Editorials
Amir Khorram-Manesh
Volume 4, Issue 4 , October 2016, Pages 183-185
Review Article
Amir Khorram-Manesh; Johan Berlin; Eric Carlström
Volume 4, Issue 4 , October 2016, Pages 186-196
Abstract
The aim of the current review wasto study the existing knowledge about decision-making and to identify and describe validated training tools.A comprehensive literature review was conducted by using the following keywords: decision-making, emergencies, disasters, crisis management, training, exercises, ...
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The aim of the current review wasto study the existing knowledge about decision-making and to identify and describe validated training tools.A comprehensive literature review was conducted by using the following keywords: decision-making, emergencies, disasters, crisis management, training, exercises, simulation, validated, real-time, command and control, communication, collaboration, and multi-disciplinary in combination or as an isolated word. Two validated training systems developed in Sweden, 3 level collaboration (3LC) and MacSim, were identified and studied in light of the literature review in order to identify how decision-making can be trained. The training models fulfilled six of the eight identified characteristics of training for decision-making.Based on the results, these training models contained methods suitable to train for decision-making.
Abdolkhalegh Keshavarzi; Mehdi Ayaz; Maryam Dehghankhalili
Volume 4, Issue 4 , October 2016, Pages 197-201
Abstract
Objective: To compare the outcome of patients with up to 60% total body surface area (TBSA) thermal burns undergoing ultra-early and early excision and grafting.Methods: This historical cohort study was performed in two referral burn centers of Shiraz during a 1-year period from 2015 to 2016. We included ...
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Objective: To compare the outcome of patients with up to 60% total body surface area (TBSA) thermal burns undergoing ultra-early and early excision and grafting.Methods: This historical cohort study was performed in two referral burn centers of Shiraz during a 1-year period from 2015 to 2016. We included those patients with thermal burns up to 60% TBSA who underwent ultra-early (48-72 hours) and early (7-10 days) excision and grafting. We excluded those who were hemodynamically unstable and those with electrical burns. The outcome of patients was determined by graft success, operation duration, blood loss, hospital length of stay and mortality rate. Results: We included a total number of 107 patients with mean age of 32.1 ± 11.6 years. There were 65 (60.7%) men and 42 (39.3%) women among the patients. Both study groups were comparable regarding the baseline characteristics. Ultra-early excision and grafting was associated with more, higher graft success rate (p=0.048), lower infection rate (p=0.037), shorter hospital length of stay (p=0.044) and lower mortality rate (p=0.027).Conclusion: Ultra-early excision and grafting in patients with thermal burns covering less than 60% TBSA was associated with higher graft success rate, shorter hospital length of stay, lower infection rate and lower mortality rate when compared to early surgery.
Fatemeh Ranjbar; Fariborz Akbarzadeh; Babak Kazemi; Abdolmohammad Ranjbar; Sonia Sharifi Namin; Homayoun Sadeghi-Bazargani
Volume 4, Issue 4 , October 2016, Pages 202-210
Abstract
Objective: To determine the type and pattern of arrhythmic events following the 2012 Ahar-Varzegan Earthquake among patients implanted with cardiac defibrillators (ICDs) in East Azarbaijan province.Methods: In a prospective cohort study, conducted in East Azerbaijan Province of Iran, 132 patients were ...
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Objective: To determine the type and pattern of arrhythmic events following the 2012 Ahar-Varzegan Earthquake among patients implanted with cardiac defibrillators (ICDs) in East Azarbaijan province.Methods: In a prospective cohort study, conducted in East Azerbaijan Province of Iran, 132 patients were enrolled in two comparison groups according to the region of residence i.e., earthquake region (n= 98) and non-earthquake (n= 34) region in 2012. Data were collected for those meeting standard criteria for sustained ventricular arrhythmias (VAs), or supraventricular tachycardias (SVTs) and triggered ICD therapies, either shock or anti-tachycardia pacing (ATP). The state version of the State-Trait Anxiety Inventory (STAI-S) was used to assess general symptoms of anxiety in both groups.Results: Males comprised 81.1% of the participants. Mean age of the participants was 59.7 ±15 years. The frequency of patients with sustained VAs increased significantly after the earthquake (p=0.008). There were more VAs (mean 2.16 vs. 6.23; p=0.008) and they occurred earlier (6th vs. 16th day; p= 0.01) in the earthquake area. The mean frequency of SVTs and the total number of delivered ICD therapies were similar between groups. Differences in anxiety levels were not significant between groups but there was a trend for presence of greater number of patients with anxiety (p=0.07) and the relative severity of anxiety (p=0.08) in the earthquake area.Conclusion: In the earthquake area, the mean frequency of VAs increased and they occurred earlier in the earthquake area. The stress of anxiety might have served as a trigger for these events.
Faramarz Pourasghar; Jafar Sadegh Tabrizi; Alireza Ala; Amin Daemi
Volume 4, Issue 4 , October 2016, Pages 211-215
Abstract
Objective: To validate the triage ratings performed by the Electronic Triage System (ETS) using hospitalization, length of stay, resource use, in-hospital mortality and patient bills as outcome measures.Methods: In this retrospective cross-sectional study the medical records of 387 patients were reviewed ...
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Objective: To validate the triage ratings performed by the Electronic Triage System (ETS) using hospitalization, length of stay, resource use, in-hospital mortality and patient bills as outcome measures.Methods: In this retrospective cross-sectional study the medical records of 387 patients were reviewed in a one-week period. The data included triage category and the outcome measures were hospitalization, length of stay, in-hospital mortality, patient bill, and used resources. The association between the triage category and hospitalization and death was assessed. The association between the triage category and the number of resources, length of stay, and the bill was also assessed.Results: The mean age of the patients was 43.65 ±21.17 years. Women comprised 40% (n=155) of 387 people who were included in the study. The frequency of Emergency Severity Index (ESI) 1, 2, 3, 4 and 5 categories were 18, 61, 127, 181 and 0 respectively. Phi and Cramer’s V for hospitalization and death were 0.365 (p<0.001) and 0.305 (p<0.001). Spearman's rho for bill, length of stay, and resource use were -0.483 (p<0.001), -0.228 (p<0.001) and -0.490 (p<0.001). The association between triage category and resource consumption was stronger than other outcomes.Conclusion: The ETS was valid in predicting all studied patient outcomes. The ETS has also the advantages of providing quick reports, giving feedback and providing data for research purposes.
Mahmood Vakili; Mohsen Mirzaei; Azar Pirdehghan; Mohamadreza Sadeghian; Majid Jafarizadeh; Mojtaba Alimi; Shadi Naderian; Arezoo Aghakoochak
Volume 4, Issue 4 , October 2016, Pages 216-222
Abstract
Objectives: To estimate the Disabled-adjusted Life Years (DALYs) of Road Traffic Accidents in patients referred to hospitals in Yazd Province, central Iran.Methods: This cross-sectional study was conducted in Yazd province during 2010. To calculate the Years of Life Lost (YLL) due to premature death ...
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Objectives: To estimate the Disabled-adjusted Life Years (DALYs) of Road Traffic Accidents in patients referred to hospitals in Yazd Province, central Iran.Methods: This cross-sectional study was conducted in Yazd province during 2010. To calculate the Years of Life Lost (YLL) due to premature death and to calculate the incidence of non-fatal injuries and Years Lost due to Disability (YLD), the data were collected from Yazd death registration system and hospital records. The causes of death and nature of non-fatal injuries were classified using International Classification of Diseases (ICD-10). We estimated Disability Adjusted Life Years (DALYs) on the guidelines of the Global Burden of Disease Study (discount rate: 0.03, age weight: 0.04, constant age weight correction factor: 0.165). Age and sex composition was taken from the National Statistical Center for the year 2010.Results: During 2009, 483 deaths were caused by traffic accidents in Yazd Province, 382 (79.09%) of which were males, and 101 (20.91%) were females. The mortality rates for males and females were 70.98 and 20.15 in 100,000, respectively. The years of life lost due to premature deaths were 15.84/1000 in men and 4.75/1,000 in women. Total YLLs caused by traffic accidents were 10,908 years. The injuries caused by traffic accidents were calculated as 15.21 and 3.73/1,000 in males and females, respectively. The total YLDs was calculated 1.51/1,000. The total burden of Road Traffic Injuries in Yazd province was 12478 years (DALYs), 87.41% of which was due to premature death, and 12.59% was related to disability. Also, 78.32% was lost in males. The age specific peak of burden was in 15-29 year.Conclusion: This study showed that traffic accidents in Yazd impose a high burden. It seems that it is one of the health sector priorities. It is recommended to revise laws on use of motorcycles, especially on helmet use for motorcyclists, enforce strict laws in residential areas, and review social determinant affecting the incidence of such accidents.
Saber Ghaffari-fam; Ehsan Sarbazi; Amin Daemi; Mohammad Reza Sarbazi; Hossein Ali Nikbakht; Shaker Salarilak
Volume 4, Issue 4 , October 2016, Pages 223-229
Abstract
Objectives: To determine the epidemiology of injuries of the motorcyclists in road traffic accidents (RTIs) between 2008 and 2014 in East Azarbayejan province of Iran.Methods: A cross-sectional study was performed in East Azerbaijan province in Imam Reza hospital on motorcyclists subjected to injuries ...
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Objectives: To determine the epidemiology of injuries of the motorcyclists in road traffic accidents (RTIs) between 2008 and 2014 in East Azarbayejan province of Iran.Methods: A cross-sectional study was performed in East Azerbaijan province in Imam Reza hospital on motorcyclists subjected to injuries in RTIs between 2008 and 2014. Demographic characteristics (age, sex), duration of hospitalization, final status of injured people after discharge from the hospital, admission ward, number of admissions due to injuries in RTIs, nature of injury, and the clinical services provided to injured people were gathered from hospital information system (HIS). Demographic characteristics (age, sex), duration of hospitalization, final status of injured people after discharge from the hospital, admission ward, number of admissions due to injuries in RTIs, injured site of the body, nature of injury, and the clinical services provided injured people were gathered from HIS. Standardized data collection form was used for uniform handling of the data.Results: Most of the victims (94.4%) were male. The most frequent injuries pertained to the age group of 18-30 with 1676 (51.4%) injuries. Head, abdomen, lower back, lumbar spine, and pelvis, were the most common injured sites, respectively. Reduction of fracture and dislocation and cranial puncture were the most common provided services. The lowest survival time belonged to the age group over 60 years old.Conclusion: Injuries to the head are the most prevalent injuries among motorcyclists in RTIs. So it is suggested that proper interventions be implemented to ensure wearing helmet by motorcyclist and pillion passengers.
Zahra Mohtasham-Amiri; Saeed Dastgiri; Ali Davoudi-kiakalyeh; Ali Imani; Keyvan Mollarahimi
Volume 4, Issue 4 , October 2016, Pages 230-235
Abstract
Objective: To determine the epidemiological characteristics of the road traffic injuries (RTIs) in Guilan province, northern Iran.Methods: This study was a cross-sectional study which included all of RTIs admitted to medical centers of Guilan province (northern Iran) during 2012. ICD-10 was used as ...
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Objective: To determine the epidemiological characteristics of the road traffic injuries (RTIs) in Guilan province, northern Iran.Methods: This study was a cross-sectional study which included all of RTIs admitted to medical centers of Guilan province (northern Iran) during 2012. ICD-10 was used as diagnostic criteria. Demographic variables also injury circumstance and in hospital variables such as length of stay, time of admission, type of surgery, ICU admission, final outcome and mechanism of injury, anatomical part of injury according to Abbreviated Injury Scale (AIS) classification were derives from records by trained research team. Descriptive data is reported. The predictors of mortality were also determined.Results: The prevalence of road traffic injuries in Guilan province was 31 in 10,000 populations. Of total 7671 accidents, 5976 (77.9%) were men and 1695 (22.1%) were women. Mean age of these victims was 33.3 ± 17.289 years (32.64±16.939 for men, 35.62±18.312 for women). Most of them (32.5%) were 20-29 years old. Motorcycle-car accidents had the highest frequency followed by car-car crashes and car accidents involving pedestrians. Most of the patients (85.9%) were hospitalized and 280 injured died (3.7%). Upper extremities were the most sites of injuries. Male sex, length of hospital stay, multiple injuries and increased age were associated with road traffic accident associated mortality.Conclusion: RTIs cause enormous death and disability in this area and more road traffic preventive programs should be enforcement in these areas to reduce incidences RTI.
Case Report
Hemanshi Shah; Charu Tiwari; Shalika Jayaswal; Keshav Murthy
Volume 4, Issue 4 , October 2016, Pages 236-239
Abstract
Impalement injuries are rare in the paediatric age group. Still rarer are injuries which traverse multiple body cavities. Such injuries require multispecialty management at a tertiary care centre. We describe a case of an accidental impalement injury in a 12-year-old boy after a fall from height. The ...
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Impalement injuries are rare in the paediatric age group. Still rarer are injuries which traverse multiple body cavities. Such injuries require multispecialty management at a tertiary care centre. We describe a case of an accidental impalement injury in a 12-year-old boy after a fall from height. The rod was seen passing through the right lung in the paracardiac region, piercing the diaphragm and segment IV of the liver and then coursing anterior to the inferior vena cava in the midline. It was seen passing through the small bowel at multiple places and then coursing behind the bladder, entering the rectum and anal canal. Intra-operatively, right intercostal chest drain was inserted. At laparotomy, the liver was mobilized and a diaphragmatic tear of 2×1cm was visualized. The rod traversed through the right lobe of liver with no active bleeding. Both the entry and exit sites through the liver were visualized. The rod was also seen passing through the small bowel and its mesentery. The rod entered the pelvis posterior to the bladder below the peritoneal reflection. Moderate hemoperitoneum and fecal contamination was present. The rod was successfully removed and the patient was discharged with good condition and was well on follow up.
Case Report
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.
Case Report
Francisco Igor B. Macedo; Alice J. Race; Laszlo M. Hoesel
Volume 4, Issue 4 , October 2016, Pages 244-247
Abstract
The majority of blunt trauma is secondary to motor vehicle crashes,especially in those wearing seatbelts or sitting in the front or passenger seat location.Hollow viscus gastrointestinal injuries occur more frequently in small bowel, followed by colorectal, duodenum, stomach and appendix. A 25-year-old ...
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The majority of blunt trauma is secondary to motor vehicle crashes,especially in those wearing seatbelts or sitting in the front or passenger seat location.Hollow viscus gastrointestinal injuries occur more frequently in small bowel, followed by colorectal, duodenum, stomach and appendix. A 25-year-old male presents after being involved in a motor vehicle accident. Initialworkup was significant for moderate amount of pelvic free fluid and curvilinear,cysticlike structures in the pelvis. He subsequently developed peritonitis and underwentdiagnostic laparoscopy, which revealed multiple cystic nodules arising from theperitoneum. Pathology demonstrated benign cystic mesothelioma (BCM). BCM is a very rarecondition of mesotheliallined, variably sized, fluidfilled cysts that arises from theserous, pericardial or peritoneal lining. Due to the scarcity of cases, its management and prognosis are not fully established. This singular case highlights the necessity for a clinician to have a widedifferential forunusual causes of free pelvic fluid after blunt abdominaltrauma.
Clinical Images
Hosseinali Khalili; Amin Niakan; Fariborz Ghaffarpasand
Volume 4, Issue 4 , October 2016, Pages 248-249
Clinical Images
Biplab Mishra; Mohit Kumar Joshi; Amulya Rattan; Subodh Kumar; Amit Gupta; Sushma Sagar
Volume 4, Issue 4 , October 2016, Pages 250-251
Best Reviewers
Best Reviewers
Volume 4, Issue 4 , October 2016
