Bulletin of Emergency And Trauma

Abstract Objective: Allergic respiratory and pulmonary emergencies, though uncommon, represent a potentially lethal risk in dentistry, and anaphylaxis is the cause of a significant percentage of perioperative allergic reactions. If left uncorrected, it increases the mortality rate.
Methods: Systematic review according to PRISMA guidelines with a literature search in PubMed, Scopus, Web of Science, Cochrane Library, and Embase (2000–2025). 47 studies were considered for analyzing allergens, treatment protocols, and preventive interventions. Data synthesis and extraction were conducted, and study quality was assessed using standardized tools.
Results: Local anesthetics (such as lidocaine), latex, antiseptics (such as chlorhexidine), and dental materials (such as methacrylates) were identified by the review to be the most common allergens responsible for respiratory allergic emergencies. IgE-mediated reactions (such as anaphylaxis) were demarcated from non-IgE-mediated reactions, and epinephrine was revealed to be the drug of choice for first-line use in anaphylaxis. Preoperative allergy screening, premedications, and material substitution were proven to be preventive measures. Reasonable gaps in the training and preparedness of dental personnel to manage allergic emergencies were identified.
Conclusion: Even though there are effective emergency protocols available, widespread implementation of universally standardized response procedures, mandatory simulation training, and enhanced preoperative risk assessment is overdue if patient safety is to evolve.

Abstract Objectives: This randomized controlled trial aimed to evaluate the effect of pre-extubation intravenous
lidocaine (1 mg/Kg) on the incidence of airway complications and hemodynamic stability in patients undergoing
emergency laparoscopic cholecystectomy, while accounting for age differences.
Methods: The study was a prospective, single-center, randomized controlled trial conducted from 2021 to 2023
at Imam Khomeini Hospital, Ilam, Iran. Ninety patients undergoing emergency laparoscopic cholecystectomy
were classified into two age groups (<50 and ≥50 years) and randomly assigned to receive either intravenous
lidocaine (1 mg/Kg) or a standard extubation protocol. The primary outcomes included post-extubation
airway complications, such as laryngospasm, cough, and sore throat, and the secondary outcomes included
hemodynamic and respiratory parameters.
Results: Lidocaine produced hemodynamic effects that differed by age group. In patients <50 years, systolic
blood pressure (SBP) increased from 129.2±16.4 mmHg to 133.1±23.1 mmHg, while diastolic blood pressure
(DBP) rose from 83.9±14.4 mmHg to 92.3±19.4 mmHg (both p<0.001). Conversely, in patients ≥50 years old,
SBP decreased from 160.5±26.7 mmHg to 145.2±19.7 mmHg, and DBP decreased from 107.9±19.5 mmHg to
99.0±16.1 mmHg (both p<0.001). Airway complications exhibited non-significant tendencies, with a decreased
incidence of cough in the older age group (15.6% vs. 31.8%) and an absence of laryngospasm in this age group.
There were no serious adverse events (e.g., bronchospasm, arrhythmias).
Conclusion: Intravenous lidocaine was safe and demonstrated a trend toward reducing airway complications
at extubation in patients undergoing emergency laparoscopic cholecystectomy, particularly in elderly patients.
However, this trend did not reach statistical significance, most likely due to insufficient statistical power.

Abstract Objectives: Chevron osteotomy could be fixed using various techniques, each yielding different outcomes.
This study aimed to determine the complications and outcomes caused by Chevron osteotomy fixed with
tension band wire in distal humeral fractures.
Methods: In this prospective study, patients with distal intra-articular humerus fractures treated by Chevron
osteotomy at Shahid Rajaei and Shahid Chamran Hospitals (Shiraz, Iran) from October 2018 to October
2023 were enrolled. Osteotomy fusion was evaluated radiographically using the Picture Archiving and
Communication System (PACS). Additional complications were assessed during periodic patient follow-ups.
Results: The study included 60 patients with a mean age of 44.6±18.14 years, including 23 (38.3%) women. All
cases demonstrated complete union of the olecranon osteotomy, with no cases of infection or fixation failure. In
three cases, the applied pins and wires were removed. Hardware-related irritation was observed in 22 patients
(36.7%).
Conclusion: The tension band wiring (TBW) method demonstrated acceptable clinical outcomes. Despite
frequent hardwire irritation, this technique achieved high rates of bony union. However, future comparative
studies evaluating multiple fixation techniques within a single center are warranted.

Abstract Objective: This study aimed to investigate the incidence and risk factors for surgical site infection (SSI)
following appendectomy.
Methods: This retrospective cohort study examined the records of 180 patients who underwent appendectomy
in Emam Khomeini Hospital from January 2021 to December 2022. The research tool included a demographic
profile form and a research checklist. After obtaining the ethical approval from the university, the researcher
visited the hospital and extracted the required data from the patient’s clinical file (in accordance with the
research checklist). Then, the collected data were entered into SPSS software (version 21) for data analysis.
Results: Of the 180 patient records included in the study, 28 (15.6%) developed SSI. The descriptive analysis
revealed that among the patients with SSI, 19 patients were men (67.9%), 18 (64.3%) had a low BMI, 8 (28.6%)
had blood type A-
, and 19 (67.9%) patients had a fever below 38 °C. Regarding clinical symptoms, 1 (3.6%)
patient had gangrenous appendicitis, and 22 (78.6%) required urgent surgery. Notably, no significant risk
factors for SSI were identified. There was no association between SSI status and demographic variables,
clinical symptoms, or underlying conditions (p>0.05).
Conclusion: The incidence of SSI following appendectomy was relatively higher than in previous studies,
though no significant risk factors were identified. Given this, standardization and adherence to evidence-based
infection control practices, such as an appropriate preoperative antiseptic preparation, timely administration
of prophylactic antibiotics, and the use of laparoscopic techniques when feasible, might help reduce SSI risk.

Abstract Objectives: This study aimed to determine the prevalence of dental trauma (DT) in pediatrics and adolescents
in Ilam.
Methods: This retrospective study was conducted in Ilam (Iran) on a group of pediatric and adolescent patients
with DT between 2017 and 2021. The researchers reviewed patient records from hospital-based specialty clinics
providing DT treatment. Using a predefined checklist, they extracted the relevant data from the patients’
medical files.
Results: In this study, 246 pediatrics and adolescents were examined, including 144 (58.5%) boys and 102
(41.5%) girls. Regarding age distribution, 104 (42.3%) patients were in the pediatric age group (mean age:
7.1±3.2 years) and 142 (57.7%) were adolescents (14.8±5.1 years). A significant relationship was found between
place of occurrence with sex (OR=0.77; 95% CI=0.64-0.93; p=0.008) and age group (OR=0.73; 95% CI=0.6-
0.89; p=0.002). Additionally, the type of trauma showed a significant association with sex (OR=1.24; 95%
CI=1.08-1.43; p=0.002), while the treatment provided was significantly associated with school type (OR=0.79;
95% CI=0.65-0.96; p=0.02). In addition, there was no significant relationship between the demographic
variables and dental injury-related factors (p>0.05).
Conclusion: The present study found a higher prevalence of DT in boys than in girls. However, this trend
reversed in the adolescent age group. In addition, public schools had a higher rate of DT, which influenced the
types of treatments provided. 

Abstract Objectives: This study aimed to explore experts’ perspectives on the factors influencing pedestrian traffic
collisions in Iran.
Methods: This qualitative study was conducted using conventional content analysis with an inductive approach
from September 2023 to March 2024. Twenty-six experts were purposefully selected from across Iran. Data
were collected through individual face-to-face interviews, guided by a semi-structured interview, developed
by a panel of experts and contained open-ended questions. Data analysis was performed manually using the
Graneheim and Lundman approach (2004). To ensure trustworthiness, four strategies proposed by Lincoln and
Guba were employed.
Results: The results revealed two main categories: direct factors and underlying factors, comprising nine
subcategories. Direct factors included five subcategories: driver, pedestrian, roads and streets, vehicle, and
geographic factors. Underlying factors included four subcategories: governance factors, social determinants,
cultural conditions, and economic status.
Conclusion: The study identified key risk factors associated with pedestrian collisions according to experts’
experiences. We recommend further qualitative studies to explore high-risk behaviors among pedestrians and
drivers in depth. Additionally, systematic reviews should examine strategies employed by developing and
successful countries to prevent or reduce pedestrian collisions.

Abstract A 19-year-old male presented with a three-day history of worsening epigastric pain, persistent vomiting,
abdominal distension, and obstipation. His medical history included high-fall trauma in 2022, resulting in a
parietal bone fracture, scalp swelling, and an epidural hematoma. Physical examination revealed epigastric
tenderness, abdominal distension, and diminished bowel sounds. Imaging revealed a 7 cm left diaphragmatic
defect with herniation of the stomach, colon, and mesentery into the thoracic cavity, confirming a diagnosis of
gastric volvulus with a diaphragmatic hernia. An exploratory laparotomy confirmed herniation of the stomach,
transverse colon, spleen, and pancreas. The procedure involved derotation of the gastric volvulus, reduction
of the herniated organs, and repair of the diaphragmatic tear; a fundoplication was also performed to prevent
recurrence. The patient’s recovery was uneventful, and he was discharged on the fifth postoperative day. He
remained asymptomatic at the six-month follow-up. This case underscored the importance of considering
gastric volvulus and diaphragmatic hernia in trauma patients presenting with gastrointestinal symptoms,
highlighting the necessity of early diagnosis and prompt surgical intervention.

Abstract I commend the authors for their insightful manuscript "Comparing the Performance of Emergency Department Personnel and Patients’ Preferences in Breaking Bad News."(1) This study examines a sensitive yet essential aspect of emergency care—effectively delivering bad news in high-stress environments. The findings highlight a notable discrepancy between emergency department (ED) personnel's communication practices and patients' expectations, underscoring the need for structured training and improved communication protocols in emergency medicine.
The article provides valuable insights into the gap between ED personnel performance and patient preferences in BBN, supported by a solid methodological foundation. However, its impact is curtailed by limited generalizability, subjective performance measures, and a lack of nuanced interpretation or practical solutions. Future research should incorporate observer validation, and categorize bad news scenarios by severity. Time constraints in EDs should be quantified to explain performance gaps. A structured BBN protocol integrating patient preferences and cultural factors would enhance communication strategies. Addressing these weaknesses could elevate the study from a descriptive snapshot to a transformative contribution to emergency medicine communication practices.