A Survey of Patients' Satisfaction in Emergency Department of Rasht Poursina Hospital

Introduction: Patients' satisfaction (PS) is one of the important indicators of emergency care quality and outcomes of health care services. Some researchers believe that improve the work processes and hospital quality are not possible without caring to comments, requirements, expectations, and satisfaction of patients. The percent study was aimed to assess the emergency department (ED) PS of Poursina hospital, Rasht, Iran. Methods: In this descriptive cross sectional study, the samples was selected from 378 patients admitted to ED of Poursina Hospital, Rasht, Iran, 2013. For each patient a check list and a questionnaire, including 37 questions about PS, were filled that had categories like physical comfort and residential aspects, physicians care, nurse care, behavioral aspect, and waiting time for service presentation. Data were analyzed by SPSS version 16. Results: Entirely, 378 patients were entered to the study with mean age of 38.44±17.8 (60.8% male). The mean score of total satisfaction of ED patients was 106.94±13.62 (range: 72-144). The mean score of physical comfort was 33.25±4.76 out of the highest obtainable score of 55, nurse care 25.33±5.13 out of 40, physician care 24.34±3.38 out of 40, waiting time for services 13.42±5.48 out of 30, and behavioral aspects 10.58±2.66 out of 20. There were significant relation among PS, sex (P=0.0001), and the shift of admission (P=0.023). Conclusion: The findings of percent study showed that giving services to emergency clients in various fields such as physical comfort and residential aspects, physicians care, nurse care, and the total ED satisfaction is relatively agreeable. The periodic and continuous assessment as well as comparison of satisfaction and dissatisfaction parameters during the time, before and after performing the changes, could be effectual

Non-Judicial Hanging in Guilan Province, Iran between 2011 and 2013

Introduction: Hanging is one of the most commonly used way to commit suicide in many countries. This method used in suicide is considered a problem in Iran too, but no clear data exists regarding hanging in different regions or the country as a whole. Because of the epidemiologic differences in non-judicial hanging in different regions, this study aimed to assess it in Gilan province, Iran between 2011 and 2013. Methods: In this cross-sectional study, profiles of hanging cases registered in Poorsina hospital in Gilan, Iran between 2011 and 2013 were evaluated. Age, sex, marital status, place of residency, level of education, occupation, history of suicide, history of clinical illness, season of suicide and hanging outcome were evaluated. Results: 59 cases of hanging (mean age 31.4 ± 13.1 years and 83.0% male) were evaluated. 12 (20.34%) suffered from psychological disorders, and 9 (15.2%) confessed to substance abuse. 7 (11.9%) had a history of suicide attempts by hanging. Hanging was significantly higher in men (p<0.001), people with an education level of less than high school diploma (p=0.02) and the unemployed (p<0.05) patients. In the end, 20 (33.9%) of these attempts resulted in death. Conclusion: The results of this study showed that in 2 years, 59 cases committed suicide by hanging themselves, 33.9% of which finally died. Committing suicide by hanging was significantly more prevalent in men, people with an education level of less than high school diploma and the unemployed

Third Ventricle Colloid Cyst as a Cause of Sudden Drop Attacks of a 13-Year-Old Boy

Colloid cysts are mucous-filled masses with an outer fibrous layer. These cysts are rare developmental malformation and not a true neoplasm. They usually found incidentally and are asymptomatic; but in some cases may associate with rapid neurologic deterioration, herniation, and sudden death. Recognition of this rare but important diagnosis may result in decreasing mortality. In this report, we presented a 13-year-old boy with complaint of two times drop attack and final diagnosis of colloid cyst in the third brain ventricle

Report of 121 Cases of Bell's Palsy Referred to the Emergency Department

Introduction: According to the high incidence of Bell's palsy (IFP) and lack of clinical data regarding different aspects of disease, the present study investigated 121 Iranian patients with peripheral facial paralysis referred to the emergency department. Methods: In this retrospective study, all patients with peripheral facial paralysis, referred to the emergency department of Poursina hospital, Rasht, Iran, from August 2012 to August 2013, were enrolled. For all patients with diagnosis of Bell's palsy variables such as age, sex, occupation, clinical symptoms, comorbid disease, grade of paralysis, and the severity of the facial palsy were reviewed and analyzed using STATA version 11.0. Results: A total of 121 patients with peripheral facial paralysis were assessed with a mean age of 47.14±18.45 years (52.9% male). The majority of patients were observed in the summer (37.2%) and autumn (33.1%) and the recurrence rate was 22.3%. The most common grades of nerve damage were IV and V based on House- Brackman grading scale (47.1%). Also, the most frequent signs and symptoms were ear pain (43.8%), taste disturbance (38.8%), hyperacusis (15.7%) and increased tearing (11.6%). There were not significant correlations between the severity of palsy with age (p= 0.08), recurrence rate (p=0.18), season (p=0.9), and comorbid disease including hypertension (p=0.18), diabetes (p=0.29), and hyperlipidemia (p=0.94). The patients with any of following symptoms such as ear pain (p<0.001), taste disturbance (p<0.001), increased tearing (p=0.03), and Hyperacusis (p<0.001) have more severe palsy. Conclusion: There was equal gender and occupational distribution, higher incidence in fourth decade of life, higher incidence in summer and autumn, higher grade of nerve damage (grade V and VI), and higher incidence of ear pain and taste disturbance in patients suffered from IFP. Also, there was significant association between severity of nerve damage and presence of any simultaneous symptoms.

An Epidemiologic Study of Traumatic Brain Injuries in Emergency Department

Introduction: Traumatic brain injuries (TBI) are one of the most important causes of death in patients under the age of 25 years and is responsible for one third of total deaths caused by trauma. Therefore, knowing its epidemiologic pattern in different populations seems vital. Therefore, this study aims to examine the epidemiologic pattern of TBI in emergency department. Methods: In this cross-sectional study, the profiles of 1000 patients affected by TBI were selected using simple random sampling. The examined variables in this study included demographic, season, mechanism of injury, accompanying injuries, level of consciousness, hospitalization duration, computed tomography (CT) scan results, needing surgery, admission to intensive care unit, and outcome of the patient. In the end, independent risk factors for the death of patients were determined. Results: 1000 patients suffering from were studied (81.8% male; mean age 38.5±21.7 years). The frequency of their referral to hospital in spring (31.4%) was more (p<0.01). 45.9% of the patients had a level of consciousness less than 9 based on the Glasgow Coma Scale (GCS). Subdural (45.9%) and epidural bleeding (23.7%) were the most common findings in CT scans in this study (p<0.001). Finally, 233 (23.3%) of the patients were dead. Over 60 years of age, falling and motorcycle accidents, intracranial hemorrhage accompanied by brain contusion, subdural bleeding, a GCS of less than 9, and the need to be admitted to intensive care unit were independent risk factors of death in TBI. Conclusion: Age Over 60 years, falling and motorcycle accidents, intracranial hemorrhage accompanied by brain contusion, subdural bleeding, a GCS of less than 9, and need to be admitted to intensive care unit were independent risk factors for the death in TBI patients

Prevalence of Tramadol Consumption in First Seizure Patients; a One-Year Cross-sectional Study

Introduction: Previous studies have shown that there is a probability of seizure even with therapeutic doses of tramadol. Yet, no accurate data exist regarding this problem in Iran. Therefore, the present study aimed to evaluate the prevalence of tramadol consumption in patients with first seizure referred to the emergency department (ED). Methods: In the present retrospective one-year cross-sectional study, all patients who were referred to the ED of Poursina Hospital, Rasht, Iran, with the complaint of first seizure were evaluated. Demographic data and data regarding history of tramadol consumption, duration, total dose, last dose, and time passed from the last dose of consumption were recorded and analyzed regarding the study questions using SPSS 20. Results: 383 (68.9%) out of the 556 patients referred to the ED, were experiencing their first seizure (mean age 26.43 ± 6.48 years; 70.5% male). 84 (21.9%) patients had recently used tramadol. History of seizure in the family of tramadol consumers was significantly lower (3.6% compared to 11%; p = 0.036). Mean total tramadol consumption dose in the last 24 hours was 140.17 ± 73.53 mg (range: 50-300 mg). Duration of tramadol consumption was less than 10 days in 84.5% (df: 2; χ2 = 96.1; p < 0.001). In addition, 62 (73.8%) patients had seizure within 6 hours of consumption (df: 3; χ2 = 29.5; p < 0.001). Conclusion: Results of the present study showed that 21.9% of the patients with first seizure had a history of tramadol consumption. Seizure following tramadol consumption is more prevalent in the initial 10 days and within 6 hours of consumption. In addition, it seems that lower doses of tramadol may also induce seizure

مقایسه اثربخشی دیازپام و متیل پردنیزولون وریدی در درمان سرگیجه حاد محیطی؛ یک کارآزمایی بالینی

Introduction: Although vertigo alone is not counted as a disease, it is one of the most common complaints of patients presenting to emergency departments (ED). Considering that in facing peripheral vertigo a single treatment has not been agreed upon, we decided to evaluate the effectiveness and side effects of intravenous (IV) methyl prednisolone and diazepam in treating acute peripheral vertigo in a clinical trial. Methods:This double blind clinical trial was done to compare the effectiveness of IV methyl prednisolone and diazepam in controlling acute peripheral vertigo in patients visiting ED. Patients were allocated to one of the 2 groups using simple randomization, and vertigo severity (based on VAS score), hemodynamic changes, level of consciousness, changes in blood sugar and the side effects were compared between the 2 groups 30, 60, and 120 minutes after injection. Results: The study was done on 113 patients with the mean age of 41.8 ± 10.4 years (20-60) (58.4 male). Patients were divided into 2 groups of IV diazepam (51 patients) and IV methyl prednisolone (62 patients). A significant difference was not found between the 2 groups regarding age (p = 0.83), sex (p = 0.339), vertigo severity (p = 0.337) and vital signs (p = 0.986) on arrival. Vertigo severity only showed significant difference between the groups after 120 minutes of drug administration (p = 0.003). No case of low blood pressure, loss of consciousness, or hemodynamic instability was seen in either group during 120 minutes. Dry mouth was significantly higher in the group receiving IV diazepam (p =0.007). Mean blood sugar for diazepam and methyl prednisolone groups after 60 and 120 minutes were 120.6 ± 36.2 and 143.1 ± 51.2 (p = 0.009) and 119.5 ± 35.1 and 162.9 ± 50.9 (p < 0.001). Conclusion: In conclusion, considering the higher effectiveness and non-significant side effects of IV diazepam, it seems to be better than IV methyl prednisolone for symptom control in patients presenting with acute peripheral vertigo. مقدمه: اگر چه سرگیجه به تنهایی یک بیماری محسوب نمی شود اما یکی از شایعترین شکایات مراجعین به بخش های اورژانس است. با توجه به اینکه در برخورد با سرگیجه محیطی درمان واحدی مورد اتفاق نظر نیست برآن شدیم که تاثیر و عوارض متیل پردنیزولون و دیازپام وریدی را طی یک کارآزمایی بالینی در درمان سرگیجه حاد محیطی مقایسه نماییم. روش کار: این مطالعه به صورت کارآزمایی بالینی دو سویه کور و با هدف مقایسه اثربخشی متیل پردنیزولون و دیازپام وریدی در کنترل سرگیجه حاد محیطی بر روی بیماران مراجعه کننده به بخش اورژانس انجام شد. بیماران با استفاده از روش تصادفی ساده به یکی از دو گروه مذکور تقسیم شدند و شدت سرگیجه (بر اساس معیار VAS)، تغییرات همودینامیک، سطح هوشیاری، تغییرات قند خون و در نهایت عوارض جانبی بین دو گروه در دقایق 30، 60 و 120 بعد از تزریق مورد مقایسه قرار گرفت. يافته ها: مطالعه بر روی 113 بیمار با میانگین سنی 4/10 ± 8/41 سال (60-20) انجام شد (4/58 مرد). بیماران به دو گروه دیازپام وریدی (تعداد = 51 نفر) و متیل پردنیزولون وریدی (تعداد = 62 نفر) تقسیم شدند. اختلاف معنی داری بین دو گروه از جهت سن (830/0 =p)، جنس (339/0 = p)، شدت سرگیجه (337/0 =p) و علائم حیاتی (986/0 =p) بدو ورود وجود نداشت.شدت سرگیجه تنها در دقیقه 120 بعد از مصرف دو دارو با هم اختلاف معنی داری داشت (003/0 = p). هیچ موردی از افت فشارخون، کاهش سطح هوشیاری و ناپایداری همودینامیک در دو گروه مورد مطالعه طی 120 دقیقه مشاهده نگردید. خشکی دهان در گروه دریافت کننده دیازپام وریدی به طور معنی داری بالاتر بود (007/0 = p). میانگین قند خون گروه دیازپام و متیل پردنیزولون در دقیقه 60 و 120 به ترتیب عبارت بودند از: 2/36 ± 6/120 و 2/51 ± 1/143 (009/0 = p) و 1/35 ± 5/119 و 9/50 ± 9/162 (001/0 > p). نتيجه گيری: به طور کلی شاید بتوان گفت با در نظر گرفتن اثربخشی مناسب تر و کم اهمیت بودن عوارض جانبی مشاهده شده با دیازپام وریدی این دارو انتخاب مناسب تری نسبت به متیل پردنیزولون وریدی در کنترل علامت بیماران مراجعه کننده با سرگیجه حاد محیطی باشد

Diagnostic Accuracy of Cincinnati Pre-Hospital Stroke Scale

Introduction: Stroke is recognized as the third cause of mortality after cardiovascular and cancer diseases, so that lead to death of about 5 million people, annually. There are several scales to early prediction of at risk patients and decreasing the rate of mortality by transferring them to the stroke center. In the present study, the accuracy of Cincinnati pre-hospital stroke scale was assessed. Methods: This was a retrospective cross-sectional study done to assess accuracy of Cincinnati scale in prediction of stroke probability in patients referred to the emergency department of Poursina Hospital, Rasht, Iran, 2013 with neurologic symptoms. Three criteria of Cincinnati scale including facial droop, dysarthria, and upper extremity weakness as well as the final diagnosis of patients were gathered. Sensitivity, specificity, predictive values, and likelihood ratios of Cincinnati scale were calculated using SPSS version 20. Results: 448 patients were assessed. The agreement rate of Cincinnati scale and final diagnosis was 0.483 ± 0.055 (p<0.0001). The sensitivity of 93.19% (95% Cl: 90.11-95.54), specificity of 51.85% (95% Cl: 40.47-63.10), positive predictive value of 89.76% (95% Cl: 86.27-92.62), negative predictive value of 62.69% (95% Cl: 55.52-72.45), positive likelihood ratio of 1.94% (95% Cl: 1.54-2.43), and negative likelihood ratio of 0.13% (95% Cl: 0.09-0.20) were calculated. Conclusion: It seems that pre-hospital Cincinnati scale can be an appropriate screening tool in prediction of stroke in patients with acute neurologic syndromes

Comparing Two Different Doses of Intravenous Midazolamin in Pediatric Sedation and Analgesia

Introduction: Midazolam has turned into a common drug for pediatric procedural sedation and analgesia. However, there is not much data regarding its proper dose and potential side effects in the Iranian children population. Therefore, the present study was done to compare 2 doses of IV midazolam in this regard. Methods: The present clinical trial was performed to compare 0.1 and 0.3 mg/kg doses of IV midazolam in induction of sedation for head trauma infant patients in need of brain computed tomography (CT) scan. Conscious infants under 2 years old, with stable hemodynamics were included. Onset and duration of action as well as probable side effects were compared between the two groups using SPSS version 22. Results: 110 infants with the mean age of 14.0 §5.9 months (range: 4–24) and mean weight of 9.7±2 kg (range: 5–15) were randomly allocated to one of the 2 study groups (54.6% female). Success rate in 0.1 and 0.3 mg /kg groups were 38.2% (21 patients)and 60% (33 patients), respectively (p=0.018). Overall, 56 (50.9%) patients did not reach proper sedation and were sedated receiving ketamine (22 patients) or another dose of midazolam (34 patients, mean additional dose needed was 2.1±1.1 mg). Conclusion: The results of the present study demonstrated the higher success rate and longer duration of action for 0.3 mg /kg midazolam compared to 0.1 mg /kg. The groups were equal regarding onset of action, effect on vital signs and probable side effects

Comparison of Oral Midazolam and Promethazine with Oral Midazolam alone for Sedating Children during Computed Tomography

Introduction: Both midazolam and promethazine are recommended to be used as sedatives in many studies but each have some side effects that limits their use. Combination therapy as an alternative method, may decreases these limitations. Therefore, this study aimed to compare midazolam with midazolam-promethazine regarding induction, maintenance, and recovery characteristics following pediatric procedural sedation and analgesia. Methods: Children under 7 years old who needed sedation for being CT scanned were included in this double-blind randomized clinical trial. The patients were randomly divided into 2 groups: one only received midazolam (0.5 mg/kg), while the other group received a combination of midazolam (0.5 mg/kg) and promethazine (1.25 mg/kg). University of Michigan Sedation Scale (UMSS) was used to assess sedation induction. In addition to demographic data, the child’s vital signs were evaluated before prescribing the drugs and after inducing sedation (reaching UMSS level 2). The primary outcomes in the present study were onset of action after administration and duration of the drugs’ effect. Results: 107 patients were included in the study. Mean onset of action was 55.4±20.3 minutes for midazolam and 32.5±11.1 minutes for midazolam-promethazine combination (p<0.001). But duration of effect was not different between the 2 groups (p=0.36). 8 (7.5%) patients were unresponsive to the medication, all 8 of which were in the midazolam treated group (p=0.006). Also in 18 (16.8%) cases a rescue dose was prescribed, 14 (25.9%) were in the midazolam group and 4 (7.5%) were in the midazolam-promethazine group (p=0.02). Comparing systolic (p=0.20) and diastolic (p=0.34) blood pressure, heart rate (p=0.16), respiratory rate (p=0.17) and arterial oxygen saturation level (p=0.91) showed no significant difference between the 2 groups after intervention. Conclusion: Based on the findings of this study, it seems that using a combination of midazolam and promethazine not only speeds up the sedation induction, but also decreases unresponsiveness to the treatment and the need for a rescue dose