Indian Journal of Emergency Medicine

The diagnosis of first episode of status epilepticus associated with head injury can be quite difficult unless it is witnessed. Such status epilepticus can lead to serious complications due to its prolonged seizure activity leading to hypoxia, hypotension, metabolic acidosis, cardiac dysrhythmias, neurogenic pulmonary edema, hyperthermia, rhabdomyolysis, and pulmonary aspiration and permanent brain damage and death. We hereby describe a case of a 41-year-old male who was found unresponsive in his balcony with multiple facial injuries initially mimicing assault with head injury but eventually confirmed to be a status epilepticus. He was well-managed by the emergency team and he was discharged in a stable condition with no focal neurological deficit.

Keywords: Head injury; Status epilepticus; Suspected assault; Seizure.

Incidence of laryngeal tuberculosis as an extrapulmonary site is not common. It can be due to primary or secondary lesions of TB. Vocal cord paralysis can be due to involvement of vagus anywhere along its course. Here we have reported a case of patient presented to emergency with hoarseness and dysphagia found to have vocal cord paralysis as a manifestation of miliary tuberculosis.

Keywords: Vocal cord paralysis; TB-tuberculosis; Larynx

Context and Aim: In Bengaluru region the Scorpion sting is not common among rural and urban population. The exact incidence of Scorpion sting bite was unreported among the people living in Bengaluru region. So, the aim of present study was to find the incidence, clinical features, complications and outcomes of Scorpion sting bite among Bengaluru region. Settings and Design: This observational prospective study was conducted in BGS Global Institute of Medical Sciences in Bengaluru region from Jan 2017 to Dec 2017. Patient between the age of 3 and 66 with history of scorpion sting bite were included in the study. Methods and Material: There were 25 patients (0.56%) with scorpion sting bite during the study period. Among which 16 (0.36%) of them were treated as outpatient basis and 9 (0.2%) scorpion sting bite patients were treated as inpatient. There clinical features, treatment, management of complication and follow up was done during their admission. Statistical analysis used: The data collected was put in the Excel sheet. The incidence of Scorpion sting bite was calculated and the other parameters were analyzed and depicted in percentages. Results: The incidence of Scorpion sting bite was 0.56% among patients who attended Emergency Department. As per this study Scorpions sting bite are more common in May to November months which is the rainy season in this area. Presentation with pain and paresthesia is common, they also had tachycardia and tachypnea as major signs. 11% of patient had myocarditis among which 1 case (4%) died with pulmonary edema. Conclusions: Scorpion sting bite is an occasional occupational health hazard affecting the farmers leaving in villages of Bengaluru region during rainy seasons.

Keywords: Bengaluru Region; Complication; Incidence; Scorpion sting; Treatment.

Introduction: Cardiac arrest is a common medical emergency with grave consequences. Cardiac arrest occurs when the heart stop to produce an effective pulse and fails to circulate blood throughout the body. CPR is an emergency procedure that involves the application of external chest compression and ventilation when heart and lung action stops. Aim: This study designed to assess the Awareness of Cardiopulmonary Resuscitation (CPR) Among General Public. Materials and Methods: A cross sectional study was conducted in general hospital, ministry of health, Wadi Al Dawasir, Saudi Arabia.The participants were randomly selected from the visitors of outpatient department and explained the purpose of the study and verbal consent was obtained from the individuals. Employees of the hospital and visitors below 16 were omitted from this study. Data was collected through self-administered questionnaire developed by the researcher which includes 19 questions regarding demographic data and information about CPR training and practice. The questions were asked in Arabic and English language. The data were calculated and analyzed by using SPSS Software 20.0. Results: A total 358 surveys distributed out of which 235 were completely filled with response rate of 65.6%. The study identified 42.1% of the participants had theoretical awareness of the signs of sudden cardiac arrest. 48.4% of them were able to properly establish the 2 elements of CPR as chest compressions and rescue breath. It is vital to concern that 86.3% participants said that they do not know how to perform CPR. Over 68.4% of them did not properly identify the location, depth and ratio of chest compressions. This shows that individuals have limited knowledge about CPR. Its worrying 77.2% of them did not answer the need of cardiopulmonary resuscitation in an unresponsive person who has airway obstruction while eating and stopped breathing and fell unconscious. 86.8% of participants have no formal training. Regarding the practice 87.4% have not performed CPR on any person. Conclusion: This study revealed lack of awareness of when and how to perform CPR among general public. The study featured an excellent potential for extensive public based education program among people to raise CPR awareness to save the life of people. Recommendations: Government and private organization and educational institution in the Wadi Al Dawasir ought to be inspired to incorporate CPR training programs and public should value the importance of CPR as life-saving skills that is important for the community.

Keywords: Awareness; Cardiopulmonary Resuscitation (CPR); General Public.

Introduction: Ischemic cerebrovascular accident (CVA) is often a sequel of atherosclerotic disease. Common carotid artery intima-media thickness (CIMT) is a surrogate marker of early atherosclerotic changes. Aim of our study was to see if increased CIMT co-related with increased risk of stroke using carotid artery Doppler duplex ultrasonography. Methods: Ours was prospective observational study including 300 patients who were divided into 2 groups: CVA group (n = 150) and non-CVA group (n = 150). Noninvasive measurements of the intima and media of the common carotid artery (CCA) were performed with high-resolution ultrasonography in all the patients in both the groups. Results: Age range of the patients was 33 to 72. CIMT was significantly increased in CVA patients (0.77 ± 0.35 mm) compared to nonCVA patients (0.57 ± 0.15 mm) on both right and left CCA. The significance of difference persisted in patients with associated comorbidities, e.g. hypertension, diabetes mellitus and smokers. Conclusion: Increased CIMT of the CCA, measured noninvasively by Doppler ultrasonography are associated with increased risk of CVA.

Keywords: CIMT; Stroke; Duplex.

Introduction: Stroke is leading cause of disability in adults and each year millions of stroke survivors has to adoptlife with restriction in activities of daily living as a consequence of stroke. Time is brain, early recognition of acute ischemic stroke is important because IV fibrinolytic treatment should be provided as early as possible, generally within 3 to 4.5 hours of onset of symptoms. Delay in presentation resulting in increased morbidity and mortality. Methods: All patients with age above 18, suspected stroke, fulfilling the Inclusion criteria at the Emergency Medicine department Bangalore Baptist Hospital, during one and half years period were enrolled in study. Diagnosis can be made on neurological assessment and neuroimaging. Data collection—Administration of questionnaire and data entry. The data collected will be entered into an excel sheet and the analysis will be done using relevant statistical methods. The characteristics of patients’ with acute stroke will be analyzed by using chi-square analysis for categorical variables and the t-test for continuous variables. Statistical analyzes will be performed using the Statistics Package for Social Scientists. Results: Out of 184 patients in the study, there were a total of 46 patients who arrived hospital within 6 hours of onset of symptoms and the rest arrived after 6 hours of onset of symptoms. A p-value of (p<0.0005) as arrived, which is significant for this study. In our study out of 184 patients who presented to emergency with symptoms of stroke, 183 patients were identified within 25 minutes. One patient was not identified who was presented beyond 6 hours of symptom onset. Once we identified that patient arrived in window period (n=5), we performed CT scan within 25 minutes (p<0.0005) and interpretation within 45 minutes (p<0.0005) and thrombolysis of these patients started within one hour (p<0.0005) which is statistically significant. Conclusion: We found that in our study prehospital factor the distance from hospital is significant factor associated with delay in arrival to hospital. It is recommended that creating awareness among general public about stroke symptom and thrombolysis is at most need of the hour. Strengthen of ambulance services and training people (paramedics and EMT) who are involved in first contact with the patient, so that identification of stroke will happen at field.

Keywords: Stroke; Pre hospital; Thrombolysis

Background: To study the effects of oxygen supplementation on the metabolic and anaerobic changes caused by tourniquet application in limb surgeries using blood gas analysis. Methodology: This study was conducted with 60 adult patients in the 18–65 age group of ASA physical status I and II undergoing limb surgeries using tourniquet are randomly assigned to one of two groups 1 and 2 containing 30 patients each. Group 1: 30 patients received nasal oxygen 3 l/min after tourniquet application. Group 2: 30 patients received preoxygenation for 5 min before tournquiet in addition to 3 l/min nasal oxygen during tourniquet. Arterial blood samples are collected before and 3 min after tourniquet respectively and analyzed forblood gases and lactate levels. Results: Patients who received preoxygenation showed reduced metabolites and reduced serum lactate when compared to the group which was not preoxygenated. This difference in serum lactate was found to be statistically significant (p-value < 0.0001). Similarly the ph of the group which was preoxygenated within the normal limit while the group not preoxygenated shown acidotic pH, the difference in p was also found to be statistically signicant (p-value < 0.0001). Conclusion: The effect of oxygen supplementation in reducing the anaerobic metabolism was studied in patients Undergoing limb surgeries using tourniquet. It was foundthat the patients who received preoxygenation showed reduced serum Lactate levels and normal pH when compared to those who were not preoxygenated. Hence it is concluded that preoxygenation reduces anaerobic metabolism in surgeries done under tourniquet.

Keywords: Tourniquet; Blood gas analysis; Lactate Levels; Oxygenation.

Background: To study the level of awareness and knowledge of BLS among Intern Doctors as well as undergraduate students of medical profession and nursing staff in Government Medical College, Surat. Diagnosis, effective management and prevention of life-threatening emergencies are the responsibility of health-care professionals. Life-threatening emergencies can be successfully managed by achieving accurate BLS skills. It was a cross-sectional study was conducted with the help of case record pro forma which included basic questions related to BLS. Out of 273 responders 99 were intern doctors, 90 medical students, and 84 were from nursing staff. Among them 128 were male and 148 were female responders. The overall mean score of awareness was 11.37 + 3.27 (score range 0–20). Out of 273 only 20 (7.33%) had scored 81–100% marks, 75 (27.47%) out of 273 scored 61- 80% marks, 117 (42.86%) out of 273 scored 41–60% marks, 59 (21.61%) scored 21–40% marks and only 2 (0.73%) had scored 0–20% marks. The statistical analysis was carried out using MS Excel and SPSS version 20 software. Our participants have knowledge and awareness about the basic life support as the BLS training has the part of our curriculum since last year in department of emergency medicine.

Keywords: Basic life support; CPR; AED awareness.

Aim: Aim of the present study is to study the significance of echocardiography in patients with septic shock along with the significance of clinical prediction scores and their correlation with echocardiography findings in prognosis of a population of 50 septic shock patients presenting to ED in a tertiary care hospital. Method: The present study is conducted on 50 patients with septic shock presented to Department of Emergency Medicine, during July 2016 to November 2018. Results: The most common comorbid condition in the study was Type II Diabetes Mellitus. The most common diagnosis in the present study is Urosepsis with a contribution of 24% patients and mortality of 50%. In present study, 46% had normal LV function, 28% had Mild LV dysfunction, 22% had moderate LV dysfunction and 4% had severe LV dysfunction. The mean APACHE II in patients with No LVD is 14.957, mild LVD is 17.929, moderate LVD is 21.818 and severe LVD is 24. The mean qSOFA in patients with No LVD is 2.04, mild LVD is 2.43, moderate LVD is 2.36 and severe LVD is 2.50. The mean IVC diameter in patients with No LVD is 1.25 cm, Mild LVD is 1.68 cm, moderate LVD is 2.08 cm and severe LVD is 2.25 cm. Mortality in patients with APACHE II score >20 is 94.1%, i.e. 16 patients. Mortality in patients with qSOFA score 3 is 92.3%. APACHE II had positive correlation with qSOFA and negative correlation with LVEF and LOHS. Outcome of the present study showed 52% survivors and 48% non-survivors. Transthoracic echocardiography in ED has significant correlation with clinical prediction scores (APACHE II and qSOFA scores). Conclusion: the prognostic power of the qSOFA score at ICU admission regarding patients with septicemia. Present study results show that the qSOFA score ≥2 in admission could be helpful as a screening device for predicting clinical intensity and medical resource make use of within 72 hours right after admission, and for forecasting the 28-day mortality price.

Keywords: Septic Shock; Glasgow Coma Scale; Left Ventricular ejection fraction; Nitric oxide