Original/Research Article

Trauma from Violence and Strife among Patients Referred to the Emergency Department; an Epidemiologic Study

Ali Arhami Dolatabadi, Hamid Kariman, Hossein Alimohammadi, Afshin Amini, Soheila Sadat Mousavifar

Iranian Journal of Emergency Medicine, Vol. 4 No. 1 (2017), 21 Dey 2016, Page 14-9

Introduction: Strife is one of the most important health threatening happenings that leads to more than 0.5 million deaths each year, and is among the most important causes of mortality in youth. Studying it can increase knowledge on its resulting traumas and be a base for supervising these crimes. Therefore, the present study aimed to evaluate the epidemiology of strife cases presenting to emergency department (ED). Methods: The present study is a retrospective cross-sectional one that evaluates the epidemiology of strife and violence in those presenting to the ED of Imam Hossein Hospital, Tehran, Iran, during April 2014 to January 2016. The studied variables included age, sex, time of visit, social history of the patient, trauma mechanism, anatomical site of trauma, measures taken, and final outcome. Results: 499 patients with the mean age of 26.4 ± 8.7 were studied. 442 (88.6%) were male and 443 (88.9%) were of Iranian nationality. Based on the obtained results, 321 (64.4%) were single and 335 (67.1%) were in the 20-29 years age group. 317 (87.3%) cases had negative social habits (smoking, drinking,…) and cigarette was the most commonly used substance in cases with positive social habits. The highest frequency of ED visits happened between 4PM and 12AM (49.7%), on weekdays (73.1%), and in spring (41.9%). 283 (56.7%) of the studied cases had visited ED following penetrating trauma and 240 (48.1%) needed some kind of surgical intervention. Finally, 398 (79.8%) cases were discharged with full recovery, 81 (16.2%) were discharged against medical advice, and 4 (0.8%) died. Conclusion: Based on the findings of the present study, prevalence of trauma due to strife was 16 in each 1000 visits to the trauma unit of the studied center. Most cases of strife happened in men, singles, those aged 21-30 years, in spring, on weekdays, in the evening and with penetrating trauma and about 80% were discharged from ED with full recovery.


The Effect of Ondansetron on Reducing Nausea Caused By Ketamine in Pediatric Patients Visiting Emergency Department; a Clinical Trial

Saeed Majidi Nejad, Leila Goudarzi, Mehrdad Esmaeilian, Farhad Heidari

Iranian Journal of Emergency Medicine, Vol. 4 No. 1 (2017), 21 Dey 2016, Page 19-15

Introduction: Nausea is a common side effect of ketamine in pediatric sedation and the controversy is still ongoing regarding use of anti-nausea drugs with ketamine to reduce this side effect. Thus, the present study was done aiming to evaluate the effectiveness of ondansetron in controlling the nausea caused by intramuscular (IM) and intravenous (IV) use of ketamine in pediatric sedation and analgesia. Methods: In the present single-blind randomized clinical trial, 1-18 year old children in need of sedation were divided into 4 treatment groups of IV ketamine, IM ketamine, IV ketamine and ondansetron, and IM ketamine and ondansetron, and prevalence of nausea and vomiting was compared between the groups as the main outcome of the study. Results: 120 children were studied (the most common age group 2-7 years 66.7%; 65.8% male). 18 (15.0%) patients were affected with nausea and vomiting. The prevalence of nausea in IV ketamine, IM ketamine, IV ketamine and ondansetron, and IM ketamine and ondansetron groups was 26.7%, 16.7%, 6.7% and 10.0%, respectively. There was no significant difference between the 4 studied groups regarding rate of nausea (p = 0.17). Conclusion: Based on the results of the present study, it seems that using ondansetron along with ketamine does not reduce nausea. Contradiction between studies is indicative of the need for further studies in this regard. 

Assessing Nurses’ Knowledge in the Face of Nuclear Accidents

Mostafa Shahabinejad, Ali Reza Ghiasi, Mohsen Ghaffari, Mahdiyeh Nejadshafiee, Somayeh Soltani Poorsheikh

Iranian Journal of Emergency Medicine, Vol. 4 No. 1 (2017), 21 Dey 2016, Page 26-20

Introduction: Nuclear accidents in any shape or anywhere require presence of trained individuals and medical teams on the site of accident. Considering the important role of nurses in efficient management of these disasters, they should possess special qualifications in different areas. This study was done with the aim of assessing the knowledge of nurses working at a military hospital in the face of nuclear accidents. Methods: This Cross-sectional descriptive study was carried out in 2015 in a military hospital. The study population consisted of nursing staff of the hospital, which were included using consecutive sampling. The tool used for this study was a questionnaire consisting of 2 parts. The first part was about the demographic data of the participants and the second part had 14 questions for evaluating the knowledge of the participants on facing nuclear accidents. Gathered data were analyzed using SPSS version 17 and descriptive statistics methods such as t-test and ANOVA. Results: In this study, 136 of the nursing staff with the mean age of 32.99 ± 4.56 years participated (76.5% female). 83.8% had a Bachelor’s degree and their mean work experience was 8.03 ± 3.86 years, while 76.5% of them had no history of presence or service in any accident or disaster. Only 5.8% of the participants had sufficient knowledge of consequences of a nuclear accident and 80.3% of them had not participated in any training courses regarding nuclear victims. Knowledge of the nurses was evaluated as poor (m = 25) and results showed that there is no significant correlation between work experience (p = 0.330) and type of ward (p = 0.718) with the knowledge of nurses on encountering nuclear accidents. Conclusion:Knowledge of nurses in facing nuclear accidents was poor and hospitals need to design disaster management programs and review its details with the staff in the form of trainings and maneuvers. In addition, decision-makers of educational programs for nursing students should include the topics related to nuclear disaster management and prepare the graduates for facing these accidents. 

Patient Handover Process Problems between Emergency Medical Service Personnel and Emergency Department Nurses

Shayesteh Salehi, Kourosh Zarea, Ahmad Akhlagh Mohammadi

Iranian Journal of Emergency Medicine, Vol. 4 No. 1 (2017), 21 Dey 2016, Page 34-27

Introduction: Patient handover is one of the safety threatening processes in caring for critical patients, deficiencies in which can be the initiator of future problems for the patient. The present study aimed to determine the problems existing in patient handover process between emergency medical service (EMS) technicians and nursing staff of emergency department (ED) in university affiliated health centers in Khuzestan province, Iran. Methods: In the present cross-sectional study, initially, the researcher prepared 2 separate questionnaires for evaluating the existing problems regarding giving and receiving the patient. After confirming their validity and reliability, the questionnaires were given to 100 EMS technicians of Khuzestan province, Iran, and 101 ED nurses of teaching hospitals in Khuzestan province, Iran, who were randomly selected. The resulting data were then analyzed. Results: Based on the obtained findings, 100% of the participants in big and intermediate cities had a high level of problems in the protocol of giving patients and 92.9% of those who were enrolled had a high level of problems regarding receiving patients. Conclusion: Based on the results of the current study, the most common problem in patient handover was lack of knowledge among the personnel of both groups regarding the existing protocols in this area. Another considerable point was presence of interpersonal communication problems in both groups. 

Review Article

Classification of Limping Causes in Children Referred to the Emergency Department; a Literature Review

Reza Shiari, Alaleh Rouhipour, Maedeh Mohammad Rezaei, Sahar Mirbaha, Alireza Baratloo

Iranian Journal of Emergency Medicine, Vol. 4 No. 1 (2017), 21 Dey 2016, Page 8-4

Unusual walking and non-weight bearing on one side of the body is called limping. The incidence of this complication, as an acute complaint in children, is among the causes of emergency department visits and considered as one of the medical challenges in this unit. It is safe to claim that in emergency department, finding the exact cause is not a priority; conversely, it is more important to know that it is not caused by a serious condition. In other words, in the emergency department, ensuring that the cause does not threaten the patient’s life or limb is prioritized over reaching the final diagnosis. Emergency medicine specialists play an important role in detection, diagnosis, and proper referral of these patients. The current manuscript was written in order to facilitate clinical decision-making regarding treatment of children with acute limping visiting emergency department. 

Letter to Editor

Clinical Practice Guidelines; a Strategy to Improve Health Care

Mehrdad Esmailian, Nasim Golestani

Iranian Journal of Emergency Medicine, Vol. 4 No. 1 (2017), 21 Dey 2016, Page 3-1

Considering the high speed at which medical sciences are growing in this age and the increase in diseases with side effects, the pressure on health care system, physicians and health care staff has intensified. This has led health care managers to seek more appropriate ways for providing health care services. In recent years, establishing standard clinical practice guidelines (CPGs) has been increasingly considered for this purpose. Using CPGs has become an important part of treatment in emergency department. These protocols are the result of general consultations regarding special clinical diagnoses and subjects, which guide the physicians for better decision making and providing logical treatments for a disease. Success in establishing it increases the quality of health care by decreasing use of improper treatment and accelerating giving effective and valuable treatments. CPG is a general and systematic vision that helps health care providers to make logical and proper decisions regarding patients and the health care system and helps physicians in special conditions. These procedures have been determined based on studies and reliable evidence that consist of different conditions and treatment methods and finally reveal the best treatment method to us. CPGs usually consider algorithms, clinical techniques and treatment policies and can definitely improve in the future. Recent studies have shown that in countries that CPGs are followed effective changes have been made in improvement of population health. One of the most important aspects of using CPGs is controlling costs. Recommendations that are given in CPGs also consider legal aspects and therefore decrease the risk of error for physicians and other medical staff. Although there are many problems, even when using CPGs, but many legal and supervisory systems have accepted CPGs and believe that not using it will give way to making errors and will bring about legal arguments. In fact designing CPGs is a policy that will provide safety in health care system. Undoubtedly, CPGs are important elements for decision making in medicine and performing them, as seen in the results and statistics reported in other countries, decreases unnecessary and dangerous interventions in the treatment process, provides effective and proper decision making for the health care providers, and leads to reduced mortality and costs. A disciplinary panel should be designed for carrying out the protocol to guide all target groups and make the goal of the CPG clear. Special clinical goals and conditions should be covered in CPGs and desirable clinical reflections should be made clear. Strong and scientific evidence should be regularly reviewed. 

Brief Report

Evaluation of the Troponin Measurements Results in Patients with Acute Coronary Syndrome; a Brief Report

Anita Sabzghabaei, Abolfazl Nazarian, Zahra Nazarian, Narges Malih, Majid Shojaee

Iranian Journal of Emergency Medicine, Vol. 4 No. 1 (2017), 21 Dey 2016, Page 39-35

Introduction: The present study aimed to evaluate the rate of positive cases in measurement of serum troponin level in patients presenting to emergency department (ED) with complaint of chest pain who were dispositioned to coronary care unit (CCU) due to probable acute coronary syndrome. Methods: This cross-sectional study was carried out between September 2014 and September 2015 in ED and CCU of Shahid Modarres Hospital, Tehran, Iran. Using the archives, profiles of patients dispositioned from ED to CCU with diagnosis of acute coronary syndrome were evaluated. No age or sex limitation was imposed in this study. Data were extracted from the profiles and were recorded using a checklist consisting of points considered in history taking and results of troponin tests. Troponin tests were taken on admission, and 3, 6, 12, 18, 24, 36, 48, and 72 hours after that. A serum troponin level higher than 0.6µg/dL was considered positive. Results: 384 patients with the mean age of 62.34 ± 12.00 years (range: 30 -93) were included in the study (66.7% male). 230 (59.9%) patients with diagnosis of myocardial infarction, 149 (38.8%) with unstable angina, and 5 (1.3%) with other diagnoses were hospitalized. 252 (65.6%) of the patients had complained of typical chest pain. The most common accompanying symptom was shortness of breath present in 107 (27.9%) patients. Hypertension, hyperlipidemia, and diabetes were the most common accompanying diseases with 49, 35.2, and 30.5%, prevalence respectively. In total, 275 (71.6%) of troponin tests were reported to be positive. In the end, 362 (94.3%) patients were discharged from CCU with good general health and 22 (5.7%) died. Conclusion: Based on the findings of the present study, in the initial 72 hours of admission, troponin test result was positive in 70% of patients who were dispositioned to CCU with probability of cardiac chest pain, in 50% of which the test result was positive on admission. 

Case Report

Traumatic Dissection of Carotid Artery in a 34-Year-Old Patient Presenting to Emergency Department; a Case Report

Fatemeh Mohammadi, Reza Mosaddegh Mosaddegh, Motahhareh Afrakhteh, Samira Vaziri

Iranian Journal of Emergency Medicine, Vol. 4 No. 1 (2017), 21 Dey 2016, Page 43-40

Dissection of neck arteries including carotid artery is among the vascular injuries following blunt neck trauma. Manifestations of this injury are usually delayed and present as neurological problems. This injury is accountable for about 2% of cerebral infarctions but causes 20% of brain strokes in patients less than 45 years old. Aiming to discuss and emphasize the importance of this injury, in this article a case of carotid dissection presenting to emergency department (ED) is presented. The patient was a 34 year-old woman that visited ED following left hemiparesis, dysartery and headache that had initiated a few hours back. She had a history of hospital admission 10 days before due to car accident and rollover, and had been discharged with good general health following required examinations. In brain computed tomography (CT) scan, there was evidence of sub-acute ischemic infarction around the middle cerebral artery. Considering the age of the patient, evidence of wide ischemia and history of recent trauma, neck artery dissection was suspected and angiography was performed, which confirmed the diagnosis of carotid artery dissection.