JOURNAL OF EMERGENCY PRACTICE AND TRAUMA
Year:2020 | Volume:6 | Issue:1|Papers Count:12

Dear Editor,As known, small bowel obstruction is one of the most common emergencies in general surgery carrying a not negligible rate of morbidity and financial expenditures as far as high social impact (1). Peritoneal adhesions are the leading cause of intestinal obstruction up to 74% of cases. In spite of increasing incidence worldwide, current management still presents some “ blind corners” , whose aspects still claim debate. In fact, notwithstanding guidelines, some issues such as limits of conservative approaches, efficacy and safety of nonoperative strategies as well as the risk of a delayed surgery arise both medical and somewhat legal concerns with an increased mortality rate from 3% to 5% for simple obstructions and 30% for complicated ones (2). Diagnostic and therapeutic aspects seem to be embraced by the use of standardized Gastrografin-based protocols, whose findings are still conflicting (3)...

Objective: Emergency medical services systems are at the first line of dealing with patients who suffer from various infections. Conducting investigations on the bacterial contamination of emergency ambulances play a crucial role to improve the occupational health of staff as well as the quality of patient care. Therefore, the aim of the present study was to investigate the presence of Staphylococcus aureus and other life treating bacteria in the urban and rural ambulances and their on-call emergency medical service personnel. Methods: This descriptive cross-sectional study was conducted on 12 front line pre-hospital emergency urban and rural ambulances in Kashan, Iran, in 2015. A total of 18 sites were sampled in each ambulance and from the nose of personnel. Grown colonies were confirmed based on colony morphology on mannitol salt agar plates, gram stain reaction and biochemical characteristics reactions. Results: The S. aureus contamination was only isolated from the nose of on-call emergency medical service providers of 12 urban and road ambulances, while no sign of contamination was found in 18 sampling sites of these front-line ambulances. Also, further evaluation of these sampling sites revealed the contamination with coagulase-negative staphylococci in all of them and oxygen tank was introduced as the most contaminated site inside the ambulances. Moreover, the prevalence of equipment contamination was significantly higher in urban ambulances. Conclusion: Identifying the rate of pathogens in clinical settings like the pre-hospital ambulance setting is an important issue which should be carefully considered.

Objective: There has been a worldwide rise in the prevalence of penetrating abdominal injury (PAI), and there are both inter-country and intra-country variations in frequencies. This study evaluates the mechanisms and pattern of penetrating abdominal injuries and the treatment outcome in our center. Methods: This descriptive study of adult patients managed for PAI was conducted at the Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti from January 2015 to December 2018. Data were prospectively collected and analyzed by using descriptive statistics from Statistical Package for Social Sciences (SPSS) version 20. 0. Results: There were 96 patients managed for abdominal injuries during the study period. Forty-six (47. 9%) of them had PAI, while 50 (52. 1%) others sustained blunt trauma. Patients ages ranged from 17-72 years (mean = 34. 2± 10. 8 years; median = 34 years). Majority, 42 (91. 3%), were males, while 4 (8. 7%) were females (M: F=11: 1). The most afflicted age group was in the 4th decade. Majority of the injuries were due to gunshot (60. 9%) followed by stab (26. 1%), unsafe abortion (6. 5%), road traffic injury (4. 3%) and fall (2. 2%). Gastrointestinal injuries were the most common with small bowel perforations predominating. Solid organ injuries were only seen in 3 (7. 9%) patients. Eight (17. 4%) had associated extra-abdominal injuries. Thirty-eight (82. 6%) patients required exploratory laparotomy, while 8 (17. 4%) were managed non-operatively. The negative laparotomy rate was 2. 6%. Seven (15. 2%) patients developed complications which were mostly wound infection (10. 8%). The duration of hospital stay was 1-58 days (mean 12. 7± 10. 5). Three patients (6. 5%) with gunshot injuries died. Conclusion: Gunshot wounds were the major variant of PAI, and the highest cause of mortality from it. Gut injuries were most common, and exploratory laparotomy remains the main-stay of treatment, while non-operative management is practicable in carefully selected cases.

Objective: The purpose of this study is to evaluate the diagnostic value of nitrite test in comparison with urine culture (U/C) results in patients with Urinary tract infection (UTI) symptoms. Methods: This cross-sectional study was performed on 203 patients with UTI symptoms. Middle urine sample was taken into sterile plastic containers, and simultaneously the urine sample and the nitrite test were done by the use of urine dipstick test. Data were analyzed using SPSS software version 23. Results: The results of the urine culture test indicated that the highest excreted organisms in both sexes were E. coli (58. 8%), Candida (17. 6%), Klebsiella (8. 8%), E. coli (MDR) (5. 9%), Pseudomonas (2. 9%), Enterococcus (2. 9%) and Acinetobacter (2. 9%). The results showed that there was a significant correlation between U/C and urine analysis (U/A) test results (P = 0. 01), and in U/C positive results, U/A results were significantly positive for UTI. Other findings showed a significant relationship between the results of nitrite one and nitrite two tests (P = 0. 001). There was a significant correlation between urinary, and nitrite1 levels (P = 0. 04). Also, in this study, the sensitivity and specificity of diagnostic tests for U/A and nitrite 1 and 2 with U/C were calculated as the Golden Standard method. Conclusion: Overall, the results of this study showed that the negative nitrite test and urine dipstick test could be performed in emergency cases to prevent ectopic dysfunction and inadequate diagnosis. Also, it can reduce the unreasonable expenses for U/A.

Objective: This study was designed to evaluate the clinical symptoms and sonographic characteristics of femoral trochlear cartilage in patients with knee joint osteoarthritis (OA). Methods: This cross-sectional study was conducted on 94 patients with painful primary knee OA according to the American College of Rheumatology criteria with a visual analog scale pain score of 30 mm or more. Clinical features were evaluated by a rheumatologist according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) criteria, and a radiologist performed ultrasonography within a week. The thickness and echogenicity grade of three cartilage regions were evaluated. Other findings such as meniscal extrusion, effusion, and Baker’ s cyst were recorded. Results: The average age of patients was 60 years. The linear regression model showed a significant association of grades II and III trochlear cartilage injury with the pain index, physical activity, and WOMAC overall index. However, there was no significant association between the trochlear cartilage thickness in these three regions and the WOMAC indexes (including pain, physical activity, and the overall index). There was also no significant association between Baker’ s cyst and the WOMAC indexes, but a significant association was found between meniscal extrusion and the WOMAC index (P≤ 0. 001). Conclusion: According to our study, the echogenicity grade determined by ultrasonography of femoral trochlear cartilage affects the clinical symptoms of patients including pain. These findings indicate the role of this diagnostic device in understanding changes due to the disease, and it can help physicians focus on the pathology in order to control clinical symptoms in patients.

Objective: Survival-to-discharge rates following in-hospital cardiac arrest (IHCA) patients remain significantly low. The use of initial documented cardiac rhythm as predictor of Survival-to-discharge is still unclear. This study aimed to assess whether the initial documented rhythm can be used as a predictor of survival-to-discharge following IHCA in an emergency department of the tertiary care referral institute, south India. Methods: This observational study was conducted for six months from January to June 2017 among all patients above 12 years, with witnessed cardiac arrest after arrival at the emergency department. After obtaining informed consent from the patients’ caregivers, data of socio-demographic details, previous relevant medical history, initial documented rhythm, neurologic status and survival-to-discharge were collected and analyzed. Results: The mean age of participants was 50 ± 17. 15 years. Of the 252 study participants, 77. 4% had non-shockable and 22. 6% had shockable rhythm as initial documented rhythm. The overall survival-to-discharge rate was 17. 5% (n=44) in our study. The overall proportion of participants who survived to discharge after IHCA was higher among participants with shockable rhythm (16/57, 28%) in comparison to participants with non-shockable rhythm (28/195, 14. 3%). These differences were found to be statistically significant. Among the patients with shockable rhythm, 61. 1% had good cerebral performance. Conclusion: Survival-to-discharge rates after IHCA can be predicted based on the initial documented cardiac rhythm. Early identification of patients with impending cardiac arrest and providing prompt management of patients with cardiac arrest will improve the survival rates significantly.

Objective: Femur is the strongest, longest and heaviest bone in the human body. Due to the great importance of femur in human body, its injury may cause large numbers of disabilities and mortality. Considering various effective parameters such as mechanical properties, geometry, loading configuration, etc. can propel the study to the trustable results. Methods: A 3D finite element model of the femur was subjected to different impact loading and orientations and also material properties. In addition to a reference healthy model of analysis, a total of 14 cases including four different loading conditions, six different bone density conditions and four different load orientations were considered. Results: Findings showed that the models with higher bone density cannot considerably reduce the stress under the impact loadings but porous models receive high mechanical stress which the bone prone to injury. The stress and displacement of the bone model received more values distributed through the femoral neck. Conclusion: Porous bone models had greater stress values under an impact load. Higher and faster impacts may create multi-fracture breaks of the femur. The inferior femoral neck regions are the most vulnerable part in response to the impacts.

Objective: Two temperamental components that are mostly associated with suicide are high novelty seeking (NS) and high harm avoidance (HA). This study aimed to evaluate the temperament and character personality dimensions of self-poisoning in suicidal attempters in an Iranian population. Methods: A descriptive-analytic study was conducted with random sampling in which 77 self-poisoning patients and equal normal counterparts were selected. Cloninger’ s Temperament and Character Inventory (TCI) and clinical interview were used as study procedures. Data were analyzed by SPSS software version 18 using chi-square, Mann-Whitney U and regression. P values<0. 05 were considered statistically significant. Results: Findings showed that people attempting suicide were significantly different from general population in terms of character and temperament. NS and HA yielded high scores in the suicide group, while reward dependence (RD), self-directedness (SD), cooperativeness (CO) and self-transcendence (ST) variables revealed significantly higher scores in the healthy group. No significant difference was observed among suicide attempters in terms of gender. Conclusion: The results confirm the difference between non-suicidal individuals and suicide attempters in terms of character and temperament in a way that suicidal patients have high harm-avoidance and introversion. In addition, the history of attempts and early alcohol consumption might be considered as suicide re-attempt predictors.

Objective: This study aimed to compare the efficacy of rescue blankets with conventional blankets in terms of preventing hypothermia in the pre-hospital setting. Methods: In this randomized clinical trial, patients older than 18 years old with Cold Discomfort Scale (CDS) > 2, and those who were transferred to the emergency department (ED) by emergency medical service entered the study. Patients were randomly divided into two groups based on the type of transfer. In this regard, one group was transferred with rescue blankets and the other group was transferred with conventional blankets. The tympanic temperature in patients and CDS were recorded before the use of blanket (primary) and at the time of arrival in the ED (secondary). Results: Finally, 161 patients with the mean age of 45. 31± 19. 8 years were included (63. 4% were male). Totally, 88 cases (54. 7%) were transferred with rescue blankets and 73 cases (45. 3%) with conventional blankets. The mean of the primary tympanic temperatures in the rescue and conventional blanket groups were 36. 20± 0. 84° C and 36. 34± 0. 65° C, respectively (P = 0. 23). The mean of the primary CDS in rescue and conventional blanket groups were 6. 55± 1. 95 and 5. 89± 2. 29, respectively (P = 0. 05). Also, the mean of the secondary tympanic temperatures in the rescue and conventional blanket groups were 36. 59± 0. 47° C and 36. 76± 0. 48 ° C, respectively (P = 0. 03). Besides, the mean of the secondary CDS in the rescue and conventional blanket groups were 2. 64± 2. 80 and 2. 41± 1. 29, respectively (P = 0. 48). Conclusion: According to the results, there is no significant difference in the tympanic temperature and CDS of the patients transferred with the rescue blanket compared with the conventional blanket.

Objective: Each imaging technique has a special application and usage, and should be used in the right situation. Physicians choose the type of imaging technique by considering the type of tissue and the benefits and disadvantages of the imaging method as well as its financial burden on the patient. The aim of this study was to estimate the cost of imaging tests performed in the emergency department (ED) of an educational hospital and determine their financial burden on both the patients and the healthcare system of the country. Methods: This retrospective descriptive cross-sectional single-center study was conducted in Shohadaye Tajrish, an educational hospital, during one year. The study population consisted of all patients who had undergone some type of imaging (CT scan, ultrasound, radiography, magnetic resonance imaging [MRI]) in the ED. The information was collected using a predesigned checklist. The costs of a variety of imaging methods for patients referred to the ED were calculated using different types of accounting units and PACS system. Results: The number of patients who visited the ED of the studied hospital during a one year period was 63 507. The total cost of performing different types of imaging methods in the studied center throughout the one-year target period was 44 018 695 695 Rials (≃ $US 423 745) (59. 27% of which was spent on CT scan, 16. 09% on ultrasound, 13. 75% on plain radiography and 10. 87% on MRI). Conclusion: According to the collected data, the total cost of radiology was 44018695695 Rials. The highest cost was related to CT scan modality, and the lowest belonged to MRI.

Objective: Patella is a sesamoid bone which develops in the quadriceps tendon. It is an uncommon site for neoplasms. The most common primary tumors which involve patella are benign. These include chondroblastoma, giant cell tumor (GCT) and aneurysmal bone cyst. Malignant lesions are less common in patella. These encompass metastasis, osteosarcoma and hemangioendothelioma. The most common complaint in patients of GCT patella is anterior knee pain. Early diagnosis and optimal management are necessary for improving survival rate in these patients. Case Presentation: The authors present a case report of GCT of patella in a 16-year old child. Incisional biopsy was done to confirm the diagnosis. Further radiological examination showed that the tumor involved almost whole of the patella. Hence, surgical management in the form of patellectomy and extensor mechanism repair was done to improve the outcome of the disease. The patient did not have any clinical or radiological symptoms at the end of the final follow up of 22 months. Conclusion: Primary tumor of patella is a rare entity. Benign tumors like GCT present only with anterior knee pain and should be included in the differential diagnosis of anterior knee pain. MRI is useful to determine the extent of involvement of tumor in the patella. Treatment may vary from curettage and bone grafting to total patellectomy with extensor mechanism repair.

Objective: One of the most frequent causes of death and acquired disability in the pediatric population is the Traumatic Brain Injury (TBI). TBI is secondary to falls, road traffic and vehicle collisions, child abuse and assaults. Penetrating brain injury is a severe form of traumatic brain injury. Blunt head injury is more frequent than TBI in children, but the second one carries a poor prognosis and a worse outcomes. Case Presentation: We report a pediatric case of penetrating craniofacial trauma, caused by a pencil in to the eye, and the successful of multidisciplinary management. Conclusion: Traumatic head injuries in children are frequently seen in the emergency ward, but the penetrating head injuries are unusual in young children. This case shows the importance of the ‘ first golden hour’ after head trauma. The collaboration between team members, added to a promptly and invasive strategy, allowed to reduce neurological sequelae.