Journal of Emergencies, Trauma, and Shock最新文献

Introduction: Disinfecting contaminated ambulances presents a challenge to emergency medical services. The process relies on a manual cleaning step or the use of foggers and gas generators. Equipment requires training, power supply, and access to reagent refills. Chlorine dioxide (ClO₂) gas is an affordable, easy-to-use alternative.

Methods: We field-tested ClO₂ dry inside an ambulance against a surrogate for SARS-CoV-2. MS2 bacteriophage was aerosolized inside of an enclosed. Airborne MS2 concentrations were measured before and after ClO₂ applications to compare reductions in viable virus. ClO₂ gas was generated using ICA-TriNova UltraShok™ 2-part media in different concentrations and time courses. Petri dishes were used to determine the surface deposition of residual MS2 phage. ClO₂ gas was monitored using a PortaSens III gas detector with high and low range sensors.

Results: MS2 bacteriophage measured at 15-min averaged 99.99% in both 100 g and 130 g applications, compared to 83.48% in controls. At 60-min, air MS2 percent reductions averaged 99.99% in 100 g applications compared to 98.05% in controls. Mean surface MS2 counts within protocols using ClO₂ gas ranged from 245 to 5110 plaque-forming unit (PFU)/petri-dish compared to 13,900-44,900 PFU/petri-dish in controls. ClO₂ gas concentrations fell below OSHA 15-min short-term exposure limit of 0.3 PPM within 5 min of passive ventilation in all tests. There were no observed detrimental impacts on materials and surfaces.

Conclusion: ClO₂ gas produced using ICA-TriNova UltraShok™ 2-part media is an effective air disinfection technique for contaminated ambulance settings. Integration with manual cleaning permits safe, rapid decontamination of ambulance vehicles.

Introduction: Cricothyroidotomy establishes an emergency surgical airway, but concerns persist that cricothyroidotomy only (CO) may be associated with higher rates of tracheal stenosis than revision to tracheostomy (RT). We characterized the incidence of RT and rates of tracheal stenosis.

Methods: We identified patients aged 19-90 years of age undergoing cricothyroidotomy in the TriNetX database from January 1, 2011 to December 31, 2020. We divided patients into CO or RT groups. The primary outcome of interest was 1-year cumulative incidence of tracheal stenosis.

Results: Six hundred and sixty-eight patients underwent cricothyroidotomy (mean age 50 standard deviation 19 years, 76% male, 34% with cardiac arrest, and 29% head injury) of whom 355 (53.1%) underwent RT. Accounting for 1-year mortality (56.7% CO vs. 34.5% RT, P < 0.001), the 1-year cumulative incidence of tracheal stenosis was higher in the RT group (13.0% vs. 4.9%, P < 0.001).

Conclusion: Cumulative incidence of 1-year mortality is high in patients undergoing cricothyroidotomy, while RT is associated with increased risk of tracheal stenosis.

Introduction: Aortic diseases have been observed to manifest the symptoms such as nausea and vomiting. We conducted a retrospective investigation to ascertain the clinical significance of antiemetic drug use for patients with aortic diseases transported by a physician-staffed helicopter in Japan doctor helicopter (DH). A retrospective analysis, Japan DH registry system data.

Methods: The following details of dispatch activity among the patients with aortic diseases were retrieved: age, sex, vital signs when contacted by the DH staff, contents of the medical intervention, duration of admission, and the final outcome. The subjects were divided into two groups: The control group, which did not receive antiemetic treatment in the prehospital setting and the anti-emetic group. The data were analyzed using Wilcoxon's test and the Chi-squared test.

Results: A notable disparity emerged in the anti-emetic group (n = 97), where heart rate, tracheal intubation rate, overall performance category (OPC), and exhibited a significant decrease compared to the control group (n = 311). The systolic blood pressure (BP) in the anti-emetic group was notably higher compared to the control group.

Conclusions: In patients with aortic diseases, prehospital administration of antiemetic agents was associated with a lower heart rate, reduced need for tracheal intubation, improved OPC, and higher systolic BP upon contact with DH staff. These findings suggest that antiemetic treatment in the prehospital setting may contribute to hemodynamic stabilization and better clinical outcomes in this patient population.

India, with the highest rate of road traffic accident-related deaths among children in the world, urgently needs an integrated system of care and an evidence-based, consensus approach for the evaluation and management of critically injured children. To develop a country-specific guideline for the systematic assessment and emergency management of critically injured children, a consensus meeting comprising members of the Academic College of Emergency Experts was held at the National Institute of Health and Family Welfare, New Delhi, on November 7, 2023. This was followed by an exhaustive literature search on selected areas of concern and multiple online meetings to arrive at this consensus guideline. The process for developing developing India-specific guidelines was based on retrospective cohort studies and multicenter studies on the management of pediatric trauma in India. These studies were crucial for understanding the local epidemiology and management of pediatric trauma. The guideline and the clinical pathway have been produced as a tool for all healthcare workers, including the prehospital staff, the emergency department (ED) doctors, as well as nurses, surgeons, and intensive care unit physicians and nurses involved in the care of an injured child. The guideline includes the following key components: The current scenario of polytrauma in children in India; the trauma chain of survival; triage, and the systematic approach to a patient in the ED. This guideline aims to standardise the approach to injured children across the country. We urge the development and creation of a robust data repository of minimal standard data elements in all the EDs to facilitate systematic measurement of the care processes and patient outcomes, providing more evidence that can be used to further modify this guideline.

A middle-aged female with a history of iatrogenic right ureteral injury and surgical reimplantation was referred to our clinic for recurrent urinary tract infection (UTI) with right-sided pyelonephritis and fever. The workup revealed Grade 4 vesicoureteral reflux (VUR) on cystogram and moderate hydroureteronephrosis with cortical scarring on computed tomography. She was offered surgical repair versus attempted minimally invasive endoscopic treatment. The patient elected for endoscopic treatment with a hyaluronic acid copolymer (Deflux), a bulking agent typically used to treat VUR in children. Posttreatment results showed a significant reduction in VUR severity, reduction of her recurrent UTIs, and resolution of chronic flank pain. This case report demonstrates a successful utilization of this approach for symptomatic reflux following ureteral reimplantation in an adult.