A review on using ultrasound for evaluation of pediatric blunt abdominal trauma

This study reviewed the former studies conducted on the usefulness of accuracy of focused assessment withsonography for trauma (FAST) or any plain ultrasonography (US) scan in pediatric blunt abdominal trauma(BAT), to assess its accuracy, sensitivity, specificity, and positive and negative predictive values (PPV and NPV).Searches were conducted using the predefined keywords and Medical Subject Headings (MeSH) terms acrossMEDLINE (PubMed), Scopus, Web of Science, Cochrane Collaboration Library, Embase, ClinicalTrials.gov, Magiran and SID.ir databases. Duplicate publications were excluded; then the titles and abstracts of eligible studies were reviewed for how they report blunt trauma, pediatric patients, and ultrasound modality in their text. Cochrane RevMan version 5.3 was used for the results analysis and assessing the risk of bias in the studies.Out of 923 studies, 902 were excluded, and only 19 articles were included in this review, out of which one wasa randomized clinical trial (RCT), three were cohort studies, two were contrast-enhanced US (CEUS) studies,and 13 were prospective or retrospective descriptive studies. The total population studied in the articles was3454 patients. The results showed that the specificity of US in pediatric BAT was 93%, the sensitivity was 54%,and the PPV in comparison to clinical examination was 73% versus 37%. CEUS protocol achieved 100% in bothsensitivity and specificity analysis. The only RCT study which included about 28% of the studies population alsoreached a sensitivity and specificity of 97% and 98%, respectively using a combinational protocol of clinical examination, laboratory investigation, and US assessment. Ultrasonography does not provide more results than clinical examination, though better PPV results. A combination of follow-up, US examination, and laboratory requests may also have more accurate results. Moreover, a CEUS protocol may reach that goal with an acceptable time-saving outcome, but it needs more studies to be confirmed

Efficacy of Half-length vs. Standard-sized Short Arm splint in Soft Tissue Injuries of the Hand and Wrist: a Randomized Controlled Trial

Introduction: Hand and wrist soft tissue injuries are common orthopedic problems that are traditionally treated with short arm splint, which covers the forearm to 1 cm distal to the elbow crease. Objective: The present study was conducted to compare the treatment efficacy of traditional standard-size splint with half-length short arm splint. Method: In this randomized, controlled, clinical trial, patients with hand and wrist soft tissue injuries were randomly assigned to two groups. Group one received standard-sized short arm splints and the other group received half-length short arm splints. The swelling and pain scores were compared between the groups by the end of weeks one, two and three. Results: A total of 256 patients with a mean age of 36.96 ± 12.27 years were enrolled in this study, and 71.9% of them were male. No statistically significant differences were observed in terms of swelling between the two groups after one and two weeks (P=0.41, P=0.18). None of the patients had swelling after three weeks. No statistically significant differences were observed between the two groups in terms of the pain score after one, two and three weeks (P=0.47, P=0.29, P=0.92). Conclusion: In this study, half-length short arm splints were found to be as effective as standard short arm splints

Excessive endotracheal tube cuff pressure: Is there any difference between emergency physicians and anesthesiologists?

Introduction. Endotracheal tube (ETT) cuff pressure is not usually measured by manometer and the providers rely on their estimation of cuff pressure by palpating the pilot balloon. In this study, we evaluated the pressure of ETT cuffs inserted by emergency physicians or anesthesiologists, and assessed the accuracy of manual pressure testing in different settings using a standard manometer. Methods. In this cross sectional study, the cuff pressure of 100 patients in emergency department (ED) and intensive care units (ICU) of two university hospitals was evaluated by using a sensitive and accurate analog standard manometer after insertion of the ETT and checking the pilot balloon by the provider. All measurements were performed by a person who was blinded to the study purpose and an ideal pressure range of 20 to 30 cmH 2 O was used for analysis. Results. Emergency physicians (n=58) and anesthesiologists (n=42) performed the intubations. The mean measured cuff pressure in our study was 69.2±29.8 cmH ded standard value of 25 cmH 2 2 O (range: 10-120 cmH 2 O) which was significantly different from the recommen- O (P<0.0001, one-sample t-test). No difference was found between anesthesiologists and emergency physicians in cuff inflation pressures (Anesthesiologists = 71.1 ± 25.7; Emergency physicians = 67.9±32.6). Conclusion. Estimation of cuff pressure using palpation techniques is not accurate. In order to prevent adverse effects of cuff overinflation, it is better to recheck the pressure using a manometer, regardless of place, time and the inserter of the endotracheal tube

Comparing the Outcome of Immobilizing Lower Limb Injuries Using Standard-Sized and Half-Length Short Leg Splints

Background: Soft tissue injuries (STIs) of lower extremities are considered as a very common complaint in those patients that were admitted to the emergency department. One of the main purposes in these patients' treatment strategies is early returning to work and regular activities. This study purpose was to compare the results of two lower limb (leg) splinting methods: standard-sized short leg splinting, and also half-sized short leg splinting. Methods: In this randomized controlled clinical trial research, we enrolled those patients with STI of the lower limb and without bone fracture. The setting was Haftom Tir trauma center and all patients signed the written consent before the study starting. We categorized participants into two groups: standard-sized short leg splint and halfsized short leg splint. The data were entered into SPSS 18 software and also were analyzed using that. Results: 300 patients were included in this study totally. The splinting complications were similar in two groups, but the splint fracture and skin burn frequency were significantly lower in half-sized short leg splint (p value &lt;0.005). The mean score of pain and swelling frequency had no significant differences in both groups (P&gt;0.005). Conclusions: The results indicated that the performance of standardsized and half-sized short leg splinting was similar in lower limbs STIs. The difficulties were less in half-sized short leg splint. Therefore, this study recommend that emergency physicians could consider half-sized short leg splinting in STIs, but the recommendation may be considered as valuable when this study results reassess in other clinical trials with multicenter researches and more sample size

Comparing the Outcome of Immobilizing Lower Limb Injuries Using Standard-Sized and Half-Length Short Leg Splints

Background: Soft tissue injuries (STIs) of lower extremities are considered as a very common complaint in those patients that were admitted to the emergency department. One of the main purposes in these patients' treatment strategies is early returning to work and regular activities. This study purpose was to compare the results of two lower limb (leg) splinting methods: standard-sized short leg splinting, and also half-sized short leg splinting. Methods: In this randomized controlled clinical trial research, we enrolled those patients with STI of the lower limb and without bone fracture. The setting was Haftom Tir trauma center and all patients signed the written consent before the study starting. We categorized participants into two groups: standard-sized short leg splint and halfsized short leg splint. The data were entered into SPSS 18 software and also were analyzed using that. Results: 300 patients were included in this study totally. The splinting complications were similar in two groups, but the splint fracture and skin burn frequency were significantly lower in half-sized short leg splint (p value &lt;0.005). The mean score of pain and swelling frequency had no significant differences in both groups (P&gt;0.005). Conclusions: The results indicated that the performance of standardsized and half-sized short leg splinting was similar in lower limbs STIs. The difficulties were less in half-sized short leg splint. Therefore, this study recommend that emergency physicians could consider half-sized short leg splinting in STIs, but the recommendation may be considered as valuable when this study results reassess in other clinical trials with multicenter researches and more sample size

Efficacy of Half-length vs. Standard-sized Short Arm splint in Soft Tissue Injuries of the Hand and Wrist: a Randomized Controlled Trial

Introduction: Hand and wrist soft tissue injuries are common orthopedic problems that are traditionally treated with short arm splint, which covers the forearm to 1 cm distal to the elbow crease. Objective: The present study was conducted to compare the treatment efficacy of traditional standard-size splint with half-length short arm splint. Method: In this randomized, controlled, clinical trial, patients with hand and wrist soft tissue injuries were randomly assigned to two groups. Group one received standard-sized short arm splints and the other group received half-length short arm splints. The swelling and pain scores were compared between the groups by the end of weeks one, two and three. Results: A total of 256 patients with a mean age of 36.96 ± 12.27 years were enrolled in this study, and 71.9% of them were male. No statistically significant differences were observed in terms of swelling between the two groups after one and two weeks (P=0.41, P=0.18). None of the patients had swelling after three weeks. No statistically significant differences were observed between the two groups in terms of the pain score after one, two and three weeks (P=0.47, P=0.29, P=0.92). Conclusion: In this study, half-length short arm splints were found to be as effective as standard short arm splints

A survey on the knowledge of patients’ companions about the concept and application of hospital triage

Introduction: Given the importance of the subject and the knowledge gap, we decided to perform this survey. Methods: In this descriptive cross-sectional study, the knowledge levels of patients’ companions about the concept and application of hospital triage were evaluated in 202 subjects. The research population included patient companions referred to the emergency department (ED). The exclusion criterion was the failure to complete the questionnaire. Convenience sampling was done. Questionnaires were delivered to the companions of the patients. In this study, the data gathering tool was a questionnaire consisting of two parts. The final questionnaire included 13 questions, 10 and 3 of which were closed (multiple choice) and open questions, respectively. Finally, the age, level of education, and gender were also asked from participants. The level of patient triage was also determined in this research. Results: 202 questionnaires were completed by companions of patients admitted to the ED. The mean age of those who completed the questionnaire was 39.95±17.92 years, and 192 individuals expressed their gender, of which 123 (64.1%) and 69 (35.9%) persons were male and female, respectively. The level of education was also reported in 180 people. Moreover, diploma and postgraduate diplomas, bachelor’s degrees, and postgraduate or doctoral degrees were observed in 59 (32.77%), 90 (50%), and 31 (17.22%) patients’ companions respectively. Conclusion: According to the results, it seems that the knowledge about the concept of triage among ordinary people of the society is lower than the desired level