Background:Bleeding and trapped air in the pleural space are called hemothorax and pneumothorax, respectively. In cases where there are delays in diagnosis and treatment, the mortality rates due to hemopneumothorax can be significant. Hemopneumothorax is characterized by decreased lung sounds or chest percussion and subcutaneous emphysema. Diagnosis of pneumothorax and hemothorax can be achieved by portable chest X-ray (CXR), computed tomography (CT) scan, or ultrasonography. Portable CXR and CT-scans have their individual drawbacks. CXR creates a high percentage of false negative results, and a CT-scan is time consuming and less cost-effective; in addition, both modalities expose patients to radiation. Therefore, the introduction of ultrasonography as an easily available and highly accurate diagnostic modality has particular importance.Objectives:The aim of this study was to evaluate the sensitivity and specificity of ultrasonography in the diagnosis of pneumothorax and hemothorax in comparison with the other two methods, namely portable CXR and CT-scan.Patients and Methods:Patients (163) with multiple trauma who were suspected of having chest injuries, and who had indications for a chest CT-scan according to ATLS algorithms, were included in the study. All patients underwent portable CXR, CT-scan, and ultrasonography.Results:In total, 163 patients were included in this study; 29 patients had a pneumothorax, 24 patients had a hemothorax, and 23 patients had a hemopneumothorax confirmed. The study revealed that ultrasonography had a sensitivity of 96.15%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 98%, in the diagnosis of pneumothorax. The sensitivity for ultrasonography in the diagnosis of a hemothorax was 82.97%, with a specificity of 98.05%, a positive predictive value of 90%, and a negative predictive value of 92.66%. Portable CXR for pneumothorax detection had a sensitivity of 34.61%, a specificity of 97.95%, a positive predictive value of 90%, and a negative predictive value of 73.84%. In the detection of hemothorax, CXR had a sensitivity of 25.53%, a specificity of 95.14%, a positive predictive value of 70.58%, and a negative predictive value of 73.68%.Conclusions:Ultrasonography sensitivity and specificity for diagnosis of hemopneumothorax was high. The sensitivity of portable CXR was low despite its high specificity for the detection of hemothorax and pneumothorax.

Worldwide trauma is currently the sixth leading cause of death, according to 10% of mortalities (1,2). Injury impact and the death from trauma are more common in males than females. People aged between 15 and 45 years include about half of the trauma deaths (3). Citizens of low-and middle-income countries (LMICs) account for 89% of all deaths from trauma worldwide. This is particularly because of hospitals' lack of facilities, equipments, and peripheral care systems (4,5). During last year since the 20th of March 2013 until the 20th of March 2014, 27 740 traumatic patients were admitted to Iran's North West Trauma Center (Emam Reza hospital) in which 105 patients were expired in emergency, surgery, and neurosurgery departments. This included 11 female patients (10%) and 94 male patients (90%) (Figure 1). According to previous studies, motor vehicle accidents are the most common reason of multitrauma. Researchers highlight that in developing countries, trauma is the leading cause of death for young people (6). In our study, the reports show that the causes of injury that led to death in 71 patients were motor vehicle crash, in 25 patients falling from a high altitude, one patient because of pedestrian motor vehicle accident, and 8 patients because of fighting (Figure 2). Seventy-five patients in morning shifts (8 am to 8 pm) and 30 patients in night shifts (8 pm to 8 am) were admitted. Approximately about 30 patients in spring, 34 patients in summer, 25 patients in fall and 18 patients in winter experienced traumatic injury leading to death.

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Objective: Cardiopulmonary resuscitation (CPR) is a lifesaving technique useful in the prevention of death or delaying it in a person with cardiac arrest. In this regard, demographic information about patients who need CPR is vital. Methods: In this cross-sectional study patients with cardiopulmonary arrest or arrhythmias admitted to Imam Reza and Sina educational hospitals of Tabriz University of Medical Sciences from 22 December 2013 to 21 December 2014 entered the study. Demographic information such as age, sex, cardiopulmonary resuscitation time, the place of cardiopulmonary arrest (outside or inside the hospital), the duration of resuscitation process, success or failure of the resuscitation process and the mechanism of cardiopulmonary arrest were obtained. Results: From a total of 354 cases of cardiopulmonary resuscitation, 281 cases (79%) were unsuccessful and 73 cases (21%) were successful. The average age of patients was 59 ± 22 years. The average time of the resuscitation process was 31 ± 12 minutes. There was a significant difference between the mean of age and resuscitation time in patients who had experienced successful or unsuccessful resuscitation (P = 0.0001). There was a significant relationship between sex and the success rate of resuscitation (P = 0.0001). In addition, a significant relationship between the success of the resuscitation operation and the ward of resuscitation was observed (P = 0.0001). Conclusion:The most common mechanism leading to cardiopulmonary arrest among patients was asystole. In this regard, no significant difference was observed between successful and unsuccessful resuscitation processes. It was also observed that the success of resuscitation from 8 am to 4 pm was more than any other time period.

Introduction: Emergency department (ED) patients'throughput includes all the processes that patients go through; this study was designed to investigate the patients throughput and the duration of stay in this department. Methods: In a prospective cross-sectional study, we evaluated the association between workflow process and admission duration in emergency department of Sina hospital of Tabriz from March 20th to July 20th 2011. Result: We studied 800 randomly selected patients referred to the emergency department between 20th March and 20th July 2011. The mean time duration between first visit and disposition was 64.94± 64.7 min (mode= 24min). The most prevalent chief complaint was common cold in which was presented in 448 patients Discussion: In the management of emergency department, all of parts must work as a member of team and if one of these members has a problem and does not work properly then pass-through will be happen.