Journal of Emergencies, Trauma, and Shock最新文献

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.

Introduction: Multiple traumatic injuries cause death among traumatized patients. Nurses at the emergency department (ED) must assess, provide nursing care, and record their interventions. Recording all patient information and nursing care procedures, however, is more challenging due to time constraints in emergency care.

Methods: The aim of this study was to evaluate the use of a web application for nursing records of multiple trauma patients in an ED and the user's satisfaction. A web application developed based on the guidelines of Advanced Trauma Life Support was implemented in a resuscitation room of a university hospital in Khon Kaen, Thailand, from January to March 2022. The quality of nursing records through the web application for 40 trauma patients was evaluated. Thirty-seven nurses were surveyed for their satisfaction. The data were analyzed using descriptive statistics.

Results: Overall, the comprehensive nursing process record through web application had 80.3% completeness. Some items were not recorded or partially recorded, including vital sign monitoring and patients' vital signs and symptoms summary records before discharge. Nurses expressed their satisfaction with the web application at a high level, with an average score of 3.99 (standard deviation [SD]: 0.68). They were most satisfied with the components of the nursing process for multiple trauma patients (mean: 4.14 and SD: 0.71).

Conclusions: The use of a web application ensures the completeness of nursing records. Nurses are satisfied with implementing the web application in their clinic. A study of its effectiveness in reducing documentation time and improving patient outcomes is needed in the future.

Traumatic thyroid hemorrhage is a rare but potentially life-threatening condition. Bilateral thyroid hemorrhage is even rarer. Herein, we report a case of traumatic bilateral thyroid hemorrhage treated with nonoperative management. A 49-year-old woman with preexisting goiter presented to the emergency department after a traffic accident. She had neck swelling and tenderness; however, no stridor or respiratory distress was noted. Traumatic bilateral thyroid hemorrhage with mild tracheal deviation to the right was diagnosed after computed tomography. Nonoperative management and intensive monitoring were applied for no signs of airway compromised. The patient was discharged after 5 days of hospital stay uneventfully. 6-month follow-up revealed stationary condition and normal thyroid function tests. This rare case demonstrated successful nonoperative management on the blunt injury of the neck, complicated with bilateral thyroid hemorrhage.

Introduction: Injury caused by large animals varies according to the regional distribution of the animals and their relationship to humans. Camels are usually friendly to humans; however, occasionally they become very hostile, especially in rutting season. Most in-hospital trauma deaths are related to head injury. Very few studies in the literature have discussed camel-related head injuries. We aimed to study the incidence, mechanism of injury, types, and outcome of camel-related head injury in a high-income developing country to give recommendations on preventive measures.

Methods: We retrospectively collected data from all patients who were admitted to Al Ain Hospital with a camel-related head injury from January 1, 2015, to January 1, 2021. Data collected included demography, mechanism of injury, anatomical location, severity of the injury, associated injuries, and management. The patients were followed up during their hospital stay to record the length of hospital stay, complications, and outcome.

Results: During the study period, 98 patients were admitted to Al Ain Hospital with camel-related injury. Thirty-nine (39.8%) of the admitted patients with a camel-related injury sustained a head injury; a camel-related head injury was more common during August (23.1%). Thirty-four (87.2%) patients were camel caregivers. Thirty-three patients (84.6%) were injured on farms. Seven patients suffered an intracranial hemorrhage, and six (85.7%) of them had a history of fall from a camel. Glasgow Coma Score was significantly correlated to the severity of head injury measured by Abbreviated Injury Severity of the head (P = 0.006, Spearman's correlation). One patient died during the study period after having decompressive craniectomy for subdural hemorrhage (overall mortality 2.6%).

Conclusions: The majority of camel-related head injury occurred in camel caregivers at camel farms and can be considered a work-related injury. Careful handling of camels, especially during the summertime can reduce the toll of camel-related head injury and its serious consequences. None of the injured patients was wearing a helmet at the time of injury. Legislation for compulsory helmet usage by camel caregivers at farms may decrease the incidence of head injuries in those patients.