Journal of Emergencies, Trauma, and Shock最新文献

Introduction: Medical literature on emergency care for children with special healthcare needs (SHCNs) reports the inherent challenges in the managing of these children, like limited history, distress for patients and families, and unique management requirements for healthcare teams. This study analyzed the demographic data on children with SHCNs to explore de-escalation strategies, the effectiveness of chemical de-escalation, and clinical management strategies used and compared the length of stay in the emergency department (ED) between patients who received medications and those who did not.

Methods: This was a retrospective and cross-sectional study. Data were collected from the last 150 patients diagnosed with SHCNs across three ED s within this hospital system since July 1, 2023. Children aged 18 years or younger diagnosed with SHCNs requiring special modifications. Chi-square test, Mann-Whitney U-test, and Kruskal-Wallis H-test.

Results: The demographic analysis showed that 60% of children with SHCNs were female, with a mean age of 12.3 years. The most common presentation time was 6-8 pm. autism spectrum disorder (28%) and anxiety disorder (27%) were the most frequent diagnoses, with substance abuse present in 45% of patients. Medications helped reduce the ED stay, which was statistically significant, suggesting that medications may facilitate effective de-escalation; At the same time, in a few cases, verbal de-escalation also appeared helpful. There is a need for robust documentation on verbal de-escalation strategies, such as details on patients who did not receive medications and were successfully managed verbally or required repeated reassurance.

Conclusions: This study provides insight into the diverse challenges of managing children with SHCNs in the emergency settings. The high prevalence of substance abuse, particularly in children with autism spectrum, increases the complexity of care. While medications may reduce ED stay, further research is needed to understand this patient population's complex needs better.

Introduction: Unilateral fracture of the first rib frequently led to severe complications such as brachial plexus or major vascular injury. Bilateral first rib fracture (BFRF) is very rare. We aimed to study the incidence, mechanism of injury, management, and outcome of BFRF in blunt trauma patients in a community-based hospital.

Methods: Data of all blunt trauma patients who were admitted to our institution with (BFRF from December 2014 through January 2017) were retrospectively collected. Data included demography, mechanism of injury, severity of the injury, associated injuries, management, and outcome.

Results: During the study period, 4779 patients with blunt trauma were included in the trauma registry and 12 (0.25%) patients had BFRF. The mean age of standard deviation (SD) was 29 (8.3) years. Seven (58.3%) patients were involved in road traffic collisions and 5 (41.7%) patients fell from more than 3 m height. The most commonly associated thoracic injury was lung contusions in 8 (66.7%) patients. The median (range) Glasgow Coma Score on admission was 15 (14-15) and Injury Severity Score (SD) was 19 (10.5). Length of hospital stay mean (SD) was 6.8 (6.4) days. No patients died in the study.

Conclusions: BFRF is a rare entity in blunt trauma patients caused by high-energy trauma. Major vascular or brachial plexus injuries in patients with BFRF are much less than those reported in the medical literature on unilateral first rib fractures. Associated injuries are the main cause of trauma-related morbidity rather than the direct effect of BFRF.

Introduction: India, with nearly 60 venomous snake species, has just one commercially available antivenom, the Indian polyvalent antivenom (IPAV). The hump-nosed pit viper (Hypnale hypnale), an indigenous venomous snake, causes considerable morbidity and at time mortality for which we have no commercially available antivenom. However, most clinicians rely purely on the clinical syndromes and end up using the available IPAV for H. hypnale envenomation.

Methods: Between April 2017 and December 2022, we reviewed 41 cases of H. hypnale envenomation, comparing clinical and laboratory profiles of patients who received IPAV with those who did not.

Results: Local signs of envenomation were seen in 39 (95.12%) cases, with the most common being edema or swelling at the bite site. Eight (19.5%) patients developed coagulopathy, and two developed renal failure during their hospital stay. Among the 39 envenomated individuals, 13 received polyvalent snake antivenom. Over half of those receiving antivenom had hypersensitivity reactions. Patients who received antisnake venom (ASV) had increased intensive care unit stay, duration of hospitalization, and hospital expenses as compared to patients who did not. There was one death among the patients who received antivenom.

Conclusion: H. hypnale viper envenomation is associated with local and systemic signs of envenomation, with coagulopathy being a common complication. Administering the current polyvalent antivenom to victims of H. hypnale bites did not reduce the morbidities or prevent mortality; instead, it exposes them to additional risks associated with ASV administration.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an invented method to facilitate a minimally invasive occlusion of the aorta to stop a life-threatening hemorrhage. This review described an established pathway for noncompressible exsanguination (REBOA procedures) in trauma patients at a Level 1 trauma center. A detailed description starting from the structural changes of the hospital and facilities itself, the initial thoughts, implementation of the process, and continuous revision and improvement of guidelines were discussed. A multidisciplinary core team consisting of trauma surgeons, anesthesiologists, interventional radiologists, and operating room (OR) staff developed step-by-step clinical practice guidelines for using REBOA at our trauma center. A comprehensive training program for specialized procedural training was implemented to ensure the competency of all relevant medical personnel in managing trauma patients. The REBOA guidelines underwent plan-do-check-act quality cycle improvement until the latest guidelines were reached with each use of REBOA in a trauma patient, leading to further auditing of the guidelines to identify areas for improvement. The current review discusses the critical role of adopting innovative technologies and adapting protocols in trauma care, particularly for vulnerable patients with a high risk of morbidity and mortality. Continuous process improvement, procedural refinement, and evolving guidelines are essential prerequisites for optimizing patient outcomes. We described a valuable framework for other trauma programs to implement and adapt similar endovascular bleeding control approaches, thereby potentially enhancing patient care.

Congenital diaphragmatic hernia (CDH) and acquired diaphragmatic hernia (ADH) are secondary to a weakness or opening in the diaphragm. Both are types of internal hernia. The abnormality can range from a minor defect in the posterior edge of the diaphragm to the entire loss of it. CDH usually leads to lung hypoplasia associated with pulmonary hypertension and immaturity, as well as cardiac dysfunction. In ADH, pathophysiology is secondary to herniation and its pressure effects. We report a series of two cases of spontaneous ADH (SADH). Spontaneous acquired rupture of the diaphragm can occur after exercise, coughing, labor (delivery), or even without any significant preceding event. It is uncertain if SADH is caused by a preexisting weak region in the diaphragm, a loss of muscle coordination during vigorous exertion, or both. It is a potentially fatal surgical emergency requiring a high index of clinical judgment in the appropriate clinical setting. SADH acts mechanically by compressing the lung. It is an infrequent entity. This case series and review concisely illustrate the genesis, diagnosis, and treatment of spontaneous diaphragmatic hernia.

Introduction: Shock is defined as inadequate delivery of oxygen to meet the tissue's demands. There are four main types of shock: cardiogenic, obstructive, distributive, and hypovolemic. Hypovolemic shock causes include hemorrhage, dehydration, and burns. Blood loss results in inadequate oxygen delivery to the cells resulting in tissue death if not reversed. Rapid infusers allow for the rapid administration of blood and crystalloid products to patients in shock; however, many community emergency departments do not have these devices. The aim of our study is to determine the fastest way to administer blood when the viscosity of the fluid is taken into consideration in a simulated setting.

Methods: Volunteers were assigned to one of two arms: either the push-pull technique or pressure bag technique. The push-pull technique involved using a 50 cc syringe connected to a 3-way stop-cock to withdraw and infuse the fluid. The pressure bag technique involved pumping a pressure bag up to the maximum to infuse the fluids. The speed of infusing 250 mL of intravenous fluids was recorded. The time for the subjects to collect the materials throughout the emergency department was also recorded.

Results: A total of three trials were conducted. On average, the push-pull technique took 228 s and the pressure bag technique took 340 s. The push-pull technique took an average of 112 s less than the pressure bag technique. Subjects took 62 s to find the materials for the pressure bag technique. It took 133 s to find the material for the push-pull technique.

Conclusion: This prospective nonblinded observation simulation-based study demonstrated that the push-pull technique was significantly faster than the pressure bag technique.