Bulletin of emergency and trauma最新文献

Objectives: Laminectomy is one of the most prevalent back surgeries. Considering the importance of controlling and minimizing surgical complications, this study was conducted to determine the effect of Sevoflurane and Propofol on the state of renal complications in patients undergoing laminectomy surgery.

Methods: This clinical trial was conducted in Ilam (Iran). The study used a double-blind random sampling procedure, and the patients were divided into three groups receiving Sevoflurane (n=25), Propofol (n=25), and the combination of Sevoflurane and Propofol (n=25). The research tool included a checklist of demographic characteristics as well as a clinical examination. Kidney complications were diagnosed based on history, clinical examinations, and laboratory test results. The obtained data were analyzed using SPSS software.

Results: In this study, the patient's mean age in the Propofol group was 52.4±5.6, the Sevoflurane group was 50.8±2.5, and Sevoflurane plus Propofol group was 53.5±3.4. The Sevoflurane plus Propofol group had the highest rate of urinary retention (n=7, 28%). In addition, there was no difference between laboratory results of creatinine and urinary retention in the studied groups (P>0.05). Besides, the comparison of the mean of renal laboratory indicators in the research patients indicated that the level of serum creatinine, and cystatin C of the patients had no significant change.

Conclusion: There was no significant difference between the complications in the three groups. Therefore, all three drugs can be administered to patients.

Objective: This study aimed to assess and compare the effects of intranasal administration of lidocaine and remifentanil on the condition of LMA insertion and cardiovascular response.

Methods: From March 2019 to March 2020, this double-blind randomized clinical trial study was conducted on 60 patients, who underwent general anesthesia with LMA insertion at Faiz Hospital, Isfahan, Iran. After induction of anesthesia and before placing the laryngeal mask, the first group received remifentanil 1 μg/Kg, the second group received lidocaine 2% 1 mg/Kg, and the third group received normal saline with the same volume intranasally. The conditions of LMA insertion and hemodynamic changes that occurred during its insertion were investigated.

Results: In terms of demographics characteristics (p>0.05), success in placing the LMA on the first try (p=0.73), number of attempts to insert LMA (p=0.61), performance of LMA (p=0.73), need for additional propofol (p=0.53), frequency of gagging (p=0.53), cough (p=0.15) p), and laryngospasm (p=0.99) did not differ significantly. In the remifentanil group, the cardiovascular response to LMA injection was less than that of the lidocaine group. Moreover, both groups were lower than the saline group, but no significant difference was observed.

Conclusion: In facilitating LMA insertion, the effect of intranasal remifentanil was comparable to intranasal lidocaine. Intranasal remifentanil was somewhat more effective than intranasal lidocaine in weakening the cardiovascular response to LMA insertion, but it did not outperform lidocaine.

Objective: This study investigated the demographic characteristics and factors influencing burn injuries, primarily in low socioeconomic societies where such incidents are prevalent due to factors such as illiteracy and poverty.

Methods: This cross-sectional study included all burn patients admitted to Shahid Motahari Hospital in Tehran, Iran. Demographic data such as age, sex, occupation, education level, and residence as well as detailed information about the burn incidents such as date, time, location, number of people present at the scene, and referral place was collected. Additionally, comprehensive burn details such as cause, extent, severity, previous history, and need for hospitalization directly at the emergency department were documented.

Results: The study included 2213 patients (mean age 34.98±19.41 years; range 1-96), with a men predominance (60.6%). The majority of burns (64.4%) occurred at home, primarily due to accidents (99.6%), with boiling water being the most common cause (39.2%). The most frequent burns were second-degree burns (91.8%), with an average injured body area of 6.31±6.67%. There were significant correlations between burn severity and demographic factors such as age, sex, occupation, cause of burn, hospital admission, outcome, and length of stay. Remarkably, the extent of burns was negatively correlated with the distance to the hospital, while positively correlated with the length of hospital stay.

Conclusion: Burn injuries were significantly influenced by demographic factors. Enhancing treatment facilities and reducing the time and distance to medical care could be crucial in high-risk cases.

Objective: Cerebral Venous Sinus Thrombosis (CVST), a complex and infrequent cerebrovascular disorder characterized by the formation of clots within the cerebral venous sinuses, occurs as a result of multiple risk factors and casualties, and its epidemiological picture should be investigated.

Methods: This descriptive study was conducted retrospectively on patients with a final diagnosis of cerebral vein thrombosis, who were referred to the emergency room of Ghaem Hospital (Mashhad, Iran) between 2009 and 2019. The study included all patients with cerebral vein thrombosis who were older than 18 years. Clinical symptoms and causes were documented and contrasted according to demographics.

Results: During the 10 years of this study, 749 cases of cerebral vein thrombosis were observed, with women accounting for the majority (72.8%). The most prevalent symptom was headache (554 cases; 74.0%), followed by seizures (23.1%), blurred vision (16.0%), nausea (7.5%), vomiting (6.9%), double nose (4.9%), and dizziness (3.3%). There was no significant difference in the frequency of symptoms between the two genders (p<0.05). The most commonly identified risk factors were OCP (110 cases; 14.7%), followed by infection (103 cases; 13.8%), malignancies (78 cases; 10.4%), and fasting (15 cases; 2.0%). There was no significant difference in risk factors between the two genders, with the exception that all cases of fasting were in women, and the differences were significant (p=0.015). The most common site of involvement according to Magnetic Resonance Venography (MRV) was the upper sagittal sinus (427 cases; 57.0%). There was no significant difference in terms of the site of the conflict between the two genders (p<0.05).

Conclusion: The findings of the present study showed that deep vein thrombosis occurred mainly in women and manifested itself mostly as a headache. Moreover, the upper sagittal sinus was the most common site of involvement.

Objective: Laryngeal mask airway (LMA) insertion has been found to reduce cardiovascular responses when compared to laryngoscopy and intubation. This research aimed to examine the impact of various techniques employed for LMA insertion on cardiovascular response.

Methods: This randomized, double-blind clinical trial included 90 elective surgery candidates divided into three groups of 30. All patients underwent similar anesthesia. The LMA was inserted using the classical technique, 180° rotation technique, and face-to-face triple maneuver technique (FFTMT). The cardiovascular responses, the success rate of LMA placement, and other outcomes were documented and compared among the three methods.

Results: The study revealed that the blood pressure of patients 10 minutes after LMA insertion using the rotational technique was higher than the standard technique (p=0.019). The pulse rate in the third (p=0.044, p=0.024) and fifth minutes (p=0.028, p=0.048) following the insertion of LMA demonstrated higher values when utilizing the FFTMT than the standard and rotational technique groups, respectively. Moreover, the incidence of sore throat following surgery in the FTFTM group was slightly greater than that observed with the standard and rotation techniques (p=0.389 and p=0.688, respectively).

Conclusion: The findings of the present investigation indicated that implementing the classic technique for LMA placement resulted in a more consistent blood pressure (BP) and pulse rate (PR) response than the 180° rotation and FFTMT. Furthermore, the classical method exhibited a marginally lower success rate in terms of LMA insertion than the alternative methods.

Objective: This study aimed to determine the prevalence and survival rate of trauma patients who underwent resuscitative thoracotomy (RT) in a level I trauma center in southern Iran.

Methods: This cross-sectional descriptive study conducted at Rajaee Hospital (Shiraz, Iran) from March 2018 to October 2022, included trauma patients who underwent RT surgery. Demographic information, vital signs at arrival, mechanism of injury, type of trauma, admission and discharge dates, length of hospital stay, blood transfusions, associated injuries, and clinical and laboratory parameters were evaluated. Statistical analyses were conducted using SPSS software.

Results: A total of 147 trauma patients underwent RT. The patients' mean age was 39±18.49 years. The majority of participants were men (82.40%). The most prevalent type of damage was blunt trauma, with a survival rate of 3%, followed by penetrating trauma, which had a 20% survival rate. The leading cause of trauma-related fatalities was road traffic accidents (78.9%). The majority of RT procedures (75.5%) took place in cardiopulmonary resuscitation (CPR) rooms. The survival group had lower systolic and diastolic blood pressure levels than the non-survival (83.0±34.96 vs. 97.83±33.10) and (40.75±20.91 vs. 62.48±25.36), respectively. Survivors exhibited a significantly higher Glasgow Coma Scale than non-survivors (8.40±6.14 vs. 4.75±3.84).

Conclusion: The study revealed a low survival rate among trauma patients undergoing RT. Blunt chest trauma emerged as an independent predictor of poor outcomes. Future studies should further explore indications and outcomes of RT to better inform clinical practice.

Objective: The present study was performed to investigate the efficacy of different resuscitation fluids in critically ill patients presenting any type of hypovolemic shock.

Methods: We comprehensively searched PubMed, Web of Science, ScienceDirect, Cochrane Library, and Google Scholar for randomized trials published in English from January 1990 to August 2023. The risk of bias and methodological quality assessment was performed using Cochrane's risk of bias tool embedded within the Review Manager software (RevMan 5.4.1). Moreover, this software was used to perform all the statistical analyses in the present study. During these analyses, the random effects model and 95% confidence interval was employed. The overall effect sizes for continuous and dichotomous data were calculated using the Mean Difference (MD) and Risk ratio (RR), respectively.

Results: Our initial database search resulted in 4768 articles, of which only 16 were reviewed and analyzed. A subgroup analysis of data from 4 of these studies showed that hydroxyethyl starches (HES), gelatins and albumins had no significant mortality benefit compared to crystalloids (RR: 0.94; 95% CI: 0.75-1.17; P=0.58, RR: 0.71; 95% 0.46-1.08; P=0.11 and RR: 1.05; 95% CI: 0.77-1.43; P=0.77, respectively). Similarly, a subgroup analysis of data from 9 studies showed that hypertonic saline plus dextran (HSD) had no significant mortality benefit over normal saline (RR: 0.84; 95% CI: 0.62-1.13; P=0.24) or Lactated ringer's solution (RR: 1.03; 95% CI: 0.75-1.42; P=0.87). In addition, we found that hypertonic saline had a similar effect on the overall mortality as isotonic crystalloids (RR: 0.92; 95% CI: 0.68-1.25; P=0.60). Also, our analysis shows that modified fluid gelatins had a similar mortality effect as HES ((RR: 1.02; 95% CI: 0.52-2.02; P=0.95).

Conclusion: Colloids, whether individually or in hypertonic crystalloids (HSD), had no mortality benefit over crystalloids in adult patients with hypovolemic shock.

Objective: This qualitative study aimed to identify the key issues within Emergency Medical Services (EMS) in large urban regions.

Methods: This study used qualitative content analysis as its research methodology. The study was conducted in 2023 and involved 21 Iranian EMS stakeholders, selected through purposive sampling with maximum diversity to ensure a broad range of expertise. Data were collected through semi-structured, in-depth interviews, which were conducted until data saturation was reached. The analysis followed the method proposed by Landman and Graneheim, which involved systematic coding and categorization to identify key themes and patterns related to EMS challenges.

Results: The study included 17 men and 4 women. The data analysis identified eight subcategories, which were then divided into three main categories based on their similarities. These main categories addressed challenges in EMS delivery, emerging issues in EMS demand, and resource constraints.

Conclusion: This study highlighted the challenges that Iran's EMS encountered in megacities due to rapid urbanization and an elderly population. Key issues included operational inefficiencies, increasing demand, and limited resources. Addressing these challenges is crucial for enhancing the effectiveness and sustainability of EMS. Further research is required to develop strategies for overcoming these obstacles and strengthening EMS in large urban regions.

Objective: Cycling is a healthy and pleasurable activity, but it can also be hazardous. The risk factors for cycling injury are unknown, considering the cycling infrastructure and cyclists' behavior in northern Iran. This study aimed to explain the experiences of injured cyclists admitted to Poursina Educational and Medical Center, Rasht in 2021, as one of the risk factors associated with cycling.

Methods: A content analysis was conducted on the experiences of cyclists over the age of 18 who had one or more injured limbs due to a crash or fall while riding a bicycle. The data were obtained from the registration system of the Guilan Road Trauma Research Center. Potentially eligible participants were contacted by telephone. Twenty people with various characteristics in terms of age, sex, and other features were included in the interview.

Results: Cyclists' experiences with risk factors were divided into 13 categories; including lack of laws, lack of training, poor traffic culture, easy to lose balance, cycling infrastructure, inappropriate roads, darkness, bad weather conditions, unsafe behavior, non-standard bicycle, unsafe protection, intentional injury to female road users, and risk of collision with other road users.

Conclusion: The extracted risk factors can be used as the ABC of cycling to novice cyclists. Thus, responsible efforts to regulate, educate, promote, and monitor cycling can encourage people to ride.