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2023 | January-April | Volume 1 | Issue 1

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Saravana Kumar

From Crisis to Care: The Spectacular Evolution of Emergency Medicine in India

[Year:2023] [Month:January-April] [Volume:1] [Number:1] [Pages:7] [Pages No:1 - 7]

   DOI: 10.5005/njem-11015-0005  |  Open Access |  How to cite  | 


Expert Review

TS Srinath Kumar

Emergency Medicine Academics in India: A Roadmap for Future

[Year:2023] [Month:January-April] [Volume:1] [Number:1] [Pages:4] [Pages No:8 - 11]

   DOI: 10.5005/njem-11015-0008  |  Open Access |  How to cite  | 


Original Article

Deepak Kishor Sharma, Sandeep B Gore

Analysis of Blood Cultures of Patients Presenting to the Emergency Department in a Tertiary Healthcare Hospital in Mumbai

[Year:2023] [Month:January-April] [Volume:1] [Number:1] [Pages:6] [Pages No:12 - 17]

Keywords: Antibiotic stewardship, Blood culture, Emergency Department, Sepsis

   DOI: 10.5005/njem-11015-0006  |  Open Access |  How to cite  | 


Aim and objectives: Analysis of blood cultures taken from patients attending emergency departments is an important exercise in determining the common pathogens prevalent in the region. The distribution of these infective pathogens keeps changing over time, and the rise in antimicrobial-resistant pathogens makes it difficult to routinely conduct effective empirical broad-spectrum antimicrobial therapy. This study aimed to analyse the results of blood cultures obtained from patients presenting to the Emergency Department of a Tertiary Healthcare Hospital in Mumbai and provide updated and detailed information on the distribution of causative pathogens in adult sepsis and study their antibiotic-susceptibility pattern. Materials and methods: A hospital-based prospective cross-sectional study of 121 positive blood culture reports was conducted at the Department of Emergency Medicine, Fortis Hospital Mulund, Mumbai, which included all adult (age > 18 yrs) suspected sepsis patients arriving to the Emergency Department whose blood cultures were sent from the Emergency Department from January 2021 to December 2021. Results: The study showed that mean age of the study cases was 59.3 years with 59.5% cases that belonged to the elderly age group with a male predominance (56.2% males–43.8% females). Overall, Gram-negative isolates were seen in 95% cases, while Gram-positive isolates were seen in only 1.7% cases. The most common organism isolated from cases with sepsis was Escherichia coli (45.5%) followed by Klebsiella (13.2%), Salmonella (10.7%), Stenotrophomonas (7.4%) and Pseudomonas (5%). Among Gram-positive organisms, Staphylococcus aureus was the most common organism isolated (1.7%). Escherichia coli isolates showed poor sensitivity towards fluoroquinolones and cephalosporins while good sensitivity towards aminoglycosides, carbapenems and combination drugs like Cefoperazone and Sulbactam and Piperacillin and Tazobactam. These findings suggest that Gram-negative organisms are the most common isolates observed in this study, with E. coli being the predominant pathogen followed by Klebsiella. High-level antimicrobial resistance was observed in sepsis cases for commonly used antimicrobials like fluoroquinolones and cephalosporins.


Original Article

Anand Raj Ramavel, Nayyara Banu, Akmal Areeb, Esther Monica Jared Premkumar

Effectiveness of Teaching and Demonstration in Improvement of Knowledge and Skill on CPR among School-going Adolescents: A Quasi-experimental Study

[Year:2023] [Month:January-April] [Volume:1] [Number:1] [Pages:5] [Pages No:18 - 22]

Keywords: Adolescents, Cardiopulmonary resuscitation, Knowledge, School-going student

   DOI: 10.5005/njem-11015-0009  |  Open Access |  How to cite  | 


Background: Cardiopulmonary resuscitation (CPR) is one of the most evolving areas of saving actions that improve the survival rates following cardiac arrest and educating high school students can play a dynamic role in case of emergencies in society. Education of school students in CPR is a strategic goal for the improvement of bystander CPR in rural society. If adolescents were trained to perform CPR during school physical education hours, this may be a cost-effective approach to CPR training. This study is conducted to assess the effectiveness of health education in the improvement of knowledge of CPR among school-going adolescents. Aim: To assess the effect of a training program on students’ knowledge of CPR. Objective: (A) To determine the background knowledge of high school students about cardiac arrest and basic life support in adult victims of cardiac arrest. (B) To determine the association between knowledge of cardiopulmonary resuscitation and skills with selected demographic variables. Materials and methods: This is a quasi-experimental study conducted among adolescents aged 13–15 years attending schools in rural areas of South India. The study was conducted between Jan 2022 and Jan 2023. 680 students were included in this study. The universal sampling method was used to enumerate the participants to reduce the impact of the dropout rate. The data was collected using a pre-tested semi-structured questionnaire by interview method. Basic teaching of CPR for the participants included 2 hours of oral teaching using lecture method, question and answer discussion method as well as 2 hours of practical session using demonstration, practice on a manikin, provision of feedback and correction of errors. Results: A total of 680 participants were grouped into three categories according to their knowledge scores: (A) fair, (B) Moderate, and (C) Good scores obtained in pre-training observation and post-training observation. Initially, there were 666 (97.9%) in the fair category, most of them improved after training as seen in the post-training observation results, with 97 (14.3%) persons in the fair (A) category. There was not a single student in the good category of the score before intervention, which increased to 665 (45.6%) in the good category of knowledge. The mean score of pre-training is 2.55, and the post-training score is significantly increased to 9.5. Conclusion: An improvement is observed in knowledge of CPR post-training with planned teaching and demonstration. Hence, this method can be considered a logical solution for improving knowledge about CPR in cases of emergency life-saving skills in a particular group of society.



Abbas Ali Khatai, Nilesh Prasad, Saumya Khard

Aortic Dissection Presenting as Acute Ischaemic Stroke and Thrombolysed: A Case Series

[Year:2023] [Month:January-April] [Volume:1] [Number:1] [Pages:3] [Pages No:23 - 25]

Keywords: Acute stroke, Aortic dissection, Case report, Thrombolysis

   DOI: 10.5005/njem-11015-0010  |  Open Access |  How to cite  | 


Acute aortic dissection (AAD) masquerading as ischaemic stroke can be a challenging diagnosis for clinicians and can pose complications for the patient. Type A dissections extending into the vessels of the brain and neck can cause cerebral hypoperfusion leading to strokes or stroke-like symptoms. Thrombolysis of ischaemic strokes caused due to aortic dissection can be catastrophic for the patient. We present a series of two cases of aortic dissection presenting as strokes which were thrombolysed and underwent surgical intervention for dissection but did not suffer catastrophic complications. We do not recommend to rule out dissection in acute stroke patients before thrombolysis.



Utsav Anand Mani, Pranay Gupta

Delayed Neurotoxic Paralysis with Confounding Hypokalaemia

[Year:2023] [Month:January-April] [Volume:1] [Number:1] [Pages:3] [Pages No:26 - 28]

Keywords: Case report, Hypokalaemia, Neurotoxic, Snake envenomation

   DOI: 10.5005/njem-11015-0002  |  Open Access |  How to cite  | 


Snakebite is a major health issue in India and developing nations across the globe. Common krait bites are associated with delayed paralysis and locked-in syndrome. Locked-in syndrome has been documented among patients of snakebite. Our case is unique due to the confounding effect of hypokalaemia which may confuse the physician as hypokalaemic periodic paralysis (HPP), a rare genetic condition which can also be precipitated by a stressful event such as snakebite. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. As krait bite are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP. We urge our fellow researchers to look out for similar findings in their patients. Key messages: Locked-in syndrome in snakebites can be due to the effect of the venom in blood onto the ventral pons. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. We presume this hypokalaemia to be nutritional in origin. As krait bites are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP.



Seetharaman Nagasubbu, Sai Surendar Mohan, Ramkumar Selvam

Anticoagulants Induced Ecchymosis

[Year:2023] [Month:January-April] [Volume:1] [Number:1] [Pages:2] [Pages No:29 - 30]

Keywords: Anticoagulants, Acenocoumarol, Case report, Ecchymosis, Haemorrhage

   DOI: 10.5005/njem-11015-0003  |  Open Access |  How to cite  | 


A case report of oral anticoagulant—acenocoumarol Induced Ecchymosis. Acenocoumarol is a coumarin derivative and vitamin K antagonist. Adverse effects like ecchymosis that is potentially fatal if not noticed with an altered coagulation profile. Initiation of safer anticoagulants for mid to long-term treatment under the supervision of coagulation profile.



A Aishwarya, Nilu Sunil

What May Stand Behind Chest Pain: A Case Report on Aortic Dissection

[Year:2023] [Month:January-April] [Volume:1] [Number:1] [Pages:5] [Pages No:31 - 35]

Keywords: Acute chest pain, Aortic dissection, Case report, CT angiography, Classification

   DOI: 10.5005/njem-11015-0004  |  Open Access |  How to cite  | 


Aortic dissection (AD) is a relatively uncommon, rare disorder and potentially misdiagnosed disease. Early diagnosis and treatment is required for the patient's survival. Aortic dissection can be fatal if misdiagnosed. A 50-year-old adult male presented to emergency with acute chest pain and having a medical history of aortic stenosis post-aortic valve replacement 9 months back and a family history of ischaemic heart disease. Pain was relieved by analgesics. After further investigations by echocardiography and CT Angiography, it was diagnosed as AD Standford type A and DeBakey type 1, in view of the critical nature of illness, patient attenders wanted only medical management. The patient was declared dead after 2 days of diagnosis.



Quiz in Emergency Medicine

[Year:2023] [Month:January-April] [Volume:1] [Number:1] [Pages:3] [Pages No:36 - 38]

   DOI: 10.5005/njem-11015-0007  |  Open Access |  How to cite  | 


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