Emergency Resuscitation of Patients Enrolled in the US Diaspirin Cross-linked Hemoglobin (DCLHb) Clinical Efficacy Trial

2014 ◽  
Vol 30 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Edward P. Sloan ◽  
Max Koenigsberg ◽  
W. Brad Weir ◽  
James M. Clark ◽  
Robert O'Connor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blunt Trauma ◽  
Surgical Intervention ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Efficacy Trial ◽  
Estimated Blood Loss ◽  
The Us ◽  
The Mean ◽  
Blood Loss Volume

AbstractIntroductionOptimal emergent management of traumatic hemorrhagic shock patients requires a better understanding of treatment provided in the prehospital/Emergency Medical Services (EMS) and emergency department (ED) settings.Hypothesis/ProblemDescribed in this research are the initial clinical status, airway management, fluid and blood infusions, and time course of severely-injured hemorrhagic shock patients in the EMS and ED settings from the diaspirin cross-linked hemoglobin (DCLHb) clinical trial.MethodsData were analyzed from 17 US trauma centers gathered during a randomized, controlled, single-blinded efficacy trial of a hemoglobin solution (DCLHb) as add-on therapy versus standard therapy.ResultsAmong the 98 randomized patients, the mean EMS Glasgow Coma Scale (GCS) was 10.6 (SD = 5.0), the mean EMS revised trauma score (RTS) was 6.3 (SD = 1.9), and the mean injury severity score (ISS) was 31 (SD = 17). Upon arrival to the ED, the GCS was 20% lower (7.8 (SD = 5.3) vs 9.7 (SD = 6.3)) and the RTS was 12% lower (5.3 (SD = 2.0) vs 6.0 (SD = 2.1)) than EMS values in blunt trauma patients (P< .001). By ED disposition, 80% of patients (78/98) were intubated. Rapid sequence intubation (RSI) was utilized in 77% (60/78), most often utilizing succinylcholine (65%) and midazolam (50%). The mean crystalloid volume infused was 4.2 L (SD = 3.4 L), 80% of which was infused within the ED. Emergency department blood transfusion occurred in 62% of patients, with an average transfused volume of 1.2 L (SD = 2.0 L). Blunt trauma patients received 2.1 times more total fluids (7.4 L vs 3.5 L, < .001) and 2.4 times more blood (2.4 L vs 1.0 L,P< .001). The mean time of patients taken from injury site to operating room (OR) was 113 minutes (SD = 87 minutes). Twenty-one (30%) of the 70 patients taken to the OR from the ED were sent within 60 minutes of the estimated injury time. Penetrating trauma patients were taken to the OR 52% sooner than blunt trauma patients (72 minutes vs 149 minutes,P< .001).ConclusionBoth GCS and RTS decreased prior to ED arrival in blunt trauma patients. Intubation was performed using RSI, and crystalloid infusion of three times the estimated blood loss volume (L) and blood transfusion of the estimated blood loss volume (L) were provided in the EMS and ED settings. Surgical intervention for these trauma patients most often occurred more than one hour from the time of injury. Penetrating trauma patients received surgical intervention more rapidly than those with a blunt trauma mechanism.SloanEP,KoenigsbergM,WeirWB,ClarkJM,O'ConnorR,OlingerM,CydulkaR.Emergency resuscitation of patients enrolled in the US diaspirin cross-linked hemoglobin (DCLHb) clinical efficacy trial.Prehosp Disaster Med.2015;30(1):1-8.

Repairing the injured bronchus in blunt chest trauma – A case series

Trauma ◽  
2021 ◽  
pp. 146040862098811
Author(s):  
Anith Nadzira Riduan ◽  
Narasimman Sathiamurthy ◽  
Benedict Dharmaraj ◽  
Diong Nguk Chai ◽  
Narendran Balasubbiah
Keyword(s):  
Blunt Trauma ◽  
Chest Trauma ◽  
Surgical Intervention ◽  
Case Series ◽  
Trauma Patients ◽  
Lung Collapse ◽  
Comprehensive Management ◽  
Lung Capacity ◽  
Management Algorithm ◽  
Operative Outcomes

Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.

Trauma in pregnancy: A review of the Pennsylvania Trauma Systems Foundation database

Trauma ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Meike Schuster ◽  
Natasha Becker ◽  
Amanda Young ◽  
Michael J Paglia ◽  
A Dhanya Mackeen
Keyword(s):  
Blunt Trauma ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Blunt Injury ◽  
Trauma Patients ◽  
Severely Injured ◽  
Trauma Systems ◽  
Severely Injured Patients ◽  
Vaginal Deliveries ◽  
Injured Patients

Objective The goal of this study is to determine if injury severity score (ISS) of ≥9 and systolic blood pressure (SBP) predict poor maternal/pregnancy outcomes in blunt and penetrating trauma, respectively. Methods The Pennsylvania Trauma Systems Foundation database was used to identify pregnant trauma patients. Blunt trauma patients were analyzed with regard to ISS, while penetrating trauma patients were analyzed to determine whether SBP < 90 mmHg was predictive of poor maternal outcome. Results Patients with severe blunt injury (ISS ≥ 9) due to motor vehicle accident were less likely to wear seatbelts (51% vs. 63%, p = 0.005), and delivery was required in 17% of these patients as compared to 6% of the less severely injured, and only 6% of those were vaginal deliveries. Severely injured patients were discharged home 68% of the time and 6% died compared to less severely injured patients of which 83% were discharged home and <1% died; all other patients required discharge to a rehabilitation facility. Patients with penetrating trauma and SBP < 90 mmHg on arrival were more likely to require delivery (35% vs. 5%, p < 0.001) and were 14 times more likely to die (58% vs. 4%, p < 0.001) when compared to the normotensive group. Conclusion ISS ≥ 9 and SBP < 90 mmHg are predictors for poor outcomes after trauma during pregnancy. Severely injured blunt trauma patients often require surgery and delivery. Patients who present with SBP < 90 after penetrating trauma are more likely to deliver and are 14 times more likely to die.

scholarly journals 23. Ambulance Sphygmomanometer Accuracy: Can It Affect Triage to the Trauma Center?

1996 ◽  
Vol 11 (S2) ◽  
pp. S33-S33
Author(s):  
Charles E. Cady ◽  
Ronald G. Pirrallo ◽  
Clarence E. Grim
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Blunt Trauma ◽  
Frequency Distribution ◽  
Trauma Center ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Industry Standards ◽  
Study Population ◽  
The Mean

Objectives: To determine the accuracy of sphygmomanometers (SPHYGs) from a metropolitan EMS system and quantitate the mis-triage of adult blunt trauma patients based on erroneous systolic blood pressure (SBP) readings.Methods-A: A cross-sectional, convenient sample of 150 SPHYGs was checked for accuracy using industry standards. Mean high and low deviations were calculated at 90 mmHg.Methods-B: Retrospectively, a frequency distribution of the initial SBPs of all blunt trauma patients, age ≥21, seen in 1994 was plotted to characterize our study population. The numbers of patients potentially over- or under-triaged were identified when their reported SBP was corrected for using the mean high and low deviation plus 2 SDs.Results-A: Overall, 25.3% of the SPHYGs were inaccurate. At 90 mmHg, 28.0% (42/150) were inaccurate with 16.7% (7/42) high by 4.6±1.5 mmHg and 81.0% (34/42) low by 6.2±4.2 mmHg; one was inoperable.Results-B: 1,005 adult blunt trauma patients were evaluated; 61 were eliminated: 35 had initial SBPs of 0 mmHg and 26 had no SBP recorded (n = 944). The mean initial SBP was 138 ±30mmHg, and 3.8% (36/944) of the patients had SBPs <90 mmHg. Potentially, 2.0% (19/944) of the patients were undertriaged (initial erroneously high SBP reading 90–98 mmHg) and 2.5% (24/944) over-triaged (initial erroneously low SBP reading 74–90 mmHg).

Utility of Plain Film Pelvic Radiographs in Blunt Trauma Patients in the Emergency Department

2006 ◽  
Vol 72 (10) ◽  
pp. 951-954 ◽  
Author(s):  
Amal Kamil Obaid ◽  
Andrew Barleben ◽  
Diana Porral ◽  
Stephanie Lush ◽  
Marianne Cinat
Keyword(s):  
Emergency Department ◽  
Ct Scan ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Plain Film ◽  
Pelvic Fractures ◽  
Trauma Patients ◽  
Pelvic Radiographs ◽  
Highly Sensitive ◽  
Pelvic Embolization

The objective of this study was to evaluate the utility and sensitivity of routine pelvic radiographs (PXR) in the initial evaluation of blunt trauma patients. A retrospective review was performed. One hundred seventy-four patients with a pelvic fracture who had computed tomography (CT) and PXR were included (average age, 36.1; average Injury Severity Score, 16.3). Nine (5%) patients died. Five hundred twenty-one fractures were identified on CT. One hundred sixteen (22%) of these fractures were missed by PXR. Eighty-eight (51%) patients were underdiagnosed by PXR alone. The most common fractures missed by PXR were sacral and iliac fractures. Eight patients required angiograms, with four undergoing therapeutic pelvic embolization. Forty-seven (27%) patients were hypotensive or required a transfusion in the emergency department. These patients were more likely to require an angiogram (17% vs 0%, P < 0.0001) and were more likely to require embolization (9% vs 0%, P < 0.001). This study demonstrates that CT scan is highly sensitive in identifying and classifying pelvic fractures. PXR has a sensitivity of only 78 per cent for identification of pelvic fractures in the acute trauma patient. In hemodynamically stable patients who are going to undergo diagnostic CT scan, PXR is of little value. The greatest use of PXR may be as a screening tool in hemodynamically unstable patients and/or those that require transfusion to allow for early notification of the interventional radiology team.

Complications in Patients with Cardiac Penetrating Trauma

2021 ◽  
Vol 21 ◽  
Author(s):  
Mojtaba Ahmadinejad ◽  
Izadmehr Ahmadinejad ◽  
Leila Haji Maghsoudi ◽  
Ali Soltanian ◽  
Mehdi Safari
Keyword(s):  
Young People ◽  
Cardiac Tamponade ◽  
Penetrating Trauma ◽  
Medical Emergency ◽  
Trauma Patients ◽  
Cardiac Trauma ◽  
The Mean ◽  
Collection Form ◽  
The Right ◽  
Type Of Injury

Background: Cardiac penetrating trauma is a medical emergency that mostly affects young people. Based on the type of injury and associated complications, it can present as a surgical challenge and can lead to mortality. Objective: The aim of this study is to evaluate the complications of penetrating heart trauma among patients referred to Shahid Madani Hospital. Methods: In this retrospective descriptive study, the data of penetrating cardiac trauma patients referred to Shahid Madani hospital, Karaj, Tehran, from 2016-2019, were investigated. Information, including age, sex, cause of trauma, traumatized area and complications, was extracted and recorded in a data collection form. The data were evaluated statistically using SPSS v18. Results: A total of 44 patients were included in the study, where the mean age of the patients was 25 years. 73.3% of these patients were men and 26.7% were women. Knife stab wounds were the most prevalent cause of the trauma, present in 93.3% of patients. 73.3% of the patients had cardiac tamponade and 20% had a pneumothorax. The right ventricle was the most common site of the injury in 46.7% of the patients. A mortality rate of 3.4% was reported in this study. Conclusion: The results of this study showed that the highest penetrating heart rate trauma occurred among young people, and the most common cause of the trauma was a knife stab. The most common area of the injury was the right ventricular, and cardiac tamponade was the most common complication.

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 The role of laparoscopy in patients with abdominal trauma

2019 ◽  
Vol 7 (5) ◽  
pp. 1853
Author(s):  
Pranav K. Sharma ◽  
Gaurav Gupta
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Case Reports ◽  
Operating Time ◽  
Penetrating Trauma ◽  
Exploratory Laparotomy ◽  
Therapeutic Interventions ◽  
Trauma Patients ◽  
Diagnostic Dilemma ◽  
Therapeutic Laparoscopy

Background: Use of laparoscopy in penetrating trauma has been well established; however, its application in blunt trauma is gaining popularity as a useful diagnostic tool to avoid unnecessary laparotomies where there is diagnostic dilemma. Even though recent case reports seem to suggest that these patients can be managed using laparoscopy, the practice is not yet wildly adopted.Methods: All adult patients who presented with abdominal trauma laparoscopic surgery was considered in patients who were deemed fit for the same in the Department of General Surgery, MMIMSR, Mullana, Ambala during a period of 18 months starting from January 1st 2015 to June 30th 2016. Data was analysed using descriptive statistics.Results: A total of 53 patients with either blunt or penetrating abdominal trauma that required surgery were included in the study. Exploratory laparotomy was performed in 45 patients (84.91%) and laparoscopy was performed in 8 patients (15.09%). Overall mesenteric injury (45.28%) was the most common intra-abdominal injury noted. The most common organ involved in blunt trauma was the spleen (68.97%). The mean operating time of laparoscopy was lesser by 57 minutes as compared to exploratory laparotomy. The use of laparoscopy avoided negative and non-therapeutic laparotomy in 2 patients (25%). Therapeutic laparoscopy was performed in 3 patients with repair of bowel and mesenteric injuries. There was no documented procedure‑related morbidity and mortality.Conclusions: The positive outcomes from the study suggest that laparoscopy can be safe and feasible in both diagnostic and therapeutic interventions in carefully selected blunt abdominal trauma patients.

scholarly journals Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems

2017 ◽  
Vol 6 (3) ◽  
pp. 160-168
Author(s):  
Danilo M Razente ◽  
Bruno D Alvarez ◽  
Daniel AM Lacerda ◽  
João MDS Biscardi ◽  
Marcia Olandoski ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Blunt Trauma ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Coma Scale ◽  
Significant Difference ◽  
Trauma Scoring ◽  
The Mean ◽  
Trauma Victims

ABSTRACT Background This study aims to compare mortality prediction capabilities of three different physiological trauma scoring systems (TSS): Revised Trauma Score (RTS) Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) and Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP). Study design A descriptive, cross-sectional study of trauma victims admitted to the emergency service between December-2013 and February-2014. Clinical and epidemiological information were gathered at admission and three TSS were calculated: RTS, GAP, and MGAP. The follow-up period to assess length of hospitalization and mortality lasted until August-2014. Two groups were created — survivals (S) and deaths (D) — and compared. P < 0.05 was considered statistically significant. Results A total of 668 trauma victims were analyzed. The mean age was 37 ± 18 and 69.8% were males. Blunt trauma prevailed (90.6%). The mean scores of RTS, GAP, and MGAP for group S (n = 657; 98.4%) were 7.77 ± 0.33, 22.8 ± 1.7, and 27.4 ± 2.3 respectively (p < 0.001), whereas group D (n = 11, 1.6%) achieved mean scores of 4.57 ± 2.95, 13 ± 7, and 15.5 ± 7 (p < 0.001). Regarding the Receiver Operating Characteristics (ROC) analysis, the areas under the curve were 0.926 (RTS), 0.941 (GAP), and 0.981 (MGAP). The three TSS demonstrated significant mortality prediction capabilities (p < 0.001). There was no statistically significant difference between the three ROC curves (p = 0.138). The MGAP achieved the highest sensitivity (100%), while GAP and RTS sensitivities were 81.8% (59—100%), and 90.9% (73.9—100%) respectively (p < 0.001). The observed specificities were 96.2% (94.77—97.7%) for GAP, 91.6% (89.5—93.7%) for MGAP, and 87.2% (84.7—89.8%) for RTS (p < 0.001). Age (p = 0.049), Glasgow Coma Scale (GCS) (p < 0.001), and trauma mechanism (p < 0.001) were different between the two groups. Conclusion Most patients were young males and victims of blunt trauma. The three TSS demonstrated reliability regarding mortality prediction. The MGAP achieved the highest sensitivity and GAP was the most specific score, which may indicate a potential use of both as valuable alternatives to RTS. How to cite this article Razente DM, Alvarez BD, Lacerda DAM, Biscardi JMDS, Olandoski M, Bahten LCV. Mortality Prediction in Trauma Patients using Three Different Physiological Trauma Scoring Systems. Panam J Trauma Crit Care Emerg Surg 2017;6(3):160-168.

scholarly journals Individualized transscleral cyclophotocoagulation as the initial surgical intervention for medically uncontrolled glaucoma after blunt trauma

2020 ◽  
Author(s):  
Xu Hou ◽  
Jing Wu ◽  
Jian Zhou ◽  
Yu-Sheng Wang ◽  
Dan Hu
Keyword(s):  
Anterior Chamber ◽  
Success Rate ◽  
Blunt Trauma ◽  
Surgical Intervention ◽  
Ultrasound Biomicroscopy ◽  
Anterior Chamber Angle ◽  
Significant Difference ◽  
Transscleral Cyclophotocoagulation ◽  
The Mean ◽  
Chamber Angle

Abstract Background: To investigate the safety and feasibility of individualized transscleral cyclophotocoagulation (TSCPC) as the initial non-incisional surgical intervention for medically uncontrolled glaucoma after blunt trauma. Methods: The therapy records were reviewed of medically uncontrolled traumatic glaucoma after blunt trauma treated with TSCPC in a single hospital between January 2014 and December 2018. 31 patients (31 eyes) received individualized TSCPC after ultrasound biomicroscopy and gonioscopy examination to localize and quantify the injured quadrants of the anterior chamber angle. In addition to the number of IOP lowing drugs, visual acuity (VA), IOP, inflammation and hemorrhage in the anterior chamber were analyzed at 1 day, 3 weeks and 3 months after operation, respectively. Success was defined as the IOP was not more than 21 mmHg.Results: Compared with the data of pre-operation, constituent ratio of VA had no significant difference at 3 weeks (c2 = 0.56, P > 0.75). At 3 months the mean IOP was 22.2±5.0 mmHg, which was significantly lower than that of pre-operation (46.6±5.6 mmHg) (t=19.818, P<0.001). No IOP lowing drug was needed in 12 eyes, and more than 3 kinds of drugs were still needed in 5 eyes. The average number of medications decreased significantly (c2=93.496，P＜0.001). The complete success rate was 38.7% and the relative success rate (combined with no more than two kinds of drugs) was 83.9% at 3 months.Conclusions: Individualized TSCPC could be applied as an initial non-incisional surgical intervention to treat traumatic glaucoma refractory to the medicine therapy.

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