Fat embolism is a rare complication of high or medium intensity trauma. It is caused by the formation of fat particles in the territories of small terminal circulation, especially at pulmonary, tegumentary and cerebral levels. The mechanism underlying the fat embolism is described by several different theories in literature. In legal medicine, fat embolism raises many controversies upon the diagnostic certainty of the thanatogenerator mechanism leading to death. The occurrence of fat embolism syndrome followed by death must be properly explained so that the fatality can be adequately framed from a legal point of view. In this paper the authors present three cases in which victims of trauma died due to clinically undiagnosed fat embolism, the diagnosis being established only by postmortem histopathological examination. The authors underline the fact that the diagnosis of fat embolism syndrome, although it is a clinical one, it is often established only during autopsy.
Background: Preparation and hospital development estimated an essential part of the policies and strategic purposes of healthcare in each government. Today, applications of management to reduce the burden of natural and technical disasters appear are very necessary. Objectives: The study aimed to review the major relevant articles in the case of the application of telemedicine for trauma injuries in disaster and military situations. Methods: Original clinical trials investigating the effects of telemedicine on trauma injuries published before April 2018 were aggregated, and used in this study. We search the scientific sources such as PubMed, MEDLINE, Wiley, EMBASE, ISI, and Scopus. The keywords that applied to identify these articles combined: Telemedicine, Mobile Health, Health, Mobile, mHealth, Telehealth, eHealth, Trauma, War, military, medicine, Wounds and Injuries, injuries. Results: The text of the articles and abstracts were examined from various aspects, the 21 articles were evaluated for quality, and then 10 papers entered in a systematic review. We found that the use of telemedicine in trauma injury, rural and the military is very helpful for high-quality trauma care; also the telemedicine and telephone consultations can be were demonstrated reducing the risk of physician-related medicine mistakes. The economic evaluation of telemedicine was demonstrated cost-saving and cost-effective of telemedicine consultations. We also realized the importance and practicable of telemedicine for improving rural trauma care. Conclusions: Ultimately, the telemedicine can help patients and health government organizations economically, the telemedicine consultations due to cost-saving and cost-effective. Further studies to evaluate the running of telemedicine need to abating the practical and high-efficiency method, that can be done everywhere and it's free from mistakes and defects.
HBOT has been used quite extensively in the last couple of decades. But there are not many centers that offer this treatment, even in civilian situations. This review has described the rationale and clinical evidence for equipping medical centers with HBO systems, especially in military areas. A narrative review of all the literature available on HBOT in combat-related injuries, studies were retrieved from systematic searches on Science Direct, PubMed, SCOPUS, ISC, Google Scholar, and by cross-referencing until 2020. First, the etiological mechanisms of action of HBOT were discussed. Furthermore, we have provided an overview of 117 studies that clinically investigated the effect of HBOT in the last couple of decades. Therefore, based on the number of studies showing a positive effect, to speed up the treatment process, especially in war-related injuries, it is better to provide its infrastructure and equip hospitals and centers with HBO.
Introduction: Investigating and recognizing the epidemiological structure of earthquake damages in earthquake- prone countries is of great importance. The aim of this study was to evaluation of traumatic injuries in1028 patients referred to the Ayatollah Taleghani Hospital from the Sarpul-Zahab earthquake (November 12, 2017). Method: This study is a cross-sectional study that includes 1028 traumatic patients from the Kermanshah earthquake. The patients, including outpatients in the emergency department, admitted in orthopedic, general surgery and neurosurgery, or even patients who needed to be transferred to other treatment centers. Result: Of the 1,028 patients, 488 were men (47.5%). The number of men with high injury severity was 51 (10.4%) and the number of women with high severity of the injury was 58 (10.7%). The average age of the injured was 33.04±15.01 years. The mean ISS measure in this study was 8.9±1.6. A total of 109 (10.6%) had scores above 17. The number of cases with head and neck injury was 328 (24%), 233 cases (17%), chest 114 (8.3%), The abdomen or pelvis is 190 (13.9%), the spine is 200 patients (14.6%). After examining the type of trauma in 1791 injuries, 1074 injuries (59.9%) had penetrating trauma and 717 injuries (40.1%) of blunt trauma were calculated. Of patients with severe trauma, 83 patients suffered severe injuries (7.7%) and in patients with blunt trauma, 68 patients suffered severe injuries (9.4%). The mortality rate was 5 (0.5%). Conclusion: This study established a fracture pattern in the referred patient of the Sarpul-Zahab earthquake to the Ayatollah Taleghani Hospital and is practical for clinicians to increase understanding of this natural disaster and permits superior selection of the triage management and therapeutic process.
Background and Aim: Abdominal compartment syndrome is a life-threatening complication that can occur in trauma patients and greatly increase their mortality. Although there is a better scientific understanding of the general phenomena involved in the pathogenesis of this complication, the particular risk factors and their implications in the trauma patient population are yet to be deciphered. Methods: The authors conducted research through 3 electronic databases (PubMed, Scopus, and ScienceDirect) using the following search formula: “(ACS OR abdominal compartment syndrome) AND (*trauma*) AND (risk factor)”. Subsequently, additional search formulas were used, including the risk factors taken into consideration (i.e. “shock”, “hypotension”, “acidosis”, “base deficit”, ”coagulopathy”, “retroperitoneal hematoma”, “HOB elevation”, “fluid resuscitation”, “damage control laparotomy”). Results: Throughout the 41 articles analyzed in this paper, 7 risk factors transcended and were further discussed: head of bed elevation/patient positioning, fluid resuscitation, the “lethal triad” of acidosis hypothermia and coagulopathy, Damage Control Laparotomy, shock/hypotension, retroperitoneal hematoma and demographics (age, gender, and race). Conclusions: To summarize, many potential risk factors were evaluated for the envisagement of the present paper, but the ones that prevailed the most were excessive fluid resuscitation, shock/hypotension, retroperitoneal hematomas, and the lethal triad. Consistent with other studies, no connection was found between age, gender, or race and the development of ACS. Further studies should focus more on the likely involvement of damage control laparotomy and patient positioning, as well as hypocalcemia, in the unfolding of ACS in trauma patients.
