BACKGROUND: HEAD injury is still a major cause of death and disability. Despite advances in intensive monitoring and clinical practice, little data is available to show the predictive value of intracranial PRESSURE monitoring in assessment of the outcome of HEAD injuries. This study was undertaken to evaluate this predictive value and is the first Iranian study in which ICP monitoring has been included. METHODS: In a prospective study from September 1999 to September 2003, all HEAD- injured patients (53 patients) with GCS of 4-8 who were admitted to Nemazee Hospital of Shiraz University of Medical Sciences were included in this study. Subarachnoid screw method or ventricular catheter via ventriculostomy was used to determine intracranial PRESSURE. Patients were monitored for 3 days and were followed for two years at 6-month intervals. RESULTS: Car accidents were the most common cause of HEAD injury (43.3%) and 43.3% of patients had GCS of 8. Sixty percent of patients had abnormal intracranial PRESSURE. The patients were most commonly in their first decade of life (18.8%) and 81% of patients were male. Controlling increased intracranial PRESSURE was successful in 60% of patients and resulted in a decrease of mortality rate from 60% to 15%. CONCLUSIONS: Early treatment of increased intracranial PRESSURE in HEAD injury patients would be beneficial in reducing mortality and morbidity rates.      

Dear Editor: Trauma patients are at high risk of cervical and associated injuries. The standard protocol includes immobilization of the cervical spine in a polytrauma as it will help to prevent spinal injuries in the prehospital settings. …

Background: The current study is to evaluate cardiovascular effects of anesthetic medications and volatile anesthetics on cardiac stress using cardiac stress index (CSI) and rate PRESSURE product (RPP) and to determine which of them in useful in evaluating cardiac stress after comparing results obtained from each method.Materials and methods: 40 patients, 60-80 years old, who were all performed trans abdominal prostatectomy were studied. Patients were divided into two groups, half of patients were placed in group A and the other half in group B. The study was carried out as a blinded study. CSI was measured and evaluated in group A and RPP changes were studied in group B.Results: The mean CSI were 60.25±5.57, 63.05±5.54, 55.75±4.78 and 67.65±4.88 before anesthesia induction, after induction, before surgical incision and in recovery respectively. There was no meaningful difference.RPP mean in four above mentioned stages was 10.15±0.44, 9.9±0.69, 6.8±0.36 and 9.2±0.61 respectively. There was a meaningful difference between RPP in stages before anesthesia induction and before surgical incision (P<0.0001).Conclusion: Considering the obtained results from this study, it can be seen that even in noncardiac surgery, the stress level is high in patients in the stage before surgery. This figure was not clear in RPP index case and was not in accordance with CSI, which means CSI has been able to illustrate existing stress level better and efficiently.

Background: A HEADache is the most common post-traumatic complaint in patients. Nurses can help to relieve the pain and to improve the quality of the care through non-pharmacological methods. The aim of this study was to determine the effect of PRESSURE on Hugo point on the severity of a HEADache after HEAD injury.Methods: In this clinical trial, 60 patients were randomly divided into two intervention and control groups after accessible sampling. At first, the severity of a HEADache was measured by Visual Analogue Scale. In experimental group, the PRESSURE was applied to Hugo point for 2 minutes followed by rest for 2 minutes; this procedure was repeated for 7 times. During this period, the control group received only routine care. The patients' pain scores were measured again after the intervention. Data analysis was performed using SPSS v.20 software.Results: There was a significant difference between the scores of pain in the experimental group before and after the intervention (P<0.05), however, this difference was not significant in the control group.Conclusion: Considering the ease of performing and the safety of this method, it is suggested to be used as an effective method to reduce the HEADache in patients.

The use of the cervical collar to support the HEAD and neck is inevitable in many patients with HEAD and spinal cord injuries. One of the consequences of using this instrument is the development of PRESSURE injuries. Therefore, in this review study, the incidence of as well as the risk factors for cervical collar-related PRESSURE injury in this group of patients was evaluated. The current study is a scoping review conducted in 2022. Five scientific databases (PubMed, Scopus, Web of Science, ProQuest, and CINAHL), as well as Google Scholar, were searched for relevant studies published from 1990 to 2022 using the following keywords: trauma, spinal cord injury, HEAD injury, HEAD trauma, collar, cervical collar, cervical immobilization, risk factors, incidence, PRESSURE injury, PRESSURE ulcer, and bed sore. The search was performed independently by two researchers. Articles from the initial search were first recorded in special tables, and then, were reviewed and analyzed separately by two researchers. After extraction, information from each article was entered into a special table categorized by year, country, study design, study population, the incidence of cervical collar-related PRESSURE injury, risk factors for cervical collar-related PRESSURE injury, and grades of PRESSURE injury. Of the 10 articles, 6 were retrospective cohort studies, 3 were cross-sectional descriptive studies, and 1 was a case report study. In terms of the study population, one study was conducted on pediatric patients, one was conducted on elderly patients, and eight were conducted on adults with HEAD and neck trauma. In eight articles, the incidence of cervical collar-related PRESSURE injury was reported. The reported incidence varied between 1. 1% and 78. 4%. In eight articles, risk factors for cervical collar-related PRESSURE injury were reported. The most common risk factors were duration of cervical collar use, hospitalization in intensive care units, low level of consciousness, and longer hospital stay. The current review study showed that a significant percentage of HEAD and neck trauma patients for whom cervical collar is used suffer from different grades of PRESSURE injuries. Hence, healthcare providers should consider this issue when caring for this group of patients and take the necessary preventive measures in this regard. It should be noted that previous studies in this field had significant limitations, and thereby, it is strongly recommended to conduct further studies with a stronger methodology.