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> en-US <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> (Somayeh Saghaei Dehkordi) (Somayeh Saghaei Dehkordi) Fri, 01 Jan 2021 00:00:00 +0000 OJS 60 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 (Author) Copyright (c) 2020 Archives of Academic Emergency Medicine Sun, 10 Jan 2021 00:00:00 +0000 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 (Author) Copyright (c) 2020 Archives of Academic Emergency Medicine Tue, 05 Jan 2021 00:00:00 +0000 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 (Author) Copyright (c) 2020 Archives of Academic Emergency Medicine Sun, 10 Jan 2021 00:00:00 +0000 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 (Author) Copyright (c) 2020 Archives of Academic Emergency Medicine Thu, 14 Jan 2021 00:00:00 +0000 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 (Author) Copyright (c) 2020 Archives of Academic Emergency Medicine Tue, 19 Jan 2021 00:00:00 +0000 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 (Author) Copyright (c) 2020 Archives of Academic Emergency Medicine Mon, 01 Feb 2021 00:00:00 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Sun, 24 Jan 2021 00:00:00 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Sat, 20 Feb 2021 04:18:10 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Wed, 24 Feb 2021 00:00:00 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Sat, 06 Mar 2021 08:31:06 +0000 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 (Author) Copyright (c) 2020 Archives of Academic Emergency Medicine Wed, 10 Feb 2021 00:00:00 +0000 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 (Author) Copyright (c) 2020 Archives of Academic Emergency Medicine Mon, 18 Jan 2021 00:00:00 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Sat, 23 Jan 2021 04:40:26 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Sat, 13 Feb 2021 06:09:35 +0000 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 (Author); Zahra Naeiji; Shahrzad Zadehmodares, Atefeh Moridi (Author) Copyright (c) 2020 Archives of Academic Emergency Medicine Fri, 15 Jan 2021 00:00:00 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Thu, 04 Feb 2021 07:27:52 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Fri, 05 Feb 2021 19:51:34 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Wed, 17 Feb 2021 08:45:31 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Sat, 27 Feb 2021 04:11:45 +0000 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 (Author) Copyright (c) 2020 Archives of Academic Emergency Medicine Sun, 14 Feb 2021 00:00:00 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Tue, 05 Jan 2021 00:00:00 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Tue, 05 Jan 2021 00:00:00 +0000 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 (Author) Copyright (c) 2021 Archives of Academic Emergency Medicine Thu, 14 Jan 2021 00:00:00 +0000