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Aim:It was aimed to evaluate necessity of performing chest X-ray (CXR) in patients with multiple traumas and injury severity score (ISS) >15 in this study.Materials and Methods:In this cross-sectional study conducted on trauma patients, the clinical and radiographic findings of all the patients were collected and the relationships between these variables were analyzed based on advanced trauma life support guidelines.Results:A total of 170 patients was included in the study. Of them, 114 (67.1%) were male. The mean age of males was 33.86±17.36 years and it was 37.75±18.33 years in females (p=0.181). Twenty six patients had symptoms; seven patients had dyspnea and 19 had chest pain. Clinical examination was abnormal in 28 patients. Emphysema was detected in one patient, ecchymosis in one patient and local tenderness in 26 patients. CXR was performed in all patients and it was normal in 161 patients (94.7%). It detected rib fracture in six patients (3.5%), pulmonary contusion in two patients (1.2%) and hemothorax in one patient (0.6%).Conclusion:Investigation of the necessity of emergency CXR in patients with multiple trauma with ISS >15 showed that there was no need to perform CXR in stable patients lacking signs and symptoms and instead we suggest physical exam to detect any problem.

Objectives: After being a solid method of measuring consciousness for decades,the Glasgow Coma Scale (GCS) was offered to bereplaced with a better option: The Full Outline of Unresponsiveness (FOUR) score, which several studies later confirmed to besuperior due to its independence from verbal response and ability to consider brain stem reflexes. In this study, we decided to comparethe two scales in the prognosis of stroke, which has never been conducted before.Patients and Methods: We conducted both methods on 150 stroke patients during admission to the emergency service and assessedthem during a 3-month follow-up after discharge.Results: The type of stroke was 80% ischemic and 20% hemorrhagic. 55.3% survived after a 3-month follow-up. The FOUR score hada significant converse relation with hospitalization, a relation with the GCS lacked. The FOUR score also had a stronger correlationwith the outcome of stroke than the GCS. Additionally, the receiver operating characteristic (ROC) curve showed greater sensitivityand specificity in the FOUR score in the prognoses of stroke patients.Conclusion: We recommend using the FOUR score as the first priority.

Objective: To differentiate familial hypocalciuric hypercalcemia (FHH), a rare condition, from primary hyperparathyroidism (PHPT), one of the most common causes of hypercalcemia, leading to avoidance of unnecessary surgical treatment; and also to review FHH.Methods: We present the history, physical, laboratory investigations, and clinical course of a 42-year-old woman who presented to our endocrinology office with hypercalcemia. An updated review on FHH is also provided.Results: FHH is a rare genetic disorder resulting from an inactivating mutation in the calcium-sensing receptor (CASR) gene. Inactivation of CASR causes increased parathyroid hormone (PTH) release with mild hypercalcemia. This condition should be differentiated from the other causes of hypercalcemia such as PHPT and malignancy. FHH does not usually have any signs, symptoms, or complications of hypercalcemia. Our patient presented with hypercalcemia with decreased urinary calcium excretion and was positive for a CASR mutation confirming FHH. This patient was able to avoid unnecessary parathyroid surgery based on these findings.Conclusion: FHH is diagnosed by mild hypercalcemia, normal or high PTH, and low urine calcium, and it is differentiated from primary PHPT by measuring the calcium/creatinine clearance ratio and finally genetic testing. FHH is a lifelong benign condition that does not require any treatment or surgery.Abbreviations: Ca calcium; CaSR calcium-sensing receptor; CASR calcium-sensing receptor gene; Cr creatinine; FHH familial hypocalciuric hypercalcemia; PTH parathyroid hormone; PHPT primary hyperparathyroidism

Introduction Multiple trauma patients frequently suffer eye injuries, especially those patients with head traumas. We evaluated the accuracy of physical findings to determine the priorities of emergency ophthalmologic intervention in these patients. Patients and methods This study included all multiple trauma patients with ophthalmic trauma who had a GCS of 15 when they arrived at the emergency department during the period of March, 2008–March, 2009. First, we evaluated the patients according to the criteria of the study. Then, an ophthalmologist evaluated them. Result From March 2008–March 2009, 306 multiple trauma patients with ocular trauma came to our ED. The sensitivity and accuracy of emergency physicians in diagnosing the priority of ophthalmologic treatment were comparable to an ophthalmologist (measure of agreement in kappa = 0.967). Discussion The ability of an emergency physician or general surgeon to determine the actual need of early ophthalmologist intervention can improve decision making and saving both time and money. Our study suggests that it is possible to determine according to clinical findings the need of the patient to have ophthalmologic intervention without referring the patient to ophthalmologist examination. Conclusion Defining specific criteria of ophthalmologic examinations can clarify the necessity of emergency ophthalmologic examination and intervention.