Comparison of educational effectiveness between lecture and demonstration based methods on emergency medical services providers of Mashhad city in dealing with patients suspected of having acute coronary syndrome

Introduction: acute coronary syndrome (ACS) is a common cause of emergency visit. Early administration of aspirin is associated with decreased mortality rate. Thus, aspirin should be administrated immediately to the patient with suspected ACS. Emergency medical services (EMS) providers should be trained to respond to heart emergencies and become familiar with presentations and complications of ACS. In this study, the effect of two educational methods â lecture and demonstration â on EMS providers were compared. ..

Acupressure has not an analgesic effect in patients with renal colic: a randomized controlled trial

BACKGROUND Easing renal colic (RC) pain is of the most important issues in the emergency departments. This study was conducted to investigate the analgesic effects of intravenous paracetamol in comparison to acupressure and intramuscular diclofenac in patients with RC. METHODS This randomized clinical trial was conducted on 96 eligible patients with RC, visiting the Emergency Department of Imam Reza Hospital of Mashhad, Iran. The participants were selected by consecutive non-random sampling method, and were randomized in three groups, each comprising of 32 participants. The first and second groups received 75 mg intramuscular diclofenac and lg intravenous paracetamol, respectively. In the third group, three acupressure points were manually stimulated for six minutes. The pain score was measured by Visual Analog Scale for pain at baseline and after 10, 30, and 60 minutes. Collected information analyses by SPSS version 20 and interpreted using descriptive statistics (frequency, percentage) and inferential statistics (chi-square test). RESULTS The mean age was 31.60 +/- 7.42 years (range:18-50). The two methods (diclofenac and paracetamol groups) were significantly better in pain reduction compared to acupressure after 10 minutes (p<0.001). Ninety four percent of participants in diclofenac group, 87% of paracetamol group and none of acupressure group were completely satisfied with their treatment method (p<0.001). CONCLUSION This study demonstrated that acupressure did not effectively reduces renal colic pain. It seems that contrary to acupressure, intravenous paracetamol is a safe and effective analgesic medicine for patients with RC.Mashhad University of Medical SciencesOpen access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Quebec Decision Rule in Determining the Need for Radiography in Reduction of Shoulder Dislocation; a Diagnostic Accuracy Study

Introduction: The Quebec Decision Rule (QDR) has been developed for deciding on the necessity of radiography for patients with shoulder dislocation. This study aimed to investigate the diagnostic value of QDR in this regard. Method: This diagnostic accuracy study was conducted on patients with shoulder dislocation visiting the emergency department. After filling out the QDR-based checklist for all patients, they underwent radiography and the obtained radiography results were compared to QDR-based clinical diagnostic findings. Results: ‌ 143 patients with the mean age of 32.1±12 years were evaluated (88.8% males). Sensitivity, specificity, and positive and negative predictive values of QDR were 50%, 58.2%, 3.3%, and 97.6%, respectively. The sensitivity and specificity were 100% and 50% in patients >40 years old, and 33.3% and 59.8% in those <40 years old. These indices were 33.3% and 60.4%, respectively, in the male sex and 100% and 40% in the female sex. Conclusion: ‌ Quebec decision rule holds promise to diagnose concomitant fractures in patients over the age of 40 with 100% sensitivity, thereby reducing the number of radiographies by 50% without causing diagnostic errors. In contrast, this criterion proved inefficient in patients younger than 40. â€

The prognostic value of cardiac ultrasonography in patients with cardiac arrest

Introduction: Echocardiography or cardiac imaging is proposed as a gold standard method for identifying high risk patients for cardiac arrest. In this systematic review, we studied the prognostic value of cardiac sonography in patients with cardiac arrest. Methods: PubMed was searched for the relevant articles. Case reports were not included. Inclusion criteria were all the studies applied transthorasic echocardiography in patients with cardiac arrest arrived at emergency department that studied the efficacy of this modality on patients survived to emergency discharge and returned to spontaneous circulation.Result: Overall, 870 articles were obtained through initial search and only nine articles were included after the evaluation of the title, abstract, and the full text. Echocardiography has high sensitivity and specificity in predicting the return of spontaneous circulation.Conclusion: Cardiac sonography is a fairly effective (not definitive) modality in predicting death in patients with lack of cardiac activity during resuscitation. Echocardiography should not be the sole basis for the decision to cease resuscitative efforts

Serum lactate is a useful predictor of death in severe sepsis and septic shock

The severe sepsis and septic shock are as common and lethal that emergency physicians routinely confront. Actually, more than two thirds of sepsis patients present initially to the ED. Only a few laboratory tests for markers of sepsis are currently available. The serum lactate level can help in determining prognosis and to risk-stratify patients with severe sepsis. This independent review of the literature includes 83 studies published in all electronic-based database such as Elsevier, PubMed, and SID during the last 18 years (40–320 patients in each). Data gathered from English language articles and books published between 1995 and 2013. The serum lactate concentrations measured in almost all patients with severe sepsis raised at admission and were higher in patients who had the worst outcomes such as higher Apache-II and SOFA score. Serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients with severe sepsis admitted to the emergency department and intensive care unit.  This review focuses on the association between initial and serial serum lactate level and mortality in patients presenting to the emergency department with severe sepsis

Improving advanced cardiovascular life support skills in medical students: simulation-based education approach

Objective: In this trial, we intend to assess the effect of simulation-based education approach on advanced cardiovascular life support skills among medical students. Methods: Through convenient sampling method, 40 interns of Mashhad University of Medical Sciences in their emergency medicine rotation (from September to December 2012) participated in this study. Advanced Cardiovascular Life Support (ACLS) workshops with pretest and post-test exams were performed. Workshops and checklists for pretest and post-test exams were designed according to the latest American Heart Association (AHA) guidelines. Results: The total score of the students increased significantly after workshops (24.6 out of 100 to 78.6 out of 100). This demonstrates 53.9% improvement in the skills after the simulation-based education (P< 0.001). Also the mean score of each station had a significant improvement (P< 0.001). Conclusion: Pretests showed that interns had poor performance in practical clinical matters while their scientific knowledge, such as ECG interpretation was acceptable. The overall results of the study highlights that Simulation based-education approach is highly effective in Improving ACLS skills among medical students

Assessment of mechanism, type and severity of injury in multiple trauma patients: A cross sectional study of a trauma center in Iran

Purpose: To accurately assess the mechanism, type and severity of injury in Iranian multiple trauma patients of a trauma center. Methods: Patients with multiple traumas referring to the emergency department of Hasheminejad University Hospital in Mashhad, Iran, entered this cross sectional study from March 2013 to December 2013. All the patients with injury severity score (ISS) > 9 were included in this study. Data analysis was performed by SPSS software (Version 11.5) and P values less than 0.05 were considered as significant differences. Results: Among the 6306 hospitalized trauma patients during this period, 148 had ISS>9. The male female ratio was 80%. The mean age of the patients was (33.5 ± 19.3) years. And 71% of the patients were younger than 44 years old. There were 19 (13%) deaths from which 68.5% were older than 44 years old. The mean transfer time from the injury scene to hospital was (55 ± 26) minutes. The most frequent mechanisms of injury were motorcycle crashes and falling from height, which together included 66.2% of all the injuries. A total of 84% of hospital deaths occurred after the first 24 h of hospitalization. Head and neck were the most common body injured areas with a prevalence of 111 cases (75%). Conclusion: Motorcycle crashes have high frequency in Iran. Since most victims are young males, injury prevention strategies should be considered to reduce the burden of injuries

Predicting outcomes 3 months after traumatic brain injury in patients admitted to emergency department

Background Traumatic brain injury (TBI) is among the leading causes of mortality and long-term disability. Prognosis assessment is a primary factor of clinical decision-making by emergency physicians. This study aimed to investigate the prognostic factors of TBI in the patients admitted to a typical emergency department. Methods This prospective cohort study was conducted involving 100 TBI patients. Baseline characteristics, including age, gender, Glasgow Coma Scale (GCS), and vital signs were recorded. Blood tests and brain CT scans were collected. The patients were followed-up three months after the date of admission. The observed outcomes were categorized as recovery without complication, recovery with complication, or death. Statistical analysis was performed using the simple and multivariate binary logistic regression in the software IBM SPSS version 19. Results The most common brain CT scan findings were subarachnoid hemorrhage (21.0%) and epidural hemorrhage (20.0%). In the follow-up performed three months after the admission, 47 patients (47.0%) had died, 39 (39.0%) were suffering from complications, and 14 patients (14.0%) were recovering without complications. Simple binary logistic regression showed that older age (OR=3.28, 95% C.I.=1.27-8.41), minor/moderate head trauma (OR=13.93, 95% C.I.=1.73-112.11), severe head trauma (OR=54.40, 95% C.I.=5.71-517.56) and presence of deep skull fracture (OR=8.92, 95% C.I.=1.04-75.53) were statistically significant predictors of mortality. Multivariate logistic regression showed that mortality chance was higher in elderly (OR=7.45, 95% C.I.=2.02-27.36), minor/moderate head trauma (OR=26.87, 95% C.I.=2.42-298.25) and severe head trauma (OR=127.97, 95% C.I.=9.11-1796.28). Conclusion This study demonstrated that severe head trauma was the most predicted risk factor of poorer clinical outcomes after TBI

سطح سرمی PRO.BNP در بیماران مبتلا به حمله حاد بیماری انسدادی مزمن ریه با و بدون وجود نارسایی قلبی

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory disorders. Various studies have been conducted to evaluate the predictive power of proBNP (pro-brain natriuretic peptide) in heart diseases. The aim of this study was to compare the serum level of proBNP in patients with acute attack of chronic obstructive pulmonary disease with and without heart failure. Methods: This cross-sectional study was conducted on 112 patients who presented to the Adalatian Emergency Department of Imam Reza Hospital of Mashhad University of Medical Sciences in 2016 and 2017. The serum level of proBNP was measured. Patients were subjected to echocardiography and Ejection Fraction evaluation by an experienced cardiologist using the image point HX echocardiography device. Finally, patients with and without heart failure were compared using SPSS version 16 software. Results: 75 patients (66.96%) did not have heart failure and 37 patients (33.04%) had heart failure. Basic characteristics including age, gender, smoking, and drug abuse were not significantly different between the two groups. However, the average number of hospitalizations was 3.2 ± 1.6 in patients with heart failure and 1.7 ± 0.8 in those without heart failure (P=0.001). The average proBNP level in patients with heart failure (16702.1 ± 6660.0 pg/dL) was significantly higher than that of patients without heart failure (1396.8 ± 161.2 pg/dL) (P=0.001). Conclusion: The level of proBNP is significantly higher in COPD patients with heart failure, and the number of hospitalizations is also significantly higher in these patients.هدف: بیماري انسدادي مزمن ریوي یکی از شایعترین اختلالات تنفسی است. مطالعات مختلفی برای ارزیابی قدرت پیشگویی ProBNP در بیماری های قلبی انجام شده است. هدف از این مطالعه مقایسه سطح سرمی PRO.BNP در بیماران مبتلا به حمله حاد بیماری انسدادی مزمن ریه با و بدون وجود نارسایی قلبی بود. روش کار: اين مطالعه مقطعی بر روی 112 بیمار مراجعه کننده به اورژانس عدالتیان بیمارستان امام رضا (ع) دانشگاه علوم پزشکي مشهد در سال 1395 و 1396 انجام شد. سطح سرمی PRO.BNP اندازه گیری شد. بیماران با استفاده از دستگاه اکوکاردیوگرافی image point HX توسط یک کاردیولوژیست با سابقه تحت اکوکاردیوگرافی و بررسی Ejection Fraction قرار گرفتند. در نهایت بیماران در دو دسته دچار نارسایی قلبی و بدون نارسایی قلبی با استفاده از نرم افزار SPSS نسخه 16 مورد مقایسه قرار گرفتند.&nbsp; &nbsp; یافته­ ها: 75 بیمار (96/66درصد ) بدون نارسایی قلبی و 37 بیمار(04/33 درصد) مبتلا به نارسایی قلبی بودند. خصوصیات پایه از جمله سن، جنسیت، استعمال دخانیات و مصرف مواد مخدر بین دو گروه تفاوت معنی داری نداشت. با این حال میانگین دفعات بستری در بیماران با نارسایی قلبی 6/1 ± 2/3 نوبت و بدون نارسایی قلبی 8/0 ± 7/1 نوبت بود (001/0P=). میانگین PRO.BNP در بیماران با نارسایی قلبی (0/6660 ± 1/16702 پیکوگرم در دسی لیتر) به طور معنی داری بیشتر از بیماران بدون نارسایی قلبی (2/161 ± 8/1396پیکوگرم در دسی لیتر) بود (001/0P=). &nbsp; نتیجه ­گیری: سطح PRO.BNP در بیماران دچار COPD با نارسایی قلبی به طور معناداری بالاتر است و در این بیماران تعداد دفعات بستری در بیمارستان به طور معناداری بیشتر است