Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 4 2024 08 12 e30 e30 Mohammad Irajian Department of Orthopedics, School of Medicine, Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Mohammad Reza Moharrami Department of Orthopedics, School of Medicine, Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Mahdi Nazari Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Nina Pilehvar Department of Anesthesiology, Neuroanesthesiology fellow, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 01 19 2024 07 07 Objective: Preparing patients for emergency surgeries requires accurate consideration of their clinical condition and medical history to avoid potential hemodynamic instability and compromise the immune system. This study aims to compare the effects of dexmedetomidine and magnesium sulfate infusions in maintaining stable hemodynamics during emergency orthopedic surgery.  Methods: The present study was conducted as a randomized and double-blind clinical trial with the participation of 80 patients who were candidates for an emergency orthopedic surgery during 2021. Magnesium sulfate was administered as an intravenous bolus at a loading dose of 50 mg/kg over 10 minutes, followed by a continuous infusion at a rate of 15-20 mg/kg/hour. Dexmedetomidine was administered as an intravenous bolus at a loading dose of 1 mcg/kg over 10 minutes, followed by a continuous infusion at a rate of 0.2-0.7 mcg/kg/hour, depending on patient response. These infusions were initiated 15 minutes before induction of anesthesia and continued until the end of surgery. All drugs (dexmedetomidine and magnesium sulfate) were diluted in a 50-cc syringe and infused. The hemodynamic status (diastolic blood pressure (DBP), systolic blood pressure (SBP) mean arterial pressure (MAP) and heart rate (HR)) of the patients between the two groups was recorded and finally compared with each other.  Results: The hemodynamic status (DBP, SBP, MAP and HR) between the two groups at all (perioperative time) times were without significant statistical differences (P˃0.05).  Conclusion: Both dexmedetomidine and magnesium sulfate are effective and safe options for achieving hemodynamic stability during emergency orthopedic surgery. https://fem.tums.ac.ir/index.php/fem/article/view/1338 https://fem.tums.ac.ir/index.php/fem/article/download/1338/494

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 4 2024 09 19 e31 e31 Sonia Piñero-Saez Nursing Faculty of the Albacete, Castilla-La Mancha University, Albacete, Spain. Angel López-González Nursing Faculty of the Albacete, Castilla-La Mancha University, Albacete, Spain. Isabel Guisado-Requena Nursing Faculty of the Albacete, Castilla-La Mancha University, Albacete, Spain. Jaime López-Tendero Castilla-La Mancha Health Service, Albacete, Spain. Carmen Guerrero-Agenjo Castilla-La Mancha Health Service, Albacete, Spain. Francisco García-Alcaraz Nursing Faculty of the Albacete, Castilla-La Mancha University, Albacete, Spain. Ignacio Martínez-González-Moro Institute for Researching in Aging, Murcia, Spain. Joseba Rabanales-Sotos Nursing Faculty of the Albacete, Castilla-La Mancha University, Albacete, Spain. 2024 03 04 2024 07 10 Objective: To assess biceps brachii and erector spinae muscular oxygen saturation (SmO2) by near infrared spectroscopy (NIRS), during 10 minutes of resuscitation at simulated altitudes of 600, 3000 and 5000 m before and after carrying out a simulation program for adaptation to hypoxia. Performing and maintaining a good-quality cardiopulmonary resuscitation (CPR) at higher altitudes may pose a significant challenge to resuscitators due tom decrease in arterial oxygen saturation. This fact adversely effects the quality of resuscitation.  Methods: Participants performed 10 minutes of CPR on a mannequin in the laboratory in environments that simulated altitudes. Subsequently, a standardized altitude conditioning protocol was carried out using intermittent hypoxia. The participants performed CPR again under the conditions and altitudes previously referred to.  Results: Initial heart rate (HR) at 5000 > 3000 m, and both > 600 m. HR at each altitude was higher conditioning at the end of CPR. The SmO2 of both muscles showed no differences at the beginning and at the end of CPR and was higher in both muscles after the conditioning program before and at the end of CPR. In both muscles, SmO2 values before and after conditioning show a slightly increasing trend during CPR.  Conclusion: NIRS use allows developing an optimum training plan. The rescuer will know his limits and optimize his performance. The improvement in physical performance and recovery capacity induced by intermittent hypoxia conditioning programs increases the quality of CPR in prolonged cardiac arrests and in adverse conditions, such as at high altitudes. https://fem.tums.ac.ir/index.php/fem/article/view/1363 https://fem.tums.ac.ir/index.php/fem/article/download/1363/495

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 4 2024 10 07 e32 e32 Yogita Sharma Socio-Behavioural, Health Systems & Implementation Research Division, Indian Council of Medical Research, New Delhi, India. Ponnaiah Manickam ICMR - National Institute of Epidemiology, Chennai, India. Kamalabai John Apollo Institute of Medical Science & Research, Chittoor, Andhra Pradesh, India. Jugal Kishore Vardhman Mahavir Medical College &Safdarjung Hospital, New Delhi, India. Daya Mangal Indian Institute of Health Management Research, Jaipur, India. Rajesh Singh Garhwal Community Development and Welfare Society, Tehri-Garhwal, India Ashish Joshi Foundation for Health Technologies Society, New Delhi, India. Bontha Babu Socio-Behavioural, Health Systems & Implementation Research Division, Indian Council of Medical Research, New Delhi, India. 2024 02 23 2024 07 10 Objective: Road traffic injuries (RTIs) have been recognized globally as an important public health problem. Effective road safety initiatives should address the traffic system as a whole to find a solution and look at the traffic system as a collective to discuss interactions between vehicles, road users and road infrastructure. Therefore, epidemiological data from different geographies of the country should be available. Hence, an electronic-based comprehensive and integrated RTI surveillance system was established in five centres located across the country to assess the burden of RTIs, including the outcome. Methods: This paper is a cross-sectional multi-centric study conducted using an electronic-based comprehensive and integrated RTI surveillance system. Results: A total of 15,319 participants were enrolled under the surveillance of road traffic events for a period of one year. Self-fall/skid was the most common (34.87%) type of accident, followed by a crash between two vehicles (25.77%) and a crash with a pedestrian (16.59%). Among them, 88.94% were the injured, who were alive with or without rehabilitation, and 673 (4.43%) were dead. Mostly, two-wheelers (geared or non-geared) were involved in the accident as they shared a significant portion (75.54%) of the total accidents. Conclusion: The study highlights the epidemiological issues related to road accidents and RTIs that need to be addressed in order to find appropriate solutions for reducing the RTI burden. It gives an understanding of the manner of trauma, the pattern of injuries, and the outcome of road traffic accidents required to adopt efficient preventive and comprehensive trauma care. https://fem.tums.ac.ir/index.php/fem/article/view/1345 https://fem.tums.ac.ir/index.php/fem/article/download/1345/497

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 4 2024 10 16 e33 e33 Asaminew Habtamu Department of Emergency Medicine and Critical Care Nursing, school of Nursing, institute of health science, Jimma University, Ethiopia. Taye Mezgebu Department of Emergency Medicine and Critical Care nursing, school of Nursing, college of health science, Wachemo University, central Ethiopia. Abdeta Workina Department of Emergency Medicine and Critical Care Nursing, school of Nursing, institute of health science, Jimma University, Ethiopia. Bulcha Lemma School of Medicine, Medical Sciences faculty, institute of health, Jimma University, Ethiopia. feyissa Tolessa Department of Health policy and management, institute of health, Public Health faculty, Jimma University, Ethiopia. Edmialem Getahun Department of Emergency Medicine and Critical Care nursing, school of Nursing’s St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Adebabay Wondimagegn Department of Emergency Medicine and Critical Care nursing, Jimma Medical Center, Jimma, Ethiopia. Achalu Kelbessa Department of Adult Health Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Fikadu Abebe Department of Reproductive Health, institute of health, Public Health faculty, Jimma University, Ethiopia. 2024 04 11 2024 08 11 Objective: Delirium is characterized by impaired attention and awareness, accompanied by cognitive deficits. It develops rapidly and poses a considerable burden on healthcare systems. Patients in the intensive care unit (ICU) are particularly vulnerable to developing delirium. This study aims to determine the incidence and predictors of delirium among ICU patients at Jimma Medical Center in southwest Ethiopia in 2023.  Methods: A prospective observational cohort study was conducted on 403 patients aged≥18 years admitted to emergency, surgical, and medical ICUs at Jimma Medical Center in southwest Ethiopia. Patients were assessed twice daily for delirium using the Richmond agitation sedation scale (RASS) and confusion assessment method (CAM). The association between independent variables and delirium incidence was analyzed using Cox proportional hazards (PH) regression. A univariate Cox PH model screened variables at a 0.25 significance level, followed by a multivariable Cox PH model for significant variables. Variables with a P-value≤0.05 were considered significantly associated with delirium incidence among ICU patients.  Results: The findings of this study revealed that the overall occurrence of delirium among critically ill ICU patients was 118 (29.3%) (95% CI: 25%,34%), and the rest, 70.7% of the participants, were censored (95% CI: 66,75). The incidence rate of delirium among intensive care unit patients was 21.2 (95% CI: 17.8,25.4) per 1000 person-days of observation. Chronic obstructive pulmonary disease (AHR: 1.94; 95% CI: 1.23,3.56), stroke (AHR: 1.8; 95%CI: 1.98,3.73), Oxygen Saturation less than 90% (AHR:1.61; 95% CI: 1.11,2.34) and Obesity (AHR: 0.35; 95%CI: 0.13,0.84) were independent predictors of delirium among ICU patients.   conclusion: This study found that, with an incidence rate of 21.2 occurrences per 1000 person-days of observation, delirium greatly affects the outcome of intensive care unit patients in the Jimma Medical Center. The study identifies several factors that independently predict the occurrence of delirium in ICU patients, including obesity, stroke, low oxygen saturation levels, and COPD. Interestingly, our findings suggest that admission for heart failure may have a protective effect against delirium. Therefore, health professionals ought to give special attention to patients with identified predictors. https://fem.tums.ac.ir/index.php/fem/article/view/1386 https://fem.tums.ac.ir/index.php/fem/article/download/1386/496

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 4 2024 11 11 e34 e34 Tannaz Pourlak Department of Oral and Maxillofacial Surgery, School of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran. Marjan Dehdilani Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. 2024 07 12 2024 09 09 Objective: Effective pain management in mandibular fractures is crucial due to the complications associated with opioids, such as respiratory depression and re-intubation. Non-opioid methods are therefore important. This study aims to compare the effectiveness, safety, and efficiency of intranasal (IN) versus intravenous (IV) dexmedetomidine (Dex) for reducing acute pain following mandibular surgery.  Methods: This study was a randomized, double-blind clinical trial. All patients underwent general anesthesia, laryngoscopy, and intubation in a standardized manner. For the IN administration group, Dex was prescribed at a dose of 0.2 µ/kg (in the form of drops) half an hour before the start of anesthesia. For the IV administration group, Dex was administered at a dose of 0.5 µ/kg intravenously over ten minutes, half an hour before anesthesia. During the first 24 hours after surgery, pain intensity and the total amount of opioid medication (measured in mg of pethidine) were recorded for each patient.  Results: There was no significant difference in pain intensity between the two groups in the post-anesthesia care unit (P=0.898), one hour (P=0.052) and 24 hours post-surgery (P=0.898). However, pain intensity was significantly lower in the IN Dex group at the second (P=0.044), fourth (P=0.041), sixth (P=0.048), and twelfth (P=0.025) hours. Total pethidine injected in the IN Dex group was significantly lower than in the IV Dex group (P=0.041).  Conclusion: This study underscores the efficacy of IN Dex as a viable alternative for postoperative pain management in traumatic mandibular fracture surgeries. https://fem.tums.ac.ir/index.php/fem/article/view/1443 https://fem.tums.ac.ir/index.php/fem/article/download/1443/500

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 8 4 2024 11 15 e35 e35 Abinavi Balaji Department of Pharmacy Practice, Saveetha College of Pharmacy, Saveetha Institute of Medical and Technical Sciences, Chennai – 602105, TN, India. Vinod Kaluram Department of Pharmacy Practice, Saveetha College of Pharmacy, Saveetha Institute of Medical and Technical Sciences, Chennai – 602105, TN, India. 2024 05 28 2024 09 03 y invite other experts in this regard. https://fem.tums.ac.ir/index.php/fem/article/view/1152 https://fem.tums.ac.ir/index.php/fem/article/download/1152/433

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2022 07 07 e4 e4 Ali Vafaye Department of Emergency Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Kamran Heydari Department of Emergency Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hossein Mardanparvar Department of nursing, Faculty of nursing & midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran Ali Alizadeh Kaseb Department of Emergency Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Saeed Safari Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2022 07 03 2022 07 07 Introduction: Emergency medicine (EM) is a relatively new medical specialty, which concerns patients who need vital and urgent medical care. This study aimed to evaluate the general medicine interns’ attitude in continuing their education in EM residency programs. Methods: This study is a prospective cross-sectional study, which was performed on 180 medical students during their internship using convenience sampling. Data were collected using a valid and reliable researcher-made questionnaire and analyzed using SPSS 26 software. Results: One hundred and eighty medical students in the internship period with the mean of 25.65 ± 2.72 (23 – 46) years were studied (53.3% male; 76.7% single). Only 33 (18.3%) interns indicated their interest in continuing their education in EM residency programs. 30 (16.66) cases were not interested in continuing their education in any residency program (61.1% of whom cited migration as the reason, 13% cited not working as a specialist, 14.8% indicated lack of economic justification, and 11.1% cited other reasons for not wanting to enter residency programs). The mean overall interest score to EM residency program was 59.61 ± 12.66 % (20 – 96.41%). The lowest and highest interest scores obtained in the economic status (47.91 ± 21.13%) and education status (70.59 ± 15.77%) of EM specialty, respectively. The mean overall interest score was not statistically different between male and female students (p = 0.366). There was a significant statistical correlation between gender and type of discipline chosen, and female mostly chose non-surgical disciplines (p = 0.001). Conclusion: The interest of general medicine interns in continuing their education in EM residency program was average. The economic field of EM has been one of the best factors in attracting students to continue their studies in this field. https://fem.tums.ac.ir/index.php/fem/article/view/1034 https://fem.tums.ac.ir/index.php/fem/article/download/1034/414

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2023 01 04 e11 e11 Sakher Awadalla Emergency Department, King’s College Hospital London, Dubai, UAE Ahmed Kamal Mohamed Emergency Department, NMC Royal Hospital Khalifa City, Abu Dhabi, UAE 2022 12 01 2022 12 06 An 8-month-old, male child was brought to the emergency department (ED) by his parents with difficulty of breathing. The child developed shortness of breath for one day with cough, but he had no fever. According to the parents, they did not notice the abdominal distension. The child was born prematurely at 25 weeks of gestation and stayed in the neonatal intensive care unit (NICU) for 2 months. Otherwise, he was healthy with minor repeated chest infections and bronchiolitis. In triage, his vital signs were as follows: heart rate: 180 beats/min; respiratory rate: 35 breaths/min; temperature: 35± C; oxygen saturation: 70%; and his blood pressure was undetected. The child was immediately transferred to the resuscitation room. The primary survey showed that the patient was comatose with a Glasgow coma scale of 3/15, the pupils were brisk with an unstable airway, and there was bilateral diminished air entry. The oxygen saturation did not improve despite assisted ventilation using an Ambu bag. The central and peripheral pulsation was weak with a delayed capillary refill, and the blood glucose level was 9 mmol/L. The abdomen was hugely distended and rigid with minimal rectal bleeding. The patient was immediately intubated and connected to mechanical ventilation with subsequent rising of his oxygen saturation to 100%. A plain chest X-ray examination followed the patient’s intubation. Intravenous access was obtained followed by administration of normal saline (20 ml/kg) with subsequent elevation of the blood pressure (82/50mmHg) and decrease in heart rate (160 beats/minute). Initial arterial blood gases (ABG) analysis after intubation showed pH: 6.6; PaCO2 >150 mmHg; PaO2: 100 mmHg; HCO3: 10mEq/L; and lactic acid: 9 mg/dL. Therefore, a bolus of sodium bicarbonate was given, intravenously. Ventilator parameters were set at the maximum limits to wash out carbon dioxide. Repeated ABG analysis showed pH: 6.7; PaCO2: 135 mmHg; PaO2: 150 mmHg; HCO3: 17 mEq/L; and lactic acid: 6.5 mg/dL. Immediate bedside abdominal X-ray and ultrasonography were carried out to rule out intussusception. The child remained critically ill and unstable with fluctuating vital signs. Despite high ventilator parameters and gasgastric tube suction, the child showed no improvement in the respiratory parameters. The child was then transferred to the operation theatre for decompression laparotomy, which showed small bowel (ileum) ischemia. After surgical decompression, the respiratory parameters improved, and the ventilator parameters were set back to normal settings for the patient’s age and weight. Unfortunately, the child remained critically ill. Then, he developed sepsis and multiple systems organ failure and died after 2 days. https://fem.tums.ac.ir/index.php/fem/article/view/1120 https://fem.tums.ac.ir/index.php/fem/article/download/1120/426

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2022 12 26 e5 e5 Seyedmohammadmehdi Samimiardestani Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran Meisam Sharifi Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran Mehri Farhange Ranjbar Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran 2022 12 26 Objective: Due to the important role of police during COVID-19 pandemics and lack of previous studies on the impact of personal protective equipment (PPE) in reduction of COVID-19 infection among police officers, we aimed to investigate the role of using PPE in prevention of COVID-19 infection among Iranian police personnel. Methods: This cross-sectional survey was conducted in Tehran, Iran during January 2021 to November 2022. The study sample consisted of police personnel who were active in field operations. Demographics (age, height, weight, gender, marital status, number of children and underlying diseases) and job characteristics such as frequency and type of operations, involvement of colleagues with COVID-19, and COVID-19 infection history, using PPE, types of used PPE (mask, face shield, gloves, etc), protective strategies (such as social distancing) and COVID-19 vaccination were recorded. Statistical analysis was performed with IBM SPSS Statistics for Windows, version 25. Results: Totally, 340 participants were analyzed (33.54±9.74 years old, 91.2% males), of whom, 150 participants (44.1%) reported at least one episode of confirmed COVID-19 infection. The most common component of PPE used both during operations and daily life was face mask (44.7% and 75%, respectively). The most popular measure with higher adherence compared to others was social distancing with 70% popularity and an adherence score of 5.85±3.74. Three hundred subjects (88.2%) had received at least one dose of COVID-19 vaccine. Among PPE items, using face mask, washing hands with soap, social distancing and vaccination were significantly different between patients with and without prior COVID-19 infection (p>0.05). Conclusion: The findings showed that use of PPE is significantly efficacious in reduction of COVID-19 infection among police officers. Therefore, despite difficulties of using PPE among police forces, it is strongly recommended for virus spread control in this population. https://fem.tums.ac.ir/index.php/fem/article/view/1144 https://fem.tums.ac.ir/index.php/fem/article/download/1144/423

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2023 01 04 e6 e6 Mohmmad Reza Khajavi Department of Anesthesiology, Tehran University of Medical Sciences, Tehran, Iran Sanaz Kharazmi School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Hossein Dialameh Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran Azam Biderafsh Epidemiology and Biostatistics Department, Health Faculty, Tehran University of Medical Sciences, Tehran, Iran 2022 11 06 2022 12 15 Objective: In this randomized clinical trial study, the impact of prophylactic administration of methadone during surgery on postoperative pain and analgesic requirement following cadaveric renal transplantation was assessed. Methods: Ninety patients were randomized to receive either methadone 0.15 mg/kg or 0.15mg/kg morphine after tracheal intubation. Both groups were treated with acetaminophen 1 gr before extubation. Protocol of anesthesia was the same in both groups and the anesthetist was blinded to the study groups. The primary outcome was defined as total opioid consumption during recovery and first day after surgery. Secondary outcomes were pain scores and level of patients’ sedation during the recovery period and first postoperative day as well as opioid-related complications. Results: Data of eighty-five eligible patients were analyzed. The mean pain and sedation scores were lower in the methadone group compared to the morphine group during recovery and the first 24 hours after surgery. The time of first rescue analgesic requirement was later in the methadone group (10.4 vs 6.3 hours). Also, postoperative morphine consumption was significantly less in the methadone group compared to patients receiving morphine (3.5 vs. 6.9 mg; P < 0.001). Conclusion: Intraoperative administration of methadone decreased postoperative pain scores, reduced opioid consumption after surgery and improved level of sedation during the first 24 hours after surgery. https://fem.tums.ac.ir/index.php/fem/article/view/1106 https://fem.tums.ac.ir/index.php/fem/article/download/1106/427

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2023 01 14 e7 e7 Mostafa Alavi-Moghaddam Emergency Medicine Department, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Sistanizad Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mehrdad Haghighi Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Tahereh Sabaghian Nephrology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran Bahare Gholami Chaboki Biostatistics Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Zahra Soroureddin Prevention of Cardiovascular Disease Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2022 08 13 2022 11 29 Objective: Despite the worldwide spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an effective specific antiviral treatment for coronavirus disease of 2019 (COVID-19) is yet to be identified .We did this study to inv