Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701Catatonia: extinct, lost, or forgotten?38393204710.15171/jept.2016.02ENForouzanElyasiDepartment of Psychiatry, Psychiatry and Behavioral Sciences Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, IranJournal Article20160829Catatonia is a neuropsychiatric syndrome that occurs in some primary psychiatric disorders (e.g., schizophrenia, mood disorders), or due to general medical conditions (e.g., neurological disorders, drug poisoning, metabolic disorders) (1). Although it is uncommon, but if it goes unrecognized in medical and surgical units (2), it can increase morbidity and mortality. Moreover, making a connection between signs observed across different systems (the motor, somatic, and psychiatric symptoms) could lead to misdiagnosis and a delay in treatment (3).Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701Does it require to exclude cardiobiliary reflex in every acute coronary syndrome follow up patient with bedside ultrasound on emergency department40413205310.15171/jept.2016.13ENMustafaBolatkaleMedipol University Hospital, İstanbul, TurkeyÇağdaşCanManisa State Hospital, Manisa, TurkeyAhmetÇağdaş AcaraGaziemir State Hospital, İzmir, TurkeyMustafaTopuzAdana Numune Education and Research Hospital, Department of Cardiology, Adana, TurkeyJournal Article20160829 <span style="color: #221e1f; font-size: xx-small;"><span style="color: #221e1f; font-size: xx-small;">In emergency department, physicians can diagnose pulseless electrical activity, asystole, pericardial effusions, ischemic heart disease, wall motion abnormalities, valvular cardiac disease volume status or global cardiac function evaluating with electrocardiographic findings or using bedside cardiac ultrasonography. But these two methods are not always sufficient to explain the underlying another pathologies such as pancreatitis and acute cholecystitis which can mimick acute cardiac events. Patients who are followed up with a preliminary diagnosis of acute coronary syndrome in the emergency department, might have underlying biliary or pancreatic pathologies, or even more, these might be the sole reason of the clinical picture. So bedside abdomen ultrasonography and liver enzymes may be requested in all patients with suspected cardiac pathology with a normal cardiac ultrasonography when a patient presented with acute chest or abdominal pain. Physicians must be aware for coexisting pathophysiologies and take into account the differential diagnosis of all life-threatening causes such as cardiac ischemia or acute abdominal situations. So the diagnostic tests for gallbladder pathology could be added to cardiac ultrasonography.</span></span><br /> <br /> <span style="color: #221e1f; font-size: xx-small;"><span style="color: #221e1f; font-size: xx-small;"> </span></span>Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701Calculation of plasma chloride levels using blood gas measurements42454219510.15171/jept.2016.16ENRezaHashemiShohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranAlirezaMajidiDepartment of Emergency Medicine, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranAliTabatabaeyDepartment of Emergency Medicine, Qom University of Medical Sciences, Qom, IranSadrollahMahmoudiDepartment of Emergency Medicine, Baqiyatallah University of Medical Sciences, Tehran, IranJournal Article20170122<span class="A11"><strong><span style="font-size: 8.5pt;">Objective: </span></strong></span><span class="A11"><span style="color: #221e1f; font-size: 8.5pt;">Chloride is the major plasma anion. There are several methods available for the determination of serum chloride levels. Unfortunately these methods are sometimes not available in the urgent setting where values are needed. Here we describe a formula for estimating plasma chloride levels.</span></span><br /> <span class="A11"><strong><span style="font-size: 8.5pt;">Methods: </span></strong></span><span class="A11"><span style="color: #221e1f; font-size: 8.5pt;">Fifty-two consecutive patients were enrolled for which serum chloride levels were estimated using the formula CL</span></span><span class="A12"><span style="font-size: 5pt;">- </span></span><span class="A11"><span style="color: #221e1f; font-size: 8.5pt;">= (Na</span></span><span class="A12"><span style="font-size: 5pt;">+ </span></span><span class="A11"><span style="color: #221e1f; font-size: 8.5pt;">+ 10 –TBB), and also measured directly through the colorimetric method. Correlation between the two values was analyzed using Pearson correlation coefficient and agreement was shown in the Bland-Altman plot. </span></span><br /> <span class="A11"><strong><span style="font-size: 8.5pt;">Results: </span></strong></span><span class="A11"><span style="color: #221e1f; font-size: 8.5pt;">Comparing the values achieved through estimation and laboratory determination of plasma chloride revealed a significant correlation (r = 0.97). Consistent agreement was described within -4.8 and +6.6 on the Bland-Altman plot throughout the measurements.</span></span><br /> <span class="A11"><strong><span style="font-size: 8.5pt;">Conclusion: </span></strong></span><span class="A11"><span style="color: #221e1f; font-size: 8.5pt;">The formula presented here may be a reliable alternative to direct measurement of serum chloride when direct results are not available</span></span>.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701Types of trauma in different seasons in patients referred to Imam Reza Hospital Trauma Center46484219910.15171/jept.2016.12ENSamadShams VahdatiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran0000-0002-4831-6691KavousShahsavari NiaRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranSarvinDalilInternal Medicine Department, Tabriz University of Medical Sciences, Tabriz, IranPariaHabibollahiDepartment of Toxicology and Pharmacology, Tabriz University of Medical Sciences, Tabriz, IranBehzadYousefiStudent Research Committee, Tabriz University of Medical Sciences, Tabriz, IranJournal Article20170122<span class="A7"><strong><span style="font-size: 8.5pt;">Objective: </span></strong></span><span class="A7"><span style="color: #221e1f; font-size: 8.5pt;">Trauma is a disease of modern societies and one of the reasons for the deaths of all ages in those societies. It is estimated that each year about 8.5 million people worldwide lose their lives as a result of trauma. Among the types of injuries around the world, road accidents are more common. We conducted this study to compare types of trauma in different seasons in patients referred to Imam Reza hospital trauma center in 2013. </span></span><br /> <span class="A7"><strong><span style="font-size: 8.5pt;">Methods: </span></strong></span><span class="A7"><span style="color: #221e1f; font-size: 8.5pt;">In this cross-sectional study, all trauma patients admitted to Trauma Emergency Department of Imam Reza hospital in Tabriz entered the study. As this study did not focus on the diagnosis and treatment of diseases, we used epidemiological data from history and physical examination as a source. Descriptive statistics such as frequency, percentage, mean and standard deviation were used for data analysis. All data were analyzed using SPSS version 15.0. </span></span><br /> <span class="A7"><strong><span style="font-size: 8.5pt;">Results: </span></strong></span><span class="A7"><span style="color: #221e1f; font-size: 9pt;">Of all 23 876 patients, 18 044 patients (75.6%) were male and 5832 (24.4%) were </span></span><span class="A7"><span style="color: #221e1f; font-size: 8.5pt;">female. The prevalence of majority of trauma cases was 11.2% (2671) and occurred in September. Traffic accidents were the most common cause of trauma in patients with a prevalence of 33.9% (8095). Head injury had a prevalence of 38.6%. We did not find any correlation between age of patients, gender, type of injuries and the affected limb. </span></span><br /> <span class="A7"><strong><span style="line-height: 107%; font-family: 'Calibri','sans-serif'; font-size: 9pt; mso-bidi-font-family: 'Myriad Pro'; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Conclusion: </span></strong></span><span class="A7"><span style="color: #221e1f; line-height: 107%; font-family: 'Calibri','sans-serif'; font-size: 9pt; mso-bidi-font-family: 'Myriad Pro'; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Findings showed that trauma is more prevalent among males and younger people. Thus, proper planning and stringent traffic rules can reduce accident rate</span></span>.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701Outcomes of cardiopulmonary resuscitation in the emergency department49524527210.15171/jept.2017.14ENSeyed HosseinOjaghi HaghighiEmergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, IranSamadShams VahdatiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran0000-0002-4831-6691TarannomMahmoudieEmergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, IranPegahSepehri MajdEmergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran0000-0001-8104-9612MohammadMirza-Aghazadeh-AttariMedical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, IranJournal Article20170502<strong>Objective: </strong>Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in the prevention of death or delaying it in a person with cardiac arrest. In this regard, demographic information about patients who need CPR is vital.<br /> <strong>Methods: </strong>In this cross-sectional study patients with cardiopulmonary arrest or arrhythmias admitted to Imam Reza and Sina educational hospitals of Tabriz University of Medical Sciences from 22 December 2013 to 21 December 2014 entered the study. Demographic information such as age, sex, cardiopulmonary resuscitation time, the place of cardiopulmonary arrest (outside or inside the hospital), the duration of resuscitation process, success or failure of the resuscitation process and the mechanism of cardiopulmonary arrest were obtained.<br /> <strong>Results: </strong>From a total of 354 cases of cardiopulmonary resuscitation, 281 cases (79%) were unsuccessful and 73 cases (21%) were successful. The average age of patients was 59 ± 22 years. The average time of the resuscitation process was 31 ± 12 minutes. There was a significant difference between the mean of age and resuscitation time in patients who had experienced successful or unsuccessful resuscitation (<em>P </em>= 0.0001). There was a significant relationship between sex and the success rate of resuscitation (<em>P </em>= 0.0001). In addition, a significant relationship between the success of the resuscitation operation and the ward of resuscitation was observed (<em>P </em>= 0.0001).<br /> <strong>Conclusion: </strong>The most common mechanism leading to cardiopulmonary arrest among patients was asystole. In this regard, no significant difference was observed between successful and unsuccessful resuscitation processes. It was also observed that the success of resuscitation from 8 am to 4 pm was more than any other time period.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701Surgical management of cardiac tamponade: Is left anterior minithoracotomy really safe and effective?53584632410.15171/jept.2017.04ENMirkoBaroneDepartment of General and Thoracic Surgery, University Hospital of Chieti, Chieti, Italy0000-0002-3578-8657MarcoPriolettaDepartment of General and Thoracic Surgery, University Hospital of Chieti, Chieti, ItalyGiuseppeCipolloneDepartment of General and Thoracic Surgery, University Hospital of Chieti, Chieti, Italy0000-0002-9362-8782DecioDi NuzzoDepartment of General and Thoracic Surgery, University Hospital of Chieti, Chieti, ItalyPierpaoloCampleseDepartment of General and Thoracic Surgery, University Hospital of Chieti, Chieti, ItalyFeliceMucilliDepartment of General and Thoracic Surgery, University Hospital of Chieti, Chieti, Italy0000-0003-1591-0325Journal Article20170527<strong>Objective: </strong>Cardiac tamponade is a life-threatening clinical entity that requires an emergency treatment. Cardiac tamponade can be caused both by benign and malignant diseases. A variety of methods have been described for the treatment of these cases from needle-guided pericardiocentesis, balloon-based techniques to surgical pericardiotomy. The Authors report their experience in surgical management of cardiac tamponade and an exhaustive review of literature.<br /> <strong>Methods: </strong>This study involved 61 patients (37 males and 24 females) with an average age of 61.80 ± 16.32 years. All patients underwent emergency surgery due to the presence of cardiac tamponade.<br /> <strong>Results: </strong>Cardiac tamponade was caused by a benign disease in 57.40% of patients. In cancer patients group, lung cancer, breast cancer and malignant pleural mesothelioma were the most common neoplasms (17-27, 87%). The average preoperative size of pericardial effusion at M-2D echocardiography was 30.15 ± 5.87 mm. Postoperative complications were observed in 11 patients (18%). The reoperation rate was 3.3% (2 patients) due to relapsed cardiac tamponade. 30-day mortality rate was 3.3%. Overall cumulative survival was 29.9 ± 20.1 months. Twenty-nine patients (47.5%) died during the follow up period. By dividing the population into two groups, group B (benign) and group M (malignant), there was a statistically significant difference (<em>P </em>< 0.001) in terms of survival.<br /> <strong>Conclusion: </strong>In conclusions, anterior minithoracotomy for surgical treatment of cardiac tamponade has to be held into account in patients both with benign diseases and malignancies.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701The prevalence of personality disorders in nurses: role of the workplace environment59634651910.15171/jept.2017.22ENSaharMirbahaDepartment of Emergency Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranParvinKashaniDepartment of Emergency Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranAliArhami DolatabadiDepartment of Emergency Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranAfshinAminiDepartment of Emergency Medicine, Imam Hosein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranFarahnazMeschiDepartment of Clinical Psychology, Karaj Branch Islamic Azad University, Alborz, IranAlirezaBaratlooDepartment of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, IranJournal Article20170601<strong>Objective: </strong>Personality disorder is a multi-factorial condition in which workplace stress plays a significant role. This study was undertaken due to scarcity of information regarding the role of workplace stress which can cause personality disorder among nurses. We aimed to evaluate the prevalence of personality disorders in nurses working in different hospital departments and assess factors affecting its onset.<br /> <strong>Methods: </strong>In this cross-sectional study the personality disorders of nurses working in various hospital departments were evaluated based on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) test. After the completion of questionnaires, data were entered to MMPI-2 test’s special software and the final result was interpreted based on the opinion of a clinical psychologist. Finally, multivariate logistic regression model was used to assess the independent effect of the mentioned factors on prevalence of personality disorders in nurses.<br /> <strong>Results: </strong>We gathered data from 2 groups of participants (n = 206). These groups included nurses in emergency departments and nurses in other hospital units. The mean of age was 32.5 ± 6.9 years. Overall, 54.3% (n = 38) of non-emergency nurses and 45.7% (n = 32) of emergency nurses showed symptoms of personality disorders respectively. Multivariate logistic regression analysis showed that history of a serious accident or trauma increased the odds of detecting personality disorders up to 3.8 times (odds ratio [OR] = 3.84; 95% CI: 1.33-11.06; <em>P </em>= 0.01). In addition, an unpleasant incident in the past year increased it up to 2.2 times (OR = 2.23; 95% CI: 1.18 – 4.22; <em>P </em>= 0.01) in both groups.<br /> <strong>Conclusion: </strong>The present study showed that there was no significant difference between emergency departments and other units of hospitals regarding the prevalence of personality disorders among nurses. Overall, somatization, hysteria, and pollyannaish were the most common personality disorders among the studied populationKerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701Lateral condyle fracture with concomitant postero-medial elbow dislocation in a child: a case report64651305210.15171/jept.2015.21ENGanesh SinghDharmshaktuDepartment of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, IndiaJournal Article20151027Simultaneous combination of fracture of the lateral condyle and postero-medial elbow dislocation is a rare event and limited to few reports or case series in the literature. Rarity of the injury also necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Various authors have reported about the condition including the management which mostly includes surgical intervention. A report of one such injury pattern in an 8 years old male child with operative management and satisfactory outcome is presented to highlight the presence of this rare combination and adherence to standard treatment protocols to address them. The report is an addition to the limited resources available on similar fractures and highlights the importance of ruling out possible associated injuries in cases of elbow dislocations. A good fixation of lateral condyle fracture is instrumental to avoid late complications leading to poor functional outcome. The early and supervised rehabilitation also plays a role in ensuring successful return to activities of daily living.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701Intussusceptions due to trauma in a 17-month-old infant66671305110.15171/jept.2015.14ENHalehMousaviEmergency Department, Tabriz University of Medical Sciences, Tabriz, IranSamadShams VahdatiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran0000-0002-4831-6691RoshanFahimiRoad Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IranJournal Article20150614Invagination is a kind of intestine disease in children and it is occurred between 2 upto 14 years old. This is a report of 17 months infant with intussusception due to trauma. The patient had admitted to emergency department because of motor vehicle accident and because of abdominal pain, abdominal computed tomography (CT) scan was done.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701Carotid artery thrombosis and cerebral infarction after multiple traumas68701493210.15171/jept.2016.01ENGholamrezaFaridaalaeeEmergency Medicine Department, Maragheh University of Medical Sciences, Maragheh, Iran0000-0002-9990-4936BahmanNaghipourDepartment of Anesthesiology, Madani Hospital, Tabriz University of Medical Sciences, Tabriz, IranSajjadAhmadiEmergency Medicine Department, Maragheh University of Medical Sciences, Maragheh, IranSeyed HesamRahmaniEmergency Medicine Department, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IranJournal Article20151118Carotid artery thrombosis and concomitant brain infarction after blunt trauma are rare conditions. We report a 34-year-old woman with multiple traumas due to pedestrian car accident. At the time of initial visiting, she was somnolent and her Glasgow coma scale (GCS) score was 14. Initial vital signs (V/S) and brain computed tomography (CT) scan were normal. One day after admission to the emergency observation unit, GCS improved to 15 but right-sided hemiparesis occurred. Magnetic resonance imaging (MRI) showed brain infarction and Doppler sonography indicated internal carotid artery thrombosis. She was admitted in the Neurosurgery ward and underwent anticoagulant therapy. With appropriate treatment, the patient’s condition improved after 5 days of admission and she was discharged on oral warfarin treatment and close follow up. Although there is no ideal treatment for traumatic internal carotid artery thrombosis, it seems that in most cases anticoagulation therapy is the preferred method of treatment but in some patients surgical or endovascular revascularization is indicated.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701Two year-old boy with ischemic stroke71723204810.15171/jept.2016.03ENMustafaBolatkaleDepartment of Emergency Medicine, Medipol University Hospital, Istanbul, TurkeyÇağdaşCanDepartment of Emergency Medicine, Manisa State Hospital, Manisa, TurkeyAhmetÇağdaş AcaraDepartment of Emergency Medicine, Bitlis State Hospital, Bitlis, TurkeyJournal Article20160829Arterial ischemic stroke (AIS) in adults is considered a serious health threat and requires urgent medical treatment. Prompt diagnosis allows the therapeutic option of thrombolysis within the time window of 3 to 6 hours after first symptoms. Alternatively, early anti-platelet therapy is effective in improving the outcome after stroke. The incidence of pediatric AIS range from 2 to 5 per 100 000 children/year. Pediatric AIS has severity and long-term outcomes similar to those in young adults. Two-thirds of children sustaining AIS have neurological deficits that may result in life-long disability, thus critically impacting their potential development. On the other hand 10%-30% of the causes of acute strokes are of unknown reasons, therefore careful structural, metabolic and genetic risk factors, requiring more specific treatment, should also be considered in any cases of stroke in children. The diagnosis and treatment should be conducted on the basis of a multidisciplinary approach, including pediatric cardiology, hematology, neurology, neurosurgery and neuroradiology.Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701For whom the desert bell tolls: heat stroke or stroke73743204910.15171/jept.2016.04ENMustafaBolatkaleDepartment of Emergency Medicine, Medipol University Hospital, Istanbul, TurkeyÇağdaşCanDepartment of Emergency Medicine, Manisa State Hospital, Manisa, TurkeyAhmetÇağdaş AcaraDepartment of Emergency Medicine, Bitlis State Hospital, Bitlis, TurkeyJournal Article20160829 <br /> <br /> <br /> Heat stroke is the most complicated and dangerous amongst heat injuries that can lead to irreversible injury and even death with itself or with creating predisposibility to different diseases. The following case report depicts a patient who presented primarily with impairment of consciousness after walking 45 km in the summer heat to cross the Syria-Turkey border and later syncope. This case report aims to highlight the possibility of higher co-incidence with heat stroke and stroke.<br /> <span style="color: #221e1f; font-size: xx-small;"><span style="color: #221e1f; font-size: xx-small;"> </span></span>Kerman University of Medical SciencesJournal of Emergency Practice and Trauma2383-45443220170701A patient with a traumatic brain injury due to barrel bomb tertiary blast effect75763205110.15171/jept.2016.10ENMustafaBolatkaleMedipol University Hospital, Istanbul, TurkeyÇağdaşCanMerkezefendi State Hospital, Manisa, TurkeyAhmetÇağdaş AcaraGaziemir State Hospital, İzmir, TurkeyAydınSarıhanManisa State Hospital, Manisa, TurkeyJournal Article20160829 Preparing to manage weapons of mass destruction events challenges emergency services systems neighboring Syria every day. Understanding injury from explosives is essential for all providers of emergency care in both civilian and military settings. In this case, the authors present a 22-year-old man who was admitted to the emergency department with displaced skull fracture, epidural hemorrhage and cerebral contusion due to barrel bomb tertiary blast effect. A 22-year-old man who complained of pain in the right temporal head region after barrel bomb explosion was admitted in the emergency department. The patient could not remember the explosion and found himself on the ground. In his medical history, there was not a record of any diseases, operations or traumas. Examination of the head revealed scalp hematoma and slump in the skull on the right temporal region. Patients computed tomography (CT) scan showed a displaced skull fracture, epidural hematoma and cerebral contusion.