فهرست مطالب

Emergency Practice and Trauma - Volume:5 Issue:2, 2019
  • Volume:5 Issue:2, 2019
  • تاریخ انتشار: 1398/04/10
  • تعداد عناوین: 12
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  • Barbara Leone, Giuseppe Cipollone, Decio Di Nuzzo, Massimo Ippoliti, Mirko Barone *, Felice Mucilli Pages 35-36
    Adhesive small bowel obstruction (ASBO) is one of the most frequently encountered disorders in Emergency Surgery Departments worldwide without negligible hospital admission rates and social costs (1,2). Notwithstanding significant improvements in techniques and materials, intra-abdominal adhesions following abdominal surgery still represent a major unsolved and debated issue harbouring challenges regarding diagnosis, pathogenesis, management and  revention. In this setting, the cornerstone lies on a proper nosological classification with a subsequent diagnostic dilemma in distinguishing ASBO from other causes of obstruction and in an early identification of emergency surgery cases. conflicting results raise more questions.
    Keywords: Adhesive small bowel obstruction, Bowel obstructive syndromes, ASBO
  • Fereshteh Jamali, Haniyeh Ebrahimibakhtavar, Mahbubeh Zomordi Torkdari, Farzad Rahmani * Pages 37-40
    Objective
    Assessing patients’ satisfaction with emergency medical services (EMSs) is an important managerial point of view. The present study aimed to assess the patients’ satisfaction with EMS in Tabriz, Iran.
    Methods
    This is a descriptive-analytic study that was done in the prehospital emergency and disaster management center of Tabriz University of Medical Sciences. In this study, from May to December 2017, we included 659 patients who were transferred to hospitals with our prehospital emergency services. A valid and reliable questionnaire was used to evaluate the satisfaction of patients about the performance of prehospital EMSs.
    Results
    Data of 659 patients were evaluated. Trauma was the most common cause of contact with 115 and help request (33.83%). The results indicated that patients’ level of satisfaction was good and very good. The highest level of satisfaction was related to the treatment of patients and use of medical equipment in the ambulance (n=578 patients, 87.7%) as well as the treatment practiced by the emergency medical technicians (EMTs) (n=575 patients, 87.24%). However, the lowest level of satisfaction was related to the absence of an active EMT in the rear cabin when transferring patients to the hospital (n=337 patients, 51.14%) and transfer of the patient from the accident scene to the ambulance (n=410 patients, 62.21%).
    Conclusion
    Patients’ satisfaction with EMS was optimal. The minimum and maximum satisfaction rates were related to the absence of an active EMT in the rear cabin, treatment of the patient, and use of medical equipment.
    Keywords: Ambulance, Prehospital emergency care, Emergency Medical Services, Satisfaction
  • Samuel Olufemi Bolarinde *, Isaiah Oyewole, Adesola Felix Abobarin Pages 41-46
    Objective
    Musculoskeletal disorders (MSDs) are one of the major complaints in the work place. This study investigated the prevalence and pattern of work-related MSDs, risk factors and the strategies of management among nurses working in various specialty areas in a tertiary health institution in Nigeria.
    Methods
    This cross-sectional survey recruited 150 nurses working in various specialty areas of a government own tertiary institution in South-west, Nigeria. Data were obtained on demographic characteristics, occupational profile, work-related musculoskeletal symptoms, perceptions on job risk factors and management strategies. Data were presented using descriptive statistics of percentages and frequency tables.
    Results
    The most common MSD among the respondents was low back pain (LBP) (60.0%), followed by neck pain (48.0%), while elbow pain was the lowest work-related musculoskeletal pain (5.3%). Findings indicated that respondents working in Intensive Care Unit (100.0%), Dental Unit (100.0%), Accident and Emergency (77.8%), Orthopaedics (75.0%), Ear Nose and Throat (75.0%) and Medicine (72.7%) suffered from LBP more than other respondents in other specialty areas. Results also revealed that frequent bending (64.0%), prolonged standing (49.3%) and frequent lifting of patients (48.0%) were major factors that contributed to LBP among the respondents. Rest (56.0%), pain killer drugs (50.7%), and exercise (36.0 %) were the most preferred pain management strategies among the respondents, while only 12.0% preferred physiotherapy management.
    Conclusion
    A great percentage of Nigerian nurses suffer from work-related MSDs in their professions with the low back being the most injured body part. Nurses working in Intensive Care Unit, Dental, Accident and Emergency and Orthopedics are more prone to work-related LBP. Education programs on back care and workplace ergonomics are recommended for reduction and prevention of occupational hazards among nurses.
    Keywords: Nurses, Work-related musculoskeletal disorders, Low back pain, Nigeria
  • Vahid Abbasi, Abolfazl Atalu *, Afshan Sharghi, Fatemeh Taghvatalab Pages 47-50
    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.
    Keywords: Prognosis, ischemic stroke, Recombinant tissue plasminogen activator, Ardabil
  • Mohammad Hasan Lotfi, Hossein Lashkardoost, Andishe Hamedi * Pages 51-55
    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.
    Keywords: Accidents, Traffic, Iran, Fatal road traffic accidents, Injury, Epidemiology
  • Hassan Amiri, Mojtaba Chardoli, Maryam Sarvari, Samad Shams Vahdati *, Niloufar Ghodrati, Roshan Fahimi Pages 56-60
    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.
    Keywords: Cervical Trauma, MRI, CT scan, Normal consciousness, Magnetic resonance imaging
  • Nahid Zamanimehr, Samad Shams Vahdati, Hamed Hojjatpanah * Pages 61-64
    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
    Keywords: INFERIOR VENA CAVA, Jugular Vein, Central venous pressure, Fluid resuscitation, Emergency medicine
  • Esmaeil Fakharian, Zahra Sehat *, Mojtaba Sehat Pages 65-70
    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.
    Keywords: Epidemiology, Iran, Kashan, Traumatic spine injury
  • Maryam Ameri, Maryam Akhgari, Roya Kordrostami * Pages 71-74
    This study aimed at describing demographic information of the deceased resulting from hanging by means of different methods of suicide. In this cross-sectional study, the file of suicide cases referred to the Central Legal Medicine Organization was investigated retrospectively. Of 1681 suicide cases, the highest suicide mode was hanging by 993 cases (57.4%) and intoxication by 674 cases (39%). The mean age of hanging was 36.22±15.76 and for other suicide methods it was 32.61±13.70 (P=0.000). Hanging was higher in males. Female victims used other methods like intoxication (P=0.000). The most common seasons for hanging were spring and winter. Toxicological analysis in cases of hanging was positive with opioid alkaloids in 95 cases (9/9%) and methamphetamine in 68 cases (7%). Intoxication with aluminum phosphide was in 35.8% of cases. Most of the cases (68.3%) were self-employed victims. A total of 534 (63%) cases were married. There was a statistically significant difference between hanging and other suicide modes concerning age, gender, occupation, marital status, and drug abuse history (P<0.001). The frequency of hanging was higher in males, marrieds, self-employed, unemployed and drug abusers. Students were victims of intoxication. Self-employed victims, unemployed victims and drug abusers were exposed to successful attempts more than others. Screening plans can be helpful in preventing suicide by prioritizing the people at risk.
    Keywords: Hanging, Gender, Addiction, Iran
  • Seyyed Mahdi Mirhamidi, Davood Soroosh, Alireza Abadi *, Elahe Fahimi Pages 75-77
    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.
    Keywords: Compartment syndrome, Volkmann’s syndrome, treatment, Complications
  • Mohit Kumar Arora *, Ela Madaan, Sandeep Kumar Pages 78-80
    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.
    Keywords: Lateral Condyle, elbow, dislocation
  • Manoel Francisco De Campos Neto, Vidal Haddad Junior * Pages 81-84
    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.
    Keywords: Wildlife, Domestic animals, Animal bites, Attacks on humans