Assessment of mechanism, type and severity of injury in multiple trauma patients: A cross sectional study of a trauma center in Iran / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To accurately assess the mechanism, type and severity of injury in Iranian multiple trauma patients of a trauma center.</p><p><b>METHODS</b>Patients with multiple traumas referring to the emergency department of Hasheminejad University Hospital in Mashhad, Iran, entered this cross sectional study from March 2013 to December 2013. All the patients with injury severity score (ISS) > 9 were included in this study. Data analysis was performed by SPSS software (Version 11.5) and P values less than 0.05 were considered as significant differences.</p><p><b>RESULTS</b>Among the 6306 hospitalized trauma patients during this period, 148 had ISS>9. The male female ratio was 80%. The mean age of the patients was (33.5 ± 19.3) years. And 71% of the patients were younger than 44 years old. There were 19 (13%) deaths from which 68.5% were older than 44 years old. The mean transfer time from the injury scene to hospital was (55 ± 26) minutes. The most frequent mechanisms of injury were motorcycle crashes and falling from height, which together included 66.2% of all the injuries. A total of 84% of hospital deaths occurred after the first 24 h of hospitalization. Head and neck were the most common body injured areas with a prevalence of 111 cases (75%).</p><p><b>CONCLUSION</b>Motorcycle crashes have high frequency in Iran. Since most victims are young males, injury prevention strategies should be considered to reduce the burden of injuries.</p>

prognostic value of cardiac ultrasonography in patients with cardiac arrest

Introduction: Echocardiography or cardiac imaging is proposed as a gold standard method for identifying high risk patients for cardiac arrest. In this systematic review, we studied the prognostic value of cardiac sonography in patients with cardiac arrest

Methods: PubMed was searched for the relevant articles. Case reports were not included. Inclusion criteria were all the studies applied transthorasic echocardiography in patients with cardiac arrest arrived at emergency department that studied the efficacy of this modality on patients survived to emergency discharge and returned to spontaneous circulation

Result: Overall, 870 articles were obtained through initial search and only nine articles were included after the evaluation of the title, abstract, and the full text. Echocardiography has high sensitivity and specificity in predicting the return of spontaneous circulation

Conclusion: Cardiac sonography is a fairly effective [not definitive] modality in predicting death in patients with lack of cardiac activity during resuscitation. Echocardiography should not be the sole basis for the decision to cease resuscitative Efforts

Serum lactate is a useful predictor of death in severe sepsis and septic shock

The severe sepsis and septic shock are as common and lethal that emergency physicians routinely confront. Actually, more than two thirds of sepsis patients present initially to the ED. Only a few laboratory tests for markers of sepsis are currently available. The serum lactate level can help in determining prognosis and to risk-stratify patients with severe sepsis. This independent review of the literature includes 83 studies published in all electronic-based database such as Elsevier, PubMed, and SID during the last 18 years [40–320 patients in each]. Data gathered from English language articles and books published between 1995 and 2013. The serum lactate concentrations measured in almost all patients with severe sepsis raised at admission and were higher in patients who had the worst outcomes such as higher Apache-II and SOFA score. Serum lactate was associated with mortality independent of clinically apparent organ dysfunction and shock in patients with severe sepsis admitted to the emergency department and intensive care unit. This review focuses on the association between initial and serial serum lactate level and mortality in patients presenting to the emergency department with severe sepsis