A 62-year-old Man with Acute Dizziness, Nausea and Vomiting

The patient was a 62-year-old man presenting to the emergency department 6 hours after the onset of dizziness, nausea and vomiting. The patient complained of numbness of the right side of her body and reported swallowing problems. The initial examination showed the patient was alert and stable. The left side of her face was sweating while the right side was completely dry. The neurological examination revealed the patient was alert, and the right pupil was about 2 mm smaller than the left eye pupil, and both pupils responded to light. A paresis was observed in the right side of the face, tongue and uvula. Uvula was slightly deviated to the right. Other signs included hoarseness and swallowing impairment. The muscle strength of all four limbs was 5/5. Babinski reflex was downward on both sides. The patient could not sit by herself, and leaned to the right. The patient had a history of primary coronary intervention (PCI) and stent placement four years ago. She had smoked a pack of cigarettes for 40 years. She used nitrocontin, pearl, lisinopril, carvedilol and furosemide. Laboratory tests were normal. The first CT scan in the emergency department was normal. As a brain stem infarction was suspected, MRI was performed and revealed an infarct (Figure 1). The patient received neurology consultation and was discharged with stable vital signs and the daily order of aspirin and atorvastatin after five days. The patient was asked to have weekly follow-up visits

A 62-year-old Man with Acute Dizziness, Nausea and Vomiting

The patient was a 62-year-old man presenting to the emergency department 6 hours after the onset of dizziness, nausea and vomiting. The patient complained of numbness of the right side of her body and reported swallowing problems. The initial examination showed the patient was alert and stable. The left side of her face was sweating while the right side was completely dry. The neurological examination revealed the patient was alert, and the right pupil was about 2 mm smaller than the left eye pupil, and both pupils responded to light. A paresis was observed in the right side of the face, tongue and uvula. Uvula was slightly deviated to the right. Other signs included hoarseness and swallowing impairment. The muscle strength of all four limbs was 5/5. Babinski reflex was downward on both sides. The patient could not sit by herself, and leaned to the right. The patient had a history of primary coronary intervention (PCI) and stent placement four years ago. She had smoked a pack of cigarettes for 40 years. She used nitrocontin, pearl, lisinopril, carvedilol and furosemide. Laboratory tests were normal. The first CT scan in the emergency department was normal. As a brain stem infarction was suspected, MRI was performed and revealed an infarct (Figure 1). The patient received neurology consultation and was discharged with stable vital signs and the daily order of aspirin and atorvastatin after five days. The patient was asked to have weekly follow-up visits

Occupational Burnout and Its Related Factors Among Iranian Nurses: A Cross-Sectional Study in Shahroud, Northeast of Iran

BACKGROUND: Good physical and mental health of employees is one of the major characteristics of a healthy organisation. AIM: Due to the importance of occupational burnout and its potentially negative consequences, the aim of this study was to assess occupational burnout and its related factors among Iranian nurses. METHODS: In this cross-sectional study, 205 nurses who were working in two educational hospitals affiliated with Shahroud University of Medical Sciences were included. Forty-two of the nurses were male, and 163 were female (mean age: 31 years). Maslach Occupational Burnout Inventory, demographic and job characteristics questionnaires were completed for each nurse. Questionnaires were then collected, and data were analysed statistically by SPSS, version 22. RESULTS: In the assessment of occupational burnout, the highest level was observed in emotional exhaustion and then in personal performance. There was a significant difference between the frequency of nurses' emotional exhaustion domain in terms of gender (P < 0.05), so that, women suffered more from emotional exhaustion. There was a significant difference between the frequencies of nurses' performance in terms of marital status (P < 0.05) so that married people had more personal performance disorder. CONCLUSION: The results of this study showed that nurses suffered from low occupational burnout. Female gender, sleeping disorders, awakening at night and employment in stressful wards such as the emergency ward was associated with a higher level of occupational burnout in nurses

Investigating the Relationship between Attention Deficit Hyperactivity Disorder and Drug Abuse: a Case-Control Study

Background: Hyperactivity disorder is one of the most common psychiatric disorders that can lead to negative consequences such as addiction in adolescence. The purpose of this study was to determine the relationship between addiction and hyperactivity disorder in Shahroud city.  Methods: This is a case-control study with sample size 240. The case group included methadone-treated addicted drug users and the control group including patients admitted to the surgical wards of Imam HosseinShahroud Hospital who have no addiction to any drugs.We used the Conges(CAAR-S: OV) short-acting diagnostic questionnaire ofadolesent (CAARS) for collectting information. For analysisng the data SPSS version 21 was used and significant level was considered (0.05). Results: This study included 150 controls and 90 cases. The age avrege of cases and controls was 36.97 ± 10.40 and 31.57 ± 10.46 years, respectively. Although case and control were statistically different in restlessness-hyperactivity(P = 0.034), they do not statistically differ in the presence of Hyperactivity Disorder (P = 0.911). Conclutions:Since in the present study, only the subgroup of restlessness-hyperactivity in the two groups was significantly different (the value was greater for the control group), it can be argued that the modesty of addicted persons is partially reduced by opiate

Investigating the Relationship between Attention Deficit Hyperactivity Disorder and Drug Abuse: a Case-Control Study

Background: Hyperactivity disorder is one of the most common psychiatric disorders that can lead to negative consequences such as addiction in adolescence. The purpose of this study was to determine the relationship between addiction and hyperactivity disorder in Shahroud city.  Methods: This is a case-control study with sample size 240. The case group included methadone-treated addicted drug users and the control group including patients admitted to the surgical wards of Imam HosseinShahroud Hospital who have no addiction to any drugs.We used the Conges(CAAR-S: OV) short-acting diagnostic questionnaire ofadolesent (CAARS) for collectting information. For analysisng the data SPSS version 21 was used and significant level was considered (0.05). Results: This study included 150 controls and 90 cases. The age avrege of cases and controls was 36.97 ± 10.40 and 31.57 ± 10.46 years, respectively. Although case and control were statistically different in restlessness-hyperactivity(P = 0.034), they do not statistically differ in the presence of Hyperactivity Disorder (P = 0.911). Conclutions:Since in the present study, only the subgroup of restlessness-hyperactivity in the two groups was significantly different (the value was greater for the control group), it can be argued that the modesty of addicted persons is partially reduced by opiate

Comparing the Outcome of Immobilizing Lower Limb Injuries Using Standard-Sized and Half-Length Short Leg Splints

Background: Soft tissue injuries (STIs) of lower extremities are considered as a very common complaint in those patients that were admitted to the emergency department. One of the main purposes in these patients' treatment strategies is early returning to work and regular activities. This study purpose was to compare the results of two lower limb (leg) splinting methods: standard-sized short leg splinting, and also half-sized short leg splinting. Methods: In this randomized controlled clinical trial research, we enrolled those patients with STI of the lower limb and without bone fracture. The setting was Haftom Tir trauma center and all patients signed the written consent before the study starting. We categorized participants into two groups: standard-sized short leg splint and halfsized short leg splint. The data were entered into SPSS 18 software and also were analyzed using that. Results: 300 patients were included in this study totally. The splinting complications were similar in two groups, but the splint fracture and skin burn frequency were significantly lower in half-sized short leg splint (p value <0.005). The mean score of pain and swelling frequency had no significant differences in both groups (P>0.005). Conclusions: The results indicated that the performance of standardsized and half-sized short leg splinting was similar in lower limbs STIs. The difficulties were less in half-sized short leg splint. Therefore, this study recommend that emergency physicians could consider half-sized short leg splinting in STIs, but the recommendation may be considered as valuable when this study results reassess in other clinical trials with multicenter researches and more sample size

Comparing the Outcome of Immobilizing Lower Limb Injuries Using Standard-Sized and Half-Length Short Leg Splints

Background: Soft tissue injuries (STIs) of lower extremities are considered as a very common complaint in those patients that were admitted to the emergency department. One of the main purposes in these patients' treatment strategies is early returning to work and regular activities. This study purpose was to compare the results of two lower limb (leg) splinting methods: standard-sized short leg splinting, and also half-sized short leg splinting. Methods: In this randomized controlled clinical trial research, we enrolled those patients with STI of the lower limb and without bone fracture. The setting was Haftom Tir trauma center and all patients signed the written consent before the study starting. We categorized participants into two groups: standard-sized short leg splint and halfsized short leg splint. The data were entered into SPSS 18 software and also were analyzed using that. Results: 300 patients were included in this study totally. The splinting complications were similar in two groups, but the splint fracture and skin burn frequency were significantly lower in half-sized short leg splint (p value <0.005). The mean score of pain and swelling frequency had no significant differences in both groups (P>0.005). Conclusions: The results indicated that the performance of standardsized and half-sized short leg splinting was similar in lower limbs STIs. The difficulties were less in half-sized short leg splint. Therefore, this study recommend that emergency physicians could consider half-sized short leg splinting in STIs, but the recommendation may be considered as valuable when this study results reassess in other clinical trials with multicenter researches and more sample size

Electrocardiographic Changes in Scuba Divers: A Quasi-Experimental Study in Iran

Background: Cardiac arrhythmias, conduction abnormalities, congenital and acquired heart disorders could threat the human life in scuba diving. This study purpose was to investigate and analyze the electrocardiographic changes in scuba divers. Methods: This quasi-experimental study was accomplished on scuba divers of saltwater in the Persian Gulf. Electrocardiogram (ECG) was taken during 10 min before, immediately and also by passing 60 min from diving. All ECGs were interpreted by an emergency medicine specialist regarding heart blocks, sinus arrhythmia and the heart rate changes, QT and PR intervals, QRS complex, ST segment and T wave. All statistical analyses were performed using SPSS software ver19. Significant level was set at 0.05. Results: 37 males with the mean age of 35.7±4.27 years old were enrolled in this study. There was observed no significant change in the mean of the heart rate, mean of the QT interval and T wave change between two age groups cases (<35 and >35 years old), BMI groups (<25 and >25 kg/m2), depth of water groups (<25 and >25 m) and water temperature groups (14 to 15 and 16 to 17 ̊C), in the studied time periods (p value>0.05, in all of the cases); but the mean of the pulse rate, mean of the QT interval and T wave change indicated significant difference between the studied time periods (p value=0.005, 0.001 and 0.001, respectively). Conclusions: This study indicated significant changes in pulse rate, QT intervals and T waves between studied periods in scuba divers; consequently, special attention to these changes is required

Electrocardiographic Changes in Scuba Divers: A Quasi-Experimental Study in Iran

Background: Cardiac arrhythmias, conduction abnormalities, congenital and acquired heart disorders could threat the human life in scuba diving. This study purpose was to investigate and analyze the electrocardiographic changes in scuba divers. Methods: This quasi-experimental study was accomplished on scuba divers of saltwater in the Persian Gulf. Electrocardiogram (ECG) was taken during 10 min before, immediately and also by passing 60 min from diving. All ECGs were interpreted by an emergency medicine specialist regarding heart blocks, sinus arrhythmia and the heart rate changes, QT and PR intervals, QRS complex, ST segment and T wave. All statistical analyses were performed using SPSS software ver19. Significant level was set at 0.05. Results: 37 males with the mean age of 35.7±4.27 years old were enrolled in this study. There was observed no significant change in the mean of the heart rate, mean of the QT interval and T wave change between two age groups cases (<35 and >35 years old), BMI groups (<25 and >25 kg/m2), depth of water groups (<25 and >25 m) and water temperature groups (14 to 15 and 16 to 17 ̊C), in the studied time periods (p value>0.05, in all of the cases); but the mean of the pulse rate, mean of the QT interval and T wave change indicated significant difference between the studied time periods (p value=0.005, 0.001 and 0.001, respectively). Conclusions: This study indicated significant changes in pulse rate, QT intervals and T waves between studied periods in scuba divers; consequently, special attention to these changes is required

Needs and Challenges of the Presence of Emergency Medicine Specialists in an Educational Hospital; a Qualitative Study

مقدمه: رشته تخصص طب اورژانس در سال 1380 در ایران به دلیل نیاز به ایجاد یک رشته تخصصی برای پاسخ به نیازهای حیاتی بیماران به وجود آمد.  با توجه به عمر کم این رشته و چالش‌های به وجود آمده از زمان ایجاد آن تا کنون، در این مطالعه به بررسی اهمیت، نیازها و چالش‌های وجود طب اورژانس در یک بیمارستان آموزشی پرداختیم. روش کار: مطالعه حاضر یک مطالعه کیفی است. در این مطالعه نمونه گیری به صورت هدفمند از بین متخصصین با سابقه رشته طب اورژانس و بنیان گذاران این رشته و مسئولین نظام سلامت صورت گرفت. مصاحبه با گروه‌های فوق به صورت نیمه ساختارمند و ملاک حجم نمونه اشباع در اطلاعات قرار گرفت و در نهایت کدهای مهم به صورت گروه و زیر گروه انتخاب شده و تحت آنالیز قرار گرفتند. یافته ها: در این مطالعه پس از مصاحبه با 12 فرد صاحب نظر در رشته طب اورژانس، اشباع اطلاعات حاصل شد. از مهم‌ترین نیازهای ایجاد رشته طب اورژانس نیاز به یک متخصص با دید جامع برای درمان بیماران بحرانی و یک مدیریت جامع برای اورژانس دیده شد و بزرگ‌ترین چالش‌ها تداخل مالی با سایر رشته‌ها و تداخل در حوزه کاری مشترک بود. نتیجه گیری: با توجه به مطالعه حاضر و بررسی‌های موجود و ورودی ماهانه بیش از 2 میلیون بیمار و مصدوم به بخش اورژانس، وجود متخصص اورژانس در بیمارستان‌های آموزشی پیشنهاد می‌شود.Introduction: Emergency medicine specialty has been established in Iran since 2001 due to the need to create a specialized field for responding to patients' vital needs. Since this is a young field and challenges have arisen since the creation of this field, we have studied the importance, needs and challenges of emergency medicine specialists being available in a teaching hospital. Methods: This study was a qualitative one. In this study, purposeful sampling was performed among experienced experts in the field of emergency medicine, the founders of this field, and authorities of the healthcare system. The mentioned groups were interviewed in a semi-structured manner and the sample size was determined via data saturation. Finally, the important codes were selected in groups and subgroups and then analyzed. Results: In this study, after interviewing 12 experts in the field of emergency medicine, information saturation was reached. One of the most important needs for establishing emergency medicine specialty was found to be the need for an expert with a comprehensive view for treatment of critical patients and a comprehensive management for emergency department; and the greatest challenges were financial interference with other disciplines and interference in the area of joint work. Conclusion: Considering the evaluations of the present study and more than 2 million patients and injured people presenting to the emergency department each month, the presence of an emergency medicine specialist in educational hospitals is recommended