Journal of Emergencies, Trauma, and Shock最新文献

Introduction: Cardiopulmonary resuscitation (CPR) is an important lifesaving technique that must taught to everyone. As most cardiac arrests occur outside of the hospital, training the general population in the recognition of cardiac arrest and performing high-quality CPR is vital. Thus, this study aimed to compare the chest compression quality data (rate, depth, and fraction) with and without the use of feedback devices during CPR.

Methods: A crossover observational study was carried out at a tertiary hospital in September 2021. Five hundred and seventeen 1^st-year university students were recruited, and the response rate was 90% (465). A feedback device was used to collect data. The data were numerically coded and statistical software (SPSS 21) was used to perform descriptive and inferential statistical analysis, including a paired t-test.

Results: The mean compression rate with feedback was statistically significantly lower after performing one cycle of CPR (mean difference: -5.610; 95% confidence interval [CI]= -7.987--3.233; P < 0.001), the difference between mean compression depth with and without feedback was not statistically significant (mean difference: = -0.006; 95% CI = -0.190-0.177; P = 0.944), and the mean compression target (%) with feedback was statistically significantly higher (mean difference: -15.951; 95% CI = -17.894--14.009; P < 0.001).

Conclusions: We found that the use of feedback devices during layperson-simulated CPR scenarios significantly improved the quality of chest compression in terms of depth and rate and resulted in more guidelines adherence. Moreover, national programs for CPR education should be implemented.

Acute subdural hematoma (ASDH) is a type of intracranial hemorrhage and is due to the collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane. It tends to occur in the temporal parietal regions. Early intervention is the key for better outcome of the patient. Management depends on neurological status and imaging. Large SDH collects along the convexity of the brain causing compression over the brain stem with midline shift. In cases of conservatively managed ASDH, spontaneous resolution usually takes weeks to months depending on the size of the bleed. In rare cases, spontaneous rapid resolution of the SDH occurs. So here, we are presenting an 11-month-old baby girl who was brought to our Emergency room/department (ER) with a history of fall and computed tomography scan was suggestion of an ASDH in the left temporoparietal region which resolves on its own in 6 h which is a rare phenomenon and needs to be highlighted.

Introduction: While rare, popliteal artery injury is a potentially devastating complication of knee trauma. Delayed diagnosis or inadequate management of popliteal artery injury can result in limb ischemia, amputation, and long-term disability. This study aimed to compare the treatment outcomes of popliteal artery injury between different medical centers and to reconsider the optimal protocol at our institution.

Methods: Medical records of patients sustaining traumatic popliteal artery injury from 2011 to 2022 at two institutions (one hospital: Group A; the other hospital: Group B) were retrospectively reviewed. Demographic data, radiological assessment, time course and content of initial treatment, clinical outcomes, and follow-up period were recorded.

Results: Group A included seven patients (dislocations, n = 3; fractures, n = 2; and glass penetration injuries, n = 2), with a mean follow-up period of 39 months. Group B included five patients (dislocations, n = 3 and fractures, n = 2), with a mean follow-up period of 36 months. Two patients in Group A and four patients in Group B exhibited contrast-medium resumption (average deficit: 57 mm and 60 mm, respectively). The time from injury to reperfusion was significantly shorter in Group A than in Group B (300 min vs. 749 min, P < 0.05). Group A underwent four temporary vascular shunting procedures, four external fixations, six fasciotomies, and five bypass grafting procedures. In Group B, temporary vascular shunt (TVS) was not used in any patient; however, three, two, and three patients underwent external fixation, fasciotomy, and bypass grafting, respectively. One patient in each group required above-the-knee amputation. The mean Lysholm score was 80.4 points in Group A and 72.0 points in Group B.

Conclusions: TVS considerably reduces the reperfusion time. Various options for the content and sequence of treatment must be carefully considered in advance. Early diagnosis, prompt intervention, and comprehensive management can improve the quality of care and patient outcomes.

[This corrects the article on p. 84 in vol. 17, PMID: 39070866.].

[This corrects the article on p. 129 in vol. 17.].

Introduction: Hemorrhagic shock demands swift intervention. Management involves the rapid infusion of blood products to restore circulation and uphold tissue perfusion. The aim of this study was to evaluate the effectiveness of prehospital plasma administration in trauma patients, comparing outcomes with normal saline. This was a meta-analysis of randomized controlled trials.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, searches were conducted in PubMed, MEDLINE, and the Cochrane Central Register of Controlled Trials from August 1, 2018, to April 4, 2023. The PubMed search string included terms related to blood plasma, prehospital care, emergency medical services, and hemorrhagic shock: (Blood Plasma [MeSH Terms] OR fresh frozen plasma [MeSH Terms] OR plasma OR fresh frozen plasma OR FFP) AND (Prehospital OR emergency care, prehospital [MeSH Terms] OR prehospital emergency care [MeSH Terms] OR prehospital OR prehospital OR EMS OR emergency medical service [MeSH Terms]) AND (hemorrhagic shock [MeSH Terms] OR hemorrhage OR hemorrhage OR hemorrhagic shock OR hemorrhagic shock). Results from the trials were pooled using a random effects model, presented as risk ratios with 95% confidence intervals.

Results: In the analysis of 760 patients from three studies, outcomes included mortality at 24 h and 28 days, multi-organ failure (MOF), acute lung injury, and vasopressor use within 24 h. Patients were divided into plasma (363) and normal saline (397) groups.

Conclusion: There is no distinction between prehospital plasma administration and normal saline concerning mortality at 24 and 28 days or the need for vasopressors within 24 h. Moreover, plasma administration did not appear to influence rates of acute lung injury or MOF.

Introduction: Identifying factors causing treatment delays is essential for guiding decisions on resource allocation within trauma systems. The three-delay model categorizes delays into: (i) deciding to seek medical care (Phase 1), (ii) recognizing the need for transporting to a medical facility (Phase 2), and (iii) receiving suitable and timely treatment (Phase 3). We seek to investigate factors influencing delays in trauma patients using the three-delay model.

Methods: We conducted an 18-month prospective observational study at a tertiary hospital, involving consenting adults (age >18 years) admitted for various traumas. We conducted a detailed interview and extracted objective patient data from medical records using a predetermined form. We observed and analyzed factors influencing the duration of the three phases.

Results: Phase 1 delays were observed in 83 patients, Phase 2 delays in 200 patients, and Phase 3 delays in 233 patients. In Phase 3 delays, a shortage of human resources was the most frequently identified cause of delay, affecting 68 out of 233 patients (29%). In severe trauma cases (injury severity score ≥16), any phase delay showed a significant association with poor outcomes (P < 0.05).

Conclusion: The three-delay model offers a valuable framework for understanding and pinpointing the factors contributing to delays in both prehospital and inhospital services.

Introduction: Maternal cardiac arrest is a rare but critical event that poses significant risks to both the mother and the fetus. As majority of population in India lives in the rural areas, Emergency Medical Professionals assist in childbirth in transit in ambulances. This timely assistance ensures the safe transportation of both mother and new born baby to the hospital. The aim of this study was to assess the effectiveness of high-fidelity simulation training in the management of maternal cardiac arrest among emergency medical professionals.

Methods: The randomized simulation study aimed to assess the effectiveness of high-fidelity simulation in managing maternal cardiac arrest. Two hundred and fifty emergency medical professionals were randomly assigned to 50 groups. Participants underwent a prebriefing session before engaging in simulation scenarios. After the initial scenarios, participants received a debriefing session emphasizing the standardized algorithm for maternal cardiac arrest management. A week later, participants engaged in a second simulation scenario, and their adherence to the algorithm was assessed. The data were analyzed using statistical tests, and the entire simulation session was video recorded for reliability.

Results: The results showed that participants demonstrated an improvement in managing both maternal and obstetric interventions in the posttraining scenario compared to the pretraining scenario. The successful implementation of the advanced cardiac life support algorithm and the debriefing session were key factors in improving participants' performance. However, continuous exposure and practice are necessary to maintain and enhance these skills.

Conclusion: Health-care professionals should actively seek opportunities for ongoing training and education to stay updated with the latest guidelines and advancements in managing maternal cardiac arrest.