مقدمه: خشونت در محل کار یک مشکل جهانی با شیوع رو به افزایش میباشد. تمام پرسنل درمانی در معرض خشون... more مقدمه: خشونت در محل کار یک مشکل جهانی با شیوع رو به افزایش میباشد. تمام پرسنل درمانی در معرض خشونت قرار دارند اما با توجه به شرایط خاص اورژانس پیش بیمارستانی ، این افراد، در معرض خشونت محل کار بیشتری نسبت به کارکنان سایر بخشهای درمانی قرار دارند. روش کار: این مطالعه از نوع مقطعی و جامعه مورد مطالعه کارکنان بخش فوریت پزشکی استان آذربایجان شرقی بود. روش نمونه گیری به صورت نمونه گیری تصادفی ساده انجام گرفت. نتایج: در مجموع از تعداد ۷۷ نفر شرکت کننده، تمام افراد از جنس مرد بودند. متوسط سن شرکت کنندگان 5/7 ± 4/34 سال و متوسط سابقه کار 7/5 ± 6/9 سال بود. بیش از نیمی از پرسنل اورژانس پیش بیمارستانی طی یکسال گذشته، دو یا بیش از ۲ بار در هفته مورد آزار بیمار قرار گرفته بودند و در ۵/۳۲ درصد موارد پرسنل تکنسین اورژانس پیش بیمارستانی توسط همراه بیمار مورد آزار قرار گرفته بودند. نتیجه گیری: میزان خشونت علیه تکنسین های عملیاتی فوریت پزشکی بالاست.
Objective: the present meta-analysis was designed to determine the value of Pediatric Emergency C... more Objective: the present meta-analysis was designed to determine the value of Pediatric Emergency Care Applied Research Network (PECARN) rule in prediction of clinically important traumatic brain injury (ciTBI).Methods: Extensive search was conducted in the databases of Medline, Embase, Scopus, Web of Sciences, Cinahl up to the end of August 2017. The search records were screened and summarized by two independent reviewers, and eventually the findings were presented as summary of receiver operating characteristics (SROC), sensitivity, specificity and diagnostic odds ratio with 95% confidence interval (95% CI). Results:Data from 10 studies were included in this meta-analysis. Area under the curve (AUC) of SROC for PECARN model in prediction of ciTBI in children younger than 2 years old was 0.85 (95% CI: 0.82-0.88). Sensitivity, specificity and diagnostic odds ratio of this model were also calculated to be 0.98 (95% CI: 0.92-1.0), 0.56 (95% CI: 0.48-0.64) and 82.53 (95% CI: 16.23-419.63...
Introduction: There is no comprehensive meta-analysis on the value of physiological scoring syste... more Introduction: There is no comprehensive meta-analysis on the value of physiological scoring systems in predicting the mortality of critically ill patients. Therefore, the present study intended to conduct a systematic review and meta-analysis to collect the available clinical evidence on the value of physiological scoring systems in predicting the in-hospital mortality of acute patients. Method: An extensive search was performed on Medline, Embase, Scopus, and Web of Science databases until the end of year 2020. Physiological models included Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), modified REMS (mREMS), and Worthing Physiological Score (WPS). Finally, the data were summarized and the findings were presented as summary receiver operating characteristics (SROC), sensitivity, specificity and diagnostic odds ratio (DOR). Results: Data from 25 articles were included. The overall analysis showed that the area under the SROC curve of REMS, RAPS, mREMS, a...
Introduction: Limitations of Glasgow coma scale (GCS) led the researchers to designing new physio... more Introduction: Limitations of Glasgow coma scale (GCS) led the researchers to designing new physiologic scoring systems such as revised trauma score (RTS), rapid acute physiology score (RAPS) and rapid emergency medicine score (REMS), and worthing physiological scoring system (WPSS). However, it is not yet known whether these models have any advantage over GCS. Objective: The present study attempted to compare the values of 4 physiologic scoring systems including RTS, RAPS, REMS and WPSS with GCS in predicting in-hospital mortality of trauma patients. Methods: The present diagnostic accuracy study was performed on trauma patients presenting to emergency departments of 4 hospitals in Iran throughout 2017. Patients were clinically evaluated and were followed until discharge from hospital. Finally, the status of patients regarding mortality and poor outcome (death, vegetative status, severe disability, and moderate disability) was recorded and predictive value of GCS was compared with p...
Using hormone replacement therapy for relieving menopausal symptoms and also for preventing some ... more Using hormone replacement therapy for relieving menopausal symptoms and also for preventing some diseases such as hip fractures had led to a widespread use of it in postmenopausal women but there is a concern about risks of breast cancer occurrence using HRT. In this study, 1000 women older than 40 years old without any clinical symptoms were selected. They were referred to a radiology center for a screening mammography. By using a questionnaire the information about using HRT was gathered. 16.7% of cases were using HRT and 83.3% had no history of using HRT. Among 1000 cases, 13 mammograms had signs of malignancy. In these cases 7.7% was using HRT and 92.3% didn't have any history of using HRT. It was concluded that there isn't any statistically significant association between the development of breast cancer and using HRT (P=0.604). [Rahmani SH, Ahmadi S, Moghbel A, Navali N, Khodaverdi Zadeh H. Association between hormone replacement therapy and occurrence of breast cancer...
Cancer is a leading cause of death worldwide with about 7.6 million deaths in 2008. Breast cancer... more Cancer is a leading cause of death worldwide with about 7.6 million deaths in 2008. Breast cancer is the most frequent cancer among women and the most common cause of cancer death. This study is a mammographic screening study on 1000 women who came to a radiology center in Tabriz at 2010. The screening technique included physical examination of breasts by an experienced physician before taking mammograms and then mammography in two standard views.1000 women between ages 40-77 years old and without any clinical symptoms was evaluated. Malignant mass or nodule: 13 cases, Benign mass or nodule: 34 cases, Benign calcified nodule: 10 cases, Fatty breast: 6 cases and Ductal ectasia: 1 case. Association between malignancy signs in mammography and positive clinical findings doesn’t have statistical significance (P=0.405) and association between benign signs in mammography and clinical findings doesn’t also have statistical significance (P=0.692). varying in prevalence of breast cancer in di...
Emergency department is the first place that medical team gets contact with the patient. In order... more Emergency department is the first place that medical team gets contact with the patient. In order to have higher standards in traumatic patient care, continuous quality control is an essence and time is an important factor for this perspective in emergency department. Current study evaluates management of traumatic patients visiting emergency department (ED) in Imam Reza hospital by assessing length of stay and its effective factors such as Routine Trauma X-rays. Between April and December 2011, 300 traumatic patients visiting emergency department, Imam Reza hospital were randomly studied. Time needed to perform the routine trauma x-rays (lateral cervical vertebra, AP chest and AP pelvis radiographies), and the length of stay (LOS) in the ED were recorded. Mean physician and nurse first visit was 7.93±0.47 and 11.91±9.38 minutes, respectively. X-rays in was performed within 70.30±53.08 minutes. Mean surgery and neurosurgery visits were obtained within 37.40±3.16 minutes and 33.48±2....
Introduction: Workplace violence is a global problem the prevalence of which is increasing. All h... more Introduction: Workplace violence is a global problem the prevalence of which is increasing. All healthcare personnel are subject to violence, but considering the special conditions of pre-hospital emergency, its personnel are exposed to a higher rate of workplace violence compared to other healthcare workers. Methods: This was a cross-sectional study and the study population consisted of pre-hospital emergency personnel of East-Azerbaijan province, Iran. The sampling method was simple random sampling. Results: A total of 77 participants were included all of whom were male. The average age of the participants was 34.4 ± 7.5 years and their average work experience was 9.58 ± 5.7 years. More than half of the pre-hospital emergency personnel had faced violence by patients twice a week or more throughout the previous year. In 32.5% of the cases, pre-hospital emergency medical technicians had experienced violence by a patient’s friend or relative. Conclusion: The rate of violence against ...
A 68-year-old man presents to the emergency department with nausea, drolling, and swelling of his... more A 68-year-old man presents to the emergency department with nausea, drolling, and swelling of his tongue that began 3 hours earlier. The patient reports previous episodes of swelling of his lip and tongue about 4 years ago, that have been attributed possibly to drug reaction. There is no family history of similar episodes. Physical examination reveals a swollen tongue and hypertension, drooling, flushing, and no rash, bronchospasm, or urticaria.
Context: In some studies, Fresh Frozen Plasma (FFP) transfusion in severely ill patients was acco... more Context: In some studies, Fresh Frozen Plasma (FFP) transfusion in severely ill patients was accompanied with an increase in the risk of nosocomial infection. However, there are no comprehensive data in terms of FFP transfusion and its relationship with nosocomial infection in heart surgery. Hence, the present systematic review and meta-analysis aimed to investigate the relationship between FFP transfusion and nosocomial infection risk in the patients undergoing cardiac surgery. Evidence Acquisition: Study selection: The present study included all the studies, which probed into nosocomial infection after FFP transfusion in patients with cardiac surgery. Data sources: Medline, Web of Science, Embase, Central, and Scopus electronic databases were searched to the end of March 2019. Results: Finally, five articles and three abstracts that studied nosocomial infection were entered into the present systematic review. FFP increased the rate of nosocomial infection in cardiac surgery in one article, but this was not the case in the remaining four articles. The three abstracts also reported that FFP increased the rate of nosocomial infection in cardiac surgery. Conclusion: The studies indicated that the benefit of FFP administration outweighed the probable risk of infection. Indeed, none of the studies indicated a strong relationship between FFP transfusion and infection rate after cardiac surgery.
Patient satisfaction plays an important role in healthcare process and certainly reflects the qua... more Patient satisfaction plays an important role in healthcare process and certainly reflects the quality of care. Evaluation of patients’ satisfaction helps discover problems and perform necessary measures to improve this quality. The objective of this study was to determine the rate of satisfaction of the emergency patients in Imam Khomeini Hospital at Urmia. Material & Methods: This cross-sectional research was conducted on 500 patients admitted in the emergency ward of Imam Khomeini hospital of Urmia. The data were gathered by a questionnaire and were analyzed by SPSS-18 software. Results: The findings showed that the highest percentage of satisfaction was related to physician behaviors (81%), availability of medicines and medical equipment (78.6%) and attending physician’s availability and late arrival at the emergency ward (69.4%).The lowest satisfaction was related to the furniture in the waiting area of the emergency ward (50%), on-time presence of patient transporter (24.4%) an...
Introduction: There is still no consensus on the value of Manchester Acute Coronary Syndromes (MA... more Introduction: There is still no consensus on the value of Manchester Acute Coronary Syndromes (MACS) decision rule in detecting acute coronary syndrome (ACS). Therefore, the purpose of the present systematic review and meta-analyzes is to summarize the clinical evidence in the evaluation of the value of MACS in the diagnosis of ACS. Methods: A literature search was performed on the Medline, Embase, Scopus, and Web of Science databases. Outcomes included acute myocardial infarction (AMI) and major adverse cardiac event (MACE). Data were analyzed in the STATA 14.0 statistical program and the results were reported as summary receiver operating characteristics (SROC), sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio with 95% confidence interval (95% CI). Results: Finally, 8 articles included in the meta-analysis. The area under the SROC of MACS was excellent in rule out of AMI (AUC = 0.99, 95% CI: 0.97 to 0.99) and MACE (AUC = 0.97, 95% CI: 0.9...
The car accident is causes of 16000 deaths in a day. Central nerves system injury is one of the m... more The car accident is causes of 16000 deaths in a day. Central nerves system injury is one of the most important causes of morbidity and mortality. After head trauma neuron cell may be has dysfunction but the recovery is possible yet. This recovery needs to suit cares. This study attempts for confirmation of efficacy of Sulfate Magnesium in moderate and sever head trauma. This study is a pilot study and clinical trial in 201 until 2011. The patients divided to two groups. First; sever head trauma (GCS <=8), second; moderate head trauma (8<=GCS<=12). Intervention group in both of groups was injected 250 micromole/kg sulfate magnesium besides definitive cares and witnessed group only have taken definitive cares. The study suggested in moderate and severe head trauma neurologic and radiologic outcome more acceptable in intervention group after injection sulfate magnesium.
Objective: Emergency departments and hospital emergency departments are important due to their cr... more Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The purpose of this study is to investigate the relationship between the patient’s chief complaint and their departure to the emergency room. Methods: From non-traumatic patients referred to the emergency department of Imam Reza Hospital during 2018, about 57000 patients were selected and enrolled in the study. Then, age, sex, initial diagnosis, time of the final decision, and time of departure from the emergency department as well as hospitalization ward were included in the checklist. Patients whose documentation was incomplete were excluded. Data were entered into SPSS software version 15.0 and descriptive statistics (normal distribution, average of time, minimum time and maximum time,...
Falling is reported to be the most common cause of mortality due to trauma in individuals over th... more Falling is reported to be the most common cause of mortality due to trauma in individuals over the age of 75 years. The present study is designed with the aim of determining the demographics of fall-related trauma among the elderly presenting to emergency department (ED). The present prospective cross-sectional study was carried out on all elderly patients ≥ 60 years old presenting to ED of a major referral trauma center in North West of Iran during 1 year. Demographic data, location and height of falling, duration of hospitalization, trauma severity and in-hospital outcome of the patients were gathered and reported via descriptive statistics. 228 patients with the mean age of 70.96 ± 5.2 years were studied (53.9% female). Most patients were in the 66-70 years age range (32.6%) and had a history of hypertension (22.3%), who had visited following a fall inside the house (69.3%), due to slipping (73.7%), and from a height equal to or less than 2m (71.9%). 6 (2.6%) patients died in the...
The main purpose of emergency department (ED) management for renal colic is prompt pain relief. T... more The main purpose of emergency department (ED) management for renal colic is prompt pain relief. The present study aimed to compare the analgesic effects of intravenus (IV) ketofol with morphine in management of ketorolac persistent renal colic. This study is a single blind randomized, clinical trial, on patients who were presented to ED with renal colic, whose pain was resistant to 30 mg IV ketorolac. The patients were randomly assigned to either IV morphine (0.1 mg/kg) or IV ketofol (0.75 mg/kg propofol and 0.75 mg/kg) and the measures of treatment efficacy were compared between the groups after 5 and 10 minutes. 90 patients with mean age of 38.01 ± 9.78 years were randomly divided into 2 groups of 45 (66.7% male). Treatment failure rate was significantly lower in ketofol group after 5 (20% vs 62.2%, p < 0.001) and 10 minutes (11.1% vs 44.4%, p < 0.001). ARR and NNT for ketofol after 5 miutes were 42.22% (95% CI: 23.86 - 60.59) and 3 (95% CI: 1.7 - 4.2), respectively. After 1...
Background: Metabolic acidosis is a fatal finding in trauma patients that complicates the process... more Background: Metabolic acidosis is a fatal finding in trauma patients that complicates the process of resuscitation. Case: The case was a 37-year-old man with open fracture in both legs and fracture in second lumbar vertebral (L2). The serial arterial blood gas (ABG) test results showed a pH value of 6.7 indicating a very severe and special case of metabolic acidosis. The rate of mortality for such a case was very high. The patient was treated with sodium bicarbonate and successfully revived after four hours post treatment and metabolic acidosis was resolved. Conclusion: This indicated that bicarbonate administration is useful for very severe cases. The good condition of the patient after survival from the severe academia allowed for extubation.
Ingestion and inhalation of phosphine are 2 forms of toxicity and their clinical manifestation is... more Ingestion and inhalation of phosphine are 2 forms of toxicity and their clinical manifestation is extremely wide. A 22-year-old girl was admitted with complaints of nausea, vomiting and epigastric pain after eating lunch. She had a history of celiac disease. On arrival, she was alert and hemodynamically stable. There was not any abdominal tenderness or guarding. Food poisoning treatment initiated but after 1 hour her condition deteriorated with hypotension, tachycardia, and epigastric pain. Venous blood gas (VBG) showed severe metabolic acidosis. She denied any drug ingestion again. New Electrocardiogram (ECG) showed extensive inferolateral ST elevation myocardial infarction (STEMI). Bicarbonate plus dopamine was initiated. After 8 hours of admission, rhythm became ventricular fibrillation (VF) and cardiopulmonary resuscitation (CPR) began. Peritoneal dialysis was performed. Next morning frequent VF occurred again but CPR was unsuccessful. Family found aluminum phosphide (AIP) tablets in her purse. Early diagnosis and supportive treatment may be effective but the most important factor is the dose of ingestion.
Introduction: Botulism is an acute form of poisoning resulted from ingestion of Clostridium botul... more Introduction: Botulism is an acute form of poisoning resulted from ingestion of Clostridium botulinum toxin. Case Presentation: Here we present five cases of food-borne botulism poisoning from home produced cheese. Five patients from one family referred to our emergency unit with complaints of weakness and two had severe symptoms. In spite of the laboratory negative results antitoxin was administered and their symptoms improved. Discussion: Botulism poisoning can develop with any home-canned food and people must avoid consumption of such products.
Head trauma is a frequent and important problem from the view of emergency physician. Estimates o... more Head trauma is a frequent and important problem from the view of emergency physician. Estimates of mortality following head injury vary from 10 to 36 per 100000 populations. Estimates of combine medical costs from trauma places of over 6 billion dollars. One of the diagnostic procedures in these cases is use of radiologic imaging. Nevertheless, visible fractures are found less than 5% in skull X-Ray films. Therefore, it is better to use this procedure when risk of detecting visible fracture is high. In a cross-sectional analytic study that performed in Emergency Medicine Department of Tabriz University of Medical Sciences from September 2010 to July 2013 on patients with head trauma, we evaluated fractures visible on plain radiographies and the clinical manifestations in patients with head traumas with GCS=15. This study besides determination of relative frequency of age, sex, etiology, visible fracture in skull X-ray and clinical manifestations in these cases tries to determine the...
مقدمه: خشونت در محل کار یک مشکل جهانی با شیوع رو به افزایش میباشد. تمام پرسنل درمانی در معرض خشون... more مقدمه: خشونت در محل کار یک مشکل جهانی با شیوع رو به افزایش میباشد. تمام پرسنل درمانی در معرض خشونت قرار دارند اما با توجه به شرایط خاص اورژانس پیش بیمارستانی ، این افراد، در معرض خشونت محل کار بیشتری نسبت به کارکنان سایر بخشهای درمانی قرار دارند. روش کار: این مطالعه از نوع مقطعی و جامعه مورد مطالعه کارکنان بخش فوریت پزشکی استان آذربایجان شرقی بود. روش نمونه گیری به صورت نمونه گیری تصادفی ساده انجام گرفت. نتایج: در مجموع از تعداد ۷۷ نفر شرکت کننده، تمام افراد از جنس مرد بودند. متوسط سن شرکت کنندگان 5/7 ± 4/34 سال و متوسط سابقه کار 7/5 ± 6/9 سال بود. بیش از نیمی از پرسنل اورژانس پیش بیمارستانی طی یکسال گذشته، دو یا بیش از ۲ بار در هفته مورد آزار بیمار قرار گرفته بودند و در ۵/۳۲ درصد موارد پرسنل تکنسین اورژانس پیش بیمارستانی توسط همراه بیمار مورد آزار قرار گرفته بودند. نتیجه گیری: میزان خشونت علیه تکنسین های عملیاتی فوریت پزشکی بالاست.
Objective: the present meta-analysis was designed to determine the value of Pediatric Emergency C... more Objective: the present meta-analysis was designed to determine the value of Pediatric Emergency Care Applied Research Network (PECARN) rule in prediction of clinically important traumatic brain injury (ciTBI).Methods: Extensive search was conducted in the databases of Medline, Embase, Scopus, Web of Sciences, Cinahl up to the end of August 2017. The search records were screened and summarized by two independent reviewers, and eventually the findings were presented as summary of receiver operating characteristics (SROC), sensitivity, specificity and diagnostic odds ratio with 95% confidence interval (95% CI). Results:Data from 10 studies were included in this meta-analysis. Area under the curve (AUC) of SROC for PECARN model in prediction of ciTBI in children younger than 2 years old was 0.85 (95% CI: 0.82-0.88). Sensitivity, specificity and diagnostic odds ratio of this model were also calculated to be 0.98 (95% CI: 0.92-1.0), 0.56 (95% CI: 0.48-0.64) and 82.53 (95% CI: 16.23-419.63...
Introduction: There is no comprehensive meta-analysis on the value of physiological scoring syste... more Introduction: There is no comprehensive meta-analysis on the value of physiological scoring systems in predicting the mortality of critically ill patients. Therefore, the present study intended to conduct a systematic review and meta-analysis to collect the available clinical evidence on the value of physiological scoring systems in predicting the in-hospital mortality of acute patients. Method: An extensive search was performed on Medline, Embase, Scopus, and Web of Science databases until the end of year 2020. Physiological models included Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), modified REMS (mREMS), and Worthing Physiological Score (WPS). Finally, the data were summarized and the findings were presented as summary receiver operating characteristics (SROC), sensitivity, specificity and diagnostic odds ratio (DOR). Results: Data from 25 articles were included. The overall analysis showed that the area under the SROC curve of REMS, RAPS, mREMS, a...
Introduction: Limitations of Glasgow coma scale (GCS) led the researchers to designing new physio... more Introduction: Limitations of Glasgow coma scale (GCS) led the researchers to designing new physiologic scoring systems such as revised trauma score (RTS), rapid acute physiology score (RAPS) and rapid emergency medicine score (REMS), and worthing physiological scoring system (WPSS). However, it is not yet known whether these models have any advantage over GCS. Objective: The present study attempted to compare the values of 4 physiologic scoring systems including RTS, RAPS, REMS and WPSS with GCS in predicting in-hospital mortality of trauma patients. Methods: The present diagnostic accuracy study was performed on trauma patients presenting to emergency departments of 4 hospitals in Iran throughout 2017. Patients were clinically evaluated and were followed until discharge from hospital. Finally, the status of patients regarding mortality and poor outcome (death, vegetative status, severe disability, and moderate disability) was recorded and predictive value of GCS was compared with p...
Using hormone replacement therapy for relieving menopausal symptoms and also for preventing some ... more Using hormone replacement therapy for relieving menopausal symptoms and also for preventing some diseases such as hip fractures had led to a widespread use of it in postmenopausal women but there is a concern about risks of breast cancer occurrence using HRT. In this study, 1000 women older than 40 years old without any clinical symptoms were selected. They were referred to a radiology center for a screening mammography. By using a questionnaire the information about using HRT was gathered. 16.7% of cases were using HRT and 83.3% had no history of using HRT. Among 1000 cases, 13 mammograms had signs of malignancy. In these cases 7.7% was using HRT and 92.3% didn't have any history of using HRT. It was concluded that there isn't any statistically significant association between the development of breast cancer and using HRT (P=0.604). [Rahmani SH, Ahmadi S, Moghbel A, Navali N, Khodaverdi Zadeh H. Association between hormone replacement therapy and occurrence of breast cancer...
Cancer is a leading cause of death worldwide with about 7.6 million deaths in 2008. Breast cancer... more Cancer is a leading cause of death worldwide with about 7.6 million deaths in 2008. Breast cancer is the most frequent cancer among women and the most common cause of cancer death. This study is a mammographic screening study on 1000 women who came to a radiology center in Tabriz at 2010. The screening technique included physical examination of breasts by an experienced physician before taking mammograms and then mammography in two standard views.1000 women between ages 40-77 years old and without any clinical symptoms was evaluated. Malignant mass or nodule: 13 cases, Benign mass or nodule: 34 cases, Benign calcified nodule: 10 cases, Fatty breast: 6 cases and Ductal ectasia: 1 case. Association between malignancy signs in mammography and positive clinical findings doesn’t have statistical significance (P=0.405) and association between benign signs in mammography and clinical findings doesn’t also have statistical significance (P=0.692). varying in prevalence of breast cancer in di...
Emergency department is the first place that medical team gets contact with the patient. In order... more Emergency department is the first place that medical team gets contact with the patient. In order to have higher standards in traumatic patient care, continuous quality control is an essence and time is an important factor for this perspective in emergency department. Current study evaluates management of traumatic patients visiting emergency department (ED) in Imam Reza hospital by assessing length of stay and its effective factors such as Routine Trauma X-rays. Between April and December 2011, 300 traumatic patients visiting emergency department, Imam Reza hospital were randomly studied. Time needed to perform the routine trauma x-rays (lateral cervical vertebra, AP chest and AP pelvis radiographies), and the length of stay (LOS) in the ED were recorded. Mean physician and nurse first visit was 7.93±0.47 and 11.91±9.38 minutes, respectively. X-rays in was performed within 70.30±53.08 minutes. Mean surgery and neurosurgery visits were obtained within 37.40±3.16 minutes and 33.48±2....
Introduction: Workplace violence is a global problem the prevalence of which is increasing. All h... more Introduction: Workplace violence is a global problem the prevalence of which is increasing. All healthcare personnel are subject to violence, but considering the special conditions of pre-hospital emergency, its personnel are exposed to a higher rate of workplace violence compared to other healthcare workers. Methods: This was a cross-sectional study and the study population consisted of pre-hospital emergency personnel of East-Azerbaijan province, Iran. The sampling method was simple random sampling. Results: A total of 77 participants were included all of whom were male. The average age of the participants was 34.4 ± 7.5 years and their average work experience was 9.58 ± 5.7 years. More than half of the pre-hospital emergency personnel had faced violence by patients twice a week or more throughout the previous year. In 32.5% of the cases, pre-hospital emergency medical technicians had experienced violence by a patient’s friend or relative. Conclusion: The rate of violence against ...
A 68-year-old man presents to the emergency department with nausea, drolling, and swelling of his... more A 68-year-old man presents to the emergency department with nausea, drolling, and swelling of his tongue that began 3 hours earlier. The patient reports previous episodes of swelling of his lip and tongue about 4 years ago, that have been attributed possibly to drug reaction. There is no family history of similar episodes. Physical examination reveals a swollen tongue and hypertension, drooling, flushing, and no rash, bronchospasm, or urticaria.
Context: In some studies, Fresh Frozen Plasma (FFP) transfusion in severely ill patients was acco... more Context: In some studies, Fresh Frozen Plasma (FFP) transfusion in severely ill patients was accompanied with an increase in the risk of nosocomial infection. However, there are no comprehensive data in terms of FFP transfusion and its relationship with nosocomial infection in heart surgery. Hence, the present systematic review and meta-analysis aimed to investigate the relationship between FFP transfusion and nosocomial infection risk in the patients undergoing cardiac surgery. Evidence Acquisition: Study selection: The present study included all the studies, which probed into nosocomial infection after FFP transfusion in patients with cardiac surgery. Data sources: Medline, Web of Science, Embase, Central, and Scopus electronic databases were searched to the end of March 2019. Results: Finally, five articles and three abstracts that studied nosocomial infection were entered into the present systematic review. FFP increased the rate of nosocomial infection in cardiac surgery in one article, but this was not the case in the remaining four articles. The three abstracts also reported that FFP increased the rate of nosocomial infection in cardiac surgery. Conclusion: The studies indicated that the benefit of FFP administration outweighed the probable risk of infection. Indeed, none of the studies indicated a strong relationship between FFP transfusion and infection rate after cardiac surgery.
Patient satisfaction plays an important role in healthcare process and certainly reflects the qua... more Patient satisfaction plays an important role in healthcare process and certainly reflects the quality of care. Evaluation of patients’ satisfaction helps discover problems and perform necessary measures to improve this quality. The objective of this study was to determine the rate of satisfaction of the emergency patients in Imam Khomeini Hospital at Urmia. Material & Methods: This cross-sectional research was conducted on 500 patients admitted in the emergency ward of Imam Khomeini hospital of Urmia. The data were gathered by a questionnaire and were analyzed by SPSS-18 software. Results: The findings showed that the highest percentage of satisfaction was related to physician behaviors (81%), availability of medicines and medical equipment (78.6%) and attending physician’s availability and late arrival at the emergency ward (69.4%).The lowest satisfaction was related to the furniture in the waiting area of the emergency ward (50%), on-time presence of patient transporter (24.4%) an...
Introduction: There is still no consensus on the value of Manchester Acute Coronary Syndromes (MA... more Introduction: There is still no consensus on the value of Manchester Acute Coronary Syndromes (MACS) decision rule in detecting acute coronary syndrome (ACS). Therefore, the purpose of the present systematic review and meta-analyzes is to summarize the clinical evidence in the evaluation of the value of MACS in the diagnosis of ACS. Methods: A literature search was performed on the Medline, Embase, Scopus, and Web of Science databases. Outcomes included acute myocardial infarction (AMI) and major adverse cardiac event (MACE). Data were analyzed in the STATA 14.0 statistical program and the results were reported as summary receiver operating characteristics (SROC), sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio with 95% confidence interval (95% CI). Results: Finally, 8 articles included in the meta-analysis. The area under the SROC of MACS was excellent in rule out of AMI (AUC = 0.99, 95% CI: 0.97 to 0.99) and MACE (AUC = 0.97, 95% CI: 0.9...
The car accident is causes of 16000 deaths in a day. Central nerves system injury is one of the m... more The car accident is causes of 16000 deaths in a day. Central nerves system injury is one of the most important causes of morbidity and mortality. After head trauma neuron cell may be has dysfunction but the recovery is possible yet. This recovery needs to suit cares. This study attempts for confirmation of efficacy of Sulfate Magnesium in moderate and sever head trauma. This study is a pilot study and clinical trial in 201 until 2011. The patients divided to two groups. First; sever head trauma (GCS <=8), second; moderate head trauma (8<=GCS<=12). Intervention group in both of groups was injected 250 micromole/kg sulfate magnesium besides definitive cares and witnessed group only have taken definitive cares. The study suggested in moderate and severe head trauma neurologic and radiologic outcome more acceptable in intervention group after injection sulfate magnesium.
Objective: Emergency departments and hospital emergency departments are important due to their cr... more Objective: Emergency departments and hospital emergency departments are important due to their critical role in providing urgent medical care to patients in dire need of medical interventions. Checking bottlenecks in new conditions and planning to reduce bed occupancy and hospitalization is needed. The purpose of this study is to investigate the relationship between the patient’s chief complaint and their departure to the emergency room. Methods: From non-traumatic patients referred to the emergency department of Imam Reza Hospital during 2018, about 57000 patients were selected and enrolled in the study. Then, age, sex, initial diagnosis, time of the final decision, and time of departure from the emergency department as well as hospitalization ward were included in the checklist. Patients whose documentation was incomplete were excluded. Data were entered into SPSS software version 15.0 and descriptive statistics (normal distribution, average of time, minimum time and maximum time,...
Falling is reported to be the most common cause of mortality due to trauma in individuals over th... more Falling is reported to be the most common cause of mortality due to trauma in individuals over the age of 75 years. The present study is designed with the aim of determining the demographics of fall-related trauma among the elderly presenting to emergency department (ED). The present prospective cross-sectional study was carried out on all elderly patients ≥ 60 years old presenting to ED of a major referral trauma center in North West of Iran during 1 year. Demographic data, location and height of falling, duration of hospitalization, trauma severity and in-hospital outcome of the patients were gathered and reported via descriptive statistics. 228 patients with the mean age of 70.96 ± 5.2 years were studied (53.9% female). Most patients were in the 66-70 years age range (32.6%) and had a history of hypertension (22.3%), who had visited following a fall inside the house (69.3%), due to slipping (73.7%), and from a height equal to or less than 2m (71.9%). 6 (2.6%) patients died in the...
The main purpose of emergency department (ED) management for renal colic is prompt pain relief. T... more The main purpose of emergency department (ED) management for renal colic is prompt pain relief. The present study aimed to compare the analgesic effects of intravenus (IV) ketofol with morphine in management of ketorolac persistent renal colic. This study is a single blind randomized, clinical trial, on patients who were presented to ED with renal colic, whose pain was resistant to 30 mg IV ketorolac. The patients were randomly assigned to either IV morphine (0.1 mg/kg) or IV ketofol (0.75 mg/kg propofol and 0.75 mg/kg) and the measures of treatment efficacy were compared between the groups after 5 and 10 minutes. 90 patients with mean age of 38.01 ± 9.78 years were randomly divided into 2 groups of 45 (66.7% male). Treatment failure rate was significantly lower in ketofol group after 5 (20% vs 62.2%, p < 0.001) and 10 minutes (11.1% vs 44.4%, p < 0.001). ARR and NNT for ketofol after 5 miutes were 42.22% (95% CI: 23.86 - 60.59) and 3 (95% CI: 1.7 - 4.2), respectively. After 1...
Background: Metabolic acidosis is a fatal finding in trauma patients that complicates the process... more Background: Metabolic acidosis is a fatal finding in trauma patients that complicates the process of resuscitation. Case: The case was a 37-year-old man with open fracture in both legs and fracture in second lumbar vertebral (L2). The serial arterial blood gas (ABG) test results showed a pH value of 6.7 indicating a very severe and special case of metabolic acidosis. The rate of mortality for such a case was very high. The patient was treated with sodium bicarbonate and successfully revived after four hours post treatment and metabolic acidosis was resolved. Conclusion: This indicated that bicarbonate administration is useful for very severe cases. The good condition of the patient after survival from the severe academia allowed for extubation.
Ingestion and inhalation of phosphine are 2 forms of toxicity and their clinical manifestation is... more Ingestion and inhalation of phosphine are 2 forms of toxicity and their clinical manifestation is extremely wide. A 22-year-old girl was admitted with complaints of nausea, vomiting and epigastric pain after eating lunch. She had a history of celiac disease. On arrival, she was alert and hemodynamically stable. There was not any abdominal tenderness or guarding. Food poisoning treatment initiated but after 1 hour her condition deteriorated with hypotension, tachycardia, and epigastric pain. Venous blood gas (VBG) showed severe metabolic acidosis. She denied any drug ingestion again. New Electrocardiogram (ECG) showed extensive inferolateral ST elevation myocardial infarction (STEMI). Bicarbonate plus dopamine was initiated. After 8 hours of admission, rhythm became ventricular fibrillation (VF) and cardiopulmonary resuscitation (CPR) began. Peritoneal dialysis was performed. Next morning frequent VF occurred again but CPR was unsuccessful. Family found aluminum phosphide (AIP) tablets in her purse. Early diagnosis and supportive treatment may be effective but the most important factor is the dose of ingestion.
Introduction: Botulism is an acute form of poisoning resulted from ingestion of Clostridium botul... more Introduction: Botulism is an acute form of poisoning resulted from ingestion of Clostridium botulinum toxin. Case Presentation: Here we present five cases of food-borne botulism poisoning from home produced cheese. Five patients from one family referred to our emergency unit with complaints of weakness and two had severe symptoms. In spite of the laboratory negative results antitoxin was administered and their symptoms improved. Discussion: Botulism poisoning can develop with any home-canned food and people must avoid consumption of such products.
Head trauma is a frequent and important problem from the view of emergency physician. Estimates o... more Head trauma is a frequent and important problem from the view of emergency physician. Estimates of mortality following head injury vary from 10 to 36 per 100000 populations. Estimates of combine medical costs from trauma places of over 6 billion dollars. One of the diagnostic procedures in these cases is use of radiologic imaging. Nevertheless, visible fractures are found less than 5% in skull X-Ray films. Therefore, it is better to use this procedure when risk of detecting visible fracture is high. In a cross-sectional analytic study that performed in Emergency Medicine Department of Tabriz University of Medical Sciences from September 2010 to July 2013 on patients with head trauma, we evaluated fractures visible on plain radiographies and the clinical manifestations in patients with head traumas with GCS=15. This study besides determination of relative frequency of age, sex, etiology, visible fracture in skull X-ray and clinical manifestations in these cases tries to determine the...
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