http://mjemonline.com/index.php/mjem/issue/feed Mediterranean Journal of Emergency Medicine 2021-04-11T06:43:26-04:00 Open Journal Systems <p style="margin: 0in; margin-bottom: .0001pt; line-height: 115%;"><strong><span style="font-family: 'Georgia','serif'; color: #333333;">Med Emergency, MJEM</span></strong></p> <p style="margin: 0in; margin-bottom: .0001pt; line-height: 115%; orphans: auto; text-align: start; widows: 1; -webkit-text-stroke-width: 0px; word-spacing: 0px;"><strong><span style="font-family: 'Georgia','serif'; color: #333333;">M</span></strong><span style="font-family: 'Georgia','serif'; color: #333333;">editerranean <strong><span style="font-family: 'Georgia','serif';">J</span></strong>ournal of <strong><span style="font-family: 'Georgia','serif';">E</span></strong>mergency <strong><span style="font-family: 'Georgia','serif';">M</span></strong>edicine</span></p> <p style="margin: 0in; margin-bottom: .0001pt; line-height: 115%; orphans: auto; text-align: start; widows: 1; -webkit-text-stroke-width: 0px; word-spacing: 0px;"><span style="font-family: 'Georgia','serif'; color: #333333;">By <strong><span style="font-family: 'Georgia','serif';">N</span></strong>ew <strong><span style="font-family: 'Georgia','serif';">H</span></strong>ealth <strong><span style="font-family: 'Georgia','serif';">C</span></strong>oncept</span></p> <p style="margin: 0in; margin-bottom: .0001pt; line-height: 115%; orphans: auto; text-align: start; widows: 1; -webkit-text-stroke-width: 0px; word-spacing: 0px;"><span style="font-family: 'Georgia','serif'; color: #333333;">Fanar P.O.Box: 90.815 Jdeideh – Lebanon</span></p> <p style="margin: 0in; margin-bottom: .0001pt; line-height: 115%; orphans: auto; text-align: start; widows: 1; -webkit-text-stroke-width: 0px; word-spacing: 0px;"><span style="font-family: 'Georgia','serif'; color: #333333;">Tel: <a href="tel:%2B961.1.888921">+961.1.888921</a></span></p> <p style="margin: 0in; margin-bottom: .0001pt; line-height: 115%; orphans: auto; text-align: start; widows: 1; -webkit-text-stroke-width: 0px; word-spacing: 0px;"><span style="font-family: 'Georgia','serif'; color: #333333;">Fax: <a href="tel:%2B961.1.888922">+961.1.888922</a></span></p> <p style="margin: 0in; margin-bottom: .0001pt; line-height: 115%; orphans: auto; text-align: start; widows: 1; -webkit-text-stroke-width: 0px; word-spacing: 0px;"><span style="font-family: 'Georgia','serif'; color: #333333;">Email: <a href="mailto:mjem@newhealthconcept.net">mjem@newhealthconcept.net</a></span></p> http://mjemonline.com/index.php/mjem/article/view/94 The making of a ruler for everyday pediatric drug prescription in a field trauma hospital 2021-04-11T03:17:16-04:00 Albert Brizio brizioalbert@hotmail.com N Tbaileh test@yahoo.com <p>Traumatic brain injury (TBI) is a worldwide major cause of morbidity and mortality particularly in the vulnerable population young males, low-income individuals and members of ethnic minority groups.</p> <p>Severe TBI, defined as head trauma associated with a Glasgow Coma Scale (GCS) score of three to eight with loss of consciousness duration and altered mental status greater than 24 hours and post traumatic amnesia more than seven days.</p> <p>In this resume of protocols article, a helpful review of the current status of management of severe TBI according to the recent up-dated brain trauma foundation 2016 and the National Institute for Health and Care Excellence (NICE) 2014 guidelines is present. A concise overview of the optimal medical management, and both the non-invasive and invasive monitoring strategies, as well as the indications of surgical interventions necessary in particular instances. It is important not only for trauma team but for all healthcare personnel to be aware of the management and prevention of complications of severe traumatic brain injury.</p> 2021-04-11T00:00:00-04:00 Copyright (c) 2021 http://mjemonline.com/index.php/mjem/article/view/95 Splenic rupture after colonoscopy diagnosed by bedside ultrasonography 2021-04-11T03:25:29-04:00 Chady El Tawil ce21@aub.edu.lb S Traboulsy test@yahoo.com A El Asmar test@yahoo.com <p><strong>Introduction: </strong>Colonoscopy is a relatively safe procedure with low complication rates. A rare, but possible complication of colonoscopy is splenic rupture.</p> <p><strong>Case Presentation: </strong>A fifty nine years old patient presented one day post colonoscopy with vomiting and abdominal distention. The patient was hypotensive despite normal saline resuscitation. Bedside ultrasound showed fluid in the pelvis and a shattered spleen with splenic hematoma. The patient had an emergent laparotomy and splenectomy with no intraoperation complications.</p> <p><strong>Conclusion: </strong>Splenic rupture after colonoscopy is a rare complication and the use of bedside ultrasound by the emergency physicians is helpful in the early diagnosis and management of hemodynamically unstable patients.</p> 2021-04-11T00:00:00-04:00 Copyright (c) 2021 http://mjemonline.com/index.php/mjem/article/view/98 Usefulness of shock index for prehospital triage of septic shock by the SAMU regulation 2021-04-11T04:12:39-04:00 Romain Jouffroy romain.jouffroy@gmail.com A Saade test@yahoo.com A Philippe test@yahoo.com P Gueye test@yahoo.com P Gueye test@yahoo.com E Bloch-Laine test@yahoo.com P Ecollan test@yahoo.com P Carli test@yahoo.com B Vivien test@yahoo.com <p><strong>Introduction: </strong>Scoring systems were developed for risk-stratification of septic shock (SS) patients but their performance is poor in the prehospital setting.</p> <p><strong>Objective: </strong>The aim of this study was to evaluate the ability of the shock index (SI) in prehospital triage of SS patients to predict their admission in intensive care unit (ICU).</p> <p><strong>Methods: </strong>We performed a two months retrospective study of call records received by the Paris SAMU 75 regulation centerconcerning patients with presumed SS. The outcome was the in-ICU admission.</p> <p><strong>Results: </strong>Among the 30 642 calls received, 140 concerned patients with presumed SS were included. Twenty-two patients (16%) were admitted to ICU and 118 (84%) to the emergency department. The area under the curve (AUC) of the SI was 0.76 [0.65-0.86]. Using a threshold for SI &gt; 0.9, the sensitivity was 82%, the specificity was 67%, the positive predictive value was 32% and the negative predictive value was 95%. After logistic regression analysis, the OR for SI &gt; 0.9 reached 7.65 [2.33- 35.00]. Using propensity score analysis, the odd-ratio (OR) for SI &gt; 0.9 was 1.34 [1.15-1.52]. Results are expressed by OR with 95 percent confidence interval [95 CI].</p> <p><strong>Conclusion: </strong>Shock index is a reliable tool for risk stratification of SS patients managed in the prehospital setting. Using a threshold of one for the SI helps the screening of patients requiring ICU admission by the SAMU 15 regulation call centre. Prospective studies including SI in the decision-making process in the prehospital triage of SS patients are needed to validate these results.</p> 2021-04-11T00:00:00-04:00 Copyright (c) 2021 http://mjemonline.com/index.php/mjem/article/view/102 Approche diagnostique et thérapeutique de la nécrolyse épidermique toxique aux urgences: résumé de deux cas Diagnostic and therapeutic approach of the toxic epidermal necrolysis in the emergency department: report of two cases 2021-04-11T06:00:21-04:00 Nourelhouda Nouira nouira_n1_h2@yahoo.fr D Wiem test@yahoo.com A Lahouegue test@yahoo.com Y Walha test@yahoo.com I Kallel test@yahoo.com M Ben Cheikh test@yahoo.com <p><strong>Introduction: </strong>Toxic epidermal necrolysis (TEN) is a serious form of drug toxidermia, characterized by the abrupt destruction of the superficial layer of the skin and mucous membranes. Although rare, this severe form is life threatening</p> <p><strong>Objective: </strong>The aim of this study was to describe the diagnostic and therapeutic approach of two cases of toxic epidermal necrolysis in the emergency department (ED).</p> <p><strong>Methods: </strong>A retrospective study of two cases of patients admitted to the ED on Mongi Slim academic hospital in 2014 and 2017 with diagnoses of: Lyell and Stevens Johnson syndromes with iconography.</p> <p><strong>Cases: </strong>We report two cases of toxic epidermal necrolysis admitted in the ED. The first patient with the diagnosis of Lyell syndrome had an estimated zone of epidermis detachment of 50% and the second patient presented with Stevens Johnson syndrome with lesions of the external genitalia and mucous membranes. The lesions were multivisceral for both patients. The interval between the first dose and the onset of the symptomatology was 48 hours, the incriminated drugs were clavulanic acid / amoxicillin for Lyell’s Syndrome and non-steroidal anti-inflammatory drugs for Stevens Johnson. The imputability of these drugs was likely. The mortality risk, according to the Scorten score, was about 90% for Lyell syndrome and 35.3% for Stevens-Johnson syndrome. Immediate cessation of the drug administration was the first therapeutic measure. Both patients received rehydration, parenteral nutrition with glycemic control and pain management. The evolution was favorable for the Stevens Johnson syndrome, the patient with a syndrome of Lyell died of a septic shock.</p> <p><strong>Conclusion: </strong>The early diagnosis and treatment of toxic epidermal necrolysis condition the prognosis. The management of this serious toxidermia must be multidisciplinary.</p> 2021-04-11T00:00:00-04:00 Copyright (c) 2021 http://mjemonline.com/index.php/mjem/article/view/97 Snakebite in Lebanon: The painful reality 2021-04-11T04:02:47-04:00 Elsy Jabbour elsyjabbour.1@gmail.com <p>Unfortunately, snakes remain a nightmare for the villagers in Lebanon. Ninety percent of snakebites are non-venomous, and snakes are not aggressive and do not bite unless provoked. Among the 25 species that were observed in Lebanon, only three were identified as venomous snakes: vipera palaestinae, vipera lebetina and vipera bornmuelleri. The objectives of this article are to present the types of Lebanese snake species, and to provide a guide for management in the emergency department and the indications for antivenom use. Finally, we will present common misconceptions and the Lebanese situation concerning antivenom availability.</p> 2020-11-03T00:00:00-05:00 Copyright (c) 2021 http://mjemonline.com/index.php/mjem/article/view/93 Prospective evaluation of two emergency triage scales: the French Emergency Nurses Classification in Hospitals (FRENCH) and the Emergency Severity Index (ESI) 2021-04-11T02:44:38-04:00 Antoine Aubrion aubrion-a@chu-caen.fr R Clanet test@yahoo.com A Guigne test@yahoo.com N Lecadet test@yahoo.com S Audigie test@yahoo.com Ch Creveuil test@yahoo.com E Roupie test@yahoo.com R Macrez test@yahoo.com <p><strong>Objective(s): </strong>Emergency Departments (ED) require a systematic approach to prioritize patient care depending on acuity. The Emergency Severity Index (ESI) scale is the most used. In France, the French Emergency Nurses’ Classification in Hospitals (FRENCH) is used. The aim of this study was to evaluate inter-rater reliability and validity of the ESI and FRENCH triage scales.</p> <p><strong>Methods: </strong>We performed a prospective monocentric study in a French University College Hospital over the 2016 summer. All patients admitted to ED were evaluated to the triage area by two pairs of emergency physicians, each unaware of the triage results of the other pair. Reliability was estimated by a quadratic weighted Kappa. Validity was evaluated by the association between the level of triage and the following indirect criteria: rate of admission, type of admission amount of resources and length of stay in the emergency ward.</p> <p><strong>Results: </strong>Both the ESI and FRENCH triage systems showed strong reliability (weighted Kappa respectively 0.85 and 0.87) without any significant difference. An association was established for both scales between the level of emergency and each of the indirect criteria of validity. The associations between triage level and the amount of resources and length of stay criteria were significantly stronger for ESI scale. The area under the Receiver Operating Characteristic curve for prediction of an admission was 0.75 for ESI and 0.71 for FRENCH scale without any significant difference.</p> <p><strong>Conclusion: </strong>ESI and FRENCH scales have a strong inter-rater reliability and appear to have a good validity. Other studies, particularly multicenter studies including more qualitative criteria, would probably make it possible to decide on the most effective triage method.</p> 2021-04-11T00:00:00-04:00 Copyright (c) 2021 http://mjemonline.com/index.php/mjem/article/view/96 Severe traumatic brain injury 2021-04-11T03:45:45-04:00 Nora Ismail Narnar_77@yahoo.com <p>Traumatic brain injury (TBI) is a worldwide major cause of morbidity and mortality particularly in the vulnerable population young males, low-income individuals and members of ethnic minority groups.</p> <p>Severe traumatic brain injury, defined as head trauma associated with a Glasgow Coma Scale (GCS) score of 3 to 8 with loss of consciousness duration and altered mental status greater than 24 hours and post traumatic amnesia more than seven days.</p> <p>In this resume of protocols article, a helpful review of the current status of management of severe TBI according to the recent up-dated brain trauma foundation 2016 and The National Institute for Health and Care Excellence (NICE) 2014 guidelines is present. A concise overview of the optimal medical management, and both the non-invasive and invasive monitoring strategies, as well as the indications of surgical interventions necessary in particular instances. It is important not only for trauma team but for all healthcare personnel to be aware of the management and prevention of complications of severe traumatic brain injury.</p> 2020-11-03T00:00:00-05:00 Copyright (c) 2021 http://mjemonline.com/index.php/mjem/article/view/100 Prise en charge des arrêts cardiaques extrahospitaliers sur un territoire français 2021-04-11T05:24:06-04:00 Mikael Martinez mikael.martinez@ch-forez.fr A Mainsel test@yahoo.com T Lefebvre test@yahoo.com S Espinouse test@yahoo.com PA Guenier test@yahoo.com A Savu test@yahoo.com O Carle test@yahoo.com S Massacrier test@yahoo.com P Parsis test@yahoo.com A Viallon test@yahoo.com <p><strong>Aim: </strong>The survival rate of out-of-hospital cardiac arrests (OHCA) remain slow in France (4.9%). The main objective of our study was to describe the management of OHCA in Loire and North Ardèche. Secondary objectives were to identify factors influencing survival and neurological prognosis at day 30 (D30).</p> <p><strong>Procedure: </strong>Retrospective study based on data from the French national register (RéAC) and including all OHCA for whom</p> <p>resuscitation was undertaken from January 1, 2013 to August 31, 2018.</p> <p><strong>Results: </strong>The study included 1984 OHCA, 69% of whom were male, with a median age of 68 years old [55-80]. A witness was present in 1265 cases (64%) and started a cardiopulmonary resuscitation (CPR) in 44.5% of cases. The etiology was medical in 88.9% of cases. The initial rhythm was shockable in 6.4% of cases. Seventy-nine patients (4%) survived at day- 30, 56 of whom had a good neurological prognosis (2.8%). Factors improving survival were: early CPR and defibrillation (OR 2.21 [1.02-4.80]), the occurrence in a public place (OR 2.39 [1.27-4.52]) and the presence of gasps at the beginning of care (OR 3.27 [1.49-7.20]). Factors reducing survival were: traumatic etiology (OR 0.11 [0.01-0.85]), non-shockable rhythm (OR 0.09 [0.04-0.19]), advanced age (OR 0.96 [0.95-0.98]), longer no-flow time (OR 0.95 [0.91-0.99]) and an adrenaline dose</p> <p>≥ 3 mg (OR 0.09 [0.04-0.18]). The same factors influenced the neurological prognosis at D30.</p> <p><strong>Conclusion: </strong>Our data were comparable to national data. The intervention of witnesses is crucial on the prognosis and needs to be encouraged.</p> 2021-04-11T00:00:00-04:00 Copyright (c) 2021 http://mjemonline.com/index.php/mjem/article/view/101 Establishment of a national catastrophe burn plan for the delivery of care for burn patients in Lebanon 2021-04-11T05:52:44-04:00 Sarah Moufarrij Sara.moufarrij@gmail.com L Deghayli test@yahoo.com M Frangieh test@yahoo.com S Assaad test@yahoo.com . Souaiby test@yahoo.com <p><strong>Objective: </strong>This study aims at gathering data concerning the care of burn patients in Lebanon. Based on the findings, a national burn plan will be drafted to standardize burn treatment.</p> <p><strong>Methods: </strong>Questionnaires were distributed to physicians in four hospitals, emergency medical team responders in two Lebanese Red Cross centers, the Lebanese Army and the Lebanese Civil Defense with the approval of the Lebanese Society of Emergency Medicine and the Syndicate of Hospitals, after obtaining informed consent. The questions covered topics including burn treatments, patient triage, burn wound evaluation, and the perceived role of the different parties involved in dealing with a burn catastrophe. A retrospective burn patient chart review was conducted at the American University of Beirut Medical Center in order to better understand the epidemiology of burns in the country</p> <p><strong>Results: </strong>A total of 97 questionnaires were distributed, 58 were collected from various hospitals throughout Lebanon and 39 were collected from various respondents, 140 charts were reviewed from the American University of Beirut’s medical records department. When asked to define a “severe burn”, the only hospital that answered with internal consistency is Nabatieh hospital, choosing “&lt; 10% of total body surface area (TBSA)” to define a severe burn in adults and “20% TBSA” to define it in the pediatric population. When asked about the most important first step when dealing with a burn patient, 32% of responders from the Lebanese Red Cross in Spears correctly identified fluid resuscitation as the first step in management, whereas no responder from the Lebanese Red Cross in Tripoli chose this answer. The medical charts reviewed from the American University of Beirut showed that the most common type of burn was the thermal burn (84.1%). Only 2.3% of patients got treated at the site of the accident and 3.8% of patients went on to get treated at a burn hospital after being seen at the American University of Beirut.</p> <p><strong>Conclusion: </strong>In Lebanon, burn care appears to be fragmented and heterogeneous, in addition to the fact that the different parties (Army, Lebanese Red Cross, Civil Defense and physicians), that should sequentially be involved in addressing burn care, seem unsure of their role in the chain of command. Centralization of burn care by means of a national catastrophe burn plan would allow for a multi-disciplinary and coordinated approach, which is the only effective way of treating a burn victim.</p> 2021-04-11T00:00:00-04:00 Copyright (c) 2021 http://mjemonline.com/index.php/mjem/article/view/103 Risk factors for occupational violence and aggression in the emergency department 2021-04-11T06:06:48-04:00 Pourya Pouryahya pourya.pouryahya@monashhealth.org A Lim test@yahoo.com <p><strong>Objective: </strong>To examine shift characteristics that increase the risk of occupational violence and aggression.</p> <p><strong>Methods: </strong>This study was a secondary analysis of survey results obtained from ‘Violence and abuse against staff in the emergency department, a descriptive analysis of a two-centre staff survey’. The purpose was to identify shift characteristics that were predictive of submitting a survey response describing a violent event. Univariable and multivariable binomial logistic regressions were used to identify significant predictors. Aggregated data from phase I findings was used to calculate odds ratios (OR) for each day of the week.</p> <p><strong>Results: </strong>The adjusted OR of experiencing violence if the respondent was a nurse was OR 2.92 [95% confidence interval (CI) 1.50, 6.00], p &lt; 0.01. There was a higher risk of violence on post meridiem (PM) (OR 2.63 [95% CI 1.45, 4.83, p &lt; 0.01) and night shifts (OR 2.65 [95% CI 1.51,4.71], p &lt; 0.001). Saturday was the only day of the week identified as a significant risk factor (OR 4.92 [95% CI 1.60,18.13], p = 0.002).</p> <p><strong>Conclusions: </strong>Based on this cohort of emergency workers, the shift characteristics that were most predictive of submitting a survey describing a violent encounter were PM or night shifts, whether the health provider is a nurse, or whether the shift was performed on a Saturday.</p> 2021-04-11T00:00:00-04:00 Copyright (c) 2021