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.
Trauma
Ramin Shahbad; Mohsen Mortazav; Fereshteh Alizadeh-Fard; Zeinab Mohammadi; Fatemeh Alavi; Mohammed N. Ashtiani
Volume 6, Issue 1 , January 2020, , Pages 28-32
Abstract
Objective: Femur is the strongest, longest and heaviest bone in the human body. Due to the great importance of femur in human body, its injury may cause large numbers of disabilities and mortality. Considering various effective parameters such as mechanical properties, geometry, loading configuration, ...
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Objective: Femur is the strongest, longest and heaviest bone in the human body. Due to the great importance of femur in human body, its injury may cause large numbers of disabilities and mortality. Considering various effective parameters such as mechanical properties, geometry, loading configuration, etc. can propel the study to the trustable results.. Methods: A 3D finite element model of the femur was subjected to different impact loading and orientations and also material properties. In addition to a reference healthy model of analysis, a total of 14 cases including four different loading conditions, six different bone density conditions and four different load orientations were considered. Results: Findings showed that the models with higher bone density cannot considerably reduce the stress under the impact loadings but porous models receive high mechanical stress which the bone prone to injury. The stress and displacement of the bone model received more values distributed through the femoral neck. Conclusion: Porous bone models had greater stress values under an impact load. Higher and faster impacts may create multi-fracture breaks of the femur. The inferior femoral neck regions are the most vulnerable part in response to the impacts.
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 medicine
Vahid Abbasi; Abolfazl Atalu; Afshan Sharghi; Fatemeh Taghvatalab
Volume 5, Issue 2 , July 2019, , Pages 47-50
Abstract
Objective: Currently, treating ischemic stroke by intravenous thrombolytic therapy has acceptable results in patients with stroke. This study aimed to evaluate the three months prognosis of patients treated with recombinant tissue plasminogen activator (rt-PA).Methods: This cross-sectional prospective ...
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Objective: Currently, treating ischemic stroke by intravenous thrombolytic therapy has acceptable results in patients with stroke. This study aimed to evaluate the three months prognosis of patients treated with recombinant tissue plasminogen activator (rt-PA).Methods: This cross-sectional prospective study was conducted on 30 patients with cerebral ischemic stroke with the National Institutes of Health Stroke Scale (NIHSS) >5. Data such as demographic information, signs and symptoms, medical history, risk factors, focused neurological examination, and the NIHSS were collected for all patients. Then, all patients received 0.9 mg/kg of rt-PA as intravenous bolus doses and intravenous infusion under close monitoring in the emergency department. All patients were checked for necessary outcomes and also disability at the admission time, 7 days later and after three months all patients were checked again. All collected data were analyzed by appropriate tests using SPSS version 22.Results: Of all patients, 63.3% were males and 36.7% were females. The mean age of the patients was 62.37 ± 12.62 years with a range of 40-91 years. The mean of NIHSS was 12.46 ± 4.28 at admission time, in day seven it was 8.06 ± 3.72 and in month three after treatment it was 3.62 ± 2.31. There was a significant relationship between age, place of residence and NIHSS. Thirty percent of patients had NIHSS more than 15 at admission time and after 7 days this rate reached to 10% and three months later it declined to 6.7%. These differences were statistically significant.Conclusion: Intravenous thrombolytic therapy is associated with proper short term results in most patients with ischemic stroke.
Emergency medicine
Mohammad Hasan Lotfi; Hossein Lashkardoost; Andishe Hamedi
Volume 5, Issue 2 , July 2019, , Pages 51-55
Abstract
Objective: The rate of road traffic accidents in Iran per capita and for the number of vehicles is much higher than the average in the world. The present study was conducted to investigate road traffic accidents in Yazd province during 2011-2015.Methods: The present study is a descriptive-analytic study ...
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Objective: The rate of road traffic accidents in Iran per capita and for the number of vehicles is much higher than the average in the world. The present study was conducted to investigate road traffic accidents in Yazd province during 2011-2015.Methods: The present study is a descriptive-analytic study in which data were obtained from data collection forms related to deaths from driving accidents of forensic medicine organizations. Data were entered into SPSS version 23. We calculated the frequency, percentage, and mean indices. We used Fisher exact test for data analysis.Results: In this research, 1437 individuals were studied. The number of deaths in men was three times more than women. Most fatal accidents occurred in the age group of 20-30 years. The most common accident which occurred during these years was the collision of vehicles with each other and in terms of the final cause of death, 1045 people died due to head injuries. In this study, we showed that the incidence decreased from 29.03 in 2011 to 22.03 in 2015.Conclusion: According to the results of this study, the most cases of fatal accidents occurred in the age group of 20-30 years, in people with elementary education and in the summer. Therefore, preventive action is necessary by raising awareness.
Emergency medicine
Hassan Amiri; Mojtaba Chardoli; Maryam Sarvari; Samad Shams Vahdati; Niloufar Ghodrati; Roshan Fahimi
Volume 5, Issue 2 , July 2019, , Pages 56-60
Abstract
Objective: This study investigates the possible magnetic resonance imaging (MRI) findings in patients with cervical trauma having a normal level of consciousness and normal CT reports. These patients have tenderness or an uncomfortable feeling in the traumatized area as well.Methods: In this cross-sectional ...
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Objective: This study investigates the possible magnetic resonance imaging (MRI) findings in patients with cervical trauma having a normal level of consciousness and normal CT reports. These patients have tenderness or an uncomfortable feeling in the traumatized area as well.Methods: In this cross-sectional anterograde study, cases were selected among patients referred to the emergency department of Hafte Tir, Iran University of Medical Sciences from 2012 to 2014. Inclusion criteria to select cases were: age above 15, blunt neck trauma, GCS=15, normal CT scan reports of neck, no past medical history of cervical vertebral surgery, and no persistent neurologic lesions. In order to analyse qualitative data, chi-square test was used and for quantitative data t test was applied accordingly.Results: Two hundred eighty patients with chief complaints of neck pain due to trauma entered our study. Among this batch, 264 of them had normal CT scan reports and MRI was done for all of them. According to the results, the maximum injury in MRI was related to intervertebral disc injury (38 cases), ligamentous edema (35 cases), and muscle edema (22 cases), respectively. Neck tenderness from the beginning of the accident and transient neurologic signs had a significant role in MRI results (P < 0.05).Conclusion: In patients with acute cervical trauma having normal CT reports, MRI must be done in those with the average age of 45 or more, tenderness in the neck area, and in those with neurologic transient symptoms.
Emergency medicine
Nahid Zamanimehr; Samad Shams Vahdati; Hamed Hojjatpanah
Volume 5, Issue 2 , July 2019, , Pages 61-64
Abstract
Objective: Fluid resuscitation is necessary in almost all critical patients. The central venous pressure (CVP) is a well-established method of assessing resuscitation. Recently, there have been attempts to investigate less invasive methods like the diameters of inferior vena cava (IVC) or the jugular ...
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Objective: Fluid resuscitation is necessary in almost all critical patients. The central venous pressure (CVP) is a well-established method of assessing resuscitation. Recently, there have been attempts to investigate less invasive methods like the diameters of inferior vena cava (IVC) or the jugular vein. We aimed to investigate this method in our research.Methods: Seventy eight critical patients admitted to the emergency department from April 2018 to December 2018 were studied. The CVP was measured along with the diameters of the two mentioned veins before and during resuscitation. The urinary output was also recorded after administering the fluid. The minimum p-value that would illustrate a significant association was equal to 0.05.Results: Findings showed that 53.8% of patients were males and 46.2% were females with an average age of 71.48 years. The causes of the critical state were 25.6% hemorrhagic shocks, 30.8% septic shocks and 43.6% hypovolemic shocks. The mean diameter of the jugular vein before and during resuscitation was 27.21 mm and 25.38 mm, respectively (P = 0.1). The mean of IVC diameter before and during resuscitation was 63.33 mm and 57.98 mm, respectively (P <0.001). The CVP was 4.23 mmHg before resuscitation and 5.61 mmHg after resuscitation (P <0.001). With an average urine output of 201.28 cc, a significant correlation was observed with the increase in the CVP, while no such correlations were observed with the decreasing state of the diameters of the IVC or the jugular vein.Conclusion: Both the IVC diameter and the jugular vein diameter are unable to assess fluid resuscitation independently from respiratory factors
Emergency medicine
Esmaeil Fakharian; Zahra Sehat; Mojtaba Sehat
Volume 5, Issue 2 , July 2019, , Pages 65-70
Abstract
Objective: Traumatic spine injuries are seriously important and are associated with considerable morbidity and mortality. The goal of this study is to determine the epidemiology of the traumatic spine injuries in Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS), the main trauma ...
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Objective: Traumatic spine injuries are seriously important and are associated with considerable morbidity and mortality. The goal of this study is to determine the epidemiology of the traumatic spine injuries in Shahid Beheshti Hospital of Kashan University of Medical Sciences (KAUMS), the main trauma center in Kashan, Iran.Methods: This cross-sectional study was undertaken on all cases of traumatic spinal injuries that were admitted to Shahid Beheshti hospital of KAUMS from 2014 to 2017. A checklist was used to collect demographic characteristics (age, gender, education, marital) and mechanism of the injury of the spine. According to ICD-10, the level of the injury was detected by diagnostic tests such as radiologic imaging and magnetic resonance imaging and computed tomography scans, and also multi-trauma final outcome of the patients with traumatic spine injury (TSI) and rate of the spinal cord injury (SCI), hospital length of stay and surgery treatment was investigated.Results: The number of patients with traumatic spine injuries was 986. Among this batch, 77% were males. The mean age of the patients was 39.5 years. Most injuries occurred in the age group of 15 to 30 years. Traffic accident was the most common mechanism of the trauma (35.2%) followed by the falls (26.95%) motorcycle accident (17.9%), assault by a sharp object or an unspecified object (10.13%) and other reasons (5.6%). The most common site of injury was in lumbar section (24.41%). Patients with traffic accident injury had the longest hospitalization. The rate of SCI was 2.63% and the rate of mortality was 2.3%.Conclusion: The TSI is an important and serious public health problem and a major cause of disability. Understanding the epidemiology can help us contrive appropriate preventative measures.
Trauma
Seyyed Mahdi Mirhamidi; Davood Soroosh; Alireza Abadi; Elahe Fahimi
Volume 5, Issue 2 , July 2019, , Pages 75-77
Abstract
Compartment syndrome is a rare vascular disorder and an orthopedic emergency caused by high intramuscular pressure following bone fractures and some other etiologies. It mostly involves extremities, but can affect other parts of the body. The syndrome is diagnosed based on extensively varying signs and ...
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Compartment syndrome is a rare vascular disorder and an orthopedic emergency caused by high intramuscular pressure following bone fractures and some other etiologies. It mostly involves extremities, but can affect other parts of the body. The syndrome is diagnosed based on extensively varying signs and symptoms including feeling pain, pallor, pulselessness, and some other signs among patients. It causes irreversible complications that may even lead to death in some cases. If not treated promptly, muscle and nerve necrosis, myoglobinuria, and ultimately extremity gangrene and renal failure may occur. Timely diagnosis requires close attention to patient’s signs and symptoms and repeated measurements of pressure in the compartment. The reported case was an 11-year-old girl suffering from a closed double fracture in her forearm following blunt trauma. Inappropriate treatment done by a local therapist resulted in compartment syndrome. The aim of this study was to obtain an accurate knowledge on it and to do timely action when facing with this syndrome.
Emergency medicine
Mohit Kumar Arora; Ela Madaan; Sandeep Kumar
Volume 5, Issue 2 , July 2019, , Pages 78-80
Abstract
Simultaneous fracture of lateral condyle and medial epicondyle of humerus along with elbow dislocation is very rare injury in adults. Only a few cases have been reported in literature in pediatric age groups. The authors describe a case report of fracture of lateral condyle and medial epicondyle of humerus ...
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Simultaneous fracture of lateral condyle and medial epicondyle of humerus along with elbow dislocation is very rare injury in adults. Only a few cases have been reported in literature in pediatric age groups. The authors describe a case report of fracture of lateral condyle and medial epicondyle of humerus along with elbow dislocation in a young adult. The patient sustained injury in the form of fall from bike. Clinically the patient had swelling and deformity of the elbow joint. There were contusions present in the skin around the elbow joint. There was no distal neuro-vascular deficit. Appropriate radiological investigations were done. The elbow joint was then reduced and found to be unstable. Hence, patient was taken up for surgery in the form of open reduction and internal fixation. The functional outcome of the surgery is presented in the case report. Open reduction and internal fixation are the treatment of choices in these types of cases.
Emergency medicine
Manoel Francisco de Campos Neto; Vidal Haddad Junior
Volume 5, Issue 2 , July 2019, , Pages 81-84
Abstract
This communication describes two attacks by domestic and wild carnivores in Caceres County, localized in the Pantanal area, an extensive flooded plain in Mato Grosso State, Midwest region of Brazil. The first attack took place in an urban area and was caused by a Rottweiler dog (Canis lupus familiaris) ...
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This communication describes two attacks by domestic and wild carnivores in Caceres County, localized in the Pantanal area, an extensive flooded plain in Mato Grosso State, Midwest region of Brazil. The first attack took place in an urban area and was caused by a Rottweiler dog (Canis lupus familiaris) created by the family of the victim. Another attack occurred in a rural area, caused by a jaguar (Panthera onca), which was disturbed while feeding, characterizing an unprovoked attack. Both the patients were wounded in the forearm, with different severity of the wounds. The lesions restricted to the forearm were the consequence of the victims using their arms as a shield, featuring the “defense” injuries, but the severity of the wounds were proportional to the strength of the attacking carnivore. Health staffs and emergency centers should be alert for soft tissue and bone injuries in the observed body regions after domestic and wild animal attacks.
Trauma
Majid Zamani; Farhad Heydari; Mehrdad Esmailian
Volume 5, Issue 1 , January 2019, , Pages 14-18
Abstract
Objective: The present study examines the diagnostic accuracy of abdominal ultrasonography and urinalysis test in children with blunt abdominal trauma, compared with CT scan. The aim of this study was to compare the diagnostic value of ultrasound and urinalysis test with CT scan as a golden standard ...
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Objective: The present study examines the diagnostic accuracy of abdominal ultrasonography and urinalysis test in children with blunt abdominal trauma, compared with CT scan. The aim of this study was to compare the diagnostic value of ultrasound and urinalysis test with CT scan as a golden standard diagnostic method in predicting abdominal peritoneal injury in these patients.Methods: This prospective study, based on diagnostic accuracy evaluation, was performed on children with blunt abdominal traumas less than 12 years of age who were referred to the emergency department from 2017-2018 and for whom abdominal ultrasonography, urinalysis and abdominal CT scans were requested. Demographic data, mechanism of trauma, the results of urine tests, ultrasound and CT scan of the abdomen were recorded. Sensitivity, specificity, positive and negative predictive values were used to measure the diagnostic power of the tests.Results: In this study, 100 children with multiple traumas were included. The mean age of these patients was 5.75 ± 3 years with a range of 1-12 years. In terms of sexual distribution, 69 (69%) were boys and 31 (31%) were girls. According to the results, ultrasound with an abnormal urinalysis test had sensitivity of 85.7%, specificity of 91.9%, positive predictive value of 63.2% and negative predictive value of 97.5%. The accuracy was 91%.Conclusion: According to the results of this study, the combination of ultrasonography and urinalysis resulted in a significant increase in diagnostic value (P <0.001). Pediatric patients with a negative ultrasonography and urinalysis test should be observed rather than subjected to the radiation risk of CT.
Trauma
Julius Gbenga Olaogun; Olusoga Olusola Akute; Amarachuku Chiduziem Etonyeaku; Joshua Taye Ige; David Brown Ajibola; Jide Michael Afolayan; Eyitayo Ebenezer Emmanuel
Volume 4, Issue 2 , July 2018, , Pages 67-72
Abstract
Objective: There has been a global increase in the incidence of abdominal trauma in surgical patients. We conducted this study to evaluate the pattern of abdominal injuries, patient characteristics and the management outcome in our setting.Methods: It was a descriptive (combined retrospective and prospective) ...
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Objective: There has been a global increase in the incidence of abdominal trauma in surgical patients. We conducted this study to evaluate the pattern of abdominal injuries, patient characteristics and the management outcome in our setting.Methods: It was a descriptive (combined retrospective and prospective) study of all patients with abdominal trauma admitted and managed at Ekiti State University Teaching Hospital, Ado-Ekiti between January 2013 and December 2016. Data on socio-demographics, clinical profile, investigations, treatments and outcome were entered into a spread sheet and analyzed using SPSS version 20.0.Results: A total of 2728 trauma patients presented during the study period. Of these, 68 (2.5%) suffered from abdominal injuries. Their ages ranged from 6 to 72 years (mean 30.3±13.2). Fifty-nine (86.8%) were males while 9 (13.2%) were females (M: F ratio = 6.6:1). Forty-nine (72.1%) sustained blunt trauma while 19 (27.9%) had penetrating injuries. Road traffic incident (RTI) (n=41; 60.3%) was the most common source of trauma, followed by assault: gunshot (n=9; 13.2%), and stab (n=7; 10.3%). Spleen (n=23; 33.8%) was the most common solid organ injured followed by the liver (n=7; 10.3%) while small bowel (n=8; 11.8%) was the most common hollow viscous injured. Forty-seven (69.1%) required operative intervention. Post-operative complication rate was 17% with wound infection (12.5%) predominating. The mortality rate was 4 (5.9%).Conclusion: RTI and assault are major causes of abdominal injury. Measures to reduce RTI, youth restiveness and criminal activities will stem the tide.
Trauma
Reza Bidaki; Mehrdad Roozbeh; Mohamad Amin Sharifi; Seyed Nader Mostafavi; Mohammad Ali Abdolkarimi Davarani
Volume 4, Issue 2 , July 2018, , Pages 86-88
Abstract
Factitious disorder as Munchausen syndrome is a time and money consuming condition that is presented with different signs and symptoms. In emergent situations, it is not a differential diagnosis with high priority, but when it becomes recurrent with atypical symptoms, factitious disorder and malingering ...
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Factitious disorder as Munchausen syndrome is a time and money consuming condition that is presented with different signs and symptoms. In emergent situations, it is not a differential diagnosis with high priority, but when it becomes recurrent with atypical symptoms, factitious disorder and malingering should be considered as well. In this survey, we report an odd and interesting presentation of a factitious disease as a scorpion sting which misled some professional healthcare providers until the patient finally confessed that she used turmeric to mimic the signs of a scorpion sting. She exaggerated her symptoms when asked about the details of the mechanism of the scorpion bite. When encountering an emergent condition, after ruling out the critical conditions especially when the symptom is recurrent, factitious disorders should be considered. Consultation with a psychiatrist help the team manage the patient properly.
Emergency medicine
Krishna Prasad; Susan Tharian; Jebu A Thomas
Volume 4, Issue 2 , July 2018, , Pages 89-91
Abstract
Traumatic spinal epidural hematoma (TSEH) is a neurosurgical emergency which is considered as one of the rare causes of back pain. The onset of symptoms presentation can vary especially following a trauma. Here, we report a case where a young girl had a trivial fall and presented symptoms of back pain ...
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Traumatic spinal epidural hematoma (TSEH) is a neurosurgical emergency which is considered as one of the rare causes of back pain. The onset of symptoms presentation can vary especially following a trauma. Here, we report a case where a young girl had a trivial fall and presented symptoms of back pain three days later. She developed abrupt onset of lower limb weakness during her stay in the emergency department (ED). X-ray and computed tomography (CT) imaging of the spine did not show any obvious abnormality whereas, Magnetic resonance imaging (MRI) imaging revealed hyper-intense lesions in the thoracic spinal segment which led to the diagnosis of TSEH. Our case highlights the importance of the atypical and varied nature of presentation and the choice of investigation which would help in the early diagnosis of this entity.
Emergency medicine
Ali Reza Shafiee-Kandjani; Seyed Gholamreza Noorazar; Saeed Aslanabadi; Nasim Rashedi; Mehrnaz Dadkhah; Mohsen Jafarzadeh-Gharehziaaddin
Volume 4, Issue 1 , January 2018, , Pages 18-23
Abstract
Objective: Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent and impairing levels of inattention, impulsivity and hyperactivity. Evidence shows that adolescents with ADHD are more exposed to trauma. This study aimed to investigate the relationship between ADHD symptom severity ...
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Objective: Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent and impairing levels of inattention, impulsivity and hyperactivity. Evidence shows that adolescents with ADHD are more exposed to trauma. This study aimed to investigate the relationship between ADHD symptom severity and trauma severity. Methods: In this descriptive correlational study, the study population included traumatic adolescents aged 12-18 years referred to Shohada hospital in Tabriz, Iran in 2016. Among this population, 91 subjects were selected. In order to exclude subjects with other psychiatric disorders, a psychiatrist performed clinical interviews with them. In this regard, the short form of Conner’s Comprehensive Behavior Rating Scales Revised Edition (CBRS-R) and Pediatric Trauma Scale were used. For data analysis, Pearson correlation coefficient and independent t test were applied. Data were analyzed using SPSS software version 22. Results: There was a significant positive relationship between trauma severity and ADHD score, hyperactivity, and oppositional/Impulsivity (P < 0.01). Conversely, no statistical significance was observed between attention deficiency and trauma severity. The severity of trauma was higher among ADHD group than normal individuals. There were also correlations between socioeconomic status (SES) and oppositional/impulsive patients. In this regard, higher scores of oppositional/impulsivity were observed among patients with lower SES. Conclusion: Traumas have significant effects on economic and humanistic aspects of life in modern era. Our findings showed that there was a statistically significant relationship between hyperactivity-inattention and trauma intensity in adolescents. Therefore, to prevent traumatic events, ADHD screening at schools is suggested. By the same token, informing parents through mass media can help reduce the consequences of inattention/ hyperactivity disorder in the society.
Emergency medicine
Farhad Heydari; Shiva Samsam Shariat; Saeed Majidinejad; Babak Masoumi
Volume 4, Issue 1 , January 2018, , Pages 24-28
Abstract
Objective: The aim of this study was to use ultrasonography for the diagnosis and confirmation of Pulled Elbow treatment.Methods: This descriptive cross-sectional study initiated in 2014 and continued until 2015. We used simple sampling method and recruited 60 samples among patients aged 4 months to ...
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Objective: The aim of this study was to use ultrasonography for the diagnosis and confirmation of Pulled Elbow treatment.Methods: This descriptive cross-sectional study initiated in 2014 and continued until 2015. We used simple sampling method and recruited 60 samples among patients aged 4 months to 6 years. The apparatus used in this study was an ultrasonogram with transducer 12 MHz probe. Ultrasound evaluation of both hands was undertaken and after reduction, the physical examination was performed to confirm the diagnosis made by ultrasonography. Then, the results were recorded by a physician in a checklist and entered into SPSS software (version 20) for further analysis.Results: In this study, 60 children with pulled elbow injuries were studied. Of these, 27 patients (45%) were girls (female) and 33 (55%) were boys (male). This indicates the higher incidence of injury among males than females. The highest incidence of pulled elbow injury was observed in children aged 3 (15%). The accuracy of ultrasonography method for the confirmation of treatment was reported to be 92%.Conclusion: This study aimed to confirm the considered therapeutic method based on the result of ultrasonography performed after the treatment. Accordingly, the sensitivity and specificity of ultrasonography in confirming the considered therapeutic method for the treatment of pulled elbow was obtained higher than 90%.
Trauma
Mohit Kumar Arora; Ela Madaan
Volume 4, Issue 1 , January 2018, , Pages 48-50
Abstract
Patellar fracture is a relatively uncommon fracture especially the vertical sagittal type. In cases of high energy trauma injury, it is usually associated with fracture of ipsilateral distal femur or proximal tibia. However, the combination of vertical sagittal fracture patella and ipsilateral fracture ...
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Patellar fracture is a relatively uncommon fracture especially the vertical sagittal type. In cases of high energy trauma injury, it is usually associated with fracture of ipsilateral distal femur or proximal tibia. However, the combination of vertical sagittal fracture patella and ipsilateral fracture lateral condyle is very rare. This necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Open reduction and internal fixation is the treatment of choice in managing these types of injuries. This should be followed by gradual mobilization of the affected knee joint. Weight bearing can be started once the fracture starts showing signs of union on X-rays. Literature search shows only one case report describing this pattern. The aim of this case report is to highlight the rarity of this injury, to understand the injury mechanism and surgical approach used for these injuries. The knowledge of this combination will help us manage these injuries so that good functional outcome is achieved
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.
Trauma
Ganesh Singh Dharmshaktu
Volume 3, Issue 2 , July 2017, , Pages 64-65
Abstract
Simultaneous combination of fracture of the lateral condyle and postero-medial elbow dislocation is a rare event and limited to few reports or case series in the literature. Rarity of the injury also necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Various ...
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Simultaneous combination of fracture of the lateral condyle and postero-medial elbow dislocation is a rare event and limited to few reports or case series in the literature. Rarity of the injury also necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Various authors have reported about the condition including the management which mostly includes surgical intervention. A report of one such injury pattern in an 8 years old male child with operative management and satisfactory outcome is presented to highlight the presence of this rare combination and adherence to standard treatment protocols to address them. The report is an addition to the limited resources available on similar fractures and highlights the importance of ruling out possible associated injuries in cases of elbow dislocations. A good fixation of lateral condyle fracture is instrumental to avoid late complications leading to poor functional outcome. The early and supervised rehabilitation also plays a role in ensuring successful return to activities of daily living.
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
Amin Beigzadeh; Ahmad Naghibzadeh Tahami; Habibolah Rezaei; Bahareh Bahman bijari; Mehrdad Nazarieh; Seyed Mostafa Seyed Askari
Volume 2, Issue 2 , July 2016, , Pages 33-36
Abstract
Objective: Trauma is one of the main causes of losing effective life among the populations. Knowing the pattern of trauma in each country can be considered as the first step in planning preventive programs to reduce trauma injuries. This study was conducted to evaluate the epidemiological status ...
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Objective: Trauma is one of the main causes of losing effective life among the populations. Knowing the pattern of trauma in each country can be considered as the first step in planning preventive programs to reduce trauma injuries. This study was conducted to evaluate the epidemiological status of trauma in Shahid Bahonar hospital in Kerman. Methods: This retrospective, descriptive cross-sectional study was conducted in 2014. The study population consisted of all traumatic patients who referred to Shahid Bahonar hospital. All patients entered the study based on census sampling. In order to collect data, the medical record of each patient was scrutinized and the demographic information, causes of trauma, and the anatomical location of trauma were extracted. All data were entered into the SPSS version 20 software. For data analysis, we used descriptive tests (frequency and mean) as well as analytical tests (chi-square). Results: 7803 (76.8%) traumatic patients were male and 2358 (23.2%) were female. Of all causes of trauma, accidents had the most frequency among women and men at 1208 (23.9%) and 3846 (76.1%) correspondingly. Other causes of trauma in both groups were related to falling (1538), violence (1720), occupation (1181), sports (663), and self-harm (5). The age group of 15-24 with 2576 patients had the highest amount of trauma (25.4%). In terms of location, limbs and thorax had the highest and the lowest amount of injury at 4527 (44.6%) and 653 (6.4%) respectively. We could observe a significant relationship between the cause of trauma with sex and the age variables (P < 0.0001). Conclusion: Males are more susceptible to traumatic problems than females regarding the nature of their jobs . Moreover, accidents are the main cause of trauma. Improving the quality of vehicles, roads safety, and establishing driver training courses to follow the rules are highly recommended.
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.
Critical Care
Maryam Ziaee; Amirhossein Mirafzal
Volume 2, Issue 2 , July 2016, , Pages 50-54
Abstract
Objective: To evaluate the association of base deficit (BD) with mortality in traumatized children, and to assess this association in a subgroup of patients with traumatic brain injury (TBI). Methods: In this cross-sectional study performed prospectively on a convenience sample of patients ...
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Objective: To evaluate the association of base deficit (BD) with mortality in traumatized children, and to assess this association in a subgroup of patients with traumatic brain injury (TBI). Methods: In this cross-sectional study performed prospectively on a convenience sample of patients under 16 years of age with trauma presenting to an academic level ІІ trauma center, we obtained venous BD values initially and followed the patients for in-hospital mortality. Initial vital signs were measured and injury severity score (ISS), randomized trauma score (RTS), and pediatric trauma score (PTS) were calculated. Results: A total of 102 patients were included, with 48 patients diagnosed with TBI. Nine patients (8.8%) died during admission, of which 6 were diagnosed with TBI. Based on the univariate analysis, BD was associated with mortality in the whole group (P = 0.01), but not in the TBI subgroup (P = 0.08). In multivariable analysis, RTS was the only variable independently associated with mortality (P = 0.001, odds ratio [OR] = 0.197). Linear regression model showed that BD was predictive of ISS, RTS, and PTS. Receiver operating characteristics (ROC) curve showed a cutoff point of -7 mmol/L for BD, below which there is a 12 fold increased risk for mortality. Conclusion: BD is a useful parameter in mortality prediction in pediatric trauma like in adult age group, but this predictive role in TBI patients is not supported by our results.