Indian Journal of Emergency Medicine

 A thrombus formation in the splenic artery occludes the vascular supply of the spleen, leading to ischemia of parenchyma of spleen and subsequently necrosis – Splenic Infarct. It is often clinically silent, the most common symptom being Pain Abdomen / LUQ (Left Upper Quadrant) pain and the sign being Left Hypochondrium Tenderness. There are a multitude of causes for splenic artery thrombosis and infarction, ranging from hematological disorders and malignancies to embolic disorders, vasculitis, autoimmune and collagen vascular diseases, trauma, systemic inflammatory disorders etc.  As the presentation tends to mimic other diseases, a high degree of clinical suspicion is warranted for diagnosis. A contrast enhanced CT scan is the current diagnostic modality of choice. Splenic infarction alone is not an indication for surgery. Non-operative medical management requires close follow up and surgery is indicated for persistence of symptoms and/or complications. We are reporting the case of a young male who presented to the emergency with 4 days of low grade fever and nausea with sudden onset severe pain in epigastrium and left hypochondrium. Normal lab investigations and USG abdomen were followed up with a CECT-abdomen that revealed splenic infarction and 90% stenosis of celiac trunk and hepatic artery with proximal splenic artery thrombosis.

Stroke is defined as the sudden occlusion or rupture of cerebral arteries or veins resulting in focal cerebral damage and neurological deficits. Types of stroke resulting from vascular occlusion are arterial ischemic stroke and those resulting from vascular rupture are called hemorrhagic stroke. Stroke in children is relatively rare and frequently results in a lack of recognition and delay in diagnosis. The etiologies of stroke in children are multifactorial. In our present case the patient who is 13 yrs old and presented with symptoms suggestive of acute CVA. The child recovered within 4-5 days and was discharged in improved neurological status.

Keywords: Imperforate Hymen; Young Females; Cyclical Abdominal Pain. 

Keywords: Coagulation; Hemostasis; Phlebotomy; Fibrinolytic System. 

 B-Type natriuretic peptide (BNP) has established itself as an important cardiovascular and cardio renal biomarker. Stroke is an emergency having high mortality, morbidity, social and economic implications. Acute ischemic stroke (AIS) accounts for approximately 70% of all strokes and is caused by embolic or atherosclerotic occlusion in the cerebral vessels. Identification of a biomarker for risk, severity and prognosis of stroke would be of great benefit. The mechanism by which the plasma levels of BNP are increased in patients with AIS independently of heart diseases is not clearly defined but the levels of BNP has shown a strong correlation with cardio-embolic stroke and has established its role as a surrogate marker for the same. Biomarkers like BNP should be used to supplement clinically guided therapy and not to substitute it. Proper interpretation of BNP would surely make the diagnosis, management and risk stratification better for stroke subjects.

Keyword: Not Provided 

 Background: The diagnostic dilemma of ECG rhythm diagnosis is very common for patients presenting in ED and Critical Care Units. A widely practiced method for diagnosing ECG rhythms of narrow-complex tachycardia is the use of double-speed (50mm/sec) ECGs in addition to the 25mm/sec speed ECG. Though widely practiced, accuracy of diagnosis by this method has not been evaluated adequately. Method: This single-center, single-blinded, comparative, questionnaire-based study was done amongst Emergency and Critical Care Physicians to assess whether adding a double speed ECG help in making a correct diagnosis of narrow-complex tachycardia. Results: The study did not show any significant improvement in diagnostic accuracy with use of 50mm/sec speed ECG. 26 ECGs were interpreted by 35 observers, each ECG set was diagnosed twice, once with 25mm speed only and once 25mm and 50mm speed together. Correct diagnosis was made in 534/910 (58.68%) in the standard group and 537/910 (59.01%) with the addition of the 50mm/s ECG. None of the narrow complex tachycardia revealed any improvement in diagnostic accuracy with the aid of double-speed ECG. Proportion of correct diagnosis by physicians of different years of experience with the help of double-speed ECG is not greater than that with standard speed ECG. The proportion of correct diagnosis by physicians with opinion that double-speed ECGs are helpful is also not better than physicians who do not find double-speed ECGs helpful. Conclusion: Though widely practiced in diagnosing narrow complex tachycardia, double speed ECG is not a very accurate tool. Perhaps physicians need more training and practice in interpreting double speed ECGs for more accurate information of rhythm analysis. 

 Background: It is essential to know to about work related stress, as prolonged stress at workplace reduces the performance of an individual and has an indirect/direct effect on health &on his/her professional social and personal life. In a health care system it is very important to know about the stressors ,as increased stress levels invariably affects interpersonal relationships ,doctor to patient communication , inter-colleague relationships and professional performance.Aim: To determine a) Levels of stress among physicians    b) Factors associated with high stress levels c) Attempt to develop tips for reducing stress on a long term basis. Materials and Method: A group administered questionnaire based survey was done in which a pre validated questionnaire was used both in clinical settings and on epidemiological settings on mental health status of the participants. All full time consultants, associate consultants, attending consultants, Post graduate trainees from Masters in Emergency Medicine, DNB Medicine, family medicine, orthopedics, pediatrics.,full time residential medical officers attached to Peerless Hospital during the study period were included. All non –physicians, non medical and ancillary staff attached to Peerless Hospital were excluded. The sample size required for this survey was calculated as 72, rounded to 70. Statistical Analysis: In the present study 20 out of 43 physicians of age group 25-35 found to have moderate to severe stress. The another factor seen is physicians who are taking care of clinical work and working in-hospital  are experiencing more stress the p values for these two factors came to be (p=0.01) which is statistically significant Result: Though majority of responders initially felt that they perfectly well, 25% realised the need of a good tonic/ refreshment. Later 36% of physicians felt that they are not feeling well in daily lives. Approximately 64% felt that they were feeling run down and out of sorts. Many (41%) experience headaches due to work stress. 41% of physicians complained both hot and cold spells recently. A large number of physicians had lost their sleep. 21% of physicians feel that they are nervous all the time.  Though majority are able to keep themselves busy some are not. Some are taking longer time to complete their routine tasks. Though 89% feel they are able to do things better than usual a large number of physicians contradict them. A large number of physicians are taking longer time to complete their routine tasks. 10% feel less satisfied in the way they have carried their task. A large chunk (9%) feels themselves to be worthless though another small  group (3%) believe that their life is entirely hopeless. A small population (3%) of physicians confesses that the idea of making away with themselves actually crossed their minds. Even some say (4%) that at some point of time they thought of taking their own life. 6% of physicians feel that their nerves are so bad that they are unable to do anything.. 4% physicians says that the idea of taking their life has crossed their mind. Conclusion: There is trend of higher GHQ scores that correlates with the higher stress levels amongst the emergency physicians and the physicians working in-hospital and taking care of clinical departments.