Journal of Emergencies, Trauma, and Shock最新文献

{"title":"Bilateral First Rib Fractures in Blunt Trauma Patients: A Retrospective Study.","authors":"Ashraf Fathi Hefny, Nirmin A Mansour, Mai A Fathi","doi":"10.4103/jets.jets_40_24","DOIUrl":"https://doi.org/10.4103/jets.jets_40_24","url":null,"abstract":"<p><strong>Introduction: </strong>Unilateral fracture of the first rib frequently led to severe complications such as brachial plexus or major vascular injury. Bilateral first rib fracture (BFRF) is very rare. We aimed to study the incidence, mechanism of injury, management, and outcome of BFRF in blunt trauma patients in a community-based hospital.</p><p><strong>Methods: </strong>Data of all blunt trauma patients who were admitted to our institution with (BFRF from December 2014 through January 2017) were retrospectively collected. Data included demography, mechanism of injury, severity of the injury, associated injuries, management, and outcome.</p><p><strong>Results: </strong>During the study period, 4779 patients with blunt trauma were included in the trauma registry and 12 (0.25%) patients had BFRF. The mean age of standard deviation (SD) was 29 (8.3) years. Seven (58.3%) patients were involved in road traffic collisions and 5 (41.7%) patients fell from more than 3 m height. The most commonly associated thoracic injury was lung contusions in 8 (66.7%) patients. The median (range) Glasgow Coma Score on admission was 15 (14-15) and Injury Severity Score (SD) was 19 (10.5). Length of hospital stay mean (SD) was 6.8 (6.4) days. No patients died in the study.</p><p><strong>Conclusions: </strong>BFRF is a rare entity in blunt trauma patients caused by high-energy trauma. Major vascular or brachial plexus injuries in patients with BFRF are much less than those reported in the medical literature on unilateral first rib fractures. Associated injuries are the main cause of trauma-related morbidity rather than the direct effect of BFRF.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"22-25"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994642","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 Single-Center Review of Cases to Understand the Indian Polyvalent Antivenom Use in Hump-Nosed Pit Viper Bites in South India.","authors":"Siju V Abraham, Sarah Paul, Martin V Paul, Clint Davis, Aboobacker Mohamed Rafi, Appu Suseel, Deo Mathew, C K Kassyap, Rajeev Punchalil Chathappan","doi":"10.4103/jets.jets_74_24","DOIUrl":"https://doi.org/10.4103/jets.jets_74_24","url":null,"abstract":"<p><strong>Introduction: </strong>India, with nearly 60 venomous snake species, has just one commercially available antivenom, the Indian polyvalent antivenom (IPAV). The hump-nosed pit viper (<i>Hypnale hypnale</i>), an indigenous venomous snake, causes considerable morbidity and at time mortality for which we have no commercially available antivenom. However, most clinicians rely purely on the clinical syndromes and end up using the available IPAV for <i>H. hypnale</i> envenomation.</p><p><strong>Methods: </strong>Between April 2017 and December 2022, we reviewed 41 cases of <i>H. hypnale</i> envenomation, comparing clinical and laboratory profiles of patients who received IPAV with those who did not.</p><p><strong>Results: </strong>Local signs of envenomation were seen in 39 (95.12%) cases, with the most common being edema or swelling at the bite site. Eight (19.5%) patients developed coagulopathy, and two developed renal failure during their hospital stay. Among the 39 envenomated individuals, 13 received polyvalent snake antivenom. Over half of those receiving antivenom had hypersensitivity reactions. Patients who received antisnake venom (ASV) had increased intensive care unit stay, duration of hospitalization, and hospital expenses as compared to patients who did not. There was one death among the patients who received antivenom.</p><p><strong>Conclusion: </strong><i>H. hypnale</i> viper envenomation is associated with local and systemic signs of envenomation, with coagulopathy being a common complication. Administering the current polyvalent antivenom to victims of <i>H. hypnale</i> bites did not reduce the morbidities or prevent mortality; instead, it exposes them to additional risks associated with ASV administration.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"15-21"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988210","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":"Implementation and Adaptation of Pathway of Resuscitative Endovascular Balloon Occlusion of the Aorta after Traumatic Injury.","authors":"Ammar Al-Hassani, Bianca M Wahlen, Ayman El-Menyar, Ibrahim Al-Hassani, Naushad A Khan, Sagar Galwankar, Sandro Rizoli, Hassan Al-Thani","doi":"10.4103/jets.jets_79_24","DOIUrl":"https://doi.org/10.4103/jets.jets_79_24","url":null,"abstract":"<p><p>Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an invented method to facilitate a minimally invasive occlusion of the aorta to stop a life-threatening hemorrhage. This review described an established pathway for noncompressible exsanguination (REBOA procedures) in trauma patients at a Level 1 trauma center. A detailed description starting from the structural changes of the hospital and facilities itself, the initial thoughts, implementation of the process, and continuous revision and improvement of guidelines were discussed. A multidisciplinary core team consisting of trauma surgeons, anesthesiologists, interventional radiologists, and operating room (OR) staff developed step-by-step clinical practice guidelines for using REBOA at our trauma center. A comprehensive training program for specialized procedural training was implemented to ensure the competency of all relevant medical personnel in managing trauma patients. The REBOA guidelines underwent plan-do-check-act quality cycle improvement until the latest guidelines were reached with each use of REBOA in a trauma patient, leading to further auditing of the guidelines to identify areas for improvement. The current review discusses the critical role of adopting innovative technologies and adapting protocols in trauma care, particularly for vulnerable patients with a high risk of morbidity and mortality. Continuous process improvement, procedural refinement, and evolving guidelines are essential prerequisites for optimizing patient outcomes. We described a valuable framework for other trauma programs to implement and adapt similar endovascular bleeding control approaches, thereby potentially enhancing patient care.</p>","PeriodicalId":15692,"journal":{"name":"Journal of Emergencies, Trauma, and Shock","volume":"18 1","pages":"32-40"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063857","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":"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}