Emergency Medicine International https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Four-Factor Prothrombin Complex Concentrate Reduces Time to Procedure in Vitamin K Antagonist-Treated Patients Experiencing Gastrointestinal Bleeding: A Post Hoc Analysis of Two Randomized Controlled Trials Tue, 19 Sep 2017 07:46:04 +0000 http://www.hindawi.com/journals/emi/2017/8024356/ Introduction. To investigate the impact of a 4-factor prothrombin complex concentrate (4F-PCC [Beriplex®/Kcentra®]) versus plasma on “time to procedure” in patients with acute/severe gastrointestinal bleeding requiring rapid vitamin K antagonist (VKA) reversal prior to invasive procedure. Methods. A post hoc analysis of two phase III trials of 4F-PCC versus plasma in patients with acute/severe gastrointestinal bleeding. The treatment arms were compared for study treatment volume, infusion times, and time from start of study treatment to procedure. Results. Analysis included 42 patients (plasma, ; 4F-PCC, ). Median (interquartile range) infusion time was significantly shorter for the 4F-PCC group than for the plasma group (16 [13, 26] min versus 210 [149, 393] min; ). Median infusion volumes were significantly smaller (103 [80, 130] mL versus 870 [748, 1001] mL; ) and median time from study treatment initiation to first procedure was significantly shorter in the 4F-PCC group than in the plasma group (17.5 [12.8, 22.8] versus 23.9 [18.5, 62.0] h; ). Conclusions. In this analysis of patients with acute/severe gastrointestinal bleeding requiring urgent VKA reversal prior to an invasive procedure, 4F-PCC (compared with plasma) was associated with smaller infusion volumes, shorter infusion times, and reduced time to procedure. Majed A. Refaai, Truptesh H. Kothari, Shana Straub, Jacob Falcon, Ravi Sarode, Joshua N. Goldstein, Andres Brainsky, Laurel Omert, Martin L. Lee, and Truman J. Milling Copyright © 2017 Majed A. Refaai et al. All rights reserved. Perception and Attitude of Emergency Room Resident Physicians toward Middle East Respiratory Syndrome Outbreak Mon, 10 Apr 2017 00:00:00 +0000 http://www.hindawi.com/journals/emi/2017/6978256/ Introduction. Middle East respiratory syndrome (MERS) outbreaks have had a considerable negative impact on health systems in Saudi Arabia. We aimed to study the psychological impact of a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak on emergency room resident physicians (ERRPs). Methods. We assessed the MERS-related psychological impact and concerns of ERRPs using a self-report questionnaire. Results. The majority (91%) of the ERRPs agreed that their work put them at risk of infection, but most (65%) did not agree that they should not be looking after patients infected with MERS. Despite that, 54% of ERRPs reported being afraid of contracting the infection from infected patients and only 4.2% of them were willing to change their current job. The majority of the ERRPs (85%) felt that their job would expose their families to risk of infection. Conclusions. Our study demonstrated the considerable psychological impact of MERS outbreaks on ERRPs. The ERRPs’ concerns and the psychological impact of MERS outbreaks should be considered in greater detail by hospital policymakers. Mohammed Al Ghobain, Turki Aldrees, Abdullah Alenezi, Saleh Alqaryan, Dana Aldabeeb, Najed Alotaibi, Abdulrahman Aldhabib, Shaker Alghalibi, and Sami Alharethy Copyright © 2017 Mohammed Al Ghobain et al. All rights reserved. Effect of Focused Bedside Ultrasonography in Hypotensive Patients on the Clinical Decision of Emergency Physicians Sun, 05 Mar 2017 07:05:24 +0000 http://www.hindawi.com/journals/emi/2017/6248687/ We assessed the effect of focused point of care ultrasound (POCUS) used for critical nontraumatic hypotensive patients presenting to the emergency department of our hospital on the clinical decisions of the physicians and whether it led to the modification of the treatment modality. This prospective clinical study was conducted at the Emergency Department of Antalya Training and Research Hospital. Nontraumatic patients aged 18 and older who presented to our emergency department and whose systolic blood pressure was <100 mmHg or shock index (heart rate/systolic blood pressure) was >1 were included in the study. While the most probable preliminary diagnosis established by the physician before POCUS was consistent with the definitive diagnosis in 60.6% () of 180 patients included in the study, it was consistent with the definitive diagnosis in 85.0% () of the patients after POCUS (). POCUS performed for critical hypotensive patients presenting to the emergency department is an appropriate diagnostic tool that can be used to enable the physicians to make the accurate preliminary diagnosis and start the appropriate treatment in a short time. M. Ikbal Sasmaz, Faruk Gungor, Ramazan Guven, K. Can Akyol, Nalan Kozaci, and Mustafa Kesapli Copyright © 2017 M. Ikbal Sasmaz et al. All rights reserved. Tranexamic Acid (TXA) in Trauma Patients: Barriers to Use among Trauma Surgeons and Emergency Physicians Mon, 20 Feb 2017 09:35:45 +0000 http://www.hindawi.com/journals/emi/2017/4235785/ Objective. Tranexamic Acid (TXA) is currently the only drug with prospective clinical evidence supporting its use in bleeding trauma patients. We sought to better understand the barriers preventing its use and elicit suggestions to further its use in trauma patients in the state of Maryland. Methods. This is a cross-sectional study. Results. The overall response rate was 38%. Half of all participants reported being familiar with the CRASH-2 trial and MATTERs study. Half reported being aware of TXA as part of their institution’s massive transfusion protocol. The majority of participants felt that TXA would have a significant positive impact on the survival of trauma patients. A majority also felt that the use of TXA would increase if its administration was the responsibility of both trauma surgeons and emergency physicians. Conclusion. Only half of responders reported being aware of TXA as being part of their institution’s massive transfusion protocol. Lack of awareness of the clinical data supporting its use is a major barrier. However, most trauma providers and emergency physicians do have a favorable view of TXA and support its incorporation into massive transfusion protocols. We believe that more studies of this kind on both state and national level are needed. Abdulaziz Alburaih Copyright © 2017 Abdulaziz Alburaih. All rights reserved. Public Medical Preparedness at the “Swiss Wrestling and Alpine Games 2013”: Descriptive Analysis of 1,533 Patients Treated at the Largest 3-Day Sporting Event in Switzerland Mon, 06 Feb 2017 08:12:11 +0000 http://www.hindawi.com/journals/emi/2017/9162095/ Introduction. Medical preparedness at mass gatherings is challenging, as little is known about the optimal planning. Most studies and case reports are based on mass casualty incidents, so the results cannot be extrapolated to mass gatherings. Aim of this study was to evaluate the preclinical medical structure and the frequency of specific injuries and medical emergencies during the event. Methods. Retrospective analysis of a prospectively collected database. Three on-site medical assistance points were set up, completed by mobile teams, and coordinated by an on-site operational management team. Medical staff requirements were calculated using Maurer’s formula. Results. A total of 1,533 patients were treated during the three-day event. Overall, the medical usage rate (MUR; patients per 10,000 visitors) was 51.1. A total of 58 patients (3.8%) required a hospital transfer. In 1,063 cases (69.3%) a diagnosis was documented. Of these, 503 patients (47.3%) suffered from hymenoptera stings; the two most common non-trauma-related diagnoses were alcohol/drug intoxication (4.1%) and gastrointestinal diseases (4.0%). Conclusion. Overall, the on-site medical care worked well. However, a high frequency of hymenoptera stings occurred, resulting in a shortage of antihistamine medication. Moreover, more than half of the patients were managed at the second largest medical assistance point. Prospective and critical evaluation of medical care at mass gatherings is crucial in order to optimize on-site medical preparedness at future events. Simone Hostettler-Blunier, Nora Müller, Tobias Haltmeier, Andreas Hosner, Heinz Bähler, Frank Neff, Daniel Baumberger, Aristomenis Exadaktylos, and Beat Schnüriger Copyright © 2017 Simone Hostettler-Blunier et al. All rights reserved. The Epidemiology of Hospital-Referred Head Injury in Ardabil City Wed, 01 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/emi/2017/1439486/ Background and Purpose. Trauma is the leading cause of death for youth in developing countries. Given the prevalence of head trauma (HT) in society and its complication and burden, the epidemiologic study of head trauma is necessary and is the main aim of this study. Materials and Methods. This retrospective population-based survey describes the epidemiology of head injury in a defined population in Ardabil city. It includes all 204 patients with head injury referred to the University Hospital of Ardabil, Iran, during 2013-2014. Data were collected by a checklist and analyzed by statistical methods in SPSS.19. Significance level was considered. Results. Of all registered cases, 146 (71.6%) were male and the rest of them were female. Most of HT patients lived in Ardabil city (60.8%). The mean age of patients was 22.6 ± 25.9 and most of victims were young. 24.5% of traumatic patients have injuries in severe to critical level (grade 3-4). The most cause of trauma was accidents (41.7%). Most of injuries occurred in night (55.9%) and in summer season (42.2%). Causes were traffic accident in 41.7%. Conclusion. Results showed that the leading cause of head trauma especially in the warm seasons is accidents and so, designing programs to reduce road accidents can dramatically reduce the rate of trauma in the future in Ardabil province. Esmaeil Farzaneh, Ghasem Fattahzadeh-Ardalani, Vahid Abbasi, Fariba Kahnamouei-aghdam, Behnam Molaei, Elham Iziy, and Habib Ojaghi Copyright © 2017 Esmaeil Farzaneh et al. All rights reserved. Adherence to Follow-Up Recommendations by Triathlon Competitors Receiving Event Medical Care Thu, 19 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/emi/2017/1375181/ Introduction. We sought to investigate triathlete adherence to recommendations for follow-up for participants who received event medical care. Methods. Participants of the 2011 Ironman Syracuse 70.3 (Syracuse, NY) who sought evaluation and care at the designated finish line medical tent were contacted by telephone approximately 3 months after the initial encounter to measure adherence with the recommendation to seek follow-up care after event. Results. Out of 750 race participants, 35 (4.6%) athletes received event medical care. Of these 35, twenty-eight (28/35; 80%) consented to participate in the study and 17 (61%) were available on telephone follow-up. Of these 17 athletes, 11 (11/17; 65%) of participants reported that they had not followed up with a medical professional since the race. Only 5 (5/17; 29%) confirmed that they had seen a medical provider in some fashion since the race; of these, only 2 (2/17; 12%) sought formal medical follow-up resulting from the recommendation whereas the remaining athletes merely saw their medical providers coincidentally or as part of routine care. Conclusion. Only 2 (2/17; 12%) of athletes who received event medical care obtained postrace follow-up within a one-month time period following the race. Event medical care providers must be aware of potential nonadherence to follow-up recommendations. Jeremy D. Joslin, Jarem B. Lloyd, Nikoli Copeli, and Derek R. Cooney Copyright © 2017 Jeremy D. Joslin et al. All rights reserved. Qualitative Inquiry into Challenges Experienced by Registered General Nurses in the Emergency Department: A Study of Selected Hospitals in the Volta Region of Ghana Thu, 03 Nov 2016 13:34:37 +0000 http://www.hindawi.com/journals/emi/2016/6082105/ Registered General Nurses (RGNs) play crucial roles in emergency departments (EDs). EDs in Ghana are primarily staffed by RGNs who have had no additional formal education in emergency care. Additionally, basic, master’s, or doctoral level nursing education programs provide limited content on the complexities of emergency nursing. Nurses in EDs are affected by many challenges such as growing patient population, financial pressures, physical violence, verbal abuse, operational inefficiencies, overcrowding, and work overload. There is a paucity of research on challenges experienced by RGNs in EDs in the Volta Region of Ghana. In this qualitative study, twenty RGNs in EDs from three selected hospitals in the Volta Region of Ghana were interviewed. All recorded interviews were transcribed, reviewed several times by researchers and supervisors, and analyzed using content analysis. Five thematic categories were identified. These thematic categories of challenges were lack of preparation for ED role, verbal abuse from patients relatives, lack of resources in ED, stressful and time consuming nature of ED, and overcrowding in ED. Formal education of RGNs in the advanced role of emergency care, adequate supply of resources, increased hospital management support, and motivations for RGNs working in ED are necessary to improve the practice of emergency care. Confidence Alorse Atakro, Jerry Paul Ninnoni, Peter Adatara, Janet Gross, and Michael Agbavor Copyright © 2016 Confidence Alorse Atakro et al. All rights reserved. Mandibular Fractures Admitted to the Emergency Department: Data Analysis from a Swiss Level One Trauma Centre Tue, 30 Aug 2016 15:47:26 +0000 http://www.hindawi.com/journals/emi/2016/3502902/ Mandibular fracture is a common occurrence in emergency medicine and belongs to the most frequent facial fractures. Historically road traffic injuries (RTIs) have played a prominent role as a cause for mandibular fractures. We extracted data from all patients between August 2012 and February 2015 with “lower jaw fracture” or “mandibular fracture” from the routine database from the emergency department. We conducted a descriptive analysis at a Swiss level one trauma centre. 144 patients were admitted with suspected mandibular fractures. The majority underwent CT diagnostic (83%). In 7% suspected mandibular fracture was not confirmed. More than half of all patients suffered two or more fractures. The fractures were median or paramedian in 77/144 patients (53%) and in other parts (corpus, mandibular angle, ramus mandibularis, collum, and temporomandibular joint) in 100/144 (69%). Male to female ratio was 3 : 1 up to 59 years of age; 69% were younger than 40 years. 72% of all patients presented during daytime, 69% had to be hospitalized, and 31% could be discharged from the ED after treatment. Most fractures were due to fall (44%), followed by interpersonal violence (25%) and sport activities (12%). Falls were a dominant cause of fracture in all age groups while violence and sport activities were common only in younger patients. Comparisons to other studies were difficult due to lack of standardization of causes contributing to the injuries. In the observed time period and setting RTIs have played a minor role compared to falls, interpersonal violence, and sports. In the future, standardized documentation as well as categorization of causes for analytic purposes is urgently needed to facilitate international comparison of studies. Kemal Yildirgan, Edris Zahir, Siamak Sharafi, Sufian Ahmad, Benoit Schaller, Meret E. Ricklin, and Aristomenis K. Exadaktylos Copyright © 2016 Kemal Yildirgan et al. All rights reserved. Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients Wed, 03 Aug 2016 12:48:42 +0000 http://www.hindawi.com/journals/emi/2016/5437490/ Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training. Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel. Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88–1.42; ). Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25–1.55) for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43–1.77). Conclusion. Simulation training improved prehospital care providers’ confidence level in performing two life-saving procedures. Christine M. Van Dillen, Matthew R. Tice, Archita D. Patel, David A. Meurer, Joseph A. Tyndall, Marie Carmelle Elie, and Jonathan J. Shuster Copyright © 2016 Christine M. Van Dillen et al. All rights reserved. Revisits within 48 Hours to a Thai Emergency Department Wed, 13 Jul 2016 14:26:27 +0000 http://www.hindawi.com/journals/emi/2016/8983573/ Objective. Emergency department (ED) revisits are a common ED quality measure. This study was undertaken to ascertain the contributing factors of revisits within 48 hours to a Thai ED and to explore physician-related, illness-related, and patient-related factors behind those revisits. Methods. This study was a chart review from one tertiary care, urban Thai hospital from October 1, 2009, to September 31, 2010. We identified patients who returned to the ED within 48 hours for the same or related complaints after their initial discharge. Three physicians classified revisit as physician-related, illness-related, and patient-related factors. Results. Our study included 172 ED patients’ charts. 86/172 (50%) were male and the mean age was (SD) years. The ED revisits contributing factors were physician-related factors [86/172 (50.0%)], illness-related factors [61/172 (35.5%)], and patient-related factor [25/172 (14.5%)], respectively. Among revisits classified as physician-related factors, 40/86 (46.5%) revisits were due to misdiagnosis and 36/86 (41.9%) were due to suboptimal management. Abdominal pain [27/86 (31.4%)] was the majority of physician-related chief complaints, followed by fever [16/86 (18.6%)] and dyspnea [15/86 (17.4%)]. Conclusion. Misdiagnosis and suboptimal management contributed to half of the 48-hour repeat ED visits in this Thai hospital. Jiraporn Sri-on, Adisak Nithimathachoke, Gregory Philip Tirrell, Sataporn Surawongwattana, and Shan Woo Liu Copyright © 2016 Jiraporn Sri-on et al. All rights reserved. Disparities in Survival with Bystander CPR following Cardiopulmonary Arrest Based on Neighborhood Characteristics Thu, 09 Jun 2016 06:20:11 +0000 http://www.hindawi.com/journals/emi/2016/6983750/ The American Heart Association reports the annual incidence of out-of-hospital cardiopulmonary arrests (OHCA) is greater than 300,000 with a survival rate of 9.5%. Bystander cardiopulmonary resuscitation (CPR) saves one life for every 30, with a 10% decrease in survival associated with every minute of delay in CPR initiation. Bystander CPR and training vary widely by region. We conducted a retrospective study of 320 persons who suffered OHCA in South Florida over 25 months. Increased survival, overall and with bystander CPR, was seen with increasing income (), with a stronger disparity between low- and high-income neighborhoods ( and , resp.). Survival with bystander CPR was statistically greater in white- versus black-predominant neighborhoods (). Increased survival, overall and with bystander CPR, was seen with high- versus low-education neighborhoods (). Neighborhoods with more high school age persons displayed the lowest survival. We discovered a significant disparity in OHCA survival within neighborhoods of low-income, black-predominance, and low-education. Reduced survival was seen in neighborhoods with larger populations of high school students. This group is a potential target for training, and instruction can conceivably change survival outcomes in these neighborhoods, closing the gap, thus improving survival for all. Nina Thakkar Rivera, Shari L. Kumar, Rohit K. Bhandari, and Sunil D. Kumar Copyright © 2016 Nina Thakkar Rivera et al. All rights reserved. Direct-Acting Oral Anticoagulants: Practical Considerations for Emergency Medicine Physicians Mon, 16 May 2016 12:37:12 +0000 http://www.hindawi.com/journals/emi/2016/1781684/ Nonvalvular atrial fibrillation- (NVAF-) related stroke and venous thromboembolism (VTE) are cardiovascular diseases associated with significant morbidity and economic burden. The historical standard treatment of VTE has been the administration of parenteral heparinoid until oral warfarin therapy attains a therapeutic international normalized ratio. Warfarin has been the most common medication for stroke prevention in NVAF. Warfarin use is complicated by a narrow therapeutic window, unpredictable dose response, numerous food and drug interactions, and requirements for frequent monitoring. To overcome these disadvantages, direct-acting oral anticoagulants (DOACs)—dabigatran, rivaroxaban, apixaban, and edoxaban—have been developed for the prevention of stroke or systemic embolic events (SEE) in patients with NVAF and for the treatment of VTE. Advantages of DOACs include predictable pharmacokinetics, few drug-drug interactions, and low monitoring requirements. In clinical studies, DOACs are noninferior to warfarin for the prevention of NVAF-related stroke and the treatment and prevention of VTE as well as postoperative knee and hip surgery VTE prophylaxis, with decreased bleeding risks. This review addresses the practical considerations for the emergency physician in DOAC use, including dosing recommendations, laboratory monitoring, anticoagulation reversal, and cost-effectiveness. The challenges of DOACs, such as the lack of specific laboratory measurements and antidotes, are also discussed. W. Frank Peacock, Zubaid Rafique, and Adam J. Singer Copyright © 2016 W. Frank Peacock et al. All rights reserved. Coca: The History and Medical Significance of an Ancient Andean Tradition Thu, 07 Apr 2016 14:06:18 +0000 http://www.hindawi.com/journals/emi/2016/4048764/ Coca leaf products are an integral part of the lives of the Andean peoples from both a cultural and traditional medicine perspective. Coca is also the whole plant from which cocaine is derived. Coca products are thought to be a panacea for health troubles in regions of South America. This review will examine the toxicology of whole coca and will also look at medicinal applications of this plant, past, present, and future. Amy Sue Biondich and Jeremy David Joslin Copyright © 2016 Amy Sue Biondich and Jeremy David Joslin. All rights reserved. Trainers’ Attitudes towards Cardiopulmonary Resuscitation, Current Care Guidelines, and Training Wed, 06 Apr 2016 11:36:39 +0000 http://www.hindawi.com/journals/emi/2016/3701468/ Objectives. Studies have shown that healthcare personnel hesitate to perform defibrillation due to individual or organisational attitudes. We aimed to assess trainers’ attitudes towards cardiopulmonary resuscitation and defibrillation (CPR-D), Current Care Guidelines, and associated training. Methods. A questionnaire was distributed to CPR trainers attending seminars in Finland () focusing on the updated national Current Care Guidelines 2011. The questions were answered using Likert scale (1 = totally disagree, 7 = totally agree). Factor loading of the questionnaire was made using maximum likelihood analysis and varimax rotation. Seven scales were constructed (Hesitation, Nurse’s Role, Nontechnical Skill, Usefulness, Restrictions, Personal, and Organisation). Cronbach’s alphas were 0.92–0.51. Statistics were Student’s -test, ANOVA, stepwise regression analysis, and Pearson Correlation. Results. The questionnaire was returned by 124/185, 67% CPR trainers, of whom two-thirds felt that their undergraduate training in CPR-D had not been adequate. Satisfaction with undergraduate defibrillation training correlated with the Nontechnical Skills scale (). Participants scoring high on Hesitation scale () were less confident about their Nurse’s Role () and Nontechnical Skills (). Conclusion. Quality of undergraduate education affects the work of CPR trainers and some feel uncertain of defibrillation. The train-the-trainers courses and undergraduate medical education should focus more on practical scenarios with defibrillators and nontechnical skills. M. Mäkinen, M. Castrén, J. Nurmi, and L. Niemi-Murola Copyright © 2016 M. Mäkinen et al. All rights reserved. Use of the Vocera Communications Badge Improves Public Safety Response Times Mon, 04 Apr 2016 11:33:11 +0000 http://www.hindawi.com/journals/emi/2016/7158268/ Objectives. Violence in the Emergency Department (ED) has been a long-standing issue complicated by deficiencies in staff training, ease of weapons access, and response availability of public safety officers. The Vocera Badge is being used by our staff to request public safety assistance in lieu of a formal phone call to the University Police Communications Center. We sought to learn if use of this technology improved officer response times to the ED. Methods. Mean response times were reviewed and descriptive statistics analyzed to determine if the use of the Vocera Badge improved public safety officer response times to the ED. Results. Average response times improved from an average of 3.2 minutes (SD = 0.456) in the 6 months before the use of the communication badges to an average of 1.02 minutes (SD = 0.319) in the 6 months after use began. Conclusions. The use of the Vocera Badge seemed to decrease response times of public safety officers to our ED compared with the traditional method of calling a dispatch center to request assistance. Jeremy D. Joslin, David Goldberger, Loretta Johnson, and D. Paul Waltz Copyright © 2016 Jeremy D. Joslin et al. All rights reserved. Reducing Time to First on Scene: An Ambulance-Community First Responder Scheme Mon, 28 Mar 2016 14:04:29 +0000 http://www.hindawi.com/journals/emi/2016/1915895/ The importance of early access to prehospital care has been demonstrated in many medical emergencies. This work aims to describe the potential time benefit of implementing a student Community First Responder scheme to support ambulance services in an inner-city setting in the United Kingdom. Twenty final and penultimate year medical students in the UK were trained in the “First Person on Scene” Business and Technology Education Council (BTEC) qualification. Over 12 months, they attended 89 emergency calls in an inner-city setting as Community First Responders (CFRs), alongside the West Midlands Ambulance Service, UK. At the end of this period, a qualitative survey investigated the perceived educational value of the scheme. The mean CFR response time across all calls was an average of 3 minutes and 8 seconds less than ambulance crew response times. The largest difference was to calls relating to falls (12 min). The difference varied throughout the day, peaking between 16:00 and 18:00. All questionnaire respondents stated that they felt more prepared in assessing and treating acutely unwell patients. In this paper, the authors present a symbiotic solution which has both reduced time to first on scene and provided training and experience in medical emergencies for senior medical students. Alan Campbell and Matt Ellington Copyright © 2016 Alan Campbell and Matt Ellington. All rights reserved. Paramedic Recognition of Sepsis in the Prehospital Setting: A Prospective Observational Study Wed, 09 Mar 2016 13:39:03 +0000 http://www.hindawi.com/journals/emi/2016/6717261/ Background. Patients with sepsis benefit from early diagnosis and treatment. Accurate paramedic recognition of sepsis is important to initiate care promptly for patients who arrive by Emergency Medical Services. Methods. Prospective observational study of adult patients (age ≥ 16 years) transported by paramedics to the emergency department (ED) of a Canadian tertiary hospital. Paramedic identification of sepsis was assessed using a novel prehospital sepsis screening tool developed by the study team and compared to blind, independent documentation of ED diagnoses by attending emergency physicians (EPs). Specificity, sensitivity, accuracy, positive and negative predictive value, and likelihood ratios were calculated with 95% confidence intervals. Results. Overall, 629 patients were included in the analysis. Sepsis was identified by paramedics in 170 (27.0%) patients and by EPs in 71 (11.3%) patients. Sensitivity of paramedic sepsis identification compared to EP diagnosis was 73.2% (95% CI 61.4–83.0), while specificity was 78.8% (95% CI 75.2–82.2). The accuracy of paramedic identification of sepsis was 78.2% (492/629, 52 true positive, 440 true negative). Positive and negative predictive values were 30.6% (95% CI 23.8–38.1) and 95.9% (95% CI 93.6–97.5), respectively. Conclusion. Using a novel prehospital sepsis screening tool, paramedic recognition of sepsis had greater specificity than sensitivity with reasonable accuracy. Robert S. Green, Andrew H. Travers, Edward Cain, Samuel G. Campbell, Jan L. Jensen, David A. Petrie, Mete Erdogan, Gredi Patrick, and Ward Patrick Copyright © 2016 Robert S. Green et al. All rights reserved. Routine Head Computed Tomography for Patients in the Emergency Room with Trauma Requires Both Thick- and Thin-Slice Images Thu, 11 Feb 2016 09:51:56 +0000 http://www.hindawi.com/journals/emi/2016/5781790/ Background. Images of head CT for the supratentorial compartment are sometimes recommended to be reconstructed with a thickness of 8–10 mm to achieve lesion conspicuity. However, additional images of a thin slice may not be routinely provided for patients with trauma in the emergency room (ER). We investigated the diagnostic sensitivity of a head CT, where axial images were 10 mm thick slices, in cases of linear skull fractures. Methods. Two trauma surgeons retrospectively reviewed head CT with 10 mm slices and skull X-rays of patients admitted to the ER that were diagnosed with a linear skull fracture. All patients had undergone both head CT and skull X-rays (). Result. The diagnostic sensitivity of head CT with a thickness of sequential 10 mm was 89% for all linear skull fractures but only 56% for horizontal fractures. This CT technique with 10 mm slices missed 6% of patients with linear skull fractures. False-negative diagnoses were significantly more frequent for older (≥55 years) than for young (<15 years) individuals (). Conclusions. A routine head CT of the supratentorial region for patients in the ER with head injuries requires both thick-slice images to visualize cerebral hemispheres and thin-slice images to detect skull fractures of the cranial vault. Kazuhide Maetani, Jun Namiki, Shokei Matsumoto, Katsutoshi Matsunami, Atsushi Narumi, Toshimi Tsuneyoshi, and Masanobu Kishikawa Copyright © 2016 Kazuhide Maetani et al. All rights reserved. Using Fresh Frozen Plasma for Acute Airway Angioedema to Prevent Intubation in the Emergency Department: A Retrospective Cohort Study Wed, 03 Feb 2016 12:18:28 +0000 http://www.hindawi.com/journals/emi/2016/6091510/ Background. Angioedema (AE) is a common condition which can be complicated by laryngeal edema, having up to 40% mortality. Although sporadic case reports attest to the benefits of fresh frozen plasma (FFP) in treating severe acute bouts of AE, little evidence-based support for this practice is available at present. Study Objectives. To compare the frequency, duration of intubation, and length of intensive care unit (ICU) stay in patients with acute airway AE, with and without the use of FFP. Methods. A retrospective cohort study was conducted, investigating adults admitted to large community hospital ICU with a diagnosis of AE during the years of 2007–2012. Altogether, 128 charts were reviewed for demographics, comorbidities, hospital courses, and outcomes. A total of 20 patients received FFP (108 did not). Results. Demographics and comorbidities did not differ by treatment group. However, nontreated controls did worse in terms of intubation frequency (60% versus 35%; ) and ICU stay (3.5 days versus 1.5 days; ). Group outcomes were otherwise similar. Conclusion. In an emergency department setting, the use of FFP should be considered in managing acute airway nonhereditary AE (refractory to steroid, antihistamine, and epinephrine). Larger prospective, better controlled studies are needed to devise appropriate treatment guidelines. Aya Saeb, Karen H. Hagglund, and Christine T. Cigolle Copyright © 2016 Aya Saeb et al. All rights reserved. New Insights into the Role of Metformin Effects on Serum Omentin-1 Levels in Acute Myocardial Infarction: Cross-Sectional Study Mon, 23 Nov 2015 13:31:20 +0000 http://www.hindawi.com/journals/emi/2015/283021/ Background. Serum omentin-1 level was low in the most types of ischemic heart disease compared to normal subjects; it also dependently correlated with coronary heart disease; thus, omentin-1 is regarded as a novel biomarker in IHD. Objective. The aim of the present study was to establish the links between omentin-1 and acute myocardial infarction in metformin patients. Subjects and Methods. A cross-sectional study was performed on eighty-five patients with type II DM and acute MI. They are divided as follows: Group I, 62 patients with type II DM who received metformin prior to onset of acute MI; Group II, 23 patients with type II DM who did not receive metformin prior to onset of acute MI; and Group III, 30 normal healthy controls. Venous blood was drawn from each participant for determination of lipid profile, plasma omentin-1, cardiac troponin-I (cTn-I) and other routine tests. Results. Patients that presented with acute MI that received metformin show a significant difference in all biochemical parameters (); metformin increases serum omentin-1 level and decreases serum cardiac troponin-I level compared with control subjects and nonmetformin treated patients. Conclusion. Metformin pharmacotherapy increases omentin-1 serum levels and may be regarded as a potential agent in the prevention of the occurrences of acute MI in diabetic patients. Hayder M. Alkuraishy and Ali I. Al-Gareeb Copyright © 2015 Hayder M. Alkuraishy and Ali I. Al-Gareeb. All rights reserved. Validation of EGSYS Score in Prediction of Cardiogenic Syncope Mon, 16 Nov 2015 09:48:44 +0000 http://www.hindawi.com/journals/emi/2015/515370/ Introduction. Evaluation of Guidelines in Syncope Study (EGSYS) is designed to differentiate between cardiac and noncardiac causes of syncope. The present study aimed to evaluate the accuracy of this predictive model. Methods. In this prospective cross-sectional study, screening performance characteristics of EGSYS-U (univariate) and EGSYS-M (multivariate) in prediction of cardiac syncope were calculated for syncope patients who were referred to the emergency department (ED). Results. 198 patients with mean age of 59.26 ± 19.5 years were evaluated (62.3% male). 115 (58.4%) patients were diagnosed with cardiac syncope. Area under the ROC curve was 0.818 (95% CI: 0.75–0.87) for EGSYS-U and 0.805 (CI 95%: 0.74–0.86) for EGSYS-M (). Best cut-off point for both models was 3. Sensitivity and specificity were 86.08% (95% CI: 78.09–91.59) and 68.29% (95% CI: 56.97–77.86) for EGSYS-U and 91.30% (95% CI: 84.20–95.52) and 57.32% (95% CI: 45.92–68.02) for EGSYS-M, respectively. Conclusion. The results of this study demonstrated the acceptable accuracy of EGSYS score in predicting cardiogenic causes of syncope at the 3 cut-off point. It seems that using this model in daily practice can help physicians select at risk patients and properly triage them. Hamid Kariman, Sepideh Harati, Saeed Safari, Alireza Baratloo, and Mehdi Pishgahi Copyright © 2015 Hamid Kariman et al. All rights reserved. Medical History of Elderly Patients in the Emergency Setting: Not an Easy Point-of-Care Diagnostic Marker Thu, 03 Sep 2015 13:26:27 +0000 http://www.hindawi.com/journals/emi/2015/490947/ Background. Medical histories are a crucially important diagnostic tool. Elderly patients represent a large and increasing group of emergency patients. Due to cognitive deficits, taking a reliable medical history in this patient group can be difficult. We sought to evaluate the medical history-taking in emergency patients above 75 years of age with respect to duration and completeness. Methods. Anonymous data of consecutive patients were recorded. Times for the defined basic medical history-taking were documented, as were the availability of other sources and times to assess these. Results. Data of 104 patients were included in the analysis. In a quarter of patients (25%, ) no complete basic medical history could be obtained. In the group of patients where complete data could be gathered, only 16 patients were able to provide all necessary information on their own. Including other sources like relatives or GPs prolonged the time until complete medical history from 7.3 minutes (patient only) to 26.4 (+relatives) and 56.3 (+GP) minutes. Conclusions. Medical histories are important diagnostic tools in the emergency setting and are prolonged in the elderly, especially if additional documentation and third parties need to be involved. New technologies like emergency medical cards might help to improve the availability of important patient data but implementation of these technologies is costly and faces data protection issues. Tobias Lindner, Anna Slagman, Arthur Senkin, Martin Möckel, and Julia Searle Copyright © 2015 Tobias Lindner et al. All rights reserved. Ultrasound Guided Intravenous Access by Nursing versus Resident Staff in a Community Based Teaching Hospital: A “Noninferiority” Trial Sun, 30 Aug 2015 06:15:21 +0000 http://www.hindawi.com/journals/emi/2015/563139/ Objectives. Ultrasound (US) guidance is a safe and effective method for peripheral intravenous (IV) catheter placement. However, no studies have directly compared the success rate of emergency medicine (EM) residents and nurses at using this technique especially in community hospital settings. This prospective “noninferiority” study sought to demonstrate that nursing staff are at least as successful as EM residents at placing US guided IVs. Methods. A group of 5 EM residents and 11 nurse volunteers with at least two years’ experience underwent training sessions in hands-on practice and didactic instruction with prospective follow-up. Two failed attempts on a patient using standard approach by an emergency department (ED) nurse were deemed to be “difficult sticks” and randomly assigned to either a nurse or resident, based on the day they presented. Results. A total of 90 attempts, consisting of trials on 90 patients, were recorded with a success rate of 85% and 86% for residents and nurses, respectively. With a value of .305, there was no statistically significant difference in the success rate between the residents and nurses. Conclusion. Properly trained nursing staff can be as equally successful as EM residents in placing US guided intravenous lines. Thomas Carter, Chris Conrad, J. Link Wilson, and Godwin Dogbey Copyright © 2015 Thomas Carter et al. All rights reserved. Morbidity and Mortality following Traditional Uvulectomy among Children Presenting to the Muhimbili National Hospital Emergency Department in Dar es Salaam, Tanzania Tue, 16 Jun 2015 12:16:07 +0000 http://www.hindawi.com/journals/emi/2015/108247/ Background. Traditional uvulectomy is performed as a cultural ritual or purported medical remedy. We describe the associated emergency department (ED) presentations and outcomes. Methods. This was a subgroup analysis of a retrospective review of all pediatric visits to our ED in 2012. Trained abstracters recorded demographics, clinical presentations, and outcomes. Results. Complete data were available for 5540/5774 (96%) visits and 56 (1.0%, 95% CI: 0.7–1.3%) were related to recent uvulectomy, median age 1.3 years (interquartile range: 7 months–2 years) and 30 (54%) were male. Presenting complaints included cough (82%), fever (46%), and hematemesis (38%). Clinical findings included fever (54%), tachypnea (30%), and tachycardia (25%). 35 patients (63%, 95% CI: 49–75%) received intravenous antibiotics, 11 (20%, 95% CI: 10–32%) required blood transfusion, and 3 (5%, 95% CI: 1–15%) had surgical intervention. All were admitted to the hospital and 12 (21%, 95% CI: 12–34%) died. By comparison, 498 (9.1%, 95% CI: 8–10%) of the 5484 children presenting for reasons unrelated to uvulectomy died (). Conclusion. In our cohort, traditional uvulectomy was associated with significant morbidity and mortality. Emergency care providers should advocate for legal and public health interventions to eliminate this dangerous practice. H. R. Sawe, J. A. Mfinanga, F. H. Ringo, V. Mwafongo, T. A. Reynolds, and M. S. Runyon Copyright © 2015 H. R. Sawe et al. All rights reserved. Use of the SONET Score to Evaluate High Volume Emergency Department Overcrowding: A Prospective Derivation and Validation Study Mon, 08 Jun 2015 12:10:32 +0000 http://www.hindawi.com/journals/emi/2015/401757/ Background. The accuracy and utility of current Emergency Department (ED) crowding estimation tools remain uncertain in EDs with high annual volumes. We aimed at deriving a more accurate tool to evaluate overcrowding in a high volume ED setting and determine the association between ED overcrowding and patient care outcomes. Methods. A novel scoring tool (SONET: Severely overcrowded-Overcrowded-Not overcrowded Estimation Tool) was developed and validated in two EDs with both annual volumes exceeding 100,000. Patient care outcomes including the number of left without being seen (LWBS) patients, average length of ED stay, ED 72-hour returns, and mortality were compared under the different crowding statuses. Results. The total number of ED patients, the number of mechanically ventilated patients, and patient acuity levels were independent risk factors affecting ED overcrowding. SONET was derived and found to better differentiate severely overcrowded, overcrowded, and not overcrowded statuses with similar results validated externally. In addition, SONET scores correlated with increased length of ED stay, number of LWBS patients, and ED 72-hour returns. Conclusions. SONET might be a better fit to determine high volume ED overcrowding. ED overcrowding negatively impacts patient care operations and often produces poor patient perceptions of standardized care delivery. Hao Wang, Richard D. Robinson, John S. Garrett, Kellie Bunch, Charles A. Huggins, Katherine Watson, Joni Daniels, Brett Banks, James P. D’Etienne, and Nestor R. Zenarosa Copyright © 2015 Hao Wang et al. All rights reserved. The Burden of Hand Injuries at a Tertiary Hospital in Sub-Saharan Africa Mon, 01 Jun 2015 09:46:29 +0000 http://www.hindawi.com/journals/emi/2015/838572/ Background. Hand injuries are common worldwide and lead to heavy financial losses in terms of treatment, job loss, and time off duty. There is paucity of data on hand injuries in sub-Saharan Africa. The aim of this study was to determine the burden and early outcomes of hand injuries at a tertiary hospital. Method. A descriptive prospective study. Eligible patients were recruited over 5 months and followed up for four weeks. Pain, nerve function, and gross functions of the hand were assessed. Results. In total 138 patients were enrolled out of 2940 trauma patients. Of these, 122 patients returned for follow-up. The majority of the patients were males (83%). Mean age was 26.7 years (SD 12.8). The commonest places of injury occurrence were the workplace (36%), home (28%), and on the road (traffic crushes) (23%). Machines (21.3%) were the commonest agent of injuries; others were knives (10%) and broken glass (10%). Sixty-three (51%) patients still had pain at one month. Conclusions. Hand injuries accounted for 4.7% of all trauma patients. Road traffic crushes and machines were the commonest causes of hand injuries. Men in their 20s were mostly involved. Sensitization for prevention strategies at the workplace may be helpful. P. Makobore, M. Galukande, E. Kalanzi, and S. C. Kijjambu Copyright © 2015 P. Makobore et al. All rights reserved. Peritoneal Breach as an Indication for Exploratory Laparotomy in Penetrating Abdominal Stab Injury: Operative Findings in Haemodynamically Stable Patients Tue, 12 May 2015 13:42:17 +0000 http://www.hindawi.com/journals/emi/2015/407173/ Introduction. Management of haemodynamically stable patients with penetrating abdominal injuries varies from nonoperative to operative management. The aim was to investigate whether peritoneal breach when used as an indication for exploratory laparotomy appropriately identified patients with intra-abdominal visceral injury. Methods. We conducted retrospective cohort study of all patients presenting with PAI at a major trauma centre from January 2007 to December 2011. We measured the incidence of peritoneal breach and correlated this with intra-abdominal visceral injury diagnosed at surgery. Results. 252 patients were identified with PAI. Of the included patients, 71 were managed nonoperatively and 118 operatively. The operative diagnoses included nonperitoneal-breaching injuries, intraperitoneal penetration without organ damage, or intraperitoneal injury with organ damage. The presenting trauma CT scan was reported as normal in 63%, 34%, and 2% of these groups, respectively. The total negative laparotomy/laparoscopy rate for all patients presented with PAI was 21%, almost half of whom had a normal CT scan. Conclusion. We found that peritoneal breach on its own does not necessarily always equate to intra-abdominal visceral injury. Observation with sequential examination for PAI patients with a normal CT scan may be more important than exclusion of peritoneal breach via laparoscopy. Jasmina Kevric, Victor Aguirre, Kate Martin, Dinesh Varma, Mark Fitzgerald, and Charles Pilgrim Copyright © 2015 Jasmina Kevric et al. All rights reserved. Isolated T Wave Inversion in Lead aVL: An ECG Survey and a Case Report Thu, 09 Apr 2015 11:52:31 +0000 http://www.hindawi.com/journals/emi/2015/250614/ Background. Computerized electrocardiogram (ECG) analysis has been of tremendous help for noncardiologists, but can we rely on it? The importance of ST depression and T wave inversions in lead aVL has not been emphasized and not well recognized across all specialties. Objective. This study’s goal was to analyze if there is a discrepancy of interpretation by physicians from different specialties and a computer-generated ECG reading in regard to a TWI in lead aVL. Methods. In this multidisciplinary prospective study, a single ECG with isolated TWI in lead aVL that was interpreted by the computer as normal was given to all participants to interpret in writing. The readings by all physicians were compared by level of education and by specialty to one another and to the computer interpretation. Results. A total of 191 physicians participated in the study. Of the 191 physicians 48 (25.1%) identified and 143 (74.9%) did not identify the isolated TWI in lead aVL. Conclusion. Our study demonstrated that 74.9% did not recognize the abnormality. New and subtle ECG findings should be emphasized in their training so as not to miss significant findings that could cause morbidity and mortality. Getaw Worku Hassen, Ana Costea, Claire Carrazco, Tsion Frew, Anand Swaminathan, Jason Feliberti, Roger Chirurgi, Tennyson Smith, Alice Chen, Sarah Thompson, Neola Gushway-Henry, Bonnie Simmons, George Fernaine, Hossein Kalantari, and Soheila Talebi Copyright © 2015 Getaw Worku Hassen et al. All rights reserved. An Online Tool for Nurse Triage to Evaluate Risk for Acute Coronary Syndrome at Emergency Department Thu, 02 Apr 2015 10:48:26 +0000 http://www.hindawi.com/journals/emi/2015/413047/ Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.220 (1.445, 12.327), 3.333 (1.040, 10.684), and 12.539 (3.876, 40.567), respectively. Conclusions. The effectiveness of the ED nurse triage for ACS was 16%. The online tool is available for the ED triage nurse to evaluate risk of ACS in individuals. Yuwares Sittichanbuncha, Patchaya Sanpha-asa, Theerayut Thongkrau, Chaiyapon Keeratikasikorn, Noppadol Aekphachaisawat, and Kittisak Sawanyawisuth Copyright © 2015 Yuwares Sittichanbuncha et al. All rights reserved.