Trauma Monthly
Volume:17 Issue: 1, Jan-Feb2012

This article sought to review and compare data of major earthquakes of the past decade and their aftermath in order to compare the magnitude, death toll, type of injuries, management procedures, extent of destruction and effectiveness of relief efforts.

A retrospective study of the various aspects of management and aftermath of 5 major earthquakes of the past decade (2000–2010) was undertaken. This included earthquakes occurring in Bam Iran, Sichuan China, Port-au-Prince Haiti, Kashmir Pakistan and Ica Peru. A literature search was done via computer of published articles (indexed in Pubmed). The issues assessed included: 1)Local magnitude,2)Type of building structure 3)Time of the earthquake (day/time/season), 4)Time to rescue, 5)Triage, Transfer, and Treatment 6) Distribution of casualties (dead/ injured), 7)Degree of city damage, 8)Degree of damage to health facilities, 9)Field hospital availability, 10)International aid, 11)Air transfer, 12) Telecommunication systems availability, 13) PTSD prevalence, 14) Most common injury and 15) Most common disease outbreak.

The Bam earthquake had the lowest (6.6 Richter’s) and the Sichuan earthquake had the greatest magnitude (8.0 Richter’s). Mortality in Haiti was 212,000 and it was the deadliest earthquake of the past decade. Collapse of heavy clay roofing structures was a major cause of death in Iran and Pakistan. Earthquakes occurring at night and nonworking days carried a high death toll. The time to rescue and treat was the lengthiest in Haiti (possibly contributing to the death to injured ratio). However, the worst dead to injured ratios were in Bam (51%) and in Pakistan (47%); the best ratio was in China (15%). Iran and Pakistan suffered the highest percentage of damage to the health facilities (90%). Field hospital availability, international aid and air transfer were important issues. Telecommunication systems were best in China and worst in Pakistan. PTSD prevalence was highest in Iran. Respiratory infection was the most common infection following all 5 earthquakes.

Earthquake damage, death toll, managerial protocols etc. vary in different countries and are influenced by many factors including the hour the earthquake hits and the day of the week. Additionally, social, structural and geographic factors as well as the medical, governmental and NGO respondents are influential. Engineered residential construction remains to be of importance in reducing mortality in developing countries. It is essential that hospitals, fire departments and police stations, water, telephone and electrical facilities be made earthquake proof.

Cardiac injury presents a great challenge to the emergency resident because these injuries require urgent intervention to prevent death. Sometimes serious cardiac injury may manifest only subtle or occult symptoms or signs. As there is an epidemic of cardiac injuries in Kashmir valley due to problems of law and order, we herein present a review on management of such injuries

Procedural sedation in children continues to be a problem in the emergency department (ED). Midazolam is the first water-soluble benzodiazepine and it has been widely used for procedural sedation in pediatric patients.

The aim of this study was evaluation of clinical safety and effectiveness of intramuscular Midazolam for pediatric sedation in the ED setting.

We performed a self-controlled clinical trial on 30 children who referred to the Baqiyatallah Hospital ED between 2009 and 2010. They received intramuscular Midazolam 0.3 mg/kg for procedural sedation and then they were followed for sedative effectiveness and safety. Vital signs and O2 saturation were also observed. The findings were compared using SPSS ver. 16 software.

The mean age was 5.50 ± 2.70 years, the mean weight was 19.50 ± 6.63 kilograms and 16 patients (53.3%) were females. The most common adverse effect was euphoria (66.66%) and vertigo (6.7%); 27.7% did not show any side effects. There was an overall complication rate of 72.3%. The vital signs including heart rate, respiratory rate, systolic and diastolic blood pressure and O2 saturation decreased significantly during sedation (P value < 0.05).

Midazolam is an effective and relatively safe sedative for pediatric patients in the ED. The patient should be observed closely and monitored for psychological and hemodynamic side effects.

Motor vehicle collisions (MVC) comprise a majority cause of referral to the emergency department (ED). A large proportion of MVC appear to be preventable, if more effective measures against driving after substance abuse can be implemented.

This study was aimed to investigate the prevalence of substance abuse among drivers of MVC, following road traffic accidents (RTA).

This case-control research was conducted from July to October 2007. One hundred MVC drivers admitted in the ED were included as the case group and 110 hospitalized patients, due to nontraumatic causes were used as controls. History of substances abused was obtained and urine samples were tested for opium in both groups. Finally the history and laboratory results of the groups were compared using SPSS 18.

Of the 100 patients in the case group, 39 (39%) were positive for substance abuse (100% males). On the other hand, 49 (44.5%) patients in the control group had positive history or laboratory findings of substance abuse (73.9% male). Opioids were the most common agent abused in both groups. There was no significant difference between two groups regarding the prevalence of substance abuse (P = 0.92).

The prevalence of substance abuse is high among victims of road traffic injury but in equal proportion to the control group. Health education and counseling is needed to reduce substance abuse in the general population although it was not significantly related to the cause of RTA.

The intra-osseous (IO) route serves as an appropriate venous access site if access is needed in an emergency.

In this study, we compared the appearance time of methylene blue (MB) in the aorta following IO and peripheral intravenous (IV) routes in a rabbit model to assess a novel idea and compare the speed of IV and IO route of serum delivery into the main circulation.

Twenty rabbits were used in our study. They were divided into two groups (odds as G1, n=10, evens as G2, n=10). After laparotomy, the aorta was located and cannulated by a 16 gauge angiocatheter. For IV injection in GII, the marginal vein of either ear was accessed. For IO injection in G1, the medial surface of the proximal extremity of left tibia was used. Once satisfied with positioning, 10 ml of methylene blue solution at a concentration of 10 mg /ml was injected and the time was recorded. The time taken from injection to appearance of MB in the aorta was measured.

All rabbits survived until the end of the experiment. There was no significant difference between the groups regarding the body weight. There was no significant difference between mean time of dye entry into the aorta in either group. It was 9.66 ± 2.51 seconds in G1 and 10.24 ± 1.95 seconds in G2 (P = 0.56).

Our study demonstrated that there was no significant difference between the time taken for MB to reach the central circulation via IO or IV routes.

Cardio-Pulmonary Resuscitation (CPR) is one of the most important procedures in emergency medicine. As new trends are evolving in medical education , we planned to evaluate the interests and knowledge of medical students regarding educational methods in CPR learning.

In a cross-sectional analytical descriptive study, a standardized questionnaire was distributed among 180 medical interns at the Mashhad University of Medical Sciences. The questionnaire had three parts: demographics, general questions, and CPR knowledge. If they had more than 10 correct answers (out of 15) in knowledge, they were placed in group A and if more than 5, in group B and correct answers less than 5 were categorized in group C.

159 interns filled the questionnaires. Mean age was 24.99 ± 0.96 and 56.5% were female; 52.7% were educated only theoretically and 47.3% had combined theoretical and clinical knowledge; male interns were significantly more educated (P = 0.041). Residents were the majority of trainers (56.8%) and only 14.3% were educated by the staffs. Only 7% mentioned that they felt they could do a complete CPR and 37.3% considered themselves as assistants; 93.7% believed that isolated emergency ward and teaching courses were needed for better education and 95% declared that continuous education is obligatory; 33.5% were in group A and 45.8% were in group B.

CPR education is of interest to most interns. Due to lack of emergency medicine wards and, the interns’ knowledge and their practical skills were insufficient to perform acceptable CPR.

Standard treatment of diaphyseal fractures of the forearm is open reduction and fixation using dynamic compression plates (DCP) and screws. This technique uses screw placement in all 6 or more of the plate holes except the hole over the fracture line. We hypothesized that DCP with selective 4-screw bicortical placement can provide adequate fixation for these fractures.

The aim of this study was to evaluate the results of conventional 6 or more screw fixation versus 4 screw fixation for adults with diaphyseal fractures of the forearm.

In this prospective study, 128 fractures of the ulna, radius or both bones of the forearm in 87 patients were treated in either one of these two groups: Open reduction and internal fixation (ORIF) with conventional DCP and screws or ORIF using DCP and selective 4- screw placement. Fractures were transverse or oblique in pattern without gross comminution. In a total of 41 patients with fractures, 28 single ulnar and 18 single radius fractures were included. Follow-up visits were done at 3-6 and 12-16 weeks and at 6 months. Outcome with respect to union an nonunion rates, union time, infection, and device failure was noted.

No change in alignment was noted in any patient. Union time in conventional and selective bicortical 4-screw fixation was 74.8 days and 73.6 days respectively which showed no significant difference (P = 0.064). Union rate and infection was 92.1% and 3.2% in conventional and 95.3% and 0% in the selective group respectively. Non-union was observed in 5 and 3 cases of fractures in conventional and the selective group respectively.

For treatment of the transverse or oblique diaphyseal fractures of the forearm, fixation by a same length 3.5 mm DCP with selective 4-screw cortical fixation (2 screws on each side of the fracture site) had similar results in comparison with conventional 6 or more DCP screws. Because of lesser impact on host bone and smaller incision, the selective 4-screw insertion can be an alternative technique for treatment of these fractures.

In the modern day cities, home treadmill usage is increasing. Toddlers are prone to a special injury by the treadmill, during workout the toddler tries to get on the belt and the roller action pulls the fingers under the belt and get caught between the belt and a metal rod under the machine and the belt scrapes the fingers. If untreated some of these injuries will lead to flexion contracture. The usual treatment is release of contracture and skin grafting, however, graft discoloration and recurrence of contracture are the complications of this method and the patients usually seek treatment for the brown discoloration of the grafts at a later age.

In this study we assess the results of Z-plasty in combination with soft tissue distraction without skin grafting with long term usage of splint as an alternative treatment for these patients.

In this retrograde descriptive cross-sectional study, we evaluated the patients presented with treadmill hand injuries between the years 2006 and 2011. Demographic data including age and sex in addition to other information including location of trauma, severity of trauma, time elapsed between the trauma and treatment, type of treatment including wound care and surgical method and treatment outcomes were assessed.

A total of 8 patients (3 girls and 5 boys) following finger treadmill injury were assessed. 15 fingers in 7 patients had volar injury. The middle finger was the most commonly injured finger. In all patients a minimum of 2 fingers were injured and in just 1 patient 3 fingers were injured. In long-term follow-up all the patients had acceptable volar skin and complete ROM of the fingers.

Due to discoloration of the skin graft and recurrence of contracture following skin graft as the sole treatment for the injury, application of Z-plasty with soft tissue distraction and long term splints seems to be a proper alternative treatment for these patients.

Severe combined burn-blast injury is a great challenge to surgical teams due to its high mortality. It also results in unsightly traumatic tattoos. The aims of these case reports were to clarify the clinical characteristic of the dynamite explosion burn-blast facial injuries and discuss appropriate management of these patients. We report two patients suffering from facial burn-blast injury following dynamite explosion in which after primary stabilization, silver sulfadiazine cream was applied to the wounds and 12 hours later the wounds were cleaned under general anesthesia with vigorous saline solution irrigation and brushing. The foreign particles were meticulously removed from wounds and simultaneous repairing of defects was done with nylon 6-0 sutures. We conclude application of silver sulfadiazine cream on facial burn-blast injury tattoos several hours before surgical removal of particles is highly efficacious in facilitating particle removal and attaining a good result following surgical intervention, and primary repair. Treatment of combined burn-blast tattoos is different from other types of tattoos not associated with burns. Debridement and removal of foreign particles under general anesthesia from skin immediately and primary reconstruction of wounds is essential. We recommend application of the topical agent silver sulfadiazine to wounds about 12 hours before surgical intervention.

Skiing is one of the more popular winter sports which may cause injuries. The objective of this study was to identify the most common types of injuries in Iran’s largest ski resort. This cross-sectional descriptive study was performed on 1233 of patients admitted to the Dizin Resort Infirmary in 2008-2009. Obtained data included age, gender, injury type and medical interventions. All data were analyzed by SPSS 16.0 software. Results showed that 75% of the patients were male and 25% female. The mean age was found to be 27.86 (± 9.95) years. Most patients were between 20-29 years old (55.2%). The most common injury was knee trauma (14.4%). Other common injuries were soft tissue injury (12.1%), shoulder trauma (8.1%), head and face trauma (7%) and wrist trauma (5.5%) respectively. There was a significant relationship between age and sex i.e. the age in women was less than men’s (P < 0.001). We found a relationship between age and injury type. The lowest mean age (24.83) was reported in the patients with head and face injuries and the highest mean age (44.5) was in the patients with malleolus fracture (P < 0.001). Additionally, sex and knee trauma proved to be connected with more prevalence in women (P = 0.001). There was also a significant relationship between sex and shoulder injuries showing a higher prevalence in men (P = 0.015).