Effect of Advanced Trauma Life Support program on medical interns＇ performance in simulated trauma patient management

Objective： Since appropriate and time- table methods in trauma care have an important impact on patients＇ outcome, we evaluated the effect of Advanced Trauma Life Support （ATLS） program on medical interns＇ performance in simulated trauma patient management. Methods： A descriptive and analytical study before and after the training was conducted on 24 randomly se- lected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed in- terns＇ clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant. Results： Our findings showed that interns＇ ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns＇ clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations （P〈0.001, P=0.016 and P=0.01 respectively）. Conclusion： ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

Bedside ultrasonography for verification of shoulder reduction： A long way to go

Purpose： Shoulder dislocation is a common joint dislocation managed by the emergency physicians in the emergency departments. Pre- and post-reduction radiographic examinations have long been the standard practice to confirm the presence of dislocation and the successful reduction. However, shoulder ultrasonography has recently been proposed as an alternative to the radiographic examination. This study aimed to assess the accuracy of ultrasonography in evaluating proper reduction of the dislocated joint. Methods： This was a prospective observational study. All patients with confirmed anterior shoulder dislocation were examined by both ultrasonography and radiography after the attempt for reduction of the dislocated joint. The examiners were blinded to the result of the other imaging modality. Results of the two methods were then compared. Results： Overall, 108 patients with confirmed anterior shoulder dislocation were enrolled in the study. Ninety-one （84.3%） of the patients were males. Mean age of the participants was （30.11 ± 11.41） years. The majority of the patients had a recurrent dislocation. Bedside ultrasonography showed a sensitivity of 53.8% （95% CI： 29.1%-76.8%） and a specificity of 100% （95% CI： 96.1%-100%） in detecting inadequate reductions. The results of ultrasonography had a statistically significant agreement with the results of radiography （Kappa - 0.672, p 〈 0.001）. Conclusion： The results suggest that the sensitivity of post-reduction ultrasound is not sufficient for it to serve as a substitute for radiography.

Echocardiography integrated ACLS protocol versus con- ventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest

Objective： To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity （PEA） cardiac arrest and pre dicting the resuscitation outcomes. Methods： In this prospective interventional study, pa tients presenting with PEA cardiac arrest were randomized into two groups. In Group A, ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity, right ventricle dilation, left ventricle function, peri cardial effusion/tamponade and IVC size along with the ad vanced cardiac life support （ACLS） protocol. Patients in Group B solely underwent ACLS protocol without applying echocardiography. The presence or absence of mechanical ventricular activity （MVA） and evidences of PEA reversible causes were recorded. The return of spontaneous circulation （ROSC） and death were evaluated in both groups. Results： One hundred patients with the mean age of （58±6.1） years were enrolled in this study. Fifty patients（Group A） had echocardiography detected in parallel with cardiopulmonary resuscitation （CPR）. Among them, 7 pa tients （14%） had pericardial effusion, 11 （22%） had hypovolemia, and 39 （78%） were revealed the presence of MVA. In the pseudo PEA subgroup （presence of MVA）, 43% had ROSC （positive predictive value） and in the true PEA subgroup with cardiac standstill （absence of MVA）, there was no recorded ROSC （negative predictive value）. Among patients in Group B, no reversible etiology was detected. There was no significant difference in resuscitation results between Groups A and B observed （P=0.52）. Conclusion： Bedside echocardiography can identify some reversible causes of PEA. However, there are no sig nificant changes in survival outcome between the echo group and those with traditional CPR.

Establishment of a regional multicenter traumatic spine fracture/dislocation registry

Objective：Trauma is one of the leading causes of mortality and morbidity in adults and a major contributor to health care expenditures.Although spine-related injuries constitute a small proportion of trauma cases,they need special consideration due to poor functional outcomes and substantial burden.Despite relatively extensive previous studies on traumatic spinal injuries,there is still obscurity in some aspects of the issue.The purpose of this study is to establish a regional multicenter traumatic spine fracture/dislocation registry.Methods：This is a prospective case series study,including all patients with acute traumatic spine lesions admitted to a regional multicenter since 2014.Data is extracted based upon a form developed by Sina Trauma and Surgery Research Center,Tehran University of Medical Sciences,Tehran,Iran.Novel electronic data entry software is initiated and data will be entered to the software.Information remains confidential and security considerations will be taken based on standards of data entry systems.Results：The results of this study will include age and gender distribution of the patients,causes of injury,location of pain and neurological deficit,the American Spinal Injury Association score and Frankel grade on admission,at discharge,after 6 and 12 months and at the latest annual follow-up,radiologic findings,details of operative procedures and methods of external fixation.Conclusion：This study will identify prognostic factors that influence the ultimate fate of spine fracture patients and determine short and long-term outcome of different treatment methods.It can lead to a considerable improvement in patient care and will have a great national and transnational impact.