Clinical Effectiveness of Pre-hospital and In-hospital Optimized Emergency Care Procedures for Patients With Acute Craniocerebral Trauma

Acute craniocerebral injury is a common traumatic disease in clinical practice, characterized by rapid changes in condition and a high rate of death and disability. Early and effective emergency care throughout the pre-hospital and in-hospital period is the key to reducing the rate of death and disability and promoting the recovery of patients. In this study, we conducted an observational study of 130 patients with acute craniocerebral injury admitted between May 2020 and May 2021. Patients were randomly divided into a regular group and an optimization group of 65 patients each, with patients in the regular group receiving the conventional emergency care model and patients in the optimization group receiving the pre-hospital and in-hospital optimal emergency care process for intervention. In this study, we observed and compared the time taken to arrive at the scene, assess the condition, attend to the patient and provide emergency care, the success rate of emergency care within 48 h, the interleukin-6 (IL-6), interleukin-8 (IL-8), and intercellular adhesion molecule-1 (ICAM-1) after admission and 1 day before discharge, the National Institute of Health Stroke Scale (NIHSS) and the Short Form 36-item Health Survey (SF-36) after resuscitation and 1 day before discharge, and the complications of infection, brain herniation, central hyperthermia, and electrolyte disturbances in both groups. We collected and statistically analyzed the recorded data. The results showed that the time taken to arrive at the consultation site, assess the condition, receive the consultation, provide first aid was significantly lower in the optimized group than in the regular group (P < 0.05); the success rate of treatment was significantly higher in the optimized group than in the regular group (P < 0.05). In both groups, IL-6, IL-8, and ICAM-1 decreased on the day before discharge compared with the day of rescue, with the levels of each index lower in the optimization group than in the regular group (P < 0.05); the NIHSS scores decreased and the SF-36 scores increased on the day before discharge compared with the successful rescue in both groups, with the NIHSS scores in the optimization group lower than in the regular group and the SF-36 scores higher than in the control group (P < 0.05). The overall complication rate in the optimization group was significantly lower than that in the regular group (P < 0.05). This shows that optimizing pre-hospital and in-hospital emergency care procedures can significantly shorten the time to emergency care for patients with acute craniocerebral injury, increase the success rate, reduce inflammation, improve neurological function and quality of life, reduce the occurrence of complications, and improve patient prognosis.

CHARACTER AND FREQUENCY OF COMPLICATIONS IN PATIENTS WITH POLYTRAUMA AND CHRONIC ALCOHOL INTOXICATION

Purpose. Identify patterns of traumatic disease and characterize complications in patients with polytrauma (PT) and chronic alcohol intoxication (CAI). Materials and methods. Case histories of 39 victims with PT and alcohol history at age 19-60 years who were undergoing treatment at the Prof. Meshchaninov Kharkov City Clinical Emergency Hospital in 2016. Patient inclusion criteria: age 19-60, damage of two or more anatomical functional areas, severity of traumatic injury on the ISS scale 9-25 points, Glasgow coma scores ≥14 at the time of admission, absence of craniocerebral trauma, the absence of general anesthesia. Results. The average age of patients was 37.4 ± 9.4 years. Among these groups of patients were 29 men (74%), which is 2.9 times the number of women 10 (26%). Attention is drawn to the fact that the most important part of the victims (28.2%) was precisely the patients of the young able-bodied age. Infectious complications that developed in the early and late period of traumatic disease in victims with CAI are the main causes of death in PT - patients and induce a negative prognosis for survival. During analyzing the timing of the development of purulent-septic complications in this group of patients, we came to the conclusion that they occur on average at 7.2 ± 2.4 days. Among the infectious complications of PT in patients with CAI were pneumonia (28.2%), sepsis (7.6%), peritonitis (7.6%), pleural empyema (5.1%), osteomyelitis (5.1%). Non-infectious complications, in contrast to infectious, manifested from the first hours of injury and reached maximum development during the period by 2.3 ± 0.8 days, they were the main trigger for the development of severe infectious complications in the early period of traumatic disease. Noninfectious complications were consisted by delirium - in 29 patients, which increased the patients duration at intensive care unit on 39,6 ± 5 3 hours. These complications significantly increased the severity of the PT patients with CAI. With a higher incidence, it occurred in hyperactive, (62%) patients with delirium, and mixed (38%) form. Attention is drawn to the fact that patients with fatal outcome (29 cases), delirium was observed significantly more frequently (χ2 to include Yeats = 3.641, p <0.05) was found in 25 patients. Less frequently in patients occurred thrombosis 5(12.8%) and fat embolism syndrom 2 (5.1%). Conclusions. Most often, multiple injuries with history of alcohol use are obtained by young working aged men. The cause of injury in more than 60% of cases is accidents. 82% of the victims were in the state of alcohol intoxication during their hospitalization. On average, the terms of stay of patients with ICU are 64.9 ± 23.7 hours, although with the development of complications, these terms increase to 103.2 ± 14.2 hours. In patients with CAI there is a complicated course of traumatic disease. Among the infectious complications that develop at 7.2 ± 2.4 days, pneumonia, sepsis and peritonitis predominate. The most common non-infectious complications were delirium, thrombophlebitis thrombosis, fat embolism. Risk of fatal outcome in patients with delirium in 6.25 times higher than in patients without acute encephalopathy. Thus, the treatment of patients with a history of with polytrauma and chronic alcohol intoxication is an extremely important medical problem that needs further study and improvement.

Forensic examination of a dog's corpse with signs of violent death: A case review

Increasingly, in the media, social networks, we encounter reports of cruelty to animals by companions, which led to their injury or death. Animal cruelty in Ukraine and all over the world, unfortunately, still remains an urgent problem. In this regard, forensic investigators ask veterinary experts questions that are aimed at assessing the severity of the damage, the mechanism of their formation and establishing the cause of death of the animal. According to the pre-trial investigation and the forensic veterinary examination results of the corpse of a dog, which was conducted at the request of investigative authorities in the inquiry of a criminal offense on the grounds of a crime under Part 1. Article. 299 of the Criminal code of Ukraine, the open craniocerebral trauma of a head of a dog with multiple fractures of the facial bones is established. The left eyeball is missing. There is a rupture of the muscular base and the mucous membrane of the tip of the tongue. Open fracture of the mandible with the discrepancy between the symphysis of the right and left arches. During the necropsy, it was noted that the subcutaneous tissue contains a small amount of fat, skeletal muscle is moderately developed, the stomach is empty and the dog's corpse is exhausted. Which indicates that the dog has spent a loong time without proper care of the pet owner. A torn-scalped wound with signs of purulent inflammation and the presence of fly larvae was noted in the head area, which may indicate that the process is 3–7 days old. Extensive left hemorrhage in the meninges of the frontal area and generalized cerebral edema caused by momentary action of a mechanical factor, a blow in the lateral direction were observed during the study of the brain. Traumatic injuries found on the dog's corpse have a lifetime character and are in a direct causal relationship between the injuries and the cause of death of the animal.

Change of Levels of NGF, ACTH, and AVP in the Cerebrospinal Fluid after Decompressive Craniectomy of Craniocerebral Injury and Their Relationship with Communicating Hydrocephalus

In recent years, the incidence of craniocerebral trauma has increased, making it one of the important causes of death and disability in neurosurgery patients. The decompressive craniectomy (DC) after severe craniocerebral injury has become the preferred treatment for patients with severe craniocerebral injury, but the incidence of postoperative hydrocephalus has become a difficult problem in clinical treatment. This study observed the changes of nerve growth factor (NGF), adrenocorticotropic hormone (ACTH), and arginine vasopressin (AVP) levels in the CSF after DC in patients with craniocerebral injury and analyzed the relationship between the three indicators and communicating hydrocephalus. The results showed that the levels of NGF, ACTH, and AVP in patients with cranial injury after DC were significantly higher than those in healthy subjects, and subdural effusion, traumatic subarachnoid hemorrhage (tSAH), and the levels of NGF, ACTH, and AVP in the CSF were independent risk factors for communicating hydrocephalus. Monitoring the levels of NGF, ACTH, and AVP is of great significance for clinicians to judge the occurrence of traffic hydrocephalus, evaluate the prognosis of patients with craniocerebral injury after DC, and guide clinical treatment.

Diagnósticos de enfermagem para pacientes com traumatismo cranioencefálico: revisão integrativa

Introducción: El trauma craneoencefálico (LCT) es cualquier impacto que afecta la región de la cabeza que involucra el cuero cabelludo, el cráneo, el cerebro y los vasos sanguíneos, afectando estas estructuras. Los profesionales de enfermería desempeñan un papel fundamental al ayudar a estos pacientes.Objetivo: Enumerar los diagnósticos de enfermería (DE) de NANDA I que se pueden proponer para pacientes hospitalizados con LCT.Método: Revisión integral de la literatura, realizada en las bases de datos: LILACS, BDENF, IBECS, MEDLINE, CINAHL, SCOPUS y WEB OF SCIENCE, utilizando los términos de búsqueda: “Traumatismo craneocerebral / craneocerebral”, “Diagnóstico de enfermería / Diagnóstico de enfermería " y " Enfermagem / Enfermería ". Se incluyeron artículos en portugués, inglés y español.Resultados: Se seleccionaron 12 artículos. A partir de la lectura de los estudios, en función de las características clínicas y las necesidades básicas afectadas de los pacientes con LCT, 18 ED se enumeran, organizan en orden alfabético y de acuerdo con el dominio en el que se encuentran en NANDA YO.Consideraciones finales: Los resultados de esta investigación permitieron caracterizar aspectos importantes relacionados con el paciente con LCT y llevar el enfoque de la literatura sobre diagnósticos de enfermería a esta audiencia. Hay una brecha en las investigaciones que abordan las DE para pacientes con LCT, teniendo en cuenta que una parte importante de la investigación informa sobre las manifestaciones clínicas percibidas durante la atención de enfermería y no aporta los diagnósticos elaborados. Introduction: Traumatic Brain Injury (TBI) is any impact that affects the head region involving the scalp, skull, brain and blood vessels, affecting these structures. Nursing professionals play a fundamental role during the care of these patients.Objective: To list the Nursing Diagnoses (ND) of NANDA I that can be proposed for patients hospitalized with TBI.Method: Integrative literature review, performed at the following databases: LILACS, BDENF, IBECS, MEDLINE, CINAHL, SCOPUS and WEB OF SCIENCE, using the search terms: “Traumatismos Craniocerebrais/Craniocerebral Trauma”, “Diagnóstico de Enfermagem/Nursing Diagnosis” and “Enfermagem/Nursing”. Articles in Portuguese, English and Spanish were included.Results: The selection included 12 articles. From the reading of the studies, based on the clinical characteristics and the basic needs affected by patients with TBI, 18 ND were listed, organized alphabetically and according to their domain in NANDA I.Final considerations: The findings of this research allowed characterizing important aspects related to the patient with TBI and bringing the literature approach on nursing diagnoses to this population. There is a gap in the investigations that address ND for patients with TBI, taking into account that a significant part of the studies report on the clinical manifestations perceived during nursing care and do not bring the elaborated diagnoses. Introdução: Traumatismo Cranioencefálico (TCE) é qualquer impacto que atinge a região da cabeça envolvendo couro cabeludo, crânio, cérebro e vasos sanguíneos, afetando essas estruturas. Os profissionais de Enfermagem desempenham um papel fundamental durante a assistência a esses pacientes. Objetivo: Elencar os Diagnósticos de Enfermagem (DE) da NANDA I que podem ser propostos para pacientes internados com TCE.Método: Revisão integrativa da literatura, realizada nas bases de dados: LILACS, BDENF, IBECS, MEDLINE, CINAHL, SCOPUS e WEB OF SCIENCE, utilizando os termos de busca: “Traumatismos Craniocerebrais/Craniocerebral Trauma”, “Diagnóstico de Enfermagem/ Nursing Diagnosis” e “Enfermagem/Nursing”. Foram incluídos artigos nos idiomas português, inglês e espanhol.Resultados: Foram selecionados 12 artigos. A partir da leitura dos estudos, com base nas características clínicas e nas necessidades básicas afetadas dos pacientes com TCE foram elencados 18 DE, estão organizados em ordem alfabética e de acordo com o domínio em que se encontra na NANDA I.Considerações finais: Os achados dessa pesquisa possibilitaram caracterizar aspectos importantes relacionados ao paciente com TCE e trazer a abordagem da literatura sobre os diagnósticos de enfermagem a esse público. Percebe-se uma lacuna nas investigações que abordem os DE para pacientes com TCE, levando em consideração que uma parte significativa das pesquisas relatam sobre as manifestações clínicas percebidas durante o cuidado de enfermagem e não trazem os diagnósticos elaborados.

Implementación de telerradiología en neurotrauma en áreas de difícil acceso -revisión sistemática

Introducción: Según la organización mundial de la salud los traumatismos representan más del 20% de los problemas en salud en el mundo. El trauma craneoencefálico y la ausencia de servicios de neurocirugía y radiología en zonas menos pobladas dificultan la valoración y manejo de pacientes con lesión cerebral. Objetivo: Describir los hallazgos clínicos y beneficios derivados de la implementación de la telerradiología en neurotrauma en áreas de difícil acceso geográfico. Materiales y métodos: Se realizó una búsqueda sistemática en Pubmed, Scopus, Ebsco host, Sciencedirect, y Embase, con los tesauros “Teleradiology” y “Craniocerebral Trauma”. Resultados: La decisión de intervenir a un paciente con traumatismo cerebral y el periodo de tiempo hasta la cirugía son fundamentales para el desenlace clínico. Aquellos centros que usan la telerradiología, precisan los traslados a los hospitales especializados, por lo cual los dispositivos tecnológicos portátiles contribuyen en el tiempo de respuesta de la atención en neurocirugía. Conclusión: La telerradiología impacta positivamente en pacientes con trauma craneoencefálico en zonas geográficas de difícil acceso, facilitando la comunicación con especialistas; brindando atención oportuna y optimizando los traslados a centros de alta complejidad.

Reconstruction of extensive sequel of frontal fracture: optimizing results

Introduction: Fractures of the frontal bone correspond to 5 to 15% of all facial fractures. This type of fracture can lead to difficulties in restoring bone congruence and to postoperative secondary aesthetic problems. Objective: This paper aims to present a clinical case report of frontal bone fracture where a late reconstruction was performed using a titanium mesh with the aid of stereolithographic model prototyping. Case report: Female patient, 26 years old, with aesthetic sequelae in the upper third of the face after a motorcycle accident. The imaging exams showed a comminuted frontal bone fracture, as well as upper edge and right orbit ceiling involvement. The planning consisted of reconstruction of the affected area with the use of a titanium mesh pre-shaped in a stereolithographic model. The procedure was performed under general anesthesia and coronal access. After installation of the fixation material, pericranial flap rotation and suture of the surgical wound were performed. The patient progressed well, with considerable improvement in facial aesthetics. Conclusion: This paper reports the importance of good planning in cases of frontal bone fracture sequel, in which the use of model-shaped mesh in a stereolithographic model tends to optimize surgery, bringing aesthetic and psychosocial benefits. Keywords Frontal bone; Titanium; Craniocerebral trauma.