دکتر فرهاد شکوهی نهرخلجی

Traumatic Hemorrhagic Shock

Hemorrhage remains the major cause of preventable death after trauma . In the acute phase of hemorrhage, the physician’s therapeutic priority is to stop the bleeding as quickly as possible. Hemorrhagic shock is a pathologic state in which intravascular volume and oxygen delivery are impaired. As long as this bleeding is not controlled, the physician…

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Enhanced Care Teams

Enhanced care teams ( ECT ) Enhanced care teams ( ECT ), consisting of a senior pre-hospital emergency medicine doctor and a critical care paramedic, are active within the region to provide advanced critical care interventions and clinical support . • If a patient has sustained major trauma they should be conveyed according to the…

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Use of Tranexamic Acid in Trauma Patients

Use of tranexamic acid in trauma patients Tranexamic acidis an antifibrinolytic agent and inhibits the activation of plasminogen to plasmin. Trial data (CRASH-2) [ Reference :Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage (CRASH-2): a randomised, placebo-controlled trial, The Lancet, Vol 376, issue 9734, 23-32;…

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Stab Wound of the Heart with Unusual Sequelae

A 31-year-old woman was admitted to the emergency department with a stab wound to the heart. She was initially stable but rapidly developed hypotension. While the operating room and staff were in preparation, she underwent pericardiocentesis. She was then rushed to the operating room by the general surgical trauma team, who performed a bilateral anterior…

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Initial Imaging Evaluation of a Patient with Penetrating Cardiac Injury

Penetrating cardiac injury is frequently lethal. Reported mortality rates vary from 3% to 84% depending on whether “prehospital” mortality is included . In patients who reach the hospital, a lower survival rate for those with firearm injuries (33%) than for those with stab wounds (65%) has been described . In one recent large study, improvement…

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Case Report – Fracture & Displacement

A 33-year-old man was admitted to the emergency department after a motorcycle accident. Clinical examination of the intubated patient showed a hard, swollen, bluish scrotum and an externally rotated and slightly shortened left leg. Computed tomography (CT) of the pelvis revealed dislocation of the left hip and a three-part trochanteric fracture of the proximal left…

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Blunt Chest Trauma – Commotio cordis

Commotio cordis (disturbance of the heart) is a descriptive term meaning cardiac arrest associated with low-impact blunt trauma to the anterior chest, usually by a relatively low-velocity missile, such as a baseball, cricket ball or hockey puck, or by a blow delivered by a fist, foot, elbow, or knee during sporting activities. It is not…

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Chest Trauma – Transmediastinal Wounds

  Transmediastinal Wounds For patients who have sustained gunshot wounds that have traversed the mediastinum and who are unstable, immediate operative repair is necessary. For those patients who are hemodynamically stable the question is somewhat controversial, some surgeons would advocate immediate exploration whilst other would advocate a more conservative approach with CT scanning. Advocates of…

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Trauma and children – Common reactions in babies and toddlers

Common reactions in babies and toddlers When babies or toddlers are exposed to life-threatening or traumatic events, they become very scared – just like anybody else. Some common reactions may include: • Unusually high levels of distress when separated from their parent or primary carer • A kind of ‘frozen watchfulness’ – the child may…

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Triad of Death

Triad of Death Injured patients presenting with hypothermia, acidosis and coagulopathy have been identified at very high risk of death ,hence the term ‘triad of death’. The triad can develop rapidly in the exsanguinating trauma patient, and is the result of the primary trauma and the secondary systemic response. Once established, it forms a vicious…

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The Multiply Injured Child

Multiple trauma (MT) is an injury to more than one body system or at least two serious injuries to one body system. In the developed world, trauma is the leading cause of death and acquired disability in the 1– ۴۵ years age groups with staggering burden of medical and societal costs. Moreover, more than 95…

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Evidence-based Pediatric Critical Care Medicine

A Clinical Scenario Raises Important Clinical Questions Evidence-based medicine (EBM) is the “conscientious explicit and judicious use of current evidence in making decisions about the care of individual patients” . Despite increasing acceptance of the role of EBM in clinical practice over the last two decades,many clinicians are unaware of EBM’s history and do not…

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