ABSTRACT
<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>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Accidents, Traffic , Cross-Sectional Studies , Hospital Mortality , Injury Severity Score , Multiple Trauma , Epidemiology , Mortality , Trauma CentersABSTRACT
Introduction: Resuscitation should be initiated immediately in shock. Early goal-directed therapy is an established algorithm for the resuscitation in septic shock. The first step is to maintain cardiac preload. Central venous pressure [CVP] plays an important role in goal-directed therapy. Central venous catheterization is invasive and time-consuming in emergency conditions. There are some alternative and noninvasive methods for estimating the intravascular volume such as measuring the inferior vena cava [IVC] diameter by ultrasonography
Methods: We searched PubMed, Google scholar, and Scopus databases with keywords [central venous pressure OR venous pressure OR CVP] AND [ultrasonography OR sonography] AND [sepsis OR septic shock] AND [inferior vena cava OR IVC]
Result: The search resulted in 2550 articles. The articles were appraised regarding the relevance, type of article, and statistical methods. Finally, 12 articles were selected. The number of patients was between 30 and 83 cases [mean age=57-67 years], intubated and non-intubated in each study. The IVC diameter was measured in respiratory cycle by bedside ultrasonography in longitudinal subxiphoid view and caval index was calculated, then they were compared with the CVP measured by central venous catheter
Discussion: CVP is an indicator of intravascular fluid status and right heart function. CVP measurement is an invasive method and of course with some complications. The IVC is the biggest vein of venous system with low-pressure; expansion of the vein reflects intravascular volume
Conclusion: It seems that IVC diameter measured by ultrasonography could be used as an alternative method for the determination of CVP in the emergency or critical patients
ABSTRACT
Anterior shoulder dislocation is the most common joint dislocation in human body. Many methods are traditionally described for reduction of shoulder dislocation. Most of these techniques are painful to patients and may be associated with further injury. An ideal method should be easy, effective, and less painful, not associated with iatrogenic complications and should be easy to teach and learn. Among different methods of reduction, external rotation and Milch methods are more popular. Both methods are found to be atraumatic, relatively painless and can be performed without anesthesia. In this article, we aimed to review the literatures regarding these two methods of reduction and comparing their success rate and outcome. We reviewed the literature to find articles related to reduction of anterior shoulder dislocations applying one of two techniques described above. We searched PubMed and Google Scholar. In total, 46 articles were found, of them 17 articles -which mainly focused on anterior shoulder dislocation reduction by means of two above methods-were included in this review. The results showed that both techniques were effective, safe, relatively painless, and were well tolerated with no complications, but the external rotation method was superior
ABSTRACT
Pain is the most common complaint in emergency department and there are several methods for its control. Among them, pharmaceutical methods are the most effective. Although intravenous morphine has been the most common choice for several years, it has some adverse effects. There are many researches about intravenous acetaminophen as an analgesic agent and it appears that it has good analgesic effects for various types of pain. We searched some electronic resources for clinical trials comparing analgesic effects of intravenous acetaminophen vs. intravenous morphine for acute pain treatment in emergency setting. In two clinical trials, the analgesic effect of intravenous acetaminophen has been compared with intravenous morphine for renal colic. The results revealed no significant difference between analgesic effects of two medications. Another clinical trial revealed that intravenous acetaminophen has acceptable analgesic effects on the post-cesarean section pain when combined with other analgesic medications. One study revealed that administration of intravenous acetaminophen compared to placebo before hysterectomy decreased consumption of morphine via patient-controlled analgesia pump and decreased the side effects. Similarly, another study revealed that the infusion of intravenous acetaminophen vs. placebo after orthopedic surgery decreased the consumption of morphine after the surgery. A clinical trial revealed intravenous acetaminophen provided a level of analgesia comparable to intravenous morphine in isolated limb trauma, while causing less side effects than morphine. It appears that intravenous acetaminophen has good analgesic effects for visceral, traumatic and postoperative pains compare with intravenous morphin
ABSTRACT
Introduction: Pulmonary embolism [PE] is a common lethal disease that its clinical symptoms may be seen in many other diseases. Computed tomography pulmonary angiography [CTPA] is a valuable diagnostic modality for detection of PE. In addition, it can accurately detect the other diseases with clinical symptoms similar to PE. The aim of this study is to evaluate the frequency of PE and nonembolic disease with similar clinical symptoms including pulmonary, pleural, mediastinal, and cardiovascular diseases that have been detected by CTPA and to describe the importance of reporting these CT findings
Materials and Methods: In this cross-sectional study, we evaluated the medical records of CTPA in 300 patients of suspected PE between March 2012 and February 2013 in Imam Reza Hospital and Ghaem Hospital in Mashhad University of Medical Sciences, Mashhad, Iran. Demographic information and the results of CTPA of these patients were re-evaluated. One radiologist reviewed all of the CTPA and the results have been analyzed by SPSS-16 soft
Results: In this study, PE was detected in 18.7% of patients. Multiple incidental imaging findings were diagnosed as follow: pulmonary consolidation [33.2%], pleural effusion [48.7%], pulmonary nodules [10%], pulmonary masses [1.3%], pneumothorax [4.7%], mediastinal mass and lymphadenopathy [9.3%], aortic calcification [42%], coronary arteries calcification [27.3%], mitral valve calcification [2 %], cardiomegaly [30.7%], and the evidences of right ventricular dysfunction [6.7%]
Conclusion: A group of disease can cause the clinical symptoms similar to that of PE. Among them, pulmonary consolidation and pleural effusion have much higher frequency than PE. In addition, CTPA can show pathologic findings in the patients that need follow-up. It is important to detect and report these imaging findings because some of them may change the treatment and prognosis of patient who are suspected to have PE