Journal of Emergencies, Trauma, and Shock最新文献

Fireworks are commonly used during holidays in the United States. Firework related injuries (FWRIs) have been rising throughout the country since 2012. Here, we describe injury trends and patterns in patients with FWRIs. The trauma registry at Desert Regional Medical Center's Level I Trauma Center was queried from July 2016 to August 2021. Injury patterns and procedures performed were reviewed. The data were reviewed, and a description of the most common injury types and the association between FWRIs and holiday celebrations, alcohol use, and toxicology results is presented. Ten patients were identified for inclusion during the study period. Fifty percent of the patients were found to be under the influence of alcohol, and 40% had other substances on board. The most common drug found was methamphetamine, accounting for 30% of patients. Ninety percent of patients suffered injuries to hands. Fifty percent of the injured patients presented around the time of either New Year's or Independence Day celebrations. Neither holiday and alcohol use nor toxicology results were associated with differences in Injury Severity Score. Patients with injuries related to fireworks are presenting to our nation's emergency rooms at an increasing rate. In this descriptive case series, we found that hand injuries are the most common, followed by face injuries. Most patients had either alcohol or drugs on board at the time of presentation. Findings from this paper will help trauma programs prepare for the presentation of these patients and design outreach programs and future research.

Emergency medicine (EM) is well established in many countries but is a relatively new specialty in India., EM was not officially declared a separate academic discipline in India until 2009, and therefore, emergency care to sick patients was being provided by physicians without any training. To enhance knowledge of such doctors, Indo-US Emergency and Trauma Collaborative started annual conferences in EM in 2005. In these annual conferences, clinico-pathologic case (CPC) competition was introduced since the beginning. Later, the World Academic Council of EM was formed, and CPC competitions were taken at the global level. In this article, we describe the growth of this event.

Damage control surgery (DCS) has revolutionized the management of critically ill patients with severe colorectal pathology. Initially developed for wartime trauma, DCS principles have been adapted to emergency colorectal surgery, emphasizing rapid contamination control, physiological stabilization, and staged surgical repair. This case series highlights the role of bailout laparotomy in managing life-threatening colorectal emergencies. This series presents seven patients aged 24-76 years, undergoing emergency colorectal surgery for varied conditions such as perforation (self-foreign body insertion and trauma), volvulus, malignant obstruction and inflammatory diseases. Surgical interventions included primary repair, Hartmann's procedure, diversion stomas, and tumor biopsy with decompression. Postoperative management focused on sepsis control and nutritional support, leading to favorable patient outcomes. Emergency colorectal surgery presents significant challenges due to the high risk of sepsis, hemodynamic instability, and complications associated with delayed treatment. DCS, particularly bailout laparotomy, prioritizes patient stabilization over immediate definitive repair, reducing intraoperative risks. This approach has demonstrated success in improving survival rates when minimizing postoperative morbidity care. Despite its advantages, DCS requires careful patient selection to avoid unnecessary staged interventions and prolonged hospitalizations. By allowing physiological stabilization before definitive repair, this approach enhances survival and reduces complications. The adaptation of wartime surgical principles to modern civilian practice underscores the evolving role of DCS in emergency gastrointestinal surgery.

Introduction: Trauma patients may die of external bleeding from junctional or peripheral injuries. Most peripheral injuries are compressible allowing for temporary bleeding control in the field. Despite the availability of simple techniques to control external hemorrhage, patients still die of extremity and junctional bleeding. The American College of Surgeons stop the bleed (STB) program was designed to help members of the public control bleeding at the scene of trauma. Our study seeks to quantify trauma mortality that could have been prevented by STB techniques.

Methods: This is a retrospective case series of patients from a level one trauma center and the National Trauma Data Bank (NTDB). We selected overall deaths and patients who died within 2 days of injury and reviewed every injury that these patients suffered. We classified injuries into noncompressible, possibly compressible, and definitely compressible. We analyzed the patterns of injuries and identified a group of patients that we believe could have been saved with STB techniques. To assess possible benefit of STB, we analyzed the changes in the incidence of exsanguinating distal extremity injuries and the mortality rate of patients who suffered these injuries over the years 2017 through 2022.

Results: For the local data, total early deaths were 577 (3.9% of total trauma). Ten (1.73%) of these patients died of an injury judged compressible by the reviewing trauma surgeon. For the NTDB data, total trauma patients were 6,715,967. Total deaths were 244,295 (3.6%). Total early deaths were 129,723 (1.9%). The proportion of total deaths due to isolated compressible injuries was 1079/244,295 (0.4%). This last group includes the patients that we believe could have been saved by STB. Over the 6-year period examined, there was a slight but significant rise in the mortality rate of isolated distal extremity injuries, but the incidence did not change significantly.

Conclusion: The problem of exsanguination from external bleeding still exists at a busy urban level one trauma center and at other trauma centers nationwide. Ongoing fatality reveals a continuing unmet need for public education that could potentially save lives.

Introduction: Almost 50% of medical students are women, yet women make up only 28% of emergency medicine-trained physicians. Studies, in other industries, have shown using masculine- or feminine-coded language in job advertisements affects the numbers of male versus female applicants who apply. Our research explores gender bias in the language of emergency medicine (EM) residency recruitment materials, and assesses if this language correlates to the gender distribution within studied residencies.

Methods: One hundred and one ACGME accredited EM residency programs (2021) were reviewed. Each program's website recruitment materials were decoded based upon prior research on gender bias in language. Recruitment materials were categorized as highly masculine, masculine, highly feminine, feminine, or neutral. Each program website was reviewed to determine current residency classes' gender distribution.

Results: One hundred and one EM residencies were reviewed. Residency sizes ranged from 17 to 86 trainees and were comprised 10%-92% females, with the average class breakdown of 38% women. The majority of EM residency recruitment materials contained some gender coded language (n = 91). Forty-two programs contained masculine or strongly masculine language, 41 contained feminine or strongly feminine language, and 17 programs coded as globally neutral, although 8 of these still contained gender-coded language. Gender coding in the language of recruitment materials was not predictive of proportion of female residents within the program (P = 0.61).

Conclusions: Gender-coded language is common in residency recruitment materials for EM but does not have a relationship to resident class demographics. Further studies should examine whether gendered language in recruitment materials impacts residents' choices during the application process.