فهرست مطالب

Journal of Emergency Practice and Trauma
Volume:2 Issue: 2, Summer - Autumn 2016

  • تاریخ انتشار: 1395/03/25
  • تعداد عناوین: 8
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  • Samad Shams Vahdati, Seyed Hossein Ojaghi Haghighi, Pooya Paknejad, Roshan Fahimi, Shahrad Tajoddini Pages 31-32
  • Amin Beigzadeh, Ahmad Naghibzadeh Tahami, Habibolah Rezaei, Bahareh Bahman Bijari, Mehrdad Nazarieh, Seyed Mostafa Seyed Askari Pages 33-36
    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
    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.
    Keywords: Wounds, injuries, Epidemiology, Shahid Bahonar hospital, Kerman
  • Afsaneh Esmaeili Ranjbar, Masoud Mayel, Mitra Movahedi, Faezeh Emaeili Ranjbar, Amirhossein Mirafzal Pages 37-41
    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,
    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.
    Keywords: Prehospital Emergency Care, Time, to, Treatment, Trauma, Transportation, Emergency medical service
  • Hassan Amiri, Ali Bidari, Samad Shams Vahdati, Nilofar Ghodrati, Tayeb Ramim, Masoumeh Emamverdy Pages 42-45
    Objective
    There are many communities at risk by a series of air pollution episodes. Tehran is one of the most polluted cities in the world. The presence of one or more air pollutants with a certain concentration in a particular period of time can cause several adverse effects on human and animals’ well-being that can cause much morbidity. There are several pollutants in the air but some of them can cause severe adverse effects on the lungs and air ways.
    Methods
    In this retrospective cross-sectional study 1958 patients with exacerbation of chronic obstructive pulmonary disease (COPD) who were admitted in the emergency department (ED) of Rasol Akram hospital between March 2004 and March 2006 entered the study. Data such as number of admissions, air pollution particles (CO, SO2, O3, NO2, PM10) according to available documents were analyzed.
    Results
    From 1958 patients who enrolled in this study, 887 (53.5%) were male and 771 (46.5%) were female. According to statistical analysis, we could observe a significant correlation between the concentration of Co, PM10, So2 with ED admission rate of COPD exacerbation (P: 0.031, 0.008, and 0.001 respectively). The effect of PM10, So2 and Co was more significant respectively in logistic regression on ED admission.
    Conclusion
    There was significant correction between concentrations of air pollutants with number of ED admission for COPD exacerbation.
    Keywords: Air Pollution, So2, No2, Co, PM10, O3, COPD
  • Rouzbeh Rajaei Ghafouri, Saeed Shahbazi, Changiz Gholipour, Samad Shams Vahdati, Manouchehr Khoshbaten, Amir Ghaffarzad, Respina Jalilian Pages 46-49
    Objective
    Acute mesenteric ischemia (IMA) is a vascular emergency with broad variability of clinical presentations and non-specific laboratory findings. Therefore, there is a significant need for reliable serological markers of ischemia. Various laboratory studies may be performed for suspected AMI, but in general, such studies will not establish the diagnosis.
    Methods
    In a prospective, non-interventional study, from October 2012 to October 2013, we investigated 70 patients with probable diagnosis of AMI. Blood samples were taken from patients and analyzed for complete blood count (CBC), prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), urea, creatinine (Cr), sodium (Na), potassium (K), D-dimer, lactate, amylase, PH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3). Finally the results were compared with AMI diagnosis confirmed by computed tomography (CT) angiography.
    Results
    Seventy patients with acute severe abdominal pain were studied. Thirty-nine patients (55.7%) were male and 31 patients (44.3%) were female. The average age was 68.01 ± 14.67 (±SD). Based on CT-angiography results, 27 (38.6%) patients had AMI and 43 (61.4%) patients did not have AMI. Chi-squire test showed P values of 0.606 and 0.986 for relations between sex and risk factors with AMI correspondingly. One-sample Kolmogorov-Smirnov revealed white blood cell (WBC), hemoglobin (Hb), platelets (Plt), urea, Cr, Na, K, PCO2 and HCO3 as normally distributed parameters (P > 0.05). Moreover PT, PTT, INR, D-dimer, lactate, amylase, and PH were non-normally distributed (P
    Conclusion
    We found a significant relation between increased serum lactate level and definitive AMI diagnosis. We recommend rising serum lactate as a finding in AMI.
    Keywords: Mesenteric ischemia, Fibrin fragment D, Lactate, Early diagnosis
  • Maryam Ziaee, Amirhossein Mirafzal Pages 50-54
    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.
    Keywords: Base deficit, Mortality, Pediatric trauma
  • Parash Ullah, Alamgir Chowdhury, Ishrat Tahsin Isha, Sultan Mahmood, Fazle Rabbi Chowdhury, Mohammad Zeesan, Ul, Abir, Aziz Al Manna, Muhammad Ismail Patwary Pages 55-57
    Wasp sting is a relatively common arthropod assault. This usually results in pain and mild allergic reactions, but sometimes may cause severe systemic reaction and multiorgan dysfunction including rhabdomyolysis, hemolysis, coagulopathy, hepatic, renal and cardiac complications. Along with several other pathomechanisms, rhabdomyolysis is a distinguished cause of acute kidney injury (AKI) in patients with wasp sting. We herein report a case in which the patient developed rhabdomyolysis followed by AKI due to multiple wasp stings. The offending wasp was brought to the hospital and the species was confirmed by a zoologist (Vespa affinis).
  • Gholamreza Faridaalaee, Seyed Hesam Rahmani, Amin Mahboubi Pages 58-61
    Cisplatin was the first of the platinum drugs. Second-generation platinum derivative was carboplatin that its efficacy in the treatment of many malignancies is equal to cisplatin, and its toxicity profile is more favorable. Here we report on a 50-year-old woman with a history of cervix cancer who developed a severe hypersensitivity reaction (HSR) to carboplatin. She was admitted to the emergency department (ED) with shortness of breath, tachypnea, restless, agitation, and lethargy. On arrival, the patient was hemodynamically unstable; we initiated treatment immediately with hydration, oxygen therapy with mask, hydrocortisone, midazolam, and adrenalin. After 1 hour, BP and O2 sat improved to 100/70 mm Hg and 92% respectively, but there was not any significant improvement in tachycardia as well as tachypnea and she was still lethargic and agitated. Her symptoms improved gradually after 18 hours of admission. She was discharged after 36 hours. HSRs to cisplatin and carboplatin can be potentially life-threatening. The symptoms can range from a mild rash to severe anaphylaxis. Doctors should be aware of these reactions, determine appropriate treatment, and know the cross-reactivity among these drugs.
    Keywords: Cisplatin, Carboplatin, Cross, reactivity, Cancer, Anaphylaxis