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Gastric ultrasound-assisted diagnosis of undifferentiated shock:A case report

Journal of Acute Disease 2022年第6期11卷 251-253页

作者： alireza Bahmani ali abdolrazaghnejad Department of Emergency Medicine Khatam-Al-Anbia HospitalZahedan University of Medical SciencesZahedanIran Infectious Diseases and Tropical Medicine Research Center Research Institute of Cellular and Molecular Sciences in Infectious DiseasesZahedan University of Medical SciencesZahedanIran

Rationale:Peptic ulcer disease and variceal bleeding are two of the most common causes of gastrointestinal(GI)bleeding.GI bleeding can present with symptoms of hemodynamic instability such as tachycardia and shock.Patient’s Concern:A 33-year-old man with confusion and hypotension(blood pressure:70/40 mmHg and pulse rate:140/min)was brought by emergency medical services from home to the emergency department without any companion.The patient was in undifferentiated shock.His hypotension was assessed with inferior vena cava(IVC)size and collapsibility,and rapid ultrasound in shock and hypotension(RUSH)protocol was used to investigate the cause of his shock.Following the RUSH protocol when scanning the IVC,parts of the stomach were seen in its vicinity and suspended heterogeneous particles were observed in the fluid.After seeing these particles,we suspected GI bleeding.Diagnosis:Endoscopy confirmed GI bleeding.Interventions:After placing an orogastric tube and suction,about 2 L of coffee-ground fluid with clots was removed.We started intravenous proton-pump inhibitors 80 mg bolus,followed by a continuous infusion of 8 mg/h.The patient received about 2 L of normal saline and 2 units of packed red blood cells to correct his hypotension.Outcomes:After being admitted to the GI ward and treated for three days,the patient was discharged from the hospital with a hemoglobin level of 11 g/dL and continued to have an outpatient follow-up at the clinic.Lessons:The use of gastric ultrasound in conjunction with the RUSH protocol can help to diagnose undifferentiated hypotensive shock.The components of the RUSH exam are the heart(H),IVC(I),Morrison’s/FAST abdominal views with the aorta(MA),and pulmonary and pipes scanning(P),and can be memorized with the mnemonic:HI-MAP.We would like to introduce a new mnemonic:Hi-MAPS,adding stomach(S)to the RUSH protocol in undifferentiated hypotension and shock to evaluate upper GI bleeding.

关键词： Gastrointestinal bleeding Emergency room Gastric ultrasound Rapid ultrasound in shock and hypotension protocol Hypovolemic shock

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Effects of oxygen therapy on the outcome of patients with acute myocardial infarction:A randomized clinical trial

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Journal of Acute Disease 2023年第2期12卷 45-50页

作者： Maryam Ziaei Hojjat Rastegari Najafabadi Mahjoubeh Keykha Mehdi Galavi ali abdolrazaghnejad alireza Bahmani Department of Emergency Medicine Khatam Al Anbia HospitalZahedan University of Medical SciencesZahedanIran Infectious Diseases and Tropical Medicine Research Center Research Institute of Cellular and Molecular Sciences in Infectious DiseasesZahedan University of Medical SciencesZahedanIran

Objective:To investigate the therapeutic effects of supplemental oxygen on patients with myocardial infarction.Methods:This study was a randomized,double-blind clinical trial.The study population included all patients who were admitted to the emergency room of ali-ibn-Abitaleb and Khatam-al-Anbia hospitals in Zahedan within six hours of the onset of classic symptoms of myocardial infarction.The patients(n=47)were divided into two groups:the case group(with oxygen therapy)and the control group(without oxygen therapy).The initial follow-up was evaluated after one month and the second follow-up was evaluated after three months in the target population in terms of mortality caused by acute myocardial infarction,mortality caused by any other cause,and re-hospitalization caused by acute myocardial infarction.Results:Out of the 47 patients,27 were male(57.4%).The average age of the patients was(60.9±8.1)years.One month after admission,2 patients(8.7%)in the case group and 2 patients(8.3%)in the control group died due to acute myocardial infarction.A total of 7 patients(14.9%)died three months after admission.There was no significant difference between the control and case groups in terms of mortality caused by acute ischemia within one and three months.After one month,2 patients(8.7%)in the case group and 1 patient(4.2%)in the control group died of other causes.After three months,4 patients(8.5%)in total died for other causes.There was no significant difference between the control and case groups in terms of mortality due to other causes within one and three months.One month after admission,5 patients(21.7%)of the case group and 4 patients(16.7%)of the control group were re-hospitalized due to acute myocardial ischemia.During the next three months,3 patients(13.0%)of the case group and 5 patients(20.8%)of the control group were re-hospitalized.There was no significant difference between the control and case groups regarding the rate of re-hospitalization caused by acute myocardial infarction within one and three months

关键词： Oxygen therapy Myocardial infarction Mortality Cardiac ischemia Hospitalization

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Intranasal ketamine as an analgesic agent for acute pain management in emergency department: A literature review

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Journal of Acute Disease 2018年第6期7卷 241-246页

作者： Abdolghader Pakniyat Morteza Qaribi Dorin Rahnama Hezaveh ali abdolrazaghnejad Department of emergency Medicine Faculty of MedicineKurdistan University of medical sceincesSanandajIran Department of Emergency Medicine School of MedicineArak University of Medical SciencesArakIran School of Medicine Medical University of LublinLublinPoland Department of Emergency Medicine Khatam-Al-Anbia HospitalZahedan University of Medical SciencesZahedanIran

Ketamine is a well-known dissociative anesthetic agent, and has been used over 50 years. Intranasal pathway is a mucosal way for absorbing agents to directly affect in brain via olfactory sheets, bypassing first pass metabolism and the blood brain barrier. The current uses of intranasal ketamine as an analgesic agent for acute pain management in emergency department are discussed in this review article. Using 'ketamine', 'pain or analgesia', and'intranasal' as keywords, a search of google scholar, Pubmed, web of science, and Medline database from 1970 until 2017 was performed. Finally, from 1204 papers extracted via primary search, 1088 papers were omitted and finally 10 studies were considered for further assessment. There were four observational studies, one case series and report and 5 clinical trials. Ketamine was used for acute pain control due to musculoskeletal trauma, burns, and painful procedures. A total of 390 cases were included in these studies. The studies used ketamine with doses ranging 0.45-1.25 mg/kg via intranasal pathway. Intranasal ketamine provides relatively rapid, well tolerated, and clinically significant analgesia for emergency department patients. Considering the lack of adequate studies and undetermined intranasal dose, it is better to conduct further high quality investigation in both adults and pediatrics.

关键词： Administration Intranasal Emergency department Ketamine Pain management Review literature

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