Ramin Tajvidi; Golnar Sabetian; hossein abdolrahimzadeh fard
Volume 12, Issue 3 , July 2024, , Pages 142-145
Abstract
Bronchial rupture following major blunt chest trauma should be suspected in any case of massive and persistentair leak through the intercostal drain tube. Chest radiographs and chest computed tomography scans (CT scans)are highly suggestive of this extremely rare tracheobronchial injury. The present ...
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Bronchial rupture following major blunt chest trauma should be suspected in any case of massive and persistentair leak through the intercostal drain tube. Chest radiographs and chest computed tomography scans (CT scans)are highly suggestive of this extremely rare tracheobronchial injury. The present study reported a patient whowas a 15-year-old boy. He was a case of a motor-car accident and was brought to the emergency room (ER)of Rajaie Hospital ( Shiraz, Iran) due to dyspnea and chest pain. The physical examination revealed a fewcrash injuries on his upper extremities, as well as subcutaneous emphysema in his neck. The chest X-rayrevealed a right clavicular fracture, multiple rib fractures, a right pneumothorax (but no complete collapseor fallen lung), and also pneumo-mediastinum and subcutaneous emphysema. The chest CT revealed severepulmonary contusion, severe right-sided pneumothorax, significant pneumo-mediastinum, subcutaneousemphysema, multiple right-side rib fractures, and mild displacement of the right main bronchus. Furthermore,no definitive signs of bronchial rupture were detected. Using a mechanical ventilator, the following parameterswere revealed. The maximum pressure (Pmax)=7cm, H2o (was very low), plateau pressure (P. Plateau), andexpiratory tidal volume (TV) were not detected due to insufficient amounts. Additionally, increasing TV didnot change those values. Bronchial rupture is one of the most important and serious differential diagnoses inforceful chest traumas when the mechanical ventilator reveals low Pmax, very low P.platue, and expiratory TV,with no change in those values with increasing TV.
Sajed Arabian; Ali Davoodi; Mehrdad Karajizadeh; Najmeh Naderi; Najmeh Bordbar; Golnar Sabetian
Volume 12, Issue 2 , April 2024, , Pages 81-87
Abstract
Objective: This study aimed to determine the rate of readmission for trauma patients in ICUs, as well as thefactors that predict this outcome.Methods: This retrospective cohort study was conducted at Emtiaz Hospital, a level I referral trauma center(Shiraz, Iran). It analyzed the ICU readmission rates ...
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Objective: This study aimed to determine the rate of readmission for trauma patients in ICUs, as well as thefactors that predict this outcome.Methods: This retrospective cohort study was conducted at Emtiaz Hospital, a level I referral trauma center(Shiraz, Iran). It analyzed the ICU readmission rates among trauma patients over three years. The requireddata were extracted from the Iranian Intensive Care Registry (IICUR), which included patient demographics,injury severity, physiological parameters, and clinical outcomes. Statistical analysis was performed using SPSSversion 25.0. Descriptive statistics and different statistical tests, such as T-tests, Mann-Whitney tests, Chisquare tests, and logistic binary regression test were utilized.Results: Among the 5273 patients discharged from the ICU during the study period, 195 (3.7%) were readmittedduring the same hospitalization. Patients readmitted to the ICU had a significantly higher mean age (54.83±22.73years) than those who were not readmitted (47.08 years, p<0.001). Lower Glasgow Coma Scale (GCS) scoresat admission and discharge were associated with ICU readmission, implying that neurological status andreadmission risk were correlated with each other. Furthermore, respiratory challenges were identified as theleading cause of unexpected readmission, including respiratory failure, hypoxic respiratory failure, respiratorydistress, and respiratory infections such as pneumonia. Injury patterns analysis revealed a higher frequency ofpoly-trauma and head and neck injuries among patients readmitted to the ICU.Conclusion: This study underscored the importance of ICU readmission among trauma patients, with a highreadmission rate during the same hospitalization. By developing comprehensive guidelines and optimizingdischarge processes, healthcare providers could potentially mitigate ICU readmissions and associatedcomplications, ultimately enhancing patient outcomes and resource utilization in trauma ICU settings. Thisresearch provided valuable insights to inform evidence-based practices and improve the quality of care deliveryfor trauma patients in intensive care settings.
Golnar Sabetian; Hossein Abdolrahimzadeh fard; Mina Ostovan; Sina Azadikhah; Farid Zand; Mansoor Masjedi; Naeimehossadat Asmarian
Volume 10, Issue 4 , October 2022, , Pages 172-180
Abstract
Objective: To compare clinical and paraclinical similarities between trauma patients with positive RT-PCRtests (PCR+ve) and the RT-PCR negative ones (PCR -ve).Methods: This a case-control study, where cases had a PCR+ve and controls had a negative result. Two groupswere compared regarding (para) clinical ...
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Objective: To compare clinical and paraclinical similarities between trauma patients with positive RT-PCRtests (PCR+ve) and the RT-PCR negative ones (PCR -ve).Methods: This a case-control study, where cases had a PCR+ve and controls had a negative result. Two groupswere compared regarding (para) clinical values. Multivariable binary logistic regression analysis investigatedthe variables predicting COVID-19 and the mortality rate.Results: Both groups were similar regarding the clinical findings and comorbidities (p>0.05). PCR+ve grouphad lower lymphocyte count (1.41 [1.45] vs. 1.66 [1.61], p=0.030), CPK level (411 [928.75] vs. 778 [1946.5].p=0.006) and CRP level (17 [42.5] vs. 24 [50.75], p=0.004). However, none of these findings were significant inthe multivariable analysis. Finally, PCR+ve group had increased odds of death (OR=2.88; 95% CI=1.22-7.41).Conclusion: Unlike our primary hypothesis, the study failed to mark any significant (para) clinical featuresguiding us to detect COVID-19 earlier in trauma patients. Moreover, the PCR+ve group is at increased mortalityrisk. A larger, multicentric prospective study should be designed to address this issue.
Golnar Sabetian; Fatemeh Aalinezhad; Mansoor Masjedi; Shahram Paydar
Volume 7, Issue 1 , January 2019, , Pages 84-87
Abstract
Pneumothorax as a complication of pleural catheter insertion could be very dangerous in patients under mechanical ventilation. In ICU patients, physical examination and supine chest x-ray (CXR) are poorly sensitive in diagnosis of pneumothorax. Moreover, CT scan has also disadvantages, such as radiation, ...
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Pneumothorax as a complication of pleural catheter insertion could be very dangerous in patients under mechanical ventilation. In ICU patients, physical examination and supine chest x-ray (CXR) are poorly sensitive in diagnosis of pneumothorax. Moreover, CT scan has also disadvantages, such as radiation, high cost, time consuming and need for patient transfer to radiology suit. In comparison to CXR and CT scan, ultrasonography is an available tool for early and rapid detection of this complication. In this study, we reported a 21-year-old woman, a victim of trauma, undergone pleural catheter insertion for drainage of hemothorax. She developed pneumothorax after the procedure. We discuss the usefulness of ultrasonography after pleural catheter insertion and concluded its adequacy and effectiveness in early diagnosis and also follow-up of pneumothorax.