Iranian Journal of Emergency Medicine

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences  have attempted to provide us with information related to the novel coronavirus.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

سخنرانی رئیس سازمان جهانی بهداشت در نشست خبری رسانه ای درباره کورونا ویروس 28 فوریه 2020

در 24 ساعت گذشته، چین 329 مورد را گزارش کرده است، این تعداد کمترین تعداد در یک ماه گذشته است.

تا ساعت 6 صبح امروز به وقت ژنو، چین در کل 78959 مورد مبتلا را به WHO گزارش داده است که شامل 2791 مورد مرگ بوده است. در خارج از کشور چین هم اکنون 4351 مورد در 49 کشور و 67 مورد فوت اتفاق افتاده است. از دیروز کشور های دانمارک، استونی، لیتوانی، هلند و نیجریه تولین موارد ابتلا به کوروناویروس را گزارش کرده اند. همه این کشور  ها به طریقی با ایتالیا در ارتباط هستند.

از ایتالیا 24 فرد مبتلا به 14 کشور و از ایران 97 مورد به 11 کشور دنیا وارد شده اند.

افزایش مداوم تعداد موارد و تعداد کشورهای مبتلا طی چند روز گذشته نگران کننده است. اپیدمیولوژیست های ما به طور مداوم این پیشرفت ها را رصد می کنند و ما اکنون ارزیابی خود را در مورد خطر انتشار و خطر ابتلا به COVID-19 به سطح بسیار بالا در سطح جهانی افزایش داده ایم.

آنچه که در حال حاضر می بینیم اپیدمی های مرتبط با هم COVID-19 در چندین کشور است اما اکثر این بیماران همچنان قابل ردیابی به موارد شناخته شده از بیماری یا خوشه هایی از بیماری می باشند. ما شواهدی مبنی بر این که ویروس به صورت آزاد در جوامع در حال چرخش است را نمی بینیم.

سناریوهای مختلفی در کشورهای مختلف و حتی سناریوهای مختلف در یک کشور وجود دارد، نکته کلیدی شکستن زنجیره های انتقال این ویروس است. دیروز درخصوص کارهایی که کشورها باید برای آماده سازی بیماران و جلوگیری از انتقال پیشرونده ویروس انجام دهند نیز صحبت کردم.

گزارش ماموریت مشترک WHO و چین هم اکنون منتشر شده است که به زبان انگلیسی در وب سایت WHO موجود است و همچنین در وب سایت کمیسیون بهداشت ملی به زبان چینی نیز موجود است.

مطالب علمی و اخبار از سایت WHO

سازمان ملل متحد 15 میلیون دلار برای کمک به کشورهای آسیب‌پذیر برای مبارزه با گسترش کرونا ویروس اهدا کرد.

1 مارس 2020

رئیس کمیته بشردوستانه سازمان ملل متحد امروز 15 میلیون دلار از صندوق مرکزی واکنش اضطراری (CERF)  برای کمک به تأمین اعتبار تلاش‌های جهانی برای مهار ویروس COVID-19 اهدا کرد.

این اطلاعیه در حالی اعلام شد که سازمان بهداشت جهانی خطر جهانی شیوع کروناویروس را در آخرین بیانیه خود "بسیار بالا" اعلام کرده بود.

افزایش ناگهانی موارد ابتلا در ایتالیا، جمهوری اسلامی ایران و جمهوری کره بسیار نگران‌کننده است. اکنون موارد بیماری کرونا ویروس واردشده به بحرین، عراق، کویت و عمان از کشور ایران و همچنین موارد بیماری وارده شده به الجزایر، اتریش، کرواسی، آلمان، اسپانیا و سوئیس از کشور ایتالیا گزارش‌شده است. بودجه سازمان ملل متحد به WHO و صندوق کودکان سازمان ملل متحد (یونیسف) اختصاص داده‌شده است. این بودجه برنامه فعالیت‌های اساسی ازجمله نظارت بر شیوع ویروس، بررسی موارد و عملکرد آزمایشگاه‌های ملی را خواهد کرد.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

To forecast the COVID-19 epidemic trend in Iran, a set of dynamic models were created. In these models, the effect of climate and community behavior change on the reproductive number is modeled. A baseline scenario is also defined as letting the epidemic grow naturally, with no prevention/control interventions. Different levels of intervention are also defined based on the extent of population isolation. Outcomes of each scenario on the number of infected cases are computed.

Modeling results shows that if effective isolation occurs in 10% of the population, 307,000 individuals will be infected with COVID-19 in Iran by May 20, 2020. For an isolation rate of 25%, started since March 10, 2020, cumulative number of deaths will be 13,450 individuals by May 20, 2020. If preventive efforts can reach a 32% effective isolation rate, a considerable decrease in the number of new cases would be expected during April and May, and the total number of deaths would decrease to 8,630. If the isolation rate increases to 40%, the total number of infected individuals is expected to be 6,030 individuals.

It should be acknowledged that this model predicts the number of deaths of all COVID-19 cases, including those who will not be confirmed as COVID-19, because of non-testing or death prior to COVID-19 identification.

This serious health issue requires both long-term and short-term planning and arrangements. Social distancing, and identification and isolation of suspected and confirmed cases are believed to be the most important and effective control measure, and should be strengthened soon. For further details on the methodology and results of these models, please visit:

http://corona.behdasht.gov.ir/files/site1/files/Covid_Modeling_V14_26.12.98.pdf

To forecast the COVID-19 epidemic trend in Iran, a set of dynamic models were created. In these models, the effect of climate and community behavior change on the reproductive number is modeled. A baseline scenario is also defined as letting the epidemic grow naturally, with no prevention/control interventions. Different levels of intervention are also defined based on the extent of population isolation. Outcomes of each scenario on the number of infected cases are computed.

Modeling results shows that if effective isolation occurs in 10% of the population, 307,000 individuals will be infected with COVID-19 in Iran by May 20, 2020. For an isolation rate of 25%, started since March 10, 2020, cumulative number of deaths will be 13,450 individuals by May 20, 2020. If preventive efforts can reach a 32% effective isolation rate, a considerable decrease in the number of new cases would be expected during April and May, and the total number of deaths would decrease to 8,630. If the isolation rate increases to 40%, the total number of infected individuals is expected to be 6,030 individuals.

It should be acknowledged that this model predicts the number of deaths of all COVID-19 cases, including those who will not be confirmed as COVID-19, because of non-testing or death prior to COVID-19 identification.

This serious health issue requires both long-term and short-term planning and arrangements. Social distancing, and identification and isolation of suspected and confirmed cases are believed to be the most important and effective control measure, and should be strengthened soon. For further details on the methodology and results of these models, please visit:

http://corona.behdasht.gov.ir/files/site1/files/Covid_Modeling_V14_26.12.98.pdf

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

To forecast the COVID-19 epidemic trend in Iran, a set of dynamic models were created. In these models, the effect of climate and community behavior change on the reproductive number is modeled. A baseline scenario is also defined as letting the epidemic grow naturally, with no prevention/control interventions. Different levels of intervention are also defined based on the extent of population isolation. Outcomes of each scenario on the number of infected cases are computed.

Modeling results shows that if effective isolation occurs in 10% of the population, 307,000 individuals will be infected with COVID-19 in Iran by May 20, 2020. For an isolation rate of 25%, started since March 10, 2020, cumulative number of deaths will be 13,450 individuals by May 20, 2020. If preventive efforts can reach a 32% effective isolation rate, a considerable decrease in the number of new cases would be expected during April and May, and the total number of deaths would decrease to 8,630. If the isolation rate increases to 40%, the total number of infected individuals is expected to be 6,030 individuals.

It should be acknowledged that this model predicts the number of deaths of all COVID-19 cases, including those who will not be confirmed as COVID-19, because of non-testing or death prior to COVID-19 identification.

This serious health issue requires both long-term and short-term planning and arrangements. Social distancing, and identification and isolation of suspected and confirmed cases are believed to be the most important and effective control measure, and should be strengthened soon. For further details on the methodology and results of these models, please visit:

http://corona.behdasht.gov.ir/files/site1/files/Covid_Modeling_V14_26.12.98.pdf

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

A number of researchers from the Epidemiology Department of the School of Public Health and Safety, Shahid Beheshti University of Medical Sciences and Kerman University of Medical Sciences have attempted to provide us with information related to the novel coronavirus.

Introduction: In the last 2 decades millions of people all over the world have lost their lives or encountered severe disabilities due to accidents and disasters. In this regard, telemedicine is one of the most recent advances in information technology and communication, a change that be useful in providing quality healthcare for people, especially in times of crisis, when optimum use of time is very important. Therefore, this study was performed with the aim of assessing telemedicine technology in accidents in teaching hospitals of Kerman. Methods: The present study was a cross-sectional one performed in 2018. The participants consisted of the chairmen, emergency medicine physicians, and information technology staff of selected teaching hospitals in Kerman and census method was used for their inclusion. The tool used for data gathering was a questionnaire designed by the researcher, validity and reliability of which was approved. SPSS version 21 was used for data analysis. Results: The results of the present study showed that the studied centers had proper infrastructures for providing telemedicine services in accidents. All the chairmen of the centers supported this program but in the planned strategic program no plans were made regarding telemedicine. From the viewpoint of most participants in this study, the obstacles to execution of telemedicine such as insufficient technical staff, repayment and insurance problems were only of trivial importance. Conclusion: Applying telemedicine in management of disasters plays a vital role in preserving and saving patients’ lives. Based on the findings of the present study, the importance of healthcare centers becoming equipped with technical infrastructure of telemedicine in accidents and familiarized with methods of carrying out and providing these services is emphasized.

ntroduction: Trauma is among the injuries associated with a high prevalence of pain and little treatment for it. Pain can change vital signs and especially cause tachycardia due to sympathetic activity. This can distort our assessment of the patient’s shock; therefore, the present study evaluates the effect of prescribing analgesics on vital signs and hydration in trauma patients with extremity or pelvic fractures. Methods: 325 trauma patients over the age of 16 with extremity or pelvic fractures and GCS score of 14 or 15 were evaluated regarding changes in vital signs and receiving crystalloid in 2 groups of with and without analgesic administration. Results: 325 patients were divided into 2 groups of with (263 patients) and without (62 patients) analgesic administration. 80.9% of the patients received analgesics. In the group receiving analgesics, on average heart rate decreased from 103 to 95 (p < 0.001). However, it did not affect blood pressure and the respiratory status of the 2 groups receiving analgesics or not showed a significant difference. The group receiving analgesics received more crystalloids. Conclusion: Pain management in trauma leads to improvement in tachycardia and probably our better understanding of presence or absence of shock in the patient. Therefore, it is recommended to move the evaluation and treatment of acute trauma pain from the secondary survey in trauma to the D phase of the primary survey.

Introduction: Emergency medicine specialty has been established in Iran since 2001 due to the need to create a specialized field for responding to patients' vital needs. Since this is a young field and challenges have arisen since the creation of this field, we have studied the importance, needs and challenges of emergency medicine specialists being available in a teaching hospital. Methods: This study was a qualitative one. In this study, purposeful sampling was performed among experienced experts in the field of emergency medicine, the founders of this field, and authorities of the healthcare system. The mentioned groups were interviewed in a semi-structured manner and the sample size was determined via data saturation. Finally, the important codes were selected in groups and subgroups and then analyzed. Results: In this study, after interviewing 12 experts in the field of emergency medicine, information saturation was reached. One of the most important needs for establishing emergency medicine specialty was found to be the need for an expert with a comprehensive view for treatment of critical patients and a comprehensive management for emergency department; and the greatest challenges were financial interference with other disciplines and interference in the area of joint work. Conclusion: Considering the evaluations of the present study and more than 2 million patients and injured people presenting to the emergency department each month, the presence of an emergency medicine specialist in educational hospitals is recommended.

Introduction: Previous researches have yield contradictory results in the studies of cognitive dysfunction following Mild Traumatic Brain Injury (MTBI ). This research was also designed and conducted to compare the cognitive condition of two areas of attention strength and executive functions in healthy people and patients with MTBI  one year after trauma. Methods: In this Case- control study, which was conducted from February 2017 to October 2018, 48  male Patien with MTBI   aged between 30 to 55 years old who were admitted to the intensive care unit of Shohadaye Haftome Tir and Baqiyatallah Hospitals in Theran were randomly selected as case group and 64 healthy men subjects with similar age range as control group. Participants were evaluated using Stroop. and Wisconsin tests in terms of cognitive function.  Results: The results of the study showed that the mean and standard deviation of the age of MTBI patients were 41.17 and 8.25, respectively, and the mean and standard deviation of healthy subjects were 41.81 and 8.609, respectively. The two group had significantly difference (p<0/01), in the areas executive functions at the levels of Categories, Perseverative, correct and error responses, number of trials to complete first category and conceptual level responses. The two group had significantly difference (p<0/05), In the attention test at the level of score of interference but the two groups had not significantly difference for interference time (p>0/05). Patients with MTBI  had overall poorer results for all the tests than healthy people. Conclusion: According to the findings of this research, mild traumatic brain injury can disturb executive functions of the brain's prefrontal lobes after one year. Hence, it is suggested that in clinical and legal evaluations of the patients, this issue to be considered and both psychological and medical interventions.

Introduction: One of the most important actions for saving a patient’s life is performing resuscitation. This study was done with the aim of evaluating the knowledge and practice of prehospital emergency medical technicians (EMTs) working in Tehran regarding advanced cardiac life support (ACLS). Methods: The present study was a cross-sectional one, performed in 2017 aiming to assess the knowledge and practice of prehospital EMTs regarding ACLS. The study population consisted of 200 prehospital EMTs working in Tehran. A number of emergency bases in Tehran were randomly selected for sampling. The tool for data gathering in this study was a researcher-designed questionnaire, which was used after confirmation of its validity and reliability. The first part of the questionnaire consisted of demographic data, the second part included 39 theoretical questions that evaluated the knowledge of the staff. The third part included 19 yes-no questions for evaluating their practice. Results: 200 prehospital EMTs working in 20 bases in Tehran participated in this study. Their mean age was 32.1 ± 4.5 years (age range between 20 - 50 years). Mean obtained points for all participants were 32.4 ±2.5 and 16.5 ± 1.5 for knowledge and practice, respectively. Based on the results, a significant statistical correlation was seen between knowledge and work experience (p = 0.041), level of education (p = 0.041), history of participating in ACLS courses (p = 0.003), and the number of times participating in ACLS courses (p = 0.010). In addition, there was a significant correlation between the obtained point in practice section and age (p = 0.004), history of participating in ACLS courses (p = 0.006) and the number of times participating in ACLS courses (p = 0.002). Conclusion: In this study, the knowledge and practice of prehospital EMTs was good regarding ACLS.

Introduction: Job burnout is a disorder due to long-term exposure of a person to work-related stress. The aim of this study was to investigate the burnout status of pre-hospital emergency staff in Shahroud city. Methods: This cross-sectional study was carried out on 100 pre-hospital emergency staff in Shahroud, Iran in 1397. The Maslach Burnout Questionnaire was used. For data analysis, descriptive statistics, mean and standard deviation, and independent t-test, Chi-square and Fisher exact tests were used based on the type of variable. The significance level was considered as 0/05. Results: In this study, 100 cases (all were male) were included. The mean age was 30.75±5.55  years. The severity and frequency of emotional exhaustion were low in 95% of subjects. Depersonalization in frequency was high in 45% of the cases and was high in severity in 50% of the subjects. Personality satisfaction was moderate in frequency in 40% of the cases and was low in severity in 65 percent. Conclusion: The results of this study showed that pre-hospital emergency staff had mild degrees of severity and frequency of emotional exhaustion and moderate degrees of severity and frequency of personal adequacy and sever feeling of personality deprivation.

Introduction: In ideal conditions, the maximum length of stay in the Emergency Department (ED) is 6 h. Increased length of stay for patients has harmful effects on the quality of patient care and patient satisfaction and causes overcrowding in the ED. The present study assessed the causes of length of stay more than 24 h in the ED of Imam Hossein Hospital affiliated to Shahid Beheshti University of Medical Sciences in Tehran. Methods: This descriptive study was conducted during a 12-month period, 2017-2018, in the ED of Tehran’s Imam Hossein Hospital. The samples were randomly selected from patients referring to the ED of Imam Hossein Hospital. The data collection tool was a checklist containing information about patients and the actions taken in the ED and the final outcome of the patients. After encoding the collected data, statistical analyzes were done using the SPSS statistical software version 18. Result: Men and women constituted 54.7% and 45.3% of the participants, respectively. The participants below and above 65 years old made up 52.6% and 47.4% of the sample group, respectively. Moreover, 81.3% were admitted to general/internal ED and 18.7% were admitted to trauma/surgery ED. Lack of empty beds in admission ward and intensive care unit (ICU) ward was the main causes of delay in admitting patients. Low patient turnover rate, involvement of multiple therapeutic services, inaccurate diagnosis, delay in lab results, delayed imaging, and the possibility of improvement in condition of the patient in ED were among other notable causes of prolonged stay. Finally, the majority of the patients were hospitalized and referees to other centers had the least frequency. Comparison of trauma and general EDs regarding causes of prolonged length of stay showed that there were no significant differences between the two EDs in prolongation length of stay. Conclusion: According to the results, lack of adequate admission and ICU beds was the main causes of prolonged stay in the ED. Using EMS diversion, increasing the number of admission and ICU beds, referring patients to other centers, setting up emergency care units, and decreasing patient ED overcrowding are suggested as solutions to decrease length of stay in ED.

Introduction: Readmission is among the causes of overcrowding in hospital emergency departments. Identifying the characteristics of patients with readmission helps healthcare administrators propose more effective strategies to reduce the frequency of their readmission to the emergency department. This study was designed to investigate the characteristics of readmitted patients in emergency departments of hospitals affiliated with Iran University of Medical Sciences. Methods: Patients with more than 5 times admissions to emergency wards of Rasoul-e-Akram, 7 Tir martyrs, and Firoozgar Hospitals from March 2017 to March 2018 were selected using Health information system (HIS), which recorded computerized patient information. Frequency of referrals and patient complaints during readmission to emergency departments were extracted from patient records. Results: Out of all referrals to hospitals (around 20 thousand patients), 208 patients were readmitted to emergency departments of the mentioned hospitals more than five times (minimum 5 and maximum 10 times). Mean readmission frequency was 6.40 ± 1.26 times and mean patient age was 52.53±17.02 years. Most frequent underlying illnesses were cancer, asthma and chronic obstructive pulmonary disease (COPD), and heart ischemic; and the least frequent were schizophrenia, aplastic anemia, and drug addiction.  Conclusion: There was a significant correlation between age and readmission (p-value=0.001). Cancer, COPD, and ischemic heart diseases were the most common causes of readmission to the emergency department. Shortness of breath, chest pain and weakness were the most common complaints at the time of readmission in this study.

Introduction: Arcuate foramen anomaly is an anatomic variation in the first thoracic vertebrae that forms a space for passing of vertebral artery. Considering the role of this bony bridge in migraine development and its effect on prevalence of various types of pain in head, shoulder, and neck areas, as well as its importance in screw placement on the lateral mass of atlas, the present study evaluated the prevalence of this anomaly among those presented to the emergency department (ED) of Poursina Hospital, Rasht, Iran. Methods: The present study is a cross-sectional one, carried out on patients over 18 years of age that visited ED of Poursina Hospital, Rasht, Iran, in 2015 and underwent lateral neck radiography using census method. Data of the patients were gathered using their medical profile or by asking them on the phone, and recorded in a pre-designed checklist. Data were analyzed with the aid of SPSS version 24 and chi-square and independent t-test statistical tests. P-values less than 0.05 were considered as significant. Results: 1146 patients with the mean age of 37.95 ± 15.88 years were studied (69.2% male). Mean age was 36.05 ± 15.26 years among men and 14.21 ± 16.44 years among women (p < 0.001). The overall prevalence of arcuate foramen was calculated to be 9.6% [95% confidence interval 7.89 – 11.30; 110 patients (74.5% male)]. This anomaly had a prevalence of 10.34% in men and 7.93% in women (p > 0.05). Conclusion: Based on the results of the present study, the prevalence of arcuate foramen anomaly was estimated to be 9.6% in Guilan province using lateral neck radiography. Its prevalence rate was 10.34% in men and 7.93% in women. Considering this prevalence rate, presence of this anomaly should be considered as a possibility in patients with complaints of head, shoulder, and neck pain.

Introduction: Since the guideline of American Heart Association (AHA) for cardiopulmonary resuscitation (CPR) is the basis for performing CPR in emergency department, updating the knowledge of residents and specialists in this field can play an important role in increasing the survival rate of the patients. This study has been designed with the aim of assessing the rate of adherence to AHA guideline for resuscitation of patients with brady/tachy dysrhythmia. Methods: The present study was performed as a cross-sectional study on all emergency medicine residents of Shahid Beheshti University of Medical Sciences in 2018-2019. Ten well-known brady/tachy Dysrhythmia cases, which have a specific treatment, were simulated using a simulator and the measures taken by the residents in dealing with these cases were evaluated considering AHA standards. Items adhered to or not were scored as 1 and 0, respectively. Finally, the percentage of adherence to the guideline was calculated for each resident as well as all residents. Results: In the common initial encounter with brady/tachy dysrhythmia scenarios, all the residents performed well in diagnosis, assessing ventilation, asking for oxygen in case of hypoxia, cardiac assessment of the patient, pulse oximetry and blood pressure evaluation. Not ordering proper peripheral artery and 12 leads electrocardiogram in the proper time occurred in 25% of cases among those who had not studied the guideline and 13.8% of cases among those who had taken training classes. Studying the guideline significantly raised awareness of unstable symptoms in treating tachyarrhythmia, and increased diagnosis of wide and narrow QRS and regular and irregular rhythm, yet was not effective regarding use of adenosine for treatment of unstable symptoms with regular and narrow complex. In addition, studying the guideline significantly increased pointing out cardioversion, considering patient sedation before cardioversion and using proper cardioversion energy in treating unstable tachyarrhythmia. Studying the guideline significantly increased use of adenosine as well as procainamide and amiodarone in treating stable tachyarrhythmia with wide and monomorphic QRS, but did not affect using sotalol. Studying the guideline led to significant increase in use of atropine as the first-line medication in treating unstable brady dysrhythmia. In addition, studying the guideline significantly increased the use of 3 temporary alternative treatments in treating unstable brady dysrhythmia. Studying the guideline did not affect asking for cardiology consultation and coordination for permanent treatment. Conclusion: The results of the present study showed that adherence to the guideline in the studied items of tachy/brady dysrhythmia ranged between 15% and 100%. Overall, passing the training program in addition to studying the guideline significantly improved the rate of adherence to AHA guideline in many cases.

Introduction: Determining the need for performing brain imaging for patients presenting to emergency department following seizure is one of the most important questions that emergency medicine specialists face. The present study has been designed with the aim of evaluating risk factors of abnormal computed tomography (CT) scan in patients presenting to emergency department following seizure. Methods: This cross-sectional study was performed on patients with seizure presenting to the emergency department of Shohadaye Tajrish Hospital from April 2017 to March 2019 using convenience sampling. Demographic data and factors possibly related to presence of brain pathologic findings in patients were gathered and their correlation with findings of CT scan, performed for all patients, was evaluated. Results: 352 patients with the mean age of 34.99 ± 22.30 (6 months to 95) years were evaluated (58.8% male). Most studied patients (40.9%) had an education level less than high school diploma. 164 (46.6%) patients had a history of seizure from childhood or as a congenital disorder and 86 (24.4%) had a family history of seizure. 51.1% consumed anti-seizure medications and 31.8% would regularly take medications. Recent lack of sleep with a frequency of 174 (49.4%) cases and heavy physical activity before seizure with a frequency of 11 (3.1%) cases had the highest and lowest frequencies among predisposing factors of seizure. 138 (39.2%) patients had at least one pathologic finding in their brain imaging. The most common findings were subdural hemorrhage (7.1%) and brain tumors (6.8%), respectively. Based on these findings, a significant correlation was observed between age over 40 years (p < 0.001), supine position at the time of seizure (p < 0.001), positive history of seizure in childhood (p < 0.001), positive family history of seizure (p < 0.001), consumption or ceasing to consume anti-seizure medication (p < 0.001), acute head trauma (p < 0.001), consuming anti-coagulant medication (p < 0.001), presence of fever (p < 0.001), positive history of malignancy (p < 0.001), focal seizure (p < 0.001), and headache (p = 0.003) with abnormal CT findings. However, there was no statistically significant correlation between sex, time of seizure onset, education, drug abuse, presence of seizure stimulating factors, focal neurologic disorder, and altered level of consciousness with presence of pathologic findings in brain CT scan. Conclusion: Based on the findings of the present study it seems that using a series of clinical decision rules, we might be able to predict the probability of pathologic findings being present in the CT scan of patients with seizure and avoid brain imaging in cases with low probability.

Introduction: Endotracheal intubation is one of the most common measures for airway management in patients with cardiac arrest and decreased consciousness.  Therefore, this study was designed to investigate the rate of correct endotracheal intubation by pre-hospital emergency personnel. Methods: In this cross-sectional study, patients who were intubated by pre-hospital emergency personnel outside the hospital and then transferred to the emergency departments of Loghman Hakim, Imam Hossein and Shohadaye Tajrish hospitals from March 2018 to March 2019 were studied regarding the accuracy of intubation. Results: 41 patients with mean age of 64.39 ± 18.64 years (range = 2 to 98) years who were intubated and referred to the emergency department by pre-hospital emergency were studied (73.2% male).  The average work experience of the evaluated personnel and the mean years of their training were 7.41 ± 2.70 (range = 15 to 3) years and 1.61 ± 1.74 (range = 0 to 5) years, respectively.  The mean distance from place of intubation to the emergency department was 30.48 ± 13.21 (range = 10 to 50) Km.  Accuracy of intubation was confirmed in 38 (92.7%) cases.  There was no significant relationship between the accuracy of intubation and patient’s sex (p = 0.792), patient’s age (p = 0.639), place of intubation (p = 0.216), time of intubation (p = 0.422), patient’s distance to hospital (p = 0.080), cause of intubation (p = 0.755), patient’s circulation status (p = 0.767), staff’s work experience (p = 0.958), staff’s training (p = 0.536),  or educational level of the intubator (p = 0.343). Conclusion: The rate of incorrect intubation by the pre-hospital emergency staff was estimated to be 7.3%.  None of the factors, including patient’s sex, patient’s age, place of intubation, time of intubation, patient's distance to hospital, cause of intubation, patient's circulation status, staff’s experience, staff’s training, and intubator’s educational level, significantly correlated with accuracy of intubation.

Dear Editor-in-Chief of Iranian Journal of Emergency Medicine

In volume 5 of the journal (2018), a paper was published titled "Comparison of Liquid Tissue Adhesive and Suture in Pediatric Wound Repair; a Case Control Study", about which some points and questions should be raised:

1. In the title and methods section of this paper, the authors stated that this study is a "case control study", while case-control studies are a type of observational study, which start with the outcome and end with exposure; as patients (as case group) and non-patients (as control group) will be questioned or examined regarding previous exposure. In addition, since they are observational, no interventions are performed in this type of study.

Following the discovery and spread of the novel coronavirus (nCoV-2019), the cause of a respiratory illness from Wuhan, Hubei province in China, extensive research has been done for identifying, preventing and treating the illness caused by this virus. The information on this virus is being updated every moment. Identifying the sources of contamination and the routes of transmission is one of the requirements for accurate prevention of infection. The original source of nCoV-2019 is still unknown and efforts are ongoing in this regard. Early detection and control of the sources of infection in the emergency department is crucial. In addition to the standard cautions, further infection prevention and control (IPC) should be initiated according to the protocols by world health organization (WHO) on presentation of suspected cases. The aim of this letter is introducing solutions for initial detection and prevention of the spread of the novel coronavirus in emergency department as the first line of dealing with patients in the hospital by adapting WHO recommendations.

در اواخر سال 2019 و اوایل سال 2020 میلادی کشورهای جهان درگیر ویروس کرنا شدند و چالش هایی در حوزه های مختلف اقتصادی، سیاسی، اجتماعی، سلامت و... برای آنها ایحاد شد. برخی از این چالش ها ارتباط مستقیم و غیر مستقیم با بحث اطلاعات دارد؛ چرا که اطلاعات مناسب، در زمان مناسب و به مخاطب مناسب می تواند برخی از چالش ها را حل و یا کاهش دهد؛ اما گاها این روند دچار نقصان شد. در طی این بحران افراد و سازمان های مختلف به تولید و اشاعه اطلاعات پرداختند که با توجه به شرایط خاص این بحران (که معمولا کشورها کمتر تجربه کرده اند) گونه هایی از اطلاعات تولید شده که شناخت و تامل راجع به آنها خالی از لطف نیست.

Iranian emergency medicine faculty members visiting emergency medical services in Paris report their observations, noting the differences between the Anglo-American model employed in Iran and the Franco-German model implemented in France.

Relative neck fixation using neck collar for all trauma patients is among the pre-hospital measures emphasized by many of the existing protocols in dealing with these patients. As emergency medicine specialists, in many cases, at the time of trauma patients’ handover from pre-hospital staff we have seen that neck collar has not been used during the transfer of patients to the emergency department. Therefore, the authors of this letter decided to study the rate of neck collar use and its consequences on these patients in the emergency department of Loghman Hakim Hospital for 1 year to document this experience. The present study was performed on 1000 patients with multiple trauma (75.3% male, 50% aged 20-40 years). The most common mechanism of trauma was falling with 245 (24.5%) patients, and level of consciousness was 13 or higher (based on Glasgow coma scale) in 715 (71.5%) cases. 466 (46.6%) cases had midline neck tenderness at the time of admission. Neck radiography findings showed that 329 (32.9%) patients had at least one fracture in their cervical vertebrae or spinous process. Among the patients with fractures in the cervical vertebra, fracture had most commonly occurred in the 7th cervical vertebrae (4.7%). Evaluation of patients in terms of neck collar usage rate showed that only 790 (79%) patients had a neck collar when entering the emergency department and 210 (21%) patients did not. The results of imaging showed cervical vertebrae or spinous process fracture in 67 (32%) of the patients who had been transferred to the hospital without a collar. Also, 262 (33.2%) of those who had a collar upon arrival, had cervical vertebrae fractures.

Out of the 210 patients who had been transferred to the hospital without a collar, 72 (34.3%) developed neurological deficits or whiplash injury, 2 (1%) died, and 136 (64.8%) were discharged from the hospital without any special complications. The results of this study confirm the assertion that all patients with multiple trauma in pre-hospital conditions will benefit from wearing neck collar during their transfer to emergency department.

Introduction: Determination of good diagnostic tools is an issue of importance specially to differentiate between sepsis etiologies and improvement of prognosis. Hence our purpose was to determine the finding of the peripheral blood smear (PBS) in patients with suspected of sepsis and its association with the final diagnosis in the year 1396. Methods: In this cross-sectional comparative survey, 348 consecutive patients with suspected of sepsis admitted in emergency department of Shohaday-e-Tajrish Hospital were enrolled and the association of finding of the peripheral blood smear in patients with the final diagnosis in the year 1396 were determined. Results: The results in this study demonstrated that pneumonia and urinary tract infection were seen in 29% and 18.1%. Thrombocytopenia (p=0.000), thrombocytosis (p=0.032), and abnormal morphology (p=0.049) were related to final diagnosis. Conclusion: Totally, according to the obtained results it may be concluded that platelet count and PBS morphology are important related factors for sepsis.

Introduction: Workplace violence is a global problem the prevalence of which is increasing. All healthcare personnel are subject to violence, but considering the special conditions of pre-hospital emergency, its personnel are exposed to a higher rate of workplace violence compared to other healthcare workers. Methods: This was a cross-sectional study and the study population consisted of pre-hospital emergency personnel of East-Azerbaijan province, Iran. The sampling method was simple random sampling. Results:  A total of 77 participants were included all of whom were male. The average age of the participants was 34.4 ± 7.5 years and their average work experience was 9.58 ± 5.7 years. More than half of the pre-hospital emergency personnel had faced violence by patients twice a week or more throughout the previous year. In 32.5% of the cases, pre-hospital emergency medical technicians had experienced violence by a patient’s friend or relative. Conclusion: The rate of violence against pre-hospital emergency medical technicians is high.

Introduction: Despite the considerable advances in medical diagnosis and treatment, treatment staff errors show an increasing trend, which can lead to decline in people’s trust and rise in stress and anxiety among patients. The present study was performed with the aim of assessing the causes of diagnostic errors leading to complaints from emergency medicine specialists from 2012 to 2017 .Methods: In the present cross-sectional study, 100 files that were referred to the forensic medicine unit were evaluated. The data gathering tool was a researcher-made checklist, using which the demographic data of the patients and the type of error were extracted from the patients’ profiles. Data were coded and entered to SPSS software, version 20, after gathering and then reported using descriptive statistics. Results: In this study, the medical profiles of 100 patients who had filed complaints due to medical errors, in which a medical error was confirmed, were evaluated. In terms of sex distribution, 67% of the patients were male and 50% of the individuals were in the 30 – 59 years age range. 32% of the errors were due to the physician not ordering laboratory tests, 37% were due to errors in examination, and 31 were due to errors in interpretation of the test results. In the level of diagnostic error and ordering diagnostic tests, the most important cause of error was that the physician did not believe testing was necessary for diagnosis. In the stage of examination and history taking also incomplete physical examination by the physician was the most important cause of error. Among the most important factors affecting medical error incidence in the studied files, judgment with 58%, changing shifts without providing information about the patients with 45%, workload with 38%, and the patient not cooperating with 29% were the most important cognitive, communicative, systemic, and patient-related factors, respectively. Conclusion: Error in judgment regarding need for ordering diagnostic tests or further imaging, error in shift handover and not providing information regarding the patients for the next shift, overcrowding and heavy workload in the emergency department, and patients not cooperating were among the most important underlying factors in incidence of errors in the emergency department.

Penetrating chest trauma is an avoidable cause of death in traumatic patients. In initial management of these patients, evaluation of airway, respiratory status and circulation are prioritized. Patients with unstable conditions and life-threatening injuries require immediate intervention, but patients with stable vital signs should be investigated with further imaging. In the presence of a foreign body in the chest in a patient with stable conditions, removal should be performed in the operating room after complete imaging assessments including computed tomography (CT) scan without contrast agent, echocardiography and CT angiography. This article introduces a patient with penetrating chest trauma and stable vital signs with the presence of a foreign body and discuss about the importance of managing such patients.

An emergency medicine specialist has written a heartfelt memorandum revealing his concerns and the sorrow he is going through during the time of COVID-19 pandemic in Iran.

An emergency medicine specialist has written a heartfelt memorandum revealing his concerns and the hardship he is going through during the time of COVID-19 pandemic in Iran.