Emergency medicine
Abdolghader Pakniyat; Farzane Jafari; Rojin Ramezani; Mohammad Ghasemi-rad
Volume 9, Issue 1 , January 2023, , Pages 54-57
Abstract
Objective: Orbital emphysema, defined as the presence of air in orbital and periorbital tissues, is a relatively uncommon clinical condition which occurs mostly following facial trauma. It can not only resolve spontaneously without any treatment, but it can also cause life threatening complications such ...
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Objective: Orbital emphysema, defined as the presence of air in orbital and periorbital tissues, is a relatively uncommon clinical condition which occurs mostly following facial trauma. It can not only resolve spontaneously without any treatment, but it can also cause life threatening complications such as pneumomediastinum (PM). PM is an uncommon complication of facial fractures and is defined as the presence of air in the mediastinal space. Developing PM following blunt trauma is commonly considered as a red flag for underlying injuries, such as trachea and esophagus rupture. Therefore, other complementary diagnostic procedures, including bronchoscopy and esophagostomy, are often necessary for patients developing this condition.Case Presentation: A 31-year-old man with a history of facial and neck trauma was presented to the emergency room of our tertiary referral hospital with a complaint of right orbital swelling. On physical examination, vital signs were stable. There was a mild swelling of right upper eyelid, but no proptosis. An hour after admission, following sneezing and blowing his nose, the patient had further swelling of his right face with extension of swelling through the right side of his neck to the nipple. He also complained of dyspnea and acute severe progressive epigastric pain.Conclusion: Orbital emphysema following orbital wall fracture is typically benign and self- limited, but physicians should be aware of serious complications such as PM. Therefore, monitoring the patient is crucial and should be considered in such ct
Zahid A Shaikh; Varsha S Shinde; Sambhaji R Shinde; Jaideo M Ughade
Volume 9, Issue 1 , January 2023, , Pages 63-65
Abstract
Objective: To demonstrate the significance of fused cervical vertebrae in emergencymedicine practice.Case report: A 35-year-old male was brought to the emergency department (ED) whoattempted suicide by hanging and was later found to have congenital fusion of cervicalvertebra C2 and C3, a condition referred ...
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Objective: To demonstrate the significance of fused cervical vertebrae in emergencymedicine practice.Case report: A 35-year-old male was brought to the emergency department (ED) whoattempted suicide by hanging and was later found to have congenital fusion of cervicalvertebra C2 and C3, a condition referred to as - vertebra critica. This is the only case reportof a patient with vertebra critica admitted for near hanging. The patient was intubatedwith a Portex® North Polar endotracheal tube (ETT) through the nasal route. This proved tobe a critical decision as it helped early airway control avoiding any complication.Conclusion: As the victims of near-hanging should have cervical spine restriction,judicious use of flexible portex® ETT may help in early intubation and resuscitationwithout aggravating the neurological injuries. It must be noted that nasal intubation iscontraindicated in base of skull fractures and it should be avoided in patients with obvioustraumatic injury to the neck including laryngeal trauma, tracheal disruption and vesselinjuries.
Emergency medicine
Garima Sharma; Sanya Vermani; Anjum Syed
Volume 8, Issue 1 , January 2022, , Pages 77-79
Abstract
Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should ...
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Objective: The presence of air within the mediastinal compartment and retro-peritoneal compartment, in the setting of trauma, can be because of visceral and skeletal injuries. However, in absence of a local site injury, an approach based on anatomical communication between various body compartments should be utilized and all potential sites of injuries must be reviewed.Case Presentation: We present a case of a 40-year-old male patient with a history of trauma (fall from height), presenting to the emergency department with loss of consciousness and ear bleed. Chest radiographs showed pneumomediastinum. On cross-sectional imaging, pneumomediastinum and pneumoretroperitoneum were seen, however no esophageal, tracheal and skeletal injuries could be identified. On careful evaluation, fractures involving the base of skull were identified as a source of ectopic air.Conclusion: This case represents a situation where the fascial connections between various compartments of the body were utilized to find the site of injury and hence the source of ectopic air. Base of skull fractures are important to be identified since these require surgical attention at an early stage.
Emergency medicine
Arash Amirrafiei; Seyyed Mahdi Zia Ziabari; Fatemeh Haghshenas-Bakerdar; Ehsan Kazemnejad-Leili; Payman Asadi
Volume 7, Issue 2 , July 2021, , Pages 101-105
Abstract
Objective: Evaluating the abilities of emergency medical services (EMS) staff who are in the frontline of the diseases could be an excellent reflection of the accuracy of curriculum both before and after graduation. This study was done to determine the clinical competencies of Guilan EMS staff in responding ...
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Objective: Evaluating the abilities of emergency medical services (EMS) staff who are in the frontline of the diseases could be an excellent reflection of the accuracy of curriculum both before and after graduation. This study was done to determine the clinical competencies of Guilan EMS staff in responding to emergency conditions using Objective Structured Clinical Examination (OSCE). Methods: In this descriptive study, 70 EMS staff from selected Emergency Centres in Guilan were recruited. Data were collected using a questionnaire and a checklist which included 9 different skills. Validity of the checklist was assessed by obtaining the opinions of 10 experts. The content validity index (CVI) and content validity ratio (CVR) of the checklist were 0.7 and 0.8, respectively. The reliability of the checklist was obtained using the test-retest method (r=0.89). In order to collect data, observations were done using the designated checklist. Data were analysed using SPSS software version 22 and descriptive statistical tests. Results: Findings showed that 56.3% of the paramedics got good scores for trauma competency but the mean scores for two competencies of spinal cord immobilization and vehicle extrication were low, indicating major skills problem. There was a statistically significant relationship between education (P=0.02) and work experience (P=0.03) as well as clinical skills in confronting trauma. Conclusion: Although the EMS staff had an acceptable range of performance in most of the skills, it seems that there is a need for training of performance-based competencies in which paramedics had a poor performance.
Emergency medicine
Majid Zamani; Maliheh Mazaheri; Farhad Heydari; Babak Masoumi
Volume 7, Issue 1 , January 2021, , Pages 17-21
Abstract
Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional ...
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Objective: Ultrasonography (US) is not the method of choice for the diagnosis of calcaneal fractures. The aim of this study was to compare the diagnostic accuracy of US with plain radiography in the diagnosis of calcaneus fractures following blunt ankle and foot trauma. Methods: In this cross-sectional study, 214 patients (over 18 years) presenting to the emergency department (ED) with suspicion of traumatic calcaneus fracture following acute blunt trauma, were enrolled. Bedside ultrasonography was performed and interpreted by emergency physicians. After that, plain radiography was performed. Furthermore, all the patients were assessed by computed tomography (CT) scan as the gold standard. Results: Finally, 193 patients were enrolled with a mean age of 29.4±15.7 years (85.5% male). Fractures in the calcaneus were detected in 49 patients. The sensitivity and specificity of ultrasonography in the detection of calcaneal fractures were 83.6%, (confidence interval (CI), 69.7 –92.2) and 100% (95% CI, 96.7 –100), while the sensitivity and specificity of X-ray were 87.7% (95% CI, 74.5 –94.9) and 100% (95% CI, 96.7 –100). There was no false positive result for X-ray and US. Conclusion: Our findings suggest that bedside US with an acceptable sensitivity and specificity can be used as a promising alternative for the diagnosis of calcaneal fracture in ED.
Emergency medicine
Seyed Reza Habibzadeh; Hamid Zamani Moghadam; Neema John Mehramiz; Mahdi Foroughian
Volume 7, Issue 1 , January 2021, , Pages 63-65
Abstract
Objective: Anterior teeth are of utmost importance with regard to chewing, speaking, and beauty. Therefore, any traumatic dental injury has psychologically undesirable effects on children and their parents. The present study reported a case of a traumatic dental injury induced by falling ...
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Objective: Anterior teeth are of utmost importance with regard to chewing, speaking, and beauty. Therefore, any traumatic dental injury has psychologically undesirable effects on children and their parents. The present study reported a case of a traumatic dental injury induced by falling off a bike and referral to an emergency department as well as measures taken for dental reconstruction and patient’s improvement.Case Presentation: An 8-year-old child was taken to an emergency department due to falling off a bike following imbalance, while suffering from dental pain in his upper jaw due to dental subluxation. Afterwards, dental retaining paste along with a fixer wire was used to maintain the position of the teeth. The patient also received oral non-steroidal analgesia (acetaminophen) for proper control of the pain and was subsequently referred to a dentist to repair the teeth. The initial examinations revealed that the child was fully conscious. Considering the patient’s severe pain and intrusion of the superior left primary first tooth and the subluxation of the superior right primary first tooth. Local anesthesia was performed using 1% lidocaine in the location of the given teeth using infiltration technique. Then they were brought into an alignment by extracting the plunged tooth and the child was referred to a dentist for advanced dental trauma care.Conclusion: Dentists are not always present in hospital emergency departments; therefore, an emergency medicine specialist should be able to diagnose common traumatic dental injuries in order to manage them appropriately at the early stages, and if necessary, refer patients to dentists for further complementary treatments. This important fact will bedone after full examination and ruling out critical causes of trauma in the emergency department.
Emergency medicine
Mishal Gillani; Sabah Uddin Saqib; Russell Seth Martins; Hasnain Zafar
Volume 6, Issue 2 , July 2020, , Pages 87-91
Abstract
Objective: Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger. It is expected to complicate around 1 in 12 pregnancies and accounts for 46% of such deaths. In this study, we present our experience of trauma during pregnancy at a tertiary care hospital ...
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Objective: Trauma is the significant non-obstetrical cause of maternal mortality in women aged 35 years or younger. It is expected to complicate around 1 in 12 pregnancies and accounts for 46% of such deaths. In this study, we present our experience of trauma during pregnancy at a tertiary care hospital in Karachi.Methods: A standardized form was used to extract data from online records for all pregnant women who presented with traumatic injuries to the Aga Khan University Hospital from 2014 to 2019.Results: A total of 48 pregnant females with a mean age of 28.80 (SD: 6.50) years were included in this study. Road traffic accidents (RTA) accounted for the commonest cause of injury in the first (66.7%) and second (65%) trimesters. However, fall (45.5%) followed by RTA (27.3%) was the most frequent mechanism of injury during the third trimester. Gunshot injuries were seen in 4 patients only. Overall, fetal ultrasound was the most commonly performed imaging (87.5%) followed by limb X-ray and focused abdominal sonography for trauma (FAST) ultrasound. Out of total, 52.1% of the patients were surgically managed. Fetal demise in utero and spontaneous abortion was reported in 2 patients only.Conclusion: Road traffic accidents and falls comprise a significant burden of maternal and fetal morbidity and mortality. In terms of prevention, several policies and interventions at the government level need to be introduced in order to reduce the incidence of traumatic events.
Emergency medicine
Seyed Reza Habibzadeh; Ehsan Bolvardi; Esmail Rayat Dost; Mahdi Foroughian
Volume 6, Issue 2 , July 2020, , Pages 109-111
Abstract
Introduction: Child abuse has been defined as allowing others to cause physical, emotional, and sexual harm, and also physical and emotional pain to a child. The present study was a report on a case of physical and sexual child abuse accompanied by traumatic brain injury (TBI) referred to an emergency ...
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Introduction: Child abuse has been defined as allowing others to cause physical, emotional, and sexual harm, and also physical and emotional pain to a child. The present study was a report on a case of physical and sexual child abuse accompanied by traumatic brain injury (TBI) referred to an emergency department.Case Presentation: A 4-year-old child was rushed into an emergency department by her mother. At the time of hospital admission, the child was feeling confused and drowsy and had symptoms of hemorrhage in the right preperitoneal space as well as bleeding from the mouth. According to the pattern of the child’s admission to the emergency department, contradictory descriptions by parents, clinical examinations, and TBI pattern; the probability of a case of child abuse was raised. Thus; neurosurgery, legal medicine, gynecology, and surgery consultations were requested. With regard to the brain injury and epidural hematoma, immediate measures (i.e. head lifting, taking Dilantin, blood glucose control, blood pressure control, and maintaining adequate oxygen saturation in the arterial blood) were taken to put a stop to secondary brain injury, and the patient was then transferred to the intensive care unit (ICU) for further treatments.Conclusion: In the present case study, the child was seriously examined and followed up. In conclusion; 20 days later, the case was discharged from the pediatric ward with good medical conditions, and received counseling and psychiatric services for one year.
Emergency medicine
Rosanna Varutti; Alessandro Mosca; Nicola Latronico
Volume 6, Issue 1 , January 2020, , Pages 50-52
Abstract
Objective: One of the most frequent causes of death and acquired disability in the pediatric population is the Traumatic Brain Injury (TBI). TBI is secondary to falls, road traffic and vehicle collisions, child abuse and assaults. Penetrating brain injury is a severe form of traumatic brain injury. Blunt ...
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Objective: One of the most frequent causes of death and acquired disability in the pediatric population is the Traumatic Brain Injury (TBI). TBI is secondary to falls, road traffic and vehicle collisions, child abuse and assaults. Penetrating brain injury is a severe form of traumatic brain injury. Blunt head injury is more frequent than TBI in children, but the second one carries a poor prognosis and a worse outcomes.Case Presentation: We report a pediatric case of penetrating craniofacial trauma, caused by a pencil in to the eye, and the successful of multidisciplinary management.Conclusion: Traumatic head injuries in children are frequently seen in the emergency ward, but the penetrating head injuries are unusual in young children. This case shows the importance of the ‘first golden hour’ after head trauma. The collaboration between team members, added to a promptly and invasive strategy, allowed to reduce neurological sequelae.
Emergency Medical Services
Bontha V Babu; Yogita Sharma
Volume 5, Issue 1 , January 2019, , Pages 2-7
Abstract
Road traffic injuries (RTIs) are the sixth leading cause of deaths in India and about 400 deaths take place every day due to road traffic accidents. The present paper analyses the data of the India’s National Crime Record Bureau (NCRB) to assess the burden of RTI. In addition, it reports the health ...
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Road traffic injuries (RTIs) are the sixth leading cause of deaths in India and about 400 deaths take place every day due to road traffic accidents. The present paper analyses the data of the India’s National Crime Record Bureau (NCRB) to assess the burden of RTI. In addition, it reports the health systems research initiated by the Indian Council of Medical Research (ICMR). As per NCRB data, in 2015, 6.3 million persons (50 persons per 10 million population) injured and out of them 1.4 million (11 persons per 10 million population) died in India. Except the NCRB data, there are no nation-wide data on RTI and the data remain poorly collected and sporadic in India. Hence, ICMR has initiated a multi-centric study to establish an electronic-based comprehensive and integrated RTI surveillance system. The second issue on which ICMR undertake research is timely and quality care of RTI patients as many deaths occur either at the scene or en route to the hospital. There is a clear survival and functional benefit for critically injured patients to receive appropriate care within the first 60 minutes of injury (‘golden hour’). Hence, this multi-centric study has been initiated to standardize structured evidence-based intervention for safety, efficacy and quality of post-crash pre-hospital and in-hospital trauma care services to improve the outcome in RTI victims. An android-based trauma registry is being built and will be used to assess the impact of interventions. These studies will provide first comprehensive estimates on various epidemiological issues related to RTI. Also, an evidence of improvement through quality post-crash prehospital and in-hospital trauma care services will emerge. These results will contribute to the setting of research and investment priorities and to formulate policies and guidelines.
Emergency medicine
Samad Shams Vahdati; Kavous Shahsavari Nia; Sarvin Dalil; Paria Habibollahi; Behzad Yousefi
Volume 3, Issue 2 , July 2017, , Pages 46-48
Abstract
Objective: Trauma is a disease of modern societies and one of the reasons for the deaths of all ages in those societies. It is estimated that each year about 8.5 million people worldwide lose their lives as a result of trauma. Among the types of injuries around the world, road accidents are more common. ...
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Objective: Trauma is a disease of modern societies and one of the reasons for the deaths of all ages in those societies. It is estimated that each year about 8.5 million people worldwide lose their lives as a result of trauma. Among the types of injuries around the world, road accidents are more common. We conducted this study to compare types of trauma in different seasons in patients referred to Imam Reza hospital trauma center in 2013. Methods: In this cross-sectional study, all trauma patients admitted to Trauma Emergency Department of Imam Reza hospital in Tabriz entered the study. As this study did not focus on the diagnosis and treatment of diseases, we used epidemiological data from history and physical examination as a source. Descriptive statistics such as frequency, percentage, mean and standard deviation were used for data analysis. All data were analyzed using SPSS version 15.0. Results: Of all 23 876 patients, 18 044 patients (75.6%) were male and 5832 (24.4%) were female. The prevalence of majority of trauma cases was 11.2% (2671) and occurred in September. Traffic accidents were the most common cause of trauma in patients with a prevalence of 33.9% (8095). Head injury had a prevalence of 38.6%. We did not find any correlation between age of patients, gender, type of injuries and the affected limb. Conclusion: Findings showed that trauma is more prevalent among males and younger people. Thus, proper planning and stringent traffic rules can reduce accident rate.
Critical Care
Haleh Mousavi; Samad Shams Vahdati; Roshan Fahimi
Volume 3, Issue 2 , July 2017, , Pages 66-67
Abstract
Invagination is a kind of intestine disease in children and it is occurred between 2 upto 14 years old. This is a report of 17 months infant with intussusception due to trauma. The patient had admitted to emergency department because of motor vehicle accident and because of abdominal pain, abdominal ...
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Invagination is a kind of intestine disease in children and it is occurred between 2 upto 14 years old. This is a report of 17 months infant with intussusception due to trauma. The patient had admitted to emergency department because of motor vehicle accident and because of abdominal pain, abdominal computed tomography (CT) scan was done.
Trauma
Gholamreza Faridaalaee; Bahman Naghipour; Sajjad Ahmadi; Seyed Hesam Rahmani
Volume 3, Issue 2 , July 2017, , Pages 68-70
Abstract
Carotid artery thrombosis and concomitant brain infarction after blunt trauma are rare conditions. We report a 34-year-old woman with multiple traumas due to pedestrian car accident. At the time of initial visiting, she was somnolent and her Glasgow coma scale (GCS) score was 14. Initial vital signs ...
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Carotid artery thrombosis and concomitant brain infarction after blunt trauma are rare conditions. We report a 34-year-old woman with multiple traumas due to pedestrian car accident. At the time of initial visiting, she was somnolent and her Glasgow coma scale (GCS) score was 14. Initial vital signs (V/S) and brain computed tomography (CT) scan were normal. One day after admission to the emergency observation unit, GCS improved to 15 but right-sided hemiparesis occurred. Magnetic resonance imaging (MRI) showed brain infarction and Doppler sonography indicated internal carotid artery thrombosis. She was admitted in the Neurosurgery ward and underwent anticoagulant therapy. With appropriate treatment, the patient’s condition improved after 5 days of admission and she was discharged on oral warfarin treatment and close follow up. Although there is no ideal treatment for traumatic internal carotid artery thrombosis, it seems that in most cases anticoagulation therapy is the preferred method of treatment but in some patients surgical or endovascular revascularization is indicated.
Trauma
Samad Shams Vahdati; Seyed Hossein Ojaghi Haghighi; Pooya Paknejad; Roshan Fahimi; Shahrad Tajoddini
Volume 2, Issue 2 , July 2016, , Pages 31-32
Abstract
Worldwide trauma is currently the sixth leading cause of death, according to 10% of mortalities (1,2). Injury impact and the death from trauma are more common in males than females. People aged between 15 and 45 years include about half of the trauma deaths (3). Citizens of low- and middle-income countries ...
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Worldwide trauma is currently the sixth leading cause of death, according to 10% of mortalities (1,2). Injury impact and the death from trauma are more common in males than females. People aged between 15 and 45 years include about half of the trauma deaths (3). Citizens of low- and middle-income countries (LMICs) account for 89% of all deaths from trauma worldwide. This is particularly because of hospitals’ lack of facilities, equipments, and peripheral care systems (4,5).
Trauma
Afsaneh Esmaeili Ranjbar; Masoud Mayel; Mitra Movahedi; Faezeh Emaeili Ranjbar; Amirhossein Mirafzal
Volume 2, Issue 2 , July 2016, , Pages 37-41
Abstract
Objective: Most previous retrospective studies failed to show a consistent association between pre-hospital time intervals and mortality in trauma patients, bringing the recommendation of “transport fast to increase survival” under question. The aim of this study was to evaluate the association ...
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Objective: Most previous retrospective studies failed to show a consistent association between pre-hospital time intervals and mortality in trauma patients, bringing the recommendation of “transport fast to increase survival” under question. The aim of this study was to evaluate the association of response time, scene time, and transport time with 24-hour in-hospital mortality.Methods: In this cross-sectional study data were collected In the emergency department (ED). Time intervals were obtained from emergency medical service (EMS) central system. All traumatized patients presented to an urban academic hospital by EMS with Emergency Severity Index (ESI) levels 1 or 2 were included in the study. Exclusion criteria were age under 16 or above 65, being transported from outside of the city, severe underlying medical illness, life threatening intoxications, and randomized trauma score (RTS) of more than 10. Patients were followed in the hospital for 24-hour mortality.Results: A total of 2884 patients were enrolled in the study. Response time, scene time, transport time, and total out of hospital time were all associated with mortality in univariate analysis (P = 0.02, 0.01, <0.001, and 0.001, respectively). In multivariate regression analysis, transport time was associated with 24-hour mortality (P < 0.001, OR [95% CI]: 1.20 [1.16-1.24]).Conclusion: Although time intervals in most previous studies did not show association with mortality, there is no recommendation such as “pre-hospital time intervals in traumatized patients should not be limited,” since limiting time intervals for taking a traumatized patient to the hospital still seems to be prudent. Our findings support the recommendation of decreasing the transportation and total out of hospital time in the present condition in Kerman city EMS system.
Trauma
Davood Soroush; Morteza Talebi Deloei; Hamidreza Reihani; Vida Vakili; Azadeh Mahmoodi Gharaee; Azadeh Tafakori; Reza Farahmand Rad; Elham Pishbin
Volume 1, Issue 2 , July 2015, , Pages 48-51
Abstract
Objective: Road traffic injuries (RTIs) are the second leading causes of death in Iran. One of the most important steps in the prevention of traffic-related trauma and its consequences is gaining insight into the epidemiology of injuries. We conducted this study to describe the characteristics of RTIs ...
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Objective: Road traffic injuries (RTIs) are the second leading causes of death in Iran. One of the most important steps in the prevention of traffic-related trauma and its consequences is gaining insight into the epidemiology of injuries. We conducted this study to describe the characteristics of RTIs and to find strategies for its prevention.
Methods: This was a prospective cross-sectional study on consecutive road traffic trauma patients admitted to the emergency department (ED) of the second largest trauma center in the northeast of Iran, during July to September 2013. Demographic characteristics, type of vehicle, and injured area of the body were documented for each patient.
Results: Of 666 included patients, 562 (84.4%) were male and 104 (15.6%) were female, with a mean age of 28.89 ± 16.62 years. Most of the patients were uneducated. The highest frequency of RTIs was related to motorcyclists with an attributed risk of RTIs for motorcycles at 75.8%. The most common traumatized area was head, face, and lower extremities.
Conclusion: The largest number of traumatized patients was among motorcyclists and uneducated population underscores the importance of public training about motorcycle usage and security and increase social awareness about reasons behind traffic law.