Mehdi Torabi
Volume 10, Issue 2 , April 2022, , Pages 92-94
Abstract
Endotracheal intubation is more commonly performed in the right main bronchus; however, it may rarely be performed in the left side. A 52-years-old man was brought to the emergency department by emergency medical services (EMS) after multiple trauma injury. There was a decrease in the right lung’s ...
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Endotracheal intubation is more commonly performed in the right main bronchus; however, it may rarely be performed in the left side. A 52-years-old man was brought to the emergency department by emergency medical services (EMS) after multiple trauma injury. There was a decrease in the right lung’s sound. Lung computed tomography (CT) scan revealed total pulmonary atelectasis. This scan was at the time that patient did not mention any recent history or complaint of pulmonary problems or diseases. In CT scan, we observed the white lung in the right side, the trachea which was deviated to the right, and the collapse-consolidation of the right lung was seen. The endotracheal tube image was observed in the left main bronchus which is a rare phenomenon. Decreasing of the right lung sound may not always be due to pneumothorax or hemothorax in trauma patients. In these patients, the rare phenomenon of left lung intubation should be considered as well. Left lung intubation may occur because of the lesion presence in the right lung.
Leila Ghahramani; Sam Moslemi; Maryam Tahamtan; Mohammad Hasan Hashemizadeh; Abdolkhalegh Keshavarzi
Volume 1, Issue 2 , April 2013, , Pages 96-98
Abstract
The uterine rupture during pregnancy is a catastrophic condition resulting in both maternal and perinatal morbidity and mortality. It occurs in nearly 1% of patients with previous cesarean sections. However, uterine rupture at the site of previous iatrogenic perforation which is spontaneously healed ...
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The uterine rupture during pregnancy is a catastrophic condition resulting in both maternal and perinatal morbidity and mortality. It occurs in nearly 1% of patients with previous cesarean sections. However, uterine rupture at the site of previous iatrogenic perforation which is spontaneously healed or repaired is less reported. We present a 29-year-old woman, gravida 3 para 1, at 20 weeks of gestation with abdominal pain of right half and hemodynamic instability whose laboratory evaluations revealed severe acute blood loss but still without any signs of peritonitis. The exploratory laparotomy revealed a uterine rupture at the site of fundus at the same location of previously repaired dilatation and curettage-induced perforation contributing to extrusion of whole pregnancy product in addition to severe intra-abdominal blood loss.
Raheleh Ganjali; Reza Golmakani; Mohsen Ebrahimi; Saeid Eslami; Ehsan Bolvardi
Volume 8, Issue 2 , April 2020, , Pages 115-120
Abstract
Objective: To evaluate the accuracy of the five-level triage system using the emergency severity index (ESI) and to determine the compliance of the triage level with patient outcomes. Methods: This was a cross-sectional study which was performed in the emergency department of Imam Reza Hospital of Mashhad ...
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Objective: To evaluate the accuracy of the five-level triage system using the emergency severity index (ESI) and to determine the compliance of the triage level with patient outcomes. Methods: This was a cross-sectional study which was performed in the emergency department of Imam Reza Hospital of Mashhad during 2017. We included all the adult patients (≥15 years of age) referring to the emergency department. The data were recorded in a questionnaire containing three sections including demographic information, results of triage by ESI and final outcome of the patient. Patients referred to the triage unit were simultaneously triaged by triage nurse and some emergency medicine physicians. The triage was performed by a nurse with an emergency medicine physician (EMP) was considered as a gold standard and the outcome was compared in 24 hours later. Results: Overall, we included 400 patients with a mean age of 46.40 ± 18.52 years among whom there were 211 (52.8%) men and 189 (47.3%) women. Finally, 123 patients were hospitalized, 12 died, 256 were discharged by a physician, and 9 people left the hospital with their own consent. The calculated weight kappa was used to determine the agreement between the observers (nurse triage and physician) at 0.701 so that the agreement between the triage performed by a nurse and an EMP was in an excellent level (p<0.001). There was a significant relationship between the triage levels (determined by physicians) and the outcome of the patient (p<0.001), and the five-level system had a high overlap and significant relation with patient's outcome. Conclusion: The results of the current study revealed that the five-level triage system using the ESI has a high accuracy in triage and estimates the patient outcomes effectively and thus, could be used as an effective system in hospital triage.
Amin Daemi; Mohammad Reza Sheikhy-Chaman
Volume 4, Issue 2 , April 2016, , Pages 116-117
Holger Rupprecht; Marius Ghidau; Katharina Gaab
Volume 5, Issue 2 , April 2017, , Pages 129-131
Abstract
Due to an adenocarcinoma of the right upper lobe with infiltration of the main bronchus a 49-years-old female patient underwent an upper bilobectomy with sleeve resection. After two completed chemotherapy bouts and signs of sepsis another thoracotomy was inevitable. As a complicating factor a supracarinal, ...
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Due to an adenocarcinoma of the right upper lobe with infiltration of the main bronchus a 49-years-old female patient underwent an upper bilobectomy with sleeve resection. After two completed chemotherapy bouts and signs of sepsis another thoracotomy was inevitable. As a complicating factor a supracarinal, necrotic and perforating lesion of the trachea appeared. The defect can be initially repaired with a suture and covered with azygos vein material. However surgical revision showed an enlargement of the tracheal necrosis. Then the lesion was occluded with a diaphragmatic pedicled flap. Nevertheless after the operation a tracheal insufficiency with massive ventilation leakage was observed. It was generated by the death of the diaphragmatic flap. As an ultimate therapeutic measure a transplantation of a pedicled omental gastric flap was performed, which in case of a failure of the conventional operative techniques, is an additional option in closing tracheal defects caused by infections. Especially in cases of massive infected thoracic cavity and tracheal necrosis omentum majus is, compared to muscle flaps, the better biological tissue to close and heal the tracheal defect. This case report firstly describes a successfully closure of a tracheal defect using the technique mentioned above.
Homayoun Sadeghi-Bazargani; Bahram Samadirad; Nasrin Shahedifar; Mina Golestani
Volume 6, Issue 2 , April 2018, , Pages 146-154
Abstract
Objective: To study the epidemiology of car user road traffic fatalities (CURTFs) during eight years, in East Azerbaijan, Iran.Methods: A total of 3051 CURTFs registered in East Azerbaijan forensic medicine organization database, Iran, during 2006-2014, were analyzed using Stata 13 statistical software ...
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Objective: To study the epidemiology of car user road traffic fatalities (CURTFs) during eight years, in East Azerbaijan, Iran.Methods: A total of 3051 CURTFs registered in East Azerbaijan forensic medicine organization database, Iran, during 2006-2014, were analyzed using Stata 13 statistical software package. Descriptive statistics (p<0.05) and inferential statistical methods such as Chi-squared test and multivariate logistic regression with p<0.1 were applied. Results: Of the 7818 road traffic injury (RTI) deaths, 3051 (39%) were car users of whom 71% were male (mean age of 36.7±18.5 years). The majority of accident mechanisms were vehicle-vehicle crashes (63.95%), followed by rollover (26.24%). Crash causing vehicle fall increased the pre-hospital death likelihood by 2.34 times. The prominent trauma causing death was head trauma (in 62.5%). In assessing the role of type of counterpart vehicle on pre-hospital mortality, considering the other cars to be the reference group for comparison, deceased victims were 1.83 times more likely to die before hospital when the counterpart vehicle was a truck and 1.66 times more for buses.Conclusion: Decreasing the car users’ fatalities using appropriate strategies such as separating the roads for heavy and light vehicles and improving the injury related facilitation may be effective. Male drivers with low education could be prioritized for being trained.
Masoud Hashemi; Payman Dadkhah; Mehrdad Taheri; Sirous Momenzadeh; Tahereh Parsa; Behnam Hosseini; Mohammadreza Abbasian
Volume 7, Issue 2 , April 2019, , Pages 150-155
Abstract
Objective: To compare the efficacy of parasagittal interlaminar (PIL) and midline interlaminar (MIL) approaches for epidural block in patients with lower limb orthopedic surgery. Methods: This double-blind randomized clinical trial was performed on 40 patients undergoing tibial shaft fracture surgery. ...
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Objective: To compare the efficacy of parasagittal interlaminar (PIL) and midline interlaminar (MIL) approaches for epidural block in patients with lower limb orthopedic surgery. Methods: This double-blind randomized clinical trial was performed on 40 patients undergoing tibial shaft fracture surgery. In PIL group, an 18-gauge, 3.5 inch, Tuohy needle was placed at the level of L2-3 or L3-4 intervertebral spaces and pushed forward in a posteroanterior (PA) direction vertical to the body surface. After determining the most lateral place for needle arrival in an anteroposterior (AP) view, needle was pushed forward into the epidural space. For the MIL group, needle was pushed forward from the midline interspinous space with the same method. After confirmation of needle position, 1 mL of contrast was injected to confirm the epidural space distribution and then 15 ml lidocaine 2% was injected. The sensory and motor block level, onset, duration, heart rate (HR), mean arterial pressure (MAP), and arterial oxygen saturation (SPO2), and success rate were recorded.Results: Mean patients’ baseline characteristics showed no statistically significant difference between the two groups. (p>0.05). Outcome measures were statistically different and significantly higher in PIL group (p-values for sensory block level
Ashley K Losing; Justin M Jones; Adis Keric; Steven E Briggs; David D Leedahl
Volume 4, Issue 3 , July 2016, , Pages 165-169
Abstract
Ketamine is a promising alternative agent for pain control that offers benefit to traditional strategies, particularly in the setting of rib fracture. Current pharmacologic therapies have clear adverse effects, and other options may be invasive, cost prohibitive, or marginally effective. We describe ...
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Ketamine is a promising alternative agent for pain control that offers benefit to traditional strategies, particularly in the setting of rib fracture. Current pharmacologic therapies have clear adverse effects, and other options may be invasive, cost prohibitive, or marginally effective. We describe three consecutive patients with traumatic injuries including rib fracture for which a ketamine infusion was utilized as part of their pain control strategy. For each patient, use of a ketamine infusion trended toward reduced opioid requirements with stable pain scores. One patient experienced a dissociative adverse effect prompting decrease and discontinuation of ketamine. No pulmonary complications in the form of emergent intubation or new diagnosis of pneumonia were observed. We believe the addition of ketamine infusion to be a valid alternative strategy for managing pain associated with rib fracture.
Luis Rafael Moscote-Salazar; Hernando Raphael Alvis-Miranda; Camilo Palencia; Andres M. Rubiano
Volume 1, Issue 4 , October 2013, , Pages 175-178
Abstract
This is a case series which report the clinical results of decompressive craniectomy in 4 patients with dilated pupils secondary to traumatic brain injury and postoperative edema. Between 2011 and 2012, four patients, 3 males and 1 female, aged between 35 and 64 with mean age of 50.1 ± 8.9 years, underwent ...
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This is a case series which report the clinical results of decompressive craniectomy in 4 patients with dilated pupils secondary to traumatic brain injury and postoperative edema. Between 2011 and 2012, four patients, 3 males and 1 female, aged between 35 and 64 with mean age of 50.1 ± 8.9 years, underwent decompressive craniectomy due to brain traumatic edema. The follow up period ranged between 1 to 6 months. All patients had Glasgow coma score (GCS) of 3-4 at admission, and the duration of pupils being mydriatic was less than 20 minutes before the operation. All patients had moderate disability with GCS of 4 after the operation. Decompressive craniectomy can be a life-saving procedure which provides a better outcome in patients with dilated pupils secondary to brain trauma injury and postoperative edema with timing of less than 20 minutes. However, the small number of the patients in this study is the main limitation to the accuracy of the results, and more studies with larger number of patients are warranted to evaluate the efficiency of decompressive craniectomy in patients with dilated pupils.
Rohit Bhoil; Neeti Aggarwal; Vineet Aggarwal; Mukesh Surya; Sanjiv Sharma; Ajay Kumar Alhuwalia; Sabina Bhoil; Surya Pratap Singh; Manveer Thakur; Siddharth Sood
Volume 8, Issue 3 , July 2020, , Pages 193-198
Abstract
Objective: To establish the incidence of arterial corona mortis variant in angiographic studies being performed using a 64 slice CT scan machine in a series of patients.Methods: This was a prospective cross-sectional study including 100 consecutive patients undergoing routineclinically indicated, ...
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Objective: To establish the incidence of arterial corona mortis variant in angiographic studies being performed using a 64 slice CT scan machine in a series of patients.Methods: This was a prospective cross-sectional study including 100 consecutive patients undergoing routineclinically indicated, standard protocol, CT-angiography for the abdominal aorta and/or lower limbs using a 64 slice CT scanner. Patients having severe arterial insufficiency (Grade 4 stenosis on CT angiography), pelvic infections and tumours, patients with past pelvic trauma and those who had previous pelvic surgery were excluded from the study. In total 200 hemi-pelvises were evaluated for the presence or absence of corona morti.Results: Overall, we included 100 patients in this series including 67 men and 33 women with mean age of 40.1±2.3 (ranging from 22-74) years. The arterial variant was identified on thin, 0.625-mm-thick images in 24 out of 100 patients studied (unilateral in 20 patients and bilateral in 4 patients; 28 out of 200 hemipelvises evaluated, having an incidence of 14%). We found that the distance of corona mortis artery from the symphysis was significantly greater for women compared to men, both on right (p=0.034) and left sides (p=0.046).Conclusion: Corona mortis may be prospectively identified at contrast-enhanced multidetector CT especially in pelvic trauma patients and help guide subsequent endovascular embolization or surgical interventions.
Naema khodadadi-hassankiadeh; Nahid Dehghan-Nayeri; Hooman Shahsavari; Shahrokh Yousefzadeh-Chabok; Hamid Haghani
Volume 5, Issue 3 , July 2017, , Pages 197-205
Abstract
Objective: To assess the psycho-social and mental variables associated with post-traumatic stress disorder (PTSD) in a series of Iranian patients.Methods: A total of 528 eligible accident survivors in pre-sampling of a randomized controlled trial targeting PTSD were included in this cross-sectional study. ...
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Objective: To assess the psycho-social and mental variables associated with post-traumatic stress disorder (PTSD) in a series of Iranian patients.Methods: A total of 528 eligible accident survivors in pre-sampling of a randomized controlled trial targeting PTSD were included in this cross-sectional study. Psycho-social characteristics associated to PTSD were explored in these survivors in an outpatient clinic. They completed the questionnaires via interview between six weeks to six months after accident. Data collection tools were PSS (DSM-V version) for PTSD and BDI-II for depression and a researcher-made questionnaire for psycho-social variables.Multivariate logistic regression indicated that some variables were associated with PTSD such as accident perceived severity, (p<000), injured situation, (p<000), current depression, (p<000), RTW (p<000), and family communication (p=0.01).Results: There was a significant association between PTSD and the following variables; family communication, current depression, return to work, history of death of relatives, witnessed the death, length of amnesia, hospitalization, injured situation, and accident severity. Multivariate logistic regression indicated that some variables were associated with PTSD such as accident severity, (p<0.001), injured situation, (p<0.001), current depression, (p<0.001), RTW (p<0.001), and family communication (p=0.01).Conclusion: Psychiatric nursing prevention efforts is best directed toward motorcycle depressed drivers with severe accident and poor family communication who do not return to work. Thus, routine assessment of PTSD, depression and psycho-social variables after traffic accidents must be taken into account.
Mozhde Momtahan; Maryam Kasraeean; Azam Faraji; shaghayegh Moradi Alamdarloo; Mina Moosaie
Volume 9, Issue 4 , October 2021, , Pages 201-203
Abstract
Spontaneous heterotopic pregnancy is a potentially life-threatening condition rarely considered when a patient with an intrauterine pregnancy is asymptomatic or presents with complaints such as abdominal pain. An advanced abdominal pregnancy is even more unusual as the form of the ectopic component ...
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Spontaneous heterotopic pregnancy is a potentially life-threatening condition rarely considered when a patient with an intrauterine pregnancy is asymptomatic or presents with complaints such as abdominal pain. An advanced abdominal pregnancy is even more unusual as the form of the ectopic component outside the context of assisted reproduction and is difficult in diagnosis with very few cases reported in the literature. We report such a case in a 31-year-old primigravida with heterotopic pregnancy which is a fetus in the uterine cavity and the other in the abdominal cavity. Her pregnancy was initially misdiagnosed and managed as a di-amniotic di-chorionic gestation. The correct diagnosis was only made after term delivery of the intrauterine pregnancy. The patient was complicated with severe bleeding which led to disseminated intravascular coagulopathy and massive transfusion. Two other operations were imposed on the patient because of bleeding. The clinical risk factor for ectopic pregnancy was only previous pelvic inflammatory disease in this woman.
Md Abu Masud Ansari; Naveen Kumar; Shailesh Kumar; Sarita Kumari
Volume 4, Issue 4 , October 2016, , Pages 240-243
Abstract
Central venous Catheterization (CVC) is a commonly performed procedure for venous access. It is associated with several complications. We report a rare case of extra luminal entrapment of guide wire during CVC placement in right jugular vein. We report a case of 28 years old female patient presented ...
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Central venous Catheterization (CVC) is a commonly performed procedure for venous access. It is associated with several complications. We report a rare case of extra luminal entrapment of guide wire during CVC placement in right jugular vein. We report a case of 28 years old female patient presented in our emergency with history of entrapped guide wire in right side of neck during CVC. X-ray showed coiling of guide wire in neck. CT Angiography showed guide wire coursing in between common carotid artery and internal jugular vein (IJV), closely abutting the wall of both vessels. The guide wire was coiled with end coursing behind the esophageal wall. Guide wire was removed under fluoroscopic guide manipulation under local anesthesia. We want to emphasize that even though CVC placement is common and simple procedure, serious complication can occur in hands of untrained operator. The procedure should be performed under supervision, if done by trainee. Force should never be applied to advance the guide wire if resistance is encountered.
Yousef Veisani; Ali Delpisheh; Fathola Mohamadian; Reza Valizadeh
Volume 6, Issue 3 , July 2018, , Pages 245-248
Abstract
Suicide is a serious public health concern in the world. Epidemiologists are considered the mainstay of the management of problem. The purpose of this study was to investigate the trend of suicide (attempts and completed) by age and gender in a 6-year time period and to compare the suicide rates between ...
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Suicide is a serious public health concern in the world. Epidemiologists are considered the mainstay of the management of problem. The purpose of this study was to investigate the trend of suicide (attempts and completed) by age and gender in a 6-year time period and to compare the suicide rates between in age and gender groups in Ilam. In this cross-sectional study, a total of number of suicidal attempts during a 6-year period from 2011 to 2016 were recorded. The data were derived from the systematic registration suicide data (SRSD) which collects official statistics from the Ilam University of Medical Sciences. Suicide rate in period of the study in men was reported to be 24.0 in 2011 to 17.9 in 2016 per 100,000 populations; also this rate in women was between 16.2 in 2011 to 7.3 in 2016 per 100,000 populations. Trend analysis revealed a decreasing trend (r= -0.82, p=.043), in attempts, as well as completed suicides (r= -0.53, p=.048). The current data demonstrated a decreasing trend in both attempts and completed suicide rates from 2011 to 2016. Also we found that the rate of completed suicide in all age groups were higher in men compared to women.
Roghieh Molaei-Langroudi; Ahmad Alizadeh; Ehsan Kazemnejad-Leili; Vahid Monsef-Kasmaie; Seyed-Younes Moshirian
Volume 7, Issue 3 , July 2019, , Pages 269-277
Abstract
Objective: To investigate the risk factors that can be proper indications for performing brain computerized tomography (CT)-scan in patients with mild and moderate traumatic brain injury (TBI) in order to avoid unnecessary exposure to radiation, saving on costs as well as time wasted in emergency wards.Methods: ...
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Objective: To investigate the risk factors that can be proper indications for performing brain computerized tomography (CT)-scan in patients with mild and moderate traumatic brain injury (TBI) in order to avoid unnecessary exposure to radiation, saving on costs as well as time wasted in emergency wards.Methods: Data of patients with mild traumatic brain injury (TBI) referring to Emergency Department with age ≥2 years and primary GCS of 13-15 were examined including focal neurological deficit, anisocoria, skull fracture, multiple trauma, superior injury of clavicle, decreased consciousness, and amnesia. Brain CT-scan was performed in all the patients. Kappa Coefficient was used to determine the ratio of agreement of the CT indications (+ and ⎼) and multiple logistic regression to determine the relative odds of positive CTs.Results: Overall we included 610 patients. One-hundred and one patients (16.5%) had positive and 509 (83.5%) had negative CT findings. Of positive CTs, the highest percentage was dedicated to high-energy mechanism of trauma. High-energy trauma mechanism (OR=1.056, 95% CI, OR, 1.03-1.04, P<0.001), superior injury of clavicle (OR=1.07, 95% CI, OR, 1.03-1.1, P<0.001) and moderate to severe headache (OR=1.04, 95% CI, OR, 1.02-1.05, P<0.001) were positive predictors of CT findings. The combined mean of positive symptoms equaled 0.29 ± 0.64 in negative CTs, but 5.13 ± 2.4 in positive CTs, showing a significant difference. (P<0.001)Conclusion: Abnormal positive brain CT in victims with mild TBI is predictable if one or several risk factors are taken into account such as moderate to severe headache, decreased consciousness, skull fracture, high-energy trauma mechanism, superior injury of clavicle and GCS of 13-14. The more the symptoms, the more likely the positive CT results would be.
Mohammadreza Maleki; Seyyed Meysam Mousavi; Mina Anjomshoa; Nasrin Shaarbafchizadeh; Zeinab Naimi Taleghani
Volume 5, Issue 4 , October 2017, , Pages 292-298
Abstract
Objective: To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors.Methods: A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design ...
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Objective: To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors.Methods: A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design of ED encounters for a 3-month period, six months before and six months after the introduction of an emergency medicine residency program in an Iranian teaching hospital. The second phase included semi-structured interviews with five individuals which purposively selected to participate in qualitative design. Quantitative data were analysed descriptively and qualitative data were analysed using an iterative framework approach.Results: The most patients were admitted to the hospital in night shift, both before and after the resident EMS. No statistically significant differences were found among all of the waiting times during the two time periods except for the average time interval between admission and physician start time (p<0.0001), which increased (instead of reducing), and the average time interval between physician start time and first treatment measure (p<0.0001), which decreased during the year the residents began. The interviewees revealed the intradisciplinary conflicts and interferences existing between ED and other specialist departments, are main important factor to delayed processing of patients visits.Conclusion: This study has shown that intradisciplinary conflict would affect the outcomes of emergency medicine residency program and ED process. These new findings enhance the understanding of the nature of conflicts and will persuade policy makers that design a set of clinical practice guidelines to clarify the duties and responsibilities of parties involved in ED.
Mehrnaz ghafarypour jahrom; Mehrdad Taghizadeh; Kamran Heidari; Hojat Derakhshanfar
Volume 6, Issue 4 , October 2018, , Pages 329-333
Abstract
Objective: To evaluate the validity, reliability, sensitivity, and specificity of the Emergency Severity Index (ESI) and Australasian Triage System (ATS) for children visiting admitted to the emergency department (ED).Methods: This was a prospective study occurred in the Mofid children's Hospital ...
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Objective: To evaluate the validity, reliability, sensitivity, and specificity of the Emergency Severity Index (ESI) and Australasian Triage System (ATS) for children visiting admitted to the emergency department (ED).Methods: This was a prospective study occurred in the Mofid children's Hospital in Iran from August 2017 to November 2018 and children had aged ≤14 years and presented at the ED with a medical symptom were considered eligible for participation. This study was divided into two phases: in the first phase, we determined the inter-rater reliability of ESI version 4 and ATS by triage nurses and pediatric residents. In the second phase, to analyze the validity, sensitivity, and specificity of each triage system. Reliability and agreement rates were measured using kappa statistics.Results: ESI showed inter-rater reliability with kappa of 0.65–0.92 (P<0.001) and ATS showed inter-rater reliability with kappa of 0.51–0.87 ESI had sensitivity ranged from 81% to 95% and specificity ranged from 73% to 86%. In addition, sensitivity ranged of the ATS were 80% to 95% and specificity ranged from 74% to 87%. Under triage and over triage occurred in 12% and 15% of patients respectively in ESI and 13% and 15% of patients respectively in ATS.Conclusion: The ESI and ATS both valid to triage children in the ED section of Mofid children's Hospital paediatric. Reliability of the ESI is good, moderate to good for the ATS.
Ali Foroutan; Seyed Taghi Heydari; Mehran Karvar; Leila Mohammadi; Yaser Sarikhani; Maryam Akbari; Kamran Bagheri Lankarani
Volume 7, Issue 4 , October 2019, , Pages 404-410
Abstract
Objective: We conducted a triple phase project for motorcycle helmets advocacy in Darab, a city in southwest Iran. The aim of this study was to evaluate the effect of the project on decreasing the hazards of motorcycle accidents. Methods: Using a questionnaire,data for ICU admission rates, hospital costs ...
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Objective: We conducted a triple phase project for motorcycle helmets advocacy in Darab, a city in southwest Iran. The aim of this study was to evaluate the effect of the project on decreasing the hazards of motorcycle accidents. Methods: Using a questionnaire,data for ICU admission rates, hospital costs for patients who required ICU admission, rate of helmet usage, mortality and the duration of ICU care for patients admitted to Darab hospital due to motorcycle accidents in Winter 2015 (before conducting the project) and Winter 2016 (after conducting the project) were gathered and compared. This feature was also separately done for patients younger than 17 years. Results: The rate of wearing helmets increased significantly in winter 2016 (from 3.4 % to 33%). Also ICU admission rate due to head trauma was significantly decreased after the project was done (from 14.5 % to 4%). However, hospital costs for patients required ICU admission were increased in winter 2016. This increase, though not significant, seems to be due to an increase in health service expenses in the year 2016 as compared with the year 2015. The mortality rate was not significantly changed between the two mentioned years results. For patients younger than 17 years, no ICU admissions were needed in winter 2016. Conclusion: Even a short period of intervention can have positive effects on increasing the safety of motorcycle drivers.
Bahareh Hamedi; Zahra Shomali
Volume 1, Issue 1 , January 2013, , Pages 46-48
Abstract
Splenic rupture during pregnancy is considered a catastrophic condition associated with high maternal and fetal mortality and morbidity. Herein, we report a case of severe preeclampsia that underwent cesarean delivery with subsequent spontaneous splenic rupture. A 21-year-old primigravid woman was transferred ...
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Splenic rupture during pregnancy is considered a catastrophic condition associated with high maternal and fetal mortality and morbidity. Herein, we report a case of severe preeclampsia that underwent cesarean delivery with subsequent spontaneous splenic rupture. A 21-year-old primigravid woman was transferred to our center due to severe preeclampsia that underwent cesarean delivery because of uncontrolled blood pressure and low platelet count. She developed coffee ground vomiting postoperatively and clinical evidence of free fluid was present. Emergency laparotomy was performed and revealed an approximately 2.5–3 cm defect in splenic capsule with active bleeding from the ruptured site. The site of splenic laceration was packed with gauze. Postoperative period was uneventful and she was discharged on day 15 after admission. As spontaneous splenic rupture is associated with severe complications, its differential diagnosis should be kept in mind in pregnant women with severe preeclampsia.
Christian David Weber; Philipp Kobbe; Christian Herren; Andreas H. Mahnken; Frank Hildebrand; Hans-Christoph Pape
Volume 5, Issue 1 , January 2017, , Pages 53-57
Abstract
While blunt trauma of the head and neck are a common pattern of injury, significant problems related to the prompt diagnosis and optimal management of traumatic artery injuries have been reported in the literature. While patients with major artery injuries might develop hemorrhagic shock very rapidly, ...
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While blunt trauma of the head and neck are a common pattern of injury, significant problems related to the prompt diagnosis and optimal management of traumatic artery injuries have been reported in the literature. While patients with major artery injuries might develop hemorrhagic shock very rapidly, patients with blunt cerebrovascular injuries (BCVI) can present asymptomatic, but complications like basilar territory infarction, cortical blindness and death may occur. We report the life- and limb-saving management in a 57-year-old hemodynamically unstable trauma patient. The individual developed hemorrhagic shock, and other major complications, including cortical blindness, related to a posterior circulation stroke. Full recovery was achieved by immediate endovascular prosthesis for subclavian artery (SA) rupture and stenting of a traumatic vertebral artery occlusion. Endovascular and alternative treatment options are discussed and the management of subsequent sequelae associated with aggressive anticoagulation in trauma patients is reviewed, including intracranial, abdominal and other sites of secondary hemorrhage.
Hernando Raphael Alvis-Miranda; Nancy Carolina Duarte-Valdivieso; Gabriel Alcala-Cerra; Luis Rafael Moscote-Salazar
Volume 2, Issue 1 , January 2014, , Pages 59-61
Abstract
Bee stings are commonly encountered worldwide. Various manifestations after bee sting have been described including local reactions which are common, systemic responses such as anaphylaxis, diffuse intravascular coagulation and hemolysis. We report a case of a 74-year-old man who developed neurologic ...
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Bee stings are commonly encountered worldwide. Various manifestations after bee sting have been described including local reactions which are common, systemic responses such as anaphylaxis, diffuse intravascular coagulation and hemolysis. We report a case of a 74-year-old man who developed neurologic deficit 5 hours after bee stings, which was confirmed to be left frontal infarction on brain CT-scan. The case does not follow the reported pattern of hypovolemic or anaphylactic shock, hemolysis and/or rhabdomyolysis, despite the potentially lethal amount of venom injected. Diverse mechanisms have been proposed to give an explanation to all the clinical manifestation of both toxic and allergic reactions secondary to bee stings. Currently, the most accepted one state that victims can develop severe syndrome characterized by the release of a large amount of cytokines.
Amin Daemi
Volume 4, Issue 1 , January 2016, , Pages 62-63
Morteza Arab-Zozani; Djavad Ghoddoosi-Nejad; Mohammad Dehghani
Volume 6, Issue 1 , January 2018, , Pages 71-72
Faruk Pehlivanlı; Oktay Aydin; Gökhan Karaca; Gülçin Aydın; Çağatay Erden Daphan
Volume 7, Issue 1 , January 2019, , Pages 72-75
Abstract
Retroperitoneal and horseshoe abscesses are particularly important because of the anatomic characteristics and the clinical differences between treatment approaches. There are several challenges in treating perirectal and retroperitoneal abscess, the most important of which are partial recovery, high ...
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Retroperitoneal and horseshoe abscesses are particularly important because of the anatomic characteristics and the clinical differences between treatment approaches. There are several challenges in treating perirectal and retroperitoneal abscess, the most important of which are partial recovery, high recurrence rates, and continence problems. A 65-yearold male patient underwent laparotomy at an external center with a diagnosis of ileus. Although no intraoperative pathology was detected, ileus persisted postoperatively, and the patient was referred to our clinic where he was diagnosed with a complicated horseshoe abscess, 9 cm in diameter and displaying retroperitoneal extension. Perirectal abscess drainage was performed, and the patient was discharged on the 5th day after the treatment. To the best of our knowledge, there have not been any previously reported cases of ileus caused by retroperitoneal abscess as a complication of horseshoe abscess. The case presented in this paper represents a rare complication, thereby contributing to the literature which remains to be explored.
Nguyen Nguyen The Phung; Trang Thi Thanh Vo; Kam Lun Ellis Hon
Volume 8, Issue 2 , April 2020, , Pages 121-124
Abstract
The aim of the current study was to describe lung ultrasonography (LUS) characteristics and to evaluate the agreement between LUS and chest radiography (CXR) in diagnosis of four conditions causing most acute dyspnea in children, namely, pneumonia, pleural effusion, pneumothorax and acute pulmonary edema ...
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The aim of the current study was to describe lung ultrasonography (LUS) characteristics and to evaluate the agreement between LUS and chest radiography (CXR) in diagnosis of four conditions causing most acute dyspnea in children, namely, pneumonia, pleural effusion, pneumothorax and acute pulmonary edema in children at a teaching hospital in Vietnam. We reviewed the records of the chidren between January and June 2018, who presented to emergency department (ED) or pediatric intensive care unit (PICU) at children hospital 1 (CH1) with acute dyspnea and had final diagnosis of one of four etiologies including pneumonia, pleural effusion, pneumothorax and acute pulmonary edema. All patients underwent CXR and LUS at the time of admission. Eighty-one children with acute dyspnea including pneumonia (n=65, 80%), pleural effusion (n=9, 11%), pneumothorax (n=3, 4%) and acute pulmonary edema (n=4, 5%) were enrolled. LUS was identified among 100% of cases with pleural effusion and pneumothorax (CXR only showed 73.3% and 50%, respectively); 92.3% of cases with pneumonia (CXR showed 93.8%) and only 75% of cases with acute pulmonary edema (CXR showed 50%). When comparing LUS with CXR, we noticed a good agreeement between the 2 methods in the diagnosis of pneumonia (kappa=0.64, p<0.001). LUS was shown to be a feasible and non-invasive technique which can help clinicians to comfirm the etiology of acute pulmonary dyspnea.
