88-year-old man with sudden onset abdominal pain

An 88-year-old man presented to the emergency department with sudden onset of abdominal pain since 6 hours before. He described his pain as an epigastric pain that had become generalized without any radiation. The pain was persistent and aggravated by meal. It was associated with nausea but not with vomiting, diarrhea, hematochezia, hematemesis or dysuria. He was a known case of chronic renal failure that underwent hemodialysis three times a week. He also suffered from hypertension and benign prostatic hyperplasia. The patient was under treatment with aspirin, atorvastatin, furosemide, finasteride, and tamsulosin. He did not use cigarette, opium or alcohol. The patients' on arrival vital signs were as follows: systolic blood pressure: 100/60 mmHg, pulse rate: 88/minute, respiratory rate: 25/minute, oral temperature: 36?C, oxygen saturation 93% in room air. He had severely ill appearance on admission. Lungs and heart auscultation was normal. Distended abdomen was considerable but had normal bowel sound and clearly, pain was disproportionate to physical examination. Rectal examination was unremarkable. Pitting edema was observable on his lower limbs; however, symmetric peripheral pulses were detected. His electrocardiogram showed sinus rhythm and venous blood gas analysis revealed the following: pH=6.96, PaCO2=49 mmHg, HCO3=11 mEq/L, Base excess= -20. By reviewing the biochemistry profile only urea=180 mg/dL and creatinine=4.8 mg/dL were no table and all others such as amylase, lipase, and liver function tests were reported in normal range. The bedside ultrasonography showed echogenic particles in hepatic parenchyma and same findings that were passing through the portal vein [Figure 1]. Chest and abdominal X-rays were reported as normal. The patient underwent abdominal and pelvic computed tomography [CT] scan with oral contrast that showed in Figure 2

Knowledge of emergency medicine residents in relation to prevention of tetanus

Knowledge of emergency medicine residents about the management of patients suspected of having tetanus-favoring wounds is very important due to their responsibility for the treatment of such patients. The aim of the present study was to evaluate this knowledge and making sure of the adequacy of instructions they have received in relation to prevention of tetanus. A reliable and reproducible questionnaire was used to evaluate knowledge of all the emergency medicine residents in Imam Hussein Hospital in Tehran, Iran, about conditions favoring tetanus [9 questions] and proper interventions in such conditions [12 questions]. The questionnaires were completed and scored as poor and good. The Mann-Whitney U test was used to analyze data. Statistical significance was set at P<0.05. In the present study, 73 emergency medicine residents were evaluated [45.2% male]. Knowledge of 31 [42.5%] residents in relation to conditions favoring tetanus and 41 [56.2%] residents in correct therapeutic interventions was in good level. The most frequent incorrect answer was related to diabetic ulcers and wounds in patients with sepsis. There was an increase in scores of conditions favoring tetanus [P<0.001] and correct therapeutic interventions [P=0.001] with an increase in educational years. However, age [P=0.64], gender [P=0.31], job experience [P=0.38] and participation in educational courses [P=0.67] had no effect on the knowledge level of emergency medicine residents. According to the findings of the pre-sent study, the knowledge of emergency medicine residents about correct management of patients suspected of tetanus was low, which emphasizes the necessity of providing further instructions on prevention of tetanus in wound management

Report of 267 cases of scorpion bite referring to an emergency department during one year

Scorpion bite is a common health problem in many parts of the world, including the Iran's tropics. There are thousands of cases and a number of deaths due to scorpion bite every year in the country. The present study aims to provide further data regarding the details, complications and outcomes of scorpion bite cases referring to Razi Hospital, Ahwaz, from March 2011 to April 2012. 267 patients [56.3% females] with a mean age of 35.2 +/- 15.8 years were included in the study. The most common genus of scorpion involved was Hemiscorpius [69.3%] and the most frequent body part involved was the lower limb [38.9%]. The frequency of hemolysis-induced renal insufficiency and death after scorpion bite were 1.9% and 1.1%, respectively. Of all the factors evaluated in this series only the old age was associated with higher possibility of renal insufficiency [P<0.001]