Bulletin of Emergency And Trauma
Year:2021 | Volume:9 | Issue:2|Papers Count:9

Objective: To analyze the factors associated with mortality in fracture patients with concomitant COVID-19 infection based on the available published data. Methods: Keywords such as “ fracture” and “ COVID or COVID-19” were searched through three major databases includes PubMed, EMBASE, and Google Scholar. Selection criteria were all published reports providing the mortality related information of COVID-19 positive fracture patients. Published papers containing mortality data of COVID-19 positive fracture patients were considered for qualitative review. For meta-analysis, the presenting individual’ s data were considered to study the different parameters association with mortality. Results: The rate of mean mortality in COVID-19 positive fracture patients was 34%, and 91. 7% of patients had hip fractures. Older age and hip fractures had a significant association with higher mortality rates in COVID-19 positive fracture patients. Conclusion: The mortality rates are considerably higher in COVID-19 positive patients with fractures compared to COVID-19 positive patients without fractures and to the COVID-19 negative fracture patients. Early surgical intervention should be preferred in hip fractures among COVID-19 positive patients for general stabilization and improved respiratory function. Older age and hip fractures are the main predictors of mortality in these patients.

Objective: To describe the restructuring in-hospital systems of care at a Level-1 trauma center in India and to analyze an injury volume and patterns for future preparedness as well as to establish a specific injuries preventive measures during health emergencies like COVID-19. Methods: Data was extracted from a prospectively managed trauma registry at level-1 trauma center in India. We have compared the data in lockdown period with the same day’ s number from the pre-lockdown period. Patients were categorized according to age, gender, injury cause, injury place, injury severity, and injury outcome to compare the statistical analysis between two periods. Results: Total emergency department (ED) trauma footfall decreased significantly by 73% during lockdown period. The injuries result increased significantly due to blunt forces. There was a significant decrease in the major injury of the patient’ s percentage. The road traffic injuries (RTIs) in individuals were less than the reported falls number, which increased significantly during lockdown. The less number of patients significantly presented without receiving primary care. Majority of the patients had been transferred by using private cars, police vehicle, and two wheelers during lockdown; however, patients’ less number were transferred significantly by three wheelers as expected. The comparative analysis between quantitative data points shows significant differences in median Injury Severity Score (ISS) and length of stay during lockdown. Conclusion: This study highlighted that the preparedness should not focus solely on the response to treat infectious disease during health emergencies but also on ensuring access and provision of reasonable quality of care for non-infectious illnesses especially acute conditions like trauma.

Objective: To assess the possible factors associated with increasing risk of COVID-19 among EMTs. Methods: This study was a case-control study conducted in Tehran, Iran. Case group was consisted of confirmed COVID-19 EMTs based on the results of reverse transcriptase polymerase chain reaction and/or lung computed tomography scan. Healthy EMTs were randomly selected as control group. Patients were asked to fill out a checklist including demographic data, data related to the work situation (such as number of missions and type of mask and cloth) and PPE precautions. Results: Sixty-eight patients and 148 healthy persons took part in this study as case and control group, respectively. Having two EMTs involved directly in taking care of patients (p<0. 001) and working with a confirmed case teammate (p<0. 001), considering the precautions such as seal check after wearing the mask (p=0. 015), covering the hair with a medical hat (p<0. 001), not using personal items despite protective clothing (p<0. 001), and avoiding contact with the outer surface of clothing while removing (p<0. 001) had significant difference in two groups. Conclusion: We found that the type and method of use of PPE were correlated with the increasing risk of COVID-19 in EMTs. Also, we found that when two EMTs were involved directly in taking care of the patients, and those who worked with a confirmed case teammate, more frequently affected.

Objective: To compare the ketamine efficacy at a sub-dissociative morphine dose to reduce pain in isolated limb traumatic injuries. Methods: A double-blind randomized clinical trial study was carried out on patients referred to emergency departments (EDs) due to isolated limb traumatic injuries. Eligible patients were divided into two groups which one group received 0. 1 mg/kg ketamine and the other group received 0. 05 mg/kg morphine, intravenously. An observed side effect includes pain scores and vital signs were recorded at baseline of every 5 minutes for 30 minutes. Results: Totally, 73 patients with the mean age of 32. 9± 10. 4 were enrolled of whom 59 (80. 8%) individuals were men. The baseline characteristics difference of the two study groups was not statistically significant. The results showed that the change of mean pain score was-6. 2 (95% CI:-5. 72 to-6. 69) points in the group receiving ketamine compared to-5. 8 (95%CI:-5. 15 to-6. 48) in the group who were administered morphine. At all assessed checkpoints, the pain mean score was lower in the ketamine group than in the morphine group (p<0. 05); the mean of total pain reduction was greater in the ketamine group during the observation period compared with patients who received morphine (p=0. 002). Conclusion: The study findings suggest that the sub-dissociative ketamine efficacy in controlling of the acute pain is not lower than morphine sulfate in patients with isolated limb trauma in ED’ s. Thus, it can be considered as a safe and effective alternative approach.

Objective: To evaluate the clinical and epidemiological features of deceased patients and comparing the discrepancies between male and female patients based on high prevalence of coronavirus disease 2019 (COVID-19), its irreversible effects and the rising mortality rate in Jahrom city, Methods: This is a descriptive-analytical retrospective study that was conducted from the beginning of March 2020 to the end of November 2020. The study population were included all patients with COVID-19 who admitted to Peymaniyeh Hospital in Jahrom and died of COVID-19. Clinical and demographic data were collected from medical records and analyzed by SPSS software. Results: In this study, 61 patients (57. 54%) were men and 45 patients (42. 36%) were women. The mean age was 68. 7± 18. 33 in men and 68. 82± 14. 24 in women. The mean hospitalization length was 9. 69± 7. 75 days in men and 9. 69± 7. 75 days in women patients. There was no statistically significant difference between men and women patients (p>0. 05). The results showed that 17 (27. 87%) men and 28 (45. 9%) of women patients had hypertension and the prevalence of this disease was significantly higher in women than men (p=0. 01). In this study, 7 (11. 48%) men and 13 (21. 31%) women had hyperlipidemia. The frequency of hyperlipidemia in women cases was significantly higher than in men patients (p=0. 024). Men cases’ diastolic blood pressure (mean=77. 53) was significantly higher than women’ s diastolic blood pressure at the same time with a mean of 71. 42 (p<0. 05). Conclusion: The findings of the study represented the mortality rate in men which is higher than women patients. The prevalence of underlying diseases such as hypertension and hyperlipidemia were higher in women than men. Despite higher mortality among women, symptoms such as fever and dyspnea were less common in women than men.

Objective: To investigate and understand the current status of inter-organizational management in relief organizations as well as the relief organizations personnel behavior when facing mass traffic incidents (MCTI). The inter-organizational barriers and facilitators are also discussed in response to MCTI management and in order to help direct future actions to improve pre-hospital emergency services. Methods: The current qualitative study was performed through face-to-face, semi-structured interviews with 31 individuals from pre-hospital emergency services authorities and personnel, Red Crescent and Yazd, Kohgiluyeh and Boyer-Ahmad, Fars, and Qom provinces police. These provinces were selected by purposive sampling in 2018-2019. The conventional content analysis method was applied to analyze the data in this research. Results: Three main categories and 14 subcategories were determined. The categories are including relief organizations coordination (having four subcategories: independent relief organizations, interdepartmental services integration, insufficient knowledge of organizations about one other, and performance based on job descriptions), resource and infrastructure management (having four subcategories: adverse information management, proper information management, lack of medical resources and capacities considered, and upgrading of medical resources and capacities considered), and response management of relief organizations (having six subcategories: incomplete assessment, improving the quality of assessment, weakness in establishing scene security, scene security management, poor response, and cooperation in response). Conclusion: Relief organizations need to perform under a unified command. It has inter-organizational cooperation and provide integration of interdepartmental services in order to manage responsiveness at the scene. It also prevents an independent, chaos, and inability of the injured to properly understand and needs in MCTI.

Introduction: Wound debridement is necessary before skin grafting or wound closure. Inappropriate wound bed preparation will led to graft rejection and sometimes catastrophic results, especially in large wounds, . Usage of popular debridement and excision devices such as dermatomes has some difficulties and disadvantages. In this study we will introduce metallic scrub sponge as a safe and effective debridement device. Methods: The surgeon usually uses a sterile metallic scrub sponge over the wound with transverse or rotational repeated movement. Wound preparing with metallic sponge should be stopped when pinpoint bleeding occurs. We used sterile metallic sponge for more than 2500 burn patients. Results: The results are excellent for deep second degree burn (and deeper burns at least 5-10 days after burn when some eschar loosening occurs). Work with scrub sponge was effective, fast and safe. Discussion: Metallic scrub sponge is a useful device for wound preparation due to its some special characteristics. Debridement of the burn wound with metallic sponge can preserve the spontaneous epithelialization potential of skin in second degree burns and reduce additional injury to the viable tissue that is inevitable by surgical debridement. Cost effectiveness, easy accessibility, safety, softness, inertness and some others are among the other advantages of metallic sponge usage for wound preparation. Conclusion: Due to metallic sponge’ s simplicity and capability to remove necrotic loose tissues and easy accessibility everywhere and minimal adverse effects, it is a good first line tool for wound preparation and debridement.

Meckel’ s diverticulum is the most common gastrointestinal congenital defect, which, although asymptomatic in adults, may present symptoms in obstruction, inflammation, bleeding and foreign body perforation. There are only 8 cases reported of Meckel’ s diverticulum perforation by chicken bone. We report a case of a 24-yearold man presenting a 2-day-history of periumbilical pain that shifted to the right lower quadrant in 24 hours. Clinical and laboratory findings led to an appendicitis diagnosis, followed by laparotomy. Normal appendix was found intraoperatively along with an incidental finding of an inflamed and perforated Meckel’ s diverticulum by chicken bone. Diverticulectomy and enteroanastomosis were performed and the patient had a successful recovery, being discharged 5 days after. Although rare, its clinical presentation might be similar to acute appendicitis, which restate the importance of collecting a detailed clinical history and examining the small bowel towards to investigate a possible Meckel’ s diverticulum complication in the differential diagnosis.

Dear Editor, I read with interest the article on this issue of the Journal of Bull Emerg Trauma, the clinical article titled “ Functional Outcome of Surgical versus Conservative Therapy in Patients with Traumatic Thoracolumbar Fractures and Thoracolumbar Injury Classification and Severity Score of 4; A Nonrandomized Clinical Trial” by Koosha et al., [1]. However, this article needs to be seriously corrected as follow: 1-Persian validation study of JOABPEQ tool was not considered; hence the study is not scientifically valid. . .