National Journal of Emergency Medicine SEMI

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2023 | May-August | Volume 1 | Issue 2

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Original Article

KK Shameel, Ashwathi Gangadharan, AV Gayathri

A Prospective Observational Study to Identify the Role of Magnesium as a Prognostic Indicator in Critically Ill Patients Admitted in the ICU of a Tertiary Care Centre in South India

[Year:2023] [Month:May-August] [Volume:1] [Number:2] [Pages:5] [Pages No:39 - 43]

Keywords: Critical care, Hypomagnesaemia, Magnesium, Mortality, Ventilatory support

   DOI: 10.5005/njem-11015-0017  |  Open Access |  How to cite  | 

Abstract

Introduction: Magnesium is the fourth most common cation seen in the body. The majority of the magnesium loads are concentrated in bones, soft tissues, and muscle, while only 2% is available extracellular. Magnesium plays a crucial role in regulating enzymatic activity. Serum magnesium levels are found to have a vital role in determining the clinical outcomes of critically ill patients. Aim: To estimate the proportion of critically ill patients with hypomagnesaemia and the predictive capacity of magnesium in assessing the outcome of the patient. Objectives: To estimate the proportion of critically ill patients with hypomagnesaemia and the predictive capacity of magnesium in assessing the outcome of the patient. We also tried to find the correlation between serum magnesium level and APACHE-IV score, serum potassium, need for ventilatory support and duration of ICU stay. Materials and methods: We did a prospective observational study among all critically ill patients admitted to the hospital during the study period. Serum magnesium levels were noted at the baseline, and all patients were chosen based on specific inclusion and exclusion criteria and after obtaining informed consent. The information on sociodemographic characteristics and comorbidity profiles was collected using a semi-structured questionnaire. Blood was taken to estimate serum magnesium and potassium levels and other biochemical investigations. All patients were followed up during their stay in ICU, and their clinical outcomes were noted. The association between hypomagnesaemia and other independent and outcome variables was assessed using the Chi-square test. Correlation analysis was also done to find the relation between serum magnesium and APACHE-IV scores, serum potassium, need for ventilatory support and duration of ICU stay. Results and conclusions: We recruited around 135 critically ill patients. The proportion of patients with hypomagnesaemia was found to be 58.5%. We found a statistically significant association between hypomagnesaemia and gender and potassium levels. We could not find any significant association between serum Mg levels and duration of ICU stay, need for ventilatory support and APACHE-IV score. Our study showed that the prevalence of hypomagnesaemia among the study participants was 58.5%. This highlights the burden of hypomagnesaemia and the importance of monitoring it. We observed a statistically significant relationship between gender and serum potassium level status and distribution of magnesium levels. We did not find any statistical association between APACHE-IV score, the need for ventilatory support and duration of ICU stay with the distribution of magnesium level even though we found that the proportion of hypomagnesaemia among all the clinical outcomes was found to be more when compared with normal and hypermagnesaemia patients. Hence, the importance of serum magnesium levels in critically ill patients cannot be underestimated.

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Original Article

Sohini Chatterjee

Community Awareness regarding Stroke: A Survey-based Study Involving Family of Patients Presenting to an Indian Emergency Medicine Department

[Year:2023] [Month:May-August] [Volume:1] [Number:2] [Pages:4] [Pages No:44 - 47]

Keywords: Acute ischaemic stroke, Stroke awareness, Thrombolysis

   DOI: 10.5005/njem-11015-0014  |  Open Access |  How to cite  | 

Abstract

Background and purpose: Cases of acute ischaemic strokes (AIS) has risen globally over the past two decades. Early recognition of stroke is of utmost importance for timely interventions, treatment, and better outcomes. Public awareness regarding AIS across the world is poor. We aimed to gauge the awareness levels in the population visiting our emergency department (ED). Materials and methods: This was a prospective survey-based study conducted amongst the family members accompanying patients who presented to the ED over 6 months. They were provided with a 3-part, 18-question questionnaire (English or Hindi) by emergency physicians during their respective shifts. Socioeconomic status, demographic details, and educational levels were also recorded for the respondents along with knowledge regarding strokes. Results: A total of 1,118 participants completed the survey. About 903 respondents answered they were aware regarding strokes. But only 0.8% of the total respondents were truly aware regarding strokes. And 2.21% of the respondents were partially aware regarding AIS. Family members, education, and healthcare providers (HCP) played a major role as sources of stroke knowledge (27, 26, 15% respectively). Conclusion: Our study revealed that stroke awareness in the study population was severely lacking irrespective of educational level. Media (print, television, and radio) needs to play a big role along with HCPs in mass dissemination regarding AIS in the population.

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Original Article

Digvijay Adake, Pushpraj Singh, Rajesh Ursekar, Elizabeth Sada, Firdaus Bhot, Sushma Shriyan

A Clinical Overview of Patients Presenting to ER with Myocardial Infarction Assessed by ESI

[Year:2023] [Month:May-August] [Volume:1] [Number:2] [Pages:4] [Pages No:48 - 51]

Keywords: Chest pain, Emergency severity index, Myocardial infarction

   DOI: 10.5005/njem-11015-0013  |  Open Access |  How to cite  | 

Abstract

Objectives: The objective of the study is to assess patients with chest pain in ER with the perspective of classifying them according to emergency severity index (ESI) and understanding the outcomes and various parameters according to ESI. Materials and methods: This study is a longitudinal observational study. Collection of data for 100 patients was done. Compilation of data and their statistical analysis were performed. Results: Gender is significantly associated with ESI (p-value = 0.020). Patients with ESI-III category had significantly lower age than the patients with ESI-I and II categories. There was no association of ESI category with hypertension, diabetes mellitus, IHD, and COPD. Smoking history was significantly associated with the ESI category. Exercise and vegetarian habits were not associated with ESI. Conclusion: Gender exhibited a significant association with ESI classification, revealing gender-related differences in severity distribution. This is a first of its kind study done where patients with chest pain are seen from the ESI point of view. We urge other centres to perform this study so that a wider consensus can be reached.

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CASE REPORT

Renaldo Pavrey, Vikrant Chouhan, Aakanksha Goyal

A Rare Case of Anterior Communicating Artery Aneurysm Rupture Presenting as Perimesencephalic Subarachnoid Haemorrhage

[Year:2023] [Month:May-August] [Volume:1] [Number:2] [Pages:4] [Pages No:52 - 55]

Keywords: ACom aneurysm, Case report, Perimesencephalic, Subarachnoid haemorrhage

   DOI: 10.5005/njem-11015-0012  |  Open Access |  How to cite  | 

Abstract

Perimesencephalic subarachnoid haemorrhage (PMSAH) is a distinct pattern of non-aneurysmal subarachnoid haemorrhage (SAH) centred on the basal cisterns around the midbrain. It is rare, with an incidence of 0.5 in 1,00,000 adults. Also, PMSAH represents 5–10% of all SAHs and nearly 33% of all non-aneurysmal SAH. While 95% of PMSAH are non-aneurysmal, 5% of cases are due to a vertebrobasilar aneurysm. We present the case of a 59-year-old female with PMSAH in whom the source of the bleeding was localised to a ruptured anterior communicating artery (ACom) aneurysm. In our report, we highlight the characteristic neuroimaging findings of PMSAH, the importance of digital subtraction angiography (DSA), and the necessity for an interdisciplinary approach in the management of such cases. Our reason for highlighting this case is that PMSAH is a rare cause of non-traumatic, predominantly non-aneurysmal SAH. In the setting of a ruptured ACom artery aneurysm, we believe the uniqueness of this case gets elevated.

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CASE REPORT

Rajesh Adangi, Manjith Kothapalli Sekhar, Harish Telu

A Case Report of BRASH Syndrome (Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalaemia)

[Year:2023] [Month:May-August] [Volume:1] [Number:2] [Pages:3] [Pages No:56 - 58]

Keywords: AV blockade, Bradycardia, Brash syndrome, Case report, Hyperkalaemia, Renal failure, Shock

   DOI: 10.5005/njem-11015-0015  |  Open Access |  How to cite  | 

Abstract

This case report discusses BRASH syndrome, characterized by bradycardia, renal failure, AV blockade, shock, and hyperkalaemia. It typically arises from the interaction between high potassium levels and drugs that affect the AV node, often triggered by factors like low blood volume or medications promoting hyperkalaemia or kidney damage. Patients with BRASH syndrome display various symptoms and are often critically ill, but early recognition can lead to effective treatment and better outcomes.

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LETTER TO THE EDITOR

Sudhakar Dhanapal Geratala

The Role and Impact of Simulation in Emergency Medicine

[Year:2023] [Month:May-August] [Volume:1] [Number:2] [Pages:2] [Pages No:59 - 60]

Keywords: Emergency medicine, Patient safety, Simulation

   DOI: 10.5005/njem-11015-0016  |  Open Access |  How to cite  | 

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