Indian Journal of Emergency Medicine

Introduction: Gynecological emergencies often present as acute abdominal pain, however diarrhoea owing to gynecological pathology is rather unusual.

Objective: We would like to report a case of diarrhoea developed secondary to ruptured tubal ectopic.

Study Design: Case report. Place and time of study: Emergency department Aster RV hospital Banagalore on 13th June 2021.

Methodology: The patient presented with diarrhoea as a major symptom and on carrying out relevant investigations, including CT abdomen and pelvis lead to our final diagnosis.

Conclusion: Our case report depicts that a typical presentations of ectopic pregnancies are important to recognize as they can gastrointestinal disease. Its recommended that women of reproductive age who present with diarrhoea, vomiting or collapse, be investigated for possible ectopic pregnancy.

The novel coronavirus disease (COVID-19) has been declared as a pandemic. With the increasing number of COVID-19 patients, it is necessary to rangeover the factors related to the disease to aid patient management until a definitive vaccine is prepared, As the disease is not limited to the respiratory system alone. COVID-19 has been associated with various cardiac, vascular complications including acute myocardial injury, arrhythmias, myocarditis and venous thromboembolism.

It can expand thrombotic complications that ultimately lead to myocardial infarction even in patients without having a history of underlying heart disease.

Abstract

India is one of the most populous countries and is moving towards providing easily accessible and affordable health care to its citizens. In recent times, it has witnessed a transformation of emergency ambulance services which has saved more than a million lives in its urban and rural areas. The COVID-19 pandemic has provided a unique opportunity to strengthen its healthcare infrastructures. MOHFW legalized telemedicine in India in March 2020 which has provided an opportunity for doctors to provide consultation to patients who is in remote part of the country and for rural patients, getting consultation from specialists of choice from their homes. Recently, there has been a lot of focus on emergency medicine and NMC reforms made it mandatory for medical colleges to have a separate unit for this specialty. There is a need to combine telemedicine with emergency medical care in India as India is facing more than 2 million medical emergencies every year and in many cases, emergency medical care is needed immediately in the form of first aid advice and/or counseling to prevent possible complications. India has one of the world’s highest internet users, as well as India, has one of the world’s highest numbers of medical institutions which are producing more than 80,000 medical graduates every year. Now a day, India is witnessing growth in its telemedicine platforms available to its citizens. In moving next to strengthen its health infrastructure, all these dots can be combined effectively to create an ecosystem for dealing with medical emergencies via telemedicine

Abstract Context: The failure of the vital signs to predict the severity of shock and the drawbacks of the trauma scoring systems have led to extensive research on shock index in polytrauma patients. This prospective, observational study was conducted to study the efficacy of the Shock Index (SI) and Modified Shock Index (MSI) as predictors of 24 h mortality in polytrauma patients.

Aim: To validate the Shock index and Modified Shock index as predictors of 24 h mortality in polytrauma patients.

Method: All patients presenting with polytrauma meeting the inclusion criteria were evaluated using the following parameters: Heart rate, Systolic blood pressure, and Diastolic blood pressure, following which SI and MSI were calculated. Abbreviated Injury Score (AIS) & Injury Severity Score (ISS) were formulated. The endpoint of the study was hospital stay, ICU stay, and 24 h mortality.

Statistical Analysis: The sensitivity, specificity, positive predictive value, negative predictive value, odds ratio, positive likelihood ratio, and negative likelihood ratio of SI and MSI were evaluated using Graphpad software. ROC curves and scatter diagrams were also plotted.

Results: SI >0.9 has a sensitivity of 96% and a negative predictive value (NPV) of 93.75%. Similarly, MSI >1.3 has a sensitivity of 96% and NPV of 94.12%. Statistically, a significant correlation was observed between SI & MSI with ISS, ICU stay, and hospital stay.

Conclusion: SI and MSI are effective predictors of 24 h mortality but less efficient in predicting mortality that does not occur before 24 h. Higher SI & MSI values are related to higher ISS, and longer duration of ICU & hospital stays.