Journal of Emergencies, Trauma, and Shock最新文献

{"title":"Spontaneous Acquired Diaphragmatic Hernia: Case Series and Review of Literature.","authors":"Yeshwant Lamture, Siddharth P Dubhashi, Deepali Shetty","doi":"10.4103/jets.jets_3_24","DOIUrl":"10.4103/jets.jets_3_24","url":null,"abstract":"<p><p>Congenital diaphragmatic hernia (CDH) and acquired diaphragmatic hernia (ADH) are secondary to a weakness or opening in the diaphragm. Both are types of internal hernia. The abnormality can range from a minor defect in the posterior edge of the diaphragm to the entire loss of it. CDH usually leads to lung hypoplasia associated with pulmonary hypertension and immaturity, as well as cardiac dysfunction. In ADH, pathophysiology is secondary to herniation and its pressure effects. We report a series of two cases of spontaneous ADH (SADH). Spontaneous acquired rupture of the diaphragm can occur after exercise, coughing, labor (delivery), or even without any significant preceding event. It is uncertain if SADH is caused by a preexisting weak region in the diaphragm, a loss of muscle coordination during vigorous exertion, or both. It is a potentially fatal surgical emergency requiring a high index of clinical judgment in the appropriate clinical setting. SADH acts mechanically by compressing the lung. It is an infrequent entity. This case series and review concisely illustrate the genesis, diagnosis, and treatment of spontaneous diaphragmatic hernia.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 4","pages":"241-244"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Push-Pull Technique to Pressure Bag for Administration of Blood Products: A Prospective Nonblinded Observation Simulation-based Study (CoPP toP Study).","authors":"Aaron Jacob Grossberg, Daniel A Fowl, Brian T Merritt, George M Nackley, Jude A Polit-Moran, Chelsea L Savona, Sagar C Galwankar","doi":"10.4103/jets.jets_14_24","DOIUrl":"10.4103/jets.jets_14_24","url":null,"abstract":"<p><strong>Introduction: </strong>Shock is defined as inadequate delivery of oxygen to meet the tissue's demands. There are four main types of shock: cardiogenic, obstructive, distributive, and hypovolemic. Hypovolemic shock causes include hemorrhage, dehydration, and burns. Blood loss results in inadequate oxygen delivery to the cells resulting in tissue death if not reversed. Rapid infusers allow for the rapid administration of blood and crystalloid products to patients in shock; however, many community emergency departments do not have these devices. The aim of our study is to determine the fastest way to administer blood when the viscosity of the fluid is taken into consideration in a simulated setting.</p><p><strong>Methods: </strong>Volunteers were assigned to one of two arms: either the push-pull technique or pressure bag technique. The push-pull technique involved using a 50 cc syringe connected to a 3-way stop-cock to withdraw and infuse the fluid. The pressure bag technique involved pumping a pressure bag up to the maximum to infuse the fluids. The speed of infusing 250 mL of <i>intravenous</i> fluids was recorded. The time for the subjects to collect the materials throughout the emergency department was also recorded.</p><p><strong>Results: </strong>A total of three trials were conducted. On average, the push-pull technique took 228 s and the pressure bag technique took 340 s. The push-pull technique took an average of 112 s less than the pressure bag technique. Subjects took 62 s to find the materials for the pressure bag technique. It took 133 s to find the material for the push-pull technique.</p><p><strong>Conclusion: </strong>This prospective nonblinded observation simulation-based study demonstrated that the push-pull technique was significantly faster than the pressure bag technique.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 4","pages":"208-211"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantification of Metabolic Acidosis at Bedside by S.A.L.T Approach.","authors":"Harshitha Seshadri, Anitha Nileshwar, Shwethapriya Rao, Nisha Sara M Jacob","doi":"10.4103/jets.jets_1_24","DOIUrl":"10.4103/jets.jets_1_24","url":null,"abstract":"<p><strong>Introduction: </strong>Traditionally, metabolic acidosis is analyzed using an anion gap (AG). The aim of the study was to compare the utility of quantitative David Story's simplified Stewart approach against traditional approach to analyze metabolic acidosis. ICU setting. Analytical, cross-sectional observational study.</p><p><strong>Methods: </strong>Blood gas reports of 50 adult critically ill patients with primary metabolic acidosis at admission were analyzed using both approaches. With traditional approach, acidosis was classified simply as high or normal AG acidosis. With S.A.L.T approach, the components of base deficit were further quantified into sodium chloride, albumin, lactate, and other ions effects. A contribution of sodium chloride or albumin effect of > 30% to the base deficit was considered significant. The proportion of patients with such abnormalities was determined. Descriptive statistics was used.</p><p><strong>Results: </strong>The mean ± standard deviation (SD) age of patients was 54.52 ± 19.71 years, 52% were males, and 72% were medical admissions. The median (interquartile range [IQR]) Sequential Organ Failure Assessment score was 10 (5-13). The mean ± SD pH, bicarbonate, base excess, and albumin were 7.198 ± 0.13, 11.73 ± 4.2 mmol/L, -15.13 ± 5.6 mmol/L, and 2.9 ± 0.77 g%, respectively. The median (IQR) of serum lactate was 6.77 (1.53, 16.32) mmol/L. Hyponatremia and hypochloremia were seen in 68% and 46% of patients, respectively. Eighty-eight percent of patients had acidosis due to other ions, 52% due to lactates. Twenty-eight percent had a significant sodium chloride effect and 32% had significant hypoalbuminemia.</p><p><strong>Conclusion: </strong>Quantification of base deficit of metabolic acidosis using S.A.L.T approach showed changes in sodium chloride levels and hypoalbuminemia affecting base deficit in nearly 30% of the patients. Quantification of metabolic acidosis using S.A.L.T approach is likely to help treat metabolic acidosis more appropriately, with clinical implications.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 4","pages":"201-207"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progression from Balanoposthitis to Septic Shock.","authors":"Kenji Kawai, Yukinori Hirooka, Soichiro Ota, Noriko Tanaka, Chihiro Maekawa, Michika Hamada, Youichi Yanagawa","doi":"10.4103/jets.jets_82_24","DOIUrl":"10.4103/jets.jets_82_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 4","pages":"249-250"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to Change ATLS Classifications of Hemorrhagic Shock.","authors":"Fabrizio Bonanno","doi":"10.4103/jets.jets_101_24","DOIUrl":"10.4103/jets.jets_101_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 4","pages":"252-254"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexplained Multiple Needle Insertions in the Abdomen of an Adult.","authors":"Marina Kharkongor, Naveen Sharma, Mahaveer Singh Rodha, Satya Prakash Meena","doi":"10.4103/jets.jets_73_24","DOIUrl":"10.4103/jets.jets_73_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 4","pages":"250-251"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diaphragmatic Injuries in Patients with Penetrating Thoracoabdominal Injuries without Shock or Acute Abdomen at Admission.","authors":"Alejandro González-Muñoz, Laura Otálora González, María Paula Fontecha Pinzón, Angela Cristina Ríos Cadavid, Cristina Judith Padilla Herrera, Danny Michell Conde Monroy, José Gabriel Rodríguez-Narváez, David Rene Rodriguez Lima","doi":"10.4103/jets.jets_33_24","DOIUrl":"10.4103/jets.jets_33_24","url":null,"abstract":"<p><strong>Introduction: </strong>Penetrating thoracoabdominal injuries (PTAIs) are associated with diaphragmatic injuries and subsequent complications. This study aimed to describe the prevalence of diaphragmatic injuries in patients with PTAI without signs of shock or acute abdomen at admission.</p><p><strong>Methods: </strong>A cross-sectional, single-centered study was conducted in Bogotá, Colombia. The study included all patients with PTAI who underwent surgical exploration and were admitted without signs of shock or acute abdomen, between January 2019 and August 2021. Indications for surgical exploration included presence of left thoracoabdominal wound, hemo- or pneumothorax in presurgical imaging, abdominal pain, hypotension, or anemia.</p><p><strong>Results: </strong>A total of 284 patients were included in the final analysis. The median age was 29 years (interquartile range: 22-33), with 269 (94.7%) patients being males. Out of these, 268 (94.3%) patients experienced stabbing as the mechanism of injury. The prevalence of diaphragmatic injuries diagnosed during surgical exploration was 15.1% (43 patients). There were 183 patients with left-sided PTAI and 115 patients with right-sided PTAI. The prevalence of the right diaphragmatic injury was 25.2% (29 patients), while for left diaphragmatic injury, it was 8.1% (15 patients). Only one patient presented with bilateral diaphragmatic injury.</p><p><strong>Conclusions: </strong>The prevalence of diaphragmatic injuries in patients with PTAI, without signs of shock or acute abdomen upon admission, was 15.1%. However, the prevalence was 25.2% in the right PTAI and 8.1% in the left PTAI. These findings suggest that surgical exploration of the diaphragm in cases of PTAI should be performed regardless of the side of the wound.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 4","pages":"225-230"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Clinical Impact of Emergency Physician-performed Ultrasound-guided Peripheral Nerve Blocks in a Level 1 Trauma Center: A Retrospective Analysis.","authors":"Sanjeev Bhoi, Bharath Gopinath, Utkarsh Khandelwal, Rakesh Nayaka, Jyothiswaroop Bhaskararayuni, Devansh Gupta, Ayush Srivastava, Anisha Anshu, Aaditya Katyal, Tej Prakash Sinha","doi":"10.4103/jets.jets_8_24","DOIUrl":"10.4103/jets.jets_8_24","url":null,"abstract":"<p><strong>Introduction: </strong>Effective pain management is crucial in the emergency department (ED), particularly for trauma patients. Ultrasound-guided regional analgesia (UGRA) has emerged as a promising technique for acute pain relief. The objective of this study is to describe the various UGRA performed and assess their effectiveness among trauma patients in our Level 1 Trauma Center ED over the past 2.5 years.</p><p><strong>Methods: </strong>Data from 485 trauma patients who underwent UGRA over 2.5 years were analyzed retrospectively. The primary outcome was the median Defense and Veterans Pain Rating Scale (DVPRS) reduction at 30 min and 1 h after nerve block administration. Patient characteristics, types of nerve blocks administered, procedural details, and outcomes were also noted. Statistical analysis was performed to determine the median reduction in pain scores and evaluate the success of UGRA.</p><p><strong>Results: </strong>UGRA demonstrated a significant reduction in pain scores, with a median DVPRS decrease from 9 (interquartile range [IQR]: 9-10) preprocedure to 4 (IQR: 2-5) at 30 min and 1 (IQR: 0-2) at 1 h postprocedure. Sixteen types of nerve blocks were administered in our ED, with the serratus anterior block (<i>n</i> = 91) and fascia iliaca compartment block (<i>n</i> = 58) being the most common. Pain relief was the most common indication for block administration. A higher volume was injected for plane blocks compared to nerve-specific blocks. No complications or failed blocks were reported.</p><p><strong>Conclusion: </strong>This study describes 16 different UGRA that can be performed by emergency physicians (EPs) in ED for trauma patients. UGRA is effective in providing substantial pain relief for trauma patients in the ED. UGRA performed by EPs offers a safe and feasible approach for managing acute pain in the ED.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 4","pages":"193-200"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blunt Trauma without Elevated Fibrin Degradation Product.","authors":"Youichi Yanagawa, Michika Hamada, Chihiro Maekawa, Noriko Tanaka, Kenji Kawai, Soichiro Ota","doi":"10.4103/jets.jets_107_24","DOIUrl":"10.4103/jets.jets_107_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 4","pages":"255-256"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's New in Emergencies, Trauma, and Shock: Point-of-Care Ultrasound-guided Pain Management in Emergency Departments.","authors":"Siju V Abraham, Julio Arrieta","doi":"10.4103/jets.jets_153_24","DOIUrl":"10.4103/jets.jets_153_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 4","pages":"191-192"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}