Bulletin of emergency and trauma最新文献

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: Intra-articular screw penetration is a probable complication of coronoid fracture fixation. The present study aimed to determine the best radiography technique for visualizing the proximal radioulnar joint (PRUJ) space. Moreover, it aimed to determine the safe angle and length of the screw to avoid PRUJ penetration during coronoid fracture fixation.

Methods: The Mimics software was used to construct a three-dimensional model of a healthy man's forearm from a computer tomography scan. It was analyzed using the Solidworks software to determine the X-ray angle that clearly showed the PRUJ space to detect penetration of screws from the coronoid process into the PRUJ and determine the maximum screw angle and length that could be used without intra-articular penetration. To verify these findings, a cadaveric study combined with radiographs was conducted.

Results: To visualize PRUJ space, the optimal X-ray angle was 13º lateral to the perpendicular line when the forearm was positioned at full supination. If the coronoid process was segmented into zones 1 (closest to the radioulnar joint) to 4 (farthest from the joint), the screw could only be inserted at a right angle in zone 1. In zones 2, 3, and 4, inclination angles less than 15, 35, and 60 would prevent intra-articular penetration, respectively.

Conclusions: The X-rays could visualize the PRUJ space with an anteroposterior radiograph at an angle of 13º ulnar deviation from the perpendicular plane. During coronoid process fracture fixation, shorter screws with less lateral inclination were safer when inserting screws in the zones of the coronoid process adjacent to the PRUJ.

Objective: This study aimed to determine the rate of readmission for trauma patients in ICUs, as well as the factors that predict this outcome.

Methods: This retrospective cohort study was conducted at Emtiaz Hospital, a level I referral trauma center (Shiraz, Iran). It analyzed the ICU readmission rates among trauma patients over three years. The required data were extracted from the Iranian Intensive Care Registry (IICUR), which included patient demographics, injury severity, physiological parameters, and clinical outcomes. Statistical analysis was performed using SPSS version 25.0. Descriptive statistics and different statistical tests, such as T-tests, Mann-Whitney tests, Chi-square tests, and logistic binary regression test were utilized.

Results: Among the 5273 patients discharged from the ICU during the study period, 195 (3.7%) were readmitted during the same hospitalization. Patients readmitted to the ICU had a significantly higher mean age (54.83±22.73 years) than those who were not readmitted (47.08 years, p<0.001). Lower Glasgow Coma Scale (GCS) scores at admission and discharge were associated with ICU readmission, implying that neurological status and readmission risk were correlated with each other. Furthermore, respiratory challenges were identified as the leading cause of unexpected readmission, including respiratory failure, hypoxic respiratory failure, respiratory distress, and respiratory infections such as pneumonia. Injury patterns analysis revealed a higher frequency of poly-trauma and head and neck injuries among patients readmitted to the ICU.

Conclusion: This study underscored the importance of ICU readmission among trauma patients, with a high readmission rate during the same hospitalization. By developing comprehensive guidelines and optimizing discharge processes, healthcare providers could potentially mitigate ICU readmissions and associated complications, ultimately enhancing patient outcomes and resource utilization in trauma ICU settings. This research provided valuable insights to inform evidence-based practices and improve the quality of care delivery for trauma patients in intensive care settings.

Objective: The present study aimed to determine the prevalence and severity of moral distress (MD) and its associated factors among emergency department nurses.

Methods: This cross-sectional study was conducted in 2023 on 172 nurses from the emergency departments of medical training centers affiliated with Mazandaran University of Medical Sciences. The census method was used to collect the data, which included demographic variables and Corley's MD questionnaire. The Data were analyzed using SPSS software (version 22), using an independent T-test, analysis of variance (ANOVA), and multiple regressions.

Results: Out of 172 nurses, 60.5% were women, with an average age of 32.52±6.88 years. The results demonstrated an average MD score of 69.73±25.68. In terms of frequency and intensity, around 53.5% of the participants experienced MD at a low level (0-72), while the remaining 46.5% reported experiencing it at a medium level (14-73). A significant association was found between MD and age (p=0.037), workplace hospital (p=0.005), and history of mental disorders (p=0.005). Furthermore, linear regression analysis revealed a statistically significant association between MD, marital status, and occupational type (p<0.05).

Conclusion: The results showed that nurses had low to moderate levels of MD. Several factors, including age, history of mental disorders, marital status, employment type, workplace hospital, and education, were associated with the overall MD score. To reduce MD and its negative effects on nurses, it is necessary to address these factors and develop an effective strategy for identifying and managing MD to improve nursing care quality.

Objective: The present study aimed to evaluate the clinical benefits and drawbacks of administering ECMO/ECLS therapies to drug-intoxicated patients.

Methods: From inception until April 30, 2024, an extensive search was performed on four main databases: PubMed, Web of Science, Cochrane Library, and EMBASE. There was no restriction on the search period. Only the studies that reported survival to hospital discharge rates, adverse events, and the utilization of ECMO/ECLS in the treatment of intoxicated patients were included. On the other hand, articles that did not report adverse events or hospital discharge rates as outcomes, as well as studies published in languages other than English, were excluded. The evaluated outcomes were the rate of survival to hospital discharge rate and the incidence of adverse events associated with ECMO therapy. The Newcastle Ottawa scale was employed to appraise each study to determine its methodological quality. The Comprehensive Meta-Analysis (CMA) software (version 3.0) for statistical analysis was used, with the random effects model (due to high heterogeneity among the studies) and a 95% confidence interval.

Results: From a total search of 2216 search results, only 10 studies were included. The pooled analysis from 10 studies indicated that ECMO therapies among drug-overdosed/poisoned patients were associated with a significant survival to hospital discharge rate of 65.6% ([95% CI: 51.5%-77.4%], p=0.030). However, the outcomes were highly heterogeneous (I²=83.47%), which could be attributed to the use of several medicines by different studies. In contrast, ECMO therapies among drug-overdosed patients were associated with a significant incidence rate of adverse events of 23.1% ([95% CI: 12.3%-39.2%], p=0.002). However, the pooled analysis had a significant heterogeneity (I²=70.27%).

Conclusion: Despite various health complications, extracorporeal membrane treatment enhanced survival to hospital discharge with good neurological outcomes. Hence, it was a viable, effective, and feasible alternative for managing drug-induced intoxication in patients.

Objective: Geriatric trauma refers to injuries sustained by elderly individuals, typically those aged 65 years and older. The management of geriatric trauma in the Emergency Department requires a comprehensive approach that takes into account the physiological changes associated with aging, as well as the increased vulnerability and complexity of injuries in this population.

Methods: This is a cross-sectional study aimed at evaluating the etiology of trauma in geriatric patients referred to the ED of level-1 an academic center. All patients with complaints of trauma are evaluated and patients over 65 years enrolled in the study. Data were analyzed by SPSS 26.

Results: 319 patients were investigated, 49.8% male and 50.2% female. The most common underlying diseases are high blood pressure, diabetes type 2, and ischemic heart disease. The most common trauma cause was falling from the same level (48.9%), followed by a fall from a height (16.6%), accidents with cars (16%), and motorcycles (9.1%). The most common injury was extremities trauma (71.5%) following head trauma (13.2%) and chest trauma (6%). The severity of injury in extremities was higher in women, and chest trauma was more severe in men.

Conclusion: The fall and subsequent car accident had the highest frequency as a cause of trauma in elderly patients admitted to our academic trauma center. Hypertension and diabetes have also been the most common underlying diseases. Head and neck injuries are life-threatening and critical in a larger number of patients than other injuries, and protecting them can be effective in reducing mortality and serious injuries in elderly trauma patients.

Bronchial rupture following major blunt chest trauma should be suspected in any case of massive and persistent air leak through the intercostal drain tube. Chest radiographs and chest computed tomography scans (CT scans) are highly suggestive of this extremely rare tracheobronchial injury. The present study reported a patient who was a 15-year-old boy. He was a case of a motor-car accident and was brought to the emergency room (ER) of Rajaie Hospital ( Shiraz, Iran) due to dyspnea and chest pain. The physical examination revealed a few crash injuries on his upper extremities, as well as subcutaneous emphysema in his neck. The chest X-ray revealed a right clavicular fracture, multiple rib fractures, a right pneumothorax (but no complete collapse or fallen lung), and also pneumo-mediastinum and subcutaneous emphysema. The chest CT revealed severe pulmonary contusion, severe right-sided pneumothorax, significant pneumo-mediastinum, subcutaneous emphysema, multiple right-side rib fractures, and mild displacement of the right main bronchus. Furthermore, no definitive signs of bronchial rupture were detected. Using a mechanical ventilator, the following parameters were revealed. The maximum pressure (Pmax)=7cm, H₂o (was very low), plateau pressure (P. Plateau), and expiratory tidal volume (TV) were not detected due to insufficient amounts. Additionally, increasing TV did not change those values. Bronchial rupture is one of the most important and serious differential diagnoses in forceful chest traumas when the mechanical ventilator reveals low Pmax, very low P.platue, and expiratory TV, with no change in those values with increasing TV.