ABSTRACT
Timely diagnosis and treatment of post-traumatic elevated intracranial pressure [EICP] could be reduced morbidity and mortality, and improved patients' outcome. This study is trying to evaluate the diagnostic accuracy of sonographic optic nerve sheath diameter [ONSD] in detection of EICP. Sonographic ONSD of patients with head trauma or cerebrovascular accident suspicious for EICP were evaluated by a trained chief resident of emergency medicine, who was blind to the clinical and brain computed tomography scan [BCT] find-ings of patients. Immediately after ultrasonography, BCT was performed and reported by an expert radiologist without awareness from other results of the patients. Finally, ultrasonographic and BCT findings regarding EICP were compared. To evaluate the ability of sonographic ONSD in predicting the BCT findings and obtain best cut-off level, receiver operating characteristic [ROC] curve were used. Sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], positive likelihood ratio [PLR], and negative likelihood ratio [NLR] of so-nographic ONSD in determining of EICP was calculated. P < 0.05 was considered as statistically significant. There were 222 patients [65.3% male], with mean age of 42.2 +/- 19.5 years [range: 16-90 years]. BCT showed signs of EICP, in 28 cases [12.6%]. The means of the ONSD in the patients with EICP and normal ICP were 5.5 +/- 0.56 and 3.93 +/- 0.53 mm, respectively [P<0.0001]. ROC curve demonstrated that the best cut off was 4.85 mm. Sensitivity, specificity, PPV, NPV, PLR, and NLR of ONSD for prediction of EICP were 96.4%, 95.3%, 72.2%, 98.9%, 20.6, and 0.04, respectively. Sonographic diameter of optic nerve sheath could be considered as an available, accurate, and noninvasive screening tool in determining the elevated intracranial pressure in cases with head trauma or cerebrovascular accident
ABSTRACT
Objective: To determine the application of preventive measures by emergency medicine residents for blood born diseases and detection of possible constraints at Imam Hussein Hospital in 2009-2010
Methods: In this observational descriptive cross-sectional study, all 40 emergency medicine residents from the first to third year of practice, were observed and evaluated during work at emergency department of Imam Hussein Hospital in 2009-2010. Data were collected by utilizing an observational checklist and a personal characteristics information form. Content validity and inter rater reliability[r=0.89] of the instruments was confirmed
Results: The mean age of the residents was 32.7+/-4.3 years. Twelve subjects [30%] were female. Fifteen residents [37.5%] were in first educational year, six subjects [14%] were in the second year, and 19 residents [47.5%] were in their third year of practice. Three most respected items were covering the hands by latex gloves before medical procedures [95+/-20 points], cleaning the bloody skin after phlebotomy or IV line preparation [88+/-32 points], and developing no blood spreading after phlebotomy, suction, or lines removal [77+/-43 points]. Higher residency educational degree and IV line preparation were the effective factors for better application of preventive measures by emergency medicine residents for blood born diseases, compared to intubation procedure [P<0.05]. The most common constraints for application of preventive measures by emergency residents for blood born diseases were high rate of patients' attending the emergency room [85%], high work load [80%], and need for fast performance at work [68%]
Conclusions: Generally, according to the obtained results, it may be concluded that the preventive measures for blood borne diseases are not optimally practiced by emergency medicine residents, and therefore, it is necessary to promote their information and practical knowledge especially with explanatory classes and continuous quality improvement