World Journal of Emergency Medicine

Hydrocarbon pneumonitis following fuel siphonage: A case report and literature review

Yi-jung Chen, Chien-chin Hsu, Kuo-tai Chen

2019, 10(2): 69-74. doi:10.5847/wjem.j.1920-8642.2019.02.001

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BACKGROUND: People sometimes siphon fuel to fill their tanks. However, this is a potentially dangerous procedure and may cause hydrocarbon pneumonitis. We present the case of a patient with severe hydrocarbon pneumonitis after siphoning fuel. The patient underwent artificial ventilation and was admitted to hospital for 97 days.
METHODS: We review the relevant literature for a better understanding of clinical features and management strategies for hydrocarbon pneumonitis following fuel siphonage.
RESULTS: We reviewed 15 articles, which included 3 original articles and 12 case reports that reported the clinical features of fuel siphonage. In addition, we added our presented case for data analysis. A total of 40 cases were included in this review. The literature review found that hydrocarbon pneumonitis caused by fuel siphonage occurs worldwide and that most patients (80%) became symptomatic within 1 day of aspiration. Cough (70%), chest pain (62.5%), dyspnoea (55%), and fever (52.5%) presented in more than half of all patients. The right middle lobe (80%) was the predominantly involved lung field; more than one-third of patients (36.7%) showed the involvement of two lobes.
CONCLUSION: Patient history, computed tomographic scans of the chest, and bronchoalveolar lavage are the commonly used diagnostic tools. Supportive care remains the foundation of treatment, whereas antibiotics, steroids, and bronchoalveolar lavage are practical therapies. Patients’ clinical improvement precedes the resolution of lesions on chest X-ray. Most complications arise from pulmonary lesions. The prognosis of patients suffering from hydrocarbon pneumonitis following fuel siphonage might be improved by accurate diagnosis and appropriate care.

Do medical students studying in the United Kingdom have an adequate factual knowledge of basic life support?

Robert D. Willmore, Damjan Veljanoski, Feray Ozdes, Bethan Stephens, James Mooney, Seamus G. Crumley, Arpan Doshi, Philippa Davies, Shreya Badhrinarayanan, Emily Day, Kristian Tattam, April Wilson, Nathan Crang, Lorna Green, Craig A. Mounsey, Howell Fu, Joseph Williams, Michelle S. D'souza, Dhanya Sebastian, Liam A. Mcgiveron, Matthew G. Percy, James Cohen, Imogen J. John, Alice Lethbridge, Imogen Watkins, Omar Amin, Mubasher A. Qamar, John Gerrard Hanrahan, Emily Cramond-Wong

2019, 10(2): 75-80. doi:10.5847/wjem.j.1920-8642.2019.02.002

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BACKGROUND: Healthcare professionals have a duty to maintain basic life support (BLS) skills. This study aims to evaluate medical students’ factual knowledge of BLS and the training they receive.
METHODS: A cross-sectional, closed-response questionnaire was distributed to the first- and fourth-year students studying at institutions in the United Kingdom. The paper questionnaire sought to quantify respondent’s previous BLS training, factual knowledge of the BLS algorithm using five multiple choice questions (MCQs), and valuate their desire for further BLS training. Students received 1 point for each correctly identified answer to the 5 MCQ’s.
RESULTS: A total of 3,732 complete responses were received from 21 medical schools. Eighty percent (n=2,999) of students completed a BLS course as part of their undergraduate medical studies. There was a significant difference (P<0.001) in the percentage of the fourth-year students selecting the correct answer in all the MCQ’s compared to the first-year students except in identifying the correct depth of compressions required during CPR (P=0.095). Overall 10.3% (95% CI 9.9% to 10.7%) of respondents correctly identified the answer to 5 MCQ’s on BLS: 9% of the first-year students (n=194) and 12% of the fourth-year students (n=190). On an institutional level the proportion of students answering all MCQ’s correctly ranged from 2% to 54% at different universities. Eighty-one percent of students (n=3,031) wished for more BLS training in their curriculum.
CONCLUSION: Factual knowledge of BLS is poor among medical students in the UK. There is a disparity in standards of knowledge across institutions and respondents indicating that they would like more training.

Theoretical knowledge and psychomotor skill acquisition of basic life support training programme among secondary school students

Israel Olatunji Gabriel, Joel O. Aluko

2019, 10(2): 81-87. doi:10.5847/wjem.j.1920-8642.2019.02.003

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BACKGROUND: The aim of the study is to evaluate the theoretical knowledge and psychomotor skill acquisition of basic life support (BLS) by a group of secondary school students in Nigeria pre and post BLS training.
METHODS: This was quasi-experimental study design with 210 participants. They were taught on adult BLS and all the participants practiced BLS on a Resusci-Anne manikin immediately after the training. Data were collected using American Heart Association (AHA) structured questionnaire and psychomotor skills checklist for BLS at baseline, and post BLS training.
RESULTS: The pre-training knowledge score was 1.9±1.4. This increased after the BLS training to 11.4±2.4, and the mean difference between the pre and post BLS training scores was 9.48571. Pre-training psychomotor skill score was 0.00±0.00, this increased to 8.9±1.9 after the training, and the mean difference was 8.90000. The knowledge and psychomotor skill difference between pre and post BLS training was significant (P<0.000).
CONCLUSION: Most Nigerian secondary school students were not knowledgeable about BLS. Therefore, there is need for the creation of more awareness among the students.

Assessment of knowledge, attitude and practice regarding oxygen therapy at emergency departments in Riyadh in 2017: A cross-sectional study

Amairah Fahad Aloushan, Faisal Abdullah Almoaiqel, Raid Naysh Alghamdi, Fatmah Ismail Alnahari, Abdulaziz Fahad Aldosari, Nazish Masud, Nawfal Abdullah Aljerian

2019, 10(2): 88-93. doi:10.5847/wjem.j.1920-8642.2019.02.004

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BACKGROUND: Administering oxygen therapy (OT) has an essential role in preventing/managing hypoxemia in both acute and chronic conditions. It should be adjusted to achieve the normal oxygen saturation of 94%-98% in most cases. This study aims to evaluate knowledge, attitude and practice (KAP) of nurses, paramedics, emergency medical technicians (EMTs) and Emergency Medical Services (EMS) physicians working at emergency departments (ED) in Riyadh, Saudi Arabia.
METHODS: In this cross-sectional study, a structured questionnaire was used to assess KAP related to OT of nurses, paramedics, EMTs and EMS physicians currently working at an ED of a tertiary care hospital. Knowledge and attitude were assessed using a Likert scale from 1-5, whereas practice was assessed as a yes/no categorical variable.
RESULTS: A total of 444 emergency health-care workers (EHCWs) participated, of which 225 (50.7%) were male, with the majority (77%) in the age group of 20-35 years. Over half of the sample were nurses (266; 59.9%). The mean score for knowledge about OT was 5.51±1.45, attitude was 26.31±3.17 and for practices 4.55±1.76. The main factors which were associated with poor KAP were workload and lack of local guidelines. The distribution of overall practice score was significantly better among paramedics - nurses group and EMT - nurses group.
CONCLUSION: This study demonstrates that there is a gap in EHCWs’ KAP, particularly regarding when to provide OT to a patient. This gap can affect patients’ safety. Extensive educational and training programs about OT are needed to raise awareness among health-care providers.

Assessing adequacy of emergency provider documentation among interhospital transferred patients with acute aortic dissection

Mark Rose, Carina Newton, Benchaa Boualam, Nancy Bogne, Adam Ketchum, Umang Shah, Jordan Mitchell, Safura Tanveer, Tucker Lurie, Walesia Robinson, Rebecca Duncan, Stephen Thom, Quincy Khoi Tran

2019, 10(2): 94-100. doi:10.5847/wjem.j.1920-8642.2019.02.005

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BACKGROUND: Acute aortic dissection (AoD) is a hypertensive emergency often requiring the transfer of patients to higher care hospitals; thus, clinical care documentation and compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA) is crucial. The study assessed emergency providers (EP) documentation of clinical care and EMTALA compliance among interhospital transferred AoD patients.
METHODS: This retrospective study examined adult patients transferred directly from a referring emergency department (ED) to a quaternary academic center between January 1, 2011 and September 30, 2015. The primary outcome was the percentage of records with adequate documentation of clinical care (ADoCC). The secondary outcome was the percentage of records with adequate documentation of EMTALA compliance (ADoEMTALA).
RESULTS: There were 563 electronically identified patients with 287 included in the final analysis. One hundred and five (36.6%) patients had ADoCC while 166 (57.8%) patients had ADoEMTALA. Patients with inadequate documentation of EMTALA (IDoEMTALA) were associated with a higher likelihood of not meeting the American Heart Association (AHA) ED Departure SBP guideline (OR 1.8, 95% CI 1.03-3.2, P=0.04). Male gender, handwritten type of documentation, and transport by air were associated with an increased risk of inadequate documentation of clinical care (IDoCC), while receiving continuous infusion was associated with higher risk of IDoEMTALA.
CONCLUSION: Documentation of clinical care and EMTALA compliance by Emergency Providers is poor. Inadequate EMTALA documentation was associated with a higher likelihood of patients not meeting the AHA ED Departure SBP guideline. Therefore, Emergency Providers should thoroughly document clinical care and EMTALA compliance among this critically ill group before transfer.

The “PAWPER-on-a-page”: Increasing global access to a low-cost weight estimation system

Mike Wells, Lara Nicole Goldstein

2019, 10(2): 101-108. doi:10.5847/wjem.j.1920-8642.2019.02.006

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BACKGROUND: The PAWPER tape is one of the most accurate weight estimation systems available today, but international access to the tape is limited because it has no commercial distribution. For this reason, the “PAWPER-on-a-page” concept was devised: downloadable image files that allow users to print and assemble their own tapes. However, the feasibility of this method is dependent on users being able to produce accurate tapes. This study was devised to determine whether untrained participants could print and assemble the “PAWPER-on-a-page” easily and accurately.
METHODS: Doctor and nurse volunteers downloaded the “PAWPER-on-a-page” and “PAWPER XL-on-a-page” image files and printed copies on a home-printer and also at a commercial printer. One copy of each tape was then assembled according to instructions from an online video. The accuracy of printing and assembly, the time taken for assembly and the cost were then evaluated.
RESULTS: There were 32 participants. The median time for assembly was 8 minutes 19 seconds and 7 minutes 31 seconds for the “PAWPER-on-a-page” and “PAWPER XL-on-a-page” respectively, with a median cost of USD 0.09 and USD 1.00 respectively. For the assembled tapes, 71.9% of the “PAWPER-on-a-page” tapes and 65.6% of the “PAWPER XL-on-a-page” achieved the required accuracy of 0.2%. Printing errors, related to scaling, were common, but easily detectable.
CONCLUSION: The “PAWPER-on-a-page” system can be easily, quickly, affordably and accurately printed and assembled by end users. Stringent double checking of the printed and fully assembled tapes is essential to ensure accuracy.

Can an 8^th grade student learn point of care ultrasound?

Alexander S. Kwon, Shadi Lahham, John C. Fox

2019, 10(2): 109-113. doi:10.5847/wjem.j.1920-8642.2019.02.007

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BACKGROUND: Point-of-care ultrasound has gained widespread use in developing countries due to decreased cost and improved telemedicine capabilities. Ultrasound training, specifically image acquisition skills, is occurring with more frequency in non-medical personnel with varying educational levels in these underdeveloped areas. This study evaluates if students without a high school education can be trained to acquire useful FAST images, and to determine if an 8^thgrade student can teach peers these skills.
METHODS: The 8^th grade students at a small middle school were divided into two groups. One group received training by a certified medical sonographer, while the other group received training by a peer 8^th grade student trainer who had previously received training by the sonographer. After training, each student was independently tested by scanning the four FAST locations. A blinded ultrasound expert evaluated these images and deemed each image adequate or inadequate for clinical use.
RESULTS: Eighty video image clips were obtained. The overall image adequacy rate was 74%. The splenorenal window had the highest rate at 95%, followed by retrovesical at 90%, hepatorenal at 75%, and subxiphoid cardiac at 35%. The adequacy rate of the sonographer-trained group was 78%, while the adequacy rate of the student-trained group was 70%. The difference in image adequacy rate between the two groups was not significant (P-value 0.459).
CONCLUSION: The majority of 8^th graders obtained clinically adequate FAST images after minimal training. Additionally, the student-trained group performed as well as the sonographer-trained group.