Background: According to the guidelines for treatment of multiple trauma patients, immobilization of the neck and neck collar fixation are essential. However, following neck collar fixation patients usually experience dyspnea. Some studies have found that neck collar fixation can lead to decreased pulmonary volumes, yet there have been no studies on the effect of neck collar fixation on patient ventilation.Objectives: The purpose of this study was to determine the effect of neck collar fixation on ventilation inmultiple trauma patients.Methods: This study was a descriptive-analytical study, which was performed in the emergency department of Tabriz University of Medical Sciences on multiple trauma patients with a Glasgow Coma Score (GCS) of 15. The effect of neck collar fixation on ventilation in the study participants was examined with the use of Capnography.Results: This study involved 163 multiple trauma patients. Of these, 65% were male. The mean of end tidal carbon dioxide (ETCO2) of the patients without neck collars was 34.62±4.46 and the mean ETCO2 of the patients with neck collars was 34.21±2.31. There was no significant difference between the means of ETCO2, before and after removing the neck collar, among the studied patients (P=0.196).Conclusions: According to the results of our study, neck collar fixation has no effect on ventilation in multiple trauma patients.

Background: Endotracheal intubation is the basic method of providing a safe cross‑, sectional airway area and the incorrect placement can be dangerous and causes complications. So this study aimed to access the diagnostic value of color Doppler epigastric ultrasound and linear probe suprasternal notch ultrasound in comparison with standard Capnography in confirmation of endotracheal tube (ETT) placement after intubation. Materials and Methods: This diagnostic value study was conducted on 104 patients requiring intubation who were referred to the Emergency Department. After the intubation, color Doppler epigastric ultrasound and suprasternal notch ultrasound as well as the standard Capnography were used to confirm the placement ETT. Results: The sensitivity and specificity of color Doppler epigastric ultrasound were 97. 96% and 100%, for suprasternal notch ultrasound were 98. 98% and 66. 67%, and for combination of the both methods were 96. 94% and 100% respectively that showed the significant diagnostic value in the confirmation of ETT placement (P < 0. 001). The mean of elapsed time to confirm the ETT placement by the standard Capnography method (17. 95 ±,2. 45 s) was significantly more than the two methods of epigastric ultrasound (10. 38 ±,4. 65 s) and suprasternal notch ultrasound (5. 08 ±,4. 45 s) as well as the combined method with the mean of 15. 46 ±,8. 31 s (P < 0. 001). Conclusion: The results of this study showed that although ultrasound is a potentially accurate, fast, and reliable method to confirm the endotracheal tube placement, but suprasternal notch ultrasound is considered to be a more appropriate diagnostic technique due to its higher sensitivity and less detection time compared to epigastric ultrasound and combined method.

Background: The analysis of arterial blood gas (ABG) is an invasive procedure that is used frequently in the emergency department (ED) to evaluate the acid-base status of critically-ill patients. However, capnometry is an alternative procedure that has been used in recent years to determine the metabolic status of patients’ blood. Considering the correlation between end-tidal carbon dioxide (ETCO2) and arterial partial pressure of carbon dioxide (PaCO2) identified in the previous studies and the strong correlation between PaCO2 and bicarbonate (HCO3-), we assumed that ETCO2 might be a useful parameter in predicting the presence of metabolic acidosis. The aim of this study was to determine the correlation between ETCO2 and the parameters of ABG in adult patients who were likely present metabolic acid-base disturbances in the Emergency Department of Imam Reza Hospital, the largest academic hospital in Mashhad in northeast Iran.Methods: This was a cross-sectional study conducted during six months on 62 adult patients who presented with suspected metabolic acid-base disorders to the ED. The exclusion criteria were patients with chronic obstructive pulmonary diseases, loss of consciousness, intubated patients, and those who were unable to tolerate Capnography. The patients’ demographic information and vital signs were recorded. Also, ABG and ETCO2 results were recorded. The Pearson product moment correlation analysis and linear regression were used to determine the correlation between ETCO2 and ABG parameters.Results: Sixty-four patients were enrolled, consisting of 37 men and 27 women with a mean age of 55.4 ± 22.7 years. The most common complaints presented were nausea and vomiting (n = 24). The average value for ETCO2 was 26.2 ± 6.1. There were significant linear correlations between ETCO2 level, pH (r = 0.368), HCO3 - (r = 0.869), PaCO2 (r = 0.795), and Base Excess (B.E.) (r = 0.346). HCO3 and PaCO2 were the significant predictor values for ETCO2 (linear regression analysis).Conclusion: ETCO2 can be an appropriate indicator to estimate HCO3- and PaCO2 in critical emergency situations, but it cannot be used as an indicator to estimate all ABG variables.

Background: While critically ill patients experience a life-threatening illness, they commonly develop ventilator-associated pneumonia (VAP) which can increase morbidity, mortality, and healthcare costs. The present study aimed to compare the effect of respiratory physiotherapy and increased positive end-expiratory pressure (PEEP) on Capnography results. Materials and Methods: This randomized control clinical trial was performed on 80 adult patients with VAP in the intensive care unit (ICU). The patients were randomized to receive either PEEP at 5 cm H2O, followed by a moderate increase in PEEP to 10 cm H2O, or PEEP at 5 cm H2O with respiratory physiotherapy for 15 min. The numerical values were recorded on the capnograph at minutes 1, 5, 10, 15, and 30 in both methods. Data collection instruments included a checklist and MASIMO capnograph. Results: As evidenced by the obtained results, the two methods significantly differed in the excreted pCO2 (partial pressure of carbon dioxide) (P<0.0001). However, the average amount of excreted pCO2 was higher in the respiratory physiotherapy and PEEP intervention (38.151mmHg) in comparison with increasing PEEP alone method (36.184mmHg). Also, PEEP elevation method prolonged the time of the first phase (inhalation time) and the second phase while shortening the third phase (exhalation time) in Capnography waves. Conclusion: CO2 excretion in patients with VAP increased after respiratory physiotherapy. Further, physiotherapy demonstrated more acceptable results in CO2 excretion compared with PEEP changes in mechanically ventilated patients.

Background: Airway management is an important skill for emergency physicians, and confi rmation of correct endotracheal tube (ETT) placement is a crucial component of airway management. Objectives: Due to the occurrence of incorrect ETT positioning in emergency departments, the present study aimed to compare the diagnostic sensitivity of ultrasound using suprasternal and subxiphoid methods for confi rming the correct placement of ETT compared to Capnography. Methods: This cross-sectional study was conducted by examining patients requiring intubation. Ultrasound was performed by two independent emergency medical assistants using two suprasternal and subxiphoid methods to confi rm correct ETT placement; the results were then interpreted. To observe the tube passage through the vocal cords, Capnography and lung auscultation were applied as the gold standards, and the results of two ultrasound methods were compared. Results: A total of 66 patients, who were intubated in the emergency department, participated in this study. The positive and negative predictive values, sensitivity, and specifi city of supernatural ultrasound were 96. 72%, 80%, 98. 33%, and 66. 67%, respectively. Also, positive and negative predictive values, sensitivity, and specifi city of subxiphoid ultrasound were 97. 95%, 29. 41%, 80%, and 83. 33%, respectively. The diagnostic odds ratios of suprasternal and subxiphoid ultrasounds were 1. 026 and 1. 024 compared to Capnography, respectively. Conclusions: Ultrasonography using the suprasternal method was feasible. Considering the high sensitivity and specifi city of this method in confi rming correct ETT placement, it produced reliable results. Overall, this modality can be used as one of the main methods to verify correct ETT placement in emergency departments.