Indian Journal of Emergency Medicine

Clubbing is one of the ancient signs in clinical medicine since the time of Hippocrates. Its pathogenesis is said to be associated with platelet derived growth factor and vascular endothelial growth factor but exactly mechanism behind this is still unknown. We present a case of 55-years-old male admitted with complaints of fever, cough, pain and swelling of fingers. On examination he had Grade 4 clubbing and radiography revealed left upper lobe opacity with malignant features and subsequently bronchoscopy confirmed the diagnosis of squamous cell carcinoma.

Keywords: Clubbing, squamous cell carcinoma, HOA

Caesarean scar pregnancy is a rarest type of ectopic pregnancy, characterized by vaginal bleeding associated with abdominal pain, usually manifested during the warly first trimester of pregnanacy. It can be diagnosed by serial beta-HCG levels monitoring coupled with ultrasonography. The treatment modalities can be Inj. Methotrexate, D&C associated with laproscopy/ laprotomy or uterine artery embolization. Rupture of ectopic pregnancy may lead to massive haemorrhage, shock & DIC.

Keywords: Caesarean scar pregnancy (CSP); Methotrexate; DIC.

A 40-year-old women developed right lateral rectus palsy during her course of treatment for prolonged coagulopathy following snake bite. There is scarcity of literature about prolonged coagulopathy and ever rare to be associated with neurological manifestation.

Keywords: Viper snake; Lateral rectus palsy.

A 18-years male came in ED with c/o chest pain since 3–4 hours before arrival in ED, ECG show ST elevation in anterior leads, lead 1 and avl suggestive of anterior wall myocardial infarction.patienthomocystine level was 41.5 mol/ lt (normal range 6–15 mol/lt)

Keywords: Myocardial Infarction; Hyperhomocystenemia.

Introduction and aim: The process of triage in the Emergency department is complex and several triage scales have been designed to guide the clinician in prioritizing the patients. This study was done to quantify patient admission to ICU through the emergency department and to identify if vital signs strongly associated with criteria predictive for admission to the intensive care unit. Methods and results: A cross sectional study was undertaken in the emergency department over a period of 6 months at MS Ramaiah hospital. The study included total of 824 Patient presented to emergency department. Patient’s demographic data, clinical Information along with vital signs were noted. Majority of subjects were in the age group 31 to 40 years (23.7%), mean age was 41.4 ± 19.7 years. 58.3% were males and 41.7% were females, mean Heart rate was 89.80 ± 20.11, mean Respiratory Rate was 23.40 ± 6.65, mean SpO2 was 92.73 ± 7.09, mean SBP was 119.74 ± 20.79 and mean DBP was 75.08 ± 12.43. In the study SpO2 had highest sensitivity in predicting the admission to ward, ICU, Discharge and death in emergency room compared to other vital parameters. Conclusion: The Abnormal vital signs are strongly associated with adverse outcome; low SpO2 had the highest sensitivity and specificity of all the vital signs.

Keywords: Intensive care unit; Vital Signs; Emergency; ICU; Mortality.

Background and Objectives: Antibiotics are widely used for variety of infections. Drugs like Macrolides, Flouroquinolones can cause prolongation of the QT interval. The objective of this study was to assess the changes in 12 lead Electrocardiogram of patients receiving intravenous Amoxicillin and Clavulanate, parameters like heart rate and corrected QT interval (QTc) were analyzed. Methods: A total of 40 patients who received intravenous Amoxicillin and Clavulanate were enrolled in the study. Serial 12 lead surface Electrocardiogram were taken at 4 time points as follows. First ECG taken before the administration of the antibiotic. These were followed by a 10 minutes, 20 minutes and 60 minutes of infusion. The parameters of Electrocardiogram viz; Heart rate, QTc Interval were assessed. Results: In our study we found that there was mean increase in the heart rate of less than 2 beats per minute and mean increase in QTc interval of 9.6 ms at 60 minutes when compared to baseline. This difference was statistically signi cant but clinically not signi cant as the corrected QT interval was still within the normal range. Conclusion: Administration of antibiotics like Amoxicillin and Clavulanate, through intravenous route caused a minimal though statistically signi cant increase in heart rate and QTc at 60 minutes compared to baseline, in patients without cardiovascular disease or electrolyte disturbances. However the corrected QT intervals remained in the normal range. These results point to the need for further studies in larger groups of patients including those with cardiovascular disease and other comorbidities.

Keywords: Antibiotic; Amoxicillin and clavulanate; ECG; Heart rate; QTc.

Background and Objectives: Currently the Acute physiology and chronic health Assessment II (APACHE II) scoring system is widely used. A controversy exists as to which is an ideal scoring system so we conducted a study to assess and compare the effectiveness of Apache II score and sequential organ failure assessment (SOFA) score for the same patients. Materials and Methods: A prospective clinical study was undertaken over a period of 18 months including a total of 80 patients admitted in the ED-ICU of the Department of emergency medicine and the Multi-disciplinary ICU at a tertiary care hospital. Results: Out of the 80 patients admitted in the ED-ICU, both APACHE II scoring and SOFA scoring had a strong significant statistical relationship (p ≤ 0.01) by fisher exact test with the outcomes. When multivariate logistic regression analysis was done there was no strong significant statistical correlation between APACHE II (24 hour) and mortality (adjusted odds ratio, 1.09; 95% CI 0.90–1.31; p = 0.371) but SOFA score had a logit coefficient of 0.53 and a high value on the Wald test =3.92 and hence a stronger statistical correlation with mortality (p = 0.048). Conclusion: We can conclude that SOFA score is better than APACHE score purely as a predictor of mortality and that SOFA score and cardiac events during stay in the ED-ICU are both individual predictors of mortality.

Keywords: APACHE II, SOFA, ED-ICU, Mortality

Aims: To assess the physiological efficiency using Modified Early warning Score (MEWS) in determining the prognosis and need for type of care required to patients presenting to Emergency department (ED). Setting and Design: This prospective study was conducted in Emergency department of tertiary care hospital during a period of one month. Methods and Material: Patients presenting to ED were evaluated with history and physical examination. The data of the patients fulfilling the study inclusion criteria were recorded: pulse rate; systolic blood pressure, respiratory rate; level of consciousness and temperature. Statistical analysis used: Data were analyzed by the use of descriptive and analytical census (Pearson correlation coefficient) and by Statistical Package for Social Sciences [SPSS] for Windows, Version 22.0. Released in 2013. Armonk, NY: IBM Corp., was used to perform statistical analyses. Results: One hundred patients were included in the study, of which 21 died and 79 recovered. The mean score in mortality group was 5.819 (p = 0.001) and in partial recovery 4.31 (p = 0.001) and complete recovery groups 4.20 (p = 0.88) respectively. The level of significance (p-value) was set at p < 0.05. Conclusion: In our study, we found Modified early warning score of five or more were associated with increased risk of death or in hospital mortality.

Keywords: MEWS-Modified early warning score; ED-Emergency department.