Bulletin of Emergency And Trauma
Volume:1 Issue: 2, Apr 2013

Worldwide, sepsis is one of the most common deadly diseases. It is one of the few conditions to strike with equal ferocity in resource-poor areas and in the developed world. Globally, 20 to 30 million patients are estimated to be afflicted every year. Every hour, about 1,000 people and each day around 24,000 people die from sepsis worldwide. Although more than 8 million people die from sepsis annually, the medical knowledge about it is scarce. In developing countries, sepsis is considered the most common cause of mortality among children accounting for 60-80% of all deaths during this period. Overall, more than 6 million neonates and children affected by sepsis annually. Sepsis is also a common cause of maternal morbidity and mortality accounting for >100,000 cases of maternal sepsis each year [1].

Most of the manuscripts submitted to biomedical journals are rejected or needs minor or major revisions. Acceptance or rejection rate of manuscripts is different in the journals. A few of manuscripts will be accepted while the majority is rejected. The primary rejection of a manuscript by editors or editorial board of a journal is when it does not comply with the Aim and Scope of the journal, or if it is not suitable for peer review. The reasons being due to short discussion, inadequate illustrations, inferior quality of the figures, and lacking new information added to the previous research.

Intracranial hypertension is the largest cause of death in young patients with severe traumatic brain injury. Decompressive craniectomy is part of the second level measures for the management of increased intracranial pressure refractory to medical management as moderate hypothermia and barbiturate coma. The literature lack of concepts is their indications. We present a review on the state of the art.

To determine the effects of triage education based on emergency severity index (ESI) on promoting the knowledge and performance of nurses and qualitative indices of emergency department. This study was a quasi-interventional study being performed in Vali Asr Hospital of Fasa University of Medical Sciences during 2012. For this purpose, 50 members of staff including nurses and technicians of emergency medicine in the Emergency department with the inclusion criteria for participation were selected. Data collection instruments included a questionnaire consisting of two parts, (personal characteristics, and knowledge) and the performance assessment checklist was prepared. Content validity was used to determine the validity. The test-retest method and quder-Richardson 20 were applied to determine the reliability of the questionnaire. Interobserver reliability and the correlation between the two observers and imaging modalities were measured to determine the reliability of the performance checklist. The questionnaires and checklist were completed by the participants before, 2 days and 6 weeks after completion of the training. Workshop in two 9-hour sessions was provided which consisted of lectures, questions and answers. The triage scores were 10.7±3.1, 17.8± 1.6 and 16.1±2.3 before, 2 days and 6 weeks after training, respectively. Triage performance score increased from 48.9 ± 9.9 before training to 59.8 ± 7.6, two days after training and to 59.7 ± 8.1 six weeks later (p=0.001). In addition to triage training of the nurses the emergency department qualitative indices were impressively upgraded. Other results showed that there was no significant correlation between individual characteristics and personal knowledge of triage score 6-week after training (r=0.018, p=0.126). However, significant positive correlation was found between nursing work experience, work experience in emergency ward and type of employment and performance scores 6 weeks after training (r=0.258, p=0.032). The results of the present study showed that triage education influences the practice and knowledge of nurses and improves the qualitative indices of emergency department. Therefore, it is recommended to include theoretical and practical training of triage for nurses in hospitals.

The aim of this study was to evaluate the etiology, associated injurers and clinical presentation of post traumatic diaphragmatic hernia. This study was a cross-sectional study being conducted in the department of Cardiovascular, thoracic surgery (CVTS) and Pediatric Surgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Kashmir, India. All patients of post traumatic diaphragmatic hernia who were admitted in the department of CVTS and Pediatric Surgery, SKIMS, during the course of study (May 2009 to Nov. 2011) were included. From the commencement of the study 21 patients had traumatic diaphragmatic hernia. Most common presenting symptoms in traumatic diaphragmatic hernia were, chest discomfort and pain abdomen presented in 81% of patients, followed by breathlessness in 61.9% and vomiting in 47.6%. Common associated injuries in traumatic diaphragmatic hernia in our study group were, rib fracture in 47.6%, splenic injury in 28.6%, head injury in 23.8%, soft tissue injury in 23.8%, gut perforation in 19%, limb fracture in 14.3%, liver injury in 9.5%, pancreatic injury in 4.8% and renal injury in 4.8%. Usually the patients of Post traumatic diaphragmatic hernia presents as emergency, early recognition and prompt surgical treatment is needed for better outcome. The Incidence of post traumatic diaphragmatic hernia when associated with blunt trauma abdomen and chest is very high (81%). A high level of suspicion is needed in these injuries. The 9.5% of traumatic diaphragmatic hernia may have delayed presentation. Early diagnosis of traumatic diaphragmatic hernia is most difficult when herniation is delayed.

To record and classify mechanisms of injury and injury severity score (ISS) in trauma patients admitted to the largest trauma center in Southern Iran. This was a prospective cross-sectional study including all the patients who were admitted to Nemazee hospital from 2009 to 2010. We recorded the trauma injury information of 1217 patients who were admitted to of emergency room of the Nemazee hospital during a 13-months period by means of a standard questionnaire. ISS was then obtained for every single patient. The mean age of patients was 26.6 ± 15.1 (range 1–95) years. The commonest type of trauma including 279 cases (22.9%) was car accident and the least resulted from shotgun injuries in 13 (1.1%) patients. The lowest ISS was due to assault multiple blunt traumas and the highest ISS resulted from shotgun injury. The mean ISS was about 6.3 ± 1.8 (range 1-66). Overall, 86 patients had scores above 17 (7.1%). A total of 69 male patients (7.5%) compared to 17 females (5.7%) had severe injury (ISS>17). Trauma injuries were significantly more severe in males compared to females (p=0.014). In the sunny and hot seasons total number of patient was higher. The mean ISS was highest in during spring (p<0.001). In Shiraz, most of the trauma injuries are occurred during summer and hot weather. Men have greater number of injuries and higher ISS compared to women. The lowest ISS was due to assault multiple blunt trauma and the highest ISS was caused by shotgun injury, and car accident was the commonest cause of trauma with head and neck being the most frequent sites in our patients.

To determine the prediction value of disorder of consciousness scale (DOCS) for consciousness recovery after traumatic brain injury (TBI) leading to coma. This is a descriptive-cross-sectional study of the correlation between the level of patients’ consciousness in the first and second weeks and the first 2 months after traumatic brain injury, using DOCS scale. The findings of the present study showed that the sensitivity and specificity of DOCS in determining individual’s consciousness after first week and two months after injury are 66% and 41% respectively, and regarding DOCSU2 the corresponding values were 94% and 50% (p=0.001). Passage of time is one of the most significant factors in predicting the resumption of consciousness in patients with brain injury, and more accurate results are expected following the acute phase. However, the application of disorder of consciousness scale could be of a great help to patients’ families and rehabilitation staff in regard to providing a better services to meet the patients” future needs.

To evaluate the role of physical examination in decision making for exploring patients with penetrating zone II neck injury. This was a cross-sectional study being performed in a level I trauma center between 2006 and 2010. The present study reviewed the records of 150 patients with penetrating neck injuries. Of 46 cases with zone II deep platysma neck injuries, 3 patients died before taking any significant medical measure. Thirty of 43 patients (70%) presented with hard sings while 13 (30%) did not show these sings. All patients underwent neck exploration. Two patients (4.6%) without hard sings exhibited positive findings, whereas 29 cases (67%) with hard sings reported positive on exploration. Briefly, we hold the view that it seems reasonable to follow an algorithmic approach by using physical examination of the patients with zone II penetrating neck injuries. This prevents unnecessary exploration for management of such patients.

The article reports a clinical case of a 39-year-old male patient who was admitted in the emergency room in shock. The clinical exams and additional tests identified a right massive hemothorax, without apparent etiological factors. He was submitted to an emergency right thoracotomy. A bulky varicose formation in the diaphragmatic surface, with evident laceration and haemorrhage was identified. The article describes this case due to its rarity. The varicose formation was simply ligated and the evolution, as well as the outcome of this clinical case was uneventful.

The uterine rupture during pregnancy is a catastrophic condition resulting in both maternal and perinatal morbidity and mortality. It occurs in nearly 1% of patients with previous cesarean sections. However, uterine rupture at the site of previous iatrogenic perforation which is spontaneously healed or repaired is less reported. We present a 29-year-old woman, gravida 3 para 1, at 20 weeks of gestation with abdominal pain of right half and hemodynamic instability whose laboratory evaluations revealed severe acute blood loss but still without any signs of peritonitis. The exploratory laparotomy revealed a uterine rupture at the site of fundus at the same location of previously repaired dilatation and curettage-induced perforation contributing to extrusion of whole pregnancy product in addition to severe intra-abdominal blood loss.