Trauma
Em Thong Huynh; Khai Duong; Duy Khai Lam; Tung Thanh Thach; Duoc Minh Le; Bao Tu Thai Nguyen
Articles in Press, Accepted Manuscript, Available Online from 03 June 2024
Abstract
Objective: This case report aims to demonstrate an instance of superficial femoral artery (SFA) rupture after an open femoral shaft fracture.Case Presentation: Our patient was a 22-year-old man admitted to the emergency department after a motorbike accident with a deformity at the distal third of the ...
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Objective: This case report aims to demonstrate an instance of superficial femoral artery (SFA) rupture after an open femoral shaft fracture.Case Presentation: Our patient was a 22-year-old man admitted to the emergency department after a motorbike accident with a deformity at the distal third of the thigh and an open wound on the medial side. Radiographs and computed tomography angiography revealed a left distal third femoral fracture with ipsilateral SFA injury. We performed fracture reduction external fixation following SFA reconstruction using a 5-cm saphenous vein autograft. Prophylaxis fasciotomy was not performed. At a 6-month follow-up, the wound was well-healed, the Doppler ultrasound showed good blood flow at the reconstructed artery, and a rigid callus entirely covered the fracture.At 1-year follow-up, the patient could walk with full weight-bearing. Maximum knee range of motion was restored, and the patient could return to daily activities.Conclusion: Vascular injury after femoral shaft fracture is rare, and accurate diagnosis with timely and appropriate surgery plays a crucial role in achieving limb salvage, reducing the risk of complications, and improving the overall quality of patient life.
Trauma
Hashem AlKotaifan; Raghad H Abdelkader; Mohammad Alshloul; Shaher H. Hamaideh; Mohammed S. ALBashtawy; Nazzal M Alshloul; Doha M Alshloul
Volume 9, Issue 2 , July 2023, , Pages 120-126
Abstract
Objective: Trauma-informed care (TIC) is an innovative concept that recognizes the lasting impactof psychological trauma. Critical care nurses’ attitude toward TIC plays an essential role in assessing,monitoring, and addressing trauma experienced by patients. This study aimed to describe criticalcare ...
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Objective: Trauma-informed care (TIC) is an innovative concept that recognizes the lasting impactof psychological trauma. Critical care nurses’ attitude toward TIC plays an essential role in assessing,monitoring, and addressing trauma experienced by patients. This study aimed to describe criticalcare nurses’ attitudes toward TIC in critical care units at Jordanian military hospitals.Methods: This descriptive-analytical cross-sectional study was performed on 315 critical care nursesat seven military hospitals (two from the north, three from the center, and two from the south) in2022. The data collection tool was the Attitudes Related to Trauma-Informed Care-35 (ARTIC-35)scale. Multi-stage sampling approach was used to recruit critical care nurses. Statistical Package forSocial Science (IBM-SPSS) V. 23 was used to analyze data.Results: In the sample of 315 nurses, gender was significantly associated with the reactions subscale(P=0.001). Also, there were statistical differences between nurses working in the emergencydepartment and those working in intensive care units regarding the responses and behaviorssubscales, with emergency department nurses scoring higher on the scale (P=0.003). Regardingin-service training in trauma-related care, the causes subscale was significantly different based onthe number of training sessions with higher scores among nurses with higher training (P=0.02).Conclusion: Critical care nurses had an unfavorable attitude toward TIC. Health organizations, nursemanagers, universities, and other stakeholders should collaborate to achieve a national strategyto raise awareness about TIC. Much research is needed to explore nurses’ attitudes toward TIC indiverse health sectors
Trauma
Mamatha Siddalingappa Nanjappa; Anjan kumar shah; Susheen Dutt; Narahari Ranganath
Volume 9, Issue 2 , July 2023, , Pages 130-133
Abstract
Objective: Penetrating injuries in the maxillofacial region pose a great challenge due to the anatomical complexity inherent to the area compounded with vital functions such as vision and airway. This paper highlights the importance of meticulous preoperative planning and a concerted effort of a multidisciplinary ...
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Objective: Penetrating injuries in the maxillofacial region pose a great challenge due to the anatomical complexity inherent to the area compounded with vital functions such as vision and airway. This paper highlights the importance of meticulous preoperative planning and a concerted effort of a multidisciplinary team in managing penetrating maxillofacial injuries.Case Presentation: A 38-year -old man reported to the emergency department with a knife impacted in the medial wall of the orbit, travelling up to the base of the cranium. A CT scan aided in evaluating the site, depth, and relation of the foreign body to the adjacent structures. A team of oral and maxillofacial surgeons, ENT and neurosurgeon successfully retrieved the knife and the patient recovered with no morbidities.Conclusions: Penetrating injuries in the maxillofacial region are rare and there is a dearth of documentation in literature. A quick response with proper preoperative planning and a team approach is paramount in the successful management of these patients.
Emergency medicine
Shahram Paydar; Armin Akbarzadeh; Ladan Nasermoadeli; Vahid Mohammadkarimi
Volume 9, Issue 1 , January 2023, , Pages 9-12
Abstract
Objective: The adherence of the physicians to guidelines in resuscitation of the patientsis of great importance since it can predict the outcome. To evaluate the adherence of thephysicians of our center in hydration of traumatic patients with crystalloids regarding theAdvanced Trauma Life Support (ATLS) ...
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Objective: The adherence of the physicians to guidelines in resuscitation of the patientsis of great importance since it can predict the outcome. To evaluate the adherence of thephysicians of our center in hydration of traumatic patients with crystalloids regarding theAdvanced Trauma Life Support (ATLS) guidelines.Methods: We designed an algorithm obtained from ATLS guidelines using vital signsand status of bleeding of the traumatic patients to classify them. After categorizing thepatients according to the algorithm, we evaluated the adherence of the physicians to theguideline in hydration of traumatic patients with crystalloids.Results: This is a cross-sectional study in which 998 traumatic patients who were admittedto the emergency ward of Rajaee trauma hospital were enrolled. Most of the patients weremen (89.6%) and the most common causes of traumatic injuries were traffic accidents.Proper hydration was seen in only 14.7% of the patients. Most of the patients were overhydrated (85%) regarding both our algorithm and the patients’ base excess.Conclusion: The present study showed that the adherence of physicians in our centerin resuscitation with crystalloid was low. Also, most of the traumatic patients wereoverhydrated with crystalloids. It is suggested that physicians retrain concerning theside effects of over hydration. In addition, we need a user friendly and more applicableguideline for hydration with crystalloids
Emergency medicine
Zahra Rahim; Mehrdad MasoudifarI; Behzad Nazemroaya; Mehrdad Norouzi; Amirali Mousavi I
Volume 9, Issue 1 , January 2023, , Pages 25-31
Abstract
Objective: In general, spinal fusion surgery causes heavy bleeding. The purpose of thisstudy was to evaluate the use of two different doses of magnesium sulfate to control thebleeding in lumbar fusion surgery.Methods: This study was carried out as a randomized double-blinded clinical trial in 2020in ...
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Objective: In general, spinal fusion surgery causes heavy bleeding. The purpose of thisstudy was to evaluate the use of two different doses of magnesium sulfate to control thebleeding in lumbar fusion surgery.Methods: This study was carried out as a randomized double-blinded clinical trial in 2020in Al-Zahra hospital in Isfahan. The participants were 60 patients selected using inclusionand exclusion criteria and were randomly allocated into three groups. In the first group,50 mg/kg and in the second group, 40 mg/kg magnesium sulfate was infused. The thirdgroup received normal saline. From the beginning of anesthesia, heart rate, diastolic andsystolic blood pressure, respiratory rate and blood oxygen saturation percentage weremonitored and logged every 30 minutes during the operation and recovery. The volumeof bleeding during the operation was calculated by counting the number of gauzes usedand the amount of suctioned blood during the operation. Other required informationsuch as the duration of operation, duration of anesthesia, time of intubation and the timeperiod of hospitalization and recovery were determined and recorded in all patients. Weused independent t-test and repeated measure ANOVA tests to compare data betweendifferent time lines and also different groups. P value<0.05 was considered as significancethreshold. The collected data were analyzed by using SPSS software version 23.Results: The group receiving 50 mg/kg magnesium sulfate had a significantly lower systolicblood pressure compared to other groups within 15, 30 and 45 minutes after the injections(P=0.04 for all). The pulse rate was significantly lower in the 50 mg/kg magnesium sulfategroup compared to other groups within 15, 30 and 45 minutes after the injections (P<0.05for all). Patients that received 50 mg/kg magnesium sulfate had a lower duration of surgery(P=0.007), lower duration of anesthesia (P=0.007), lower bleeding volume (P<0.001),lower fluid intake (P=0.01) and also lower transfused blood (P=0.01). The surgeons alsohad a significantly higher satisfaction with these patients (P=0.001).Conclusion: Injection of 50 mg/kg magnesium sulfate had a correlation with reducedblood pressure as well as bleeding volume compared to 40 mg/kg magnesium sulfate.
Emergency medicine
Smita Bhat; Amal Suresh; Apeksha Inamdar; Anil Kumar Desai; Gopal Krishnan
Volume 9, Issue 1 , January 2023, , Pages 52-53
Abstract
Objective: Fractures of orbital rims are common and restoration of these fractures back toits normal anatomic form is essential to maintain the function and aesthetics of the eyes.Low profile miniplates are the rigid fixation device of choice for such fractures. But in caseof sagittal and grossly displaced ...
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Objective: Fractures of orbital rims are common and restoration of these fractures back toits normal anatomic form is essential to maintain the function and aesthetics of the eyes.Low profile miniplates are the rigid fixation device of choice for such fractures. But in caseof sagittal and grossly displaced fractures of orbital rims it is difficult to achieve stability byusing miniplate osteosynthesis. The low profile miniplates may not be able to withstandthe forces to reduce this kind if grossly displaced fractures, another stable option needs tobe considered in these situations.Case presentation: This case report presents a simple and effective technique of reductionand fixation of an oblique fracture of infraorbital rim fracture using lag screw principle.A standard titanium screw of 2 mm diameter and 10 mm length is being used in thedescribed technique for stable fixation of fractured segments.Conclusion: The technique is simple, hardware’s are easily available and can be practisedin emergency circumstances where newer advanced technologies are not available
Emergency medicine
Seyed Ahmad Rasoulinejad
Volume 9, Issue 1 , January 2023, , Pages 58-59
Abstract
Objective: Purtscher’s retinopathy is the retinal damage following trauma or non-traumatic systemic disease, which may contain cotton-wool spots (CWSs), and may cause Purtscher flecken, atrophy of the optic nerve, and hemorrhage of the posterior pole of the eye.Case Presentation: A 28-year-old ...
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Objective: Purtscher’s retinopathy is the retinal damage following trauma or non-traumatic systemic disease, which may contain cotton-wool spots (CWSs), and may cause Purtscher flecken, atrophy of the optic nerve, and hemorrhage of the posterior pole of the eye.Case Presentation: A 28-year-old male patient fell down from a height of 10 m and was admitted with swelling and ecchymosis of the peri-orbit of the right eye. The patient’s vision was at the level of light perception. A mild subconjunctival hemorrhage and hyphema were seen in the right eye. In the fundus, the hemorrhage, edema, and CWS were seen in the posterior pole and around the optic disk. Macular thickness (MT) in Purtscher’s retinopathic eye was 353 μm. Also, the patient had a nose and mandibular fracture and was hospitalized for several days.Conclusion: The findings indicate a decrease in the vision due to Purtscher’s retinopathy caused by trauma. There was no improvement spontaneously
Emergency medicine
Alper Alp; Burcu Arslan; Dilek Gibyeli Genek; Bülent Huddam
Volume 9, Issue 1 , January 2023, , Pages 72-75
Abstract
Objective: Rhabdomyolysis is an important etiology for developing acute kidney injury(AKI). Among the many varying reasons for rhabdomyolysis, electrical injury seems to bea lesser-known factor. The clinical presentation of rhabdomyolysis is usually in the formof severe and widespread pain, tenderness, ...
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Objective: Rhabdomyolysis is an important etiology for developing acute kidney injury(AKI). Among the many varying reasons for rhabdomyolysis, electrical injury seems to bea lesser-known factor. The clinical presentation of rhabdomyolysis is usually in the formof severe and widespread pain, tenderness, weakness in the muscles and dark urine. Itis characterized by the disruption of cell integrity in myocytes as a result of widespreaddamage to skeletal muscles and the passage of intracellular components into thecirculation.Case Presentation: Here we presented a case report of a young man who hadrhabdomyolysis induced by electrical injury which is relatively less common among theother etiological factors with preserved renal functions. He had electrical injury relatedwounds on extremities. Urgent intravenous fluid therapy was initiated as soon as hisadmission to the emergency department (ED), without delay.Conclusion: AKI is very common due to the nephrotoxic effect of myoglobinuria and theprerenal status. It is rare that AKI does not develop in patients with a severe increase increatinine kinase. It is a very important point to start effective fluid therapy in a short time.
Emergency medicine
Anton Kasatkin; Aleksandr Urakov; Alekse Shchegolev; Vadim Matreshkin; Ivan Zlobin
Volume 9, Issue 1 , January 2023, , Pages 76-78
Abstract
Objective: Ultrasound assessment of inferior vena cava (IVC) collapsibility is performed todetermine the volume status of critically ill patients. We propose a new acoustic windowfor visualizing a vein in a prone patient.Case Presentation: A healthy volunteer took part in the study. The study protocol ...
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Objective: Ultrasound assessment of inferior vena cava (IVC) collapsibility is performed todetermine the volume status of critically ill patients. We propose a new acoustic windowfor visualizing a vein in a prone patient.Case Presentation: A healthy volunteer took part in the study. The study protocol includestwo stages: 1) performing a magnetic resonance imaging (MRI) examination to determinethe projection of a certain IVC area on the posterior chest surface (holotopy), 2) performingan ultrasound scanning in the area of IVC projection in order to identify it and determineits dimensions.Conclusion: The 11th intercostal space parallel to the paraspinal line allows to visualizethe IVC in the prone position. This gives a potential opportunity to use it to assess the IVCcollapsibility. Its potential advantage is the ability to assess the compressibility of IVC inthe antero-posterior direction
Emergency medicine
Raheleh Faramarzi; Mohammad Davood Sharifi; Elnaz Vafadar Moradi; Behnaz Alizadeh
Volume 8, Issue 2 , July 2022, , Pages 95-98
Abstract
Objective: Partial dislocation of radius head (pulled elbow) is the most common trauma observed in out-patient orthopedic treatment of children. The typical mechanism of this trauma includes exertion of longitudinal force along the forearm in a pronation position, causing partial dislocation of the radius ...
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Objective: Partial dislocation of radius head (pulled elbow) is the most common trauma observed in out-patient orthopedic treatment of children. The typical mechanism of this trauma includes exertion of longitudinal force along the forearm in a pronation position, causing partial dislocation of the radius head.Methods: This Retrospective descriptive and cross-sectional study was undertaken on patients referring to the emergency ward of Imam Reza hospital of Mashhad with typical history of partial dislocation of radius head (pulled elbow). The present study was conducted between March 20, 2018 and March 20, 2019. Based on the number of patients at the emergency ward, the sample size was determined to be 80. Descriptive statistics such as mean and standard deviation were used to describe the collected data.Results: From among 80 children diagnosed with partial radius bone dislocation, 66.23% were girls and 33.77% were boys. The age range of patients was 28.08 months for girls and 31.04 months for boys. Findings also showed that 32 patients had a history of recent respiratory infection within 1 week before the pulled elbow incident.Conclusion: Findings revealed that, similar to previous studies, the pulled elbow injury was more common in girls than in boys. Successful reduction in first and second attempts, notwithstanding the maneuvers used indicated that the success rate of first attempts at reduction was 93%. The history of recent respiratory infections during 1 week before the injury was taken into account, where 40% of the children had some history of such respiratory infections.
Emergency medicine
Rahul Chaurasia; Naveen Akhtar; Subramanian Arulselvi; Vedanand Arya; Sulekha Karjee
Volume 8, Issue 2 , July 2022, , Pages 104-109
Abstract
Objective: Type and crossmatch (TC) policy is the most common approach for pretransfusion compatibility testing prior to issue of blood for transfusion. As it involvesreserving of the blood units (usually up to 72 hours) prior to issue or un-reserving, it can leadto excessive blood cross matching, inventory ...
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Objective: Type and crossmatch (TC) policy is the most common approach for pretransfusion compatibility testing prior to issue of blood for transfusion. As it involvesreserving of the blood units (usually up to 72 hours) prior to issue or un-reserving, it can leadto excessive blood cross matching, inventory management problems, undue workload,blood outdating and reagent wastage. Type and screen (TS) policy is an alternativeapproach without the need to cross match and reserve blood units prior to issue. The aimof the current study was to retrospectively assess the impact of the implementation of TSpolicy for pre-transfusion compatibility testing on blood transfusion services at an urbanlevel Ι trauma center.Methods: The study was done in two phases in the Department of Transfusion Medicineat Jai Prakash Narayan Apex Trauma Center AIIMS, New Delhi, India. Transfusion data wascollected and compared during two phases: initial phase (Oct 2016-Mar 2017) of TC policyand second phase (Apr 2017-Sept 2017) of TS policy.Results: TS policy resulted in the reduction of C:T ratio from 5.3 to 1.9. Transfusionprobability increased to 29.5% during TS policy from 23.6% during TC policy. Issuable stockindex (ISI) also showed reduction from 12.5 to 11.4 after TS policy. Wastage as percentageof issue (WAPI) was reduced from 2.3% (TC) to 1.3% (TS). TS policy also led to reductionin expenses incurred on pre-transfusion compatibility testing by 35%. No hemolytictransfusion reaction was reported during the study.Conclusion: TS policy was found to be a safe and an efficient alternative approach to TCpolicy for pre-transfusion compatibility at our center. We recommend the implementationof TS policy, but each center should first assess its feasibility based on patient population,blood bank resources and staff knowledge
Emergency medicine
Pegah Sepehri Majd; Amirhossein Alimohammadi Siyabani; Haniyeh Ebrahimi Bakhtavar; Farzad Rahmani
Volume 8, Issue 2 , July 2022, , Pages 128-133
Abstract
Objective: Awareness of the severity of trauma and the outcome of patients can help physicians decide how long to treat patients. The objective of this study is to design a new score (R-GAP: Revised-GCS, Age, Pressure) for multi-trauma patients and determine its predictive value concerning in-hospital ...
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Objective: Awareness of the severity of trauma and the outcome of patients can help physicians decide how long to treat patients. The objective of this study is to design a new score (R-GAP: Revised-GCS, Age, Pressure) for multi-trauma patients and determine its predictive value concerning in-hospital outcome of these patients.Methods: This cross-sectional study was performed in the emergency ward of Imam Reza (AS) and Shohada hospitals (referral centers for trauma patients) affiliated to Tabriz University of Medical Sciences from 2019 to 2020. The sample size of this study was estimated to be 2000 people. Required information was collected and the final diagnosis of the patients was recorded. The hospital outcome was recorded at the time of discharge. Patients’ outcome was also recorded using the Glasgow Outcome Scale (GOS) system. Based on the obtained data, GAP, R-GAP, new trauma score (NTS) scores were also collected and their results were compared with the designed model. Receiver operating characteristic (ROC) curve and logistic regression were used to analyze the predictive value of the scores.Results: The mean age of the subjects was 34.09 (± 15.23) years. The highest outcome of patients based on the GOS system was recovery, moderate disability, and severe disability with 1309 cases (54.9%), 743 cases (31.2%), and 212 cases (8.9%), respectively. The mean of GAP, R-GAP, and NTS scores were 21.83 (± 3.1), 21.47 (± 3.4), and 21.27 (± 3.3), respectively. The intensity of GAP, R-GAP, and NTS in most subjects was low with 2143 cases (89.9%), 1994 cases (83.6%), and 2138 cases (89.7%). Among the significant variables included in the regression model, O2sat, primary GCS, GAP, R-GAP, and NTS with modulation on other variables, significantly equalized the mortality chance by 0.416, 0.622, 0.595, 0.601, 0.637, respectively (P value < 0.001).Conclusion: According to the study results, it seems that GAP, R-GAP, and NTS respectively, have the highest strength of predictive value in the survival of patients with multiple traumas. It is suggested that a comprehensive study be conducted to better estimate this issue.
Emergency medicine
Khosro Ayazi; Parham Nikraftar; Hamidreza Hatamabadi; Fatemeh Shojaeian; Shervan Family
Volume 8, Issue 2 , July 2022, , Pages 145-147
Abstract
Objective: One of the most prevalent surgical emergencies is appendicitis, caused by different factors. However, its relation to trauma has not been well-known yet. Here we have described three cases with blunt abdominal trauma and a secondary diagnosis of appendicitis that were transferred to the operation ...
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Objective: One of the most prevalent surgical emergencies is appendicitis, caused by different factors. However, its relation to trauma has not been well-known yet. Here we have described three cases with blunt abdominal trauma and a secondary diagnosis of appendicitis that were transferred to the operation room.Case Presentation: Three patients suffering from blunt trauma and abdominal pain were referred to the emergency department (ED). Of these patients, one of them was transferred to the operation room (OR) with a peritonitis diagnosis and the other two patients had appendicitis signs and symptoms. The abdominal pain and related signs and symptoms of these three patients were due to appendicitis. All three patients were discharged from the hospital with normal vital signs.Conclusion: Traumatic appendicitis might be regarded as one of the differential diagnoses of the patients referred to the ED with blunt abdominal trauma and abdominal pain; hence, appendicitis and blunt abdominal trauma have some unknown relations.
Emergency medicine
Seyyed Meysam Amini; Mehriyar Yoldashkhan; Sima Zohari; Malihe Nasiri; Zahra Mousavi; Seyed Mohammad Amini
Volume 8, Issue 1 , January 2022, , Pages 8-12
Abstract
Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase ...
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Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase activity and reduces pain and inflammation. It can be considered as the strongest analgesic drug in this category. The aim of this study was to evaluate the effectiveness of ketorolac in pain management of traumatic injuries in a prehospital setting.Methods: This descriptive cross-sectional study was undertaken to evaluate the effectiveness of a treatment method in the pain management of traumatic injuries in the prehospital environment of Lorestan province in Iran. We included 134 injured patients from road emergency bases of Lorestan province. In order to control the pain of these injured patients, 30 mg of ketorolac was injected slowly intravenously in one minute. Pain was measured in the time interval of zero minutes (before injection), 15 minutes, 30 minutes, and 45 minutes by visual acuity scale (VAS). The analysis of the obtained data was performed by SPSS software version 23.Results: The mean age of participants was 37.42±23.6. There were 47 female injuries (35.1%) and 87 male injuries (64.9%). In terms of pain intensity, 49 patients (36.6%) had moderate pain (VAS = 4-6) and 85 patients (63.4%) had severe pain (VAS = 7-10). The average of pain relief in the injured group with severe and moderate pain 15 minutes after the injection was 0.471 and 0.878 (P = 0.001), respectively. In addition, the mean of pain relief in the injured group with severe and moderate pain 30 minutes after the injection was 1.124 and 1.796, respectively (P = 0.001). Pain reduction in the group of severely injured patients with moderate pain in the first 30 minutes was statistically significant.Conclusion: Findings revealed that ketorolac is a suitable drug in pain management for trauma patients with moderate and severe pain in trauma patients. On the other hand, due to the peak effect (more than 30 minutes), it is not an effective drug for trauma patients with severe pain in a short period transferred to the prehospital environment.
Emergency medicine
Vikas Bhatia; Suzanne Koshi; Varun Bansal; Uma Debi; Lokesh Singh; Manavjit Singh Sandhu
Volume 8, Issue 1 , January 2022, , Pages 13-18
Abstract
Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective ...
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Objective: Contrast-enhanced computed tomography (CECT) is the investigation of choice in trauma patients. The purpose of this study was to retrospectively evaluate the pattern, severity and association of abdominal injuries based on imaging at a high-volume tertiary trauma care centre. Methods: Retrospective evaluation of the CT records of patients over a period of 5 years was done at our institute. A total of 1519 patients who had undergone contrast-enhanced abdominal CT at a 64-slice Multidetector CT for abdominal trauma were included in this study. Inclusion criteria were: 1) History of blunt abdominal trauma, 2) Patients who had undergone a biphasic CECT abdomen scan. Exclusion criteria were: 1) Patients with penetrating injury, 2) Patients with incomplete data set/records. Results: Liver was the most common injured organ in both adult (38.8%) and paediatric population (40.9%). Significant higher incidence of mesenteric injury, bladder injury, spinal and rib fractures were seen in adult patients. Significant association of anorectal injuries (P=0.003) and bladder/urethral injuries with pelvic fractures was also seen (P <0.001). Conclusion: Our study provided important insights about the pattern, severity and association between the various abdominal injuries based on imaging findings in a large patient population. Larger studies with incorporation of clinical outcome in such patients can help in formulating appropriate management strategies.
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
Luis Miguel Castro; Rui Manuel Mendes; Coelho Fátima Borges; Capella Vanessa; Ávila Leonor
Volume 8, Issue 1 , January 2022, , Pages 80-82
Abstract
Objective: A Perforation of hollow viscus is the most common cause of pneumoperitoneumafter a blunt thoracoabdominal trauma and demands prompt surgical exploration.Alternative routes into the peritoneal cavity, such as the presence of a diaphragmaticlaceration associated with pneumothorax, although rare, ...
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Objective: A Perforation of hollow viscus is the most common cause of pneumoperitoneumafter a blunt thoracoabdominal trauma and demands prompt surgical exploration.Alternative routes into the peritoneal cavity, such as the presence of a diaphragmaticlaceration associated with pneumothorax, although rare, should be considered whenapproaching these patients.Case Presentation: We present the case of a 78-year-old male admitted to the emergencydepartment after being ran over by a car resulting in right thoracoabdominal trauma,presenting with dyspnea and signs of peritoneal irritation. CT scan identified rightpneumothorax, pneumoperitoneum and free abdominal fluid. The pneumothoraxwas drained and posteriorly he underwent exploratory laparotomy where a traumaticlaceration of the diaphragm was identified as the cause of pneumoperitoneum.Conclusion: Alternative causes of pneumoperitoneum should be considered in bluntthoracoabdominal trauma with possibility of conservative management in the absenceof peritoneal irritation signs. Pneumothorax drainage is mandatory before intubation toavoid creation of a tension pneumothorax.
Emergency medicine
Anita Sabzghabaei; Fariba Farahi; Masoud Ghanbari Boroujeni; Hamidreza Hatamabadi
Volume 7, Issue 2 , July 2021, , Pages 97-100
Abstract
Objective: The aim of this study was to determine the effect of an ultrasound training course on the performance of emergency medical technicians (EMTs) in terms of using extended-focused assessment with sonography in trauma (E-FAST) in the pre-hospital setting.Methods: In this quasi-experimental study, ...
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Objective: The aim of this study was to determine the effect of an ultrasound training course on the performance of emergency medical technicians (EMTs) in terms of using extended-focused assessment with sonography in trauma (E-FAST) in the pre-hospital setting.Methods: In this quasi-experimental study, 107 EMTs affiliated to Shahid Beheshti and Kashan Universities of Medical Sciences, were randomly selected. At first, the EMTs were given a pre-test of five images concerning normal and abnormal ultrasound views of thoracic and abdominal cavities. Then, 6 hours of theoretical and practical sessions were done by emergency medicine specialists to teach the EMTs to use ultrasound for the detection of pneumothorax and free fluid. The EMTs were tested again in the form of 18 images post-test as well as a 13-item survey to evaluate their skills in taking correct 10 E-FAST.Results: A total of 107 EMTs with the mean age of 27±15.21 and average of 3.5 years work experience participated in this study. The mean of test score increased from 0.57± 0.19 to 0.81±0.08 (with P < 0.001) out of the total score of 100. In the 4-graded survey, 98% of EMTs obtained good to excellent grades in working with ultrasound machine. Also, 50.5% of EMTs were good in taking Morison’s view and 46.6% and 45.6% had medium grades in pericardial and splenorenal views, respectively. In addition, 22.3% had weak grades in taking pericardial views.Conclusion: The results of the present study showed that the implementation of the training course significantly improved the accuracy of free fluid detection in thoracic and abdominal cavities by EMTs.
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
Mahnaz Yadollahi; sarina sahmeddini
Volume 7, Issue 2 , July 2021, , Pages 118-122
Abstract
Objective: The purpose of the current study is to determine the prevalence and pattern of maxillofacial trauma.Methods: This is a cross sectional study of maxillofacial trauma cases treated in the referral trauma center of south of Iran. Data of 264 patients were extracted from patients’ records ...
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Objective: The purpose of the current study is to determine the prevalence and pattern of maxillofacial trauma.Methods: This is a cross sectional study of maxillofacial trauma cases treated in the referral trauma center of south of Iran. Data of 264 patients were extracted from patients’ records and analyzed. Data included patient’s demographics, injury mechanism, types of maxillofacial injuries, Injury Severity Score (ISS), associated injuries, length of hospital stay and outcome. Binary logistic regression by backward method was applied to determine the effects of independent variables on mortality odds ratio.Results: 85.23% of patients were males and of all patients 87.5% survived. The mean of age was 34.95 ± 16.51. The commonest cause of maxillofacial injury was road traffic accidents (86.31%). The median of ISS was 20.39± 10.24 and patients aged 30-39 years had the highest ISS. Overall, the most common maxillofacial injuries were orbital (59.47%, n=157) followed by maxillary (48.11%, n=127); common associated injuries were related to head (81.44%, n=215) followed by thorax (58.33%, n=154). Age and gender (being male) increased the odds ratio of mortality. An increase in ISS decreased the odds ratio of mortality, but it was not significant.Conclusion: Most of maxillofacial trauma patients suffered from orbital injuries and there were a huge percentage of associated injuries. Gender (male), age and length of hospital stay were the significant variables of mortality in maxillofacial patients. The findings of the current study sheds light on further investigation to treat these patients and enforce road traffic legislation and public education to prevent these traumas.
Emergency medicine
Lalit Kumar Bansal; Raja Bhanukiran; Poras Chaudhary; Arun Kumar Gupta
Volume 7, Issue 2 , July 2021, , Pages 137-139
Abstract
Objective: objectives: Penetrating abdominal trauma secondary to bamboo stick injury is a rare entity in the developed world. Most of such kind of trans abdominal penetrating bamboo stick injury is associated with multiple solid and hollow viscus injuries. In developing countries like India, where nearly ...
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Objective: objectives: Penetrating abdominal trauma secondary to bamboo stick injury is a rare entity in the developed world. Most of such kind of trans abdominal penetrating bamboo stick injury is associated with multiple solid and hollow viscus injuries. In developing countries like India, where nearly 70% of the population reside in rural areas, it is not that uncommon. Aim of this report is to recognition of risk factors and explain optimum surgical management in trans-abdominal bamboo stick injury.Case Presentation: Here we describe a case of penetrating trans abdominal bamboo stick injury resulting due to fallover a branch of bamboo stick with multiorgan damage, which was successfully managedby early surgical exploration in our institute.Conclusion: There are many factorswhich can prognosticate the penetrating trauma cases. The most important factors includea long interval between injury and surgical exploration, presence or absence of shock, andother associated organ injuries at the time of admission. Early recognition of the severity ofinjury with surgical management is utmost necessary. These patients have high morbidityand mortality rates due to multiorgan damage and post-operative infection
Emergency medicine
Harshit Shah; Bhavin P Vadodariya; Vibhuti Jaju; Sanjay Nagral; Nitin Borle; Manoj Jain
Volume 7, Issue 1 , January 2021, , Pages 7-11
Abstract
Objective: To study the demographic profile and outcomes of pediatric trauma victims.Methods: A prospective observational study was performed at a secondary care centre in urban India over 15 months. Permission from the local ethics body was obtained prior to the commencement of the study. Children under ...
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Objective: To study the demographic profile and outcomes of pediatric trauma victims.Methods: A prospective observational study was performed at a secondary care centre in urban India over 15 months. Permission from the local ethics body was obtained prior to the commencement of the study. Children under the age of 12 years admitted with trauma to the General Surgical department were included. Demographic data, history of events leading to trauma, clinical findings and treatment were recorded. Pediatric Trauma Score (PTS), Functional Independence Measure (FIM) and Pediatric Quality of Life Index (PQLI) were used to assess the outcomes.Results: A total of 178 patients were included in the study. Preschool age group (3-5 years) (45%) was the most commonly affected. Majority of traumas occurred at home (75%). These homes were informal slum houses where children stayed in lofts. Fall from height (49%) due to fall from lofts (44%) was observed to be the most common mode of injury at home. Majority of patients had minor trauma with PTS (9-12) presenting with head injury (88%). However, only 35% had positive radiologic findings. There was a significant difference in PQLI of all patients and in FIM of preschool age group patients, irrespective of severity of trauma before admission and at one month of follow up.Conclusion: Child’s home was found as the most common site of trauma. Physical, psychosocial and cognitive impairment were seen in all pediatric trauma patients and functional impairment was seen mainly in preschool age. Majority of pediatric injuries are preventable.
Emergency medicine
Fardin Shahbazzadeh; Sajjad Narimani; Shiva Ahmadi; Zahra Anvari; Mehdi Khezeli
Volume 7, Issue 1 , January 2021, , Pages 41-45
Abstract
Objective:This study aimed to determine the motivation to helmet use among motorcyclists in Ardabil city using the trans-theoretical model (TTM) motivational interview. Methods: Random cluster sampling was used for this study. Five gas stations were selected from the crowded areas of Ardabil city and ...
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Objective:This study aimed to determine the motivation to helmet use among motorcyclists in Ardabil city using the trans-theoretical model (TTM) motivational interview. Methods: Random cluster sampling was used for this study. Five gas stations were selected from the crowded areas of Ardabil city and motorcyclists who came to these places were randomly interviewed. In this descriptive cross-sectional study, 350 motorcyclists in Ardabil were selected and interviewed by TTM Motivational questionnaire. We used one-way analysis of variance (ANOVA) and linear regression for analysis of data in SPSS software version 20. Results: Findings revealed that 12.6% of respondents consistently wore a helmet when they rode a motorcycle, while 45.2% of helmet non-wearers were uncertain about wearing a helmet in the future. Decisional balance (pros), self-efficacy (decreasing the negative affect situation score), and behavioral process of change can motivate participants to helmet use. Conclusion: Reducing negative social situations and increasing positive emotional states can motivate people to use helmet.
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.
Radiology
Mustafa Mahmood Eid; Maythem Al-Kaisy
Volume 6, Issue 2 , July 2020, , Pages 82-86
Abstract
Background:Trauma is considered to be a major cause of morbidity and mortality all over the world. This descriptive study has an emphasize on the epidemiology, mechanism and patterns of trauma, with a consideration of why trauma code was activated, and the imaging results in regard to the severity of ...
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Background:Trauma is considered to be a major cause of morbidity and mortality all over the world. This descriptive study has an emphasize on the epidemiology, mechanism and patterns of trauma, with a consideration of why trauma code was activated, and the imaging results in regard to the severity of the trauma. Method: A descriptive study was conducted in Al Ain Hospital over the year of 2017. Totally 886 patients were included who presented with a trauma and considered dangerous according to hospital guidelines. They underwent a full body trauma CT, and were admitted to the hospital. We looked at the mechanisms, patterns, time of the day and radiological findings. Injury severity score (ISS) and Revised trauma score (RTS) were calculated, and the cause of trauma code activation was evaluated.Results: The study showed that; positive imaging findings were found in 364 (41%) of patients while 522 (59%) had normal radiological tests. The principal mechanism of injury was motor vehicle accident (54.4%) followed by falls (21.4%) and pedestrian accidents (10.2%). Overall, 69.75% (618 patients) were admitted to the hospital, 22 patients (2.5 %) needed immediate interventions and 36 patients (4 %) needed ICU admission. Only 2 patients (0.25 %) died in the emergency room.Conclusion:The hospital policy in activating a trauma code should be revised, with more care being paid to the mechanisms of injury and the condition of the patient, without missing any injury that could harm the patient. So, the emergency physician should be better prepared to do a detailed physical examination and weigh the risk of radiation against missing a dangerous injury.