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

{"title":"B-CON Course: Skills Acquired at Training in Bleeding Control Techniques for the Prevention of Exsanguinating Hemorrhage","authors":"Juan P. Fernandez, R. D. Algieri, María Soledad Ferrante, Carolina Brofman, Agustín Algieri","doi":"10.5005/jp-journals-10030-1302","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1302","url":null,"abstract":"Introduction: Bleeding is one of the main causes of death associated with trauma. In the general population, knowledge of techniques to control bleeding is scarce or null in most situations, as well as the tools needed to perform them. The American College of Surgeons (ACS) “Stop the Bleed” campaign has the objective of training non-medical personnel to perform life-saving maneuvers to control bleeding in emergency and trauma situations. Materials and methods: A prospective, observational study. Surveys were conducted on knowledge of maneuvers to control bleeding among non-medical personnel. The training was done using the “Stop the Bleeding” B-CON Course of the ACS followed by evaluations. Results: Four hundred and twelve non-medical military personnel were trained, of whom 320 were medical students 27 surgical assistants, 35 nursing assistants, and 30 members of the armed forces. 92.7% (382) had no previous knowledge of any of the maneuvers. 73.3% (302) had some familiarity with tourniquets, of whom 6.55% (27) knew how to apply it. One hundred percent reported being unprepared to perform the maneuvers on their own before the course. Evaluation: after taking the course, 401 (92.3%) were able to correctly place the tourniquet on others, while 223 (54.1%) were able to apply on themselves. All participants (100%) performed wound compression correctly. Three hundred and forty-one (82.7%) reported feeling fully capable to perform the maneuvers after the course, while 71 (17.2%) requested to repeat it. One hundred percent of the respondents reported that the acquired skills and knowledge were beneficial. Conclusion: The training of non-medical military personnel, as well as the general population, may be valuable to reduce deaths caused by exsanguinating hemorrhage. The authors believe educational programs are recommended and should be implemented in the general civilian and military communities as well as making the necessary tools widely available. The active participation of the medical community and their continuous interaction with the general population via injury prevention activities are important to reduce deaths caused by trauma.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78568504","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":"Personal Protection Equipment and Emergency Surgery during the COVID-19 Pandemic in Spain","authors":"C. Y. Benítez, J. Fernando, A. Güemes, J. Aranda, F. Turégano, L. Ponchietti, F. Pareja, V. Duran, J. Blas","doi":"10.5005/jp-journals-10030-1292","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1292","url":null,"abstract":"Ab s t r Ac t Introduction: In December 2019, in Wuhan, China, a new viral disease, COVID-19, was diagnosed, and in January 2020, the first case was diagnosed in Spain. In April, Spain had reported more than 200,000 cases, 38,000 of which were health workers, representing more than 16% of the volume of contagion in the general population. The objective of our study was to determine the availability, characteristics of use, and the need for improvisation of personal protective equipment (PPE) during the first wave of the COVID-19 pandemic in Spain. Materials and methods: An online, anonymous, prospective survey was carried out from April 2 to 15 by an e-mail invitation to 562 of the Trauma and Emergency Surgery sections of the Spanish Association of Surgeons. The survey collected demographic data, the region of clinical practice, patterns of PPE use in emergency surgeries, and the improvisation of equipment. Results: Total 58 health workers from 12 communities completed the survey, 95% surgeons. Total 28% received training with PPE during the pandemic, and 44% rated it as insufficient. The PPE used in surgery were double glove (74%), face shield (72%), surgical glasses (67%), waterproof gown (67%), and boot covers (32%). Lack of N95/FPP2/3 was reported by 82% and other elements of PPE by 68%. More than half of the respondents (51%) improvised PPE. Conclusion: The results reflect a low degree of training on PPE use before and during the first wave of the pandemic, the lack of PPE, especially masks, and the need to use nonapproved material as a protection mechanism.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88814441","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":"Hanging in There. Living beyond Hanging: A Retrospective Review of the Prognostic Factors from a Regional Trauma Center","authors":"S. Biswas, Heather X. Rhodes, Kirklen Petersen, Kyle Schwarz, Gaukhar Amandossova","doi":"10.5005/jp-journals-10030-1295","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1295","url":null,"abstract":"Background: A common cause of suicide in the United States is hanging, which is increasing in incidence. Patients with near-hanging injuries survive long enough to present to the emergency department for resuscitative care. Identifying prognostic factors that can predict survival is needed to improve emergency management in this patient population. Materials and methods: A retrospective review of all patients diagnosed with an attempted suicide by hanging that presented to a regional level 2 trauma center was studied, inclusive years January 2013 to December 2017. The patients who died upon arrival were excluded. The data collected for comparison included demographic with prognostic characteristics, trauma center admission vitals, type and frequency of injuries, and near-hanging outcomes. Results: Several statistically significant findings were presented. Associations between systolic blood pressure (BP) upon admission of <90 Hg in patients <65 years of age and survival were statistically significant (Fisher’s exact test, p = 0.005). The association between Glasgow coma scale (GCS) category and survival was statistically significant (Fisher’s exact test, p = 0.012). Further, there was a weak positive association between the GCS category on admission vitals and survival (F = 0.554, p = 0.006). Associations between cervical spine injury with fracture and survival were significant (Fisher’s exact test, p = 0.024). A strong negative relationship was found between cerebral anoxia and survival (F = –0.772, p = 0.001). The association between cerebral injury and survival was statistically significant (Fisher’s exact test, p = 0.002). Finally, a strong negative relationship was found between pulmonary edema and survival (F = –0.592, p = 0.004). Conclusion: Independent risk factors for poor outcomes in near-hanging trauma were identified. These factors include relationships between systolic BP, GCS categories, admission vitals, cervical spine injures with fracture, cerebral anoxia, cerebral injury, and pulmonary edema with survival.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82492826","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":"Monitoring Organs Susceptible to Ischemia/Reperfusion Injury after Prolonged Resuscitative Endovascular Balloon Occlusion of the Aorta in a Hemorrhagic Shock Swine Model","authors":"T. Scalea, J. Glaser, Alexander J Burdette, W. Gamble, D. Parsell, Leslie E Neidert, Y. Matsumura, R. Kozar","doi":"10.5005/jp-journals-10030-1298","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1298","url":null,"abstract":"Background: Despite advancements in critical care, hemorrhage remains a leading cause of potentially survivable deaths in civilian and military settings. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a viable technology that could be used in the prehospital setting. However, the potential complications of prolonged REBOA use, especially in the military setting where the pre-hospital phase could exceed 2 hours, are not completely understood with regards to organ damage susceptibility to prolonged REBOA use. Materials and methods: Fifteen male Yorkshire swine underwent a 40% volume-controlled hemorrhage over 20 minutes. Animals were then randomly assigned ( n = 5/group) to REBOA inflation times of 120, 180, and 240 minutes, followed by 1 hour of resuscitation with shed whole blood and crystalloid before euthanasia. Samples were collected for blood gas analysis, chemistry, Luminex, enzyme-linked immunosorbent assays (ELISAs), and histology. Results: Metabolic acidosis increased with prolonged REBOA inflation times along with inflammation as shown by increases in interleukin (IL)-6 and neutrophil levels. Organs most susceptible to prolonged REBOA inflation times were the liver and intestines as demonstrated by histology. Conclusion: While REBOA has been shown to effectively staunch hemorrhage and improves survival, complications exist for prolonged REBOA inflation times. The results of this study demonstrate that the liver and intestines are particularly susceptible to prolonged REBOA inflation out to 4 hours, in addition to increased metabolic acidosis and systemic inflammation. These findings should help guide clinicians while using REBOA over a prolonged period of time to improve survival and mitigate potential REBOA-associated ischemic organ damage. torso hemorrhage REBOA, Shock, Swine, Trauma.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75054466","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":"Prevention of Hospital-acquired Pressure Ulcers in Patients with Prone Ventilation: A Retrospective Observational Study","authors":"Megha Sharma, G. Chandan, Padmakumar V Arayamparambil, Shivangi Mishra, P. Sarada","doi":"10.5005/jp-journals-10030-1296","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1296","url":null,"abstract":"Aim: Prone positioning improves oxygenation in patients with hypoxic respiratory failure. A pressure ulcer is a disturbing complication of prone positioning. The use of air mattresses and soft silicone dressing reduces the incidence of pressure ulcers in supine patients and prone intraoperative cases. We have compared the effect of two different strategies on the incidence of hospital-acquired pressure ulcers in patients undergoing prone ventilation for hypoxic respiratory failure. Materials and methods: We retrospectively analyzed the records of patients who underwent prone ventilation for hypoxic respiratory failure. Patients were divided into groups based on the hospital-acquired pressure ulcer prevention strategy used for prone patients. Patients in group S (Standard) were prone to the use of pillow support, headrest, and gel pads for pressure areas, while those in group O (Observation) were prone to air mattress along with soft silicone dressing and gel pads for pressure areas. The primary outcome was the incidence of pressure ulcers in both groups. The secondary outcomes were hemodynamic changes, oxygenation, and ventilatory parameters. Results: A total of 40 patients were included in the study, with equal distribution of 20 patients in each group. The incidence of hospital-acquired pressure ulcers was lower in group O as compared to group S (15 vs 25%, p = 0.35). No difference was seen in oxygenation, ventilation, or hemodynamic parameters. Conclusion: Use of air mattress and soft silicone dressing instead of pillow supports and headrest reduces the incidence of pressure ulcers in patients with prone ventilation (15 vs 25%, p = 0.35), which, in our opinion, is clinically significant. Albeit, there is no statistical difference in our study, we believe that a larger, well-designed, prospective study will show clinical and statistical difference. Reduced incidence of pressure ulcers will prevent facial scars, improves patient comfort, and will significantly contribute to better patient outcomes.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88793836","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 Abstracts","authors":"","doi":"10.5005/jp-journals-10030-1293","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1293","url":null,"abstract":"","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76786015","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":"Dedication","authors":"Manuel Lorenzo","doi":"10.5005/pajt-9-2-vi","DOIUrl":"https://doi.org/10.5005/pajt-9-2-vi","url":null,"abstract":"","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75968038","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":"Conservative Management of Residual Pneumothorax Following Tube Thoracostomy Removal in Trauma Patients","authors":"","doi":"10.5005/jp-journals-10030-1257","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1257","url":null,"abstract":"Ab s t r Ac t Introduction: Residual pneumothorax (rPTX) after tube thoracostomy (TT) is not an uncommon occurrence (10–20%) in any active trauma center. Many different practice patterns exist on how to deal with this clinical conundrum. These differing strategies can include more invasive procedures and increased length of stay (LOS). We hypothesize that the vast majority of these patients can be safely managed with observation and most can be discharged home without complete resolution. Materials and methods: A retrospective study was conducted on trauma patients managed in a level I center over a 2-year period. A “post-pull” chest X-ray was obtained on all TT patients after removal. All patient with rPTX were included for analysis. Results: A total of 412 patients required chest tubes. Since 98 patients were deceased, we excluded them from the study. A total of 314 patients were studied. Forty-two percent of the patients were male, with median age 40. Sixty-one percent of the patients were blunt trauma victims and 39% were penetrating trauma victims. The indications for chest TT were pneumothorax, hemothorax, and hemopneumothorax. A total of 163 had post-pull pneumo and discharged home with residual pathology prior to discharge. Five of these patients were readmitted (3%), and only one required repeat TT, roughly 0.6%. Conclusion: The vast majority of “post-pull” rPTX patients can be managed conservatively and can be safely discharged even without complete resolution.","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":"87740236","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":"Management of Liver Injuries: The Panamerican Trauma Society 2018 Consensus Guidelines","authors":"","doi":"10.5005/jp-journals-10030-1247","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1247","url":null,"abstract":"Objective: The objective of this guideline is to create a framework and recommendations for best practice management of traumatic liver injuries in trauma patients cared for by surgeons in the Americas. The guidelines presented are based on an extensive literature review including international studies and data as well as in-depth consensus discussions at the 2018 Panamerican Trauma Society Liver Trauma Consensus session. Materials and methods: A PubMed literature review was performed including all relevant prospective, retrospective, meta-analysis studies, and guideline manuscripts between 1995 and 2018. Expert presentations, literature review, and guideline proposal discussions were completed at the liver trauma consensus session at the annual Panamerican Trauma Society meeting in Cartagena, Colombia 2018. Results: The literature search revealed 32 relevant studies and manuscript as a foundation for the Panamerican Trauma Society Liver Trauma Management Guidelines. Expert discussions at the liver trauma consensus sessions added important aspects unique to clinical practice in rural and urban trauma centers in Latin American countries. The developed guidelines may contribute to a more standardized and evidence-based approach to the management of patients with liver trauma in the Americas. Conclusion: Liver trauma consensus sessions and detailed literature review were effective in completing a Panamerican Trauma Society consensus guidelines manuscript for the management of patients with liver trauma. The guidelines may assist physicians in the provision of a standard and effective approach to the management of patients with liver trauma across the Americas with the intent to improve outcomes and outcomes measurement.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90414165","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":"Maxillofacial Fractures among Motorcycle Crash Victims Attended at a Tertiary Hospital in Tanzania","authors":"","doi":"10.5005/jp-journals-10030-1251","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1251","url":null,"abstract":"Introduction: Motorcycles have become a popular choice of transport in Tanzania, hence there is an increase in motorcycle crashes. Considering the high rate of motorcycle crashes, magnitude and seriousness of the injuries in the head and neck region, studying the pattern of maxillofacial injuries in motorcycle crash victims (MCV) is inevitable. The aim of the study was to investigate the occurrence, types, and treatment of maxillofacial fractures in MCV at Muhimbili, a tertiary national hospital in Tanzania. Materials and methods: This was a descriptive, cross-sectional, and hospital-based study that included all MCV. These were received, interviewed (including the use or nonuse of helmets and alcohol intake), physically examined, and investigated for maxillofacial injuries. Maxillofacial fractures were categorized as mandibular, midface, and upper third of face (frontal) fractures. Management of the injuries included supportive, medical, and surgical treatment. The data were analyzed using Statistical Package for Social Sciences (SPSS) Version 20. Results: A total of 116 MCV predominantly (113, 97.4%) men were included in this study with a male-to-female ratio of 37.7:1. The crash victims were aged between 14 years and 66 years (mean of 29.43 ± 8.88), and the 20 years and 39 years age group was the most affected. More than half (53.4%) of the victims had not put on helmets and only 18.1% of the victims were under the influence of alcohol during the crashes. The majority (89.7%) of MCV sustained maxillofacial fractures whereby 71.2% had mandibular fractures, 66.3% had midface fractures, and 9.6% had frontal bone fractures. The severity of injuries significantly correlated with the speed of motorbikes during crashes. Maxillomandibular fixation (MMF) was the commonest treatment modality of the fractures employed. Conclusion: The findings of this study revealed that young men (14–39 years) were more prone to motorcycle crashes. The majority of MCV did not wear helmets and only a few were under the influence of alcohol during the crashes. The mandible and zygoma were the frequently fractured bones and the odds of multiple fractures increased with increased speed of motorbikes. Clinical significance: The results of this study cast light on the pattern and burden of oral and maxillofacial injuries in Tanzania, thus serving as the basis for future interventions to improve the injured patient outcomes, and reduce morbidity and mortality. The information obtained from this study can be used by public health researchers to improve health policies on road traffic crash prevention.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73259871","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}