فهرست مطالب

  • Volume:1 Issue: 1, 2015
  • تاریخ انتشار: 1394/03/25
  • تعداد عناوین: 8
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  • Samad Shams Vahdati, Narges Moradi, Jamil Hemat Ghadim, Shahrad Tajoddini Pages 1-2
  • Ali Arhami Dolatabadi, Parvin Kashani, Hamidreza Hatamabadi, Hamid Kariman, Alireza Baratloo Pages 3-6
    Objective
    This study aimed to determine the association of cardiac risk factors and the risk of Acute Myocardial Infarction (AMI) in Emergency Department (ED) patients with non-diagnostic ECG changes.
    Methods
    This cross-sectional study was conducted in the ED of Imam Hossein Hospital during a period of one year. In this study, patients with symptoms suggestive of AMI including chest pain, dyspnea, palpitation, syncope, cerebrovascular incidents, nausea, vomitting, dizziness and loss of consciousness were included. The demographic data and risk factors, such as age, gender, history of diabetes, Hypertension (HTN), Hyperlipidemia (HLP), renal failure, positive family history of Coronary Artery Disease (CAD), smoking, substance abuse, alcohol consumption within the past 24 hours and cocaine use within the past 48 hours were recorded. Non-diagnostic ECG included: normal, non-specific, abnormal without ischemic symptoms such as old bundle branch block, Left Ventricular Hypertrophy (LVH), etc. The final diagnosis of AMI was determined by Creatine Phosphokinase-MB (CPK-MB) serum markers and Troponin I. The data were analyzed by using SPSS V. 20 and the level of statistical significance was considered to be P< 0.05.
    Results
    HTN, HLP, family history of heart disease were significantly higher in those who had non-diagnostic ECG (P< 0.05). However, the ischemic heart diseases were significantly lower in those with non-diagnostic ECG. History of diabetes, stroke, renal failure, alcohol or opium and menopause showed no significant association with non-diagnostic or diagnostic ECG.
    Conclusion
    Overall, the risk factors are limitedly associated with the occurrence of Myocardial Infarction (MI) in cases where ECG is not diagnostic and it is better to use other criteria to diagnose AMI.
    Keywords: Risk factor, Acute myocardial infarction, Emergency department, Electrocardiogram
  • Hamidreza Reihani, Niazmohammad Jafari, Mohsen Ebrahimi, Elham Pishbin, Ehsan Bolvardi, Veda Vakili Pages 7-11
    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.
    Keywords: Advanced cardiovascular life support (ACLS), Cardiopulmonary resuscitation (CPR), Intern, Human patient simulation (HPS), Simulation, based education
  • Fereshte Zamani, Hydar Ali Abedi Pages 13-18
    Introduction
    According to the previous studies, several social, cultural, and organizational factors are involved in the decision of families of brain death victims for organ donation. The present study was performed to determine the effective factors in the decision of organ donation among families of brain death victims.
    Methods
    In this descriptive-comparative study data were gathered through a self-made questionnaire. The reliability of questionnaire was determined by calculating Cronbach’s alpha (0.81) and the face and content validity were studied and approved by a number of experts. Statistical population included all family members of brain death victims in Isfahan/Iran during 2012-2013. They were divided into two groups of with and without consent to organ donation. The whole population was considered as the study sample. Data analysis were done through SPSS using independent T-test, ANOVA, and Chi-square tests.
    Results
    According to the present study, age and marital status of the victims have no effect on their families’ consent to organ donation (P> 0.05); but sex, duration of hospitalization in the emergency department, having organ donation card, and personal opinion of the brain death victim showed significant relationship with consent to organ donation (P< 0.05).
    Conclusion
    Since the rate of awareness, knowledge, and attitude of family members are effective in their decision for organ donation, improving cultural backgrounds required for this decision and increasing awareness and knowledge of people can improve the attitude of people in this regard and facilitate the acceptance of family members.
    Keywords: Brain death, Organ donation, family, Consent
  • Aboutaleb Beigi, Alireza Mazinanian, Mansour Ashrafinia, Alireza Baratloo, Saeed Safari Pages 19-21
    Introduction
    There are major differences in neonatal and obstetrics outcomes of labour among different ethnicities. The present study compared the neonatal and obstetrics outcomes of labour between the Iranian and Afghan ethnicities.
    Methods
    Neonatal and obstetrics problems were evaluated in Iranian and Afghan pregnant women, who had referred to Arash Educational/Treatment Center for labour during a year.
    Results
    3020 (93.7%) Iranian and 202 (63%) Afghan women were evaluated. There were no significant differences between the two ethnicities in relation to a need for Neonatal Intensive Care Unit (NICU), the rate of live births, infant birth weight, congenital anomalies and premature births (P>0.05). The rate of Caesarian section was higher in Iranian women (P=0.001).
    Conclusion
    It seems that the differences in neonatal problems and outcomes of labour obstetrics between Iranians and Afghans can be attributed to different cultural, economic, and social conditions in comparison to different ethnicities.
    Keywords: Neonatal problems, Outcomes of labour, Ethnic differences
  • Mohammad Reza Amiresmaili, Mahmood Nekooi Moghadam, Amin Saberi Nia, Rahil Ghorbani Nia Pages 23-27
    Introduction
    Emergency department is the most important part of a hospital and it seems that 24-hour presence of emergency medicine specialist can be effective in improving the performance of this ward. Therefore, the present study was performed with the aim of studying the effect of 24-hour presence of emergency medicine specialists in the emergency department of Shahid Bahonar hospital, Kerman/Iran.
    Methods
    In this mixed methods study, data collection was done through studying various related documents and semi-structured interview. Data analysis was performed using descriptive statistics and qualitative content analysis.
    Results
    The presence of emergency medicine specialists resulted in a decrease in waiting time, hospital’s revenue growth, increase in number of requested laboratory tests, improvement of decision-making for patients and decrease of first 24-hour mortality rate. Economic benefits, improvement of the quality of services and emergency department management were among qualitative results of the present study.
    Conclusion
    In whole, 24-hour presence of emergency medicine specialists in the emergency department of Kerman Shahid Bahonar hospital has been effective in improving the performance and quality of services.
    Keywords: Emergency medicine specialists, Emergency, Hospital, Emergency medicine's presence, Specialists
  • Samad Shams Vahdati, Neda Parnianfard, Sanaz Beigzali, Shahrad Tajoddini Pages 29-34
    Acute chest pain is an important and frequently occurring symptom in patients. Chest pain is often a sign of ischemic heart disease. Chest pain due to suspected Acute Coronary Syndrome (ACS) is responsible for a large and increasing number of hospital attendances and admissions. Current practice for suspected ACS involves troponin testing 10–12 hours after symptom onset to diagnose Myocardial Infarction (MI). Patients with a negative troponin can be investigated further with Computed Tomographic Coronary Angiography (CTCA) or exercise Electrocardiography (ECG).A review of cardiac biomarkers as screening test in acute chest pain over 15 years was conducted. Separate searches were under taken for biomarkers. We Searched electronic databases up to 2004-2014, reviewed citation lists and contacted experts to identify diagnostic and prognostic studies comparing a relevant index test (biomarker, CTCA or exercise ECG) to the appropriate reference standard. We classified studies to two part early rise biomarkers, high sensitivity biomarkers.
    Conclusion
    Although presentation troponin has suboptimal sensitivity, measurement of a 10-hour troponin level is unlikely to be cost-effective in most scenarios compared with a high sensitivity presentation troponin. Measurement of cardiac troponin using a sensitive method was the best test for the early diagnosis of an Acute Myocardial Infarction (AMI). Measurement of myoglobin or Creatine Kinase-MB (CK-MB) in addition to a sensitive troponin test is not recommended. Heart-type Fatty Acid-Binding Protein (H-FABP) shows promise as an early marker and requires further study.
    Keywords: Risk factor, Acute myocardial infarction, Emergency department, Troponin
  • Alireza Baratloo, Pauline Haroutunian, Alaleh Rouhipour, Saeed Safari, Farhad Rahmati Pages 35-38
    Background
    Potassium, as an extracellular ion, plays an important role in the electrophysiologic function of the myocardium and any change in extracellular concentration of this ion might have a marked impression upon myocyte electrophysiologic gain. High serum potassium levels are thought to impair pulse conduction in Purkinje fibers and ventricles more than that in the Atrioventricular (AV) node. Therefore, although complete AV block can occur, it is a rare initial presentation.Case Report: We describe a 62-year-old man with a history of diabetes mellitus, ischemic heart disease and previous Coronary Artery Bypass Graft (CABG), who came to our emergency department due to generalized weakness starting 2 days before admission. The patient also had decreased force in lower limbs, exacerbating from the morning, and was finally diagnosed as a hyperkalemia-induced Complete Heart Block (CHB). It should also be noted that the patient responded dramatically to the administration of 10 mL of 10% calcium gluconate along with external pacing until potassium level correction became effective.
    Conclusion
    In spite of the fact that Hyperkalemia can be associated with frequent Electrocardiogram (ECG) abnormality, advanced heart blocks (second- and third-degree AV blocks) are usually found only in patients with pre-existing heart failure, conduction abnormalities, or other cardiac diseases. Institution of effective treatment rapidly and forgiveness of traditional non-effective, time consumptive and sometimes risking full-adjustment modalities, such as sodium bicarbonate infusion or exchange resins that prevent their use in the emergent phase, can help minimize patient morbidity and mortality.
    Keywords: Hyperkalemia, Complete heart block, External pacing