Flying Blind: Early Outcomes Following Implementation of Formal Critical Care Services in a Low-Resource Setting
Elizabeth M Stoeckl, BS, Kristin L Long, MD, MPH and Emnet Tesfaye, MD
Article Type: Commentary | First Published: May 14, 2020
Global health endeavors in low- and middle-income countries (LMIC) have traditionally emphasized humanitarian relief and primary care. Increasingly, specialty services, such as critical care medicine, are recognized as key components of sustainable, effective health care systems, even in settings with constrained resources. We illustrate the successful implementation of critical care services at Hawassa University teaching hospital in Ethiopia. Although not without challenges, the introduction o...
Simulation Education to Advance Emergency Medicine and Pediatric Critical Care in Nepal
Roshana Shrestha MD, Lisa Alianiello CNP, Shaza Aouthmany MD, Fenil Kholwadwala MD, Nicholas Deluga MD, Kevin Nguyen MD, Kris Brickman MD and Anmol Shrestha MD
Article Type: Research Article | First Published: May 06, 2020
Internationally emergency medicine is a relatively young specialty that is increasingly recognized for its potential for growth. In low middle-income countries (LMICs) like Nepal resources are quite limited and the development of new specialties such as emergency medicine can be slow to evolve. Specific areas of emergency care, including pediatric critical care have significant challenges due to clinical and educational limitations in countries like Nepal. Countries with robust healthcare system...
Acute Pneumonia: The Beginning of a Revision of Views or Just a Statement of Known Facts?
Igor Klepikov, MD
Article Type: Commentary | First Published: March 14, 2020
The author conducted research on the topic under discussion in the USSR at the State Institute for advanced training of doctors (Novokuznetsk). To date, the USSR and the mentioned Institute no longer exist. However, research and clinical trials of new approaches to the treatment of children with acute pneumonia and the results of this work can provide answers to a number of questions facing us today, which allows us to consider the research of thirty years ago relevant and worthy of mention....
Safety and Effectiveness of Neuromuscular Blockers in the Treatment of Acute Respiratory Distress Syndrome: Systematic Review and Meta-Analysis
Alfredo Aisa-Alvarez MsC, MD, Cesar A Rojas-Gomez, MD and Gilberto Camarena-Alejo MHA, MD
Article Type: Research Article | First Published: March 07, 2020
Two review authors independently screened the abstracts and titles for relevance. Screening for inclusion, data extraction, and risk of bias assessment were performed by one author and checked by the second. We assessed trials for the overall quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) instrument. We calculated the risk ratios (RR) and 95% confidence intervals (95% CI) for dichotomous outcomes, while for continuous results we obtaine...
Organophosphate Poisoning and Suicide in Nepal: A Reflection on the limitations of Behavioral Health Resources
Tyler Johnston, MS, Kris Brickman, MD, Roshana Shrestha, MD, Anmol Shrestha, MD and Shaza Aouthmany, MD
Article Type: Case Report | First Published: February 15, 2020
Organophosphate poisoning is the most common cause of suicide attempt in Nepal. Mortality rates of organophosphate poisoning are 41 times higher than they are in the United States, even with appropriate treatment. In low middle income countries organophosphate poisoning is much more prevalent than any other forms of suicide due to the easy availability in these agricultural countries. The most common cause of organophosphate poisoning for intentional suicide is from depression. Social reforms wi...
Evaluation of Accidents and Injuries in International Rally Organizations Held in Turkey
Ramazan SABIRLI, Damla ANBARLI METIN, Emre KARSLI and Omer CANACIK
Article Type: Original Research | First Published: February 13, 2020
International rally events, such as the World Rally Championship (WRC) and the Bosphorus Rally and the World Rally Cross Championship (WRX), have been held in Turkey from 2014 onwards. WRX race is an asphalt runway race in which two different categories of vehicles (Super car and RX-Lite) are racing and the rally racers aim to get the first place by passing one another. Super cars have approximately 650 hp engine, RX-Lite cars have approximately 380hp engine. Having been known since 1967, rallyc...
Electrocardiographic Brugada Pattern Unmasked by Febrile Illness
Antonio Villa, Alfredo Corticelli, Luisa Chiappa and Antonella Savinelli
Article Type: Case Report | First Published: December 04, 2019
Brugada syndrome is associated with a high risk of sudden cardiac death and some authors suggested the possibility that a febrile state may unmask the Brugada syndrome. We present a case of fever-induced type I electrocardiographic Brugada pattern. This is well known among the cardiologists, but it is necessary to introduce this clinical entity to other specialists, especially among internists and physicians of the emergency. Brugada syndrome, first described in 1992 as a new clinical entity by ...
Psychosocial Considerations for Pediatric Care in Emergency Departments
Julie Lerwick, PhD, LPC, NCC, RPT
Article Type: Case Study | First Published: August 26, 2019
When pediatric patients are admitted into emergency departments a different course of psychological care is required. Often, when admitted, children are scared and in pain. Fear and pain at any age introduces unexpected behavioral responses, and this is not an exception for children. This makes children quite vulnerable in emergency departments, regardless if caregivers are trained to work with pediatric patients. Within the urgency of delivering emergent medical care, as well as maintaining str...
Hyponatremia in Children with Systemic Inflammatory Response Syndrome Presenting to the Emergency Department
Osama El-Assal, MD, PhD, Sarah A Marzec, MD, Michael L Forbes, MD, Michael Bigham, MD, Ryan Reichert, MD, Jeffrey D Solomon, MD and Miraides F Brown, MS
Article Type: Retrospective Study | First Published: July 25, 2019
Hyponatremia is observed in children with meningitis, encephalitis, pneumonia, urinary tract infections, and Kawasaki disease. The presence of hyponatremia is associated with increased morbidity and mortality in adults. The clinical significance of hyponatremia in febrile pediatric patients is unknown. The objective of this study was to evaluate the prevalence and prognostic value of hyponatremia in children presenting to the emergency department (ED) with systemic inflammatory response syndrome...
Comparison of the Sequential Organ Failure Assessment (SOFA) and Quick SOFA Scores in Predicting in-Hospital Mortality among Adult Critical Care Patients with Suspected Infection
Mohammed A Said, MBChB, MPH, Wangari-Waweru Siika, MBChB, Vitalis Mung'ayi, MBChB and Reena Shah, MBChB, MRCP, MSc
Article Type: Original Article | First Published: July 13, 2019
Sepsis is global health priority and the leading cause of death in critical care. The SEPSIS 3 criteria introduced in 2016 is the latest tool in diagnosing sepsis. It uses SOFA and qSOFA scores in place of the SIRS criteria for better ability to predict mortality in patients with suspected infections. The performance of these scores in critical care units outside high-income countries remains largely unknown....
Characterization of Pediatric Procedural Competency in Emergency Physicians
Daniel Slubowski, MD , Brian Wagers, MD and Jessica Kanis, MD
Article Type: Research Article | First Published: July 11, 2019
Medical and traumatic resuscitation are among the core competencies of emergency medicine. When compared to adult patients, the frequency of high acuity pediatric patients requiring procedures is low. Currently in emergency medicine practice, especially in academic settings, maintaining proficiency in high acuity and low frequency pediatric procedures may be a problem for physicians after completing training....
The 'SAFE PT' Handover: A Qualitative Study for Developing an Improvised Tool Facilitating Safe Patient Handover
Ahmed Mikky, MD, Mohamed Al Busafi, MD and Issa Al Salmi, MD, PHD
Article Type: Qualitative Study | First Published: July 03, 2019
The aim of this study is to identify and establish an effective and a standardized tool that is easily reproducible for the safe handover of patients at end of shift at the emergency department (ED) for continuity of care, smooth transition and minimising errors. This tool is designed to assist emergency physician and nurses in building a safe patient culture one that is reliable and upholds the standards of quality and improvement guided by international goals....