scholarly journals Trauma Team Activation: Which Surgical Capability Is Immediately Required in Polytrauma? A Retrospective, Monocentric Analysis of Emergency Procedures Performed on 751 Severely Injured Patients

2021 ◽  
Vol 10 (19) ◽  
pp. 4335
Author(s):  
Daniel Schmitt ◽  
Sascha Halvachizadeh ◽  
Robin Steinemann ◽  
Kai Oliver Jensen ◽  
Till Berk ◽  
...  
Keyword(s):  
Chest Tube ◽  
Trauma Team ◽  
Pressure Probe ◽  
Emergency Laparotomy ◽  
External Fixators ◽  
Surgical Interventions ◽  
Emergency Procedures ◽  
Body Regions ◽  
Life Saving ◽  
Polytrauma Patients

There has been an ongoing discussion as to which interventions should be carried out by an “organ specialist” (for example, a thoracic or visceral surgeon) or by a trauma surgeon with appropriate general surgical training in polytrauma patients. However, there are only limited data about which exact emergency interventions are immediately carried out. This retrospective data analysis of one Level 1 trauma center includes adult polytrauma patients, as defined according to the Berlin definition. The primary outcome was the four most common emergency surgical interventions (ESI) performed during primary resuscitation. Out of 1116 patients, 751 (67.3%) patients (male gender, 530, 74.3%) met the inclusion criteria. The median age was 39 years (IQR: 25, 58) and the median injury severity score (ISS) was 38 (IQR: 29, 45). In total, 711 (94.7%) patients had at least one ESI. The four most common ESI were the insertion of a chest tube (48%), emergency laparotomy (26.3%), external fixation (23.5%), and the insertion of an intracranial pressure probe (ICP) (19.3%). The initial emergency treatment of polytrauma patients include a limited spectrum of potential life-saving interventions across distinct body regions. Polytrauma care would benefit from the 24/7 availability of a trauma team able to perform basic potentially life-saving surgical interventions, including chest tube insertion, emergency laparotomy, placing external fixators, and ICP insertion.

scholarly journals Preparedness for transplantation during COVID-19 outbreak: how to manage?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Valdi ◽  
G Varadi ◽  
A Panzera ◽  
M Parpinel ◽  
R Peressutti
Keyword(s):  
Organ Transplantation ◽  
Task Force ◽  
Emergency Situation ◽  
Donor Pool ◽  
Surge Capacity ◽  
Emergency Procedures ◽  
Life Saving ◽  
Critical Patients ◽  
End Stage ◽  
Assessment Procedures

Abstract Problem When WHO declared COVID-19 “international”, it was important not to damage some critical patients who need emergency procedures like organ transplantation, due to end stage organ disease. In 2003 SARS outbreak demonstrated the vulnerability of organ transplantation services o network. Descritption If transplantation is required as a life-saving procedure, it can be conducted with appropriate risk infection assessment. It is crucial during these emergencies to assess donor pool, as it is expected to decrease. A crucial point is to organize and evaluate the surge capacity, in terms of understaffing and lack of supplies, especially in ICU. The research methods were literature review using Pub Med, CDC, ECDC, WHO, TTS, searching as key words “SARS-CoV-2”, “COVID-19”, “transplantation”, “preparedness”. The analysis has been conducted between Feb 26th 2020 and March 5th 2020. Results As happened during SARS breakout in 2003, it is essential to establish a task force for crisis, currently updated and skilled for this particular management. Preparedness should regard especially the adoption of donor safety assessment procedures, ICU capability, the availability of covid-19 test for all the donors, and the adoption of specific post-transplant care. It is essential in this case establish preparedness in several points: education and training of the staff, practice drills, inspection of supplies, evaluation of surge capacity, relocation of patients. Lessons SARS-CoV-2 imposed in public health to establish new protocols and guidelines, which should be regularly updated to be useful in other epidemics outbreaks or other emergency situation. These protocols should focus on donor pool and ICU capability in order to carry on transplantation activities. Key messages This outbreak has tested the resilience of the whole system by day-by-day updating for transplantation teams and preparedness of the staff involved in transplantation management. During outbreak, seems to be useful a task force for crisis in order to support organ transplantation services.

scholarly journals Perioperative Management of Polytrauma Patients with Severe Traumatic Brain Injury Undergoing Emergency Extracranial Surgery: A Narrative Review

2021 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Edoardo Picetti ◽  
Israel Rosenstein ◽  
Zsolt J. Balogh ◽  
Fausto Catena ◽  
Fabio S. Taccone ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Trauma Team ◽  
Narrative Review ◽  
Brain Protection ◽  
Team Members ◽  
Complex Patients ◽  
Polytrauma Patients ◽  
Challenging Situation

Managing the acute phase after a severe traumatic brain injury (TBI) with polytrauma represents a challenging situation for every trauma team member. A worldwide variability in the management of these complex patients has been reported in recent studies. Moreover, limited evidence regarding this topic is available, mainly due to the lack of well-designed studies. Anesthesiologists, as trauma team members, should be familiar with all the issues related to the management of these patients. In this narrative review, we summarize the available evidence in this setting, focusing on perioperative brain protection, cardiorespiratory optimization, and preservation of the coagulative function. An overview on simultaneous multisystem surgery (SMS) is also presented.

scholarly journals Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy

2019 ◽  
Vol 109 (2) ◽  
pp. 89-95 ◽  
Author(s):  
J. Kosola ◽  
T. Brinck ◽  
A. Leppäniemi ◽  
L. Handolin
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Organ Injury ◽  
General Surgeon ◽  
Emergency Laparotomy ◽  
Trauma Patients ◽  
Emergency Procedures ◽  
Complex Skills

Background and Aims: Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon. Materials and Methods: The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006–2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated. Results: A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4). Conclusion: The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.

Magnetic Chest Tube Positioning System

2018 ◽  
Vol 12 (2) ◽  
Author(s):  
Danuel Laan ◽  
Trang Ngoc Diem Vu ◽  
Matthew Hernandez ◽  
Henry Schiller
Keyword(s):  
Chest Tube ◽  
Standard Of Care ◽  
Positioning System ◽  
Open Technique ◽  
Current Standard ◽  
Life Saving ◽  
Open Standard ◽  
Magnetic Guidance ◽  
Distal Aspect ◽  
Domestic Swine

Tube thoracostomy (TT) insertion can serve as a life-saving adjunct for thoracic trauma. Unfortunately, suboptimal positioning using the open, standard of care technique is associated with complications resulting in impaired TT function. Using a porcine model, we aimed to determine whether a magnetic chest tube positioning system (MCTPS) could be utilized to direct the intrathoracic TT position. Using recently deceased cross-bred domestic swine, we performed TT using our MCTPS and the standard of care open technique. The operator held one magnet outside of the thorax. The second magnet was positioned at the distal aspect of the TT. The operator was tasked with positioning the TT to distinct premarked intra-thoracic locations under blinded conditions. The experiment was video-recorded through an open sternotomy incision. As a control, TT was inserted using the standard of care open technique. The utilization of MCTPS successfully directed TT from one premarked location to another in 4 of 5 attempts (80%). Conversely, the control TT without magnetic guidance failed to navigate the premarked intra-thoracic locations with 0 of 5 attempts successful (p = 0.05). Positional flaws after TT placement are common. We demonstrate the feasibility of the MCTPS as an alternative to traditional hand-guided technique under simulated TT insertion conditions. The MCTPS is possibly superior to the current standard of care technique of TT. Additional studies are needed to develop this emerging technology in humans.

scholarly journals Redox Changes Induced by General Anesthesia in Critically Ill Patients with Multiple Traumas

2015 ◽  
Vol 2015 ◽  
pp. 1-11 ◽  
Author(s):  
Marius Papurica ◽  
Alexandru Florin Rogobete ◽  
Dorel Sandesc ◽  
Raluca Dumache ◽  
Radu Nartita ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
General Anesthesia ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Trauma Team ◽  
Multiple Organ ◽  
Cellular Mechanisms ◽  
Surgical Interventions ◽  
Polytrauma Patient ◽  
Multiple Traumas

The critically ill polytrauma patient is a constant challenge for the trauma team due to the complexity of the complications presented. Intense inflammatory response and infections, as well as multiple organ dysfunctions, significantly increase the rate of morbidity and mortality in these patients. Moreover, due to the physiological and biochemical imbalances present in this type of patients, the bioproduction of free radicals is significantly accelerated, thus installing the oxidative stress. In the therapeutic management of such patients, multiple surgical interventions are required and therefore they are being subjected to repeated general anesthesia. In this paper, we want to present the pathophysiological implications of oxidative stress in critically ill patients with multiple traumas and the implications of general anesthesia on the redox mechanisms of the cell. We also want to summarize the antioxidant treatments able to reduce the intensity of oxidative stress by modulating the biochemical activity of some cellular mechanisms.

scholarly journals Early complications of tracheostomy: a study on 100 patients at a single tertiary care centre

2017 ◽  
Vol 4 (1) ◽  
pp. 217
Author(s):  
Pooja Pal ◽  
Arvinder Singh Sood ◽  
Sumant Singla
Keyword(s):  
Tertiary Care ◽  
Care Centre ◽  
Early Complications ◽  
Tertiary Care Centre ◽  
Intraoperative Bleeding ◽  
Tube Obstruction ◽  
Emergency Procedures ◽  
Early Postoperative Complications ◽  
Life Saving ◽  
Fatal Complications

<p class="abstract"><strong>Background:</strong> Tracheostomy is a life saving procedure, which when performed correctly greatly impacts the final outcome of the patient. Although uncommon, fatal complications have been known to occur. The present study was conducted to observe the incidence of early complications of tracheostomy in a tertiary care centre.</p><p class="abstract"><strong>Methods:</strong> 100 consecutive patients subjected to tracheostomy were enrolled, and data pertaining to the indication, and intraoperative and early postoperative complications was collected.  </p><p class="abstract"><strong>Results:</strong> The overall incidence of complications was 77%, with 53% cases of intraoperative bleeding and 13% tube obstruction. A higher incidence of complications was noted in emergency procedures and pediatric tracheostomies. No mortality was seen in the present series.</p><p><strong>Conclusions:</strong> Serious complications may be associated with tracheostomies, many of which can be avoided by meticulous surgical technique and postoperative care.</p>

scholarly journals Clinical characteristics of bacterial complications of chickenpox in children

2019 ◽  
pp. 121-125
Author(s):  
O. V. Prokopiv ◽  
N. M. Prykuda
Keyword(s):  
Pathogenic Bacteria ◽  
Soft Tissues ◽  
Clinical Symptoms ◽  
Clinical Course ◽  
Cervical Lymphadenitis ◽  
Surgical Interventions ◽  
Surgical Department ◽  
Clinical Hospital ◽  
Body Regions ◽  
Etiological Agents

The article presents data on the frequency of development and clinical course of bacterial complications of chickenpox in children aged from 2 months to 18 years, who were treated at inpatient department of Infectious Diseases Communal Clinical Hospital in Lviv and surgical department of Communal Municipal Children’s Clinical Hospital in 2000–2016. Bacterial complications were diagnosed in 136 patients (27.2 % out of total number of hospitalized children with chickenpox). Among the complications of chickenpox – lesions of the skin, underlying soft tissues and mucous membranes dominated (43.4 %): surface (pyoderma, erysipelas, conjunctivitis, blepharitis, gingival stomatitis), deep circumscribed (furuncle, abscess), as well as deep non-circumscribed (phlegmons) lesions of various body regions. Particularly severe flow was characterized by phlegmon, which developed in 18.4 % of children, 68% of them with mild forms of chickenpox. Most frequently, phlegmons were diagnosed in children under age 4 years. The first clinical symptoms (swelling and hyperemia with distinct margins, acute tenderness on palpation) appeared on the 3rd–10th day of the disease. Complication of respiratory organs – pneumonia, was diagnosed in 30.1 % of patients. The development of pneumonia was primarily observed in severe forms of chickenpox. Pneumonia, as a rule, developed on the 4th–10th day of the disease and was accompanied by intensification of the signs of intoxication syndrome, appearance of respiratory failure manifestations, cough. Other bacterial complications of chickenpox were also observed in patients: purulent otitis (7.4 % of patients), phlegmonous appendicitis (5.1 %), lacunar tonsillitis (4.4 %), pyelonephritis (3.7 %) cervical lymphadenitis (2.2 %), erosive gastroduodenitis (1.5 %), purulent meningitis (1.5 %), and osteomyelitis (0.7 %). On bacteriological examination of the content, obtained in surgical interventions from the lesion regions in 26 (19.1 %) children, pathogenic and conditionally pathogenic bacteria were isolated. Dominant etiological agents were S. pyogenes та S. aureus.

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