Bulletin of emergency and trauma最新文献

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.

Dental injury is a common anesthesia-related adverse event, with a high incidence of damage to teeth and surrounding tissues during oro-endotracheal intubation. Poor oral hygiene, compromised periodontium, faulty or loose prosthesis, proclined maxillary incisors along with increased difficulty level of airway management, improper use of laryngoscope, and use of maxillary anterior teeth as a fulcrum for achieving accessibility to the airway are all risk factors for iatrogenic dental injury. This type of injury provides additional physical and psychological trauma to patients who have already undergone medical surgical procedures. The consequences of such mishaps might potentially result in medico-legal suits and financial claims. The present case series described three cases of managing iatrogenic dental lesions during oro-endotracheal intubation, after obtaining written informed consent, as well as methods for preventing such accidental injuries. This study emphasized the importance of collaboration between medical and dental professionals in preventing and successfully managing accidental dental injuries.

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.

Objective: This study aimed to evaluate the outcome and risk factors in operative and non-operative management of splenic injury.

Methods: This cross-sectional study was conducted on patients with traumatic splenic injuries who were hospitalized in Kashani Hospital (Isfahan, Iran) from 2017 to 2019. The studied variables were extracted from the medical records of the enrolled participants. The outcomes such as mortality complications and risk factors were compared based on treatment methods.

Results: A total of 240 patients were investigated. The mean age of the patients was 29.8±12.2, with 180 (77.5%) patients being men. 154 (64.2%) patients underwent operative treatment. The mortality rate was 18.9% and 4.6% among operative and non-operative groups (p<0.001). Complications were observed in 11.5% and 46.1% of non-operative and operative groups, respectively (p<0.001). Operative treatment inversely correlated with mortality (p<0.001) and complications (p<0.05). Splenic injury severity was correlated positively with mortality (p<0.001) and negatively with complications (p<0.001). Unstable hemodynamic status was positively correlated with complications (p<0.001). Age had a positive correlation with mortality (p<0.001) and complications (p<0.001). Male sex had a negative correlation with complications (p<0.001). GCS score and admission were positively correlated with mortality (p<0.001). There was no statistically significant correlation between correlated injuries and outcomes (p≥0.05).

Conclusion: Patients who received surgery had higher rates of mortality and complications. However, after controlling for confounders, operative treatment was found to be inversely correlated with mortality and complications.

Objective: Recently, different serum markers have been used for the diagnosis and prognosis of acute heart diseases in emergency departments. To determine such a role, the present study was designed and conducted.

Methods: This is an analytical cross-sectional study conducted on patients with syncope complaints. The patients enrolled in the study based on the inclusion and exclusion criteria and underwent initial evaluations, including collecting a history, physical examination, ECG, blood sugar measurement, and, if necessary, brain CT scan, Doppler echocardiography, and CTA.

Results: This study included 100 participants who complained of syncope. The results showed that 19% and 81% of the subjects suffered from cardiac and non-cardiac syncope, respectively. The average Pro BNP of the studied individuals was 196.06±128.45 pg/mL. According to the results, age and length of hospitalization had a positive and significant relationship with the average Pro BNP (p<0.01). Individuals with positive TPI, cardiac syncope, and abnormal ECG or Doppler findings had significantly higher average Pro BNP levels (p<0.01). The results of the diagnostic value of Pro BNP in diagnosing cardiac syncope also showed that its sensitivity and specificity were 94.73% and 56.79%, respectively.

Conclusion: The results of this study showed that the increase in the Pro BNP values was associated with age, length of hospitalization, and ECG abnormalities. In addition, as an independent marker, Pro BNP had optimal acceptability in identifying cardiac syncope cases.

Airgun injuries are prevalent in the pediatric population. The present study described a case of air gun pellet injury to the left carotid artery and its successful management. A 25-year-old man presented to the emergency department complaining that his son had accidentally injured him with an air gun pellet while playing. The X-ray cervical spine revealed a single foreign body (pellet) located directly anterior to the C5-C6 vertebra. A CT angiography of the neck showed a spherical hyperdense object just anterior to the C6 vertebral body on the left side, 3 mm posteromedial to the left common carotid artery, which was most likely a pellet foreign body. The patient was sent to operation theatre (OT) for exploration. There was a rent in the internal carotid artery with active bleeding. After exerting both proximal and distal control, the rent was closed. Close air gun injury could result in gunshot wounds, as in the present case. Plain X-rays in AP and lateral view are required. Nonoperative management could be employed in a restricted group of patients with satisfactory outcomes. Those who have vascular involvement will require surgical intervention.