JournalTOCs

Journal of Emergency Practice and Trauma
Number of Followers: 6

This is an Open Access Journal

Open Access journal
ISSN (Online) 2383-4544
Published by Kerman University of Medical Sciences

[5 journals]

Evaluation of the efficacy of the valsalva maneuver and fentanyl
administration for attenuating etomidate injection pain: A double-blind
clinical trial
- Abstract: Objective: Etomidate is mentioned as one of the rapid intravenous anesthetic drugs whose unique characteristics include hemodynamic stability, negligible respiratory depression, and brain protection. The most common complication of etomidate is intravenous pain during injection. The purpose of this study was to compare the effectiveness of the Valsalva maneuver and fentanyl in reducing the pain caused by etomidate injection for anesthesia induction.Methods: This clinical trial was performed on 96 patients at Alzahra hospital, affiliated with the Isfahan University of Medical Sciences, from January to June 2021. Patients were divided into two groups of 48 people: the Valsalva maneuver group (group 1) and the fentanyl group (group 2). Blood pressure, heart rate (HR), oxygen saturation, and pain of etomidate injection using the withdrawal response score were graded on a four-point scale (no pain = zero, mild pain = 1, average pain = 2, and severe pain = 3). The collected information was entered into SPSS software version 24. Then, the pain score in the two groups was compared using the chi-square test. The significance level in the present study was P < 0.05.Results: The mean HR (P = 0.07), mean arterial pressure (MAP) (P = 0.33), systolic pressure (P = 0.90), diastolic pressure (P = 0.67), and oxygen saturation level (P = 0.27) at different times between the two groups showed no significant difference (P > 0.05). However, during the etomidate injection, the HR increased and after the injection, the HR decreased in both groups (P = 0.042). The two groups had no significant difference regarding pain frequency.Conclusion: There was no difference in the effect of the Valsalva maneuver and fentanyl on reducing the pain caused by etomidate injection.
Is Clavicular Fracture Associated with Accompanying Injuries in Multi
Trauma Patients'
- Abstract: Objective: This study aimed to evaluate the relationship between clavicular fracture and associated injuries in multi-traumatic patients.Methods: In this prospective cohort study, 185 multi-traumatic patients referred to the Emergency Department of Imam Reza (AS) Hospital of Tabriz University of Medical Sciences were selected between August 2019 and September 2021. The census sampling method was used until the required sample size was achieved. The following patient information was recorded and studied: mechanism of trauma, age, gender, Glasgow Coma Scale (GCS) score, systolic blood pressure (SBP), the presence of clavicular fracture, concomitant injuries, hospital outcome, duration ofhospitalization, and severity of trauma. The participants were divided into two groups based on the presence of a clavicular fracture. Data were analyzed using SPSS software.Results: Of all 185 patients, 51 had clavicular fractures. The mean age of the patients was 34.72±12.99. Of all patients, 27.6% had clavicular fractures. There was no statistically significant difference in GCS scores between the two groups (P=0.927). The highest percentage of injuries associated with clavicular traumas was traumatic brain injuries, with rates of 22.4% and 19.6% in the study and control groups, respectively. There were statistically significant differences inconcomitant injuries between the two groups (P<0.001). There was no statistically significant relationship between clavicular fracture and the patient’s outcome (P=0.10), nor between clavicular fracture and GAP (GCS, age, SBP) (P=0.143) or New Trauma Score (NTS) (P=0.257).Conclusion: The results showed a difference in the associated injuries between the groups; however, there was no statistically significant difference in patient outcomes. Healthcare providers are suggested to consider concomitant injuries in patients with clavicular fractures.
Severity of organ dysfunction in pediatric intensive care using PELOD-2
- Abstract: Objective: Organ dysfunction is an important factor determining the severity and outcome of critical illness in children. Organ dysfunction scores are based on the number of organs involved and the severity of dysfunction in each. This study aimed to evaluate organ dysfunction using PELOD-2 in critically ill children.Methods: This prospective observational study included all consecutive critically ill children with organ dysfunction aged one month to 15 years admitted to pediatric intensive care unit of a Ramaiah Medical College Hospital, Bangalore between January 2018 and December 2020. The severity of organ dysfunction was scored using Pediatric logistic organ dysfunction-2 (PELOD-2) and evaluated based on the outcome using SPSS and PASW statistics for Windows version 18.0. The sample size required for the study with 95% confidence level and 10% relative precision was 149 critically ill children. The children were classified based on the presence of single and multiple organ dysfunction. Demographics and laboratory parameters were compared between the two groups using non parametric tests. The factors affecting mortality among children with multiple organ dysfunction were assessed using univariate and multivariate analysis.Results: Of the 550 children admitted with critical illness during the study period, organ dysfunction was present in 84% of the patients. Of these, 43% had multiple-organ dysfunction. The median (interquartile range) of the patients was 5.5 (1, 11) years with a male-to-female ratio of 1.7:1. The mortality rate was 14.4%. The PELOD-2 score and mortality steadily increased with the number of organs involved. The presence of more than two organ dysfunctions had an odd ratio (OR) of 45.7 for mortality (95% CI: 18.9–110.6, P value<0.001). The area under the receiver operating curve(ROC) for predicting mortality using the number of organs affected was 0.96 (95% CI: 0.94–0.97, P value<0.001). Dysfunction in more than two organs had a sensitivity of 92.5% and a specificity of 91% in predicting mortality. The presence of cardiovascular dysfunction and the need for ventilation were found to be independent predictors of mortality.Conclusion: The presence of more than two organ dysfunctions in PELOD-2 increased the risk of mortality; the need for ventilation and the presence of cardiovascular dysfunction were independent predictors of mortality.
Comparison of high-flow nasal cannula and conventional oxygen therapy in
treating COVID-19 patients referred to the emergency department: A
randomized, single-blind clinical trial
- Abstract: Objective: Recently, high-flow nasal cannula (HFNC) oxygen therapy has been implicated in the treatment of patients with acute respiratory failure. In this study, the effect of this treatment on COVID-19 patients was investigated.Methods : This was a prospective, randomized, single-blind clinical trial on patients with COVID-19 referred to the emergency department. COVID-19 patients who had peripheral oxygen saturation (SpO2) ≤90% despite receiving nasal oxygen (up to 6 L/min) were included in the study and randomized to HFNC or conventional oxygen therapy (COT). Then the patients were compared in terms of vital signs, SpO2, need for endotracheal intubation, and need for intensive care unit admission. The sample size was calculated at 35 patients in each group. Variables were compared using the chi-square test, Student’s t-test, or the Mann-Whitney U test.Results: 87 patients with a mean age of 65.3±14.8 (62.1% male) were included. The two groups were similar in terms of age, sex, time interval from onset to diagnosis, and underlying diseases (hypertension, diabetes, coronary artery disease, etc.) (P<0.05). No statistically significant difference was reported between SpO2 and PaO2/FiO2 vital signs at the beginning of treatment between the two groups. One hour after treatment, respiratory rate, SpO2, and PaO2/FiO2 were better in the HFNC group compared to the COT group (P<0.05). Also, there was no significant difference between the two groups in terms of the need for endotracheal intubation, the need for ICU admission, and in-hospital mortality.Conclusion: Early use of HFNC oxygen therapy in patients with COVID-19 can improve SpO2, respiratory rate, and PaO2/FiO2 levels. Therefore, it has high clinical value.
Fecal incontinence after ileal pouch-anal anastomosis in patients with
ulcerative colitis
- Abstract: Objective: Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the restorative procedure of choice for medically refractory ulcerative colitis (UC). In patients who undergo proctocolectomy with IPAA, fecal continence outcomes are an issue. The present study evaluated fecal incontinence in patients who underwent IPAA for UC.Methods: This was a case series study. We reviewed the clinical records of all patients who had undergone a proctocolectomy with IPAA for UC at the Colorectal Department of Shiraz University of Medical Sciences, Iran, between January 2010 and December 2022. Each patient completed a Cleveland Clinic Florida Fecal Incontinence Scoring System (CCFFIS) questionnaire to evaluate fecal incontinence one year after the closure of the colostomy. Data analysis was conducted utilizing various statistical measures such as mean, count (percentage), chi-square, and one-way ANOVA tests. The entire analysis was performed using SPSS 26 software. P values less than 0.05 were deemed statistically significant.Results: From January 2010 to December 2022, 159 patients who underwent IPAA surgery were included in the study. Of these patients, 108 (67.9%) had no complaint about fecal incontinence (score 0). The median CCFFIS score was 2.19, and there were no significant differences between gender, age, technique, and number of procedures regarding fecal incontinence (P values 0.475,0.125, 0.319, and 0.376, respectively).Conclusion: This study confirmed that total proctocolectomy with IPAA is a complex surgery that could have good functional results if patients are selected carefully and an experienced surgeon performs the procedure.
Emergency transfusion of different rhesus blood type: Will there be
complications'
- Abstract: Objective: Antepartum hemorrhage (APH) is one of the leading causes of maternal and fetalmortality worldwide, complicating 2–4% of pregnancies. Considering the probability of bloodtransfusion, blood testing and cross-matching are essential for the anesthesiologist duringperioperative management. Rhesus (Rh) is the second most significant blood group systemafter ABO. Hence, this blood type system needs to be taken into consideration. Furthermore, inIndonesia, Rh-negative blood types are rare.Case Presentation: A 39-year-old woman with Gravida IV, three term pregnancies, no pretermpregnancies, no abortions, and three living children (GIVP3003) and gestational age 26 to 27weeks arrived at the hospital with massive bleeding from the birth canal three hours beforeadmission. The bleeding was fresh red, and the patient had changed diapers twice before arrivingat the hospital. She presented hypovolemic shock, a blood pressure of 71/39 mm Hg, andanemic conjunctivas, with a history of B Rh (-) blood type, ongoing HIV therapy, and completedpulmonary tuberculosis (TB) treatment. The hospital’s and PMI’s (Indonesian Red Cross) bloodbank had no Rh (-) bloodstock. An emergency cesarean section under general anesthesia wasperformed, and a 900 g neonate was delivered. The patient received a total of four stored wholeblood (SWB) bags of type B Rh (+) blood products, one SWB bag during surgery, and three SWBbags during recovery in the intensive care unit (ICU).Conclusion: Rh (+) transfusion in patients with Rh (-) should be the last option in an emergency.The transfusion reaction did not occur right away in the initial transfusion. Under promptmanagement, the transfusion response and the life-threatening condition were then successfullymanaged.
Splenic injury in pregnancy requiring urgent splenectomy: A rare surgical
emergency
- Abstract: Objective: The spleen is the most frequently injured organ in blunt abdominal trauma (BAT). We present an interesting case of traumatic splenic rupture in pregnancy managed successfully by emergency splenectomy in a low-resource setting.Case Presentation: A 27-year old multiparous woman at 23 weeks gestational age presented to the emergency department with a history of BAT following a road traffic accident (RTA). This study was conducted in the Department of Surgery, General Surgery Unit, College of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA), Ebonyi State, Southeast Nigeria, in 2023. A vehicle strayed and hit her from the left side of the abdomen while she was sitting down. She suddenly developed abdominal pain, bruises on the left upper abdomen, andprogressive abdominal distension. The abdominal ultrasound report showed a deep trabecular laceration and massive hemoperitoneum. The fetus was viable from obstetric and ultrasound assessments. The patient was hemodynamically unstable and was subsequently prepared for emergency exploratory laparotomy. Intraoperatively, incomplete hilar avulsion injury and multiple parenchymal lacerations of the spleen were noted. An accessory spleen without injury was also noted. Splenectomy with preservation of the accessory spleen was performed.Postoperatively, the fetus remained viable, and the patient was hemodynamically stable. The mother had no morbidities other than paralytic ileus and fever, and both were amenable to conservative management.Conclusion: Emergency splenectomy is a life-saving procedure in hemodynamically unstable patients with splenic trauma, even in pregnancy.
Superficial femoral artery rupture after open distal third femoral shaft
fracture: A case report
- Abstract: Objective: This case report aims to demonstrate an instance of superficial femoral artery (SFA) rupture after an open femoral shaft fracture.Case Presentation: Our patient was a 22-year-old man admitted to the emergency department after a motorbike accident with a deformity at the distal third of the thigh and an open wound on the medial side. Radiographs and computed tomography angiography revealed a left distal third femoral fracture with ipsilateral SFA injury. We performed fracture reduction external fixation following SFA reconstruction using a 5-cm saphenous vein autograft. Prophylaxis fasciotomy was not performed. At a 6-month follow-up, the wound was well-healed, the Doppler ultrasound showed good blood flow at the reconstructed artery, and a rigid callus entirely covered the fracture.At 1-year follow-up, the patient could walk with full weight-bearing. Maximum knee range of motion was restored, and the patient could return to daily activities.Conclusion: Vascular injury after femoral shaft fracture is rare, and accurate diagnosis with timely and appropriate surgery plays a crucial role in achieving limb salvage, reducing the risk of complications, and improving the overall quality of patient life.
The approach to the treatment of venomous and poisonous arthropod bites
and stings in ancient medicine: A narrative review
ABDOMINAL SEPSIS: WHAT IS THE BEST SCORE'
- Abstract: Intra-abdominal infections still represent a challengefor surgeons. The systemic physiopathological effects ofinfection rapidly progress, leading to sepsis and multiorganfailure, whose prognosis is often dramatic. Mortality riskstratification using scoring systems would unequivocallyaid the early identification of patients at risk of diseaseprogression. 
Metastatic liver mass with heart failure presentation: A Case Report
- Abstract: Objective: Dyspnea is a common symptom of heart disease that can also be related to otherdisorders, such as liver disease. In this case report, we aim to describe a rare case of metastatic livermass that presented with heart failure.Case Presentation: A 50-year-old woman without a past medical history arrived at our hospitalwith a history of dyspnea and swelling in the lower extremities. She did not complain of pain,arthralgia, trauma, or chest pain but complained of exertional dyspnea and fatigue that had startedone month before and had aggravated two days before. Her laboratory test indicated anemia. Inechocardiography, we saw mild right ventricle enlargement and dysfunction, but the left heart wasnormal with acceptable systolic and diastolic function. In the subcostal view, the inferior vena cava(IVC) was dilated but under compression of a large liver mass. According to our literature review, thisis the first case in which a metastatic liver mass had presented with heart failure.Conclusion: In patients presenting with dyspnea, despite normal echocardiographic findings, theexact evaluation of the IVC should be considered.
Comparison of diagnostic value of ultrasound with chest CT Scan in
- Abstract: Objective: According to the most recent guidelines, the recommended imaging approaches forthe diagnosis of pneumonia are chest X-ray (CXR) and computed tomography (CT) scan. However,there are limitations to these approaches. Lung ultrasound (LUS) has attracted a lot of attentionin intensive care units (ICUs) and emergency departments. Considering the importance of thetimely diagnosis and proper treatment of pneumonia, this study aimed to determine the diagnosticvalue of bedside LUS in comparison to chest CT scans in patients with suspected pneumonia orunspecified CXR findings in the emergency department.Methods: This prospective descriptive-analytic study was conducted in the emergency departmentof Imam Reza hospital. Patients aged 3 years and older with early diagnosis of pneumonia orany unspecified CXR findings with an indication of CT scan were included in the study. LUS wasperformed with a deep curved and linear surface probe. The results obtained from the chestultrasound were compared with the results obtained by CT scan as the diagnostic gold standard.Results: A total of 175 patients were included in this study. According to the results, the sensitivityand specificity of LUS in the diagnosis of subpleural consolidation were 94.1% and 100%,respectively, and the positive predictive value and the negative predictive value were 100% and33.3%, respectively. The sensitivity and specificity of LUS in diagnosing pleural effusion were69.2% and 100%, respectively, and the positive predictive value and the negative predictive valuewere 100% and 90.7%, respectively. Furthermore, the sensitivity of LUS in diagnosing dynamic airbronchogram was 98%.Conclusion: According to the findings of the present study, in patients suspected of pneumonia,LUS is more sensitive and specific in the diagnosis of pneumonia and is less time-intensive andcostly. Additionally, the ultrasound device is easily portable and accessible. It can be widely used anddoes not have the secondary side effects of ionizing radiation in patients. However, the technician’sskill in performing ultrasound is a matter of importance.
Determining hematological indices in patients admitted to the poisoning
referral center: a 10 year cross sectional study
- Abstract:   Introduction: Poisoning is one of the most common methods of suicide in developing countries. We assessed the frequency of impaired hematological indices in patients with acute poisoning. Methods: The present study was a cross-sectional retrospective. Using the census sampling method, all patients who had attempted suicide by poisoning and were admitted from 2013 to 2023 were included in this study. Different variables, including age, gender, hematological index on admission, hospital stay, and outcome (mortality), were recorded in a data-gathering form. ANOVA and chi-square or Fisher’s exact tests were used for analysis. Results: This study was conducted on 48186 patients, 53.4% of whom were male. The average age of the patients was 34.92 (± 13.23). Of all patients, 6% had anemia, 15.1% leukocytosis, 15% higher than average hemoglobin, and 9.1% lower than average platelet count. White blood cell (WBC) count was higher (mean difference = 3741.85, SD = 151.35, 95% CI = 3445.21–4038.5) in deceased patients, while platelet count was significantly lower in deceased patients (mean difference = 17.19, SD = 2.57, 95% CI = 12.14–22.24) (P < 0.001). Anemia correlated with more extended hospital stay by an average of 1.61 days (SD = 0.27, 95% CI = 0.98–2.24) compared to patients with normal hemoglobin. Thrombocytopenia also correlated with more extended hospital stays by an average of 1.38 days  (SD = 0.21, 95% CI = 0.88–1.89). Conclusion: The frequency of abnormal hematological indices was not high in patients with acute poisoning. Deceased patients had higher WBC and lower platelet counts compared to surviving patients. Patients with anemia and thrombocytopenia had more extended hospital stays.
spontaneous pneumothorax, pneumomediastinum and pneumorrhachis in a case
of paraquat ingestion: a report.
- Abstract: Objective: Dependency on agriculture and the unregulated sale of paraquat makes it an easyalternative for homicidal and suicidal use in developing nations. It kills by multiorgan failure,predominantly pulmonary fibrosis, and ARDS. We report a case of alleged paraquat ingestionwith spontaneous pneumothorax, spontaneous pneumomediastinum, and pneumorrhachis.Aim is to reinforce the importance of a high index of suspicion in early diagnosis when theabove findings are present with ARDS in absence of trauma and a history of alleged substanceingestion.Case Presentation: A 35-year-old male presented with loose stool occasionally bloody, oralulcers, yellow discoloration of eyes with fever, and decreased urine output for three days afterconsuming some substance with his seafood. On examination, he had yellow discoloration ofeyes and oral mucosa along with multiple ulcers on the buccal region as well as the dorsumof the tongue and lateral margins with generalized subcutaneous emphysema. In addition,decreased air entry in the bilateral lung field and muffled heart sounds were present. He hadan acute hepatorenal failure and severe metabolic acidosis with respiratory failure. Urine testedpositive for myoglobin and muscle enzymes (creatinine kinase and LDH) were raised. He wasintubated and shifted to the intensive care unit. Injectable N-acetyl cysteine (NAC) for acute liverfailure was started with empirical antibiotics and intravenous fluids. We supplemented thiamineand vitamin K, and hemodialysis was done in view of progressive renal failure. Radiologicalevaluation showed spontaneous pneumothorax, pneumomediastinum, and pneumorrhachiswhich were managed conservatively. His respiratory parameters worsened despite maximalventilatory support. Renal failure and metabolic acidosis worsened in spite of hemodialysis. Hesuccumbed to his illness on day five of admission and seven days after toxin ingestion.Conclusion: We recommend that the sale of paraquat be restricted and regulated to avoid itsuse for suicidal and homicidal purposes. More research is required to find measures to interveneearly and prevent pulmonary fibrosis. We propose that paraquat toxicity be considered early in apatient with the triad in an atraumatic setting with acute respiratory distress syndrome (ARDS)
Where is the diagnostic key' Sudden weakness in a 4-year-old child. A
case report
- Abstract: Objective: Snake bites represent a significant public health issue worldwide, as venomous snake bites can result in dangerous and sometimes lethal consequences. Sometimes, the diagnosis is difficult. Herein, we present the case of a 4-year-old child who posed a challenge to diagnosis.  Case presentation: A 4-year-old child was brought to the emergency department with sudden, severe general weakness and impaired consciousness. Initially, the cause of these symptoms was unclear and difficult to diagnose. However, after a more thorough examination, it was determined that the likely cause was a neurotoxic snake bite. The child was hospitalized for three days. He received anti-venom, painkillers, and symptomatic treatments and left the hospital in good general condition. Conclusion: Snakebites are very dangerous and sometimes have unusual manifestations, so adequate personnel and physician information is necessary for timely diagnosis and appropriate management.
Post-traumatic growth and perceived social support in young adolescents
during the COVID-19 pandemic
- Abstract: Objectives: Pandemics would certainly have a negative impact on mental health. Positivemodifications as well as negative alterations have been documented in earlier viralpandemic according to previous investigations. Teenagers face a variety of challengesduring adolescence. Adolescents may become more concerned if this time coincides withother worries. This study aims to investigate the positive changes that occur in a youngadolescent’s life after COVID-19 pandemic, and to see how they relate to perceived socialsupport.Methods: This cross-sectional study was performed on adolescents who were randomlyselected from high schools in Kerman, Iran 2020 during the COVID-19. the sample sizewas 108 and for sampling wes used multi-stage random sampling at the end the data wasanalyzed by Pearson correlation test. Demographic information, the MultidimensionalScale of Perceived Social Support (MSPSS) and Posttraumatic Growth Inventory short form(PTGI-SF) were used to collect data. The data were subjected to descriptive and analyticalstatistical tests (Pearson correlation) using SPSS software version 24.Results: Statistically a positive correlation was found between the PTG total score andyoung homeschooled adolescents, parents working remotely, income loss and COVID-19experience. Moreover, during the COVID-19 pandemic, a positive association was foundbetween perceived social support and PTG total scores in young adolescents. There werealso substantial positive connections between the MSPSS subscales and the PTGI overallscore.Conclusion: Based on the findings, an overall growth in all areas of PTG was observedduring the COVID-19 among young adolescents. Perceived social support scores have apositive and significant relationship with COVID-19 effects. In the crises we face throughoutlife, intimate family members and friends play a significant supporting role in adapting tothese situations
Using Weibull model of survival analysis workflow and its relevant
factors: A prospective cohort study
Rhabdomyolysis following electical injury without acute kidney injury
- Abstract: Objective: Rhabdomyolysis is an important etiology for developing acute kidney injury(AKI). Among the many varying reasons for rhabdomyolysis, electrical injury seems to bea lesser-known factor. The clinical presentation of rhabdomyolysis is usually in the formof severe and widespread pain, tenderness, weakness in the muscles and dark urine. Itis characterized by the disruption of cell integrity in myocytes as a result of widespreaddamage to skeletal muscles and the passage of intracellular components into thecirculation.Case Presentation: Here we presented a case report of a young man who hadrhabdomyolysis induced by electrical injury which is relatively less common among theother etiological factors with preserved renal functions. He had electrical injury relatedwounds on extremities. Urgent intravenous fluid therapy was initiated as soon as hisadmission to the emergency department (ED), without delay.Conclusion: AKI is very common due to the nephrotoxic effect of myoglobinuria and theprerenal status. It is rare that AKI does not develop in patients with a severe increase increatinine kinase. It is a very important point to start effective fluid therapy in a short time.
Penetrating maxillofacial injury: A case report
- Abstract: Objective: Penetrating injuries in the maxillofacial region pose a great challenge due tothe anatomical complexity inherent to the area compounded with vital functions suchas vision and airway. This paper highlights the importance of meticulous preoperativeplanning and a concerted effort of a multidisciplinary team in managing penetratingmaxillofacial injuries.Case Presentation: A 38-year -old man reported to the emergency department with aknife impacted in the medial wall of the orbit, travelling up to the base of the cranium. ACT scan aided in evaluating the site, depth, and relation of the foreign body to the adjacentstructures. A team of oral and maxillofacial surgeons, ENT and neurosurgeon successfullyretrieved the knife and the patient recovered with no morbidities.Conclusions: Penetrating injuries in the maxillofacial region are rare and there is a dearthof documentation in literature. A quick response with proper preoperative planning and ateam approach is paramount in the successful management of these patients.
New acoustic window for assessing the inferior vena cava collapsibility in
humans in the prone position
- Abstract: Objective: Ultrasound assessment of inferior vena cava (IVC) collapsibility is performed todetermine the volume status of critically ill patients. We propose a new acoustic windowfor visualizing a vein in a prone patient.Case Presentation: A healthy volunteer took part in the study. The study protocol includestwo stages: 1) performing a magnetic resonance imaging (MRI) examination to determinethe projection of a certain IVC area on the posterior chest surface (holotopy), 2) performingan ultrasound scanning in the area of IVC projection in order to identify it and determineits dimensions.Conclusion: The 11th intercostal space parallel to the paraspinal line allows to visualizethe IVC in the prone position. This gives a potential opportunity to use it to assess the IVCcollapsibility. Its potential advantage is the ability to assess the compressibility of IVC inthe antero-posterior direction
Spontaneous uterine artery rupture in a non-pregnant woman: A case report
- Abstract: Objective: Spontaneous uterine artery rupture in a non-pregnant woman is an extremelyuncommon event. To date, there have only been a few cases. Patients often present withacute abdomen and are hemodynamically unstable.Case Presentation: A 42-year-old female presented with multiple episodes of syncopalattack associated with vomiting and generalized abdominal pain. Upon arrival, she washypotensive which required aggressive fluid resuscitation with crystalloids and bloodproducts. Urine pregnancy test was negative. In addition, ultrasound scan showedfree fluid in the abdomen mainly at the splenorenal area and organized clots aroundthe uterus. Computed tomography of the Abdomen revealed a moderate amount ofhemoperitoneum with hypodense clots at the left para-colic gutter and pelvis. Sheunderwent an exploratory laparotomy and intraoperatively noted bleeding from leftuterine artery with 1.2 L of hemoperitoneum with no other abnormalities detected.Intraoperatively, there was an estimated 5 L blood loss which required packed cell anddisseminated intravascular coagulation transfusion. Subsequently, the patient was sent tointensive care unit where she recovered well and was discharged home 5 days later.Conclusion: Spontaneous uterine artery rupture is an extremely rare occurrence with highmortality if there is failure to detect and intervene early
Relationship between cardiac ultrasound findings during cardiopulmonary
resuscitation with the outcome of patients
- Abstract: Objective: Cardiopulmonary arrest is a devastating outcome of some clinical situationsand requires strict implementation of cardiopulmonary resuscitation (CPR) protocols.Since ultrasound is one of the recommended tools to determine the presence of cardiacmovements and may be a predictor of the outcome, this study examined the relationshipbetween echocardiographic findings during CPR with patients’ outcomes.Methods: This cross-sectional prospective observational study was conducted on patientswith cardio-respiratory arrest in the emergency department of Shariaty hospital during2019. sampling method was random. Echocardiography was done at the patient’s bedsideduring the CPR process in accordance with the last advanced cardiac life support (ACLS)guidelines, on two points, after the end of the second and 10th minutes from the start ofCPR. The echocardiography findings (cardiac movement vs standstill) were recorded, andpatient outcomes were followed. Thirty-two patients enrolled in this study with a meanage of 56.9±15.3 years. Chi-square and Mann-Whitney U tests were used to calculate theassociation between heart contractions during resuscitation and the outcomes via SPSSV.22. Fisher’s exact test and Kruskal-Wallis test were used to evaluate the relationshipbetween heart rhythm in the second and tenth minutes with the outcomes of CPR.Results: The presence of cardiac movement in the 10th minute of CPR, in contrast to thefindings of the second minute, had a significant correlation with the success rate of CPRand outcomes (P<0.05). Moreover, patients with ventricular tachycardia (VT)/ventricularfibrillation (VF) cardiac rhythm had a better resuscitation rate, 24-hour survival rate, andbetter outcome than patients with other cardiac rhythms and asystole (P<0.05).Conclusion: Echocardiographic findings in the 10th minute of the CPR process can beused as a prognostic factor for cardiac arrest
Effects of perioperative use of two doses of magnesium sulfate infusion on
intraoperative blood loss in patients undergoing lumbar spinal fusion
surgery
- Abstract: Objective: In general, spinal fusion surgery causes heavy bleeding. The purpose of thisstudy was to evaluate the use of two different doses of magnesium sulfate to control thebleeding in lumbar fusion surgery.Methods: This study was carried out as a randomized double-blinded clinical trial in 2020in Al-Zahra hospital in Isfahan. The participants were 60 patients selected using inclusionand exclusion criteria and were randomly allocated into three groups. In the first group,50 mg/kg and in the second group, 40 mg/kg magnesium sulfate was infused. The thirdgroup received normal saline. From the beginning of anesthesia, heart rate, diastolic andsystolic blood pressure, respiratory rate and blood oxygen saturation percentage weremonitored and logged every 30 minutes during the operation and recovery. The volumeof bleeding during the operation was calculated by counting the number of gauzes usedand the amount of suctioned blood during the operation. Other required informationsuch as the duration of operation, duration of anesthesia, time of intubation and the timeperiod of hospitalization and recovery were determined and recorded in all patients. Weused independent t-test and repeated measure ANOVA tests to compare data betweendifferent time lines and also different groups. P value<0.05 was considered as significancethreshold. The collected data were analyzed by using SPSS software version 23.Results: The group receiving 50 mg/kg magnesium sulfate had a significantly lower systolicblood pressure compared to other groups within 15, 30 and 45 minutes after the injections(P=0.04 for all). The pulse rate was significantly lower in the 50 mg/kg magnesium sulfategroup compared to other groups within 15, 30 and 45 minutes after the injections (P<0.05for all). Patients that received 50 mg/kg magnesium sulfate had a lower duration of surgery(P=0.007), lower duration of anesthesia (P=0.007), lower bleeding volume (P<0.001),lower fluid intake (P=0.01) and also lower transfused blood (P=0.01). The surgeons alsohad a significantly higher satisfaction with these patients (P=0.001).Conclusion: Injection of 50 mg/kg magnesium sulfate had a correlation with reducedblood pressure as well as bleeding volume compared to 40 mg/kg magnesium sulfate.
Prognostic value of intensive care scores concerning the prediction of
30-day mortality in COVID-19
- Abstract: Objective: The goal of our study was to determine the prognostic value of CURB-65,Sequential Organ Failure Assessment (SOFA), pneumonia severity index (PSI), MuLBSTA,and Acute Physiology and Chronic Health Evaluation (APACHE) II upon admission inpatients with coronavirus disease 2019 (COVID-19, as well as the prediction cut-off valuefor death regarding these parameters.Methods: This observational retrospective study was performed in COVID-19 triagein Peymaniyeh hospital in Jahrom in 2021. In order to calculate SOFA, APACHE II, PSI,MuLBSTA, and CURB-65, data were collected from patients who were selected by availablesampling method from PCR-confirmed COVID-19 patients. Thirty-day mortality wasassessed as the primary outcome. ROC analysis was conducted using the STATA software toevaluate the prognostic value of the scoring systems. DeLong test was utilized to compareAUC of scores using a web based tool.Results:Ninety-two patients were included in this study with the mean age of 51.02±17.81years (male to female ratio was 1:1). SOFA had an AUC of 0.656 (P=0.130), but other indiceshad statistically significant values of AUC. Based on the comparison of the AUCs, SOFAwas the worst scoring system in COVID-19 as it had significantly lower AUC than PSI andAPACHE II (P<0.05); while its comparison with MULBSTA and CURB65 was not statisticallysignificant (P>0.05).Conclusion: It seems that APACHE II and PSI are the best prognostic factors in our studywith no statistical difference compared together (P>0.05). The sensitivity of APACHE II andPSI was 0.857 with the specificity of 0.927 and 0.976, respectively. The optimal cut-off pointwas 13 and 50 for APACHE II and PSI, respectively
The importance of considering rhabdomyolysis as the underlying cause of
myalgia in patients with COVID-19: A case report
- Abstract: Objective: Since the identification and spread of the novel coronavirus disease 2019(COVID-19) in December 2019, respiratory presentations have been introduced as themain symptoms of this new type of viral disease; however, the extra-pulmonary featuresare raising awareness for researchers due to the vast diversity of vital organs affectedby the virus. Among the wide range of clinical manifestations, limited data are availableregarding rhabdomyolysis (RML) in COVID-19.Case Presentation: In this report, we present a 58-year-old woman with COVID-19presenting with RML, with extremely elevated creatinine phosphokinase (CPK) and lactatedehydrogenase (LDH) levels (3283 and 1280 U/L, respectively) as the second sign ofdisease. Since the onset of the COVID-19 pandemic, several COVID-19 induced RML caseshave been reported, and timely diagnosis and proper management are of paramountimportance.Conclusion: Due to the findings that rhabdomyolysis can be a critical and missed cause ofmyalgia in COVID-19 patients, the importance of checking the serum level of CPK in patientswith myalgia and fatigue in the era of COVID-19 upon their arrival will be highlighted.
Comparing the effectiveness of oral versus intravenous antibiotics in the
prophylaxis of wound infection in hand laceration
- Abstract: Objective: Hand lacerations are among the most frequent causes of visiting emergencydepartments (EDs). Wound infection is one of its complications. There is still an ongoingdisagreement on the administration of oral versus intravenous (IV) antibiotics (ABs). Theobjective of this study is to compare the effectiveness of oral versus IV ABs in preventingwound infection of hand lacerations.Methods: In this double-blind, randomized clinical trial, we enrolled all patients with handlacerations (based on the inclusion criteria) during 6 months in the EDs of 2 tertiary referralcenters. Convenient sampling was done. Finally, in the first group, 382 patients receivedoral AB (two 500 mg cephalexin capsules) and the other 382 patients in the second groupreceived IV AB (1 gr IV cefazolin) before wound management. Both groups were followedand received oral cephalexin during 48 hours after suturing. Rates of wound infection anddifferent complications were compared between the two groups. T-test, Mann-Whitney Utest, Chi square and Fisher analysis were used.Results: Both groups had the same age and gender distribution rate (79.8% of males withthe mean age of 30.8 years in the first group, and 83.5% of males with the mean age of 32.6years in the second group (P = 0.19 and 0.39, respectively). In our study, wound infectiondeveloped in 2.6% and 1.8% of patients in the first and second groups, respectively (P =0.46).Conclusion: Based on the results of this study, oral and IV ABs were not significantlydifferent in terms of preventing wound infection
Adherence to guideline in hydrating traumatic patients with crystalloid
fluids: A single center experience from Southern Iran
- Abstract: Objective: The adherence of the physicians to guidelines in resuscitation of the patientsis of great importance since it can predict the outcome. To evaluate the adherence of thephysicians of our center in hydration of traumatic patients with crystalloids regarding theAdvanced Trauma Life Support (ATLS) guidelines.Methods: We designed an algorithm obtained from ATLS guidelines using vital signsand status of bleeding of the traumatic patients to classify them. After categorizing thepatients according to the algorithm, we evaluated the adherence of the physicians to theguideline in hydration of traumatic patients with crystalloids.Results: This is a cross-sectional study in which 998 traumatic patients who were admittedto the emergency ward of Rajaee trauma hospital were enrolled. Most of the patients weremen (89.6%) and the most common causes of traumatic injuries were traffic accidents.Proper hydration was seen in only 14.7% of the patients. Most of the patients were overhydrated (85%) regarding both our algorithm and the patients’ base excess.Conclusion: The present study showed that the adherence of physicians in our centerin resuscitation with crystalloid was low. Also, most of the traumatic patients wereoverhydrated with crystalloids. It is suggested that physicians retrain concerning theside effects of over hydration. In addition, we need a user friendly and more applicableguideline for hydration with crystalloids
Lag screw principle to fix unstable sagittal fracture of infraorbital rim:
A technical note
- Abstract: Objective: Fractures of orbital rims are common and restoration of these fractures back toits normal anatomic form is essential to maintain the function and aesthetics of the eyes.Low profile miniplates are the rigid fixation device of choice for such fractures. But in caseof sagittal and grossly displaced fractures of orbital rims it is difficult to achieve stability byusing miniplate osteosynthesis. The low profile miniplates may not be able to withstandthe forces to reduce this kind if grossly displaced fractures, another stable option needs tobe considered in these situations.Case Report: This case report presents a simple and effective technique of reductionand fixation of an oblique fracture of infraorbital rim fracture using lag screw principle.A standard titanium screw of 2 mm diameter and 10 mm length is being used in thedescribed technique for stable fixation of fractured segments.Conclusion: The technique is simple, hardware’s are easily available and can be practisedin emergency circumstances where newer advanced technologies are not available
Late presentation of isolated caecal perforation following blunt abdominal
trauma: The utility of point-of-care ultrasound
- Abstract: Colonic injuries after blunt trauma abdomen are a rareentity which may sometimes have a delayed presentation(1). In the intensive care unit (ICU), various interventionslike sedation, analgesia and paralysis may confoundclinical examination findings pertaining to abdominalpathology. Computed tomography (CT) provides anexcellent diagnostic modality in blunt trauma abdomen(2) but requirement of high ventilatory support and/orvasopressors may preclude safe transfer of patients fromICU to radiology suites. Point of care ultrasound (POCUS)provides an excellent adjunct in diagnosis of hollow viscusperforation and is considered as a reliable alternative toplain radiograph for the diagnosis of pneumoperitoneum
Minimal invasive management of proximal small bowel bleeding: A case
report and reviewing the evidences
- Abstract: Objective: Gastrointestinal bleeding is one of the surgical emergencies that is routinelyvisited in emergency departments. Although most of these patients are managed withendoscopic modalities, some of them are managed with surgical interventions. Most ofemergency surgical interventions are done via laparotomy. With evolution in minimalinvasive surgery, the role of laparoscopic surgeries in emergency settings is on a rise.Case Presentation: In this report we describe a case of lower gastrointestinal bleedingthat was presented with melena and during workups no bleeding lesion was detectedin colon, stomach or duodenum. Further investigations revealed bleeding of proximaljejunum mass that was resected with the laparoscopic approach which is rarely used inthe emergency management of patients with gastrointestinal bleedings. Also, resectionand anastomosis of proximal jejunal loop was challenging in this case.Conclusion: This report is intended to describe the feasibility of laparoscopy in proximalsmall bowel lesion resection in emergency settings as well as the role of CT angiography indetecting the source of obscure gastrointestinal bleeding
Vertebra critica in a case of near-hanging
- Abstract: Objective: To demonstrate the significance of fused cervical vertebrae in emergencymedicine practice.Case report: A 35-year-old male was brought to the emergency department (ED) whoattempted suicide by hanging and was later found to have congenital fusion of cervicalvertebra C2 and C3, a condition referred to as - vertebra critica. This is the only case reportof a patient with vertebra critica admitted for near hanging. The patient was intubatedwith a Portex® North Polar endotracheal tube (ETT) through the nasal route. This proved tobe a critical decision as it helped early airway control avoiding any complication.Conclusion: As the victims of near-hanging should have cervical spine restriction,judicious use of flexible portex® ETT may help in early intubation and resuscitationwithout aggravating the neurological injuries. It must be noted that nasal intubation iscontraindicated in base of skull fractures and it should be avoided in patients with obvioustraumatic injury to the neck including laryngeal trauma, tracheal disruption and vesselinjuries.
Cellulitis: when to say its treatment failure
- Abstract: Cellulitis is treated with antibiotics as routine management and based on the literature the cellulitis hospitalization can be avoided by 11% if appropriate antibiotics are used.1 Randomized clinical trials and Cochrane reviews have suggested that oral antibiotics are non-inferior to intravenous administration (1). We would like to highlight here the unrequired use of intravenous antibiotics in cellulitis. Intravenous antibiotics are recommended in patients with sepsis. This is supported by a study done on 1800 patients with cellulitis diagnosis, where one third of patients were hospitalized
The effect of chit powder technology in the treatment of burn hazards
victims: A systematic review
- Abstract: Objective: In order to heal burn wounds, many researches have been done, including the use of biological scaffolds due to their ability to achieve the desired properties. Owing to the appropriate biological properties of chitosan such as biocompatibility and antimicrobial properties as well as the promotion of wound healing in biomedical applications, we aimed to perform a systematic review to investigate the effect of this technology on the treatment of burn hazards victims.Methods: The present research was conducted in 2020 as a systematic review of studies related to the effect of chitosan on burns. In this study, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Critical Appraisal Skills Programme (CASP) guidelines were used to assess the articles. The key words “Chitosan,” “Chitin,” “victim,” “Injury,” “Burn,” “Heal,” “wound” “treat,” “hazard,” and “care” were used in combination with the Boolean operators OR and AND. The ISI web of science, PubMed, Scopus, Science Direct, Ovid, Pro Quest, Wiley and Google Scholar were searched.Results: Recently, chitosan and its derivatives have been proposed as suitable candidates for scaffolding and can be used as temporary scaffolds to modify and stimulate the growth of new tissues. Studies to demonstrate the use of chitosan in the treatment of burns have been limited to research on animal models and have been superior to conventional therapies in terms of time, pain, and efficacy.Conclusion: The effect of chitosan on burns has been positive in animal models and has accelerated wound healing. Since the main ingredient of chit powder is chitosan and due to the limited studies done on humans, it cannot be said with certainty that the use of chitosan and its derivatives to treat burns is better than other ways to treat burns.
Periorbital emphysema and pneumomediastinum following blunt orbital
fracture: A case report and review of the literature
Purtscher’s retinopathy following trauma: A case report
- Abstract: Objective: Purtscher’s retinopathy is the retinal damage following trauma or non-traumatic systemic disease, which may contain cotton-wool spots (CWSs), and may cause Purtscher flecken, atrophy of the optic nerve, and hemorrhage of the posterior pole of the eye.Case Presentation: A 28-year-old male patient fell down from a height of 10 m and was admitted with swelling and ecchymosis of the peri-orbit of the right eye. The patient’s vision was at the level of light perception. A mild subconjunctival hemorrhage and hyphema were seen in the right eye. In the fundus, the hemorrhage, edema, and CWS were seen in the posterior pole and around the optic disk. Macular thickness (MT) in Purtscher’s retinopathic eye was 353 μm. Also, the patient had a nose and mandibular fracture and was hospitalized for several days.Conclusion: The findings indicate a decrease in the vision due to Purtscher’s retinopathy caused by trauma. There was no improvement spontaneously

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