فهرست مطالب
Trauma Monthly
Volume:25 Issue: 5, Sep Oct 2020
- تاریخ انتشار: 1399/10/06
- تعداد عناوین: 8
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Pages 193-199BackgroundHip hemiarthroplasty (HHA) is the selected procedure among patients with femoral neck fracture and aged over 70 years old. Lots of different approaches have been proposed for this operation. However, neither of them is confirmed to be superior.ObjectivesThe purpose of this study was to compare the posterolateral vs. direct lateral approach with regard to dislocation and mortality rates.MethodsFor this retrospective study, 154 patients with femoral neck fracture were assessed from 2012 to 2018. Demographic data, surgical sheet reports, and plain radiography were evaluated. Postoperative dislocation, reoperation, infection, thromboembolic events, one-year mortality and total mortality rates were extracted through interviews and medical documents.ResultsThere was no significant difference between these two surgical approaches in terms of age, gender, time delayed to perform the surgery, Garden classification, and the etiology of fracture. The duration of the surgery was longer in the posterolateral approach without statistical significance. 36 months later, dislocation, infection, and one-year mortality rates were higher in the direct lateral approach. Recurrent dislocation and total mortality rates were higher in the posterolateral approach. No statistical significance was found between the two groups regarding the above-mentioned variables.ConclusionThe two HHA approaches were similar in terms of the duration of the surgery, dislocation, reoperation, and mortality rates. None of the approaches was superior to the other.Keywords: Hemiarthroplasty, dislocation, mortality, HIP, Infection
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Pages 200-206Background
The investigation of trauma-related mortality is one of the key components in trauma studies and it is used as a performance index and measure of health care quality.
ObjectiveThe present study aimed to evaluate the performance of pre-hospital interventions and identify possible mismanagements in dealing with trauma patients transferred by emergency medical services (EMS) to the hospital and died.
MethodsThis study was conducted in 2019, in Tehran, Iran. All trauma patients who were transferred to the emergency department (ED) of three main referral hospitals, by Tehran EMS and died at the hospital within 24 hours of admission, were studied retrospectively. The required information was collected from the EMS and the hospital records. A panel of experts was asked to identify possible errors based on standards for each patient.
ResultsDuring the one-year study period, almost 14000 trauma patients were transported by Tehran EMS to the studied hospitals. Of them, a total of 197 deaths were recorded. The most and least provided services were breathing management (87.3%) and intravenous (IV) fluid therapy (12.2%), respectively. Needle thoracostomy, IV fluids therapy, life supports (basic and advanced cardiac), and airway management had the highest percentage of mismanagement among provided services. Bleeding control and resuscitation were consistent with the recommended standard.
ConclusionIn the current study, bleeding control and immobilization was performed appropriately. Needle tracheostomy was not performed at all. Airway management and life supports of the victims were not performed properly.
Keywords: Advanced Trauma Life Support Care, Emergency Medical Services, Death, Management Audit, Multiple Trauma -
Pages 207-211Background
The international standing of a nation is based on its status in science production.
ObjectivesWe aimed to assess the scientific growth and global ranking of Iran regarding the domain of medical sciences, based on the Scopus database.
MethodsIn the scientometric evaluation, we considered two indicators for the evaluation of Iran's global ranking in medical sciences and "emergency medicine", as a subcategory of medical science namely the number of documents and citations using the Scopus database (ranking of countries was extracted from the SCImago website).
ResultsIran’s trend in the number of documents and citations was progressive. This improvement trend had a slower slope in the medical sciences and emergency medicine.
ConclusionThe results showed Iran's scientific growth to be consistent. It is recommended that indexing Iranian journals in the Scopus database, promoting scientific collaborations, and providing the necessary funding could promote Iran's scientific growth.
Keywords: Scientometric, Science, Medical, Scientific ranking -
Pages 212-219Background
Availability and efficiency of early rehabilitation care are crucial for the restoration and improvement of brain function. Moreover, it can help increase the possibility of the patient’s successful future integration in the community. However, there is no clear and general consensus on this concept (regarding patients with traumatic brain injury) and it is considered a poorly developed area of research.
ObjectiveThe purpose of this study was to analyze the concept of early rehabilitation care in patients with traumatic brain injury (TBI).
MethodsWalker and Avant’s (2011) approach was employed to analyze this concept. Various databases and search engines were explored to find all the relevant data regarding the concept of early rehabilitation care from 1990 to 2016. Finally, the definition, usage, features, antecedents, attribute, consequences, and empirical referents on the subject of early rehabilitation care were extracted.
ResultsThe results of the concept analysis demonstrated that the most important features of early rehabilitation care include early specialized comprehensive care, purposeful and patient-centered care, and teamwork. Hence, the objectives include decreasing the bad consequence caused by immobility, contracture, bladder and intestinal dysfunction, pressure ulcer, and sleeping disorders.
ConclusionsIt is believed that the concept of early rehabilitation care is not fully established in the literature in patients with traumatic brain injury, and there are only rudimentary ideas and steps toward applying this concept. Therefore, clarifications on this concept can pave the way for further application of early rehabilitation care.
Keywords: Early Rehabilitation Care, Concept Analysis, Traumatic Brain Injury -
Pages 220-226BackgroundIran is a disaster-prone country, and many flood events occur in its provinces annually. The unprecedented amount of rainfall in the northern region of Iran (from March 17 to 22, 2019) led to flash flooding of the Golestan Province.ObjectivesThis study assessed the challenges and strengths of health-related needs in the first 10 days after the great flood in Golestan; via interviews with experts.MethodsThis cross-sectional and qualitative study was carried out in Gonbad-e-Kavoos, Anbar Alum, Aq-Qala, Simin Shahr, and Gomishan cities of the flood-hit province of Golestan from March 21 to April 13, 2019. The data were collected using the researcher’s field observations and interviews with 26 experts and policymakers.ResultsThe findings were categorized into 10 main groups namely mental health, environmental health, health education, maternal, infant, and child health, nutrition, epidemics, drugs, mobile hospitals, non-communicable diseases, and management. Environmental health issues were faced with a wide range of challenges.ConclusionDue to the insufficient development of many health infrastructures in underdeveloped and developing countries, health policymakers and disaster management experts should collaborate before and after the disaster to detect and resolve the flaws. This will help reduce health problems and challenges when a natural disaster occurs, particularly by diminishing the number of morbidities and mortalities.Keywords: challenge, Health, flood, Golestan, Iran
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Pages 227-230
A 51-year-old war veteran referred to us with typical chest pain and dyspnea on exertion. He had a history of hypertension from several years before, for which he had been prescribed anti-hypertensive medications. He also gave a history of missile fragment injury to his chest from the Iran-Iraq war, for which he had been hospitalized, but had received conservative medical treatment only. After admission and initial workup, echocardiography revealed mild left ventricular dysfunction with an ejection fraction of 45% and a metallic fragment at the diaphragmatic surface of the right ventricle. Coronary angiography showed significant stenosis at the LAD – Diagonal bifurcation, as well as a metallic fragment occluding the PDA branch of the right coronary artery. Coronary artery bypass surgery was performed successfully and the patient was discharged uneventfully. To the best of our knowledge, this is the first report of an embolized missile fragment to the coronary artery found incidentally in a patient undergoing surgery for coronary artery disease.
Keywords: missile fragment embolism, Coronary Artery, Coronary artery bypass surgery, Penetrating Chest Trauma -
Pages 231-233
Cardiovascular emergencies have a high prevalence and are important among other pre-hospital emergencies. In such emergency situations, making decisions to provide the best care and transport to the hospital are brought with many challenges. The current study reports paramedics’ on-scene decision-making challenges in relation to a patient with the acute coronary syndrome. The case was an old woman who complained of sudden dizziness and weakness. The patient’s vital signs included a blood pressure of 100/70 mm Hg, heart rate of 58 beats per minute, respiratory rate of 17 breaths per minute, O2 sat of 96% and blood sugar of 145 mg/dL. The past medical history of the patient indicated that she had no previous disease or use of medications. In the hospital emergency unit, electrocardiography was recorded and ST-segment elevation myocardial infarction was observed. Paramedics face many challenges in on-scene decision making, which affect the time, process, and consequences of their decisions. In low and middle-income countries, due to resource limitations, all ambulances are not equipped with diagnostic equipment including portable sonograph and electrocardiograms. In such contexts, decision-making protocols need to be designed and used at the emergency scenes to guide the paramedic and ensure their optimal performance.
Keywords: Decision-making, Paramedics, Pre-hospital, Emergency