BACKGROUND:The Alvarado score is utilized to determine the likelihood of appendicitis based on clinical signs, symptoms, and laboratory results. The goal of this study was to determine whether Alvarado scores can be used to aid in the accurate diagnosis of appendicitis.
BackgroundFocused assessment with sonography for trauma (FAST) has become a part of initial examinations in trauma care at emergency departments (ED).ObjectivesThe goal of the present study was to evaluate the accuracy of FASTs performed by emergency residents (ER) in detection of abdominal free fluid following blunt trauma.Materials and MethodsIn this study, the reports of ERs performing FASTs on 286 admitted patients following blunt trauma were compared with those of radiology residents (RR) in relation to presence of abdominal free fluid. In addition, the reports of the two resident groups were compared with the final abdominal outcome, based on the results of abdominal computed tomography (CT) and clinical follow up.ResultsThe ERs had reported abdominal free fluid in 20 (6.9%) patients while RRs performing FAST had positive results in 22 (7.6%) patients. The reports of FASTs revealed significant correlation between the two resident groups (P < 0.001). ERs performing FASTs had 90% sensitivity and 98.5% specificity in comparison to RRs sonography reports. Furthermore, ER-performed FASTs had 96.5% accuracy in relation to final outcome.ConclusionsFollowing training, ED residents can perform FAST with high accuracy and specificity, similar to RR residents, in patients with blunt abdominal trauma.
Background: Assessing the prevalence of brain stroke and its clinical patterns across countries and nations could be valuable. It is an important concern for Iran as one of the countries with a high rate of stroke. Objectives: The present study was aimed to assess the epidemiological aspects of ischemic brain stroke. Methods: This cross-sectional study was conducted in Loghman-e-Hakim Hospital, Tehran, Iran from January 2013 to December 2016. The data were gathered by retrospectively reviewing the hospital records. Results: In this study, 2041 cases were admitted that 1145 (56%) cases were male. The mean age of the patients was 66.50 ± 13.49 years. The most common underlying risk factor was hypertension in 73.7% followed by diabetes mellitus in 44.3%. Left carotid stenosis was reported in 17.2% of the cases and right carotid stenosis in 9.5%. Left ventricular ejection fraction < 40% was found in 8.6% of the cases. The most common areas involved in the brain CT scanning were periventricular areas in 20.5%, left middle cerebral artery in 15.4%, and lacunar infarction 8.8% of the cases. In addition, 214 patients died indicating a crude mortality rate of 10.5%. Conclusions: The prevalence of ischemic brain stroke in males is slightly higher than females and the mean age of the patients was estimated to be 66 years. The most common risk factors are comprised of hypertension, diabetes mellitus, and smoking. Carotid stenosis is evident in more than 25% of the patients, and the mortality rate was 10% in the studied population.
Obstetric emergencies during COVID-19 pandemic pose an enormous challenge to the concerned obstetrician. Risk stratification during obstetric triage will guide in the initial assessment & planning of further management to reduce maternal and fetal morbidity and mortality rates. As the health system adapts to cope with this pandemic, special attention needs to be given to the several moral and ethical dilemmas that may occur during patient care.
Objective: The aim of this study was to determine the effect of an ultrasound training course on the performance of emergency medical technicians (EMTs) in terms of using extended-focused assessment with sonography in trauma (E-FAST) in the pre-hospital setting. Methods: In this quasi-experimental study, 107 EMTs affiliated to Shahid Beheshti and Kashan Universities of Medical Sciences, were randomly selected. At first, the EMTs were given a pre-test of five images concerning normal and abnormal ultrasound views of thoracic and abdominal cavities. Then, 6 hours of theoretical and practical sessions were done by emergency medicine specialists to teach the EMTs to use ultrasound for the detection of pneumothorax and free fluid. The EMTs were tested again in the form of 18 images post-test as well as a 13-item survey to evaluate their skills in taking correct 10 E-FAST. Results: A total of 107 EMTs with the mean age of 27±15.21 and average of 3.5 years work experience participated in this study. The mean of test score increased from 0.57± 0.19 to 0.81±0.08 (with P < 0.001) out of the total score of 100. In the 4-graded survey, 98% of EMTs obtained good to excellent grades in working with ultrasound machine. Also, 50.5% of EMTs were good in taking Morison’s view and 46.6% and 45.6% had medium grades in pericardial and splenorenal views, respectively. In addition, 22.3% had weak grades in taking pericardial views. Conclusion: The results of the present study showed that the implementation of the training course significantly improved the accuracy of free fluid detection in thoracic and abdominal cavities by EMTs.
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