Disaster drill at a university hospital

The course of a disaster drill held on 23 October 2001 at Aga Khan University, Karachi is reported. The Hospital Emergency Plan was put to trial on that day. Volunteers were invited to become simulated casualties in the drill. Briefing seminars had been conducted with the key players of the hospital. The scenario was a man-made type disaster. A 747 jumbo jet with 200 passengers had crashed at the end of the runway at Quaid-e-Azam International Airport while taking off in a thunderstorm. Fifty casualties were sent to Emergency Room by ambulance. The Plan was activated and relevant units were mobilized according to the Plan. It took 2 hours to complete the disaster drill. Major difficulties were identified in the operations, communications, staff deployment, and emergency control center. Debriefing sessions reviewed difficulties encountered throughout the drill and the possible remedies

Return of spontaneous circulation and survival at hospital discharge in patients with out-of-hospital and emergency department cardiac arrests in a tertiary care centre.

OBJECTIVE: To examine clinical variables and outcomes in patients with out-of-hospital (unwitnessed) and emergency department (ED; witnessed) cardiac arrests at a tertiary care hospital in Karachi. METHODS: A prospective observational study was conducted to note that outcomes in patients with first attempted cardiopulmonary resuscitation in the Emergency Department of the Aga Khan University Hospital, Karachi, between Jan. 2000 and Dec. 2000. Cardiac arrest was defined as absence of a palpable central pulse and apnoea. Return of spontaneous circulation (ROSC) and survival at hospital discharge were primary outcomes. Logistic regression was applied to determine predictors for ROSC. RESULTS: Of 106 patients with cardiac arrest, 59% (n = 62/106) patients had ROSC [52% (n = 29/56) of unwitnessed group; 64% (n = 32/50) of witnessed group]. Mean age was 48 years (range: 27-86); 68% (n = 72/106) were males; and 41% (n = 43/106) had ventricular fibrillation (VF) as initial rhythm. Male gender (OR 0.381; CI 0.156-0.928), PEA (OR 0.175; CI 0.063-0.489, reference VF) and asystole (OR 0.328; CI 0.114-0.944, reference VF) were negatively associated with ROSC. Less than ten minutes duration of CPR (OR 63.628; CI 8.221-429.457) and one co-morbidity status (OR 3.607; CI: 1.26-10.327, reference two or more co-morbidities) were positively associated with ROSC. Overall, 22% (n = 23/106) of enrolled patients left the hospital alive: 34% (n = 17/50) of the witnessed group and 12% (n = 6/56) of the unwitnessed group. CONCLUSION: Out of hospital arrest was associated with dismal survival at hospital discharge, emphasizing the need for development of pre-hospital care services for our country

Narcotic analgesics for acute migraine in the emergency room: are we meeting headache societies\u27 guidelines?

We analysed 161 patients with acute migraine in our emergency room (ER) to identify the use of narcotic analgesics as first-line treatment. Twenty-four percent of patients were treated with opioid analgesics and 76% patients were treated with non-opioid analgesics. Pain was completely relieved in 100 (62%) patients, partially relieved in 50 (31%) patients and was not relieved in 11 (7%) patients at the time of discharge. Pain relief was not related to the use of opioids vs. non-opioids. The treatment of acute migraine in our ER is in line with the guidelines of the Headache Societies and needs further improvement

Suicidal bus bombing of French nationals in Pakistan: physical injuries and management of survivors

Abstract BACKGROUND: Suicidal bombing is particularly devastating and an increasingly common form of terrorist violence. In this paper, we present an epidemiologic description of the physical injuries of patients who survived the suicidal bombing attack in the context of the limited medical resources of a developing nation. METHODS: The management of individual patients was reviewed from a preprinted trauma form. Information on the nature of injuries, operative management and hospital course was recorded and data analyzed using the Trauma Registry. RESULTS: Twelve survivors out of 36 bomb blast victims brought to the Aga Khan University Hospital were transferred from primary receiving hospitals. The average number of injuries per patient was eight. The mean Injury Severity Score was 10.8. The majority of patients had secondary and tertiary blast injuries. Most of the survivors had calcaneal injuries; these have not been reported in the literature in similar terrorist attacks. Twelve operative interventions were undertaken. All of the 12 patients were stabilized and evacuated within 24 h of admission. CONCLUSIONS: All of the 12 patients transferred to the Aga Khan University Hospital survived. Unlike the reported injuries, calcaneal fractures were most commonly encountered in the survivors

Incidence of early pregnancy bleeding in the Eastern region of Saudi Arabia

Background: Early pregnancy bleeding (EPB) is defined as bleeding within the first 20 weeks of gestation.  Women who present with bleeding in early pregnancy have 30 – 50% probability of having a failed pregnancy.  Recent US statistics report that it accounts for 1.6% of all ED visits. Although first-trimester vaginal bleeding is an alarming symptom, there is limited published literature on its incidence, timing, and risk factors and there is no published data from the KSA.Methods: This retrospective cohort study included pregnant women who attended their first antenatal visit between August 2011 and May 2012.Results: The number of participants was 724 women who attended the antenatal clinic for first pregnancy visit. 37.85% of them (274) of developed first trimester vaginal bleeding. 62% experienced mild bleeding, 15.4% had moderate bleeding, 13.9% had spotting, while 4.9% of had severe bleeding. The incidence of threatened miscarriage was the highest (11.5%) followed by incomplete miscarriage (8.8%) and missed carriage (7.7%). The incidence of molar pregnancy in our study of 0.55% was very high.Conclusions: The incidence of first trimester vaginal bleeding is high in our center when compared with figures from published literature. The incidence of threatened miscarriage is low, while the incidence of complete or incomplete miscarriage is relatively high. Similar to other reports from Asia, the incidence of molar pregnancy was very high. Further research is recommended to justify the detected high first trimester vaginal bleeding rates and to identify potentials of prevention or improvement of the outcomes of bleeding

Cardiopulmonary resuscitation: outcome and its predictors among hospitalized adult patients in Pakistan.

Introduction:Our aim was to study the outcomes and predictors of in-hospital cardiopulmonary resuscitation (CPR) among adult Patients at a tertiary care centre in Pakistan.Methods:We conducted a retrospective chart review of all adult Patients (age \u3e or =14 years), who underwent CPR following cardiac arrest, in a tertiary care hospital during a 5-year study period (June 1998 to June 2003). We excluded Patients aged 14 years or less, those who were declared dead on arrival and Patients with a do not resuscitate order. The 1- and 6-month follow-ups of discharged Patients were also recorded.Results:We found 383 cases of adult in-hospital cardiac arrest that underwent CPR. Pulseless electrical activity was the most common initial rhythm (50%), followed by asystole (30%) and ventricular tachycardia/fibrillation (19%). Return of spontaneous circulation was achieved in 72% of Patients with 42% surviving more than 24 h, and 19% survived to discharge from hospital. On follow-up, 14% and 12% were found to be alive at 1 and 6 months, respectively. Multivariable logistic regression identified three independent predictors of better outcome (survival \u3e24 h): non-intubated status [adjusted odds ratio (aOR): 3.1, 95% confidence interval (CI): 1.6-6.0], location of cardiac arrest in emergency department (aOR: 18.9, 95% CI: 7.0-51.0) and shorter duration of CPR (aOR: 3.3, 95% CI: 1.9-5.5).Conclusion:Outcome of CPR following in-hospital cardiac arrest in our setting is better than described in other series. Non-intubated status before arrest, cardiac arrest in the emergency department and shorter duration of CPR were independent predictors of good outcome

Accuracy of urine dipstick to predict urinary tract infections in an emergency department.

BACKGROUND: Urine dipstick is a useful and commonly used test in the Emergency Department because of its rapidity and low cost; however its diagnostic accuracy is debatable. Our objective was to compare the urine dipstick and urinalysis for Urinary Tract Infection in a developing country, where there are significant cost considerations. METHODS: This was an observational study of adults\u27 patients presenting to Section of Emergency section (SEM) of the Aga Khan University Hospital, from March to May 1998. The patient\u27s urine sample was tested immediately, using the Multistix 10SG. The sample was sent within one hour to the hospital laboratory for analysis, while the urinary specimen was sent for culture, where appropriate. The dipstick results were compared with the results of automated urinalysis in the laboratory, leukocyte counts on microscopy and urine culture. Sensitivity, Specificity, and predictive values were also calculated. RESULTS: We evaluated 984 samples of urine during the study period. The sensitivity of nitrite test was 81% and that of leukocyte esterase 77% for positive cultures. However, the sensitivity for combined nitrite and leukocyte esterase test was 94%. Nitrite test was more specific (87%) than leukocyte esterase test (54%) or both tests taken together (50%). The predictive value of nitrite and leukocyte esterase together for a negative urine culture was 95%. Leukocyte esterase test sensitivity increased as the number of white blood cells on microscopy increased. Similarly the predictive value of leukocytes on microscopy for a positive culture increased as the number of leukocytes increased. CONCLUSION: Dipstick alone cannot accurately predict urinary tract infection in emergency department