ISRN Emergency Medicine

Management of Pain in the Emergency Department

Stephen H. Thomas — Thu, 16 May 2013 16:51:17 +0000

Since pain is a primary impetus for patient presentation to the Emergency Department (ED), its treatment should be a priority for acute care providers. Historically, the ED has been marked by shortcomings in both the evaluation and amelioration of pain. Over the past decade, improvements in the science of pain assessment and management have combined to facilitate care improvements in the ED. The purpose of this review is to address selected topics within the realm of ED pain management. Commencing with general principles and definitions, the review continues with an assessment of areas of controversy and advancing knowledge in acute pain care. Some barriers to optimal pain care are discussed, and potential mechanisms to overcome these barriers are offered. While the review is not intended as a resource for specific pain conditions or drug information, selected agents and approaches are mentioned with respect to evolving evidence and areas for future research.

Clinical Findings in Albanian Patients with 2009 Influenza AH1N1 Admitted to the Intensive Care Unit

Wed, 08 May 2013 14:49:36 +0000

Background. The 2009 AH1N1 (H1N1) epidemics expanded rapidly around the world by the current ease of cross-continent spread of infectious diseases. We aimed to describe clinical characteristics of admission, demographic characteristics, treatment, and outcome for critically ill patients with laboratory-confirmed H1N1 virus. Methods. This is an observational prospective study of 31 Albanian patients, admitted to Intensive Care Unit (ICU) of the Infectious Disease Department during the period from November 2009 to March 2010. Demographic data, symptoms, comorbid conditions, days of stay at ICU, radiologic/laboratory findings, and clinical outcomes were collected using a case report form. Results. The median age of patients was 35 years, and 54% of them were female. Five patients (16%) required endotracheal intubation; in 15 (48%) patients O2-therapy was given via nasal sound and mask, and 11 (35%) of patients received O2-therapy with noninvasive ventilation (NIV). All patients were treated with oseltamivir. Four patients did not survive during the disease’s course. Conclusion. Critical illness from 2009 influenza H1N1 in ICU predominantly affects young adults. The NIV could have a beneficial effect in 2009 influenza H1N1 infection-related hypoxemic respiratory failure and was associated with severe hypoxemia, pneumonia, requirement for prolonged mechanical ventilation, and the frequent use of antiviral therapy.

Self-Limited Pneumoporta in the Era of Computed Tomography: A Case Report and Review of the Literature

Yu-Tso Liao, Hong-Shee Lai, Rey-Heng Hu, Po-Huang Lee, and Cheng-Maw Ho — Mon, 10 Dec 2012 15:10:05 +0000

Pneumoporta in patients with abdominal pain has been thought to be suggestive of fatal underlying conditions, such as mesenteric infarct, requiring emergency treatment. Widespread use of computed tomography (CT) has increased the frequency of detection of pneumoporta in patients with diseases other than mesenteric infarct. The natural course of resolution of pneumoporta has been rarely discussed in the literature and mainly focused on patients with iatrogenic diseases. Herein, we report the case of a 64-year-old woman who presented at our emergency department with positive peritoneal signs and pneumoporta. A 10 cm long segment of resolved ischemic bowel was detected on exploratory laparotomy, and bowel resection was not performed. Follow-up CT performed 62 hours later revealed complete resolution of pneumoporta. The patient was discharged uneventfully and was administered short-term prophylactic therapy with enoxaparin for thromboembolism. The epidemiology, etiology, and resolution of pneumoporta are also reviewed.

Challenges of Managing Emergency Ileostomy: Nutrition—A Neglected Aspect

Tue, 04 Dec 2012 14:04:22 +0000

Objective. The present study was carried out with an aim to study the nutritional status of patients undergoing emergency ileostomy using simple bedside tools in a developing country. Methods. Nutritional assessment (anthropometry, biochemical, immunological, and dietary) was done within 24–36 hours of admission and 6 weeks postoperatively. Primary endpoint was the study of the nutritional status of the patients with ileostomy. Results. , 47 males with mean age 32 years. Postoperatively 50 (86.2%) patients experienced some complications including those related to ileostomy. Malnutrition varied from 7 (12.1%) using BMI to 54 (93.1%) by triceps skinfold thickness. At 6 weeks, despite adequate nutritional intake, there was a significant decrease in almost all nutritional parameters except serum albumin which was normal in most patients. Factors contributing to weight loss in 41 (70.7%) patients were decreased length of proximal bowel left (), increased ileostomy output (), delayed surgery (), and increased disease severity score (). Conclusion. Majority of patients undergoing emergency ileostomy were malnourished and had significant nutritional depletion despite adequate nutritional support. Serial assessment helps to assess nutritional recovery in these patients.

Community Stepdown Care: A Safe Alternative for Selected Elderly Patients Attending Emergency Department?

Chee Kheong Ooi, Chik Loon Foo, Alicia Vasu, and Eillyne Seow — Tue, 04 Dec 2012 14:01:52 +0000

Background. The Community Stepdown Care Initiative attempts to provide right siting of care for elderly emergency department attendees whose main need is rehabilitation. Objectives. The aim of this study was to compare reattendance and rehospitalisation rates, length of stay, medical complication rates, and discharge destination between the community hospital cohort and the acute hospital cohort. Methods. A retrospective cohort study was conducted from June 2007 to November 2008. Results. Two hundred and thirty patients were enrolled in the study. 68 patients were successfully transferred to stepdown care; 162 patients were admitted to acute hospital. The odds ratio of reattendance was similar in both cohorts at 2 weeks, 6 months, and 12 months. The odds ratio of rehospitalisation was similar in both cohorts at 2 weeks, 3 months, 6 months, and 12 months. There was no statistical difference in the medical complication rates between the cohorts. Patients were more likely to be discharged home from the community hospital compared to acute hospital (adjusted OR 4.11, ). 14% of patients from the acute hospital cohort was discharged to community hospital. Conclusions. For selective elderly emergency department attendees whose predominant need is rehabilitation, stepdown care is a safe alternative compared to usual acute hospital care.

The Effects of QuikClot Combat Gauze, Fluid Resuscitation, and Movement on Hemorrhage Control in a Porcine Model

Thu, 29 Nov 2012 15:27:11 +0000

The purpose of this study was to compare the effectiveness of QuikClot Combat Gauze (QCG) compared to a control group on hemorrhage control; the amount of crystalloid volume infusion on rebleeding; the effect of movement on hemorrhage. This was a prospective, experimental design. Swine were randomly assigned to either the QCG () or the control group (). Investigators transected the femoral artery and vein in each swine. After one minute of uncontrolled hemorrhage, the hemostatic agent, QCG, was placed into the wound followed by standard wound packing. The control group underwent the same procedures but without a hemostatic agent. After five minutes of direct pressure, a standard pressure dressing was applied. After 30 minutes, dressings were removed, and the wound was observed for rebleeding for 5 minutes. If hemostasis occurred, 5 liters of crystalloid was given over 5 minutes, and the wound was observed for rebleeding for 5 additional minutes. If no bleeding occurred, the extremity on the side of the injury was moved. There were significant differences in the amount of hemorrhage (), the amount of fluid administration (), and the number of movements () between the QCG and control.

Attitudes and Beliefs towards Patients with Hazardous Alcohol Use: A Systematic Review

Wed, 28 Nov 2012 16:35:08 +0000

Objective. To describe emergency department (ED) staff attitudes and beliefs towards patients presenting with hazardous alcohol use and their clinical management. Methods. A search of MEDLINE, EMBASE, CINAHL, SCOPUS from 1990 to 2010, and reference lists from included studies was conducted. Two reviewers independently screened for inclusion and assessed study quality. One reviewer extracted the data and a second checked for completeness and accuracy. Results. Among nine studies four reported varied beliefs on whether screening was worthwhile for identifying hazardous alcohol use (physicians: 42%–88%; nurses: 50%–100%). Physicians in three studies were divided on intervention provision (32%–54% in support of intervention provision) as were nurses in two studies (39% and 64% nurses in support of intervention provision). Referral for treatment was identified in two studies as an important part of ED management (physicians: 62% and 97%; nurses: 95%). Other attitudes and beliefs identified across the studies included concern that asking about alcohol consumption would be seen as obtrusive or offensive, and a perceived lack of time and resources available for providing care and referrals. Conclusions. ED staff had varying attitudes towards ED management of patients with hazardous alcohol use. Investigations into improving clinical care for hazardous alcohol use are needed to optimize ED management for these patients.

Lipothymia and Syncope—Aetiology and Outcome in a Prehospital Setting: A Retrospective Study

Stine T. Zwisler and Søren Mikkelsen — Sun, 25 Nov 2012 08:39:04 +0000

Background. A firm aetiology of lipothymia or syncope can be difficult to establish prehospitally. The aim of the study was to investigate patients initially assigned the diagnosis of lipothymia or syncope prehospitally and establish the aetiology of their condition either based on prehospital or in-hospital medical records. Methods. From May 1, 2006 to April 30, 2010, all patients receiving the diagnosis of lipothymia or syncope by the MECU were investigated. If admitted to hospital, the patients’ medical records were investigated to confirm the prehospital diagnosis. Results. Within 17980 MECU runs registered, 678 were assignments in which the patients were diagnosed with lipothymia or syncope (3.8%). 578 patients (85%) were admitted to hospital. 278 of the patients were discharged directly from the emergency department, while 271 were admitted to a ward. 112 patients refused treatment offered by the MECU or at the emergency department, died, or were left at the scene following treatment. 17 were lost to followup. Of all patients investigated, 299 were discharged with the diagnosis of lipothymia or syncope. 250 patients were discharged with other diagnoses. Conclusions. In 44% of the patients presenting with lipothymia or syncope, no other diagnosis was established at the hospital, and no explanatory aetiology was found.

Ultrasound for the Detection of Pleural Effusions and Guidance of the Thoracentesis Procedure

Kamila Sikora, Phillips Perera, Thomas Mailhot, and Diku Mandavia — Tue, 20 Nov 2012 08:15:07 +0000

Objective. To review the use of ultrasound for the detection of pleural effusions and guidance of the thoracentesis procedure. Methods. Two clinical cases will be presented in which ultrasound proved beneficial in guiding the diagnosis and management of patients with pleural effusions and respiratory distress. The ultrasound techniques for the evaluation of pleural effusions and performance of the thoracentesis procedure are discussed. A review of the most current literature follows to present the known diagnostic and safety benefits of ultrasound guidance for thoracentesis. Conclusions. Ultrasound improves the diagnostic accuracy for the detection of pleural effusions over standard chest radiographs. Ultrasound can also diagnose a complicated pleural effusion that may be at higher risk for an adverse outcome during a thoracentesis. Optimally, thoracentesis should be performed under direct ultrasound guidance to decrease the complication rate and improve patient safety.

Prediction of Repeat Visits by Victims of Intimate Partner Violence to a Level III Trauma Centre

Patricia Janssen and Kathleen Mackay — Wed, 14 Nov 2012 16:01:05 +0000

Background. The purpose of this study was to describe and contrast the population of persons presenting to a Vancouver hospital emergency department two or more times with those presenting once. Methods. Subjects for this study had disclosed intimate partner violence on at least one visit to Vancouver General Hospital Emergency Department during the study period 1997–2009. We compared sociodemographic characteristics, presenting complaints and disposition on discharge among single versus repeat visitors. Results. We identified 2246 single visitors and 257 repeat visitors. In a multivariate model, repeat visitors to the ER were more likely to be of First Nations (aboriginal) status, odds ratio (OR) 2.29, 95% confidence intervals (1.30–4.01); to have had a history of previous abuse 3.38 (1.88–6.08); to have received threats of homicide 2.98 (1.74–5.08); and to present with mental illness 3.03 (1.59–5.77). Police involvement was protective against repeat visits 0.54 (0.36–0.98). Conclusion. Persons with potential for multiple visits to the emergency room can be characterized by a number of factors, the presence of which should trigger targeted assessment for violence exposure in settings where assessment is not routine.

Optimizing Transport Time from Accident to Hospital: When to Drive and When to Fly?

D. V. Weerheijm, M. H. Wieringa, J. Biert, and N. Hoogerwerf — Tue, 23 Oct 2012 08:30:51 +0000

Objective. In prehospital emergency medicine, rapid transport to a hospital is often required. Transport can be done by ambulance or HEMS (Helicopter Emergency Medical Service). Factors influencing transport time are mostly unknown. This study aims to identify these factors and optimize prehospital transport times. Methods. This is a retrospective study with HEMS data from 2010-2011. Trauma mechanism, patient characteristics, and weather conditions were collected from each transport. Distance to the hospital, predicted transport time, and the actual transport time were calculated. Each factor was analysed to determine influence on transport time. Results. We analysed 732 cases (612 by ambulance and 120 by helicopter) and found no association between mechanism of trauma, age, time of day, or weather conditions on transport time. However, transport by HEMS helicopter was nearly always faster, even at short distances. The average transport time of ambulance transport was 79% (95% CI 77.1–80.3) of target time, while in helicopter transport this was 39% (95% CI 37.4–42.9). Conclusion. This study shows the advantage of the HEMS helicopter in rapid transport from the scene to the hospital. Transport by helicopter was twice as fast as ground transport, independent of trauma mechanism, distance to hospital, or weather conditions.

Emergency Peripartum Hysterectomy: A 10-Year Review

Tue, 16 Oct 2012 09:36:02 +0000

Background. Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Purpose. To determine the incidence, risk factors, indications, outcomes, and complications of EPH performed in a tertiary teaching hospital and to compare the results with other reports in the literature. Methods. The medical records of 13 patients who had undergone EPH, between January 2000 and December 2010, were reviewed retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions, and maternal and neonatal outcomes were evaluated. Results. There were 13 EPHs out of 31.767 deliveries, a rate of 0.41 per 1,000 deliveries. Eight hysterectomies were performed after cesarean delivery and five after vaginal delivery. The most common indication for hysterectomy was uterine atony (10/13), followed by placenta previa (2/13). There were one case of intraoperative bladder injury and one case of relaparotomy because of hemoperitoneum. We had one maternal death because of septic shock. There were no cases of neonatal morbidity and mortality. Conclusion. Postpartum hemorrhage is one of the leading causes of maternal mortality and morbidity and represents the most challenging complication that an obstetrician will face.

Teaching Emergency Surgical Skills for Trauma Resuscitation-Mechanical Simulator versus Animal Model

Jameel Ali, Anne Sorvari, and Anand Pandya — Mon, 15 Oct 2012 15:55:05 +0000

Background. Traditionally, surgical skills in trauma resuscitation have been taught using animal models in the advanced trauma life support (ATLS) course. We compare one mechanical model (TraumaMan simulator) as an alternative teaching tool for these skills. Method. Eighteen providers and 14 instructors performed four surgical procedures on TraumaMan and compared educational effectiveness with the porcine model. Evaluation was conducted (Likert system 1: very poor to 5: excellent). The participants indicated if TraumaMan was a suitable (scale 1: not suitable to 4: excellent) ATLS teaching model considering cost, animal ethics concerns, and other factors. Comments were solicited for both models. Results. Overall ratings for educational effectiveness of the 4 skills ranged from 3.58 to 4.36 for the porcine and 3.48 to 4.29 for the TraumaMan model. TraumaMan suitability was rated 3-4 (mean 3.38) by 84% participants. TraumaMan as a substitute for the porcine model was recommended by 85% participants. With no ethical or cost concerns, 44% students and 71% instructors preferred TraumaMan. Considering all factors, TraumaMan was preferred by 78% students and 93% instructors. Conclusions. TraumaMan is a suitable alternative to the porcine model and considering all factors it may be the preferred method for teaching ATLS emergency trauma surgical skills.

Patient Use of Tablet Computers to Facilitate Emergency Department Pain Assessment and Documentation

Sun, 14 Oct 2012 15:51:43 +0000

Introduction. The goal of this project is to pilot automated pain tracker (APT) hardware/software system allowing patients to indicate their pain levels and whether they want analgesia, using tablet computers. Methods. Patients in an academic emergency department (ED) used a tablet computer (iPad, Apple Computer Company, Cupertino, CA, USA), programmed to allow them to indicate their pain level, whether pain medication was desired, and prompted the subject at regular intervals to indicate their pain level. The iPad was linked to a monitor in the ED's nursing/physician station. The pain assessment information was printed for scanning and inclusion in the ED's electronic medical records (EMR) system. A 5-point Likert scale questionnaire was used to assess the perceptions of patients and nurses about the utility of the APT. Results. The majority of 30 subjects (28 of 30; 93%) agreed or strongly agreed that the number of pain assessments was adequate. All of the subjects indicated the APT was easy to use, and 28 of 30 subjects (93%) thought the APT should be used more in the ED. Conclusions. The benefits of the iPad pain-tracking and reporting-system include patient satisfaction, improved pain care, operational efficiency, and improved pain assessment documentation.

Racial Disparities in Healthcare: Are We Prepared for the Future? Brief Report on Emergency Medical Services in a County Health Department in California

Ken Russell Coelho and Virginia T. Nguyen — Sun, 14 Oct 2012 15:50:42 +0000

Demographic trends indicate that ethnic minority populations constitute 25 percent of the current population and will be the majority of the United States population in 2050. Forty percent of the demographic in California are ethnic minorities making encounters between healthcare workers and patients from different cultural backgrounds commonplace. Research also indicates that ethnic minority patients are more likely to utilize emergency medical services as an entry point into the health system due to lack of medical insurance and access to primary care. Our qualitative study attempts to understand health disparities through focus groups with 76 patients and their feedback on the use of emergency medical services. Patients revealed challenges in both service provision and delivery of emergency medical services. Implications include the development of cultural competence training programs and the selection of diverse groups of county emergency medical first responders in California.

Amatoxin: A Review

Brandon Allen, Bobby Desai, and Nate Lisenbee — Mon, 03 Sep 2012 10:25:54 +0000

This paper presents a comprehensive review of amatoxin poisoning. The paper discusses the biochemistry of amatoxin, as well as the clinical manifestations of amatoxin ingestion. In addition, the evaluation of the patient with amatoxin ingestion is discussed, along with the treatment—including newer therapy—and the ultimate prognosis of the syndrome.

Challenges Faced by the Intensive Care Unit during a Terrorist Attack: The Riyadh Experience

Abdullah Al-Shimemeri — Thu, 30 Aug 2012 12:14:40 +0000

Background. Globally, we are facing a “terror epidemic” with incidences of terrorist attacks on innocent civilians increasing worldwide. The volume and nature of injuries resulting from such attacks challenge even the most sophisticated and well-prepared trauma systems and health institutions. Over seventy percent of terror attacks involve bomb explosions with improvised explosive devices (IEDs) resulting in a unique pattern of injuries to the victims. Here, we present data on the terrorist attacks on the city of Riyadh, Saudi Arabia, between March 1991 to the present and discuss in retrospect the event outcomes and features which may be useful for the preparedness of the intensive care unit (ICU) in the wake of future attacks. Methods. Data from nine hospitals in Riyadh that catered to patients during terrorist strikes were collected retrospectively. Details of the incidents were collected from news media archives. Results. The majority of terror strikes (~80%) involved a bomb blast with the use of explosives. The victims included 148 casualties, 45 hospitalizations, 103 discharges after first aid, and 3 incidences of admission to the critical care unit. Conclusion. Using the Riyadh experience, we analyze data and the series of events in the ICU following terrorist explosions. The analysis provides important insights for the trauma unit so that it is better prepared and organized for such incidents in the future.

Comparison of Full Blood Count Parameters Using Capillary and Venous Samples in Patients Presenting to the Emergency Department

R. Ponampalam, Stephanie Man Chung Fook Chong, and Sau Chew Tan — Thu, 23 Aug 2012 08:25:55 +0000

Full blood count (FBC) analysis is a common investigation done in the emergency department (ED). The aim of this study was to determine the accuracy of bedside FBC analysis using capillary blood samples from a finger stab at point of care (POC) compared to a conventional venous blood sample analysis. A total of 314 consecutive patients presenting to the ED were recruited. After consenting, a sample of the patient’s venous (V) blood was obtained via venepuncture and sent to the haematology laboratory for analysis as standard practice. This was followed immediately by collection of a capillary (C) blood sample from a finger stab which was analysed at site using an automated FBC analyser at POC. Agreement between the paired samples for blood parameters including the total white cell count, hemoglobin, and platelet count was assessed by the statistical method of Bland and Altman using V sample as the gold standard. The results showed a statistically significant deviation between capillary and venous samples only for platelet counts (𝑃<0.001) and haemoglobin (𝑃<0.001). However, the magnitudes of this difference 7.3 × 109/L and 0.5 g/dL respectively, were not clinically significant. The study suggest that the analysis of capillary samples for FBC parameters is a reliable and acceptable alternative to conventional methods with the benefits of being a rapid, convenient, and minimally invasive technique.

Paramedics Manage the Airway Easier with Laryngeal Mask Airway Than with Intubation during Simulated CPR Scenarios

Eleni Bassiakou, Konstantinos Stroumpoulis, and Theodoros Xanthos — Fri, 17 Aug 2012 14:22:33 +0000

Objectives. In this study, we investigated whether minimally trained paramedics with no previous experience in securing the airway would be more efficient in placing laryngeal mask airway (LMA) than intubating the trachea with direct laryngoscopy using 2 manikin scenarios: without chest compressions (non-CPR scenario) and with continuous chest compressions (CPR scenario). Methods. One hundred and twenty-four paramedics with no previous experience in managing the airway comprised our study population. Three 20 min lectures on the anatomy of the airway and endotracheal intubation with the Macintosh blade and LMA placement were given. Each participant attempted to insert a LMA or to intubate a manikin with the Macintosh blade using 2 different scenarios: without chest compressions and with continuous chest compressions. Results. All participants managed to place a LMA in both scenarios, but only 85% of them managed to intubate the trachea using the Macintosh blade in the non-CPR and even less than (80%) in the CPR scenario. Insertion of the LMA was statistically significantly faster than intubation with the Macintosh blade in both scenarios (𝑃<0.001). Conclusions. Our results provide evidence that for minimally trained paramedics, LMA insertion is much faster than endotracheal intubation.

A Profile of Emergency Departments in Slovenia

Blanka Jaklic, Leana S. Wen, Ashley F. Sullivan, and Carlos A. Camargo Jr. — Thu, 19 Jul 2012 19:01:19 +0000

Objectives. Emergency departments (EDs) are the basic unit of emergency medicine (EM), but there is often significant heterogeneity and differences in ED organization. We sought to describe and characterize EDs in Slovenia. Methods. All EDs open 24/7 to the general public were surveyed using the National ED Inventories survey instrument. Staff were asked about ED characteristics with reference to calendar year 2007. Results. Fifty-five EDs participated (81% response). All EDs treated children and adults. Eleven (20%) of the EDs were hospital based and 44 (80%) were non-hospital based. The median number of annual visits for hospital-based EDs was 21,400 (interquartile range, 19,900–34,200) and 5,000 (interquartile range, 1,100–9,300) for non-hospital-based EDs. All hospital-based EDs had triage to service, and only one was an independent department. Most respondents (76%, 95% CI 64–89%) thought their ED was at good balance or capacity. While hospital-based EDs had high availability of technological resources and ability to treat virtually all emergency types 24/7, these characteristics were less frequent in non-hospital-based EDs. Conclusions. The organization of emergency care in Slovenia is complex, with some variation in the layout, characteristics, and capabilities of its EDs. This initial study establishes a benchmark for future investigations into intra-country comparisons of different types of EDs.

Caval Aorta Index and Central Venous Pressure Correlation in Assessing Fluid Status! “Ultrasound Bridging the Gap”

Harshitha Sridhar, Pavan Mangalore, V. P. Chandrasekaran, and Rishya Manikam — Sun, 08 Jul 2012 14:25:52 +0000

Accurate body fluid assessment and estimation of fluid status are essential in guiding fluid therapy in emergency setup. This prospective cross-sectional descriptive study conducted to ascertain the effectiveness of inferior vena cava and aorta (IVC/Aorta) index in assessing the fluid status by comparing it with the central venous pressure (CVP). Results showed the mean IVC/Aorta index in patients who had normal CVP range was 1.2 ± 0.12 SD, while in patients with low CVP, the mean index was 0.7 ± 0.09 SD, and, patients with high CVP, the mean index was 1.6 ± 0.05 SD. In conclusion, the sonographic IVC/Aorta index assessment seems to be a quick, simple, noninvasive, and reliable method to access the fluid status in a busy setup like an emergency room.

Demographic Changes and Their Implications in a Nonacademic Emergency Department in Switzerland: An 11-Year Trend Analysis (2000–2010) of 104,510 Patients

Thu, 14 Jun 2012 10:52:35 +0000

Background. Recent demographic developments outline a worldwide increase in the older population. The aim of the present study was to assess whether the sociodemographic characteristics of patients with emergency department (ED) admissions have changed over time. Methods. This study utilized the database of a level I accident and emergency unit in eastern Switzerland, a prospective database of consecutive patients aged ≥16 admitted between 2000 and 2010. Sociodemographic data were extracted as well as date and time of admission, instances of referral, diagnosis, time needed for ED treatment, and nursing effort. Results. Data from 104,510 patients were utilized. There was a significant increase in the percentage of patients aged ≥65 years (from 25.7 per cent (1,775/6,905) to 29.6 per cent (3,845/12,340); 𝑃trend<0.01 ). The mean length of stay in the ED was significantly longer (from 140.3 minutes, SD 91.9 to 169.5 minutes, SD 101.1; 𝑃trend<0.01) and the percentage of illness as the cause of admission was significantly higher over time (from 58.3 per cent to 59.4 per cent; 𝑃trend<0.01). Conclusions. The change in patients’ demographics found and the resulting considerably increasing workload in EDs might be helpful for planning purposes, future training of ED personnel, and allocating resources.

Emergency Room Admission of On-Duty Police at a Swiss University Hospital

Mon, 09 Apr 2012 10:12:58 +0000

Background. Police and law enforcement officers may face physical violence and multiple occupational hazards in the line of duty. There is no nationwide statistical reporting of police officers’ injuries in Switzerland. The aim of this study was to describe the epidemiological features of emergency room admissions of on-duty police officers. Methods. The retrospective analysis was based on the prospective database of the Emergency Department of Bern University Hospital. Fifty-seven (57) police officers presenting to our department were included and analysed. Results. Minor blunt trauma (32/57) associated with extremity trauma was the leading cause of admission to our emergency department. 16 body fluid born exposures with a possible risk of viral transmission were reported, with 12/16 cases during summer; serological testing for HBV, HCV, and HIV was negative in all cases. No police death was reported. Conclusions. Police officers are exposed to occupational hazards. In comparison to other countries the number of severely injured or killed officers is very low. In the light of the daily reports in the lay media about assaulted police officers, it may be assumed that the majority of injured police officers were treated by general practitioners outside the hospital or treated by themselves. An adequate injury prevention strategy is desirable, combined with more meticulous nationwide reporting of police officers’ injuries.

Clinical Profile and Outcomes of Hair Dye Poisoning in a Teaching Hospital in Nellore

Thu, 01 Mar 2012 09:22:56 +0000

Demographic profiles, volume consumed, time to hospitalization, clinical presentation, laboratory findings, treatment details, and outcomes of patients with hair dye poisoning were analyzed to assess the effect of Super Vasmol 33. The efficacy of methylprednisolone as compared to hydrocortisone in patients was also investigated. Findings show that there are significant differences in the clinical profiles laboratory markers such as markers of leukocytosis, rhabdomyolysis, and hepatitis among patients who consumed fewer volumes than larger volumes. Toxicity is dose dependent with increased morbidity and mortality. Consumption of even lower volumes resulted in hepatitis. For an apparently similar clinical and laboratory profile of patients, treatment with hydrocortisone is as effective as methylprednisolone in the clinical outcomes. These findings suggest that Super Vasmol 33 is emerging as a major source of poisoning.

Serum Levels of Biochemical Markers of Traumatic Brain Injury

Thu, 19 Jan 2012 15:27:05 +0000

Background. A biomarker would be valuable in the diagnosis, risk stratification and prognosis of patients with traumatic brain injury (TBI). Methods. We measured serum levels of S-100β, neuron specific enolase (NSE) and myelin basic protein (MBP) in 50 TBI subjects, and 50 age and gender matched controls. Patients were recruited within 6 hours of the initial injury, they had an initial Glasgow Coma Scale (GCS) score of 14 or less, or a GCS score of 15 with witnessed loss of consciousness (LOC) or amnesia. Results. S-100β, NSE and MBP levels were significantly higher in TBI subjects than in control subjects (𝑃<0.001 for S-100β and NSE; 𝑃=0.009 for MBP). Initial S-100β levels were significantly higher in TBI subjects who had not retuned to normal activities 2 weeks following their injury than in TBI subjects who had retuned to normal activities (𝑃=0.022). MBP levels were higher in TBI subjects with positive findings on the baseline CT scan than in CT-negative subjects (𝑃=0.007). Conclusions. S-100β, NSE and MBP may be present in the sera of TBI subjects in elevated quantities relative to controls. S-100β may aid in predicting short-term outcome in TBI subjects.

Family-Witnessed Resuscitation: Perceptions of Nurses and Doctors Working in an Australian Emergency Department

Rose Chapman, Rochelle Watkins, Angela Bushby, and Shane Combs — Tue, 13 Dec 2011 12:54:49 +0000

Inconsistencies abound in the literature regarding staff attitudes and perceptions toward family-witnessed resuscitation. Our study builds on previous research by using a validated tool to investigate emergency department staff perceptions of family-witnessed resuscitation. A cross-sectional survey was distributed to 221 emergency department doctors' and nurses'. We found few differences between doctors and nurses perceptions toward family-witnessed resuscitation. Both nurses and doctors who held a specialty certification, who were more highly qualified, who had more experience with family presence during resuscitation, and who had a personal preference for having family members present during their own resuscitation perceived more benefits and fewer risks, as well as more confidence in their ability to manage these events. However, nurses more than doctors want patients to provide advanced directives for family presence. The findings will enable clinicians, educators, and hospital management to provide better support to all stakeholders through these events.

Penetrating Neck Trauma in a Level II Trauma Hospital, Saudi Arabia

Wagih Mommtaz Ghnnam, Ali Saeed Al-Mastour, and Mohamed Fayez Bazeed — Mon, 05 Dec 2011 15:05:13 +0000

Background. Penetrating neck trauma is a unique form of trauma that is on the rise all over the world and contributes significantly to high morbidity and mortality. Design. Retrospective and prospective case series. Setting. Urban, level II trauma hospital. Patients. Patients who had sustained penetrating trauma to the neck. Main Outcome Measures. The aim of this study was to evaluate the incidence, injury characteristics, and treatment outcome of penetrating neck trauma in our local setting and to suggest treatment protocols. Patients and Methods. This was a combined retrospective and prospective study of penetrating neck trauma patients who were managed at level II trauma hospital, Asceer region, Saudi Arabia, from March 2008 to March 2011. Results. A total of 49 patients were studied. Males outnumbered females by a ratio of 11.25:1. Their mean age (SD) was 31.1(12.6) years. Fourteen patients were caused by stab-wound injuries. Most injuries were in zone II (83.7%). More than one-third of patients were treated conservatively. Wound exploration and debridement were the mode of treatment in the majority of cases. The mean duration of hospital stay was 6.6 days (1–18 days). Mortality rate was 12.2%. Conclusion. The present paper illustrates the difficulties of managing penetrating neck injuries in our region, Saudi Arabia.

Performance of a Simplified Wall Motion Score Index Method for Noncardiologists to Assess Left Ventricular Ejection Fraction

Tue, 22 Nov 2011 09:28:50 +0000

Backgrounds. For emergency physicians performing a goal-directed transthoracic echocardiogram (TTE), a reliable estimate of LVEF must be obtained rapidly. We compared rapid LVEF estimates obtained from short axis sections to those obtained from apical sections using two methods of evaluation. Methods. The TTE's of 6 patients were interpreted by 16 echo-proficient readers (PRO group) and 105 novice readers (NOV group). LVEF was assessed by each group. The strategies consisted of either a global visual estimation (VIS) of LVEF or semiquantitative (SQ) methods. Results. Using RNV and BIP as a reference standard, NOV readers performed better with the SQ method than global visual estimation. For NOV readers, best agreement was achieved with the 234C sequence in low LVEF situations, but with the BMA series in normal LVEF settings. Neither series of views was better than the other in the setting of mild LVEF depression. Conclusion. Semi-quantitative method was superior to global visual estimation of LVEF in NOV group in most of the LVEF ranges.