Current Issue : July - September Volume : 2020 Issue Number : 3 Articles : 9 Articles
Benign paroxysmal positional vertigo (BPPV) is the most prevalent form of peripheral vertigo and is common in posttraumatic\npatients. Sometimes, posttraumatic BPPV and subarachnoid hemorrhage (SAH) exist together. How to effectively recognize SAH\nespecially concealed bleeding before maneuver treatment for BPPV is worth paying attention by every clinician. Presently\ndescribed is a case that when there are some clinical symptoms cannot be completely explained by simple BPPV, the combination\nof CT and FLAIR MRI sequences are needed in the early-stage detection of acute SAH....
Anaphylaxis is a serious life-threatening allergic disease in children. This study is aimed at determining the characteristics of\npediatric patients who experienced anaphylaxis along with treatments administered in order to determine the usefulness of\ntryptase level assessment as a marker of anaphylaxis in Korean children. A total of 107 patients who were diagnosed with\nanaphylaxis in a single pediatric emergency center over a 3-year period were included in the study. Patient clinical\ncharacteristics, symptoms, signs, allergy history, trigger factors, treatments, and laboratory findings, including serum tryptase\nlevels, were included in the analysis. Food allergies (39.3%) were the most commonly reported patient allergic history, and 58\npatients (54.2%) were triggered by food. Among this group, nuts and milk exposure were the most common, affecting 15\npatients (25.9%). History of anaphylaxis and asthma were more common in severe anaphylaxis compared to mild or moderate\nanaphylaxis cases. Epinephrine intramuscular injection was administrated to 76 patients (71.0%), and a self-injectable\nepinephrine was prescribed to 18 patients (16.8%). The median tryptase level was 4.80 ng/mL (range: 2.70â??10.40) which was\nlower than the 11.4 ng/mL value commonly documented for standard evaluation in adults with anaphylaxis. The most common\ncause of pediatric anaphylaxis was food including nuts and milk. The rate of epinephrine injection was relatively high in our\npediatric emergency department. The median tryptase level associated with anaphylaxis reactions in children was lower than\n11.4 ng/mL. Further studies are needed to help improve diagnostic times and treatment accuracy in pediatric patients who\ndevelop anaphylaxis...
Background. Drug use evaluation is a system of continuous, systematic, criteria-based drug evaluation that ensures the appropriate\nuse of drugs. Rationalization of drug therapy in emergency medicine would be useful in managing the broad array of conditions\nthat present for emergency care. High-quality drug utilization is associated with the use of a relatively limited number of essential\nmedicines. The World Health Organization developed core drug use indicators for conducting drug utilization studies in\nhealthcare setting. WHO core drug use indicators including prescribing indicators, patient care indicators, and health facility\nindicators are used nowadays. Objective. The aim of this study was to evaluate the drug use pattern in the Emergency Department\nof Dilchora Referral Hospital, Dire Dawa, Ethiopia, 2018. Methods. A retrospective cross-sectional descriptive study was\nconducted in the emergency department (ED) of Dilchora Referral Hospital from July 20 to August 19, 2018, using structured data\ncollection format. Result. Out of 344 prescriptions analyzed, a total of 753 medications were prescribed. The average number of\ndrugs per prescription was 2.19. Of drugs prescribed, 685 (90.97%) were in their generic names. Antibiotics were prescribed in 95\n(27.62%) of encounters, and injections were prescribed in 154 (44.77%) of encounters. Among 753 medications prescribed, the\nname and strength of drugs are indicated in 100% and 95.22%, respectively. 679 (90.17%) of drugs were prescribed from the\nessential drug list of Ethiopia. Conclusion. The findings of this study revealed that the drug utilization pattern was not optimal in\naccordance with the standard values of WHO prescribing indicators. Some of the prescribing indicators like overprescribing of\nantibiotics and injections were a problem. Therefore, it is very imperative for the concerned stakeholders and healthcare providers\nto work toward ensuring drug use according to the standard....
Background. Emergency physicians (EPs) face critical admission decisions, and their judgments are questioned in some developing\nsystems. This study aims to define the factors affecting mortality in patients admitted to the hospital by EPs against inservice\ndepartmentsâ?? decision and evaluate EPsâ?? admission diagnosis with final discharge diagnosis. Methods. This is a retrospective\nanalysis of prospectively collected data of ten consecutive years (2008â??2017) of an emergency department of a university\nmedical center. Adult patients (more than or equal to18 years-old) who were admitted to the hospital by EPs against in-service departmentsâ?? decision\nwere enrolled in the study. Significant factors affecting mortality were defined by the backward logistic regression model. Results.\n369 consecutive patients were studied, and 195 (52.8%) were males. The mean (SD) age was 65.5 (17.3) years. The logistic\nregression model showed that significant factors affecting mortality were intubation (p < 0.0001), low systolic blood pressure\n(p = 0.006), increased age (p = 0.013), and having a comorbidity (p = 0.024). There was no significant difference between EPsâ??\nprimary admission diagnosis and patientâ??s final primary diagnosis at the time of disposition from the admitted departments\n(McNemarâ??Bowker test, p =0.45). 96% of the primary admission diagnoses of EPs were correct. Conclusions. Intubation, low\nsystolic blood pressure on presentation, increased age, and having a comorbidity increased the mortality. EPs admission diagnoses\nwere highly correlated with the final diagnosis. EPs make difficult admission decisions with high accuracy, if needed....
Background: The health effects of war and armed conflict on casualties and mental health of those directly\nexposed has been well described, but few studies have explored the indirect health effects of violent events. This\npaper assesses the indirect health impact of several violent events that took place in Beirut in 2013â??2014 on ED\nvisit utilization and disease patterns.\nMethods: As tracked by media reports, there were 9 violent events in Beirut during 2013â??2014. We compared visits\nto the Emergency Department of a major medical center during weeks when violent events happened and weeks\nwithout such events (the preceding week and the same week in preceding years). After re-coding de-identified\ndata from the medical records of 23,067 patients, we assessed differences in the volume of visits, severity index, and\ndischarge diagnoses. Individual control charts were used to analyze ED visit trends post-event.\nResults: Comparisons of weeks with violent events and weeks without such events indicate that the sociodemographic\ncharacteristics of patients who visited the Emergency Department were similar. Patients seen during\nviolent weeks were significantly more likely to be admitted to the hospital, and less likely to present with low acuity\ncomplaints, indicating greater complexity of their conditions. The discharge diagnoses that were significantly higher\nduring violent event weeks included anxiety disorders, sprains, and gastritis. Daily ED visits dropped post events by\n14.111%, p < 0.0001.\nConclusions: The results indicate that violent events such as bombs, explosions, and terrorist attacks reverberate\nthrough the population, impact patterns of ED utilization immediately post-event and are associated with adverse\nhealth outcomes, even among those who are not directly affected by the events....
Context. Studies about knowledge of emergency management of traumatic dental injuries (TDIs) which affect children by general\ndental practitioners (GDPs) and specialists in Saudi Arabia are lacking. Aim. The aim of this cross-sectional study was to assess the\nknowledge level of GDPs and specialists about TDI emergency management and its relation with demographic variables in Qassim\nregion, Saudi Arabia. Materials and Methods. A random sample of 239 GDPs and specialists was given a two-part questionnaire; the\nfirst part included demographic questions and the second part included questions related to knowledge of emergency management\nof luxation (intrusion and extrusion), complicated crown fracture, and avulsion injuries. Data was statistically analyzed using chisquare\nand ordinal logistic regression tests. The significance was set at P < 0:05. Results. The mean knowledge score was 5.57 for\nGDPs and 6.69 for specialists (out of 12). A significant difference was observed between both groups in the management of\navulsion injury. Three factors significantly improved the dentistsâ?? knowledge: gender (female), practice type (specialist), and\nprevious experience of encountered TDIs (P < 0:05). Conclusions. GDPs and specialists in Qassim region had moderate\nknowledge of emergency management of TDIs. Specialists were significantly more knowledgeable than GDPs in the\nmanagement of avulsion injury when compared to the rest of the injuries....
Objectives. Frequent attendance for nonemergency problems to emergency departments (EDs) contributes to ED overcrowding,\nresulting in medical care delays, increased medical errors, and social and economic burdens. Most studies regarding frequent\nattenders of EDs examine general patients without classifying certain subgroups. This study aimed to investigate patients with liver\ncirrhosis who present repeatedly to the ED. Methods. This was a retrospective, observational cohort study of adult patients with a\nhistory of liver cirrhosis presenting to the ED from January 2011 to December 2015. We included patients with cirrhosis whose\nfirst ED visit occurred during the study period. We went far back for 20 years and excluded patients with any ED visits (including\nboth cirrhosis and noncirrhosis-related ones) before the study period. We categorized frequent attenders as patients with more\nthan 4 ED visits within 12 months after the first ED visit; infrequent attenders were those who did not meet this criterion. Results.\nA total of 3513 patients with cirrhosis were included in this retrospective cohort study. Compared with the infrequent attenders,\nfrequent attenders had a higher rate of presentations due to hepatic encephalopathy (15.2% vs 13.7%,.................
Background: Early prognostication in trauma patients is challenging, but particularly important. We wanted to\nexplore the ability of copeptin, the C-terminal fragment of arginine vasopressin, to identify major trauma, defined as\nInjury Severity Score (ISS) > 15, in a heterogeneous cohort of trauma patients and to compare its performances with\nlactate. We also evaluated copeptin performance in predicting other clinical outcomes: mortality, hospital\nadmission, blood transfusion, emergency surgery, and Intensive Care Unit (ICU) admission.\nMethods: This single center, pragmatic, prospective observational study was conducted at Arcispedale Santa Maria\nNuova, a level II trauma center in Reggio Emilia, Italy. Copeptin determination was obtained on Emergency\nDepartment (ED) arrival, together with venous lactate. Different outcomes were measured including ISS, Revised\nTrauma Score (RTS), hospital and ICU admission, blood transfusion, emergency surgery, and mortality.\nResults: One hundred and twenty five adult trauma patients admitted to the ED between June 2017 and March\n2018. Copeptin showed a good ability to identify patients with ISS > 15 (AUC 0.819). Similar good performances\nwere recorded also in predicting other outcomes. Copeptin was significantly superior to lactate in identifying\npatients with ISS > 15 (P 0.0015), and in predicting hospital admission (P 0.0002) and blood transfusion (P 0.016).\nComparable results were observed in a subgroup of patients with RTS 7.84.\nConclusions: In a heterogeneous group of trauma patients, a single copeptin determination at the time of ED\nadmission proved to be an accurate biomarker, statistically superior to lactate for the identification of major trauma,\nhospital admission, and blood transfusion, while no statistical difference was observed for ICU admission and\nemergency surgery. These results, if confirmed, may support a role for copeptin during early management of\ntrauma patients....
We present a case of a low energy penetrating neck injury with only facial nerve (FN) palsy in the clinical finding. A 32-year-old\nmale patient was admitted to the emergency department with a penetrating injury on the right side of the neck just behind the\nright ear, accompanied by evident right (FN) palsy, evaluated as House Brackmann grade IV. Computed tomography demonstrated\nan isolated soft tissue injury in the right retroauricular region without bone fracture, parotid gland lesion, or vascular\nstructure involvement. The FN palsy was treated with corticosteroids (CS), and the patient had an uneventful and complete\nrecovery. This case report presents an unusual mechanism of isolated, extratemporal, blunt injury of the FN after a penetrating\nneck injury followed by complete recovery....
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