Background The emergency department (ED) receives patients from all over the world every day. Hence, using various triage scales to detect sick patients and the need for early admission are essential. Triage is a process used in the ED to prioritize patients requiring the most urgent care over those with minor injuries based on medical urgency and medical needs. These decisions may be based on patients’ chief complaints at the time of their ED visit and their vital signs. Vital signs, including blood pressure (BP), respiratory rate (RR), heart rate (HR), and body temperature, are necessary tools that are traditionally used in the ED during procedures such as triage and recognizing high-risk hospital inpatients. This study aimed to determine the relationship between abnormal vital signs and mortality in the ED. Method and Material This retrospective record review study was performed at the ED of King Abdulaziz University Hospital (KAUH). Altogether, 641 patients fulfilled our inclusion criteria. Data including patients’ demographics, vital signs, in-hospital mortality, triage level, and precipitating factors were collected. Results The mean age of the patients was 45.66 ± 18.43 years (69.3% females), and the majority of them had Canadian Triage and Acuity Scale (CTAS) level 3 (71.1%). The total number of in-hospital mortalities was 32 (5%). Lower systolic blood pressure (SBP) and diastolic blood pressure (DBP), high respiratory rates, and low oxygen saturation (O 2 SAT) were significantly associated with high mortality rates. Conclusion Abnormal vital signs play a major role in determining patient prognosis and outcomes. Triage score systems should be adjusted and carefully studied in each center according to its population.
Opiophobia is the physicians’ irrational fear of prescribing opioids for patients with severe pain. It’s one of the major reasons for many patients to not receive adequate analgesia (oligoanalgesia). It’s an old phenomenon that still persists in both developed and developing countries with diff erent rates. This is an unsystematic literature review of studies that have been written about opiophobia since 1960 using Google Scholar, PubMed and EBSCO to search for the following terms: opiophobia, oligoanalgesia and necrophobia. Studies included were review articles and surveys studies. We found that the three main reasons for opiophobia are concern over addiction, concern over serious side eff ects (mainly respiratory depression) and concern over legal consequences. These consequences, such as being sued, result from serious side eff ects masking or delaying the diagnosis. Lack of knowledge about pain management was another factor among young physicians and interns. As a result, many patients are not adequately treated for severe pain. Physicians prescribe lesser dosages than required and nurses administer even lesser dosages than the physicians prescribed. To tackle such problems, it’s important to know the causes. Education, clarifi cation of the myths and increasingthe physicians’ and nurses’ awareness about pain management is a critically important step especially for new physicians and interns.
Gamma-hydroxybutyrate (GHB) is a central nervous system (CNS) depressant with limited clinical use but has been misused in the last few decades. During intoxication, the patient may develop CNS depression and may have agitation, while during withdrawal, the patient can present with severe agitation or delirium. Here, we report the case of a 30-year-old Saudi male patient who was brought by his brother to the emergency department (ED) with agitation and delirium. The patient’s friend stated the patient had been misusing GHB mixed with alcohol for the last seven months, with the last use occurring 24 hours before the ED presentation. The patient was put on a five-point restraint for safety concerns and received supportive therapy. After two days of admission, the patient completely recovered. As the patient provided a limited history of his GHB misuse, the clinician lacked sufficient information to determine whether the patient was intoxicated or withdrawing. Clinicians in Saudi Arabia need to be highly suspicious of GHB misuse when treating patients with drug intoxication or withdrawal.
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