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Chen DY, Zhu XY, Ma W, Shao SF, Zhang L, Xie JR, Wang YL, Zhao H. Blast injuries with contrasting outcomes treated by military surgery strategies: A case report. Chin J Traumatol 2024:S1008-1275(24)00003-8. [PMID: 38350782 DOI: 10.1016/j.cjtee.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 02/15/2024] Open
Abstract
The treatment strategy for blast injuries is closely linked to the clinical outcome of blast injury casualties. However, the application of military surgery experience to blast injuries caused by production safety accidents is relatively uncommon. In this study, the authors present 2 cases of blast injuries caused by one gas explosion, both cases involved individuals of the same age and gender and experienced similar degree of injury. The authors highlight the importance of using a military surgery treatment strategy, specifically emphasizing the need to understand the concept of damage control and disposal. It is recommended that relevant training in this area should be strengthened to improve the clinical treatment of such injuries. This study provides a valuable reference for healthcare professionals dealing with blast injuries.
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Affiliation(s)
- Di-You Chen
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China; Department of Radiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Xi-Yan Zhu
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Wei Ma
- Department of Wound Infection and Drug, State Key Laboratory of Trauma, Burn and Combined Injury, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Shi-Feng Shao
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Liang Zhang
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Jing-Ru Xie
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Yao-Li Wang
- Wound Trauma Medical Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, China.
| | - Hui Zhao
- Institute for Traffic Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Mitchnik IY, Regev S, Rivkind AI, Fogel I. Disparities in trauma care education: An observational study of the ATLS course within a national trauma system. Injury 2023; 54:110860. [PMID: 37328347 DOI: 10.1016/j.injury.2023.110860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Disparities in trauma systems, including gaps between trauma center levels, affect patient outcomes. Advanced Trauma Life Support (ATLS) is a standard method of care that improves the performance of lower-level trauma systems. We sought to study potential gaps in ATLS education within a national trauma system. METHODS This prospective observational study examined the characteristics of 588 surgical board residents and fellows taking the ATLS course. The course is required for board certification in adult trauma specialties (general surgery, emergency medicine, and anesthesiology), pediatric trauma specialties (pediatric emergency medicine and pediatric surgery), and trauma consulting specialties (all other surgical board specialties). We compared the differences in course accessibility and success rates within a national trauma system which includes seven level 1 trauma centers (L1TC) and twenty-three non-level 1 hospitals (NL1H). RESULTS Resident and fellow students were 53% male, 46% employed in L1TC, and 86% were in the final stages of their specialty program. Only 32% were enrolled in adult trauma specialty programs. Students from L1TC had a 10% higher ATLS course pass rate than NL1H (p = 0.003). Trauma center level was associated with higher odds to pass the ATLS course, even after adjustment to other variables (OR = 1.925 [95% CI = 1.151 to 3.219]). Compared to NL1H, the course was two-three times more accessible to students from L1TC and 9% more accessible to adult trauma specialty programs (p = 0.035). The course was more accessible to students at early levels of training in NL1H (p < 0.001). Female students and trauma consulting specialties enrolled in L1TC programs were more likely to pass the course (OR = 2.557 [95% CI = 1.242 to 5.264] and 2.578 [95% CI = 1.385 to 4.800], respectively). CONCLUSIONS Passing the ATLS course is affected by trauma center level, independent of other student factors. Educational disparities between L1TC and NL1H include ATLS course access for core trauma residency programs at early training stages. Some gaps are more pronounced among consulting trauma specialties and female surgeons. Educational resources should be planned to favor lower-level trauma centers, specialties dealing in trauma care, and residents early in their postgraduate training.
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Affiliation(s)
- Ilan Y Mitchnik
- Israel Defense Force Medical Corps, Tel Hashomer, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel; Military Medical Academy, Israel Defense Force, Negev, Israel.
| | - Stav Regev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avraham I Rivkind
- Department of General Surgery and Shock Trauma Center, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Itay Fogel
- Israel Defense Force Medical Corps, Tel Hashomer, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel; Military Medical Academy, Israel Defense Force, Negev, Israel
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Chavez MA, Weinberg JA, Jacobs JV, Soe-Lin H, Chapple KM, Ryder M, Conley I, Bogert JN. Commonly performed pelvic binder modifications for femoral access may hinder binder efficacy. Am J Surg 2022; 224:1464-1467. [PMID: 35623945 DOI: 10.1016/j.amjsurg.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 03/06/2022] [Accepted: 04/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pelvic fractures are common and potentially life-threatening. Pelvic circumferential compression devices (PCCD) can temporize hemorrhage, but more invasive strategies that involve femoral access may be necessary for definitive treatment. The aim of our study was to evaluate the efficacy of PCCDs reducing open book pelvic fractures when utilizing commonly described modifications and placement adjustments that allow for access to the femoral vasculature. METHODS Open book pelvic fractures were created in adult cadavers. Three commercially available PCCDs were used to reduce fractures. The binders were properly placed, moved caudally, or moved cranially and modified. Fracture reduction rates were then recorded. RESULTS The pelvic fracture was completely reduced with every PCCD tested when properly placed. Reduction rates decreased with improper placement and modifications. CONCLUSION Modifying PCCD placement to allow femoral access decreased the effectiveness of these devices Clinicians should be aware of this possibility when caring for critically injured trauma patients with pelvic fractures.
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Affiliation(s)
- Marin A Chavez
- St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd. Phoenix, Arizona, 85013, United States
| | - Jordan A Weinberg
- St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd. Phoenix, Arizona, 85013, United States
| | - Jordan V Jacobs
- St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd. Phoenix, Arizona, 85013, United States
| | - Hahn Soe-Lin
- St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd. Phoenix, Arizona, 85013, United States
| | - Kristina M Chapple
- St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd. Phoenix, Arizona, 85013, United States
| | - Madison Ryder
- Ira A. Fulton School of Engineering at Arizona State University, 699 S. Mill Ave. Tempe, Arizona, 85281, United States
| | - Ian Conley
- Ira A. Fulton School of Engineering at Arizona State University, 699 S. Mill Ave. Tempe, Arizona, 85281, United States
| | - James N Bogert
- St. Joseph's Hospital and Medical Center, 350 W. Thomas Rd. Phoenix, Arizona, 85013, United States.
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Huang GH, Tang JA, Yang TY, Liu Y. Floating elbow combining ipsilateral distal multiple segmental forearm fractures: A case report. World J Clin Cases 2021; 9:3372-3378. [PMID: 34002147 PMCID: PMC8107907 DOI: 10.12998/wjcc.v9.i14.3372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/04/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Floating elbow along with ipsilateral multiple segmental forearm fracture is a rare and high-energy injury, although elbow dislocation or fracture of the ulna and radius may occur separately.
CASE SUMMARY We report the case of a 37-year-old woman with open (IIIA) fracture of the right distal humerus with multiple shaft fractures of the ipsilateral radius and ulna with a history of falling from a height of almost 20 m from a balcony. After providing advanced trauma life support, damage control surgery was performed to debride the arm wound and temporarily stabilize the right upper limb with external fixators in the emergency operating room. Subsequently, one-stage internal fixation of multiple fractures was performed with normal values of biochemical indicators and reduction in limb swelling. The patient achieved good outcome at the 7 mo follow-up.
CONCLUSION One- or two-stage treatment must be performed according to the type of injury; we efficiently used the “damage control principle.”
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Affiliation(s)
- Guo-Hua Huang
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
| | - Jiang-An Tang
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
| | - Tie-Yi Yang
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
| | - Yue Liu
- Department of Orthopedics, Shanghai Pudong New Area Gongli Hospital, Affiliated to the Second Military Medical University, Shanghai 200135, China
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Rattan A, Ravi P, Rao S, Kaur S, Kant R, Misra MC. Embracing the change: Resuming advanced trauma training in the COVID-19 era. Med J Armed Forces India 2021; 77:S140-S145. [PMID: 33612945 DOI: 10.1016/j.mjafi.2020.12.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022] Open
Abstract
Background Trauma is slowly regaining its pre-COVID-19 status in terms of prevalence. Advanced trauma training cannot be deferred indefinitely in the current pandemic owing to defense requirements and disaster preparedness in vulnerable regions. Advanced Trauma Life Support (ATLS) India resumed ATLS and Advanced Trauma Care For Nurses (ATCN) courses at one civilian and one military site. Methods Stakeholders of respective centers for advanced trauma training deliberated over safe means to resume ATLS and ATCN. Meticulous screening of all participants and pre- and post-course tracking were deemed the most important components for the safe resumption of courses. 'Paperless' course, 'open-air' skill stations, 'payment protection', 'buddy system', point of care sanitizer installation, packed food, and potable beverages were major organizational changes. Participants above 60 years and with uncontrolled comorbidities were not enrolled. Results Two ATCN, one ATLS (civilian), and one combined ATLS-ATCN (military) were conducted. 78 delegates trained by 32 faculties and 13 personnel. All underwent daily thermal scanning and smartphone application-based COVID-19 tracking. Manikins were utilized instead of moulages and instructors took up the role of nursing assistants in Initial Assessment. Exit exams were conducted with full PPE precautions at the military site and mask-distancing precautions at the civilian site. High fidelity simulator was used at one station at the civilian site. Expenses at the civilian site per course were USD 570 lower than conventional courses. There was no incidence of COVID-19 in any of the 123 participants at 14 days follow up. Conclusion With stringent participant selection and moderate precautions, ATLS and ATCN can be resumed safely in the current COVID-19 pandemic. To the best of our knowledge and after a thorough search of published English literature, this is the first paper reporting on resuming Advanced trauma training in the COVID-19 era.
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Affiliation(s)
- Amulya Rattan
- Assistant Professor (Trauma Surgery), Course Director & Site In-charge, ATLS & ATCN Program, AIIMS, Rishikesh, India
| | - Parli Ravi
- Senior Adviser (Anesthesiology), Course Director & Site In-charge ATLS, Command Hospital (Air Force), Bengaluru, India
| | - Shalinee Rao
- Professor & Head, Advanced Centre of Continuous Professional Development, AIIMS, Rishikesh, India
| | - Shivpreet Kaur
- Nursing Officer, Course Coordinator, ATLS & ATCN, AIIMS, Rishikesh, India
| | - Ravi Kant
- Director & CEO, Professor of Surgery, AIIMS, Rishikesh, India
| | - Mahesh C Misra
- Program Director & Chair, ATLS, Ex-President & Vice Chancellor, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, Formerly Director, AIIMS, New Delhi, India
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Gäble A, Hebebrand J, Armbruster M, Mück F, Berndt M, Kumle B, Fink U, Wirth S. [Update polytrauma and computed tomography in ongoing resuscitation : ABCDE and "diagnose first what kills first"]. Radiologe 2020; 60:247-57. [PMID: 31925467 DOI: 10.1007/s00117-019-00633-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CLINICAL ISSUE The mean number of trauma room admissions and applied CT dose increase as the severity of injuries decreases. Therefore, appropriateness of established procedures should be re-evaluated. STANDARD RADIOLOGICAL METHODS Considering severely injured patients with an Injury Severity Score (ISS) ≥16, whole body CT (WB-CT) compared to selective CT decreased mortality by about 25%. Thus, the ISS is a good indicator for the severity of injuries. However, since ISS can only be determined after diagnosis, it does not help with the primary assessment. METHODOLOGICAL INNOVATION AND EVALUATION In addition to the currently used very fast WB-CT protocol with the highest diagnostic precision, a second protocol should be established applying a substantially lower dose. Under ongoing resuscitation, WB-CT often makes a substantial contribution towards targeted therapy or to justifying the discontinuation of resuscitation measures. The WB-CT findings should be performed several times and, at least in the acute emergency situation, it should follow the ABCDE scheme as close as possible. PRACTICAL RECOMMENDATIONS In the trauma room it should be initially decided whether the classification as polytrauma is to be maintained. If yes, every institution should provide a dose-reduced WB-CT protocol in addition to the maximum variant used so far. Dose-reduced WB-CT seems to be appropriate for stable and oriented patients, who receive a CT primarily because of the trauma mechanism. Even under resuscitation conditions, WB-CT is easy to perform and medically as well as ethically of high value. The reporting and communication should be structured according to "diagnose first what kills first".
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Franke A, Bieler D, Paffrath T, Wurmb T, Wagner F, Friemert B, Achatz G. [ATLS® and TDSC®: how it fits together : A treatment concept for mass casualty and terrorist-related mass casualty situations, life-threatening and special scenarios]. Unfallchirurg 2020; 123:453-463. [PMID: 31690983 DOI: 10.1007/s00113-019-00735-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Terrorist-related mass casualty incidents represent a medical and organizational challenge for all hospitals. The main reasons are the special patterns of injuries, the onset and development of the scenario, the lack of information at the beginning, the overall number of casualties and the number of uninjured but involved patients presenting at the hospital.Due to these circumstances and the high percentage of penetrating injuries with a permanent risk of uncontrollable bleeding and other life-threatening complications, a strategic and tactical initial surgical care is necessary.For these special terrorist-related mass casualty (MasCal) situations, the Terror and Disaster Surgical Care (TDSC®) course was developed and imparts special medical and surgical knowledge as well as a scenario-based training in surgical decision-making. The TDSC® course focusses on the scenario-related provision of surgical care and distribution of the limited resources to enable survival for as many patients as possible.To improve individualized trauma care course formats, such as the Advanced Trauma Life Support (ATLS®) were established and are nowadays widespread in Germany. It could be shown that standardized approaches and algorithm-based treatment could improve the outcome of trauma victims. Faced with the present day permanent risk of a possible terrorist-related MasCal situation, the question arises how and to what extent elements and principles of both course formats (TDSC® and ATLS®) could be used to improve and organize the initial care in a terrorist-linked MasCal incident.For the first time it is shown that the key elements of both courses (primary survey of the ATLS® and the TDSC® principles: categorization, prioritization, disposition and realization) could be established and integratively used to structure the initial intrahospital medical and surgical care.
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Affiliation(s)
- A Franke
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellung- und Handchirurgie, Verbrennungsmedizin, BundeswehrZentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland
| | - D Bieler
- Klinik für Unfallchirurgie und Orthopädie, Wiederherstellung- und Handchirurgie, Verbrennungsmedizin, BundeswehrZentralkrankenhaus Koblenz, Rübenacher Str. 170, 56072, Koblenz, Deutschland.
| | - T Paffrath
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Klinikum Köln-Merheim, Köln-Merheim, Deutschland
| | - Th Wurmb
- Sektion Notfall- und Katastrophenmedizin, Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - F Wagner
- Klinik für Rekonstruktive Unfallchirurgie und Orthopädie, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - B Friemert
- Klinik Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - G Achatz
- Klinik Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
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Jost D, Lemoine S, Lemoine F, Lanoe V, Maurin O, Derkenne C, Franchin Frattini M, Delacote M, Seguineau E, Godefroy A, Hervault N, Delhaye L, Pouliquen N, Louis-Delauriere E, Trichereau J, Roquet F, Salomé M, Verret C, Bihannic R, Jouffroy R, Frattini B, Hong Tuan Ha V, Dang-Minh P, Travers S, Bignand M, Martinaud C, Garrabe E, Ausset S, Prunet B, Sailliol A, Tourtier JP. French lyophilized plasma versus normal saline for post-traumatic coagulopathy prevention and correction: PREHO-PLYO protocol for a multicenter randomized controlled clinical trial. Trials 2020; 21:106. [PMID: 31969168 PMCID: PMC6977230 DOI: 10.1186/s13063-020-4049-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/06/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Post-trauma bleeding induces an acute deficiency in clotting factors, which promotes bleeding and hemorrhagic shock. However, early plasma administration may reduce the severity of trauma-induced coagulopathy (TIC). Unlike fresh frozen plasma, which requires specific hospital logistics, French lyophilized plasma (FLYP) is storable at room temperature and compatible with all blood types, supporting its use in prehospital emergency care. We aim to test the hypothesis that by attenuating TIC, FLYP administered by prehospital emergency physicians would benefit the severely injured civilian patient at risk for hemorrhagic shock. METHODS/DESIGN This multicenter randomized clinical trial will include adults severely injured and at risk for hemorrhagic shock, with a systolic blood pressure < 70 mmHg or a Shock Index > 1.1. Two parallel groups of 70 patients will receive either FLYP or normal saline in addition to usual treatment. The primary endpoint is the International Normalized Ratio (INR) at hospital admission. Secondary endpoints are transfusion requirement, length of stay in the intensive care unit, survival rate at day 30, usability and safety related to FLYP use, and other biological coagulation parameters. CONCLUSION With this trial, we aim to confirm the efficacy of FLYP in TIC and its safety in civilian prehospital care. The study results will contribute to optimizing guidelines for treating hemorrhagic shock in civilian settings. TRIAL REGISTRATION ClinicalTrials.gov, NCT02736812. Registered on 13 April 2016. The trial protocol has been approved by the French ethics committee (CPP 3342) and the French Agency for the Safety of Medicines and Health Products (IDRCB 2015-A00866-43).
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Affiliation(s)
- Daniel Jost
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France.
| | - Sabine Lemoine
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Frederic Lemoine
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Vincent Lanoe
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Olga Maurin
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Clément Derkenne
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | | | - Maëlle Delacote
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Edouard Seguineau
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Anne Godefroy
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Nicolas Hervault
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Ludovic Delhaye
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Nicolas Pouliquen
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Emilie Louis-Delauriere
- Department of Education, Research and Innovation, Service de Santé des Armées, 1 Place Alphonse Laveran, 75230, Paris, France
| | - Julie Trichereau
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Florian Roquet
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Marina Salomé
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Catherine Verret
- Department of Education, Research and Innovation, Service de Santé des Armées, 1 Place Alphonse Laveran, 75230, Paris, France
| | - René Bihannic
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Romain Jouffroy
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Benoit Frattini
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Vivien Hong Tuan Ha
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Pascal Dang-Minh
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Stéphane Travers
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
- French Military Health Service, Val de Grâce military hospital, 1, Place Alphonse Laveran, 75230, Paris, France
| | - Michel Bignand
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
| | - Christophe Martinaud
- French Military Health Service, Val de Grâce military hospital, 1, Place Alphonse Laveran, 75230, Paris, France
- French army blood transfusion center, 1 Rue du Lieutenant Raoul Batany, 92140, Clamart, France
| | - Eliane Garrabe
- French Military Health Service, Val de Grâce military hospital, 1, Place Alphonse Laveran, 75230, Paris, France
- French army blood transfusion center, 1 Rue du Lieutenant Raoul Batany, 92140, Clamart, France
| | - Sylvain Ausset
- French Military Health Service, Val de Grâce military hospital, 1, Place Alphonse Laveran, 75230, Paris, France
- Department of Anesthesiology and Intensive Care, Percy military teaching hospital, 101 avenue Henri Barbusse, BP 406, 92141, Clamart, Cedex, France
| | - Bertrand Prunet
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
- French Military Health Service, Val de Grâce military hospital, 1, Place Alphonse Laveran, 75230, Paris, France
| | - Anne Sailliol
- French Military Health Service, Val de Grâce military hospital, 1, Place Alphonse Laveran, 75230, Paris, France
- French army blood transfusion center, 1 Rue du Lieutenant Raoul Batany, 92140, Clamart, France
- French Military Research Institute, 1 place Valérie Andre, BP 73, 91223, Brétigny sur Orge, France
| | - Jean Pierre Tourtier
- Paris Fire Brigade Medical Emergency Department, 1 place Jules Renard, 75017, Paris, France
- French Military Health Service, Val de Grâce military hospital, 1, Place Alphonse Laveran, 75230, Paris, France
- Department of Anaesthesiology and Intensive Care, Begin military teaching hospital, 94160, Saint-Mande, France
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Ianniello S, Piccolo CL, Trinci M, Ajmone Cat CA, Miele V. Extended-FAST plus MDCT in pneumothorax diagnosis of major trauma: time to revisit ATLS imaging approach? J Ultrasound 2019; 22:461-9. [PMID: 31686355 DOI: 10.1007/s40477-019-00410-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/08/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Pneumothorax (PNX) detection is of the utmost clinical relevance because it may quickly progress to cause hemodynamic instability as a consequence of invasive ventilation. Radiography is characterized by a low sensitivity to detect this disease; in recent years, chest ultrasound (US) has gained increased visibility in the diagnosis of acute respiratory emergencies including PNX. The aim of this retrospective study was to evaluate the clinical impact of extended focused assessment with sonography in trauma (E-FAST) during the past 6 years of experience with this technique in our Level I trauma center. METHODS Between January 2013 and December 2018, we performed a retrospective case-series study including 3320 consecutive patients admitted to the emergency department of our hospital because of major trauma. Extended-US was always performed and reported immediately after FAST during primary survey and before multidetector computed tomography (MDCT) scans. The presence of PNX was determined using the well-known accepted US criteria. US findings were compared with computed tomography (CT) findings, the reference standard for PNX detection. RESULTS Of the 6640 lungs observed with E-FAST, there were 1244 PNX cases, while 1328 PNX cases were detected either on the basis of MDCT or on the basis of the presence of air flush during the thoracic decompression in the emergency room. Among the 84 false negatives, 12 patients had subcutaneous emphysema, 38 had a body mass index higher than 27, 6 had a thoracic wall hematoma, and 4 had chest penetrating trauma. There were 10 false positives in the diagnosis of PNX at US examination, with mild extension and not clinically significant. The overall sensitivity of E-FAST for PNX detection was 93.6% (1244/1328), the specificity of E-FAST was 99.8% (5312/5322), the negative predictive value (NPV) was 98.4% (5312/5396), and the positive predictive value (PPV) was 99.2% (1328/1338). CONCLUSION Our results demonstrate that bedside thoracic US is characterized by a very good accuracy in the diagnostic work-up of major trauma patients, even in difficult conditions, allowing rapid diagnosis of PNX. ADVANCES IN KNOWLEDGE The novelty of this research lies in the possibility of diagnosing potential life-threatening conditions in a very short time by means of US, thus proposing a revision of the Advanced Trauma Life Support (ATLS) guidelines in order to incorporate it in the work-up of high-energy injured patients.
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Rief M, Zoidl P, Zajic P, Heschl S, Orlob S, Silbernagel G, Metnitz P, Puchwein P, Prause G. Atlanto-occipital dislocation in a patient presenting with out-of-hospital cardiac arrest: a case report and literature review. J Med Case Rep 2019; 13:44. [PMID: 30803441 PMCID: PMC6390378 DOI: 10.1186/s13256-018-1926-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/13/2018] [Indexed: 12/18/2022] Open
Abstract
Background Atlanto-occipital dislocation is a rare and severe injury of the upper spine associated with a very poor prognosis. Case presentation We report the case of a 59-year-old European man who suffered from out-of-hospital cardiac arrest following a motor vehicle accident. Cardiopulmonary resuscitation was initiated immediately by bystanders and continued by emergency medical services. After 30 minutes of cardiopulmonary resuscitation with a total of five shocks following initial ventricular fibrillation, return of spontaneous circulation was achieved. An electrocardiogram recorded after return of spontaneous circulation at the scene showed signs of myocardial ischemia as a possible cause for the cardiac arrest. No visible signs of injury were found. He was transferred to the regional academic trauma center. Following an extended diagnostic and therapeutic workup in the emergency room, including extended focused assessment with sonography for trauma ultrasound, whole-body computed tomography, and magnetic resonance imaging (of his head and neck), a diagnosis of major trauma (atlanto-occipital dislocation, bilateral serial rip fractures and pneumothoraces, several severe intracranial bleedings, and other injuries) was made. An unfavorable outcome was initially expected due to suspected tetraplegia and his inability to breathe following atlanto-occipital dislocation. Contrary to initial prognostication, after 22 days of intensive care treatment and four surgical interventions (halo fixation, tracheostomy, intracranial pressure probe, chest drains) he was awake and oriented, spontaneously breathing, and moving his arms and legs. Six weeks after the event he was able to walk without aid. After 2 months of clinical treatment he was able to manage all the activities of daily life on his own. It remains unclear, whether cardiac arrest due to a cardiac cause resulted in complete atony of the paravertebral muscles and caused this extremely severe lesion (atlanto-occipital dislocation) or whether cardiac arrest was caused by apnea due the paraplegia following the spinal injury of the trauma. Conclusions A plausible cause for the trauma was myocardial infarction which led to the car accident and the major trauma in relation to the obviously minor trauma mechanism. With this case report we aim to familiarize clinicians with the mechanism of injury that will assist in the diagnosis of atlanto-occipital dislocation. Furthermore, we seek to emphasize that patients presenting with electrocardiographic signs of myocardial ischemia after high-energy trauma should primarily be transported to a trauma facility in a percutaneous coronary intervention-capable center rather than the catheterization laboratory directly.
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Affiliation(s)
- Martin Rief
- Division of General Anaesthesiology, Emergency and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria. .,Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Philipp Zoidl
- Division of General Anaesthesiology, Emergency and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.,Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Paul Zajic
- Division of General Anaesthesiology, Emergency and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.,Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Stefan Heschl
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.,Division of Cardiac, Thoracic and Vascular Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Simon Orlob
- Division of General Anaesthesiology, Emergency and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.,Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Günther Silbernagel
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Philipp Metnitz
- Division of General Anaesthesiology, Emergency and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.,Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Paul Puchwein
- Department of Orthopedics and Trauma Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Gerhard Prause
- Division of General Anaesthesiology, Emergency and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.,Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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11
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Knobel A, Overheu D, Gruessing M, Juergensen I, Struewer J. Regular, in-situ, team-based training in trauma resuscitation with video debriefing enhances confidence and clinical efficiency. BMC Med Educ 2018; 18:127. [PMID: 29879979 PMCID: PMC5992768 DOI: 10.1186/s12909-018-1243-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 05/25/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND To assess the clinical impact of a regular, multidisciplinary, video debriefed training intervention for trauma team members on real trauma resuscitations. In addition, attending personnel evaluated the training program via questionnaire. METHODS The training intervention is a regular (monthly), video debriefed, team-based trauma simulation. Training takes place in the fully functional resuscitation bay (in-situ) of the Department of Traumatology at the Klinikum Oldenburg (Level 1, primary teaching hospital for the Carl von Ossietzky University Oldenburg) involving a complete trauma team. Laerdal® Resusci Anne® dummy serves as the patient simulator. A special feature is a structured video debriefing of each participating team to analyse team performance. Data before and after implementation of training was retrospectively analysed. RESULTS We found a significant decrease in the time from arrival of the patient to computer tomography (CT, Spearman rank coefficient r = - 0.236, p = 0.001). Evaluation of the questionnaire by team members described a significant increase in self-confidence (p < 0.05). CONCLUSION Monthly video assisted team based in situ training with video debriefing significantly reduces resuscitation time in the emergency bay.
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Affiliation(s)
- Alexander Knobel
- Department of Orthopaedics and Trauma Surgery, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg, Rahel-Straus Str. 10, 26133 Oldenburg, Germany
| | - Daniel Overheu
- Department of Anaesthesiology, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg, Rahel-Straus Str. 10, 26133 Oldenburg, Germany
| | - Matthias Gruessing
- Department of Orthopaedics and Trauma Surgery, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg, Rahel-Straus Str. 10, 26133 Oldenburg, Germany
| | - Ingke Juergensen
- Department of Orthopaedics and Trauma Surgery, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg, Rahel-Straus Str. 10, 26133 Oldenburg, Germany
| | - Johannes Struewer
- Department of Orthopaedics and Trauma Surgery, Carl von Ossietzky Universität Oldenburg, Klinikum Oldenburg, Rahel-Straus Str. 10, 26133 Oldenburg, Germany
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12
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Grünherz L, Jensen KO, Neuhaus V, Mica L, Werner CML, Ciritsis B, Michelitsch C, Osterhoff G, Simmen HP, Sprengel K. Early computed tomography or focused assessment with sonography in abdominal trauma: what are the leading opinions? Eur J Trauma Emerg Surg 2018; 44:3-8. [PMID: 28730296 DOI: 10.1007/s00068-017-0816-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The initial assessment of severely injured patients in the resuscitation room requires a systematic and quickly performed survey. Whereas the Advanced Trauma Life Support (ATLS®)-based algorithm recommends focused assessment with sonography in trauma (FAST) among others, recent studies report a survival advantage of early whole-body computed tomography (WBCT) in haemodynamically stable as well as unstable patients. This study assessed the opinions of trauma surgeons about the early use of WBCT in severely injured patients with abdominal trauma, and abdominal CT in patients with isolated abdominal trauma, during resuscitation room treatment. METHODS An online cross-sectional survey was performed over 8 months. Members of the Swiss Society for Surgery and the Austrian and German associations for trauma surgery were invited to answer nine online questions. RESULTS Overall, 175 trauma surgeons from 155 departments participated. For haemodynamically stable patients, most considered FAST (77.6%) and early CT (82.3%) to be the ideal diagnostic tools. For haemodynamically unstable patients, 93.4% considered FAST to be mandatory. For CT imaging in unstable patients, 47.5% agreed with the use of CT, whereas 52.5% rated early CT as not essential. For unstable patients with pathological FAST and clinical signs, 86.8% agreed to proceed with immediate laparotomy. CONCLUSIONS Most surgeons rely on early CT for haemodynamically stable patients with abdominal trauma, whereas FAST is performed with similar frequency and is prioritized in unstable patients. It seems that the results of recent studies supporting early WBCT have not yet found broad acceptance in the surgical community.
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13
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Sunde GA, Sandberg M, Lyon R, Fredriksen K, Burns B, Hufthammer KO, Røislien J, Soti A, Jäntti H, Lockey D, Heltne JK, Sollid SJM. Hypoxia and hypotension in patients intubated by physician staffed helicopter emergency medical services - a prospective observational multi-centre study. BMC Emerg Med 2017; 17:22. [PMID: 28693491 PMCID: PMC5504565 DOI: 10.1186/s12873-017-0134-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 06/30/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The effective treatment of airway compromise in trauma and non-trauma patients is important. Hypoxia and hypotension are predictors of negative patient outcomes and increased mortality, and may be important quality indicators of care provided by emergency medical services. Excluding cardiac arrests, critical trauma and non-trauma patients remain the two major groups to which helicopter emergency medical services (HEMS) are dispatched. Several studies describe the impact of pre-hospital hypoxia or hypotension on trauma patients, but few studies compare this in trauma and non-trauma patients. The primary aim was to describe the incidence of pre-hospital hypoxia and hypotension in the two groups receiving pre-hospital tracheal intubation (TI) by physician-staffed HEMS. METHODS Data were collected prospectively over a 12-month period, using a uniform Utstein-style airway template. Twenty-one physician-staffed HEMS in Europe and Australia participated. We compared peripheral oxygen saturation and systolic blood pressure before and after definitive airway management. Data were analysed using Cochran-Mantel-Haenszel methods and mixed-effects models. RESULTS Eight hundred forty three trauma patients and 422 non-trauma patients receiving pre-hospital TI were included. Non-trauma patients had significantly lower predicted mean pre-intervention SpO2 compared to trauma patients. Post-intervention and admission SpO2 for the two groups were comparable. However, 3% in both groups were still hypoxic at admission. For hypotension, the differences between the groups were less prominent. However, 9% of trauma and 10% of non-trauma patients were still hypotensive at admission. There was no difference in short-term survival between trauma (97%) and non-trauma patients (95%). Decreased level of consciousness was the most frequent indication for TI, and was associated with increased survival to hospital (cOR 2.8; 95% CI: 1.4-5.4). CONCLUSIONS Our results showed that non-trauma patients had a higher incidence of hypoxia before TI than trauma patients, but few were hypoxic at admission. The difference for hypotension was less prominent, but one in ten patients were still hypotensive at admission. Further investigations are needed to identify reversible causes that may be corrected to improve haemodynamics in the pre-hospital setting. We found high survival rates to hospital in both groups, suggesting that physician-staffed HEMS provide high-quality emergency airway management in trauma and non-trauma patients. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01502111 . Registered 22 Desember 2011.
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Affiliation(s)
- Geir Arne Sunde
- Norwegian Air Ambulance Foundation, Drøbak, Norway. .,Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. .,Department of Health Sciences, University of Stavanger, Stavanger, Norway. .,Norwegian Air Ambulance Foundation, Møllendalsveien 34, 5009, Bergen, Norway.
| | - Mårten Sandberg
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Richard Lyon
- University of Surrey, Guildford, UK.,Kent, Surrey & Sussex Air Ambulance Trust, Marden, UK
| | - Knut Fredriksen
- UiT - The Arctic University of Norway, Tromsø, Norway.,The University Hospital of North Norway, Tromsø, Norway
| | - Brian Burns
- Sydney HEMS, NSW Ambulance, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Jo Røislien
- Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Akos Soti
- Hungarian Air Ambulance Nonprofit Ltd, Budaors, Hungary
| | - Helena Jäntti
- Centre for Pre-hospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - David Lockey
- Department of Health Sciences, University of Stavanger, Stavanger, Norway.,London's Air Ambulance, Bartshealth NHS Trust, London, UK
| | - Jon-Kenneth Heltne
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Medical Sciences, University of Bergen, Bergen, Norway
| | - Stephen J M Sollid
- Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Health Sciences, University of Stavanger, Stavanger, Norway.,Air Ambulance Department, Oslo University Hospital, Oslo, Norway
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14
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Ausserer J, Moritz E, Stroehle M, Brugger H, Strapazzon G, Rauch S, Mair P. Physician staffed helicopter emergency medical systems can provide advanced trauma life support in mountainous and remote areas. Injury 2017; 48:20-25. [PMID: 27650943 DOI: 10.1016/j.injury.2016.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/17/2016] [Accepted: 09/02/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In remote and mountainous areas, helicopter emergency medical systems (HEMS) are used to expedite evacuation and provide pre-hospital advanced trauma life support (ATLS) in major trauma victims. Aim of the study was to investigate feasibility of ATLS in HEMS mountain rescue missions and its influence on patient condition at hospital admission. PATIENTS 58 major trauma victims (Injury Severity Score ≥16), evacuated by physician staffed HEMS from remote and mountainous areas in the State of Tyrol, Austria between 1.1.2011 and 31.12.2013. RESULTS Pre-hospital time exceeded 90min in 24 (44%) cases. 31 (53%) patients suffered critical impairment of at least one vital function (systolic blood pressure <90mmHg, GCS <10, or respiratory rate <10 or >30). 4 (6.9%) of 58 patients died prior to hospital admission. Volume resuscitation was restrictive: 18 (72%) of 25 hypotensive patients received ≤500ml fluids and blood pressure was increased >90mmHg at hospital admission in only 9 (36%) of these 25 patients. 8 (50%) of 16 brain trauma patients with a blood pressure <90mmHg remained hypotensive at hospital admission. Endotracheal intubation was accomplished without major complications in 15 (79%) of 19 patients with a Glasgow Coma Scale score <10. Rope operations were necessary in 40 (69%) of 58 cases and ATLS was started before hoist evacuation in 30 (75%) of them. CONCLUSIONS The frequent combination of prolonged pre-hospital times, with critical impairment of vital functions, supports the need for early ATLS in HEMS mountain rescue missions. Pre-hospital endotracheal intubation is possible with a high success and low complication rate also in a mountain rescue scenario. Pre-hospital volume resuscitation is restrictive and hypotension is reversed at hospital admission in only one third of patients. Prolonged pre-hospital hypotension remains an unresolved problem in half of all brain trauma patients and indicates the difficulties to increase blood pressure to a desired level in a mountain rescue scenario. Despite technical considerations, on-site ATLS is feasible for an experienced emergency physician in the majority of rope rescue operations.
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Affiliation(s)
- Julia Ausserer
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Elizabeth Moritz
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Matthias Stroehle
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy
| | - Giacomo Strapazzon
- EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy
| | - Simon Rauch
- EURAC Institute of Mountain Emergency Medicine, Drususallee 1, 39100 Bolzano, Italy
| | - Peter Mair
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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15
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Kulkarni A, Chandrasala S, Nimbeni B, Vishnudas P, Dev A. An Interesting Case of Penetrating Craniofacial Trauma Involving a Wooden Stick. J Clin Diagn Res 2016; 10:ZD01-3. [PMID: 27190963 DOI: 10.7860/jcdr/2016/16916.7571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 12/16/2015] [Indexed: 11/24/2022]
Abstract
Penetrating craniofacial trauma, although uncommon, has a high potential for death or catastrophic consequences from head injury or vital neurovascular injuries. The foreign body may cause significant challenge, especially when it is a large one. Airway obstruction, vascular injuries, intracranial communication, ocular injury and injuries to any other adjacent vital structures when involved may change the treatment objectives from simple foreign body retrieval to a comprehensive multidisciplinary approach to stabilize the patient. Retrieval of foreign bodies may be challenging because of many factors including the size of the object, its site, and the surrounding anatomical structures. Accurate localization of the foreign body before removal is essential in craniofacial region. We present a case of penetrating craniofacial trauma from a wooden stick, with an in situ foreign body, that was managed by emergency surgical exploration in general anaesthesia and retrieval of foreign body in Toto under antibiotic coverage and tetanus prophylaxis.
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Affiliation(s)
- Ambadas Kulkarni
- Senior Resident, Department of Oral and Maxillofacial Surgery, Government Dental College , Calicut, Kerala, India
| | - Soumithran Chandrasala
- Professor and Head, Department of Oral and Maxillofacial Surgery, Government Dental College , Calicut, Kerala, India
| | - Basavaraj Nimbeni
- Assistant Professor, Department of Pedodontics & Preventive Dentistry, College of Dental Sciences, Chitwan Medical College and Teaching Hospital , Bharatpur, Chitwan, Nepal
| | - Praveesh Vishnudas
- Senior Resident, Department of Oral and Maxillofacial Surgery, Government Dental College , Calicut, Kerala, India
| | - Arul Dev
- Junior Resident, Department of Oral and Maxillofacial Surgery, Government Dental College , Calicut, Kerala, India
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16
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Abstract
We have tried in a recently published systematic review (World J of Surg 2014; 38: 322-329) to study the educational value of advanced trauma life support (ATLS) courses and whether they improve survival of multiple trauma patients. This Frontier article summarizes what we have learned and reflects on future perspectives in this important area. Our recently published systematic review has shown that ATLS training is very useful from an educational point view. It significantly increased knowledge, and improved practical skills and the critical decision making process in managing multiple trauma patients. These positive changes were evident in a wide range of learners including undergraduate medical students and postgraduate residents from different subspecialties. In contrast, clear evidence that ATLS training reduces trauma death is lacking. It is obvious that it is almost impossible to perform randomized controlled trials to study the effect of ATLS courses on trauma mortality. Studying factors predicting trauma mortality is a very complex issue. Accordingly, trauma mortality does not depend solely on ATLS training but on other important factors, like presence of well-developed trauma systems including advanced pre-hospital care. We think that the way to answer whether ATLS training improves survival is to perform large prospective cohort studies of high quality data and use advanced statistical modelling.
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17
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Daurka JS, Rankin I, Jaggard MKJ, Lewis A. A priority driven ABC approach to the emergency management of high energy pelvic trauma improves decision making in simulated patient scenarios. Injury 2015; 46:340-3. [PMID: 25542155 DOI: 10.1016/j.injury.2014.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/09/2014] [Accepted: 11/16/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION An ABC priority driven approach to the management of high energy pelvic injuries has been developed and applied as a teaching tool. A prospective study assessed whether trainees taught this ABC aide memoire gave better priority driven care in simulated patient scenarios. They were compared directly to colleagues undergoing the same pelvic training but without reference to the ABC concept. METHODS Orthopaedic trainees were formally assessed by viva scenario upon their pelvic trauma management 6 weeks after a pelvic trauma teaching event. Trainees all received standard pelvic trauma teaching but were randomised into two groups. One group alone had an introduction to the ABC algorithm. Inclusion criteria were trainees belonging to the same deanery teaching group with similar levels of training and experience in pelvic trauma. Those completing a pelvic trauma post or teaching in pelvic trauma were excluded. RESULTS There were 20 trainees included and three scenarios giving 60 scores. The mean year of training or the number of pelvic trauma cases experienced did not differ significantly between the groups (p=0.426 and p=0.347). The ABC teaching concept yielded significant improvements in several aspects: coagulopathy assessment and management (p=<0.001); urological injury (p=0.047), appropriate prioritisation (p=0.006) and bowel injury/open fracture assessment (p=0.007). A poorer response was seen in CT assessment (p=0.004). DISCUSSION AND CONCLUSION The ABC priority driven approach to pelvic trauma management provides structure when decision making. This method improves clinician's recall, prioritisation and potentially clinical outcomes.
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Affiliation(s)
- Jasvinder S Daurka
- Department of Trauma and Orthopaedics, Kings College Hospital NHS Trust, London SE9 5RS, United Kingdom.
| | - Iain Rankin
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, St Mary's Hospital, London W6 8RP, United Kingdom.
| | - M K J Jaggard
- Department of Trauma and Orthopaedics, Kings College Hospital NHS Trust, London SE9 5RS, United Kingdom.
| | - Angus Lewis
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, St Mary's Hospital, London W6 8RP, United Kingdom.
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18
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Tazarourte K, Cesaréo E, Sapir D, Atchabahian A, Tourtier JP, Briole N, Vigué B. Update on prehospital emergency care of severe trauma patients. ACTA ACUST UNITED AC 2013; 32:477-82. [PMID: 23916517 DOI: 10.1016/j.annfar.2013.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The prognosis of severe trauma patients is determined by the ability of a healthcare system to provide high intensity therapeutic treatment on the field and to transport patients as quickly as possible to the structure best suited to their condition. Direct admission to a specialized center ("trauma center") reduces the mortality of the most severe trauma at 30 days and one year. Triage in a non-specialized hospital is a major risk of loss of chance and should be avoided whenever possible. Medical dispatching plays a major role in determining patient care. The establishment of a hospital care network is an important issue that is not formalized enough in France. The initial triage of severe trauma patients must be improved to avoid taking patients to hospitals that are not equipped to take care of them. For this purpose, the MGAP score can predict severity and help decide where to transport the patient. However, it does not help predict the need for urgent resuscitation procedures. Hemodynamic management is central to the care of hemorrhagic shock and severe head trauma. Transport helicopter with a physician on board has an important role to allow direct admission to a specialized center in geographical areas that are difficult to access.
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Affiliation(s)
- K Tazarourte
- Pôle Samu-urgence-réanimation, hôpital Marc-Jacquet, 77000 Melun, France.
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19
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Abstract
Considerable improvements have occurred in the care of injured patients since the times of World War I and II. This has been brought about not only by technological advances but also due to improved training of doctors and nurses in providing trauma care. Important elements of combat trauma training are realism, human-specific injuries and treatments, volume of trauma exposure, and team building. In all modern armies training is imparted using human simulators and mannequins, human cadavers, occasionally live animals but more often using animal tissues. Worldwide trauma training courses are mandatory for both paramedics and medical officers. There is a need to set up an organised system of trauma training in India and we, in the Armed Forces have to capitalize on the wealth of combat and non-combat trauma experience, in setting up such courses.
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Affiliation(s)
- Rps Gambhir
- Reader, Department of Surgery, Armed Forces Medical College, Pune-40
| | - A Agrawal
- Graded Specialist, Surgery, Armed Forced Clinic, New Delhi
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