Are all helicopter dispatches really necessary? a cross-sectional study.

BACKGROUND: Pre-hospital emergency care is a critical part of the health care system. Helicopter emergency medical service (HEMS) is a novel part of the medical services of the health care delivery system. The goal of these medical services is to provide appropriate treatments at the right place and time. The pre-hospital emergency is the first line of providing emergency care to patients and injured. To reduce the death and disability of patients, the optimal performance of various pre-hospital emergency branches, such as HEMS, is needed. Thereby, it is essential to pay attention to the importance of hospital wards and patient transfer. However, the HEMS can impose a high cost on the health care system. Due to a lack of evidence, in this study, we will investigate the reasons and consequences of transferring patients by HEMS in Shahid Beheshti Hospital in Qom. METHODS: This study is a cross-sectional descriptive study. In this study, sampling was done by the census, and all patients were transferred by air ambulance during the year 1400 (March 2021 to 2022) using the emergency department of Qom province, and the study of patient health records was performed. RESULTS: A significant percentage of patients (46.8%) were discharged from the emergency department in the first 6 hours. Most of the patients (79%) did not need surgery. 41.1% of the patients were traumatic patients with no pathological findings in their imaging. CONCLUSIONS: Many cases did not necessarily need HEMS to transfer. It is recommended to choose the candidates more carefully for air ambulance transfer to reduce unnecessary costs.

A retrospective study on evaluating GAP, MGAP, RTS and ISS trauma scoring system for the prediction of mortality among multiple trauma patients.

Objectives: Predicting the outcome of trauma helps clinician to prioritize patients and provide timely and effective treatment. Several scoring systems are implemented to predict prognosis and mortality among these patients. Our study aims to use four scoring systems to predict mortality among multiple trauma patients. Methods: In retrospective descriptive study, the data was collected from records of (XXX) of multiple trauma patients referred to the hospital from June 2019-January 2020. The patients were scored using four scoring systems: MGAP (mechanism, Glasgow coma scale, age, and arterial pressure), GAP (Glasgow coma scale, age, and arterial pressure), ISS (injury severity score) and RTS (revised trauma score). Results: The mean age of the patients was 37.4 ± 4.2 years and of 112 patients, 92 patients (82.1%) were males. Sensitivity of GAP, RTS and ISS was 100% in predicting mortality where MGAP had highest specificity, 97.2%. All four scoring systems significantly predicted mortality, p < 0.001, respectively and the highest area under the curve was for RTS criteria, 0.969. Conclusion: MGAP, GAP, RTS and ISS were all effective in predicting mortality among multiple trauma patients whereas MGAP had both, highest sensitivity and specificity. Scoring trauma for mortality can be achieved by using any of the systems, provided the information required for score can be obtained.

Airway Management: Difficulty of Intubation and Range of Movement of the Thyroid Cartilage.

PURPOSE: Difficult endotracheal intubation has been associated with a number of anatomic factors. According to our experience, the range of movement of thyroid cartilage can be used as a useful test to determine the difficulty in endotracheal intubation. The aim of this study was to evaluate the association between the range of movement of thyroid cartilage and difficulty in intubation. DESIGN: Cross-sectional study. METHODS: This study was carried out on 400 patients at (Shohada Ashayer Hospital, Khorramabad). After obtaining consent letters from the patients who were between 18 and 60 years of age, the patients underwent general anesthesia. The participants were evaluated by Mallampati and other evaluating tests. The range of movement of thyroid cartilage from the midline was measured and recorded. FINDINGS: There were significant correlation between the range of movement of thyroid cartilage and thyromental distance. In addition, in patients with Cormack-Lehane class 1, the mean range of movement of thyroid cartilage was significantly more than the patients with Cormack-Lehane class 3 and 4. CONCLUSIONS: The outcomes of our study indicate that the range of movement of thyroid cartilage can be used for predication of difficult intubation. However, further randomized trials should be conducted in this regard.

Invasive mechanical ventilation and clinical parameters in COVID19 patient: Can age be a factor?

BACKGROUND: Severity of corona virus disease 2019 (COVID19) is presented with respiratory distress and requires mechanical ventilation. Advanced age is one of the significant risk factors of the worst prognosis and mortality in this disease. The aim of this study is to investigate the clinical parameter among COVID19 patients under mechanical ventilation in regard to the age groups. METHOD: In this retrospective study, COVID19 patients under invasive mechanical ventilation at Shahid Beheshti Hospital in Qom were included. The patients were divided in two age groups, those aged ≥50 years and <50 years. Clinical parameter of these patients like blood pressure, heart rate, respiratory rate, oxygen saturation and body temperature were recorded at the time of mechanical ventilation and 24, 48 and 72 h under the mechanical ventilation. RESULT: A total of 317 patients were included in the study where 214 patients were over the age of 50 years and 98 were under 50 years. The mean age of patients was 59.71 ± 16.46 year. At the start of mechanical ventilation and 24, 48 and 72 h during the ventilation, blood pressure, pulse rate, rate of respiration, oxygen saturation, Glasgow coma scale and temperature were not significantly different at among the two age groups, p > 0.05, respectively. CONCLUSIONS: The findings of the study indicated that prognosis of COVID19 patients under invasive mechanical ventilation in terms of changes in clinical parameters might not be associated with the age.

Evaluating characteristics associated with the mortality among invasive ventilation COIVD -19 patients.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated acute respiratory distress syndrome that leads to intensive care unit admission and subsequent need of invasive ventilation. The aim of this study is to evaluate mortality rate and associated parameters among COVID 19 patients under invasive ventilation. METHODS: In this retrospective studies, COVID 19 patients referred to our center we evaluated. The data regarding demographic characteristics, comorbidities, biochemical and radiographic findings, need of invasive ventilation and mortality were collected and recorded for all the patients. Statistical analysis was performed to evaluate the risk of mortality in invasive ventilation patients relative to each risk factor or paraclinical or clinical feature. RESULTS: Among patients included in the study, 63 patients underwent invasive ventilation where 53 (84%) of these died. The mortality rate among invasive ventilation was significantly associated with advanced age, p = 0.006 whereas it was not significantly associated with smoking, gender, c-reactive protein, platelet count, hypertension, lymphopenia, leukopenia, creatinine kinase, addiction, blood urea nitrogen to creatinine ratio, malignancy, cough, fever, nausea, chronic obstructive pulmonary disease and erythrocyte sedimentation rate. CONCLUSIONS: The findings of our study indicate that advanced age can increase the risk of mortality in COVID 19 patients under invasive ventilation whereas, mortality among invasive ventilation patients is high, irrespective of their characteristic. Guidelines are therefore, required regarding the use of invasive ventilation among these patients.

Pulmonary thromboembolism with transthoracic ultrasound and computed tomography angiography.

OBJECTIVE: The detection of pulmonary embolism in emergency department requires an urgent therapeutic and diagnostic attention. This study was performed to determine the accuracy and efficacy of ultrasound in the diagnosis of pulmonary embolism. METHODS: In this study, 110 patients who referred to the emergency department with traumatic embolism symptoms were enrolled. All the patients underwent computed tomography (CT) angiography. Patients were divided into positive and negative outcomes according to the results of transthoracic ultrasonography and CT angiography. RESULTS: In this study, 110 patients were enrolled, of whom 52 (47.3%) were male and 58 (52.7%) were female. Among the patients, 100 (90.9%) patients presented with dyspnea, whereas the frequency of pleural pain was 27% (24.5%). Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasound were 45.67%, 77.41%, 88.09%, and 35.29%, respectively. The positive outcomes from CT scan were significantly associated with gender, p = 0.005. The gender and transthoracic ultrasonography outcomes were also significantly correlated, p = 0.019, and the outcomes of ultrasound were significantly different from those of CT scan, p = 0.008. CONCLUSION: Transthoracic ultrasonography may be used to diagnose pulmonary embolism as a technique in the emergency department, especially in patients who are unable to move due to the severity of the disease. However, further comparative studies are required in this aspect.

Evaluation of invasive ventilation (intubation) prognosis in patients with Covid-19 symptoms.

BACKGROUND: Coronavirus 2019 (COVID 19) has been reported as a pandemic by the world health organization. Increasing number of cases and associated mortality have demanded the need for clinical studies and researches. OBJECTIVE: The aim of this study is to evaluate intubation prognosis of the COVID 19 patients referred to Shahid Beheshti hospital in Qom city. METHOD: COVID 19 patients referred to (XXX)were included in this study. Clinical sign and symptoms were recorded for each patient in a questionnaire. The diagnosis was made using real time polymerase chain reaction and chest CT scans. Lab findings from renal and liver function tests, blood count, c-reactive protein and electrolytes were also recorded. Shortness of breath was measured using oxygen saturation levels in these patients. The data was recorded in the electronic form and was analyzed using SPSS v21. RESULT: Of 317 patients included in this study, the average age of COVID 19 patients were 59.71 ± 16.46 years. The need of ventilation among the patients older than 50 years was significantly higher than younger patients, p = 0.013. Smoking status, gender and drug addiction was not associated with the need of invasive mechanical ventilation, p = 0.73, p = 0.44 and p = 0.76. Patients need invasive mechanical ventilation compared to those receiving non-invasive ventilation were significantly older, p = 0.001. CONCLUSION: The need of mechanical ventilation is significantly greater in advanced age COVID-19 patients.