Emergency Medicine Commons^™

Methanol Poisoning: 27 Years Experience At A Tertiary Care Hospital, Fareed Ahmed, Nadeem Ullah Khan, Noman Ali, Asher Feroze

Department of Emergency Medicine

Methanol toxicity can result in serious morbidity and mortality without timely diagnosis and treatment. Many cases of methanol poisoning outbreaks have been noted in our population but no study has been performed to estimate methanol exposure and its outcomes and complications. A retrospective study was conducted to review all the cases of methanol poisoning admitted from January 1988 to December 2015 at the Aga Khan University Hospital. A total of 35 methanol poisoning cases were reported. All the patients were male, and the mean age was 36.2±8.6 years. The mean Glasgow Coma Scale score on presentation in the emergency was …

A Resident's Note, Syed Muhammad Mustahsan

Department of Emergency Medicine

No abstract provided.

Abruptio Placentae With Type Ii Respiratory Failure Secondary To Acute Interstitial Pneumonia Responsive To Steroids., Muhammad Umer Salim, Syed Muhammad Mustahsan, Anum Fatima

Department of Emergency Medicine

Acute Interstitial Pneumonia (AIP) is categorized as Idiopathic Interstitial Pneumonia (IIP), in which the cause is unknown. Ayoung female of 22 years presented in 34 weeks gestation with abruptio placentae (AP) and underwent Lower Segment Caesarian Section (LSCS) for AP. It progressed to type II respiratory failure secondary to AIPon 4th day post-surgery. It remained unresponsive when treated with noninvasive ventilation (NIV-BiPAP) along with antibiotics. Later, a trial treatment of pulse therapy of Methylprednisolone was executed on 7th day post-surgery which resulted in dramatic improvement in symptoms. It is uncommon to have type II respiratory failure secondary to AIP, and …

Post-Traumatic Stress Disorder And Its Predictors In Emergency Medical Service Personnel: A Cross-Sectional Study From Karachi, Pakistan, Salima Kerai, Uzma R. Khan, Muhammad Islam, Nargis Asad, Junaid Razzak, Omrana Pasha

Department of Paediatrics and Child Health

Background: Emergency medical service (EMS) personnel who work to provide emergency medical care at the scene and during transportation are exposed to various kinds of stressors and are particularly susceptible to developing stress-reactions. This study assesses symptoms of post-traumatic stress disorder and its predictors among the personnel of a selected EMS in Karachi, Pakistan.
Methods: Data were gathered from 518 personnel working in an EMS setting from February to May 2014. Participants were screened for post-traumatic stress symptoms using the Impact of Event Scale-Revised (IES-R). Demographic and work-related characteristics, coping styles and the social support systems of the participants were …

A Retrospective Review Of Paediatric Head Injuries In Asia - A Pan Asian Trauma Outcomes Study (Patos) Collaboration, Shu-Ling Chong, Uzma R. Khan, Indumathy Santhanam, Jun Seok Seo, Quan Wang, Sabariah Faizah Jamaluddin,, Quoc Ai Hoang Quoc, Su Yah Chew, Marcus Eng Hock Ong

Department of Emergency Medicine

Objective: We aim to examine the mechanisms of head-injured children presenting to participating centres in the Pan Asian Trauma Outcomes Study (PATOS) and to evaluate the association between mechanism of injury and severe outcomes.
Design and Setting: We performed a retrospective review of medical records among emergency departments (EDs) of eight PATOS centres, from September 2014 - August 2015.
Participants: We included children <16 years old who presented within 24 hours of head injury and were admitted for observation or required a computed tomography (CT) of the brain from the ED. We excluded children with known coagulopathies, neurological co-morbidities or prior neurosurgery. We reviewed the mechanism, intent, location and object involved in each injury, and the patients' physical findings on presentation.
Outcomes: Primary outcomes were death, endotracheal intubation or neurosurgical intervention. Secondary outcomes included hospital and ED length of stay.
Results: 1438 children were analysed. 953 children (66.3%) were male and the median age was 5.0 years (IQR …

Hydrogen Sulfide Gas Poisoning In Fish Garbage Room: A Report Of A Fisherman, Sadaf Sheikh, Muhammad Akbar Baig, Noman Ali, Nadeemullah Khan

Department of Emergency Medicine

We report the case of a fisherman who was exposed to high concentrations of hydrogen sulfide (H2S) gas from the fish garbage room. The patient survived and was discharged with full recovery from the hospital. H2S is a colourless, foul smelling and highly toxic gas next to carbon monoxide, which causes inhalation death. It is a by-product of various industrial processes particularly involves exposure from agriculture, petrochemical industry and organic matter decomposition from sewage processing. It is a by-product of H2S has been referred as the "knock down gas" because inhalation of high concentrations can cause immediate loss of consciousness …

Mental Illness And Injuries: Emerging Health Challenges Of Urbanisation In South Asia, Devaki Nambiar, Junaid Razzak, Kaosar Afsana, Alayne M. Adams, Arif Hasan, Dinesh Mohan, Vikram Patel

Department of Emergency Medicine

No abstract provided.

Uchunguzi (Journal Watch/ Montre De Journal) March 2017, Benjamin Wachira

Emergency Medicine, East Africa

Without the need for expensive videoconferencing equipment or computer networks, doctors in the developing world have found practical use for WhatsApp Messenger in clinical and administrative settings because the service is ubiquitous, free and easy to use. This study reviewed the literature on WhatsApp in clinical practice, to determine how it was used, and users’ satisfaction. It revealed that the service was widely used in intradepartmental communication across a range of aspects, including second opinion, changes in treatment plans, sharing of X-rays and photographs, scheduling of academic meetings, and sharing of educational materials such as papers. There was a report …

Uchunguzi (Journal Watch/ Montre De Journal) June 2017, Benjamin Wachira

Emergency Medicine, East Africa

The purpose of an effective emergency care system is to provide universal emergency care to all regardless of socioeconomic status, to stabilise patients who have a life-threatening illness or injury, and to reduce consequences of preventable mortality, morbidity and disability. Unfortunately, the limited availability of resources remains a significant barrier to the development and implementation of emergency care systems in low- and middle-income countries (LMICs). In this recent study from Cameroon, of 3201 participants from 619 households surveyed, 1113 (34.8%) had experienced one or more emergency conditions in the previous year. Despite this high incidence of emergency conditions, only 7% …

Emergency Medical Services (Ems) Training In Kenya: Findings And Recommendations From An Educational Assessment, Benjamin Nicholson, Chelsea Mccollough, Benjamin Wachira, Nee-Kofi Mould-Millman

Emergency Medicine, East Africa

Background: Over the past twenty years, Kenya has been developing many important components of a prehospital emergency medical services (EMS) system. This is due to the ever-increasing demand for emergency medical care across the country. To better inform the next phase of this development, we undertook an assessment of the current state of EMS training in Kenya.

Methods: A group of international and Kenyan experts with relevant EMS and educational expertise conducted an observational qualitative assessment of Kenyan EMS training institutions in 2016. Three assessment techniques were utilised: semi-structured interviews, document review, and structured observations. Recommendations were reached through a …

Ogilvie's Syndrome, Muhammad Waqas Khan, Sanniya Khan Ghauri, Sara Shamim

Department of Emergency Medicine

Ogilvie's syndrome, also known as 'paralytic ileus of the colon', is characterised by pseudo-obstruction of the large intestine in the absence of any mechanical obstructing component; and presents as a massively distended abdomen. If left untreated, it may lead to bowel perforation or ischemia. Ogilvie's syndrome usually presents as a postsurgical complication, mainly due to the lack and/or restriction of movement coupled with a possible electrolyte imbalance. Here, we present a case of a pre-surgical 63-year lady, having a right hip fracture, who came with complaints of severe abdominal pain and distension for 4 days. Abdominal X-rays showed massively dilated …

Uchunguzi (Journal Watch/Montre De Journal) December 2016, Benjamin Wachira

Emergency Medicine, East Africa

Uchunguzi means investigation in Swahili and provides a summary of some of the most recent international literature as presented in other leading journals, but with an emphasis on what is relevant to our continent

Trends Of Acute Poisoning: 22 Years Experience From A Tertiary Care Hospital In Karachi, Pakistan., Nadeem Ullah Khan, Uzma Rahim Khan, Asher Feroze, Sajjad Ali Khan, Najia Ali, Kiran Ejaz, Afshan Rahim Khan, Shahnila Nooruddin, Jabeen Fayyaz

Department of Emergency Medicine

Objective: To determine the trends of acute poisoning in terms of frequency, nature of poisoning agent, clinical presentation and its outcome. Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients who presented with poisoning between January 1989 and December 2010.The patients were randomly selected , and demographic, chemical information, clinical feature, treatment and outcome were analysed using SPSS 16. Results: Of the total hospital admissions during the period, 3,189(0.3%) were cases of poisoning. Of them, medical records of 705(22%) cases were reviewed; 462(65.5%) adult and 243(34.5%) paediatric cases below 16 years …

Uchunguzi (Journal Watch/Montre De Journal) September 2016, Benjamin Wachira

Emergency Medicine, East Africa

Most states in the USA have ‘Good Samaritan’ laws that oblige doctors to stop and render emergency treatment under certain circumstances, without incurring legal liability even if they are negligent. Whether doctors are legally obliged to stop and render assistance at road accidents in most countries across the world remains controversial. In 1978, the South African Medical and Dental Council ruled that ‘in cases of emergency a practitioner is obliged to render assistance in all circumstances’. It has therefore been said that ‘where persons are in a situation where their life or health will be seriously endangered unless they receive …

Type 1 Diabetes Mellitus Presenting With Diabetic Ketoacidosis (Dka) In A Neonate, Fareed Ahmed, Sayyeda Ghazala Kazi, Waqas Khan

Department of Emergency Medicine

Neonatal diabetes mellitus (NDM) is a rare manifestation with an incidence of one affected individual among 400000 live births. NDM can be divided into Transient (TNDM) and Permanent (PNDM) types. A significant overlap occurs between both groups, to an extent that TNDM cannot be distinguished from PNDM based solely on clinical features. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (TIDM). DKA at diagnosis is more common in young children near the age of five years. Neonatal DKA is a rare occurrence causing it to be missed in the differential …

Pattern Of Relapse In Paediatric Acute Lymphoblastic Leukaemia In A Tertiary Care Unit, Emaduddin Siddiqui, Sayyeda Ghazala Kazi, Muhammad Irfan Habib, Khalid Mehmood Ahmed Khan, Nukhba Zia

Department of Emergency Medicine

OBJECTIVE:

To determine the frequency, site and time to relapse from diagnosis, and to see the relationship of relapse with important prognostic factors.

METHODS:

The prospective descriptive observational study was conducted at the National Institute of Child Health, Karachi, June 2005 to May 2007, and comprised newly-diagnosed cases of acute lymphoblastic leukaemia. Bone marrow aspiration was done on reappearance of blast cells in peripheral smear and cerebrospinal fluid. Detailed report was done each time when intra-thecal chemotherapy was given or there were signs and symptoms suggestive of central nervous system relapse. SPSS 12 was used for data analysis.

RESULTS:

Of …

Frequency And Outcome Of Meningitis In Pediatric Intensive Care Unit Of Pakistan, Amna Jawaid, Surriya Bano, Anwarul Haque, Khubaib Arif

Department of Emergency Medicine

Meningitis is a leading cause of morbidity and mortality worldwide in intensive care settings. The aim of this study was to assess the frequency and outcome in children with meningitis through a retrospective chart review done in pediatric intensive care unit of a tertiary care hospital from January 2000 to December 2014. During these 14 years, 64 patients were admitted with meningitis in pediatric intensive care unit. Out of 64, 36 were diagnosed with pyogenic meningitis, 18 patients with viral meningitis, and 10 with tuberculous meningitis. Most complications were observed in the initial 48 hours. Most common presentation was altered …

Control Of Poisoning Through Product Labeling Of Hazardous Chemicals, Nadeem Ullah Khan, Arshad Iqbal, Sadaf Sheikh

Department of Emergency Medicine

No abstract provided.

Uchunguzi (Journal Watch/Montre De Journal) June 2016, Benjamin Wachira

Emergency Medicine, East Africa

When someone telephones for an ambulance, an interaction ensues which should be efficient and effective to facilitate a speedy dispatch of the appropriate level of vehicle, equipment and personnel to where it is needed. The process in South Africa begins with a three-part opening sequence which typically identifies the organisation, introduces the call-taker (CT) and invites the caller to proceed with the business of the call. In a recent project conducted in a South African emergency service, the researchers aimed to ascertain the impact of the CT’s identification sequence on the progression of the call and to determine whether there …

Biventricular Thrombus In Hypereosinophilic Syndrome Presenting With Shortness Of Breath, Abdul Baqi, Shahan Waheed, Fateh Ali Tipoo Sultan, Aamir Hameed

Section of Cardiology

A 48 years old male presented to clinic with 12 months of low grade fever with shortness of breath which has progressively worsened with no associated weight loss, night sweats or loss of appetite. There was no prior history of chronic illness before the current illness. Laboratory workup revealed a high white blood cell count with predominant eosinophils. Chest X-ray was normal. Transthoracic echocardiography and Cardiac Magnetic Resonance showed biventricular thrombi. On further extensive workup the findings were consistent with hypereosinophilic syndrome. The patient was started on oral steroids, hydroxyurea, imatanib mesylate and oral anticoagulation. The patient responded to the …

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.

Safety Netting Through The Prevention And Detection Of Child Abuse In Low And Middle Income Countries: Lessons From Pakistan, Kanwal Nayani, Muhammad Akbar Baig, Nick Brown, Asad Mian

Department of Paediatrics and Child Health

No abstract provided.

Uchunguzi (Journal Watch/Montre De Journal) March 2016, Benjamin Wachira

Emergency Medicine, East Africa

Increasing demand on emergency healthcare systems throughout Africa means there is a need to develop and harmonise standards of emergency care for the benefit of African populations. This can potentially be achieved by developing guidelines for appropriate and high quality education to prepare future generations of emergency healthcare providers for their role in all regions of Africa. With this in mind, the African Emergency Nursing Curriculum was developed by emergency nurses, academics and researchers from Africa and the rest of the world to provide a consensus document to guide the development of harmonised standards of emergency nursing theory and practice …

Cerebral Venous Sinus Thrombosis With Tentorial Haemorrhagic Infarctions In Combined Proteins Deficiency And Hyperhomocysteinemia Treated With Anticoagulation- Limited Evidence With Good Results: A Case Report, Muhammad Waqas, Muhammad Akbar Baig, Shahan Waheed Aga Khan University, Munawar Khursheed

Department of Emergency Medicine

We are presenting a case of a 40-year-old lady who presented with sudden loss of consciousness. Computed Tomography scan of her brain revealed the presence of blood in her sub-arachnoid space on her right hemisphere, cerebral oedema, and cerebral venous sinus thrombosis later magnetic Resonance Imaging revealed extensive cerebral venous sinuses thrombosis formation associated with supra and infra-tentorial haemorrhages. Elevated levels of plasma homocysteine and deficient levels of protein S. Patient was anticoagulated with warfarin and INR was monitored. She recovered successfully with no complication of anticoagulation observed. The use of anticoagulation had a favourable outcome in our …

Small Bowel Ascaris Infestation: A Diagnostic Challenge, Muhammad Waqas Khan, Sanniya Khan Ghauri

Department of Emergency Medicine

Ascariasis is a common infestation in developing countries where there is poor hygiene. A majority of the cases are asymptomatic, with a few cases presenting with mild abdominal pain and nutritional deficiencies in the long term. Here we present a case of a young boy who presented as a diagnostic dilemma, with signs of acute intestinal obstruction without any supporting radiological evidence. A barium study revealed the presence of low-burden Ascaris infestation that was managed medically.

794 Evaluating Disability In Adult Burn Injury Patients Treated At A Tertiary-Care Burn Unit In Karachi, Pakistan: A Longitudinal Study Using Who Disability Assessment Schedule Ii, Nukhba Zia, Asim Durrani, Safia Awan, Madiha Hashmi, Mazhar Nizam, Asad Latif

Department of Anaesthesia

Background: Disability after burn injury is not assessed in the context of Pakistan. This study assesses disability among adult burn injury patients presenting to a burn unit in Karachi, Pakistan.
Methods: This longitudinal study was conducted at a burn centre is Karachi, Pakistan. Adult patients(>18 years) who were discharge after 24-hour admission were enrolled from August 2014–March 2015. Baseline assessment before discharge and follow-up at 2,6 and 12 weeks after discharge via telephone was done using 12-item WHODAS 2.0 (5 -point likert-scale; 1 = none; 2 = mild; 3 = moderate; 4 = severe; and 5 = extreme) related …

Community Emergency Medicine: Benefits And Challenges Of Screening For Elder Abuse In The Emergency Department Of A Developing Country, Muhammad Akbar Baig, Asad Mian, Erfaan Hussain, Shahan Waheed

Department of Emergency Medicine

No abstract provided.

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 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 …