Independent Predictive Factors of Hospitalization in a North-West Burn Center of Iran; an Epidemiologic Study

Introduction: A high grade burn is one of the most devastating injuries with several medical, social, economic, and psychological effects. These injuries are the most common cause of accidental deaths after traffic injuries in both the developed and developing countries. Therefore this research was aimed to determine demographic characteristics of patients with burn injury admitted to the emergency department and identify predictive factors of hospitalization. Methods: This is a cross sectional descriptive study, which is done in 20 March up to 20 September 2011 in emergency department of Sina Hospital, Tabriz, Iran. Patients’ information including demographic characteristic, cause of burn, place of accident, anatomical areas burned, grading and percent of burning and disposition were gathered and analyzed using SPSS version 18.0 statistical software. Stepwise multivariate regression analysis was used for recognition of independent predictive factors of hospitalization in burned patients. Results: One hundred and sixty patients were enrolled (54.4% female). The average age of those was 20.47±13.5 years. The prevalence of burn was significantly higher in ages under 20 years (p<0.001). Lower limb (37.5%), head and neck (21.25%) and upper limb (17.5%) were three frequent site of burn. The most common cause of burns was boiling water scalding (34.4%). Home related burn was significantly higher than other place (p<0.001). The most frequent percent of burn was <5% (46.25%). Finally 50 (31.25%) cases hospitalized. Univariate analysis demonstrated that age under 20 years old (p=0.02) female gender (p=0.02), burning site (p=0.002), cause (p=0.005), place (p<0.001), grade (p<0.001), and percent (p<0.001) was related to disposition of patients. Stepwise multiple logistic regression showed female gender (OR=3.52; 95% CI: 1.57-7.88; p=0.002), work related burning (OR=1.78; 95% CI: 1.26-2.52; p=0.001), and burning over 5 percent (OR=2.15; 95% CI: 1.35-3.41; p=0.001) as independent predictive factors of hospitalization. Conclusion: The results of present study showed that burns injury are most frequent in age under 20 year old, lower limbs, with boiling water, and at home. Also the most frequent type and percentage of burned area were second degree and <5% of total body surface area, respectively. Among age under 20 years old, female gender, burning site, cause, place, grade, and percent only female gender, work related burning, and burning over 5% were detected as independent predictive factors of hospitalization

Periumbilical Pain with Radiation to Both Legs Following Tarantula Bite; a Case Report

Tarantulas have recently become as pets in most parts of the world that increased the probability of encountering emergency physicians with patients hurt with these spiders. Their attacks usually do not cause general manifestation, however there are some case reports in this regard. Here, a 40-year-old man was reported who was referred to the emergency department with severe periumbilical pain that radiated to both legs and diagnosed as a victim of tarantula bite. Such symptoms usually are belonging to other spiders like Black Widow spider, but it seems that tarantula can mimic them in some cases, too

مدیریت درد در اورژانس پیش بیمارستانی: ضرورتی مغفول در نظام سلامت ایران

Pain, as a complex neurophysiological and neuropsychological mechanism, is one of the most common experiences among patients in prehospital emergency service. Although, there is no accurate data regarding the prevalence of pain in prehospital settings like there is for hospital emergency departments, in developed countries, despite the contradictions in the results of the numerous studies, the evidence indicate the high prevalence of acute pain in prehospital emergency service ranging from 20% to 53%. Yet, unfortunately, in Iran there is no statistics available in this regard. The physiological (affecting cardiovascular, respiratory, endocrine and other systems) and psychological (anxiety, anger, aggression, and …) complications due to uncontrolled acute pain have many adverse effects on the clinical outcomes of medical and traumatic patients and impose immense direct and indirect financial burdens on the limited resources of healthcare systems. Therefore, effective pain management using various pharmaceutical and non-pharmaceutical methods both on the scene and during transportation has become a potentially indispensable necessity and considered as a potential key performance indicator according to the National Association of EMS Physicians.An extensive literature review also revealed remarkable improvements in the use of analgesics in prehospital emergency service of many developed countries and opioid analgesics (e.g., morphine sulfate, fentanyl and ketamine); nonsteroidal anti-inflammatory drugs (e.g., Ketorolac and ibuprofen); and Paracetamol and Nitric Oxide (inhalation gas) have been put on the list of prehospital emergency service for relieving patients’ pain, which can be used based on qualification/competencies, roles, responsibilities, and degrees (EMR, EMT, AEMT, paramedic) of the providers of prehospital care with approval of the consultant physician or through use of a combination of off-line and on-line medical protocols in this regard. The majority of recent studies in this field focus on the inadequacy of prehospital pain management as well as the comparison and combination of various analgesic drugs to enhance efficacy, effectiveness and quality of healthcare provision.درد، به عنوان یک مکانیسم پیچیده نوروفیزیولوژیک و نوروسایکولوژیک، یکی از شایع ترین تجارب مشترک بیماران در اورژانس پیش بیمارستانی می باشد. هر چند آمار دقیق شیوع درد در اورژانس پیش بیمارستانی همچون اورژانس های بیمارستانی در دست نیست، اما در کشورهای توسعه یافته، علیرغم ناسازگاری نتایج مطالعات متعدد، شواهد حاکی از شیوع بالای درد حاد در اورژانس پیش بیمارستانی بین 20 تا 53 درصد است. این در حالی است که متاسفانه در ایران آماری در رابطه با این موضوع موجود نیست. عوارض فیزیولوژیک (تاثیر بر سیستم قلب و عروق، تنفس، اندوکرین و...) و سایکولوژیک (اضطراب، خشم، پرخاشگری و ...) ناشی از درد حاد کنترل نشده، اثرات سوء بسیاری بر پیامدهای بالینی بیماران داخلی و تروما داشته و هزینه های مالی مستقیم و غیرمستقیم کلانی را بر منابع محدود نظام های مراقبت سلامت تحمیل می نماید. لذا، امروزه مدیریت موثر درد با استفاده از روش های مختلف دارویی و غیر دارویی در صحنه و حین انتقال در اورژانس پیش بیمارستانی، به عنوان یک شاخص عملکردی بالقوه کلیدی به ضرورتی غیرقابل انکار مبدل گردیده است.مرور گسترده متون نیز نشان داد که اخیرا پیشرفت های چشمگیری در بهره گیری از تجهیزات و داروهای ضد درد در اورژانس پیش بیمارستانی بسیاری از کشورهای توسعه یافته حاصل شده و داروهای ضد درد اپیوئیدی (مورفین سولفات، فنتانیل و کتامین)؛ داروهای ضد التهاب غیر استروئیدی (کتورولاک و ایبوپروفن)؛ آپوتل و گاز نیتریک اکسید برای تسکین درد بیماران در لیست داروهای اورژانس پیش بیمارستانی قرار گرفته  که استفاده از این داروها بر حسب شرح وظايف و مدارج علمي تحصيلي پرسنل پیش بیمارستانی، با هماهنگی پزشک مشاور و یا با بهره گیری از پروتکل هاي باليني آف-لاين در این عرصه میسر گردیده است. همچنین اکثر پژوهش های اخیر در این حوزه بر عدم کفایت مدیریت درد پیش بیماستانی و نیز مقایسه و ترکیب داروهای مختلف ضد درد جهت افزایش کارایی و اثربخشی و بهبود کیفیت متمرکز می باشد.

اپیدمیولوژی شکستگی های ناحیه سر و گردن ناشی از تصادفات موتور سیکلت

Introduction: Injuries resulting from motor-vehicle accidents are a growing burden to health all over the world. Each year, many people get severely injured or die due to road traffic accidents. Therefore, we aimed to evaluate the demographics of head and neck fractures caused by motorcycle accidents. Methods: In the present retrospective cross-sectional study, all the patients who were referred to emergency department, during the time from March 2013 to March 2014, with head and neck injuries due to motorcycle accidents were included using census sampling. A checklist consisting of demographic data, trauma mechanism, time of trauma, being the driver or the passenger, using safety equipment, head and neck fractures, accompanying injuries, imaging findings, and final outcome was filled for all patients using their medical files, and the data were used for descriptive analysis. Results: 386 patients with the mean age of 28.4 ± 10.79 years were evaluated (84.4% male). Most of the patients were under 30 years old (p = 0.001). Spring, with 152 (39.4%) cases, had the highest rate of accidents among the seasons. 223 (57.8%) accidents happened in the daytime (p = 0.037). Only 191 (49.5%) patients had used helmets. The most frequent fracture was cervical vertebrae fracture with 61 (15.8%) cases. Finally, 207 (53.6%) of the patients were discharged from emergency department after diagnostic and therapeutic measures were taken. 175 (45.4%) cases were hospitalized in other departments for further treatments and were later discharged with good general condition. 4 (1%) cases of mortality were recorded. Conclusion: The results of the present epidemiologic study reveal that the prevalence of head and neck fractures in motorcycle accidents is higher in young people, male sex, and those who do not use safety equipment. The most common site for head and neck fractures are cervical vertebrae, skull, and face bones, respectively. مقدمه: در سراسر جهان آسیب های ناشی از تصادفات وسایل موتوری یک معضل در حال رشد برای سلامت جمعیت عمومی محسوب می شوند. سالانه تعداد افراد زیادی به علت تصادفات جاده ای شدیدا زخمی می شوند و یا جان خود را از دست می دهند. لذا بر آن شدیم تا با طراحی مطالعه حاضر به بررسی دموگرافیک شکستگی های ناحیه سر و گردن ناشی از تصادفات موتورسیکلت بپردازیم. روش کار: در این مطالعه مقطعی گذشته نگر تمامی بیمارانی که در طول سال 1392 به بخش اورژانس ارجاع شدند و دچار آسیب های ناحیه سر و گردن ناشی از تصادف با موتورسیکلت بودند به صورت سرشماری وارد گردیدند. چک لیستی شامل اطلاعات دموگرافیک، مکانیسم تروما، زمان وقوع تروما، راکب یا سرنشین بودن، کاربری وسیله نقلیه، استفاده از تجهیزات ایمنی، شکستگی های ناحیه سر و گردن، آسیب های همراه، یافته های تصویربرداری و پیامد نهایی از طریق مراجعه به پرونده های بالینی برای تمامی بیماران تکمیل و مورد آنالیز توصیفی قرار گرفت. يافته ها: 386 بیمار با میانگین سنی بیماران 79/10 ± 4/28 سال مورد ارزیابی قرار گرفتند (4/84 درصد مرد). اکثر بیماران در محدوده سنی کمتر از 30 سال قرار داشتند (001/0p =). سه ماهه اول سال با 152 (4/39 درصد) مورد بیشترین آمار تصادفات از جهت توزیع فصلی را به خود اختصاص داد. 223 (8/57 درصد) مورد از تصادفات در طی روز افتاده بود (037/0p =). تنها 191 (5/49 درصد) نفر از بیماران از کلاه ایمنی استفاده کرده بودند. شایع ترین شکستگی مربوط به مهره های گردنی با 61 (8/15 درصد) مورد بود. در نهایت 207 (6/53 درصد) مورد بعد از انجام اقدامات تشخیصی و درمانی مقتضی از اورژانس ترخیص شدند. 175 (4/45 درصد) مورد در بخش های مختلف بیمارستان برای اقدامات درمانی بیشتر بستری و بعد از مدتی با حال عمومی خوب ترخیص گردیدند. 4 (1 درصد) مورد هم مرگ و میر ثبت  شد. نتيجه گيری: نتایج این مطالعه اپیدمیولوژیک نشان می دهد، شیوع شکستگی های ناحیه سر و گردن در تصادف با موتورسیکلت  در افراد با سن پایین، جنس مذکر و عدم استفاده از تجهیزات ایمنی بیشتر است. شایعترین محل شکستگی های ناحیه سر و گردن به ترتیب مربوط به شکستگی مهره های گردن، جمجمه و در نهایت استخوان های صورت بود

Comparing of Frequent Central Venous Catheter Insertion and Selection Procedure and its Complications

Background: Central venous catheterization is used for several goals in the emergency department. Common sites of insertion of central venous lines are the right and left jugular veins as well as the right and left subclavian veins. The aim of this study was to evaluate the tendency frequency of emergency medicine residents to choose central venous line insertion route and also to determine the post-procedure complications. Methods: In this descriptive cross-sectional study, all patientswhounderwent central venous catheterization and were in the emergency ward of the Imam Reza hospital, Tabriz, Iran during March 21, 2015 to September 23, 2015 were included, preferences route of insertion and complications of both right and left jugular and subclavian veins were descriptively analyzed. Results: Of all the 134 evaluated patients, 54.5% were catheterized in course of shock. 88.1% of patients underwent right jugular vein catheterization and only 4.5% experienced post-procedure complications. In 91.8% of cases, the decision-making was done by the physician and 75.4% of the catheterizations were fulfilled by second-year emergency medicine residents. Conclusions: The most common route of catheterization was through the right jugular vein. Additionally, the most common complication was hematoma of the insertion site. In most of the cases, decision making was made by the physician and most of the catheterization procedures were fulfilled by second-year emergency medicine residents

Cardiac enzyme in emergency medicine

Acute chest pain is an important and frequently occurring symptom in patients. Chest pain is often a sign of ischemic heart disease. Chest pain due to suspected Acute Coronary Syndrome (ACS) is responsible for a large and increasing number of hospital attendances and admissions. Current practice for suspected ACS involves troponin testing 10–12 hours after symptom onset to diagnose Myocardial Infarction (MI). Patients with a negative troponin can be investigated further with Computed Tomographic Coronary Angiography (CTCA) or exercise Electrocardiography (ECG). A review of cardiac biomarkers as screening test in acute chest pain over 15 years was conducted. Separate searches were under taken for biomarkers. We Searched electronic databases up to 2004-2014, reviewed citation lists and contacted experts to identify diagnostic and prognostic studies comparing a relevant index test (biomarker, CTCA or exercise ECG) to the appropriate reference standard. We classified studies to two part early rise biomarkers, high sensitivity biomarkers. Conclusion: Although presentation troponin has suboptimal sensitivity, measurement of a 10-hour troponin level is unlikely to be cost-effective in most scenarios compared with a high sensitivity presentation troponin. Measurement of cardiac troponin using a sensitive method was the best test for the early diagnosis of an Acute Myocardial Infarction (AMI). Measurement of myoglobin or Creatine Kinase-MB (CK-MB) in addition to a sensitive troponin test is not recommended. Heart-type Fatty Acid-Binding Protein (H-FABP) shows promise as an early marker and requires further study

Epidemiological Survey of Multiple Sclerosis in East-Azerbaijan Province, Iran, 2014

Abstract:Introduction and background: MS as a chronic CNS disease is very prevalent in all around the world. Its epidemiology is different region by region and most of geographical and environmental factors may play a role in its incidence. To analyze demographic characteristics of the disease we designed this study.Methods and Materials: This Survey has been conducted in East-Azerbaijan province, North-West of Iran. Prevalence of the disease has been measured using data of Committee for diagnosis and Treatment of Multiple Sclerosis in 2014. Age, gender and type of the disease also been investigated in this research. Independent T Test, Chi square, Pearson and Fisher exact test used to analyze data.Results: We had 2774 MS patients in 2014. 726 were male (26%) and 2003 were female (73%). Mean age of males was 38±9 and mean age of females was 37.09±9. Mean age in male patients was more than in females significantly (P=0.001). We measured 73.26 prevalence per 100000 populations in East-Azerbaijan.Conclusion: Prevalence of the disease showed significant increase in 5 years compared to previous studies. Because of disease's disabilatating entity more interventional investigations are recommended to perform in preventing disease incidence or improving quality of life of sufferers and increasing their life expectancy.

Comparing the early function and complications between fluoroscopic guidance and blindly insertion of permanent hemodialysis catheter

Objective: Chronic kidney disease (CKD) is a complicated kidney defect causing permanent failure in renal function in progressive stages. Hemodialysis is the most accepted treatment to maintain body’s fluid/electrolyte homeostasis at the terminal stages of the disease. Permanent hemodialysis catheter (permicath) may be inserted blindly or by fluoroscopic guidance. This study aimed to compare the early function and complications between fluoroscopic guidance and blindly insertion of permanent hemodialysis catheter. Methods: This prospective randomized clinical trial was undertaken in the emergency department of Modarres hospital in Tehran, Iran during 2014 and 2015. Patients who needed catheter due to renal failure entered the study. Patients who needed emergency dialysis and those who could not wait for permicath were excluded. Patients were randomly assigned into 2 groups, under fluoroscopic guidance and blindly catheter insertion. Data were collected using a questionnaire and a checklist related to function (after 24 hours and 1 month), a need to exchange the catheter and the early adverse effects such as pneumothorax, hemothorax, and vascular injury. Results: A total of 101 patients were enrolled in this trial. Early dysfunction (blind group = 5), a need for catheter exchange (blind group = 2), pneumothorax (blind group = 2), vascular injury (blind group = 1) were recorded but the difference between the two groups was not statistically significant (P > 0.05). Conclusion: We did not observe a significant difference between the placement of permicath by fluoroscopic or blind method. However, more studies with larger groups are recommended

Demographic information and risk factors of stroke patients younger than 65 years old

Objective: The main objective of this study is to evaluate the prevalence of risk factors for and demographics ofpatients younger than 65 years old with stroke. Methods: This retrospective cross-sectional study took into consideration all patients younger than 65 years old who were admitted to the emergency department from 2016 to 2018. Some significant criteria such as age, sex, type of stroke, stroke risk factors, and modified Ranking Scale (mRS) were extracted from patients’ medical records. Based on their age, these patients were divided into three groups: younger than 35 years old (Group A), between 35-50 years old (Group B), and older than 50 years old (Group C). Data analysis was carried out using IBM® SPSS® Statistics 20.0 software. Results: A total of 392 patients with stroke were included in this study. Groups A, B, and C included 31, 124, and 237 patients, respectively. Among them, 313 patients (79.84%) were admitted to the hospital in cold seasons, while 73 patients (18.6%) had no symptoms related to stroke at the time of admission. The most common adjustable risk factor among the patients was hypertension (HTN) with a frequency of 230 (58.7%). Of note, the frequency of HTN, diabetes, atrial fibrillation (AF), oral contraceptive pill (OCP) consumption, and coronary artery disease (CAD) in patients was significantly different among these three groups. Conclusion: According to the findings of the present study, the prevalence rate of stroke probably varies for male and female (gender) in the studied groups, which is significantly correlated with age. Among the adjustable risk factors for stroke, HTN, diabetes, AF, OCP consumption, and CAD are significantly correlated with the age

Gray area; a novel strategy to confront COVID-19 in emergency departments

Introduction: Coronavirus disease 2019 (COVID-19) pandemic, affects almost every aspect of human life. To confront this crisis, a separate ward called gray area was designed for emergency departments (EDs) and applied at the provincial level in East-Azerbaijan, Iran. This study aimed to evaluate the effectiveness of this project, increase the serviceability and segregation of the location of infected patients, and show how feasible and fruitful it can be. Methods: This study is an analytical study. The statistical data collection from 39 hospitals was performed between 20 March to 21 September 2020. Descriptive Statistics as well as correlation coefficients were calculated using the 26th version of IBM SPSS. Results: Among 77489 COVID-19 patients admitted to the EDs, approximately 0.38% of patients died in EDs. 22.63% of EDs area was allocated to COVID-19 patients and 70.46% of ED nurses, worked in the gray area. There was no significant correlation between area, number of patients, number of nurses, number of shifts of nurses, number of nurses for each patient, number of nurse shifts for each patient, and area for each patient with mortality rate and rates of disposition in 6 and 12 hours. Conclusion: Gray area is an appropriate strategy to confront COVID-19 in EDs and if more studies approve these results, this strategy can be used to confront this pandemic and future similar conditions in resource-limited countries