فهرست مطالب

  • Volume:21 Issue: 4, Sep-Oct 2016
  • تاریخ انتشار: 1395/06/11
  • تعداد عناوین: 11
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  • Ali Reza Ala, Samad Shams Vahdati, Ali Taghizadieh, Payman Moharamzadeh, Houri Arjmandi, Mahboub Pouraghaei* Page 1
    Background

    Trauma is currently the fourth leading cause of death in developed countries. One of the main objectives in abdominal trauma patients is to develop a rapid and accurate diagnosis. There is a tendency to use emergency abdominal ultrasound with abdominal trauma, therefore, it is recommended in some centers as a diagnostic tool and as a primary choice in abdominal trauma.

    Objectives

    The aim of this study was to determine the diagnostic accuracy of sonography for trauma by emergency medicine residents and radiology residents Patients and

    Methods

    This was a descriptive and analytical study performed on patients with abdominal blunt trauma who referred to the emergency ward. The diagnostic accuracy of sonography for trauma by emergency medicine residents and radiology residents was evaluated.

    Results

    Of the 380 patients, 296 weremales and 84 were females. Themean ages of male and female patients were 34.52±16.38 years and 41.19 ± 21.38 years, respectively (P = 0.009). The sonographies performed by emergency residents were positive in 46 patients, with 22 of these confirmed by CT scans. The sensitivity and specificity of the sonography by emergency residents, as confirmed by CT scans, were 78.5% and 93.2%, respectively. The sonographies performed by radiology residents were positive in 38 patients, with 24 being confirmed by CT scans.

    Conclusions

    The sensitivity and specificity of the sonography by radiology residents, as confirmed by CT scans, were 85.7% and 96%, respectively. Sonographies performed by emergency residents were positive in 46 patients with 34 of these being confirmed by sonographies by radiology residents. The sensitivity and specificity of the sonographies by emergency residents, as confirmed by sonographies by radiology residents, were 89.5% and 96.5%, respectively

    Keywords: Abdominal trauma, Sonography, Emergency Medicine Resident, Radiology Resident, Abdominal CT scan
  • Farzad Rahmani, Payman Moharamzadeh, Ebrahim Mashhadi, Mahboob Pouraghaei* Page 2
    Background

    According to the guidelines for treatment of multiple trauma patients, immobilization of the neck and neck collar fixation are essential. However, following neck collar fixation patients usually experience dyspnea. Some studies have found that neck collar fixation can lead to decreased pulmonary volumes, yet there have been no studies on the effect of neck collar fixation on patient ventilation.

    Objectives

    The purpose of this study was to determine the effect of neck collar fixation on ventilation in multiple trauma patients.

    Methods

    This study was a descriptive-analytical study, which was performed in the emergency department of Tabriz University of Medical Sciences on multiple trauma patients with a Glasgow Coma Score (GCS) of 15. The effect of neck collar fixation on ventilation in the study participants was examined with the use of capnography.

    Results

    This study involved 163 multiple trauma patients. Of these, 65% were male. The mean of end tidal carbon dioxide (ETCO2) of the patients without neck collars was 34.62 ± 4.46 and the mean ETCO2 of the patients with neck collars was 34.21 ± 2.31. There was no significant difference between the means of ETCO2, before and after removing the neck collar, among the studied patients (P = 0.196).

    Conclusions

    According to the results of our study, neck collar fixation has no effect on ventilation in multiple trauma patients.

    Keywords: Capnography, Multiple Trauma, Ventilation
  • Spontaneous Hemarthrosis of the Knee - Late Complication of Flexible Femur Nailing: A Case Report
    Indranil V Kushare_Matthew E Oetgen_Suzanne J Walters Page 3

    We present a case report of acute spontaneous knee hemarthosis due to erosion of the nail through the knee joint capsule in a boy, seven months following retrograde flexible nailing for fractured femur. Careful positioning of the location of the insertion site of flexible nails and proper nail tip management are important to avoid this rare late complication.

    Keywords: Postoperative complications, Intramedullary Nailing, Femur Neck Fracture, Hemarthrosis, knee
  • Amir Mirhaghi, Mohsen Ebrahimi, Mohsen Noghani Dokht Bahmani, Abbas Heydari* Page 4
    Background

    Triage in the interactive atmosphere of the emergency department (ED) has been described as complex and challenging. Nonemergent ED visits have been accompanied by ethical and legal conflicts.

    Objectives

    The aim of this study was to gain an understanding of ED nurses’ practice regarding triage of nonemergent patients. Patients and

    Methods

    Focused micro-ethnography based on Spradley’s developmental research sequence (DRS) was used. This study was conducted in an emergency department. Data was collected through complete participant observations along with formal and informal interviews, and then analyzed using DRS.

    Results

    Nine key informants were interviewed formally. Four main categories emerged from the nurses’ culture: nonemergent patient as an uninvited guest, nonemergent patient as an elephant in a dark room, nonemergent patient as an aggressive client, and being nonemergency unless at risk of death.

    Conclusions

    Providing care in the emergency department is significantly affected by nonemergent patients, as the emergency department is a place for critically ill patients thus awareness training program is recommended.

    Keywords: Nonemergent Patient, triage, Emergency, Ethnography
  • Cankat Erdogan, Dogakan Yigit, Anil Ozgur, Dincer Avlan, Ali Nayci, Hakan Taskinlar* Page 5
    Introduction

    Air weapons are used for sport, hunting, firearm training or just for fun, especially by teenagers, worldwide. These weapons are generally regarded as toys, and injuries from these weapons are thought to be harmless by users, parents and even officials. Improvements in weapons technology make the penetration power of these toys similar to conventional hand guns. To increase awareness about the serious injuries associated with these guns.

    Case Presentation

    The medical records of four teenage boys shot by air weapons between January 2012 and January 2013 in Mersin, Turkey, were retrospectively reviewed in this study. Of the four boys, two needed prompt thoracic intervention due to pneumo/hemothorax, one needed urgent abdominal exploration due to pneumoperitoneum and bleeding from the spleen and one was treated conservatively.

    Conclusions

    Air weapons can cause serious injuries among children. Increased public awareness, limitations to their usage and strict legislation are needed to protect children.

    Keywords: children, Guns, Injury, Toys
  • Fatemeh Alizadeh Shirazi, Nasrin Sharifi, Najaf Zareh, Marzieh Moattari* Page 6
    Background

    Several lines of evidence suggest that early sensory stimulation and regular family visiting programs are potential nursing interventions to improve the outcomes of head injured comatose patients. However, little is known about the impacts of family involvement in providing sensory stimulation.

    Objectives

    To determine the effects of a sensory stimulation program conducted by nurses and families on the consciousness, level of cognitive function, and basic cognitive sensory recovery of head injury comatose patients. Patients and

    Methods

    This was a randomized clinical trial performed at the Shiraz level I trauma center including 60 head injured comatose patients with an initial Glasgow coma score (GCS) of less than 8. Patients were randomly assigned to receive sensory stimulation by a qualified nurse (nurse group; n = 20), by the family (family group; n = 20), or usual care (control group; n = 20). The sensory stimulation program involving the nurses and patients’ families was conducted, twice daily, in the morning and evening for 7 days. The level of consciousness, level of cognitive function, and basic cognitive sensory recovery of the patients were evaluated and monitored using the GCS, Rancho Los Amigos (RLA), and Western Neuro-Sensory stimulation profile (WNSSP). Data were analyzed by chi square, Kruskal-Wallis, and repeated-measures tests using SPSS.

    Results

    All the patients were comparable regarding their baseline characteristics, level of consciousness, level of cognitive function, and basic cognitive sensory recovery determined by GCS, RLA, and WNSSP. Although the two intervention groups of the study improved, those who received the sensory stimulation program from their families had significantly higher GCS (P = 0.001), RLA (P = 0.001), and WNSSP (P = 0.001) scores after 7 days when compared to the two other groups.

    Conclusions

    The application of sensory stimulation by families led to significant increases in the consciousness, level of cognitive function, and basic cognitive sensory recovery of comatose patients with severe injuries.

    Keywords: Coma, Sensory Stimulation, Traumatic Brain Injury, Consciousness Level, Cognitive Function
  • Shahram Paydar, Maryam Barhaghtalab, Fariborz Ghaffarpasand, Saeed Safari, Alireza Baratloo, Hamed Kabiri* Page 7
    Background

    The management of trauma patients is often difficult. The American college of surgeons suggests using advanced trauma life support (ATLS) measures. ATLS is regarded as the gold standard for the resuscitation of cases with acute life threatening injuries.

    Objectives

    To assess the change in base excess (BE) values and central venous pressure (CVP) one and six hours after injection of 1000 cc normal saline in trauma patients admitted to the ICU. Patients and

    Methods

    According to the inclusion and exclusion criteria, patients were randomly selected to participate in the project. Inclusion criteria included trauma patients admitted to the ICU with a CVP line and who had indication for hydration. In trauma patients, at the zero time period, BP, PR, RR and CVP were measured, and a blood gas test was used to assess Hb, pH, BE, PO2, HCO3 and PCO2. Then 1000 cc of normal saline was injected, and after one and six hours, the same values were re-evaluated.

    Results

    The mean age of the patients was 38.1 ± 3.9 (range 15 - 60). The mean duration of hospitalization was 7.4 ± 4.4 (range 1 - 21) days. The mean ISS for these patients was 14.33 ± 5.3. BE changes in both groups of patients, based on Hb primary division, showed a significant difference (P ≤ 0.05). The results showed that there was no significant relation between the measured ISS and the changes in base values (P ≥ 0.05).

    Conclusions

    According to our results, the infusion of one liter normal saline will cause a statistically significant decrease only in BD, after one hour, in patients withmoderate to severe ISS. The changes in SBP, PR, CVP and also pH, HCO3 and Hb were not statistically remarkable

    Keywords: Fluid Therapy, Multiple Trauma, Hemodilution
  • Batoul Khoundabi, Anoshirvan Kazemnejad, Marjan Mansourian, Seyed Mohammadreza Hashemian, Mehdi Kazempoor Dizaji* Page 8
    Background

    Admission to the ICU (intensive care unit) is frequently complicated by early AKI (acute kidney injury). The development of AKI following cardiac surgery is particularly associated with increased mortality and morbidity. According to AKIN (acute kidney injury network) criteria, UO (urinary output) is a predictor for AKI.

    Objectives

    The goal of this study was to determine the effects of some AKI risk factors on AKI and also to investigate changes in UO as a predictor of AKI using joint modeling. Patients and

    Methods

    In a retrospective study, 300 cardiac-operated patients, who had been admitted over a period of three years, were selected according to the consecutive sample selection method, using the ICU at Masih Daneshvari Hospital in Iran as a referral center. The random mixed effect model and the survival model were used to investigate UO changes and estimate the effect of UO and other risk factors on the hazard rate of AKI in a joint analysis.

    Results

    AKI occurred in 38.0% of patients. A significant decrease of UO occurred more often in female and infected patients, as well as those with a low DBP (diastolic blood pressure). The survival model showed that the risk of AKI in females, older patients and patients with low DBP, lower UO and with infection was higher (P = 0.001). Using joint modeling, the association parameter between the risk of AKI and UO was estimated (-0.3, P = 0.002).

    Conclusions

    Where there is a relationship between two longitudinal and survival responses, joint modeling can estimate it

    Keywords: Acute kidney injury, Joint Models, risk factor, Urinary Output, Cardiac Surgery
  • Esmaeil Fakharian, Shirin Behdadmehr, Hamid Reza Sabri, Azadeh Sadat Mirzadeh, Javad Mohammadzadeh, Mahdi Mohammadzadeh* Page 9
    Background

    Traumatic brain injury (TBI) is a worldwide problem, especially in countries with high incidence of road traffic accidents such as Iran. Patients with a single occurrence of TBI have been shown to be at increased risk to sustain future TBI.

    Objectives

    The aim of this study was to present the incidence and characteristics of repeated TBI (RTBI) in Iranian patients. Patients and

    Methods

    During one year, all admitted TBI patients with prior TBI history were enrolled into the study. In each patient, data such as age, gender, past medical history, injury cause, anatomic site of injury, TBI severity, clinical findings and CT scan findings were collected.

    Results

    RTBI comprised 2.5% of TBI cases (41 of 1629). The incidence of RTBI per 100,000 individuals per years was 9.7. The main cause of RTBI was road traffic accident (68.3%); 9.7 % of cases had preexisting seizure/epilepsy disorder; 36.6% of patients with RTBI had pervious ICU admission due to severe TBI. Ten patients had Glasgow coma scale (GCS) ≤ 13 (24.4%). Seizure was seen in seven patients (17.1%). Thirty-nine percent of patients with RTBI had associated injuries. Eleven patients had abnormal CT scan findings (26.9%).

    Conclusions

    Considering the high incidence of trauma in developing countries, RTBI may also be more common compared with that of developed countries. This mandates a newer approach to preventive strategies, particularly in those with a previous experience of head injury.

    Keywords: Brain Injuries, Epidemiology, Repeat Traumatic Brain Injury
  • Alireza Hamidian Jahromi, David Pennywell, John T. Owings* Page 10
    Introduction

    Diaphragmatic rupture (DR) is an uncommon, potentially serious complication following blunt or penetrating abdominal trauma. Even with a high index of suspicion, the diagnosis of DR can easily be missed for a long period post injury. Delayed or missed diagnosis [delayed diagnosis of diaphragmatic rupture (DDDR)] and delayed diaphragmatic rupture (DDR) are possible explanations in cases where the initial operative exploration fails to show the diaphragmatic damage.

    Case Presentation

    Here we present a patient with suspected DR that was not seen on initial open abdominal exploration, but was suggested by subsequent serial imaging. This injury was ultimately identified on laparoscopic exploration. The procedure was converted to open (celiotomy) due to poor tolerance of the pneumoperitoneum required for laparoscopy, and the laceration was primarily repaired. We propose that DDR and DDDR be considered as a differential diagnosis in patients with a previous thoracoabdominal trauma when presenting with radiologic/clinical signs suspicious for DR, even when the immediate post traumatic exploration failed to demonstrate a DR.

    Conclusions

    A high index of suspicion is essential for early detection of DDR and DDDR. Patients with high impact injuries or surrounding organ damage should be followed with serial clinical examinations, follow-up radiologic assessments, and even reexploration in situations highly suspicious for diaphragmatic injuries.

    Keywords: Delayed Diaphragmatic Rupture, celiotomy, Diaphragm, Complications, CT scan, Imaging
  • Maryam Dastoorpoor, Esmaeil Idani, Gholamreza Goudarzi, Abbas Bahrampour, Narges Khanjani* Page 11
    Background

    Air pollution and weather are just two of many environmental factors contributing to traffic accidents (RTA).

    Objectives

    This study assessed the effects of these factors on traffic accidents and related mortalities in Ahvaz, Iran.

    Methods

    In this ecological study, data about RTA, traffic-relatedmortalities, air pollution (including NO, CO, NO2, NOx PM10, SO2, and O3 rates) and climate data from March 2008 until March 2015 was acquired from the Khuzestan State Police Force, the Environmental Protection Agency and the State Meteorological Department. Statistical analysis was performed with STATA 12 through both crude and adjusted negative binomial regression methods.

    Results

    There was a significant positive correlation between increase in the monthly average temperature, the number of rainy days, and the number of frost days with the number of RTA (P < 0.05). Increased monthly average relative humidity, evaporation, and number of sunny days were negatively correlated with the frequency of RTA (P < 0.05). We also observed an inverse significant correlation between monthly average relative humidity, evaporation, and wind speed with traffic accident mortality (P < 0.05). Some air pollutants were negatively associated with the incidence rate of RTA.

    Conclusions

    It appears that some weather variables were significantly associated with increased RTA. However, increased levels of air pollutants were not associated with increased rates of RTA and/or related mortalities. Additional studies are recommended to explore this topic in more detail.

    Keywords: Air pollution, Weather, Traffic Accidents, mortality