Journal of Emergencies, Trauma, and Shock最新文献

Introduction: Traditionally, metabolic acidosis is analyzed using an anion gap (AG). The aim of the study was to compare the utility of quantitative David Story's simplified Stewart approach against traditional approach to analyze metabolic acidosis. ICU setting. Analytical, cross-sectional observational study.

Methods: Blood gas reports of 50 adult critically ill patients with primary metabolic acidosis at admission were analyzed using both approaches. With traditional approach, acidosis was classified simply as high or normal AG acidosis. With S.A.L.T approach, the components of base deficit were further quantified into sodium chloride, albumin, lactate, and other ions effects. A contribution of sodium chloride or albumin effect of > 30% to the base deficit was considered significant. The proportion of patients with such abnormalities was determined. Descriptive statistics was used.

Results: The mean ± standard deviation (SD) age of patients was 54.52 ± 19.71 years, 52% were males, and 72% were medical admissions. The median (interquartile range [IQR]) Sequential Organ Failure Assessment score was 10 (5-13). The mean ± SD pH, bicarbonate, base excess, and albumin were 7.198 ± 0.13, 11.73 ± 4.2 mmol/L, -15.13 ± 5.6 mmol/L, and 2.9 ± 0.77 g%, respectively. The median (IQR) of serum lactate was 6.77 (1.53, 16.32) mmol/L. Hyponatremia and hypochloremia were seen in 68% and 46% of patients, respectively. Eighty-eight percent of patients had acidosis due to other ions, 52% due to lactates. Twenty-eight percent had a significant sodium chloride effect and 32% had significant hypoalbuminemia.

Conclusion: Quantification of base deficit of metabolic acidosis using S.A.L.T approach showed changes in sodium chloride levels and hypoalbuminemia affecting base deficit in nearly 30% of the patients. Quantification of metabolic acidosis using S.A.L.T approach is likely to help treat metabolic acidosis more appropriately, with clinical implications.

Introduction: Penetrating thoracoabdominal injuries (PTAIs) are associated with diaphragmatic injuries and subsequent complications. This study aimed to describe the prevalence of diaphragmatic injuries in patients with PTAI without signs of shock or acute abdomen at admission.

Methods: A cross-sectional, single-centered study was conducted in Bogotá, Colombia. The study included all patients with PTAI who underwent surgical exploration and were admitted without signs of shock or acute abdomen, between January 2019 and August 2021. Indications for surgical exploration included presence of left thoracoabdominal wound, hemo- or pneumothorax in presurgical imaging, abdominal pain, hypotension, or anemia.

Results: A total of 284 patients were included in the final analysis. The median age was 29 years (interquartile range: 22-33), with 269 (94.7%) patients being males. Out of these, 268 (94.3%) patients experienced stabbing as the mechanism of injury. The prevalence of diaphragmatic injuries diagnosed during surgical exploration was 15.1% (43 patients). There were 183 patients with left-sided PTAI and 115 patients with right-sided PTAI. The prevalence of the right diaphragmatic injury was 25.2% (29 patients), while for left diaphragmatic injury, it was 8.1% (15 patients). Only one patient presented with bilateral diaphragmatic injury.

Conclusions: The prevalence of diaphragmatic injuries in patients with PTAI, without signs of shock or acute abdomen upon admission, was 15.1%. However, the prevalence was 25.2% in the right PTAI and 8.1% in the left PTAI. These findings suggest that surgical exploration of the diaphragm in cases of PTAI should be performed regardless of the side of the wound.

Introduction: Effective pain management is crucial in the emergency department (ED), particularly for trauma patients. Ultrasound-guided regional analgesia (UGRA) has emerged as a promising technique for acute pain relief. The objective of this study is to describe the various UGRA performed and assess their effectiveness among trauma patients in our Level 1 Trauma Center ED over the past 2.5 years.

Methods: Data from 485 trauma patients who underwent UGRA over 2.5 years were analyzed retrospectively. The primary outcome was the median Defense and Veterans Pain Rating Scale (DVPRS) reduction at 30 min and 1 h after nerve block administration. Patient characteristics, types of nerve blocks administered, procedural details, and outcomes were also noted. Statistical analysis was performed to determine the median reduction in pain scores and evaluate the success of UGRA.

Results: UGRA demonstrated a significant reduction in pain scores, with a median DVPRS decrease from 9 (interquartile range [IQR]: 9-10) preprocedure to 4 (IQR: 2-5) at 30 min and 1 (IQR: 0-2) at 1 h postprocedure. Sixteen types of nerve blocks were administered in our ED, with the serratus anterior block (n = 91) and fascia iliaca compartment block (n = 58) being the most common. Pain relief was the most common indication for block administration. A higher volume was injected for plane blocks compared to nerve-specific blocks. No complications or failed blocks were reported.

Conclusion: This study describes 16 different UGRA that can be performed by emergency physicians (EPs) in ED for trauma patients. UGRA is effective in providing substantial pain relief for trauma patients in the ED. UGRA performed by EPs offers a safe and feasible approach for managing acute pain in the ED.

Introduction: Acute blood loss and uncontrolled hemorrhage in trauma require quick identification and action to restore circulating volume and save the patient. These patients have the opportunity to receive massive transfusion (MT) to reduce mortality rates and avoid overtransfusion using a suitable ratio of blood components. This study aims to systematically review and analyze the predictive factors for the activation of MT protocol (MTP) in trauma patients, which is critical for improving clinical decision-making and patient outcomes.

Methods: PubMed, ScienceDirect, Cochrane, and other sources were searched for articles from 2007 to 2020. Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, this systematic review included original studies published in English, involving trauma patients aged 15 years or older who received MTP. The risk of bias (RoB) was assessed using the RoB in Nonrandomized Studies of Interventions-I and RoB 2 tools, and statistical analysis was performed, focusing on the homogeneity of effect sizes across trials.

Results: The articles search identified a total of 424 studies. Nine studies met all inclusion criteria. The most common predictors were age, sex, systolic blood pressure (SBP), heart rate (HR), hemoglobin (Hb) levels, international normalized ratio (INR), base excess (BE), and lactate levels. The analysis showed that parameters such as SBP, HR, Hb, INR, BE, and lactate were significantly associated with the activation of MTP. However, age and sex were not significant predictors. The survival rate was notably lower in the MTP group compared to the non-MTP group. There was no evidence of publication bias.

Conclusion: Several physiological parameters: low SBP, elevated HR, reduced Hb, increased INR, diminished BE, and elevated lactate are significantly correlated with an increased likelihood of necessitating MTP in trauma patients. Among those who received MTP, the survival rate was lower compared to the non-MTP group.