Trauma Monthly
Volume:26 Issue: 2, Mar-Apr 2021

The military nursing profession is one of the 40 most stressful professions worldwide, meaning that nurses are under lots of Job Stress (JS).

This study aimed to investigate JS among military nurses.

This study was conducted using a systematic review. At first, all the papers related to keywords (JS, occupational stress, and military nurses) were searched in the following databases: Google scholar, PubMed, Embase, CINAHL, Psycinfo, and Cochrane Database of systematic reviews from 2011 to 2020. Thereafter, all the papers related to JS among military nurses were selected. In terms of the inclusion criteria, the papers related to JS among military nurses were analyzed (n=12). Predefined inclusion and exclusion criteria were as follows: papers related to JS among military nurses, papers published in Persian or English language, types of papers as being original, and available free full text for all the papers.

In the initial search, 120 papers were found, of them, after reviewing the titles and abstracts of articles and removing repetitive and non-related, 30 possible related articles were investigated. Of these, 18 papers were omitted from the abstract because of a lack of access to the original article. Finally, 12 papers were included in this study. In general, the results of these studies showed that the experience military nurses in warfare that help to identify and analyze problems during Wartime, as well as adaptation facilitating and better coping of health care providers in unusual and critical conditions.

The study showed that almost whole of papers on JS among military nurses highlighted similar findings regarding stressors among military nurses. Also, they experience a lot of difficulties during wartime, which can be used to identify problems and provide appropriate solutions in similar conditions to generate knowledge in the field of training and preparing military nurses to face critical situations.

Gunshot wound injuries to penile are relatively infrequent.

This study aimed at reviewing the patterns of gunshot injuries to the penile and their treatments.

In November 2019, PubMed (MEDLINE), Scopus, Embase, ISI web of sciences and Google Scholar databases were searched for finding relevant studies. For this reason, various meshes and keywords were used to search including wound/injury, genitalia/genitourinary, Gunshot/war/explosion/firearm/military, penile/penis, scrotum, and urethral.

Of the five included studies, three studies were related to civilian gunshot injuries and two studies were related to war-injury. The average age of patients was in the range of 28-31 years old. The major gunshot penile injuries were Corporotomy, Corpus cavernosum, superficial penile wounds, and urethral injury. The most frequent concomitant damages were injuries to adjacent anatomies, including thigh injury, scrotal/testicular, abdominal organs, bladder, and rectum. There are several surgical procedures depending on the degree of gunshot penile injuries such as surgical exploration, closing the residual penile stump of a partly amputated penis, penile degloving, penoscrotal approach, simple suturing, hemostatic suturing of Buck’s fascia and skin, and surgical re-anastomosis or total replacement with phallic reconstruction.

Penile gunshot injuries often are concomitant with other severe injuries in adjacent anatomies, which have a negative impact on the mortality of victims. For the management of these cases, it is essential to evaluate the length and size of and type of weapons.

COVID-19 can affect multiple organs including heart and blood vessels, kidneys, gut, and brain. This study aimed to assess all aspects of skin traumas and damages in COVID-19. The main causes of skin trauma in COVID-19 and its consequences can be examined in four parts, including cutaneous manifestations that appear during COVID-19, drug reactions that occur during hospitalization or outpatient treatment of patients, skin damages caused by over-washing or rinsing with inappropriate detergents, or inappropriate use of personal protective equipment (mask, gloves,…), and changes the duration of COVID-19 in patients with autoimmune, chronic and inflammatory underlying skin diseases. The rate of skin manifestations in patients with COVID-19 in the range of 1.8%-20.4%, including vascular lesions (petechiae, purpura, livedo reticularis, pernio, and chilblain lesions), urticaria and maculopapular rash, and other less common skin manifestations such as erythema multiforme, pityriasis rosea, suite syndrome.  These skin manifestations were commonly seen in men aged 45-89 years. The most lesions distribution (69.4%) was in the body, but in 19% of cases, lesions were observed in the hands and feet. Patients with COVID-19 receive multiple viral treatments, antibiotics, and various anti-inflammatory drugs. Receiving these drugs has led to cutaneous manifestations in some patients. Medical staff is prone to various traumatic skin conditions, due to the long-term use of personal protective equipment. These conditions include itching, redness, skin irritation, contact dermatitis, and worsening of underlying diseases. The effects of COVID-19 on the skin system can be serious and long-lasting. Adequate treatment and supportive therapy can prevent the long-lasting consequences and disability of the patient.

Perilunate dislocations and perilunate fracture-dislocations (PLD/PLFD) are the second most common wrist injuries.

Given the limited available case series due to the rarity of these injuries, in this study, we report the functional outcomes of 20 patients who received surgical treatment with a mean follow-up of 28 months (range 24-36).

We retrospectively reviewed the admissions to Imam Khomeini Hospital Sari, Iran, and included patients with (PLD/PLFD) who underwent surgical treatment between January 2014 to December 2019. We included 20 patients (16 males, mean age±SD=33.6±12.4) who had received urgent surgical treatment following the initial closed reduction in the emergency department. All of the patients received surgical treatment from the same surgical team using the dorsal approach.

We observed the average Mayo Wrist Score (MWS) of 73.8±8.4 (range 65-100) with excellent or good outcomes in 40% of patients. The MWS was slightly higher in patients with the non-dominant injured side, yet it did not significantly differ with those with a dominant hand injury (75.4±9.6 vs. 71.2±5.8, P=0.29). Furthermore, we did not find a significant difference in MWS between the lesser and greater arc injuries (76.5±10.1 vs. 71.1±5.7, P=0.15). The observed flexion and extension ROM were significantly lower than the contralateral side (P<0.001). Similar patterns of lower grip and pinch strength were observed on the injured side, which was significantly lower than the contralateral hand; 38.4±8.6 (74±14% of the contralateral) and 9.9±2.4 (81±15% of the contralateral), respectively (P<0.001).

In line with other cohorts, the present case series demonstrates relatively good functional postoperative outcomes in PLD/PLFD. Our findings are comparable with prior reports concerning reasonably satisfactory MWS, ROM relative to the contralateral side and reported occasional mild pain with activity. Future studies should be directed to investigate long-term complications associated with these injuries, particularly the development of wrist osteoarthritis.

Patients with a history of hypertension experience higher postoperative complications than healthy individuals. The frequency of such complications is also higher in emergency patients than elective ones; therefore, it seems that preventive measures are essential.
The present study aimed at determining the effect of dexmedetomidine on blood pressure in patients with hypertension after emergency laparotomy for trauma.
The present study was a randomized, double-blind clinical trial performed from 2019 to 2020 on patients with a history of hypertension undergoing emergency laparotomy. Patients received the intervention 15 minutes before surgery (the intervention group: intravenous (iv) dexmedetomidine and the control group: normal saline), and the intensity of the pain(VAS), agitation(RASS), and blood pressure were measured and compared at different time points. Data were compared using SPSS software (version 21) by t-test and Chi-square tests considering a significance level of <0.05.
There were statistically significant differences between the two groups just after the drug infusion and at all studied time points (P<0.05), so that the intervention group had more stable blood pressure. Pain intensity (P<0.05) and the degree of agitation (P<0.05) in the intervention group were significantly lower than that in the control group at all studied time points.
Dexmedetomidine infusion leads to a stabilization of blood pressure during surgery and after surgery, pain relief, and agitation in patients with hypertension undergoing emergency laparotomy for trauma.

Responses for medical emergencies can be different during most terrorist attacks in which civilians and military personnel might be killed or wounded. The present study aimed to reflect on injury patterns and the outcome of victims in terrorist attacks. A retrospective research design study was conducted on the data obtained from terrorist attacks in the city of Ahvaz, Iran, on September 22, 2018. In this deadly incident, 92 military and civilian victims had been transferred to hospitals within the first 24 hours. To this end, the data including age, gender, causes, site of injuries, outcomes, and the Injury Severity Score (ISS) values were analyzed.  Data were acquired from the Iranian Legal Medicine Organization, the Iranian Emergency Department, as well as health care facilities. The findings revealed that, out of 92 victims of Ahvaz terrorist attack, 85 cases (92.4%) were men. The mean age of these individuals was about 28.68±11.22 years and 41.3% of them were in need of urgent surgical interventions. There was no information regarding casualties in 22.3% of the cases. Moreover, 25% of the causalities had led to death. The mean of ISS was 8.19±13. Besides, there was a significant relationship between ISS values and patient outcomes (p <0.0001). A relationship was also observed between multiple injuries and mortality rates although it did not include main body parts. The results showed that the mortality rate of casualties in the Ahvaz terrorist attack was high. With respect to the findings, extensive actions are needed to maintain the readiness of the emergency medical care services and to manage such events.

The brachial plexus is a group of major neural structures providing sensory and motor innervations to the upper limb. The brachial plexus originates from four cervical (C5-C8) and the first thoracic root (T1).
The aim of the current study was to evaluate the role of MRI in the diagnosis and localization of traumatic brachial plexopathies and co-relate MRI findings with intraoperative findings wherever possible.
A total of 40 patients with traumatic brachial plexitis underwent a dedicated MRI at our institution. Clinical and electrodiagnostic tests were done in all patients. The findings of MR imaging were correlated with surgical findings as concordant (CR), partially concordant (PC), or nonconcordant (NC). Patients who were not operated were followed over a period of six months to one year.
Road traffic accidents (n=32) were the most common cause of brachial plexopathy in our study. Clinical evaluation revealed sensory symptoms in 28 (70 %), motor symptoms in 25 (63%), and autonomic manifestation in 2 (5%) patients. The electrodiagnostic tests were abnormal in 30 (75%) of our patients. MRI findings included pre-ganglionic injury (n=5, 12.5%), post-ganglionic injury (n=17 42.5%), mixed injury (n=9 22.5%) and normal in 9 (22.5%) patients. MRI findings were perfectly concordant with surgical findings in 23(66%), partially concordant in 8(23%), and nonconcordant in 4(11%) patients. MRI has a sensitivity of 87.88%, specificity of 100%, and accuracy of 89.47% for traumatic brachial plexopathy evaluation.
MRI is an essential component of traumatic brachial plexopathy evaluation. MR imaging, although not absolutely perfect, helps in the localization of injury in traumatic plexopathies (pre vs. post-ganglionic), thereby acting as a guiding light for surgical management. Normal MRI in traumatic brachial plexopathy is an enigma, and management in these patients should be based on clinical and electrodiagnostic tests.

Secondary peritonitis is a serious complication of all the inflammatory diseases and injuries of the abdominal organs and requires urgent surgical intervention. The mortality rate of patients with secondary bacterial peritonitis (SBP) reaches 70%. In some patients, despite the treatment, secondary peritonitis turns into tertiary peritonitis (TP), which complicates the healing process and aggravates the prognosis. Inadequate drainage of the abdominal cavity is a possible contributing factor to the formation of TP.

A prospective study of the result of surgical treatment of patients with SBP was carried out to improve the results of treatment. Methods. The study included 608 patients with SBP who underwent surgery in a clinical hospital in Russia in 2013-2019. All the patients were divided into groups depending on the method of draining the abdominal cavity and on signs of the purulent process generalization, the marker of which was multiple organ failure. Efficiency of abdominal drainage (by the incidence of TP) and of treatment results (in terms of mortality) were assessed in each group.

In patients without signs of the purulent process generalization, drainage of the abdominal cavity with drainage tubes (293 observations) is accompanied by the development of TP in 4.1% of cases and by mortality in 22.9%. If the purulent process is of a generalized nature (315 observations), the incidence of TP increases ten-fold and is 41.9%, and the mortality rate increases 2.7 times and reaches 62.8%. With the generalization of the purulent process, the efficiency of drainage of the abdominal cavity has a significant impact on the results of surgical treatment of patients with SBP. If abdominal drainage is carried out with drainage tubes (129 observations), the incidence of TP is 41.9%, and the mortality rate is 62.8%. Drainage of the abdominal cavity using traditional laparostomy (Bogota bag, 104 cases) is accompanied by the development of TP in 36.5% of cases and mortality in 45.2%. If the abdomen is drained using active laparostomy (VAC-system, 82 observations), the incidence of TP is reduced to 18.3% and mortality to 19.5%.

Conclusion:

Drainage of the abdominal cavity is the most important stage of surgical intervention in patients with SBP. In cases of the purulent process generalization, drainage of the abdominal cavity in the most effective way– by active laparostomy (VAC-system) will improve the results of treatment of these patients.