Papers by Frontiers in Emergency Medicine
Case report, 2023
The diagnosis and treatment of foreign bodies in the urogenital system are difficult and it's rar... more The diagnosis and treatment of foreign bodies in the urogenital system are difficult and it's rare in children; It may also cause secondary injuries. In this article, we present a 14-year-old male patient who was admitted to the emergency outpatient clinic with complaints of difficulty in voiding and dysuria. He was diagnosed with a pin in the urethra and treated using an endoscopic method. He was hospitalised for foreign body removal after he admitted in his anamnesis about insertion a pin into his urethra the day before his complaints started. A pin was seen in the urethra on the urethrocystoscopy, and was successfully removed. Since foreign body in the urogenital system is rare in children, it is necessary to suspect, in order to make the diagnosis. In most cases, endoscopic intervention is sufficient. Psychiatric consultation should be requested for the patients, especially for pediatrics.
Case based learning points, 2023
The patient was a 61-year-old smoker male, who presented to emergency department (ED) with compla... more The patient was a 61-year-old smoker male, who presented to emergency department (ED) with complaints of sudden onset of headache followed by painless blurring of vision of the right eye that was started 10 hours prior to the admission. Due to blood pressure of 190/104 mmHg at home, the patient had taken amlodipine 10mg orally. The patient reported some episodes of transient ischemic attacks in his past medical history, for which he did not take any advice from physicians. The patient was also found to be hypertensive with deranged cholesterol. On examination in ED, the patient was afebrile, and had pulse rate= 88/min, blood pressure (BP)= 130/90 mmHg, respiratory rate=22/min, and O2 Saturation=99% in room air. There was not any positive finding in systemic examination. Patient was admitted for further evaluation and management. Paraclinical lab tests were all reported in normal range. Echocardiography revealed left ventricular ejection fraction (LVEF) of 60%, with no regional wall motion abnormality (RWMA), mild concentric left ventricular hypertrophy (LVH) and normal cardiac chambers. In view of Headache, brain computed tomography (CT) scan was performed, in which, there was prominence of sulci, basal cistern, sylvian fissure and ventricular system suggestive of age-related diffuse cerebral atrophy. Ill-defined hypodensities were seen in bilateral periventricular white matter, suggestive of chronic ischemic changes. Later, brain magnetic resonance imaging (MRI) was also performed, which revealed multiple discrete and confluent areas of hyperintensity scattered in subcortical deep and periventricular white matter of both cerebral hemispheres, suggestive of nonspecific small vessel ischemic changes, likely a combination of ischemic demyelination chronic lacunar infarcts and prominent perivascular space. The ventricular system and subarachnoid space were prominent, suggestive of age-related cerebral atrophy. In the next step, cervical and brain MRI angiography was performed, which revealed 100% occlusion of right internal carotid artery at its origin, with no distal reformation of the artery in the neck and intracranial part. The right middle and anterior cerebral artery were filling via circle of Willis and were severely diffusely narrowed in calibre. There were mild atheromatous changes in the left common carotid artery and carotid bulb causing mild narrowing. Bilateral vertebral arteries were normal. There was evidence of diffuse severe narrowing and poor visualization of entire left anterior cerebral artery. Ophthalmology reference was taken and fundus examination was done. On examination, the patient was found to have finger counting close to face with no improvement with glasses. In the right eye, anterior segment examination showed relative afferent pupillary defect (RAPD), while fundus examination revealed retinal background pale white with cherry red spot in macula and absent venous pulsation in the right eye, suggestive of Central Artery Retinal Obstruction (CRAO), and thread like blood vessels and Grade II Hypertensive retinopathy. After starting the low molecular weight heparin, antiplatelet and steroid, vision improved from finger counting close to face to finger counting at 3 feet distance. Patient was later discharged under follow-up for further recovery.
Review article, 2023
The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct ... more The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct an annual search of peer-reviewed literature relevant to cardiac arrest. Now in its fourth year, the goals of this review are to highlight annual updates on clinically relevant and impactful clinical and population-level studies in the interdisciplinary world of cardiac arrest research from 2021. To achieve these goals, a search of PubMed using keywords related to clinical research in cardiac arrest was conducted. Titles and abstracts were screened for relevance and sorted into seven categories: Epidemiology & Public Health; Prehospital Resuscitation; In-Hospital Resuscitation & Post-Arrest Care; Prognostication & Outcomes; Pediatrics; Interdisciplinary Guidelines; and Coronavirus disease 2019. Screened manuscripts underwent standardized scoring of methodological quality and impact by reviewer teams lead by a subject matter expert editor. Articles scoring higher than 99th percentile by category were selected for full critique. Systematic differences between editors’ and reviewers’ scores were assessed using Wilcoxon signed-rank test. A total of 4,730 articles were identified on initial search; of these, 1,677 were scored after screening for relevance and deduplication. Compared to the 2020 ICARE review, this represents a relative increase of 32% and 63%, respectively. Ultimately, 44 articles underwent full critique. The leading category was In-Hospital Resuscitation, representing 41% of fully reviewed articles, followed by Prehospital Resuscitation (20%) and Interdisciplinary Guidelines (16%). In conclusion, several clinically relevant studies in 2021 have added to the evidence base for the management of cardiac arrest patients including implementation and incorporation of resuscitation systems, technology, and quality improvement programs to improve resuscitation.
Case based learning points, 2023
An 8-month-old, male child was brought to the emergency department (ED) by his parents with diffi... more An 8-month-old, male child was brought to the emergency department (ED) by his parents with difficulty of breathing. The child developed shortness of breath for one day with cough, but he had no fever. According to the parents, they did not notice the abdominal distension. The child was born prematurely at 25 weeks of gestation and stayed in the neonatal intensive care unit (NICU) for 2 months. Otherwise, he was healthy with minor repeated chest infections and bronchiolitis. In triage, his vital signs were as follows: heart rate:
180 beats/min; respiratory rate: 35 breaths/min; temperature: 35± C; oxygen saturation: 70%; and his blood pressure was undetected. The child was immediately transferred to the resuscitation room. The primary survey showed that the patient was comatose with a Glasgow coma scale of 3/15, the pupils were brisk with an unstable airway, and there was bilateral diminished air entry. The oxygen saturation did not improve despite assisted ventilation using an Ambu bag. The central and peripheral pulsation was weak with a delayed
capillary refill, and the blood glucose level was 9 mmol/L. The abdomen was hugely distended and rigid with minimal rectal bleeding. The patient was immediately intubated and connected to mechanical ventilation with subsequent rising of his oxygen saturation to 100%. A plain chest X-ray examination followed the patient’s intubation. Intravenous access was obtained followed by administration of normal saline (20 ml/kg) with subsequent elevation of the blood pressure (82/50mmHg) and decrease in heart rate (160 beats/minute). Initial arterial blood gases (ABG) analysis after intubation showed pH: 6.6; PaCO2 >150 mmHg; PaO2: 100 mmHg; HCO3: 10mEq/L; and lactic acid: 9 mg/dL. Therefore, a bolus of sodium bicarbonate was given, intravenously. Ventilator parameters were set at the maximum limits to wash out carbon dioxide. Repeated ABG analysis showed pH: 6.7; PaCO2: 135 mmHg; PaO2: 150 mmHg; HCO3: 17 mEq/L; and lactic acid: 6.5 mg/dL. Immediate bedside abdominal X-ray and ultrasonography were carried out to rule out intussusception. The child remained critically ill and unstable with fluctuating vital signs. Despite high ventilator parameters and gasgastric tube suction, the child showed no improvement in the respiratory parameters. The child was then transferred to the operation theatre for decompression laparotomy, which showed small bowel (ileum) ischemia. After surgical decompression, the respiratory parameters improved, and the ventilator
parameters were set back to normal settings for the patient’s age and weight. Unfortunately, the child remained critically ill. Then, he developed sepsis and multiple systems organ failure and died after 2 days.
Original article, 2023
Objective: In this randomized clinical trial study, the impact of prophylactic administration of ... more Objective: In this randomized clinical trial study, the impact of prophylactic administration of methadone during surgery on postoperative pain and analgesic requirement following cadaveric renal transplantation was assessed. Methods: Ninety patients were randomized to receive either methadone 0.15 mg/kg or 0.15mg/kg morphine after tracheal intubation. Both groups were treated with acetaminophen 1 gr before extubation. Protocol of anesthesia was the same in both groups and the anesthetist was blinded to the study groups. The primary outcome was defined as total opioid consumption during recovery and first day after surgery. Secondary outcomes were pain scores and level of patients’ sedation during the recovery period and first postoperative day as well as opioid-related complications. Results: Data of eighty-five eligible patients were analyzed. The mean pain and sedation scores were lower in the methadone group compared to the morphine group during recovery and the first 24 hours after surgery. The time of first rescue analgesic requirement was later in the methadone group (10.4 vs 6.3 hours). Also, postoperative morphine consumption was significantly less in the methadone group compared to patients receiving morphine (3.5 vs. 6.9 mg; P < 0.001). Conclusion: Intraoperative administration of methadone decreased postoperative pain scores, reduced opioid consumption after surgery and improved level of sedation during the first 24 hours after surgery.
Original article, 2023
Objective: Despite the worldwide spread of the severe acute respiratory syndrome coronavirus-2 (S... more Objective: Despite the worldwide spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an effective specific antiviral treatment for coronavirus disease of 2019 (COVID-19) is yet to be identified .We did this study to investigate the safety and efficacy of sofosbuvir as antiviral therapy among hospitalized adult patients with SARS-CoV-2. Methods: Patients were randomized into intervention arm receiving sofosbuvir or comparison arm receiving usual antiviral agents in addition to standard of care. The primary end point of the study was clinical recovery as defined by normal body temperature and normal oxygen saturation. The main secondary outcome was all-cause mortality during the admission in hospital or within 14 days after discharge if applicable. Reports of severe adverse events were observed in the intervention arm. Results: Fifty-seven patients enrolled into either the clinical trial arm (n=27) or the comparison arm (n=30). Primary outcome was achieved by 24 (88.9%) and 10 (33.3%) in the intervention and comparison arms, respectively. Median hospital length of stay was significantly shorter in the intervention arm (10 days [IQR: 5-12] vs. 11.5 days [IQR: 8.5-17.75], P = 0.016). All-cause mortality was two and thirteen in intervention and comparison groups, respectively. No serious adverse events were reported by the patients receiving sofosbuvir during the study. Conclusion: Among patients hospitalized with SARS-CoV-2, those who received sofosbuvir had more clinical recovery rate and had a shorter hospital length of stay than those who received usual antiviral agents in the study and these differences were statistically significant.
Original article, 2023
Objective: This study assesses the severity of mental health problems in healthcare professionals... more Objective: This study assesses the severity of mental health problems in healthcare professionals (HCPs) and its associated risk factors during COVID-19 pandemic at a tertiary hospital in Harar, Eastern Ethiopia. Methods: An institutional-based cross-sectional study was done from November 01 to 15, 2020. Data was collected by using a web-based self-administered questionnaire. Descriptive statistical analysis, cross tabs, and logistic regressions were utilized. Results: Out of 238 HCPs, 54.6% of them had a mental health problem. The prevalence of depression, anxiety, and stress was 44.1%, 48.3%, and 29.0%, respectively. Cigarette smoking was the only factor associated with depression. Being female, a cigarette smoker, and previously diagnosed with COVID-19 were associated with anxiety, while cigarette smoking and previous COVID-19 suspect had a significant association with stress. Conclusion: The burden of mental health problems among HCPs is high. The Federal Ministry of Health should incorporate psychosocial support for healthcare professionals during pandemics. This study highlights the need for developing policies to decrease mental health problems among HCPs during the COVID-19 pandemic.
Original article, 2023
Objective: Due to the important role of police during COVID-19 pandemics and lack of previous stu... more Objective: Due to the important role of police during COVID-19 pandemics and lack of previous studies on the impact of personal protective equipment (PPE) in reduction of COVID-19 infection among police officers, we aimed to investigate the role of using PPE in prevention of COVID-19 infection among Iranian police personnel. Methods: This cross-sectional survey was conducted in Tehran, Iran during January 2021 to November 2022. The study sample consisted of police personnel who were active in field operations. Demographics (age, height, weight, gender, marital status, number of children and underlying diseases) and job characteristics such as frequency and type of operations, involvement of colleagues with COVID-19, and COVID-19 infection history, using PPE, types of used PPE (mask, face shield, gloves, etc), protective strategies (such as social distancing) and COVID-19 vaccination were recorded. Statistical analysis was performed with IBM SPSS Statistics for Windows, version 25. Results: Totally, 340 participants were analyzed (33.54±9.74 years old, 91.2% males), of whom, 150 participants (44.1%) reported at least one episode of confirmed COVID-19 infection. The most common component of PPE used both during operations and daily life was face mask (44.7% and 75%, respectively). The most popular measure with higher adherence compared to others was social distancing with 70% popularity and an adherence score of 5.85±3.74. Three hundred subjects (88.2%) had received at least one dose of COVID-19 vaccine. Among PPE items, using face mask, washing hands with soap, social distancing and vaccination were significantly different between patients with and without prior COVID-19 infection (p>0.05). Conclusion: The findings showed that use of PPE is significantly efficacious in reduction of COVID-19 infection among police officers. Therefore, despite difficulties of using PPE among police forces, it is strongly recommended for virus spread control in this population.
Original article, 2023
Introduction: Emergency medicine (EM) is a relatively new medical specialty, which concerns patie... more Introduction: Emergency medicine (EM) is a relatively new medical specialty, which concerns patients who need vital and urgent medical care. This study aimed to evaluate the general medicine interns' attitude in continuing their education in EM residency programs. Methods: This study is a prospective cross-sectional study, which was performed on 180 medical students during their internship using convenience sampling. Data were collected using a valid and reliable researcher-made questionnaire and analyzed using SPSS 26 software. Results: One hundred and eighty medical students in the internship period with the mean of 25.65 ± 2.72 (23-46) years were studied (53.3% male; 76.7% single). Only 33 (18.3%) interns indicated their interest in continuing their education in EM residency programs. 30 (16.66) cases were not interested in continuing their education in any residency program (61.1% of whom cited migration as the reason, 13% cited not working as a specialist, 14.8% indicated lack of economic justification, and 11.1% cited other reasons for not wanting to enter residency programs). The mean overall interest score to EM residency program was 59.61 ± 12.66 % (20-96.41%). The lowest and highest interest scores obtained in the economic status (47.91 ± 21.13%) and education status (70.59 ± 15.77%) of EM specialty, respectively. The mean overall interest score was not statistically different between male and female students (p = 0.366). There was a significant statistical correlation between gender and type of discipline chosen, and female mostly chose non-surgical disciplines (p = 0.001). Conclusion: The interest of general medicine interns in continuing their education in EM residency program was average. The economic field of EM has been one of the best factors in attracting students to continue their studies in this field.
Letter to the editor, 2023
Dear editor
We read with interest Abdolrazaghi and his colleague’s paper entitled ‘’ Brachial ... more Dear editor
We read with interest Abdolrazaghi and his colleague’s paper entitled ‘’ Brachial plexus injury following blunt trauma; an anatomical variation in electrodiagnostic findings’’ and enjoyed it a lot. They presented a brachial plexus injury (BPI) case, which was rare in clinical practice because blunt traumas did not commonly cause BPI. There is ample evidence that most cases are men and adolescents aged 15 to 25 years, and the main mechanism of injury (70%) is motor vehicle accidents. As BPI is increasing, we will provide some epidemiologic and clinical characteristics of our cases registered at Sina Hospital, affiliated with the National Trauma Registry of Iran (NTRI). The Sina Trauma and Surgery Research Center launched the NTRI in 2016 and first recorded the related data from Sina Hospital. As the registry expanded, the NTRI included some other Iranian hospitals from different cities in the next step. The inclusion criteria were discussed elsewhere. We have registered 10 cases of BPI since 2016 at Sina Hospital. All of them were men, ranging from 19 to 45 years. The cause of injury was cut/stab in nine and road traffic accidents in one patient; seven were intentional, and most were due to interpersonal violence. Five of the injuries happened outdoors, three cases in commercial and service departments, and two at homes. Furthermore, the median injury severity score (ISS) was 5.0 (IQR=1). All of the patients had surgical operations. No death or need for ventilators was reported. Only one patient needed intensive care unit (ICU) admission and stayed for three days in the ward. We hope this information can be helpful for the Frontiers in Emergency Medicine’s readers to know more about BPI and can compare similarities and differences between our cases and the others included in the literature.
Editorial, 2023
In 2022, Frontiers in Emergency Medicine published 60 papers in four distinct issues with authors... more In 2022, Frontiers in Emergency Medicine published 60 papers in four distinct issues with authors from various nationalities, including Mexico, Turkey, Egypt, India, Yemen, the USA, Palestine, Poland, Saudi Arabia, the Netherlands, the UAE, Algeria, Ethiopia, Jordan, Cameroon, the UK, and Iran. As we did last year, we decided to review and evaluate various aspects of our work in the previous year. In the year 2022, despite the not-yet-ended pandemic, COVID-19 apparently missed its priority as the hottest topic of research and it seems that researchers took time to focus on their main research lines. Therefore, we were able to publish articles in different fields and cover more topics; however, we still received so many papers on COVID-19 and published some of them, not only on treatment but also on other aspects of the disease, and also some case reports. We also published a letter in which the authors pointed to increased prevalence of bloodstream infection with Klebsiella species in patients with recent COVID-19 infection, which may be an interesting issue for further investigations. We had two other papers that were published as “Letter to the Editor”. One was related to blunt abdominal injuries in the National Trauma Registry of Iran, and the other was concerned with Eye emergencies during wars, which was published around the beginning of Russia's war against Ukraine. There were 25 published papers in 2022 that fulfilled the criteria of an original article. Of these, only 7 were focused on COVID-19, and the rest covered other topics including critical care, neurological emergencies, experimental studies, point of care ultrasound, cardiovascular emergencies, emergency department management topics, trauma, and prehospital emergency care. Interestingly, the most viewed article was the one in which a series of oleander poisoning cases were reported by a group of authors from India. In addition to original articles, there were also one umbrella review, one systematic review, and some other types of reviews that have their own value and specific audiences, in which some recommendations were reviewed by experts in the fields. Case presentation maybe the most popular part of the journals. We have various structures in this regard, so that we can respond to the passion of our addressees. We published 5 Case reports, and also 5 papers categorized as “case-based learning points”. However, there are some other structures available for those interested in sharing their experience with their patients, which we regularly suggest to the authors in the peer review process of their submissions. We are honored to have published a series of educational papers on “electrocardiogram interpretation”, all written by Jerry W. Jones as an invited author, and we are very grateful for his participation and companionship. We also intend to introduce historical aspects of emergency medicine in various countries; therefore, an editorial paper written by Ozgur Karcioglu was published, which points to the emergency medicine journey in Turkey. We are very eager to have this type of papers from other countries and we will certainly invite other experts in this regard.
Case Report, 2022
Shortly after the onset of the coronavirus pandemic, different vaccines were developed to combat ... more Shortly after the onset of the coronavirus pandemic, different vaccines were developed to combat it. The vaccines had different mechanisms and triggered cellular and humoral immune responses against the virus. In addition to their positive effects, various side effects have been reported for them. They rarely cause severe complications. They can also rarely trigger latent infections. The present case report presents a patient who developed herpes simplex encephalitis after receiving the second dose of the Covaxin (BBV152).
Review Article, 2022
Providing early health care services in natural disaster is one of the essential applications of ... more Providing early health care services in natural disaster is one of the essential applications of telemedicine. This narrative review aims to investigate the applications, advantages and challenges of telemedicine in natural disaster-stricken areas. Medline (through PubMed), Web of Science (WOS), and Scopus databases were searched for related articles published from beginning to 2022. The keywords used for the search included "telemedicine" and "natural disaster." After removing duplicate papers, irrelevant review articles and letters to editors, 44 relevant papers were selected and reviewed. Information sharing through audio, visual, and data-oriented services is among critical approaches that telemedicine services mainly use. Teleconsultation, tele-education, remote interpretation, tele-psychiatry, and tele-surgery are among measures that can be implemented in emergencies like earthquakes, fires, floods, storms, and drought. The fundamental requirements of a telemedicine-oriented system for providing emergency services in natural disasters include wireless scales, conversation tools, blood pressure monitor, respiratory rate monitor, spo2 sensor, glucometer, portable ultrasound unit, wearable thermometers, virtual stethoscopes, portable three leads electrocardiograph monitor, and digital otoscopes. Simple telemedicine systems can have many advantages in the natural disasters. However, the main challenge in this regard is to adapt the necessary communication systems to a telemedicine paradigm. Another critical challenge is to interpret and apply the summary of acquired information and the inevitable interaction outcomes at the required time and place.
Review Article, 2022
Evaluation of a pregnant trauma patient (PTP) in the emergency department (ED) is somehow challen... more Evaluation of a pregnant trauma patient (PTP) in the emergency department (ED) is somehow challenging, as two patients should be managed simultaneously. Here, we reviewed recently published articles to provide up-todate information on the management of PTPs. We examined 35 articles and categorized their topics as follows: trauma severity, management of trauma patients, general approach to pregnant women with trauma, primary evaluation of pregnant women with trauma, breathing and ventilation, airway, circulatory system evaluation simultaneous with bleeding control, uterine replacement, blood transfusion, uterine displacement, cardiovascular resuscitation, defibrillation, pneumatic anti-shock garment, and perimortem cesarean section. Concerning trauma during pregnancy, the basic principle should be successful maternal resuscitation, which is vital for fetus survival.
Case Based Learning Points, 2022
A 33-year-old woman presented to the emergency department with colicky abdominal pain, nausea and... more A 33-year-old woman presented to the emergency department with colicky abdominal pain, nausea and vomiting, constipation, obstipation, and rectorragia. She had a history of similar abdominal pain from a few months ago. She had no history of any specific disease and taking any medication. She had no history of surgery and specific family diseases. Her vital signs on admission were heart rate 90/minute, respiratory rate 18/minute, blood pressure 110/70 mmHg, and temperature of 37.1°C. There were several brown spots on her lips and inside her mouth. On abdominal examination, she had a generalized tenderness, especially in the LLQ. In the digital rectal examination, the rectum was empty. Lab tests showed the following results: leukocyte count 4000/mm3 with 80.9% neutrophils, hemoglobin 12.1 g/dl, platelet 320000/µl, and creatinine 0.6 mg/dl, BUN 14 mg/dl, glucose 152 mg/dl, sodium 137 mEq/L, potassium 4.5 mEq/L. Chest and abdominal radiographs were performed on the patient (Figure 1). No subdiaphragmatic free air was seen in the chest x-ray. The abdominal x-ray showed no air-fluid levels as well as any gas in the rectum. On abdominal and pelvic ultrasound, a moderate amount of free fluid was seen in the abdomen along with jejunoileal intussusception in the LLQ with an intestinal loops thickness increase.
Electrocardiogram Interpretation, 2022
This is the fourth installment in the electrocardiogram (ECG) interpretation series by Jerry W. J... more This is the fourth installment in the electrocardiogram (ECG) interpretation series by Jerry W. Jones MD FACEP FAAEM for this journal. At first, he discussed simple atrioventricular (AV) dissociation versus AV dissociation caused by third degree AV block; then, he shares some very important pearls regarding ECG interpretation. And in latest one, he pointed to the importance of Hexaxial Reference Grid. For this paper, some valuable references were reviewed.
Review Article, 2022
Since the authoring of the seminal report by the Institute of Medicine (IOM) "To Err is Human: Bu... more Since the authoring of the seminal report by the Institute of Medicine (IOM) "To Err is Human: Building a Safer Health System" in 2000, there has been an increased focus on patient safety and the responsibility born by the healthcare system to reduce what are known as adverse events (AE). One of the recommendations of the IOM report was the establishment and development of Incident Reporting System (IRS) that would track AE resulting in serious injury and death. The Joint Commission in the USA similarly requires all hospitals have and use an IRS. The objective of this review is to explore barriers and feature of IRS and patient safety.
Original Article, 2022
Objective: Determining the exact underlying etiology of loss of consciousness (LOC) can become a ... more Objective: Determining the exact underlying etiology of loss of consciousness (LOC) can become a real challenge for physicians due to the broadness of differential diagnoses. The current study aimed to assess the accuracy of a commercially available strip for urine drug screening, in patients presenting with LOC. Methods: One hundred fifty patients with LOC were enrolled in the current cross-sectional study. The diagnostic accuracy of a multidrug urinary strip rapid test was evaluated in comparison to blood analysis as the reference test, and the screening performance characteristics of the rapid test for each substance were estimated. Results: The average age of patients was 46.21±18.59 years (72.67% male). The most frequent false positive results of the test were related to Benzodiazepine (21.5%), Methamphetamine (7.5%), and Tramadol (5.4%), respectively. The screening performance characteristics of the test tape were the best in detection of Amitriptyline with 100.0% (95% CI: 30.99-100.0) sensitivity, Cocaine with 100.0% (95% CI: 5.46-100.0) sensitivity, and Methadone with 91.54% (95% CI: 81.88-96.51) sensitivity, respectively. Conclusion: The current study reveals that employing a urinary strip test for detecting drug intoxication in the setting of emergency department can lead to significant false positive and negative results. Accordingly, relying on a urine drug screen to determine the underlying etiology of LOC should be done with caution.
Case Based Learning Points, 2022
A 62 years old Palestinian woman with a history of diabetes mellitus presented to our department ... more A 62 years old Palestinian woman with a history of diabetes mellitus presented to our department with a decrease in urine output since a week with a complete anuria with the onset of bilateral flank pain more prominent in the right side since the last 3 days. The pain was dull in nature, continuous, severe and changing with the position. Other symptoms included epistaxis, anorexia, nausea, and eye redness appearing 10 days before the admission which resolved in 2 days on home remedies (herbal compressor).
Case Report, 2022
Spontaneous subcapsular renal hematoma is a rare complication with potentially fatal effects in c... more Spontaneous subcapsular renal hematoma is a rare complication with potentially fatal effects in clinical practice. We discuss a case of a patient who arrived at the emergency room with abrupt onset flank discomfort and hematuria. The damaged kidney was effectively embolized by interventional radiology, and the patient quickly recovered. Follow-up tests revealed that the hematoma had shrunk in size. We believe that early arterial embolization should be explored in the care of patients with renal bleeding because it may enhance outcomes.
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Papers by Frontiers in Emergency Medicine
180 beats/min; respiratory rate: 35 breaths/min; temperature: 35± C; oxygen saturation: 70%; and his blood pressure was undetected. The child was immediately transferred to the resuscitation room. The primary survey showed that the patient was comatose with a Glasgow coma scale of 3/15, the pupils were brisk with an unstable airway, and there was bilateral diminished air entry. The oxygen saturation did not improve despite assisted ventilation using an Ambu bag. The central and peripheral pulsation was weak with a delayed
capillary refill, and the blood glucose level was 9 mmol/L. The abdomen was hugely distended and rigid with minimal rectal bleeding. The patient was immediately intubated and connected to mechanical ventilation with subsequent rising of his oxygen saturation to 100%. A plain chest X-ray examination followed the patient’s intubation. Intravenous access was obtained followed by administration of normal saline (20 ml/kg) with subsequent elevation of the blood pressure (82/50mmHg) and decrease in heart rate (160 beats/minute). Initial arterial blood gases (ABG) analysis after intubation showed pH: 6.6; PaCO2 >150 mmHg; PaO2: 100 mmHg; HCO3: 10mEq/L; and lactic acid: 9 mg/dL. Therefore, a bolus of sodium bicarbonate was given, intravenously. Ventilator parameters were set at the maximum limits to wash out carbon dioxide. Repeated ABG analysis showed pH: 6.7; PaCO2: 135 mmHg; PaO2: 150 mmHg; HCO3: 17 mEq/L; and lactic acid: 6.5 mg/dL. Immediate bedside abdominal X-ray and ultrasonography were carried out to rule out intussusception. The child remained critically ill and unstable with fluctuating vital signs. Despite high ventilator parameters and gasgastric tube suction, the child showed no improvement in the respiratory parameters. The child was then transferred to the operation theatre for decompression laparotomy, which showed small bowel (ileum) ischemia. After surgical decompression, the respiratory parameters improved, and the ventilator
parameters were set back to normal settings for the patient’s age and weight. Unfortunately, the child remained critically ill. Then, he developed sepsis and multiple systems organ failure and died after 2 days.
We read with interest Abdolrazaghi and his colleague’s paper entitled ‘’ Brachial plexus injury following blunt trauma; an anatomical variation in electrodiagnostic findings’’ and enjoyed it a lot. They presented a brachial plexus injury (BPI) case, which was rare in clinical practice because blunt traumas did not commonly cause BPI. There is ample evidence that most cases are men and adolescents aged 15 to 25 years, and the main mechanism of injury (70%) is motor vehicle accidents. As BPI is increasing, we will provide some epidemiologic and clinical characteristics of our cases registered at Sina Hospital, affiliated with the National Trauma Registry of Iran (NTRI). The Sina Trauma and Surgery Research Center launched the NTRI in 2016 and first recorded the related data from Sina Hospital. As the registry expanded, the NTRI included some other Iranian hospitals from different cities in the next step. The inclusion criteria were discussed elsewhere. We have registered 10 cases of BPI since 2016 at Sina Hospital. All of them were men, ranging from 19 to 45 years. The cause of injury was cut/stab in nine and road traffic accidents in one patient; seven were intentional, and most were due to interpersonal violence. Five of the injuries happened outdoors, three cases in commercial and service departments, and two at homes. Furthermore, the median injury severity score (ISS) was 5.0 (IQR=1). All of the patients had surgical operations. No death or need for ventilators was reported. Only one patient needed intensive care unit (ICU) admission and stayed for three days in the ward. We hope this information can be helpful for the Frontiers in Emergency Medicine’s readers to know more about BPI and can compare similarities and differences between our cases and the others included in the literature.
180 beats/min; respiratory rate: 35 breaths/min; temperature: 35± C; oxygen saturation: 70%; and his blood pressure was undetected. The child was immediately transferred to the resuscitation room. The primary survey showed that the patient was comatose with a Glasgow coma scale of 3/15, the pupils were brisk with an unstable airway, and there was bilateral diminished air entry. The oxygen saturation did not improve despite assisted ventilation using an Ambu bag. The central and peripheral pulsation was weak with a delayed
capillary refill, and the blood glucose level was 9 mmol/L. The abdomen was hugely distended and rigid with minimal rectal bleeding. The patient was immediately intubated and connected to mechanical ventilation with subsequent rising of his oxygen saturation to 100%. A plain chest X-ray examination followed the patient’s intubation. Intravenous access was obtained followed by administration of normal saline (20 ml/kg) with subsequent elevation of the blood pressure (82/50mmHg) and decrease in heart rate (160 beats/minute). Initial arterial blood gases (ABG) analysis after intubation showed pH: 6.6; PaCO2 >150 mmHg; PaO2: 100 mmHg; HCO3: 10mEq/L; and lactic acid: 9 mg/dL. Therefore, a bolus of sodium bicarbonate was given, intravenously. Ventilator parameters were set at the maximum limits to wash out carbon dioxide. Repeated ABG analysis showed pH: 6.7; PaCO2: 135 mmHg; PaO2: 150 mmHg; HCO3: 17 mEq/L; and lactic acid: 6.5 mg/dL. Immediate bedside abdominal X-ray and ultrasonography were carried out to rule out intussusception. The child remained critically ill and unstable with fluctuating vital signs. Despite high ventilator parameters and gasgastric tube suction, the child showed no improvement in the respiratory parameters. The child was then transferred to the operation theatre for decompression laparotomy, which showed small bowel (ileum) ischemia. After surgical decompression, the respiratory parameters improved, and the ventilator
parameters were set back to normal settings for the patient’s age and weight. Unfortunately, the child remained critically ill. Then, he developed sepsis and multiple systems organ failure and died after 2 days.
We read with interest Abdolrazaghi and his colleague’s paper entitled ‘’ Brachial plexus injury following blunt trauma; an anatomical variation in electrodiagnostic findings’’ and enjoyed it a lot. They presented a brachial plexus injury (BPI) case, which was rare in clinical practice because blunt traumas did not commonly cause BPI. There is ample evidence that most cases are men and adolescents aged 15 to 25 years, and the main mechanism of injury (70%) is motor vehicle accidents. As BPI is increasing, we will provide some epidemiologic and clinical characteristics of our cases registered at Sina Hospital, affiliated with the National Trauma Registry of Iran (NTRI). The Sina Trauma and Surgery Research Center launched the NTRI in 2016 and first recorded the related data from Sina Hospital. As the registry expanded, the NTRI included some other Iranian hospitals from different cities in the next step. The inclusion criteria were discussed elsewhere. We have registered 10 cases of BPI since 2016 at Sina Hospital. All of them were men, ranging from 19 to 45 years. The cause of injury was cut/stab in nine and road traffic accidents in one patient; seven were intentional, and most were due to interpersonal violence. Five of the injuries happened outdoors, three cases in commercial and service departments, and two at homes. Furthermore, the median injury severity score (ISS) was 5.0 (IQR=1). All of the patients had surgical operations. No death or need for ventilators was reported. Only one patient needed intensive care unit (ICU) admission and stayed for three days in the ward. We hope this information can be helpful for the Frontiers in Emergency Medicine’s readers to know more about BPI and can compare similarities and differences between our cases and the others included in the literature.