ANATOMIJA I LIJEČENJE PRIJELOMA REBARA U AVICENINU PRIKAZU

Introduction: Avicenna stated interesting points on the symptoms of rib bone fractures, their physical examination, and also treatment and management of the complications in his master piece Canon in Tibb. Method: We reviewed Avicenna’s Canon and his viewpoints on the anatomy of the rib bones and their fractures and compared it with conventional medicine. Result: He described the anatomy of the ribs; he explained the effectiveness of their structure in the protection of vital organs. He also suggested some methods for the management of rib fractures, such as using vacuum at the fracture site or open surgery in case of complications. Conclusion: Avicenna’s point of view on the approach toward rib fractures had some similarities and differences with conventional practice. Some of his suggestions could be taken into account.Uvod: U svom remek-djelu Canon u Tibbu Avicena je iznio zanimljiva gledišta vazana uz simptome prijeloma rebrenih kostiju i njihov fizički pregled te liječenje komplikacija. Metoda: Donosimo pregled Avicenina Canona i njegova pogleda na anatomiju rebrenih kostiju i njihove prijelome i uspoređujemo ih s konvencionalnom medicinom. Rezultat: Avicena je opisao anatomiju rebara; objasnio je djelotvornost njihove strukture u zaštiti vitalnih organa. Predložio je i neke od metoda za liječenje prijeloma rebara poput upotrebe vakuuma na mjestu prijeloma ili otvorene operacije u slučaju komplikacija. Zaključak: Avicenin pogled na pristup liječenju prijeloma rebara imao je neke sličnosti i razlike s konvencionalnom praksom. Neka od njegovih razmišljanja mogu se i danas uzeti u obzir

Outcome of Patients Underwent Emergency Department Thoracotomy and Its Predictive Factors

Introduction: Emergency department thoracotomy (EDT) may serve as the last survival chance for patients who arrive at hospital in extremis. It is considered as an effective tool for improvement of traumatic patients’ outcome. The present study was done with the goal of assessing the outcome of patients who underwent EDT and its predictive factors. Methods: In the present study, medical charts of 50 retrospective and 8 prospective cases underwent emergency department thoracotomy (EDT) were reviewed during November 2011 to June 2013. Comparisons between survived and died patients were performed by Mann-Whitney U test and the predictive factors of EDT outcome were measured using multivariate logistic regression analysis. P < 0.05 considered statistically significant. Results: Fifty eight cases of EDT were enrolled (86.2% male). The mean age of patients was 43.27±19.85 years with the range of 18-85. The mean time duration of CPR was recorded as 37.12±12.49 minutes. Eleven cases (19%) were alive to be transported to OR (defined as ED survived). The mean time of survival in ED survived patients was 223.5±450.8 hours. More than 24 hours survival rate (late survived) was 6.9% (4 cases). Only one case (1.7%) survived to discharge from hospital (mortality rate=98.3%). There were only a significant relation between ED survival and SBP, GCS, CPR duration, and chest trauma (p=0.04). The results demonstrated that initial SBP lower than 80 mmHg (OR=1.03, 95% CI: 1.001-1.05, p=0.04) and presence of chest trauma (OR=2.6, 95% CI: 1.75-3.16, p=0.02) were independent predictive factors of EDT mortality. Conclusion: The findings of the present study showed that the survival rate of trauma patients underwent EDT was 1.7%. In addition, it was defined that falling systolic blood pressure below 80 mmHg and blunt trauma of chest are independent factors that along with poor outcome

Initial GCS and laboratory findings of patients with TBI are associated with the GOSE and mortality rate at one year

Background: To evaluate the relationship between presenting Glasgow Coma Scale (GCS) or laboratory data of patients with TBI and Extended Glasgow Outcome Scale (GOSE) and final outcome (deceased, survived) at one year.Methods: 74 patients (59 males and 15 females; mean age ±SD of 40±19years) who presented with TBI were entered into the study, and their GCS and laboratory data were recorded. After one year, GOSE level and final outcome were evaluated with 11 yes/no questions obtained from the patients or their first-degree relatives.Results: The patients with lower GCS on admission or day six, significantly had lower GOSE. Moreover, the lower the GCS in the first week of admission, the poorer the final outcome. Among laboratory data, the base deficit (BD) level of -6 or worse on admission was an indicator of mortality at one year. Hypernatremia was the only laboratory factor which predicted poor GOSE after a year. Furthermore, patients with serum hypernatremia, hyperkalemia, or high PTT levels on the first week of admission had poor final outcome.Conclusions: Presenting GCS and metabolic derangements are reliable indicators of long-term outcome and GOSE at one year.

Potential Risk Factors of Death in Multiple Trauma Patients

Introduction: Trauma has been recognized as one of the leading causes of death in many countries for decades. Reduction in mortality and morbidity rate of trauma cases is one of the most important attitudes in this field. Evaluation of different risk factors have been considered as the main goal of some studies. The purpose of this study was determining potential risk factors of death in trauma patients. Method: In a retrograde study, data of 740 patients admitted during three years (2009-2011) were studied. Demographic data (sex and age), clinical factors (blood pressure, pulse rate, respiratory rate, Glasgow coma scale (GCS)), trauma characteristics (location, type of injury, etc.), as well as outcome of patients were evaluated. Data analyses was done using SPSS 18.0. Stepwise multivariate regression analysis was used for recognition of independent predictive factors of death in multiple trauma patients. Results: Of those admitted, majority of patients were male (81.4%), 68% between 18 to 60 years, and 11.2% of them died during the course of treatment. Age; type of trauma; abnormal respiration rate, pulse rate, blood pressure; total GCS ≤8; abnormal pupil size; and head and neck; vertebral, and extremities fractures were obtained as significant predictive factor of death. GCS≤8, head and neck fracture, and abnormal pulse rate were independent death predictors. Conclusion: We identified GCS≤8, head and neck fracture, and abnormal pulse rate as predictive factors of mortality after trauma, which remained independent in the presence of all other factors and potentially treatable

The Coagulopathy-Predicting Factors In Acute Trauma Patients Using The Generalized Estimation Equations Model

Introduction: Coagulation disorder is one of the major phenomena following the trauma which can deteriorate the condition of the patients. The aim of this study is to determine some factors predicting the incidence of coagulation disorder among acute trauma patients. Methods: The generalized estimation equations were used to determine the predictors of blood coagulation disorders in a sample of 736 people over 16 years of age with acute trauma in Shahid Rajaei Hospital in Shiraz. The response variable was converted based on PT, PTT, INR, and fibrinogen level criteria as a two-state variable (with/without coagulation disorder). In the data analysis, the correlation of the coagulation disorder was considered in the first and second stages. Results:The prevalence of coagulation disorders (mild, moderate and severe) was 19% in two stages and coagulation disorders (moderate and severe) was 7.5%. Motor vehicle accident was the most common cause of injury.The variables of blood sugar, diastolic blood pressure, pH, and sodium had a significant effect on coagulation disorders (mild, moderate, and severe). Moreover, blood phosphorus, age, and pupillary reflex had a significant effect on coagulation disorders (moderate and severe). Conclusion: Predictors of coagulation disorders (mild-moderate-severe) include blood sugar, diastolic blood pressure, pH, and sodium. Moreover, blood phosphorus, age, and pupil reflex are predictors of moderate and severe coagulopathy. this model that taking into account the exchangeable correlation of first- and second-stage coagulopathy had a better fit than the model ignoring this correlation

Efficiency of Respiratory Index in Determining Short-Term Prognosis of Multiple Trauma Patients: A Cross-Sectional Study

Background Being aware of trauma patients conditions and predicting their outcome has always been of a great interest. To determine the state and prognosis of these patients, we should find ways to enable the timely identification of those with poor health and allow the physicians to treat them before the situation gets out of hand. Objectives The present study aimed at evaluating the efficiency of respiratory index (RI) in determining the short-term prognosis of multiple trauma patients in comparison with revised trauma score (RTS). Methods In this cross-sectional study, all multiple trauma patients who were admitted to emergency department (ED) of Shahid Rajaee hospital, Shiraz, Iran, during September and October 2013 were included. Demographic data and data regarding vital signs (blood pressure, heart rate, respiratory rate, GCS, and oxygen saturation), respiratory tract status, trauma type, blood gases, procedures performed in resuscitation room, and final outcome of the patients (discharge, disposition to general unit, intensive care unit, or operating room, and dying) were recorded using a predesigned checklist. Based on the collected data, RTS and RI were calculated for each patient and their correlation and the final outcome were evaluated. Results Evaluating 187 multiple trauma patients showed that 131 (70) patients had head injury, 78 (42) chest injury, 66 (35) abdominal injury, 49 (26) extremity injury, 27 (14) neck injury, and 4 (2) vascular injury. A significant correlation was seen between RI and RTS (P = 0.024). RTS differentiated patients with good and poor health (P < 0.05), while RI showed no significant correlation with patients short-term final outcome. Conclusions Based on the findings of this study, RI cannot properly estimate short-term prognosis of multiple trauma patients, but it can be used as an independent factor in evaluating the severity of injury

Effects of Intravenous Fluid Therapy on Clinical and Biochemical Parameters of Trauma Patients

Introduction: The administration of crystalloid fluids is considered as the first line treatment in management of trauma patients. Infusion of intravenous fluids leads to various changes in hemodynamic, metabolic and coagulation profiles of these patients. The present study attempted to survey some of these changes in patients with mild severity trauma following normal saline infusion. Methods: This study comprised 84 trauma patients with injury of mild severity in Shahid Rajaei Hospital, Shiraz, Iran, during 2010-2011. The coagulation and metabolic values of each patient were measured before and one and six hours after infusion of one liter normal saline. Then, the values of mentioned parameters on one and six hours after infusion were compared with baseline measures using repeated measures analysis of variance. Results: Eighty four patients included in the present study (76% male). Hemoglobin (Hb) (df: 2; F=32.7; p&lt;0.001), hematocrit (Hct) (df: 2; F=30.7; p&lt;0.001), white blood cells (WBC) (df: 2; F=10.6; p&lt;0.001), and platelet count (df: 2; F=4.5; p=0.01) showed the decreasing pattern following infusion of one liter of normal saline. Coagulation markers were not affected during the time of study (p&gt;0.05). The values of blood urea nitrogen (BUN) showed statistically significant decreasing pattern (df: 2; F=5.6; p=0.007). Pressure of carbon dioxide (PCO2) (df: 2; F=6.4; p=0.002), bicarbonate (HCO3) (df: 2; F=7.0; p=0.001), and base excess (BE) (df: 2; F=3.3; p=0.04) values showed a significant deteriorating changes following hydration therapy. Conclusion: It seems that, the infusion of one liter normal saline during one hour will cause a statistically significant decrease in Hb, Hct, WBC, platelet, BUN, BE, HCO3, and PCO2 in trauma patients with mild severity of injury and stable condition. The changes in, coagulation profiles, pH, PvO2, and electrolytes were not statistically remarkable.

Design and Evaluation of the “Preparation Course for New Entrant Assistants” on the Awareness and Skills of Newly Arrived Surgery Resident

Background: Beginning of assistance course is associated with anxiety. This due to unfamiliarity with the&nbsp;assistance and insufficient training, knowledge, and required skills. The aims of this study were to design,&nbsp;implement and evaluate the effects of a period of 1-month as “preparation course for new entrant assistants” on&nbsp;the awareness and skills of newly arrived residents.Methods: 12 newly arrived assistant student were divided into two equal groups. Some steps such as&nbsp;understanding the environment and legislation, education about an emergency, and dealing with patients and&nbsp;also, suturing, chest tube insertion, and cut down skills were passed by the first group before starting the&nbsp;assistance course. The second group was entered in the assistance course without this preparation course. For&nbsp;performance evaluation and comparison of these two groups, four questionnaires were created and filled&nbsp;consequently before the entrance, at the end of the 2nd&nbsp;month, based on direct observation of procedural skills&nbsp;(DOPS) exam, and at the end of 6th&nbsp;month.Results: There were no significant differences between two groups at the beginning of the study (P &lt; 0.05). At&nbsp;the end of the 2nd&nbsp;month, the first group had better performance in understanding the environment, patient&nbsp;examination, diagnosis and emergency skills in comparison to the second group (P &lt; 0.05). Based on the&nbsp;DOPS score, the first group had significantly better performance (P &lt; 0.05) except in performing cut-down (P &gt; 0.05). Also procedure, the first group was better than the second group just in the consensus of the&nbsp;procedure (P &lt; 0.05). Finally, at the end of the 6th&nbsp;month, the difference between two groups was becoming&nbsp;lower, and supervisors believed that after additional 3 months, this difference would be lost.Conclusions: Conducting a 1-month period of preparation for new entrant assistants can be useful in&nbsp;increasing awareness, understanding the environment, performance, the knowledge of the theory and how to&nbsp;deal with patients as well as increase their skills in performing the expected procedures

The Prevalence of Pain and the Role of Analgesic Drugs in Pain Management in Patients with Trauma in Emergency Department

Background: Pain could potentially affect all aspects of patient admission course and outcome in emergency&nbsp;department (ED) when left undertreated. The alleviation of acute pain remains simply affordable but is usually,&nbsp;and sometimes purposefully, left untreated in patients with trauma. This study challenged the conventional&nbsp;emergency department policies in reducing the intensity of acute pain considering the pharmacological treatments.Methods: In this case-control study, the prevalence and intensity of pain in 200 patients were evaluated on&nbsp;admission (T1) and 24 hours later (T2) based on the valid, standardized 10-point numeric rating scale (NRS 0-10) for pain intensity. A group of patients received analgesic drugs and others did not. Changes in pain&nbsp;patterns regarding different aspects of trauma injuries in these two groups were compared.Results: The pain prevalence was high both on admission and 24 hours later. 51.5% of the study population&nbsp;received analgesics and 77.6% of them reported a decrease in the intensity of their pain. Only half of the&nbsp;patients, who did not receive any medication, reported a decrease in their pain intensity after 24 hours. The&nbsp;most beneficial policy to manage the acute pain was a combination therapy of the injury treatment and a&nbsp;supplementary pharmacological intervention.Conclusions: Pharmacological management of pain in patients with trauma is shown to be significantly&nbsp;beneficial for patients as it eases getting along with the pain, and still seems not to affect the diagnostic aspects&nbsp;of the trauma. Pain management protocols or algorithms could potentially minimize the barriers in current pain&nbsp;management of patients with trauma