Exploring the Feelings of Nurses during Resuscitation—A Cross-Sectional Study

Cardiopulmonary resuscitation (CPR) is one of the most stressful situations in emergency medicine. Nurses involved in performing basic and advanced resuscitation procedures are therefore exposed to a certain amount of stress. The purpose of this study was to determine the stressors and the level of stress experienced by nurses during resuscitation. A cross-sectional quantitative study was done. The sample consisted of 457 nurses who worked in emergency units. First demographic data were collected, followed by a questionnaire regarding the effect of different situations that occur during and after resuscitation on nurses including Post-Code Stress Scale questionnaire. The most disturbing situations for respondents were resuscitation of young person (MV = 3.7, SD = 1.4), when they fail to establish an intravenous pathway (MV = 3.5, SD = 1.4), chaotic situation during resuscitation (MV = 3.4, SD = 1.4) and making decision about termination of resuscitation (MV = 3.1, SD = 1.5). Research has shown that nurses are exposed to a certain amount of stress during resuscitation, but most of them manage to compensate for stress effectively.

Distinct effectiveness in containing COVID-19 epidemic: Comparative analysis of two cities in China by mathematical modeling

For better preparing future epidemic/pandemic, important lessons can be learned from how different parts of China responded to the early COVID-19 epidemic. In this study, we comparatively analyzed the effectiveness and investigated the mechanistic insight of two highly representative cities of China in containing this epidemic by mathematical modeling. Epidemiological data of Wuhan and Wenzhou was collected from local health commission, media reports and scientific literature. We used a deterministic, compartmental SEIR model to simulate the epidemic. Specific control measures were integrated into the model, and the model was calibrated to the recorded number of hospitalized cases. In the epicenter Wuhan, the estimated number of unisolated or unidentified cases approached 5000 before the date of city closure. By implementing quarantine, a 40% reduction of within-population contact was achieved initially, and continuously increased up to 70%. The expansion of emergency units has finally reduced the mean duration from disease onset to hospital admission from 10 to 3.2 days. In contrast, Wenzhou is characterized as an emerging region with large number of primarily imported cases. Quick response effectively reduced the duration from onset to hospital admission from 20 to 6 days. This resulted in reduction of R values from initial 2.3 to 1.6, then to 1.1. A 40% reduction of contact through within-population quarantine further decreased R values until below 1 (0.5; 95% CI: 0.4–0.65). Quarantine contributes to 37% and reduction of duration from onset to hospital admission accounts for 63% to the effectiveness in Wenzhou. In Wuhan, these two strategies contribute to 54% and 46%, respectively. Thus, control measures combining reduction of duration from disease onset to hospital admission and within-population quarantine are effective for both epicenters and settings primarily with imported cases.

Etiology and treatment modalities in epistaxis

<p><strong>Background:</strong> Epistaxis or 'hemorrhage from the nose' is a frequent presentation in the otorhinolaryngologic emergency and both conservative and surgical modalities have been used in the treatment. The present study was undertaken to estimate the proportion of patients with epistaxis who are effectively managed with conservative modalities.</p><p class="abstract"><strong>Methods:</strong> A total of 60 patients (39 males and 21 females) between 18 and 70 years, with epistaxis were studied in the department of otorhinolaryngology and emergency units of Dr. Somervell Memorial C.S.I Medical College Hospital, Karakonam, Thiruvananthapuram, between November 2018 and April 2020. The data, that is the proportion of patients who are effectively managed with conservative modalities, was entered into Microsoft - Excel sheet and analysis was done using statistical package for social sciences (SPSS) software trial version.</p><p class="abstract"><strong>Results: </strong>Out of 60 cases of epistaxis, 81.67% were effectively controlled by conservative management like general first aid (43.33%), chemical cautery (10%), and nasal packings via anterior (21.67%) and posterior (6.67%).</p><p class="abstract"><strong>Conclusions:</strong> In 81.67% nasal bleeding was effectively controlled by conservative treatment measures and in 18.33% surgical measures were required. </p>

Paediatric Trauma Burden in Tanzania: Analysis of Prospective Registry Data from Thirteen Health Facilities

BackgroundTrauma is among the leading causes of morbidity and mortality among paediatric and adolescent populations worldwide, with over ninety percent of childhood injuries occurring in low-income and middle-income countries. Lack of region-specific data on paediatric injuries is among the major challenges limiting ability to implement interventions to prevent injuries and improve outcomes. We aimed to characterise the burden of paediatric injuries seen at thirteen diverse health facilities in Tanzania.MethodsThis was a prospective descriptive cohort study of children aged up to 18 years, and presenting to emergency units (EUs) of thirteen multi-level health facilities in Tanzania from 1st October 2019 to 30th September 2020. We describe injury patterns, mechanisms and early interventions performed at the emergency units of these health facilities.ResultsAmong 18,553 trauma patients seen in all thirteen-health facilities, 4368 (23.5%) were children, of whom 2894 (66.7%) were male. The overall median age was 8 years (Interquartile range 4-12 years). Fall 1592 (36.5%) and Road Traffic Crash (RTC) 840 (19.2%) were the top mechanisms of injury. Most patients 3748 (85.8%) arrived at EU directly from the injury site, using motorized (two or three) wheeled vehicles 2401 (55%). At EU 651 (14.9%) were triaged as an emergency category. Multiple superficial injuries (14.4%), fracture of forearm (11.7%), and open wounds (11.1%) were the top EU diagnoses, while 223 (5.2%) had intracranial injuries. Children aged 0-4 years had the highest proportion (16.3%) of burn injuries. Being referred, and being triaged as an emergency category was associated with high likelihood of serious injuries with risk ratio 3.3 (95%CI 2.7-4.0) and 2.3 (95% CI 2.0-2.8) respectively. 1095 (25.1%) of patients were admitted to inpatient care and 25 (0.6%) died in the EU.ConclusionsIn these multilevel health facilities in Tanzania, paediatric injuries accounted for nearly one-quarter of all injuries. Over half of injuries occurred at home. Fall from height was the leading mechanism of injury, followed by RTC. Most patients sustained fractures of extremities. Future studies of paediatric injuries should focus on evaluating various preventive strategies that can be instituted at home to reduce the incidence and associated impact of such injuries.

Challenges Affecting Health Referral Systems in Low-And Middle-Income Countries: A Systematic Literature Review

Aims: Low and middle-income countries are still facing challenges of dysfunctional referral systems which have impaired health service provision. This review aimed at investigating these challenges to understand their nature, cause, and the impacts they have on health service provision. Methods: Database search was made in Google scholar, ACM Library, PubMed health, and BMC public health, and a total of 123 papers were generated. Only 14 fitted the inclusion criteria. Inclusion criteria included studies that were both quantitative and qualitative addressing challenges facing referral systems or health referral systems, studies describing the barriers to effective referral systems, and studies describing factors that affect referral systems. The review only included studies conducted in LMICs and included literature between January 2010 and February 2021. Findings: Results revealed that human resource and financial constraints, non-compliance, and communication are the key challenges affecting referral systems in LMICs. Recommendation: Countries that are facing these challenges need to overhaul the system and improve end-to-end communication between hospitals, improve capacity specifically in referral and emergency units, and sensitizing patients on the adherence to emergency protocols.

Initial Limb Salvage Intervention for a Mangled Lower Extremity in a Four-Year-Old Male: A Case Report of the Alternatives in Low-resource Settings

Introduction: Mangled extremity injuries in civilian settings are challenging conditions for the accident and emergency units of low-resource settings where salvage therapies may not be feasible or affordable for the patients. Case Report: We have described a successful case of initial conservative limb salvage management for a mangled distal left lower limb in a four-year-old male who sustained the injury when a vehicle ran over his extremity as he played by the road. The treatment approach was in contrast to the radical completion of amputation with its attendant revisions, which are associated with similar injuries with the mangled extremity severity scores of ≥ 7. Conclusions: The benefits and challenges of the limb salvage intervention were discussed based on the literature in this regard, and a recommendation was proposed while considering an initial conservative limb salvage approach in well-resuscitated children presenting early with a mangled extremity injury.

Incidence of Injuries, Illness and Related Risk Factors in Cross-Country Marathon Mountain Biking Events: A Systematic Search and Review

Background Cycling is a popular global sport and method of transportation and a significant contributor to admissions to hospital emergency units following an injury. Mountain biking events present additional challenges with remote venues and isolated courses, for which on-site medical care is often provided, for both injury and illness occurring during races. National health data may not represent these unique events, and specific data on incidence of injury and illness in mountain biking events are essential. Therefore, the aim of this study was to review the available injury and illness literature, reporting methods and risk factors in cross-country mountain biking. Methods Search engines PubMed, Scopus, CINAHL (EBSCOhost), Scopus, PEDro and the Cochrane Library were systematically searched, and a grey literature search was performed. Narrative analyses of the types, severity and area of injuries and illness type and severity were performed as pooling of data was impossible due to insufficient high-quality studies with the same injury and illness definitions. Results Seven studies comprising 28,021 participants were included for analysis. Four to 71% of participants sustained an injury in a cross-country mountain bike event. Injuries to the skin were the most common, followed by bony injuries and concussion. Five to 47% of cyclists reported the onset of gastrointestinal symptoms post-event. The prevalence of illness during events ranged from 0.5 to 23.0%. Conclusion The injury and illness definitions were varied and prevented clear comparisons between studies. Injury and illness present a concern in cross-country marathon mountain biking and should be investigated further to provide the true burden of these during race events. Registration: This protocol has been registered with PROSPERO International prospective register of systematic reviews (No: CRD42019134586).