Bulletin of Emergency And Trauma

Abstract Objective: To identify the elements of teamwork in resuscitation, an integrative review and synthesize current primary studies conducted.
Methods: PubMed, Scopus, Web of Science, and Embase, as well as Google Scholar search engine were searched from November 2015 to March 2020 to review previously published peer‐reviewed studies. Out of the 5495 articles, 16 were finally included in the study. Search strategy implemented with these keywords (in the title/abstract) were (team* AND CPR) or (team* AND resuscitation). Six descriptive criteria was performed by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to analyze the articles and a modified version of Cooper’s five‐stage method.
Results: Sixteen studies were included in this research. Twenty elements related to teamwork in resuscitation were identified by using data synthesis, then classified into four categories includes team interaction elements, leadership skills, individual elements and environmental elements. Communication, leadership, situation awareness and scene organization had the highest frequency of reviewed articles 10, 5, 4, 4, respectively.
Conclusion: The interactions between resuscitation team members and the skills of the leader and team members along with environmental elements had attracted the most attention of researchers by focusing on teamwork in resuscitation. Due to the limited number of articles related to this subject, more research is needed to reveal all the key elements of teamwork in resuscitation.

Abstract Objective: To evaluate the efficacy of chest x-ray (CXR) in blunt traumatic aortic injury (BTAI) as a primary
imaging tool in trauma patients.
Methods: We retrospectively reviewed our hospital records for blunt thoracic aortic injury patients who had a
therapeutic intervention from January 2015 to February 2021. Patients’ characteristics, initial chest x-rays, and
computed tomography (CT) scan were extracted and re-evaluated.
Results: Eighteen patients matched the criteria of our research. The mean age and the injury severity score
(ISS) was 29.8±11.2 and 38.4±14.4, respectively. Seven patients (38.9%) underwent thoracic endovascular
aortic repair (TEVAR), and 11 (61.1%) had open surgery. The TEVAR group had significantly lower mean
intensive care unit stay days (6.6±3.9 vs. 10.8±6.9 in open aortic repair (OAR), p<0.05). The percentile of
patients requiring blood transfusion was significantly lower in the TEVAR group (57% vs. 100% in OAR,
p<0.05). Mediastinal widening (66.7%) was the most common finding during the evaluation of initial chest
x-rays. Interestingly, 22.2% of the initial x-rays were not remarkable for BTAI.
Conclusion: TEVAR is an advantageous choice in the management of BTAI. However, open aortic repair is the
optimal decision in certain situations. It is suggested that the Interventional management of the BTAI must be
performed by experienced vascular surgeons in a medical center capable of both OAR and TEVAR.

Abstract Objective: To evaluate the effect of COVID-19 pandemic on the incidence and mortality rate of road traffic
injuries in Shiraz, Iran.
Methods: This cross-sectional study was performed on the data of patients who admitted by road traffic
accidents 18 months before the outbreak of COVID-19 and 18 months after COVID-19 in the largest provider
of trauma level 1 care services in southern Iran. SPSS 19 software was used to analyze the data.
Results: A significant decrease of 12.8% was observed in the number of patients admitted by road traffic
accidents during the COVID-19 pandemic period compared to the same period before the pandemic (p<0.0001).
But the death toll from road traffic accidents has increased significantly during the COVID-19 pandemic period
compared to the same period before the pandemic (p=0.01).
Conclusion: Due to the COVID-19 restrictions, it seems that factors such as restrictions on suburban travel,
closure of public and recreational spaces, reduction of intra-city traffic, people staying at home and a significant
reduction in injuries caused by traffic accidents, is reasonable. On the other hand, these restrictions, quarantines,
and COVID disease itself can lead to confusion, anxiety, fear of infection, and thus avoid or delay the search
for health care and increase mortality. Therefore, planning and policy-making is essential in order to prepare
the correct guidance for seeking treatment.

Abstract Objective: To evaluate the clinical and radiographic findings of long head biceps tendon (LHBT) transfer in
traumatic proximal humeral fractures with the biceps groove breakage or comminution.
Methods: In this interventional study, subjects surveyed in terms of shoulder function, clinical signs of LHBT
tendinitis, radiographic signs of transferred biceps as a possible depressor of the shoulder, and mechanical
changes of the scapula. Data were analyzed in SPSS version 21.
Results: Fifteen patients were included in the case group (tendon transfer to the conjoined tendon), and 10
patients were evaluated in the control group (non-transfer or non-manipulation of the exposed tendon in
the fracture callus of biceps groove). The mean age of the study population was 46.56±14.31 years, and the
majority of patients (14.56%) were men. The differences between two groups were not significant in terms of
the American Society of Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles
(UCLA) score, and constant shoulder score (CSS) (p=0.535, p=0.419, and p=0.266, respectively). Also, there
was no significant differences between the case and control groups regarding the biceps muscle involvement
(Popeye sign: p=1.00; tenderness: p=0.477; pain: p=1.00; speed test: p=1.00; Yergason’s test: p=1.00).
Conclusion: LHBT transfer to the conjoined tendon in proximal humerus fractures with cleavage or
comminution at the bicipital groove showed no advantages.

Abstract Objective: To compare the ability of quantitative trauma severity assessment methods based on Glasgow coma
scale, age, and arterial pressure (GAP), revised trauma score (RTS), and injury severity score (ISS) criteria in
determining the prognosis of accidental patients.
Methods: This cross-sectional study was performed on random patients referred to Imam Khomeini Hospital
in Urmia from March 20, 2020 to September 21, 2020. The data were obtained by using a checklist includes
items such as age, sex, respiration rate, oxygen saturation level, pulse rate, primary blood pressure, initial
Glascow coma scale (GCS), patient outcome and injury to different parts of body. After collecting the data, it
was entered into SPSS 18 and analyzed with the descriptive and analytical statistics include an independent
t-test and receiver operating characteristic curve (ROC) curves.
Results: Out of 1930 studied patients, 365 (18.9%) were women and 1565 (81.1%) were men. The mean age of
patients was 37.05±17.11 years and women were significantly older than men. The mortality rate was 4.8% and
was significantly more in men compared to women. The mean blood pressure, GCS and oxygen saturation level
were lower in deceased patients. The mean GAP, ISS and RTS values were 23.13±2.69, 4.07±3.82, 7.72±0.52,
respectively. The mean values of GAP and RTS were significantly low in deceased patients whereas the mean
ISS value was significantly high in the deceased patients. The Area under the curve (AUS) for ISS was greater
than the other two scoring systems.
Conclusion: The findings of the current study showed that all three systems were adequately efficient to
prognoses the final outcome in multi-trauma patients but the ISS measure was better than the other two criteria.

Abstract Objective: To evaluate the presence/severity of depression, anxiety, and stress among health care workers
(HCWs) who work on the specially allocated COVID-19 ward (Group A) and HCWs on the other wards
(Group B).
Methods: This questionnaire-based study was conducted from January 25 to February 28, 2021. The mental
status was assessed using the Persian version of the 42-item Depression, Anxiety, and Stress score (DASS-42).
Gathered data was analyzed using SPSS version 25. The independent T-test and Chi-square tests were used to
compare quantitative and qualitative variables.
Results: Two-hundred and twenty two questionnaires were eligible for analysis. Group A consisted of 33
HCWs, and 189 (85.1%) individuals were working on the other wards. No statistically significant differences
were seen regarding the Socio-demographic features except for the marital status (p=0.005). The depressions’
mean score was comparable between group A and B (p=0.102). The mean scores of anxiety and stress were
significantly lower in group A than group B (p=0.006), although the frequency of DASS-42 parameters did not
differ between these two groups (p>0.05).
Conclusion: Contrary to our assumptions, this study showed that the DASS-42 parameters were not higher in
HCWs working on the COVID-19 wards. This might be justified by developing coping mechanisms, being on
the honeymoon phase of the disaster, compassion satisfaction, promising vaccine news, and working on the
less impacted hospital.

Abstract Traumatic cervical translational injury is a notably rare and highly unstable subtype of type C sub-axial cervical spine injury with high morbidity and mortality rates. Hereby, we report a 41-years-old man who was a case of multiple trauma due to car rollover. He was completely conscious, complaining of cervical pain, with a GCS score of 15/15. His neurological examination was unremarkable. The cervical CT scan revealed a vertical translation at the C6-C7 level (roughly 11 mm) and bilateral facet joint diastases which are highly unstable injuries. A two-stage combined anterior and posterior fixation operation was performed. First, an anterior cervical discectomy and fusion with autologous graft and plate fixation, and then a posterior approach with lateral mass screw fixation was performed. Disruption of the anterior longitudinal ligament, annulus fibrosis, facet capsules, and severe strain of ligamentum flavum was noted intraoperatively. He had no early and late complications within 2 years of follow-up.

Abstract Nowadays, the use of central venous catheter insertion (CVC), has abundantly increased. It is a common technique in critically ill patients who are admitted to intensive care and emergency departments in order to hemodynamic monitoring and fluid and medication administration. In this report, we express a 28-year-old man who has multiple trauma with decreased level of consciousness during a car accident three months ago and needs intensive care and monitoring by central venous catheter placing. A missed guide wire remaining inside the venous system after peripherally inserted in femoral vein that was incidentally diagnosed by taking a chest X-ray after three months. Although, guide wires are often retrieved by snaring catheter under fluoroscopic guidance and an interventional cardiologist, we have successfully extracted the lost wire through vascular surgery. Eventually, this report is supposed to increase awareness of this rare and preventable complication and to provide a solution to prevent this complication. Finally, the purpose of this report is to emphasize that surgical extracting is the best intervention to remove the missed guide wire (after 3 months) and this option
could be developed, introduced and standardized in appropriate and controlled conditions.