Bulletin of emergency and trauma最新文献

Objective: Ventilator-associated pneumonia is the common cause of morbidity and mortality in the intensive care unit. Due to the antimicrobial effect of chlorhexidine, and the long-lasting result of mucoadhesive drugs, this study aimed to determine the effect of chlorhexidine mucoadhesive gel on the prevention of ventilator-associated pneumonia in critical patients.

Method: In this clinical trial, 64 ventilated patients were selected and randomly allocated into two groups. The first group received 0.2% chlorhexidine mucoadhesive gel and the second group received 0.2% chlorhexidine solution as a mouthwash. Every three days, the incidence of ventilator-associated pneumonia was evaluated by the clinical score of pulmonary infection. The data were analyzed by SPSS statistical software version 20.

Results: There was no statistically significant difference in demographic characteristics between the two groups. In the control group, 25% of the patients had ventilator-associated pneumonia, while it was only 15.6% in the intervention group; however, the incidence of ventilator-associated pneumonia revealed no significant difference between the two groups (HR ratio, 0.86; 95% confidence interval, 0.49 to 1.83 p =0.356).In addition, there was no statistically significant difference between the number of days connected to the ventilator (p =0.854), the number of days hospitalized in the intensive care unit (p =0.423), and the death rate (p =0.634) between the two groups.

Conclusion: Although no significant statistical difference was detected between chlorhexidine mucoadhesive gel and chlorhexidine solution in the prevention of ventilator-associated pneumonia, the incidence of pneumonia in the mucoadhesive gel group was clinically less than in the control group. It is better to repeat the study with a larger statistical population.

Wunderlich syndrome, also known as the spontaneous non-traumatic retroperitoneal hemorrhage, is an uncommon condition characterized by acute, spontaneous, non-traumatic renal hemorrhage into the subcapsular or perirenal spaces. The majority of the cases are caused by renal cell carcinoma or renal angiomyolipoma. Other causes are arteriovenous malformation, cystic renal disease, and anticoagulation medications. The classic presentation is "Lenk's triad" of acute flank pain, palpable flank mass, and hypovolemia. The diagnosis is based on clinical suspicion and confirmed by a CT scan, which is the preferred imaging modality. Due to the rarity of these cases and the wide range of clinical manifestations, the treatment is divergent ranging from conservative management to nephrectomy. Herein, we present a case of massive right renal hemorrhage caused by warfarin toxicity that was initially misdiagnosed as acute renal colic due to the patient's refusal to refer to the clinic during Corona Virus Disease- 19 era and was later managed with a right nephrectomy.

Due to the specific features of the adrenal glands, traumatic adrenal injury is a rare phenomenon. The majority of these rare types of traumas are caused by blunt force injuries and rarely by penetrating mechanisms. In such cases, a whole-body computed tomography scan is essential for early diagnosis. This paper describes an uncommon case of adrenal hematoma and contusion followed by blunt abdominal trauma. A 35-year-old woman was admitted to the emergency department after a high-speed vehicle-pedestrian collision. She presented with decreasing level of consciousness. Additionally, a thoracoabdominal CT scan revealed a left flank hematoma. Blunt adrenal injury, often accompanied by multiorgan damage, is a rare occurrence resulting from severe accidents. Accurate diagnosis based on clinical symptoms requires high clinical suspicion, particularly in isolated cases, and treatment depends on the patient's condition.

Objective: This study aimed to investigate the necessity of cervical collars in patients with neck problems.

Methods: This cross-sectional study was conducted on 114 patients who were admitted to the Haft Tir and Rasoul Akram Hospitals (Tehran, Iran) from August to September 2022. The Nexus protocol was used to select the patients with cervical collars. According to the protocol, a cervical collar was required for individuals who had at least one symptom. If none of these symptoms existed, the cervical collar was deemed unnecessary. The data were analyzed using the Chi-square test and Fisher's exact test.

Results: Of the 114 trauma patients, the cervical collar was used unnecessarily by 49 (43%) patients. Tenderness was the most common complication in 62 patients (54.4%). The prevalence of unnecessary cervical collar use was 37.5% in female trauma patients and 43.88% in male trauma patients, which was not statistically significant (p=0.63). The prevalence of unnecessary cervical collar use in trauma patients with multiple trauma was 39.42% and 80% in patients without multiple trauma, which was statistically significant (p=0.018). Patients with a medical history had a higher rate of unnecessary use of the cervical collar (47.96%) than those without a history (12.5%), and this difference was statistically significant (p=0.008).

Conclusion: The guidelines for using cervical collars need to be updated by the EMS. Due to the large number of trauma patients in Iran, cervical collars for necessary conditions can help to reduce the healthcare expenses and injuries caused by unnecessary cervical collars.

Objectives: To study the anti-inflammatory and antioxidant effects of flaxseed oil and olive oil on inflammatory markers for facilitating wound healing.

Methods: One hundred and twelve patients were randomly selected to four groups with a total burn surface area (TBSA) of 20-50%. The four groups includes olive oil (OO), flaxseed oil (FO), mixture of olive oil and flaxseed oil (OF), and control group and received 30g of oils for three weeks. Serum high-sensitivity C-reactive protein (hs-CRP), ferritin and albumin level as inflammatory markers, as well as cholesterol, triglyceride, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) as the lipid profile were explored. Wound healing was assessed by photographing on days 2, 8, 15, and 22 (during three weeks of intervention) and were analyzed in imageJ software.

Results: The greatest reduction in the level of hs-CRP and ferritin was observed in the OF (-21.38±44.41) (-132.79±165.36), while the lowest reduction was reported in the control group (-36.36±79.03) (141.08±262.36). Compared to control group, OO significantly increased albumin (0.88±0.65). Reduction of wound healing at the end of the first week of intervention was not significant in the study groups. However, the stereology examination showed significant improvement in wound healing at the end of the second and third weeks in the OF.

Conclusion: Based on the findings, combination of herbal oils reduce inflammation and improve wound healing and showed positive effects on the size of wounds in burn patients.

Objective: Considering the growing use of emergency medical services (EMS), we evaluated the level of public awareness of emergency situations in Iran.

Methods: This cross-sectional study was conducted from August 2021 to January 2023 on Iranian residents in Tehran, who were older than 18 years old. The participants were directed to a URL for an online survey link and asked to select their preferred options for the predetermined scenarios. We divided the participants into three groups: abuse, misuse, and non-use. At least 12 correct answers were required to qualify as acceptable knowledge and practice responses (KP score). Then, the relationship between participants' baseline characteristics and their level of awareness was investigated.

Results: Totally, 3864 people participated in the study, of whom 50.5% were men. The participants' ages ranged from 18 to 90 years old, with a mean age of 40.01±11.30 years. In general, the rate of abuse, misuse, and not-use in at least one scenario was 74.5%, 64%, and 70.4%, respectively. The results of the multivariable regression analysis indicated that female sex (OR=1.29), a higher education level (OR=3.36), a higher income level (OR=1.64), and Turkish ethnicity (OR=1.20) were significantly associated with the correct KP score.

Conclusion: The degree of inappropriate utilization of EMS services in Iran was significant. We found that the proper knowledge regarding the appropriate use of EMS was significantly associated with the participant's level of education, academic field, job, and income.

Objective: Burn trauma is a life-threatening incident that may be accompanied by several risk factors that increase morbidity and mortality. Drug abuse is one of the lifestyle dangers on the rise globally and can have an impact on the outcomes of burn injuries. This study aimed to evaluate the effect of drug abuse on the clinical outcomes of adult burn patients who were admitted to a burn center in the North of Iran.

Methods: This retrospective cross-sectional study included adult burn patients who were referred to Velayat Hospital, between March 1, 2021, and March 20, 2022. The hospital information system (HIS) was used to select patients with a history of drug use and then were compared with burn victims who had never used drugs before. In both groups, demographic information, the cause of the burn, the comorbid diseases, total body surface area, length of stay, and outcomes were collected and recorded for both groups.

Results: This study included 114 inpatients, 90 of whom (78.95%) were men. The mean age of the patients was 43±15 years. The mean length of hospitalization in the drug-user group was significantly higher than in the non-drug abuse group (p=0.004). The drug abuse group had significantly higher rates of comorbid diseases (p=0.021), inhalation injury (p<0.001), mortality (p=0.002), and pneumonia (p<0.001). However, there were no statistically significant differences in the Infection and Sir's rates (p=0.583) between the groups.

Conclusion: Drug abuse is a risk factor in adult burn patients, which can affect the length of stay and burn-related morbidities.

Objective: According to the reports of the World Health Organization approximately 300,000 deaths occur yearly worldwide due to burns or burn-associated injuries. This study aims to review the epidemiology of burns in pediatrics and adolescents in Fars province between 2017 and 2018.

Methods: This is a cross-sectional study that investigated all people ≤18 years old who suffered from burn injuries in Fars province between 2017 and 2018. We use data from the file of burn patients which was provided by pre-hospital emergency services of Fars province. This data comprises demographic information (age and gender), burn-related information (type, degree, and severity of burns), mode of transfer (outpatient surgery or transfer to hospital) and the outcome of the disease (death before arrival to the hospital or alive).

Results: The average age of the subjects of this study was 5.8±8.9. We also categorized the subjects into four age groups, 1-4, 5-8, 9-13 and 15-18 years. The number of boys who suffered from burn injuries is significantly more than the girls (p=0.011). Also, there is a remarkable correlation between burn with age (p<0.001) and burn with disease outcome (p=0.01). The Most common cause of burns in boys was nonchemical hot objects and liquids (28.5%). Likewise, the possibility of mortality in burn patients who faced an electric shock was 22.66%. ([95%CI=2.32-220.63], p<0.001 OR=22.66).

Conclusion: This study shows that pediatrics and adolescents ≤ 4 have the most burn injuries, and boys have twice as many burn events as girls. More importantly, the most common cause of burns in both genders was burning with non-chemical hot objects and liquids, in particular, in the age group of 1-4 years, in which event happens at home.

Objective: This study aims to characterize the demographic, clinical, and radiological features of gunshot wound (GSW) patients as well as identify predictors of prolonged hospitalization.

Methods: In this retrospective study, a consecutive sampling method was used, including all patients with GSWs in any anatomical region. Data collection included demographic and clinical information, radiological findings, treatment specifics, and outcome variables, such as hospitalization length of stay (LOS) as the primary outcome. To identify predictive factors associated with prolonged LOS, logistic regression analysis was used.

Results: We studied 212 GSW cases, including 95.8% were men and 4.2% were women. The mean age of the studied group was 30.17±7.80 years. GSWs occurred in extremities (80.2%), abdomen (9.0%), thorax (4.7%), and head or neck (5.2%). Two patients (0.9%) had both abdominal and thoracic GSWs. The most prevalent radiological study was an X-ray (83.0%). Patients with head and neck GSWs had the longest emergency department stay, while patients with abdominal GSW patients had the shortest (p=0.068). The highest rates of blood product transfusion were observed in abdominal GSWs (63.2%), emergency surgery (63.2%), and ICU admission (42.1%). Head and neck GSWs had the longest hospitalization LOS (7.5 days). Longer LOS was significantly associated with abnormalities in radiological findings, receiving blood products, and ICU admission (p≤0.001). Significant predictors of prolonged LOS were major abnormalities in radiological findings [odds ratio (OR)=5.3; 95% confidence interval (CI):2.8-10.2], head and neck GSWs (OR=6.1; 95% CI:1.2-31.9), and blood product transfusion (OR=4.1; 95% CI: 1.0-16.3).

Conclusion: This study provides insights into factors influencing prolonged hospitalization in GSW patients, highlighting the importance of radiological findings, head and neck injuries, and blood product transfusion.