Combination of liver enzymes, amylase and abdominal ultrasound tests have acceptable diagnostic values as an alternative test for abdominopelvic CT scan in blunt abdominal trauma.

INTRODUCTION: Abdominal trauma accounts for 15-20% of all-cause mortality of trauma. Abdominopelvic CT scan with intravenous contrast is considered the most accurate non-invasive diagnostic tool in detecting intra-abdominal injuries. In previous studies, rise in liver enzymes and amylase was associated with intra-abdominal injuries but the studies were not sufficient. Our aim was to assess the diagnostic values of liver enzymes and amylase for intra-abdominal injuries in blunt trauma patients. METHODS: We included blunt abdominal trauma patients who referred to three teaching hospitals in 2018. The patients who had 14 years old or more and Glasgow Coma Scale above 8 were enrolled the study if the treating physician had high index of suspicion for intra-abdominal injuries and sent the patients for abdominopelvic CT scan with intravenous contrast. Sensitivity, specificity, positive and negative predictive values are calculated for results of liver enzymes, amylase and abdominal ultrasound. RESULTS: Eventually, 300 patients with blunt abdominal trauma entered the study. Sensitivity, specificity, positive and negative predictive values of concurrent positive results of abdominal ultrasound, amylase and liver enzymes were 81.73 (95% CI, 73.2-88.1), 63.78 (95% CI, 65.36-70.61), 58.38 (95% CI, 56.36-70.61) and 84.89 (95% CI, 77.6-90.19), respectively. CONCLUSION: Considering findings of the present study, the combination of liver enzymes, amylase and abdominal ultrasound results can be an alternative method for detecting intra-abdominal injuries in patients in whom treating physicians have limitations such as overweight, instability of hemodynamic and lack of CT scan facility.

Are serial hematocrit measurements sensitive enough to predict intra-abdominal injuries in blunt abdominal trama?

OBJECTIVE: Routine serial hematocrit measurements are a component of the trauma evaluation for patients without serious injury identified on initial evaluation. We sought to determine whether serial hematocrit testing was useful in predicting the probable injuries in blunt abdominal trauma. MATERIALS AND METHOD: We performed a prospective study of trauma patients admitted in our observation unit over a 12-month period. Patients routinely underwent serial hematocrit testing in 6-hour intervals (two hematocrit levels). We compared trauma patients with a hematocrit drop of 5 and 10 points or more to those without a significant hematocrit drop. RESULTS: Five hundred forty-two isolated blunt abdominal trauma patients were admitted to observation unit, and 468 patients (86.35%) had serial hematocrit during their 6-hour stay. Of these patients, 36.11% had a hematocrit drop of 5 or more and 12.61% a drop of 10 or more. Of patients with the hematocrit drop >10, 50.8% have had diagnostic manifestations of intra-abdominal injury in both ultrasonographic and computed tomography scanning (P<0.001). There was no significant correlation between hematocrit drop >5 and positive imaging. CONCLUSION: Although serial hematocrit testing may be useful in specific situations, routine use of serial hematocrit testing in trauma patients at a level I trauma center's observation unit did not significantly aid in the prediction of occult injuries.

Validity, reliability and acceptability of Professionalism Mini-Evaluation Exercise (P-MEX) for emergency medicine residency training.

Professionalism is a core competency in the medical profession. In this paper, we aimed to confirm the validity, reliability and acceptability of the Professionalism Mini-Evaluation Exercise (P-MEX) instrument for the emergency medicine (EM) residency program. Twenty-two EM attending physicians completed 383 P-MEX forms (the Persian version) for 90 EM residents. Construct validity was assessed via structural equation modeling (SEM). The reliability coefficient was estimated by the generalizability theory, and acceptability was assessed using two researcher-made questionnaires to evaluate the perspectives of residents and assessors. There was a consensus among the participants regarding the content of P-MEX. According to the results of SEM, the first implementation of the original model was associated with a moderate fit and high item loadings. The model modified with correlated error variances for two pairs of items showed an appropriate fit. The reliability of P-MEX was 0.81 for 14 occasions. The perception survey indicated high acceptability for P-MEX from the viewpoint of the residents and increasing satisfaction with P-MEX among the assessors over time. According to the results of the research, P-MEX is a reliable, valid, and acceptable instrument for assessing professionalism in EM residents.

Effectiveness of an interprofessional education model based on the transtheoretical model of behaviour change to improve interprofessional collaboration.

This study aimed to assess the effectiveness of an interprofessional education model (IPE) based on the transtheoretical model to improve the participants' interprofessional collaborative practice. The study was conducted in Iran using a controlled before-and-after study design. The participants (n = 91) were the residents of emergency medicine and nurses of the emergency units from two teaching hospitals affiliated to Iran University of Medical Sciences. The participants in the intervention group (n = 40) were 22 residents and 18 nurses. The control group (n = 51) consisted of 20 residents and 31 nurses. The participants were classified based on their stage of readiness to change. The interventions were two-day workshops for each stage (i.e., attitude and intention). We used the Interprofessional Collaborator Assessment Rubric (ICAR) to assess the effectiveness of the developed model. The interprofessional collaboration of the participants in the intervention and control groups was assessed at four time points before and after the intervention in the real emergency unit environment. Student's t-test and repeated measures analysis of variance (RM-ANOVA) were used to analyse the data. We used partial eta-squared (η2) for effect size calculations. The mean values of ICAR scores in the intervention and control groups were 95.63 ± 19.14 and 89.19 ± 16.11 before the intervention. The mean values of ICAR scores at 3 months after the intervention were 99.82 ± 22.32 and 88.29 ± 16.87 in the intervention and control groups, respectively. After 6 months, the mean values of ICAR scores of the intervention and control groups were 98.6 ± 23.40 and 87.98 ± 16.01, respectively. The results showed that the intervention had a medium educational effect size (partial η2 = 0.06) on performance of the participants. Our results showed that an IPE model that is tailored to the learners' stage of readiness to change improves interprofessional collaboration in the participants. The developed model could be applied for improving interprofessional collaborative performance in other IPE programmes.

Ice Reduces Needle-Stick Pain Associated With Local Anesthetic Injection.

BACKGROUND: Local anesthetic injections are widely used in the emergency department for different purposes. Pain management for such injections is of great importance to both patients and the healthcare system. OBJECTIVES: Our study aimed to determine the effectiveness and safety of cryotherapy in patients receiving local anesthetic injections. METHODS: Subjects who presented with superficial lacerations were randomly assigned to 2 groups, the first group received ice packing prior to injection and the second did not. The pain severity, length and depth of the laceration, and the other necessary information before and after the pain-reducing intervention were measured, documented, and compared at the end of the study. Pain scores were measured using a numerical rating scale before and after the procedure, and the differences were compared using a t-test. RESULTS: Ninety subjects were enrolled in the study, 45 in each group. There were no statistical differences between the 2 groups in terms of baseline preoperative and operative characteristics (P > 0.05). The pain scores in the cryotherapy group were significantly lower before and after the procedure (P < 0.001). There was no statistically significant difference between the 2 groups for wound infection (P = 0.783). CONCLUSIONS: Cooling the injection site prior to local anesthetic injection is an effective and inexpensive method to reduce the pain and discomfort caused by the injection.

Serum cortisol level and adrenal reserve as a predictor of patients' outcome after successful cardiopulmonary resuscitation.

INTRODUCTION: It is thought that pituitary-adrenal axis has a fundamental role in outcome of cardiopulmonary arrest (CPA). This study designed to evaluate the correlation between adrenal reserve and post-resuscitation outcome. METHODS: In this clinical trial study, 52 consecutive patients with CPA were enrolled in two emergency departments (EDs) over a 3-month period. Plasma cortisol level was measured at the beginning of CPR. Intravenous adrenocorticotropic hormone (ACTH) stimulation test was carried out after successful CPR, and blood samples were taken at 30 and 60 minutes, and 24 hours thereafter. Patients were divided into two groups: in-hospital death or hospital discharge. RESULTS: In patients who died, baseline and post-ACTH serum cortisol after 30 and 60 minutes and 24 hours were higher than patients who discharged from the hospital, but it was not statistically significant except to that of minute 60 (P=0.49). A model of multivariate logistic regression analysis showed that age and need for vasopressor infusion correlated with mortality. CONCLUSION: Current study could not show the statistically significant difference in initial and post-ACTH serum cortisol levels between survivor and non-survivor patients with cardiac arrest who had initial successful CPR, except to that of minute 60.