Journal of Practical Emergency Medicine

Background: Trauma is a leading cause of mortality and morbidity worldwide, with a disproportionate burden on low- and middle-income countries like Nigeria. Understanding the specific patterns of trauma deaths is crucial for developing targeted interventions. This study aimed to review the socio-demographic and clinico-epidemiological characteristics of trauma deaths in the Accident and Emergency (A&E) department of a tertiary hospital in South-Eastern Nigeria.

Methods: A retrospective review of all trauma patients presenting to the A&E department of Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA) between January 1, 2022, and December 31, 2022, was conducted. Data were extracted from the departmental trauma registry and patient case files. Descriptive statistics were used to analyze the data, focusing on the 118 patients who died in the A&E.

Results: A total of 3,325 trauma patients were managed, with an in-hospital mortality rate of 3.5% (n=118). Males constituted 84.0% (n=99) of the deceased, and the 16-39 age group was the most affected at 54.7% (n=65). Road Traffic Accidents (RTAs) were the predominant cause of fatal injuries at 82.4% (n=97). Head and neck injuries were the most common cause of death, accounting for 67.7% (n=80) of fatalities. A significant deficiency in formal pre-hospital care was observed; only 2.9% (n=3) of patients arrived by ambulance. Major challenges encountered during management included patient financial constraints (19.5%) and the non-availability of hospital resources (17.8%). Most deaths, 78.5% (n=93), occurred within 24 hours of arrival.

Conclusion: Trauma-related mortality at this Nigerian tertiary center is primarily driven by RTAs affecting young males, with head injuries being the leading cause of death. The findings highlight critical systemic failures, including a near-total absence of formal emergency medical services and significant in-hospital resource limitations. There is an urgent need for policy interventions focused on road safety, establishment of a structured pre-hospital care system, and strengthening of hospital emergency services to reduce preventable trauma deaths.

Background: The escalating use of emergency departments (EDs) by the elderly population is a pressing concern, particularly in anticipation of a surge in older adult patients. This study was undertaken to probe the demographic and clinical characteristics of elderly patients referred to the EDs. The findings underscore the immediate and critical need for enhanced care.

Methods: A comprehensive cross-sectional retrospective study was conducted based on Hospital Information System data from 2015 to 2019. Out of 12872 elderly patients, 500 were included in the study using random systematic sampling. Various data points were meticulously collected to understand the issue comprehensively, including demographic information, chief complaints, triage levels, hospitalization details, final diagnoses, outcomes, and comorbidities, ensuring the thoroughness and reliability of the research.

Results: The study revealed that the mean age of the elderly patients was 72.79±8.65 years, ranging from 60 to 97 years (55% male). Additionally, specific cardiovascular disorders (34.2%), kidney and urinary tract diseases (15.4%), and respiratory diseases (7.8%) were identified as the most common conditions among elderly patients. Furthermore, the most common consequences observed were transfer to medical-surgical wards (57.2%), transfer to critical care wards (14.4%), and death (1.8%) in a small percentage of cases. These findings underscore the importance of our research in understanding and addressing the needs of elderly patients in emergency departments.

Conclusion: The study's findings have substantial implications for healthcare policy. They underscoring the need to empower emergency staff and the presence of specialists and geriatricians in EDs. This is crucial for providing effective care and preventing readmission in elderly patients. The study's findings point towards a promising future for enhancing geriatric care.

Background: Rapid sequence intubation (RSI) in hemodynamically unstable patients - characterized by tachycardia and hypotension- is critical in the emergency department (ED). The use of vasopressors and sympathomimetics during airway management needs careful consideration. No studies have examined the hemodynamic effects of ephedrine and ketamine in this context. This study aims to compare the efficacy of ephedrine and ketamine in preventing hemodynamic instability in ED patients with systolic blood pressure (SBP) of ≤100 mmHg undergoing intubation-assisted mechanical ventilation.

Method: A prospective observational study was conducted involving 50 patients (mean age: 48.15±17.42 years, 52.0% male) requiring mechanical ventilation with an SBP of ≤ 100 mmHg. The patients were randomly assigned to the ephedrine group (30 mg/kg; n=26) and ketamine group (2 mg/kg; n=24). Hemodynamic variables were compared before and after intubation at the 5-minute and 10-minute marks. The intubation conditions were evaluated according to rapid sequence intubation (RSI) protocols.

Results: The heart rate exhibited minimal variability between the two groups, with the ephedrine group showing a mean of 110.79 ± 23.89 bpm compared to the ketamine group at 111.19 ± 18.95 bpm, recorded 10 minutes post-intubation. Conversely, there was a notable increase in mean SBP following the administration of both pharmacological agents, with a statistically significant elevation observed in the ketamine group (94.42 ± 12.82 mmHg) compared to the ephedrine group (86.70 ± 12.29 mmHg, p < 0.05) at the 10-minute mark post-intubation. Additionally, mean diastolic blood pressure (DBP) also demonstrated an upward trend in both cohorts’ post-drug administration, with the ephedrine group recording a higher mean DBP of 61.92 ± 9.24 mmHg versus 59.40 ± 8.95 mmHg in the ketamine group (p < 0.0001).

Conclusion: Ephedrine administered at 30 mg/kg during the intubation process has enhanced the conditions for successful intubation. The study concluded that ephedrine is more effective than ketamine in mitigating hemodynamic instability in intubated patients receiving mechanical ventilation.

Background: Approximately 1.2 million individuals suffer from renal colic every year, making up about 1% of total hospital admissions. This study aims to clarify the management strategies used in the Iranian emergency department for treating renal colic.

Methods: This retrospective cross-sectional study was conducted between 2021 and 2022 using the Hospital Information System. Following the development of a diagnostic and treatment checklist for renal colic, a census survey was performed on the medical records of all patients diagnosed with renal colic. The data were analyzed using SPSS 22 software, employing both descriptive and analytical methods.

Results: This study analyzed 150 medical records of patients with renal colitis. Most of these patients were young males, comprising 62% of the sample, with a mean age of 33 ± 5.55 years. The initial diagnostic approach frequently involved simultaneous evaluations using ultrasound and blood tests. Pain relief medications were administered to 64.5% of the patients, including narcotics for 48 individuals and non-steroidal anti-inflammatory drugs for 72 patients.

Conclusion: The renal colic management protocols employed in Iran exhibit notable similarities to those established in other countries, particularly in the emerging trend of utilizing non-narcotic analgesics, favoring diagnostic ultrasonography over conventional radiographic methods, and consistently prescribing analgesic medications. This alignment underscores a global shift towards more conservative and practical approaches in renal colic treatment.

Background: Spinal cord injury (SCI) impairs sensory and motor functions, resulting in significant physical, psychological, and financial impacts. In Asia, SCI incidence ranges from 12.06 to 61.6 cases per million, lower than North America's 27.1 to 83.0 cases per million. Glucocorticoids like dexamethasone are used for SCI treatment but have limitations due to high-dose complications. Resveratrol, a polyphenol with antioxidative and anti-inflammatory properties, shows promise in central nervous system protection but requires further investigation for SCI.

Methods: This systematic review and meta-analysis follows PRISMA guidelines and is registered with PROSPERO (Code: CRD42024569681). It will assess resveratrol's effects on motor function (BBB/BMS score), anti-inflammatory proteins (IL-10, IL-6, TNF-α, IL-1β), and antioxidants (SOD, MDA, GSh) in SCI rat models. Searches will be conducted in PubMed/MEDLINE, Embase, Scopus, and Web of Science using relevant keywords, synonyms, MeSH, and EMTREE terms, including grey literature. Eligible studies will involve rats with traumatic SCI and resveratrol treatment, excluding combination therapies or different control groups. Two independent reviewers will screen and review studies, with a third reviewer resolving disagreements. Data will be extracted into an Excel sheet, covering study design, animal models, interventions, and outcomes. The SYRCLE tool will assess bias, and the GRADE scale will determine evidence certainty, with discrepancies resolved by discussion or third-party input.

Discussion: This review aims to elucidate resveratrol's potential to improve motor function and provide anti-inflammatory and antioxidant effects in SCI, potentially offering a non-toxic, cost-effective treatment option.

Lead poisoning is a significant health concern that can manifest as chronic abdominal pain. We recently documented instances of lead poisoning within a family that resulted from prolonged exposure to deteriorating lead plumbing. The affected individuals exhibited abdominal discomfort and demonstrated marked improvement following chelation therapy.  A 20-year-old male with no notable medical history sought medical attention at our emergency department due to chronic abdominal pain that had persisted for a duration of two months, exacerbating over the previous five days. Laboratory evaluations revealed microcytic anemia and positive toxicological results for opiates. Abdominopelvic computed tomography (CT) scans identified multiple punctate densities and fecal impactions in the ascending colon and cecum. Upon further investigation, it was disclosed that the patient resided in a building equipped with aging water pipes. Blood analysis indicated an elevated plasma lead level (PLL) of 87 μg/dl, significantly exceeding the normal range of less than 10 μg/dl, thereby raising a strong suspicion of lead intoxication. The positive opiate toxicology results were attributed to chronic use of analgesics.  Interestingly, during his hospitalization, the patient's 57-year-old mother presented to our clinic with similar chronic abdominal pain accompanied by symptoms of depression and irritability. Despite prior investigations, including endoscopy, colonoscopy, ultrasound, and CT scans yielding normal results, blood tests revealed evidence of normocytic anemia. Testing for PLL similarly indicated elevated levels (67 μg/dl), akin to her son's. The administration of chelation therapy using dimercaprol and sodium calcium edetate substantially improved abdominal symptoms. In addition to medical treatment, we provided practical recommendations, advising the family to alter their living conditions and facilitating connections with local real estate agents. Six months post-treatment, follow-up assessments showed increased hemoglobin levels and a significant decline in PLL.

Transcatheter aortic valve replacement (TAVR) in the modern era of valvular disease management is considered an attractive alternative to surgery in higher-risk patients with symptomatic aortic stenosis. We report on a case of failed TAVR in a 78-year-old male, complicated by the dislodgment of a CoreValve into the distal ascending aorta after it was successfully implanted. The case was managed surgically by retrieving and re-implanting the dislodged valve as a bailout strategy.