Improved recall of handover information in a simulated emergency - A randomised controlled trial

Background

Handovers during medical emergencies are challenging due to time-critical, dynamic and oftentimes unorderly and distracting situations. We evaluated the effect of distraction-reduced clinical surroundings during handover on (1) the recall of handover information, (2) the recall of information from the surroundings and (3) self-reported workload in a simulated in-hospital cardiac arrest scenario.

Methods

In a parallel group design, emergency team leaders were randomly assigned to receive a structured handover of a cardio-pulmonary resuscitation (CPR) either inside the room ("inside group") right next to the ongoing CPR or in front of the room ("outside group") with no audio-visual distractions from the ongoing CPR. Based on the concept of situation awareness, the primary outcome was a handover score for the content of the handover (0-19 points) derived from the pieces of information given during handover. Furthermore, we assessed team leaders' perception of their surroundings during the scenario (0-5 points) and they rated their subjective workload using the NASA Task Load Index.

Results

The outside group (n = 30) showed significant better recall of handover information than the inside group (n = 30; mean difference = 1.86, 95% CI = 0.67 to 3.06, p = 0.003). The perception of the surroundings (n = 60; mean difference = -0.27, 95% CI = -0.85 to 0.32, p = 0.365) and the NASA Task Load Index (n = 58; mean difference = 1.1; p = 0.112) did not differ between the groups.

Conclusions

Concerning in-hospital emergencies, a structured handover in a distraction reduced environment can improve information uptake of the team leader.

Epidemiology and management of transient ischemic attack in Trieste district, how day hospital assessment improves outcomes: a five-year retrospective study

BACKGROUND

Transient ischemic attack (TIA) is defined as a transient episode of neurologic dysfunction, without acute infarction or tissue injury lasting less than 24 h. Previous data suggest TIA precedes 15% of ischemic strokes, with a higher risk in the first week. Current practice guidelines advise evaluation through rapid neurological visit or admission to hospital. We provide data on TIA incidence in Trieste, and we compare three different types of assessment: day hospital (DH), stroke unit (SU), and emergency department/outpatients (ED).

METHODS

This is a 5-year retrospective study of transient cerebrovascular events admitted in the University Hospital of Trieste (230.623 inhabitants), between 2016 and 2020. We calculated TIA prevalence in Trieste district's general population. Our primary endpoint is ischemic recurrences within 90 days, and we evaluate the possible association between different types of management.

RESULTS

TIA incidence rate was 0.54/1000 inhabitants. In the multivariate analysis remained significantly associated with primary endpoint: ABCD2 (OR 1.625, CI 95% 1.114-2.369, p = 0.012) and DH evaluation (OR 0.260, CI 95% 0.082-0.819, p = 0.021).

CONCLUSIONS

Incidence of TIA in Trieste district is in line with previous data. We demonstrate the crucial role of DH evaluation over the outpatient/ED in reducing overall mortality and recurrence rate. Prompt recognition of patients at high risk for cerebrovascular events and specialist follow-up may reduce the incidence of major vascular events and death.

Simulation training for medical emergencies of dental patients: A review of the dental literature

In recent years, due to the aging of the population, the number of dental patients with comorbidities such as hypertension and diabetes has increased. Although it has been reported that these patients are increasingly developing medical emergencies during their dental treatments, many dental providers still do not possess the skills to manage medical emergencies appropriately. Simulation training is essential to improve this situation however, there is no report describing how to conduct an effective simulation in detail for dental office medical emergencies. The purpose of this review is to provide information on simulations that is effective and practical. The authors will highlight the key characteristics for providing effective simulation trainings, such as the selection of simulators, simulation locations, instructors, debriefings, methods for evaluating educational effectiveness, and the use of telesimulation as a method for simulation training due to the global COVID-19 pandemic. In addition, this review provides recommendations on tailoring an ideal simulation training course for those who wish to create one. The authors hope that this review will promote the spread of effective simulation training and in turn, contribute to improving the medical safety of dental patients.

PREVALENCE OF RENAL DYSFUNCTION IN ACUTE STROKE PATIENTS AT ABAKALIKI NIGERIA: AN OBSERVATIONAL STUDY

Introduction

Renal dysfunction is commonly seen in hospitalized stroke patients. It serves both as a risk factor for stroke and as a complication of stroke. Renal dysfunction is a poor prognostic factor for stroke and increases the risk of recurrence. Despite the above poor indices, there is a paucity of data on the prevalence of renal dysfunction in acute stroke patients in Nigeria.

Objective

It is against this background that this study was conducted to identify the prevalence and pattern of renal dysfunction among acute stroke patients who were managed at a Federal Teaching Hospital in Abakaliki Nigeria. Methodology: This is a cross-sectional observational hospital-based study undertaken at the Emergency unit of the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria from October 2021 to April 2022 (7-month period).

Result

Amongst the 210 acute stroke patients enrolled in the study, 51 (24%) had renal dysfunction with no age and sex predilection. Haemorrhagic stroke, alteration in consciousness, and anaemia were significantly associated with renal dysfunction.

Conclusion

The prevalence of renal dysfunction following acute stroke is high and there is a need for assessment of renal functions in every acute stroke patient and institute prompt multi-disciplinary treatment.

Knowledge of handling medical emergencies among general dental practitioners pan India: a cross-sectional survery

BACKGROUND

Medical emergency situations in dental clinics have been contemplated to be an issue in most of the countries by reason of dentist's lack of knowledge and preparedness to attend emergency situations in dental offices. The aim of this paper is to observe the knowledge, attitude, and perceived confidence of the general dental practitioners regarding emergency medical care and its practical application. Questionnaire on knowledge assessment was circulated among 500 dentists using printed questionnaire formats and various social media platforms. The questionnaire included details on treating hypertensive patients, cardiopulmonary resuscitation training, accessibility of medical emergency equipments in the dental clinics, prevalence of medical emergency cases in the dental office and the self-assessed competence to handle medical emergency situations in the dental clinics. Data was surveyed and scrutinized using the Statistical Package for Social Sciences (SPSS), version 17 (SPSS Inc., Chicago IL). Descriptive statistics was tabulated and Chi square tests was applied.

FINDINGS

500 general dental practitioners pan India were involved in the study (294 were females and 207 were males). They were grouped into different age groups (20-30 yrs, 30-40 yrs, 40-50 yrs, 50 and above) and experience (0-5 yrs, 5-10 yrs and more than 10 years). 279 participants did not attend any medical emergency training whereas, 222 participants from all groups attended training program. It was observed that with increased experience in the field, the knowledge, awareness and confidence to treat medical emergency situation in the dental clinics was better. Dentists should update themselves from time-to-time with the latest technologies in the field and need to attend training programs to handle any medical emergency situations in the dental offices. Medical emergencies in a dental clinic can be encountered at any point of time and the clinician should have apt knowledge in handling such situations. Majority of the dentists feel subdued in managing medical situations in dental offices. Training and workshops for handling medical situations in the dental offices should be mandated at the undergraduate and postgraduate levels. This will help the dentist to shape one's confidence in managing such situations without apprehension. Availability of proper infrastructure and equipments is recommended in every dental clinics so as to ease the handling of the situation.

CONCLUSION

This paper enlightens the need of basic life support training on regular basis among the dentists to improve the competence among them and to improve the confidence in handling such situations.

Comparing the stress response using heart rate variability during real and simulated crises: a pilot study

Medical personnel often experience stress when responding to a medical emergency. A known stress-response is a measurable reduction in heart rate variability. It is currently unknown if crisis simulation can elicit the same stress response as real clinical emergencies. We aim to compare heart rate variability changes amongst medical trainees during simulated and real medical emergencies. We performed a single center prospective observational study, enrolling 19 resident physicians. Heart rate variability was measured in real time, using a 2-lead heart rate monitor (Bodyguard 2, Firstbeat Technologies Ltd) worn during 24 h critical care call shifts. Data was collected at baseline, during crisis simulation and when responding to medical emergencies. 57 observations were made to compare participant's heart rate variability. Each heart rate variability metric changed as expected in response to stress. Statistically significant differences were observed between baseline and simulated medical emergencies in Standard Deviation of the N-N interval (SDNN), Root mean square standard deviation of the N-N interval (RMSSD), Percentage of successive R-R intervals that differ by more than 50 ms (PNN50), Low Frequency (LF) and Low Frequency: High Frequency ratios (LF:HF). No statistically significant differences between simulated and real medical emergencies were identified in any heart rate variability metrics. We have shown using objective results, that simulation can elicit the same psychophysiological response as actual medical emergencies. Therefore, simulation may represent a reasonable way to practice not only essential skills in a safe environment but has the additional benefit of creating a realistic, physiological response in medical trainees.

Oral Health Considerations and Dental Management for Epileptic Children in Pediatric Dental Care

Epilepsy is a chronic neurological disorder characterized by recurrent seizures. Epilepsy generally begins in childhood, potentially impeding education, employment, social relationships, and the development of a sense of self-worth. The number of decayed and missing teeth, the degree of abrasion, and periodontal indices are significantly worse in patients with epilepsy. Epileptic patients require special care during dental treatment. A seizure episode in a dental clinic is a medical emergency, and it is imperative as an oral health care provider to have adequate knowledge about this condition in order to render safer dental care to epileptic patients. There is a paucity of information in the medical literature on the dental management of epileptic patients. The purpose of this case series is to elaborate on the oral health considerations in epileptic patients and educate oral healthcare providers on the diagnosis, treatment, and emergency management of epilepsy, along with special dental treatment needs in epileptic patients. The case series is a compilation of two cases of petit mal epilepsy and one case of generalized tonic-clonic seizure with detailed descriptions of preventive seizure measures and dental management undertaken during the treatment of patients.

How to cite this article

Goswami M, Johar S, Khokhar A. Oral Health Considerations and Dental Management for Epileptic Children in Pediatric Dental Care. Int J Clin Pediatr Dent 2023;16(1):170-176.

Prevalence of Hyponatremia in Acute Stroke Patients in a Federal Teaching Hospital, Abakaliki, Nigeria

BACKGROUND

Hyponatremia is a common electrolyte imbalance which is readily observed in patients with neurological disorders such as stroke. It is associated with increased morbidity and mortality during and after hospitalization. There has not been any study to demonstrate the frequency of admission hyponatremia in acute stroke patients in Nigeria. It is against this backdrop that we embarked on this study to determine the frequency and pattern of admission hyponatremia in acute stroke patients in a Federal Teaching Hospital, Abakaliki, Nigeria.

METHODS

This was a cross-sectional observational hospitalbased study undertaken at the Emergency unit of the Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria from November 2021 to April 2022.

RESULTS

Amongst the 177 acute stroke patients enrolled in the study, 58 (32.8%) had hyponatremia. Advanced age, alteration in consciousness, and haemorrhagic (intracerebral and subarachnoid haemorrhage) stroke were significantly associated with presence of hyponatremia.

CONCLUSION

Admission hyponatremia is prevalent amongst acute stroke patients in Abakaliki, Nigeria and commonly associated with advanced age, alteration in consciousness and haemorrhagic stroke.

Perceptions and experiences of medical student first responders: a mixed methods study

CONTEXT

Medical Student First Responders (MSFRs) are volunteers who respond to emergency calls, managing patients before ambulance staff attend. The MSFR role provides opportunities to manage acutely unwell patients in the prehospital environment, not usually offered as part of formal undergraduate medical education. There are few previous studies describing activities or experiences of MSFRs or exploring the potential educational benefits. We aimed to investigate the activity of MSFRs and explore their experiences, particularly from an educational perspective.

METHODS

We used a mixed methods design, combining quantitative analysis of ambulance dispatch data with qualitative semi-structured interviews of MSFRs. Dispatch data were from South Central and East Midlands Ambulance Service NHS Trusts from 1st January to 31st December 2019. Using propensity score matching, we compared incidents attended by MSFRs with those attended by other Community First Responders (CFRs) and ambulance staff. We interviewed MSFRs from five English (UK) medical schools in those regions about their experiences and perceptions and undertook thematic analysis supported by NVivo 12.

RESULTS

We included 1,939 patients (median age 58.0 years, 51% female) attended by MSFRs. Incidents attended were more urgent category calls (category 1 n = 299, 14.9% and category 2 n = 1,504, 77.6%), most commonly for chest pain (n = 275, 14.2%) and shortness of breath (n = 273, 14.1%). MSFRs were less likely to attend patients of white ethnicity compared to CFRs and ambulance staff, and more likely to attend incidents in areas of higher socioeconomic deprivation (IMD - index of multiple deprivation) (p < 0.05). Interviewees (n = 16) consistently described positive experiences which improved their clinical and communication skills.

CONCLUSION

MSFRs' attendance at serious medical emergencies provide a range of reported educational experiences and benefits. Further studies are needed to explore whether MSFR work confers demonstrable improvements in educational or clinical performance.

Regional Anesthesia Facilitating Surgical and Medical Management of a Patient with Necrotizing Fasciitis and Diabetic Ketoacidosis

Emergent surgery in the setting of a concomitant medical (nonsurgical) emergency challenges the anesthesiology team with multiple and often conflicting concerns. During these rare situations, general anesthesia is often employed. This case report demonstrates a safe and effective regional anesthetic technique utilized as the primary anesthetic during emergent surgery in the setting of a medical emergency. In this particular case, the medical emergency was profound diabetic ketoacidosis and the surgical emergency was life-threatening necrotizing fasciitis of the left upper extremity. An ever-increasing body of literature supports that anesthetic technique has an impact on morbidity and mortality outcomes in specific patient populations. The aim of this case report is to describe the successful use of regional anesthesia to facilitate emergent surgery in a patient who also has a concurrent emergent medical condition. In addition, we review the literature describing the utility of regional anesthesia in such patients.

Current status of variations in in-hospital cardiac arrest call numbers in Japan: a nationwide survey

The use of standardized internal hospital phone numbers for cardiac arrest is advocated in Europe. We evaluated the current status of variations in medical emergency call numbers for in-hospital patients in Japan and whether anesthesiologists would approve a standardized number. From June 2018 to August 2018, a questionnaire survey was mailed to anesthesiologists in 1373 Japanese Society of Anesthesiologists (JSA)-accredited hospitals. The basis for opinions on using a standardized cardiac arrest call number in all Japanese hospitals was evaluated. Of 1373 facilities (response rate, 58%, n = 800), 741/776 (96%) reported a response system for in-hospital cardiac arrest; 638/710 (90%) responded to cardiac arrest through loudspeaker broadcast, audible to both patients and staff; 346/777 (48%) used a number between one and five digits long, four-digit numbers being the most common. Across Japan, 370 different numbers were reported. Only 385/688 (56%) of respondents had the emergency number memorized. Finally, 423/776 (55%) respondents approved standardizing a hospital telephone number for summoning help. Multivariate analysis showed that facilities where the anesthesiologists already memorized the call number were the only reason identified for opposition to the standardization. Although 96% of JSA-accredited hospitals had a response system for in-hospital cardiac arrests, discussions for standardization of a unified number need to be encouraged for improved emergency response.

Feasibility of bystander-administered naloxone delivered by drone to opioid overdose victims

BACKGROUND

Currently, ≤5% of bystanders witnessing an opioid overdose (OD) in the US administer antidote to the victim. A possible model to mitigate this crisis would be a system that enables 9-1-1 dispatchers to both rapidly deliver naloxone by drone to bystanders at a suspected opioid OD and direct them to administer it while awaiting EMS arrival.

METHODS

A simulated 9-1-1 dispatcher directed thirty subjects via 2-way radio to retrieve naloxone nasal spray from atop a drone located outside the simulation building and then administer it using scripted instructions. The primary outcome measure was time from first contact with the dispatcher to administration of the medication.

RESULTS

All subjects administered the medication successfully. The mean time interval from 9 -1-1 contact until antidote administration was 122 [95%CI 109-134] sec. There was a significant reduction in time interval if subjects had prior medical training (p = 0.045) or had prior experience with use of a nasal spray device (p = 0.030). Five subjects had difficulty using the nasal spray and four subjects had minor physical impairments, but these barriers did not result in a significant difference in time to administration (p = 0.467, p = 0.30). A significant number of subjects (29/30 [97%], p = 0.044) indicated that they felt confident they could administer intranasal naloxone to an opioid OD victim after participating in the simulation.

CONCLUSIONS

Our results suggest that bystanders can carry out 9-1-1 dispatcher instructions to fetch drone-delivered naloxone and potentially decrease the time interval to intranasal administration which supports further development and testing of a such a system.

The heuristic version of Cognitive Work Analysis: A first application to medical emergency situations

Cognitive Work Analysis is an original method that seeks to describe work systems made up of nested sets of constraints, from ecological constraints imposed by the work domain to cognitive constraints. This top-down approach starts with a work domain model in order to analyze and specify contexts of activity. To complement this method, we propose a bottom-up version of Cognitive Work Analysis focusing on contexts of activity and depicting how operators adapt to the ecological constraints. Based on Rasmussen's Dynamic Safety Model, the ecological constraints involved are those bounding the workspace in which operators dynamically navigate with control loops, strategies, work organization, and competencies. This analysis relies on the simulation of specific contexts of activity. A first illustrative application of this framework to a simulated medical emergency situation with a team of nurses and nursing aids shows that this framework can help identify design issues.

[Patients with chronic diseases in emergency rooms in Germany : Cross-sectional analysis of consultations, reasons for use, and discharge diagnosis]

BACKGROUND

The number of patients in emergency rooms without a medical emergency is increasing. Outpatient services for mutual support and relief between the in-patient and out-patient sector are not yet fully established.

AIM OF THE WORK

The aim was to determine the extent to which patients in emergency rooms have real medical emergencies by comparing patients with at least two and those with a maximum of one chronic illness. An additional aim was to identify factors influencing the previous use of outpatient structures.

MATERIAL AND METHODS

The study participants included emergency room patients from the cross-sectional study "PiNo-Nord." All persons in five emergency rooms in northern Germany between October 2015 and July 2016 who were not treated as "immediate" or "very urgent" were interviewed. An exploratory data analysis and multivariate logistic regression were performed.

RESULTS

The 293 patients with ≥2 chronic diseases were just as often a medical emergency compared to the 847 patients with a maximum of 1 chronic disease. The most frequent occasions for consultation were musculoskeletal trauma (33%, n = 293 vs. 42%, n = 847) or trauma of the skin (11%, n = 293 vs. 13%, n = 847). In both groups, the general practitioner or specialist caregiver, as well as diagnostic or treatment options, rarely played a role in visiting the emergency department. The strongest predictors of previous outpatient treatment were the duration of the appeal in the last six months, a high subjective treatment urgency, the presence of at least two chronic conditions, and a consultation event concerning the musculoskeletal injuries.

CONCLUSIONS

In both patient groups, no evidence of unnecessary visits to the emergency room was found. For the most part, outpatient structures are used in advance and the emergency department is only visited in the event of an actual medical emergency.

[Dermatological emergencies: A descriptive study in a tertiary hospital]

INTRODUCTION

Nowadays, there is an increasing number of patients who seek emergency treatment for their dermatology complaints. However, it is unknown to what extent a skin disease is urgent enough to require immediate specialised care. Our aims were to assess the type and prevalence of the dermatological diseases treated in the division of Dermatology of a tertiary hospital, as well as to determine the main features of the patients with these disorders and the means of access to the Dermatology Department.

MATERIAL AND METHOD

A descriptive and prospective study was conducted on patients with dermatological conditions diagnosed in the Dermatology outpatient clinic of a hospital during a 5 month period. For this purpose, the information corresponding to health cover, basic epidemiological characteristics, origin, diagnosis, and destiny of each patient was entered into a database.

RESULTS

The dermatologist attended 242 patients, of whom 49% were women and 51% men. The mean age was 49.2 years. The 78 different diagnoses made were grouped into 12 categories to facilitate analysis. According to this classification, most patients had eccemas (17.8%), followed by miscellaneous (17.4%), tumours and cysts (16.2%), and infectious dermatoses (15%). In 7 (2.9%) cases, the patient was admitted to hospital.

CONCLUSIONS

Dermatological diseases attended to in the Dermatology Department were varied. The most common diagnoses were psoriasis, eccemas, and toxicoderma. The profile of the patient seeking emergency dermatological care is a person between the fourth and fifth decade of the life, who arrives directly to the Emergency Department without requesting previous assessment by a Primary Care physician. The most common reason for admission was erythrodermic psoriasis.

Relationship between diurnal patterns in Rapid Response Call activation and patient outcome

BACKGROUND

The Rapid Response Call (RRC) is a system designed to escalate care to a specialised team in response to the detection of patient deterioration. To date, there have been few studies which have explored the relationship between time of day of RRC and patient outcome.

OBJECTIVE

To examine the relationship between the time of RRC activations and patient outcome.

METHOD

All adult inpatients with a RRC in non-critical care wards of a metropolitan Australian hospital in 2012 were retrospectively reviewed. RRCs occurring between 18:00-07:59 were defined as 'out of hours'.

RESULTS

There were 892 RRC during the study period. RRCs out of hours were associated with a higher rate of ICU admissions immediately after the RRC (19.4% vs. 12.3%, p<0.001). Patients experiencing an out-of-hours RRC were more likely to have an in-hospital cardiopulmonary arrest (OR=1.7, p<0.04). In-hospital mortality rate was significantly higher for patients with out-of-hours RRCs (35.5% vs. 25.0%, p=0.014). After adjusting for confounders out-of-hours RRC were independently associated with increased need for ICU admissions and in-hospital mortality.

CONCLUSION

The diurnal timing of RRCs appears to have significant implications for patient mortality and morbidity, patient outcomes are worse if RRC occurs out of hours. This finding has implications for staffing and resource allocation.

Correlation of Gerkin, Queen's College, George, and Jackson methods in estimating maximal oxygen consumption

Background and aim

Test of maximal oxygen consumption is the gold standard for measuring cardio-pulmonary fitness. This study aimed to determine correlation of Gerkin, Queen’s College, George, and Jackson methods in estimating maximal oxygen consumption, and demographic factors affecting maximal oxygen consumption.

Methods

This descriptive cross-sectional study was conducted in a census of medical emergency students (n=57) in Qazvin University of Medical Sciences in 2016. The subjects firstly completed the General Health Questionnaire (PAR-Q) and demographic characteristics. Then eligible subjects were assessed using exercise tests of Gerkin treadmill, Queen’s College steps and non-exercise George, and Jackson. Data analysis was carried out using independent t-test, one way analysis of variance and Pearson correlation in the SPSS software.

Results

The mean age of participants was 21.69±4.99 years. The mean of maximal oxygen consumption using Gerkin, Queen’s College, George, and Jackson tests was 4.17, 3.36, 3.64, 3.63 liters per minute, respectively. Pearson statistical test showed a significant correlation among fours tests. George and Jackson tests had the greatest correlation (r=0.85, p>0.001). Results of tests of one-way analysis of variance and t-test showed a significant relationship between independent variable of weight and height in four tests, and dependent variable of maximal oxygen consumption. Also, there was a significant relationship between variable of body mass index in two tests of Gerkin and Queen’s College and variable of exercise hours per week with the George and Jackson tests (p>0.001).

Conclusion

Given the obtained correlation, these tests have the potential to replace each other as necessary, so that the non-exercise Jackson test can be used instead of the Gerkin test.

Managing medical emergencies in mental health settings using an interprofessional in-situ simulation training programme: A mixed methods evaluation study

BACKGROUND

In the UK, people with severe mental illness die up to 20years earlier than the general population, prompting increased focus on physical health in mental illness. However, training for mental health inpatient staff to meet patients' physical health needs has not received the same attention, with physical health training often being reactive and lacking evidence of effectiveness.

OBJECTIVES

To evaluate an interprofessional, in situ, simulation training intervention for managing medical deterioration in mental health settings. Investigating the impact of training on: 1. Participants' knowledge, confidence, and attitudes towards managing medical deterioration; and 2. Incident reporting, as an objective index of incident management. Participants' perceptions of the impact on their practice were qualitatively explored.

DESIGN

This evaluation employed a mixed-methods pre-post intervention design.

PARTICIPANTS & SETTINGS

Fifty-three healthcare professionals participated including: mental health nurses, psychiatrists, healthcare assistants, and activity co-ordinators from two busy psychiatric triage wards in South London, UK.

METHODS

The intervention comprised eight half-day sessions delivered weekly across two wards. Structured surveys assessed participants' knowledge, confidence, and attitudes towards medical deterioration pre and post training. Participants' experience of training was qualitatively captured through post-course surveys and focus groups three months post training. Incident reporting rates for seven-month periods pre and post training were compared.

RESULTS

Following training, participants showed significant improvement in knowledge (p<0.001), confidence (p<0.001), and attitudes towards (p<0.02) managing medical deterioration. Incident reporting increased by 33% following training. Participants' reported improved confidence in managing medical deterioration, better understanding of effective communication, improved self-reflection and team working, and an increased sense of responsibility for patients' physical health.

CONCLUSIONS

Interprofessional, in situ simulation training for medical deterioration yielded promising outcomes for individuals and teams. Simulation is an under-used training modality in mental health, offering a holistic training approach with the potential to provide educational and clinical benefits while supporting workforce resilience.

Step Test: a method for evaluating maximum oxygen consumption to determine the ability kind of work among students of medical emergencies

Introduction

Maximum oxygen consumption shows the maximum oxygen rate of muscle oxygenation that is acceptable in many cases, to measure the fitness between person and the desired job. Given that medical emergencies are important, and difficult jobs in emergency situations require people with high physical ability and readiness for the job, the aim of this study was to evaluate the maximum oxygen consumption, to determine the ability of work type among students of medical emergencies in Qazvin in 2016.

Methods

This study was a descriptive – analytical, and in cross-sectional type conducted among 36 volunteer students of medical emergencies in Qazvin in 2016. After necessary coordination for the implementation of the study, participants completed health questionnaires and demographic characteristics and then the participants were evaluated with step tests of American College of Sport Medicine (ACSM). Data analysis was done by SPSS version 18 and U-Mann-Whitney tests, Kruskal-Wallis and Pearson correlation coefficient.

Results

Average of maximum oxygen consumption of the participants was estimated 3.15±0.50 liters per minute. 91.7% of medical emergencies students were selected as appropriate in terms of maximum oxygen consumption and thus had the ability to do heavy and too heavy work. Average of maximum oxygen consumption evaluated by the U-Mann-Whitney test and Kruskal-Wallis, had significant relationship with age (p<0.05) and weight groups (p<0.001). There was a significant positive correlation between maximum oxygen consumption with weight and body mass index (p<0.001).

Conclusion

The results of this study showed that demographic variables of weight and body mass index are the factors influencing the determination of maximum oxygen consumption, as most of the students had the ability to do heavy, and too heavy work. Therefore, people with ability to do average work are not suitable for medical emergency tasks.

[Hypertensive crisis and sudden change of vision in young patients]

The sudden change in vision is a medical emergency that must be evaluated immediately to rule out important institutions as systemic vasculitis or ischemic stroke. Its association with hypertensive crisis makes it necessary to rule out accelerated-malignant hypertension, which is accompanied by other retinal disorders (exudates and hemorrhages) and adrenal involvement. Nonarteritic anterior ischemic optic neuropathy (AION) is another entity to consider, as is it not uncommon in the young (12.7% in a series of 848 cases). Its association with hypertension has been described in 32% of cases.

Types, Risk Factors, Clinical symptoms and Diagnostic Tests of Acute Adult Meningitis in Northern Iran During 2006-2012

BACKGROUND

Acute bacterial meningitis is a medical emergency condition that requires prompt diagnosis and treatment and otherwise associated with serious morbidity and mortality.

AIM

The aim of this study was to assess types, risk factors, clinical symptoms and diagnostic tests of meningitis in hospitalized patients of Mazandaran University of medical sciences hospitals during 2006-2012.

MATHERIALS AND METHODS

This is a retrospective descriptive study. Following approval of the ethics committee of Mazandaran University of Medical Sciences, records of adult patients diagnosed with acute meningitis from 2006 to 2012 were extracted from Mazandaran Provincial Health Center and patients attending hospitals affiliated to Mazandaran University of Medical Sciences.

STATISTICAL ANALYSIS

Data were analyzed with SPSS-16 using descriptive statistics (frequency, mean, standard deviation, and median).

RESULTS

In this study, of the 137 patients with meningitis, 73 (53.9%) were viral, 61 (46%) bacterial, 1 (0.7%) fungal, and 2 (1.4%) unknown. The majority of risk factors in patients were head trauma, upper respiratory infection, and drug addiction. The most common clinical signs were headache, fever, nausea and vomiting, and stiff neck.

CONCLUSION

In this study, the incidence of meningitis was much lower than any other country. It could be due to geographic variation or incomplete recording of patient's data. It is recommended to perform a longitudinal study during the coming years on patients with meningitis.

Anaphylaxis: an update

Anaphylaxis is a medical emergency. Virtually, any individual may develop hypersensitivity to any of the various formulations/substances used in dental practice and this necessitates all dental professionals to keep themselves updated with the latest guide-line on management of life threatening anaphylaxis. Guidelines by the World Allergy Organization for the assessment and management of anaphylaxis in 2011 are discussed.

Acute dystonic reaction as medical emergency: a report of two cases

Drug-induced dystonic reactions are common presentations to the emergency department. Two cases of acute dystonic reactions presenting as acute medical emergency illustrate the associated fatality and possibility of misdiagnosis. This case series reports two cases of medication-induced (haloperidol and metoclopramide) acute dystonic reactions presenting with torticollis, tongue protrusion, and respiratory distress which resolved with the administration of intramuscular biperiden and oxygen by facemask. In developing countries like Nigeria where atypical anti-psychotic medications with fewer and lesser troublesome side effects are not affordable to many, the training of physicians and other doctors should adequately include a high degree of clinical suspicion and knowledge of management of acute dystonic reactions.