الهام پیش بین

Using radius hematoma block method can provide good anesthesia in distal radius fractures, but sometimes it is difficult to do it using anatomical landmarks. Performing the block procedure under ultrasound guidance can improve the success rate of the block and pain relief during delivery.

In this double-blind clinical trial study, 100 patients over 15 years of age with acute distal radius fracture were randomly assigned to two groups of hematoma block without ultrasound guidance and hematoma block with ultrasound guidance (47 people). Examining the amount of pain during block and insertion based on a Likert scale of 0 to 10 (0=no pain and 10=most pain) during insertion and half an hour after insertion was done and compared in two groups.

In this study, 69% of participating patients were women, the average age of patients in the group with ultrasound guidance was 47.25 years and in the group without ultrasound guidance was 55.16 years. The average number of VAS during descent in the group with ultrasound guidance and without ultrasound guidance was 5.42 and 5.81, respectively, and half an hour later, it was 1.91 and 2.33, respectively.

It seems that performing hematoma block under ultrasound guidance especially in cases where there are no suitable local landmarks or for reasons such as swelling of soft tissue, bone anatomy, crushing of fracture fragments, or the presence of interfering factors in diagnosing the exact location of the fracture. Hematoma block becomes complicated and difficult, it can be very helpful.

Asthma is a chronic disease usually characterized by periodic wheezing, coughs, and shortness ofbreath as a result of hyper responsiveness and inflammation of the airway. The purpose of this study was to assessthe correlation between the results of single breath counting and peak expiratory flow rate methods in evaluation ofpulmonary function among patients presenting to the emergency department with acute asthma attack.

This cross-sectional study was performed on 33 patients with complaint of acute asthma attack before and after theinitial treatment, peak flowmetry, and Single Breath Counting (SBC) were performed. A checklist including age, sex,respiratory rate, blood oxygen saturation, asthma severity, SBC, and Peak Expiratory Flow Rate (PEFR) was filled outbefore and after treatment. Statistical analysis was performed to evaluate the relationship between data using SPSSv.26.

33 patients, including 13 women and 20 men with the mean age of 32.39±10.58 years were studied.Statistical analysis showed a significant direct linear relationship between SBC and PEFR before and after treatment,percentage of oxygen saturation changes, and between percentage of SBC changes with PEFR (r = 0.933, r = 0.915,and r = 0.892, respectively) and a significant inverse linear relationship was observed between PEFR and SBC withasthma severity (P <0.05). There was no significant inverse linear relationship between SBC and the percentage ofchanges in respiratory rate (r = -0.279, P> 0.05).

The results can indicate the competency of SBC toreplace PEFR in evaluation of pulmonary function in adult patients presenting to the emergency department withacute asthma attack.

The Skin and soft tissue infections are among the leading causes of outpatient visits to medical clinics or hospitals.These infections have a wide range of clinical severity. They can just be superficial infections with a curable course by medical treatments or they can be severe and life threatening without prompt diagnosis and justified interventions.The purpose of this study was to investigate the signs, symptoms and treatment protocols of soft tissue infections. In a cross-sectional study, the patients with soft tissue infections referred to Imam Reza Hospital during the years 1388-1391, who had the inclusion criteria, were enrolled.After collecting the data, the statistical analysis using SPSS software and chi-square and t-tests were performed. During the study period, 300 patients with a mean age of 42.9 ±17.32 years were evaluated. The mean hospital stay was 4.1 ±2.41 days.The most common underlying condition among them was intravenous drug abuse in 85 patients (28.5 percent). In 254 patients (84.6%) the initial diagnosis was cellulitis.In 56% of patients a single antibiotic regimen was prescribed from the beginning to the end of the treatment course.Overal, 6% of the patients eventually died. The most common soft tissue infection in the patients studied was cellulitis and the empirical antibiotic therapy resulted in good response and recovery in more than half of the patients.

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 – lecture and demonstration – on EMS providers were compared. A total of 30 EMS providers were enrolled in this interventional study. One group attended the lecture and classroom training and the second group was trained with demonstration in skill lab center. Ten days after the course، they were evaluated in dealing with ACS patients. EMS evaluation was according to patients transfer official forms. Data analyzed by SPSS software with chi-square test. Overall 410 patients with possible acute coronary syndrome who were transferred to Medical Center by EMS divided into 2 groups (243 and 167 patients). In the first group، patients received 32. 1% aspirin، 75. 3% nitroglycerin and 90. 1% oxygen while the second group received 49. 7 % aspirin، 58. 7% nitroglycerin and 90. 1% oxygen. In the first group، 43. 1% of 183 patients who had received nitroglycerin، also received aspirin. In the second group 67. 3% of 98 nitroglycerin received patients، had also received aspirin. None of the patients received Morphine، cardiac monitoring and ECG. Findings showed 17. 6% increase in aspirin administration and other management practices (nitroglycerin and oxygen) in the second group. None of the patients received cardiac monitoring. EMS providers usually use less beneficial interventions such as IV line، nitroglycerin and oxygen.

Assessment is an essential and integral part of medicine. In addition to validity and reliability, a desirable method for student evaluation should leave a positive effect on student’s learning and be feasible and acceptable by students and teachers. Hence, this study aimed to survey students’ and teachers’ satisfaction with DOPS examination. This experimental study used a single group post test study design in which a total of 60 medical internship students of emergency ward of 22 Bahman and Arya educational hospitals participated. After obtaining testimonial from students, in an emergency course, they were trained for one month on how the DOPS evaluation is run. The assessors (n=23) included clinical teachers and other professionals such as nurses. Expert panel selected seven basic medical skills and provided assessment checklists. Students selected two skills out of seven and performed through DOPS. A researcher-made questionnaire in Likert scale (0-3 points) was developed to investigate students’ and assessors’ viewpoints in areas of feasability, educational effects, and satisfaction that and its validity and reliability was confirmed prior to utilization. Data was analyzed using students’ one-sample and paired samples t test. From students’ viewpoint, feasibility, educational effects, and satisfaction rates were significantly higher than 50 (average expected grade). Meanwhile, educational and learning effects showed the highest points (78±14.8) among them. From the assessors’ viewpoint also, satisfaction in the mentioned areas was significantly higher than fifty. Satisfaction with examination showed highest score (76.7±11.6) among all domains. According to the compliance of DOPS method with the performance objectives of medical curriculum and students’ and assessors’ viewpoints regarding its acceptability, feasibility, and educational impact in the existing clinical centers, as well as their satisfaction with this method, it is recommended to assess senior medical students’ clinical performance using this method.

Beside assessment by physical examination a device also should be used to confirm the correct position of endotracheal tube immediately after intubation. Recent studies have shown that ultrasound can be a used to detect diaphragmatic motion as an indirect sign of endotracheal intubation. Our objective was to assess the sensitivity and specificity of ultrasound for verification of tube position after intubation and to evaluate whether ultrasound could be used as a usefull method for secondary confirmation of tube position. Ultrasound imaging was performed immediately after intubation for each patient. Scanning window was in right lower chest where the right lateral part of diaphragm could be imaged just on top of the liver. Then a second laryngoscopy was performed by the means of a glydoscope and tube position was assessed under direct visualization. Sensitivity، specificity and agreement between 2 methods were calculated. Overall 100 patients with a mean age of 67. 1 ± 16. 6 [SD] years were included in the study. The sensitivity and specificity of ultrasound for correct tracheal intubation was 97% and 100% respectively. Agreement between ultrasound and glydoscope in assessment of tube position was 0. 713 which indicated that there was an acceptable agreement between the 2 methods. We successfully identified all 4 esophageal intubations and 9 tracheal intubations which had been positioned down in to the right main bronchus. Diaphragmatic ultrasound is a rapid، noninvasive and useful method for assessment of endotracheal tube position.