National Journal of Emergency Medicine SEMI

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Volume 2, Number 1, January-April 2024
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EDITORIAL

Sowjanya Patibandla, TS Srinath Kumar, Imron Subhan, Saravana Kumar, Rajadurai Meenakshisundaram, Sudip Chakraborty, Rajani Adepu

Beyond the Crisis: How Emergency Medicine Specialist Wellness can Transform Emergency Care in India: A Position Statement from the Society for Emergency Medicine India

[Year:2024] [Month:January-April] [Volume:2] [Number:1] [Pages:5] [Pages No:1 - 5]

   DOI: 10.5005/njem-11015-0037  |  Open Access |  How to cite  | 

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Original Article

Renaldo Pavrey, Sonal Patnaik, Naiyyar H Rizvi

Perception of Emergency Medicine as a Medical Specialty among the General Public of India: A Descriptive Study

[Year:2024] [Month:January-April] [Volume:2] [Number:1] [Pages:5] [Pages No:6 - 10]

Keywords: Emergency department, Emergency medicine, General public perception, India, Medical specialty

   DOI: 10.5005/njem-11015-0033  |  Open Access |  How to cite  | 

Abstract

Background: India has struggled in establishing Emergency Medicine (EM) as a medical specialty, and providing emergency medical care. In the current scenario of India, EM is a young speciality which is in its nascent stage of development. In the past 20 years, significant progress has been made, but there is a broad estimate that over a million deaths happened in this country because of suboptimal care during the ‘Golden Hour’, or due to a lack of knowledge about an Emergency Department (ED). When the knowledge and awareness about the ED and Emergency Physicians (EP) fail to impress the patient or patient's attenders, then this question arises. Materials and methods: This study was a cross-sectional Pan-India study which was conducted using a questionnaire that asked participants about their awareness and opinion of EM as a medical specialty. Result: Among a Pan-India sample size of 1,010 majority of the participants were from the state of Odisha. Total of 74.51% considered EM as a distinct medical speciality. Emergency Physicians treated 89.71%. Participants of 63.35% chose to visit the ED when their primary caregiver or general practitioner was unavailable whereas only 39.56% visited the ED for serious medical illnesses. Conclusion: The participants of this survey had an encouraging perception of EM as a speciality and EPs as medical specialists. However, they have limited knowledge and poor expectations with regard to the ED as an autonomous department.

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Original Article

Ashwin Deepak, Rajadurai Meenakshisundaram, Salman Saeed, Hari Baskar, P Prabakaran, J Esther Monica, Athivaram Chaitanya Reddy, Nihas Babu, Anand Raj

Discerning Gradients of Paediatric Pain; Employing the Colour Analogue Scale (CAS) for Stratifying Degrees of Pain Severity in Juvenile Patients in Emergency Department

[Year:2024] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:11 - 14]

Keywords: Colour analogue scale, Convenience sampling, Emergency department, Exclusion criteria, Paediatric pain perception

   DOI: 10.5005/njem-11015-0034  |  Open Access |  How to cite  | 

Abstract

Background: This study endeavours to accurately gauge the spectrum of mild, moderate, and severe acute pain in the paediatric demographic by leveraging the colour analogue scale (CAS). The primary objectives encompass the meticulous quantification of pain gradients, delineating specific centimetre thresholds for each category. Through this, the research aims to augment precision in the realm of paediatric pain management practices. Materials and methods: This prospective study, utilising convenience sampling, focused on pain complaints in children aged 5–16 in the Emergency Department. Exclusions involved altered sensorium, clinical instability, intensive care unit (ICU) admission needs, or developmental delays. Participants used a standardised 10-cm CAS to mark and categorise their pain severity as ‘none’, ‘mild’, ‘moderate’, or ‘severe’. This approach aims to comprehensively understand paediatric pain in the Emergency Department. Results: In a cohort of 150 juveniles (mean age 10.51 years), gender distribution was balanced (48% males, 52% females). Trauma-related cases constituted 47%, with 63% falling into the low socio-economic category. Pain nature analysis revealed 47% soft painful conditions, 31% abdominal pain, and 21% headaches. Preliminary assessments showed 12% reporting no pain, 23.3% mild, 42.7% moderate, and 22% severe pain. Traumatic aetiology comprised 46.7%, primarily soft-tissue injuries. Numeric representations for pain scores were 0.56 cm (no pain), 2.03 cm (mild), 4.61 cm (moderate), and 7.62 cm (severe). Statistical analysis found no significant differences in age, gender, or aetiology concerning pain scores, but socio-economic status correlated significantly with CAS scores. A highly significant correlation was observed between pain type, pain score, and CAS score (correlation coefficient 0.903). Conclusion: This study delves into defining levels of mild, moderate, and severe pain on the CAS in paediatric cases. The insights gained provide a practical guide for promptly recognising children experiencing significant pain. The outlined scores also prove valuable for identifying eligible participants in analgesic studies. It's crucial to note the distinction in the perception of pain severity between adults, as documented in existing literature, and the nuanced paediatric perspective.

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CASE SERIES

Anurag Aggarwal, Siddharth Anand, Bhavna Gupta, Peeyuusha A Duppala

Acute Onset Visual Loss in the Emergency Department: A Case Series

[Year:2024] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:15 - 17]

Keywords: Acute onset, Case report, Emergency medicine, Visual loss

   DOI: 10.5005/njem-11015-0030  |  Open Access |  How to cite  | 

Abstract

Acute-onset visual loss is a distressing symptom encountered in emergency departments (EDs) worldwide, presenting a diagnostic challenge due to its diverse aetiologies and potential for irreversible visual impairment. We present a series of four cases illustrating different aetiologies of acute visual loss and their diagnostic and therapeutic approaches. The cases include a 73-year-old female with vertigo and previous blindness in one eye, diagnosed with a cerebrovascular event; a 19-year-old male presenting with psychogenic blindness secondary to stress; a 32-year-old female with progressive visual loss due to idiopathic intracranial hypertension; and a 61-year-old female presented with blurring of vision since last 1 day, which later progressed to bilateral complete vision loss. These cases highlight the importance of comprehensive assessment, including neuroimaging, ophthalmological evaluation, and psychiatric assessment, to optimise outcomes in patients presenting with acute visual loss in the ED setting.

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CASE REPORT

Vineeth C Karapparambil, Venugopalan Poovathumparambil, Jumeena S Maliyekkal

Role of Bedside Ultrasound in Diagnosing and Preventing Inadvertent Intra-arterial Cannulation: A Case Report

[Year:2024] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:18 - 21]

Keywords: Adverse effects, Cannula, Case report, Complications, Radial artery, Vascular access devices, Veins

   DOI: 10.5005/njem-11015-0032  |  Open Access |  How to cite  | 

Abstract

Peripheral vein cannulation is one of the commonest procedure performed in the emergency department and the veins of the forearm are the most commonly cannulated vessels. Although the aberrant course of an artery in the forearm is reported in the literature by as high as 1% of the general population, they are not given due importance during vessel cannulation. Inadvertent arterial cannulation and administration of the drug can have serious short-term and long-term consequences. This case report is about two such cases of unintentional intra-arterial cannulation of an aberrant radial artery which was confirmed with the help of a bedside ultrasound performed by the emergency physician. This case report reminds us that peripheral vein cannulation must always be done considering the possibility of an aberrant course of arteries in the forearm and performing a bedside screening ultrasound scan in the forearm can be a useful tool to prevent inadvertent intra-arterial cannulation.

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CASE REPORT

Monisha Chandrasekaran, Nithyaraj Ramanathan, Anas Mohammed Muthanikkatt, Reenaa Mohan

The Hearse Song of a Cestode

[Year:2024] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:22 - 24]

Keywords: Case report, Emergency medicine, Neurological disorders, Pain

   DOI: 10.5005/njem-11015-0031  |  Open Access |  How to cite  | 

Abstract

Neurocysticercosis (NCC) is a CNS infection with variable presentations based on cyst factors. Racemose NCC is an aggressive form of extraparenchymal NCC with high morbidity/mortality. We report a case of racemose NCC presenting with seizures in a 17-year-old male nonpork consumer. Emergency assessment enabled diagnosis via imaging/labs, identifying this rare form despite the absence of NCC risk factors. Management was initiated, with anthelmintics and monitoring leading to recovery. This case demonstrates NCC's spectrum even in unusual hosts, highlighting the need for wide diagnostics based on clinical findings when NCC likelihood is high regardless of the typical risk profile due to exposure knowledge gaps. Despite atypical features, emergency evaluation of this patient's symptoms facilitated appropriate diagnosis and life-saving racemose NCC-directed therapy. It underscores NCC's variable manifestations and reinforces employing a broad differential and individualised care based on clinical presentation rather than stereotyped expectations.

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CASE REPORT

Vivek Nanda, AN Venkatesh, B Ramesh

Upper Extremity Deep Venous Thrombosis: A Case Report

[Year:2024] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:25 - 27]

Keywords: Case report, Emergency department, Thromboembolic, Upper extremity

   DOI: 10.5005/njem-11015-0027  |  Open Access |  How to cite  | 

Abstract

Upper extremity deep venous thrombosis (UEDVT) is a lesser-known phenomenon than its lower extremity equivalent, accounting for a smaller proportion of venous thromboembolic events. Despite its modest prevalence, the condition merits attention due to its potential complications, including pulmonary embolism and chronic venous insufficiency. Whilst lower extremity deep vein thrombosis (DVT) cases frequently take the centre stage in clinical discourse, knowing UEDVT's complexities is critical for earlier intervention and improved patient outcomes. The prevalence of secondary UEDVT has been on the rise, attributed to the widespread utilisation of central venous catheters in patients with cancer and other chronic illnesses. We report a case of 51-year-old female with no co-morbidities diagnosed with UEDVT in emergency department (ED) and its pathway to successful management.

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CASE REPORT

Dinesh Kumar Madeshwaran, Kasthuri Palanisamy

Unravelling the Mysteries: A Comprehensive Exploration of Neuro-mitochondrial Disorder

[Year:2024] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:28 - 30]

Keywords: Airway, Emergency medicine, Magnetic resonance imaging brain, Neurological disorders, Safe intubation

   DOI: 10.5005/njem-11015-0028  |  Open Access |  How to cite  | 

Abstract

Leigh syndrome is a severe neurological disorder that usually becomes apparent in the first year of life. This condition is characterised by progressive loss of mental and movement abilities (psychomotor regression) and typically results in death within 2–3 years. A 6-month-old male infant was brought to ER with a complaint of irritable crying since yesterday night and had an episode of up-rolling of the eye with unresponsiveness.

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LETTER TO EDITOR

Ankur Verma, Sanjay Jaiswal

#SATisfied Airway: A Novel Concept

[Year:2024] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:31 - 33]

Keywords: Airway, First-pass success, Safe intubation

   DOI: 10.5005/njem-11015-0026  |  Open Access |  How to cite  | 

Abstract

Endotracheal intubations are routinely performed in the emergency department (ED) on a daily basis worldwide. A high percentage of first-pass success and safe intubations is a goal that every ED works toward. We introduced the novel concept of the #SATisfied airway which would help achieve high rates of first-pass success and equally high numbers of safe intubations. We have observed a marked difference in the way airways are now being managed in our department. The team has a more organised approach and strives to achieve a #SATisfied airway in every intubation attempted.

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LETTER TO EDITOR

Farzin Vajifdar

The Essence of an Emergency Department

[Year:2024] [Month:January-April] [Volume:2] [Number:1] [Pages:2] [Pages No:34 - 35]

Keywords: Emergency medicine, Emergency physician, Essay

   DOI: 10.5005/njem-11015-0035  |  Open Access |  How to cite  | 

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