Indian Journal of Emergency Medicine

Spontaneous pneumomediastium refers to the presence of air in the mediastinum without any obvious cause. It is an uncommon condition occurring due to alveolar rupture as a result of increased intrathoracic pressure. In this report, we present a case of Subcutaneous Emphysema and Spontaneous Pneumomediastium. Although there are several causes responsible for this condition, it is extremely rare to occur spontaneously with no prior trauma or Predisposing factors, especially in older age groups.

 

Objectives: The Emergency Department (ED) is one of the most important places in a hospital in which patients are full of pain and stress because of its hectic nature. Consequently, there are a lot of quarrels and fights in the emergency department. This study intends to assess the effect of exhibition of educational messages as a way to decrease the violence in the Emergency Room (ER).

Methods: We conducted a cross-sectional prospective survey at the Emergency Room (ER) of Shariati hospital of Tehran in September 2016. Data collection was carried out via distributing a qualitative questionnaire among the Emergency Department (ED) staff at baseline and 3 months after the educational intervention. We measured the total and mean number of various types of violence per survey. We utilized SPSS software version 16 in analysis of data using Mann-Whitney Test.

Results: The analysis showed 47.5% verbal violence before the intervention vs 60% after that (p-value=0.598), 20.8% financial violence pre- ervention versus 43.8% post intervention (p-value=0.253), both of which were notsignificant statistically; however, physical violence considerably decreased from 83.9% to 47.6% during the study (p-value=0.01). During the semi-structured interviews with personnel, it was found that this presentation had some positive effects on controlling the stress of the environment practically, although it did not appear in the analysis.

Conclusion: This type of public education in the hospital does not seem to be independently effective in reducing the violence in the Emergency Room (ER). According to the results, most violence indexes, except Physical violence, have not been mitigated after the intervention significantly. Perhaps, it could be more efficient by using audiovisual media, animation, and other captivating methods.

Aims and objectives: In this Research, we study the difficulties faced by postgraduate trainee doctors while
conducting research and the measures that can be taken to assist post-graduate trainee doctors in conducting
research.
Material and Methods: A questionnaire based survey was carried out among Post-graduate trainee doctors (DNB
& MD PG residents) from teaching hospitals in Kolkata duration of the study was approximately 1 year between July
2018 - June 2019. 170 postgraduate trainee doctors from the clinical and pre/para clinical specialty were evaluated,
difficulties faced by them in conducting research, and suggestions on how research can be promoted among PG
residents was taken.
Results: In the present study, residents reported significant reasons for not conducting adequate research during
residencies, such as lack of time, inadequate guidance from teaching staff, and lack of financial support, inadequate
support by mentors/assistants, and lack of research curriculum. Among personal reasons, 51.8% of the respondents
reported that inadequate research facilities were the main reason for not conducting research/lack of research
interest. The respondents of both the groups stated that lack of time due to the vast curriculum of PG subjects was
also one of the reasons for not conducting research/ lack of research interest.
Among institutional reasons, 44.1% of the respondents reported that a lack of research curriculum was the main
reason for preventing PG residents from conducting research
Conclusion: In the present study, the participants were asked about what can be done for research promotion in
institutions, majority of the respondents wanted 2-3 months of allocated time for supervised research and provision
of a research stipend. Others suggested the provision of research grants and the creation of an active research
cell. About MCI body measures, incorporation of compulsory research methodology workshops in PG curriculum,
providing a paid fellowship in research, giving priority for students who have participated in part-time research,
enter super speciality courses were also suggested.

Background: Millions of people sustain head injuries by different MOIs due to various causes most of them being preventable. Head injuries mostly end up in either mortality or de-capacitating disabilities, often persisting lifelong. They cause the society to pay the heavy penalty of “the global loss of economy and human resources.” The study of the profiles of the head injury patients throws light on many important causes for concern to formulate strategies for patient management and injury prevention, as proved by studies. Early institution of appropriate management and care based on the head injury severity per GCS scores and timely transfers of patients to facilities that can cope with the patients’ needs play a pivotal role in preventing the worsening of primary and occurrence of secondary neuronal damages. Aim: To evaluate the clinical profile of Head Injury patients presenting to ED. Objectives: 1) To evaluate the correlation between GCS scores and the Head Injury severity 2) To evaluate the correlation between the time bound changes in the GCS scores and head injury severity Materials and Methods: The pre-approved prospective observational study was conducted on 100 head injury patients of both genders of all ages, presented to the ED of a quaternary care hospital in Kerala, India. Inclusion and exclusion criteria were strictly adhered to in the patient selection. MOIs in these patients were RTAs and nonaccidental (slip and fall) and accidental falls (fall from height). The clinical profile data collected, analyzed, and studied included gender, age, vital signs (heart rate and blood pressure on arrival), mechanism of injury, the need for cervical spine immobilization, the patient disposal, and GCS scores, and head injury severity based on GCS scores the last two assessed on patients' arrival, and subsequently at 2 and 4 hours after that. Results: The head injury prevalence was preponderant in the males and the age group between 20 and 50 years. Almost all the head injuries were due to high energy impacts, caused mainly through RTAs (> 2/3) and many (about 1/3) by non-accidental falls, and the last few (3%) because of accidental falls from heights. Except for a hand full of patients, all others needed cervical spine immobilization. However, all others were hospitalized in the ICU for the few duly discharged after observation in the ED, and the others were wheeled to or for emergent neurosurgical procedures after resuscitation. Based on GCS scores on arrival, the head injury severity was moderate and severe in one-fourth and one-third of the patients, respectively. There had been time bound de-escalation of the GCS scores with a proportional escalation of the severity in an appreciable number of patients. Conclusion: A part from the preponderance of head injury prevalence in the males and the second to fifth decade of life, most of the head injuries were due to high energy impacts, the majority of them being caused by RTAs and next by non-accidental falls, especially in the older adults and lastly in the least few due to accidental falls from height, often of occupational in nature. Except for very few, all others needed cervical spine immobilization and ICU care. In situations inaccessible for immediate access for Imaging, GCS scoring played a vital role in assessing and reassessing the head injury severity, which helped make patient management and transfer decisions early to prevent secondary neuronal injuries. “Most of the head injuries are often preventable.”A closer look globally at the prevailing traffic conditions, laxity in the traffic rules and regulations, including the lacuna in their implementation, would ensure safety on the road averting a high incidence of RTAs. Not only this, but also there needs to be a deep concern for the older adults succumbing to head injuries by ‘slip and fall’ and those sustaining head injuries by accidental falls from heights, mostly of occupational origin, are all of preventable nature by appropriate measures. Every health care personnel involved in the care of the head injury patients straight from the pre-hospital setup is being endorsed with the great responsibility of preventing the occurrence of secondary neuronal injuries in addition to averting further worsening of the already sustained neural damages.

Guillain-Barre Syndrome (GBS) usually present as1 symmetrical ascending muscle weakness associated with areflexia and flaccidity with or without sensory symptoms. However,2 in some patients it may present atypically and one of the rare variant is Pharyngeal-cervical-brachial variant, usually presented as muscle weakness extending from cervical area to the upper extremities often affected with proximal muscle groups. A 20-year-old male presented in ER with complaints of weakness over bilateral upper limb, dysphagia and difficulty in speaking followed by quadriparesis and breathing difficulty. Diagnosis of PCB variant was made by CSF and nerve conduction study and all other possible differentials were excluded. The patient improved by administration of iv immunoglobulin and other supportive measures. Physician should think about PCB variant of GBS, whenever a patient presenting with symmetrical upper limb weakness and bulbar palsy.