Journal of Emergencies, Trauma, and Shock最新文献

{"title":"Air Everywhere without Bowel Injury.","authors":"Shikha Bhatia, Binit Sureka, Niladri Banerjee","doi":"10.4103/jets.jets_13_24","DOIUrl":"10.4103/jets.jets_13_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788166","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":"A Case of Spastic Quadriplegia Remaining after Multiple Traumatic Injuries Complicated by Sepsis and Reversible Posterior Leukoencephalopathy Syndrome, as well as Delayed Multifocal Microbleeds.","authors":"Hiromichi Ohsaka, Hiroki Nagasawa, Rino Isogai, Hiroaki Taniguchi, Soichiro Ota, Michika Hamada, Tatsuro Sakai, Youichi Yanagawa","doi":"10.4103/jets.jets_154_23","DOIUrl":"10.4103/jets.jets_154_23","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788164","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":"Using Children's Artwork to Improve Adherence with Timely Antibiotic Administration in Open Fractures.","authors":"Kathy Chu, Shahriar Zehtabchi, Valery Roudnitsky, Fred Harry, Bonny J Baron","doi":"10.4103/jets.jets_133_23","DOIUrl":"10.4103/jets.jets_133_23","url":null,"abstract":"<p><strong>Introduction: </strong>Antibiotics for open fractures (OFs) administered within 60 min of emergency department (ED) arrival reduce patients' infection risk. We tested a novel method of displaying children's drawings to prompt clinicians to improve adherence with early antibiotics for OFs.</p><p><strong>Methods: </strong>Registry-based pre- (January 1, 2016-June 30, 2019) and post- (July 1, 2019-March 31, 2022) intervention at a level 1 trauma center. In July 2019, children's artwork depicting OF was displayed in the ED alongside OF guidelines and E-mailed to faculty and residents. Primary outcome: proportion of OF patients who received antibiotics within 60 min of arrival. Time to antibiotics was calculated from ED arrival to time-stamped administration in the electronic health record. We compared time to antibiotics as continuous variables between the two groups. Proportions are presented with percentages and 95% confidence interval (CI); continuous variables as median and quartiles. Chi-square or Mann-Whitney <i>U</i>-tests were used for group comparisons.</p><p><strong>Results: </strong>Five hundred fifty-four total OF patients were identified (excluded: transferred = 1, ED death = 4, unclear time to antibiotics = 11); 281 pre-implementation and 257 post-implementation. The median age was 34 years (quartiles 24 and 46). Trauma mechanisms of injury included 300 blunt (56%) and 238 penetrating (44%). Gustilo OF classification by type were as follows: 71% I, 13% II, 15% III, 1% unclassified. There was a significant difference (<i>P</i> = 0.001) in both percentage of patients who received antibiotics within 60 min (58%, 95% CI, 52%-63% vs. 79%, 95% CI, 74%-84%) and time to antibiotics (median: 46 min vs. 25 min) between pre- and postphases, respectively.</p><p><strong>Conclusions: </strong>Children's artwork in our ED improved adherence with OF guidelines and decreased time to antibiotics.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788174","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":"Outcomes of Video-assisted Thoracic Surgery-guided Early Evacuation of Traumatic Hemothorax: A Randomized Pilot Study at Level I Trauma Center.","authors":"Abhinav Kumar, Dinesh Gora, Dinesh Bagaria, Pratyusha Priyadarshini, Narendra Choudhary, Amit Priyadarshi, Sahil Gupta, Junaid Alam, Amit Gupta, Biplab Mishra, Subodh Kumar, Sushma Sagar","doi":"10.4103/jets.jets_132_23","DOIUrl":"10.4103/jets.jets_132_23","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic hemothorax is accounted for about 20% of traumatic chest injuries. Although majority can be managed with the timely placement of intercostal tube (ICT) drainage, the remaining pose a challenge owing to high complication rates associated with retained hemothorax. Although various treatment modalities including intrapleural instillation of fibrinolytics, radioimage guided drainage, VATS guided evacuation and thoractomy do exist to address the retained hemothorax, but indications along with timing to employ a specific treatment option is still unclear and ambiguous.</p><p><strong>Methods: </strong>Patient with residual hemothorax (>200 mL) on ultrasonography after 48 h of indwelling ICT was randomized into either early video-assisted thoracic surgery (VATS) or conventional approach cohort. Early VATS cohort was subjected to video-assisted thoracoscopic evacuation of undrained blood along with normal saline irrigation and ICT placement. The conventional cohort underwent intrapleural thrombolytic instillation for 3 consecutive days. The outcome measures were the duration of indwelling ICT, removal rate of tube thoracostomy, length of hospital stay, duration of intensive care unit (ICU) monitoring, need for mechanical ventilation, incidence of pulmonary and pleural complications, and requirement of additional intervention to address undrained hemothorax and mortality rate.</p><p><strong>Results: </strong>The early VATS cohort had shorter length of hospital stay (7.50 ± 0.85 vs. 9.50 ± 3.03, <i>P</i> = 0.060), reduced duration of indwelling ICT (6.70 ± 1.25 vs. 8.30 ± 2.91, <i>P</i> = 0.127) with higher rate of tube thoracostomy removal (70% vs. 30%, <i>P</i> = 0.003) and lesser need of additional interventions (0% vs. 30%, <i>P</i> = 0.105). Thoracotomy (3 patients) and image-guided drainage (4 patients) were additional interventions to address retained hemothorax in the conventional cohort. However, similar length of ventilator assistance (0.7 ± 0.48 vs. 0.60 ± 1.08, <i>P</i> = 0.791) and prolonged ICU monitoring (1.30 ± 1.06 vs. 0.90 ± 1.45, <i>P</i> = 0.490) was observed in early VATS cohort. Both the cohorts had no mortality.</p><p><strong>Conclusion: </strong>VATS-guided early evacuation of traumatic hemothorax is associated with shorter length of hospital stay along with abbreviated indwelling ICT duration, reduced incidence of complications, lesser readmissions, and improved rate of tube thoracostomy removal. However, the duration of ventilator requirement, ICU stay, and mortality remain unchanged.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788171","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":"A High-grade Aneurysmal Subarachnoid Hemorrhage in the Peripartum Period","authors":"Nissar Shaikh, Adnan Saadeddin, F. Ummunnisa, Umm-e Amara, Abdulnasser Thabet, S. Nahid","doi":"10.4103/jets.jets_84_23","DOIUrl":"https://doi.org/10.4103/jets.jets_84_23","url":null,"abstract":"\u0000 Aneurysmal subarachnoid hemorrhage (aSAH) is a rare but devastating complication with increased morbidity and mortality. It is still unclear whether the incidence is increased during pregnancy and in the peripartum period. However, the incidence of cerebral aneurysmal rupture is higher during the third trimester than in the first trimester. The risk of aneurysmal rupture and subarachnoid hemorrhage (SAH) during general anesthesia or spinal anesthesia is unclear. We report a case of left supraclinoid aneurysm rupture after spinal anesthesia for Low Segment Caesarean Section (LSCS) in the immediate postpartum period causing high-grade aSAH.","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140077232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scurvy: A Rare Disease or a Rare Diagnosis?","authors":"D. Gaieski","doi":"10.4103/jets.jets_108_23","DOIUrl":"https://doi.org/10.4103/jets.jets_108_23","url":null,"abstract":"\u0000 \u0000 \u0000 Scurvy, the disease state caused by ascorbic acid deficiency, was once an extremely common disease but is now thought to be a rare disease in postmodern societies. Physicians are not trained to consider scurvy as a possible diagnosis in patients at risk; rather, it is considered a rare diagnosis to add to a differential for completeness’s sake.\u0000 \u0000 \u0000 \u0000 We sought to describe the scorbutic patients seen by one physician during a busy academic emergency medicine career. Case series of patients seen by one physician between 1993 and 2023 at five academic teaching hospitals with Emergency Departments (EDs) in the mid-Eastern United States. Presenting signs and symptoms, known scurvy risk factors, Vitamin C levels, clinical course, and outcome for each patient are described.\u0000 \u0000 \u0000 \u0000 There were 14 presentations by 12 patients diagnosed with scurvy who were initially evaluated in the ED between 1993 and 2023. Each patient had a known risk factor for inadequate Vitamin C intake. All had clinical findings suggestive of scurvy and all but one had a subnormal serum Vitamin C level detected on serum samples sent from the ED.\u0000 \u0000 \u0000 \u0000 The detection of 12 cases of scurvy by one physician over a three-decade period highlights the importance of screening for scurvy in at-risk populations and generates the hypothesis that scurvy is not a rare disease but rather a rare diagnosis. This research hypothesis should be investigated in further studies.\u0000","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140421756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging Trend of Acute Poisonings Presenting to an Emergency Department in South India","authors":"Ezhilkugan Ganessane, Anas Mohammed Muthanikkatt, S. Ayyan","doi":"10.4103/jets.jets_138_23","DOIUrl":"https://doi.org/10.4103/jets.jets_138_23","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140422293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Perspectives on Innovations in Emergency Care during the COVID-19 Pandemic: A Mixed Methods Study","authors":"Timothy Visclosky, Tara Funk, Chinonso B Agubosim, C. Chaou, Prashant Mahajan","doi":"10.4103/jets.jets_129_23","DOIUrl":"https://doi.org/10.4103/jets.jets_129_23","url":null,"abstract":"\u0000 \u0000 \u0000 In mid-2020, the Emergency Medicine Education and Research by Global Experts (EMERGE) network surveyed the emergency response to the COVID-19 pandemic. We demonstrated that innovative measures were being generated at unprecedented rates. Our aim was to build on these findings to develop the first theoretical model with utility in assessing and developing emergency innovations.\u0000 \u0000 \u0000 \u0000 Phase 1 of a two-phase, explanatory sequential mixed methods study was a secondary analysis of the original EMERGE survey. Phase 2 involved follow-up interviews of a purposeful sample of 15 of the original survey respondents, representing 12 countries and all 6 World Health Organization regions. Thematic analysis was performed by three members of the research team.\u0000 \u0000 \u0000 \u0000 Innovation is a nonlinear process in which ideas are developed, implemented, refined, and spread. Ideas grew from departmental needs or the spread of successful innovations from other sites. Development was highly localized, influenced by institutional and regional factors. Obtaining buy-in from relevant stakeholders and addressing various barriers were essential to implementation. The majority of innovations then underwent a process of evolution before some were spread to other institutions through a largely unidirectional flow of information.\u0000 \u0000 \u0000 \u0000 This study proposes the first model for emergency innovation processes and highlights multiple areas for improvement. Understanding how to prioritize departmental needs and the barriers may streamline development and implementation. Furthermore, the apparent unidirectional flow of information demonstrated by our participants suggests both an opportunity and a need for improved information systems. We present a framework for further research and an outline for innovation management.\u0000","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140417723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizure Prophylaxis in Young Patients Following Traumatic Brain Injury","authors":"A. Bahey, T. Chughtai, A. El-Menyar, Vishwajit Verma, G. Strandvik, Mohammad Asim, R. Consunji, Basil Younis, A. Parchani, Sandro Rizoli, H. Al-Thani","doi":"10.4103/jets.jets_93_23","DOIUrl":"https://doi.org/10.4103/jets.jets_93_23","url":null,"abstract":"\u0000 \u0000 \u0000 Phenytoin is one of the commonly used anti-seizure medications in nontraumatic seizures. However, its utility and safety in young patients with traumatic brain injury (TBI) for the prevention of early-onset seizures (EOS) are debatable. We sought to explore the use of phenytoin as a seizure prophylaxis following TBI. We hypothesized that administering phenytoin is not effective in preventing EOS after TBI.\u0000 \u0000 \u0000 \u0000 This was a retrospective observational study conducted on adult TBI patients. EOS was defined as a witnessed seizure within a week postinjury. Data were compared as phenytoin versus no-phenytoin use, EOS versus no-EOS, and among TBI severity groups.\u0000 \u0000 \u0000 \u0000 During 1 year, 639 TBI patients were included with a mean age of 32 years; of them, 183 received phenytoin as seizure prophylaxis, and 453 received no prophylaxis medication. EOS was documented in 13 (2.0%) patients who received phenytoin, and none had EOS among the nonphenytoin group. The phenytoin group was more likely to have a higher Marshall Score (P = 0.001), lower Glasgow Coma Scale (GCS) (P = 0.001), EOS (P = 0.001), and higher mortality (P = 0.001). Phenytoin was administrated for 15.2%, 43.2%, and 64.5% of mild, moderate, and severe TBI patients, respectively. EOS and no-EOS groups were comparable for age, gender, mechanism of injury, GCS, Marshall Score, serum phenytoin levels, liver function levels, hospital stay, and mortality. Multivariable logistic regression analysis showed that low serum albumin (odds ratio [OR] 0.81; 95% confidence interval [CI] 0.676–0.962) and toxic phenytoin level (OR 43; 95% CI 2.420–780.7) were independent predictors of EOS.\u0000 \u0000 \u0000 \u0000 In this study, the prophylactic use of phenytoin in TBI was ineffective in preventing EOS. Large-scale matched studies and well-defined hospital protocols are needed for the proper utility of phenytoin post-TBI.\u0000","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140423713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal Delayed Aortic Perforation Resulting from a Sternal Fracture","authors":"Y. Yanagawa, I. Takeuchi, H. Nagasawa, Kan Kajimoto","doi":"10.4103/jets.jets_146_23","DOIUrl":"https://doi.org/10.4103/jets.jets_146_23","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140417884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}