Pub Date : 2021-04-01DOI: 10.30491/TM.2021.215811.1058
Mousa Asadi, Hasan Goodarzi, Sadrollah Mahmoodi
Background: Gunshot wound injuries to penile are relatively infrequent. Objectives: This study aimed at reviewing the patterns of gunshot injuries to the penile and their treatments. Methods: 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. Results: 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. Conclusion: 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.
背景:阴茎枪伤相对少见。目的:本研究旨在回顾阴茎枪伤的类型及其治疗。方法:于2019年11月检索PubMed (MEDLINE)、Scopus、Embase、ISI web of sciences和Google Scholar数据库查找相关研究。为此，我们使用了各种网格和关键词进行搜索，包括伤口/损伤、生殖器/泌尿生殖系统、枪击/战争/爆炸/火器/军事、阴茎/阴茎、阴囊和尿道。结果:在纳入的五项研究中，三项研究与平民枪伤有关，两项研究与战争伤害有关。患者平均年龄28 ~ 31岁。枪弹性阴茎损伤以阴茎切开术、阴茎海绵体伤、阴茎浅表伤和尿道伤为主。最常见的伴随损伤是相邻解剖的损伤，包括大腿损伤、阴囊/睾丸、腹部器官、膀胱和直肠。根据阴茎枪伤的程度，有几种手术方法，如手术探查、关闭部分切除的阴茎残端、阴茎脱套、阴茎阴囊入路、简单缝合、止血缝合巴克氏筋膜和皮肤、手术再吻合或阴茎重建全置换。结论:阴茎枪弹损伤常伴有邻近解剖的其他严重损伤，对受害者的死亡率有不利影响。为了处理这些案件，必须评估武器的长度、大小和类型。
{"title":"Assessments and Treatment of Gunshot Injuries to the Penis","authors":"Mousa Asadi, Hasan Goodarzi, Sadrollah Mahmoodi","doi":"10.30491/TM.2021.215811.1058","DOIUrl":"https://doi.org/10.30491/TM.2021.215811.1058","url":null,"abstract":"Background: Gunshot wound injuries to penile are relatively infrequent. Objectives: This study aimed at reviewing the patterns of gunshot injuries to the penile and their treatments. Methods: 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. Results: 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. Conclusion: 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.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"55 1","pages":"72-76"},"PeriodicalIF":0.5,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85298932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.30491/TM.2021.274843.1249
R. M. Gargari, H. Anvari
Background: 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. Objectives: The present study aimed at determining the effect of dexmedetomidine on blood pressure in patients with hypertension after emergency laparotomy for trauma. Methods: 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. Results: 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. Conclusion: 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.
{"title":"Effect of Dexmedetomidine on Blood Pressure in Hypertension Patients after Emergency Laparotomy for Trauma: A Randomized Double-blind Clinical Trial","authors":"R. M. Gargari, H. Anvari","doi":"10.30491/TM.2021.274843.1249","DOIUrl":"https://doi.org/10.30491/TM.2021.274843.1249","url":null,"abstract":"Background: 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. Objectives: The present study aimed at determining the effect of dexmedetomidine on blood pressure in patients with hypertension after emergency laparotomy for trauma. Methods: 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. Results: 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. Conclusion: 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.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"122 1","pages":"94-99"},"PeriodicalIF":0.5,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87639006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.30491/TM.2021.227086.1098
H. Araghizadeh, H. Khoshmohabat, S. H. Hossini, M. Moayed
Background: Responses for medical emergencies can be different during most terrorist attacks in which civilians and military personnel might be killed or wounded. Objectives: The present study aimed to reflect on injury patterns and the outcome of victims in terrorist attacks. Methods: 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. Results: 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. Conclusion: 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.
{"title":"Pattern of Injury and Outcome of Victims in Ahvaz Terrorist Attack","authors":"H. Araghizadeh, H. Khoshmohabat, S. H. Hossini, M. Moayed","doi":"10.30491/TM.2021.227086.1098","DOIUrl":"https://doi.org/10.30491/TM.2021.227086.1098","url":null,"abstract":"Background: Responses for medical emergencies can be different during most terrorist attacks in which civilians and military personnel might be killed or wounded. Objectives: The present study aimed to reflect on injury patterns and the outcome of victims in terrorist attacks. Methods: 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. Results: 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. Conclusion: 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.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"23 1","pages":"100-105"},"PeriodicalIF":0.5,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90077216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.30491/TM.2021.281240.1278
M. I. Bokarev, A. I. Mamykin, Khaled J Alali, Andrey I Demyanov, E. Stolyarchuk, A. E. Markarov
Background: 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. Aims: 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. Results: 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.
{"title":"Comparative Evaluation of Various Methods of Drainage of the Abdominal Cavity in Patients with Secondary Bacterial Peritonitis","authors":"M. I. Bokarev, A. I. Mamykin, Khaled J Alali, Andrey I Demyanov, E. Stolyarchuk, A. E. Markarov","doi":"10.30491/TM.2021.281240.1278","DOIUrl":"https://doi.org/10.30491/TM.2021.281240.1278","url":null,"abstract":"Background: 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. Aims: 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. Results: 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.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"80 1","pages":"114-129"},"PeriodicalIF":0.5,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90958437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.30491/TM.2021.237623.1140
Mehran Razavipour, S. Ghaffari, Alireza Kazemi, M. Azar
Background: Perilunate dislocations and perilunate fracture-dislocations (PLD/PLFD) are the second most common wrist injuries. Objectives: 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). Methods: 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. Results: 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). Conclusion: 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.
{"title":"Surgical Outcomes of Perilunate Dislocations and Perilunate Fracture-dislocations: A Review of 20 Cases","authors":"Mehran Razavipour, S. Ghaffari, Alireza Kazemi, M. Azar","doi":"10.30491/TM.2021.237623.1140","DOIUrl":"https://doi.org/10.30491/TM.2021.237623.1140","url":null,"abstract":"Background: Perilunate dislocations and perilunate fracture-dislocations (PLD/PLFD) are the second most common wrist injuries. Objectives: 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). Methods: 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. Results: 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). Conclusion: 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.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"93 1","pages":"87-93"},"PeriodicalIF":0.5,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74933139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.30491/TM.2021.250496.1177
Hojjat Shafaee, A. Ostadtaghizadeh, Davoud Khorasani-Zavareh, S. Nematollahi, J. Hirshon, A. Mirhaghi, M. Moradian
Background: Injuries and deaths from RTC are critical health problems of societies and one of the main causes of death especially among the young. Objective: This study aimed to design and compile a guideline for emergency medical communication centers (EMCC) staff to provide direct assistance offered by road traffic crash (RTC) bystanders. Methods: Based on prior literature, the RTC bystanders' initial draft guideline contained 20 domains and 28 items. As a validation step, the draft guideline was reviewed by content experts (one emergency medicine and two disaster specialists) and modified based on their recommendations. The subsequent draft guideline was then reviewed in three Delphi rounds by 67 participants, including health professionals in emergencies and disasters, emergency medicine, nurses, emergency medical experts, and EMCC staff. The accepted agreement coefficient was set at ≥70%. As the final step, an expert consensus meeting was held to review the guideline. Results: The participants agreed on 56 items regarding 20 domains, including scene safety, hand precautions, and personal protection, alertness assessment, respiration, cardiopulmonary resuscitation (CPR), bleeding control, recovery position, splinting, rapid evacuation, scene management, patient transfer, triage, spinal cord injury prevention and immobilization, injured transportation, psychological support, hypothermia prevention, water and food, amputated limb protection, and support of deceased people. Two items in relation to airway opening maneuvers were added to the guideline during the expert consensus meeting. Conclusion: Compared to other RTC bystander guidelines for EMCC staff, more comprehensive guidelines can be served as a basis for directing RTC bystanders to provide assistance. Important areas of hand care and personal protection, breathing, airway, splinting, scene management, mental and psychological support, and support of deceased people were included in this guideline. EMCC staff can provide guidance to be performed by RTC bystanders. RTC bystanders can play important roles at crash scenes, including preventing secondary injury, supporting scene management, and providing first aid for the injured people. This guideline can be used to help direct appropriate care and behavior by RTC bystanders.
{"title":"Designing a Guideline for Emergency Medical Communication Center Staff to Help Road Traffic Crash Patients: A Delphi Study","authors":"Hojjat Shafaee, A. Ostadtaghizadeh, Davoud Khorasani-Zavareh, S. Nematollahi, J. Hirshon, A. Mirhaghi, M. Moradian","doi":"10.30491/TM.2021.250496.1177","DOIUrl":"https://doi.org/10.30491/TM.2021.250496.1177","url":null,"abstract":"Background: Injuries and deaths from RTC are critical health problems of societies and one of the main causes of death especially among the young. Objective: This study aimed to design and compile a guideline for emergency medical communication centers (EMCC) staff to provide direct assistance offered by road traffic crash (RTC) bystanders. Methods: Based on prior literature, the RTC bystanders' initial draft guideline contained 20 domains and 28 items. As a validation step, the draft guideline was reviewed by content experts (one emergency medicine and two disaster specialists) and modified based on their recommendations. The subsequent draft guideline was then reviewed in three Delphi rounds by 67 participants, including health professionals in emergencies and disasters, emergency medicine, nurses, emergency medical experts, and EMCC staff. The accepted agreement coefficient was set at ≥70%. As the final step, an expert consensus meeting was held to review the guideline. Results: The participants agreed on 56 items regarding 20 domains, including scene safety, hand precautions, and personal protection, alertness assessment, respiration, cardiopulmonary resuscitation (CPR), bleeding control, recovery position, splinting, rapid evacuation, scene management, patient transfer, triage, spinal cord injury prevention and immobilization, injured transportation, psychological support, hypothermia prevention, water and food, amputated limb protection, and support of deceased people. Two items in relation to airway opening maneuvers were added to the guideline during the expert consensus meeting. Conclusion: Compared to other RTC bystander guidelines for EMCC staff, more comprehensive guidelines can be served as a basis for directing RTC bystanders to provide assistance. Important areas of hand care and personal protection, breathing, airway, splinting, scene management, mental and psychological support, and support of deceased people were included in this guideline. EMCC staff can provide guidance to be performed by RTC bystanders. RTC bystanders can play important roles at crash scenes, including preventing secondary injury, supporting scene management, and providing first aid for the injured people. This guideline can be used to help direct appropriate care and behavior by RTC bystanders.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"16 1","pages":"41-51"},"PeriodicalIF":0.5,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82422715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.30491/TM.2021.223980.1082
Zahra Jamshidi, K. Tabrizi, M. Fallahi-khoshknab, A. Dalvandi, F. Vizeshfar, H. Khankeh
Background: Caregiving for trauma patients has many challenges. Inadequate knowledge of these challenges can affect the patients and worsen their conditions. Objectives: We aimed to explore the caregivers’ experiences about these challenges and problems of caring for patients with trauma emergencies. Methods: The study adopted a concurrent triangulation mixed-method and was conducted in Shahid Rajaee Hospital, southern Iran, in 2019. Semi-structured interviews, focus groups, observation and ward document assessments were conducted with focusing on the challenges experienced by the caregivers. A checklist was used to assess the performance of caregivers and measure the indices related to the care process. Statistical results and qualitative data on the main categories were compared and integrated for data analysis. Results: In total,307 codes were extracted by analyzing the content of the interviews and available evidence. The codes were summarized in 20 subcategories, and six main categories were extracted as follows: lack of professional capability, uncoordinated team response, deficits in managerial commitments, inadequate work motivation, complex nature of trauma emergency, and lack of clinical communication. The quantitative results indicated that caregivers’ performance was considerably far from the expected scores and also many indices indicated a waste of time in responding to the patient needs. Conclusion: Various dimensions of trauma care challenges indicate that professional capability, team coordination and communication, managerial commitments and work motivation considering the complex nature of trauma emergency wards are crucial to enhance patients' access to optimum quality care. Caregivers’ performance and quality of indices also affect the care process. Future studies are required for compiling strategies and protocols for the quality of care for trauma patients.
{"title":"Identifying Challenges of Providing Care for Trauma Patients; A Concurrent Mixed Methods Study","authors":"Zahra Jamshidi, K. Tabrizi, M. Fallahi-khoshknab, A. Dalvandi, F. Vizeshfar, H. Khankeh","doi":"10.30491/TM.2021.223980.1082","DOIUrl":"https://doi.org/10.30491/TM.2021.223980.1082","url":null,"abstract":"Background: Caregiving for trauma patients has many challenges. Inadequate knowledge of these challenges can affect the patients and worsen their conditions. Objectives: We aimed to explore the caregivers’ experiences about these challenges and problems of caring for patients with trauma emergencies. Methods: The study adopted a concurrent triangulation mixed-method and was conducted in Shahid Rajaee Hospital, southern Iran, in 2019. Semi-structured interviews, focus groups, observation and ward document assessments were conducted with focusing on the challenges experienced by the caregivers. A checklist was used to assess the performance of caregivers and measure the indices related to the care process. Statistical results and qualitative data on the main categories were compared and integrated for data analysis. Results: In total,307 codes were extracted by analyzing the content of the interviews and available evidence. The codes were summarized in 20 subcategories, and six main categories were extracted as follows: lack of professional capability, uncoordinated team response, deficits in managerial commitments, inadequate work motivation, complex nature of trauma emergency, and lack of clinical communication. The quantitative results indicated that caregivers’ performance was considerably far from the expected scores and also many indices indicated a waste of time in responding to the patient needs. Conclusion: Various dimensions of trauma care challenges indicate that professional capability, team coordination and communication, managerial commitments and work motivation considering the complex nature of trauma emergency wards are crucial to enhance patients' access to optimum quality care. Caregivers’ performance and quality of indices also affect the care process. Future studies are required for compiling strategies and protocols for the quality of care for trauma patients.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"99 1","pages":"32-40"},"PeriodicalIF":0.5,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76985228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.30491/TM.2021.214296.1045
M. Mahmoudkhani, A. Shakibaee, H. Minoonejad, R. Rajabi, A. Barati
Background: Judo as martial arts have a higher risk of trauma during training rather than competition. Thus, an efficient training procedure should be accomplished. Objectives: Since the use of trauma prohibition approaches and athletic performance enhancement is essential, this study aimed at investigating the effect of 8-week Judo Specific Functional Training (JSFT) on the Traumatic factors and athletic performance in male judokas. Methods: 46 subjects were randomly classified into 2 groups of experimental (N: 23) and control (N: 23) groups. For eight weeks, the experimental group attended a JSFT program designed by the researchers. The control group participated in the usual judo training program presented by the coaches. The exercises were accomplished 3 times per week for 90 minutes each session. The subjects participated in pre-and post-tests. In order to approve the data normality and compare the variables, Shapiro-Wilk, ANCOVA analysis was implemented at the significant level of p˂ 0.05 using SPSS (version 21). Results: The outcomes showed that the scores of functional movement screening (p=0.001), upper extremity Y balance test (p=0.001), vertical jump (p=0.001) and JSFT (p=0.001) significantly increased among the experimental group in comparison to the control group. Conclusions: The JSFT program simultaneously modifies or decreases the Traumatic factors and improves athletic performance and offers more efficiency and effectiveness rather than the usual judo training programs.
{"title":"Effect of an Injury Prevention Program on Traumatic Factors and Athletic Performance in Judo Athletes: MSSLSTS Intervention","authors":"M. Mahmoudkhani, A. Shakibaee, H. Minoonejad, R. Rajabi, A. Barati","doi":"10.30491/TM.2021.214296.1045","DOIUrl":"https://doi.org/10.30491/TM.2021.214296.1045","url":null,"abstract":"Background: Judo as martial arts have a higher risk of trauma during training rather than competition. Thus, an efficient training procedure should be accomplished. Objectives: Since the use of trauma prohibition approaches and athletic performance enhancement is essential, this study aimed at investigating the effect of 8-week Judo Specific Functional Training (JSFT) on the Traumatic factors and athletic performance in male judokas. Methods: 46 subjects were randomly classified into 2 groups of experimental (N: 23) and control (N: 23) groups. For eight weeks, the experimental group attended a JSFT program designed by the researchers. The control group participated in the usual judo training program presented by the coaches. The exercises were accomplished 3 times per week for 90 minutes each session. The subjects participated in pre-and post-tests. In order to approve the data normality and compare the variables, Shapiro-Wilk, ANCOVA analysis was implemented at the significant level of p˂ 0.05 using SPSS (version 21). Results: The outcomes showed that the scores of functional movement screening (p=0.001), upper extremity Y balance test (p=0.001), vertical jump (p=0.001) and JSFT (p=0.001) significantly increased among the experimental group in comparison to the control group. Conclusions: The JSFT program simultaneously modifies or decreases the Traumatic factors and improves athletic performance and offers more efficiency and effectiveness rather than the usual judo training programs.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"61 1","pages":"25-31"},"PeriodicalIF":0.5,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87043991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.30491/TM.2021.214604.1049
Rozita Ghahremani, A. Asadi, S. Zahri
Background: Since bone defects can result in different disabilities, many efforts have been made to bone tissue engineering. In this case, scaffolds play an important role as a key element of tissue engineering in providing three-dimensional structure for cell growth in vitro Objective: The aim of the present study was to provide the three-dimensional biological bioscaffold from the bovine femur dense bone and investigate the possibility of its potential for application in tissue engineering as biological 3D ECM bioscaffold via mesenchymal stem cells seeding and differentiation toward bone tissue. Methods: For the preparation of bioscaffolds, after cutting bovine femur bone into small pieces, demineralization and decellularization were done. Bioscaffolds biocompatibility was evaluated using an MTT assay. The morphological and cell adhesion characteristics of Bone marrow mesenchymal stem cells (BMSCs) on the bioscaffolds were evaluated using Scanning Electron Microscopy (SEM) technique. Finally, the cells were treated with an osteogenic differentiation medium and then evaluated for differentiation. Results: Histological studies showed that the use of sodium dodecyl sulfate (2.5%) for 8 h eliminated the cells. Radiography and calcium oxalate test confirmed demineralization. MTT assay and SEM studies showed that the obtained bioscaffolds are biocompatible and could provide an optimum three-dimensional environment for cell adhesion and movement. Moreover, the Alizarin red staining showed a higher differentiation rate for BMSCs. Conclusion: In the present study, bone-derived 3D bioscaffold showed an important role in the growth and differentiation of BMSCs, due to the natural characteristics, cell adhesion properties, and potential to enhance differentiation toward bone tissue. It may have the potential for use as bioscaffold as supporting metrics for maintenance, growth in bone tissue engineering.
{"title":"Dense Bone-Derived 3d Bioscaffold: Preparation, Characterization, and Assessment of Its Potential for Bone Marrow Mesenchymal Stem Cells (BMSCS) Growth and Differentiation","authors":"Rozita Ghahremani, A. Asadi, S. Zahri","doi":"10.30491/TM.2021.214604.1049","DOIUrl":"https://doi.org/10.30491/TM.2021.214604.1049","url":null,"abstract":"Background: Since bone defects can result in different disabilities, many efforts have been made to bone tissue engineering. In this case, scaffolds play an important role as a key element of tissue engineering in providing three-dimensional structure for cell growth in vitro Objective: The aim of the present study was to provide the three-dimensional biological bioscaffold from the bovine femur dense bone and investigate the possibility of its potential for application in tissue engineering as biological 3D ECM bioscaffold via mesenchymal stem cells seeding and differentiation toward bone tissue. Methods: For the preparation of bioscaffolds, after cutting bovine femur bone into small pieces, demineralization and decellularization were done. Bioscaffolds biocompatibility was evaluated using an MTT assay. The morphological and cell adhesion characteristics of Bone marrow mesenchymal stem cells (BMSCs) on the bioscaffolds were evaluated using Scanning Electron Microscopy (SEM) technique. Finally, the cells were treated with an osteogenic differentiation medium and then evaluated for differentiation. Results: Histological studies showed that the use of sodium dodecyl sulfate (2.5%) for 8 h eliminated the cells. Radiography and calcium oxalate test confirmed demineralization. MTT assay and SEM studies showed that the obtained bioscaffolds are biocompatible and could provide an optimum three-dimensional environment for cell adhesion and movement. Moreover, the Alizarin red staining showed a higher differentiation rate for BMSCs. Conclusion: In the present study, bone-derived 3D bioscaffold showed an important role in the growth and differentiation of BMSCs, due to the natural characteristics, cell adhesion properties, and potential to enhance differentiation toward bone tissue. It may have the potential for use as bioscaffold as supporting metrics for maintenance, growth in bone tissue engineering.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"28 1","pages":"1-10"},"PeriodicalIF":0.5,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74809172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.30491/TM.2021.219676.1073
E. Jafarbegloo, Faride Faridnya, R. Ahangari, A. Mohammadbeigi
Background: Post-partum haemorrhage (PPH) is a major cause of maternal mortality worldwide. Tranexamic acid, an anti-fibrinolytic agent, is a novel approach in an attempt to prevent this dreadful complication. Objective: This study aimed to evaluate the efficacy and safety of tranexamic acid in reducing blood loss during and after cesarean section (CS). Methods: In this prospective randomized placebo-controlled clinical trial, 50 pregnant women were randomized into two groups. In the study group, 25 women received tranexamic acid 10 minutes before CS, whereas in the control group 25 women received distilled water. Blood was collected during two periods. The first time was from placental delivery to the end of CS and the second was from the end of CS to 2 h postpartum. The volume of blood was measured and compared between the two groups. Results: Tranexamic acid significantly reduced the quantity of blood from the end of CS to 2 h postpartum, which was 65.15±31.97 mL and 101.14±44.94 mL in the study and control groups, respectively (P =0.002). It also significantly reduced the volume of total blood from placental delivery to 2 h postpartum, which was 616.32±176.87 mL and 731.45±178.79 mL in the study and control groups (P =0.028). Total blood loss in the study group was 18.7% less than the control group. No complications or side effects were reported in the groups. Conclusions: Tranexamic acid statistically reduces the volume of blood loss from placental delivery to 2 h postpartum and its use was not associated with any side effects or complications. Therefore, tranexamic acid can be used as a safe and effective approach to reducing bleeding resulting from CS.
背景:产后出血(PPH)是全世界孕产妇死亡的一个主要原因。氨甲环酸，一种抗纤溶剂，是一种尝试预防这种可怕并发症的新方法。目的:评价氨甲环酸减少剖宫产术中及术后出血量的疗效和安全性。方法:采用前瞻性随机安慰剂对照临床试验，将50例孕妇随机分为两组。在研究组中，25名妇女在CS前10分钟服用氨甲环酸，而在对照组中，25名妇女服用蒸馏水。血液采集分两期进行。第一次是从胎盘分娩到CS结束，第二次是从CS结束到产后2h。测量两组患者的血容量并进行比较。结果:氨甲环酸可显著降低CS结束至产后2 h的血流量，研究组为65.15±31.97 mL，对照组为101.14±44.94 mL (P =0.002)。研究组与对照组总血容量分别为616.32±176.87 mL和731.45±178.79 mL，差异有统计学意义(P =0.028)。研究组总失血量比对照组减少18.7%。两组均无并发症或副作用。结论:氨甲环酸在统计学上可减少胎盘分娩至产后2小时的失血量，其使用与任何副作用或并发症无关。因此，氨甲环酸可以作为一种安全有效的方法来减少CS引起的出血。
{"title":"Prophylactic Use of Tranexamic Acid on Blood Loss in Cesarean Delivery: A Randomized Controlled- Clinical Trial","authors":"E. Jafarbegloo, Faride Faridnya, R. Ahangari, A. Mohammadbeigi","doi":"10.30491/TM.2021.219676.1073","DOIUrl":"https://doi.org/10.30491/TM.2021.219676.1073","url":null,"abstract":"Background: Post-partum haemorrhage (PPH) is a major cause of maternal mortality worldwide. Tranexamic acid, an anti-fibrinolytic agent, is a novel approach in an attempt to prevent this dreadful complication. Objective: This study aimed to evaluate the efficacy and safety of tranexamic acid in reducing blood loss during and after cesarean section (CS). Methods: In this prospective randomized placebo-controlled clinical trial, 50 pregnant women were randomized into two groups. In the study group, 25 women received tranexamic acid 10 minutes before CS, whereas in the control group 25 women received distilled water. Blood was collected during two periods. The first time was from placental delivery to the end of CS and the second was from the end of CS to 2 h postpartum. The volume of blood was measured and compared between the two groups. Results: Tranexamic acid significantly reduced the quantity of blood from the end of CS to 2 h postpartum, which was 65.15±31.97 mL and 101.14±44.94 mL in the study and control groups, respectively (P =0.002). It also significantly reduced the volume of total blood from placental delivery to 2 h postpartum, which was 616.32±176.87 mL and 731.45±178.79 mL in the study and control groups (P =0.028). Total blood loss in the study group was 18.7% less than the control group. No complications or side effects were reported in the groups. Conclusions: Tranexamic acid statistically reduces the volume of blood loss from placental delivery to 2 h postpartum and its use was not associated with any side effects or complications. Therefore, tranexamic acid can be used as a safe and effective approach to reducing bleeding resulting from CS.","PeriodicalId":23249,"journal":{"name":"Trauma monthly","volume":"1 1","pages":"19-24"},"PeriodicalIF":0.5,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89879117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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