Bulletin of Emergency And Trauma
Volume:2 Issue: 2, Apr 2014

To determine the effects of glycemic level on outcome patients with traumatic brain injury. From September 2010 to December 2012, all medical records of adult patients with TBI admitted to the Emergency Room of Laura Daniela Clinic in Valledupar City, Colombia, South America were enrolled. Both genders between 18 and 85 years who referred during the first 48 hours after trauma, and their glucose level was determined in the first 24 hours of admission were included. Adults older than 85 years, with absence of Glasgow Coma Scale (GCS) score and a brain Computerized Tomography (CT) scans were excluded. The cut-off value was considered 200 mg/dL to define hyperglycemia. Final GCS, hospital admission duration and complications were compared between normoglycemic and hyperglycemic patients. Totally 217 patients were identified with TBI. Considering exclusion criteria, 89 patients remained for analysis. The mean age was 43.0±19.6 years, the mean time of remission was 5.9±9.4 hours, the mean GCS on admission was 10.5±3.6 and the mean blood glucose level in the first 24 hours was 138.1±59.4 mg/dL. Hyperglycemia was present in 13.5% of patients. The most common lesions presented by patients with TBI were fractures (22.5%), hematoma (18.3%), cerebral edema (18.3%) and cerebral contusion (16.2%). Most of patients without a high glucose level at admission were managed only medically, whereas surgical treatment was more frequent in patients with hyperglycemia (p=0.042). Hyperglycemia was associated with higher complication (p=0.019) and mortality rate (p=0.039). GCS was negatively associated with on admission glucose level (r=0.11; p=0.46). Hyperglycemia in the first 24-hours of TBI is associated with higher rate of surgical intervention, higher complication and mortality rates. So hyperglycemia handling is critical to the outcome of patients with traumatic brain injury.

To compare the conventional angiographic findings in extremity trauma patients with or without runoff. This was cross-sectional study including all the patients with extremity trauma who underwent conventional angiography during the 2 year period from 2011 to 2013 in Angiography departments of Mashhad University of Medical Sciences. Mechanism of trauma, type of injury and angiographic findings were recorded in a questionnaire for each patient. After completion of treatment and discharge, the treatment type was added. The characteristics as well as clinical findings were compared between those who were diagnosed to have arterial runoff ad those who did not. One hundred and forty eight traumatic patients including 15 female with age range of 11-82 years and 133 men ranging from 25 to 40 years were enrolled. Abnormal angiographic findings were provided in 99 (66.9%) patients including cutoff with distal runoff (n=60, 60.6% of abnormalities), cut off without distal runoff (n=21,21.2%) and spasm (n=14, 14.1%) and other findings (n=4, 4%). Fifty one cases were treated under open surgery and amputation of traumatic limb was done for 13 patients. Amputation rate was higher in patients with cutoff and without runoff than those with cutoff and runoff (33.3% vs. 6.78%; p=0.002). Causes and types of traumatic arterial injury in our study were different with other reports. It was shown that angiographic findings were less important in prognosis and management of patients. Patients with spasm in angiographic findings had a better prognosis than other patients and mostly did not need any vascular surgery. The presence or absence of a distal run off in primary angiographic findings can have a predictive value in the final amputation rate.

To determine the correlation between blood gas parameters and central venous pressure (CVP) in patients suffering from septic shock. Forty adult patients with diagnosis of septic shock who were admitted to the emergency department (ED) of Shohadaye Tajrish Hospital affiliated with Shahid Beheshti University of Medical Sciences, and met inclusion and exclusion criteria were enrolled. For all patients, sampling was done for venous blood gas analysis, serum sodium and chlorine levels. At the time of sampling; blood pressure, pulse rate and CVP were recorded. Correlation between blood gas parameters and hemodynamic indices were. A significant direct correlation between CVP with anion gap (AG) and inversely with base deficit (BD) and bicarbonate. CVP also showed a relative correlation with pH, whereas it was not correlated with BD/AG ratio and serum chlorine level. There was no significant association between CVP and clinical parameters including shock index (SI) and mean arterial pressure (MAP). It seems that some of non invasive blood gas parameters could be served as alternative to invasive measures such as CVP in treatment planning of patients referred to an ED with septic shock.

To determine the patterns,complications and casualties of road traffic accidents in North West of Iran during 2013 New Year holidays. One hundred and eighty one patients with trauma-related vehicle crashes were investigated in a cross sectional-descriptive study. We only included those road traffic accidents which were recorded during the 2013 Iranian New Year holidays. Severity of injury based on Glasgow Coma Scale (GCS) score, patient transmission type, damaged organ and the final diagnosis was determined. The mortality rate as well as complications were also recorded and reported. The pattern was analyzed and presented using descriptive statistics. Overall we included 181 patients who were victims of road traffic accidents during the study period. Most cases of multiple traumas were from two car accident (49.2%). Of 181 cases, 71 (39.2%), 66 (36.5%), 16 (8.8%) and 11 (6.1%) subjects had limb, head and neck, abdominal, and spinal cord injuries respectively, while 16 cases (8.8%) did not have any organ damage. In final diagnosis, a limb fracture was noticed in 32 cases (17.7%) and skull fractures in 5 subjects (2.8%) as the first and second causes. As head and neck were the most damaged organs after the limbs in patients with multiple traumas, it seems that there is a necessity for these patients in transmission and examination of head traumas. So there is a need for a proper referral system.

To investigate maternal beliefs, practices about causes and determinant factors on drowning and maternal socioeconomic correlated factors on child mortality from drowning. From March 2005 to March 2009, in a register-based cohort study and household survey, individual records utilizing drowning registry data of northern Iran were enrolled. Mothers (n=276) who responded to multiple questions in a household survey were included. The patterns, interrelationships and effects of socioeconomic correlated factors on child mortality were analyzed. Children drowning mortality among youngest and oldest groups was positively and significantly correlated with family income (p=0.841), mother’s educational level (p=0.482) and age (p=0.414). Participants in household survey also reported that establishment of a multi-sectorial collaboration, integration of public health messages into local television, additional rescue stations and lifeguard, hazard environment fencing, increasing adult supervision, more support on increasing swimming ability among the children were all effective on reducing of drowning death. Due to the high rate of drowning in children and lack of attention among olders, a greater emphasis should be placed on educating mothers to assist a better supervision on their children.

Mycotic aneurysm of external carotid artery is extremely rare. We herein report a case of external carotid artery (ECA) aneurysm following severe traumatic brain injury. A 24-year-old man with severe traumatic brain injury (TBI) following a car accident was referred to Rajaee Trauma Center Emergency Room affiliated to Shiraz University of Medical Sciences in Shiraz, Iran. He underwent ventriculostomy on arrival for intracerebral pressure (ICP) monitoring and for a second time due to hydrocephalus following decompressive craniectomy. He developed fulminant meningitis and ventriculitis during his hospital course. A bulged pulsatile lesion under the frontotemporal scalp resulted into the suspicion to underlying vascular pathology. Six-vessel angiography of brain was done which revealed mycotic aneurysm of external carotid artery. The patient underwent a two-week course of a combination of intravenous antibiotics. Follow-up angiography was performed which confirmed successful treatment of mycotic aneurysm of ECA. Mycotic aneurysm of ECA is extremely rare. To our knowledge, this is the first report of mycotic aneurysm of ECA following severe TBI which was successfully treated with antimicrobial therapy.

Traumatic brain injury is a common entity. However cerebral infarction in infants is a rare entity while the diagnosis of this pathology in the pediatric population is usually difficult. The mild head trauma is rarely accompanied by intracranial injury and even less, with cerebral infarction. We herein report the first case of cerebral infarction after a mild brain trauma in a 2-year-old Latin-American male patient, in which brain computed tomography (CT) scan was performed on the first day of the accident, showed right hemispheric cerebral ischemia compromising the fronto-parieto-occipital region. Conservative management was established. The patient died at day 5. So Brain CT scan may be beneficial to reveal any hemispheric infarction due to a probable mass effect.