Current Concepts about Managing of Trauma Patients.

Background: Managing principles for traumatized patients have continued to evolve with advances in technology. Hemorrhage remains the leading cause of morbidity and mortality in trauma, pre-hospital management by well-trained and well-equipped medical teams at the scene as well as in hospitals have continued to improve treatment outcomes. Although new treatment options continue to be evidence, as well as the implementation of concepts related to the optimal time for the operation. Although the preliminary assessment was performed using the Injury Significance Score (ISS) as an assessment and prognostic element to determine the timing of the intervention The current consensus argues that unnecessary delays in fracture care should be avoided while respecting the complex physiology of certain groups of patients who may remain at increased risk for complications. Using innovative techniques and understanding concepts such as the anatomy of traumatic injuries, the optimal approach to the polytrauma patient continues to evolve day by day.

5th Albanian Congress of Trauma and Emergency Surgery

The 5th Albanian Congress of Trauma and Emergency Surgery - ACTES 2021, on November 12-13, 2021 - Hybrid Edition. The biggest event in region about Trauma & Emergency Surgery and not only,... organized by ASTES - Albanian Society for Trauma and Emergency Surgery with support of UMT (University of Medicine of Tirana). "With persistence and clear ideas, everything is possible" is our slogan. The main topic of this congress is trauma and emergency surgery and more ... The Local Scientific Committee, led by the Prof. Arben Gjata (Rector of University of Medicine of Tirana, but complemented by experts in the field from many other specialties and societies together with the ASTES Executive Board and Section Chairs. Colleagues from all Albanian areas and many European and non- European countries will be taking part in 21 sessions during 2 days: Thank you very much for your support and encouragement!

Gastric adenocarcinoma advanced ina final year student. A case report

Gastric carcinoma is most common in the 50-70 age group [2], and is extremely rareunder the age of 30; grows rapidly andsteadily to reach higher levels in older agegroups [3]. Basically, there are two sub-types of adenocarcinoma arising from thegastric mucosa: intestinal and diffusebased on Lauren (1965) criteria. The disease was fatigue, with dysphagia associated with solid food, with anorexia, and with weight loss; (about 10 kg for the last 3 months). During this period, he rece-ived symptomatic medication but without any medical visit.Clinical examination revealed a pale skin, with decreased turgor, and in the abdomen was found a tangible mass in the abdomen, easily sensible, other quadrats of the abdo-men loose… Conclusion: Whenever symptoms of dys-phagia, loss of appetite and hematemesis appear, and further investigations should be made, as early diagnosis of a gastric tumor in this group plays a crucial role in determining the prognosis.

Disseminated Alveolar Echinococcosis.

Alveolar echinococcosis (AE) is caused by the larval form of the tapeworm Echinococcus multilocularis. In humans, E. alveolaris metacestode cells proliferate in the liver inducing a hepatic disorder that mimics liver cancer and can spread to other organs. From 1960 to 1972 mortality was at 70% and 94% after 5 and 10 years of follow-up, respectively. Since then, studies have shown an increasing trend towards improving survival rates [1]. As AE is also spreading to new areas of Eastern Europe, researchers seek to better understand the clinical presentation of pathology, including asymptomatic forms. Clinical case; One 36-year-old woman from Peshkopia has been admitted to the Gastrohephatology department on 20.07.2011 with fatigue, anorexia, dull pain in right hypochondrium, mild epigastric pain, bloating, and weight loss. The epidemiological anamnesis showed that the patient lived in the village and had pets. On physical examination, the patient appeared severely ill with jaundice, massive hepatomegaly, massive mass in the mesogastric area, and anxiety. Laboratory examinations were as follows: Hb 11.1 g/dl, sediment 25 mm/h; leukocytes 6700/mm3; platelets 127000/mm3; prothrombin level 60%, uremia 12.7 mmol/l; creatinine 0.78 mmol /l; ALP 127 U/I; AST 15 U/I; ALT 37 U/I; GGT 131 U/I; bilirubin 3.7 mg/l, albumin 2.8 gr / l, total protein 8.1 gr / l, HbsAg negative, anti-HCV negative. Regarding serology, the titer of anti-echinococcal antibodies was positive (22, n = 11) Conclusions: Clinical presentation and radiologic imaging findings of disseminated alveolar echinococcosis can mimic metastatic malignancy, and diagnosis can be challenging in atypically advanced cases. As the incidence of human alveolar echinococcosis appears to be increasing and, physicians should be aware of alveolar echinococcosis, its epidemiology, and its clinical features.

Endotracheal Intubations in Emergency Department: A Clinical Audit at a Tertiary Health Centre in South India

Background: Endotracheal intubation in the emergency department is challenging. Hence, regular audits can help us improve our critical airway management skills. Our study aimed to evaluate the practice of endotracheal intubations performed in the emergency department. Materials and Methods: A retrospective cross-sectional study was conducted among the patients intubated in our teaching hospital's emergency department. The study period was from November 1, 2019, to August 31, 2020. We analyzed first attempt success rates, drug use, indication, and complications. Results: We analysed 90 endotracheal intubations, out of which 70(77.8%) were performed by emergency physicians and 20(22.2%) by anaesthetists. The first attempt success rate was 81.11% (n=73) and had significant differences between the both departments. (p value= 0.003, χ2= 7.48). More patients had medical indications compared to trauma for intubation (n=88 vs n=32) among which respiratory failure (n=25, 27.78%) was the most common indication. Rapid Sequence Intubation( RSI) adherence was 82.22% (n=74). Lignocaine (n=16, 19.75%), etomidate (n=35, 43.2%) and succinylcholine (n=65, 80.25%) were the commonly used drugs for premedication, induction and as relaxants respectively. 17(18.89%) out of 90 intubation had complications. Desaturation (n=10, 11.11%), bradycardia (n=1, 1.11%), hypotension (n=4, 44%), dental trauma (n=5, 5.55%) and oesophageal intubation (n=3, 3.33%) were observed in our study. Conclusion: Our study is the first from India which describes the characteristics of endotracheal intubations done in the Emergency Department along with data on RSI adherence. The first attempt success rate, indications, and complications were comparable with other studies in the literature. We recommend future prospective studies to analyze success rates between different specialties and resident doctors to improve the airway management skills in the Department

Impact of Fluid Resuscitation Regimes in Relative Risk of Mortality in Burned Patients

Background; Some studies have supported the opinion that patients who get greater volumes of resuscitation fluids are at a higher chance of edema, complications, and probably bad outcomes. In the results of the International Society of Burn Injuries approximately half (49.5%) added colloid before 24h. This study aims to analyze the relative risk for mortality comparing resuscitation in the first 24 hours with Parkland and resuscitation with the use of Colloids. Material and Methods; This was an observational prospective cohort study conducted in the Service of Burns of the University Hospital Centre "Mother Teresa" in Tirana (UHCT), Albania. The study includes adult patients with critical burns > 40% TBSA, hospitalized in the Intensive Care Unit of the service during the period 2014 to 2019. Resuscitation in the first 24 hours is done with Ringer Lactate according to Parkland and with Ringer Lactate with the addition of colloids after 12 hours. Results; The data for organ dysfunction and organ insufficiency were the same in the two groups without statistical significance. Mortality in the RL group was 48% (24 deaths of 50 patients) while in the RL + Colloid rehydrated group was 46% (23 deaths of 50 patients). Patients which have 40-60% burns and are rehydrated with RL + Colloids have a risk of death 0.4 times less than those rehydrated with RL. Conclusions; Resuscitation with Ringer lactate and Colloids in the first 24 hours of thermal damage is a rehydration alternative for the treatment of burn shock. This therapy especially helps patients with major burns > 40% TBSA who during rehydration require large amounts of fluids and are associated with severe plasma hypoalbuminemia. Number Need to Treat (NNT benefit) is 10 so 1 in 10 patients can benefit in lowering the risk of death with RL + Colloid rehydration.

Supralevator Abscess Complicated by Necrotic Fasciitis of Peritoneum, Genitalia, Anterior Abdominal Wall and Retroperitoneum.

A supralevator anorectal abscess may lead to a rare clinical complication, such as perineal necrotizing fasciitis. A 57-year-old man was admitted on an emergency basis with evidence of a deep anorectal abscess of 5-day duration. The clinical presentation involved an unbounded purulent destructive inflammation spreading onto the adjacent areas, with the development of a septic condition. Following a short preparation, a radical surgical debridement of a subfascial purulent necrotic phlegmon of the pelvic space was performed. Since the lower part of the abdomen, retroperitoneum and scrotum were involved, 4 additional subsequent necrectomies were performed at 48-hour intervals. The aggressive radical operative treatment and the combined intensive therapy were the main contributors to the favorable outcome of the disease.

Challenges and Problems Affecting the Development Emergency Medical Services in Kosovo.

Emergency medical service is organized as a separate field of health activities in order to provide uninterrupted emergency medical care for citizens who due to illness or injury have directly threatened the life, certain organs or certain parts of the body respectively cut the optimal time of occurrence of the emergency until the start of the final treatment process. Emergence clinic for 2020. Year ED over 100. 000-cases. The emergency health system doesn’t have a consolidated network and integrated emergency medical services. Emergency health services in Europe are being challenged by changes in life dynamics, scientific advancements, which do increase the request to further improve the way of delivering emergency services. Health-system resilience can be defined as the capacity of health actors, institutions, and populations to prepare for and effectively respond to crises, to maintain core functions when a crisis hits, and—informed by lessons learned during the crisis to reorganize if conditions require it. Emergency clinic today at UCCK offers an area of 507m2, with 22 beds in the living room (1 bed per 100,000 population). Compliance with the law on emergency medical care, support, and improvement of EMS creating a special budget for EMS. EMS Independence (Decentralization). Budget, Management, accreditation, initiation of a project of systematization doctors of nurses in an integrated system. Regulation of administrative and legal infrastructure for EMS. The increase in salary (during holidays, weekends), shortening working hours for EMS, beneficial path (stress, risk, complexity, infections, first contact with the patient), the extension of annual leave. Functionalization of the Permanent National Center for Education EMS training, licensing, relicensing (medical staff) Quality control or EMS quality.

Abdominal disturbances in children with Covid-19

Covid-19 continues to spread at an unprecedented pace, sparing no country in the world and including almost all ages. Although at the beginning of the pandemic, it was thought that the virus did not affect children, however over time, in different countries, more and more cases of children with Covid-19 begun to appear, though rarely among them were recorded any victims. However, the clinical picture of infections with this virus in children was much more challenging than in adults. In this article, we will present the case of three children of ages 4 to 14 years, with signs of acute abdomen, respectively with acute abdominal pain, fever, vomiting, and in whom acute appendicitis was suspected. In all three patients, anamnestic data showed positive family members infected with covid-19. All three children were sent to the surgery ward for follow-up and further treatment. The laboratory analyzes in all of them resulted in increased values ​​of both erythrocyte sediment and CRP, while only in one of them the values ​​of LDH and transaminases (AST, ALT) were also increased. Ultrasonographic examination of the abdomen in two children showed the presence of a small amount of free fluid in the abdomen and mesentery thickening with several packets of enlarged lymph nodes. Radiography of the lungs did not show pulmonary lesions in any of the children. Body temperature ranged from 37.2 to 38.50C, while urine was within the normal range. All children were hospitalized and kept under observation for several consecutive days. At the same time, they were treated with antibiotics of the group of cephalosporins of the third generation, as well as with antipyretics (paracetamol). As their condition improved and the abdominal pain subsided completely, they were released from the hospital with instructions to continue the rest and taking vitamins at home in the form of ready-made preparations for children. Conclusion: While the Covid-19 pandemic is rapidly spreading and not sparing even children, pediatricians and surgeons must be very cautious in treating children with acute abdominal pain since infections with Covid-19, and not surgical diseases, might be the real cause of these concerns.

Isolated Volar Distal Radioulnar Joint Dislocation, a Very Rare and Easily Missed Injury.

Background: Isolated distal radioulnar joint (DRUJ) dislocations without associated fracture are very rare entities. A few mechanisms of injury were reported in the literature with dorsal(posterior) dislocation being more common than the volar (palmar, anterior) dislocation. Case report: A 26-year-old male, manual laborer presented to our emergency department (ED) 24 hours post-self-inflected injury with right wrist pain, deformity, and decreased range of motion (ROM). The physical examination showed bruising over the dorsal ulnar side of the wrist, loss of the ulnar styloid bony prominence, abnormal volar fullness of the wrist, and gutter deformity on the dorsal aspect of the distal forearm and wrist. The diagnosis was confirmed by comparative radiographs which were followed by closed reduction and immobilization in the below-elbow cast in pronation for 4 weeks. Conclusion: Timely accurate diagnosis and conservative treatment with favorable outcome necessitate a proper history on the mechanism of injury with a thorough physical examination, accurate radiographic positioning, and true lateral view.