Bulletin of Emergency And Trauma

Abstract Objective: This study aimed to assess and compare the effects of intranasal administration of lidocaine and
remifentanil on the condition of LMA insertion and cardiovascular response.
Methods: From March 2019 to March 2020, this double-blind randomized clinical trial study was conducted
on 60 patients, who underwent general anesthesia with LMA insertion at Faiz Hospital, Isfahan, Iran. After
induction of anesthesia and before placing the laryngeal mask, the first group received remifentanil 1 μg/Kg,
the second group received lidocaine 2% 1 mg/Kg, and the third group received normal saline with the same
volume intranasally. The conditions of LMA insertion and hemodynamic changes that occurred during its
insertion were investigated.
Results: In terms of demographics characteristics (p>0.05), success in placing the LMA on the first try
(p=0.73), number of attempts to insert LMA (p=0.61), performance of LMA (p=0.73), need for additional
propofol (p=0.53), frequency of gagging (p=0.53), cough (p=0.15) p), and laryngospasm (p=0.99) did not
differ significantly. In the remifentanil group, the cardiovascular response to LMA injection was less than that
of the lidocaine group. Moreover, both groups were lower than the saline group, but no significant difference
was observed
Conclusion: In facilitating LMA insertion, the effect of intranasal remifentanil was comparable to intranasal
lidocaine. Intranasal remifentanil was somewhat more effective than intranasal lidocaine in weakening the
cardiovascular response to LMA insertion, but it did not outperform lidocaine.

Abstract Objective: Cerebral Venous Sinus Thrombosis (CVST), a complex and infrequent cerebrovascular disorder
characterized by the formation of clots within the cerebral venous sinuses, occurs as a result of multiple risk
factors and casualties, and its epidemiological picture should be investigated.
Methods: This descriptive study was conducted retrospectively on patients with a final diagnosis of cerebral
vein thrombosis, who were referred to the emergency room of Ghaem Hospital (Mashhad, Iran) between 2009
and 2019. The study included all patients with cerebral vein thrombosis who were older than 18 years. Clinical
symptoms and causes were documented and contrasted according to demographics.
Results: During the 10 years of this study, 749 cases of cerebral vein thrombosis were observed, with women
accounting for the majority (72.8%). The most prevalent symptom was headache (554 cases; 74.0%), followed
by seizures (23.1%), blurred vision (16.0%), nausea (7.5%), vomiting (6.9%), double nose (4.9%), and dizziness
(3.3%). There was no significant difference in the frequency of symptoms between the two genders (p<0.05). The
most commonly identified risk factors were OCP (110 cases; 14.7%), followed by infection (103 cases; 13.8%),
malignancies (78 cases; 10.4%), and fasting (15 cases; 2.0%). There was no significant difference in risk factors
between the two genders, with the exception that all cases of fasting were in women, and the differences were
significant (p=0.015). The most common site of involvement according to Magnetic Resonance Venography
(MRV) was the upper sagittal sinus (427 cases; 57.0%). There was no significant difference in terms of the site
of the conflict between the two genders (p<0.05).
Conclusion: The findings of the present study showed that deep vein thrombosis occurred mainly in women
and manifested itself mostly as a headache. Moreover, the upper sagittal sinus was the most common site of
involvement.

Abstract Objective: This study aimed to evaluate the outcome and risk factors in operative and non-operative
management of splenic injury.
Methods: This cross-sectional study was conducted on patients with traumatic splenic injuries who were
hospitalized in Kashani Hospital (Isfahan, Iran) from 2017 to 2019. The studied variables were extracted from
the medical records of the enrolled participants. The outcomes such as mortality complications and risk factors
were compared based on treatment methods.
Results: A total of 240 patients were investigated. The mean age of the patients was 29.8±12.2, with 180
(77.5%) patients being men. 154 (64.2%) patients underwent operative treatment. The mortality rate was 18.9%
and 4.6% among operative and non-operative groups (p<0.001). Complications were observed in 11.5% and
46.1% of non-operative and operative groups, respectively (p<0.001). Operative treatment inversely correlated
with mortality (p<0.001) and complications (p<0.05). Splenic injury severity was correlated positively
with mortality (p<0.001) and negatively with complications (p<0.001). Unstable hemodynamic status was
positively correlated with complications (p<0.001). Age had a positive correlation with mortality (p<0.001)
and complications (p<0.001). Male sex had a negative correlation with complications (p<0.001). GCS score and
admission were positively correlated with mortality (p<0.001). There was no statistically significant correlation
between correlated injuries and outcomes (p≥0.05).
Conclusion: Patients who received surgery had higher rates of mortality and complications. However, after
controlling for confounders, operative treatment was found to be inversely correlated with mortality and
complications.

Abstract Objective: This study aimed to investigate the incidence and pattern of tramadol-induced seizures and injuries
in patients admitted to the hospital.
Methods: The cross-sectional study included 300 patients with alleged tramadol intoxication. Demographic
information, tramadol dosage and duration of abuse, co-existing illicit drug abuse, hospital stay length, and
occurrence of seizures and trauma (type and site of injuries) were collected. Different statistical tests, including
the Mann-Whitney U-test, Pearson’s Chi-square test, and Student’s t-test, were conducted to compare the
patients with and without seizures, trauma, and co-ingestion of illicit drugs. The analysis was performed using
SPSS software (version 21.0). A p value of less than 0.05 was considered statistically significant.
Results: The average patient’s age was 24.66±5.64 years, with males comprising 84.3% of the sample. The
mean tramadol dose and duration of abuse were 1339.3±1310.2 mg and 2.43±1.35 years, respectively. Seizures
were observed in 66% of patients, with men having a higher incidence (69.6% vs. 46.8%; p=0.004). Trauma was
reported in 23% of patients, accounting for 35.4% of seizure cases. All trauma patients had experienced seizures,
with the head and neck being the most prevalent injury sites (55.1%), typically presenting as abrasions (55.9%).
Patients with seizures and trauma had an average hospital stay of 1.73±0.94 days, which was significantly
longer.
Conclusion: Trauma occurs in more than one-third of tramadol-induced seizures, highlighting the need
to perform physical examinations to detect and localize injuries. Tramadol-associated traumas prolonged
hospitalization times and thus required prompt attention to prevent further injuries during pre-hospital handling
and transferring to hospitals.

Abstract Objective: This study investigated the demographic characteristics and factors influencing burn injuries,
primarily in low socioeconomic societies where such incidents are prevalent due to factors such as illiteracy
and poverty.
Methods: This cross-sectional study included all burn patients admitted to Shahid Motahari Hospital in
Tehran, Iran. Demographic data such as age, sex, occupation, education level, and residence as well as detailed
information about the burn incidents such as date, time, location, number of people present at the scene, and
referral place was collected. Additionally, comprehensive burn details such as cause, extent, severity, previous
history, and need for hospitalization directly at the emergency department were documented.
Results: The study included 2213 patients (mean age 34.98±19.41 years; range 1-96), with a men predominance
(60.6%). The majority of burns (64.4%) occurred at home, primarily due to accidents (99.6%), with boiling
water being the most common cause (39.2%). The most frequent burns were second-degree burns (91.8%),
with an average injured body area of 6.31±6.67%. There were significant correlations between burn severity
and demographic factors such as age, sex, occupation, cause of burn, hospital admission, outcome, and length
of stay. Remarkably, the extent of burns was negatively correlated with the distance to the hospital, while
positively correlated with the length of hospital stay.
Conclusion: Burn injuries were significantly influenced by demographic factors. Enhancing treatment facilities
and reducing the time and distance to medical care could be crucial in high-risk cases.

Abstract Objective: Subarachnoid hemorrhage (SAH) is still considered a life-threatening medical condition with
a high mortality rate, particularly in developing countries. Thus, the present study aimed to investigate the
angiographic findings of non-traumatic or spontaneous SAH.
Methods: This retrospective cohort study included 642 health records of patients with non-traumatic SAH over
a 10-year period, from 2010 to 2020. The required data, including demographic information, aneurysm type,
size, location, disease severity classification, and secondary complications, were extracted.
Results: The study included 642 patients, with 262 (40.8%) being male. The mean age of the participants was
54.72±13.51 years. The most prevalent type of aneurysm was saccular (89.1%), while serpentine (0.2%) and
dissecting saccular (0.2%) aneurysms had the least prevalence. The most frequently involved arteries were the
anterior communicating artery (ACoA; 38%), internal carotid artery (ICA; 27.6%), and middle cerebral artery
(MCA; 13.4%). There was a significant correlation between sex and aneurysms occurring at ACoA and ICA
(p< 0.0001), and ACoA – A1 (p=0.02). Patient age and sex were also significantly correlated with one another
(p<0.0001). There was no statistically significant correlation between sex, aneurysm size, Glasgow coma scale
(GCS), and modified Rankin scale (MRS).
Conclusion: Based on our findings, the presence of aneurysms at ACoA, ACoA – A1, and ICA should be
thoroughly ruled out in patients with severe headaches of sudden onset, particularly male patients of younger
ages.

Abstract Approaching posterior fossa pathologies is fairly challenging. Poor exposure, Cerebrospinal Fluid (CSF) leak following surgery, post-operative suboccipital and neck pain, and wound healing are common challenges following traditional suboccipital midline incision. Herein, we present a new incision for approaching posterior fossa pathologies. The incision is shaped like a question mark and makes a musculofascial flap supplied by occipital artery on top of providing a wide area for craniotomy. In our technique, the dura is also incised in a question mark shaped manner. Three patients with masses in posterior fossa were operated with the new incision. Following surgeries, there were no adverse events including CSF leak, wound complications, severe suboccipital pain and neck instability in any of the patients. This new incision not only facilitates approaching to pathologies in posterior fossa with providing wider exposure, but also enables us for watertight Dural closure which decreases CSF leak. Also, as the muscular incision provides a sufficient area for craniotomy, muscular retraction can be minimized to avoid post-operative pain. Moreover, as opposed to the midline avascular incision, the flap is well supplied by occipital artery which facilitates the healing procedure.