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Background: Pneumothorax is a potential life-threatening condition especially in patients with underlying disorders. In this study we compared the diagnostic accuracy of general practitioners and emergency medicine specialists in interpreting chest x-rays (CXR) suspected of having iatrogenic pneumothorax in emergency departments. Methods: This cross-sectional study was conducted in Shahid Chamran Hospital in Tehran, Iran during 2008- 2010. The study was designed to compare the ability of general practitioners and emergency medicine specialists in diagnosing iatrogenic pneumothorax regarding 500 CXRs of one-hundred patients admitted for upper central venous catheterization. Results: General practitioners and emergency medicine specialists could accurately (P<0.001) diagnose pneumothorax in 484 (96.8%) and 497 (99.4%) CXRs, respectively. None of the underlying causes of the condition affected the diagnostic accuracy of both physician groups (P>0.05). Conclusion: These findings indicate that the diagnostic accuracy of emergency medicine specialists is significantly higher than those of general physicians. The diagnostic accuracy of both physician groups was higher than the values in similar studies that signifies the role of relevant training given in the emergency departments of the Hospital. [ABSTRACT FROM AUTHOR]

Background: Procedural sedation in children continues to be a problem in the emergency department (ED). Midazolam is the first water-soluble benzodiazepine and it has been widely used for procedural sedation in pediatric patients. Objectives: The aim of this study was evaluation of clinical safety and effectiveness of intramuscular Midazolam for pediatric sedation in the ED setting. Materials and Methods: We performed a self-controlled clinical trial on 30 children who referred to the Baqiyatallah Hospital ED between 2009 and 2010. They received intramuscular Midazolam 0.3 mg/kg for procedural sedation and then they were followed for sedative effectiveness and safety. Vital signs and O2 saturation were also observed. The findings were compared using SPSS ver. 16 software. Results: The mean age was 5.50 ± 2.70 years, the mean weight was 19.50 ± 6.63 kilograms and 16 patients (53.3%) were females. The most common adverse effect was euphoria (66.66%) and vertigo (6.7%); 27.7% did not show any side effects. There was an overall complication rate of 72.3%. The vital signs including heart rate, respiratory rate, systolic and diastolic blood pressure and O2 saturation decreased significantly during sedation (P value < 0.05). Conclusions: Midazolam is an effective and relatively safe sedative for pediatric patients in the ED. The patient should be observed closely and monitored for psychological and hemodynamic side effects. [ABSTRACT FROM AUTHOR]

Background: The overcrowded hospital is an unsafe one. Overcrowding the emergency department (ED) results in increased patient suffering, prolonged waiting time, deteriorating level of service, and on occasion, a worsened medical condition or even death. Objectives: This study proposes a strategy to overcome ED overcrowding. Materials and Methods: The proportion of acute area admitted patients to screened patients (A/S), and the proportion of patients who were finally transferred to inpatient wards (W/A) to those admitted in ED acute area were investigated during 6 consecutive months. Emergency medicine residents were assigned to screen patients before ED admission and afterwards. Results: The average A/S changed from 82.4% to 44.2% (P = 0.028), and the average W/A changed from 28.3% to 51.48% (P = 0.028) before and after screening patients respectively. The initiative resulted in 97 less patients in the acute area per day. Conclusions: Decreased number of acute area admitted patients, and increase W/A proportion showed that the initiative was successful in obviating ED overcrowding while provision of care to those most in need was not altered. [ABSTRACT FROM AUTHOR]