Pan African Journal of Emergency Medicine and Critical Care

Documentation practice and associated factors among nurses working in adult intensive care units at public hospitals in Addis Ababa, Ethiopia, 2022

2025-04-01T13:26:10+00:00

Background: Nursing care documentation is a vital and powerful tool in the healthcare system to ensure continuity of care and communication between health personnel for better patient outcomes. Nurses' practice towards nursing care documentation affects the quality and coordination of patient care. Hence, this study aimed to assess practice and associated factors towards nursing care documentation among nurses working at public hospitals in Addis Ababa, Ethiopia.

Methods: An institutional-based cross-sectional study was conducted among 358 nurses working in intensive care units at public hospitals in Addis Ababa from August 2021 to January 2022. All nurses were selected by proportional allocation. Data was collected by using a self-administered questionnaire and observation checklist. EPI info and SPSS were used for data entry and analysis, respectively. Binary analysis was performed to select candidate variables for multivariable logistic regression analysis. All independent variables with p-values less than 0.20 were taken as candidates for the multivariable logistic regression model. The AOR is estimated to measure the strength of the association. In the final model, a p-value of less than 0.05 at 95% CI was considered a statistically significant association.

Results: 358 respondents participated in this study, with a response rate of 97.8%. Of all the nurses who took part in the study, 61.17%) of them were females. Two hundred twenty (61.45%) of the study respondents scored as having good practice, 222 (62.01%) as having good knowledge, and 221 (61.73%) had favorable attitudes. In the final model of multivariable logistic analysis, knowledge (AOR= 1.63; 95% CI: 1.04, 2.54) and attitude of nurses (AOR= 2.30; 95%CI: 1.47, 3.58) had a statically significant association with nursing documentation practice.

Conclusion and Recommendation: This study revealed that good nursing documentation practice was 61.45 % among ICU nurses. The knowledge and attitude of intensive care unit nurses toward nursing documentation were the only factors associated with nursing care documentation practice.

Clinical pattern, management outcome, and associated factors of patients admitted to COVID-19 ICU center of St. Paul's Hospital Millennium Medical College

2025-04-03T08:45:20+00:00

Background: The coronavirus disease 2019, caused by the recent severe acute respiratory syndrome novel virus, is considered one of the greatest global public health crises by the WHO. It claimed millions of lives globally, with death occurring among populations with certain contributing factors. This study aimed to assess the clinical profile, management outcome, and associated factors of COVID-19-infected patients who were admitted to St. Paul Hospital Millennium Medical College COVID-19 ICU Center.

Methods: Institution-based cross-sectional study was conducted in St. Paul's Hospital Millennium Medical College among patients admitted to the COVID-19 ICU from June 8, 2020, to May 30, 2021. A systematic random sampling technique was applied to select eligible patients’ charts. The data were entered and analyzed using SPSS version 26. Descriptive analysis was used for statistical analysis of baseline data, and regression analysis was used to determine the association between dependent and independent variables. A p-value <0.05 was considered significant.

Results: A total data of 272 patients were analyzed, with a median age of 60.5 years and more than two-thirds, 183(67.3%) being males. Most (75.7%) had a pre-existing comorbid medical condition, and a majority (71.3%) had a COVID-19 disease of critical disease severity. Overall, the in-ICU mortality rate was 64.3%. Multivariable analysis showed that mortality was significantly associated with intubation (AOR: 2.813; 95% CI: 1.176–6.731), pulmonary embolism (AOR: 36.702; 95% CI: 4.062–331.605), Vasopressor usage (AOR: 84.954; 95% CI: 23.413–308.254), Dialysis or RRT (AOR: 4.191; 95% CI: 1.511-11.620) and ARDS (AOR: 21.149; 95% CI: 4.217–106.075) were associated with death among the studied patients.

Conclusion: The most common comorbidities were hypertension, diabetes, and CKD. Moreover, high mortality among ICU-admitted COVID-19 patients was strongly associated with septic shock with vasopressor use, ARDS, Pulmonary embolism, RRT, and intubated patients.

Rising epidemic of road traffic injuries in Ethiopia: A systematic review of available literature

2025-04-03T08:52:33+00:00

Introduction: Road traffic injury is a silent epidemic causing death in low and middleincome countries, including Ethiopia. In this systematic review, we seek to analyze road traffic injury characteristics in Ethiopia from available literatures.

Methods: An electronic search for road traffic injuries was conducted on peer-reviewed literature and websites from 1965 to 2022. A systematic narrative summary was done on the literature involving study design, study setting, topic focus, results, and other study variables. Identified themes were analyzed.

Result: A total of 451 literature search results were found in the specified period, with 33 of the studies meeting the inclusion criteria. The majority of studies (28/33) were hospital-based. In all reports, a higher proportion of injury was found in economically active age groups, with an age range of 10-50, with the highest proportion of 87.9%. Most of the studies reported a higher proportion (2/3^rd) of injuries among male patients. One study (31) gave occupational details of the patients. The majority of the road traffic victims were daily laborers 41.3%. The proportion of pedestrians affected in Addis Ababa was more than in the outskirts, ranging from 62.6-93 % (11, 22, 23), while in the regional hospitals’ report, the range was from 33.4-35.4. In regards to the causes of the accidents, indicated that 84% were due to driver error. After 2004, the incidence of car crashes rapidly increased. In central Ethiopia, the number of crashes, fatal accidents, and non-fatal road traffic collisions had increased by more than double in a six-year period.

Conclusion: This literature review has revealed the increasing burden of road traffic accidents in Ethiopia. People of low socioeconomic status, young age, male sex, and productive communities are disproportionately affected. Urgent action, focusing on human factors, should be taken to prevent road traffic injuries in Ethiopia.

Case report on atypical Guillain Barre Syndrome with bulbar dysfunction and descending paralysis

2025-04-03T09:02:40+00:00

Guillain-Barrie syndrome (GBS) is a common cause of acute flaccid, usually ascending paralysis, characterized by symmetrical weakness of the limbs and hyporeflexia or areflexia, which reaches maximum severity within 4 weeks. The motor and sensory axons of the peripheral and autonomic nervous systems may be locally or regionally involved in the atypical presentation group of Guillain-Barré syndrome. We describe the case of a male patient, age 17, who came to our ED with symptoms of bulbar dysfunction and descending arreflexic quadriparesis. A nerve conduction test confirmed the diagnosis of atypical GBS. He was treated in the emergency room with mechanical ventilation support for respiratory failure and airway protection and other fundamental supportive care like analgesia and sedation. He was then admitted to the intensive care unit (ICU) and treated for complications, such as autonomic dysfunction and ventilator-associated pneumonia that arose during his stay at the emergency room. After a three-month stay in the ICU, he was transferred to the medical ward, where he was discharged walking with support and able to feed himself with no swallowing difficulty with instructions on how to comply with ongoing medical management of his dysautonomia and follow-up.

Acute phenobarbital poisoning in a resource-limited setting: A case report of successful management through high index of suspicion and immediate care

2025-04-03T10:03:37+00:00

A 33-year-old known epileptic female patient, who has been on phenobarbital 100 mg orally once daily for the past 6 years, presented to our emergency room after she was found unconscious. On presentation, she was unable to protect her airway and had significant oral secretions upon airway examination. Glasgow Coma Scale was 3/15 with severe respiratory compromise, necessitating immediate intubation and mechanical ventilation. Due to the high index of suspicion given the clinical presentation, serum phenobarbital level was determined and had shown to be markedly elevated. Hence, the diagnosis of phenobarbital poisoning was confirmed. Following this, the patient was promptly managed with two cycles of hemodialysis. After that, the patient regained consciousness. This case led us to conclude that clinicians need to have a high index of suspicion of medication overdose in epileptic patients and, therefore, should take a thorough medication history.

Acute intentional iron overdose in pregnancy: An overview of case and treatment in a resource-limited setting

2025-04-03T10:10:46+00:00

Iron is a commonly ingested overdose medication in pregnancy, considering it is easily Iron is a commonly ingested overdose medication in pregnancy, considering it is easily accessible to pregnant women. Iron toxicity is a serious but often overlooked problem because of its unspecific and gradually developing symptoms. When Iron toxicity fails to be treated, it may sequentially undergo gastrointestinal, latent, systemic, hepatic, and obstructive stages.

This case report discusses a 21-year-old primigravida patient at 17week gestation who presented with acute iron toxicity after ingesting 76 tablets of pills containing ferrous sulfate. She presented with severe abdominal pain and persistent vomiting. This report highlights the clinical presentation, diagnostic approach, and management strategies employed to treat this rare case of severe iron toxicity during pregnancy.