فهرست مطالب

Trauma Monthly - Volume:29 Issue: 1, Jan-Feb 2024

Trauma Monthly
Volume:29 Issue: 1, Jan-Feb 2024

  • تاریخ انتشار: 1403/02/30
  • تعداد عناوین: 6
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  • Saeed Nazari *, Faeze Baniyaghoobi, Mahboobeh Afzali, Farshid Alazmani Noodeh, Mansoureh Jafarkhani Pages 1003-1019
    Introduction

    Radiological and Nuclear disasters are emergencies which can result in injury, illness, or death. On-site health management are underprepared to respond to recognize key factors which underlie the On-site health management Radiological and Nuclear response is crucial to provide evidence-based knowledge to inform policies and above all clinical practice. Thus, this study aimed to extract the effective components and factors in the dynamic On-site health management and Emergency on the Scene systems.

    Methods

    A systematic review was accomplished in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The seven-stage structure was used in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. The coverage index was strict in terms of the environment, participants (first responders), condition (Radiological and Nuclear responses), and proceedings (diagnosis, decontamination and detection). Twenty databases and topic-specific journals were searched. Researches were critically appraised using Mixed Methods Appraisal Tool. Studies were thematically coded and synthesized using NVivo 10.

    Results

    Totally, 1065 articles were extracted through the systematic review. After studying the titles, abstracts and contents of the extracted articles, 20 were selected for the final analysis. Data were grouped into 4 themes: of preparedness in Scene, Medical Triage System, Contamination Survey, and Management of uninjured.

    Conclusion

    The results of this systematic review presented an overall view of the effective components in the dynamic On-site health management and Emergency on the Scene systems. Key factors infrastructure the dynamic On-site health management and Emergency on the Scene system to plan, prepare, and respond to emergencies effectively has legal, practical, and spiritual implications. Further, with the Known concerns from this review, in terms of both knowledge and behaviors propoSEl that a systems approach is required to comprehend the On-site health management and Emergency on the Scene Nuclear and Radiological response in the future.

    Keywords: Nuclear, Radiological, Incidents, and Disasters, Emergency on the Scene
  • Iraj Nazari, Seyyed Masoud Mousavi, Hossein Minaee, MohammadAmin Zargar * Pages 1020-1026
    Introduction

    This study aimed to assess the feasibility of endovascular treatment for trauma patients with vascular damage, providing the foundation for establishing a treatment protocol for trauma patients.

    Methods

    The study involved 22 patients with arterial injuries caused by blunt, penetrating, or iatrogenic trauma, who underwent endovascular intervention between September 2021 and September 2022. Patient demographics, trauma type, affected artery, mortality and morbidity, packed red blood cell (PRBC) transfusion during hospitalization, hospital stay duration, reoperation, and infection were collected. Follow-up was conducted for three months using sonography.

    Results

    The study cohort comprised 20 males and two females, with an average age of 31 years (ranging from 22 to 45). During hospitalization, primary and secondary success rates, infection rates, and artery pathologies were analyzed. The subclavian artery (36.36%) was the most frequently treated artery in our facility. Stab wounds (50%) were the most common cause of arterial injury requiring endovascular intervention, followed by gunshot wounds (22.72%). Pseudoaneurysm (86.38%) was the most prevalent arterial injury pathology, and endovascular intervention was effective in its management. Coil embolization (59.09%) was the most common endovascular intervention technique, followed by stent graft placement. The average hospital stay duration was 9.8 days. Reoperation was required in four patients (18.1%).

    Conclusion

    Endovascular intervention is a viable option for vascular trauma treatment in various body regions. Vascular specialists should have access to this technique to provide timely and effective patient care.

    Keywords: Endovascular, Trauma, Arterial Injury
  • Masoud Bitaraf, Iraj Najafi, Saman Behboodi Tanourlouee, Mahmoud Yousefifard, Saeed Safari * Pages 1027-1036
    Introduction
    To determine the optimum volume of intravenous fluid administration in traumatic rhabdomyolysis patients to prevent acute kidney injury (AKI) and the need for dialysis.
    Methods
    Systematic search was done via the electronic databases Medline, Embase, Scopus, and Web of Science on January 21, 2024 using the query formed for keywords rhabdomyolysis, fluid therapy, and AKI. No filter was used. Citation searching was done, as well. Trials and observational studies reporting data on fluid therapy and AKI in traumatic rhabdomyolysis patients were included. Animal studies, case reports, reviews, and studies on non-traumatic causes were excluded. Risk of bias assessment was done using NHLBI tool for observational and cohort studies. The quality of evidence was assessed using the GRADE score. Analyses were carried out using STATA v.18 for outcomes AKI and dialysis by categorizing studies into three treatment volumes of ≤3 L/day, >3 L/day, and Better et al. protocols.
    Results
    Eight studies were included in the final analysis. The estimated prevalence of AKI and the need for dialysis in traumatic rhabdomyolysis patients were lowest when administering 3-8 L of IV fluid per 24 hours (AKI: 0.02 (95% CI: 0.00, 0.11) compared with 0.48 (95% CI: 0.0, 1.0), and 0.16 (95% CI: 0.01, 0.38) in studies administering ≤3 L/day, and those following Better et al. protocol, respectively; Dialysis: 0.01 (95% CI: 0.00, 0.03) compared with 0.05 (95% CI: 0.00, 0.18) in ≤3, and 0.16 (95% CI: 0.01, 0.38) in Better protocol.). All studies were of non-low risk of bias and the quality of evidence is very low.
    Conclusions
    There is paucity of high quality data on fluid therapy in traumatic rhabdomyolysis, which warrants further studies. The scarce evidence is in favor of administering a volume of 3-8 L/day to prevent AKI and the need for dialysis in traumatic rhabdomyolysis patients, albeit with very low quality.
    Keywords: Rhabdomyolysis, Fluid Therapy, Acute kidney injury, Renal Replacement Therapy
  • Majid Mirzaei Nodoushan, Mohammad Amrollahi Sharifabadi, Ebrahim Salimi Sabour, Bahman Jalali Kondori, Alireza Shahriary, Masoud Ezami, Seyed Morteza Hosseini, AhmadReza Sharifi Olounabadi, Hadi Esmaeili Gouvrchin Ghaleh * Pages 1037-1047
    Introduction

    Although several studies have highlighted the beneficial effects of Baneh gum extract (BGE), characterizing its anti-inflammatory effects remains an unmet need. The present study aimed to investigate the in vivo effects of the BGE on the inflammation induced by carrageenan in an in vivo mouse model.

    Methods

    Inflammation induced using carrageenan. The animal population included 50 BALB/c mice with an age range of 6-8 weeks and a weight of 25-30 grams. The animals were divided into 5 groups (n=10 in each group) including inflammation control group (no treatment), intraperitoneal injection group before inflammation (25µg/ml BGE injected intraperitoneally), oral administration group before inflammation (25µg/ml BGE orally administered), the group of intraperitoneal injection concurrently with the induction of inflammation (25µg/ml BGE injected intraperitoneally), the group of oral administration concurrently with inflammation (25µg/ml BGE orally administered). Seven hours after the induction of inflammation, animals euthanized and samples harvested to measure biomarkers including pro-inflammatory and anti-inflammatory cytokines, antioxidant enzyme, oxidative stress indices, and liver enzymes.

    Results

    Our findings showed that the BGE can significantly reduce the amount of inflammatory cytokines and oxidative stress compared to the control group. Moreover, BGE can augment the amount of antioxidant enzymes and anti-inflammatory cytokines.

    Conclusions

    Based on the results of this study, it is proposed that the BGE can be a beneficial natural product with anti-inflammatory properties requiring further clinical studies to evaluate its potential application in the treatment of diseases with underlying cause of inflammation.

    Keywords: Antioxidant enzymes, BGE, oxidative stress
  • Malihe Salami-Bani, Vinciya Pandian, Amir Vahedian-Azimi *, Seyed Tayeb Moradian, Ali Bahrami Far Pages 1048-1051

    Delay in the transfer of critically ill patients admitted to the emergency department to the intensive care unit (ICU) leads to worsening of their clinical outcomes. The long time from the beginning of the primary organ disorder to the appropriate interventions in critically ill patients has a direct impact on the survival rate of these patients because critically ill patients often need time-sensitive therapeutic interventions to reduce mortality.  Shortening the admission time of critically ill patients who need to be hospitalized in ICU can be significantly decreased mortality in the patients. Different interventions can be done in this field. One of the most cost-effective measures to reduce the mortality of these patients is to preserve the golden and precious time to start the care and treatment process. Evidence-based and need-based training is always effective and beneficial. This letter highlights the crucial role of RCCN in emergency and critical care settings and emphasizes the need for a comprehensive training program to equip them with the necessary skills. By investing in the development of RCCN, we can enhance patient outcomes, reduce complications, optimize resource utilization, and ultimately save lives.

    Keywords: Critical Ill, Intensive Care Unit, mortality, Respiratory Critical Care Nurse
  • Mostafa Khafaei, Yunes Panahi, Hassan Abolghasemi, Ali Miri, Forouzan Karimi, Gholamreza Farnoosh * Pages 1052-1057

    White phosphorus, a chemical compound with highly flammable and smoke-generating properties, is extensively used in military weaponry. Consequently, this substance is regarded as very dangerous. The risk of harm or fatality resulting from contact with WP is heightened when it is inhaled, ingested, or absorbed by the skin. There is a correlation between this risk and the probability of mortality. This research thoroughly investigates the possible ramifications of being exposed to WP, including systemic toxicity and deep tissue burns. The text covers the process of igniting, the generation of dense smoke with a characteristic garlicky aroma, and associated subjects. Performing laboratory tests, including measuring creatinine, potassium, calcium, serum phosphorus levels, and liver enzymes and conducting blood gas analysis, is essential for accurately diagnosing phosphorus poisoning based on the patient's symptoms. Promptly extracting the individual exposed from the origin of contamination, cleansing the impacted skin or injuries with frigid water or a saline solution, and cautiously managing phosphorus particles to avert more igniting are all crucial elements of immediate post-exposure treatment. It is essential to see an ophthalmologist promptly upon detecting any indications of an eye injury and to wash the area thoroughly with water or a saline solution. Immediate medical intervention is necessary to carry out a thorough assessment and treatment. The Israel Defense Forces' use of white phosphorous in densely populated areas of Gaza throughout the war raises significant moral and humanitarian concerns. Exposure to WP poses a considerable danger to workers because of its pyrotechnic and smoke-generating properties, which may lead to systemic poisoning and significant tissue damage. This article examines the use of White Phosphorus by the Israel Defense Forces, elucidating the challenges in preventing injury and the possible consequences for innocent bystanders. The use of WP serves as evidence of the very intricate ethical dilemmas associated with the deployment of chemical weapons in modern warfare. Enhanced understanding and accountability in executing military operations are necessitated as a consequence.

    Keywords: White phosphorus (WP), Systemic toxicity, Phosphorus poisoning, Immediate post-exposure treatment, Ethical Dilemmas