Helicopter Emergency Medical Services in East Azerbaijan province: Assessment of patients' outcome.

BACKGROUND: In this study, we aimed to evaluate the outcomes of patients transported by Helicopter Emergency Medical Services in East Azerbaijan Province. METHODS: This retrospective cross-sectional study was conducted on patients transported by the HEMS centre of Tabriz from August 2014 to March 2017. Records of the centre were used to collect data. Statistical analysis was performed by SPSS software version 20; the statistical significance level was considered below 0.05. RESULTS: In this study, 268 patients were transferred to Tabriz hospitals by 167 missions performed. The mean age of patients was 34.26±19.43, and 173 (65%) patients were male. The most common reason for call-out was the need for professional care (91.4%). The target of the majority of missions was on countryside routes. The mean distance of destinations was about 99.13±35.9 Kms, with a mean transference time of 54.68±14.17 minutes, while the mean estimated ground route time was 86.38±26.26 minutes. The most prevalent diagnosis was trauma; The Glasgow Coma Scale (GCS) and vital signs of the majority of patients were above 13 and stable, respectively. About 98 percent of patients received fluid therapy, and 71 percent were immobilized, and only 6 percent needed intubation. Also, 28 percent of patients needed Intensive Care Unit (ICU), 56 percent of whom passed away later. CONCLUSION: Our results suggest that Tabriz HEMS missions have reduced the patient transport time and also made the mortality rate closer to international standards.

Comparison of Three Techniques on Facility of Bag-Mask Ventilation: Thenar Eminence, E-O and E-C.

BACKGROUND: Rapid and secure management of airway is an important lifesaving intervention in critically ill patients at emergency wards. Training undergraduate students about airway management must be regarded as a priority in their education period. The aim of the present study was to compare the quality of three ventilation techniques with a bag and mask among two groups of undergraduate students (Novices) and senior group (Experienced) in Tabriz University of Medical Sciences. METHODS: This study was a mannequin type research that was carried out in the faculty of medicine, Tabriz University of Medical Sciences. The study population consisted of two elementary groups (Novices) and senior group (Experienced). The number of participants included 100 individuals. Ventilation quality by bag and mask in two groups was recorded based on the rise of lungs and two reviewers' opinions who gave a score from 1 as weak to 4 as excellent using three techniques of E-C, E-O, and Thenar Eminence. In the E-C technique, index fingers and thumbs form two "C"s facing each other while the remaining fingers lift the mandible and form two "E"s. In E-O techniques, the web between thumb and index finger is used to form a circle around the neck of the mask while other fingers perform a chin lift. In thenar eminence techniques, the thenar eminence and thumb are placed on the top of the mask while other fingers perform jaw thrust. RESULTS: In our study, 27% of undergraduate participants and 59% of seniors were male and the others were female. The mean of age of elementary and seniors were 24 and 33.5, respectively (P < 0.05). E-O technique was well done by the novices group. CONCLUSIONS: Based on our results, it was concluded that the elementary group performed E-O bag and mask ventilation technique appropriately. Therefore, it can be suggested that training of this technique will be placed in educational curriculum of undergraduate students.

Demographics of Fall-Related trauma among the Elderly Presenting to Emergency Department; a Cross-Sectional Study.

INTRODUCTION: Falling is reported to be the most common cause of mortality due to trauma in individuals over the age of 75 years. The present study is designed with the aim of determining the demographics of fall-related trauma among the elderly presenting to emergency department (ED). METHODS: The present prospective cross-sectional study was carried out on all elderly patients ≥ 60 years old presenting to ED of a major referral trauma center in North West of Iran during 1 year. Demographic data, location and height of falling, duration of hospitalization, trauma severity and in-hospital outcome of the patients were gathered and reported via descriptive statistics. RESULTS: 228 patients with the mean age of 70.96 ± 5.2 years were studied (53.9% female). Most patients were in the 66-70 years age range (32.6%) and had a history of hypertension (22.3%), who had visited following a fall inside the house (69.3%), due to slipping (73.7%), and from a height equal to or less than 2m (71.9%). 6 (2.6%) patients died in the hospital. Mean trauma severity of patients based on ISS, RTS, and TRISS were 10.65 ± 3.95 (3-19), 7.84 ±.21 (1.4-14.5) and 1.66 ±1.31 (-1.49-3.82), respectively. Regarding need for hospitalization, only ISS shows a significant difference between outpatients and inpatients (p = 0.023). Patients who died had a significantly higher trauma severity based on ISS (p < 0.0001) and RTS (p < 0.0001). CONCLUSION: Based on the findings of the present study, slipping and syncope are the most common causes of falling in the studied elderly that had mostly happened inside the house and from a height less than 2m. Therefore, most patients were in the mild to moderate range of trauma severity. ISS and RTS were significantly higher in the 6 (2.6%) patients who died.

Comparison of Electronic Learning Versus Lecture-based Learning in Improving Emergency Medicine Residents' Knowledge About Mild Induced Hypothermia After Cardiac Arrest.

BACKGROUND: The process of medical education depends on several issues such as training materials, students, professors, educational fields, and the applied technologies. The current study aimed at comparing the impacts of e-learning and lecture-based learning of mild induced hypothermia (MIH) after cardiac arrest on the increase of knowledge among emergency medicine residents. METHODS: In a pre- and post-intervention study, MIH after cardiac arrest was taught to 44 emergency medicine residents. Residents were randomly divided into 2 groups. The first group included 21 participants (lecture-based learning) and the second had 23 participants (e-learning). A 19-item questionnaire with approved validity and reliability was employed as the pretest and posttest. Then, data were analyzed with SPSS software version 17.0. RESULTS: There was no statistically significant difference in terms of the learning method between the test scores of the 2 groups (P = 0.977). CONCLUSIONS: E-learning and lecture-based learning methods was effective in augmentation of residents of emergency medicine knowledge about MIH after cardiac arrest; nevertheless, there was no significant difference between these mentioned methods.

Clinical Scoring Systems in Predicting the Outcome of Acute Upper Gastrointestinal Bleeding; a Narrative Review.

Prediction of the outcome and severity of acute upper gastrointestinal bleeding (UGIB) has significant importance in patient care, disposition, and determining the need for emergent endoscopy. Recent international recommendations endorse using scoring systems for management of non-variceal UGIB patients. To date, different scoring systems have been developed for predicting the risk of 30-day mortality and re-bleeding. We have discussed the screening performance characteristics of Baylor bleeding score, the Rockall risk scoring score, Cedars-Sinai Medical Center predictive index, Glasgow Blatchford score, T-score, and AIMS65 systems, in the present review. Based on the results of this survey, there are only 3 clinical decision rules that can predict the outcome of UGIB patients, independent from endoscopy. Among these, only Glasgow Blatchford score was highly sensitive for predicting the risk of 30-day mortality and re-bleeding, simultaneously.

Comparison of four techniques on facility of two-hand Bag-valve-mask (BVM) ventilation: E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (non-dominant hand) and Thenar Eminence (non-dominant hand) - E-C (dominant hand).

Introduction: Bag-valve-mask (BVM) ventilation is the first and important part of the airway management. The aim of present study was to evaluate the quality of four different BVM ventilation techniques - E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (Non dominant hand), and Thenar Eminence (Non dominant hand)-E-C (Dominant hand) - among two novice and experienced groups. Methods: In a case-control and mannequin based study that was conducted in Tabriz University of medical sciences, 120 volunteers were recruited and divided into two groups. 60 participants in experienced and other 60 as novice group who observed BVM ventilation but hadn't practical experience about BVM ventilation. Every participant in both groups performed 4 BVM ventilation techniques under the supervision of an experienced assessor. Quality of mannequin chest expansion was recorded by two other experienced assessors who were blind to ventilation process. The data were analyzed with SPSS 17.0. Results: In novice group, when evaluating each technique performance, they did Thenar Eminence (non-dominant hand) - E-C (dominant hand) technique much better than the others (P<0.0001). But in the experienced group, there was no meaningful difference between the all four techniques (P= 0.102). Conclusion: Novice participants did Thenar Eminence (non-dominant hand) - E-C (dominant hand) technique better than the others. Therefore, it is recommended that training of this technique was placed in educational program of medical students.

Epidemiology of Alcohol Poisoning and Its Outcome in the North-West of Iran.

INTRODUCTION: Alcohol poisoning is one of the main preventable causes of death, disability, and injury in many societies. Ethanol and methanol are the most prevalent kinds of alcohol used. There is no any exact reports of alcohol poisoning and its outcome in Iranian society. Therefore, the present study was assessed the status of alcohol poisoning and its outcome in referees to the emergency department. METHODS: This is a cross-sectional study, which was done from July 2013 to 2014 in Sina Trauma Center, Tabriz, Iran. The studied population included all alcohol-poisoning cases referred to this center. Demographic variables, clinical evaluation, laboratory tests, and patient's outcome were evaluated. To assess the relation between evaluated factors and outcome of alcohol poisoning. After univariate analysis, a multivariate logistic regression was applied to evaluate independent risk factors for death. P<0.05 was considered as a significant level. RESULTS: Lastly, 81 patients with alcohol poisoning were entered to the study (91.4% male) with the mean age of 27.9±10.4 years. Ten (12.3%) subjects were dialyzed and 34 (42%) cases hospitalized that 3 (3.7%) of them died. The multivariate logistic regression test displayed that plasma creatinine level (OR=2.2 95%Cl: 1.8-2.5; p=0.015) and need for dialysis (OR=6.4; 95%Cl: 5.3-7.5; p<0.001) were the only risk factors of death among these patients. CONCLUSION: The findings of the present study revealed that total mortality rate of referees to the emergency with alcohol poisoning was 3.7% all of whom related to methanol poisoning. Based on this result, the mortality rate of methanol poisoning was estimated 20%. Need for dialysis and increasing the creatinine level were accounted as independent risk factors of death.

The Comparison of Apotel plus Low Dose of Morphine and Full Dose of Morphine in Pain Relief in Patients with Acute Renal Colic.

BACKGROUND: Renal colic is an acute flank pain which may radiate to the groin, lower abdomen, or external genitalia due to the passage of a urinary stones. Pain management is the most important task in emergency wards when a patient with renal colic attends. This study aims to compare intravenous acetaminophen plus a low dose of morphine with a full dose of morphine in renal colic. METHODS: In present randomized clinical trial, 100 patients with confirmed renal colic were recruited from the Emergency Ward of Imam Reza Teaching Hospital affiliated to Tabriz University of Medical Sciences, Iran, during a one-year period. These patients randomly received either intravenous acetaminophen (Apotel, 1 g) plus a low dose of morphine (n = 50), or a high dose of morphine (5 mg) (n = 50). Visual analogue scale (VAS) was used for reporting pain during 35 minutes. Side effects and rescue analgesic demand were recorded after 30 minutes. FINDINGS: The two groups were matched for the patients' age and gender. Intra-group analysis showed significant gradual decreases in pain intensity after 35 minutes for both groups. Inter-group analysis, however, did not show a significant difference between the two groups in this regard. There was no significant difference between the two groups in terms of side effects. The rate of rescue analgesic demand was 36% in the first and 40% in the second group (P = 0.68). CONCLUSION: According to the results study, Apotel plus a low dose of morphine is at least as effective and safe as a full dose of morphine in patients with renal colic.