scholarly journals Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans

2021 ◽  
Vol 6 (1) ◽  
pp. e000752
Author(s):  
Michael M Neeki ◽  
Christina Cheung ◽  
Fanglong Dong ◽  
Nam Pham ◽  
Dylan Shafer ◽  
...  
Keyword(s):  
Pleural Cavity ◽  
Retrospective Chart Review ◽  
Needle Insertion ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Traumatic Injuries ◽  
Life Saving ◽  
Life Threatening ◽  
And Performance

BackgroundTraumatic tension pneumothoraces (TPT) are among the most serious causes of death in traumatic injuries, requiring immediate treatment with a needle thoracostomy (NT). Improperly placed NT insertion into the pleural cavity may fail to treat a life-threatening TPT. This study aimed to assess the accuracy of prehospital NT placements by paramedics in adult trauma patients.MethodsA retrospective chart review was performed on 84 consecutive trauma patients who had received NT by prehospital personnel. The primary outcome was the accuracy of NT placement by prehospital personnel. Comparisons of various variables were conducted between those who survived and those who died, and proper versus improper needle insertion separately.ResultsProper NT placement into the pleural cavity was noted in 27.4% of adult trauma patients. In addition, more than 19% of the procedures performed by the prehospital providers appeared to have not been medically indicated.DiscussionLong-term strategies may be needed to improve the capabilities and performance of prehospital providers’ capabilities in this delicate life-saving procedure.Level of evidenceIV.

scholarly journals Adrenal Insufficiency - Aetiology, Diagnosis and Treatment

2015 ◽  
Vol 3 (1) ◽  
pp. 36-47
Author(s):  
Nazma Akter ◽  
Nazmul Kabir Qureshi
Keyword(s):  
Quality Of Life ◽  
Adrenal Insufficiency ◽  
Presenting Symptoms ◽  
Life Saving ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up ◽  
Term Management

Adrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis. Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2014 because of its lethal nature. Though, it is a rare disease but is life threatening when overlooked. Main presenting symptoms such as fatigue, anorexia and weight loss are nonspecific, thus diagnosis is often delayed. The diagnostic work-up is well established but some pitfalls remain. The diagnosis is adequately established by the 250 ?g ACTH (adrenocorticotropic hormone) stimulation test in most cases. Glucocorticoids provide life saving treatment but long-term quality of life is impaired, perhaps because therapy is not given in a physiologic way. Dehydroepiandrosterone-replacement therapy has been introduced that could help to restore quality of life. It may be useful in pubertal girls, but not in adults. Monitoring of glucocorticoid-replacement is difficult due to lack of objective methods of assessment and is therefore largely based on clinical grounds. Thus, long-term management of patients with adrenal insufficiency remains a challenge, requiring an experienced specialist. DOI: http://dx.doi.org/10.3329/dmcj.v3i1.22238 Delta Med Col J. Jan 2015; 3(1): 36-47

scholarly journals World trauma education: hemorrhage control training for healthcare providers in India

2019 ◽  
Vol 4 (1) ◽  
pp. e000263 ◽  
Author(s):  
Lindsay Andrea Smith ◽  
Sarah Caughey ◽  
Susan Liu ◽  
Cassandra Villegas ◽  
Mohan Kilaru ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Trauma Patients ◽  
Bleeding Control ◽  
Cross Sectional Survey ◽  
Hemorrhage Control ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Life Saving ◽  
Poor Outcomes ◽  
Trauma Education

BackgroundHemorrhage remains a major cause of death around the world. Eighty percent of trauma patients in India do not receive medical care within the first hour. The etiology of these poor outcomes is multifactorial. We describe findings from the first Stop the Bleed (StB) course recently offered to a group of medical providers in southern India.MethodsA cross-sectional survey of 101 participants who attended StB trainings in India was performed. Pre-training and post-training questionnaires were collected from each participant. In total, 88 healthcare providers’ responses were analyzed. Three bleeding control skills were presented: wound compression, wound packing, and tourniquet application.ResultsAmong participants, only 23.9% had received prior bleeding control training. Participants who reported feeling ‘extremely confident’ responding to an emergency medical situation rose from 68.2% prior to StB training to 94.3% post-training. Regarding hemorrhage control abilities, 37.5% felt extremely confident before the training, compared with 95.5% after the training. For wound packing and tourniquet application, 44.3% and 53.4%, respectively, felt extremely confident pre-training, followed by 97.7% for both skills post-training. Importantly, 90.9% of StB trainees felt comfortable teaching newly acquired hemorrhage control skills. A significant majority of participants said that confidence in their wound packing and tourniquet skills would improve with more realistic mannequins.ConclusionTo our knowledge, this is the first StB training in India. Disparities in access to care, long transport times, and insufficient numbers of prehospital personnel contribute to its significant trauma burden. Dissemination of these critical life-saving skills into this region and the resulting civilian interventions will increase the number of trauma patients who survive long enough to reach a trauma center. Additionally, considerations should be given to translating the course into local languages to increase program reach.Level of EvidenceLevel IV.

scholarly journals Traumatic infra-renal aortic dissection after a high-energy trauma: a case report of a primary missed diagnosis

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Holger Godry ◽  
Guido Rölleke ◽  
Achim Mumme ◽  
Thomas A. Schildhauer ◽  
Martin Gothner
Keyword(s):  
Aortic Dissection ◽  
Ct Scan ◽  
High Energy ◽  
The Body ◽  
Trauma Patients ◽  
Traumatic Injuries ◽  
High Energy Trauma ◽  
Missed Injuries ◽  
Lumbar Vertebral Body ◽  
Life Threatening

A traumatic infra-renal aortic dissection is a rare but life-threatening injury that follows deceleration injuries. The mechanism of blunt abdominal aortic injury involves both direct and indirect forces. The successful management of patients with traumatic injuries depends on a prompt suspicion of the injury and early diagnosis and therapy. Missed injuries in trauma patients are well-described phenomena and implementation of the ATLS® trauma schedule led to a decrease in the number of missed injuries, but trauma computed tomography (CT) scans in injured patients are still not standard. We report on a 54-year old Caucasian female patient who was involved in a car accident. The fellow passenger of the car was seriously injured. The patient had been previously treated at two different hospitals, and a dislocated acetabular fracture had been diagnosed. Because of this injury, the patient was transferred to our institution, a level 1 trauma-center where, according to the nature of the accident as a high-energy trauma, a complete polytrauma management was performed at the time of admission. During the body check, a moderate tension of the lower parts of the abdomen was detected. During the CT scan, an aneurysm of the infra-renal aorta with a dissection from the height of the second lumbar vertebral body to the iliac artery was observed. The patient required an operation on the day of admission. After 19 days post-trauma care the patient was able to leave our hospital in good general condition. Therefore, missed injuries in multiple injury patients could be fatal, and it is essential that the orthopedic surgeon leaves room for suspicion of injuries based on the nature of the trauma. Traumatic injuries of the abdominal aorta are rare. According to the ATLS® trauma schedule, all of the patients who have experienced high-energy trauma and associated fractures should undergo routine screening using a trauma CT scan with contrast agents to detect potential life-threatening injuries. In case of abdominal trauma, an aortic dissection, which can easily be overlooked, has to be considered.

Principles of trauma management

2018 ◽  
pp. 151-160
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Major Trauma ◽  
Trauma Team ◽  
Trauma Patients ◽  
Trauma Management ◽  
Economic Output ◽  
Specific Organ ◽  
Life Threatening ◽  
Clinically Significant ◽  
The Impact

Major trauma is defined as an injury or a combination of injuries that are life-threatening and could be life changing because it may result in long-term disability. The impact of trauma is huge. Injuries from accidental trauma worldwide causes moderate to severe disability in > 45m people each year. Trauma is the biggest killer of people age < 45y. UK annual trauma cost is ~£0.35b in immediate treatment; subsequent financial costs are unknown. UK annual lost economic output due to major trauma is ~£3.5b. Trauma management is challenging. Up to 40% of trauma patients have injuries that are initially missed, and up to 20% of these are clinically significant. The trauma team should be appropriately formed to achieve the assigned level of care and prioritize management. Guidelines for specific organ trauma management should be followed and practice standardized to ensure the best outcome.

Selective Use of Cardiopulmonary Bypass in Trauma Patients

2005 ◽  
Vol 71 (1) ◽  
pp. 46-50
Author(s):  
Christine Dauphine ◽  
Charles Mckay ◽  
Christian De Virgilio ◽  
Bassam Omari
Keyword(s):  
Cardiopulmonary Bypass ◽  
Los Angeles ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Chest Injuries ◽  
Life Saving ◽  
Life Threatening ◽  
Level I

The need for cardiopulmonary bypass (CPB) in the treatment of trauma patients is controversial, and not all level I trauma centers have CPB readily available. Our purpose was to review the selective use of CPB in the management of trauma victims at a level I trauma center in Los Angeles County. We reviewed the records of all patients for whom the CPB team was called in from 1994 to 2002. Perfusionists were present for the initial operative management of 24 patients, 22 (92%) of which were male. Twelve patients had penetrating and nine had blunt injuries, two were severely hypothermic, and the last suffered embolization of a bullet to the pulmonary artery. Overall survival was 75 per cent. Sixteen (67%) patients required CPB due to the life-threatening nature of their injuries and/or hemodynamic instability; 11 (69%) survived. The remaining 8 patients were operated on with the CPB team present but on standby; 7 (88%) survived. Cardiopulmonary bypass could be life-saving in select trauma patients with major chest injuries. Hypothermia, acidemia, and shock can be reversed earlier while allowing increased time to gain adequate exposure and perform quality repairs. Level I trauma centers should have CPB capabilities immediately available.

scholarly journals BROAD PECTUS EXCAVATUM TREATMENT: LONG TERM RESULTS OF A BRAZILIAN TECHNIQUE

2021 ◽  
Vol 29 (4) ◽  
pp. 197-202
Author(s):  
Davi de Podestá Haje ◽  
Sydney Abrão Haje ◽  
José Batista Volpon ◽  
Ana Carolina Oliveira da Silva ◽  
Leonardo Ferreira Braz Lima ◽  
...  
Keyword(s):  
Pectus Excavatum ◽  
Skeletal Maturity ◽  
Long Term Results ◽  
Treatment Results ◽  
Level Of Evidence ◽  
End Of Treatment ◽  
Long Term Follow Up ◽  
And Performance

ABSTRACT Objective: This study aims the treatment results of broad pectus excavatum after a long-term follow-up and skeletal maturity. Methods: Eighty-four children and adolescents with broad-type pectus excavatum were selected for evaluation after treatment with a dynamic orthosis that applies compression to the lower rib projections and prescription of exercises. The broad pectus excavatum was defined as a deformity that the depressed area was greater and covered the area above and below the nipple line. All patients were evaluated for more than 1 year after the end of treatment and skeletal maturity. Post-treatment results were categorized as mild, moderate and severe. Statistic correlations between results and deformity flexibility, deformity severity, and adherence to treatment were assessed. Results: The mean age at the beginning of treatment was 13.3 years, and the follow-up duration was 25.7 months after suspension of orthosis use. Forty-eight percent of patients showed good results. With regular use of orthoses and performance of exercises, this rate increased to 70% (p < 0,001). Mild cases showed more success than severe cases (p = 0,007). Initial flexibility didn’t influence the results (p = 0,63). Conclusion: Treatment of broad pectus excavatum with orthoses and exercises led to good definitive results in most resilient patients, especially in those with mild deformities. Level of Evidence V, Expert Opinion.

scholarly journals National estimates of the use and outcomes of extracorporeal membrane oxygenation after acute trauma

2019 ◽  
Vol 4 (1) ◽  
pp. e000209 ◽  
Author(s):  
Parker J Hu ◽  
Lauren Griswold ◽  
Lauren Raff ◽  
Rachel Rodriguez ◽  
Gerald McGwin Jr ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Statistical Significance ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Traumatic Injuries ◽  
Membrane Oxygenation ◽  
Diagnostic Codes ◽  
The Usa ◽  
Ninth Edition ◽  
National Estimates

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for patients with severe acute respiratory distress syndrome is gaining greater acceptance among trauma intensivists. The objective of this study was to review ECMO usage in trauma patients in the USA.MethodsThe National Inpatient Sample (NIS) from years 2002 to 2012 was queried for patients aged 15 and older treated with ECMO who had one or more acute traumatic injuries as defined by the International Diagnostic Codes, Ninth Edition (ICD-9). The primary outcomes of interest were incidence of ECMO and overall inpatient mortality.ResultsA total of 1347 patients were identified in the NIS database who had both ECMO performed and ICD-9 codes consistent with trauma. Patients were predominantly aged 15 to 29 years (31.4%) and were male (65.5%). The incidence of ECMO for patients after traumatic injuries has increased 66-fold during the 10-year period. In-hospital mortality was 48.0% overall, with a decreasing trend during the study period that approached statistical significance (p=0.06).DiscussionAlthough ECMO use in patients in the post-trauma setting remains controversial, there is an increasing trend to use ECMO nationwide, suggesting an increasing acceptance and/or increased availability at trauma centers. Given the decrease in mortality during the study period, ECMO as a salvage method in trauma patients remains a potentially viable option. Evaluation in a prospective manner may clarify risks and benefits.Level of evidenceLevel IV, epidemiological.

scholarly journals Feasibility of telephone-administered interviews to evaluate long-term outcomes of trauma patients in urban Ethiopia

2018 ◽  
Vol 3 (1) ◽  
pp. e000256 ◽  
Author(s):  
Adam D Laytin ◽  
Nebyou Seyoum ◽  
Aklilu Azazh ◽  
Ayalew Zewdie ◽  
Catherine J Juillard ◽  
...  
Keyword(s):  
Low Income ◽  
Functional Outcomes ◽  
Functional Disability ◽  
Mobile Telephone ◽  
Sub Saharan Africa ◽  
Financial Impact ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Middle Income

BackgroundLittle is known about long-term functional outcomes of trauma patients in low-income and middle-income countries. In sub-Saharan Africa most studies of injury only collect data through emergency department disposition or hospital discharge, and methods of collecting long-term data are subject to significant bias. With the recent increase in access to mobile telephone technology, we hypothesized that structured, telephone-administered interviews now offer a feasible means to collect data about the long-term functional outcomes of trauma patients in urban Ethiopia.MethodsWe piloted a telephone-administered interview tool based on the Glasgow Outcome Scale-Extended. Using departmental logbooks, 400 consecutive patients presenting to two public referral hospitals were identified retrospectively. Demographics, injury data, and telephone numbers were collected from medical records. When a telephone number was available, patients or their surrogates were contacted and interviewed 6 months after their injuries.ResultsWe were able to contact 47% of subjects or their surrogates, and 97% of those contacted were able and willing to complete an interview. At 6-month follow-up, 22% of subjects had significant persistent functional disability. Many injuries had an ongoing financial impact, with 17% of subjects losing or changing jobs, 18% earning less than they had before their injuries, and 16% requiring ongoing injury-related medical care. Lack of documented telephone numbers and difficulty contacting subjects at recorded telephone numbers were the major obstacles to data collection. Language barriers and respondents’ refusal to participate in the study were not significant limitations.DiscussionIn urban Ethiopia, many trauma patients have persistent disability 6 months after their injuries. Telephone-administered interviews offer a promising method of collecting data about the long-term trauma outcomes, including functional status and the financial impact of injury. These data are invaluable for capacity building, quality improvement efforts, and advocacy for injury prevention and trauma care.Level of evidenceIII, retrospective cohort study.

scholarly journals Establishment of a novel triage system for SARS-CoV-2 among trauma victims in trauma centers with limited facilities

2021 ◽  
Vol 6 (1) ◽  
pp. e000726
Author(s):  
Hossein Abdolrahimzadeh Fard ◽  
Roham Borazjani ◽  
Golnar Sabetian ◽  
Zahra Shayan ◽  
Shahram Boland Parvaz ◽  
...  
Keyword(s):  
Trauma Patients ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Laboratory Findings ◽  
Triage System ◽  
Traumatic Injuries ◽  
Specificity And Sensitivity ◽  
Number Of Patients ◽  
Triage Protocol ◽  
Control And Prevention

ObjectivesThe triage of trauma patients with potential COVID-19 remains a major challenge given that a significant number of patients may be asymptomatic or pre-symptomatic. This study aimed to compare the specificity and sensitivity of available triage systems for COVID-19 among trauma patients. Furthermore, it aimed to develop a novel triage system for SARS-CoV-2 detection among trauma patients in centers with limited resources.MethodsAll patients referred to our center from February to May 2020 were enrolled in this prospective study. We evaluated the SARS-CoV-2 triage protocols from the WHO, the Iranian Ministry of Health and Medical Education (MOHME), and the European Centre for Disease Control and Prevention (ECDC) for their effectiveness in finding COVID-19 infected individuals among trauma patients. We then used these data to design a stepwise triage protocol to detect COVID-19 positive patients among trauma patients.ResultsAccording to our findings, the WHO protocol showed 100% specificity and 13.3% sensitivity. The MOHME protocol had 99% specificity and 23.3% sensitivity. While the ECDC protocol showed 93.3% sensitivity and 89.5% specificity, it did not prioritize patients based on traumatic injuries and unstable conditions. Our stepwise triage protocol, which prioritizes traumatic injuries, had 93.3% sensitivity and 90.3% specificity.ConclusionOur study shows that the triage protocols from the WHO, MOHME and ECDC are not best equipped to diagnose SARS-CoV-2 infected individuals among trauma patients. In our proposed stepwise triage system, patients are triaged according to their hemodynamic conditions, COVID-19 related clinical states, and COVID-19 related laboratory findings. Our triage model can lead to more accurate and resource-effective management of trauma patients with potential COVID-19 infection.Level of evidenceLevel Ⅲ.

Incidence of Obstetric Lacerations and Episiotomy Following Labiaplasty

2020 ◽  
Author(s):  
Aaron M Kearney ◽  
Sergey Y Turin ◽  
Otto J Placik ◽  
Laura Wattanasupachoke
Keyword(s):  
Vaginal Delivery ◽  
Significant Proportion ◽  
Retrospective Chart Review ◽  
Level Of Evidence ◽  
Obstetric Lacerations ◽  
Phone Survey ◽  
Vaginal Deliveries ◽  
Increased Risk ◽  
Small Cohort

Abstract Background A significant proportion of patients seeking labiaplasty are nulliparous and may experience later changes to their labia following vaginal delivery. Objectives In the present study, the authors reported the long-term outcomes of a single surgeon’s patient cohort who had vaginal delivery after labiaplasty. Methods A retrospective chart review of the senior author’s database was conducted. All patients who underwent in-office labiaplasty from 2007 to 2018 were surveyed. The resulting cohort was stratified into patients who had delivered children prior to labiaplasty and those who delivered after labiaplasty. Results A total of 204 patients responded to a phone survey. Seventy patients had children prior to undergoing labiaplasty, and 33 had children after labiaplasty. The rate of vaginal delivery was lower in the women who had children before labiaplasty (82.6% vs 91.8%, P = 0.015). The tear/episiotomy rate for vaginal deliveries was lower in women who had children prior to labiaplasty compared with after labiaplasty (3.1% vs 17.8%, P &lt; 0.001). Among the women who had children only after labiaplasty, the reported tear/episiotomy rate was 7/39 vaginal deliveries (17.9%). Conclusion Patients in our cohort had over 90% success with vaginal deliveries after labiaplasty. For nulliparous patients contemplating the procedure, the data we present suggest the risk of episiotomy or vaginal tear risk with vaginal birth after labiaplasty is comparable with or lower than the general population, further supporting the safety of this procedure. For patients with previous delivery, the data are more limited but suggest no increased risk in this small cohort. Level of Evidence: 4

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