scholarly journals Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

CJEM ◽  
2015 ◽  
Vol 17 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Julian J Owen ◽  
Niv Sne ◽  
Angela Coates ◽  
Peter K Channan
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Survival Rates ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Trauma Patients ◽  
National Guidelines ◽  
Emergency Department Thoracotomy ◽  
Life Saving ◽  
Record Review

AbstractObjectiveEmergency department thoracotomy (EDT) is a rare and potentially life-saving intervention performed for trauma patients in extremis. EDT is rare at Canadian trauma centres because of our infrequent occurrence of penetrating trauma. This study was undertaken to evaluate outcomes at a Canadian level 1 trauma facility and compare survival to large published datasets. Also, we evaluated the appropriateness of an EDT performed at our centre based on published national guidelines.MethodsRetrospective medical record review of all patients undergoing an EDT during their resuscitation in the emergency department. Records were identified using our trauma registry, and all charts were manually reviewed. The primary outcome was survival to hospital discharge.ResultsOver a 20-year period, 58 EDTs were performed with 6 (10.3%) survivors. Patients undergoing an EDT secondary to penetrating trauma had the highest survival (5 of 24 patients or 20.8% survival) compared to patients undergoing an EDT for blunt trauma (1 of 34 patients or 2.9% survival). Patients undergoing an EDT who had not suffered cardiac arrest represented the group with the highest survival rate (3 of 6 patients or 50% survival). The majority of EDTs (79.3%) were indicated, and no patient undergoing an EDT survived if it was performed outside of published guidelines.ConclusionsSurvival following an EDT in our small, regional trauma centre is consistent with survival rates from larger published datasets. An EDT should continue to be performed under accepted clinical indications.

scholarly journals Life-saving emergency clamshell thoracotomy with damage-control laparotomy

2019 ◽  
Vol 12 (3) ◽  
pp. e227879
Author(s):  
Asif Masroor Farooqui ◽  
Clare Cunningham ◽  
Nick Morse ◽  
Onyekwelu Nzewi
Keyword(s):  
Emergency Department ◽  
Damage Control ◽  
Survival Rates ◽  
Penetrating Trauma ◽  
Chest Drain ◽  
Thoracic Injuries ◽  
Emergency Thoracotomy ◽  
Midline Laparotomy ◽  
Life Saving ◽  
Clamshell Thoracotomy

Clamshell thoracotomy for thoracic injuries is an uncommon emergency department procedure. The survival rates following emergency thoracotomy are very low at 9%–12% for penetrating trauma and 1%–2% for blunt trauma. We report an unusual case of survival after emergency department clamshell thoracotomy for penetrating thoracic trauma with cardiac tamponade in a 23-year-old man with multiple stab wounds on the chest and abdomen. The patient was awake and alert on arrival in the emergency department. Bilateral chest decompression by needle thoracostomy released air and blood. During subsequent chest drain insertion, the patient suddenly deteriorated and arrested. Clamshell thoracotomy was performed, and sinus rhythm restored before transfer to theatre. Following repair of the thoracic injuries, a midline laparotomy was performed as bleeding was suspected from the abdomen and a splenic injury repaired. The patient survived and has made a full recovery. This case demonstrates how clamshell thoracotomy can be a life-saving procedure.

scholarly journals Anaphylactic Reactions in the Emergency Department of a Portuguese Tertiary Hospital: Clinical Characterization and Disease Notification

2019 ◽  
Vol 32 (2) ◽  
pp. 91
Author(s):  
Ana Teresa Fróis ◽  
Teresa Cardoso
Keyword(s):  
Emergency Department ◽  
Adverse Reactions ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Clinical Approach ◽  
National Guidelines ◽  
Disease Notification ◽  
Health Products ◽  
Mandatory Notification ◽  
Clinical Records

Introduction: Anaphylaxis is significantly underdiagnosed, and the medical community’s knowledge about it is precarious. The aim of this study is to characterize the patient population and the Emergency Department approach of anaphylaxis.Material and Methods: Retrospective study of adult patients attending the Emergency Department of a tertiary care Portuguese hospital, over a year, with anaphylaxis. Data were obtained from each patient’s clinical records and anonymized. A questionnaire evaluating knowledge about the notification of anaphylaxis was applied to Emergency Department physicians.Results: The study included 69 patients. Cutaneous (97%) and respiratory features (80%) were most prevalent; 22% of patients presented with shock or related symptoms. There were no reported biphasic reactions or deaths. The likely allergen was identified in 73%, most commonly food; 12% of reactions were related to a previously known allergen. Epinephrine was administered to 15%. Referral to an Immunoallergologist was done in 36% of patients, and 10% received or already possessed an epinephrine autoinjector. Among six parameters recommended for auditing clinical practice, 70% of cases fulfilled less than half. Only 13% of physicians knew it was mandatory to register all cases in the Portuguese Catalogue of Allergies and Other Adverse Reactions, and only 4% knew how to do it; regarding notification to the National Authority of Medicines and Health Products results were slightly better.Discussion: Many patients with anaphylaxis present to the Emergency Department every year, and their clinical approach is not in agreement with national guidelines. Conclusion: An educational program to increase medical awareness of the national guidelines and mandatory notification of all anaphylactic reactions should be implemented.

Predictors for Survival of Penetrating Trauma Using Emergency Department Thoracotomy in an Urban Trauma Center: The Cardiac Instability Score

2010 ◽  
Vol 102 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Suryanarayana Siram ◽  
Tolulope Oyetunji ◽  
Shaneeta M. Johnson ◽  
Amal L. Khoury ◽  
Patricia M. White ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Center ◽  
Penetrating Trauma ◽  
Emergency Department Thoracotomy

scholarly journals Compliance of tranexamic acid administration to trauma patients at a level-one trauma centre

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 216-221
Author(s):  
Abeer Ghawnni ◽  
Angela Coates ◽  
Julian Owen
Keyword(s):  
Tranexamic Acid ◽  
Major Bleeding ◽  
Controlled Trial ◽  
Compliance Rate ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Inclusion Criteria ◽  
Peripheral Hospital ◽  
Prospective Randomized Controlled Trial ◽  
Record Review

AbstractIntroductionCurrent practice for the treatment of traumatic hemorrhage includes fluid resuscitation and the administration of blood products. The administration of tranexamic acid (TXA) within 8 hours of injury has been shown to significantly reduce mortality in a large, prospective, randomized controlled trial. As a result, TXA is widely used in trauma centres to manage trauma patients with major bleeding. The primary aim of this study was to assess the compliance of TXA administration at a level-one trauma centre in Hamilton, Ontario, Canada.MethodsWe conducted a retrospective medical record review of consecutive adult trauma patients received at the Hamilton General Hospital between January 1, 2012 and December 31, 2014. Compliance with TXA administration was based on the inclusion criteria of the CRASH–2 trial.ResultsFive hundred and thirty-four of 2,475 trauma patients met the inclusion criteria for TXA administration. Twenty-one patients who received TXA at peripheral hospital prior to their arrival at the level-one trauma centre were excluded from the analysis, and 18 patients were excluded due to missing data. One hundred and thirty-four patients received TXA, representing a compliance rate of 27%. Mean time from arrival to TXA administration was 47 minutes. Compliance increased for those who required massive transfusion and as the number of criteria for TXA administration increased.ConclusionsCompliance with TXA administration to trauma patients with suspected major bleeding was low. Quality improvement strategies aimed at increasing appropriate use of TXA are warranted.

Extreme Interventions for Trauma Patients in Extremis: Variations among Trauma Centers

2017 ◽  
Vol 83 (10) ◽  
pp. 1033-1039
Author(s):  
Galinos Barmparas ◽  
Ara Ko ◽  
Navpreet K. Dhillon ◽  
James M. Tatum ◽  
Mark Choi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Trauma Patient ◽  
National Level ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Inclusion Criteria ◽  
Emergency Department Thoracotomy ◽  
National Trauma ◽  
High Level ◽  
Trauma Surgeons

Although guidelines for the performance of an emergency department thoracotomy (EDT) are available, high level evidence remains scarce potentially leading to variation in decisions and practices among trauma surgeons. The National Trauma Databank was queried for all subjects who died in the emergency department (ED) between 2007 and 2011. Trauma centers were divided into four quartiles based on the rate of EDTamong ED deaths. A total of 31,623 subjects admitted to 729 trauma centers met inclusion criteria. Most of of these centers (n = 328, 53%) never performed an EDT during the study period. Very few outlier centers (1.1%) performed this procedure in 50.0 per cent or more of all patients who died in the ED. Trauma centers in the highest quartiles in performing EDT were more likely to intervene with both surgical and nonsurgical procedures in patients who died in the ED, independent of the performance of an EDT. There are significant variations among trauma centers in the management of trauma patients who expire in the ED. Further research at a national level toward standardizing the management of the trauma patient in extremis and the decision to perform an EDT is necessary, given the extremely low survival associated with this procedure.

scholarly journals Radiation Exposure From CT Scanning in the Resuscitative Phase of Trauma Care: A Level One Trauma Centre Experience

CJEM ◽  
2015 ◽  
Vol 17 (6) ◽  
pp. 617-623 ◽  
Author(s):  
Lorri Beatty ◽  
Elizabeth Furey ◽  
Cupido Daniels ◽  
Avery Berman ◽  
John M. Tallon
Keyword(s):  
Radiation Exposure ◽  
Tissue Injury ◽  
Tertiary Care ◽  
Trauma Team ◽  
Trauma Centre ◽  
Whole Body ◽  
Trauma Patients ◽  
X Rays ◽  
Imaging Data ◽  
Trauma Team Activation

AbstractObjectivesThe initial management of a trauma patient often involves imaging in the form of x-rays, computed tomography (CT) and other radiographic studies, which expose the patient to ionizing radiation, an entity known to cause tissue injury and malignancy at high doses. The purpose of this study was to use a calculation-based method to determine the radiation exposure of trauma patients undergoing trauma team activation in a Canadian tertiary-care trauma centre.MethodsA retrospective chart review was conducted using the Nova Scotia Provincial Trauma Registry. All patients age 16 years old and over who underwent trauma team activation between March 1, 2008 and March 1, 2009 were included. Patients who died prior to imaging tests were excluded. Dose reports for each CT were used to calculate a whole-body radiation dose for each patient.ResultsThere were 230 trauma team activations during the study period, of which 206 had CT imaging. Data were available for 162 patients. The mean whole-body radiation exposure for all patients was 24.4±10.3 mSv, which may correlate to one additional cancer death for every 100 trauma patients scanned.ConclusionsTrauma patients are exposed to significant amounts of radiation during their initial trauma work-up, which may increase the risk of fatal cancer. Clinicians who care for these patients must be aware of the radiation exposure, and take measures to limit radiation exposure of trauma patients.

scholarly journals Contemporary management of renal trauma in Canada: A 10-year experience at a level 1 trauma centre

2018 ◽  
Vol 13 (6) ◽  
Author(s):  
Uday Mann ◽  
Logan Zemp ◽  
Keith F. Rourke
Keyword(s):  
Penetrating Trauma ◽  
Injured Patient ◽  
Trauma Centre ◽  
Renal Trauma ◽  
Trauma Patients ◽  
High Grade ◽  
Mechanism Of Injury ◽  
Level 1 ◽  
Grade 3 ◽  
Urological Intervention

Introduction: Contemporary Canadian renal trauma data is lacking. Our objective is to describe 10-year outcomes of renal trauma at a Canadian level 1 trauma centre using a conservative approach. Methods: The Alberta Trauma Registry at the University of Alberta was used to identify renal trauma patients from October 2004 to December 2014. Hospital records and imaging were reviewed to identify clinic-radiographical factors, including patient age, gender, Injury Severity Score (ISS), American Association of the Surgery for Trauma (AAST) grade, computerized tomography (CT) findings, urological interventions, length of stay, transfusion and death rates. Descriptive statistics, Chi-square, and t-tests were used when appropriate. Results: A total of 368 renal trauma patients were identified. Mechanism of injury was blunt trauma in 89.1% of cases, mean age was 36.2 years, and mean ISS was 30.8 (±13.6). AAST grade distribution was 16.6% (Grade 1), 22.8% (Grade 2), 36.4% (Grade 3), 20.9% (Grade 4), and 3.3% (Grade 5). Overall, 9.5% (35) of patients required urological intervention for a total of 40 treatments, including ureteral stenting (3.0%), angioembolization (3.3%), percutaneous drainage (0.3%), or open intervention including nephrectomy (2.4%) and renorrhaphy (0.5%). No Grade 1 or 2 injuries required intervention, while 1.5%, 31.2%, and 75.0% of Grade 3, 4, and 5 injuries did, respectively. The overall renal salvage rate was 97.6%, which did not differ by mechanism of injury (p=0.25). Patients with penetrating trauma were more likely to require urological intervention (20.0% vs. 8.2%; p=0.04). Of the high-grade (III–V) renal injuries identified, 15.7% (35/223) required urological intervention, 4.9% (11) required open surgical intervention, and only 4.0% (9) of patients with high-grade renal injury required nephrectomy. Conclusions: The trend towards conservative treatment of renal trauma in Canada appears well-supported even in a severely injured patient population, as over 90% of patients avoid urological intervention and only 3% require operative intervention resulting in renal salvage rates of 97.6%.

Emergency Department thoracotomy - life saving procedure - case report

2004 ◽  
Vol 21 (Supplement 32) ◽  
pp. 181
Author(s):  
V. Cengic ◽  
Z. Knezevic ◽  
M. Lovre-Bilbija ◽  
D. Matkovic
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Emergency Department Thoracotomy ◽  
Life Saving
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