The Value of Emergency Nursing Mode in the Treatment of Patients with Traumatic Shock

Objective. To study the value of emergency nursing mode in patients with traumatic shock. Methods. 76 patients with traumatic shock in our hospital from March 2019 to February 2021 were selected and divided into study group and control group according to different rescue modes, 38 cases in each group. The study group adopted emergency nursing mode for rescue, while the control group adopted routine nursing mode for rescue. The rescue intervention, emergency stay and preoperative preparation time, rescue success rate, emergency rescue effect, complications, and satisfaction rate of patients and their families for rescue were compared between the two groups. Results. The rescue intervention, emergency stay and preoperative preparation time of the study group were significantly shorter than those of the control group, and the difference was statistically significant ( P < 0.05 ). The rescue success rate of the study group was 97.37%, which was significantly higher than 84.21% of the control group, and the difference was statistically significant ( P < 0.05 ). The improvement rate of the study group was significantly higher than that of the control group, the disability rate was significantly lower than that of the control group, the overall emergency rescue effect was better than that of the control group, and the difference was statistically significant ( P < 0.05 ). The incidence of complications in the study group was 2.63%, which was significantly lower than 23.68% in the control group ( P < 0.05 ). The satisfaction rate of patients and their families in the study group was 97.37%, which was significantly higher than 84.21% in the control group ( P < 0.05 ). Conclusion. Emergency nursing mode in patients with traumatic shock owns higher rescue value, can buy time for the operation, improve the success rate and effect of rescue, make safety and satisfaction higher. Overall, for patients with traumatic shock, emergency nursing mode is better than conventional rescue nursing.

FORENSIC MEDICAL ASSESSMENT OF INJURY SEVERITY OF LARYNX AND HYOID BONE BASED ON PRE-JUDICIAL AND JUDICIAL INVESTIGATION

Victims with fatal and non-fatal closed blunt trauma of the larynx and hyoid bone often become the object of forensic medical service during the pre-judicial and judicial investigation. The purpose of this study is to analyze the features of expert qualification of bodily injuries in victims with closed blunt trauma of the larynx and hyoid bone, depending on the nature and severity to determine ways to unify its forensic diagnosis. Materials and methods. The study was based on the conclusions of 35 forensic medical examinations of cases of closed blunt trauma of the larynx and hyoid bone, obtained from the leading expert institution of the Kharkiv region. Results. We determined the peculiarities of estimating the degrees of severity of above bodily injuries. Severe injuries were found in 12 (34.4%) cases of death of the victims from mechanical asphyxia, in one case of reflex cardiac arrest, and in one case of traumatic shock. Injuries of moderate severity were established by experts in 6 (17.1%) cases of lethal and in 6 (17.1%) cases of non-lethal cases with laryngeal cartilage fractures; in 2 (6.2%) cases of non-lethal injuries with acute oedema, hematoma, laryngeal stenosis of the second degree. 7 (20%) cases of non-lethal laryngeal injuries with further development of acute posttraumatic laryngitis were qualified as simple injuries. Conclusion. There are no clear morphoclinical criteria for objective assessment of injuries of the larynx and hyoid bone that can lead to pre-diagnostic expert errors. According to the results of the work, the ways to unify forensic medical assessment and diagnosis of such injury was determined.

THROMBOELASTOGRAPHY IN ASSESSING THE HEMOSTATIC SYSTEM IN INTENSIVE CARE PATIENTS

The results of thromboelastography and standard coagulogram were analyzed in 35 patients aged from 18 to 86 who were treated in the resuscitation and intensive care unit. The majority of patients (34%) were hospitalized in the department with multisystem and concomitant injuries. The remaining patients were taken to the medical institution with different diagnoses (urolithiasis, liver cirrhosis, pancreatic lesion of various types, poisoning, peptic ulcer, sepsis). The data of coagulogram and thromboelastography at different stages of treatment were compared. In patients with the development of traumatic shock, the coagulogram parameters were changed to varying degrees depending on the stage of shock. At the first stage of shock, only an increase in soluble fibrin-monomer complexes by almost 2 times and a slight increase in fibrinogen dynamics were noted in the analysis. In a patient with stage 3 traumatic shock, the coagulogram parameters were within the normal range, but according to thromboelastography (EXTEM and FIBTEM tests), hypocoagulation due to the platelet link was noted. Only the coagulogram was evaluated in dynamics, hypocoagulation was noted in the indicators of internal and external hemostasis pathways: lengthening of the activated partial thromboplastin time, a decrease in the prothrombin index and an increase in the international normalized ratio, an increase in fibrinogen A and soluble fibrin-monomer complexes. In the group of male patients with closed craniocerebral trauma, an increase in soluble fibrin-monomer complexes in the coagulogram was always combined with changes in the FIBTEM test during thromboelastography. In most patients, no changes in the classical coagulogram tests immediately after the injury are noted. At this, thromboelastography makes it possible to make up for this deficiency at an earlier time, which indicates a high sensitivity of the method.

Fatal road traffic collisions-An autopsy based study

The Deaths due to Road Traffic Collision has become a Major Public Health issue, hence Understanding the Deaths and the Factors involved is important to prevent Fatalities and at the same time Prevent Road Traffic Collision in General. The present Study is a Retrospective Study conducted during the period 2013 to November 2020. Road Traffic Accidents constituted 39.35%[n-1168] of the Cases. Males formed the Majority of the Victims contributing to 83.04% of the cases. Majority of the Victims were I the age group 31-40 years, consisting of 422 victims. The least Age Group affected were those below the age 10years and those individuals above the age 70years. Light Motor Vehicle were the Major Contributor to the Accidents, contributing to 46.40%[n-542] of the cases. Head and Neck was the Major region affected in 795 cases. The Maximum Fatality reported were due to Head or Craniocerebral Injuries in 87% of the cases. Abrasions were Present in all the Victims. Majority of the Deaths were due to Traumatic Shock reported in on the Spot Deaths or Brought Dead Victims in 35.45% [n-414] cases. The commonest Cause of Death reported after 07days of Treatment, were Septicemia, Lung infections, Peritonitis, Coma. Craniocerebral Injuries were the Main Contributors to Fatality in 87% of Accidents. Majority of Deaths were due to Traumatic Shocks due to Multiple injuries involved. Importance of Emergency Care is well understood in this study.