Journal of Emergencies, Trauma, and Shock最新文献

{"title":"Prehospital Care for Road Traffic Injury Victims.","authors":"Alphonsa Mathew, Salish Varghese, Rajeev Punchalil Chathappan, Babu Urumese Palatty, A B Vijay Chanchal, Siju V Abraham","doi":"10.4103/jets.jets_139_23","DOIUrl":"10.4103/jets.jets_139_23","url":null,"abstract":"<p><strong>Introduction: </strong>Prehospital capabilities are inadequately developed to meet the growing needs for emergency care in most low- and middle-income countries. This study aims to describe the prehospital care received by the road traffic injury (RTI) victims presenting to a level I Trauma Care Center in Central Kerala, India.</p><p><strong>Methods: </strong>This was a hospital-based prospective observational study, which included consecutive victims of RTI attending the emergency department within 24-h of the event. A structured interview schedule was developed for collecting the data on various domains and the patients were followed up for their duration of hospital stay.</p><p><strong>Results: </strong>A total of 920 RTI victims, were included in this study. Two percent (17/920) of first responders had some sort of training in trauma care whereas the rest were untrained. The time taken to get any help at the scene after an RTI was 8 ± 12.9 min (95% confidence interval [CI] 7.16-8.84) and for first medical contact 25 ± 16 min (95% CI 24-26). No attempt at field stabilization occurred in any case. Three percent (26/920) had received some form of prehospital care, like arrest of hemorrhage using a compression bandage and splinting of the fractured limb with a wooden plank. None of the patients received supplemental oxygen, airway management, or cervical spine immobilization at the site of the accident or en route to the hospital.</p><p><strong>Conclusion: </strong>A lack of an organized prehospital care system results in minimal care before hospital admission. Urgent establishment of ambulance services and structured prehospital care tailored to our health-care system is imperative.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 3","pages":"166-171"},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11563236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648065","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":"Barriers to Effective Prehospital and Hyperacute Stroke Care in India: A Physician Perspective.","authors":"Siju V Abraham, Anita Joy, Ankit Kumar Sahu, Prithvishree Ravindra, Shirshendu Dhar, Ravi Teja, S Vimal Krishnan, Renyu Liu, Anthony George Rudd, Gary A Ford","doi":"10.4103/jets.jets_156_23","DOIUrl":"10.4103/jets.jets_156_23","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of stroke is increasing in India. Prehospital stroke care is crucial for reducing stroke morbidity and mortality, but its implementation in India faces several challenges. Limited original research exists on prehospital stroke care in India, making it essential to identify the problems in implementing effective prehospital stroke care.</p><p><strong>Methods: </strong>A web-based survey was conducted among registered medical practitioners in India who treat acute stroke. The survey questionnaire was developed in English and included 26 questions divided into five parts: questions about the physician's practice setup/hospital in India, perception of community awareness, existing prehospital care/systems, in-hospital stroke care availability, and specific issues faced.</p><p><strong>Results: </strong>Eighty-three doctors in India participated in the survey (43% response rate). Most of the respondents worked in private hospitals (68%) and urban areas (76%). While 89% of hospitals had ambulance services, over 33% reported that patients had to pay for ambulance transport. Among respondents, 12% reported a community stroke care network, with infrequent prehospital procedures such as random blood glucose measurement (22%), stroke identification (15.7%), \"last seen normal\" documentation (14.5%), and low prehospital notification to hospitals (5%). Delays in referral from peripheral centers were reported by 73% of respondents. Most hospitals had standard operating procedures (SOPs) (84%), computed tomography (CT) (94%), magnetic resonance imaging (MRI) (85%), and offered intravenous thrombolysis (IVT) (77%). However, 24 h availability of CT was reported only by 6%, MRI by 19% and IVT by 12%. Nearly half (45%) reported treatment with thrombolysis was not covered by insurance. Mechanical thrombectomy was available in 34% of hospitals and 63% of hospitals conducted in-hospital audits for stroke patients.</p><p><strong>Conclusions: </strong>The capabilities of stroke-catering hospitals in urban settings are encouraging, with many having SOPs, imaging capabilities, and thrombolysis and mechanical thrombectomy services. However, there is much room for improvement, in making the essential stroke care services financially accessible to all and available around the clock.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 3","pages":"129-135"},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11563232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648126","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":"Diagnostic Clinical Tool in Trauma Patients to Rule out Thoracolumbar Fracture.","authors":"Sajid Atique, Ahammed Mekkodathil, Tariq Siddiqui, Saji Mathradikkal, Khalid Ahmed, Mushreq Al-Ani, Ahad Kanbar, Abubaker Alaieb, Suhail Hakim, Basil Younis, Ahmed Ajaj, Aldwin Guerrero, Maarij Masood, Sherwan Khoschnau, Abdel Aziz Hammo, Nuri Abdurraheim, Husham Abdelrahman, Ruben Peralta, Syed Nabir, Shatha Al-Hilli, Ayman El-Menyar, Hassan Al-Thani","doi":"10.4103/jets.jets_145_23","DOIUrl":"10.4103/jets.jets_145_23","url":null,"abstract":"<p><strong>Introduction: </strong>The primary objective of this study was to assess the effectiveness of the clinical decision tool (CDT) in trauma patients, providing a comparable ability to rule out thoracolumbar (TL) fractures as traditional imaging methods. The goal is to facilitate early clearance of the TL spine without an immediate requirement for radiological tests, thereby minimizing unnecessary utilization of TL-spine imaging.</p><p><strong>Methods: </strong>A prospective, observational study was conducted on trauma patients with suspected TL injury. To achieve early TL clearance, the CDT assessed criteria such as absence of pain, tenderness, and pain-free axial movement and flexion. The study enrolled alert trauma patients with thoracic and/or lumbar spine injuries, defined by the Glasgow Coma Scale of 15. The study excluded patients not aligning with CDT criteria, such as those who received intravenous opioid analgesia within 4 h and those unable to stand due to suspected pelvic or lower limb injuries.</p><p><strong>Results: </strong>Following the completion of the CDT steps, there were 31 true negative cases, signifying the absence of TL fractures according to both CDT and imaging studies. The sensitivity of the CDT was 99.38% (95% confidence interval [CI]: 96.59%-99.98%), specificity 9.1% (95% CI: 6.30%-12.73%), negative predictive value (NPV) 96.87% (95% CI: 81.02%-99.56%), positive predictive value (PPV) 34.19% (95% CI: 33.38%-35.00%), negative likelihood ratio (LHR) 0.07 (95% CI: 0.01-0.49), and positive LHR 1.09 (95% CI: 1.06-1.13). The sensitivity, specificity, NPV, PPV, negative LHR, and positive LHR varied with each step in the CDT. Notably, the overall sensitivity was high; however, the stepwise sensitivity decreased, albeit with an improvement in specificity with each further step in the tool. The overall sensitivity in the study cohort (<i>n</i> = 500) was high; however, the stepwise sensitivity decreased, albeit with an improvement in the specificity.</p><p><strong>Conclusions: </strong>The CDT to rule out TL fracture is a feasible bedside stepwise tool in fully awake trauma patients after a thorough clinical neurological examination on arrival. The tool could help Level II or III trauma centers avoid secondary triage to the higher center.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 3","pages":"159-165"},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11563237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648139","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":"Lemierre's Syndrome Complicated by Venous Stroke due to a Massive Cerebral Venous Thrombus.","authors":"Sayaka Nakahara, Kaoru Obata, Tetsunori Ikegami","doi":"10.4103/jets.jets_5_24","DOIUrl":"10.4103/jets.jets_5_24","url":null,"abstract":"<p><p>Lemierre's syndrome is a rare disease characterized by thrombophlebitis of the internal jugular vein and metastasis to distant organs. It occurs after an anaerobic infection of the larynx or dental region; the central nervous system involvement is infrequent. A 50-year-old woman presented with impaired consciousness. She had undergone several days of dental treatment for a toothache before presentation. Contrast-enhanced computed tomography (CT) revealed a head-and-neck abscess and a massive thrombus in the internal jugular vein, and a diagnosis of Lemierre's syndrome was made. After symptoms improved with surgical drainage and antimicrobial therapy, the patient was discharged on day 58. In this case, Lemierre's syndrome was complicated by a venous stroke caused by venous congestion due to a massive cerebral venous thrombus. Venous stroke due to thrombi may occur in patients with Lemierre's syndrome, and magnetic resonance imaging or CT with venous phase imaging may aid in the diagnosis.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 3","pages":"184-186"},"PeriodicalIF":1.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11563235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648059","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":"Acute Myocardial Infarction with Refractory Cardiogenic Shock after High-Voltage Electrocution: An Intriguing Case.","authors":"Nikhil Pantbalekundri, Sourya Acharya, Samarth Shukla, Khadija Hamdulay","doi":"10.4103/jets.jets_6_24","DOIUrl":"10.4103/jets.jets_6_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"122-124"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788165","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":"Multiple Cerebral Infarctions after Treatment of Acquired Factor XIII Deficiency with Retroperitoneal Hematoma.","authors":"Youichi Yanagawa, Hiroaki Taniguchi, Tatsuro Sakai, Kenji Kawai, Yousuke Mori, Hiroki Nagasawa","doi":"10.4103/jets.jets_7_24","DOIUrl":"10.4103/jets.jets_7_24","url":null,"abstract":"","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"124-125"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790916","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":"Effective Management of Severe Burn Injury Complicated by Acute Kidney Injury in a Patient with Preexisting Chronic Kidney Disease.","authors":"Suhas Vidyadhar Abhyankar, Chandan Chaudhari, Vedanti Rajesh Patil, M M Bahadur, Arvind M Vartak","doi":"10.4103/jets.jets_128_23","DOIUrl":"10.4103/jets.jets_128_23","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is a common and severe complication in severe burns. Preexisting chronic kidney disease (CKD) can make the management more challenging. We present the management strategy adopted in such a case, highlighting the adaptations in fluid resuscitation, dialysis, and septicemia prevention. The case involved the 2^nd and 3^rd degree burns covering 53% body surface, in a patient with preexisting CKD and hypertension. Despite initial fluid resuscitation, the patient developed AKI. Sustained low-efficiency dialysis (SLED) was started, along with nutritional support using buttermilk diet. Aggressive antibiotic prophylaxis was initiated based on wound swabs culture and sensitivity. Wound debridement was deferred and daily dressing with silver nitrate gel and moisture-retaining film was used. Debridement and grafting were performed on postburn days 43 and 65. The patient was discharged after 80 days, with healed wounds. Our approach included meticulous fluid and nutrition supplementation coupled with SLED and appropriate wound management coupled with aggressive antimicrobial prophylaxis to prevent septicemia.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"114-117"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788169","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":"Transfusion Practices in Severely Injured Patients at a Level 1 Trauma Center.","authors":"Aparna Krishna, Arulselvi Subramanian, Rahul Chaurasia, Tej Prakash Sinha, Shivam Pandey, Rajesh Malhotra","doi":"10.4103/jets.jets_58_23","DOIUrl":"10.4103/jets.jets_58_23","url":null,"abstract":"<p><strong>Introduction: </strong>Acute trauma resuscitation is challenging and disorganized in low- and middle-income countries as there is lack of evidence-based transfusion practices with respect to ratio, volume, trigger, cutoff points for various triggers. This study aims to study the patterns of blood use in various mechanisms of injury, by interfacility transfer status and define triggers for transfusion of various blood components. Prospective observational study, emergency department of level 1 trauma center (August 2017-August 2018).</p><p><strong>Methods: </strong>Demographic, injury, clinical, laboratory, transfusion characteristics, and patient outcomes were collected from electronic hospital records and transfusion service records. We used multivariate logistic regression to identify triggers of transfusion of red blood cells, plasma, platelets (PLTs), cryoprecipitate, and mortality predictors.</p><p><strong>Results: </strong>Among 986 severely injured patients 80% were males, 92% had blunt injuries and commonest trauma was Head. The median length of intensive care unit stay and hospital stay were more in a referred group. Patients brought to center directly received more massive transfusions (56, 13.05% vs. 48, 8.62%). Railway track injuries received the most total median packed red blood cells (PRBCs) units in both groups. The triggers for various blood product transfusions include: Hematocrit < 32.08 for PRBC, PT >16.9 s for plasma, PLT count <130 lakhs for platelets, MAP <89.7 mmHg and PT >18.2 s for cryoprecipitate.</p><p><strong>Conclusion: </strong>Railway track injuries with inferior extremity injuries required maximum transfusion requirements and were a trigger for PRBC, plasma, PLTs, and cryoprecipitate. Smartphone-based apps and transfusion prediction models can be framed based on the triggers and cut points.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"84-90"},"PeriodicalIF":16.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788173","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":"Bed-up-head-elevated Position versus Supine Sniffing Position in Patients Undergoing Rapid Sequence Intubation Using Direct Laryngoscopy in the Emergency Department - A Randomized Controlled Trial.","authors":"Admala Anudeep Reddy, S Manu Ayyan, D Anandhi, Ezhilkugan Ganessane, V T Amrithanand","doi":"10.4103/jets.jets_109_23","DOIUrl":"10.4103/jets.jets_109_23","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study is to compare bed-up-head-elevated (BUHE) position with supine sniffing position (SSP) in patients undergoing rapid sequence intubation (RSI) using direct laryngoscopy in the emergency department (ED).</p><p><strong>Methods: </strong>This single-center randomized controlled superiority trial was carried out from September 2021 to December 2022 in an academic emergency medicine department. The patients undergoing RSI in ED were grouped into two arms, namely BUHE position and SSP. The primary outcome was the time taken for endotracheal intubation. The secondary outcomes were the first-pass success rates and postintubation complications.</p><p><strong>Results: </strong>A total of 136 patients were enrolled in the study. Time for intubation in the BUHE group was no different from SSP (32.09 s [interquartile range (IQR): 23.30-42.68] vs. 33.40 [IQR: 27.53-45.90], <i>P</i> = 0.17). There was a modest reduction in intubation time when performed by trained experts (22.5 s [IQR: 17.7-25.3] versus 30.3 s [IQR: 21.3-33.2], <i>P</i> = 0.04). The first-attempt success rate in the BUHE position was also similar to the SSP position ([91.18% vs. 90.91%] <i>P</i> = 0.958). Postintubation complications were lesser in BUHE compared to the SSP group ([7.4% vs. 19.7%] <i>P</i> = 0.04).</p><p><strong>Conclusions: </strong>In our study, BUHE position did not improve time to intubation and first-pass success rate in ED patients compared to SSP. A modest decrease in intubation time was noted while experts used the BUHE position. The postintubation complications were slightly lesser in the BUHE group.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"58-65"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788167","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":"Erratum: Emergency Departments: Preparing for a New War.","authors":"","doi":"10.4103/JETS.JETS_81_24","DOIUrl":"10.4103/JETS.JETS_81_24","url":null,"abstract":"<p><p>[This corrects the article on p. 157 in vol. 15, PMID: 36643772.].</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"17 2","pages":"117"},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11279500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788170","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}