Journal of Emergencies, Trauma, and Shock最新文献

{"title":"Outcomes and Factors Associated with Occult Septic Shock in Emergency Department Patients with Soft Tissue Infection.","authors":"Laura Marie Tiffany,&nbsp;Quincy K Tran,&nbsp;Maie Abdel-Wahab,&nbsp;Austin Widjaja,&nbsp;Aya Aligabi,&nbsp;Fernando Albelo,&nbsp;Samantha Asunción,&nbsp;Dominique Gelmann,&nbsp;Daniel J Haase,&nbsp;Sharon Henry,&nbsp;Evan Leibner,&nbsp;Lucas Sjeklocha","doi":"10.4103/jets.jets_38_22","DOIUrl":"https://doi.org/10.4103/jets.jets_38_22","url":null,"abstract":"<p><strong>Introduction: </strong>Patients who develop occult septic shock (OSS) are associated with worse outcomes than those with early septic shock (ESS). Patients with skin and soft tissue infection (SSTI) may have underlying organ dysfunction due to OSS, yet the prevalence and the outcomes of patients with SSTI and early versus occult shock have not been described. This study compared the clinical characteristics of SSTI patients and the prevalence of having no septic shock (NSS), ESS, or OSS.</p><p><strong>Methods: </strong>We retrospectively analyzed charts of adult patients who were transferred from any emergency department to our academic center between January 1, 2014, and December 31, 2016. Outcomes of interest were the development of OSS and acute kidney injury (AKI). We performed logistic regressions to measure the association between clinical factors with the outcomes and created probability plots to show the relationship between key clinical variables and outcomes of OSS or AKI.</p><p><strong>Results: </strong>Among 269 patients, 218 (81%) patients had NSS, 16 (6%) patients had ESS, and 35 (13%) patients had OSS. Patients with OSS had higher mean serum lactate concentrations than patients with NSS (3.5 vs. 2.1 mmol/L, <i>P</i> < 0.01). Higher sequential organ failure assessment (SOFA) score was associated with higher likelihood of developing OSS (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.23-1.62, <i>P</i> < 0.001). NSS was associated with very low odds of developing AKI (OR 0.16, 95% CI 0.08-0.33, <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>13% of the patients with SSTI developed OSS. Patients with OSS had elevated serum lactate concentration and higher SOFA score than those with NSS. Increased SOFA score is a predictor for the development of OSS.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"15 3","pages":"128-134"},"PeriodicalIF":1.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9639725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40690232","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":"Prevention is Better than Cure: Intra-abdominal Migration of Drain Placed for Bile Duct Injury.","authors":"Arvind Kumar Bodda,&nbsp;Bhargavi Srividya,&nbsp;Pankaj Kumar","doi":"10.4103/jets.jets_6_22","DOIUrl":"https://doi.org/10.4103/jets.jets_6_22","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"15 3","pages":"153-154"},"PeriodicalIF":1.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9639731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40674957","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":"Ultrasound Killed the Pelvic Examination: Over-reliance on Ultrasound Resulted in Delayed Diagnosis of Fitz-Hugh-Curtis Syndrome and Potential Loss of Fertility in a Young Female Patient.","authors":"Luke Lin,&nbsp;Alfredo Tirado,&nbsp;Erin Mateer,&nbsp;Sagar Galwankar,&nbsp;Veronica Tucci","doi":"10.4103/JETS.JETS_136_20","DOIUrl":"https://doi.org/10.4103/JETS.JETS_136_20","url":null,"abstract":"<p><p>We describe a case of multiple missed opportunities to diagnose Fitz-Hugh-Curtis syndrome in a sexually active 26-year-old woman in the emergency department (ED). Repeat ultrasound scans showed a hemorrhagic ovarian cyst. Multiple ED providers relied exclusively on these ultrasound findings as the presumed cause of her pelvic pain, to the detriment of their physical examination. A manual pelvic examination was not performed until her fourth ED return visit, which showed mucopurulent discharge. On the basis of our findings, obstetrics and gynecology team was consulted and the patient underwent diagnostic laparoscopy, which revealed extensive adhesions suggestive of pelvic inflammatory disease (PID) and Fitz-Hugh-Curtis syndrome. With the advent of ultrasound, we have noticed providers rely on technology to the detriment of their physical examination skills. Many ED providers are hesitant to perform a pelvic examination when a transvaginal ultrasound has already suggested a cause of the patient's pain. Ultrasound will not and cannot diagnose PID.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"15 3","pages":"146-148"},"PeriodicalIF":1.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9639729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40675368","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":"Who's Who in the Trauma Bay? Association between Wearing of Identification Jackets and Trauma Teamwork Performance: A Simulation Study.","authors":"Marie Saleten,&nbsp;Philippe Laitselart,&nbsp;Thibault Martinez,&nbsp;Chloé Descamps,&nbsp;Bruno Debien,&nbsp;Mathieu Boutonnet,&nbsp;Pierre Pasquier","doi":"10.4103/jets.jets_168_21","DOIUrl":"https://doi.org/10.4103/jets.jets_168_21","url":null,"abstract":"<p><strong>Introduction: </strong>Trauma is the leading cause of under-45 mortality worldwide, and the leading cause of years of life lost. To manage the severe trauma patients, trauma teams require both improved technical and nontechnical skills, such as communication, leadership, teamwork, and team resource management. The objective of this study was to measure the impact of the identification of trauma team members on teamwork performance. The hypothesis was that wearing identification jackets was associated with better teamwork performance.</p><p><strong>Methods: </strong>The study was conducted from 2015 to 2019 at the Percy Army Training Hospital, a trauma center in the <i>Ile-de-France</i> region. In 2016, the protocol for receiving severe trauma patients was modified, including the obligation to wear identification jackets. Thus, each member of the trauma team wore a jacket identifying his or her function. This study was carried out by analyzing videos of medical simulation sessions during the reception of trauma patients in the trauma bay. The study compared the teamwork performance before 2016, a period with no identification jackets wearing, with the teamwork performance after 2016, a period with identification jackets wearing. The Team Emergency Assessment Measure (TEAM)Scale was used. This TEAM scale is a benchmark measure of teamwork performance, particularly adapted to the context of trauma.</p><p><strong>Results: </strong>A total of 48 participants were included in the study. Six videos of medical simulation sessions \"arrival of severe trauma patients\" were analyzed and divided into two groups. A first group of three videos with no identification jackets wearing was the GROUP ID(-). A second group of three videos with identification jackets wearing was the GROUP ID(+). An 11-item TEAM scale was used to rate each video for a total of 33 scores per group. The distribution of the median scores for the GROUP ID(+) was significantly different from the distribution of the median scores for the GROUP ID(-) (<i>P</i> = 0.001). These results were consistent with those of other single-center studies conducted in operating theaters and in emergency departments, where clearly identifying the roles of each member of the medical teams was associated with less communication errors. The main limits of this study were its single-center nature and a limited data sample.</p><p><strong>Conclusion: </strong>In this single-center simulation study, wearing identification jackets was associated with an improvement in the trauma team performance TEAM scores. Further studies are needed to confirm these results but they already encourage the consideration of nontechnical skills in the management of severe trauma patients.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"15 3","pages":"139-145"},"PeriodicalIF":1.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9639728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40690231","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":"Factors Affecting Stress Levels in Attendants Accompanying Patients to Emergency Department.","authors":"Madhukar Jaygopal,&nbsp;Sandeep Jain,&nbsp;Sameer Malhotra,&nbsp;Anoop Purkayastha,&nbsp;Shreya Singhal","doi":"10.4103/jets.jets_156_21","DOIUrl":"https://doi.org/10.4103/jets.jets_156_21","url":null,"abstract":"<p><strong>Introduction: </strong>Staff in emergency departments work in an environment where they are continuously exposed to situations with aggressive patients and their caretakers. With increasing incidents of reported violence, the present study was conducted to identify factors associated with stress levels among patients' attendants.</p><p><strong>Methods: </strong>A prospective, cross-sectional, observational study was conducted among 256 attendants of patients presenting to Emergency Department (ED). Signs of stress and imminent violence were recorded using STAMP method at initial encounter. Stress levels were assessed using Perceived Stress Scale 10 and Visual Analog Scale at the end of 2 h during patient's stay in emergency department. Factors associated with stress were studied using linear regression analysis. There was a follow-up to estimate the level of stress, to identify risk factors and types of violence in the sample population.</p><p><strong>Results: </strong>98.9% of attendants exhibited some form of stress. Age of <40 years, female gender, single marital status, lower educational background, lack of previous experience with ED, perceived long waiting time, and first-degree relatives were the significant risk factors associated with high stress. Verbal aggression was the most common and frequent form of aggression. Noncritically ill patient attendants, no previous experience with EDs, graduates, middle age group, perceived long waiting time, and poor patient response to treatment were found to be risk factors for impending violence.</p><p><strong>Conclusion: </strong>Stress was exhibited in majority of caregivers. Further programs are needed to strengthen training for ED staff to identify early and impending violence and to develop coping mechanisms for well-being of both attendants and health-care professionals.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"15 3","pages":"116-123"},"PeriodicalIF":1.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9639734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40690224","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":"Prospective Validation of a Novel Triage System Developed in a Middle Income Country - AIIMS Triage Protocol.","authors":"Satish Kumar Singh,&nbsp;Ankit K Sahu,&nbsp;Akshay Kumar,&nbsp;L R Murmu,&nbsp;Sanjeev Bhoi,&nbsp;Praveen Aggarwal,&nbsp;Meera Ekka,&nbsp;Nayer Jamshed,&nbsp;Bharath Gopinath,&nbsp;Ghanashyam Timilsina","doi":"10.4103/jets.jets_146_21","DOIUrl":"https://doi.org/10.4103/jets.jets_146_21","url":null,"abstract":"<p><strong>Introduction: </strong>Triage is a crucial process not only to identify sick patients and prioritize prompt management but also to foster efficient resource utilization. In low-and middle-income countries (LMICs) most emergency departments (ED) still have an informal triage process. Although an important element of emergency care, triage research has not been a priority in LMICs, and hence, very few triage systems have been validated. The All India Institute of Medical Sciences (AIIMS) triage protocol or ATP for adult patients was developed by expert consensus at AIIMS using the Delphi method. We attempted a prospective validation of the ATP in terms of mortality and intensive care unit (ICU)/hospital admission at 24 h.</p><p><strong>Methods: </strong>Patients presenting to the ED, who were 14 years and above were included in the study. The patients were followed up at 24 h and their outcome documented on a standardized data collection form. Mortality and ICU admission were noted at 24 h.</p><p><strong>Results: </strong>A total of 15,505 patients were recruited. After exclusion, among 13,754 patients, 6303 (45.83%) were triaged red and 7451 (54.17%) were triaged yellow. Mortality at 24 h was 10.31% (650) in red triaged patients and 0.35% (26) in yellow triaged patients. The 24-h mortality of red triaged patients was significantly higher (<i>P</i> <0.001) than that of yellow triaged patients. The presence of one or more ATP \"Red\" criteria was 96.2% (95% confidence interval [CI]: 94.42%-97.47%) sensitive and 56.8% (95% CI: 55.92%-57.63%) specific in predicting 24-h mortality. The sensitivity and specificity of ATP \"Red\" criteria for 24-h ICU admission were 98.5% (95% CI: 97.7%-99.1%) and 59.6% (95% CI: 58.8%-60.5%), respectively.</p><p><strong>Conclusion: </strong>When applied to adult nontrauma patients, ATP had a high accuracy in recognizing sick patients presenting to the ED. A time-tested and validated triage system like ATP may be a good starting point for public hospital EDs in LMICs.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"15 3","pages":"124-127"},"PeriodicalIF":1.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9639733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40674958","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":"Military Marking Round Injury to the Globe.","authors":"Patrick James Donegan,&nbsp;Matthew Allen De Niear,&nbsp;Janice C Law,&nbsp;Behin Barahimi","doi":"10.4103/jets.jets_108_21","DOIUrl":"https://doi.org/10.4103/jets.jets_108_21","url":null,"abstract":"<p><p>Marking cartridges are an increasingly popular form of nonlethal training munitions used primarily for military live-fire simulations. We report a case of ocular trauma due to such a projectile, resulting in the complete loss of vision and placement of a scleral shell. A 20-year-old man presented with decreased visual acuity in his right eye after being struck at close range by a marking cartridge during military training. Computed tomography imaging revealed a retained metallic foreign body within a deflated right globe, prompting emergent exploration and repair of the right globe. Postoperative course was complicated by pain and pruritis which resolved over a period of months. Nonlethal weapons, such as marking cartridges, are increasingly used for civilian crowd control as well as military and law enforcement training. Despite guidelines mandating the use of personal protective equipment with marking cartridges, eye protection may not be consistently used during simulated combat exercises. To the best of our knowledge, this is the first formal report of ocular injury due to this type of ammunition. Based on this case, we discuss other similar types of nonlethal munition used by military and law enforcement, their risks to the eye and orbit, and what steps may be undertaken to reduce future injury.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"15 2","pages":"108-110"},"PeriodicalIF":1.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9336640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40570911","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":"Myocardial Infarction after ChAdOx1 nCoV-19 in a Young Male.","authors":"V V S S Sagar,&nbsp;Anil Wanjari,&nbsp;Sunil Kumar,&nbsp;Sourya Acharya","doi":"10.4103/jets.jets_20_22","DOIUrl":"https://doi.org/10.4103/jets.jets_20_22","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"15 2","pages":"112-113"},"PeriodicalIF":1.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9336646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40570915","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 - Burnout in Emergency Physicians.","authors":"Murtuza Ghiya,&nbsp;William Wilson","doi":"10.4103/jets.jets_76_22","DOIUrl":"https://doi.org/10.4103/jets.jets_76_22","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"15 2","pages":"75-76"},"PeriodicalIF":1.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9336645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40570908","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":"Identification of Seniors at Risk Scoring in Geriatric Trauma: Exploring Clinical Outcome Correlations.","authors":"Stephen D Dingley,&nbsp;Wayne B Bauerle,&nbsp;Christine Ramirez,&nbsp;Holly Weber,&nbsp;Rebecca Wilde-Onia,&nbsp;Ann-Marie Szoke,&nbsp;Adam Benton,&nbsp;Danielle Frutiger,&nbsp;Alaa-Eldin Mira,&nbsp;William Hoff,&nbsp;Stanislaw P Stawicki","doi":"10.4103/jets.jets_19_22","DOIUrl":"https://doi.org/10.4103/jets.jets_19_22","url":null,"abstract":"<p><strong>Introduction: </strong>Geriatric trauma patients (GTP) make up an increasing percentage of the overall trauma population. Due to frailty, GTP are at an increased risk of morbidity and readmission. Therefore, it is becoming increasingly important to prognosticate outcomes to assist with resource utilization. We hypothesized that the \"Identification of Seniors at Risk\" (ISAR) score may correlate with both clinical outcomes and resource utilization for geriatric trauma patients.</p><p><strong>Methods: </strong>Patients older than 65 years who were admitted to the trauma service were screened using an ISAR scoring algorithm. Outcomes, including 30-day mortality, all-cause morbidity, hospital length of stay (LOS), intensive care unit (ICU) LOS, functional independence measures (FIM) at discharge, and percent discharged to a facility, were analyzed. Both descriptive and data-appropriate parametric and non-parametric statistical approaches were utilized, with significance set at α = 0.05.</p><p><strong>Results: </strong>One thousand and two hundred seventeen GTP were included in this study. The average age was 81, median injury severity score was 9, and 99% had a blunt trauma mechanism. ISAR scores were generally associated with increasing 30-day mortality (0%, 1.9%, 2.4%, and 2.1% for ISAR 0, ISAR 1-2, ISAR 3-4, and ISAR 5-6, respectively), morbidity (2.6%, 7.6%, 14.7%, and 7.3% for respective categories), longer hospital (3.1, 4.6, 5.1, and 4.3 days, respectively) and ICU stays (0.37, 0.64, 0.81, and 0.67, respectively), lower FIM score at discharge (18.5, 17.1, 15.8, and 14.4, for respective categories), as well as increasing percentage of patients discharged to a facility (29.8%, 58.9%, 72.1%, and 78.8% for respective categories).</p><p><strong>Conclusions: </strong>This exploratory study provides important early insight into potential relationships between ISAR and geriatric trauma outcomes. ISAR screening is a quick and easy-to-use tool that may be useful in GTP triage, level-of-care determination, and disposition planning. Understanding populations at risk, especially those with more intricate discharge needs, is an important step in mitigating those risks and implementing appropriate care plans.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"15 2","pages":"93-98"},"PeriodicalIF":1.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9336643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40573402","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}