Bedside ultrasonography for verification of shoulder reduction: A long way to go / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Shoulder dislocation is a common joint dislocation managed by the emergency physicians in the emergency departments. Pre- and post-reduction radiographic examinations have long been the standard practice to confirm the presence of dislocation and the successful reduction. However, shoulder ultrasonography has recently been proposed as an alternative to the radiographic examination. This study aimed to assess the accuracy of ultrasonography in evaluating proper reduction of the dislocated joint.</p><p><b>METHODS</b>This was a prospective observational study. All patients with confirmed anterior shoulder dislocation were examined by both ultrasonography and radiography after the attempt for reduction of the dislocated joint. The examiners were blinded to the result of the other imaging modality. Results of the two methods were then compared.</p><p><b>RESULTS</b>Overall, 108 patients with confirmed anterior shoulder dislocation were enrolled in the study. Ninety-one (84.3%) of the patients were males. Mean age of the participants was (30.11 ± 11.41) years. The majority of the patients had a recurrent dislocation. Bedside ultrasonography showed a sensitivity of 53.8% (95% CI: 29.1%-76.8%) and a specificity of 100% (95% CI: 96.1%-100%) in detecting inadequate reductions. The results of ultrasonography had a statistically significant agreement with the results of radiography (Kappa = 0.672, p < 0.001).</p><p><b>CONCLUSION</b>The results suggest that the sensitivity of post-reduction ultrasound is not sufficient for it to serve as a substitute for radiography.</p>

Sonography as a new modality in the management of shoulder dislocation

The need for both pre- and post-reduction radiographs has recently been questioned when treating shoulder dislocation. Several case reports and case series have suggested that ultrasonography might be useful bedside diagnostic modality for evaluating shoulder dislocation. The purpose of this review was to evaluate studies that questioned necessity of radiographs for shoulder dislocation and also studies that evaluated bedside ultrasound as an alternative modality in shoulder dislocation. Ultrasonography can be used in patients with suspected shoulder dislocation. It cannot replace radiography because of possible associated fractures but it can be used before and after reduction to confirm successful relocation to reduce the risk of repeated sedation. It can also increase the certainty of physicians in cases that shoulder dislocation management needs to be performed without X-ray assessmen

Impact of intravenous acetaminophen therapy on the necessity of cervical spine imaging in patients with cervical spine trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>We evaluated a new hypothesis of acetaminophen therapy to reduce the necessity of imaging in patients with probable traumatic cervical spine injury.</p><p><b>METHODS</b>Patients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen (15 mg/kg) intravenously after cervical spine immobilization. Then, all the patients underwent plain radiography and computerized tomography of the cervical spine. The outcome measure was the presence of traumatic cervical spine injury. Sixty minutes after acetaminophen infusion, posterior midline cervical tenderness was reassessed.</p><p><b>RESULTS</b>Of 1 309 patients, 41 had traumatic cervical spine injuries based on imaging. Sixty minutes after infusion, posterior midline cervical tenderness was eliminated in 1 041 patients, none of whom had abnormal imaging.</p><p><b>CONCLUSION</b>Patients with cervical spine trauma do not need imaging if posterior midline cervical tenderness is eliminated after acetaminophen infusion. This analgesia could be considered as a diagnostic and therapeutic intervention.</p>

Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Since appropriate and time-table methods in trauma care have an important impact on patients'outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns' performance in simulated trauma patient management.</p><p><b>METHODS</b>A descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant.</p><p><b>RESULTS</b>Our findings showed that interns'ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P less than 0.001, P equal to 0.016 and P equal to 0.01 respectively).</p><p><b>CONCLUSION</b>ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.</p>