Journal of Emergency Practice and Trauma
Volume:7 Issue: 1, Winter-Spring 2021

The Clinical Toxicology Center in Imam Reza hospital in Mashhad is the referral center of poisonings in the East of Iran and many cases of poisoned children are referred to this center and some cases are admitted.In this letter we report some specific, strange and unusual poisonings in children admitted in our center.

The coronavirus disease 2019 (COVID-19) was first emerged from Wuhan, China, in late 2019, and has since been spreading progressively all around the world. Its prevalence is climbing increasingly and almost all countries worldwide are confronting this pandemic. As of April 11, 2020, reports obtained about the management of COVID-19 patients indicate that the mortality rate of the disease is around 5% with consideration of the active cases and 21% of the closed cases

To study the demographic profile and outcomes of pediatric trauma victims.

A prospective observational study was performed at a secondary care centre in urban India over 15 months. Permission from the local ethics body was obtained prior to the commencement of the study. Children under the age of 12 years admitted with trauma to the General Surgical department were included. Demographic data, history of events leading to trauma, clinical findings and treatment were recorded. Pediatric Trauma Score (PTS), Functional Independence Measure (FIM) and Pediatric Quality of Life Index (PQLI) were used to assess the outcomes.

A total of 178 patients were included in the study. Preschool age group (3-5 years) (45%) was the most commonly affected. Majority of traumas occurred at home (75%). These homes were informal slum houses where children stayed in lofts. Fall from height (49%) due to fall from lofts (44%) was observed to be the most common mode of injury at home. Majority of patients had minor trauma with PTS (9-12) presenting with head injury (88%). However, only 35% had positive radiologic findings. There was a significant difference in PQLI of all patients and in FIM of preschool age group patients, irrespective of severity of trauma before admission and at one month of follow up.

Child’s home was found as the most common site of trauma. Physical, psychosocial and cognitive impairment were seen in all pediatric trauma patients and functional impairment was seen mainly in preschool age. Majority of pediatric injuries are preventable.

The purpose of the current study was to assess the success rate of posterior tibial nerve block in the ankle with and without ultrasound guidance for pain management in emergency departments. This clinical trial was conducted on 80 individuals who needed posterior tibial nerve block in the ankle at the emergency department of Hashemi Nejad hospital and Edalatian emergency center in Mashhad, Iran. The eligible individuals were randomly assigned to one of two groups, designated the control (landmark-based nerve block) and the case group (ultrasound-guided nerve block). The two groups were compared in terms of the main measurable outcomes. The data were analyzed using SPSS software (version 20) by nonparametric tests. According to the findings, the mean and median of nerve block success in the landmark-based and ultrasound-guided methods were significantly different between the two groups, both 15 (P=0.02) and 30 (P=0.001) min post-intervention. In this regard, nerve block with ultrasound guidance had a higher success rate compared to the landmark method. However, no significant difference between the two interventions was found in terms of the mean and median of the procedure duration (P=0.8) and injection frequency (P=0.4). On the other hand, the two groups were significantly different regarding the median and mean of patient satisfaction (P=0.00), duration of analgesia (P=0.004), and nerve block-related complications (P=0.03). The findings revealed that the relatively new technique of nerve block by ultrasound-guide resulted in better outcomes than the landmark-based method. Consequently, this method could be adopted to control acute pain in the emergency departments and improve patient care.

Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. In this cross-sectional study, 214 patients (over 18 years) presenting to the emergency department (ED) with suspicion of traumatic calcaneus fracture following acute blunt trauma, were enrolled. Bedside ultrasonography was performed and interpreted by emergency physicians. After that, plain radiography was performed. Furthermore, all the patients were assessed by computed tomography (CT) scan as the gold standard. Finally, 193 patients were enrolled with a mean age of 29.4±15.7 years (85.5% male). Fractures in the calcaneus were detected in 49 patients. The sensitivity and specificity of ultrasonography in the detection of calcaneal fractures were 83.6%, (confidence interval (CI), 69.7 –92.2) and 100% (95% CI, 96.7 –100), while the sensitivity and specificity of X-ray were 87.7% (95% CI, 74.5 –94.9) and 100% (95% CI, 96.7 –100). There was no false positive result for X-ray and US. Our findings suggest that bedside US with an acceptable sensitivity and specificity can be used as a promising alternative for the diagnosis of calcaneal fracture in ED.

This study was conducted to investigate the role of an emergency nurse coordinator (ENC) in improving patient satisfaction at the emergency department (ED) in Tehran, Iran. This was an interventional study in the field of ED management. This study was undertaken in the ED of Sina hospital in Tehran, Iran, during March 2018 until April 2019. An ENC was assigned to the ED on even days and during the next week. Also, the presence of the ENC was switched to odd days and so on. Patient satisfaction was evaluated by a questionnaire. In order to analyze data, independent T-test was used to assess the mean difference in satisfaction scores. In addition, analysis of covariance (ANCOVA) test was utilized to assess the difference in satisfaction scores after considering age, sex and triage level as confounding variables. Finally, 315 and 291 patients were allocated to the intervention (patients with ENC) and control groups (patients without ENC), respectively. The total satisfaction rate in the intervention and control groups was 63.9% and 59.3%, respectively. The mean score of total satisfaction in the intervention group was significantly higher than the control group [115.1 (SD = 20.0) vs 106.8 (SD = 22.3); P < 0.001]. The ANCOVA analysis showed that age, sex and triage level were not confounding factors affecting the satisfaction score. This study showed that the presence of the ENC in the ED can increase patient satisfaction, especially in domains related to “diagnostic and therapeutic services”, “cleanliness”, “cost and discharge information”, “ethical and privacy issues”, “admission, discharge and management services”.

Inguinal hernia surgery is one of the most commonly used surgical procedures in the world. The aim of this study was to compare the recurrence and postoperative complications between a new mesh implant technique in the floor of the inguinal canal with limited tissue repair on it and Liechtenstein technique for inguinal hernia repair. In this cross-sectional study, patients were studied by Liechtenstein technique and a new technique of insertion of mesh at the foam of the inguinal canal with a limited tissue repair on it. Data were collected by interview and we assessed the recurrence rate, urinary retention and post-operative pain. Data were analyzed using SPSS software version 24. Chi-square test and t test were used for quantitative data and P value less than 0.05 was considered significant. The mean age of patients was 49.28 ± 15.84. The mean age and sex ratio between the two groups were similar. Recurrence was seen in 11 (1.83%) of all patients and the difference between the two groups was not significant. Of all patients, 28 (4.7%) had urinary retention after surgery and the difference between the two groups was significant (p=0.01). Of all patients, 91 (15.2%) had pain after three weeks and 29 (4.8%) had pain after six months. The results showed that the new method had less complications concerning post-operative pain and urinary retention in comparison with the Liechtenstein method as an acceptable method for inguinal hernia repair in future.

Due to the rapid pace of industrialization and the high prevalence of addiction, toxicity caused by heavy metals, especially lead, has become one of the major health problems associated with high morbidity and mortality. Therefore, reliable information is critical to manage this condition. This descriptive cross-sectional study was performed on 30 cadavers, suspected of lead poisoning. The hospital records and the results of anatomical investigations were studied. Data were collected in a researcher-made questionnaire and analyzed in SPSS Version 22. The results showed a significant correlation between the pathological results of pulmonary autopsy and the duration of drug use (P= 0.01). Also, the pathological results of cardiac autopsy had significant correlations with age (P= 0.006) and blood lead level (P= 0.03). Moreover, significant correlations were found between the pathological results of liver autopsy and age (P=0.00), between the pathological results of brain autopsy and the route of drug administration (P=0.01), and between the pathological results of kidney autopsy and age (P=0.00). Most pathological changes were observed in the brain and kidney tissues. Lead poisoning does not cause any specific pathological changes in the liver, heart, brain, lung, or kidney tissues; however, these non-specific changes, alone or together, can lead to death

COVID-19 has become a major public health concern in recent times with detrimental effects on health and economy of the nation exerting unbearable pressure on health care personnel. It is vital for the caretakers and the people accompanying those patients to be aware of the ongoing pandemic and its impact on the society and to realize their responsibility towards curbing the spread of the disease. The aim of this study is to assess the awareness of COVID-19 among the attendants accompanying the patients at emergency department (ED) and to determine their perception of the disease.

A questionnaire was prepared and the attendants were approached with it. The attendants responded to the questionnaire by choosing the appropriate answers. Illiterates were explained about the questions in the language they understood and the responses were recorded. The survey was conducted from May 25th, 2020 to June 10th, 2020. Descriptive analysis was done to represent the study characters.

A total of 509 participants responded to the questionnaire with the mean age between 30 to 50 years. Participants were fairly conversant of the preventive measures but a significant portion lacked the knowledge of transmission and the impact of COVID-19. Education was observed to have a positive correlation with the correct responses given.

Public education for the spread of awareness is yet to reach the illiterate section of the society. The need exists for educating the attendants of the patients as well who actually are potential candidates for contracting and also for spreading the disease

This study aimed to determine the motivation to helmet use among motorcyclists in Ardabil city using the trans-theoretical model (TTM) motivational interview. Random cluster sampling was used for this study. Five gas stations were selected from the crowded areas of Ardabil city and motorcyclists who came to these places were randomly interviewed. In this descriptive cross-sectional study, 350 motorcyclists in Ardabil were selected and interviewed by TTM Motivational questionnaire. We used one-way analysis of variance (ANOVA) and linear regression for analysis of data in SPSS software version 20. Findings revealed that 12.6% of respondents consistently wore a helmet when they rode a motorcycle, while 45.2% of helmet non-wearers were uncertain about wearing a helmet in the future. Decisional balance (pros), self-efficacy (decreasing the negative affect situation score), and behavioral process of change can motivate participants to helmet use. Reducing negative social situations and increasing positive emotional states can motivate people to use helmet.

Literature on the obstacles of clinical rounds is dispersed and has not been well established under a unified systematic investigation. Teaching and learning in clinical rounds, where a variety of skills important for the medical profession, cannot be augmented if barriers related to main factors in the clinical environment are not identified.

A systematic review of English articles using Web of Science, PubMed, Embase, Scopus and Cochrane library were conducted. Relevant keywords and their synonyms were used for the domains “medical students/clinical teachers/barriers and clinical round”. Additional studies were identified by searching reference lists of retrieved articles. All searches for English language articles were conducted within a 10-day period from 25 May to 3 June 2017. No time limit was considered for article searching. We contacted Kerman University of Medical Sciences to locate some studies due to access limitation. In this systematic review, studies on the subject of barriers to clinical rounds from clinical teachers’ and medical students’ perspectives were identified. Our search strategy yielded 600 articles. After title and abstract review, 43 of these were obtained and finally 20 were included in the study. All data were abstracted from the included studies. Two authors independently screened the studies. We used inductive content analysis and categories of barriers were derived from the data. MAXQDA software version 10 was used for data analysis.

A total of 20 articles were included and analyzed in depth. Content analysis yielded identification of 320 codes concerning barriers to clinical rounds in six categories classified as system-, climate-, teacher-, student-, patient-, and personnel-related factors.

Our investigation depicts primarily main barriers in teaching on rounds. In this regard, effective teaching in clinical rounds is not obtained unless barriers concerning the learning triad and its environment are explored and necessary actions are adopted accordingly

Both natural and man-made disasters need near-term and long-term interventions to reduce morbidity and mortality among the affected population. Recently, telemedicine has been effectively used in both man-made and natural disasters and showed its effectiveness in eliminating the adverse consequences of disasters. Therefore, the purpose of this study was to identify the application of telehealth in different phases of disaster.

We systematically searched all English papers regarding the use of telemedicine in different phases of disaster indexed in PubMed, Embase, and Web of Science databases until June 2020. A data collection form was designed to extract the required data such as types of systems, telecommunication technologies, and phases of disaster.

In this study, 16 out of 4490 retrieved articles were selected as relevant and reviewed by the authors. Findings indicated that the majority of studies highlighted the use of telemedicine in natural disasters (n=12), and only four discussed it in a man-made disaster like war and terrorist attacks. In 6 studies out of 16, telemedicine was used to treat and assess mental disorders among the affected population. And the internet was the most common technology for telemedicine development.

Providing health care during a disaster is necessary, and telemedicine is important for such care. This systematic review helps define the components and application of telemedicine in disaster as a new technology in recent days, but we need to consider it and develop this technology in all phases of disaster management, especially during the response phase.

Anterior teeth are of utmost importance with regard to chewing, speaking, and beauty. Therefore, any traumatic dental injury has psychologically undesirable effects on children and their parents. The present study reported a case of a traumatic dental injury induced by falling off a bike and referral to an emergency department as well as measures taken for dental reconstruction and patient’s improvement.

An 8-year-old child was taken to an emergency department due to falling off a bike following imbalance, while suffering from dental pain in his upper jaw due to dental subluxation. Afterwards, dental retaining paste along with a fixer wire was used to maintain the position of the teeth. The patient also received oral non-steroidal analgesia (acetaminophen) for proper control of the pain and was subsequently referred to a dentist to repair the teeth. The initial examinations revealed that the child was fully conscious. Considering the patient’s severe pain and intrusion of the superior left primary first tooth and the subluxation of the superior right primary first tooth. Local anesthesia was performed using 1% lidocaine in the location of the given teeth using infiltration technique. Then they were brought into an alignment by extracting the plunged tooth and the child was referred to a dentist for advanced dental trauma care.

Dentists are not always present in hospital emergency departments; therefore, an emergency medicine specialist should be able to diagnose common traumatic dental injuries in order to manage them appropriately at the early stages, and if necessary, refer patients to dentists for further complementary treatments. This important fact will bedone after full examination and ruling out critical causes of trauma in the emergency department.

Clostridium botulinum is one of the most common life-threatening agents all around the world which produces botulinum neurotoxin (BoNT). It may lead to morbidities such as paralysis and mortality after consuming canned tuna fish, local dairy products and home-preserved or commercial food. People use a good deal of local dairy products such as cheese and it exposes a variety of population to botulinum intoxication.

A 48-year-old woman referred to the ED complaining about acute dysphonia accompanied with symmetric hypotonia and bilateral ptosis. She had a history of consuming local dairy cheese.

It is indispensable for the physician to identify major features of foodborne botulism in order to differentiate it from other illnesses and early initiation of intensive care for intoxicated patients. To prevent the incidence of dairy product derived botulinum, it is firmly suggested to have quality control on local dairy products

Unilateral and bilateral tongue cyanosis usually occurs due to the Raynaud syndrome and in the underlying severe types of vasculitis and rheumatology.

The present study was conducted on a 54-year-old woman who referred to the emergency department with complaints of sudden and painless discoloration of the left half of the tongue. The patient had no history of disease other than diabetes controlled with glibenclamide. Clinical examination of the head and neck revealed evidence of unilateral cyanosis in the left half of the tongue without pain, whose discoloration did not improve with warming of the tongue.

Cyanosis in the emergency department can be managed appropriately by considering some parameters including history taking, history of cyanosis occurrence, history of cardiopulmonary disease, cold sensitivity and history of rheumatologic diseases, presence or absence of nail clubbing, arterial blood oxygen saturation and arterial blood gas test results. These parameters can be effective in designing a treatment regimen, while differentiating the causes of central from peripheral cyanosis.

 Aortic dissection is an uncommon disorder with a high mortality rate, especially if misdiagnosis and mistreatment are not considered.

We present a 67-year old female with slurred speech and left sided plegia during her brother’s funeral. The patient did not have any chest pain. she was referred to our emergency department by EMS due to being suspicious of cerebrovascular accident (CVA) )as code 724). However, owing to low blood pressure and atypical symptoms of the patient, we did RUSH exam in the emergency department to detect aortic dissection. After doing the Computed tomography (CT) angiography, the diagnosis of aortic dissection was confirmed. As the vascular surgeon was not present in our surgery department, we transferred the patient to Namazi hospital by air ambulance to undergo the surgery. She was discharged from hospital with complete recovery.

Aortic dissection symptoms can be manifested in different ways such as pulmonary embolism, ACS, and CVA. Therefore, clinicians must always have the differential diagnosis of aortic dissection in their mind and be aware of its various manifestations.

We are going to alert the emergency physicians to be aware of drugs side effects. Some drugs like methotrexate are not routine drugs, and the symptoms may be miss diagnosed if not completely notified.

We present two patients under treatment with methotrexate. Both of them suffered from methotrexate poisoning due to improper use. We discuss the causes of methotrexate poisoning and its prevention.

A significant proportion of methotrexate users may not be completely aware of its proper use and the side effects. One of the important ways to prevent the toxicity of methotrexate is educating patients and their companions in order to use it correctly.

Epidural anesthesia is one of the famous, generally safe, and most requestedpain relief measures in labor. Nevertheless, it can have some complications thoughpneumocephalus and subdural effusion are very rare complications.

A 32-year-old woman presented with a severe persistent headacheafter a vaginal delivery, where epidural anesthesia was used for pain control. Her braincomputerized tomography (CT) scan confirmed pneumocephalus and subdural effusionas a complication of the procedure.

Although headache can be present in many women post-delivery,investigations should run in susceptible women with alerting signs.