Panamerican journal of trauma, critical care & emergency surgery最新文献

{"title":"Prior Emergency Department Utilization as a Predictor for Severe Penetrating Trauma: A Retrospective Cohort Study","authors":"","doi":"10.5005/jp-journals-10030-1256","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1256","url":null,"abstract":"Background: While extensive research has been conducted on healthcare utilization after severe penetrating trauma events, there is a dearth of information on healthcare utilization prior to these events. This study examined the emergency department (ED) utilization patterns to determine if prior ED visits for injury were a risk factor for severe penetrating trauma. Materials and methods: This retrospective cohort study examined the ED visit records of 215,800 patients with 489,800 ED visits and 3,322 trauma registry patients from November 2010 to February 2015 at Grady Memorial Hospital, a large, urban hospital with a level I trauma center. Data analysis was conducted using logistic regression and Cox proportional hazard models. Results: Among 215,800 ED patients, 224 patients with prior ED visits experienced severe penetrating trauma (as reported to the trauma registry). After adjustment for age, sex, employment, insurance, high utilization, and admission status, prior ED visits for injury were associated with severe penetrating trauma (OR 1.60, CI 1.21–2.10, p = 0.001). Cox proportional hazard models were used to estimate hazard ratios (HR) for factors associated with time to a penetrating trauma event following a patient’s last ED visit. After adjusting for age, sex, employment status, admission status, high utilization, and insurance status, patients with an injury diagnosis at their last ED visit had a HR of 1.43 (CI 1.07–1.93, p = 0.016). Conclusion: After adjusting for confounders, a previous ED visit for injury remained a significant risk factor for severe penetrating trauma and an elevated rate of time to penetrating trauma. These findings suggest a need for targeted violence intervention programs and improved ED injury surveillance.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79554913","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":"Duodenal and Pancreatic Trauma","authors":"","doi":"10.5005/jp-journals-10030-1250","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1250","url":null,"abstract":"The difficulty in diagnosing injuries to the duodenum and pancreas is attributed to the fact that they are retroperitoneal structures, therefore, well protected by the surrounding viscera. As a result, injuries to these organs are rare and also easily missed. Most trauma surgeons have limited experience in treating them. The epidemiologic study from Trauma Audit and Research in the UK found a combined incidence of 4.7% for pancreatic and duodenal injuries among patients with abdominal trauma.1 The retroperitoneal location of these organs results in a delay of symptomatology and frequently diagnosis. Injuries requiring surgical repair are more common as a consequence of a penetrating mechanism. In most cases, trauma to the duodenum and pancreas is associated with other injuries potentially changing the surgical approach. Moreover, in patients with pancreatic or duodenal injury, a complete evaluation must be performed in order to rule out an associated visceral injury. Injuries caused by blunt or penetrating trauma with high mechanisms can continue to evolve over time such as contusion of the mesentery or blunt trauma to the bowel. This is particularly important when evaluating injuries to the pancreas and the duodenum, since injuries that might have appeared insignificant can result in ischemia and perforation if not treated appropriately.2 There are significant implications of a joint pancreatic and duodenal injury. Injury to the pancreatic duct results in uncontrolled leak of pancreatic enzymes that become a threat to any repair. Secretion of pancreatic enzymes increases morbidity and mortality secondary to suture line dehiscence and secondary intra-abdominal sepsis.3 The outcomes of these injuries have improved over the years secondary to increased awareness, earlier diagnosis and treatment, appropriate resuscitation to euvolemia avoiding secondary physiological insult to the patient, and advances in adjuncts for nutritional support.4 The following chapter will focus on clinical presentation and operative techniques that can help the surgeon treat these complicated patients. An Ato m I c A l co n s I d e r At I o n s Vascular Supply The vascular supply to the duodenum and pancreas is provided by the superior and inferior pancreaticoduodenal arteries, which are branches from celiac and superior mesenteric arteries, respectively. Both pancreaticoduodenal arteries provide anterior and posterior branches. In turn these branches have several small vessels entering the duodenal wall and the head of the pancreas. Therefore, dissecting and isolating the duodenum from the pancreas is a difficult maneuver due to bleeding. Duodenal devascularization is always a concern. The right gastric artery and the splenic artery give rise to additional arterial branches to the duodenum and the body and tail of the pancreas. The venous drainage follows the arteries and provides tributaries to the splenic vein and superior mesenteric vein. Both drain into the portal ve","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74966290","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":"Análisis de una serie de trauma renal en pacientes menores de 15 años en un centro hospitalario de alta complejidad de la ciudad de Medellín, Colombia","authors":"","doi":"10.5005/jp-journals-10030-1253","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1253","url":null,"abstract":"El riñón es un órgano frecuentemente afectado en niños con trauma abdominal. Aproximadamente 1 de cada 10 pacientes tendrá una lesión del parénquima renal, los hilios vasculares o los sistemas colectores. El objetivo de este trabajo fue analizar una serie de pacientes pediátricos con trauma renal, evaluar su comportamiento y el resultado de las conductas mediante un estudio retrospectivo y descriptivo. Se incluyeron pacientes menores de 15 años ingresados con sospecha y/o diagnóstico de trauma renal entre enero 2013 y marzo de 2019 al Hospital Universitario San Vicente Fundación de la ciudad de Medellín, Colombia. Los criterios de exclusión fueron todos aquellos pacientes con historia clínica incompleta, mayores de 15 años, lesiones iatrogénicas y malformación renal conocida. Se identificaron 144 pacientes con diagnóstico de trauma abdominal y sospecha de compromiso renal; en el 29.9% se pudo confirmar el diagnóstico. De los 43 pacientes, el 65.1% fueron hombres y la edad promedio fue de 9.4 años. El trauma cerrado correspondió al 93% siendo la principal etiología las caídas (27.9%) seguidas del trauma contuso (20.9%). Los síntomas principales fueron el dolor lumbar, abdominal y la hematuria. El trauma grado III fue el más frecuente (40.2%) seguido del IV (30.2%). La conducta más frecuente fue la observación clínica (76.7%) con una efectividad del 100%. El 16.3% requirió cirugía y el 7% angioembolización como manejos iniciales con una efectividad del 100% y 66% respectivamente. La tasa de complicaciones fue del 7% y no se presentaron muertes en el presente estudio. Palabras clave: Angioembolización, Conservadora, Riñón, No operativo, Pediátrica, Trauma.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88703851","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":"Minimal Leak Test vs Manometry for Endotracheal Cuff Pressure Monitoring: A Pilot Study","authors":"","doi":"10.5005/jp-journals-10030-1252","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1252","url":null,"abstract":"Ab s t r Ac t Introduction: Optimal cuff pressure for intubated patients is 20–30 cm H2O as routinely measured by manometry. This methodology is associated with elevated costs due to equipment requirements. The objective of this study was to evaluate another methodology, i.e., the minimal leak testing (MLT). Materials and methods: Initial cuff pressures were measured by manometry for all mechanically ventilated patients in a surgical intensive care unit (ICU). Two critical care physicians separately performed an MLT for each subject and cuff pressure was then remeasured by manometry. The rate of ventilator-associated pneumonia (VAP) was determined. Results: Thirty subjects with 100 patient events were evaluated. The post-MLT measured cuff pressures were highly consistent between physicians, with a Pearson correlation coefficient of 0.770 (p = 0.01). Average initial cuff pressures were not significantly different between manometry and MLT (25 cm H2O vs 14 cm H2O, p = 0.1894). Manometry had a higher incidence of elevated cuff pressures (n = 13/50 vs 2/100, p < 0.0001), while MLT had higher incidences low cuff pressures (n = 72/100 vs 17/50, p < 0.0001). No difference was observed in the VAP rate (2.8 vs 3.0 per 1,000 ventilator days, p = 0.96). Conclusion: Minimal leak testing is a known method of cuff pressure monitoring that was demonstrated in this study to provide a reproducible technique.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90846894","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":"Trauma Por Onda Explosiva La Mirada Del Cirujano General En La Práctica Civil","authors":"","doi":"10.5005/jp-journals-10030-1249","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1249","url":null,"abstract":"Re s u m e n Introducción: Onda explosiva se define como la liberación violenta de energía que es transferida hacia el ambiente; siendo esta capaz de empujar columnas de aire, material particulado y gases calientes que al encontrarse con el cuerpo humano ocasionan lesiones que pueden llegar a comprometer la vida. Materiales y métodos: Se presenta una revisión narrativa de la literatura con herramientas de revisión sistemática sobre el tema de trauma por onda expansiva. Excluyendo artículos no relacionados con trauma por onda expansiva publicados en idiomas diferentes al español y al inglés y aquellos cuya temática central es diferente de lo tratado por la cirugía general y sus subespecialidades. Discussion: Se describe cada uno de los 5 mecanismos de lesión descritos para este tipo de trauma, y se hace un resumen del diagnóstico y manejo de las lesiones más frecuentes a nivel torácico, abdominal y vascular periférico. Conclusión: Es esencial conocer los mecanismos de lesión para dar el manejo adecuado a los pacientes víctimas de este tipo de lesiones de una manera multidisciplinaria. Palabras clave: Cirugía general, Onda explosiva, Poli-trauma, Terrorismo, Trauma, Trauma de explosión.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88469446","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":"Perforating Pancreatic Injury: New Approaches and Unexpected Complications","authors":"E. Utiyama, Leonardo Ks Koyama, Alissom Vitti Cincoto, Adriano Rm Pflug, F. D. S. C. E. Silva","doi":"10.5005/jp-journals-10030-1255","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1255","url":null,"abstract":"Perforating pancreatic injury (PPI) is an uncommon event in trauma centers. In rare cases, it can complicate with pancreatic fluid collections (PFC). Although it is well known in cases of acute pancreatitis, there are few described cases in trauma patients. Another feared complication is the disconnection of the major pancreatic duct (MPD), which most authors recommend to be treated immediately. We hereby report a successful case of PPI that was initially approached by videolaparoscopy, coursed with an infected PFC formation and a MPD disconnection. This case analysis suggests that videolaparoscopy may be feasible in patients with PPI and that minimally invasive approaches in the acute phase might postpone more aggressive procedures to an elective and well-planned approach.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"130 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79605490","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":"Impact of Participation in an International Surgical Observership Program: Results of an Online Survey","authors":"","doi":"10.5005/jp-journals-10030-1248","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1248","url":null,"abstract":"Aim: To assess the impact of international surgical observership, the level of satisfaction of past participants and obtain their feedback on their experience. Since 2011, the international observership program (IOP) is offered in partnership with the Panamerican Trauma Society (PTS) and the Virginia Commonwealth University (VCU), Division of Acute Care Surgery Services. The IOP has facilitated knowledge exchange opportunities on trauma care and emergency medical systems (EMSs) for physicians in training from Latin America countries. Materials and methods: An online survey using REDCap was conducted among past participants (n = 36). The 14-question survey had a combination of dichotomous, multiple-choice, open-ended, and Likert scale questions. To keep the survey anonymous, participant identifiers were not used. Descriptive analysis was carried out. Results: The response rate was 53% (n = 19). The overall effect of IOP should be considered as positive, as 17 (89%) respondent alumni consider the IOP exceeded or met their expectations and 18 (95%) would recommend it to a friend and colleague. Similarly, 89% of the IOP’s alumni believe that the observership helped them with their career growth. Most of the observers commented that the experience was inspiring, opened their minds, and broadened their horizons. Conclusion: The present survey adds further evidence of the positive impact that international observerships offer to physicians in training coming from lowand middle-income countries. The IOP introduces students to new knowledge for comprehensive care of trauma patients that would be advantageous to their future professional roles.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75512538","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":"Single-pass Whole-body vs Organ-selective Computed Tomography for Trauma—Timely Diagnosis vs Radiation Exposure: An Observational Study","authors":"C. Ordoñez, A. García, M. Parra, J. Herrera-Escobar, M. Guzmán-Rodríguez, Carlos García, Hernán E. Munevar, C. Navarro, Alejandra de las Salas, Laura Ibarra, A. Holguín, Ana Milena del Valle","doi":"10.21203/rs.2.14656/v1","DOIUrl":"https://doi.org/10.21203/rs.2.14656/v1","url":null,"abstract":"\u0000 Background Single Pass Whole-Body Computed Tomography (WBCT) has been used as a high yield diagnostic tool in trauma. However, increased exposure to radiation and delay in treatment, have been cited as challenges to its widespread use. We hypothesized that WBCT has at least the same radiation exposure compared to Organ-Selective CT and it does not inflict further delays in treatment. Methods We retrospectively review all trauma patients in whom CT-scans were performed on arrival at a Level I Trauma Center from January, 2016 to December, 2017. Results 123 patients were included: 53 in the OSCT group and 70 in the WBCT group. In the OSCT group, 64.1% of the patients had penetrating trauma and chest injuries were the most common injured body cavity (79.3%). In the WBCT group, 65.7% had blunt trauma and head injuries were the most common (71.9%) injured organ. The OSCT group required subsequent trips to the scanner suite for follow-up studies to rule out other potential injuries which in turn did not occur in the WBCT group (47.2% vs 0%, p< 0.001). The total radiation exposure dose was higher in the OSCT group compared to the WBCT group [22 mSv (IQR 6-31) vs 15.1 mSv (IQR 9.9-24.8) p<0.001]. Conclusion OSCT has the potential of missing potentially life threatening injuries that require subsequent follow-up scans. This, in turn, would increase the patient’s overall radiation exposure and potentially delay definitive surgical treatment. Trauma patients undergoing WBCT had lower total radiation exposure with no delay in treatment.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90169285","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":"Prehospital and First Hospital System Response to a Terrorist Attack in Bogotá, Colombia.","authors":"Maria F Jimenez,&nbsp;Andrés Becerra,&nbsp;Sergio Cervera,&nbsp;Elio F Sánchez,&nbsp;Jorge Ospina,&nbsp;Francisco J Henao,&nbsp;Alexander Paz,&nbsp;Gabriel Paredes,&nbsp;María I Gutiérrez,&nbsp;Juan C Puyana","doi":"10.5005/jp-journals-10030-1254","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1254","url":null,"abstract":"<p><strong>Background: </strong>Assembling an effective medical response for an overwhelming number of casualties has become a priority worldwide. Terrorist attacks have been part of the Colombian contemporaneous history. On February 7, 2003, a terrorist car bomb explosion occurred inside a private club in Bogotá, causing the largest number of casualties of all terrorist attacks for over 15 years. The present study analyses the hospital and prehospital responses to this mass casualty event by characterizing the patterns of injury, resource allocation, and outcome in a tertiary-level hospital where most of the casualties were treated.</p><p><strong>Materials and methods: </strong>This is a retrospective chart review of the patients brought to a single hospital (La Clínica del Country), which was the nearest to the terrorist attack. Demographics, severity of injury, patterns of injury, prehospital care, and outcomes were determined from the hospital medical records and government registries.</p><p><strong>Results: </strong>Of the 240 victims, 35 died at the explosion site (immediate mortality 17%). The 205 survivors were dispersed throughout the city, of whom 63 patients came to La Clínica del Country hospital. Most of these patients were evaluated only clinically and deemed not serious. The main mechanism of trauma was blunt (81.4%). The mean injury severity score (ISS) was 5.6 ± 8.3. Ten patients required emergent surgical intervention and 14 patients were admitted. The in-hospital mortality was 20%.</p><p><strong>Conclusion: </strong>This mass casualty event was a true test for the Colombian emergency medical system and disaster preparedness. The medical response and resource optimization resulted in an overall mortality rate similar to those observed in the recent European and North American bombings. Despite the limited resources, the continuous challenge of terrorist's attacks in Colombia made the country feel the need for training and preparing the healthcare professionals, allowing effective delivery of medical care.</p>","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"8 3","pages":"143-147"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9a/f8/nihms-1815163.PMC9529020.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33487394","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":"New Editor-in-Chief Announcement","authors":"T. Scalea","doi":"10.5005/pajt-8-2-vi","DOIUrl":"https://doi.org/10.5005/pajt-8-2-vi","url":null,"abstract":"","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78732617","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}