Journal of Emergencies, Trauma, and Shock最新文献

Introduction: Abdominal trauma is a major cause of morbidity and mortality in low- and middle-income countries. There is a paucity of trauma data in this region and this study aimed to show the pattern of presentation and outcome of patients with abdominal trauma at a North-Central Nigerian Teaching Hospital.

Methods: This was a retrospective, observational study of patients with abdominal trauma who presented at the University of Ilorin Teaching Hospital from January 2013 to December 2019. Patients with clinical and/or radiological evidence of abdominal trauma were identified, and data extracted and analyzed.

Results: A total of 87 patients were included in the study. There were 73 males and 14 females (5.2:1) with a mean age of 34.2 years. Blunt abdominal injury occurred in 53 (61%) patients with 10 patients (11%) having concomitant extra-abdominal injuries. A total of 105 abdominal organ injuries occurred in 87 patients with the small bowel being the most frequently injured organ in penetrating trauma, while in blunt abdominal injury, the spleen was most commonly injured. A total of 70 patients (80.5%) had emergency abdominal surgery with a morbidity rate of 38.6% and negative laparotomy rate of 2.9%. There were 15 deaths in the period accounting for 17% of patients with sepsis as the most common cause of death (66%). Shock at presentation, late presentation >12 h, need for perioperative intensive care unit admission, and repeat surgery were associated with a higher risk of mortality (P < 0.05).

Conclusion: Abdominal trauma in this setting is associated with a significant amount of morbidity and mortality. Typical patients present late and with poor physiologic parameters often resulting in an undesirable outcome. There should be steps targeted at preventive policies focused on reducing the incidence of road traffic crashes, terrorism, and violent crimes as well as improving health care infrastructure to cater to this specific group of patients.

Introduction: Sepsis is the leading cause of mortality, and various scoring systems have been developed for its early identification and treatment. The objective was to test the ability of quick sequential organ failure assessment (qSOFA) score to identify sepsis and predict sepsis-related mortality in the emergency department (ED).

Methods: We conducted a prospective study from July 2018 to April 2020. Consecutive patients with age ≥18 years who presented to the ED with a clinical suspicion of infection were included. Sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV), and odds ratio (OR) for sepsis related mortality on day 7 and 28 were measured.

Results: A total of 1200 patients were recruited; of which 48 patients were excluded and 17 patients were lost to follow-up. 54 (45.4%) of 119 patients with positive qSOFA (qSOFA >2) died at 7 days and 76 (63.9%) died at 28 days. A total of 103 (10.1%) of 1016 patients with negative qSOFA (qSOFA score <2) died at 7 days and 207 (20.4%) died at 28 days. Patients with positive qSOFA score were at higher odds of dying at 7 days (OR: 3.9, 95% confidence interval [CI]: 3.1-5.2, P < 0.001) and 28 days (OR: 6.9, 95% CI: 4.6-10.3, P < 0.001). The PPV and NPV with positive qSOFA score to predict 7- and 28-day mortality were 45.4%, 89.9% and 63.9%, 79.6%, respectively.

Conclusion: The qSOFA score can be used as a risk stratification tool in a resource-limited setting to identify infected patients at an increased risk of death.

Introduction: Retrospectively investigated this relationship using data from Shimoda Fire Department.

Methods: We investigated patients who were transported by Shimoda Fire Department from January 2019 to December 2021. The participants were divided into groups based on the existence of incontinence at the scene or not (Incontinence [+] and Incontinence [-]). We compared the variables mentioned above between these groups.

Results: There were 499 cases with incontinence and 8241 cases without incontinence. There were no significant differences between the two groups with respect to weather and wind speed. The average age, percentage of male patients, percentage of cases in the winter season, rate of collapse at home, scene time, rate of endogenous disease, disease severity, and mortality rate in the incontinence (+) group were significantly greater in comparison to the incontinence (-) group, whereas the average temperature in the incontinence (+) group was significantly lower than that in the incontinence (-) group. Regarding the rates of incontinence of each disease, neurologic, infectious, endocrinal disease, dehydration, suffocation, and cardiac arrest at the scene had more than twice the rate of incontinence in other conditions.

Conclusions: This is the first study to report that patients with incontinence at the scene tended to be older, showed a male predominance, severe disease, high mortality, and required a long scene time in comparison to patients without incontinence. Prehospital care providers should therefore check for incontinence when evaluating patients.

Trauma to the adrenal glands is very rare. The variation in clinical manifestations is marked and markers for its diagnosis being limited, makes it tough to be diagnosed. Computed tomography remains the gold standard for detecting this injury. Prompt recognition and the potential for mortality with adrenal insufficiency can provide the best guidance for the treatment and care of the severely injured. We present a case of a 33-year-old trauma patient who was not responding to the management of his shock. He was finally found to have a right adrenal haemorrhage leading to adrenal crisis. The patient was resuscitated in the Emergency Department but succumbed 10 days post admission.

The patient was a 69-year-old man who called an ambulance due to dyspnea. When emergency medical technicians found him, he had collapsed into deep coma in front of his house. On arrival, he remained in a deep coma with severe hypoxia. He underwent tracheal intubation. An electrocardiogram showed ST elevation. Chest roentgen showed bilateral butterfly shadow. Cardiac ultrasound revealed diffuse hypokinesis. Head computed tomography (CT) showed early cerebral ischemic signs that had been initially overlooked. Urgent transcutaneous coronary angiography showed obstruction of the right coronary artery that was treated successfully. However, the next day, he was still in coma and demonstrated anisocoria. Repeated head CT showed diffuse cerebral infarction. He died on the 5^th day. We herein report a rare case of cardio-cerebral infarction with a fatal outcome. Patients with acute myocardial infarction and a coma state should be evaluated for cerebral perfusion or occlusion of major cerebral vessels by enhanced CT or an aortogram if percutaneous coronary intervention is performed.

Introduction: The shock index (SI), modified shock index (MSI), and age multiplied by SI (ASI) are used to assess the severity of shock. They are also used to predict the mortality of trauma patients, but their validity for sepsis patients is controversial. The aim of this study is to assess the predictive value of the SI, MSI, and ASI in predicting the need for mechanical ventilation after 24 h of admission among sepsis patients.

Methods: A prospective observational study was conducted in a tertiary care teaching hospital. Patients with sepsis (235) diagnosed based on systemic inflammatory response syndrome criteria and quick sequential organ failure assessment were included in the study. The need for mechanical ventilation after 24 h is the outcome variables MSI, SI, and ASI were considered as predictor variables. The utility of MSI, SI, and ASI in predicting mechanical ventilation was assessed by receiver operative curve analysis. Data were analyzed using coGuide.

Results: Among the study population, the mean age was 56.12 ± 17.28 years. MSI value at the time of disposition from the emergency room had good predictive validity in predicting mechanical ventilation after 24 h, as indicated by the area under the curve (AUC) of 0.81 (P < 0.001), SI and ASI had fair predictive validity for mechanical ventilation as indicated by AUC (0.78, P < 0.001) and (0.802, P < 0.001), respectively.

Conclusion: SI had better sensitivity (78.57%) and specificity (77.07%) compared to ASI and MSI in predicting the need for mechanical ventilation after 24 h in sepsis patients admitted to intensive care units.