Loading...
Sign In    Register

Table of Content

    15 March 2019, Volume 10 Issue 1
    Original Articles
    Venous thromboembolism in the emergency department: A survey of current best practice awareness in physicians and nurses in China
    Wen-hua Zhou, Jian-qiang He, Shi-gong Guo, Joseph Walline, Xiao-ying Liu, Li-yuan Tian, Hua-dong Zhu, Xue-zhong Yu, Yi Li
    2019, 10(1):  5-13.  doi:10.5847/wjem.j.1920-8642.2019.01.001
    Asbtract    HTML    PDF (320KB)   

    BACKGROUND: For emergency department (ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism (VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE.
    METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software.
    RESULTS: In this survey, 180 questionnaires were distributed and 174 valid responses (response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no significant differences were found with respect to job (doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses’ current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years (n=83) scored significantly higher on the questionnaire than those under 5 years (n=91) (95.75 vs. 79.97, P=0.039). There was a significant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime.
    CONCLUSION: Our survey has shown deficiencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events (including VTE).

    The use of outcome feedback by emergency medicine physicians: Results of a physician survey
    Rakesh Gupta, Isaac Siemens, Sam Campbell
    2019, 10(1):  14-18.  doi:10.5847/wjem.j.1920-8642.2019.01.002
    Asbtract    HTML    PDF (248KB)   

    BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of emergency department (ED) outcome feedback called the return visit report (RVR) and present the results of a survey assessing physicians’ perceptions of this novel form of feedback.
    METHODS: An Opinio web-based survey was conducted in 81 emergency physicians (EPs) at three EDs.
    RESULTS: Of the 81 physicians surveyed, 40 (49%) responded. Most participants indicated that they frequently review their RVRs (83%), that RVRs are valuable to their practice of medicine (80%), and that RVRs alter their practice in future encounters (57%). Respondents reported seeking other forms of outcome feedback including speaking with other EPs (83%) and reviewing discharge summaries of admitted patients (87%). There was no correlation between demographic data and use of RVRs.
    CONCLUSION: EPs value RVRs as a form of feedback. RVRs could be improved by reducing the observational interval and optimizing report relevance and differential weighting.

    Rapid sequence induction (RSI) in trauma patients: Insights from healthcare providers
    Bianca M. Wahlen, Ayman El-Menyar, Mohammad Asim, Hassan Al-Thani
    2019, 10(1):  19-26.  doi:10.5847/wjem.j.1920-8642.2019.01.003
    Asbtract    HTML    PDF (293KB)   

    BACKGROUND: We aimed to describe the current practice of emergency physicians and anaesthesiologists in the selection of drugs for rapid-sequence induction (RSI) among trauma patients.
    METHODS: A prospective survey audit was conducted based on a self-administered questionnaire among two intubating specialties. The preferred type and dose of hypnotics, opioids, and muscle relaxants used for RSI in trauma patients were sought in the questionnaire. Data were compared for the use of induction agent, opioid use and muscle relaxant among stable and unstable trauma patients by the intubating specialties.
    RESULTS: A total of 102 participants were included; 47 were anaesthetists and 55 were emergency physicians. Propofol (74.5%) and Etomidate (50.0%) were the most frequently used induction agents. Significantly higher proportion of anesthesiologist used Propofol whereas, Etomidate was commonly used by emergency physicians in stable patients (P=0.001). Emergency physicians preferred Etomidate (63.6%) and Ketamine (20.0%) in unstable patients. The two groups were comparable for opioid use for stable patients. In unstable patients, use of opioid differed significantly by intubating specialties. The relation between rocuronium and suxamethonium use did change among the anaesthetists. Emergency physicians used more suxamethonium (55.6% vs. 27.7%, P=0.01) in stable as well as unstable (43.4 % vs. 27.7%, P=0.08) patients.
    CONCLUSION: There is variability in the use of drugs for RSI in trauma patients amongst emergency physicians and anaesthesiologists. There is a need to develop an RSI protocol using standardized types and dose of these agents to deliver an effective airway management for trauma patients.

    Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury
    Hojat Sheikh Motahar Vahedi, Hadi Hajebi, Elnaz Vahidi, Amir Nejati, Morteza Saeedi
    2019, 10(1):  27-32.  doi:10.5847/wjem.j.1920-8642.2019.01.004
    Asbtract    HTML    PDF (230KB)   

    BACKGROUND: Rapid and effective pain relief in acute traumatic limb injuries (ATLI) is one of the most important roles of emergency physicians. In these situations, opioid addiction is an important concern because of the dependency on opioids. The study aims to compare the effectiveness of intravenous (IV) fentanyl versus morphine in reducing pain in patients with opioid addiction who suffered from ATLI.
    METHODS: In this double-blind randomized clinical trial, 307 patients with ATLI, who presented to the emergency department (ED) from February 2016 to April 2016, were randomly divided into two groups. One group (152 patients) received 0.1 mg/kg IV morphine. The other group (155 patients) received 1 mcg/kg IV fentanyl. Patients’ demographic data, pain score at specific intervals, vital signs, side effects, satisfaction and the need for rescue analgesia were recorded.
    RESULTS: Eight patients in the morphine group and five patients in the fentanyl group were excluded. Pain score in the fentanyl group had a significant decrease at 5-minute follow-up (P value=0.00). However, at 10, 30, and 60-minute follow-ups no significant differences were observed between the two groups in terms of pain score reduction. The rescue analgesia was required in 12 (7.7%) patients in the fentanyl group and in 48 (31.6%) patients in the morphine group (P value=0.00). No significant difference was observed regarding side effects, vital signs and patients’ satisfaction between the two groups.
    CONCLUSION: Fentanyl might be an effective and safe drug in opioid addicts suffering from ATLI.

    Establishment of trauma registry at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi and mapping of high risk geographic areas for trauma
    Linda C. Chokotho, Wakisa Mulwafu, Mulinda Nyirenda, Foster J. Mbomuwa, Hemant G. Pandit, Grace Le, Christopher Lavy
    2019, 10(1):  33-41.  doi:10.5847/wjem.j.1920-8642.2019.01.005
    Asbtract    HTML    PDF (516KB)   

    BACKGROUND: Less attention is directed toward gaining a better understanding of the burden and prevention of injuries, in low and middle income countries (LMICs). We report the establishment of a trauma registry at the Adult Emergency and Trauma Centre (AETC) at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi and identify high risk geographic areas.
    METHODS: We devised a paper based two-page trauma registry form. Ten data clerks and all AETC clinicians were trained to complete demographic and clinical details respectively. Descriptive data, regression and hotspot analyses were done using STATA 15 statistical package and ArcGIS (16) software respectively.
    RESULTS: There were 3,747 patients from May 2013 to May 2015. The most common mechanisms of injury were assault (38.2%), and road traffic injuries (31.6%). The majority had soft tissue injury (53.1%), while 23.8% had no diagnosis indicated. Fractures (OR 19.94 [15.34-25.93]), head injury and internal organ injury (OR 29.5 [16.29-53.4]), and use of ambulance (OR 1.57 [1.06-2.33]) were found to be predictive of increased odds of being admitted to hospital while assault (OR 0.69 [0.52-0.91]) was found to be associated with less odds of being admitted to hospital. Hot spot analysis showed that at 99% confidence interval, Ndirande, Mbayani and Limbe were the top hot spots for injury occurrence.
    CONCLUSION: We have described the process of establishing an integrated and potentially sustainable trauma registry. Significant data were captured to provide details on the epidemiology of trauma and insight on how care could be improved at AETC and surrounding health facilities. This approach may be relevant in similar poor resource settings.

    Prehospital response to respiratory distress by the public ambulance system in a Ukrainian city
    Colin A. Meghoo, Stanislav Gaievskyi, Oleksandr Linchevskyy, Bindhu Oommen, Kateryna Stetsenko
    2019, 10(1):  42-45.  doi:10.5847/wjem.j.1920-8642.2019.01.006
    Asbtract    HTML    PDF (216KB)   

    BACKGROUND: The capability of the public ambulance system in Ukraine to address urgent medical complaints in a prehospital environment is unknown. Evaluation using reliable sources of patient data is needed to provide insight into current treatments and outcomes.
    METHODS: We obtained access to de-identified computer records from the emergency medical services (EMS) dispatch center in Poltava, a medium-sized city in central Ukraine. Covering a five-month period, we retrieved data for urgent calls with a patient complaint of respiratory distress. We evaluated ambulance response and treatment times, field diagnoses, and patient disposition, and analyzed factors related to fatal outcomes.
    RESULTS: Over the five-month period of the study, 2,029 urgent calls for respiratory distress were made to the Poltava EMS dispatch center. A physician-led ambulance typically responded within 10 minutes. Seventy-seven percent of patients were treated and released, twenty percent were taken to hospital, and three percent died in the prehospital phase. On univariate analysis, age over 60 and altered mental status at the time of the call were strongly associated with a fatal outcome.
    CONCLUSION: The EMS dispatch center in a medium-sized city in Ukraine has adequate organizational infrastructure to ensure that a physician-led public ambulance responds rapidly to complaints of respiratory distress. That EMS system was able to manage most patients without requiring hospital admission. However, a prehospital fatality rate of three percent suggests that further research is warranted to determine training, equipment, or procedural needs of the public ambulance system to manage urgent medical conditions.

    Assessment of clinical dehydration using point of care ultrasound for pediatric patients in rural Panama
    Genevieve Mazza, Carina Mireles Romo, Marlene Torres, Ali Duffens, Annasha Vyas, Katherine Moran, Joshua Livingston, Savannah Gonzales, Shadi Lahham, Inna Shniter, Maxwell Thompson, John Christian Fox
    2019, 10(1):  46-50.  doi:10.5847/wjem.j.1920-8642.2019.01.007
    Asbtract    HTML    PDF (319KB)   

    BACKGROUND: Dehydration and its associated symptoms are among the most common chief complaints of children in rural Panama. Previous studies have shown that intravascular volume correlates to the ratio of the diameters of the inferior vena cava (IVC) to the aorta (Ao). Our study aims to determine if medical students can detect pediatric dehydration using ultrasound on patients in rural Panama.
    METHODS: This was a prospective, observational study conducted in the Bocas del Toro region of rural Panama. Children between the ages of 1 to 15 years presenting with diarrhea, vomiting, or parasitic infection were enrolled in the study. Ultrasound measurements of the diameters of the IVC and abdominal aorta were taken to assess for dehydration.
    RESULTS: A total of 59 patients were enrolled in this study. Twenty-four patients were clinically diagnosed with dehydration and 35 were classified to have normal hydration status. Of the 24 patients with dehydration, half (n=12) of these patients had an IVC/Ao ratio below the American threshold of 0.8. Of the remaining asymptomatic subjects, about half (n=18) of these subjects also had an IVC/Ao ratio below the American threshold of 0.8.
    CONCLUSION: Our study did not support previous literature showing that the IVC/Ao ratio is lower in children with dehydration. It is possible that the American standard for evaluating clinical dehydration is not compatible with the rural pediatric populations of Panama.

    Case Letters
    Intussusception in an infant with two non-diagnostic abdominal ultrasound studies
    Vanessa Santos, James Espinosa, Alan Lucerna
    2019, 10(1):  51-54.  doi:10.5847/wjem.j.1920-8642.2019.01.008
    Asbtract    HTML    PDF (495KB)   
    Elderly male with blurry vision
    Anthony Maselli, Sarah E. Frasure
    2019, 10(1):  59-60.  doi:10.5847/wjem.j.1920-8642.2019.01.010
    Asbtract    HTML    PDF (324KB)   
    Instructions for Authors
    Instructions for Authors
    2019, 10(1):  61-64. 
    Asbtract    HTML    PDF (186KB)