Iranian Journal of Emergency Medicine

Introduction: Emergency department (ED) has been designed to provide services for patients that are physiologically unstable and need continuous evaluation and treatment according to the process of their illness. Therefore, a major part of critical care is provided for patients in this department. However, a number of patients visiting ED do not need these kinds of services. The present study was done aiming to evaluate the causes of non-emergency cases using ED services. Methods: This cross-sectional study was carried out in ED of Imam Hossein Hospital, Teran, Iran, from August 2014 to August 2015. Convenience sampling was used and all the patients admitted to ED were divided into groups of in need of emergency services and other, based on the algorithm of New York University ED. Cases that visited due to an illness that did not need emergency services based on the evaluations and were in levels 4 and 5 of triage were included in the study after approval of a physician. Data gathering was done by a trained nurse using a pre-designed checklist. Results: In the present study, 1500 patients with the mean age of 40.0 ± 17.34 years were evaluated (54.47% female). Finally, 601 (40.1%) cases were non-emergency visits based on the definitions of this study. Rewriting the prescriptions due to distortion (16.7%) and unavailability of their physician (14.07%) were the most common causes of non-emergency visits to ED. Sex, time of visit and positive past medical history were identified as variables influencing non-emergency referrals. Conclusion: Based on the findings of the present study, it seems that about 40% of visits to the studied ED were non-emergency cases. Rewriting the prescriptions due to distortion and unavailability of their physician were the most common causes of non-emergency visits. Sex and history of illness were found to be effective variables of non-emergency visits. 

Introduction: Ectopic pregnancy is one of the important obstetric emergencies. Rapid diagnosis, correct triage, and referral of ectopic pregnancy cases can be effective in prevention of mortality in these patients to a great extent. Therefore, the present study was designed to evaluate the baseline characteristics of the patients presenting to emergency department (ED) with final diagnosis of ectopic pregnancy. Methods: In this cross-sectional study, all the patients with the final diagnosis of ectopic pregnancy presenting to ED during a 5-year period, from October 2011 to September 2016, who were hospitalized in the obstetrics department of Shahid Rajaii Hospital, Tonekabon, were evaluated regarding their baseline characteristics. Data were gathered by referring to the patients’ medical profile and then analyzed and reported using SPSS 21 software and descriptive statistics. Results: 140 patients with the mean age of 30.77 ± 5.94 (16-45) years were evaluated (10% with a positive history). Only 26 (18.6%) had reported irregular period in the past month. The most common pregnancy prevention methods used in this group of patients were natural in 123 cases (87.9%), pills in 6 cases (4.3%), condoms in 6 cases (4.3%), and tubectomy in 3 cases (2.1%). Only 3 (2.1%) patients had unstable vital signs on admission. The most common complaints of the patients on admission were abdominal pain with 136 cases (97.1%) and vaginal bleeding with 81 (57.9%). The most common finding in clinical examination was abdominal tenderness in 99 (70.7%) patients. Average time interval between presenting to ED and final diagnosis was 16.24 ± 17.03 hours (0-96). 51 (36.4%) patients needed blood transfusion in the end. On average, patients were hospitalized for 3.44 ± 1.50 days (1-10). All the patients were discharged from the hospital and no case of mortality was reported. Conclusion:Based on the findings of the present study, the most common complaints of patients with ectopic pregnancy on presentation to ED were abdominal pain and vaginal bleeding. Irregular period was reported in less than 19% of the patients and 97.9% had presented with stable hemodynamics. 67% of the participants needed laparotomy in the end and no case of mortality was reported in this series of patients. 

Introduction: The present cross-sectional study was done to evaluate the standards of clinical training regarding morning report and data gathering was done using 3 assessment lists and a list of evidence, which covered 54 standards of morning report in total. The first assessment list, which included 37 questions, was filled in person by direct observation during morning report. The second assessment list included 26 questions and was filled by interviewing either education chief executive or department head of the emergency department (ED). The third assessment list consisted of 10 questions and was filled by questioning the chief resident of the department. Then the final absolute score and its percentage were determined and ranked based on obligatory and preferred standards. SPSS version 21 was used for data analysis and 0.05 was considered as significance level. Methods: The present cross-sectional study was done to evaluate the standards of clinical training regarding morning report and data gathering was done using 3 assessment lists and a list of evidence, which covered 54 standards of morning report in total. The first assessment list, which included 37 questions, was filled in person by direct observation during morning report. The second assessment list included 26 questions and was filled by interviewing either education chief executive or department head of the emergency department (ED). The third assessment list consisted of 10 questions and was filled by questioning the chief resident of the department. Then the final absolute score and its percentage were determined and ranked based on obligatory and preferred standards. SPSS version 21 was used for data analysis and 0.05 was considered as significance level. Results: Findings resulting from 50 morning reports in ED of Imam Hossein Hospital and 94 morning reports in ED of Shohadaye Tajrish Hospital were analyzed. In ED of Imam Hossein Hospital, mean score was 89.5% regarding obligatory standards and 45.7% in preferred standards. In ED of Shohadaye Tajrish Hospital, mean score was 73.6% for obligatory standards and 60% for preferred standards. Mean score of Imam Hossein Hospital was significantly higher than Shohadaye Tajrish Hospital regarding obligatory standards (p = 0.025). Although preferred standards were carried out better in Shohadaye Tajrish Hospital, compared to Imam Hossein Hospital, this difference was not statistically significant (p = 0.1). In total, mean score of the hospitals considering all standards of morning report, was 66.8% in Shohadaye Tajrish Hospital and 67.6% in Imam Hossein Hospital, which were not significantly different (p = 0.92). Conclusion: Based on the findings of the present study, mean total score of all the standards regarding morning report in EDs of Shohadaye Tajrish and Imam Hossein Hospitals was average. Mean score of obligatory standards was significantly higher in ED of Imam Hossein Hospital, compared to ED of Shohadaye Tajrish Hospital. Although the score regarding preferred standards was higher in Shohadaye Tajrish Hospital, compared to Imam Hossein Hospital, this difference was not statistically significant.

Introduction: Currently improvement of human resources is considered a major strategy for success of the organizations and rapid development of scientific and research fields emphasizes its importance. Medical emergencies are a part of care and treatment that has not been immune to these changes. Medical emergency centers need education and improvement of human resources to enhance the quality of their service, which in turn require assessment of needs. The present study was carried out aiming to assess the educational needs of pre-hospital emergency technicians. Methods: The present observational study in medical emergencies center of Kerman, Iran, was carried out using convenience sampling. The tool used for gathering data was a questionnaire designed by the researcher, which consisted of 39 questions that evaluated educational needs of emergency medical technicians from 3 aspects of knowledge, skill, and attitude based on the Likert scale. Results: A total of 170 individuals with the mean age of 31.21 ± 5.51 years participated in the study, all of which were male. The most important educational need of the emergency technicians regarding knowledge was “knowledge and information regarding drugs and probable side effects of using them” with 25.9%; in the skill item, it was “ability and skill of performing endotracheal intubation” with 28.8%; and in the attitude section, it was “taking interest in participating in training courses during service to improve their knowledge regarding practical skills” with 71.8%. Conclusion: Based on the findings of the present study, most medical emergency technicians expressed that their need regarding knowledge is “drug information and their side effects” from skills aspect, it is “ability and skill of performing endotracheal intubation” and from the aspect of attitude, it is “taking interest in participating in training courses during service to improve their knowledge regarding practical skills”. 

Introduction: Primary percutaneous coronary intervention (PPCI) is the intervention of choice for treating patients with acute myocardial infarction (MI). This study was done aiming to measure the time interval between the patient calling emergency medical services (EMS) to performance of primary angioplasty on patients with acute MI. Methods: The present cross-sectional study was carried out on patients brought to emergency department (ED) by EMS who complained from cardiac chest pain and underwent primary PCI. Data regarding age, sex, and various time intervals from the moment the patient calls emergency medical service until performing primary PCI, which were accurately recorded in their medical profile, were gathered in a pre-designed checklist and analyzed. Results: Data of 121 patients with the mean age of 58.36 ± 12.09 years was assessed (77.68% male). Mean time interval between calling EMS and undergoing primary PCI was 145.84 ± 62.37 minutes. Mean time interval between arriving at triage and primary PCI (door to balloon time) was 104.61 ± 62.37 minutes. The biggest part (32%) belonging to the time interval between diagnosis of acute MI and dislocation of patient to the angiography unit. The difference between door to balloon time in this study and the standard 90-minutes time was 14.61 minutes (minimum 3.38; maximum 25.83), which is significant (p = 0.011). Conclusion: Although in the present study, most patients underwent primary PCI in less than 3 hours of calling EMS following chest pain, comparing the overall door to balloon time in the present study with the 90-minute standard showed a significant difference. With EMS staff obtaining the patient’s electrocardiogram on the scene and confirming MI diagnosis before reaching the hospital, the patient can be directly delivered to angiography unit and the door to balloon time can be reduced by about 57%. 

Introduction: The present study compares the diagnostic accuracy of urinalysis with computed tomography (CT) scan in pediatrics with blunt abdominal trauma. The aim of this study was comparing the diagnostic value of urinalysis and abdominal CT scan with contrast, as the gold standard, for predicting probable abdominal organ injury in these patients. Methods: The present diagnostic accuracy study was done on children with blunt abdominal trauma aged less than 16 years who were presented to emergency department and both urinalysis and abdominal CT scan had been done for them. Demographic data, trauma mechanism, and results of urinalysis, ultrasonography and abdominal CT scan regarding abdominal organs were recorded. To evaluate the diagnostic power of urinalysis, statistical indices such as sensitivity, specificity, positive and negative predictive value were used. Results: In this study, 70 children under 16 years old who visited ED were evaluated. Mean age of the studied population was 7.1 ± 4.86 years and 48 of the patients (68.6%) were male. The correlation between hematuria and positive CT scan findings was confirmed. Sensitivity, specificity and positive and negative predictive values of hematuria were calculated to be 26.67%, 92.73%, 50% and 82.26%, respectively. Conclusion: Based on the results of the present study, although presence of hematuria has acceptable specificity, its sensitivity is very low compared to CT scan for prediction of abdominal organ injuries in pediatrics with blunt abdominal trauma. In other words, absence of hematuria is not a good reference to dismiss abdominal organ injury, yet its presence can be an indicator of serious injury. 

Introduction: Health sector evolution plan has been developed aiming to protect people from healthcare costs and improve the quality and availability of health care services. It has been executed since May 2014 in public hospitals all over Iran. The present study was done aiming to evaluate the epidemiology of patients presenting to emergency department (ED) before and after execution of health sector evolution plan. Methods: This retrospective study was done in June 2013 and June 2015 in ED of Shohadaye Tajrish Hospital, Tehran, Iran. A group of 400 was randomly selected from those admitted to general (non-trauma) ward of the ED in each time span. The clinical profiles of the patients were retrieved from the archives and reviewed by the researcher. A pre-designed checklist consisting of age, sex, marital status, route of visit, type of illness, and decision-making status was filled for each case. Results: The number of patients presenting to ED of Shohadaye Tajrish Hospital in June 2013 and June 2015 was 3275 and 3872, respectively. Mean age of the studied patients was 51.4 ± 16.7 (59.2% male) before, and 53.7 ± 18.4 (56.5% male) after execution of health sector evolution plan. No significant difference was detected regarding age (p = 0.72), sex (p = 0.43), and marital status (p = 0.76) before and after execution of health sector evolution plan. Route of visit to ED had not significantly changed (p = 0.36) and although a slight increase was seen in cancer-related visits after execution of the plan, the pattern of visits regarding type of illness had not changed (p = 0.10). However, there was a significant change in decision-making status for discharging the patients (p < 0.001). Conclusion: It seems that although the number of visits to ED has increased after execution of health sector evolution plan, patients’ age, sex, marital status, route of visit and pattern of visits regarding type of illness has not changed dramatically. However, a significant change has occurred regarding decision-making status for patient discharge. 

The final interpretation of this ECG is heterotopic transplanted heart.