Publications by authors named "Manu Ayyan"

Objectives: To better understand the clinical and radiological characteristics of Cerebral Venous Thrombosis (CVT), we conducted a study focusing on the assessment of neurological outcomes and factors associated with poor prognosis in patients with CVT.

Methods: This prospective, observational study took place over two years (July 2020 to June 2022) in a tertiary care teaching hospital in South India, encompassing adults aged 18 years and over. Key data points included demographic information, symptomatology, physical and neurological examinations, neuroimaging findings, hospital interventions, and neurological outcomes at discharge and at a six-week telephonic follow-up.

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Article Synopsis
  • The study aimed to compare the effectiveness of the bed-up-head-elevated (BUHE) position versus the supine sniffing position (SSP) during rapid sequence intubation (RSI) in the emergency department.
  • Conducted as a randomized controlled trial, the study included 136 patients and focused on intubation time, first-pass success rates, and complications after intubation.
  • Results showed no significant difference in intubation times and success rates between the two positions, but fewer post-intubation complications were observed in the BUHE group.
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Introduction: Pain, more frequently due to musculoskeletal injuries, is a prevalent concern in emergency departments (EDs). Timely analgesic administration is paramount in the acute setting of ED. Despite its importance, many EDs face challenges in pain management and present opportunities for improvement.

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Objective: The objective is to evaluate the outcome of early emergency intubation and early dialysis in formic acid (FA) poisoning and to determine the clinical features associated with its mortality.

Methods: It is a retrospective cohort study of 78 patients who presented to the emergency medicine department from July 2008 to June 2015 with alleged history and clinical features of FA poisoning. The outcome of early intubation and early dialysis was studied in terms of 7-day and 30-day mortality.

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Objectives: Early diagnosis of relative afferent pupillary defects (RAPDs) in patients with ocular trauma is crucial for timely management and improved outcomes. However, clinical examination can be challenging for patients with periorbital ecchymosis. This study aimed to compare the diagnostic accuracy of point-of-care ultrasound (POCUS) and clinical examination by emergency physicians for detecting RAPD in adult ocular trauma patients and to evaluate the proportion of RAPD in patients with ocular trauma who presented to the ED.

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Background: Serum and radiological parameters used to predict prognosis in COVID patients are not feasible in the Emergency Department. Due to its damaging effect on multiple organs and lungs, scores used to assess multiorgan damage and pneumonia such as Pandemic Medical Early Warning Score (PMEWS), National Early Warning Score 2 (NEWS2), WHO score, quick Sequential Organ Failure Assessment (qSOFA), and DS-CRB 65 can be used to triage patients in the Emergency Department. They can be used to predict patients with the highest risk of seven-day mortality and need for intensive respiratory or vasopressor support (IRVS).

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Objectives: The primary objective was to compare the analgesic efficacy of ultrasound-guided erector spinae plane block (ESPB) with a sham procedure in adult patients presenting with rib fractures to the emergency department (ED).

Methods: A randomized controlled trial was conducted at an academic ED over a 17-month period. Forty-six adults with confirmed rib fractures and numeric rating score (NRS) greater than 4 were randomized to one of two treatment arms: ultrasound-guided ESPB group or placebo (sham procedure).

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Pneumomediastinum can be primary (spontaneous) or secondary to iatrogenic, traumatic, and non-traumatic causes. The incidence of spontaneous and secondary pneumomediastinum is higher in patients with coronavirus disease 2019 (COVID-19) compared to the general population. So, pneumomediastinum should be considered in the differential diagnosis of any patient with COVID-19 presenting with chest pain and breathlessness.

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Several debriefing models have been described in the literature. However, all these debriefing models are designed in the general medical education format. Hence, for people involved in patient care and clinical teaching, sometimes it may become tedious and difficult to incorporate these models.

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Background: Trauma patients present to the emergency department with various injuries. Few injuries can be easily missed during the evaluation of polytrauma patients. We report one such rare injury in a trauma patient.

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Narrow complex tachycardia (NCT) is often due to supraventricular tachycardia (SVT). SVT with aberrancy, preexcitation, paced rhythm, rate-dependent bundle branch block, preexisting conduction defects or SVT due to drugs, and electrolyte abnormality can also be wide complex. Wide-complex tachycardia (WCT) is often ventricular tachycardia (VT), but fascicular VT (fVT) can present as NCT.

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Article Synopsis
  • Crocodile bites can result in serious injuries, particularly in the limbs, due to their powerful bite force, often leading to severe tissue damage and complications such as fractures and amputations.
  • A case study highlights a victim who suffered vascular issues, specifically thrombosis and compression of blood vessels in the leg after a crocodile bite, resulting in acute limb ischemia.
  • The patient underwent successful thrombectomy and hematoma removal, leading to full recovery without lasting physical damage, emphasizing the importance of imaging techniques in assessing injuries from crocodile bites.
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Effusive pneumothorax can be hemopneumothorax, pyopneumothorax, or hydropneumothorax depending on the type of fluid compartment within the pleural cavity. Hydropneumothorax is the abnormal collection of air and serous fluid within the pleural cavity. Here, we report a case of a 34-year-old male who presented to the emergency department with cough and breathlessness.

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Introduction: Coronavirus disease 2019 (COVID-19) is a highly contagious disease transmitted by contact, droplets, and aerosols. Front line health-care workers (HCWs), particularly emergency physicians and acute care providers, are vulnerable to being exposed while treating their sick patients. Despite appropriate personal protective equipment use, HCW gets infected, suggesting the need for multiple layers of protection such as barrier devices.

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Aortic dissection (AD) is a great imitator, and its diagnosis is quite challenging due to its varied presentations and unreliable clinical findings. Based on the literature search we found, this is the first case report of Stanford-A/DeBakey Type 1 AD reported as a triple mimic, namely stroke, acute limb ischemia, and pericarditis. Here, we describe the case of a 46-year-old male who presented to our emergency department with features suggestive of acute pericarditis, cerebrovascular accident, acute limb ischemia, which could have been attributed to athero-thrombo-embolic disease and AD could have been possibly missed.

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Background: Patients with coronavirus disease 2019 (COVID-19) commonly present with fever, constitutional symptoms, and respiratory symptoms. However, atypical presentations are also well known. Though isolated mesenteric arterial occlusion associated with COVID-19 has been reported in literature, combined superior mesenteric arterial and venous thrombosis is rare.

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has two main subspecies: subspecies (SDSD) and subspecies (SDSE). Although there are various case reports of SDSE causing clinical infection in humans, very few reports of SDSD causing human infections have been reported in the literature. As of date, there are only five case reports of infection with SDSD and all five patients survived the infection.

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