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Motamed H, Mohammadi M, Tayebi Z, Rafati Navaei A. The diagnostic utility of creatine kinase-MB versus total creatine
phosphokinase ratio in patients with non-ST elevation myocardial infarction from
unstable angina. SAGE Open Med 2023; 11:20503121221148609. [PMID: 36969724 PMCID: PMC10034342 DOI: 10.1177/20503121221148609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/16/2022] [Indexed: 03/24/2023] Open
Abstract
Objective: The present study seeks to find a way to quickly and correctly differentiate
myocardial infarction from unstable angina by measuring the creatine
kinase-MB/creatine phosphokinase ratio and comparing in non-ST elevation
myocardial infarction patients with unstable angina at different time
intervals, to improve the health quality of patients with coronary artery
disease. Methods: The present study is a retrospective epidemiological analysis of 260 patients
with non-ST elevation myocardial infarction and 260 patients with unstable
angina, including age, sex, creatine kinase-MB, and creatine phosphokinase
biomarkers at two-time intervals, including referral (4–8 h from the onset
of pain) as the first interval, and 8 h after the first sampling was
extracted as the second interval. Moreover, the delta of the creatine
kinase-MB/creatine phosphokinase ratio during two interval times was
measured. Results: In non-ST elevation myocardial infarction patients in the first and second
intervals, creatine kinase-MB/creatine phosphokinase ratio was 32.7 and
33.8% higher than the normal laboratory cutoff (positive), respectively, and
in the group of unstable angina patients, this index was positive in 31.9
and 30.4% of patients, respectively. There was no significant difference
between the mean creatine kinase-MB to creatine phosphokinase index between
the patients with non-ST elevation myocardial infarction and unstable angina
(p = 0.507). In the first interval, the sensitivity and
specificity of this index in differentiating non-ST elevation myocardial
infarction from unstable angina were 51.5 and 57.3% (area under the
curve = 0.518), respectively. While in the second interval, the sensitivity
and specificity of this index were 17.7 and 87.8% (area under the
curve = 0.519), respectively. The creatine kinase-MB/creatine phosphokinase
delta in the non-ST elevation myocardial infarction group was significantly
higher than in patients with unstable angina during different time intervals
(p = 0.01). Conclusion: According to our results, creatine kinase-MB/creatine phosphokinase index
cannot help differentiate the two groups of non-ST elevation myocardial
infarction and unstable angina. However, the findings show that higher
levels of creatine kinase-MB enzyme and creatine kinase-MB/creatine
phosphokinase delta in the early hours, 4–16 h after the onset of pain in
non-ST elevation myocardial infarction patients, can be used to
differentiate between non-ST elevation myocardial infarction and unstable
angina.
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Affiliation(s)
- Hassan Motamed
- Department of Emergency Medicine,
Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran
| | - Mohammad Mohammadi
- Atherosclerosis Research Centre, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Tayebi
- Department of Emergency Medicine,
Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran
| | - Alireza Rafati Navaei
- Department of Emergency Medicine,
Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
Iran
- Alireza Rafati Navaei, Department of
Emergency, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 61357-15794,
Iran.
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Moezzi M, Motamed H, Mozafari J, Fattah M, Delirrooyfard A. A comparison of magnesium sulfate plus morphine with morphine alone for acute pain reduction in long-bone fractures; a double blind randomized clinical trial. J Nephropharmacol 2022. [DOI: 10.34172/npj.2022.10455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Acute pain is a common symptom in patients with bone fractures referring to the emergency department (ED). Objectives: The present study aimed at evaluating the efficacy of intravenous (IV) magnesium sulfate in controlling acute pain of long-bone fractures in EDs. Patients and Methods: The present double-blind, randomized clinical trial was conducted on patients with isolated limb fractures referred to Golestan hospital of Ahvaz from 2019 to 2020. Patients in the intervention group were injected with 0.1 mg/kg morphine plus 30 mg/kg magnesium sulfate and 0.1 mg/kg morphine alone in the morphine group. The patient’s pain scores were measured at 0, 15, 30, 45 and 60 minutes after injection. The patients’ condition was monitored every 10 minutes, including respiratory and pulse rate, blood pressure, and knee reflex. Results: The present study was conducted on 64 patients with long-bone fractures allocated to two groups of IV morphine plus magnesium sulfate and IV morphine alone (each of 32). The hemodynamic factors and mean body temperature did not significantly change after intervention and had a similar level in both groups. Before the intervention, the mean score of pain was measured in the morphine and magnesium sulfate plus morphine groups using a visual analogue scale. Results which were 8.87±0.83 and 8.93±0.94, respectively, showing no significant differences (P=0.69). After 60 minutes, the pain score reduced considerably in both groups. Conclusion: In the study, magnesium sulfate plus morphine could better reduce pain than morphine alone without influencing the respiratory rate. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trials (IRCT20190617043913N1; https://en.irct.ir/trial/40370, ethical code# IR.AJUMS.REC.1398.143).
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Affiliation(s)
- Meisam Moezzi
- Department of Emergency Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hassan Motamed
- Department of Emergency Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Javad Mozafari
- Department of Emergency Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Fattah
- Department of Emergency Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Delirrooyfard
- Department of Emergency Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Motamed H, Moezi M, Khilghi A, Fahimi MA. Evaluating the analgesic and sedative effects of intravenous ketamine versus morphine administration on relieving long/short bone-fracture pain in the upper/ lower limbs; a phase II clinical trial. Immunopathol Persa 2022. [DOI: 10.34172/ipp.2022.30334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: The importance of pain control in patients with limb trauma admitted to emergency departments as well as its complications is among the main concerns in post-emergency care, which contributes to the accelerated improvement of patients’ conditions in a significant manner. Objectives: The present study was to evaluate the analgesic and sedative effects of intravenous (IV) ketamine versus morphine administration on relieving long/short bone-fracture pain in the upper/lower limbs. Patients and Methods: The present study is as a double-blind randomized clinical trial. For this purpose, the effect of ketamine and morphine were initially examined using IV ketamine and morphine administration, respectively, at the doses of 0.4 and 0.1 mg/kg/IV/10 min in patients, aged 18-65 years with limb trauma, and admitted to hospital emergency departments. Afterward, the duration of the analgesic effect, the amount of pain relief, according to the visual analog scale (VAS) outcomes, and the complications for each drug, including apnea, bradycardia, tachycardia, altered level of consciousness, nausea, vomiting, hypertension/hypotension, seizures and disturbed sleep were compared, and then the preferred method was introduced. Results: In this study, 120 patients in total, including 60 cases receiving ketamine and 60 individuals receiving morphine, were recruited. The participants’ age range was between 19 -70 years. The patients’ mean age was 47.04±12.57 years of whom 89 patients (74.2%) were male. The study results indicated that the potency of the low-dose ketamine infusion in relieving pain in patients was comparable to that of morphine. Conclusion: It was concluded that ketamine could be administered as an alternative to IV morphine to reduce long/short bone-fracture pain in the upper/lower limbs. Trial Registration: The trial protocol was authorized by the Iranian Registry of Clinical Trials, (identifier: IRCT20170716035105N3; https://en.irct.ir/trial/26628, ethical code: IR.AJUMS.REC.1396.248).
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Affiliation(s)
- Hassan Motamed
- Department of Emergency Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Meisam Moezi
- Department of Emergency Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Azam Khilghi
- Department of Emergency Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Ali Fahimi
- Department of Emergency Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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4
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Nematollahi AV, Motamed H, Masoumi K, Forouzan A, Nobakht E. Efficacy evaluation of budesonide nebulizer as an adjunctive medication in post-rain asthma acute phase attack. Adv Respir Med 2022; 90:37-48. [PMID: 35084724 DOI: 10.5603/arm.a2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 12/01/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Bronchospasm attacks occur following syndromic rainfall and are increasing due to air pollution and need effective treatments. In this study, the effect of salbutamol nebulizer in comparison with salbutamol plus budesonide nebulizer in patients referred to the emergency department with dyspnea was investigated. MATERIAL AND METHODS The trial study was conducted on 228 patients with dyspnea after the first rainfall in Ahvaz. Two groups of 114 patients have been randomly allocated. On the course of treatment, the first group received salbutamol plus budesonide nebulizer and the second group received salbutamol alone. In the experimental group, budesonide 0.5 mg with salbutamol was nebulized three times for 20 minutes. In all patients, 20, 40, and 60 minutes after the start of the intervention, forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR) and vital signs of size were recorded and analyzed by SPSS and t-test. RESULTS Data revealed that there were significant differences between PEFR parameters of studied. Groups in minute 40 and 60 after intervention (p = 0.000001). There was better improvement.in PEFR values in minute 40 and 60 in budesonide plus salbutamol study group. There were no significant differences for FEV1 in minute 0, 20, 40, 60 between to studied group. Also there were no significant differences for borg dyspnea scale for minute 0 and 60 between two experimented group. Respiratory rates have significant differences in minutes 20, 40 after intervention and there was better improvement for salbutamol plus budesonide group rather than sulbutamol intervention group alone.(p = 0.001142). CONCLUSION Experiment data revealed. that due to the significant difference between PEFR and increased FEV1 in the combination of the two drugs and due to the corticosteroid effects of budesonide in reducing and preventing inflammation and swelling of the lungs, nebulizer salbutamol + budesonide has better effects on moderate breath than in nebulizer salbutamol.
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Affiliation(s)
- Ali Vefagh Nematollahi
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hassan Motamed
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Kambiz Masoumi
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Arash Forouzan
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elnaz Nobakht
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Motamed H, Forouzan A, Masoumi K, Sajadi R. The effect of albuterol with heliox versus albuterol nebulization in acute asthma exacerbation: a randomized controlled clinical trial. Adv Respir Med 2022; 90:86-93. [PMID: 35084726 DOI: 10.5603/arm.a2022.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/23/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Asthma is one of the most common chronic disorders of the respiratory tract. Thus, this study intended to evaluate the clinical effects and the peak flow metric effects of nebulized albuterol with heliox versus albuterol nebulization in acute asthma exacerbation. MATERIAL AND METHODS In this randomized clinical trial study, 109 patients with acute asthma attacks admitted to the emergency departments (EDs) in *** were enrolled. The patients were divided randomly into two groups: the intervention and control groups. The intervention group was nebulized with heliox (helium/oxygen-70: 30) plus albuterol with a 10 mL/min dose for 20 minutes three times, which lasted 60 minutes. The control group received standard treatment (albuterol in combination with oxygen). RESULTS The results showed that the mean scores of FEV1 and PEFR after 20 minutes were significantly different in the two groups, as FEV1 scores in the intervention group were 2.76 and 3.01 at 20 and 60 minutes, respectively, while FEV1 scores in the control group were 1.99 and 2.64, respectively (P < 0.001). In addition, PEFR scores in the intervention group at 20 and 60 minutes were 299.24 and 310.57, respectively. However, these scores in the control group were 237.98 and 274.56, respectively (P < 0.001). CONCLUSION The results showed that the use of heliox in t eating severe asthma attacks could be regarded as a different standard treatment that can lead to significantly better control of asthma attacks in the short term.
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Affiliation(s)
- Hassan Motamed
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Arash Forouzan
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran..
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran..
| | - Kambiz Masoumi
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
| | - Rozbeh Sajadi
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical sciences, Ahvaz, Iran
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Motamed H, Masoumi K, Moezzi M, Ghoraian P. Clinical Efficacy of Dexmedetomidine versus Ketamine in Shoulder Dislocation Reduction: A Randomized Clinical Trial Study. Med J Islam Repub Iran 2021; 35:152. [PMID: 35341088 PMCID: PMC8932213 DOI: 10.47176/mjiri.35.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Indexed: 11/09/2022] Open
Abstract
Background
:Shoulder joint dislocation and displacement is a common clinical condition. The present research aims to compare the clinical efficacy of ketamine versus dexmedetomidine during shoulder joint reduction.
Methods
: In this randomized clinical double-blind trial method, patients aged 18 to 65 years with shoulder dislocation referred to the Emergency Hospital of Imam Khomeini Hospital in Ahvaz, Iran, were enrolled. Patients were separated into two groups, patients in group A received 1mg/kg nebu-lized ketamine and patients in group B received 1 μg/kg nebulized dexmedetomidine. Pain score was recorded at 5 different time points: Zero (before intervention), 10 minutes, 20 minutes, 30 minutes, and 60 minutes after intervention., The pain score was evaluated using the visual analog scale (VAS) test. A linear regression test was carried out to compare the slopes. Also, ANOVA repeated measures test variables differences between groups. Then Tukey's multiple comparisons as post-hock were applied to compare the pains at different time points. Using IBM SPSS version 19.0 software, all analyzes were accomplished.
Results
: The pain score in both groups significantly decreased during different time points. The pain reduction slope in the group that received dexmedetomidine is meaningfully upper than that of ketamine (-0.08 vs. -0.06, p=0.012). The ketamine action onset time was 20 minutes after the in-tervention. In comparison, the effect of dexmedetomidine has an onset of 10 minutes after the in-tervention.
Conclusion
: Overall, the results of current research demonstrated that although nebulized dexme-detomidine and nebulized ketamine produce a significant decrease in pain score, dexmedetomidine provides a faster effect. Therefore, nebulized dexmedetomidine seems to be used as an appropriate choice to induce sedation during shoulder joint reduction in emergency departments.
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Affiliation(s)
- Hassan Motamed
- Department of Emergency Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kambiz Masoumi
- Department of Emergency Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Meisam Moezzi
- Department of Emergency Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Corresponding author:Dr Meisam Moezzi,
| | - Payam Ghoraian
- Department of Emergency Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Soltani KM, Motamed H, Eslami K, Majdinasab N, Kouti L. Randomised trial of IV metoclopramide vs IV ketorolac in treatment of acute primary headaches. Am J Emerg Med 2021; 50:376-380. [PMID: 34474267 DOI: 10.1016/j.ajem.2021.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/25/2021] [Accepted: 08/08/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Headache is one of the most common neurological conditions among emergency department visits (ED), although the best therapy has not been identified yet. Therefore, in the current study, we aimed to compare the pain-relieving effect of metoclopramide and ketorolac in acute primary headaches patients. METHODS This double-blind, randomised clinical trial was conducted at Golestan Hospital, Ahvaz, Iran. This research involved all adult patients with acute primary (migraine or tension-type) headaches presented to the ED. Pain intensity was assessed with 0 to 10 verbal Numeric Rating Scales (NRS). The subjects were randomised into 10 mg intravenous (IV) metoclopramide or 30 mg IV ketorolac groups. Pain score and drug adverse reactions were compared between the two groups at baseline, 15, 30, and 60 min after baseline. RESULTS 108 patients completed this trial and were equally divided into two groups (mean age of 34 ± 8.54 years; 57.4% female). Before treatment, the mean pain score was 6.9 and 6.8 in metoclopramide and ketorolac groups, respectively (p > 0.05). Metoclopramide failed to provide more improvement in pain score at 30 min (p = 0.55) and 60 min (p = 0.15) from baseline. There were no serious adverse events in this study. Only five patients required rescue medication which four of them were in ketorolac group. CONCLUSION We were unable to reject the null hypothesis that there would be no difference in pain outcomes between metoclopramide and ketorolac.
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Affiliation(s)
- Kasra Morad Soltani
- Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Pain Research Center, Imam Khomeiny Hospital Research and Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hassan Motamed
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kaveh Eslami
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nastaran Majdinasab
- Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Kouti
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Motamed H, Forouzan A, Moezzi M, Alizadeh H. Dexmedetomidine as an adjunctive treatment for acute asthma. Clin Exp Emerg Med 2021; 8:89-93. [PMID: 34237813 PMCID: PMC8273673 DOI: 10.15441/ceem.20.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/29/2020] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to compare the efficacy of using dexmedetomidine with salbutamol and salbutamol nebulization alone in patients with acute exacerbation of asthma presenting to the emergency department. Methods This clinical trial included 60 patients, in the age range of 18 to 55 years, with signs of bronchospasm presenting to the emergency department. In the intervention group, dexmedetomidine 0.5 µg/kg was injected intravenously and three doses of salbutamol nebulization were administered over 60 minutes. In the control group, salbutamol nebulization was administered for 60 minutes three times. The patient’s clinical status, based on clinical symptoms, consciousness, speech, breathing rate, heart rate, and blood pressure were recorded before the intervention, and peak expiratory flow rate and forced expiratory volume in 1 second were measured at 20, 40, and 60 minutes after intervention. Patients who did not respond to the intervention were excluded from the study within 60 minutes. Results The increased mean forced expiratory volume in 1 second and mean peak expiratory flow rate were found to be similar in both groups during the treatment (P=0.304). The mean systolic and diastolic blood pressure recorded at 40 and 60 minutes were significantly lower in the intervention group. During this study, no patient was excluded before 60 minutes. Conclusion Administration of dexmedetomidine in addition to standard salbutamol treatment has no beneficial effect in patients with acute asthma attacks and merely causes hypotension in patients.
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Affiliation(s)
- Hassan Motamed
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Arash Forouzan
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Meisam Moezzi
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hossein Alizadeh
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Motamed H, Verki MM, Nematollahi AV, Hesam S. Evaluation of efficacy of nebulized low molecular weight heparin as an adjunctive extra treatment for acute mild-moderate asthma attack; a randomized clinical trial study. Pulm Pharmacol Ther 2021; 68:102037. [PMID: 33989812 DOI: 10.1016/j.pupt.2021.102037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 03/14/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma is the most common chronic disorders of the respiratory tract. This study aimed to evaluate the effect of low-molecular-weight heparins (LMWHs) in the treatment of acute asthma. METHODS In this randomized clinical trial, patients with acute asthma attacks were enrolled. The patients were divided randomly into two groups. Patients in the intervention group received nebulized LMWH (1 mg/kg) with albuterol (2.5 mg) every 20 min for 10 min. The patients in the control group received nebulized albuterol with the same dose. Then peak expiratory flow rates (PEFR) and forced expiratory volume in 1 s (FEV1), and hemodynamic parameters in both groups were assessed for every 20 min. RESULTS In total 70 patients enrolled in this study. We found that the mean PEFR at 40 min was higher in the LMWH group than the control group (202.51 L/min and 180.2 L/min) (p = 0.001). Moreover, this difference remains significant in the 60th minute (p < 0.001). Further, FEV1 was significantly higher in the LMWH group after 60 min (1.82 L/min vs 1.48 L/min, p < 0.001). Moreover, we found that the hemodynamic parameters were sustainable in the intervention group. CONCLUSION The study suggests that LMWH in mild-moderate asthma attacks may be beneficial in the short term and could be prescribed in addition to standard albuterol therapy.
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Affiliation(s)
- Hassan Motamed
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohamadreza Maleki Verki
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Ali Vefagh Nematollahi
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Hesam
- Epidemiology and Statistics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Motamed H, Verki MM, Barzegari H, Shariat S, Hesam S. Montelukast Efficacy for Improvement of Adult Acute Phase Mild-Moderate Asthma Attack: A Clinical Trial Study. CRMR 2021. [DOI: 10.2174/1573398x17666210204164717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Asthma, an inflammatory disease of the respiratory tract, is one of the
most frequent causes of referral to emergency departments. The aim of this study is to evaluate the
efficacy of montelukast as a member of LTRAs for the improvement of pulmonary function and
clinical symptoms of patients with asthma.
Methods:
The study was conducted on 80 patients with acute mild- moderate asthma, divided randomly
into two groups of 40 subjects. A double-blind clinical trial was conducted on asthmatic patients
who encounter an acute phase asthma attack. The experimental group received two montelukast
5 mg chewable tablets at arrival, accompanied by standard mild-moderate asthma treatment
consisting of oxygen and nebulization with albuterol 2.5 mg and ipratropium bromide 0.5 mg
in 3 doses for 60 minutes. The control group received standard mild-moderate asthma treatment
plus placebo chewable tablets at the beginning without any leukotriene inhibitors. Pulmonary function
tests, hemodynamic variables and Borg Dyspnea Scale were evaluated and analyzed at 0, 30,
60, 90 and 150 minutes in both case and control groups.
Results:
No significant differences were observed between the case and the control group in terms
of PEFR and FEV1 measurements during the study at different time points [P > 0.05]. There were
no significant differences in terms of hemodynamic variables [blood pressure, pulse and respiration
rate, pressure of oxygen in arterial blood] and Borg Dyspnea Scale in both groups as well.
Conclusion:
The study findings showed that the montelukast administration in mild-moderate
acute asthma attack setting had no significant impact on pulmonary function tests and clinical
symptoms of the studied patients rather than standard asthma treatment.
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Affiliation(s)
- Hassan Motamed
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Hassan Barzegari
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Siamak Shariat
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Hesam
- Department of Biostatistics and Epidemiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Motamed H, Forouzan A, Heybar H, Khorasani MJ, Hesam S. Bronchodilatory effects of B-type natriuretic peptide in acute asthma attacks: a randomized controlled clinical trial. Adv Respir Med 2020; 88:531-538. [PMID: 33393645 DOI: 10.5603/arm.a2020.0178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/26/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION B-type natriuretic peptide (BNP) regulates different physiological processes such as blood pressure, cardiac growth, and neural and skeletal development. Thus, the aim of this study w as to evaluate the effect of BNP in the treatment of acute asthma attacks. MATERIAL AND METHODS In this randomized clinical trial, patients with acute asthma attacks were enrolled. The patients were divided randomly into two groups. Patients in the interventional group received BNP via intravenous infusion. Two µg/kg of BNP was injected as a bolus in 60 seconds. Then, infusion of BNP immediately began and was given in 0.01, 0.02, and 0.03 µg/kg/min doses every 30 minutes for the first 1.5 hours. The patients in the control group received nebulized salbutamol. Afterwards, peak flow meter findings, hemodynamic parameters, and estimation of the clinical severity of asthma in both groups were checked every 30 minutes. RESULTS In total, 40 patients were included in this study. The values of PEFR in the 60th and 90th minutes in the control group were lower than those in the interventional group. In the 60th minute, the mean of PEFR was 377.3 in the BNP group but 335.95 in the control group (P = 0.049). Moreover, this difference remained significant in the 90th minute (P = 0.021). However, forced expiratory volume in one second (FEV1) did not differ between the groups at any time (p > 0.05). CONCLUSION Although a large experimental study is needed to verify our hypothesis, it seems that BNP might be a therapeutic option in asthma exacerbations, particularly in those with b2 agonist receptor polymorphism.
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Affiliation(s)
- Hassan Motamed
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Arash Forouzan
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Habib Heybar
- Cardiology Department, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Saeed Hesam
- Biostatistics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khouzestan, Iran
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Mozafari J, Maleki Verki M, Motamed H, Sabouhi A, Tirandaz F. Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial. Am J Emerg Med 2020; 38:549-553. [DOI: 10.1016/j.ajem.2019.05.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/22/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022] Open
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Mozafari J, Motamed H, Hanafi MG, Fatehifar B. The Diagnostic Value of Neuron-Specific Enolase in Children with Mild Blunt Trauma Requiring Cranial CT Scan. Open Access Emerg Med 2020; 12:1-5. [PMID: 32021497 PMCID: PMC6970105 DOI: 10.2147/oaem.s223179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background The present study was conducted to investigate the relationship between serum levels of enolase and pathological findings obtained from CT scans of the brain in children with mild blunt brain trauma and help with a more accurate diagnosis of brain injuries. Methods The present observational study was conducted on children presenting with head traumas to the emergency department (ED) of Golestan Hospital in Ahvaz, Iran in 2016. A venous blood sample was immediately taken by the ward nurse from all the eligible patients within 6 hrs of the incident after obtaining their information, performing initial examinations and their initial stabilization. Laboratory serum levels and the corresponding interpretations of CT scans of the brain were collected, recorded and then evaluated and analyzed. Results A total of 62 children with mild blunt brain trauma were included in the study. A significant difference was observed between the positive CT scan group (2.7±9.74 µg/L) and the negative group (4.23±1.33 µg/L) in terms of serum levels of enolase (P<0.0001). The area under the receiver operating characteristic (ROC) curve was 0.992 for serum levels of enolase in diagnosing brain lesions caused by mild head traumas. Moreover, with a cut-off point of 6.97 µg/L, brain lesions could be detected with a sensitivity of 93.55% and a specificity of 100%. Conclusion Serum levels of enolase were found to be higher in patients with brain injuries. This highly accurate diagnostic biomarker can be recommended for estimating the presence of brain lesions associated with mild head traumas in infants.
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Affiliation(s)
- Javad Mozafari
- Department of Emergency Medicine, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hassan Motamed
- Department of Emergency Medicine, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Ghasem Hanafi
- Department of Radiology, Ahvaz Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bita Fatehifar
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Forouzan A, Motamed H, Delirrooyfard A, Zallaghi S. Serum Cleaved Tau Protein and Clinical Outcome in Patients with Minor Head Trauma. Open Access Emerg Med 2020; 12:7-12. [PMID: 32021498 PMCID: PMC6980837 DOI: 10.2147/oaem.s217424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/03/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Minor head trauma is due to the transfer of a mechanical energy to the brain caused by a traumatic event. The present study was accomplished aiming to investigate the cleaved tau protein (CTP) as a brain injury biomarker among patients with minor head trauma. PATIENTS AND METHODS This observational study was performed on patients with minor head trauma in 2017 who referred to emergency department of Imam Khomeini Hospital and Golestan Hospital of Ahvaz, Iran. The patients over the age of 16 years old with minor head trauma, who had computed tomography (CT) scan at most 10 hrs after the incident, and consented to participate in the study, were enrolled. C-tau evaluation was performed by the enzyme-linked immunosorbent assay (ELISA) method with monoclonal antibodies detecting the C-tau marker. Investigation of the injury after 3 months of minor head trauma was conducted using a post-concussion syndrome questionnaire (RPCS). RESULTS In this study, 86 patients were evaluated. CTP was positive in 14% of the patients and the results revealed that there was a significant relationship between traumatic brain injury (TBI) and positive CTP (p < 0.0001). The CTP had a sensitivity and specificity of, respectively, 92% and 100% in detecting intracranial trauma. In addition, positive and negative predictive powers for this marker were 100% and 98%, respectively. CONCLUSION In general, contrary to previous studies, the findings of this study suggest that evaluation of the CTP levels can be a strong biomarker with high sensitivity and specificity in detecting TBI.
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Affiliation(s)
- Arash Forouzan
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hassan Motamed
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Delirrooyfard
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sara Zallaghi
- Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Mozafari J, Motamed H, Masoumi K, Hanafi MG, Fahimi MA, Derakhshani Z, Ehyaie F. Characteristics of S100B and Neuron Specific Enolase in Differentiating Acute Vertigo Cases with Central Cause; a Diagnostic Accuracy Study. Arch Acad Emerg Med 2020; 8:e3. [PMID: 32021984 PMCID: PMC6946037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Differentiating central vertigo from peripheral ones poses a challenge to specialists. The present study aimed to examine the potential screening value of S100B and neuron-specific enolase (NSE) in this regard. METHODS This prospective cross-sectional study recruited adult acute vertigo patients with suspected central causes visiting the emergency department (ED) in the first six hours since the onset of symptoms. The screening performance characteristics of S100B and NSE biomarkers in differentiating central vertigo cases were measured considering brain magnetic resonance imaging (MRI) as the reference test. RESULTS 85 cases who met the criteria were enrolled to the study (82.3% female). The MRI of 21 (24.7%) cases had abnormal findings. The two groups were the same in terms of age, sex, and vital signs. Patients with abnormal brain MRI had significantly higher levels of S100B (p < 0.001) and NSE (p < 0.001). S100B and NSE had area under the receiver operating characteristic (ROC) curve of 90.3 (95% CI: 80.7 - 99.8) and 96.9 (95% CI: 93.7 - 100.0) in differentiating the central causes of acute vertigo, respectively. At the cut-off point of above 119.68 pg/l, S100b had sensitivity of 90.00% (95% CI: 78.83 -95.86) and specificity of 92.00% (95% CI: 72.49 - 98.60). The sensitivity and specificity of NSE at the cut-off point of above 18.12 ng/ml were 100.00% (95% CI: 93.14 - 100.00) and 89.47% (95% CI: 65.46 - 98.15), respectively. CONCLUSION The serum levels of S100B and NSE were significantly higher in patients with central vertigo, and could therefore be considered as accurate tools in screening acute vertigo cases with central causes in ED.
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Affiliation(s)
- Javad Mozafari
- Department of Emergency Medicine, Golestan General Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hassan Motamed
- Department of Emergency Medicine, Golestan General Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kambiz Masoumi
- Department of Emergency Medicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Corresponding author: Kambiz Masoumi; Department of Emergency Medicine, Imam Khomeini General Hospital, Ahvaz, Iran.
| | | | - Mohammad Ali Fahimi
- Department of Emergency Medicine, Golestan General Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Derakhshani
- Department of Emergency Medicine, Golestan General Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farzaneh Ehyaie
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Maleki Verki M, Mozafari J, Tirandaz F, Motamed H, Khazaeli A. Efficacy of nebulized fentanyl and low dose ketamine for pain control of patients with long bone fractures: A randomized, double-blind, clinical trial. Afr J Emerg Med 2019; 9:119-122. [PMID: 31528528 PMCID: PMC6742599 DOI: 10.1016/j.afjem.2019.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/13/2018] [Accepted: 02/04/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction Fentanyl is a lipid soluble, highly potent opioid. The lipid solubility of fentanyl makes it an ideal opioid to be administrated by inhalation. The current study compared ketamine infusion and nebulized fentanyl in bone fracture pain relief. Methods In this double-blind, randomized clinical trial, patients aged 18 to 55 years who were admitted to the emergency department (ED) with limb fracture were recruited. A total of 127 patients were included in the study, 51.1% (65) of whom were male and 48.9% (62) of whom were female. The patients were divided equally into two groups: Group I received 100 cm3 IV infusion of normal saline and 4 μg/kg of 50 μg/ml nebulized fentanyl; Group II received 0.4 mg/kg ketamine in 10 min and 5 cm3 nebulized normal saline. Pain was assessed using a visual analog scale just before treatment and 5, 10, 15, 30, and 60 min post-treatment. Results Before intervention, the pain scores of both groups showed no significant difference. However, log linear analysis in both groups showed a significantly decrement during the follow up (60 min) (p < 0.0001). Multiple comparison analysis showed that pain scores were significantly higher in the patients of Group I. Moreover, patients in Group I required additional treatment. Conclusion Ketamine can be used as an alternative non-invasive treatment to successfully relieve pain in patients with limb fractures.
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Forouzan A, Masoumi K, Motamed H, Esfahani SRN, Delirrooyfard A. Comparison of the Analgesic Effect of Intravenous Ketamine versus Intravenous Morphine in Reducing Pain of Renal Colic Patients: Double-Blind Clinical Trial Study. Rev Recent Clin Trials 2019; 14:280-285. [PMID: 31284871 DOI: 10.2174/1574887114666190705122727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/17/2019] [Accepted: 05/30/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND The effective relief of renal colic patients with low complications is one of the important concerns of emergency physicians. The aim of this study was to investigate the use of injectable ketamine as an alternative to routine drugs in the relief of pain in patients with renal colic. METHODS This double-blind clinical trial was conducted on patients who had suffered kidney pain due to kidney stones in 2017, referred to Ahvaz Imam Khomeini Hospital. Patients were divided into 2 groups: the first group received intravenous ketamine (0.3 mg/kg) and the second group received intravenous morphine (0.1 mg/kg) in a double-blind form. Finally, the mean pain was evaluated before injection, after 10, 20, 30, and 60 minutes as the initial result while the side effects were considered as secondary results. RESULTS In this study, 135 patients with renal colic participate in this study. The mean pain at the time of referral to the hospital in the group receiving morphine and ketamine was 9.2 and 9.2, respectively, which did not show any significant difference. Based on these findings, there was no significant difference between the factors evaluated during the study of the two groups. Only in the ketamine group, there were 3 cases of nausea and 1 of vomiting. However, there was a significant increase in the need for additional doses of fentanyl in the morphine recipient group (p = 0.02). CONCLUSION The findings suggest that the use of ketamine can produce a more rapid relief effect, and decrease the use of opioids which create various complications, including nausea and vomiting in patients, especially patients with renal colic.
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Affiliation(s)
- Arash Forouzan
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kambiz Masoumi
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hassan Motamed
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Ali Delirrooyfard
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Moezzi M, Delirrooyfard A, Motamed H, Mortazavi MK. Antiemetic effects of metoclopramide with and without dexamethasone in children with minor head trauma: a single blind randomized clinical trial. Electron Physician 2018. [DOI: 10.19082/7307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Maleki Verki M, Motamed H. Rectus Muscle Hematoma as a Rare Differential Diagnosis of Acute Abdomen; a Case Report. Emerg (Tehran) 2018; 6:e28. [PMID: 30009230 PMCID: PMC6036518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Rectus sheath hematoma is a rare but well-known problem. Exercise, pregnancy, subcutaneous injection of insulin, abdominal surgery and severe coughs can be predisposing factors of hemorrhage in the mentioned muscle sheath. Here, we will discuss a case of rectus sheath hematoma in a 28 year-old female patient who presented to emergency department with complaint of abdominal pain and improved in 1 week with palliative care.
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Affiliation(s)
| | - Hassan Motamed
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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20
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Motamed H, Moezzi M, Rooyfard AD, Angali KA, Izadi Z. A Comparison of the Effects and Side Effects of Oral Betahistine with Injectable Promethazine in the Treatment of Acute Peripheral Vertigo in Emergency. J Clin Med Res 2017; 9:994-997. [PMID: 29163732 PMCID: PMC5687903 DOI: 10.14740/jocmr3093w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/11/2017] [Indexed: 12/13/2022] Open
Abstract
Background Vertigo is an illusion of rotation that is caused by the asymmetry of neurological function of the right and left vestibular nuclei. The aim of this study was to compare the efficacy and side effects of oral betahistine with injectable promethazine in treatment of acute peripheral vertigo. Methods In this double-blind clinical trial study, the patients with acute peripheral vertigo were assigned in the two groups: receiving promethazine intramuscularly at a dose of 25 mg (group A) and receiving 8 mg betahistine tablets (group B) and the severity of their vertigo was evaluated on the visual analog scale (VAS) scoring system. In addition, adverse events in both groups of patients were compared and evaluated. Results A total of 162 patients (82 subjects in group A) participated in this study. The mean age, gender distribution, intensity and symptoms of vertigo were similar in both groups before the intervention. At 2 and 3 h after the intervention, the score of VAS in patients taking betahistine was significantly higher than promethazine. In addition, the clinical symptoms after taking betahistine were significantly less. Side effects seen in patients taking the promethazine include mainly drowsiness. After taking betahistine, the most common complication was abdominal problems (nausea and vomiting). Conclusion The results of this study show that betahistine is a safe and effective drug in controlling patients with acute vertigo and its impact is more than promethazine.
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Affiliation(s)
- Hassan Motamed
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Meisam Moezzi
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Dalir Rooyfard
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kambiz Ahmadi Angali
- Department of Biostatistics and Epidemiology, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Izadi
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Mozafari J, Masoumi K, Forouzan A, Motamed H, Saki MA, Dezham M. Sublingual Buprenorphine Efficacy in Renal Colic Pain Relief: A Randomized Placebo-Controlled Clinical Trial. Pain Ther 2017; 6:227-234. [PMID: 29052805 PMCID: PMC5693813 DOI: 10.1007/s40122-017-0082-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction This study was designed to compare the analgesic efficacy of sublingual (SL) buprenorphine and intravenous (IV) ketorolac for renal colic pain relief. Methods The present study was carried out as a double-blind, double-dummy randomized clinical trial in patients diagnosed with acute renal colic attending the emergency department. The study subjects were 63 patients with confirmed renal stones. The subjects were randomly divided into two groups. One group, which included 32 patients, received SL buprenorphine tablets (2 mg) with an IV placebo, and another group, including 31 patients, received ketorolac tromethamine (30 mg) with a SL placebo. After medication, the pain of subjects was measured by a standard visual pain analogous scale (VPAS) in minutes 0, 20, 40, and 60 of study. Also, probable adverse effects were recorded. Results In 28.1% of patients in the buprenorphine group, the mean pain score decreased from 9.2 to 5.9, 2.8, and 1.5 after 20, 40, and 60 min, respectively, as determined by VPAS. Also, in 38.7% of patients in the ketorolac group, the mean pain score decreased from 9.1 to 5.5, 3.0, and 1.6 after 20, 40, and 60 min, respectively, as determined by VPAS. The two groups did not significantly differ for pain reduction at 20, 40, and 60 min (P value = 0.16, 0.34, and 0.3, respectively). No adverse effects were seen in the ketorolac group, but vomiting (18.8%), nausea (18.8%), and dizziness (21.9%) were detected in the buprenorphine group. Conclusions We found no difference between SL buprenorphine and intravenous ketorolac in renal colic pain relief but more adverse effects in the buprenorphine group. Trial Registration Iranian Registry of Clinical trials identifier, IRCT2015041421773N1.
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Affiliation(s)
- Javad Mozafari
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kambiz Masoumi
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Arash Forouzan
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hassan Motamed
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Malehi Amal Saki
- Department of Vital Statistics, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Marzieh Dezham
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Forouzan A, Barzegari H, Motamed H, Khavanin A, Shiri H. Intravenous Lidocaine versus Morphine Sulfate in Pain Management for Extremity Fractures; a Clinical Trial. Emerg (Tehran) 2017; 5:e68. [PMID: 28894783 PMCID: PMC5585838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Considering the existing contradictions regarding effectiveness of intravenous (IV) lidocaine, especially in emergency department (ED), the present study was designed to compare the analgesic effect of IV lidocaine and morphine sulfate in pain management for extremity bone fractures. METHOD In this triple blind clinical trial, 15 to 65 year-old patients with extremity fractures and in need of pain management were randomly allocated to either IV lidocaine or morphine sulfate group and were compared regarding severity of pain 5, 10, 15, 20, 25, and 30 minutes after infusion via intention to treat analysis. The absolute risk reduction, number needed to treat and relative risk of IV lidocaine after 30 minutes were 0.40 (95%CI: 0.25 - 0.64), 7 (95%CI: 3.7 - 23.1), and 20.71 (95%CI: 10.91 - 30.51), respectively. RESULTS 280 patients with the mean age of 32.50 ± 12.77 years were randomly divided into 2 equal groups of 140 (73.9% male). The 2 groups had similar baseline characteristics. 15 minutes after injection success rate was 49.28% in lidocaine and 33.57% in morphine sulfate group (p = 0.011), and after 30 minutes it reached 85.71% and 65.00%, respectively (p < 0.001). CONCLUSION Based on the results of the present study, IV lidocaine could be considered as a reasonable alternative choice for pain management in ED.
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Affiliation(s)
- Arash Forouzan
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hassan Barzegari
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hassan Motamed
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Khavanin
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamideh Shiri
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Abstract
Introduction: Using alpha blockers such as intravenous (IV) lidocaine has been deemed effective in controlling acute pain. Therefore, the current study was designed with the aim of evaluating the efficiency of IV lidocaine in comparison to IV fentanyl in pain management of patients with renal colic in emergency department (ED). Methods: In this double blind clinical trial, 18-65 year old patients that presented to ED with colicky flank pain and met the inclusion criteria of the study were allocated to either lidocaine or fentanyl group using block randomization and compared regarding pain severity 5, 10, 15, and 30 minutes after drug administration. Results: 90 patients with the mean age of 35.75±8.87 years were divided into 2 groups of 45 (90% male). The 2 groups were not significantly different regarding the studied baseline variables. Pain severity was not significantly different between the 2 groups at various times after injection. Treatment failure rate 15 minutes after injection was 44.4% (20 cases) in IV lidocaine and 17.8% (8 cases) in IV fentanyl group (p = 0.006). These rates were 26.6% (12 patients) versus 22.2% 30 minutes after injection (p = 0.624). Absolute risk increase of treatment failure in case of using lidocaine was 26.7 (95% CI: 8.3-44.9) in the 15th minute and 4.4 (95% CI: 13.3-22.2) 30 minutes after injection. Number needed to harm (NNH) in treatment with lidocaine 15 and 30 minutes after injection were 4 (95% CI: 2.2-12.0) and 23, respectively. Conclusion: Although mean pain severity was not significantly different between IV fentanyl and lidocaine at various times after injection, treatment failure rate was significantly higher in the IV lidocaine group 15 minutes after injection.
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Affiliation(s)
- Hassan Motamed
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammadreza Maleki Verki
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Corresponding Author: Mohammadreza Maleki Verki; Emergency Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Tel: 00989122782787,
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Barzegari H, Masoumi K, Motamed H, Zohrevandi B, Zeynadini Meymand S. Comparing Two Different Doses of Intravenous Midazolam in Pediatric Sedation and Analgesia. Emerg (Tehran) 2016; 4:192-195. [PMID: 27800539 PMCID: PMC5007910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Midazolam has turned into a common drug for pediatric procedural sedation and analgesia. However, there is not much data regarding its proper dose and potential side effects in the Iranian children population. Therefore, the present study was done to compare 2 doses of IV midazolam in this regard. METHODS The present clinical trial was performed to compare 0.1 and 0.3 mg/kg doses of IV midazolam in induction of sedation for head trauma infant patients in need of brain computed tomography (CT) scan. Conscious infants under 2 years old, with stable hemodynamics were included. Onset and duration of action as well as probable side effects were compared between the two groups using SPSS version 22. RESULTS 110 infants with the mean age of 14.0 ± 5.9 months (range: 4 - 24) and mean weight of 9.7 ± 2 kg (range: 5 - 15) were randomly allocated to one of the 2 study groups (54.6% female). Success rate in 0.1 and 0.3 mg/kg groups were 38.2% (21 patients) and 60% (33 patients), respectively (p = 0.018). Overall, 56 (50.9%) patients did not reach proper sedation and were sedated receiving ketamine (22 patients) or another dose of midazolam (34 patients, mean additional dose needed was 2.1 ± 1.1 mg). CONCLUSION The results of the present study demonstrated the higher success rate and longer duration of action for 0.3 mg/kg midazolam compared to 0.1 mg/kg. The groups were equal regarding onset of action, effect on vital signs and probable side effects.
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Affiliation(s)
- Hassan Barzegari
- Department of EmergencyMedicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University ofMedical Sciences, Ahvaz, Iran
| | - Kambiz Masoumi
- Department of EmergencyMedicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University ofMedical Sciences, Ahvaz, Iran.,Corresponding Author: Department of Emergency Medicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University of Medical Sciences, Azadegan Avenue, Ahvaz, Khuzestan Province 6193673166, Iran; Tel/Fax: +986112229166;
| | - Hassan Motamed
- Department of EmergencyMedicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University ofMedical Sciences, Ahvaz, Iran
| | - Behzad Zohrevandi
- Road trauma Research Center, Guilan University ofMedical Sciences, Rasht, Iran
| | - Shima Zeynadini Meymand
- Department of EmergencyMedicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University ofMedical Sciences, Ahvaz, Iran
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Motamed S, Mousavizadeh SM, Niazi F, Khajouei Kermani H, Saberi A, Motamed H. Lateral lower face and neck contouring following burn injury. Acta Med Iran 2015; 53:225-230. [PMID: 25871020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 07/01/2014] [Accepted: 12/22/2014] [Indexed: 06/04/2023] Open
Abstract
The neck is normally a concave and highly mobile structure. Facial and cervical skin is prone to burn scar contracture because of its thin nature. The goal of treatment is to reconstruct this region to achieve a good aesthetic outcome and also normal neck and chin mobilization. This study was conducted to compare the effect of one row of suture and three rows of suture in critical points of the neck to recreate cervicomandibular angle for better contouring of the neck. A cross-sectional study was performed from July 2006 until August 2010. A total of 65 patients underwent lower lateral face and neck burn scar contracture reconstruction. The mean age of participants was 25.5 years old. After designing a local flap, in 31 patients we applied one row of suture. In 34 patients, we used three rows of suture on each side of the neck incorporation with the recipient bed and the flap dermis or capsule to recreate a natural lower lateral face and neck contour (P<0.001). The standard deviation in hospitalization was 7 ± 2 days for group A and 6 ± 1 days for group B. In a two years follow-up, no blunting of cervicomandibular angle occurred and three rows of suture were superior according to present findings.
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Affiliation(s)
- Sadrollah Motamed
- Department of Plastic and Reconstructive Surgery, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Seyed Mehdi Mousavizadeh
- Department of Plastic and Reconstructive Surgery, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Feyzollah Niazi
- Department of Plastic and Reconstructive Surgery, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Houman Khajouei Kermani
- Department of Plastic and Reconstructive Surgery, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Alireza Saberi
- Department of Plastic and Reconstructive Surgery, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hassan Motamed
- Department of Emergency Medicine, Ahvaz University of Medical Sciences, Ahvaz, Iran.
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Majidi A, Dinpanah H, Ashoori S, Motamed H, Tabatabaey A. Comparison of morphine–midazolam versus morphine injection for pain relief in patients with limb fractures - a clinical trial. ULUS TRAVMA ACIL CER 2015; 21:22-6. [DOI: 10.5505/tjtes.2015.64494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hashemi R, Majidi A, Motamed H, Amini A, Najari F, Tabatabaey A. Erythrocyte Sedimentation Rate Measurement Using as a Rapid Alternative to the Westergren Method. Emerg (Tehran) 2015; 3:50-3. [PMID: 26495381 PMCID: PMC4614602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Erythrocyte sedimentation rate (ESR) remains as one of the most reliable tests in clinical practices. Yet its use is time consuming and requires a large blood sample. The aim of this study was assessing a faster and reliable method of ESR estimation. METHODS An ESR estimation method was described and performed on 108 patients using capillary tube (micro ESR) and capillary peripheral blood. Micro ESR results at different intervals were measured and compared with Westergren ESR (conventional ESR) estimation by Pearson and Spearman's coefficients. A regression equation was derived to predict conventional ESR values based on micro ESR results. The agreement of two measurements was demonstrated using the Bland-Altman plot. RESULTS Micro ESR results at 20 minutes showed the earliest close correlation with conventional ESR results at one hour (r = 0.987). The presented regression equation was able to closely predict ESR values (r(2) = 0.974) and the Bland-Altman plot showed an acceptable agreement between converted and conventional ESR measurements. CONCLUSION Using capillary tube and capillary blood sample (micro ESR) appears to be a faster, cheaper, more reliable, and precise tool for ESR measurement in the ED. The results have acceptable correlation with conventional ESR, especially at 20 minutes of measurement.
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Affiliation(s)
- Reza Hashemi
- Department of Internal Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Majidi
- Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding Author: Alireza Majidi, Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Shohadaye Tajrish medical center, Tajrish square, Tehran, Iran. Tel: +982122721155; Fax: +982122721155;
| | - Hassan Motamed
- Department of Emergency Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Afshin Amini
- Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fares Najari
- Department of Forensic Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Tabatabaey
- Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Majidi A, Tabatabaey A, Motamed H, Motamedi M, Forouzanfar MM. Development of an Easy-to-Use Tool for the Assessment of Emergency Department Physical Design. Emerg (Tehran) 2014; 2:59-65. [PMID: 26495348 PMCID: PMC4614581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Physical design of the emergency department (ED) has an important effect on its role and function. To date, no guidelines have been introduced to set the standards for the construction of EDs in Iran. In this study, we aim to devise an easy-to-use tool based on the available literature and expert opinion for the quick and effective assessment of EDs in regards to their physical design. For this purpose, based on current literature on emergency design, a comprehensive checklist was developed. Then, this checklist was analyzed by a panel consisting of heads of three major EDs and contradicting items were decided. 178 crude items were derived from available literature. The Items were categorized in to three major domains of Physical space, Equipment, and Accessibility. The final checklist approved by the panel consisted of 163 items categorized into six domains. Each item was phrased as a "Yes or No" question for ease of analysis, meaning that the criterion is either met or not.
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Affiliation(s)
- Alireza Majidi
- Department of emergency medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Tabatabaey
- Department of emergency medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding Author: Ali Tabatabaey, Department of Emergency Medicine, Shohadaye Tajrish Medical Center, Tajrish Square, Tehran, Iran, Phon/Fax: 0098-2122721155.
| | - Hassan Motamed
- Department of emergency medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Motamedi
- Department of emergency medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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