[Diagnostic value of WBC count and C-reactive protein for detection of acute appendicitis in children]

The role of inflammatory markers in diagnosis of acute appendicitis has not been clearly defined. To determine the diagnostic value of WBC count and C-reactive protein in diagnosis or rejection of acute appendicitis in children. In a prospective study, 100 child with probable diagnosis of acute appendicitis [Alvarado score

[Are patients concerned about medical errors in emergency department?]

Concern about medical errors in all patients has been elevated recently. Understanding of how patients conceptualize medical error would help health care providers to diminish safety concerns and increase patient satisfaction. This study was performed to evaluate patients worrisome form medical errors and relationship with patient concern, characteristic and satisfaction. This descriptive cross-sectional study was done in Tehran on October 2008. A questionnaire was performed to assess patients feeling about medical errors and their satisfactions according to Likert Scale. During 1 week period, all of the patients who came to the emergency department of Hazrat Rassol Akram hospital were included in the study. Patients who had altered level of consciousness or intoxication or were less than 18 years old were excluded. Telephone interview were conducted 7 days later. Patients were asked about medical safety, concerns about medical errors and satisfaction with care. Data were gathered and analyzed by chi 2 and T test via SPSS 14 software. Of 638 patients, 48.3% of patients reported experiencing at least one specific error related concern; that most commonly were consuming too much time in emergency ward and medical stadents faalts. Their concerns were associated with age, educational level, length of stay and disposition [P<0.001]. 62% of patients showed high satisfaction regarding medical care service. Patient satisfaction was highly related to their concern. Although many patients have a good sense of security medical care services, but due to stressful situation in emergency departments, understanding of patient concerns, education and good communication with patients could decrease their concerns and increase satisfaction

[Use of diagnostic tests in patients with non traumatic acute abdominal pain referred to the emergency department]

Non-traumatic acute abdominal pain is one of the most common complaints in patients referred to emergency department. To make diagnosis decision several diagnostic tests such as WBC count, urine analysis, and abdominal sonography are usually ordered which disturb emergency department, staff and force significant cost to patient and are time consuming. This study was done for determining the tests frequency for diagnosis of patients presenting in ED of Hazrate rasoul hospital with non traumatic acute abdominal pain that had been dismissed from hospital in comparison to previous studies to find whether we can omit some unnecessary tests. Study method was descriptive-cross sectional. By sequential sampling, the data of 400 dismissed patients with non-traumatic acute abdominal pain were gathered and interpreted by statistical descriptive methods. Participants were 29-22 years old, 40.8% male and 59.2% female. WBC had been ordered in 92% of cases. Urine analysis and abdominal sonography had been ordered 91.7% and 95.5% respectively. Frequency of CBC ordering was similar to previous studies while was 2 and 4 fold more for UA and abdominal sonography in comparison to previous studies. These results necessitate revising the diagnostic tests for non-traumatic acute abdominal pain to omit unnecessary tests

Comparison evaluation of tracheal intubation with and without succinylcholine administration in emergency department

Succinylcholine isn't used in Emergency Department intubations routinely, that, this study was performed to compare success and complications of tracheal intubation with and without succinylcholine administration. This interventional study was done on 150 patients admitted in Emergency Department of Hazrat Rasoul Akram Hospital who underwent intratracheal intubation. Demographic data were evaluated. The Cases were entered in protocol A [rapid sequence intubation with succinylcholine] or B [modified RSI without succinylcholine] randomly and then intubated. During and after intubations, results and complications were recorded in checklists and analyzed via SPSS11 software. The mean age in group A was 34.1 +/- 5.1 yrs while in group B was 35.1 +/- 5.3 yrs. In group A, 35 cases [46.6%] were female and 40 cases [53.4%] were male and in group B 37 cases [49.3%] were female and 38 cases [50.7%] were male. The differences between groups were not significant. In group A, 74 cases [98%] were intubated in first attempt and 1 case [2%] in second attempt. Bradicardia was seen in 3 cases [4%], hypotension in 8 cases [10.6%], vomiting in 8 cases [2.6%], hypertension in 2 cases [2.6%] and hypoxia [O2 sat<90%] in 9 cases [12%]. In group B, 64 cases [88%] were intubated in first attempt and 9 cases [12%] in second attempt. Bradicardia occurred in 2 cases [2.6%], hypotension in 9 cases [12%], vomiting in 3 cases [4%], hypoxia in 11 cases [14%] and hypertension in no case. In this study, the success rate of intubation in RSI with succynilcholine was higher significantly. There are no significant differences regarding in complications between two groups. Our study showed that in emergency patients intubation the which there is no contraindication for succynilcholine, it is better to try RSI

Comparison of analgesia effect between intravenous propacetamol and Tramadol

IV Acetaminophen [Propacetamol] is one the drugs which has recently been discussed in pain management. The Purpose of this study, is the comparison of analgesic effect of Propacetamol and Tramadol in pain relief of renal colic patients. This double blinded randomized clinical trial was preformed on 80 patients who came to ED of Hazrat Rasool Akram Hospital [HRAH] due to renal colic. Demographic data and pain scores were evaluated prior to injection [through numeric rating scale]. Then, patients received one of the drugs, drug A [1 gr Propacetamol] or B [100mg Tramadol] randomly. Pain relief and adverse effects of the drugs were evaluated 30 minutes after injection. After 1 hour satisfaction and the need to administer a narcotic were evaluated. Data was gathered and analyzed by T-test via SPSS software. The P value less than 0/05 was dertermined to be significant.The mean age in group A, was 33 +/- 8.6 yrs and in group B, was 34.2 +/- 8.2 yrs. Mean of pain score in group A, was 7.6 +/- 1.6 and in group B, was 7.5 +/- 15 Pain relief in group A, was 4.4 +/- 1.6 and in group B, was 2.6 +/- 1.2. Differences between the groups were significant. 12 cases [%30] in group A, and in 25 cases [%62/5] in group B, recieced additional analgesic for pain relief, thus, difference between groups was significant. According this study, IV Propacetamol is a safe and effective drug for pain relief in renal colic patients, without any significant adverse effects. Our survey showed that IV Propacetaimol is more efficient and has less side effects in comparison with Tramadol in the pain relief of renal colic patients

[Audit on necessity of radiographs in anterior shoulder dislocations]

Anterior shoulder dislocation is the most common major joint dislocation. In most cases, this dislocation is being relocated in emergency departments. Routinely, pre and post reduction radiographs are performed. This study was done to determine the necessity of radiographs in the emergency department for management of patients with suspected anterior shoulder dislocation. In this case series study, 116 patients suspected of anterior shoulder dislocation were referred to Hazrat Rasoul Akram and Haftome Tir Hospitals emergency departments in Tehran, and were investigated for a one year period. The emergency physicians evaluated and documented the possibility of dislocation or relocation, before obtaining radiographs. Outcome measures were the assessment of joint positions on the x-rays by an orthopedic surgeon. 84 cases [72%] were male and 32 cases [28%] were female. Mean age of the patients was 31.5 +/- 8.5 yrs. Thirty [30] patients had recurrent dislocations without traumatic mechanism [group 1] and eighty six [86] patients had no prior dislocation or a blunt mechanism of injury [group 2]. The accuracy of the emergency physician's assessment in dislocations was 100% in group 1 and 98% in group 2. False assessments occurred only in patients with fractures. There is no significant difference between emergency physicians and orthopedic surgeons in the assessment of dislocations and relocations, when the emergency physicians did accuralty diagnose them. Our study showed that the physicians are highly accurate in clinical determination of anterior shoulder dislocation and relocation. Pre-reduction films should be obtained when the mechanism of injury is trauma. Post-reduction films should be obtained in fracture-dislocations or when the physicians are uncertain of correct relocation

Assessment of emergency medical education on knowledge alterations of medical students in Rasoul Akram Hospital [2005-2006]

Education and management are considered two integrated and non-separable requirements of an emergency department [ED]. Despite the emphasis on teaching of essentials of approaching and management of critical patients, medical students do not acquire the necessary knowledge to handle these patients during their rotation in different specialties other than emergency medicine [EM]. This study aims to evaluate the changes in EM knowledge of interns during their one month rotation in ED of Rasoul Akram Hospital. In a 15-month period, 226 interns were entered into this study. A pretest was taken at the beginning of their one-month internship period. Then, the interns were provided with a handbook, which was prepared and revised according to the approved curriculum of Ministry of Health and Medical Education of Iran and latest emergency medicine textbooks. The interns were taught by several lecture and practical sessions. At the end of their EM internship period, a post-test was taken and the change of their emergency medical knowledge was assessed by comparison of pre-and post-test results. The results showed a significant increase of mean post-test scores compared with the pretest scores. Also, there was a significant difference between the scores obtained by males and those obtained by females [P < 0.001]. The one-month EM training significantly improved the level of interns' knowledge