Search

【Abstract】Objective: An accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagno- sis of IAI after blunt trauma. Methods: This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chisquare test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β) was given based on the contribution of each of them. Scoring system was developed based on the obtained total βof each factor. Results: Altogether 261 patients (80.1% male) were enrolled (48 cases of IAI). A 24-point blunt abdominal trauma scoring system (BATSS) was developed. Patients were divided into three groups including low (score

Introduction: Induction of anesthesia for emergency procedures, without prior gastric preparation and incomplete fasting, is associated with the risk of reflux of stomach contents and aspiration. This study aimed to evaluate the effect of intravenous (IV) metoclopramide administration on gastric emptying in opium users, candidate for procedural sedation and analgesia (PSA). Methods: In the present case-control study, opium-dependent (case) and non-dependent (control) patients in need of PSA were administered with 10 mg IV metoclopramide after undergoing gastric ultrasonography for determination of its area and contents. Then, 30 minutes after the administration of metoclopramide, the area and contents of the stomach were measured again and compared with the measures obtained before the intervention. Results: 135 patients were evaluated in three groups of 45, including the case, control, and placebo groups. The three groups were similar regarding mean age (p = 0.068), sex (p = 0.067), weight (p = 0.596), height (p = 0.671), body mass index (BMI) (p = 0.877), duration of fasting (p = 0.596), and type of gastric contents (p = 0.124). Mean antral cross-sectional area (CSA) of the study participants in the case, control, and placebo groups before the administration of the drug was 8.49 ± 1.40, 8.31 ± 2.56, and 6.56 ± 1.72 cm2, respectively. Mean gastric area in the case (p < 0.001) and control (p < 0.001) groups had significantly decreased after the intervention. Mean antral gastric grade of gastric contents in the case (p < 0.001) and control (p < 0.001) groups had significantly decreased after the intervention. Conclusion: It seems that metoclopramide administration in opium users in need of PSA leads to a significant decrease in mean gastric area and increases gastric emptying.

مقدمه: سونوگرافی عصب بینایی ممکن است به شناسایی فشار داخل مغزی بیماران کمک نماید. باتوجه به اهمیت تشخیص زودتر بیماران جهت انجام اقدامات درمانی اخیراً استفاده از روش های غیرتهاجمی بیشتر مورد توجه پژوهشگران قرار گرفته است. این مطالعه با هدف بررسی صحت تشخیص CVA ایسکمیک از هموراژیک با استفاده از سونوگرافی عصب اپتیک در بیماران CVA انجام شده است. روش کار: این مطالعه به صورت توصیفی تحلیلی انجام گرفت. با استفاده از روش نمونه گیری در دسترس 212 نفر از بیماران مراجعه کننده به بیمارستان های امام حسین، لقمان و شهدای تجریش در سال 1397 انتخاب شدند. ابزار جمع‌آوری اطلاعات چک‌لیست محقق ساخته که شامل ویژگی‌های دموگرافیک، ویژگی‌های بالینی بیماران و اطلاعات مربوط به قطر عصب بینایی با استفاده از پرونده بیماران و نتایج حاصل سونوگرافی جمع آوری شد. نتایج حاصل از تخمین میانگین قطر غلاف عصب چشم با یافته‌های حاصل از گزارش سی‌تی اسکن مغزی به عنوان استاندارد طلایی مورد تجزیه و تحلیل آماری قرار گرفت. در نهایت با استفاده از آزمون‌های آماری شاخص‌های مربوط به حساسیت، ویژگی، ارزش اخباری مثبت و منفی و همچنین دقت سونوگرافی در تشخیص سکته ایسکمیک و هموراژیک محاسبه شد. نتایج: نتایج مطالعه نشان داد که از بین افراد شرکت کننده در مطالعه 163 نفر سکته ایسکمیک و 56 نفر سکته هموراژیک داشتند. میانگین قطر عصب اپتیک در افراد شرکت کننده در مطالعه در گروه با سکته ایسکمیک 35/0±26/5 و در گروه هموراژیک 51/0±80/5 بدست آمد (001/0 = p). میزان حساسیت و ویژگی به ترتیب (34/91-28/80) 50/86 و (19/78-19/52) 07/66 درصد بدست آمد. نتیجه‌گیری: نتایج مطالعه حاضر نشان داد که نقطه برش 5/5 میلی متر برای قطر سونوگرافیک عصب اپتیک حساسیت و ویژگی 50/86 و 07/66 درصد و صحت 81 درصد (متوسط) در تشخیص سکته ایسکمیک و هموراژیک دارد. بنابراین استفاده از این روش می تواند به عنوان یک روش غیرتهاجمی در تشخیص سکته ایسکمیک و هموراژیک مورد استفاده قرار گیرد.

Introduction: Predicting the outcomes of COVID-19 cases using different clinical, laboratory, and imaging parameters is one of the most interesting fields of research in this regard. This study aimed to evaluate the correlation between chest computed tomography (CT) scan findings and outcomes of COVID-19 cases. Methods: This cross sectional study was carried out on confirmed COVID-19 cases with clinical manifestations and chest CT scan findings based on Iran's National Guidelines for defining COVID-19. Baseline and chest CT scan characteristics of patients were investigated and their correlation with mortality was analyzed and reported using SPSS 21.0. Results: 380 patients with the mean age of 53.62 ± 16.66 years were evaluated (66.1% male). The most frequent chest CT scan abnormalities were in peripheral (86.6%) and peribronchovascular interstitium (34.6%), with ground glass pattern (54.1%), and round (53.6%) or linear (46.7%) shape. There was a significant correlation between shape of abnormalities (p = 0.003), CT scan Severity Score (CTSS) (p

Introduction: The duration and severity of neutropenia directly correlate with the incidence of life-threatening infections. This study aimed to evaluate the clinical characteristics and associated factors of mortality in febrile neutropenia patients. Method: This retrospective cross sectional study was conducted on all febrile neutropenia patients who were admitted to oncology department of two educational hospitals, Tehran, Iran, from 2011 to 2016. Available patients’ data regarding baseline characteristics, treatment, and outcome were collected and analyzed using SPSS 21. Results: 357 patients with the mean age of 50.9±17.7 years were studied (59.7% female). Mean white blood cell count of the studied patients was 715.1 ± 270.4 (100 – 1400) cells/mm3. The absolute neutrophil count (ANC) of all patients was 500 cells/mm3 was 2.45 ± 2.1 (1 – 16) days. 186 (52.1%) subjects reached ANC>500 cells/ mm3 after 2-5 days of hospitalization. The rate of hospital mortality was 5.3% (338 (94.7%) survived). The correlation between gender (p = 0.11), temperature (p = 0.123), number of ED visits (p = 0.765), presenting clinical manifestation (p = 0.201), source of malignancy (p= 0.328), presence of metastasis (p = 0.69), positive urine culture (p = 0.45), positive blood culture (p = 0.62), time from last chemotherapy (p = 0.677), and time to reach ANC>500 cells/mm3 (p = 0.739) with mortality was not significant. Conclusion: Based on the findings of the present study, the rate of hospital mortality in patients with febrile neutropenia was 5.3%. Older age and lower white blood cell count were among the significant associated factors of mortality in this series.

Introduction: Strife is one of the most important health threatening happenings that leads to more than 0.5 million deaths each year, and is among the most important causes of mortality in youth. Studying it can increase knowledge on its resulting traumas and be a base for supervising these crimes. Therefore, the present study aimed to evaluate the epidemiology of strife cases presenting to emergency department (ED). Methods: The present study is a retrospective cross-sectional one that evaluates the epidemiology of strife and violence in those presenting to the ED of Imam Hossein Hospital, Tehran, Iran, during April 2014 to January 2016. The studied variables included age, sex, time of visit, social history of the patient, trauma mechanism, anatomical site of trauma, measures taken, and final outcome. Results: 499 patients with the mean age of 26.4 ± 8.7 were studied. 442 (88.6%) were male and 443 (88.9%) were of Iranian nationality. Based on the obtained results, 321 (64.4%) were single and 335 (67.1%) were in the 20-29 years age group. 317 (87.3%) cases had negative social habits (smoking, drinking,…) and cigarette was the most commonly used substance in cases with positive social habits. The highest frequency of ED visits happened between 4PM and 12AM (49.7%), on weekdays (73.1%), and in spring (41.9%). 283 (56.7%) of the studied cases had visited ED following penetrating trauma and 240 (48.1%) needed some kind of surgical intervention. Finally, 398 (79.8%) cases were discharged with full recovery, 81 (16.2%) were discharged against medical advice, and 4 (0.8%) died. Conclusion: Based on the findings of the present study, prevalence of trauma due to strife was 16 in each 1000 visits to the trauma unit of the studied center. Most cases of strife happened in men, singles, those aged 21-30 years, in spring, on weekdays, in the evening and with penetrating trauma and about 80% were discharged from ED with full recovery.

Introduction: Distal radius fractures are a common traumatic injury, particularly in the elderly population. In the present study we examined the effectiveness of ultrasound guidance in the reduction of distal radius fractures in adult patients presenting to emergency department (ED). Methods: In this prospective case control study, eligible patients were adults older than 18 years who presented to the ED with distal radius fractures. 130 consecutive patient consisted of two group of Sixty-Five patients were prospectively enrolled for around 1 years. The first group underwent ultrasound-guided reduction and the second (control group) underwent blind reduction. All procedures were performed by two trained emergency residents under supervision of senior emergency physicians. Results: Baseline characteristics between two groups were similar. The rate of repeat reduction was reduced in the ultrasound group (9.2% vs 24.6%; P = .019). The post reduction radiographic indices were similar between the two groups, although the ultrasound group had improved volar tilt (mean, 7.6° vs 3.7°; P = .000). The operative rate was reduced in the ultrasound groups (10.8% vs 27.7%; P = .014). Conclusion: Ultrasound guidance is effective and recommended for routine use in the reduction of distal radius fractures.

Introduction: Although vertigo is a common complaint in patients presenting to the emergency department (ED), its ideal treatment is still under debate. This study was conducted to compare oral betahistine and oral piracetam in management of outpatients with peripheral vertigo. Methods: This was a randomized clinical trial performed on patients who were presented to the EDs of 4 teaching hospitals, with complaint of true vertigo. Patients were randomly allocated to either betahistine or piracetam group and their 7-day outcomes were compared. Results: 100 cases with the mean age of 54.72 ± 14.09 years were randomly allocated to either group (62.0% female). The two groups were similar regarding age, sex, and intensity of symptom at the time of presenting to the ED. Twelve (24%) patients in piracetam group and 6 (12%) patients in betahistine group experienced adverse events (odds ratio: 2.32, CI 95%: 0.79-6.76; p = 0.125). There were 3 (6%) patients in each group that experienced a recurrence of their symptoms and 2 (4%) patients in each group saw another physician for vertigo. Conclusion: Oral piracetam is a potentially proper treatment for management of peripheral vertigo and there are few adverse effects associated with it.

Introduction: Vertigo prevalence is estimated to be 1.8% among young adults and more than 30% in the elderly. 13-38% of the referrals of patients over 65 years old in America are due to vertigo. Vertigo does not increase the risk of mortality but it can affect the patient’s quality of life. Therefore, this study was designed to evaluate the epidemiologic characteristics of vertigo patients referred to the emergency department (ED). Methods: In this 6-month retrospective cross-sectional study, the profiles of all vertigo patients referred to the ED of Imam Hossein Hospital, Tehran, Iran, from October 2013 to March 2014 were evaluated. Demographic data and baseline characteristics of the patients were recorded and then patients were divided into central and peripheral vertigo. The correlation of history and clinical examination with vertigo type was evaluated and screening performance characteristics of history and clinical examination in differentiating central and peripheral vertigo were determined. Results: 379 patients with the mean age of 50.69 ± 11.94 years (minimum 18 and maximum 86) were enrolled (58.13% female). There was no sex difference in vertigo incidence (p = 0.756). A significant correlation existed between older age and increase in frequency of central cases (p < 0.001). No significant difference was detected between the treatment protocols regarding ED length of stay (p = 0.72). There was a significant overlap between the initial diagnosis and the final decision based on imaging and neurologist’s final opinion (p < 0.001). In the end, 361 (95.3%) patients were discharged from ED, while 18 were disposed to the neurology ward. No case of mortality was reported. Conclusion: Sensitivity and specificity of history and clinical examination in differentiating central and peripheral vertigo were 99 (95% CI: 57-99) and 99 (95% CI: 97-99), respectively.

Introduction: Ankle fracture is one of the most common joint fractures. X-ray and physical examination are its main methods of diagnosis. Recently, ultrasonography (US) is considered as a simple and non-invasive method of fracture diagnosis. This study evaluated the diagnostic accuracy of US in detection of ankle fracture in comparison to plain radiography. Methods: In this diagnostic accuracy study, which was done in emergency departments of Imam Hossein and Shohadaye Tajrish hospitals, Tehran, Iran, during 2014, 141 patients with suspected diagnosis of distal leg or ankle fracture were examined by US and radiography (gold standard), independently. Screening performance characteristics of US in detection of distal leg fractures were calculated using SPSS version 21. Results: 141 patients with the mean age of 34§11.52 years (range: 15–50) were evaluated (75.9% male). Radiography confirmed ankle fracture in 102 (72.3%) patients. There was a significant correlation between the results of US and radiography [Agreement: 95%; kappa: 0.88 (95% CI: 0.80–0.97); P Ç 0.001]. The screening performance characteristics of US in detection ankle fracture were as follows: sensitivity 98.9% (95% CI: 93.5% - 99.9%), specificity 86.4% (95% CI: 71.9%–94.3%), PPV 94.1% (95% CI: 87.1%–97.6%), NPV 97.4% (95% CI: 84.9%– 99.8%), PLR 16 (95% CI: 7.3–34.8), and NLR 0.02 (95% CI: 0.003 – 0.182). The area under the ROC curve of US in this regard was 95.8 (95% CI: 91.9§99.7). Conclusion: According to the results of this study, we can use US as an accurate and non-invasive method with high sensitivity and specificity in diagnosis ofmalleolus fractures. However, the inherent limitations of US such as operator dependency should be considered in this regard.

Introduction: Pro-brain natriuretic peptide (Pro-BNP) can act as an independent predictor of mortality in septic patients. This study aimed to compare the diagnostic accuracy of pro-BNP and Mortality in Emergency Department Sepsis (MEDS) score in this regard. Method: This cross-sectional study was conducted on > 14 years old sepsis patients of an emergency department (ED), during 2 years. The level of Pro-BNP and MEDS score were measured for all eligible patients and considering one-month mortality as reference, screening performance characteristics of the two tests were compared using SPSS 21 and STATS 11. Results: 121 patients with the mean age of 75.87±11.82 years were studied (55.4% male). 85 (70.25%) patients had moderate to high probability of mortality according to MEDS score. The mean Pro-BNP levels of survivor and non-survivor patients were 489.69 ± 327.47 and 3954.98 ± 2717.85 pg/ml, respectively (p < 0.0001). Sensitivity and specificity of Pro-BNP (in 1000 pg/ml cut off) and MEDS score (in level 3) in prediction of 1-month mortality were 93.6 (83.7-97.9), 94.8 (84.7-98.6), 65.0 (51.9-76.3), and 98.2 (89.5-99.9), respectively. Area under the ROC curve of the two tests were 97.36 (95% CI: 92.92-94.48) and 92.31 (95% CI: 86.35-96.53), respectively (p = 0.0543). Conclusion: Pro-BNP and MEDS score both have excellent diagnostic accuracy in predicting 1-month mortality of sepsis patients. However, considering the higher sensitivity as well as availability and ease of calculation, it seems that Pro-BNP can be considered an appropriate tool for screening patients with high risk of mortality following sepsis in ED. Â

Introduction: Currently, using various combinations of narcotic and analgesic drugs has received attention for induction of sedation and analgesia due to their synergy in controlling pain and anxiety. The present study was designed with the aim of comparing dexmedetomidine-fentanyl combination with midazolam-fentanyl in this regard. Methods: In this randomized clinical trial, patients diagnosed with distal radius fracture who had visited the emergency department (ED) were allocated to either the group receiving the combination of fentanyl-midazolam or the one receiving dexmedetomidine-fentanyl for procedural sedation and analgesia (PSA) and were compared regarding analgesic characteristics, time to recovery and side effects. Results: 80 patients with the mean age of 42.08 ± 12.17 (18 - 60) years were randomly allocated to 2 groups of 40 (83.80% male). The 2 groups did not have a significant difference regarding baseline characteristics as well as pain severity.  Mean pain score at the time of procedure was 3.47 ± 1.37 in dexmedetomidine and 2.85 ± 1.05 in midazolam group (p = 0.025). In addition, time to recovery in dexmedetomidine and midazolam groups was 6.60 ± 1.86 minutes and 12.70 ± 1.70 minutes, respectively (p < 0.001). Out of the 9 patients who experienced treatment failure, 8 (88.90%) patients were in dexmedetomidine group and 1 (11.10%) was in midazolam group (p = 0.029). Absolute risk increase rate of treatment failure in case of using dexmedetomidine instead of midazolam was 17.50% (95%CI: 4.19 – 30.81) and number needed to harm was 6.00 (95% CI: 3.20 – 23.80). Conclusion: Although the combination of dexmedetomidine-fentanyl had a shorter time to recovery compared to midazolam-fentanyl for induction of sedation and analgesia, the treatment failure rate in case of using dexmedetomidine with 1 µg/kg increased 17.5% and about 1 out of each 6 patients needed a rescue dose.

Introduction: Timely diagnosis and treatment of post-traumatic elevated intracranial pressure (EICP) could be reduced morbidity and mortality, and improved patients’ outcome. This study is trying to evaluate the diagnostic accuracy of sonographic optic nerve sheath diameter (ONSD) in detection of EICP. Methods: Sonographic ONSD of patients with head trauma or cerebrovascular accident suspicious for EICP were evaluated by a trained chief resident of emergency medicine, who was blind to the clinical and brain computed tomography scan (BCT) findings of patients. Immediately after ultrasonography, BCT was performed and reported by an expert radiologist without awareness from other results of the patients. Finally, ultrasonographic and BCT findings regarding EICP were compared. To evaluate the ability of sonographic ONSD in predicting the BCT findings and obtain best cut-off level, receiver operating characteristic (ROC) curve were used. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of sonographic ONSD in determining of EICP was calculated. P < 0.05 was considered as statistically significant. Results: There were 222 patients (65.3% male), with mean age of 42.2±19.5 years (range: 16-90 years). BCT showed signs of EICP, in 28 cases (12.6%). The means of the ONSD in the patients with EICP and normal ICP were 5.5 ± 0.56 and 3.93 ± 0.53 mm, respectively (P

Introduction: Finding a fast-acting compound with minimal side-effects to induce a safe and efficient analgesia with short or medium duration of action is of great interest in the emergency department. The present study has been designed with the aim of comparing the effect of midazolam + fentanyl + lidocaine combination with midazolam + fentanyl + placebo in pain management of anterior shoulder dislocation reduction. Methods: The present two-arm parallel double-blind randomized controlled trial was performed on patients who presented to emergency department with anterior shoulder dislocation. Patients were randomly allocated to the 2 treatment groups of midazolam + fentanyl + placebo (double-drug group) and midazolam + fentanyl + intravenous (IV) lidocaine (triple-drug group). Then outcomes such as treatment success rate and side-effects following prescription of drugs were compared between the 2 groups. Results: 100 patients were included in the present study (50 patients in each group; mean age of the studied patients 27.3±8.9 years; 93.0% male). Using the double-drug regimen led to 35 (70%) cases of complete analgesia, while this rate in the triple-drug group was 41 (82%) cases (p=0.16). The calculated number needed to treat was 9 cases. This means that about one in every 9 patients in treatment arm will benefit from the treatment. The most important side-effects observed included dysrhythmia (1 patient in double drug and 1 patient in triple-drug group), apnea (2 patients in each group) and SPO2

Introduction: Considering its high prevalence and cost as well as frequent complications, trauma is one of the major health problems in Iran. Knowing the epidemiologic characteristics of these patients could be helpful in arrangement for decreasing the burden of disease. This study was aimed to evaluate the epidemiology of upper extremity trauma among patients visiting trauma unit of emergency department (ED). Methods: The present cross-sectional study was done using census method on all patients with upper extremity trauma visiting the ED of Imam Hossein Hospital, Tehran, Iran in 2012. Required data were gathered using a checklist consisting of questions regarding demographic data (age, sex), trauma mechanism, time of trauma, type of trauma, and therapeutic measures taken. Gathered data were statistically analyzed via SPSS version 19.0. Results: 751 patients with the mean age of 27 ± 7.6 years were evaluated. 616 (82%) patients were male and the highest frequency belonged to the age range of 20 – 30 years with 248 (33%) cases. 339 (45.1%) accidents had occurred between 8 AM and 4 PM. Injury caused by motorcycle accidents was the most common mechanism of trauma among those evaluated with 185 (24.6%) cases. 575 (76.6%) cases had an isolated extremity trauma and 176 (23.4%) had multiple trauma that included extremity trauma. The most prevalent injuries that needed surgical intervention were distal radius fracture with 143 (34%) cases, soft tissue injury with 75 (17.8%) cases, and isolated ulna fracture with 46 (10.9%) cases. Conclusion: Based on the results of this study, the most common cases of upper extremity trauma occurred in men, age range of 20 – 30 years, spring, and between 8 AM and 4 PM. The most common trauma mechanism was motorcycle accident and distal radius fracture was the most prevalent injury that needed surgical intervention.

Introduction: Vertigo prevalence is estimated to be 1.8% among young adults and more than 30% in the elderly. 13-38% of the referrals of patients over 65 years old in America are due to vertigo. Vertigo does not increase the risk of mortality but it can affect the patient’s quality of life. Therefore, this study was designed to evaluate the epidemiologic characteristics of vertigo patients referred to the emergency department (ED). Methods: In this 6-month retrospective cross-sectional study, the profiles of all vertigo patients referred to the ED of Imam Hossein Hospital, Tehran, Iran, from October 2013 to March 2014 were evaluated. Demographic data and baseline characteristics of the patients were recorded and then patients were divided into central and peripheral vertigo. The correlation of history and clinical examination with vertigo type was evaluated and screening performance characteristics of history and clinical examination in differentiating central and peripheral vertigo were determined. Results: 379 patients with the mean age of 50.69 ± 11.94 years (minimum 18 and maximum 86) were enrolled (58.13% female). There was no sex difference in vertigo incidence (p = 0.756). A significant correlation existed between older age and increase in frequency of central cases (p < 0.001). No significant difference was detected between the treatment protocols regarding ED length of stay (p = 0.72). There was a significant overlap between the initial diagnosis and the final decision based on imaging and neurologist’s final opinion (p < 0.001). In the end, 361 (95.3%) patients were discharged from ED, while 18 were disposed to the neurology ward. No case of mortality was reported. Conclusion: Sensitivity and specificity of history and clinical examination in differentiating central and peripheral vertigo were 99 (95% CI: 57-99) and 99 (95% CI: 97-99), respectively.

مقدمه: ارزیابی حجم داخل عروقی موضوعی مهم اما پیچیده در مدیریت بیماران بدحال به ویژه در کودکان می باشد. تکنیک های تهاجمی هرچند قادرند تخمین بسیار دقیقی از حجم داخل عروقی ارائه نمایند اما عوارض ناشی از آن بسیار خطرناک می باشد. لذا مطالعه حاضر با هدف مقایسه دقت تشخیصی قطر سونوگرافیک ورید اجوف تحتانی، شریان آئورت، قطر ورید ژوگولار داخلی و نسبت قطر ورید اجوف به شریان آئورت در تعیین وضعیت دهیدراتاسیون کودکان مراجعه کننده به بخش اورژانس طراحی شده است. روش کار: مطالعه مقطعی حاضر با هدف تعیین ارزش تشخیصی قطر سونوگرافیک وریدهای اجوف تحتانی و ژوگولار و شریان آئورت در تخمین میزان دهیدراتاسیون بر روی کودکان مراجعه کننده به بخش اورژانس مبتلا به دهیدراتاسیون خفیف و متوسط انجام شد. از محاسبه شاخص های غربالگری شامل سطح زیر منحنی، حساسیت و ویژگی برای نیل به هدف مذکور بهره گرفته شد. داده ها توسط نرم افزار آماری STATA 11.0 تجزیه تحلیل گردید و سطح معنی داری معادل 05/0 در نظر گرفته شد. يافته ها: در نهایت 54 بیمار وارد مطالعه شدند (4/57 درصد پسر، میانگین سنی برابر 7/2±9/4 سال). سطح زیر منحنی قطر ورید اجوف تحتانی در تشخیص دهیدارتاسیون متوسط در نمای ساژیتال و عرضی به ترتیب برابر 775/0 (91/0-65/0:CI 95%) و 8086/0 (93/0-69/0:CI 95%) بود. همچنین قطر شریان آئورت نیز در تشخیص دهیدراتاسیون متوسط در نمای ساژیتال و عرضی دارای سطح زیر منحنی برابر 658/0 (81/0-51/0: CI 95%) و 7126/0 (86/0-57/0:CI 95%) بود. قطر ورید ژوگولار نیز دارای سطح زیر منحنی برابر 7332/0 (88/0-59/0: CI 95%) بود. مقایسه سطح زیر منحنی پارامترهای مورد مطالعه نشان داد قطر ورید اجوف تحتانی در نمای ساژیتال (004/0=p) و عرضی (001/0>p) شاخص بهتری برای تشخیص دهیدراتاسیون متوسط می باشد. نتيجه گيری: بر اساس یافته های پژوهش حاضر به نظر می رسد که قطر ورید ژوگلار، ورید اجوف تحتانی و شریان آئورت معیار چندان دقیقی برای غربالگری وضعیت دهیدراتاسیون کودکان نباشد چرا که حتی در مورد قطر سونوگرافیک ورید اجوف تحتانی که نسبت به سایر پارامترها به طور معنی داری دقت بیشتری داشت حساسیت 48/81 درصدی و ویژگی 15/48 در تمایز دهیدراتاسیون متوسط از خفیف بدست آمد.

مقدمه: درد از شکایتهای رایج بیماران مراجعه کننده به بخش اورژانس می باشد که کنترل آن از وظایف مهم پزشکان می باشد. مطالعه حاضر با هدف ارزیابی کارایی سوفنتانیل اینترانازال با مورفین سولفات وریدی در کنترل درد بیماران با ترومای اندام در بخش اورژانس طراحی شده است. روش کار: در کارآزمایی بالینی حاضر موارد ترومای اندام مراجعه کننده به بخش اورژانس بیمارستان امام حسین، تهران، ایران، در بازه زمانی مهر 1393 تا فروردین 1394 به طور تصادفی به دو گروه تحت درمان با سوفنتانیل اینترانازال (0/3 میکروگرم بر کیلوگرم) و مورفین سولفات (0/1 میلی گرم بر کیلوگرم) به صورت تک دوز قرار گرفتند. داده های دموگرافیک و اطلاعات مربوط به کیفیت کنترل درد، شدت درد قبل از مداخله و دقایق 15، 30 و 60 بعد از دریافت دارو و عوارض احتمالی از طریق چک لیستی جمع آوری و بین دو گروه مقایسه گردید. يافته‌ها: 88 بیمار با میانگین سنی 14/8±35/5سال وارد مطالعه شدند (81/8 درصد مرد). 44 بیمار مورفین سولفات وریدی و 44 بیمار سوفنتانیل اینترانازال دریافت کردند. از نظر اطلاعات زمینه ای تفاوت معناداری بین دو گروه مورد بررسی مشاهده نشد. اختلاف معنی داری در میزان کاهش شدت درد در زمان های مورد مطالعه بین دو دارو مشاهده نگردید (0/12 = p؛ 2/46 = F؛ 86، 1:df). میزان موفقیت درمانی دو دارو نیز در زمان های مورد مطالعه اختلافی معنی داری نداشت (0/52 = p). اختلاف معنی داری بین دو گروه از جهت عوارض دارویی مشاهده نشد (0/24 = p). نتیجه‌گیری: براساس یافته های بدست آمده بنظر می رسد سوفنتانیل اینترانازال در کنترل سریع، مناسب و غیرتهاجمی درد بیماران با آسیب های تروماتیک اثری مشابه مورفین سولفات داخل وریدی دارد و لذا شاید بتواند به عنوان جایگزینی مناسب برای کنترل درد بیماران ترومایی مد نظر قرار گیرد.

Introduction: Pain is one of the most common complaints of patients referred to emergency department (ED) and its control is one of the most important responsibilities of the physicians. The present study was designed, aiming to compare the efficiency of intranasal sufentanil and intravenous (IV) morphine sulfate in controlling extremity trauma patients' pain in ED. Methods: In the present clinical trial, extremity trauma cases referred to the ED of Imam Hossein Hospital, Tehran, Iran, from October 2014 to March 2015 were randomly divided into 2 groups treated with intranasal sufentanil (0.3 µg/kg) and IV morphine sulfate (0.1 mg/kg) single-doses. Demographic data and information regarding the quality of pain control such as pain severity before intervention and 15, 30, and 60 minutes after intervention, and probable side effects were gathered using a checklist and compared between the 2 groups. Results: 88 patients with the mean age of 35.5 ± 14.8 years were included in the study (81.8% male). 44 patients received IV morphine sulfate and 44 got intranasal sufentanil. No significant difference was detected between the 2 groups regarding baseline characteristics. In addition, there was no significant difference in the groups regarding pain relief at different studied times (p = 0.12; F = 2.46; df: 1, 86). Success rate of the drugs also did not differ significantly at different studied times (p = 0.52). No significant difference was seen between the groups regarding side effects (p = 0.24). Conclusion: Based on the results of this study, it seems that intranasal sufentanil has a similar effect to IV morphine sulfate in rapid, efficient, and non-invasive pain control in patients with traumatic extremity injuries.

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.

Introduction: Each year a large number of patients present to emergency departments (EDs) following accidental or intentional poisoning with methadone. This study was designed with the aim of demographic evaluation of methadone poisoning in children presenting to ED and proposing preventive measures to parents and the healthcare system. Methods: This cross sectional study was carried out on children under the age of 12 years presenting to ED of a poisoning referral center. Demographic characteristics of the child and parents, cause of poisoning, form of drug consumed, dose consumed, the symptoms of the child on admission, clinical examination, laboratory findings, and final outcome were recorded and reported using descriptive statistics. Results: 179 cases were studied (59.2% boys). Cause of consumption was accidental in 175 (97.8%) cases and consumed drug dose was unknown in 53 (53.6%) cases. On admission 6 cases were in deep coma, 133 (74.3%) had miotic pupils, and 52 (29.1%) were affected with respiratory apnea and cyanosis. In 132 (73.8%) cases drugs were obtained from unapproved stores and form of drug consumed was syrup in 146 (81.6%) cases. 177 (98.9%) cases were discharged after 2 or3 days and 2 (1.1%) cases died. Conclusion: Based on the results of the present study, most cases of methadone poisoning were accidental, in children residing in poor and middle-class areas, with parents who had a low level of education and had obtained the drug from unapproved stores and stored it in improper containers or at improper places. Only 64.8% of the parents were educated regarding drug storage.

Introduction: Timely diagnosis and treatment of post traumatic, elevated intracranial pressure (EICP), could reduce morbidity and mortality, as well as improve patients’ outcome. This study is trying to evaluate the diagnostic accuracy of sonographic optic nerve sheath diameter (ONSD) in detection of EICP. Methods: Sonographic ONSD of patients with head trauma or cerebrovascular accident suspicious for EICP were evaluated by a trained chief resident of emergency medicine, who was blind to the clinical and brain computed tomography scan (BCT) findings of patients. Immediately after ultrasonography, BCT was performed and reported by an expert radiologist without awareness from other results of the patients. Finally, ultrasonographic and BCT findings regarding EICP were compared. To evaluate the ability of sonographic ONSD in predicting the BCT findings and obtain best cut-off level, receiver operating characteristic (ROC) curve were used. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of sonographic ONSD in determining of EICP was calculated. P < 0.05 was considered to be statistically significant. Results: There were 222 patients (65.3% male), with mean age of 42.2±19.5 years (range: 16-90 years). BCT showed signs of EICP, in 28 cases (12.6%). The means of the ONSD in the patients with EICP and normal ICP were 5.5 ± 0.56 and 3.93 ± 0.53 mm, respectively (PConclusion: Sonographic diameter of optic nerve sheath could be considered as an available, accurate, and noninvasive screening tool in determining the elevated intracranial pressure in cases with head trauma or cerebrovascular accident.

Introduction: Trauma due to accidents or fall from height is a major cause of disability and mortality. The present study was designed aiming to evaluate the baseline characteristics of fall from height victims presenting to emergency department (ED). Methods: This prospective cross-sectional study evaluates the baseline characteristics of fall from height cases presenting to EDs of three educational Hospitals, Tehran, Iran, during one year. Data were analyzed using SPSS 21 and presented using descriptive statistics. Results: 460 patients with the mean age of 27.89 ± 20.95 years were evaluated (76.5% male). 191 (41.5%) falls occurred when working, 27 (5.9%) during play, and 242 (52.6%) in other times. Among construction workers, 166 (81.4%) had not used any safety equipment. Fracture and dislocation with 180 (39.1%) cases and soft tissue injury with 166 (36.1%) were the most common injuries inflicted. Mean height of falling was 3.41 ± 0.34 (range: 0.5 – 20) meters. Finally, 8 (1.7%) of the patients died (50% intentional) and 63% were discharged from ED. A significant correlation was detected between mortality and the falls being intentional (p < 0.0001) as well as greater height of fall (p < 0.0001). Conclusion: Based on the findings, most fall from height victims in the present study were young men, single, construction workers, with less than high school diploma education level. Intentional fall and greater height of falling significantly correlated with mortality.

A 25-year-old Afghan male was presented to the emergency department with femoral shaft fracture following fall from the height. The patient was subjected to femoral nerve block and general anesthesia. First try for performing nerve block led to vascular puncture. Therefore, the needle was removed and re-inserted 1 cm lateral to first puncture site and DEX injected slowly with aspiration check after every 5 mL to avoid intravascular injection. Immediately after injection, heart rate dropped to 40, blood pressure decreased to 85/50 mmHg and the BIS dropped to 30. Because of not spontaneous resolving the situation atropine and ephedrine were ordered that resulted to regain hemodynamic stability. It is likely that vascular puncture during peripheral nerve block can lead to some adverse events that need to be monitored precisely.