Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 05 27 e9 e9 Athar Rasekhjahromi Obstetrics and Gynecology Department, Jahrom University of Medical Sciences, Jahrom, Iran Zahra Jafarzadehjahromi Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran Navid Kalani Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran Zahra Zarei Babaarabi Women's Health and Diseases Research Center, Jahrom University of medical sciences, Jahrom, Iran. 2021 05 02 2021 05 09 Numerous symptoms and complications of COVID-19 include pneumothorax as a rare but potentially-lethal condition. The present case report involved a pregnant woman with COVID-19 presenting with pneumothorax. A 30-year-old pregnant woman with COVID-19 and a gestational age of 32 weeks presented to our hospital with dyspnea, coughs and fever. The rales initially heard in both lungs continued to be heard only in the left lung after 24 hours. Pneumothorax was confirmed through radiology. The emergency cesarean section performed to avoid the potential detrimental effects of the infection on the fetus caused no breathing episodes in the biophysical profile. The patient recovered postpartum without complications and both the mother and the newborn were discharged 12 days later. Spontaneous pneumothorax is a rare complication in COVID-19 pregnant patients that can emerge at any stage of the disease. https://fem.tums.ac.ir/index.php/fem/article/view/744 https://fem.tums.ac.ir/index.php/fem/article/download/744/358

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 09 26 e7 e7 Amir Ghabousian Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Saeed Safari Emergency Medicine Department, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Niloufar Ansari Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 2021 07 12 2021 07 14 Paraquat dichloride (PQ) poisoning is a relatively rare yet critical medical condition that has a high case fatality rate. Lung tissue is highly susceptible to PQ-induced injury, and respiratory failure is the leading cause of death in these patients. Unfortunately, there is a lack of an effective therapeutic approach to ameliorate outcomes. It is well-known that PQ interferes with a variety of cell signaling pathways and induces the generation of reactive oxygen species (ROS), which ultimately results in cell injury. The traditional treatment decisions have not been able to significantly change the clinical course of PQ poisoning. Moreover, novel therapeutic strategies for PQ poisoning have centered on the inhibition of PQ-induced signaling pathways. In the current review, we sought to provide a bird’s-eye view of the available therapeutic approaches in patients with PQ poisoning. https://fem.tums.ac.ir/index.php/fem/article/view/800 https://fem.tums.ac.ir/index.php/fem/article/download/800/368

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 10 10 e1 e1 Ebraheem Albazee Faculty of Medicine, Hashemite University, Zarqa, Jordan Mohammad Alnifise Faculty of Medicine, Hashemite University, Zarqa, Jordan Lina Almahmoud Faculty of Medicine, Hashemite University, Zarqa, Jordan Ahmed Alsaeedi Faculty of Medicine, Hashemite University, Zarqa, Jordan Mohammed Al-balawi Faculty of Medicine, Hashemite University, Zarqa, Jordan Talal Alotaibi Faculty of Medicine, Hashemite University, Zarqa, Jordan Aiman Al Sharei Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan 2021 05 29 2021 07 24 Objective: Performing basic life support (BLS) in patients with cardiopulmonary arrest decreases mortality and morbidity. In addition, BLS knowledge is a prerequisite for medical graduation. The present study was conducted to determine the awareness level of undergraduate medical students in Jordan regarding BLS and background knowledge. Methods: This cross-sectional study was conducted between 17 April 2021 and 12 May 2021. A validated questionnaire was used as an online Google form and was posted in all medical student groups and Jordanian universities through various social medias. We categorized level of awareness into two groups: adequate awareness for those who got 60% or more, and inadequate awareness for those who got less than 60% in BLS test. Chi-square test was used to compare different variables. Results: A total of 886 students with a mean age of 21.5 (± 2.2) years completed the survey, including 552 females (62.3%). Among participated students, only 281 (31.7%) had adequate awareness, whereas 605 (68.3%) had inadequate awareness, with a mean score of 10 (± 3.8) out of 20. Surprisingly, there was no statistically significant correlation (P=0.210) between grade point average (GPA) and awareness level among participated students. On the contrary, we detected statistically significant relationships (P<0.001) between various variables and awareness level. Conclusion: Overall, we found that awareness of BLS among medical students in Jordan is not adequate. We can improve the awareness of medical students in this regard through obligating them to educate the general population, especially school students, as a volunteer campaign. https://fem.tums.ac.ir/index.php/fem/article/view/765 https://fem.tums.ac.ir/index.php/fem/article/download/765/370

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 11 16 e13 e13 Jerry W. Jones Chief Instructor, Medicus of Houston, Texas, USA 2021 11 15 2021 11 15 One of the most difficult decisions for many physicians and advanced practice providers occurs when having to distinguish between simple atrioventricular (AV) dissociation and AV dissociation caused by a third degree AV block. Third degree AV block is only one cause of AV dissociation and it is a very infrequent cause. The majority of simple AV dissociations are caused by variations in the balance of sympathetic and parasympathetic inputs from the autonomic nervous system. All of us probably experience an occasional episode of simple AV dissociation while we are asleep. Treatment for simple AV dissociation may be as simple as having the patient get out of bed and walk around the room a few times, while AV dissociation caused by a third degree AV block is going to require an emergent placement of a permanent pacemaker. In order to make this decision properly and confidently, you must have a very clear understanding of the difference. Here, in this educational paper, we aim to discuss more in this regard. https://fem.tums.ac.ir/index.php/fem/article/view/893 https://fem.tums.ac.ir/index.php/fem/article/download/893/377

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 09 01 e2 e2 Reza Azizkhani Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Farhad Heydari Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Ahmad Sadeghi Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran Omid Ahmadi Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Azita Azimi Meibody Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 2021 06 16 2021 07 23 Objective: Healthcare workers (HCWs) are among the highest groups impacted by the COVID-19 pandemic. This study aimed to analyze professional quality of life (ProQOL) and its association with emotional well-being in HCWs during the pandemic. Methods: This cross-sectional study was conducted on HCWs being in close contact with COVID-19 patients in Iran. The questionnaires assessing ProQOL, emotional well-being, and demographic and occupational characteristics were recruited via email or social media. The ProQOL was used to measure compassion fatigue (CF), burnout (BO) and compassion satisfaction (CS). Results: Among the respondents, 705 HCWs were enrolled, including a higher proportion of physicians 449 (63.7%), females 452 (64.1%), and married 486 (68.9%). The mean of participants’ work experience was 8.41 ± 8.91 years. Almost all of HCWs showed moderate to high levels of CS (98.3%). Also, most of HCWs showed a moderate level of CF (96.3%), and the majority of them (76.6%) had a moderate level of BO. There were significant differences in the duration of contact with COVID-19 patients for all three components of ProQOL and emotional well-being score. Women had a higher level of BO than men (P=0.003). CS was significantly higher in married HCWs than in singles (P=0.007). Pearson correlation coefficient showed that CS had a negative relationship with CF and BO. However, there was a direct correlation between emotional well-being and the CS. Conclusion: During the COVID-19 pandemic, Iranian HCWs showed to have moderate to high levels of CS, and a moderate level of both CF and BO, and showed that emotional well-being had a direct correlation with CS. https://fem.tums.ac.ir/index.php/fem/article/view/772 https://fem.tums.ac.ir/index.php/fem/article/download/772/366

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 09 28 e10 e10 Debkumar Chowdhury Emergency Department, Royal Blackburn Hospital, Blackburn, United Kingdom 2021 07 28 2021 08 19 Phlegmasia cerulea dolens is an uncommon complication of deep venous thrombosis. This is associated with high rates of morbidity if not treated effectively. We present a young lady 13 weeks pregnant with one-day history of left lower limb swelling with pain and discolouration. Bedside ultrasonography revealed thrombosis occluding the common femoral vein and collateral femoral vein. She had history of neonatal alloimmune thrombocytopaenia (NAIT), and had immunotherapy previously. The safest option was to give low molecular weight heparin (LMWH) on an inpatient basis. Anticoagulation with LMWH has been well established as thromboprophylaxis during pregnancy, however, the safety profile of systemic anticoagulation is matter of debate. As highlighted in this scenario the management needs to be tailored on an individual basis. The cause for the extensive deep vein thrombosis could be possibly due to the recent immunoglobulin therapy, undiagnosed prothrombotic state (outwith pregnancy) or the procoagulant state associated with pregnancy. https://fem.tums.ac.ir/index.php/fem/article/view/820 https://fem.tums.ac.ir/index.php/fem/article/download/820/369

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 11 01 e8 e8 Mojtaba Chardouli Emergency Medicine Department, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Mohammadreza Yasinzadeh Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran Mohammad Meshkini Emergency Medicine Department, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Hadi Jalilvand International Safe Community Support Center, Research Center for Road Traffic Injury, Tabriz University of Medical Sciences, Tabriz, Iran Hamed Basir Ghafouri Emergency Medicine Department, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran Homayoun Sadeghi-Bazargani International Safe Community Support Center, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Sayyed Mohammadreza Mirkarimi Emergency Medicine Department, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran 2021 05 16 2021 07 15 This study reviewed the former studies conducted on the usefulness of accuracy of focused assessment with sonography for trauma (FAST) or any plain ultrasonography (US) scan in pediatric blunt abdominal trauma (BAT), to assess its accuracy, sensitivity, specificity, and positive and negative predictive values (PPV and NPV). Searches were conducted using the predefined keywords and Medical Subject Headings (MeSH) terms across MEDLINE (PubMed), Scopus, Web of Science, Cochrane Collaboration Library, Embase, ClinicalTrials.gov, Magiran and SID.ir databases. Duplicate publications were excluded; then the titles and abstracts of eligible studies were reviewed for how they report blunt trauma, pediatric patients, and ultrasound modality in their text. Cochrane RevMan version 5.3 was used for the results analysis and assessing the risk of bias in the studies. Out of 923 studies, 902 were excluded, and only 19 articles were included in this review, out of which one was a randomized clinical trial (RCT), three were cohort studies, two were contrast-enhanced US (CEUS) studies, and 13 were prospective or retrospective descriptive studies. The total population studied in the articles was 3454 patients. The results showed that the specificity of US in pediatric BAT was 93%, the sensitivity was 54%, and the PPV in comparison to clinical examination was 73% versus 37%. CEUS protocol achieved 100% in both sensitivity and specificity analysis. The only RCT study which included about 28% of the studies population also reached a sensitivity and specificity of 97% and 98%, respectively using a combinational protocol of clinical examination, laboratory investigation, and US assessment. Ultrasonography does not provide more results than clinical examination, though better PPV results. A combination of follow-up, US examination, and laboratory requests may also have more accurate results. Moreover, a CEUS protocol may reach that goal with an acceptable time-saving outcome, but it needs more studies to be confirmed. https://fem.tums.ac.ir/index.php/fem/article/view/751 https://fem.tums.ac.ir/index.php/fem/article/download/751/372

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 07 27 e3 e3 Mohammad Haji Aghajani Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Sistanizad Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Amirmohammad Toloui Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran Arian Madani Neishaboori Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran Asma Pourhoseingholi Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Ali Maher Department of Health Policy, Economics and Management, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ziba Asadpoordezaki Department of Psychology, Maynooth University, Kildare, Ireland Reza Miri Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mahmoud Yousefifard Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran 2021 04 29 2021 06 05 Objective: Our aim is to assess the effective factors on hospitalization costs of COVID-19 patients. Methods: Data related to clinical characteristics and cost of hospitalized COVID-19 patients from February 2020 until July 2020, in a public teaching hospital in Tehran, Iran was gathered in a retrospective cohort study. The corresponding factors influencing the diagnostic and therapeutic costs were evaluated, using a generalized linear model. Results: The median COVID-19 related diagnostic and therapeutic costs in a public teaching hospital in Iran, for one hospitalized COVID-19 patient was equal to 271.1 US dollars (USD). In patients who were discharged alive from the hospital, the costs increased with patients’ pregnancy (P<0.001), loss of consciousness during hospitalization (P<0.001), a history of drug abuse (P=0.006), history of chronic renal disease (P<0.001), end stage renal disease (P=0.002), history of brain surgery (P=0.001), history of migraine (P=0.001), cardiomegaly (P=0.033) and occurrence of myocardial infarction during hospitalization (P<0.001). In deceased patients, low age P<0.001), history of congenital disease (P=0.024) and development of cardiac dysrhythmias during hospitalization (P=0.044) were related to increase in therapeutic costs. Conclusion: Median diagnostic and therapeutic costs in COVID-19 patients, hospitalized in a public teaching hospital in Iran were 271.1 USD. Hoteling and medications made upmost of the costs. History of cardiovascular disease and new onset episodes of such complications during hospitalization were the most important factors contributing to the increase of therapeutic costs. Moreover, pregnancy, loss of consciousness, and renal diseases are of other independent factors affecting hospitalization costs in COVID-19 patients. https://fem.tums.ac.ir/index.php/fem/article/view/740 https://fem.tums.ac.ir/index.php/fem/article/download/740/364

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 09 19 e11 e11 EN Atie Moghtadaie Internal Medicine Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Seyed Amir Miratashi Yazdi General Surgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Haleh Ashraf Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran Abbas Soleimani Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2021 05 28 2021 07 16 Coexisting myocardial infarction (MI) and diabetic ketoacidosis (DKA) are the most common causes of death in diabetic patients. We report a patient with ischemic heart disease manifestations who was finally diagnosed to have DKA as a predisposing factor. The case we present in this paper is a 57-year-old man who was found unconscious in a hotel and presented with complaints of vomiting, abdominal pain, and diarrhea. He had severe dyspnea and chest pain radiating to his back. He had ST-segment elevation in anterior leads on electrocardiogram (ECG), with non-obstructive coronary artery disease in the subsequent heart catheterization. MI patients should be treated with primary percutaneous coronary intervention (PCI) or fibrinolytic agents, but pseudoinfarction due to DKA responds to medical treatment. Thus, it is also important to know that coexistence of both DKA and MI is possible, and neglecting such situations can lead to lethal consequences. https://fem.tums.ac.ir/index.php/fem/article/view/763 https://fem.tums.ac.ir/index.php/fem/article/download/763/367

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 06 29 e4 e4 Naeimeh Hosseinzadeh Emergency Medicine Research Team, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Alireza Ala Emergency Medicine Research Team, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Sama Rahnemayan Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran Elyar Sadeghi-Hokmabadi Neuroscience Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Aylar Gholami Milani Emergency Medicine Research Team, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Maryam Rahimpour Asenjan Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran Samad Shams Vahdati Emergency Medicine Research Team, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran 2021 04 22 2021 05 30 Objective: The main objective of this study is to evaluate the prevalence of risk factors for and demographics of patients younger than 65 years old with stroke. Methods: This retrospective cross-sectional study took into consideration all patients younger than 65 years old who were admitted to the emergency department from 2016 to 2018. Some significant criteria such as age, sex, type of stroke, stroke risk factors, and modified Ranking Scale (mRS) were extracted from patients’ medical records. Based on their age, these patients were divided into three groups: younger than 35 years old (Group A), between 35-50 years old (Group B), and older than 50 years old (Group C). Data analysis was carried out using IBM® SPSS® Statistics 20.0 software. Results: A total of 392 patients with stroke were included in this study. Groups A, B, and C included 31, 124, and 237 patients, respectively. Among them, 313 patients (79.84%) were admitted to the hospital in cold seasons, while 73 patients (18.6%) had no symptoms related to stroke at the time of admission. The most common adjustable risk factor among the patients was hypertension (HTN) with a frequency of 230 (58.7%). Of note, the frequency of HTN, diabetes, atrial fibrillation (AF), oral contraceptive pill (OCP) consumption, and coronary artery disease (CAD) in patients was significantly different among these three groups. Conclusion: According to the findings of the present study, the prevalence rate of stroke probably varies for male and female (gender) in the studied groups, which is significantly correlated with age. Among the adjustable risk factors for stroke, HTN, diabetes, AF, OCP consumption, and CAD are significantly correlated with the age. https://fem.tums.ac.ir/index.php/fem/article/view/733 https://fem.tums.ac.ir/index.php/fem/article/download/733/361

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 10 19 e12 e12 Deepak Chaudhary Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India Ashish Behera Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India Navneet Sharma Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India 2021 06 27 2021 08 18 Mucormycosis is an opportunistic fungal infection that occurs primarily in immunocompromised individuals, usually affecting the rhino-orbital areas followed by the lungs. This case report presents renal mucormycosis in a young man after COVID-19 pneumonia that escalates the need for regular follow-up of COVID-19 patients. Post-COVID-19 fungal infections are on a steep rise, and the increased use of steroids and immune modulators for COVID-19-associated immune dysregulation and cytokine syndrome increases the risk among patients treated for COVID-19. https://fem.tums.ac.ir/index.php/fem/article/view/781 https://fem.tums.ac.ir/index.php/fem/article/download/781/371

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 06 15 e5 e5 Fatemeh Moradiha Department of Obstetrics and Gynecology, School of Medicine, Zanjan University Medical Sciences, Zanjan, Iran Sahar Farahmandrad Department of Obstetrics and Gynecology, School of Medicine, Zanjan University Medical Sciences, Zanjan, Iran Hamideh Gholami Department of Obstetrics and Gynecology, School of Medicine, Zanjan University Medical Sciences, Zanjan, Iran 2021 06 15 Objective: Nausea and vomiting are the most common complications and the first cause of hospitalization of pregnant women in the first trimester of pregnancy. Given the maternal and fetal complications as well as the negative psychosocial and economic effects of nausea and vomiting, the present study aimed to compare the antiemetic effects of ondansetron and metoclopramide. Methods: The present double-blind randomized clinical trial study was conducted on 153 pregnant women with a complaint of nausea and vomiting during pregnancy referred to the obstetrics and gynecology ward. Patients were randomly divided into two metoclopramide and ondansetron groups. The outcomes of interest were nausea and vomiting, the number of used doses of the drug, and the length of hospital stay. The Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire was used to assess the severity of nausea and vomiting. Results: The mean age was significantly higher in the metoclopramide group (28.44±6.45 vs. 25.43±5.42 years, P=0.004). On day 3, the PUQE score was significantly higher in the ondansetron group (6.60±1.10 vs. 6.56±0.88, P<0.001). The decrease in the severity of nausea and vomiting was significantly higher in the ondansetron group (5.29±1.35 vs. 4.90±1.17, P=0.05) in the second day compared to the first day. In the repeated measure analysis, significant differences were found between the two treatment groups (F=7.01, P=0.009). There was no significant difference between the two groups in terms of the length of hospital stay (P>0.05). Conclusion: In this study, ondansetron revealed more efficacy than metoclopramide on the nausea and vomiting of pregnancy (NVP) management. Ondansetron may, therefore, be considered as a safe and effective alternative for metoclopramide in the treatment of NVP. https://fem.tums.ac.ir/index.php/fem/article/view/771 https://fem.tums.ac.ir/index.php/fem/article/download/771/360

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 6 1 2021 11 03 e6 e6 Somayeh Mehrpour Department of Anesthesiology and Critical Care, Qom University of Medical Sciences, Qom, Iran Atabak Najafi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Arezoo Ahmadi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tayebeh Zarei Department of Anesthesiology and Critical Care, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Vasili Pleqi Department of Clinical Research, Mayo Clinic, Jacksonville, Florida, USA Kamal Basiri Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran. Khalil Komlakh Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hamed Abdollahi Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Kaveh Hedayati Emami Department of Anesthesiology & Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2021 09 28 2021 10 01 Objective: The purpose of this study was to quantitatively evaluate if the use of the optic nerve sheath diameter (ONSD) can be a suitable noninvasive surrogate approach for repeated invasive intracranial pressure (ICP) measures. Methods: The study used a sample of 22 adult patients with traumatic brain injury (TBI) from an in intensive care unit (ICU). ICP levels were measured using the gold standard and recorded in cmH20. ONSD was measured using ultrasonography with 5.6-5.7 MHz linear probe and recorded in millimeters. The data analysis was done using STATA software version 15. Results: The results showed a strong positive correlation between ICP and ONSD (r = 0.743, p = 0.001). The accuracy of the sonographic ONSD declined over time, starting from a high of 90.9% at the baseline and declining to a low of merely 20.0% after 48 hours. Conclusion: These findings indicate that the ONSD approach could be very useful alternative and noninvasive method for monitoring ICP.    https://fem.tums.ac.ir/index.php/fem/article/view/868 https://fem.tums.ac.ir/index.php/fem/article/download/868/375