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 ial worker considering the clinical features of the case. The social service experts and providing physicians were reassured there was no concerns for child abuse, sexual abuse, neglect, behavioral or psychiatric disorders. The patient was discharged with Bactrim and analgesics for one week after he was able to void independently. One month follow up at the urology clinic revealed that the patient had good skin preservation, wound healing, and micturition. The patient had no difficulties with anxiety, depression, or post-traumatic stress at his follow up appointments with a behavioral health therapist. https://fem.tums.ac.ir/index.php/fem/article/view/1157 https://fem.tums.ac.ir/index.php/fem/article/download/1157/436

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 2 2023 03 10 e20 e20 Wajeeha Musharraf Star Hospitals, Banjara Hills, Hyderabad, Telangana, India Sudhir Mane SVS Medical College and Hospital, Mahabubnagar, Telangana, India Habeeba Musharraf Shadan Institute of Medical Sciences, Peeramcheru, Hyderabad, Telangana, India 2023 02 08 2023 03 09 Workplace violence in hospitals, specifically in emergency departments (ED), has become a growing concern in recent years. This violence can come from patients, their families, or visitors and can take the form of verbal or physical attacks. Preventing violence in EDs can be achieved through design modifications with minimal personnel and infrastructure requirements. Infrastructure design plays a crucial role in reducing the risk of violence. Private lockers should be available at the ED entrance to limit dangerous objects being brought into the department. Furnishings should be fixed to prevent them from being used as weapons, and evacuation should be facilitated through open rows of seating. Positive distractions, such as gardens or natural areas visible through windows, can reduce stress in patients and lower aggression. Ligature points should be eliminated and tamper-resistant items should be provided to reduce dangers in the built environment. The triage desk should be positioned in a secure area with access control and panic buttons available for staff. Hidden exits should be provided in case of violence and emergency exits should open outward and be lockable only from the outside. It seems that preventing violence in EDs requires a combination of management, technology, planning, and physical design. Proper infrastructure design can play a crucial role in reducing the risk of violence, and healthcare professionals, administrators, and architects should be aware of best practices in ED design. https://fem.tums.ac.ir/index.php/fem/article/view/1164 https://fem.tums.ac.ir/index.php/fem/article/download/1164/437

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 2 2023 12 31 e14 e14 Shirin Madadian School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mojgan Rahimi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Peyman Saberian Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Parisa Hasani-Sharamin Tehran Emergency Medical Service Center, Tehran, Iran Amirhossein Orandi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Alireza Jalali Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Seyed Khalil Pestechi Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Sepideh Aarabi Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Mahshid Faghani Department of Internal Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran 2023 04 19 Objective: There are several methods for teaching emergency medical technicians (EMTs) cardiopulmonary resuscitation (CPR); but choosing the most effective option depends on several factors. This study was designed to compare the effectiveness of three different CPR training methods, including traditional, peer, and virtual methods, for EMTs. Methods: This study was a pretest-posttest study, which was performed from March to September 2020 in Tehran, Iran. Participants were EMTs working in the operations department of the EMS center. In the first step, for the pretest evaluation, an Objective Structured Clinical Evaluation (OSCE) exam was held for all participants. Thereafter, the subjects were divided into 3 groups including master-centered traditional collective education, peer training, and virtual courses. Then the participants underwent educational intervention and after that, another OSCE exam was held about 1 week after the sessions to evaluate the effect of interventions. Results: At first, 156 volunteers entered the study and participated in the pretest OSCE exam, of which 125 volunteers participated in the posttest OSCE exam. Of these, 51 volunteers participated in the peer education group, 35 volunteers were in the virtual education group, and 39 volunteers in the classic education group. The mean score of the participants in all 4 assessed skills, including endotracheal intubation, laryngeal mask airway insertion, basic life support, and advanced life support, increased significantly after educational intervention in all 3 groups (p<0.05); and this increase was higher in the virtual group compared to the other two groups (p<0.05). Conclusion: We found that virtual training was more effective than classic and peer training for CPR training of EMTs. https://fem.tums.ac.ir/index.php/fem/article/view/1201 https://fem.tums.ac.ir/index.php/fem/article/download/1201/441

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 2 2023 04 22 e15 e15 Khalid Almulhim Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia Ali Mobarki College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia Abdulelah Aljasir College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia. Abdullah Almulhim College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia. Ibrahim Almulhim College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia. 2022 12 25 2023 04 20 Objective: This study aims to understand students' skills based on their self-assessment and their perceptions regarding emergency medicine (EM) physicians, EM patients, and choosing EM as a future career. Methods: This study employed prospective observational design. It was conducted from 2 October to 2 November 2022 in Saudi Arabia. The study participants were senior medical students at King Faisal University. Senior students who finished a four-week EM rotation were involved as post-cases, and senior students who had not finished their EM rotation were involved as pre-cases. An online survey was administrated to all students who met out criteria. Results: A total of 161 students were included in the study; 65.2% had not yet done their EM clerkship, while 34.8% had completed their EM clerkship. Among them, 48.4% were male, and 51.6% were female. On average, post-EM clerkship students showed greater confidence in their skills of conducting an initial assessment of a patient (p=0.027), developing a management plan (p=0.007), explaining the principles of EM to others (p<0.001), presenting patient cases formally (p=0.049), interpreting electrocardiogram (p=0.006), and applying medical resuscitation (p=0.041). No significant differences were found between the average confidence in the skills and abilities of male and female students. Post-EM clerkship and male students were more likely to choose EM as a career when compared with pre-EM clerkship (p<0.001) and female students (p=0.006). Conclusion: It seems that, after completing a four-week rotation, students exhibited significant advances in knowledge, illness management, and procedural skills. It is likely that the EM clerkship significantly improved students' perceptions of the EM specialty. https://fem.tums.ac.ir/index.php/fem/article/view/1142 https://fem.tums.ac.ir/index.php/fem/article/download/1142/443

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 2 2023 04 26 e16 e16 Kiumarth Amini Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Mojtaba Mojtahedzadeh Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Atabak Najafi Department of Anaesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Hamidreza Sharifnia Department of Anaesthesiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Aliasghar Tabatabaei Mohammadi Urmia University of Medical Sciences, Urmia, Iran 2022 12 13 2023 01 16 Objective: Sepsis is one of the leading causes of mortality in intensive care unit. Despite advances in its management, its mortality rate remains high. Recently, high dose of vitamin C in sepsis treatment has attracted the attention of researchers. In the current study, the impacts of 25 mg/kg of vitamin C every 6 hours as a bolus for 3 days were assessed in septic patients in intensive care unit (ICU). Methods: This was a prospective cohort study that was performed on adult patients with diagnosis of sepsis. Patients were assigned to control group (administration of placebo) or intervention group, i.e., those receiving a 25 mg/kg dose of vitamin C every 6 hours as a bolus for 3 days. Clinical data were recorded before and after the experiment. Also, plasma levels of antithrombin III, syndecan-1, fibrin degradation product (FDP), D-dimer, and C-reactive protein (CRP) were measured at 0, 24, 48, and 72 hours. Results: In septic patients receiving vitamin C, a significant upregulation of antithrombin III and significant decreases in the levels of syndecan-1 (at 48 hours; P-value=0.046 and at 72 hours; P-value=0.007), D-dimer and CRP were observed compared to the control. Reductions in sequential organ failure assessment (SOFA) score, in-hospital mortality, and ICU length of stay were seen in septic patients receiving vitamin C. Conclusion: Prescribing high dose of intravenous vitamin C can reduce the mortality of sepsis patients and reduce the length of stay in the ICU. https://fem.tums.ac.ir/index.php/fem/article/view/1131 https://fem.tums.ac.ir/index.php/fem/article/download/1131/442

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 2 2023 04 27 e17 e17 Alireza Zemestani Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran. Iran Amir Kavousi Department of Epidemiology, School of Public Health and Safety, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Homayoun Sadeghi-Bazargani Road Traffic Injury Prevention Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Hamid Soori Department of Epidemiology, School of Public Health and Safety, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2023 01 03 2023 01 22 Objective: Vehicle safety pl