Telemedicine-guided forearm emergency decompressive fasciotomy for compartment syndrome

2020 ◽  
pp. 1357633X2096435
Author(s):  
J Patrick Park ◽  
Julien Montreuil ◽  
Anas Nooh ◽  
Paul A Martineau
Keyword(s):  
Compartment Syndrome ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Rural Setting ◽  
Surgical Emergencies ◽  
Operative Exploration ◽  
Rural Settings ◽  
Irrigation And Debridement ◽  
Forearm Compartment Syndrome ◽  
Prompt Diagnosis

Introduction We highlight the utility of telemedicine and telementoring for the management of orthopaedic emergencies using a case of forearm compartment syndrome following a penetrating trauma in a northern Inuit community in Nunavik, Quebec, Canada. Methods & Results As in many cases of compartment syndrome in rural settings, the patient was at a high risk of developing irreversible complications. A prompt diagnosis followed by an emergency decompressive fasciotomy was warranted. Using telemedicine and telementoring guidance, the diagnosis of compartment syndrome was made, and the patient’s volar compartment was successfully decompressed by a local emergency physician in a timely manner. Subsequently, the patient was able to be safely transferred to a level 1 trauma centre for further surgical management. This included a second-look operative exploration, irrigation and debridement, completion of volar fasciotomy and ulnar nerve decompression. No complications were seen. Discussion Our experience highlights two important clinical implications. First, telemedicine can be successfully implemented to facilitate clinical diagnosis of surgical emergencies in the rural setting. Second, telementoring can effectively allow surgeons to guide physicians remotely to perform emergency decompressive fasciotomy, which can help salvage the affected limb and significantly decrease the risk of debilitating complications.

scholarly journals The contribution of helicopter emergency medical services in the pre-hospital care of penetrating torso injuries in a semi-rural setting

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
M. Gavrilovski ◽  
J. E. Griggs ◽  
E. ter Avest ◽  
R. M. Lyon ◽  
Keyword(s):  
Emergency Medical Services ◽  
Rural Areas ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Rural Setting ◽  
Medical Services ◽  
Hospital Treatment ◽  
Helicopter Emergency Medical Services ◽  
Emergency Medical ◽  
Major Trauma Centre

Abstract Background Although the merit of pre-hospital critical care teams such as Helicopter Emergency Medical Services (HEMS) has been universally recognized for patients with penetrating torso injuries who present with unstable physiology, the potential merit in patients initially presenting with stable physiology is largely undetermined. The ability to predict the required pre-hospital interventions patients may have important implications for HEMS tasking, especially when transport times to definitive care are prolonged. Methods We performed a retrospective cohort study of patients who sustained a penetrating torso injury and were attended by the Air Ambulance Kent Surrey Sussex (AAKSS) over a 6-year period. Primary outcome was defined as the percentage of patients with penetrating torso injuries requiring HEMS-specific interventions anytime between HEMS arrival and arrival at hospital. Secondary outcomes were the association of individual patient- and injury characteristics with the requirement for HEMS interventions. Results During the study period 363 patients met inclusion criteria. 90% of patients were male with a median age of 30 years. 99% of penetrating trauma incident occurred more than 10-min drive from a Major Trauma Centre (MTC). Presenting GCS was > 13 in 83% of patients. Significant hemodynamic- or ventilatory compromise was present in more than 25% of the patients. Traumatic cardiac arrest was present in 34 patients (9.4%), profound hypotension with SBP < 80 mmHg in 30 (8.3%) and oxygen saturations < 92% in 30 (8.3%). A total of 121 HEMS-specific interventions were performed. Although HEMS-specific interventions were associated with presenting physiology (TCA OR 1.75 [1.41–2.16], SBP < 80 mmHg (OR 1.40 [1.18–1.67] and SpO2 < 92% (OR 1.39 [1.17–1.65], a minority of the patients presented initially with stable physiology but deteriorated on route to hospital and required HEMS interventions (n = 9, 3.3%). Conclusion HEMS teams provide potentially important contribution to the pre-hospital treatment of patients with penetrating torso injuries in rural and semi-rural areas, especially when they present with unstable physiology. A certain degree of over-triage is inevitable in these patients, as it is hard to predict which patients will deteriorate on route to hospital and will need HEMS interventions. The results of this study showing a potentially predictable geographical dispersion of penetrating trauma could inform multi-agency knife crime prevention strategy.

scholarly journals Tackling Rural Health, Energy, … and Technological Issues All at Once: A Call for a Global Interdisciplinary Platform for Strengthening Rural Setting Amid the COVID-19 Pandemic

Challenges ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 16
Author(s):  
Farshad Amiraslani
Keyword(s):  
Rural Communities ◽  
Rural Health ◽  
Rural Areas ◽  
Rural Setting ◽  
Global Challenges ◽  
Rural Settings ◽  
Research Studies

The recent COVID-19 pandemic has revealed flaws in rural settings where most people live without the necessary tools, income, and knowledge to tackle such unprecedented global challenges. Here, I argue that despite the research studies conducted on rural areas, these have not solved rising rural issues, notably poverty and illiteracy. I propound a global institute to be formed by governments that provides a platform for empowering rural communities through better training, skills, and competencies. Such global endeavour will ensure the remaining rural communities withstand future pandemics if they occur.

scholarly journals Ovarian Torsion in a 5-Year Old: A Case Report and Review

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Matthew F. Ryan ◽  
Bobby K. Desai
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Case Report ◽  
Urinary Tract ◽  
Clinical Suspicion ◽  
Ovarian Torsion ◽  
Surgical Emergencies ◽  
High Clinical Suspicion ◽  
Tract Infections ◽  
Prompt Diagnosis

Ovarian torsion represents a true surgical emergency. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the Emergency Department (ED) such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as appendicitis. Prompt diagnosis can be further complicated in low-risk populations such as young children. Herein, we describe the case of a 5-year-old girl with a seemingly benign presentation of abdominal pain who was diagnosed in the ED and treated for acute ovarian torsion after two prior clinic visits. A brief discussion of evaluation, treatment, and management of ovarian torsion follows.

Insidious Onset Compartment Syndrome of the Forearm in a Teenager: A Case Report and Review of the Literature

2021 ◽  
Vol 26 (03) ◽  
pp. 481-484
Author(s):  
Hidetoshi Iwata ◽  
Hideki Okamoto ◽  
Yohei Kawaguchi ◽  
Kojiro Endo ◽  
Yuji Joyo ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Single Case ◽  
Case Reports ◽  
Upper Extremities ◽  
Review Of The Literature ◽  
Right Hand ◽  
Insidious Onset ◽  
Forearm Compartment Syndrome ◽  
Cash Register ◽  
Proximal Forearm

Compartment syndrome affecting the upper extremities is a relatively underreported event compared with compartment syndrome affecting the lower extremities. Moreover, insidious onset forearm compartment syndrome has been rarely reported and is usually limited to single case reports. We report a compartment syndrome of the forearm in a teenager. She hit her right proximal forearm lightly on the cash register, but there was no pain. However, the next day, she had difficulty in moving her right hand. Although she underwent electrotherapy, her right forearm gradually became swollen, and she felt numbness in the ring and little fingers of her right hand. Six day after the onset, she came to our hospital and underwent fasciotomy. There was no aftereffect, and very good functional recovery was obtained. All clinicians need to keep the case of forearm compartment syndrome in a young individual with a diffuse course, such as in this case in mind.

Forearm Compartment Syndrome Concomitant with Pseudoaneurysm of the Anterior Interosseous Artery after Minor Penetrating Injury

2018 ◽  
Vol 23 (03) ◽  
pp. 395-398
Author(s):  
Shingo Komura ◽  
Akihiro Hirakawa ◽  
Yasuharu Matsushita ◽  
Tomihiro Masuda ◽  
Marie Nohara ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Penetrating Injury ◽  
Successful Outcome ◽  
Pseudoaneurysm Formation ◽  
Anterior Interosseous Artery ◽  
Traumatic Pseudoaneurysm ◽  
Interosseous Artery ◽  
Forearm Compartment Syndrome ◽  
A Minor ◽  
Type Of Injury

A 16-year-old man sustained a minor penetrating injury to his forearm, resulting in pseudoaneurysm formation that caused acute compartment syndrome with muscle contracture. Surgical treatment, including fasciotomy, evacuation of the hematoma and aneurysmectomy, followed by intensive hand therapy provided a successful outcome. Traumatic pseudoaneurysm after penetrating injury is a rare cause of acute forearm compartment syndrome. Although minor penetrating injuries tend to be underestimated, this type of injury can cause subsequent serious pathological conditions.

scholarly journals Determinants of preconception care among pregnant women in an urban and a rural health facility in Kenya: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. K. Okemo ◽  
D. Kamya ◽  
A. M. Mwaniki ◽  
M. Temmerman
Keyword(s):  
Child Health ◽  
Pregnant Women ◽  
Preconception Care ◽  
Healthcare Providers ◽  
Preventive Health Care ◽  
Structured Interview ◽  
University Hospital ◽  
Rural Setting ◽  
Rural Settings ◽  
And Child Health

Abstract Background Preconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could contribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in rural areas. Little is known regarding PCC use in Kenya that could help in addressing this shortfall. This study aimed to qualitatively assess the determinants of PCC in urban and rural settings in Kenya. Methods A qualitative approach was employed to assess determinants of PCC using a semi-structured interview guide. The study was conducted from May to October 2017. Selected pregnant women seeking antenatal care (ANC) were recruited by quota sampling, at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). The interviews were thereafter transcribed verbatim and analyzed thematically. Findings A total of 26 women were invited, of whom 21 accepted to participate in in-depth interviews (IDIs). Saturation of themes occurred with 13 interviews (7 at AKUH and 6 at MLFH). Transcription, coding and thematic analysis of the IDIs yielded 12 themes. Eleven of these themes were identified as determinants of PCC. The twelfth theme contained suggested strategies of increasing PCC awareness and utilization, such as using the media, setting up PCC clinics and integrating PCC into other clinics. The dominant themes were awareness about PCC and attitudes towards PCC and pregnancy. The broad determinants of PCC were similar in urban and rural settings – with a few notable exceptions. For example, in the rural setting, women’s level of education and a pervasive history of poor interactions with healthcare providers were major determinants of PCC. Conclusion From this study we conclude that women’s lack of awareness about PCC, in conjunction with attitudes towards PCC and pregnancy impact strongly on its utilization. This lack of awareness could be addressed through health education programs for both the public and for healthcare providers, as well as integrating PCC in the curricula of the later.

scholarly journals Determinants of Preconception care among Pregnant Women In an Urban and a Rural Health Facility In Kenya: A Qualitative Study

2021 ◽  
Author(s):  
Joan Khavugwi Okemo ◽  
Dorothy Kamya ◽  
Abraham Mukaindo Mwaniki ◽  
Marleen Temmerman
Keyword(s):  
Child Health ◽  
Pregnant Women ◽  
Preconception Care ◽  
Healthcare Providers ◽  
Preventive Health Care ◽  
Structured Interview ◽  
University Hospital ◽  
Rural Setting ◽  
Rural Settings ◽  
And Child Health

Abstract BACKGROUNDPreconception care (PCC) is a form of preventive health care that is offered to women and couples before conception, with the aim of improving their health status and mitigating various risk factors that could contribute to poor maternal and child health outcomes. The levels of PCC utilization are still low globally, especially in developing countries and in the rural areas. Little is known regarding PCC use in Kenya that could help in bridging this gap. This study aimed to assess the determinants of PCC in urban and rural settings in Kenya.METHODSSelected pregnant women seeking antenatal care (ANC) were recruited by purposive sampling at the Mother and Child Health (MCH) clinics in Aga Khan University Hospital, Nairobi (AKUH, N-urban) and Maragua Level Four Hospital (MLFH-rural). A qualitative approach was employed to assess determinants of PCC using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed thematically.RESULTS A total of 26 women were invited, of whom 21 accepted to participate in in-depth interviews (IDIs). Saturation of themes occurred after 13 interviews (7 at AKUH and 6 at MLFH).Transcription, coding and thematic analysis of the IDIs yielded 12 main themes. Eleven of the main themes were identified as determinants of PCC while the twelfth theme contained suggested strategies of increasing PCC awareness and utilization, such as using the media, setting up PCC clinics and integrating PCC into other clinics. The dominant themes were awareness about PCC and attitudes towards PCC and pregnancy.The broad determinants of PCC were similar in urban and rural settings – with a few notable exceptions. For example, in the rural setting, women’s level of education and a pervasive history of poor interactions with healthcare providers were major determinants of PCC.CONCLUSIONFrom this study we conclude that women’s lack of awareness about PCC, in conjunction with attitudes towards PCC and pregnancy impact strongly on its utilization. This lack of awareness could be addressed through health education programs for both the public and for healthcare providers, as well as integrating PCC in the curricula of nurses and doctors.

scholarly journals Iatrogenic forearm compartment syndrome

2016 ◽  
Vol 18 (1) ◽  
pp. 63-65
Author(s):  
Ahmed Elmorsy ◽  
James Nutt ◽  
Nick Taylor ◽  
Justin Kirk-Bayley ◽  
Sean Hughes
Keyword(s):  
Critical Care ◽  
Compartment Syndrome ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Blood Sampling ◽  
Forearm Compartment Syndrome ◽  
Arterial Damage

Limb compartment syndrome may be sequelae of trauma, but in the context of critical care blood sampling, arterial damage may have profound consequences. We describe a series of three cases and their progress and discuss guidelines for prevention of this potentially devastating occurrence in critically ill patients.

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