Indian Journal of Emergency Medicine

Aims: Emergency medicine is a new specialty that started in India in 2012 to treat severely ill patients as soon as possible. The main principle is triage which is useful for patient treatment and counseling of attenders regarding prognosis. Material and Methods: A prospective study was conducted in the adult ED of a 1200-bed hospital. A total of thousand patients presented with acute medical conditions were included in the study. Data collected at admission included pulse rate, respiratory rate, mean arterial pressure, mental status, pulse oximetry, age, blood pressure, and Glasgow coma scale. Aim was to investigate relationship between the scoring systems to predict in-hospital mortality. Results: In our study majority of the population was male and in the age group of 21 to 30 years. Cases admitted in ICU (62%) were higher than in wards (38%).The HOTEL score showed a better prediction of mortality compared with REMS and MEWS. Conclusion: A HOTEL score of more than 1, predicts ICU admission and in-hospital mortality compared to MEWS and REMS.

Background: In emergency medicine, for sepsis, pain management and many other conditions the right interventions at the right time are essential. Patients with sepsis must be given antibiotics promptly. Likewise, effective pain relief enhances patient comfort and reduces complications. Although ED has quality assurance programs that ensure prompt care, scanty research investigates their efficiency in multi-bedded super specialty centers managing complex cases. These settings have high patient volumes and variable caseloads making it difficult to follow time-sensitive protocols. This study aims at analyzing the effectiveness of our existing QA policy of ED’s in our multi-bedded super specialty centre with a major focus on ensuring the timely administration of antibiotics for septicemia patients. In addition, we shall also assess how efficient the ED is by looking at two main time measures; medical practitioners’ initial assessment time and time from pain recognition to appropriate analgesic administration. We anticipate this will help identify gaps within the QA policy and general practices to enhance faster and better services offered across these critical areas within our emergency department. AIM: Study to evaluate the effectiveness of the existing QA policy within our multibedded super specialty center ED, with a primary focus on ensuring timely antibiotic administration for sepsis patients Analyze the ED’s performance regarding two key time metrics: 1. Initial assessment time by medical practitioners. 2. The time interval for appropriate pain medication administration. Materials and Methods: Prospective cohort study was conducted at Amrita Institute of Medical Sciences and Research Centre Kochi, India for this includes sixty two patients for primary objective. The aim is to evaluate the quality of emergency department (ED) care using direct observation of essential time intervals. Meticulous observation will be employed to collect data from patient encounters in the ED between [11/2023] to [06/2024]. This study aims at capturing and analyzing time intervals like initial assessment, ED arrival to antibiotic administration in sepsis and septic shock cases and ED arrival to analgesic administration. Patients observed would be eligible if they had presented to the ED within that period as per inclusion criteria. Patients who refuse treatment / Patients who are indecisive with regards to their care or family members denying them care will be excluded based on exclusion criteria. Result: Examining ED quality assurance, we found that 85.5% of sepsis cases received antibiotics within the recommended time frame, with mean times of 105.66 minutes for sepsis and 53.03 minutes for septic shock. In pain management, 81.5% of cases received analgesics within guidelines, with mean times of 25.36 minutes for mild pain and 15.69 minutes for severe pain. Initial patient assessments met timeliness standards in 98.3% of cases. Conclusion: The study shows that the Emergency Department (ED) strictly follows clinical guidelines for sepsis, septic shock, as well as pain treatment by presenting high adherence to antibiotic administration, and analgesic delivery. Besides, prompt and adequate initial patient evaluations show the ED’s commitment to the provision of quality healthcare services. These results uncover a strong framework for fostering ongoing improvements which means continuous efforts should be made towards optimizing ED performance to increase better results on patients’ side.

Overcrowding in Emergency Departments (EDs) is a pressing global healthcare issue that negatively impacts patient care, staff well-being, and overall healthcare system efficiency. This review explores the complex problem of ED overcrowding, examining its causes, consequences, and potential solutions. Key factors contributing to overcrowding include increased demand for emergency services, inadequate inpatient bed availability, inefficient patient flow, and limited resources and staffing. The consequences of overcrowding are severe, encompassing increased patient morbidity and mortality, prolonged wait times, higher healthcare costs, and heightened provider stress. The review synthesizes findings from systematic reviews and key studies, highlighting the detrimental effects of overcrowding on patient outcomes and the economic implications for healthcare facilities. It also discusses potential strategies to alleviate the problem, including improving patient flow, expanding access to primary care, utilizing observation units, and implementing policy interventions. By adopting a multifaceted approach, healthcare systems can improve the quality of emergency care, reduce patient harm, and enhance the working conditions for providers. This review underscores the need for a systemic strategy to address ED overcrowding effectively and ensure timely, high-quality care for all patients.

Alcoholic ketoacidosis is a severe metabolic disorder occurring in individuals with a history of binge alcohol intake. AKA diagnosis is challenging and often delayed, due to its close resemblance with DKA. AKA can turn fatal due to severe metabolic disturbances and electrolyte imbalance. In this caste report, we discuss an old age female patient brought into the ED with symptoms of AKA, the challenges faced and the diagnosis and treatment in this patient.

Rabies is fatal neglected tropical disease that is transmitted through the saliva of infected animals with rabid dogs being the common source. Postexposure prophylaxis (PEP) involving rabies vaccination is very essential to prevent the clinical symptoms. This case report examines the tragic death of a 30 year old worker from Bihar following category 3 dog bite. After receiving the initial dose of Anti Rabies Vaccine (ARV) and tetanus toxoid the patient failed to complete the PEP regimen due to various factors. Six months latter he developed the clinical features of rabies, was administered the late dose of rabies vaccine, anti-rabies serum and tetanus toxoid but his condition deteriorated leading to his demise. Neglecting the administration the administration of Anti Rabies Serum (ARS) and failure to adhere to full PEP schedule allowed the virus to progress resulting in clinical rabies symptoms and death. Proper education, counselling and follow up are crucial to ensure PEP compliance and adherence to guidelines.

Children are at risk for injuries to the tongue as their curiosity may predispose them to place different object in the mouth.1 Tissue Entrapments within Elctric nail clipper are new child hood accidents, we have encountered recently in our emergency department. The most worrisome is a tongue entrapment, it counts as airway emergency. Tongue entrapment causes excessive salivation, drooling, child faces difficulty in clearing the secretion, chances of aspiration and breathing difficulty increases and prolonged hours in resolving tongue entrapment will restrict oral intake predisposing to dehydration. Planning to maintain airway patency, oxygenation, and ventilation is critical in such soft tissue entrapment accidents. Entrapment of loose skin as happened in another case involving upper eyelid was less risky and under lying eyeball injury was less likely but chances of corneal injury with hanging electric nail clipper of eye trauma with hanging electric clipper was anticipated. Here, we report two cases, one of a 4-year-old boy presenting to a pediatric emergency department with tip of tongue stuck in electric nail clipper. Second case 6-yearold boy presented with entrapment of skin of upper eyelid in electric nail clipper though underlying eyeball and cornea was not injured but child was not able to open eye and had pain. Both entrapments were resolved dismantling the device with the help of safety team in the emergency department.Both the children had only minor injuries post removal of device requiring no additional repair and both discharged in stable condition.

Penetrating injuries to the hand and fingers are frequent in the emergency department, particularly among laborers and workers in industries such as textiles, carpentry, and construction. The management of foreign bodies in the hand remains a topic of debate. This case report discusses a 35 year-old female who presented with a metallic button embedded in her right thumb following an accidental injury while stitching. The patient was stabilized, treated with tetanus prophylaxis, pain management, and underwent an uneventful removal of the foreign body under local anesthesia in a minor operating theater. Studies indicate that hand and wrist injuries account for 10-30% of emergency visits, with complications ranging from pain and infection to functional impairment. Appropriate imaging, such as X-rays and ultrasound, is crucial for foreign body detection, especially when objects are radiolucent. Understanding hand anatomy is vital for successful and safe removal. Prompt identification and removal of foreign bodies in the hand are essential to avoid complications. Most visible foreign bodies can be managed safely in an emergency setting, with ultrasound being a preferred tool for detecting radiolucent objects due to its availability and cost-effectiveness.

Spontaneous spinal epidural hematomas (SSEH) typically happen under specific situations; rarely do they occur without any cause. The incidence of spontaneous spinal epidural hematoma is ~0.1 per 100,000 population, and male to female ratio is about 1.4:1.1 This case report is aimed at enlightening emergency physicians about the possible presence of an initial asymptomatic phase and quick progression of symptoms in patients presenting with lower back ache due to spinal epidural hematoma. Patients present initially with lower back pain, observation and close follow up are necessary. A rare case of a spontaneous spinal epidural hematoma will be described herein.

Autoimmune encephalitis is a form of brain disorder with varied presentation. Due to this reason it is usually misdiagnosed or underdiagnosed in these patients and is often confused with viral encephalitis or other pathologies. The diagnosis is always challenging as the routine blood workup and studies like the electroencephalogram and brain magnetic resonance imaging are normal. The cerebrospinal fluid analysis and immunological study is confirmatory for the disease. In this case report, we discuss a young female in her 20’s having symptoms of acute autoimmune encephalitis, the challenges in diagnosis and treatment outcome in this young female.

Spinal arteriovenous malformations (AVMs) are a rare form of spinal blood vessel defect that result in engorgement of the vessel leading to clinical manifestations due to mass effect and cord ischemia. They are a heterogeneous group that can cause acute, subacute, or chronic spinal cord dysfunction. Most of these patients present to the Emergency Department (ED) after a prolonged course with severe neurological disability. Spinal vascular lesions comprise approximately 3-4 % of all intradural spinal lesions. When it comes to clinical impact, these lesions have a comparatively worse curve when compared to their intracranial counterparts. We describe the case of a 32-year-old female with no previous medical co-morbid conditions, who presented to us with the symptoms of progressive bilateral lower limb weakness since 3 weeks, with the subsequent inability to stand. There was no urinary bladder or bowel involvement. Her physical examination was positive for lower truncal and lower limb proximal muscle weakness (left > right), with diminished sensations corresponding to the T9-T10 dermatome levels. Magnetic resonance imaging (MRI) of the thoraco-lumbar spine showed a type IV vascular malformation in the left anterior perimedullary region of T10 vertebra spanning to L1. Unfortunately, the patient left the Emergency Department against medical advice, due to severe financial constraints, and was lost to follow-up. We believe this case to be of clinical value because intradural perimedullary arteriovenous fistula are rare, with true incidence rates not yet defined. Our aim is to highlight this extremely uncommon cause of myelopathy presenting as progressive paraparesis in the Emergency Department.

Since the onset of the COVID-19 pandemic, the widespread use of alcohol-based hand sanitizers for hygiene management has significantly increased their presence in households. This case report details a rare instance of acute isopropyl alcohol poisoning (AIpAP) in a 78-year-old female, who accidentally ingested hand sanitizer, mistaking it for a beverage. The patient presented with severe symptoms, including unresponsiveness and vomiting, requiring immediate medical attention. Despite the gravity of her condition, conservative treatment led to a full recovery. This case emphasizes the urgent need for public education on the safe storage and labeling of hand sanitizers to prevent accidental ingestion and highlights the importance of considering AIpAP in the differential diagnosis of unexplained consciousness disorders.