Knowledge of Emergency Medicine Residents in Relation to Prevention of Tetanus

Introduction: Knowledge of emergency medicine residents about the management of patients suspected of having tetanus favoring wounds is very important due to their responsibility for the treatment of such patients. The aim of the present study was to evaluate this knowledge and making sure of the adequacy of instructions they have received in relation to prevention of tetanus.  Methods: A reliable and reproducible questionnaire was used to evaluate knowledge of all the emergency medicine residents in Imam Hussein Hospital in Tehran, Iran, about conditions favoring tetanus (9 questions) and proper interventions in such conditions (12 questions). The questionnaires were completed and scored as poor and good. The Mann-Whitney U test was used to analyze data. Statistical significance was set at P<0.05. Results: In the present study, 73 emergency medicine residents were evaluated (45.2% male). Knowledge of 31 (42.5%) residents in relation to conditions favoring tetanus and 41 (56.2%) residents in correct therapeutic interventions was in good level. The most frequent incorrect answer was related to diabetic ulcers and wounds in patients with sepsis. There was an increase in scores of conditions favoring tetanus (P<0.001) and correct therapeutic interventions (P=0.001) with an increase in educational years. However, age (P=0.64), gender (P=0.31), job experience (P=0.38) and participation in educational courses (P=0.67) had no effect on the knowledge level of emergency medicine residents. Conclusion: According to the findings of the present study, the knowledge of emergency medicine residents about correct management of patients suspected of tetanus was low, which emphasizes the necessity of providing further instructions on prevention of tetanus in wound management.

ریسک فاکتورهای سی تی اسکن غیرنرمال در بیماران مراجعه کننده به بخش اورژانس به دنبال تشنج؛ یک مطالعه مقطعی

Introduction: Determining the need for performing brain imaging for patients presenting to emergency department following seizure is one of the most important questions that emergency medicine specialists face. The present study has been designed with the aim of evaluating risk factors of abnormal computed tomography (CT) scan in patients presenting to emergency department following seizure. Methods: This cross-sectional study was performed on patients with seizure presenting to the emergency department of Shohadaye Tajrish Hospital from April 2017 to March 2019 using convenience sampling. Demographic data and factors possibly related to presence of brain pathologic findings in patients were gathered and their correlation with findings of CT scan, performed for all patients, was evaluated. Results: 352 patients with the mean age of 34.99 ± 22.30 (6 months to 95) years were evaluated (58.8% male). Most studied patients (40.9%) had an education level less than high school diploma. 164 (46.6%) patients had a history of seizure from childhood or as a congenital disorder and 86 (24.4%) had a family history of seizure. 51.1% consumed anti-seizure medications and 31.8% would regularly take medications. Recent lack of sleep with a frequency of 174 (49.4%) cases and heavy physical activity before seizure with a frequency of 11 (3.1%) cases had the highest and lowest frequencies among predisposing factors of seizure. 138 (39.2%) patients had at least one pathologic finding in their brain imaging. The most common findings were subdural hemorrhage (7.1%) and brain tumors (6.8%), respectively. Based on these findings, a significant correlation was observed between age over 40 years (p < 0.001), supine position at the time of seizure (p < 0.001), positive history of seizure in childhood (p < 0.001), positive family history of seizure (p < 0.001), consumption or ceasing to consume anti-seizure medication (p < 0.001), acute head trauma (p < 0.001), consuming anti-coagulant medication (p < 0.001), presence of fever (p < 0.001), positive history of malignancy (p < 0.001), focal seizure (p < 0.001), and headache (p = 0.003) with abnormal CT findings. However, there was no statistically significant correlation between sex, time of seizure onset, education, drug abuse, presence of seizure stimulating factors, focal neurologic disorder, and altered level of consciousness with presence of pathologic findings in brain CT scan. Conclusion: Based on the findings of the present study it seems that using a series of clinical decision rules, we might be able to predict the probability of pathologic findings being present in the CT scan of patients with seizure and avoid brain imaging in cases with low probability.مقدمه: نیاز به انجام تصویر برداری مغزی برای بیماران مراجعه کننده به بخش اورژانس به دنبال تشنج از سوالات مهم پیش روی متخصصین طب اورژانس است. این مطالعه با هدف ارزیابی ریسک فاکتورهای سی‌تی‌اسکن غیر نرمال در بیماران مراجعه کننده به بخش اورژانس به دنبال تشنج طراحی شده است. روش‌ کار: این مطالعه مقطعی بر روی بیماران مبتلا به تشنج مراجعه کننده به بخش اورژانس بیمارستان شهدای تجریش از فروردین سال 1396 تا اسفند سال 1397 با استفاده از روش نمونه گیری در دسترس صورت پذیرفت. اطلاعات دموگرافیک و فاکتورهای احتمالی مرتبط با وجود یافته های پاتولوژیک مغزی بیماران جمع آوری و ارتباط آنها با یافته های سی تی اسکن، که برای تمامی بیماران انجام شد، مورد بررسی قرار گرفت. نتایج: 352 بیمار با میانگین سنی 30/22±99/34 (6 ماه تا 95) سال مورد مطالعه قرار گرفتند (8/58 درصد مرد). بیشتر افراد مورد بررسی (9/40%) تحصیلاتی زیر دیپلم  داشتند. 164 (6/46%)  نفر از بیماران سابقه تشنج از دوران کودکی یا به صورت مادرزادی را داشتند و 86 (4/24%) نفر سابقه خانوادگی تشنج داشتند. 1/51 درصد داروی ضد تشنج دریافت می‌کردند و 8/31 درصد مصرف منظم دارو داشتند. بی خوابی اخیر با فراوانی 174 (4/49%) مورد و انجام فعالیت سنگین پیش از تشنج با فراوانی 11 (1/3%) مورد به ترتیب بیشترین و کمترین فراوانی را در بین فاکتورهای مستعد کننده تشنج داشتند. 138 (2/39 درصد) نفر از بیماران دارای حداقل یک یافته پاتولوژیک در تصویر برداری مغزی بودند. شایع ترین یافته ها به ترتیب خونریزی زیر دورا (1/7 درصد) و تومرهای مغزی (8/6 درصد) بودند. بر این اساس همبستگی معنی داری بین سن بالای 40 سال (001/0 > p)، حالت خوابیده هنگام تشنج (001/0 > p)، سابقه مثبت تشنج در کودکی (001/0 > p)، سابقه مثبت خانوادگی تشنج (001/0 > p)، مصرف یا قطع داروی ضد تشنج (001/0 > p)، ضربه به سر حاد (001/0 > p)، مصرف داروی ضد انعقاد (001/0 > p)، وجود تب (001/0 > p)، سابقه مثبت بدخیمی (001/0 > p)، تشنج فوکال (001/0 > p)، و سردرد (003/0 = p) و امکان وجود یافته مثبت در سی تی مغز مشاهده شد. ولی ارتباط آماری معنی‌داری بین متغیرهای جنس، زمان بروز تشنج، تحصیلات، سومصرف مواد، وجود فاکتور تحریک کننده تشنج، اختلال عصبی موضعی، کاهش سطح هوشیاری با وجود یافته پاتولوژیک در سی تی اسکن مغزی وجود نداشت. نتیجه گیری: بر اساس یافته های مطالعه حاضر به نظر می رسد که شاید بتوان با استفاده از یک سری معیار های بالینی احتمال وجود ضایعه پاتولوژیک در سی تی اسکن بیماران مبتلا به تشنج را پیشگویی نمود و از انجام تصویر برداری مغزی در موارد با احتمال پایین خودداری نمود

Epidemiology and Death-Related Factors of Oncology Patients in Emergency Department

Introduction: Accurate diagnosis and proper treatment of oncology patients presented to emergency department(ED) can dramatically enhance their quality of life and decrease their mortality rate. Therefore, the presentstudy aimed to evaluate these patients from an epidemiologic point of view as well as identifying death-relatedfactors. Methods: In this retrospective cross-sectional study, all the oncology patients presented to ED duringone year were evaluated using census sampling. A checklist that consisted of clinical and demographic data aswell as patients outcome was filled for each patient. Using SPSS 21, multivariate stepwise logistic regressionanalysis was done to identify independent death-related factors. Results: 568 patients with the mean age of53.64§18.99 years were studied (56.5% male). The most common locations of tumor were brain (32.7%) andgastrointestinal tract (27.1%). Pain (32.5%) was the most frequent chief complaint on ED arrival. The overallmortality rate of studied patients was 154 (27.1%), 25 (16.2%) of them in ED. Among the evaluated factors,marital status, visiting on a weekday, arrival to ED via ambulance, type of cancer, stage of cancer, presence ofmetastasis, being under treatment with chemo-radiotherapy, chief complaint on arrival, tumor location, andadmission to intensive care unit (ICU) correlated significantly with in-hospital mortality. Conclusion: The mostcommon type of cancer in the studied patients was solid, located in the brain or gastrointestinal tract, in stage IIIand IV, metastatic, and under chemo-radiotherapy. Independent death-related factors included ICU admission,presentation with loss of consciousness or bleeding, arrival via ambulance, cancer stage > II, neuroendocrineand genitourinary location of cancer, and being under chemo-radiotherapy

Evaluation of type 2 Diabetes Mellitus Risk in Patients with post Trauma Splenectomy

Introduction: Recent studies suggest that the spleen has an important role as a source of multipotent stem cells and precursors of beta cells of pancreas islets. In addition, increased risk of developing hyperglycemia was reported in patients who underwent splenectomy due to trauma in long-term follow up. Therefore, there might be an association between splenectomy and an increased risk of type 2 diabetes mellitus. In this study, we evaluated the risk of type 2 diabetes and its risk factors including hyperglycemia, dyslipidemia, obesity and hypertension in trauma patients with splenectomy. Materials and methods: In this study, 221 patients who underwent splenectomy surgery due to trauma in the surgical ward of Imam Hossein Hospital 5 to 10 years ago were selected. Those with a history of diabetes, cancer, hyperthyroidism, Cushing's syndrome, pancreatitis, renal failure, and cirrhosis were excluded from the study. Then fasting plasma glucose, hemoglobin A1c (HbA1c), triglyceride, cholesterol and high density lipoprotein (HDL), body mass index and blood pressure have been evaluated in 90 patients who had had a history of splenectomy due to trauma from 2007, July 23 to 2012, July 22. Results: The results indicate that none of these patients has diabetes, 14.4 percent are in pre-diabetic stage, 56.6 percent has dyslipidemia, 57.7 percent has obesity and 20 percent has hypertension. Conclusion: The results of this study suggest that splenectomy does not increase the risk of type 2 diabetes. Prevalence of diabetes risk factors was approximately the same with those of Tehran population

The Prevalence of Personality Disorders among Emergency Nurses Based on MMPI-2 Questionnaire; a Cross-sectional Study

Introduction: The prevalence of behavioral disorders is substantially higher in stressful working environments such as emergency departments. The present study aimed to evaluate the prevalence of personality disorders among emergency nurses.Methods: In the present epidemiologic study, the prevalence of personality disorders among emergency nurses of three educational hospitals, Tehran, Iran, were evaluated based on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) test. After the questionnaires were filled, data were entered to a special software for MMPI-2 test and the final result was interpreted based on the opinion of a clinical psychologist. Findings were reported using descriptive statistics.Results: 102 emergency nurses with the mean age of 30.2 ± 5.6 years were enrolled (100% female; 100% with master’s degree in nursing). The mean working time and experience of studied nurses were 210.8 ± 47.9 hours/month (130-370) and 4.1 ± 3.6 years (1-20), respectively. 32 (31.4%) cases showed symptoms of personality disorders The most common personality disorder detected in this study was somatization with 8.8%, hysteria with 6.9% prevalence, and pollyannaish with 4.9%. Among the studied factors only recent history of unpleasant event has significant correlation with existence of personality disorders (p = 0.015).Conclusion: The present study showed that somatization, hysteria, and pollyannaish were the most common personality disorders among the emergency nurses. History of an unpleasant event in the past year was the only effective factor in existence of personality disorders in the studied nurses

Development of an Easy-to-Use Tool for the Assessment of Emergency Department Physical Design

Physical design of the emergency department (ED) has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed.  Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. Overall 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a “Yes or No” question for ease of analysis, meaning that the criterion is either met or not.

Trends of Serum Electrolyte Changes in Crush syndrome patients of Bam Earthquake; a Cross sectional Study

Introduction: Electrolyte imbalances are very common among crushed earthquake victims but there is notenough data regarding their trend of changes. The present study was designed to evaluate the trend of changesin sodium, calcium, and phosphorus ions among crush syndrome patients. Methods: In this retrospectivecross-sectional study, using the database of Bam earthquake victims, which was developed by Iranian Society ofNephrology following Bam earthquake, Iran, 2003, the 10-day trend of sodium, calcium, and phosphorus ionschanges in > 15 years old crush syndrome patients was evaluated. Results: 118 patients with the mean age of25.6 § 6.9 yearswere studied (57.3 male). On the first day of admission, 52.5% (95% CI: 42.7 - 62.3) of the patientshad hyponatremia, which reached 43.9% (95% CI: 28.5 - 59.3) on day 10. 100.0% of patients were hypocalcemicon admission and serum calcium level did not change dramatically during the 10 days of hospitalization. Theprevalence of hyperphosphatemia on the first day was 90.5% (95% CI: 81.5 - 99.5) and on the 10th day of hospitalization66.7% (95% CI: 48.5 - 84.8) of the patients were still affected. Conclusion: The results of the presentstudy shows the 52.5%prevalence of hyponatremia, 100% hypocalcemia, and 90.5% hyperphosphatemia amongcrush syndrome patients of Bam earthquake victims on the first day of admission. Evaluation of 10-day trendshows a slow decreasing pattern of these imbalances as after 10 days, 43.9% still remain hyponatremic, 92.3%hypocalcemic, and 66.7% hypophosphatemic

Epidemiology and Outcome of Patients with Acute Kidney Injury in Emergency Department; a Cross-Sectional Study

Introduction: Elimination of preventable deaths due to acute kidney injury (AKI) in low-income countries by 2025 is an important healthcare goal at the international level. The present study was designed with the aim of evaluating the prevalence and outcome of AKI in patients presenting to emergency department.Methods: The present cross-sectional, retrospective study was performed on patients that presented to the emergency departments of 3 major teaching hospitals, Tehran, Iran, between 2005 and 2015 and were diagnosed with AKI. Patient selection was done using consecutive sampling and required data for this study was extracted by referring to the medical profiles of the patients and filling out a checklist designed for the study.Results: 770 AKI patients with the mean age of 62.72 ± 19.79 (1 – 99) years were evaluation (59.1% male). 690 (89.61%) cases of AKI causes were pre-renal or renal. Among the pre-renal causes, 74 (73.3%) cases were due to different types of shock (p < 0.001). The most common etiologic causes of AKI in pre-renal group were hypotension (57.3%) and renal vascular insufficiency (31.6%). In addition, regarding the renal types, rhabdomyolysis (35.0%), medication (17.5%) and chemotherapy (15.3%) and in post-renal types, kidney stone (34.5%) were the most common etiologic causes. 327 (42.5%) patients needed dialysis and 169 (21.9%) patients died. Sex (p = 0.001), age over 60 years (p = 0.001), blood urea nitrogen level (p < 0.001), hyperkalemia (p < 0.001), metabolic acidosis (p < 0.001), cause of failure (p = 0.001), and type of failure (p = 0.009) were independent risk factors of mortality.Conclusion: The total prevalence of AKI in emergency department was 315 for each 1000000 population and preventable mortality rate due to AKI was estimated to be 28.2 cases in each 1000000 population. The most important preventable AKI causes in the pre-renal group included shock, sepsis, and dehydration; in the renal group they included rhabdomyolysis and intoxication; and stones in the post-renal group

An Audit of Emergency Department Accreditation Based on Joint Commission International Standards (JCI)

Introduction: Despite thousands of years from creation of medical knowledge, it not much passes from founding the health care systems. Accreditation is an effective mechanism for performance evaluation, quality enhancement, and the safety of health care systems. This study was conducted to assess the results of emergency department (ED) accreditation in Shohadaye Tajrish Hospital, Tehran, Iran, 2013 in terms of domesticated standards of joint commission international (JCI) standards. Methods: This is a cohort study with a four months follow up which was conducted in the ED of Shohadaye Tajrish hospital in December 2013. The standard evaluation check list of Iran hospitals (based on JCI standards) included 24 heading and 337 subheading was used for this purpose. The effective possible causes of weak spots were found and their solutions considered. After correction, assessment of accreditation were repeated again. Finally, the achieved results of two periods were analyzed using SPSS version 20. Results: Quality improvement, admission in department and patient assessment, competency and capability test for staffs, collection and analysis of data, training of patients, and facilities had the score of below 50%. The mean of total score for accreditation in ED in the first period was 60.4±30.15 percent and in the second period 68.9±22.9 (p=0.005). Strategic plans, head of department, head nurse, resident physician, responsible nurse for the shift, and personnel file achieved the score of 100%. Of total headings below 50% in the first period just in two cases, collection and analysis of data with growth of 40% as well as competency and capability test for staffs with growth of 17%, were reached to more than 50%. Conclusion: Based on findings of the present study, the ED of Shohadaye Tajrish hospital reached the score of below 50% in six heading of quality improvement, admission in department and patient assessment, competency and capability test for staffs, collection and analysis of data, training of patients, and facilities. While, the given score in strategic plans, head of department, head nurse, resident physician, responsible nurse for the shifts, and personnel file was 100%

Predictive Factors of Poor Outcome in Road Traffic Injures; a Retrospective Cohort Study

Introduction: Road traffic injuries (RTI) are among the most important health problems worldwide as they cause more than 1.2 million deaths and 50 million injuries each year. Therefore, the present study aims to evaluate the outcome and aftermath of RTI in those who were injured and hospitalized due to a traffic accident.Methods: In the present retrospective cohort study with a one-year follow-up, data were extracted from the profiles of the RTI hospitalized patients. Outcome of the patients was evaluated at the time of discharge and 1-year later including their living state, presence of a disability or complete recovery.Results: 1471 patients were studied (mean age of 32.8±17.0; 80.3% male). 571 (38.8%) had mild disability, 684 (46.5%) moderate disability, and 85 (5.8%) had severe disability at the time of discharge. In the end, 53 (3.6%) died. In the 1-year follow-up, 194 (13.2%) had mild disability, 43 (2.9%) had moderate disability, 9 (0.6%) had severe disability, and 7 (0.5%) were in a vegetative state. Presence of an underlying disease (p=0.03), loss of consciousness for more than 24 hours (p=0.04), spinal injury (p=0.002), presence of multiple trauma (p=0.01), increased ISS (p<0.001), need for ventilator (p<0.001), and organ injuries during hospitalization (p<0.001) are independent factors that increase the risk of poor outcome in RTI patients.Conclusion: Based on the results of the present study, underlying illnesses, loss of consciousness for more than 24 hours, spinal injury, multiple trauma, increased ISS, need for ventilator, and organ injuries during hospitalization were independent factors that increased the probability of poor outcome in RTI injuries