ABSTRACT
Objective: To determine the correlation between blood gas parameters and central venous pressure [CVP] in patients suffering from septic shock
Methods: Forty adult patients with diagnosis of septic shock who were admitted to the emergency department [ED] of Shohadaye Tajrish Hospital affiliated with Shahid Beheshti University of Medical Sciences, and met inclusion and exclusion criteria were enrolled. For all patients, sampling was done for venous blood gas analysis, serum sodium and chlorine levels. At the time of sampling; blood pressure, pulse rate and CVP were recorded. Correlation between blood gas parameters and hemodynamic indices were
Results: A significant direct correlation between CVP with anion gap [AG] and inversely with base deficit [BD] and bicarbonate. CVP also showed a relative correlation with pH, whereas it was not correlated with BD/ AG ratio and serum chlorine level. There was no significant association between CVP and clinical parameters including shock index [SI] and mean arterial pressure [MAP]
Conclusion: It seems that some of non invasive blood gas parameters could be served as alternative to invasive measures such as CVP in treatment planning of patients referred to an ED with septic shock
ABSTRACT
Physical design of the emergency department [ED] has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study, we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed. Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a "Yes or No" question for ease of analysis, meaning that the criterion is either met or not
ABSTRACT
Emergency department performance index [EPI] greatly influences the function of other hospital's units and patient satisfaction. Recently, the Iranian Ministry of Health has defined specific national EPI containing five indexes. In the present study the performance indexes of emergency department [ED] in one educational hospital has been assessed before and after establishment of emergency medicine. In the present cross-sectional study the ED of Shohadaye Tajrish Hospital, Tehran, Iran was assessed during one-year period from March 2012 to February 2013. The study was divided into two six-month periods of before and after establishment of emergency medicine. Five performance indexes including: the percentage of patients were disposed during 6-hour, left the ED in a 12-hour, had unsuccessful cardiopulmonary resuscitations [CPR], discharged against medical advice, and the mean time of triage were calculated using data of department of medical records on daily patients' files. Then, Mann-Whitney U test was used to make comparisons at P<0.05. The average triage time decreased from 6.04 minutes in the first six months to 1.5 minutes in the second six months [P=0.06]. The percentage of patients leaving the ED in a 12-hour decreased from 97.3% to 90.4% [P=0.004]. However, the percentage of disposed patients during 6-hour [P=0.2], unsuccessful CPR [P=0.34] and discharged against medical advice [P=0.42] did not differ between the two periods. It seems that establishment of emergency medicine could be able to improve ED performances indexes such as time to triage and leave in a 12-hour period