scholarly journals Socio-Demographic Characteristics of Patients Presenting to the Vascular Emergency Department of National Institute of Cardiovascular Diseases (NICVD)

2016 ◽  
Vol 11 (1) ◽  
pp. 3-6
Author(s):  
Sultan Mahmud ◽  
Mohammad Samir Azam Sunny ◽  
Md Enamul Hakim ◽  
Rezwanul Haque ◽  
Md Aftabuddin
Keyword(s):  
Emergency Department ◽  
Cardiovascular Diseases ◽  
Vascular Surgery ◽  
Road Traffic ◽  
Vascular Trauma ◽  
Blunt Injury ◽  
Vascular Injuries ◽  
Care Needs ◽  
Female Ratio ◽  
Epidemiological Characteristics

Emergency department of vascular surgery of National Institute of Cardiovascular Diseases (NICVD) is rendering service for the patients suffering from vascular trauma since 2001. Data regarding this practice of emergency services is rarely published. This paper aims to provide the epidemiological characteristics of patients presenting the vascular emergency department of NICVD between 01/9/14 to 30/09/14. This study is intended to benefit the policy makers, healthcare providers in Bangladesh to promote and define the specialty of emergency vascular department and to allocate resources more effectively to address country’s acute care needs. In total sixty four (64) patients was attended in this 1 month. The male to female ratio was 60:4 with age range from nine to sixty four years (mean age 30.8years). Among them thirty nine percent patients belong to low socioeconomic class, thirty one percent from middle class and others from affluent family. Forty patients (62.5%) were referred from various institute of Dhaka city and rest from outside Dhaka. Seventy five percent patients came by ambulance, eight percent by private vehicles and rest by other means. Fifty eight patients (90.62%) came with referral papers from other health institutes, where there is no vascular surgery department. Most common cause of referral was vascular trauma (78.12%), other causes of referral were complicate vascular aneurysm (7.8%) and vascular thrombosis (14.06%). The time since injury and seeking treatment for vascular surgery ranged two hours to six days. Mean time was 10.3 hours. Forty cases (62.5%) sustained vascular trauma by accident with sharp cutting objects during occupational and house hold activities, assault (stab injury, blunt injury and gunshot) ten cases (15.62%), road traffic accident seven cases (10.93%), intravenous drug abusers three cases (4.68%), accidentally fall from height three cases (4.68%) and post operative complication one cases (1.56%). This study demonstrates that eighty eight percent study populations presented with arterial injuries and only twelve percent with venous injuries. Associated injuries (tendon, nerve, muscle, fracture of bones and joints dislocation) were present in fifty six patients (87.5%). Most common artery that was injured was radial artery. Vascular Injuries were treated with end to end anastomosis in twenty five patients (36.6%), ligation of vessels in twenty three patients (35.9%), fasciotomy was done in eight patients (12.5%) , embolectomy (fogerty) was done in four patients (6.25%) ,. aneurysmectomy was needed in two patients (3.1%) and interposition venous graft was used in two cases (3%). The emergency department of vascular surgery of National Institute of Cardiovascular Diseases (NICVD) is taking the entire burden with their small resources to ensure the best quality care for the management of the patients with vascular injuries. The data can inform and guide the allocation of national resources towards emergency care, injury prevention campaigns, emergency service evaluation and clinical guideline development.University Heart Journal Vol. 11, No. 1, January 2015; 3-6

scholarly journals Clinical Profile of Extremity Vascular Surgeries at Trivandrum Medical College

2021 ◽  
Vol 10 (37) ◽  
pp. 3207-3212
Author(s):  
Sony Paul Suraja ◽  
Vinu C. V ◽  
Kishore Lal J ◽  
Ravi Kumar T.D ◽  
Suresh Kumar J
Keyword(s):  
Lower Extremity ◽  
Vascular Surgery ◽  
Upper Extremity ◽  
Vascular Injury ◽  
Vascular Trauma ◽  
Clinical Profile ◽  
Vascular Injuries ◽  
Total Study Population ◽  
Female Ratio ◽  
Medical College

BACKGROUND One of the most common emergency diseases is traumatic vascular injury. The damage mechanism is linked to the environment and the time frame. The treatment of vascular injury is evolving in tandem with the passage of time. In short, vascular injury treatment ranges from simple to complex, and from simple to diverse. Patients suffering from vascular injury can now benefit from advanced medical equipment. Traditional treatments, on the other hand, continue to play an important role. It remains to be seen which treatment method will be adopted as the standard. Traumatic vascular injury is an emergency in surgery, mainly characterized by damage to veins and arteries. Haemorrhage (commonly from truncal vascular injuries) and ischemia (typical of peripheral arterial injuries) are the main clinical manifestations of vascular injuries. If vascular trauma has not been treated in time, it may cause disability or even death, especially for limb vascular surgery. There are many difficulties in diagnosis and treatment of vascular injuries, which have brought many challenges to the surgeons since the 20th century. Vascular trauma accounts for 3 % of all traumatic injuries. Vascular injury may lead to severe complications, so early diagnosis and timely treatment are critical. The purpose of this study was to assess the clinical profile of emergency extremity vascular cases at Trivandrum medical college. METHODS The demographic details, aetiology, mode of injury, limb and structures involved, concomitant injuries, clinical finding, delay in reaching trauma centre and surgical intervention done were recorded in a planned proforma and analysis was done. In this retrospective cross-sectional study, a total of 67 patients with extremity vascular emergencies referred to and called for intraoperative assistance in cardiovascular and thoracic surgery, Trivandrum Medical College over a period of 2 years from January 2018 to December 2019were included. RESULTS The mean age was 44 (SD 16.2) years with male to female ratio being 10.1 : 1.0. Trauma was the most common aetiology of vascular emergency (76.1 %). Out of the total study population, lower extremity emergencies (82 %) were high compared to upper extremity emergencies (18 %). Popliteal and superficial femoral arteries were the most common sites of injury in lower extremity, whereas radial and brachial arteries were the most common arteries involved in the upper extremity. Vessels were seen contused in majority of patients (46.3 %) followed by thrombosis, transection and rupture. No patients presented with venous injuries. But tendon and nerve injuries were present in 36 patients (53.7 %). Average time delay in reaching trauma center was 3 hours. Simple injuries to arteries were repaired with simple stitches as direct repair in 2 patients (2.99 %) and end to end anastomosis was done in 19 patients after resecting the injured segment. CONCLUSIONS Majority of the affected patients belonged to younger age group with trauma being the predominant aetiology. This may be due to the increase in incidence of road traffic accidents and other industrial accidents. Road safety measures are needed and awareness among public should be increased to reduce these types of injuries. All patients presented to our centre could be managed by performing emergency vascular surgeries, owing to timely reporting to hospital and by better use of imaging modalities. KEY WORDS Extremity Vascular Surgery, Anastomosis, Embolectomy

scholarly journals Delayed Presentation Of Missed Vascular Injuries And Pitfalls In Primary Treatment– Experience Of A Vascular Surgery Unit In Pakistan

2018 ◽  
Vol 08 (04) ◽  
pp. 258-262
Author(s):  
Ahsin Manzoor Bhatti ◽  
Junaid Mansoor ◽  
Haroon Sabir Khan
Keyword(s):  
Vascular Surgery ◽  
Vascular Injury ◽  
Tertiary Care ◽  
Primary Treatment ◽  
Vascular Trauma ◽  
Adverse Outcomes ◽  
Delayed Presentation ◽  
Vascular Injuries ◽  
Vascular Repair ◽  
Missed Injuries

Objective: To analyze errors in primary treatment of vascular injuries and delayed presentations of missed vascular injuries as a surrogate indicator of need for improved vascular surgical training of upcoming general surgeons. Materials and methods: This retrospective observational study was carried out at vascular surgery department of two tertiary care hospitals of Armed Forces from Jan 2012 to June 2017. Hospital records of all patients with vascular trauma were analyzed for presence of pitfalls in primary treatment and delayed presentation of missed vascular injuries which resulted in redo surgeries or adverse outcomes. Results: Out of 256 patients with vascular injury sequel 41 had either a problem in primary treatment or presented with delayed complications of missed injuries. The omissions can be divided into: missed injuries (24/41), technical errors in initial repair (12/24), reperfusion of mangled Extremity (3/41) and non availability of a surgeon capable of undertaking vascular repair. The commonest operative fault was failure to debride the vessel adequately and vascular repair under tension. The commonest primary assessment problem was failure to timely appreciate hard signs of vascular injury. Conclusion: With better training and emphasizing the need of thorough clinical examination outcome of vascular trauma can be improved.

scholarly journals Emergency Department Referral Profile of Traumatic Brain Injury Records at a Tertiary Care Hospital of Pakistan

2021 ◽  
Author(s):  
Maria Khan ◽  
Uzair Yaqoob ◽  
Zair Hassan ◽  
Muhammad Muizz Uddin
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Road Traffic ◽  
Tertiary Care ◽  
Initial Assessment ◽  
Care Hospital ◽  
Mild Tbi ◽  
Epidemiological Characteristics ◽  
The Impact

Abstract Background: Traumatic Brain Injury (TBI) is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective here is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This was a cross-sectional study conducted at the Lady Reading Hospital, Peshawar, Pakistan. Data were extracted from the medical records from January 1st to December 31st, 2019. Patient age, sex, type of trauma, and immediate outcome of the referral to the Emergency Department were recorded. The severity of TBI was categorized based on Glasgow Coma Scale (GCS) in mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS <8) classes. The Emergency Department referral profile was classified as admissions, disposed, detained and disposed, referred.Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). Road Traffic accident was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively commonplace picture of epidemiological data on the burden of TBI in Pakistan. As a large proportion of patients had a mild TBI, and there is a high risk of mild TBI being under-diagnosed, we warrant further investigation of mild TBI in population-based studies.

scholarly journals Maintaining vascular trauma proficiency for military non-vascular surgeons

2020 ◽  
Vol 5 (1) ◽  
pp. e000475
Author(s):  
Andrew Hall ◽  
Iram Qureshi ◽  
Kegan Brumagen ◽  
Jacob Glaser
Keyword(s):  
Vascular Surgery ◽  
High Volume ◽  
Vascular Trauma ◽  
University Hospital ◽  
General Surgeon ◽  
Vascular Injuries ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Combat Casualty ◽  
Civilian Trauma

BackgroundVascular injuries in combat casualty patients are common and remain an ongoing concern. In civilian trauma centers, vascular surgeons are frequently available to treat vascular injuries. Within the military, vascular surgeons are not available at all locations where specialty expertise may be optimal. This study aims to determine if a visiting surgeon model, where a general surgeon can visit a civilian trauma center, would be practical in maintaining proficiency in vascular surgery.MethodsAll vascular trauma relevant cases done by any surgical service were identified during a 2-year period at Saint Louis University Hospital between October 1, 2016 and September 30, 2018. These included cases performed by trauma/general, thoracic, vascular, and orthopedic surgery. Predictions on the number of call days to experience an operative case were then calculated.ResultsA total of 316 vascular cases were performed during the time period. A surgeon on call for five 24-hour shifts would experience 2.1 urgent vascular cases with 95% certainty. To achieve five cases with 95% certainty, a surgeon would have to be on call for 34 24-hour shifts.DiscussionA visiting surgeon model would be very difficult to maintain to acquire or maintain proficiency in vascular surgery. High-volume trauma centers, or centers with significant open vascular cases in addition to trauma, may have more reasonable time requirements, but would have to be evaluated using these methods.Level of evidenceEconomic and value-based evaluations, level II.

scholarly journals Study of Abdominal Injury: An Analysis of 50 Cases

1970 ◽  
Vol 17 (2) ◽  
pp. 84-88 ◽  
Author(s):  
MAB Siddique ◽  
MK Rahman ◽  
ABMA Hannan
Keyword(s):  
Road Traffic ◽  
Penetrating Injury ◽  
Abdominal Injury ◽  
Blunt Injury ◽  
College Hospital ◽  
Female Ratio ◽  
Medical College ◽  
Clinical Presentations ◽  
Stab Injuries ◽  
Age Range

Abdominal injury is an important aspect of trauma because of difficulty in diagnosis and its lethal potential if not properly treated. Fifty cases of abdominal injury admitted in the surgical wards of Rajshahi Medical College Hospital over 2 years have been studied here. All the patients underwent laparotomy for their management. The age range of the patient was 14 to 70 years and most commonly involved age group was 21 to 30 years. Male to female ratio was 15.6:1. The incidence of penetrating injury predominated (64%) over non-penetrating injury and majority had stab injuries. Road traffic accident predominated in blunt injury. Small gut injury outnumbered all other injuries in both groups. Abdominal pain was the most frequent symptom. Most of the patient arrived in the hospital within 24 hours. Considering clinical presentations and results of investigations, decision for laparotomy was taken with prior resuscitation.   doi: 10.3329/taj.v17i2.3452 TAJ 2004; 17(2): 84-88

scholarly journals Epidemiological characteristics of child injury in a tertiary paediatric surgical centre in Bangladesh

2020 ◽  
Vol 6 (3) ◽  
pp. 577-586
Author(s):  
Tanvir Kabir Chowdhury ◽  
Ayesha Sadia ◽  
Rumana Khan ◽  
Abida Farjana ◽  
Efat Sharmin ◽  
...  
Keyword(s):  
Seasonal Variations ◽  
Road Traffic ◽  
School Age Children ◽  
Paediatric Surgery ◽  
School Age ◽  
Mechanism Of Injury ◽  
Child Injury ◽  
College Hospital ◽  
Female Ratio ◽  
Epidemiological Characteristics

While high income countries (HICs) have reduced the mortality from child injury, it is increasing in the low- and middle-income countries (LMICs). However, injury registry and reporting are inconsistent and not well developed in the LMICs. This study aims at describing the epidemiology of child injury in a tertiary paediatric surgical centre in Bangladesh. We retrospectively analysed all patients of injury between 0 and 12 years of age admitted in the Department of Paediatric Surgery, Chattogram Medical College Hospital during January 2017 to June 2020. Analysis was done for the hospital prevalence, age and sex distribution, seasonal variations, mechanism of injury, site of involvement, and mortality from injury. There were a total of 538 patients and male to female ratio was 2.01:1. Hospital prevalence was 6.71%. Mean age was 6.60 ± 3.32 years. School age children were affected more (51.7%); and “6-10 years” age group had the highest number injuries (251 patients, 46.65%). The most common mechanisms of injuries were road-traffic accident (RTA, 35.32%), followed by fall (26.39%) and „stab or cut injury‟ (20.63%). Males experienced more abdominal injuries and females had more perineal injuries (P=0.00). RTA was the commonest mechanism in males (37.05%) and falls were the commonest mechanism in females (32.96%). „Stab or cut injury‟ was the commonest mechanism in infants and toddlers, and RTA was commonest among pre-school and school age children. There were no significant seasonal variations (P=0.09). There were 5.76% intentional injuries. Mortality was 2.60% and major causes of mortality were RTA and animal assaults. Injuries were more prevalent during the mid-childhood with an overall increasing trend with age. Mechanism of injury and site of involvement were different among different age groups and between sexes. Asian J. Med. Biol. Res. September 2020, 6(3): 577-586

scholarly journals Patient profile of patients attending to emergency department of a tertiary neurological and neurosurgical hospital of Nepal: One year experience

2020 ◽  
Vol 1 (1) ◽  
pp. 20-24
Author(s):  
Rashmi Shrestha ◽  
Rachana Nakarmi ◽  
Ritesh Luitel ◽  
Subodh Sharma Paudel
Keyword(s):  
Emergency Department ◽  
Road Traffic ◽  
Neurological Diseases ◽  
Physical Assault ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
Patient Profile ◽  
Number Of Patients ◽  
One Year ◽  
Ischemic Attack

Introduction: Neurological emergencies are life threatening conditions that arise frequently and have devastating results if not diagnosed and treated quickly with high rates of neurological mortality and morbidity. Being a tertiary neurological center, Upendra Devkota Memorial National Institute of Neurological and Allied Science is a major referral center for neurological diseases. The objective of this study is to assess the types and number of diseases that present to the emergency department of a tertiary neurological center. Methods: This is a retrospective study conducted in emergency department of national neurosurgical/neurological referral hospital in Kathmandu, from Oct 2018 to Sept 2019. Clinico-epidemiological details of the patients were noted. Results: The total number of patients presenting to the emergency in one year period were 2995. 58.33% were males and 41.67% were females with male to female ratio of 1:1.4. Majority of the patients (24.91%) were above 60 years of age. Trauma (26.08%) was the major admissions followed by stroke (25.71%) and headache (11.79%). The majority of trauma were road traffic accident (43.02%) followed by fall injury (29.83%) and physical assault (18.96%). Out of the stroke cases, 51.68% were ischemic followed by hemorrhagic stroke 44.55% and transient ischemic attack (3.77%). One thousand eight hundred and ten people were admitted. Conclusion: The study presents an overview of the patients presenting as neurological emergency. It helps to better plan and devise resources and system in a neurosurgical emergency.

scholarly journals Vascular injuries of the upper extremity

2006 ◽  
Vol 5 (4) ◽  
pp. 271-276 ◽  
Author(s):  
Raafat Shalabi ◽  
Yoysifh Al Amri ◽  
Elham khoujah
Keyword(s):  
Limb Salvage ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Vascular Trauma ◽  
Lower Extremity Injury ◽  
Surgical Approaches ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Peripheral Vascular ◽  
Study Results

OBJECTIVE: This study analyzes the causes of injuries, presentations, surgical approaches, outcome and complications of vascular trauma of the upper limbs, in spite of limited hospital resources. METHODS: A 5-year retrospective analysis. From 01/01/2001 to 31/12/2005, 165 patients were operated for vascular injuries at King Fahd Hospital, Medina, Saudi Arabia. Of all peripheral vascular trauma patients (115), upper limb trauma was present in 58. Diagnosis was made by physical examination and hand-held Doppler alone or in combination with Doppler scan/angiography. Primary vascular repair was performed whenever possible; otherwise, the interposition vein graft was used. Fasciotomy was considered when required. Patients with unsalvageable lower extremity injury requiring primary amputation were excluded from the study. RESULTS: Fifty patients were male (86%) and eight were female (14%), aged between 2.5-55 years (mean 23 years). Mean duration of presentation was 8 h after the injury. The most common etiological factor was road traffic accidents, accounting for 50.5% in the blunt trauma group and 33% among all penetrating and stab wound injuries. Incidence of concomitant orthopedic injuries was very high in our study (51%). The brachial artery was the most affected (51%). Interposition vein grafts were used in 53% of the cases. Limb salvage rate was 100%. CONCLUSION: Patients who suffer vascular injuries of the upper extremities should be transferred to vascular surgery centers as soon as possible. Decisive management of peripheral vascular trauma will maximize patient survival and limb salvage. Priorities must be established in the management of associated injuries, and delay must be avoided when ischemic changes are present.

scholarly journals Mandibular Fractures Admitted to the Emergency Department: Data Analysis from a Swiss Level One Trauma Centre

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Kemal Yildirgan ◽  
Edris Zahir ◽  
Siamak Sharafi ◽  
Sufian Ahmad ◽  
Benoit Schaller ◽  
...  
Keyword(s):  
Emergency Department ◽  
Interpersonal Violence ◽  
Road Traffic ◽  
Age Groups ◽  
Trauma Centre ◽  
Mandibular Fracture ◽  
Minor Role ◽  
Mandibular Fractures ◽  
Female Ratio ◽  
Sport Activities

Mandibular fracture is a common occurrence in emergency medicine and belongs to the most frequent facial fractures. Historically road traffic injuries (RTIs) have played a prominent role as a cause for mandibular fractures. We extracted data from all patients between August 2012 and February 2015 with “lower jaw fracture” or “mandibular fracture” from the routine database from the emergency department. We conducted a descriptive analysis at a Swiss level one trauma centre. 144 patients were admitted with suspected mandibular fractures. The majority underwent CT diagnostic (83%). In 7% suspected mandibular fracture was not confirmed. More than half of all patients suffered two or more fractures. The fractures were median or paramedian in 77/144 patients (53%) and in other parts (corpus, mandibular angle, ramus mandibularis, collum, and temporomandibular joint) in 100/144 (69%). Male to female ratio was 3 : 1 up to 59 years of age; 69% were younger than 40 years. 72% of all patients presented during daytime, 69% had to be hospitalized, and 31% could be discharged from the ED after treatment. Most fractures were due to fall (44%), followed by interpersonal violence (25%) and sport activities (12%). Falls were a dominant cause of fracture in all age groups while violence and sport activities were common only in younger patients. Comparisons to other studies were difficult due to lack of standardization of causes contributing to the injuries. In the observed time period and setting RTIs have played a minor role compared to falls, interpersonal violence, and sports. In the future, standardized documentation as well as categorization of causes for analytic purposes is urgently needed to facilitate international comparison of studies.

scholarly journals Management of Vascular Injury in a Vascular Center of a Developing Country

2021 ◽  
Vol 36 (1) ◽  
pp. 32-37
Author(s):  
Quazi Abul Azad ◽  
Aizizul Islam Khan ◽  
Abdullah Al Mamun ◽  
Nirmal Kanti Dey ◽  
Sajia Sajmin Siddiqua ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Developing Country ◽  
Vascular Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Young Male ◽  
Developed Countries ◽  
Limb Amputation ◽  
Vascular Injuries ◽  
Associated Injuries

In surgical practice management of vascular injuries are challenging. Vascular injuries are well addressed in developed countries but there is scarcity of vascular surgeons in developing countries like us and a large number of victims fail to reach specialist in time with consequent loss of limbs or lives. To observe the pattern and outcome of management of vascular injury in a developing country this retrospective study was conducted at the department of vascular surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. All patients with vascular injury arrived alive were included in the study. Date in terms of age, sex, cause of injury, segment of vessel involved, associated injuries, time elapsed after injury, vascular procedures done and postoperative complications were taken from records of the department and were analyzed. Out of 2174 patients with vascular injury 11 patients died at resuscitation & 52 did not come back after referral to other hospitals for management of associated injuries. Most of the patients were young male & road traffic accidents was the most common cause (91.50%). Majority (53.60%) of the patients presented after 6 hours. Majority of the cases lower limb vessels were injured (64.05%). Among the associated injuries combine orthopedic & soft tissue injuries were most common (60.58%). Among the vascular procedures antilogous venous graft (42.39%) followed by end to end anastomosis (27.79%) were in majority of the cases. In case of extremity vascular injury limb amputation rate was 35.40%. This morbidity can be reduced by improvement of road safely measures, encouraging doctors to vascular surgery specialty and effective training of orthopedic & general surgeons in the management of extremity vascular injury till the availability of vascular surgeons for provision of vascular services in remote areas. Bangladesh Heart Journal 2021; 36(1) : 32-37

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