dexmedetomidine in Supraclavicular
Brachial Plexus Block

A Comparative Study of Ropivacaine Alone Versus Ropivacaine With Dexmedetomidine in Supraclavicular Brachial Plexus Block

Authors: Surath Manimala Rao Rao
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Abstract

Background and Aims: Supraclavicular brachial plexus block is frequently used procedure to provide anaesthesia and good post-operative analgesia for surgery on upper limb. The purpose of this study was to compare the hemodynamic, sedative and analgesic effects of ropivacaine alone versus ropivacaine given along with dexmedetomidine. Materials and Methodology: This prospective, randomized and double-blinded study included total 60 patients of either sex with age between 18-60 years posted for various elective upper limb surgery and randomly allocated into 2 equal groups of 30 each. Control Group-R received injection ropivacaine (0.75%) 30 ml plus 1 ml normal saline and Group-RD received injection ropivacaine (0.75%) 30 ml plus dexmedetomidine 25 µg (1 ml) for supraclavicular brachial plexus block using the peripheral nerve stimulator. Sensory and motor block, monitoring of vitals (systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR)), presence of any side effect, Ramsay sedation score and visual analogue scale or visual analog scale (VAS) score were determined every 5 mins in 1st 30 mins and then every 15 mins during 1st hr followed by every 2nd hourly during 24 hrs. Results: There was no significant difference in the study groups with regards to demographic profile and duration of surgery. The onset of sensory and motor blockade was faster in Group-RD than Group-R. {Onset of sensory block: (Group-R=14.133±1.676 min and Group-RD=12.667± 1.213 min) (p=0.000), Onset of motor block: (Group-R=25.967±2.748 min and Group-RD=23.333±3.467 min) (p=0.002). Also total duration of sensory blockade {Group-R=547.833±26.152 mins, Group-RD=811.667±25.405 mins (p value=0.000)}, motor blockade {Group-R=509.667±24.703 mins, Group-RD=760.667±28.062 mins (p value=0.000)} and number of rescue injections in 24 hrs {Group-R=2.733±0.450, Group-RD=1.400±0.498 (p value=0.000)} was significantly different in 2 groups. There was good haemodynamic stability in both groups. SBP and DBP in Group-R and Group-RD with p values 0.416 and 0.784 were comparable between the groups. The difference was statistically not significant. There was no incidence of any side effects like hypotension and bradycardia in any of the 60 patients. Conclusion: Dexmedetomidine in a dose of 25 µg added to ropivacaine in supraclavicular brachial block for upper limb surgery significantly shortens the onset time and prolongs the duration of sensory and motor block without producing sedation in patients.

Keywords: Ropivacaine. Dexmedetomidine. Adjuvant. Supraclavicular brachial plexus block.
Primary Intra-Abdominal Hypertension
and Abdominal Compartment Syndrome:
Pathophysiology and Treatment

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Authors: Chiappa A.
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Abstract

Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.

Keywords: Intra-abdominal hypertension.Abdominal compartment syndrome.Damage control laparotomy.Laparostomy.Open abdomen.
Life Threatening Airway Angioedema Secondary to Captopril

Life Threatening Airway Angioedema Secondary to Captopril

Authors: Feriyde Calıskan Tur
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Abstract

Angioedema associated with Angiotensin-Converting Enzyme Inhibitors (ACEI) is an emergency, which can develop in 0.1-1% of the recipients. Severe life-threatening total airway obstruction secondary to angioedema can occur rarely. In this case report, the clinical approach, diagnosis and treatment of ACEI induced angioedema with special focus on the differential diagnosis from hereditary angioedema are discussed.

Keywords: Angioedema. Captopril induced angioedema. Hereditary angioedema. Difficult airway.
The Effect of Adenotonsillectomy on Mean Platelet Volume and Neutrophil-to-Lymphocyte Ratio

The Effect of Adenotonsillectomy on Mean Platelet Volume and Neutrophil-to-Lymphocyte Ratio

Authors: Mustafa Çelik
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Abstract

Objectives: To explore the effect of adenotonsillectomy on mean platelet volume (MPV) levels and neutrophil to lymphocyte ratio (NLR) values in children with obstructive sleep apnea syndrome (OSAS). Subjects and Methods: In total, 127 children (69 males, 58 females; average age 10.20±8.96 years; range, 5-18 years) who underwent adenotonsillectomy with a diagnosis of OSAS were included in the study. Pre-operative MPV levels and NLR values were compared with measurements in the post-operative third month. A p-value <0.05 was considered to reflect statistical significance. Results: Mean pre-operative MPV values were 8.12±1.28 femtoliters (fL) and mean post-operative MPV values were 7.96±1.01 fL, respectively. Post-operative MPV values were significantly lower than pre-operative measurements (p=0,028, p<0.05). Mean pre-operative NLR levels were 1.46±0.82 and post-operative NLR values were 1.42±1.01, respectively. Post-operative NLR values were significantly lower than pre-operative NLR values (p=0.032, p<0.05). Conclusion: We observed statistically significant lower MPV levels and NLR values after adenotonsillectomy in children with OSAS. Future randomized studies should explore the relationship between the MPV levels, NLR values and parameters in polysomnography in larger numbers of patients with OSAS.

Keywords: Mean platelet volume (MPV). Neutrophil to lymphocyte ratio (NLR). Adenotonsillectomy. Obstructive sleep apnea syndrome (OSAS).
Hot or Immediate Tonsillectomy: A Safe and Effective Method for Treatment of Acute Tonsillitis’ Complications

Hot or Immediate Tonsillectomy: A Safe and Effective Method for Treatment of Acute Tonsillitis’ Complications

Authors: Katarzyna Amernik
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Abstract

Aim: The aim of this study was retrospective analysis of indications to hot tonsillectomy, its effectiveness and safety. Peritonsillar abscess (PTA) is one of the most common complications of acute tonsillitis and the cause of emergency laryngological counselling. In some cases, it is necessary to perform hot tonsillectomy. Material and Methods: In between 2009-2015, 21 patients (aged between 4 to 43 years old) with an initial diagnosis of peritonsillar abscess were admitted. Among them, 11 were women and 10 were men. All underwent hot tonsillectomy. Results: Most of the patients were between 20-40 years old. The most common symptoms were pain in the throat, trismus and dysphagia. In all cases incision of an abscess was made, in 9 patients purulent discharge was present. In all patients there was no relief of symptoms after incision and antibiotic therapy. In 12 cases without drainage after initial incision, pus was drained after tonsillectomy. In the remaining 9 cases there were additional reservoirs of pus, which were drained after surgery in 6 patients. In 8 patients there was more than one localization of an abscess. There were no problems with intubation and no complications in the early and late post-operative periods occurred. The average time of stay in hospital was 8 days (5-12 days). Conclusion: Lack of improvement after initial treatment of PTA is an indication to hot tonsillectomy. This procedure is not connected with an increased risk of complications. Evacuation of purulent content does not exclude presence of another abscess, unusual localization or parapharyngeal space abscess.

Keywords: Peritonsillar abscess (PTA). Tonsillectomy. Hot tonsillectomy. Acute tonsillitis. Complication. Parapharyngeal space abscess.
Assessment of the Pittsburgh Sleep Quality Index among Physician's Speciality Who Work Night Shifts

Assessment of the Pittsburgh Sleep Quality Index among Physician's Speciality Who Work Night Shifts

Authors: Feriyde Calıskan Tur
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Abstract

Objective: As with other people, sleep quality has an impact on a physician’s work safety. Aim of this study is determine the sleep quality among medical specialists whose working night shifts, and detect other independent factors that affect their sleep quality. This is essential for improving the physician health and their daily performance for patient care. Methods: A qualitative study was design with a cross-sectional method. Sampling was conducted with stratification among night shift physicians who work in the emergency, internal medicine and surgical departments at an education and research hospital. Scores on the Pittsburgh Sleep Quality Index (PSQI) and the Swedish Demand-Control-Support Questionnaire (DCSQ) were assessed. Results: One hundred eight physicians who worked night shifts responded to the questionnaire. The average age of the physicians was 31.3±5.9, and 40.7% were women. The average PSQI score in male participants was significantly higher (8.1±3.7 vs. female 7.6±3.9; p=0.014). The majority of physicians (83.3%) had high PSQI values, i.e., scores of 5 or more. No significant difference was found in the average PSQI values between the emergency and internal medicine physicians and surgeons (p>0.05). The most important factors that affected physicians’ sleep quality were the number of night shifts per month, age, gender and the existence of a chronic disease. Conclusion: The sleep quality of medical specialists who work night shifts is equally low. The existence of a chronic disease, age, gender and higher numbers of night shifts affect sleep quality as powerful independent factors.

Keywords: Sleep quality. Sleep disorder. Medical specialties. Emergency physician. Night shift work.
Challenges in Diagnosing Adult Epiglottitis: Limitations of CT Scan

Challenges in Diagnosing Adult Epiglottitis: Limitations of CT Scan

Authors: Georges Ramalanjaona
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Abstract

Adult Epiglottitis (AE) is a life-threatening but uncommon condition which presents with non-specific symptoms such as sore throat and odynophagia. Because CT scan is readily available in the Emergency Department (ED), it is often used to evaluate adult patients with AE when laryngoscopy is not available and examination inadequate and to exclude other ENT (Ear, Nose and Throat) emergencies. However, up to this date, there is no report of CT scan accuracy in evaluating AE in our literature. Our case is a 26 year old African American female who complains of sore throat and odynophagia after she ate at a barbecue 8 hour prior to the ED visit. On examination, VS (Vital Signs) were stable, throat revealed marked erythema without any peritonsillar abscess. Neck was supple without any cervical adenopathy - Chest=clear, no rales/ronchi - The rest of the exam was within normal limits. Initial CT scan of the neck was read as normal by the on call Radiologist. A direct laryngoscopy had shown findings consistent with acute epiglottitis. Repeat CT scan 24 hours after ED visit confirmed the diagnosis of AE. Patient was started on IV steroids and antibiotics and admitted to ICU. Our case illustrates the challenges facing the Emergency Physicians in diagnosing AE. It reports the role and limitations of CT scan in evaluating AE in the ED.

Keywords: CT scan. Adult Epiglottitis (AE). Direct laryngoscopy.

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