Thoracic Pneumorrhachis in Patient with Lumbar Fractures; a Case Report

Pneumorrhachis as a relatively rare condition may be an indication of substantial intra-spinal column injury. Here we report a 39-year-old man was admitted because of low back pain and dyspenea after locating between motor vehicle and wall three days before admission. On arrival, physical exams and vital signs were normal. Computed tomography (CT) scan showed bilateral pleural effusion, fracture of ribs number 8, 9 and 10 in lower left side of thorax, fracture of vertebra in L2-L4, and air bubbles in upper thoracic spinal canal.

برقراری راه هوایی به روش جاگذاری لارنژیال تیوب در مقایسه با کامبی تیوب توسط دستیاران طب اورژانس بر روی مولاژ آموزشی

Introduction: Laryngeal tube (LT) and combitube (CT) are among devices used for establishing the airway in patients. This study was done with the purpose of comparing the success rate and duration of intubation when emergency medicine (EM) residents used LT or CT. Methods: In this cross sectional study, carried out in Tabriz, Iran, in 2016, all EM residents of Tabriz University of Medical Sciences were included. Number of attempts and time required for successful intubation via LT and CT and airway management were evaluated for each participant using a manikin. Results: A total of 52 EM residents in three groups (First Year: 17, Second Year: 16, and Third Year: 19) with the mean age of 36.24 ± 9.21 years participated in this study (61.53% male). All the residents were successful in inserting LT and CT on the first attempt. Mean duration of CT and LT placement in third year residents (7.5 ± 2.01, 6.39 ± 1.21, respectively) was significantly shorter than second year residents (9.25 ± 2.87, 8.06 ± 2.24, respectively) and first year residents (13.06 ± 3.54, 11.76 ± 2.43, respectively). Mean duration of CT placement (9.9 ± 3.15) was significantly greater than LT placement (8.71 ± 2.88) (p<0.05). Conclusion: Based on the results obtained in the present study, EM residents were successful in LT and CT placement into a manikin on the first attempt. However, time required for placement of LT was shorter than CT. مقدمه: لارنژیال تیوب و کامبی تیوب از جمله ابزاری هستند که برای برقراری راه هوایی در بیماران مورد استفاده قرار می گیرند. این مطالعه با هدف مقایسه میزان موفقیت و مدت زمان لوله گذاری با استفاده از لارنژیال تیوب و کامبی تیوب توسط دستیاران طب اورژانس انجام گرفت. روش کار: در این مطالعه مقطعی که در سال 1395 در شهر تبریز، ایران انجام گرفت کلیه دستیاران طب اورژانس دانشگاه علوم پزشکی تبریز مشارکت نمودند. تعداد دفعات تلاش و همچنین مدت زمان لازم جهت لوله گذاری موفق با استفاده از لارنژیال تیوب و کامبی تیوب و برقراری راه هوایی در یک مولاژ آموزشی توسط هر یک از شرکت کنندگان مورد ارزیابی قرار گرفت. يافته ها: در مجموع 52 نفر دستیار طب اورژانس در 3 گروه (سال اول 17، سال دوم 16و سال سوم 19 نفر) و با میانگین سن 21/9 ± 24/36 سال در این مطالعه شرکت نمودند (53/61 درصد مرد). تمام دستیاران در تلاش اول موفق به جاگذاری موفقیت آمیز لارنژیال تیوب و کامبی تیوب شدند. متوسط زمان جاگذاری کامبی تیوب و لارنژیال تیوب توسط دستیاران سال سوم (به ترتیب 01/2±5/7 و 21/1±39/6) به طور معنی داری کمتر از دستیاران سال دوم (به ترتیب 87/2±25/9 و 24/2±06/8) و دستیاران سال اول (به ترتیب 54/3±06/13 و 43/2±76/11) بود. میانگین زمان جاگذاری کامبی تیوب (15/3±9/9) به طور قابل توجهی بیشتر از جاگذاری لارنژیال تیوب (88/2±71/8) بود (05/0 > p). نتيجه گيری: بر اساس نتایج حاصل از این مطالعه دستیاران طب اورژانس در تلاش اول موفق به جاگذاری لارنژیال تیوب و کامبی تیوب بر روی مولاژ آموزشی شدند. ولی زمان مورد نیاز برای تعبیه لارنژیال تیوب در مقایسه با کامبی تیوب کمتر بود

Hypophosphatemia in critically ill children.

Introduction: Hypophosphatemia is a common disorder in critically ill patients, and is associated with myasthenia, especially in respiratory muscles, and respiratory infections. This study was conducted to describe the prevalence of hypophosphatemia in children hospitalized in the pediatric intensive care unit (PICU) of Children’s Hospital in Tabriz, Iran, in 2014-2015. Methods: In this descriptive study, medical records of all children admitted to the PICU of the children’s university hospital affiliated to Tabriz University of Medical Sciences were collected from archives of the hospital from 2014-2015 upon adopting permission. The medical records were examined in terms of demographic information, clinical diagnosis of the disease, serum phosphate level, nutritional status, therapeutic interventions, and other underlying specifications. The data were analyzed using SPSS software and descriptive tests. Results: Of the 83 eligible medical records, 45 records belonged to boys, and 38 records belonged to girls. The most prevalent and the least prevalent diseases in these children were acute pulmonary disease (57.8%) and septic shock (1.2%) respectively. Regarding the nutritional status, 38.6% of the children suffered malnutrition. Phosphorus deficiency was prevalent in the first day in 10.8% of the children, and abnormal levels of phosphorus were observed from the fourth to the sixth day in 26.5% of the children, which increased to 34.9% from the seventh to the tenth day. Conclusion: This study showed no statistically significant correlation between sex and prevalence of hypophosphatemia. Type of disease was not significantly associated with the level of phosphorus. Moreover, the patients’ nutritional status was not significantly associated with the prevalence of hypophosphatemia