EVALUATION OF UTILITY OF EXTENDED – FOCUSED ASSESSMENT WITH SONOGRAPHY IN TRAUMA (E-FAST)

2011 ◽  
pp. 124-130
Author(s):  
Thang Tran ◽  
Thi Phuong Ly Doan ◽  
Thi Nhan Le
Keyword(s):  
Chest Tube ◽  
Traffic Accidents ◽  
Thoracic Trauma ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Tube Thoracostomy ◽  
Trauma Patients ◽  
Emergent Operation ◽  
Study Results ◽  
Emergency Units

Objective: to evaluate the effectiveness of utility of Extended – Focused Assessment with Sonography in Trauma (E-FAST) at Hue Central Hospital. Methods: descriptive statistics of 75 patients with diagnosis of blunt abdominal and/or thoracic trauma, admitted to the emergency room from April 2007 to June 2010, underwent E-FAST within first minutes of admission, was under observation for emergent management. Results: the study included 64 male and 11 female patients, ranging from ages 5 to 80, traffic accidents were the most commonly cause (57.3%), the time from trauma happening to admission up to 6 hours was highest rate (50.7%). Study results showed that isolated blunt abdominal trauma 45.3%, isolated blunt thoracic trauma 6.7%, blunt abdominal and thoracic trauma 20%, blunt abdominal and/or thoracic trauma associated with other injuries 28%, haemoperitoneum 63.3%, haemothorax 13.3%, pericardial effusions 1.3%, treatment results showed emergent operation 25.4%, conservative treatment 64%, chest tube thoracostomy 4%, operation and chest tube thoracostomy 6.6%. Conclusions: E-FAST is a rapid, besides diagnostic tool for identifying accurately, timely the presence of fluid in the peritoneal, pleural, pericardial cavities and is a clinical decision-making tool to help improve effectively, early definitive care. Levels of emergency units should perform routinely E-FAST in trauma patients who give a history of abdominal - thoracic trauma, especially with hypotension, or impaired consciousness due to associated head injury.

scholarly journals P014: Incidental findings in trauma whole-body CT scans: a systematic review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S69-S69
Author(s):  
V. Tsang ◽  
K. Bao ◽  
J. Taylor
Keyword(s):  
Systematic Review ◽  
Incidental Findings ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Subsequent Treatment ◽  
Whole Body ◽  
Trauma Patients ◽  
Patient Demographics ◽  
Study Results

Introduction: Whole-body computed tomography scans (WBCT) are a mainstay in the work-up of polytrauma or multiple trauma patients in the emergency department. While incredibly useful for identifying traumatic injuries, WBCTs also reveal incidental findings in patients, some of which require further diagnostic testing and subsequent treatment. Although the presence of incidental findings in WBCTs have been well documented, there has been no systematic review conducted to organize and interpret findings, determine IF prevalence, and document strategies for best management. Methods: A systematic review was conducted using MEDLINE, PUBMED, and EMBASE. Specific journals and reference lists were hand-mined, and Google Scholar was used to find any additional papers. Data synthesis was performed to gather information on patient demographics, prevalence and type of incidental findings (IFs), and follow-up management was collected. All documents were independently assessed by the two reviewers for inclusion and any disagreements were resolved by consensus. Results: 1231 study results were identified, 59 abstracts, and 12 included in final review. A mean of 53.9% of patients had at least one IF identified, 31.5% had major findings, and 68.5% had minor findings. A mean of 2.7 IFs per patient was reported for articles that included number of total IFs. The mean age of patients included in the studies were 44 years old with IFs more common in older patients and men with more IFs than women. IFs were most commonly found in the abdominal/pelvic region followed by kidneys. Frequency of follow-up documentation was poor. The most common reported mechanisms of injury for patients included in the study were MVA and road traffic accidents (60.0%) followed by falls from >3m (23.2%). Conclusion: Although there is good documentation on the mechanism of injury, patient demographics, and type of IF, follow-up for IFs following acute trauma admission lacks documentation and follow-up and is an identified issue in patient management. There is great need for systematic protocols to address management of IFs in polytrauma patients.

Thoracic trauma in small animals: road traffic accidents

2021 ◽  
Vol 12 (1) ◽  
pp. 15-19
Author(s):  
Kate Sheard
Keyword(s):  
Traffic Accidents ◽  
Thoracic Trauma ◽  
Road Traffic ◽  
Positive Outcome ◽  
Multiple Organ ◽  
Trauma Patients ◽  
Small Animals ◽  
Road Traffic Accidents ◽  
Blunt Force Trauma ◽  
Organ Systems

Thoracic trauma is common in small animals and can be caused by a variety of insults from penetrating wounds to blunt force trauma. Patients that have sustained any form of thoracic trauma require immediate attention and intensive nursing care in order to have a positive outcome for the patient. These cases can prove challenging as multiple organ systems can be affected and surgery is often required. However, combined with the appropriate medical care, the outcome can be successful.

scholarly journals The impact of a chest tube management protocol on the outcome of trauma patients with tube thoracostomy

2015 ◽  
Vol 42 (4) ◽  
pp. 231-237 ◽  
Author(s):  
EMANUELLE MARIA SÁVIO DE ABREU ◽  
CARLA JORGE MACHADO ◽  
MARIO PASTORE NETO ◽  
JOÃO BAPTISTA DE REZENDE NETO ◽  
MARCELO DIAS SANCHES
Keyword(s):  
Chest Tube ◽  
Injury Severity ◽  
Antimicrobial Prophylaxis ◽  
Surgical Site Infections ◽  
Respiratory Therapy ◽  
Tube Thoracostomy ◽  
Independent Effect ◽  
Trauma Patients ◽  
Tube Insertion ◽  
Management Protocol

ABSTRACTObjective:to investigate the effect of standardized interventions in the management of tube thoracostomy patients and to assess the independent effect of each intervention.Methods:A chest tube management protocol was assessed in a retrospective cohort study. The tube thoracostomy protocol (TTP) was implemented in August 2012, and consisted of: antimicrobial prophylaxis, chest tube insertion in the operating room (OR), admission post chest tube thoracostomy (CTT) in a hospital floor separate from the emergency department (ED), and daily respiratory therapy (RT) sessions post-CTT. The inclusion criteria were, hemodynamic stability, patients between the ages of 15 and 59 years, and injury severity score (ISS) < 17. All patients had isolated injuries to the chest wall, lung, and pleura. During the study period 92 patients were managed according to the standardized protocol. The outcomes of those patients were compared to 99 patients treated before the TTP. Multivariate logistic regression analysis was performed to assess the independent effect of each variable of the protocol on selected outcomes.Results:Demographics, injury severity, and trauma mechanisms were similar among the groups. As expected, protocol compliance increased after the implementation of the TTP. There was a significant reduction (p<0.05) in the incidence of retained hemothoraces, empyemas, pneumonias, surgical site infections, post-procedural complications, hospital length of stay, and number of chest tube days. Respiratory therapy was independently linked to significant reduction (p<0.05) in the incidence of seven out of eight undesired outcomes after CTT. Antimicrobial prophylaxis was linked to a significant decrease (p<0.05) in retained hemothoraces, despite no significant (p<0.10) reductions in empyema and surgical site infections. Conversely, OR chest tube insertion was associated with significant (p<0.05) reduction of both complications, and also significantly decreased the incidence of pneumonias.Conclusion:Implementation of a TTP effectively reduced complications after CTT in trauma patients.

scholarly journals Characteristics of pediatric thoracic trauma: in view of before and after the establishment of a regional trauma center

2021 ◽  
Author(s):  
Pil Young Jung ◽  
Jae Sik Chung ◽  
Youngin Youn ◽  
Chang Wan Kim ◽  
Il Hwan Park ◽  
...  
Keyword(s):  
Trauma Center ◽  
Traffic Accidents ◽  
Thoracic Trauma ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Efficient Treatment ◽  
Before And After ◽  
Level 1 ◽  
Tissue Recovery

Abstract Purpose Pediatric thoracic trauma differs from those of adult in terms of the small anatomy and rapid tissue recovery. Therefore, it is important to know the characteristics of the pediatric thoracic trauma to improve treatment results. In addition, this study examined the changes in pediatric thoracic trauma features and results from the establishment of a level 1 regional trauma center. Methods Data of 168 patients’ ≤ 15 years old diagnosed with thoracic trauma between 2008 and 2019 were retrospectively analyzed. Results Pedestrian traffic accidents were the most common cause of chest injury. The average injury severity score was 17.1 ± 12.4 and the average pediatric trauma score was 5.6 ± 4.1. Lung contusion was the most common in 134 cases. There were 48 cases of closed thoracostomy. There was one thoracotomy for cardiac laceration, one case for extracorporeal membranous oxygenation, and six cases for embolization. Of all, 25 patients died, providing a mortality rate of 14.9%. In addition, independent risk factors of in-hospital mortality were hemopneumothorax and cardiac contusion. Since 2014, when the level 1 regional trauma center was established, more severely injured thoracic trauma patients came. However, the mortality was similar in the two periods. Conclusions Understanding the clinical features of pediatric thoracic trauma patients can help in efficient treatment. In addition, as the severity of pediatric thoracic trauma patients has increased due to the establishment of the regional trauma center, so pediatric trauma center should be organized in regional trauma center to improve the outcomes of pediatric thoracic trauma.

scholarly journals Cervical Spine Computed Tomography Imaging Artifact Affecting Clinical Decision-Making in the Traumatized Patient

2014 ◽  
Vol 8 (1) ◽  
pp. 372-374 ◽  
Author(s):  
Aaron C Coats ◽  
Matthew S Nies ◽  
David Rispler
Keyword(s):  
Computed Tomography ◽  
Decision Making ◽  
Cervical Spine ◽  
Clinical Decision Making ◽  
Ct Scanning ◽  
Clinical Decision ◽  
Trauma Patients ◽  
Advanced Imaging ◽  
X Ray ◽  
Ct Artifact

CT scanning is an important tool in the evaluation of trauma patients. We review a case involving a trauma patient in which a cervical spine computed tomography (CT) artifact affected decision-making by physicians. The CT artifact mimicked bilateral dislocated facets (51-B1.1). On the basis of CT findings, the patient was transferred to a different hospital for evaluation. Discrepancy between the primary CT scan and patient physical exam prompted secondary CT scans and X-ray evaluation; neither of these studies showed osseous abnormalities. This case reinforces the necessity for physicians to formulate their diagnosis based upon multiple areas of information including physical examination, plain x-ray and subsequent advanced imaging, rather than relying solely on advanced imaging.

scholarly journals Thorax Gunshot and Sharp Cutting Tool Injuries: For 5 Months Nyala Experiences

2020 ◽  
Author(s):  
Hüseyin Fatih SEZER ◽  
Hakan DAYANIR
Keyword(s):  
Thoracic Trauma ◽  
Cutting Tool ◽  
Tube Thoracostomy ◽  
Trauma Patients ◽  
Thoracic Injuries ◽  
Mortality And Morbidity ◽  
Surgical Interventions ◽  
Minimal Morbidity ◽  
Penetrating Thoracic Trauma ◽  
Post Traumatic

Background: The two most common causes of penetrating thoracic trauma are firearm injuries and injuries by sharpened cutting tool. Penetrating thoracic injuries are risk factors for high mortality and morbidity, so they need to be diagnosed correctly and timely in order to perform an effective intervention. In this study, patients with penetrating thoracic trauma were treated through surgical intervention accompanying minimal morbidity–mortality  compared to literature, even though they were admitted relatively late. Methods: In this retrospective study, 29 gunshot and stab wounds penetrating thoracic trauma patients were admitted to the emergency department of Nyala Sudan Turkey Education and Research Hospital between April and September 2018. Results: Of the 29 patients, 7 (24.13%) were gunshot injuries and 22 (75.86%) were injured with a sharp cutting tool. While 13 of the cases (44.82%) were admitted on the day the incident took place, 5 of them (17.24%) were post-traumatic first day of the admission, 9 of them (31.03%) were post-traumatic day 2, whereas 1 of them (3.44%) was post-traumatic the third day of admission. Finally, 14 patients (48.28%) were followed-up conservatively without tube thoracostomy, while 15 patients (51.72%) underwent tube thoracostomy in follow-up. No patient was operated for penetrant trauma. Mortality was not seen. Conclusion: Patients with penetrating thoracic trauma were treated by surgical interventions accompanying minimal morbidity–mortality even though they were admitted relatively late to healthcare facilities. Key words:  penetrating thoracic injuries, sharp cutting tool, gunshot

scholarly journals Conceptualizations of Clinical Decision-Making: A Scoping Review in Geriatric Emergency Medicine

2020 ◽  
Author(s):  
Maria Louise Gamborg ◽  
Mimi Mehlsen ◽  
Charlotte Paltved ◽  
Gitte Tramm ◽  
Peter Musaeus
Keyword(s):  
Decision Making ◽  
Emergency Medicine ◽  
Scoping Review ◽  
Clinical Decision Making ◽  
Data Extraction ◽  
Empirical Studies ◽  
Clinical Decision ◽  
Future Research ◽  
Study Results ◽  
Geriatric Emergency Medicine

Abstract Background: Clinical decision-making (CDM) is an important competency for young doctors, especially under complex and uncertain conditions, which is present in geriatric emergency medicine (GEM). Research in this field is however characterized by an unclear conceptualization of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is thus important to identify different definitions and their operationalisations in studies on GEM.Objective: A scoping review of empirical articles was designed to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM.Methods: A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized.Results: Four themes of operationalization of CDM emerged; CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions differed according to how CDM was conceptualized. It was evident how especially frailty- heuristics lead to biases in treatment of geriatric patients, and that the complexity of this patient group was seen as a challenge for CDM.Conclusions: This scoping review summarizes how different studies in GEM use the term CDM. It provides a snapshot of findings in GEM. Potentially, findings from CDM research can guide implementation of adequate CDM strategies in clinical practice but this requires application of more stringent definitions of CDM in future research.

scholarly journals Conceptualizations of clinical decision-making: a scoping review in geriatric emergency medicine

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Maria Louise Gamborg ◽  
Mimi Mehlsen ◽  
Charlotte Paltved ◽  
Gitte Tramm ◽  
Peter Musaeus
Keyword(s):  
Decision Making ◽  
Emergency Medicine ◽  
Scoping Review ◽  
Clinical Decision Making ◽  
Data Extraction ◽  
Empirical Studies ◽  
Clinical Decision ◽  
Future Research ◽  
Study Results ◽  
Geriatric Emergency Medicine

Abstract Background Clinical decision-making (CDM) is an important competency for young doctors especially under complex and uncertain conditions in geriatric emergency medicine (GEM). However, research in this field is characterized by vague conceptualizations of CDM. To evolve and evaluate evidence-based knowledge of CDM, it is important to identify different definitions and their operationalizations in studies on GEM. Objective A scoping review of empirical articles was conducted to provide an overview of the documented evidence of findings and conceptualizations of CDM in GEM. Methods A detailed search for empirical studies focusing on CDM in a GEM setting was conducted in PubMed, ProQuest, Scopus, EMBASE and Web of Science. In total, 52 publications were included in the analysis, utilizing a data extraction sheet, following the PRISMA guidelines. Reported outcomes were summarized. Results Four themes of operationalization of CDM emerged: CDM as dispositional decisions, CDM as cognition, CDM as a model, and CDM as clinical judgement. Study results and conclusions naturally differed according to how CDM was conceptualized. Thus, frailty-heuristics lead to biases in treatment of geriatric patients and the complexity of this patient group was seen as a challenge for young physicians engaging in CDM. Conclusions This scoping review summarizes how different studies in GEM use the term CDM. It provides an analysis of findings in GEM and call for more stringent definitions of CDM in future research, so that it might lead to better clinical practice.

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 Pola trauma tembus toraks di Instalasi Rawat Darurat Bedah RSUP Prof. Dr. R. D. Kandou Manado periode Juli 2013 – Juni 2015

e-CliniC ◽  
2016 ◽  
Vol 4 (2) ◽  
Author(s):  
Christianto Kissra ◽  
Adrian Tangkilisan ◽  
Heber B. Sapan
Keyword(s):  
Traffic Accidents ◽  
Thoracic Trauma ◽  
Public Health Problem ◽  
High Morbidity ◽  
Major Public Health Problem ◽  
Trauma Patients ◽  
Age Group ◽  
Penetrating Thoracic Trauma ◽  
Keywords Trauma ◽  
Common Causes

Abstract: Trauma continues to be major public health problem worldwide since it is associated with high morbidity and mortality in developed and developing countries. Penetrating thoracic trauma respresents a common and challenging problem whether it is caused either by gunshot or by non-gunshot-related accidents (stabs, traffic accidents). This study was aimed to obtain the profile of penetrating thoracic trauma in Surgery Emergency Unit of Prof. Dr. R. D. Kandou Hospital Manado from July 2013 to June 2015. This was a retrospactive descriptive study using the medical record data of penetrating thoracic trauma patients. The results showed that there were 31 patients of penetrating thoracic trauma out of 108 patients of thoracic trauma patients. Most cases occurred in 2014 (48.41%). Based on age group, the majority of patients were at the age group 16-30 years old (58.05%). Based on sex, most patients were males (96.80%). The most common causes of penetrating thoracic trauma was puncture wounds/stabs (80.64%) and the most common intrathoracic complication was hemothorax (58.1%).Keywords: trauma, penetrating thoracic trauma. Abstrak: Trauma merupakan masalah kesehatan masyarakat yang utama di seluruh dunia karena dikaitkan dengan morbiditas dan mortalitas yang tinggi baik di negara maju dan berkembang. Trauma tembus toraks merupakan masalah umum dan menantang, baik oleh tembakan atau non-tembakan-kecelakanaan (tikaman, kecelakaan lalu lintas). Penelitian ini bertujuan untuk mendapatkan pola trauma tembus toraks di IRDB RSUP Prof. Dr. R. D. Kandou Manado periode Juli 2013 – Juni 2015. Jenis penelitian ialah deskriptif retrospektif dengan menggunakan data rekam medik pasien trauma tembus toraks di IRDB RSU Prof. Dr. R. D. Kandou Manado. Hasil penelitian mendapatkan jumlah kasus trauma tembus toraks sebanyak 31 pasien dari 108 pasien trauma toraks. Kasus terbanyak terjadi pada tahun 2014 (48,41%). Berdasarkan kelompok usia mayoritas penderita trauma tembus toraks (58,05%)pada usia 16-30 tahun. Berdasarkan jenis kelamin sebagian besar penderita (96,80%) berjenis kelamin laki-laki. Penyebab trauma tembus toraks terbanyak karena luka tusukan/tikaman (80,64%), dan komplikasi intratoraks terbanyak yaitu hemotoraks (58,1%). Kata kunci: trauma, trauma tembus toraks

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