Archives of Academic Emergency Medicine <p><strong>Welcome to "Archives of Academic Emergency Medicine (AAEM)"</strong></p> <p>This journal was published under the title "Emergency" from 2013 to 2018. From the beginning of 2019, the journal is published on this website. Archives of Academic Emergency Medicine (AAEM) is an international, peer-reviewed, and open access journal. The journal publishes articles on critical care, disaster and trauma management, environmental diseases, toxicology, pediatric emergencies, emergency medical services, emergency nursing, and other related topics.</p> SBMU Journals en-US Archives of Academic Emergency Medicine 2645-4904 <p>Based on the obtained author agreement upon submission, "Archives of Academic Emergency Medicine" is the copyright owner of the published material. However, according to Bethesda Statement, all works published in this journal are open access and freely available to anyone on the journal web site without cost under creative common license BY-NC. Based on this license, under the condition of proper citation, "Archives of Academic Emergency Medicine" grants to all users the following rights:</p> <p>1. Free, irrevocable, worldwide, perpetual access to all published materials.</p> <p>2. To copy, use, distribute, transmit and display the work on third party repositories and social media.</p> <p>3. To make and distribute derivative works in any digital medium for any non-commercial purpose.</p> Clinical Predictors of Emergency Department Revisits within 48 Hours of Discharge; a Case Control Study <p><strong>Introduction: </strong>Emergency department (ED) revisits increase overcrowding and predicting which patients may need to revisit could increase patient safety. This study aimed to identify clinical variables that could be used to predict the probability of revisiting ED within 48 hours of discharge.</p> <p><strong>Methods</strong>: A retrospective case-control study was conducted between July 2018 and January 2019 at the Emergency Medicine Department in Ramathibodi Hospital, Bangkok, Thailand. Patients who revisited the ED within 48 hours of discharge (case group) and patients who did not (control group) participated. The predictive factors for ED revisit were identified through multivariate logistic regression analysis.</p> <p><strong>Results</strong>: The case group consisted of 372 patients, who revisited the ED within 48 hours, and the control group consisted of 1488 patients. The most common reason for revisiting the ED was recurring gastrointestinal illness, in 107 patients (28.76%). According to the multivariate data analysis , five factors influenced the probability of revisiting the ED: age of more than 60 years (p &lt; 0.001, OR = 2.04, 95%CI: 1.51-2.77), initial Emergency Severity Index (ESI) triage level of 2 (p = 0.007, OR = 1.20, 95%CI: 0.93-1.56), ED stay duration of 4 hours or longer (p = 0.013, OR = 1.12, 95%CI: 0.87-1.44), body temperature of ≥37.5ºC on discharge (p = 0.034, OR = 1.34, 95%CI: 1.00-1.80), and pulse rate of less than 60 (OR = 1.55, 95%CI: 0.87-2.77) or more than 100 beats/minute (OR = 1.53, 95%CI: 1.10-2.11) (p = 0.011).</p> <p><strong>Conclusion</strong>: According to the findings, the most important and independent predictive factor of ED revisit within 48 hours of discharge were, age ≥ 60 years, ESI triage level 2, ED length of stay ≥ 4 hours, temperature ≥ 37.5 C, and 60 &gt; pulse rate ≥ 100 beats/minute.</p> Panvilai Tangkulpanich Chaiyaporn Yuksen Wanchalerm Kongchok Chestsadakon Jenpanitpong Copyright (c) 2020 Archives of Academic Emergency Medicine 2021-01-05 2021-01-05 9 1 e1 e1 10.22037/aaem.v9i1.891 Antibody Rapid Test Results in Emergency Medical Services Personnel during COVID-19 Pandemic; a Cross Sectional Study <p><strong>Introduction:</strong> Like other infectious diseases, it is expected that COVID-19 will mostly end with the development of neutralizing antibody immunity. This study aimed to evaluate the value of COVID-19 antibody rapid test assessment in emergency medical services (EMS) personnel.</p> <p><strong>Methods: </strong>This cross-sectional study was conducted in Tehran, Iran from 20th March until 20th May 2020. The results of chest computed tomography (CT) scan, and antibody rapid test were compared in EMS personnel with confirmed COVID-19, as well as symptomatic and asymptomatic ones who had exposure to a probable/confirmed COVID-19 teammate. In symptomatic or asymptomatic individuals who were only IgM-positive, chest CT scan or RT-PCR was recommended.</p> <p><strong>Results: </strong>A total of 243 EMS personnel with the mean age of 36.14±8.70 (range 21 to 59) years took part in this study (87.7% were males). Most of the participants (73.3%) had history of exposure. One hundred sixty-three EMS personnel were tested using either RT-PCR test or chest CT-scan or both, and 78 (47.9%) of them had at least one positive result. Among the participants who had undergone chest CT-scan and/or RT-PCR test (n=163), 78 had positive chest CT-scan and/or RT-PCR test; of these, 18 individuals had negative results for IgM and IgG. The rate of positive IgM and IgG in participants with positive chest CT-scan was 1.6 or 1.3 times more than those with negative chest CT-scan, respectively (p &lt; 0.05). The percentage of positive results for both IgM and IgG in participants having positive RT-PCR test was 1.7 times more than those having negative RT-PCR test (p &lt; 0.05).</p> <p><strong>Conclusion: </strong>Rapid antibody test could help in diagnosis of COVID-19 in asymptomatic or symptomatic EMS personnel who did not undergo RT-PCR test or the test was reported as negative. However, its sensitivity could be enhanced through use along with other diagnostic methods.</p> Peyman Saberian Seyed Mohammad Mireskandari Alireza Baratloo Parisa Hasani-Sharamin Sepideh Babaniamansour Ehsan Aliniagerdroudbari Mahnaz Jamshididana Copyright (c) 2020 Archives of Academic Emergency Medicine 2021-01-10 2021-01-10 9 1 e2 e2 10.22037/aaem.v9i1.993 The Clinical Skills of Emergency Medical Service (EMS) Personnel Regarding Spinal Immobilization of Trauma Victims; a Cross Sectional Study <p><strong>Introduction</strong>: Spinal immobilization is the most important measure the Emergency Medical Service (EMS) has to take when facing the victims of traumatic events, especially those with confirmed or suspected traumatic spinal cord injury (TSCI). The aim of this study was to investigate the clinical skills of EMS personnel regarding the spinal immobilization of trauma victims.</p> <p><strong>Methods</strong>: This cross-sectional study was conducted to examine the clinical skills of EMS personnel, regarding spinal immobilization of trauma victims during a 1-year period in 2019. EMS personnel were selected via convenience sampling method. Data collection tools were a demographic questionnaire and a researcher-made checklist to assess clinical skills. The face and content validity of the tool was reviewed and approved by 10 experts. Also, the overall reliability coefficient for the skills was 0.98. Data were collected by the researcher through observing the skills performed, and filling out the clinical skills checklist accordingly.</p> <p><strong>Results</strong>: The mean overall score of the clinical skills of the 120 participants regarding spinal immobilization of trauma victims in supine, prone, and sitting positions were 0.60 ± 1.44, 0.58 ± 1.42 and 0.65 ± 1.62, respectively. Most of the studied personnel had moderate clinical skills in spinal immobilization, and they had poor clinical skills required to correctly pull the trauma victims in the longitudinal axis of the body to put them on a long backboard and immobilize their torso, legs, and head using the Kendrick Extrication Device (KED).</p> <p><strong>Conclusion</strong>: The studied EMS personnel had moderate clinical skills regarding the spinal immobilization of trauma victims. It is recommended that the EMS training programs focus more on the practical aspects of clinical skills in addition to theoretical aspects.</p> Nasir Jadgal Malahat Nikravan Mofrad Maryam Jamsahar Malihe Nasiri Copyright (c) 2020 Archives of Academic Emergency Medicine 2021-01-10 2021-01-10 9 1 e3 e3 10.22037/aaem.v9i1.928 Straddle versus Conventional Chest Compressions in a Confined Space; a Comparative Study <p><strong>Introduction</strong><strong>: </strong>When cardiac arrest occurs in a confined space, such as in an aircraft or ambulance, kneeling by the patient’s side may be difficult. Straddle chest compression is an alternative technique that can be used in a confined space. This study was performed to compare the quality of chest compressions in straddle versus conventional CPR on a manikin model.</p> <p><strong>Methods</strong><strong>: </strong>The participants were randomized into two groups using the sequential numbered, opaque, sealed envelope method chosen through block-of-four randomization: straddle and conventional chest compression technique. Each participant performed a maximum of 4 minutes of hands-only chest compressions, and quality parameters (compression rate and depth) were recorded from the defibrillator's monitor.</p> <p><strong>Results</strong><strong>:</strong> 124 participants with mean age of 26.67 ± 6.90 years (27.58% male) were studied. There was no difference in the mean compression rate between the conventional and straddle chest compression techniques (126.18 ± 17.11 and 127.01 ± 21.01 compressions/min, respectively; p = 0.811) or their mean compression depth (43.8 ± 9.60 and 43.4 ± 9.10 mm, respectively; p = 0.830). The participants’ comfort and fatigue were assessed through changes in their vital signs. In both methods, statistically significant differences were observed in vital signs before and after performing chest compression, but the differences were not clinically significant. In addition, there was no difference between the 2 groups in this regard.</p> <p><strong>Conclusion</strong><strong>: </strong>The quality of CPR using the straddle chest compression was as good as conventional chest compression technique. No significant differences were found in the quality of chest compressions or the participants’ comfort and fatigue levels.</p> Praphaphorn Supatanakij Chaiyaporn Yuksen Terapat Chantawong Pilaiwan Sawangwong Chetsadakon Jenpanitpong Jirayoot Patchkrua Ponlawat Kanchayawong Copyright (c) 2020 Archives of Academic Emergency Medicine 2021-01-14 2021-01-14 9 1 e4 e4 10.22037/aaem.v9i1.994 Topical Tranexamic Acid versus Phenylephrine-lidocaine for the Treatment of Anterior Epistaxis in Patients Taking Aspirin or Clopidogrel; a Randomized Clinical Trial <p><strong>Introduction: </strong>Epistaxis is one of the most prevalent complaints in the emergency department (ED), especially in patients who take antiplatelet agents. This study aimed to compare the effect of topical use of tranexamic acid (TXA) with phenylephrine-lidocaine anterior nasal packing (PANP) in controlling epistaxis of patients who take aspirin or clopidogrel.</p> <p><strong>Methods: </strong>This prospective, double-blind, parallel-group, randomized clinical trial was conducted to compare the effect of topical use of intravenous (IV) TXA compared with PANP on controlling anterior epistaxis in patients who take aspirin or clopidogrel.</p> <p><strong>Results: </strong>One hundred patients with the mean age of 59.24 ± 7.75 (45 – 75) years were studied (52% male). Two groups were similar in terms of age (p=0.81) and sex (p=0.23) distribution, diabetes mellitus (p=0.54), and hypertension (p = 0.037). The mean time to stop bleeding was 6.70 ± 2.35 minutes in the TXA group and 11.50±3.64 minutes in the PANP group (p=0.002). Bleeding recurrence occurred in 3 (6%) cases of the TXA group and 10 (20%) cases of the PANP group (p =0.03). Time to discharge from ED in the TXA group was significantly lower than the PANP group (p&lt;0.001)<strong>. </strong>The absolute risk reduction (ARR), relative risk reduction, and number needed to harm of treatment with TXA for anterior nasal bleeding were 14.00% (95%CI: 1.11 – 26.89), 17.50% (95%CI: 0.60 - 37.27), and 7.14 (95%CI: 3.71 -90.43), respectively.</p> <p><strong>Conclusion: </strong>Topical TXA is an appropriate treatment option in bleeding cessation, and reducing re-bleeding and duration of hospital stay in patients with epistaxis who take antiplatelet agents.</p> Keyvan Amini AmirAhmad Arabzadeh Sevda Jahed Payman Amini Copyright (c) 2020 Archives of Academic Emergency Medicine 2021-01-19 2021-01-19 9 1 e6 e6 10.22037/aaem.v9i1.875 Baseline Characteristics and Outcomes of Patients with Head and Neck Burn Injuries; a Cross-Sectional Study of 2181 Cases <p><strong>Introduction:</strong> Despite recent progress in treatment of burn injuries, head and neck burn and its complications is still considered a challenge. This study aimed to evaluate the baseline characteristics and outcomes of patients with head and neck burn.</p> <p><strong>Methods:</strong> In this retrospective cross-sectional study, the medical profiles of patients with head and neck burn referring to a burn care center during 2 years were reviewed and analyzed regarding the baseline characteristics and outcomes of participants.</p> <p><strong>Results:</strong> 392 (17.97%) cases suffered from head and neck burns. The mean burn percentage of participants was 29.31 ± 24.78, and 126 (32.14%) cases required tracheal intubation. There was a direct correlation between length of hospital stay and the degree of burn (p &lt; 0.001). The length of hospitalization for patients burned by electricity was longer than those burned by other mechanisms (p = 0.003). There was a significant correlation between degree of burn and abnormal laryngoscopy findings (p = 0.036), developing acute respiratory distress syndrome (ARDS) (p &lt; 0.001) and pneumonia (p &lt; 0.001), need for mechanical ventilation (p &lt; 0.001), and mortality rate (p &lt; 0.001).</p> <p><strong>Conclusion: </strong>Based on the findings of the present study, the prevalence of head and neck burn injuries was about 18% and 32.14% of these cases required airway management. 19 (4.85%) cases developed ARDS, 41 (10.46%) developed pneumonia, and 50 (12.76%) cases died. There was a significant correlation between degree of burn and abnormal laryngoscopy findings, developing ARDS and pneumonia, need for mechanical ventilation, and mortality rate.</p> Soudabeh Haddadi Arman Parvizi Reza Niknama Shadman Nemati Ramyar Farzan Ehsan Kazemnejad Copyright (c) 2020 Archives of Academic Emergency Medicine 2021-02-01 2021-02-01 9 1 e8 e8 10.22037/aaem.v9i1.948 Determining the Need for Computed Tomography Scan Following Blunt Chest Trauma through Machine Learning Approaches <p><strong>Introduction:</strong> The use of computed tomography (CT) scan is essential for making diagnoses for trauma patients in emergency medicine. Numerous studies have been conducted on guiding medical examinations in light of advances in machine learning, leading to more accurate and rapid diagnoses. The present study aims to propose a machine learning-based method to help emergency physicians prevent performance of unnecessary CT scans for chest trauma patients.</p> <p><strong>Methods:</strong> A dataset of 1000 samples collected in nearly two years was used. Classification methods used for modeling included the support vector machine (SVM), logistic regression, Naïve Bayes, decision tree, multilayer perceptron (four hidden layers), random forest, and K nearest neighbor (KNN). The present work employs the decision tree approach (the most interpretable machine learning approach) as the final method.</p> <p><strong>Results: </strong>The accuracy of 7 machine learning algorithms was investigated. The decision tree algorithm was of higher accuracy than other algorithms. The optimal tree depth of 7 was chosen using the training data. The accuracy, sensitivity and specificity of the final model was calculated to be 99.91% (95%CI: 99.10% – 100%), 100% (95%CI: 99.89% – 100%), and 99.33% (95%CI: 99.10% – 99.56%), respectively.</p> <p><strong>Conclusion:</strong> Considering its high sensitivity, the proposed model seems to be sufficiently reliable for determining the need for performing a CT scan.</p> Mohsen Shahverdy Hamed Malek Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-01-24 2021-01-24 9 1 e15 e15 10.22037/aaem.v9i1.1060 Effects of Intravenous Lipid Emulsion on Tramadol-Induced Seizure; a Randomized Clinical Trial <p><strong>Introduction</strong>: There are numerous studies on the efficacy of intralipid emulsion (ILE) in various xenobiotic toxicities. This study aimed to evaluate the potential role of ILE as an antidote in tramadol-induced seizure.</p> <p><strong>Methods:</strong> A single-blind clinical trial was undertaken to establish the efficacy and safety of ILE in patients with acute tramadol intoxication, who referred to Booali Hospital in Qazvin. Patients were randomly assigned to 2 groups. The Control group received standard care while the intervention group received intralipid emulsion (ILE) 20% in addition to the standard care. The occurrence of in-hospital seizure was compared between the groups.</p> <p><strong>Results:</strong> 80 patients who abused tramadol and met the study criteria were randomly assigned to either the intervention (40 cases) or the control (40 cases) group. Seizure occurred in 44 (56%) patients before admission to the emergency department. There were not any statistical differences between the groups regarding sex distribution (p=0.513) and mean age (p=0.19), presenting vital signs (p &lt; 0.05), laboratory findings (p &lt; 0.05), and mean abused dose of tramadol (p = 0.472) as well as occurrence of prehospital seizure (p = 0.7). In-hospital seizure occurred in 15 (18.75%) cases (all in the control group; p &lt; 0.001). The mean duration of admission was 2.01 ± 1.13 days in the control group and 2.15 ± 1.04 days in the intervention group (p = 0.6).&nbsp; The number needed to treat for ILE to prevent tramadol-induced seizure was 2.7 (37.5% absolute risk reduction).</p> <p><strong>Conclusions:</strong> The findings of this study supported ILE administration, as an adjunct to standard antidote protocols, in tramadol intoxication to prevent tramadol-induced seizures.</p> Amir Mohammad Kazemifar Zohreh Yazdi Abbas Bedram Javad MAhmoudi Mojtaba Ziaee Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-02-20 2021-02-20 9 1 e20 e20 10.22037/aaem.v9i1.1070 Echocardiographic Abnormalities as Independent Prognostic Factors of In-Hospital Mortality among COVID-19 Patients <p><strong>Introduction:</strong> Direct and indirect sequels of COVID-19 in the cardiovascular system are unclear. The present study aims to investigate the echocardiography findings in COVID-19 patients and possible correlations between the findings and the disease outcome.</p> <p><strong>Methods:</strong> In this cross-sectional study, baseline characteristics and echocardiographic findings of hospitalized COVID-19 cases, and their correlation with mortality were evaluated. Furthermore, computed tomography (CT) angiography was performed to assess possible pulmonary embolism. In-hospital mortality was considered as the main outcome of the present study.</p> <p><strong>Results:</strong> 680 confirmed COVID-19 cases with the mean age of 55.15 ± 10.92 (range: 28 – 79) years were studied (63.09% male). Analysis showed that history of ischemic heart disease (RR=1.14; 95% CI: 1.08-1.19), history of hypertension (RR=1.04; 95% CI: 1.00-1.08), presence of embolism in main pulmonary artery (RR=1.53; 95% CI: 1.35-1.74), CT involvement more than 70% (RR=1.08; 95% CI: 1.1.01-1.16), left ventricular ejection fraction &lt; 30 (RR=1.19; 95% CI: 1.07-1.32), pleural effusion (RR=1.08; 95% CI: 1.00-1.16), pulmonary artery systolic blood pressure 35 to 50 mmHg (RR=1.11; 95% CI: 1.03-1.18), right ventricular dysfunction (RR=1.54; 95% CI: 1.40-1.08), and collapsed inferior vena-cava (RR=1.05; 95% CI: 1.01-1.08) were independent prognostic factors of in-hospital mortality.</p> <p><strong>Conclusion:</strong> Our study showed that cardiac involvement is a prevalent complication in COVID-19 patients. Echocardiography findings have independent prognostic value for prediction of in-hospital mortality. Since echocardiography is an easy and accessible method, echocardiography monitoring of COVID-19 patients can be used as a screening tool for identification of high-risk patients.</p> Mehdi Pishgahi Kimia Karimi Toudeshki Saeed Safari Mahmoud Yousefifard Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-02-24 2021-02-24 9 1 e21 e21 10.22037/aaem.v9i1.1155 The Correlation between Head of Bed Angle and Intra-Abdominal Pressure of Intubated Patients; a Pre-Post Clinical Trial <p><strong>Introduction:</strong> The recommended position for measuring Intra-Abdominal Pressure (IAP) is the supine position. However, patients put in this position are prone to Ventilator-associated pneumonia. This study was done to evaluate the relationship between bed head angle and IAP measurements of intubated patients in the intensive care unit.</p> <p><strong>Methods</strong><strong>:</strong> In this clinical trial, seventy-six critically ill patients under mechanical ventilation were enrolled. IAP measurement was performed every 8 hours for 24 hours using the KORN method in three different degrees of the head of bed (HOB) elevation (0 , 15 , and 30 ). Bland-Altman analysis was performed to identify the bias and limits of agreement among the three HOBs. According to World Society of the Abdominal Compartment Syndrome (WSACS), we can consider two IAP techniques equivalent if a bias of &lt;1 mmHg and limits of agreement of - 4 to +4 were found between them. Data were analyzed using SPSS statistical software (v. 19), and the significance level was considered as 0.05.</p> <p><strong>Results:</strong> The prevalence of intra-abdominal hypertension was 18.42%. Mean ± standard deviation (SD) of IAP were 8.44 ± 4.02 mmHg for HOB angle 0°, 9.58 ± 4.52 for HOB angle 15 &nbsp;and 11.10 ± 4.73 for HOB angle 30<sup>o</sup> (p = 0.0001). The IAP measurement bias between HOB angle 0°and HOB angle 15° was 1.13 mmHg. This bias was 2.66 mmHg between HOB angle 0° and HOB angle 30°.</p> <p><strong>Conclusion:</strong> Elevation of HOB angle from 0 to 30 degree significantly increases IAP. It seems that the measurement of IAP at HOB angle 15° was more reliable than 30°.</p> Sedigheh Samimian Sadra Ashrafi Tahereh Khaleghdoost Mohammadi Mohammad Reza Yeganeh Ali Ashraf Hamideh Hakimi Maryam Dehghani Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-03-06 2021-03-06 9 1 e23 e23 10.22037/aaem.v9i1.1065 The Geographical Distribution of Probable COVID-19 Patients Transferred by Tehran Emergency Medical Services; a Cross Sectional Study <p><strong>Introduction:</strong> Mapping of COVID-19 infection in the city can help us know more about how the disease is distributed and spread. This study was conducted to investigate the geographical distribution of probable COVID-19 patients who were transferred to destination hospitals by emergency medical services (EMS) in the first wave of the epidemic, in Tehran, Iran.</p> <p><strong>Methods: </strong>This cross-sectional study was performed based on recorded missions during the first 3-month period of the pandemic in Tehran, Iran. All probable cases of COVID-19 who were transferred to the hospitals following contact with Tehran EMS during the study period were enrolled. Arc-GIS software was utilized to draw the distribution map of the contact places of the cases.</p> <p><strong>Results: </strong>In this study, the data of 4018 patients were analyzed (60.9% male). The mean age of the patients was 54.1 ± 20.7 years; and the mean age of the patients had increased with time during the studied 3 months (p = 0.003). The average incidence rate of this disease in Tehran during the study period was 4.6 per 10,000 population. Generally, the lowest and highest raw frequencies of Tehran COVID-19 contamination were seen in municipal districts 21 and 4, respectively. The raw frequency of cases during the 3-month study period also showed that the highest number of cases in Tehran occurred in municipal districts 5 and 4, respectively.</p> <p><strong>Conclusion: </strong>In the present study, using geographic information systems (GIS), geographical distribution map of COVID-19 in Tehran, Iran, during the first 3 months of the pandemic was drawn.</p> Peyman Saberian Hosein Rafiemanesh Mostafa Sadeghi Parisa Hasani-Sharamin Fatemeh Dadashi Alireza Baratloo Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-03-10 2021-03-10 9 1 e25 e25 10.22037/aaem.v9i1.1177 Fibrinogen Dysregulation is a Prominent Process in Fatal Conditions of COVID-19 Infection; a Proteomic Analysis <p><strong>Introduction</strong>: Molecular pathophysiology of COVID-19 is not completely known. Expression changes in patients' plasma proteins have revealed new information about the disease. Introducing the key targeted plasma protein in fatal conditions of COVID-19 infection is the aim of this study.</p> <p><strong>Methods: </strong>Significant differentially expressed proteins (DEPs) in the plasma of cases with a fatal condition of COVID-19 were extracted from an original article. These proteins were included in a network via STRING database along with 100 first neighbor proteins to determine central nodes of the network for analyzing.</p> <p><strong>Results</strong>: Queried and added proteins were included in a scale free network. Three hub nodes were identified as critical target proteins. The top queried hub proteins were chains of fibrinogen; Fibrinogen Alpha chain (FGA), Fibrinogen gamma chain (FGG), and Fibrinogen beta chain (FGB), which are related to the coagulation process.</p> <p><strong>Conclusions:</strong> It seems that fibrinogen dysregulation has a deep impact on the fatality of COVID-19 infection.</p> Mostafa Rezaei-Tavirani Mohammad Rostami Nejad Babak Arjmand Sina Rezaei Tavirani Mohammadreza Razzaghi Vahid Mansouri Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-03-15 2021-03-15 9 1 e26 e26 10.22037/aaem.v9i1.1128 Platelet and Haemostasis are the Main Targets in Severe Cases of COVID-19 Infection; a System Biology Study <p><strong>Introduction:</strong> Many proteomics-based and bioinformatics-based efforts are made to detect the molecular mechanism of COVID-19 infection. Identification of the main protein targets and pathways of severe cases of COVID-19 infection is the aim of this study.</p> <p><strong>Methods: </strong>Published differentially expressed proteins were screened and the significant proteins were investigated via protein-protein interaction network using Cytoscape software V. 3.7.2 and STRING database. The studied proteins were assessed via action map analysis to determine the relationship between individual proteins using CluePedia. The related biological terms were investigated using ClueGO and the terms were clustered and discussed.</p> <p><strong>Results: </strong>Among the 35 queried proteins, six of them (FGA, FGB, FGG, and FGl1 plus TLN1 and THBS1) were identified as critical proteins. A total of 38 biological terms, clustered in 4 groups, were introduced as the affected terms. “Platelet degranulation” and “hereditary factor I deficiency disease” were introduced as the main class of the terms disturbed by COVID-19 virus.</p> <p><strong>Conclusion: </strong>It can be concluded that platelet damage and disturbed haemostasis could be the main targets in severe cases of coronavirus infection. It is vital to follow patients’ condition by examining the introduced critical differentially expressed proteins (DEPs).</p> Mona Zamanian Azodi Babak Arjmand Mohammadreza Razzaghi Mostafa Rezaei Tavirani Alireza Ahmadzadeh Mohammad Rostaminejad Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-03-14 2021-03-14 9 1 e27 e27 10.22037/aaem.v9i1.1108 Early Detection of Rhabdomyolysis-Induced Acute Kidney Injury through Machine Learning Approaches <p><strong>Introduction:</strong> Rhabdomyolysis-induced acute kidney injury (AKI) is one of the most common complications of catastrophic incidents, especially earthquakes. Early detection of AKI can reduce the burden of the disease. In this paper, data collected from the Bam earthquake was used to find a suitable model that can be used in prediction of AKI in the early stages of the disaster.</p> <p><strong>Methods:</strong> Models used in this paper utilized many inputs, which were extracted from the previously published dataset, but depending on the employed method, other inputs have also been considered. This work has been done in two parts. In the first part, the models were constructed from a smaller set of records, which included all of the required fields and in the second part; the main purpose was to find a way to replace the missing data, as data are mostly incomplete in catastrophic events.&nbsp; The data used belonged to the victims of the Bam earthquake, who were admitted to different hospitals. These data were collected on the first day of the incident via questionnaires that were provided by the Iranian Society of Nephrology, in collaboration with the International Society of Nephrology (ISN).</p> <p><strong>Results: </strong>Overall, neural networks have more robust results and given that they can be trained on more data to gain better accuracy, and gain more generalization, they show promising results. Overall, the best specificity that was achieved on testing almost all of the records was 99.24% and the best sensitivity that was achieved in testing almost all of the records was 94.44%.</p> <p><strong>Conclusion: </strong>We introduced several machine learning-based methods for predicting rhabdomyolysis-induced AKI on the third day after a catastrophic incident. The introduced models show higher accuracy compared to previous works performed on the Bam earthquake dataset. &nbsp;</p> Poorya Poorsarvi Tehrani Hamed Malek Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-03-25 2021-03-25 9 1 e29 e29 10.22037/aaem.v9i1.1059 High Incidence of Workplace Violence in Metropolitan Emergency Departments of Thailand; a Cross Sectional Study <p>Introduction: Violence against healthcare workers mostly occurs in emergency departments and is a serious global public health issue. This study aimed to evaluate the prevalence of violence directed towards emergency department healthcare personnel and to ascertain the factors that might be correlated with it.</p> <p>Methods: In this cross-sectional study, an anonymous questionnaire was used to gather data from healthcare personnel working in the emergency departments under the direction of the Bangkok Metropolitan Administration between 1 August 2019 and 30 November 2019, regarding the experience of violence during the previous year.</p> <p>Results: A total of 258 (87.5%) responses were received from 295 personnel. The results showed that 88.4% (228 personnel) had experienced violence during the past year, of these, 37.6% involved physical abuse that caused minor injuries. Employees with shorter tenures, nurses, and those working in tertiary academic emergency departments in the central business district were found to have increased likelihood of confronting violence. Measures taken to prevent violence had a limited impact on the occurrence rate. The most common impact on employees after experiencing violence was discouragement in their jobs (75.1 %). The key factors that promoted cases of violence were the consumption of alcohol or drugs (81.3%) and long waiting times (73.6%). Most violence tended to occur during non-office hours (95.4%). One-third of emergency healthcare personnel reported facing violence during their work.</p> <p>Conclusion: Emergency healthcare personnel in metropolitan of Thailand had a high rate of experiencing violence in the previous year. Younger age, lower work experience, being a nurse, and working in the urban academic or tertiary emergency department increased the likelihood of being a victim of workplace violence.</p> Adisak Nithimathachoke Wanawat Wichiennopparat Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-03-25 2021-03-25 9 1 e30 e30 10.22037/aaem.v9i1.1140 HEART Score in Predicting One-Month Major Adverse Cardiac Events in Patients with Acute Chest Pain; a Diagnostic Accuracy Study <p><strong>Introduction:</strong> Screening of high-risk patients and accelerating their therapeutic procedures can reduce the burden of acute coronary syndrome (ACS). This study aimed to evaluate the accuracy of HEART score in predicting the risk of one-month major adverse cardiac events (MACE) in these patients.</p> <p><strong>Methods:</strong> In this prospective cross-sectional study, the accuracy of HEART score in patients over 18 years old who presented to emergency department following acute chest pain, was evaluated during a 21-month period. Each patient was followed up regarding the incidence of MACE for one month via phone call and the hospital’s integrated health information system.</p> <p><strong>Results:</strong> 240 cases with the mean age of 60.50 ± 16.07 years were studied (56.3% male).&nbsp; MACE was observed in 77 (32.1%) cases. The most common MACE was percutaneous coronary artery revascularization (PCAR) (12.9%). The mean HEART score of studied cases was 4.74 ± 2.12. The mean score of cases with MACE was significantly higher than others (6.25 ± 1.97 versus 4.03 ± 1.79; p &lt; 0.0001).&nbsp; Based on this score, the risk of MACE was high in 34 (14.2%), moderate in 118 (49.2%), and low in 88 (36.7%) cases. The incidence of one-month MACE was 85.3% in high-risk cases, 35.6% in moderate one, and 6.8% in low-risk cases based on HEART score. The area under the ROC curve of HEART score in predicting the risk of MACE was 0.796 (95% CI: 0.736 – 0.856). The best cut off point of HEART score in this regard was calculated as 4.5. The sensitivity and specificity of this score in 4.5 cut off were 83.11% (95% CI: 72.49 – 90.35) and 66.25% (95% CI: 58.38 – 73.35), respectively.</p> <p><strong>Conclusion:</strong> Based on the findings of the present study the mean HEART score of ACS patients with one-month MACE was significantly higher than others and the incidence of MACE in high-risk patients was significantly higher. But the overall accuracy of score in predicting one-month MACE in ACS patients was in moderate range.</p> Hossein Alimohammadi Majid Shojaee Mohammad Reza Sohrabi Saman Salahi Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-03-27 2021-03-27 9 1 e31 e31 10.22037/aaem.v9i1.1052 Factors Related to Mortality in Patients with Fournier’s Gangrene or Necrotising Fasciitis; a 10-year Cross-Sectional Study <p><strong>Introduction: </strong>Fournier’s gangrene (FG) is a life-threatening disease, even with early diagnosis and administration of vigorous treatment, its mortality rate is high. This study aimed to evaluate the factors relate to mortality in patients with FG or necrotising fasciitis managed in a referral center.&nbsp;</p> <p><strong>Methods</strong>: This retrospective cross-sectional study was conducted on patients managed in a tertiary referral center, Tehran, Iran, from March 2009 to March 2019, with diagnosis of FG or necrotising fasciitis. The correlation between different demographic and clinical parameters with mortality was analysed and reported.</p> <p><strong>Results:</strong> 73 cases with the mean age of 59.1 ± 15.8 (range: 25 – 88) years were studied (87.7% male). 21 (28.8%) patients died. Escherichia coli (26 cases, 35.6%) was the most frequent microorganism in cultures. Non-survived cases had higher mean age (p = 0.01), higher frequency of hyperlipidaemia (p = 0.02), immunosuppression (p &lt; 0.001), longer hospital stay (p=0.02), lower blood pressure (p=0.01), and lower platelet count (p=&lt;0.001). Based on multivariate analysis, age (p = 0.015; Odds: 0.88 (0.79-0.97)), haematocrit level (p = 0.01; Odds: 1.27 (1.04-1.55)), platelet count (p = 0.03; Odds: 10.11 (1.14-89.35)), and immunosuppression (p = 0.01; Odds: 0.01 (0.0-0.54)) were independent related factors of mortality.</p> <p><strong>Conclusions:</strong> The rate of mortality due to FG and necrotizing fasciitis was 28.8%. Based on multivariate analysis, the independent related factors of mortality were older age, lower haematocrit level and platelet count, and presence of immunosuppression.</p> Anahita Ansari Djafari Amirhossein Rahavian Babak Javanmard Saeed Montazeri Vahid Shahabi Seyyed Ali Hojati Saleh Ghiasy Ramin Hamidi jalallodin khoshnevis Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-04-17 2021-04-17 9 1 e33 e33 10.22037/aaem.v9i1.1123 Neurological Manifestations and their Correlated Factors in COVID-19 Patients; a Cross-Sectional Study <p><strong>Introduction: </strong>COVID-19 might present with other seemingly unrelated manifestations; for instance, neurological symptoms. This study aimed to evaluate the neurologic manifestations and their correlated factors in COVID-19 patients.</p> <p><strong>Methods: </strong>This retrospective observational study was conducted from March 17, 2020 to June 20, 2020 in a tertiary hospital in Iran. The study population consisted of adult patients with a positive result for COVID-19 real-time reverse transcriptase polymerase chain reaction (RT-PCR) using nasopharyngeal swabs. Both written and electronic data regarding baseline characteristic, laboratory findings, and neurological manifestations were evaluated and reported.</p> <p><strong>Results: </strong>727 COVID-19 patients with the mean age of 49.94 ± 17.49 years were studied (56.9% male). At least one neurological symptom was observed in 403 (55.4%) cases. Headache (29.0%), and smell (22.3%) and taste (22.0%) impairment were the most prevalent neurological symptoms, while seizure (1.1%) and stroke (2.3%) were the least common ones. Patients with neurological manifestations were significantly older (p = 0.04), had greater body mass index (BMI) (p = 0.02), longer first symptom to admission duration (p &lt; 0.001) and were more frequently opium users (p = 0.03) compared to COVID-19 patients without neurological symptoms. O<sub>2 </sub>saturation was significantly lower in patients with neurological manifestations (p = 0.04). In addition, medians of neutrophil count (p = 0.006), neutrophil-lymphocyte ratio (NLR) (p = 0.02) and c-reactive protein (CRP) (p = 0.001) were significantly higher and the median of lymphocyte count (p = 0.03) was significantly lower in patients with neurological manifestations.</p> <p><strong>Conclusion: </strong>The prevalence of neurological manifestations in the studied cases was high (55.4%). This prevalence was significantly higher in older age, grated BMI, longer lasting disease, and opium usage.</p> Farzad Ashrafi Davood Ommi Alireza Zali Sina Khani Amirali Soheili Mehran Arab-Ahmadi Behdad Behnam Shabnam Nohesara Farbod Semnani Alireza Fatemi Mehri Salari Reza Jalili khoshnood Mohammad Vahidi Niloofar Ayoobi-Yazdi Saeed Hosseini Toudeshki Elham Sobhrakhshankhah Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-04-27 2021-04-27 9 1 e34 e34 10.22037/aaem.v9i1.1210 Prevalence and Related Factors of Post-Traumatic Stress Disorder in Emergency Medical Technicians; a Cross-Sectional Study <p><strong>Introduction:</strong> Ongoing exposure to a variety of Pre-hospital Emergencies (PE) has placed Emergency Medical Technicians (EMTs) at serious psychiatric compromise such as Post-Traumatic Stress Disorder (PTSD). The present study aimed to evaluate the prevalence and associated factors of PTSD among EMTs.</p> <p><strong>Methods</strong>: This prospective cross-sectional&nbsp;study was conducted on EMTs in the Emergency Medical Services (EMS) in west of Iran. A baseline information questionnaire including personal work-related characteristics and the PTSD&nbsp;checklist&nbsp;of DSM-5&nbsp;(PCL-5) were used for data collection. Non-parametric tests and multivariate linear regression were used to evaluate the associated factors of PTSD in these participants.</p> <p><strong>Results:</strong> Among the participants, 22% of technicians had PTSD-diagnostic criteria. The mean total PCL-5 score was 21.60 ± 11.45, while the scores were 38.02 ± 6.08 and 17.47 ± 8.36 in the PTSD-diagnosed and undiagnosed groups, respectively. The most common symptom of the clusters was negative alterations in cognition with a mean score of 7.42 ± 4.63. After adjusting confounders, the number of missions (t= 2.50, P= 0.013), work experience (t= -3.24, P= 0.001) and number of shifts (t: 26.38, P &lt; 0.001) were significantly corelated with PCL-5 score.</p> <p><strong>Conclusion</strong>: The results indicated that the prevalence of PTSD among EMTs personnel of Hamadan province is high. EMTs with the age of ≤ 30 years, work experience of ≤ 10 years, married status, informal employment, emergency medical technician's degree, and more than 8 shifts per month, as well as no previous training history had a higher total PCL-5 score.</p> Afshin Khazaei Maryam Esmaeili Habib Masoumi Elham Navab Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-04-30 2021-04-30 9 1 e35 e35 10.22037/aaem.v9i1.1157 Comparing the Accuracy of Ohmann and Alvarado Scoring Systems in Detection of Acute Appendicitis; a Cross-Sectional Study <p><strong>Introduction:</strong> Alvarado Scoring System (ASS) and Ohmann Scoring System (OSS) are two scoring systems for diagnosing acute appendicitis (AA). This study was designed to compare the diagnostic accuracy of the two mentioned scores in detection of acute abdominal cases at risk for AA.</p> <p><strong>Methods</strong>: In this prospective cross-sectional study, patients admitted to the emergency departments of two academic hospitals in Qom, Iran, with right lower quadrant (RLQ) abdominal pain suspected to AA were evaluated. All cases were scored using ASS and OSS, and screening performance characteristics of the two scores were calculated and reported considering the pathologic findings as a gold standard.</p> <p><strong>Results: </strong>174 patients with a preliminary AA diagnosis and the mean age of 38.1 ± 10.63 years (11- 73) were included in this study (62.07% male). At the optimal cutoff point of ≥7 for the ASS, the sensitivity and the specificity were 46.43% (95% CI: 37.97%-55.07%), 97.05% (95% CI: 84.67%-92.93%), respectively. At the optimal cutoff point of ≥11 for the OSS, the sensitivity and the specificity were 74.29% (95% CI: 66.22%-81.29%), and 55.88% (95% CI: 37.89% - 72.82%), respectively.</p> <p><strong>Conclusion: </strong>Based on the finding of this study, the ASS ≥ 7 was more accurate than the OSS ≥ 11 for detection of AA. But it should be considered that the overall accuracy of Alvarado and Ohmann scores in this regard were fair (0.83) and poor (0.67), respectively.&nbsp;</p> seyed Jalal Eshagh Hoseini Mostafa Vahedian Alireza Sharifi Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-05-05 2021-05-05 9 1 e37 e37 10.22037/aaem.v9i1.1187 Validation of Songklanagarind Pediatric Triage Model in the Emergency Department; a Cross-Sectional Study <p><strong>Introduction</strong><strong>: </strong>An effective triage needs to consider many factors, such as good triage protocol, experienced triage nurses, and patient factors. This study aimed to evaluate the validity of Songklanagarind Pediatric Triage (SPT) for triage of pediatric patients in the emergency department (ED) and identify the factors associated with triage appropriateness.</p> <p><strong>Methods</strong><strong>: </strong>This study was done in two phases. In the first phase, a team of emergency physicians, a pediatric emergency physician, and a pediatric critical care physician developed SPT model by considering and combining Emergency Severity Index (ESI), Pediatric Assessment Triangle (PAT), Pediatric Canadian Triage and Acuity Scale (PaedCTAS), and Pediatric Septic Shock early warning signs protocol of the hospital as the core concept. In the second phase, a prospective observational study was conducted in the ED of Songklanagarind Hospital, which is a tertiary university hospital in southern Thailand, from September to October 2019 to evaluate the accuracy of the developed triage model.</p> <p><strong>Results</strong><strong>:</strong> A total of 520 pediatric patients met the inclusion criteria. The pediatric triage model had sensitivity and specificity values of 98.28% and 26.24%, respectively, and positive and negative predictive values of 27.67% and 98.15%, respectively, in prediction of death, hospitalization, and resource utilization. The rates of appropriate triage, over-triage, and under-triage were 68.8%, 28.5%, and 2.7%, respectively. Significant factors associated with appropriateness of triage were underlying disease of the respiratory system (OR = 4.16, 95%CI: 1.75‒9.23), fever (OR = 0.60, 95%CI: 0.41‒0.88), dyspnea (OR: 6.38, 95%CI: 2.51‒16.22), diarrhea (OR = 0.26, 95%CI: 0.09‒0.73), oxygen saturation &lt;95% (OR = 3.18, 95%CI: 1.09‒9.27), accessory muscle use during breathing (OR = 3.67, 95%CI: 1.09‒12.41), and wheezing or rhonchi (OR = 6.96, 95%CI: 3.14‒15.43).</p> <p><strong>Conclusion</strong><strong>: </strong>SPT showed good correlation of hospital admission rates and resource utilization with pediatric triage level of urgency. However, further efforts are needed to decrease the rates of over- and under-triage.</p> Siriwimon Tantarattanapong Nut Chonwanich Wannipha Senuphai Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-05-20 2021-05-20 9 1 e39 e39 10.22037/aaem.v9i1.1237 Awareness of Iranian Medical Sciences Students Towards Basic Life Support; a Cross-Sectional study <p><strong>Introduction: </strong>Augmentation of the number of trained basic life support (BLS) providers can remarkably reduce the number of cardiac arrest victims. The aim of this study was to evaluate the level of BLS awareness among students of medical sciences in Iran. <strong>&nbsp;</strong></p> <p><strong>Methods:</strong> This multicenter cross-sectional study was performed on medical students at the 4 major medical schools in Tehran, the capital of Iran, between Jan 2018 and Feb 2019, using convenience sampling method. The level of medical sciences students’ awareness of BLS was measured using an international questionnaire.</p> <p><strong>Results:</strong> Finally, 1210 students with the mean age of 21.2 ± 2.3 years completed the survey (79% female). 133 (10.9%) students had CPR experience and none had received any formal training. None of the responders could answer all questions correctly. The mean awareness score of participants was 11.93 ± 2.87 (range: 10.13 -17.25). The awareness score of participants was high in 49 (4.04 %) participants, moderate in 218 (18.01%), and low in 943 (77.93%) of studied cases.</p> <p><strong>Conclusion: </strong>Based on the findings of this study, more than 70% of the studied medical sciences students obtained a low score on BLS awareness.</p> Meisam Akhlaghdoust Saeid Safari Poorya Davoodi Shaghayegh Soleimani Maryam Khorasani Fatemeh Raoufizadeh Hosna Karimi Elahe Etesami Zeynab Hamzehloei Seyedeh Sara Sadeghi Ladan Heidaresfahani Tooba Ebadi Fard Azar Haniyeh Afshari Badrloo Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-05-20 2021-05-20 9 1 e40 e40 10.22037/aaem.v9i1.1231 Is Social Distancing Policy Effective in Controlling COVID-19? An Interrupted Time Series Analysis <p><strong>Introduction:</strong> The social distancing plan is one of the ways that was implemented for management of COVID-19 pandemic. This study aimed to evaluate the effect of the social distancing on reducing the daily new cases and deaths from COVID-19.</p> <p><strong>Methods</strong>: In this cross-sectional study, the data of daily new cases and daily deaths were collected from 15/02/2020 to 19/04/2020. Changes in the level and trend of daily new cases and daily deaths before and after the implementation of social distancing plan were evaluated using interrupted time series (ITS) analysis in STATA software.</p> <p><strong>Results:</strong> The post-intervention trend had a decrease of 102 new cases per day and 7 new deaths per day compared to the pre-intervention trend (p &lt; 0.001). Moreover, in the post-intervention period, the daily new cases had a decrease of 58 new cases per day and 2 new deaths per day (p &lt; 0.001).</p> <p><strong>Conclusion</strong>: It Could be concluded that social distancing plan directly affects the new daily cases and new daily deaths.</p> Mehdi Yaseri Rahim Soleimani-Jelodar Zohreh Rostami Saeed Shahsavari Mostafa Hosseini Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-05-25 2021-05-25 9 1 e41 e41 10.22037/aaem.v9i1.1201 Comparing the Severity of Injury and Trauma Pattern between Scooter and Street Motorcycle Riders; a Prospective Cohort Study <p><strong>Introduction:</strong> The popularity of motorcycle riding in Iran is increasing. However, there is a lack of information about the safety of different motorcycle types. This study aimed to compare the severity of injury and trauma pattern between scooter (vespa) and street (standard) motorcycle riders.</p> <p><strong>Method</strong>: In a prospective cohort study, a comparison of demographics, injury severity, trauma pattern, and clinical characteristics between 324 riders (162 Vespa and 162 standard motorcycles) admitted to emergency departments was undertaken. The risk factors associated with severe injuries in the two groups were also determined. An emergency medicine specialist determined the severity of trauma based on the abbreviated injury scale (AIS).</p> <p><strong>Results</strong>: The Odds Ratio (OR) of severe injuries was significantly higher in the standard motorcycle riders’ group (OR: 3.09; 95% CI: 1.9-4.21; p: 0.013). The frequency of lower extremity fractures was significantly lower in the Vespa group (OR: 4.11; 95% CI: 2.01-6.25; p = 0.012). The frequency of admission to the intensive care unit was significantly higher in the standard motorbike riders’ group (OR: 1.64; 95% CI: 1.11-2.51; p = 0.033). The multivariate analysis indicated that motorcycle type, the speed at the time of the accident, use of helmet, and age of riders are the most important predictors of trauma severity in riders (p&lt;0.05).</p> <p><strong>Conclusion</strong>: The pattern of injury varies between standard and Vespa motorcycles. The standard motorcycle riders were prone to a higher risk of adverse outcomes such as severe injuries. Due to the particular structure of scooters, the rate of lower limb injuries was significantly lower than standard motorcycles.</p> Mansour Bahardoust Arman Karimi Behnagh Abolfazl Bagherifard Mehrdad Khodabandeh Sayed Ali Emami Shakiba Ghasemi Assl Farid Najd Mazhar Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-06-08 2021-06-08 9 1 e43 e43 10.22037/aaem.v9i1.1229 Door-to-antibiotic Time and In-hospital Mortality of Elder Patients Presenting to Emergency Department with Sepsis; a Cross-Sectional Study <p><strong>Introduction: </strong>The current international sepsis guideline recommends that administration of intravenous broad-spectrum antibiotics should be initiated within 1 hour of emergency department (ED) arrival for sepsis patients. This study aimed to evaluate the association between door-to-antibiotic time and in-hospital mortality of these patients.</p> <p><strong>Methods:</strong> In this retrospective cross-sectional study, elderly patients (age ≥65 years) diagnosed with sepsis in the ED of a tertiary referral and academic hospital from January to December 2019 were enrolled. Door-to-antibiotic time was defined as the time from ED arrival to antibiotic initiation. The associations of door-to-antibiotic time and each hour delay in first antibiotic initiation with in-hospital mortality were assessed.</p> <p><strong>Results</strong>: Six hundred patients with the median age of 78.0 (IQR: 72.0-86.0) were studied (50.8% female). The median door-to-antibiotic time was 51.0 (36.0 – 89.0) minutes and in-hospital mortality rate was 12.5%. There was no significant difference in the in-hospital mortality rate between door-to-antibiotic time ≤1 hour and &gt;1 hour (13.1% vs. 11.6%, p = 0.726). When considering hour-upon-hour of door-to-antibiotic time, no significant difference in in-hospital mortality was observed (p = 0.866). Factors that led to a delay in door-to-antibiotic time were presenting body temperature &lt;38°C (odds ratio [OR] 3.34; 95% CI, 2.12-5.29; p &lt; 0.001) and age &lt;75 years (OR 1.7; 95% CI, 1.09-2.64; p = 0.019).</p> <p><strong>Conclusion: </strong>Door-to-antibiotic time was not associated with in-hospital mortality in elderly sepsis patients in this study. Significant factors that led to a delay in door-to-antibiotic time were no fever, age &lt;75 years, doctor time, and blood sample taking time.</p> Siriwimon Tantarattanapong Thanaporn Hemwej Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-06-11 2021-06-11 9 1 e44 e44 10.22037/aaem.v9i1.1266 Electrocardiographic Findings and In-Hospital Mortality of COVID-19 Patients; a Retrospective Cohort Study <p><strong>Background</strong>: Although current evidence points to the possible prognostic value of electrocardiographic (ECG) findings for in-hospital mortality of COVID-19 patients, most of these studies have been performed on a small sample size. In this study, our aim was to investigate the ECG changes as prognostic indicators of in-hospital mortality.</p> <p><strong>Methods</strong>: In a retrospective cohort study, the findings of the first and the second ECGs of COVID-19 patients were extracted and changes in the ECGs were examined. Any abnormal finding in the second ECG that wasn’t present in the initial ECG at the time of admission was defined as an ECG change. ECGs were interpreted by a cardiologist and the prognostic value of abnormal ECG findings for in-hospital mortality of COVID-19 patients was evaluated using multivariate analysis and the report of the relative risk (RR).</p> <p><strong>Results</strong>: Data of the ECGs recorded at the time of admission were extracted from the files of 893 patients; likewise, the second ECGs could be extracted from the records of 328 patients who had an initial ECG. The presence of sinus tachycardia (RR = 2.342; p &lt;0.001), supraventricular arrhythmia (RR = 1.688; p = 0.001), ventricular arrhythmia (RR = 1.854; p = 0.011), interventricular conduction delays (RR = 1.608; p = 0.009), and abnormal R wave progression (RR = 1.766; p = 0.001) at the time of admission were independent prognostic factors for in-hospital mortality. In the second ECG, sinus tachycardia (RR = 2.222; p &lt;0.001), supraventricular arrhythmia (RR = 1.632; p &lt;0.001), abnormal R wave progression (RR = 2.151; p = 0.009), and abnormal T wave (RR = 1.590; p = 0.001) were also independent prognostic factors of in-hospital mortality. Moreover, by comparing the first and the second ECGs, it was found that the incidence of supraventricular arrhythmia (RR = 1.973; p = 0.005) and ST segment elevation/depression (RR = 2.296; p &lt;0.001) during hospitalization (ECG novel changes) are two independent prognostic factors of in-hospital mortality in COVID-19 patients.</p> <p><strong>Conclusion</strong>: Due to the fact that using electrocardiographic data is easy and accessible and it is easy to continuously monitor patients with this tool, ECGs can be useful in identifying high-risk COVID-19 patients for mortality.</p> Mohammad Haji Aghajani Amirmohammad Toloui Moazzameh Aghamohammadi Asma Pourhoseingholi Niloufar Taherpour Mohammad Sistanizad Arian Madani Neishaboori Ziba Asadpoordezaki Reza Miri Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-06-12 2021-06-12 9 1 e45 e45 10.22037/aaem.v9i1.1250 Comparing the Clinical Characteristics, Laboratory Findings, and Outcomes between Epidemic and Episodic Methanol Poisoning Referrals; a Cross-sectional Study <p><strong>Introduction:</strong> Due to illegal manufacturing and sales of alcoholic beverages, epidemic outbreaks of methanol poisoning may occur. The aim of this study was to determine if there were differences in the severity, course of poisoning, and outcomes between methanol-poisoned patients admitted during an outbreak versus those who were admitted following episodic exposures.</p> <p><strong>Methods: </strong>The present retrospective study was performed in a single referral poisoning center between March 2018 and March 2019 in patients with confirmed methanol poisoning. During this time, in addition to episodic cases of methanol intoxication, there were three methanol poisoning outbreaks. Outbreaks were characterized by an unexpected increase in the number of methanol-poisoned patients in a short period of time, which impacted resources and decision-making. The two groups were compared regarding their severity of poisoning, sessions of hemodialysis, and clinical outcomes.</p> <p><strong>Results: </strong>Outbreak cases had a higher level of methanol than episodic cases. Odds of being dialyzed more than once was 5.4 times higher in the cases presenting during an outbreak (95% CI 2.1-14.0; p=0.001). Mean hospital stay, intubation/mechanical ventilation, and death were similar between the two groups. An evaluation of the alcoholic beverage samples available in the Iranian black market during the outbreak showed a 7-percent methanol concentration with no ethanol content.</p> <p><strong>Conclusions:</strong> Poisoning risk may be higher during methanol outbreaks due to the higher methanol concentrations, requiring more hemodialysis sessions for persistent metabolic acidosis. In addition to alcohol dehydrogenase blockade, careful risk assessment of all methanol poisonings can assist with stratifying the priority for, and duration of, hemodialysis to optimize outcomes.</p> Mehdi Hadipourzadeh Sara Ebrahimi Pardis Ziaeefar Nasim Zamani Hassan Falahati Darren M Roberts Hossein Hassanian-Moghaddam Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-06-12 2021-06-12 9 1 e46 e46 10.22037/aaem.v9i1.1278 Burnout among Healthcare Providers of COVID-19; a Systematic Review of Epidemiology and Recommendations <p><strong>Introduction:</strong> In the current systematic review, we intended to systematically review the epidemiology of burnout and the strategies and recommendations to prevent or reduce it among healthcare providers (HCPs) of COVID-19 wards, so that policymakers can make more appropriate decisions.</p> <p><strong>Methods:</strong> MEDLINE (accessed from PubMed), Science Direct, and Scopus electronic databases were systematically searched in English from December 01, 2019 to August 15, 2020, using MESH terms and related keywords. After reading the title and the abstract, unrelated studies were excluded. The full texts of the studies were evaluated by authors, independently, and the quality of the studies was determined. Then, the data were extracted and reported.</p> <p><strong>Results:</strong> 12 studies were included. Five studies investigated the risks factors associated with burnout; none could establish a causal relationship because of their methodology. No study examined any intervention to prevent or reduce burnout, and the provided recommendations were based on the authors' experiences and opinions. None of the studies followed up the participants, and all assessments were done according to the participants’ self-reporting and declaration. Assessing burnout in the HCPs working in the frontline wards was performed in four studies; others evaluated burnout among all HCPs working in the regular and frontline wards.</p> <p><strong>Conclusion</strong>: Paying attention to the mental health issues, reducing the workload of HCPs through adjusting their work shifts, reducing job-related stressors, and creating a healthy work environment may prevent or reduce the burnout.</p> Mehrdad Sharifi Ali Akbar Asadi-Pooya Razieh Sadat Mousavi-Roknabadi Copyright (c) 2020 Archives of Academic Emergency Medicine 2021-02-10 2021-02-10 9 1 e7 e7 10.22037/aaem.v9i1.1004 Electrocardiography in Early Diagnosis of Cardiovascular Complications of COVID-19; a Systematic Literature Review <p><strong>Introduction:</strong> Many reports have stated that patients admitted for COVID-19 may also suffer from cardiovascular diseases, suggesting cardiovascular involvement in COVID-19. Since there is direct association between electrocardiography (ECG) data and the prognosis of cardiovascular disease, a systematic literature review was performed in the present study to address this association and make a conclusive agreement on the early diagnostic and prognostic values of ECG in patients with COVID-19.</p> <p><strong>Methods:</strong> Electronic databases including PubMed, Scopus, Web of Science, Science Direct, Ovid, Embase, and Google Scholar were searched for “COVID-19” and “ECG” using all their equivalents and similar terms as search words. Afterwards, the records were limited to English articles and irrelevant documents, as well as articles that reported drug-induced cardiac dysfunction or patients with previous history of cardiovascular complications were excluded.</p> <p><strong>Results:</strong> Overall, 31 articles with 2379 patients were found and used for qualitative data extraction. Findings showed that there is a significant association between COVID-19 infection and ECG findings. Also, ST-segment changes, T wave inversions, QT prolongation, and atrial fibrillation were found to be early indicators of cardiac involvement of COVID-19, which were associated with worse outcomes.</p> <p><strong>Conclusion:</strong> It is recommended to use ECG as a valuable diagnostic and prognostic tool for cardiac evaluation of patients with COVID-19.</p> Reza Nemati Mahasty Ganjoo Faezeh Jadidi Ahmad Tanha Reza Baghbani Copyright (c) 2020 Archives of Academic Emergency Medicine 2021-01-18 2021-01-18 9 1 e10 e10 10.22037/aaem.v9i1.957 Late Complications of COVID-19; a Systematic Review of Current Evidence <p><strong>Introduction: </strong>COVID-19 is a new rapidly spreading epidemic. The symptoms of this disease could be diverse as the virus can affect any organ in the body of an infected person. This study aimed to investigate the available evidence for long-term complications of COVID-19.</p> <p><strong>Methods:</strong> This study was a systematic review of current evidence conducted in November 2020 to investigate probable late and long-term complications of COVID-19. We performed a systematic search, using the keywords, in online databases including PubMed, Scopus, Science Direct, Up to Date, and Web of Science, to find papers published from December 2019 to October 2020. Peer-reviewed original papers published in English, which met the eligibility criteria were included in the final report. Addressing non-human studies, unavailability of the full-text document, and duplicated results in databases, were characteristics that led to exclusion of the papers from review.</p> <p><strong>Results:</strong> The full-texts of 65 articles have been reviewed. We identified 10 potential late complications of COVID-19. A review of studies showed that lung injuries (n=31), venous/arterial thrombosis (n=28), heart injuries (n=26), cardiac/brain stroke (n=23), and neurological injuries (n=20) are the most frequent late complications of COVID-19.</p> <p><strong>Conclusion:</strong> Since we are still at the early stages of the COVID-19 epidemic, it is too soon to predict what long-term complications are likely to appear in the survivors of the disease in years after recovery. Furthermore, the complexity of COVID-19 behaviors and targets in the human body creates uncertainty in anticipating long-term complications.</p> SeyedAhmad SeyedAlinaghi Amir Masoud Afsahi Mehrzad MohsseniPour Farzane Behnezhad Mohammad Amin Salehi Alireza Barzegary Pegah Mirzapour Esmaeil Mehraeen Omid Dadras Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-01-20 2021-01-20 9 1 e14 e14 10.22037/aaem.v9i1.1058 Cardiac Complications and Pertaining Mortality Rate in COVID-19 Patients; a Systematic Review and Meta-Analysis <p><strong>Introduction:</strong> Raising knowledge over cardiac complications and managing them can play a key role in their recovery. In this study, we aim to investigate the evidence regarding the prevalence of cardiac complications and the resulting mortality rate in COVID-19 patients.</p> <p><strong>Method</strong>: Search was conducted in electronic databases of Medline (using PubMed), Embase, Scopus, and Web of Science, in addition to the manual search in preprint databases, and Google and Google scholar search engines, for articles published from 2019 until April 30<sup>th</sup>, 2020. Inclusion criterion was reviewing and reporting cardiac complications in patients with confirmed COVID-19.</p> <p><strong>Results: </strong>The initial search resulted in 853 records, out of which 40 articles were included. Overall analysis showed that the prevalence of acute cardiac injury, heart failure and cardiac arrest were 19.46% (95% CI: 18.23-20.72), 19.07% (95% CI: 15.38-23.04) and 3.44% (95% CI: 3.08-3.82), respectively. Moreover, abnormal serum troponin level was observed in 22.86% (95% CI: 21.19-24.56) of the COVID-19 patients. Further analysis revealed that the overall odds of mortality is 14.24 (95% CI: 8.67-23.38) times higher when patients develop acute cardiac injury. The pooled odds ratio of mortality when the analysis was limited to abnormal serum troponin level was 19.03 (95% CI: 11.85-30.56).</p> <p><strong>Conclusion: </strong>Acute cardiac injury and abnormal serum troponin level were the most prevalent cardiac complications/abnormalities in COVID-19 patients. The importance of cardiac complications is emphasized due to the higher mortality rate among patients with these complications. Thus, troponin screenings and cardiac evaluations are recommended to be performed in routine patient assessments.</p> Amirmohammad Toloui Donya Moshrefiaraghi Arian Madani Neishaboori Mahmoud Yousefifard Mohammad Haji Aghajani Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-02-13 2021-02-13 9 1 e18 e18 10.22037/aaem.v9i1.1071 The Value of Lactate Dehydrogenase in Predicting Rhabdomyolysis-Induced Acute Renal Failure; a Narrative Review <p><strong>Introduction:</strong> Determining the diagnostic value of available biomarkers in predicting rhabdomyolysis-induced acute kidney injury (AKI) is a priority. This study aimed to review the current evidence about the value of lactate dehydrogenase (LDH) in this regard.</p> <p><strong>Methods</strong>: In this narrative review, the papers in PubMed, Embase, and web of science were studied. The keywords prognosis, prognoses, prognostic, LDH, rhabdomyolysis, emergency patients, and acute kidney failure or AKI had been selected from MeSH medical dictionary. Related papers written in English and published from November 2007 to December 2020 were selected.</p> <p><strong>Results</strong>: Finally, 14 articles were accepted for analysis. Among the selected articles, four were randomized clinical trials, seven were cross-sectional, and three were case-control studies. The results of the present review showed that abuse of illegal drugs is the most common cause of rhabdomyolysis. AKI is the most serious complication of rhabdomyolysis reported in the studies. These studies have shown a three-fold increase in AKI following drug-induced rhabdomyolysis. The review of the included articles shows that high LDH can predicts AKI, especially in critical and emergency situations such as rhabdomyolysis where there is a risk of death if diagnosed late. These studies show that LDH increases in the presence of renal failure and tissue damage.</p> <p><strong>Conclusion:</strong> Serum LDH is an appropriate and cost-effective prognostic indicator that can be used for risk classification of patients at risk for rhabdomyolysis-induced AKI.</p> Hazhir Heidari Beigvand Kamran Heidari Behrooz Hashemi Amin Saberinia Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-03-09 2021-03-09 9 1 e24 e24 10.22037/aaem.v9i1.1096 Corticosteroid Therapy in Management of Myocarditis Associated with COVID-19; a Systematic Review of Current Evidence <p><strong>Introduction: </strong>Myocarditis in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seems to be associated with a higher mortality rate<strong>. </strong>This study aims to summarize the latest evidence on whether the use of corticosteroids in patients with myocarditis associated with COVID-19 is necessary.</p> <p><strong>Methods: </strong>We performed an extensive search using a combination of search terms in PubMed, Europe PMC, ProQuest, EBSCOhost, and Google Scholar up to January 2021. Full-text articles that met the predefined inclusion criteria were included in the present study.</p> <p><strong>Results: </strong>The full-texts of 18 articles have been reviewed. Thirteen out of the eighteen (72%) patients who got corticosteroid administration experienced major clinical improvements during follow-up while the other five (28%) were experiencing uneventful events. The mean age of the reported patients was 47.8±13.2 years. There was no gender predominance. Most of the reported cases were from USA (39%) followed by Spain, China, and UK (11% each), while Brazil, Colombia, France, Belgium, and Italy contributed one case each. Various corticosteroids were used but the most commonly applied were methylprednisolone (89%), hydrocortisone (5.5%), and prednisolone (5.5%). The most common route of administration among the studies was intravenous administration and the duration of treatment varied between one and fourteen days.</p> <p><strong>Conclusion: </strong>A review of the currently available literature shows that with the use of corticosteroid agents in treating myocarditis associated with COVID-19, favorable outcomes are attainable. Well-established randomized clinical trials are needed to evaluate the efficacy and safety of using corticosteroids in this condition.</p> William Kamarullah Nurcahyani Claudia Mary Josephine Rachmatu Bill Multazam Aqila Ghaezany Nawing Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-04-16 2021-04-16 9 1 e32 e32 10.22037/aaem.v9i1.1153 Cardiovascular Diseases in Natural Disasters; a Systematic Review <p><strong>Introduction: </strong>As a result of destruction and lack of access to vital infrastructures and mental stress, disasters intensify cardiovascular diseases (CVDs) and hence management of CVDs becomes more challenging. The aim of this study is investigating incidence and prevalence of CVDs, morbidity and mortality of CVDs, treatment and management of CVDs at the time of natural disasters.</p> <p><strong>Methods:</strong> In the present systematic review, the articles published in English language until 28. 11. 2020, which studied CVDs in natural disasters were included. The inclusion criteria were CVDs such as myocardial infarction (MI), acute coronary syndrome (ACS), hypertension (HTN), pulmonary edema, and heart failure (HF) in natural disasters such as earthquake, flood, storm, hurricane, cyclone, typhoon, and tornado.</p> <p><strong>Result: </strong>The search led to accessing 4426 non-duplicate records. Finally, the data of 104 articles were included in quality appraisal. We managed to find 4, 21 and 79 full text articles, which considered cardiovascular diseases at the time of flood, storm, and earthquake, respectively.</p> <p><strong>Conclusion:</strong> Prevalence of CVD increases after disasters. Lack of access to medication or lack of medication adjustment, losing home blood pressure monitor as a result of destruction and physical and mental stress after disasters are of the most significant challenges of controlling and managing CVDs. By means of quick establishment of health clinics, quick access to appropriate diagnosis and treatment, providing and access to medication, self-management, and self-care incentives along with appropriate medication and non-medication measures to control stress, we can better manage and control cardiovascular diseases, particularly hypertension.</p> Javad Babaie Yousef Pashaei asl Bahman Naghipour Gholamreza Faridaalaee Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-05-04 2021-05-04 9 1 e36 e36 10.22037/aaem.v9i1.1208 Possible Vertical Transmission of COVID-19 to the Newborn; a Case Report <p>Vertical transmission of the novel coronavirus 2019 (COVID-19), has been reported in case reports and series, while the data regarding its transmission is still not enough. Thus, presenting different experiences form various regions could help better understand the virus behavior in pregnancy. We herein report a possible vertical transmission of COVID-19 from a mother to the neonate. A 41-year-old mother with signs and symptoms of acute respiratory illness presented with labor pain and vaginal leak at 37 weeks of gestation. &nbsp;She tested positive for COVID-19 using RT-PCR and underwent emergency cesarean section delivery and gave birth to a girl neonate. The baby tested positive for the COVID-19. Although vertical transmission of COVID-19 has not been proved yet, but there are several lines of evidences suggesting it. Paying close attention to the mother and newborn with COVID-19 and long-term follow-up are needed for better understanding of the virus in pregnancy.</p> Yekta Parsa Nazila Shokri Tayebeh Jahedbozorgan Zahra Naeiji Shahrzad Zadehmodares Atefeh Moridi Copyright (c) 2020 Archives of Academic Emergency Medicine 2021-01-15 2021-01-15 9 1 e5 e5 10.22037/aaem.v9i1.923 Plastic Bronchitis in a Five-Year-Old Boy Treated Using Extracorporeal Membrane Oxygenation; a Case Report <p>Plastic bronchitis is an uncommon disorder marked by the production of bronchial casts and acute respiratory failure development. In pediatric cases, influenza infection sometimes results in the obstruction of bronchi and leads to this potentially life-threatening condition. We report the case of a five-year-old boy with plastic bronchitis related to influenza A infection, which could only be recovered by the use of extracorporeal membrane oxygenation (ECMO). ECMO could effectively provide sufficient oxygenation for patients suffering from severe reversible acute respiratory failure. If patients infected with the influenza virus present acute respiratory distress with total lung atelectasis, clinicians should consider the diagnosis of plastic bronchitis and the subsequent treatment interventions with ECMO in a severe cases.</p> Tsuyoshi Nojima Hiromichi Naito Takafumi Obara Kohei Tsukahara Atsunori Nakao Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-01-27 2021-01-27 9 1 e16 e16 10.22037/aaem.v9i1.1014 Rare and Underestimated Association of Pulmonary Embolism and Olanzapine Therapy; Report of Two Cases <p><strong>Abstract:</strong></p> <p>Venous thromboembolic disease (VTD) is a very common and severe pathological condition in which there are many predisposing factors. Olanzapine is a drug frequently used in psychiatric practises; it is thought to increase the risk of VTD. Here, we report two cases, a young man and a woman, with a medical history of schizophrenia treated by olanzapine who developed pulmonary embolism and we did not find any aetiologies of VTD in them. Due to the link between olanzapine and pulmonary embolism, which has been previously described, olanzapine is considered responsible for this problem. Two mechanisms have been reported in the literature in this regard; significant weight gain and lethargy, which are very common side effects of olanzapine. So far, no direct effect of olanzapine on platelet aggregation or coagulation has been found. In patients developing VTD while being treated with olanzapine, discontinuation of olanzapine as a treatment option must be done with an adjustment of antipsychotic treatment and regular monitoring of psychic symptoms. Since the diagnosis of pulmonary embolism is not easy to make in a schizophrenic patient, clinicians should take that in consideration when prescribing these drugs and when facing clinical situations where VTD is suspected.</p> Hammam Rasras Mustapha Beghi Maryem Samti Nabila Ismaili Noha El Ouafi Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-02-05 2021-02-05 9 1 e17 e17 10.22037/aaem.v9i1.1063 Thyrotoxic Periodic Paralysis with Thyroid Storm as the First Presentation of Graves’ disease; a Case Report <p>Thyrotoxic periodic paralysis is a rare endocrine emergency that manifests as acute onset muscle weakness and hypokalaemia secondary to thyrotoxicosis. It mainly occurs due to rapid and dramatic intracellular shift of potassium resulting in hypokalaemia and acute flaccid paralysis. This condition predominantly affects males of Asian descent, and presentation can range from mild generalized weakness to complete quadriplegia, as seen in our case. We herein report a case of a 40-year-old female, who presented to us with acute onset flaccid quadriplegia and thyroid storm, which is the first ever manifestation of previously undiagnosed Grave’s disease. Liver abscess was found to be the underlying trigger for thyrotoxic paralysis and thyroid storm.</p> Tejaswee Banavathu Swapnil Tripathi Pankaj Sukhadiya Kamlesh Ahari Durga Shankar Meena Mahendra Kumar Garg Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-02-17 2021-02-17 9 1 e19 e19 10.22037/aaem.v9i1.1083 Delayed post-traumatic Tension Hydropneumocephalus; a Case Report of Conservative Treatment <p>Pneumocephalus refers to the presence of air in the cranial cavity. Trauma is the most common cause of acquired pneumocephalus. Tension pneumocephalus occurs when intracranial accumulation of air causes high pressure on the brain as compared to extracranial pressure. Tension pneumocephalus is usually acute, and causes neurological symptoms, and its delayed form rarely occurs. A 12-year-old girl presented with a headache, lethargy, mild fever, and nausea from two days before admission to emergency department of Shahid Rajaei Hospital, Qazvin, Iran. The patient had a history of head trauma in a driving accident six weeks before and had undergone brain computed tomography (CT) scan in another centre, which had revealed no sign of pneumocephalus. The patient had been treated for one week and had been discharged in good general condition.</p> <p>Considering her reduced consciousness, the patient underwent brain CT scan again in our centre. CT scan revealed tension hydropneumocephalus. The patient was transferred to the intensive care unit (ICU) for treatment. Considering the trend of her recovery, the patient was a candidate for conservative non-surgical therapy based on the in-charge neurosurgery specialist’s decision. The patient reported no complications during the six-month follow-up. Delayed tension pneumocephalus is among neurosurgery emergencies usually treated with early surgical intervention and dura defect restoration, but this patient received non-surgical treatment without any serious problem during the six-month follow-up.</p> Talayeh Mirkarimi Mohammad Salek Ehsan Modirian Peyman namdar Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-02-27 2021-02-27 9 1 e22 e22 10.22037/aaem.v9i1.1172 Discrepancy in Screening Performances of Different Rapid Test Kits for SARS-CoV-2; a Letter to Editor <p>Point-of-care testing has always been an attractive modality to quickly confirm diagnosis in the emergency department (ED). This attribute is highly valuable during the current Coronavirus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), where early diagnosis means quicker case detection and earlier isolation. Rapid test kits (RTKs) developed to diagnose COVID-19 utilised two types of assay to detect SARS-CoV-2 infection(1). Molecular assays detect antigen in the form of viral RNA or protein on the patient’s respiratory tract, whilst serology immunoassays are used to detect IgM and IgG antibodies in the blood. There are many RTKs available commercially, but reports on effectiveness are scarce. We share the results of our study, which evaluated three colloidal gold-based immunoassay RTKs available in our centre (Sabah Women and Children’s Hospital, Kota Kinabalu, Malaysia).</p> Phee Kheng Cheah Darlene F. Ongkili Fatin Salwani Zaharuddin Muammar Iqbal Hashim Chiak Vun Ho Heng Gee Lee Phaik Kin Cheah Copyright (c) 2020 Archives of Academic Emergency Medicine 2021-02-14 2021-02-14 9 1 e9 e9 10.22037/aaem.v9i1.1045 Cardiologists’ Knowledge and Perception towards American Heart Association Guidelines of Cardiopulmonary Resuscitation; a Letter to Editor <p>Sudden cardiac arrests (SCA) pose massive threats to millions of lives worldwide. Latest statistics report an annual death count of approximately 17.9 million for cardiovascular diseases (1). SCA has caused 15% of these deaths (2) and is considered a major threat in both out-of-hospital and in-hospital settings. Early identification and prompt cardiopulmonary resuscitation (CPR) is essential to increase the survival rate of SCA patients from about 50% to 70% (3). To accomplish this increment, it is cardinal for each physician to be versed with the protocols of basic life support (BLS) and advanced cardiac life support (ACLS).&nbsp;</p> Sajjad Ali Annam Zahid Syed Zahid Jamal Samahir Tariq Khan Nisha Lohana Raahim Ahmed Nobia Mehdi Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-01-02 2021-01-02 9 1 e11 e11 10.22037/aaem.v9i1.1053 Video-Laryngoscopy-Assisted Fishbone Removal from the Upper Digestive Tract; a Letter to the Editor <p>Fish bones are frequently lodged in the upper digestive tract, usually at the palatine tonsils, tongue base, valleculae, and pyriform sinuses. The otorhinolaryngologist represents the first point of contact in such cases, which may in fact account for a sizeable percentage of ENT emergencies (1). Persistent sharp pain in the throat, experienced by the patient following eating fish, indicates that a fishbone has stuck. If the bone is not removed in a timely manner, it may result in serious septic complications (2).</p> <p>Fishbone removal requires dexterity on the part of the ENT Surgeon and co-operation on the part of the patient. Removal of fishbones in the oro-pharynx or base of tongue is usually easy; bones lodged further down may require a three-hand technique, i.e. the patient or an assistant holding the tongue, and not infrequently, turn out to be an intolerable task in the outpatient setting. We Have succeeded in managing such cases under general anaesthesia without intubation, with the use of a rigid anaesthetic video-laryngoscope and a pair of Magill forceps.</p> Petros Vlastarakos Konstantinos Chondrogiannis Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-01-05 2021-01-05 9 1 e12 e12 10.22037/aaem.v9i1.1068 Mass Suicide of COVID-19 Patient's Survivors; a Clinical Experience <p>We had just started our shift at the emergency department that day, when a highly agitated pale middle-aged woman was brought to the emergency department by the emergency medical service (EMS). Behind her were 5 of her family members, 3 were her children and the other 2 were her sister and her brother in law. She was immediately transferred to the cardiopulmonary resuscitation (CPR) room and cardiac and respiratory monitoring were provided, central venous access was established (due to lack of peripheral vascular access because of severe hypotension), and fluid infusion was performed. During the time these services were provided, a history was taken from her relatives.</p> Mohammad Mahdi Forouzanfar Ziba Shahini Behrooz Hashemi Sahar Mirbaha Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-01-13 2021-01-13 9 1 e13 e13 10.22037/aaem.v9i1.1092 Emergency Department and Overcrowding During COVID-19 Outbreak; a Letter to Editor <p><strong>Dear editor;</strong></p> <p>Emergency Physicians (EPs) work under extreme stress conditions (1). Overcrowding – defined as hospital beds not being available for several patients who need one – has been a significant public health problem for more than a decade and is the consequence of the increase in health care demand and the decrease in bed spaces and number of staff (2). These parameters increase stress at work, which leads EPs to experience significant stress consequences, a feeling of diminished skills, and loss of time control (3). Many studies are interested in the overcrowding problem, like a recent study by Tangkulpanich et al. who found the predictive factors of revisiting in 48 hours (4).</p> Jean-Baptiste Bouillon-Minois Julien Raconnat Maelys Clinchamps Jeannot Schmidt Frédéric Dutheil Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-03-25 2021-03-25 9 1 e28 e28 10.22037/aaem.v9i1.1167 Tactile Method in Confirming Proper Endotracheal Intubation in Emergency Setting; a Letter to Editor <p>Orotracheal intubation is one of the sure ways to manage airways in critical patients (1, 2). Failed intubation (Failure to properly place the endotracheal tube (ETT) in trachea) is a rather common event (3). There have been many techniques to confirm proper intubation, but none of them are applicable in all conditions. Methods such as capnography, tracheal sonography and chest-X-ray, were introduced for verification of proper tracheal intubation but they have their own limitations (4, 5). Given the significance of proper airway management, the authors focused on a secondary method of verifying proper intubation using tracheal tactile method and compared it to existing methods.</p> Behrang Rezvani Kakhki Mohsen Miri Morteza Talebi Doluee Zeynab Sabeti Baygi Zahra Abbasi Shaye Elnaz Vafadar Moradi Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-05-09 2021-05-09 9 1 e38 e38 10.22037/aaem.v9i1.1148 Rapid and Deep versus Normal Breathing in Salbutamol Inhalation Effectiveness; a Letter to Editor <p>Metered dose Inhalers (MDIs) are widely used in the management of patients with asthma and choronoc obstractyive polmunary disease (COPD). Studies comparing the efficacy of inhalers versus nebulizers have shown no significant difference (<a href="#_ENREF_1">1</a>, <a href="#_ENREF_2">2</a>). Good inhaler technique is essential to improve patient compliance and control of symptom, and diminish side effects. The usual technique is to use 5 tidal breaths. The&nbsp;Global Initiative for Asthma&nbsp;guidelines suggest that&nbsp;patients can take a slow and single breath to inhale the drug or do tidal breathing. The total lung deposition of an inhaled treatment is strongly affected by the speed of inhalation.</p> Faeze Zeinali.N Naser Mohammad Karimi Mohamadali Jafari Ebrahim Akbarzadeh Moghadam Copyright (c) 2021 Archives of Academic Emergency Medicine 2021-05-26 2021-05-26 9 1 e42 e42 10.22037/aaem.v9i1.1122