Bulletin of Emergency And Trauma

Abstract Objective: The present study aimed to evaluate the clinical benefits and drawbacks of administering ECMO/
ECLS therapies to drug-intoxicated patients.
Methods: From inception until April 30, 2024, an extensive search was performed on four main databases:
PubMed, Web of Science, Cochrane Library, and EMBASE. There was no restriction on the search period. Only
the studies that reported survival to hospital discharge rates, adverse events, and the utilization of ECMO/ECLS
in the treatment of intoxicated patients were included. On the other hand, articles that did not report adverse
events or hospital discharge rates as outcomes, as well as studies published in languages other than English,
were excluded. The evaluated outcomes were the rate of survival to hospital discharge rate and the incidence
of adverse events associated with ECMO therapy. The Newcastle Ottawa scale was employed to appraise each
study to determine its methodological quality. The Comprehensive Meta-Analysis (CMA) software (version
3.0) for statistical analysis was used, with the random effects model (due to high heterogeneity among the
studies) and a 95% confidence interval.
Results: From a total search of 2216 search results, only 10 studies were included. The pooled analysis from
10 studies indicated that ECMO therapies among drug-overdosed/poisoned patients were associated with
a significant survival to hospital discharge rate of 65.6% ([95% CI: 51.5%-77.4%], p=0.030). However, the
outcomes were highly heterogeneous (I2
=83.47%), which could be attributed to the use of several medicines
by different studies. In contrast, ECMO therapies among drug-overdosed patients were associated with a
significant incidence rate of adverse events of 23.1% ([95% CI: 12.3%-39.2%], p=0.002). However, the pooled
analysis had a significant heterogeneity (I2
=70.27%).
Conclusion: Despite various health complications, extracorporeal membrane treatment enhanced survival to
hospital discharge with good neurological outcomes. Hence, it was a viable, effective, and feasible alternative
for managing drug-induced intoxication in patients.

Abstract Objectives: The present study compared respiratory parameters between the two methods of airway
establishment, ETT and LMA, for patients scheduled for orthopedic surgery with general anesthesia.
Methods: This randomized double-blinded clinical trial was conducted on patients scheduled for elective
orthopedic surgery under general anesthesia, in Bandar Abbas, Iran, from January 2021 to December 2021.
Using a random allocation table, the study participants were randomly divided into two groups, to employ
either ETT (n=48) or LMA insertion (n=48). The study’s ultimate goal was to assess the respiratory parameters
in 1, 3, 5, 10, and 15 minutes following intubation.
Results: At all-time points, the average of peak airway pressure (P peak) and P plateau parameters in the
ETT group was much higher than the EMA group (p<0.001 in all comparisons). The value of dynamic lung
compliance in the LMA group was significantly higher than the ETT group in all considered time periods
(p<0.001 in all comparisons). The upward trend in the value of this index was significant only in the LMA
group (p=0.030). There were no significant differences in arterial oxygen saturation and end-tidal carbon
dioxide levels between the two groups (p>0.05).
Conclusion: In terms of arterial oxygen saturation stability and at the same time providing respiratory dynamic
compliance, the LMA device outperformed the ETT.

Abstract Objective: Intra-articular screw penetration is a probable complication of coronoid fracture fixation. The
present study aimed to determine the best radiography technique for visualizing the proximal radioulnar joint
(PRUJ) space. Moreover, it aimed to determine the safe angle and length of the screw to avoid PRUJ penetration
during coronoid fracture fixation.
Methods: The Mimics software was used to construct a three-dimensional model of a healthy man’s forearm
from a computer tomography scan. It was analyzed using the Solidworks software to determine the X-ray angle
that clearly showed the PRUJ space to detect penetration of screws from the coronoid process into the PRUJ
and determine the maximum screw angle and length that could be used without intra-articular penetration. To
verify these findings, a cadaveric study combined with radiographs was conducted.
Results: To visualize PRUJ space, the optimal X-ray angle was 13º lateral to the perpendicular line when the
forearm was positioned at full supination. If the coronoid process was segmented into zones 1 (closest to the
radioulnar joint) to 4 (farthest from the joint), the screw could only be inserted at a right angle in zone 1. In zones
2, 3, and 4, inclination angles less than 15, 35, and 60 would prevent intra-articular penetration, respectively.
Conclusions: The X-rays could visualize the PRUJ space with an anteroposterior radiograph at an angle of
13º ulnar deviation from the perpendicular plane. During coronoid process fracture fixation, shorter screws
with less lateral inclination were safer when inserting screws in the zones of the coronoid process adjacent to
the PRUJ.

Abstract Objective: Geriatric trauma refers to injuries sustained by elderly individuals, typically those aged 65 years and
older. The management of geriatric trauma in the Emergency Department requires a comprehensive approach
that takes into account the physiological changes associated with aging, as well as the increased vulnerability
and complexity of injuries in this population.
Methods: This is a cross-sectional study aimed at evaluating the etiology of trauma in geriatric patients referred
to the ED of level-1 an academic center. All patients with complaints of trauma are evaluated and patients over
65 years enrolled in the study. Data were analyzed by SPSS 26.
Results: 319 patients were investigated, 49.8% male and 50.2% female. The most common underlying diseases
are high blood pressure, diabetes type 2, and ischemic heart disease. The most common trauma cause was
falling from the same level (48.9%), followed by a fall from a height (16.6%), accidents with cars (16%), and
motorcycles (9.1%). The most common injury was extremities trauma (71.5%) following head trauma (13.2%)
and chest trauma (6%). The severity of injury in extremities was higher in women, and chest trauma was more
severe in men.
Conclusion: The fall and subsequent car accident had the highest frequency as a cause of trauma in elderly
patients admitted to our academic trauma center. Hypertension and diabetes have also been the most common
underlying diseases. Head and neck injuries are life-threatening and critical in a larger number of patients than
other injuries, and protecting them can be effective in reducing mortality and serious injuries in elderly trauma
patients.

Abstract Introduction: Recently, various serum markers have been used for the diagnosis and prognosis of acute heart diseases in emergency departments. Thus, the present study was designed and conducted to determine such a role.
Methods: This is an Analytical Cross-Sectional study conducted on the patients with syncope complaints. The patients were entered the study based on the inclusion and exclusion criteria and were subjected to initial evaluations including history, physical examination, ECG, blood sugar measurement, and, if necessary, brain CT scan, Doppler echocardiography, and CTA.
Results: A hundred people complaining of syncope were included in this study. The results showed that 19% and 81% of the subjects were suffering from cardiac and non-cardiac syncope, respectively. The average Pro BNP of the studied individuals was 196.06 ± 128.45 pg/ml. according to the results, age and length of hospitalization had a positive and significant relationship with the average Pro BNP (P value<0.01). Furthermore, the average Pro BNP was significantly higher in the people with positive TPI, cardiac syncope, and abnormalities in ECG and Doppler findings (P value<0.01). The results of the diagnostic value of Pro BNP in identifying cardiac syncope also showed that its sensitivity and specificity were 94.73% and 56.79%, respectively.
Conclusion: The results of this study showed that the increase in the Pro BNP values was associated with age, increased length of hospitalization, and ECG abnormalities. In addition, as an independent marker, Pro BNP had good acceptability in identifying cardiac syncope cases.

Abstract Objectives: This study was conducted to investigate the factors affecting mortality due to spinal cord trauma
in patients admitted to the intensive care unit (ICU).
Methods: This study was conducted in a group of patients who were admitted to the ICU with a Traumatic
Spinal Injuries (TSI) diagnosis. The researcher started sampling by assessing the documents of the patients
hospitalized in the ICU, and the diagnosis of TSI was confirmed for them. Besides, utilizing a researcher-made
checklist, factors affecting the mortality of patients were identified. The data were analyzed using the SPSS
software version 16. P<0.05 was considered statistically significant.
Results: About 412 (64.2%) patients were men, about 213 (33.2%) of the patients had GCS between 3-8 grade.
There were injuries in the pelvis area. Moreover, there was a significant relationship between GCS score status
and the number of injury follow-ups in addition to TSI. Therefore, the mortality rate was higher in patients who
had lower GCS (Odds ratio=2.32, p<0.001). There was also a significant relationship between the number of
injuries and the mortality rate, and patients who had multiple traumas had a higher mortality rate. Besides, a
significant relationship was observed between the complications caused by trauma, including cerebrovascular
accident, cardiac arrest, acute respiratory distress syndrome (ARDS), pneumonia, and the mortality of patients
hospitalized in the SICU (p<0.05)
Conclusion: The patients’ mortality was influenced by factors such as their level of consciousness, the number
of traumas caused in the spinal cord, and the occurrence of comorbidities such as cerebrovascular accident,
cardiac arrest, ARDS, and pneumonia. Therefore, it is necessary to take the essential measures to reduce these
complications.

Abstract Bronchial rupture following major blunt chest trauma should be suspected in any case of massive and persistent
air 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 who
was 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 few
crash injuries on his upper extremities, as well as subcutaneous emphysema in his neck. The chest X-ray
revealed a right clavicular fracture, multiple rib fractures, a right pneumothorax (but no complete collapse
or fallen lung), and also pneumo-mediastinum and subcutaneous emphysema. The chest CT revealed severe
pulmonary contusion, severe right-sided pneumothorax, significant pneumo-mediastinum, subcutaneous
emphysema, 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 parameters
were revealed. The maximum pressure (Pmax)=7cm, H2
o (was very low), plateau pressure (P. Plateau), and
expiratory tidal volume (TV) were not detected due to insufficient amounts. Additionally, increasing TV did
not change those values. Bronchial rupture is one of the most important and serious differential diagnoses in
forceful 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.

Abstract We are writing to express my appreciation for the insightful article on pain management in trauma patients and its critical role in improving patient outcomes. The current protocol utilizing acetaminophen and opiate agents has proven to be significantly effective. However, Recent studies have indicated that the combination of acetaminophen and NSAIDs can provide superior analgesic effects compared to either agent alone, potentially surpassing the effect of opioids The current protocol utilizing acetaminophen and opiate agents has proven to be significantly effective. However, Recent studies have indicated that the combination of acetaminophen and NSAIDs can provide superior analgesic effects compared to either agent alone, potentially surpassing the effect of opioids. Integrating NSAIDs into the pain management protocol could offer several benefits, including enhanced Pain Relief (3) and Reduced Opioid Consumption. we believe that incorporating acetaminophen plus NSAIDs into the existing pain management algorithm could be a valuable step towards optimizing care for trauma patients. Enclosed is a revised proposed algorithm based on your previously published protocol for the management of acute pain in trauma patients.