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Tip-Over Injuries Among Children: Data From An Urban Emergency Department Of Karachi, Pakistan, Rubaba Naeem, Asrar Ali, Ahmed Raheem Buksh, Ayesha Quddusi, Uzma Rahim Khan

Department of Emergency Medicine

Introduction: Most unintentional injuries among children occur in the home environment. Tip-overs, defined as incidents where heavy objects fall on children due to some type of interaction, are one of the reasons for injuries inside the home. This study aims to determine injury patterns and outcomes for child injuries resulting from tip-overs in the home environment as reported in the emergency department.
Methods: We performed a retrospective chart review of pediatric (under 18 years) tip-overs injuries occurred in years 2010 to 2015 at the Aga Khan University Hospital. Furthermore, parents of injured children participated in phone interviews to provide information …

Mindfulness In The Emergency Department (Med): An Asynchronous Learning Course To Practise Mindfulness And Resilience In The Emergency Room Of Low Resource Setting, Syed Maaz Salahuddin, Shahan Waheed

Department of Emergency Medicine

Owing to the fast-paced, stressful, and frequent crucial rapid decisions that trigger cognitive exhaustion, emergency physicians are especially vulnerable to burnout. Mindfulness practices have been defined in the literature and it focuses on the well-being and resilience. Mindfulness is characterised as the ability to use tools and expertise to mentally respond to environmental problems to fulfil psychological needs. To overcome burnout, a self-directed learning course was developed for emergency physicians that will include learning goals on mindfulness, peer group discussions and tasks, role playing and practising meditation exercises. It would concentrate on the foundations of mindfulness and resilience, learning and …

Knowledge, Attitudes, Practices And Perceived Barriers Of Emergency Health Care Providers Regarding Sepsis And Septic Shock In A Tertiary Care Centre: A Cross-Sectional Study, Madiha Ismail, Umaira Aftab, Kiran Azizi, Badar Afzal Khan

Department of Emergency Medicine

This study aimed to assess knowledge, attitudes, practices, and perceived barriers of emergency healthcare providers regarding the management of sepsis and septic shock. This cross-sectional study was conducted in the Emergency Department of Aga Khan University Hospital, Karachi, Pakistan from August to October 2017. A total of 53 healthcare providers participated in the study. Overall, 42(79%) of the participants demonstrated correct knowledge of the sepsis bundle. The most common barrier reported in the compliance of the sepsis bundle was a shortage of staff (62%), followed by delayed presentation of patients (58%) and overcrowding (42%). Furthermore, better staffing was perceived by …

Etiology Of Acute Undifferentiated Fever In Patients Presenting To The Emergency Department Of A Tertiary Care Center In Karachi, Pakistan, Noman Ali, Nadeem Ullah Khan, Shahid Shahid, Syed Mustahsan

Department of Emergency Medicine

Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital.
Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever.
Results: A …

Emergency Department Admissions During Covid-19: Implications From The 2002-2004 Sars Epidemic, Muhammad Musaab Munir, Russell S. Martins, Asad Mian

Medical College Documents

No abstract provided.

Emergency Preparedness And Response To The Covid-19 Pandemic: Our Experience From The Emergency Department Of A Tertiary Care Hospital In Pakistan, Badar Afzal Khan, Noman Ali, Asad Mian

Department of Emergency Medicine

No abstract provided.

Pediatric Congenital Heart Diseases: Patterns Of Presentation To The Emergency Department Of A Tertiary Care Hospital, Surraiya Bano, Saleem Akhtar, Uzma R. Khan

Department of Emergency Medicine

Objective: To observe presentation of Pediatric congenital cardiac defects to the Emergency Department (ED) of a tertiary care hospital in Pakistan.
Methods: This is a retrospective chart review of patients under the age of 16 years with congenital cardiac defects presenting to the Emergency Department of Aga Khan University Hospital over a period of eighteen months, from January 2012 to June 2013. Study population was divided into two groups; first group constituted children with undiagnosed congenital cardiac defects, whereas second group constituted children with diagnosed congenial cardiac defects presented to ED. In previously diagnose cases each visit was counted as …

Impact Of Delay In Admission On The Outcome Of Critically Ill Patients Presenting To The Emergency Department Of A Tertiary Care Hospital From Low Income Country, Badar Afzal Khan, Nishi Shakeel, Emad Uddin Siddiqui, Ghazala Kazi, Irum Qamar Khan, Munawer Khursheed, Asher Feroze, Kiran Ejaz, Sumaiya Tauseeq Khan, Hatem Adel

Department of Emergency Medicine

Objective: To assess the impact of admission delay on the outcome of critical patients.Methods: The retrospective chart review was done at Aga Khan University Hospital, Karachi, and comprised adult patients visiting the Emergency Department during 2010. Outcome measures assessed were total hospital length of stay, total cost of the visit and in-hospital mortality. Patients admitted within 6 hours of presentation at Emergency Department were defined as non-delayed. Data was analysed using SPSS 19.Results: Of the 49,532 patients reporting at the Emergency Department during the study period, 17,968 (36.3%) were admitted. Of them 2356(13%) were admitted to special or intensive care …

Imparting Research Ethics In Emergency Medicine-A Perspective From The Developing World, Shahan Waheed, Muhammad Akbar Baig, Asad Mian

Department of Emergency Medicine

No abstract provided.

Pattern Of Fall Injuries In Pakistan: The Pakistan National Emergency Department Surveillance (Pak-Neds) Study., Jabeen Fayyaz, Shirin Wadhwaniya, Hira Shahzad, Asher Feroze, Nukhba Zia, Mohammed Umer Mir, Uzma Rahim Khan, Sumera Iram, Sabir Ali, Junaid Abdul Razzak, Adnan A. Hyder

Department of Emergency Medicine

Background: We aimed to analyse the frequency and patterns of fall-related injuries presenting to the emergency departments (EDs) across Pakistan.
Methods: Pakistan National Emergency Departments surveillance system collected data from November 2010 to March 2011 on a 24/7 basis using a standardized tool in seven major EDs (five public and two private hospitals) in six major cities of Pakistan. For all patients presenting with fall-related injuries, we analysed data by intent with focus on unintentional falls. Simple frequencies were run for basic patient demographics, mechanism of falls, outcomes of fall injuries, mode of arrival to ED, investigations, and procedures with …

Intentional And Unintentional Poisoning In Pakistan: A Pilot Study Using The Emergency Departments Surveillance Project., Nadeem Ullah Khan, Ricardo Pérez-Núñez, Nudrat Shamim, Uzma Rahim Khan, Naureen Naseer, Asher Feroze, Junaid Abdul Razzak, Adnan A. Hyder

Department of Emergency Medicine

Background: Acute poisoning is one of the most common reasons for emergency department visits around the world. In Pakistan, the epidemiological data on poisoning is limited due to an under developed poison information surveillance system. We aim to describe the characteristics associated with intentional and unintentional poisoning in Pakistan presenting to emergency departments.
Methods: The data was extracted from the Pakistan National Emergency Department Surveillance (Pak-NEDS) which was an active surveillance conducted between November 2010 and March 2011. All patients, regardless of age, who presented with poisoning to any of Pakistan's seven major tertiary care centers' emergency departments, were included. …

The Pakistan National Emergency Department Surveillance Study (Pak-Neds): Introducing A Pilot Surveillance, Mohammed Umer Mir, Abdulgafoor Muhammad Bachani, Haseeb Khawaja, Shiraz Qayoom Afridi, Sabir Ali, Muhammad Mujeeb Khan, Seemin Jamali, Fareed Ahmed Sumalani, Adnan Ali Hyder, Junaid Ali Razzak

Department of Emergency Medicine

Background:

Evidence-based decision making is essential for appropriate prioritization and service provision by healthcare systems. Despite higher demands, data needs for this practice are not met in many cases in low- and middle-income countries because of underdeveloped sources, among other reasons. Emergency departments (EDs) provide an important channel for such information because of their strategic position within healthcare systems. This paper describes the design and pilot test of a national ED based surveillance system suitable for the Pakistani context.

Methods:

The Pakistan National Emergency Department Surveillance Study (Pak-NEDS) was pilot tested in the emergency departments of seven major tertiary healthcare …

The Pakistan National Emergency Department Surveillance Study (Pak-Neds): Introducing A Pilot Surveillance, Mohammed Umer Mir, Abdulgafoor M. Bachani, Haseeb Khawaja, Shiraz Qayoom Afridi, Sabir Ali, Muhammad Mujeeb Khan, Seemin Jamali, Fareed Ahmed Sumalani, Adnan A. Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

Background

Evidence-based decision making is essential for appropriate prioritization and service provision by healthcare systems. Despite higher demands, data needs for this practice are not met in many cases in low- and middle-income countries because of underdeveloped sources, among other reasons. Emergency departments (EDs) provide an important channel for such information because of their strategic position within healthcare systems. This paper describes the design and pilot test of a national ED based surveillance system suitable for the Pakistani context.

Methods

The Pakistan National Emergency Department Surveillance Study (Pak-NEDS) was pilot tested in the emergency departments of seven major tertiary healthcare …

Setting Up Triage Services In The Emergency Department: Experience From A Tertiary Care Institute Of Pakistan. A Journey Toward Excellence., Munawar Khursheed, Jabeen Fayyaz, Ahsan Jamil

Department of Emergency Medicine

The history of triage started from the French battle field for prioritizing patients. Emergency triage was started in early 1950's in USA in order to treat the sickest first. It has now become an integral component of all emergency departments (ED). The basic aim of triage is not only to sort out patients according to the criticality of their illness, but it also serves to streamline the patient flow. This will ultimately enable the ED physician to provide right management at the right time to the right patient in the available resources. In turn has a positive impact in reducing …

Intubation In Emergency Department Of A Tertiary Care Hospital In A Low-Income, Nadeem Ullah Khan, Uzma R. Khan, Kiran Ejaz, Humaid Ahmad, Nukhba Zia, Junaid Abdul Razzak

Department of Emergency Medicine

Objective: To study the indications, method, success rate and complications of intubation at the Emergency Department of a private, tertiary care hospital in Karachi, Pakistan.
Methods: The case series involved 278 patients above 14 years of age who underwent emergency intubation at the Emergency Department of Aga Khan University Hospital, Karachi between 1998 and 2003. Descriptive statistics were used to compare rapid sequence intubation with crash intubation. The level of significance was p<0.05.
Results: Of the total 278 intubations performed, 37 (13.3%) had to be left out for incomplete information. The study population remaining for inferential analysis comprised of 241 …

Nitric Oxide And Its Metabolites In The Critical Phase Of Illness: Rapid Biomarkers In The Making, Asad Mian, Mayank Aranke, Nathan S. Bryan

Department of Emergency Medicine

The potential of nitric oxide (NO) as a rapid assay biomarker, one that could provide a quantum leap in acute care, remains largely untapped. NO plays a crucial role as bronchodilator, vasodilator and inflammatory mediator. The main objective of this review is to demonstrate how NO is a molecule of heavy interest in various acute disease states along the emergency department and critical care spectrum: respiratory infections, central nervous system infections, asthma, acute kidney injury, sepsis, septic shock, and myocardial ischemia, to name just a few. We discuss how NO and its oxidative metabolites, nitrite and nitrate, are readily detectable …

Nitric Oxide Metabolites As Biomarkers For Influenza-Like Acute Respiratory Infections Presenting To The Emergency Room, Asad Mian, Federico R Laham, Andrea T Cruz, Harsha Garg, Charles G Macias, A. Chantal Caviness, Pedro A Piedra

Department of Emergency Medicine

Aims: Nitric oxide (NO) is increased in the respiratory tract in pulmonary infections. The aim was to determine whether nasal wash NO metabolites could serve as biomarkers of viral pathogen and disease severity in children with influenza-like illness (ILI) presenting to the emergency department (ED) during the 2009 influenza A H1N1 pandemic.
Methods: Children ≤18 years old presenting to the ED with ILI were eligible. Nasal wash specimens were tested for NO metabolites, nitrate and nitrite, by HPLC and for respiratory viruses by real-time PCR.
Results: Eighty-nine patients with ILI were prospectively enrolled during Oct-Dec, 2009. In the …

Urinary Nitrate Might Be An Early Biomarker For Pediatric Acute Kidney Injury In The Emergency Department, Asad Mian, Yue Du, Harsha K Garg, Chantal Caviness, Stuart L Goldstein, Nathan S Bryan

Department of Emergency Medicine

NO is involved in normal kidney function and perturbed in acute kidney injury (AKI). We hypothesized that urinary concentration of NO metabolites, nitrite, and nitrate would be lower in children with early AKI presenting to the emergency department (ED), when serum creatinine (SCr) was uninformative. Patients up to 19 y were recruited if they had a urinalysis and SCr obtained for routine care. Primary outcome, AKI, was defined by pediatric Risk, Injury, Failure, Loss of function, End-stage renal disease (pRIFLE) criteria. Urinary nitrite and nitrate were determined by HPLC. A total of 252 patients were enrolled, the majority (93%) of …

Diagnosis Of Enteric Fever In The Emergency Department: A Retrospective Study From Pakistan., Uzma R. Khan, J. Razzak, Ali Faisal Saleem Dr, Adnan Ahmed, Sabeena Jalal

Department of Emergency Medicine

Background:Enteric fever is one of the top differential diagnoses of fever in many parts of the world. Generally, the diagnosis is suspected and treatment is initiated based on clinical and basic laboratory parameters.
Aims: The present study identifies the clinical and laboratory parameters predicting enteric fever in Patients visiting the emergency department of a tertiary care hospital in Pakistan.
Methods:This is a retrospective chart review of all adult Patients with clinically suspected enteric fever admitted to the hospital through the emergency department during a 5-year period (2000-2005).
Results:A total of 421 emergency department Patients were admitted to …

How Early Do Antibiotics Have To Be To Impact Mortality In Severe Sepsis? A Prospective, Observational Study From An Emergency Department., Shahla Siddiqui, Nawal Salahuddin, Adeel Raza, Junaid Abdul Razzak

Department of Emergency Medicine

BACKGROUND:

The objective of this study was to assess the promptness of antibiotic administration to patients presenting with sepsis and the effects on survival and length of hospitalization.

METHODS:

Consecutive, adult patients presenting with Systemic Inflammatory Response Syndrome (SIRS) to the emergency department of the Aga Khan University hospital were enrolled in a prospective, observational study over a period of 4 months. Univariate, multivariate regression modeling and one-way ANOVA were used to examine the effects of various variables on survival and for significant differences between timing of antibiotic administration and survival, two-sided p values < 0.05 were considered significant.

RESULTS:

One hundred and eleven patients …

How Early Do Antibiotics Have To Be To Impact Mortality In Severe Sepsis? A Prospective, Observational Study From An Emergency Department, Shahla Siddiqui, Nawal Salahuddin, Adeel Raza, Junaid Razzak

Department of Anaesthesia

BACKGROUND: The objective of this study was to assess the promptness of antibiotic administration to patients presenting with sepsis and the effects on survival and length of hospitalization.

METHODS: Consecutive, adult patients presenting with Systemic Inflammatory Response Syndrome (SIRS) to the emergency department of the Aga Khan University hospital were enrolled in a prospective, observational study over a period of 4 months. Univariate, multivariate regression modeling and one-way ANOVA were used to examine the effects of various variables on survival and for significant differences between timing of antibiotic administration and survival, two-sided p values < 0.05 were considered significant.

RESULTS: One hundred and eleven patients …