Archives of Academic Emergency Medicine
Volume:3 Issue: 1, 2015

This text is a real-time description of an emergency medicine resident’s shift in an overcrowded emergency department (ED), Tehran, Iran.

Ebola hemorrhagic fever (EHF) was first reported in 1976 with two concurrent outbreaks of acute viral hemorrhagic fever centered in Yambuku (near the Ebola River), Democratic Republic of Congo, and also in Nzara, Sudan. The current outbreak of the Ebola Virus was started by reporting the first case in March 2014 in the forest regions of southeastern Guinea. Due to raising infection rates of over 13,000% within a 6-month period, now is considered as a global public health emergency and in August 8, 2014 the World Health Organization (WHO) has declared the epidemic to be a Public Health Emergency of International Concern. With more than 5000 involved cases and also nearly 3000 deaths, this event has turned to the largest and most dangerous Ebola virus outbreak in all around the world. Based on above mentioned, the present article aimed to review the virologic characteristics, transmission, clinical manifestation, diagnosis, treatment, and prevention of Ebola virus disease.

Many physicians have received a frantic call from anxious parents stating that their child had stopped breathing, become limp, or turned blue but then had recovered quickly. An apparent life-threatening event (ALTE) is defined as “an episode that is frightening to the observer, and is characterized by some combination of apnea, color change, marked change in muscle tone, choking, gagging, or coughing”. The incidence of ALTE is reported to be 0.05% to 6%. The knowledge about the most common causes and factors associated with higher risk of ALTE could be resulted in a more purposeful approach, improving the decision making process, and benefiting both children and parents. The aim of this review article was to report the epidemiology, etiology, evaluation, management, and disposition of ALTE. Infants with an ALTE might present no signs of acute illness and are commonly managed in the emergency settings that often require significant medical attention; hence, the emergency medicine personnel should be aware of the its clinical importance. There is no specific treatment for ALTE; therefore, the clinical evaluations should be focused on the detection of the underlying causes, which will define the outcomes and prognosis. ALTE is a confusing entity, representing a constellation of descriptive symptoms and signs; in other words, it is not a diagnosis. There are multiple possible etiologies and difficulties in evaluating and managing infants with these events, which are challenges to primary care physicians, emergency medicine specialists, and subspecialty pediatricians. The evaluation of these events in infants includes a detailed history, appropriate physical examination, diagnostic tests guided by obtained clues from the history and physical examination, and observation in the emergency department.

Health care providers and health policy managers need updated and valid information regarding causes of death (COD) for development the health care facilities, directing primary prevention, assigning funds, and promoting public health. The major causes of death and its burden have not been yet appropriately identified in Iran. Although several studies had been carried out in this area, most of them were local or performed in the past years and need to be update. Thus, the present study aimed to address the major causes of death and its burden in Iran. The present cross-sectional study was performed on graduate students and their families from February to March 2014. Through a two-stage random sampling procedure, data on 11315 subjects were obtained. The corresponding age of death, gender, and calendar year of death were inquired. All causes of death were categorized in nine groups including major cardiovascular disease, cancers, motor vehicle accidents, unintentional injuries, intentional injuries, stroke, lower respiratory infections, diabetes, and other reasons. Years of life lost (YLL) and person years of life lost were computed as the burden of diseases. Totally, 11315 (50.4% male) subjects were studied. The results regarding death of relatives revealed that 360 deaths occurred (66.9% male). COD in 95 cases (26.4%) was cardiovascular diseases, 64 (17.8%) motor vehicle accidents, 41 (11.4%) cancers, 23 (6.4%) unintentional injuries, 22 (6.1%) intentional injuries, 10 (2.8%) stroke, 8 (2.2%) lower respiratory infections, 6 (1.8%) diabetes, and 91 (25.3%) other reasons. The average YLL due to all COD was 34.4±18.5. YLL for motor vehicle accidents and injuries (unintentional and intentional) were higher than cardiovascular diseases (p<0.001). In addition, person years of life lost for motor vehicle accidents were 2613.1 years. Cardiovascular diseases (2159.4 years), cancers (1321.0 years), and unintentional injuries (990.4 years) were in the next ranks. Based on the findings, it seems that cardiovascular diseases, motor vehicle accidents, cancers, intentional and unintentional injuries are the major causes of death in Iranian population. Most of years of life lost were due to motor vehicle accidents, cardiovascular diseases and cancers, intentional and unintentional injuries, respectively.

Physicians frequently deal with procedures which require sedation of pediatric patients. Laceration repair is one of them. No study has been performed regarding the comparison between induction of sedation with sodium thiopental and ketamine in laceration repair. Therefore, the present study was aimed to comparison of induced sedation by rectal sodium thiopental and muscular injection of hydrochloride ketamine in pediatric patients need laceration repair. The presented study is a single-blinded clinical trial performed through 2013 to 2014 in Ayatollah Kashani and Alzahra Hospitals, Isfahan, Iran. Patients from 3 months to 14 years, needed sedation for laceration repair, were entered. Patients were sequentially evaluated and randomly categorized in two groups of hydrochloride ketamine with dose of 2-4 milligram per kilogram and sodium thiopental with dose of 25 milligram per kilogram. Demographic data and vital signs before drug administration and after induction of sedation, Ramsey score, time to onset of action, and sedation recovery time were evaluated. Chi-squared, Mann-Whitney, and Non-parametric analysis of covariance tests were used. P<0.05 was considered as a significant level. In this study 60 pediatric patients were entered. 30 patients with mean age of 42.8±18.82 months were received sodium thiopental and the rest with mean age of 30.08±16.88 months given ketamine. Mann-Whitney test was showed that time to onset of action in sodium thiopental group (28.23±5.18 minutes) was significantly higher than ketamine (7.77±4.13 minutes), (p<0.001). The sedation recovery time in ketamine group (29.83±7.70) was higher than sodium thiopental. Depth of sedation had no significant difference between two groups based on Ramsey score (p=0.87). No significant difference was seen between two groups in the respiratory rate (df=1, 58; F=0.002; P=0.96) and heart rate (df=1, 58; F=0.98; P=0.33). However, arterial oxygen saturation level (df=1, 58; F=6.58; P=0.013) was significantly higher in ketamine group. The findings of the present study show that Although the recovery time from sedation by ketamine is more than sodium thiopental, it’s fast-acting function without effecting on the oxygen saturation level causes that ketamine is considered as the better choice for induction of sedation in pediatric patients need laceration repair. In addition, long-term effect of ketamine provides more time for the physician to do the procedure and this issue decreases the need probability to the repeated-dose. However, effectiveness of both drugs to decrease the agitation was equal, based on the Ramsey score.

Alcohol poisoning is one of the main preventable causes of death, disability, and injury in many societies. Ethanol and methanol are the most prevalent kinds of alcohol used. There is no any exact reports of alcohol poisoning and its outcome in Iranian society. Therefore, the present study was assessed the status of alcohol poisoning and its outcome in referees to the emergency department. This is a cross-sectional study which was done from July 2013 to 2014 in Sina Trauma Center, Tabriz, Iran. The studied population included all alcohol poisoning cases referred to this center. Demographic variables, clinical evaluation, laboratory tests, and patient''s outcome were evaluated. To assess the relation between evaluated factors and outcome of alcohol poisoning. After univariate analysis a multivariate logistic regression was applied to evaluate independent risk factors for death. P<0.05 was considered as a significant level. Lastly 81 patients with alcohol poisoning were entered to the study (91.4% male) with the mean age of 27.9±10.4 years. Ten (12.3%) subjects were dialyzed and 34 (42%) cases hospitalized that 3 (3.7%) of them died. The multivariate logistic regression test displayed that plasma creatinine level (OR=2.2 95%Cl: 1.8-2.5; p=0.015) and need for dialysis (OR=6.4; 95%Cl: 5.3-7.5; p<0.001) were the only risk factors of death among these patients. The findings of the present study revealed that total mortality rate of referees to the emergency with alcohol poisoning was 3.7% all of whom related to methanol poisoning. Based on this result, the mortality rate of methanol poisoning was estimated 20%. Need for dialysis and increasing the creatinine level were accounted as independent risk factors of death.

Organ donation is one of the surviving procedures which can increase the life expectancy of end-stage patients. Inappropriate beliefs and attitude of individuals to organ donation, their poor knowledge, and the socio-economic level are one of the most important barriers for organ donation. Therefore, here knowledge and attitude levels among relatives of trauma patients regarding organ donation were evaluated. This cross-sectional study was done on relatives of trauma patients referred to the emergency department of Sina Hospital, Tabriz, Iran, through 2013 to 2014. The questionnaire included parts of demographic data and socio-economic situations as well as status of knowledge and attitude regarding organ donation. A score between 0-7 was belonged to each person based on his/her level of knowledge. Attitude level had a score between 0-12. Chi- square, Fisher, and Mann–Whitney U test were performed to assess the relation between demographic variables and the level of knowledge and attitude. P<0.05 was considered as a significant level. 79 persons (57.1% male) with the mean age of 31.3±11.3 years were evaluated. 57 (73.1%) of subjects agreed with organ transplant. The main causes of disagreement among relatives regarding organ donation were dissatisfaction of the donor''s relatives (25%) and religious issues (15%). 49 (62.02%) studied people had inappropriate attitude and 27 (34.2%) ones had good knowledge. male gender (OR=5.87; 95%CI: 3.32-8.42; p=0.001) and self-employed job (OR=7.78; 95%CI: 4.64-10.92; p=0.001) are independent factors associated with poor knowledge about organ donation. Self-employed job (OR=3.86; 95%CI: 1.41-6.11; p=0.009) and poor knowledge (OR=15.3; 95%CI: 9.03-21.57; p<0.001) were related to inappropriate attitude toward organ donation. The present study showed that 73.1% of participants agreed with organ donation. The major causes of disagreements were dissatisfaction of other relatives and religious beliefs. 62.0% of the studied people had positive view regarding organ donation and 34.2% of them well-informed about. The most important causative factors for poor knowledge in this context were male gender and self-employed occupation. In addition, poor knowledge and self-employed job were two factors associated with inappropriate attitude toward organ donation.

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. 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. 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. 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.

Hydatid cyst is a serious parasitic infection in places which people has a close contact with dogs or sheep. They may be found as an incidental findings during routine clinical examination or even followed by radiographic or ultrasonography evaluation. The disease becomes more complicated if rupture of the cysts occurs due to blunt trauma or spontaneously increases of intra-cystic pressure. Here, we reported a case of hydatid liver cyst that ruptured into the peritoneal cavity after blunt abdominal trauma.