scholarly journals Blunt Traumatic Aortic Injury

2021 ◽  
Author(s):  
Domenico Calcaterra
Keyword(s):  
Trauma Team ◽  
Aortic Injury ◽  
Complex Patients ◽  
Key Factor ◽  
Threatening Condition ◽  
Life Threatening ◽  
Aortic Injuries ◽  
Definition Of ◽  
Blunt Traumatic Aortic Injury ◽  
Treatment Priorities

Traumatic aortic injuries represent a leading cause of death following motor-vehicular accidents. These injuries curry a very high mortality rate even though a significant number of patients reaches the hospital alive. These injuries are identified in the contest of a polytrauma work up and are almost always associated with multiple other severe traumatic injuries which makes the management of these patients very challenging. The technology advancements seen in recent years with radiologic imaging and the progress of the therapeutic options brought up by the uprise of endovascular therapy, along with the sophistication of the techniques of trauma resuscitation and intensive care management, have improved significantly the overall prognosis of these patients. Although traumatic aortic injuries need to be generally considered a life-threatening condition, their degree of severity may differ significantly from case to case requiring immediate repair in some patients, whereas their repair can be delayed in cases when the severity of the aortic injury does not represent an immediate threat to the patient life. Therefore, the challenge of treatment of the polytrauma patients with an aortic injury is to identify the best strategy of therapy able to prioritize the treatment of the injuries based on their lethal potential. In this contest, the ability of properly defining the severity of the aortic injury is the key-factor to allow the appropriate definition of a treatment strategy able to identify treatment priorities. In our experience, radiologic assessment of the aortic injury in correlation with the evaluation of clinical parameters and a comprehensive polytrauma assessment allows to optimize the ability of the trauma team to establish the most appropriate strategy for the care of this complex patients’ group.

scholarly journals P058: Paramedic recognition and management of anaphylaxis in the prehospital setting

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S77-S77
Author(s):  
M. Welsford ◽  
R. Gupta ◽  
K. Samoraj ◽  
S. Sandhanwalia ◽  
M. Kerslake ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Prehospital Treatment ◽  
Case Identification ◽  
System Involvement ◽  
Service Areas ◽  
Before And After ◽  
Threatening Condition ◽  
Life Threatening ◽  
Definition Of ◽  
Treatment Priorities

Introduction: Anaphylaxis is a life-threatening condition that paramedics are equipped to treat effectively in the field. Current literature suggests improvements in paramedic recognition and treatment of anaphylaxis could be made. The aim of this study was to compare the proportion of cases of anaphylaxis appropriately treated with epinephrine by paramedics before and after a targeted educational intervention. Methods: This was a retrospective medical records review of patients with anaphylaxis managed by primary or advanced care paramedics in five Emergency Medical Service areas in Ontario, before and after an educational module was introduced. This module included education on anaphylaxis diagnosis, recognition, treatment priorities, and feedback on the recognition and management from the before period. All paramedic call records (PCRs) coded as local allergic reaction or anaphylaxis during 12-month periods before and after the intervention were reviewed by trained data abstractors to determine if patients met an international definition of anaphylaxis. The details of interventions performed by the paramedics were used to determine primary and secondary outcomes. Results: Of the 600 PCRs reviewed, 99/120 PCRs in the before and 300/480 in the after period were included. Of the charts included, 63/99 (63.6%) in the before and 136/300 (45.3%) in the after period met criteria for anaphylaxis (p=0.002). Of the cases meeting anaphylaxis criteria, 41/63 (65.1%) in the before and 88/136 (64.7%) in the after period were correctly identified as anaphylaxis (p=0.96). Epinephrine was administered in 37/63 (58.7%) of anaphylaxis cases in the before period and 76/136 (55.9%) in the after period (p=0.70). Anaphylactic patients with only two-system involvement received epinephrine in 20/40 (50.0%) cases in the before period and 45/93 (48.4%) in the after period (p=0.86). Conclusion: There are gaps in paramedic recognition and management of anaphylaxis, particularly in cases of two-system involvement. These gaps persisted after the implementation of an educational intervention. Other quality interventions and periodic refreshers may be necessary to improve prehospital treatment of anaphylaxis. Limitations include an increase in overall cases and decrease in rate of true anaphylaxis in the after period, which may relate to better case identification after electronic PCR implementation and changes in paramedic recognition.

scholarly journals Blunt traumatic aortic injury: CT angiography images and short review of current literature

2021 ◽  
Vol 0 (Ahead of Print) ◽  
Author(s):  
Sok-Sithikun Bun ◽  
Duygu Ozgul ◽  
Yasin Guzel ◽  
Erol Aksungur
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Short Review ◽  
High Energy ◽  
Aortic Injury ◽  
Vehicle Accidents ◽  
Vehicle Accident ◽  
Threatening Condition ◽  
Life Threatening ◽  
Blunt Traumatic Aortic Injury

Blunt traumatic aortic injury in high-energy motor vehicle accidents is a rare but life-threatening condition. Proper treatment after prompt and accurate diagnosis is critical to reduce the death rate. The purpose of this article was to highlight the points to be considered in blunt traumatic aortic injury due to high-energy motor vehicle accident.

scholarly journals Atypical presentation of isolated traumatic ascending aortic dissection with cardiac tamponade

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110606
Author(s):  
Shunya Ono ◽  
Retsu Tateishi ◽  
Masato Shioya ◽  
Yoshihumi Itoda ◽  
Yusuke Tsukioka ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Dissection ◽  
Cardiac Tamponade ◽  
High Energy ◽  
Aortic Injury ◽  
Trauma Patients ◽  
Aortic Replacement ◽  
Threatening Condition ◽  
Ascending Aortic Replacement ◽  
Blunt Traumatic Aortic Injury

Blunt traumatic aortic injury is a rare but life-threatening condition, usually following high-energy trauma. We present the case of a 79-year-old man who was transferred to a hospital complaining of nausea after being struck on the chest. Computed tomography led to diagnosis of ascending aortic dissection with cardiac tamponade. Emergent ascending aortic replacement was performed successfully and he was discharged home on postoperative day 24 without any complications. The key to early diagnosis of blunt traumatic aortic injury is careful and detailed history-taking. If trauma patients complain of unexplained symptoms, the threshold for conducting computed tomography should be lowered to avoid misdiagnosis or therapeutic delay.

scholarly journals Emerging Optical Techniques for the Diagnosis of Onychomycosis

2020 ◽  
Vol 10 (7) ◽  
pp. 2340 ◽  
Author(s):  
Chrysoula Petrokilidou ◽  
Georgios Gaitanis ◽  
Ioannis D Bassukas ◽  
Aristea Velegraki ◽  
Edgar Guevara ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Infectious Agents ◽  
Optical Techniques ◽  
Key Factor ◽  
Threatening Condition ◽  
Causative Agents ◽  
Rational Therapy ◽  
Life Threatening ◽  
Nail Infection

Onychomycosis is the most prevalent nail infection. Although it is not a life-threatening condition, it impacts the quality of life for many patients and often imposes a challenging diagnostic problem. The causative agents are dermatophytes, yeasts and non-dermatophytic moulds. Accurate and early diagnosis, including the identification of the causative species, is the key factor for rational therapy. Still, early diagnosis is not optimal as the current gold standard for the differentiation of the infectious agents is culture-based approaches. On the other hand, noninvasive optical technologies may enable differential diagnosis of nail pathologies including onychomycosis. When light penetrates and propagates along the nail tissue, it interacts in different ways with the components of either infected or healthy nail segments, providing a wealth of diagnostic information upon escaping the tissue. This review aims to assess alternative optical techniques for the rapid diagnosis of onychomycosis with a potential to monitor therapeutic response or even identify the fungal agent non-invasively and in real time in a clinical setting.

scholarly journals BIOMARKERS OF SEPSIS

JMS SKIMS ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 2-4
Author(s):  
Bashir Ahmad Fomda
Keyword(s):  
Altered Mental Status ◽  
Respiratory Alkalosis ◽  
Blood Stream ◽  
Rapid Progression ◽  
Microbial Invasion ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Definition Of ◽  
Infectious Source

“Sepsis is a state caused by microbial invasion from a local infectious source into the blood stream which leads to signs of systemic illness in remote organs,” this was the first scientific definition of sepsis proposed by Dr. Schottmuller in 1914.Sepsis is among the most common causes of death in hospitalized patients. Its death toll is in the same range as that of myocardial infarction. 1 Early and reliable diagnosis is imperative, because of the remarkably rapid progression of sepsis into a life-threatening condition.2 Findings in a patient with suspected or proven infection include fever or hypothermia, tachypnea, tachycardia, leukocytosis or leucopenia, acutely altered mental status, thrombocytopenia, an elevated blood lactate level, respiratory alkalosis, or hypotensions. 3  JMS 2017; 20(1):2-4

Evaluation and Anesthetic Management for Patients With Cardiac Trauma

2019 ◽  
pp. 348-359
Author(s):  
Daniel Smith ◽  
Eric Ness ◽  
Amanda M. Kleiman
Keyword(s):  
Anesthetic Management ◽  
Clinical Suspicion ◽  
Operating Conditions ◽  
Mechanical Support ◽  
Cardiovascular Collapse ◽  
Cardiac Trauma ◽  
Complex Patients ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Level

Cardiac trauma, either blunt or penetrating, is a life-threatening condition often requiring immediate intervention. Cardiac trauma causes varied hemodynamic effects, from stable arrhythmia to cardiovascular collapse. The diagnosis of cardiac trauma relies on a high level of clinical suspicion paired with imaging, including transthoracic echocardiography. Anesthetic management for cardiac trauma focuses primarily on maintenance of preload and cardiac function while optimizing operating conditions for surgical repair. Depending on the injuries involved, support that includes inotropes, vasopressors, and potentially mechanical support may be required. This chapter discusses the pathophysiology and presentation of cardiac trauma and explores the intricate anesthetic management of these complex patients.

The essence of a helpless state of a person as an important component in the investigation of crimes

2021 ◽  
Vol 28 (2) ◽  
pp. 269-276
Author(s):  
Oleh V. Kravchuk ◽  
Volodymyr M. Atamanchuk ◽  
Yurii M. Turovets ◽  
Serhii H. Volkotrub ◽  
Oleksandr Ye. Ostapenko
Keyword(s):  
Mental State ◽  
Physiological State ◽  
Legal Framework ◽  
Legal Analysis ◽  
State Identification ◽  
Original Definition ◽  
Threatening Condition ◽  
Life Threatening ◽  
Definition Of

The modern legal framework, despite the definition of a helpless state in the corresponding provisions of criminal, administrative, and civil legislation, does not answer the question of what exactly should be understood by such a state due to the lack of any definitions or interpretations of this concept. This determines the relevance of this study. The purpose of this study is to develop an interpretation of a helpless or other life-threatening condition, with the subsequent possibility of the corresponding improvement of the current legislation of Ukraine. The leading method of research is the method of comparative legal analysis. The study analyses the definitions of the concept of a helpless state of a person available in legal and scientific sources. Based on the results of the study, the author’s position on the essence of the concept of a helpless state is presented. The causes that can act as factors of a helpless state are identified. It is noted that the helpless state of a person, under certain conditions, can transform into a dangerous state of a person, as a result of which there is a threat of violation of citizens’ rights. The authors conclude that a helpless state is not only a physical or mental state in which a person can be located, but also a physiological state (psychophysiological), as its factor, acts as a component of the content of a helpless state. Identification of the scope and content of the rights of citizens in need of external security due to the presence of the relevant citizens, owners of these rights in a helpless or other life-threatening state, another task of solving which requires prior clarification of the essence of the helpless state or related states. Based on the analysis, the authors propose an original definition of the helpless state, as well as determine its features

scholarly journals The Knowledge of Nursing Internship Program Students about Early Detection of Sepsis

2021 ◽  
Vol 9 (T6) ◽  
pp. 116-121
Author(s):  
Stefani Stefani ◽  
Yanny Trisyani ◽  
Anita Setyawati
Keyword(s):  
Early Detection ◽  
Sampling Technique ◽  
Knowledge Score ◽  
Clinical Criteria ◽  
Knowledge Deficit ◽  
Threatening Condition ◽  
Life Threatening ◽  
Definition Of ◽  
Almost All ◽  
Sepsis Care

Background: Sepsis is a life-threatening condition due to the failure of the body’s regulation of infection. Knowledge deficit is one of the barriers to early detection and initiation of sepsis care. Nursing internship program students as future nurses need to have sufficient knowledge about early detection of sepsis to support their behavior. Thus, the purpose of this study was to describe the knowledge of nursing internship program students regarding the early detection of sepsis and the demographic factor related to the knowledge.      Methods: The study design was a quantitative study. Through the proportionate stratified non-random sampling technique, the researcher involved 143 nursing internship program students of Universitas Padjadjaran. Data collection used a questionnaire based on the Sepsis-3 guidelines to measure nursing internship program students’ knowledge about early detection of sepsis. The data was carried out in July-August 2021.   Results: The average knowledge score of the respondents was 70.4 (SD=11.9). More than half of the respondents (56.6%) got a score below the average. Almost all respondents do not know the current definition of sepsis and still use the SIRS definition as clinical criteria for sepsis. However, respondents could identify clinical criteria for sepsis based on qSOFA and analyse sepsis indicators based on case scenarios. Meanwhile, based on its characteristics, the information is a factor that significantly affects the knowledge score (p < 0.05).          Conclusion: In conclusion, there is still a gap in the knowledge of the nursing internship program students regarding the update of the Sepsis-3 guidelines. Besides, information is identified as the factor that influences knowledge. Therefore, it suggested that the institution provide further effective educational methods to update students’ knowledge about the early detection of sepsis.

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

Severe Alveolar Hemorrhage – What’s in it for the Gastroenterologist?

2016 ◽  
Vol 25 (4) ◽  
pp. 555-558
Author(s):  
Alina Popp
Keyword(s):  
Celiac Disease ◽  
International Normalized Ratio ◽  
Gluten Free Diet ◽  
Alveolar Hemorrhage ◽  
Severe Anemia ◽  
Gluten Free ◽  
Pulmonary Infiltrates ◽  
Pulmonary Hemosiderosis ◽  
Threatening Condition ◽  
Life Threatening

Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet. Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu

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