مرتضی غریبی

Nowadays, the use of minimally invasive procedures in emergency care is more favorable. Medication via intranasal is interesting, due to easy administration even in the critical conditions, rapid-onset absorption and good tolerability by patients.

This study aimed to investigate the effect of using IN Agents for prescribing drugs in emergency setting.

This study was a systematic review with the key words such as Intranasal، Nasal، pre-hospital، prehospital، Emergency Care، Emergency medical services، First Responder، Out-of-Hospital and Emergency Medical Technician which was used library Studies search the databases such as PubMed, OVID, Scopus, Magiran and SID. All searches were done in 2005-2015.

134 articles were included in the primary analysis. Twelve studies met inclusion criteria and research aims. The findings of this study suggest that this route is effective for drugs administration such as fentanyl, ketamine, naloxone and midazolam in hospital and prehospital care setting. The comparison between intranasal and other drug administration routes was shown this route has been more effective and safe than others. Also intranasal agents are available and easy to use especially in cases where the catheter insertion is impossible or difficult.

Therefore, regarding the safe use of intranasal route especially in prehospital care, it is recommended that similar studies be designed and conducted on the implementation of this route in prehospital setting in Iran.

Acute compartment syndrome is considered a debilitating complication of limb trauma. Early detection of this compartment syndrome helps us in the early initiation of treatment which will result in preventing its subsequent complications reported in these cases.

This research was an analytical cross-sectional study. Patients with direct trauma to extremities, who were referred to the emergency department of Valiasr and Amir Al-Momenin hospitals were studied from October 2018 to April 2019 in Arak, Iran. Patients were selected if they met all of the inclusion criteria and none of the exclusion criteria. Vital signs were measured and recorded for each patient. Also, the results of physical examination, intra-compartmental pressure measurement by a wick catheter and the level of the creatine phosphokinase were recorded. All data analyses were performed with the use of SPSS v21 software.

A total number of 70 subjects were included in this study, comprising 65 males (93.1%) and 5 females (6.9%). The results showed that there is a significant relationship between intra-compartment pressure and the level of creatine phosphokinase enzyme. The higher the intracompartmental pressure, the higher the creatine phosphokinase level. Statistically significant associations were observed between intracompartmental pressure and pallor, edema, lack of limb pulse, and diastolic blood pressure. No significant relationship was found between intracompartmental pressure and limb pain, numbness, inability to move the injured limbs, and systolic blood pressure. In addition, our findings indicated that creatine phosphokinase is significantly associated with edema and lack of limb pulse. No significant relationship was found between creatine phosphokinase with pain, pallor, numbness, inability to move limbs, and systolic and diastolic blood pressure.

The study findings suggest that measurement of intracompartmental pressure could be considered as an effective alternative approach to creatine phosphokinase levels to diagnose compartment syndrome. So, this will prevent irreparable damage to the extremities and is of great importance.

American College Of Emergency Medicine (ACEM) guideline has a recommendation for early diagnosis of head injuries following mild trauma. In this study we examined the prediction power, sensitivity, and specificity of this clinical guideline in the need for computed tomography (CT) scan 

 This cross-sectional study was performed for 6 months on patients over 18 years old referred to the emergency department of Vali-e-Asr Hospital in Arak who met ACEM criteria for head CT scan for suspected mild trauma. Demographic characteristics, clinical symptoms, trauma mechanism, physical injuries caused by head trauma, and history of drug abuse were recorded. The consciousness level (Glasgow Coma Scale) was checked every two hours. Patients underwent treatment if there was a pathology in CT images, and those with no clear pathology were discharged after 6 hours and, followed up by phone for two weeks, and in case of any abnormality in the level of consciousness, they were re-examined by CT scanning.

This study has an ethical approval obtained from Arak University of Medical sciences (code: IR.ARAKMU.REC.1396.227).

500 patients, 335 male (67%) and 165 females (33%) with the mean age of 46.39± 2.01 years were studied; the sensitivity the ACEM guideline for predicting the need for CT scan in patients with mild head trauma were 100% with a specificity of 3.46% (for the second recommendation, the sensitivity was 100% with a specificity of 6.7%) which indicated that the test was highly sensitive to diagnosing the patients, but its specificity was low.

 The ACEM guideline had high sensitivity to predicting the need for CT in patients with mild head trauma, but had very low specificity which makes it an unacceptable criterion for rejecting or performing CT scan in these patients.