Helicopter emergency medical service in Fars province: the referral trauma center of South of Iran

Considering the limited available resources, high cost of the helicopter emergency medical service [HEMS], and high load of trauma patients especially in our centers, a careful assessment of HEMS in our center seemed to be necessary for trauma patients. From April 2001 to September 2007, the data of all patients transferred by HEMS were extracted including: Annual number of services, clinical category, number of proper or improper services, and rescue time for HEMS and ground ambulance. The criteria for the properly transferred group included: Death or being operated in the first 24 hours of admission, admission in ICU care units, and transfer of more than three patients in one mission. Others were considered as improper group. In this period through 185 flights, 225 victims were transferred. The most common reason of HEMS dispatching was trauma. The most difference of rescue time between ground ambulance and HEMS was recorded in Lamerd that was transferring patients with HEMS needed 3 hours less than ground ambulance. However, in Sarvestan, Dashte-Arjan, and Marvdasht, transferred patients with ground ambulance needed less time than air transfer. Most of transferred patients were from Kazeroon, Nourabad and Lamerd respec-tively while 46.3% of patients were in the proper group, and the rest were considered as improper group. Our study revealed that helicopter dispatch to the cities like Lamerd, Lar, Khonj, Abadeh can be more effective, whereas, for the towns like Marvdasht, Dashte-Arjan, Sarvestan, Sepidan, Saadatshar, Tang Abolhayat use of HEMS should be limited to specific conditions. Our study showed inclusion of physicians in the decision making team increased the number of transferred cases

Surgical emergency room workload charecteristics: single center experience during one year

Having information on characteristics of work load of emergency surgical room in 3 working-shifts per day help to manage facilities and health care providers more efficiently. The aim of this study is to evaluate the workload pattern of 3 working-shifts of a day in Nemazee Hospital, southern Iran. The patients who were admitted in the surgical Emergency Room from April 2007 to May 2008 were enrolled including the patients' demographics, referral sources, the busiest working-shifts and the type of procedures performed in the Emergency Room. 33,837 emergency surgery referrals were recorded, of which 74.7% were male and 25.3% were female with a mean age of 30.8 +/- 20.1 years. The busiest working-shift of the day was between 8.00 PM and 8.00 AM, when 48.4% patients were admitted. 12.1% were admitted in the Emergency Room while 4.8% patients were admitted in the hospital wards and 5.6% underwent emergency surgery. 32.4% of them were discharged while 39.7% left the hospital with their own responsibility and 4.7% patients escaped from the hospital. The total number of the deaths during the study period was 0.7%. Our results showed that patients were mainly male teenagers and most of the accidents happened by motorbike during the busiest working-shift of the day from 8 PM to 8 AM. Therefore, it would be useful to persuade health system administrators to set up some educational programs to increase the awareness of families and teenagers regarding trauma and also to allocate more resources to shorten waiting lists

Cardiopulmonary arrest outcome in Nemazee hospital, southern Iran

Many factors are important determinants in the outcome of cardiopulmonary resuscitation [CPR] such as quality of CPR, age of patients, co morbidities, time and location of arrest, and skill of rescuers. This study was conducted to evaluate the efficacy of CPR in Shiraz, southern Iran. From October 2007 to March 2008, all patients who received in-hospital CPR in Nemazee Hospital affiliated to Shiraz University of Medical Sciences were enrolled. Two standard scales of ROSC [Return of Spontaneous Circulation] and DR [Discharge Rate] were used to evaluate the efficacy of CPR. Two hundred and seventy one patients [45.1%] had ROSC while 329 [54.9%] died immediately after resuscitation. Among ROSC patients, 18 [6.6%] cases were discharged from the hospital [3% of study population]. Although ROSC was comparable with developed countries, but the DR was lower. It shows that in our area, post-resuscitation care needs more attention in relation to organized trainings and the skills in post-resuscitation care together with expansion of the facilities

Percutaneous vertebroplasty

Percutaneous vertebroplasty is a promising therapeutic technique for pain control in patients with pathologic fractures of vertebral bodies. Percutaneous vertebroplasty is an appropriate treatment for vertebral pathologic fractures, which is resistant to other usual treatment. It is a useful and only choice in special cases, because of less tissue damage and there is no risk of open surgery and patient's embolization is rapid. Herein we described the first case of percutaneous vertebroplasty in Yazd shahid sadoughi teaching hospital, which was done in ordybehesht 1386 in a 72 years old male with pathologic fracture of 2 lumbar vertebrae. He was suffered from pain and disability and open surgery was not appropriate treatment for him

Comparison between two methods of excision and primary closure of pilonidal sinus

Controversy still exists about the best surgical method for the treatment of pilonidal sinus. The aim of this study was to compare two methods of excision and primary closure. One hundred and seventy-three patients with pilonidal sinus, 119 [69%] men and 54 [31%] women, and a mean age of 23.3 +/- 7.5 yrs and divided into two Groups of A [electrocautery] and B [excision] for the removal of pilonidal sinus. Wound complications, hospital stay, times to heal, return to work, patient's comfort and recurrence rate were recorded for the two groups. The postoperative follow-up was 6 months. All patients were able to resume their normal lives and activities 7-9 days after the operation. Wound infection and recurrence rate were significantly [P<0.05] less prevalent in Group A [5% and 3.8%] than in Group B [1% and 0%]. There was no significant difference between two groups in regard to hospital stay, time to heal, time to return to work and patients' comfort after 6 months of follow-up. The use of electrocautery at the base of the wound is not recommended because it may obscure the exact extent of the pilonidal sinus and increase the rate of recurrences

clinicolaboratory scoring system for the management of acute appendicitis

Despite widespread imaging techniques which have significantly improved the management of acute appendicitis, cost-effective clinical decision-making concerning this condition is still a matter of debate. The aim of this study was to design a simple scoring system based on routine clinical and paraclinical data in patients suspected of having acute appendicitis. In this cross-sectional study, 402 consecutive patients, clinically suspected of having acute appendicitis and who were referred for general surgery consultation were evaluated. Nine common clinical and laboratory data including abdominal guarding, fever, shifting pain, leukocytosis, rebound tenderness, tenderness on rectal examination, vomiting, right lower quadrant tenderness and anorexia/nausea were recorded in each case and individually evaluated for sensitivity, specificity, positive predicted value and accuracy based on final outcome. A score of 3 was attributed to sign/symptoms with an accuracy of >/= 80%, 2 to sign/symptoms with an accuracy of 60-70%, and 1 to sign/symptoms with an accuracy of 50-70%. By selecting a cut-off point of more than 7 for operation and 6-7 for observation, the proposed scoring system decreased the negative appendectomy rate to 6.6% and observation rate to 3.5% as compared to 29% and 18% respectively, in conventional decision making. Applying this scoring system can improve clinical decision-making in acute appendicitis and effectively reduce negative appendectomy rates without increasing the rate of complications