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12 results on '"Aghili, Mehrad"'

8. Effectivness of Nebulized Budesonide for COPD Exacerbation Management in Emergency Department; a Randomized Clinical Trial

Author

Aghili, Mehrad, Vahidi, Elnaz, Mohammadrezaei, Narges, Mirrajei, Tina, and Abedini, Atefeh

Subjects
Emergency Service, Chronic Obstructive, Budesonide, Drug Administration Routes, Emergency Service, Hospital, Nebulizers and Vaporizers, Peak Expiratory Flow Rate, Prednisolone, Pulmonary Disease, Chronic Obstructive, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RC86-88.9, respiratory tract diseases, Pulmonary Disease, Hospital, Original Research
Abstract

Introduction: Nebulized budesonide has been long used in chronic obstructive pulmonary disease (COPD) exacerbation. This study aimed to compare the effectiveness of nebulized budesonide (NB) versus oral prednisolone (OP) in increasing peak expiratory flow rate (PEFR) of COPD patients in emergency department (ED). Methods: Patients with COPD exacerbation, referring to ED were enrolled in this randomized trial study. In the first group, NB 0.5 mg every 30 minutes till three doses, placebo tablet, and standard treatment was administered. In the second group, nebulized normal saline, OP tablet 50 mg, and standard treatment were administered. Patients’ demographic data, vital signs, PEFR, venous blood gas (VBG) analysis, disposition, and patient and physician satisfaction were all collected and compared between the two groups. Results: 43 patients in the NB group and 41 patients in the OP group were evaluated. The two groups had similar age (p=0.544) and gender (p=0.984) distribution, duration of illness (p=0.458), and baseline PEFR (p=0.400). 12 and 24 hours after treatment, significant increase in PEFR in the NB and OP groups were observed (p=0.032 and 0.008; respectively). The upward trend of PEFR in NB group was significantly better than that of OP group during 24 hours of treatment (p=0.005). Vital signs and VBG results showed no significant differences between the two groups during the studied time interval. Conclusion: NB, compared to OP, could more effectively increase PEFR and ameliorate disease severity of patients with COPD exacerbation at 12 and 24 hours after treatment in ED.

Published
2020

12. Can emergency medicine residents diagnose neurogenic stunned myocardium in the emergency department by Focused Assessment Diagnostic Echocardiography?

Author

Karimialavijeh, Ehsan, Zarrabi, Aaliyeh, Akbari, Hamideh, Aghili, Mehrad, Vahidi, Elnaz, and Rasooli, Fatemeh

Subjects
MYOCARDIAL infarction diagnosis, HEART ventricle diseases, CARDIOLOGISTS, CEREBROVASCULAR disease, CONFIDENCE intervals, ELECTROCARDIOGRAPHY, EMERGENCY medicine, LEFT heart ventricle, HOSPITAL emergency services, HOSPITAL medical staff, LONGITUDINAL method, STROKE, INTER-observer reliability, NATIONAL competency-based educational tests, CROSS-sectional method, ACUTE diseases, TROPONIN, DESCRIPTIVE statistics, DISEASE complications
Abstract

Purpose: To assess the ability of trained emergency medicine (EM) residents to diagnose neurogenic stunned myocardium (NSM) in patients with acute intracranial events in the emergency department (ED) using the Focused Assessment diagnostic Echocardiography (FADE). Methods: This prospective cross-sectional study was conducted between February 2018 and January 2019. First, four postgraduate year-3 (PGY-3) EM residents were trained through participation in 10 hours of theoretical FADE education and 20 hands-on FADE on ED patients. Then, adult patients (aged over 18 years old) with acute cerebrovascular accidents (CVAs) were enrolled in the study. Patients with a history of prior cardiac disease, concurrent CVA and ST-elevation myocardial infarction (STEMI), and cardiopulmonary arrest in the ED were excluded. The results of echocardiography by the cardiologists were considered as the gold standard. Results: Eighty-five cases were enrolled in the final analysis. The mean age of participants was 62.7 years, and 47 (55.3%) were male. There was a good agreement between the EM residents and cardiologists in diagnosing left ventricular (LV) dysfunction (Cohen's Kappa=0.7, 95%CI=0.65-0.8). Troponin I was positive in 3 (3.5%) patients. Based on the diagnosis of cardiologists, all three patients had heart failure and received a definitive diagnosis of NSM. Whereas, according to the FADE exam by EM residents, 2 out of 3 cases with positive enzyme had heart failure (interrater agreement= 66.6%). Conclusion: Our study showed that trained EM residents could use the FADE exam to diagnose the NSM in CVA patients in the ED. [ABSTRACT FROM AUTHOR]

Published
2020

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