Journal of Emergency Medicine, Trauma and Acute Care - Volume 2020, Issue 2

The need to resume scheduled hospital activities requires accurate screening for severe acute respiratory syndrome–Coronavirus disease 2019 (SARS–COVID-19) represented by real-time polymerase chain reaction on the nasal swab for each patient admitted. In order to prevent cross-contamination, we propose a model in which only two entry points are available: one for the urgent/emergent pathway and the other for all patients needing scheduled admission. If the patient needs emergent procedure and the swab test is not yet available, it will be viewed as a positive COVID-19 test. The hospital should be divided into two different areas: a green zone for negative-test patients and a blue zone for positive or undetermined patients in need of urgent care.

Background: There is limited research outside the USA, Europe, or Australia on the capacity, efficiency, and development of prehospital emergency medicine services (EMS) between urban and rural areas. This study aimed to examine the usage of prehospital EMS across rural and urban areas in Riyadh region in the Kingdom of Saudi Arabia. Methods: A random sample of 800 (400 urban and 400 rural) emergency patient records from the Saudi Red Crescent Authority EMS was collected. The following variables were analyzed: patient demographics, clinical characteristics, length of hospital stay, and length of intensive care unit (ICU) stay. Results: A skewed distribution was noted with respect to sex, i.e., 559 men versus 241 women. Rural patients were younger (42.75 vs. 39.72 years) and had significantly longer hospital (15 days versus 9 days) and ICU (5 days versus 2 days) stays than urban patients following transportation. All injury types were comparable, except for head injury, which was higher in the rural group than in the urban group. Advanced treatment and trauma transport were more often used in rural areas than in urban areas. Conclusions: In this study, rural EMS users were more likely to experience trauma-related incidents that necessitate EMS transportation, while medical reasons were more common among urban EMS users. Moreover, men used EMS at much higher rates than women and were more likely to be transported to the hospital following a call-out.

Background: The role of prehospital care (PHC) services in out-of-hospital cardiac arrest (OHCA) is well established in developed countries. The American Heart Association has defined PHC as the ‘chain of survival’ between public and advanced medical care. For developing countries such as Malaysia, the importance of PHC services in OHCA is evolving; however, data are lacking. Objective: This study aimed to investigate OHCA outcomes in relation to PHC services in Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia. Method: This was a prospective study conducted on OHCA cases attended by the PHC staff of Hospital Canselor Tuanku Muhriz. Independent variables were patient background, OHCA nature, and PHC interventions, while dependent variables were patient outcomes. Results: A total of 82 OHCA cases were identified. The survival rate to admission was 12.2% (n = 10), while the survival rate to discharge was 1.2% (n = 1) with cerebral performance categories of 1 or 2. The mean ambulance response time was 14.91 min. Among the variables, only OHCA location and adrenaline administration show significant association with OHCA outcome. OHCA location was significant in both outcomes (admission χ²(4) = 16.354, p < 0.03, Cramer's V = 0.447, discharge χ²(4) = 19.741, p < 0.001, Cramer's V = 0.491). However, adrenaline administration was significant only for survival to admission (χ²(1) = 3.776, p < 0.052, Cramer's V = 0.215) but not for survival to discharge (χ²(1) = 0.964, p < 0.326). Conclusion: Improvement in ambulance response time, public availability of automated external defibrillator, and public awareness of early cardiac arrest and cardiopulmonary resuscitation are required to increase the survivability of OHCA in developing countries.

Objective: Deliberate self-harm (DSH) is an important cause for intensive care admission in developing countries. The evaluation of incidence and risk factors for nosocomial infection development in DSH with its impact on the outcome is not clearly elucidated. Methods: Demographic, infection, and outcome data were collected in this retrospective study of 2 years. Factors associated with infection and mortality were explored using bivariate and multivariate logistic regression analyses, which were expressed as odds ratio (OR) with 95% confidence interval (CI). Results: Of the 3274 admissions, 302 (9.2%) were due to DSH, whereas the majority (n = 178, 58.9%) were due to organophosphorus (OP) compounds, with the mean (SD) APACHE-II score of 14.7 (6.0); 278 (92.1%) patients were ventilated. 55 (18.2%) patients developed a nosocomial infection, accounting for 15.6 infections per 1000 hospital days, with an overall mortality of 14.2%. Mortality was significantly (p < 0.001) higher in those who developed an infection (30.9% vs. 10.5%). Multivariate logistic regression analysis demonstrated that DSH due to OP compounds (OR 2.9; 95%CI 1.1–7.1) and ventilation duration (OR 1.1; 95%CI 1.1–1.3) were independently associated with nosocomial infection development. APACHE-II score, nosocomial infection, and the need for dialysis significantly (p < 0.001) associated with mortality. Conclusion: In the DSH setting, acquiring nosocomial infection during intensive care admission impacts mortality. DSH due to OP compounds and duration of ventilation were independent risk factors for the development of infection.

Introduction: Peptic ulcer perforation is the most common complication in peptic ulcer disease and can lead to serious complications and mortality; however, despite the widespread use of antisecretory agents and eradication of Helicobacter pylori, the incidence of peptic ulcer perforation remains largely unchanged. This study aimed to evaluate the risk factors for perioperative morbidity and mortality in patients with peptic ulcer perforation. Methods: This was a prospective, observational study involving patients with perforated peptic ulcer disease admitted to the Al-Basra Teaching Hospital from January 2017 to December 2019. A total of 100 patients were followed for 4 weeks. Patients’ demographic data, history of chronic diseases, American Society of Anesthesiologist (ASA) score, nonsteroidal anti-inflammatory drug (NSAID) and steroid use, duration before surgery, preoperative shock status, previous symptoms of peptic ulcer disease, smoking habits, and fasting status were evaluated, and significant correlations with postoperative complications were analyzed statistically. Results: A total of 100 patients aged 16–87 years were included in the study, and the male-to- female ratio was 3:1. Sixty-seven (67%) patients underwent surgery within 12 h after admission, 41% of patients had a history of chronic disease, 54% of patients had an ASA score of 1, 57% of patients were smokers, 45% of patients reported previous peptic ulcer symptoms, and 22% of patients had preoperative shock status. Thirty-seven (37%) patients developed postoperative complications, and 8% of patients died. Conclusion: This study confirmed that advanced age, a high ASA score, preoperative shock, comorbidities, and delayed presentation before surgery were all risk factors for postoperative complications and mortality in patients with perforated peptic ulcer disease. Habitual smoking, fasting status, and NSAID and steroid use were not correlated with mortality.

Background: Distal radius fractures, the most prevalent of all fracture types, are often associated with severe pain and discomfort and treated with closed reduction and splinting. This study aimed to compare ultrasound-guided supracondylar radial nerve block with procedural sedation for the treatment of distal radius fractures in the emergency department. Methods: Patients with isolated distal radius fractures and limited displacement who met the inclusion criteria were randomly divided into two groups, an ultrasound-guided nerve block group and a procedural sedation group, which were compared in terms of managing patients with distal radius fractures. The number of patients in each group was 27. Results: The duration of the procedure was significantly shorter in the nerve block group than in the ketamine group (p < 0.001). Physician and patient satisfaction were determined according to the unipolar Likert scale and unlike for patients (p = 0.001), no significant difference was noted between the two groups for the physicians (p = 0.619). Unlike nerve block, emergence reactions (p = 0.038) and vomiting (p = 0.009) occurred in the ketamine intervention. Conclusion: Ultrasound-guided supracondylar radial nerve block can be prescribed as an alternative method in minimal or non-displaced distal radius fractures instead of IV sedation due to fewer side effects and a shorter procedural duration.

The World Health Organization (WHO) and member countries aimed to eliminate measles by 2020. In 1997, the Regional Committee for the Eastern Mediterranean (EMR) had unanimously adopted a resolution for measles elimination reduction goals for the interruption of measles transmission in EMR countries by 2010.^1,2,3 Among Gulf Cooperation Council (GCC) countries of the Eastern Mediterranean Region of WHO, Oman and Bahrain accomplished this goal and were certified. However, those countries noted a resurgence of measles cases in 2018–2019 and integrated measles-related goals in their health plans beyond 2020. Documentation of GCC countries’ achievements and setbacks from 2015 to 2019 was conducted with data from WHO, UNICEF, and published related literature. An analysis of underlying factors, such as gross domestic product per capita, the ratio of nationals to expatriate population, seasonal reporting of measles, and their relation to the achievements, limitations, and subsequent challenges of the last five years in these countries are described. The lessons learned in GCC countries included heightened national commitment toward measles elimination, surveillance, allocation of dedicated human resources, and adept public health strategies, which could help professionals worldwide to realign their strategies and reset the goals for elimination of measles.