Spinal Cord Injuries in Emergency Medicine

Spinal cord injury is a serious medical disorder that frequently leads in significant morbidity and permanent impairment. Direct damage to the spinal cord or compression owing to broken vertebrae or masses such as epidural hematomas or abscesses are the most common causes of spinal cord injury. When examining a blunt trauma victim, medical professionals are taught to presume the patient has a spinal column damage unless it is proven otherwise. The early examination of a patient with a suspected cervical spinal injury in the emergency department (ED) is no different than that of any other trauma patient. The ABCs, or airway, breathing, and circulation, procedures are being taken into consideration. In acute spinal cord damage, hypotension can be hemorrhagic or neurogenic. Because of the high prevalence of concomitant injuries and vital sign confusion in acute spinal cord injury, a thorough search for hidden sources of bleeding is required. Surgical removal of bone fragments, foreign objects, herniated discs, or broken vertebrae that appear to be compressing the spine is frequently required. In order to avoid future discomfort or deformity, surgery may be required to stabilize the spine. In this review we’ll be looking at spinal cord injury, it’s diagnosis and treatment.

Unanticipated Difficult Airway Management in a Trauma Partient with Severe Ankylosing Spondylitis

Ankylosing Spondylitis is a debilitating chronic arthropathy that affects multiple joints. Anaesthesiologists face significant challenges when dealing with the airway implications of this disease, especially when it is unanticipated that a difficult airway may be encountered. This case describes a 42-year-old trauma victim who required an emergency denitive trachea at his ward. Ankylosing Spondylitis and complex airway anatomy led to his intubation failure. He was eventually given an emergency surgical tracheostomy. The successful management of a difficult airway was possible thanks to the appropriate use of modern airway adjuncts as well as workplace soft skills.

UNANTICIPATED DIFFICULT AIRWAY MANAGEMENT IN A TRAUMA PATIENT WITH SEVERE ANKYLOSING SPONDYLITIS

Ankylosing spondylitis is a chronic debilitating arthropathy affecting multiple joints in the body. Airway implications related to the disease pose a signicant challenge to the anaesthesiologists especially when an unanticipated difcult airway is encountered. A case of 42 year old trauma victim who needed an emergency denitive airway at ward set up, is reported here. Failed intubation due to complex airway anatomy associated with ankylosing spondylitis ensued him being ended up with an emergency surgical tracheostomy. Appropriate use of newer airway adjuncts and workplace soft skills contributed to successful management of an unanticipated difcult airway.

The Resilience of the Captive Girl Child in 2 Kings 5

2 Kings 5 contains a brief reference to an unnamed Israelite girl, a war captive in the household of leprosy-afflicted Naaman, the commander of the Syrian army. She instigates her master’s healing by recommending that he seek out the prophet (Elisha). Although the girl utters only a single statement (2 Kgs 5.3), her words have been subject to divergent critical interpretations. Some scholars valorize her utterance as evidence of her faith, compassion, and courage. A contrasting view maintains that as a trauma victim whose sufferings have been glossed over, the girl’s words express her adaptation to an abusive environment. This study posits an alternative interpretation, by drawing upon research on the concept of resilience with regard to war-affected children. While acknowledging the girl’s trauma, this article argues that her words reflect a resilience-building process by affirming her cultural identity, values, and beliefs.

Impact of trauma workshop on knowledge, attitude and practice conducted on undergraduate MBBS students

In India the organized trauma care services are restricted only to tertiary care centres and golden hour trauma care is often delayed. We decided to create awareness among the MBBS students by teaching basic trauma management skills since they are the first responders to a trauma victim brought to any hospital setup. This would help improve primary trauma care. Aim: To assess the improvement in knowledge, attitude and practice after primary trauma care workshop in MBBS students Methods and Material: A one day primary trauma care workshop was conducted in our institute for two consecutive years during the annual academic undergraduate conference 2018 and 2019 respectively. The MBBS students enrolled were given a questionnaire to solve before and after the workshop. They received a lecture on triage and hands-on practice on Primary survey, log roll & cervical spine stabilization, Airway management, Intravenous fluids & shock management and Basic life support. Statistical analysis: The pre and post workshop questionnaires were statistically analyzed by paired t-test using software version SPSS 20.0 and a P value of < 0.05 was considered statistically significant. Results: Pre workshop 9.9% and 10.5% of the students had above average total score in 2018 and 2019 respectively which increased to 67.6% and 78.5% post workshop. The mean Knowledge, Attitude and Practice scores also improved individually. Conclusion: We should include such workshops in the undergraduate curriculum, it would improve primary trauma care and will reduce trauma related morbidity and mortality

Expectation of administering the first aid for traumatic victims during the absence of pre-hospital service

Traffic incidents become typical cases of trauma outside of hospitals. The integrated-emergency nursing system outside of hospitals becomes an important component to minimize any worsening condition of the traumatic victims. However, this pre-hospitalized<em> </em>service system has not been formally established in several cities or municipalities. This research aims to explore various hopes of the trauma-victim aid process in a region that has not applied pre-hospitalized<em> </em>emergency service formally. This research was carried out by implementing a qualitative research method and a case study approach to identify the themes. The research was conducted in Konawe municipality, from February until March 2020. It was done by interviewing eight participants consisting of the citizens, traffic police officers, hospital party, and health agency. Four themes result from this research. Establishing the pre-hospitalized<em> </em>emergency service, socializing the first aid for the incident victims, training dealing with the first aid of taking care of trauma victims, and promoting socialization for all citizens about the emergency numbers of health service institutions which could be immediately contacted when an accident occurs. There is a need for an emergency service system establishment and development.

The importance of videolaryngoscopy in maxillofacial practice associated with restricted mouth opening in traumatized patients

Orotracheal intubation is considered the most delicate maneuver performed by anesthesiologists, and failure to manage the airways is one of the main causes of possible complications that can be catastrophic during its performance, thus requiring good team planning. Anatomical and / or physiological characteristics, such as limited mouth opening, a condition often found in patients suffering from fractures of the zygomatic arch or who have some abnormality in the temporomandibular joint (TMJ), can characterize a difficult airway, which demands attention greatest of the professional. Therefore, in order to overcome the obstacles that may occur during a difficult or unexpected intubation, new tools have been used, such as videolaryngoscopy in which an intubation device containing miniature video cameras is used in order to allow the operator has an indirect view of the glottis to increase success rates and decrease intubation time. The aim of the present study is to report a clinical case of a trauma victim, with limited mouth opening, who underwent intubation with the aid of a video laryngoscope after failed attempts at conventional intubation.

A Tale of Two Trans Men: Transmasculine Identity and Trauma in Two Fairy-Tale Retellings

Transgender identities in fairy tale retellings are rare, but can reveal much about gender fluidity. Helen Oyeyemi’s novel Boy, Snow, Bird conflates transgender identities with mirrored falsehoods and fairy-tale spells, pathologizing a trauma victim who turns out to also become an abuser, while Gabriel Vidrine’s novella “A Pair of Raven Wings” depicts a queer transgender man with dignity, making it clear that the trauma he suffers is at the hands of bigots rather than being an invention of a sick mind or the cause of his transition. Pairing these fairy-tale retellings illuminates the topic of gender fluidity in fairy tales by demonstrating that gender is indeed fluid, but that representations of gender fluidity due to trauma are misguided at best and harmful at worst, while those representations that assert the dignity of transgender people, even as they face trauma at the hands of bigoted people, are another stellar example of the genre’s potential to represent people who are culturally marginalized, connecting identity to power in a classic magical fairy-tale move.

Estabilização da coluna vertebral na vítima de trauma – revisão integrativa

Objetivo: Identificar efectos perjudiciales causados por la estabilización de la columna vertebral en la víctima de trauma y situaciones de trauma sin indicación para estabilización de la columna vertebral en el prehospitalario.Método: Se trata de una revisión integrativa de literatura orientada por las cuestiones de investigación: ¿Existe evidencia científica de efectos perjudiciales en las víctimas de trauma, causados por la estabilización de la columna vertebral en el cuidado prehospitalario? y ¿Existen situaciones de trauma sin indicación para estabilización de la columna vertebral?Resultados: Se realizó una investigación booleana en las bases electrónicas Cochrane Library y Pubmed ya través del motor EBSCOhost en las bases de datos CINAHL Plus, MEDLINE, MedicLatina, SPORTDiscus, PsycBras, PsycBOOKS, Psychología y Behavioral Sciences Collection, Academic Search Complete. Se obtuvieron doce artículos y tras la aplicación de los criterios de inclusión y exclusión constituyen la muestra cinco artículos.Conclusiones: Se describen efectos perjudiciales de la estabilización de la columna vertebral en la víctima de trauma relacionados con la gestión de la vía aérea, dolor, malestar y lesiones por presión.Las situaciones de trauma penetrante con circulación inestable y víctimas con lesiones por arma de fuego en la cabeza no carecen de estabilización de la columna vertebral.Se han reunido recomendaciones de apoyo a la decisión prehospitalaria en cuanto a la estabilización de la columna vertebral.Es crucial para la mejora del cuidado prehospitalario, integrar un enfoque individualizado de la víctima que se refiera a su estado clínico y al mecanismo de lesión. Goal: To identify harmful effects caused by the stabilization of the vertebral column in a trauma victim and in trauma situations without indication for stabilization of the spine in the prehospital.Method: It was perform an integrative literature review guided by research questions: is there a scientific evidence of harmful effects on trauma victims caused by spinal stabilization in prehospital care? and are there situations of trauma with no indication for stabilization of the spine?Results: We have performed a Boolean search in the electronic bases Cochrane Library and Pubmed and through the EBSCOhost engine in the databases CINAHL Plus, MEDLINE, MedicLatina, SPORTDiscus, PsycARTICLES, PsycBOOKS, Psychology and Behavioral Sciences Collection, Academic Search Complete. Twelve articles were obtained and after applying the inclusion and exclusion criteria, the sample was five articles.Conclusions: Harmful effects of spinal stabilization on the victim of trauma related to airway management, pain, discomfort and pressure injuries are described.Situations of penetrating trauma with unstable circulation and victims with gunshot injuries to the head do not require stabilization of the spine.Recommendations to support the prehospital decision regarding stabilization of the spine were collected.It is crucial for the improvement of prehospital care to integrate an individualized approach of the victim that refers to its clinical state and mechanism of injury. Objetivo: Identificar efeitos prejudiciais causados pela estabilização da coluna vertebral na vítima de trauma e situações de trauma sem indicação para estabilização da coluna vertebral no pré-hospitalar.Método: Trata-se de uma revisão integrativa de literatura norteada pelas questões de pesquisa: existe evidência científica de efeitos prejudiciais nas vítimas de trauma, causados pela estabilização da coluna vertebral no cuidado pré-hospitalar? e existem situações de trauma sem indicação para estabilização da coluna vertebral?Resultados: Foi realizada pesquisa booleana nas bases eletrónicas Cochrane Library e Pubmed e através do motor EBSCOhost nas bases de dados CINAHL Plus, MEDLINE, MedicLatina, SPORTDiscus, PsycARTICLES, PsycBOOKS, Psychology and Behavioral Sciences Collection, Academic Search Complete. Obtiveram-se doze artigos e após aplicação dos critérios de inclusão e exclusão constitui a amostra cinco artigos.Conclusões: Estão descritos efeitos prejudiciais da estabilização da coluna vertebral na vítima de trauma relacionados com a gestão da via aérea, dor, desconforto e lesões por pressão.Situações de trauma penetrante com circulação instável e vítimas com lesões por arma de fogo na cabeça não carecem de estabilização da coluna vertebral.Foram reunidas recomendações de apoio à decisão pré-hospitalar quanto à estabilização da coluna vertebral.É crucial para a melhoria do cuidado pré-hospitalar, integrar uma abordagem individualizada da vítima que se refira ao seu estado clínico e ao mecanismo de lesão.