Journal of Emergency Practice and Trauma
Volume:5 Issue: 1, Winter - Spring 2019

Acute traumatic brain injury is a worldwide public health crisis. Post-traumatic subarachnoid hemorrhage (SAH) is a finding that is present at a frequency of 40% according to data from American TCDB (1,2). Among the mechanisms that have been implicated as causes of post-traumatic SAH is the cortical bleeding through the subarachnoid space. It is estimated that the incidence of post-traumatic SAH is 11% to 60% in patients with traumatic brain injury. The brain CT is considered a technique with good sensitivity, economical and available in many hospitals worldwide. We have reviewed the literature and found some imaging characteristics of post-traumatic subarachnoid hemorrhage. We have called “the five preferences for post-traumatic SAH”.

Road traffic injuries (RTIs) are the sixth leading cause of deaths in India and about 400 deaths take place every day due to road traffic accidents. The present paper analyses the data of the India’s National Crime Record Bureau (NCRB) to assess the burden of RTI. In addition, it reports the health systems research initiated by the Indian Council of Medical Research (ICMR). As per NCRB data, in 2015, 6.3 million persons (50 persons per 10 million population) injured and out of them 1.4 million (11 persons per 10 million population) died in India. Except the NCRB data, there are no nation-wide data on RTI and the data remain poorly collected and sporadic in India. Hence, ICMR has initiated a multi-centric study to establish an electronic-based comprehensive and integrated RTI surveillance system. The second issue on which ICMR undertake research is timely and quality care of RTI patients as many deaths occur either at the scene or en route to the hospital. There is a clear survival and functional benefit for critically injured patients to receive appropriate care within the first 60 minutes of injury (‘golden hour’). Hence, this multi-centric study has been initiated to standardize structured evidence-based intervention for safety, efficacy and quality of post-crash pre-hospital and in-hospital trauma care services to improve the outcome in RTI victims. An android-based trauma registry is being built and will be used to assess the impact of interventions. These studies will provide first comprehensive estimates on various epidemiological issues related to RTI. Also, an evidence of improvement through quality post-crash prehospital and in-hospital trauma care services will emerge. These results will contribute to the setting of research and investment priorities and to formulate policies and guidelines.

Low back pain is one of the most important job injuries among emergency medical personnel. This study was carried out to investigate the prevalence of low back pain as well as its physical, mental and managerial predisposing factors among emergency medical personnel in Iran. In this analytical cross-sectional study we recruited 298 pre-hospital emergency medical personnel based on census sampling. Data were gathered using Nordic and a research-made questionnaire related to physical, mental and managerial back pain factors. Data were analyzed using SPSS version 20. Descriptive and analytical tests including chi-square test were used appropriately. P value less than 0.05 was considered as the level of significance. Findings showed that 46.3% of pre- hospital emergency technicians had a history of low back pain with different intensities. We observed a significant relationship between age, work experience, occupational-physical factors with low back pain (P > 0.001). However, there was no significant relationship between occupational-managerial factors and mental-occupational factors with low back pain (P > 0.05). Results show that the prevalence of back pain among emergency medical personnel is high. Identifying the factors associated with back pain can help the managers as well as the personnel to control the problem of back pain and increase employees’ productivity.

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. 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. 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%. 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.

Chronic kidney disease (CKD) is a complicated kidney defect causing permanent failure in renal function in progressive stages. Hemodialysis is the most accepted treatment to maintain body’s fluid/electrolyte homeostasis at the terminal stages of the disease. Permanent hemodialysis catheter (permicath) may be inserted blindly or by fluoroscopic guidance. This study aimed to compare the early function and complications between fluoroscopic guidance and blindly insertion of permanent hemodialysis catheter. This prospective randomized clinical trial was undertaken in the emergency department of Modarres hospital in Tehran, Iran during 2014 and 2015. Patients who needed catheter due to renal failure entered the study. Patients who needed emergency dialysis and those who could not wait for permicath were excluded. Patients were randomly assigned into 2 groups, under fluoroscopic guidance and blindly catheter insertion. Data were collected using a questionnaire and a checklist related to function (after 24 hours and 1 month), a need to exchange the catheter and the early adverse effects such as pneumothorax, hemothorax, and vascular injury. A total of 101 patients were enrolled in this trial. Early dysfunction (blind group = 5), a need for catheter exchange (blind group = 2), pneumothorax (blind group = 2), vascular injury (blind group = 1) were recorded but the difference between the two groups was not statistically significant (P > 0.05). We did not observe a significant difference between the placement of permicath by fluoroscopic or blind method. However, more studies with larger groups are recommended.

Acute poisoning is a common cause of hospital admission in Bangladesh. But, risk factors and characteristics of victims of different modes of poisoning have not been evaluated for possible intervention strategies. So, in this study we aimed to describe the pattern of acute poisoning in central Bangladesh as well as identifying risk factors for various mode of poisoning. A prospective observational study was undertaken in Dhaka Medical College Hospital in 2015. Consenting adult acute poisoning victims were included as study subjects. A pretested structured case record form was used to systematically record the cases. The poisoning cases were defined by clinical toxidrome (sympathomimetic, antimuscarinic, opioids, cholinergic, sedative, etc) during acute presentation with suspected poisoning and groups accordingly. SPSS 20 was used for data analysis and statistical tests including mean ± standard division (SD), percentage, t test and chi-square were used accordingly. Total poisoning cases were 1155. Suicidal (62.25%, n = 719), commuter poisoning (24.16%, n = 279) and accidental poisoning (12.38%, n = 143) were main types of poisoning. Risk factors of suicidal poisoning were young females of 11 to 30 years, married, housewives and students (P < 0.0001). Stressful relationship was the commonest reason of suicidal poisoning. Pesticides and sedatives were frequently chosen for easy availability. Commuter poisoning was common in males and urban areas (P < 0.0001). Accidental poisoning was more in males and rural areas (P < 0.0001) and snake envenomation was the main cause. Poisoning burden is high in central Bangladesh. Identified risk factors will help develop poisoning prevention strategies.

Hypokalemic periodic paralysis is anautosomal dominantdisease characterized by muscle weakness or paralysis with a matching fall in blood potassium levels. Paralysis attacks often occur in adolescence and are induced by strenuous exercise followed by rest, high carbohydrateor high sodiummeal content, sudden changes in temperature, and even excitement, noise, flashing lights and cold temperatures. Despite global daily use of intravenous and oral potassium in the treatment of patients, data about intravenous bolus potassium is rare. Here we report a 29-year-old man complaining of weakness in the upper and lower limbs. By initial diagnosis of periodic hypokalemic paralysis, potassium chloride was ordered by oral route. After a few minutes, we heard patient screaming in pain. He complained of severe acute pain in peripheral intravenous line, palpitation and dyspnea. We noticed that potassium chloride vial was infused directly via cubital vein in few minutes erroneously. Physical exam revealed sinus tachycardia and hypertension. We began hyperkalemia treatment immediately. With appropriate treatment,the patient was discharged with good condition after 12 hours of admission.

Anaphylaxis is a serious clinical condition that can affect all ages and many systems (skin, gastrointestinal system, respiratory and cardiovascular systems). There are a few case reports of cardiac and cerebrovascular complications due to the anaphylaxis and/or the treatment with epinephrine. A 69-year-old female patient with known coronary artery disease (CAD), coronary artery bypass graft (CABG), and diabetes mellitus (DM) was admitted to the emergency department. She was brought to the emergency service with the complaints of shortness of breath, swelling of the tongue and lip, widespread itching and nausea after the use of amoxicillin-clavulonic acid due to soft tissue infection. The patient was considered as having anaphylaxis. 0.5 mg intramuscular (IM) epinephrine was administered. Following the emergency electrocardiography (ECG), the rate was 140/min and the rhythm was evaluated as atrial fibrillation. We present a case of cardiovascular complications and acute ischemia stroke following intramuscular epinephrine administration with anaphylactic diagnosis in this study. As a result, anaphylaxis management is extremely important in elderly patients with preexisting cardiovascular conditions.