Carlos Serna, José Julián Serna, Yaset Caicedo, Natalia Padilla, Linda M Gallego, Alexander Salcedo, Fernando Rodríguez-Holguín, Adolfo González-Hadad, Alberto García, Mario Alain Herrera, Michael W Parra, Carlos A Ordoñez
The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.
{"title":"Damage control surgery for splenic trauma: \"preserve an organ - preserve a life\".","authors":"Carlos Serna, José Julián Serna, Yaset Caicedo, Natalia Padilla, Linda M Gallego, Alexander Salcedo, Fernando Rodríguez-Holguín, Adolfo González-Hadad, Alberto García, Mario Alain Herrera, Michael W Parra, Carlos A Ordoñez","doi":"10.25100/cm.v52i2.4794","DOIUrl":"https://doi.org/10.25100/cm.v52i2.4794","url":null,"abstract":"<p><p>The spleen is one of the most commonly injured solid organs of the abdominal cavity and an early diagnosis can reduce the associated mortality. Over the past couple of decades, management of splenic injuries has evolved to a prefered non-operative approach even in severely injured cases. However, the optimal surgical management of splenic trauma in severely injured patients remains controversial. This article aims to present an algorithm for the management of splenic trauma in severely injured patients, that includes basic principles of damage control surgery and is based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. The choice between a conservative or a surgical approach depends on the hemodynamic status of the patient. In hemodynamically stable patients, a computed tomography angiogram should be performed to determine if non-operative management is feasible and if angioembolization is required. While hemodynamically unstable patients should be transferred immediately to the operating room for damage control surgery, which includes splenic packing and placement of a negative pressure dressing, followed by angiography with embolization of any ongoing arterial bleeding. It is our recommendation that both damage control principles and emerging endovascular technologies should be applied to achieve splenic salvage when possible. However, if surgical bleeding persists a splenectomy may be required as a definitive lifesaving maneuver.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/94/85/1657-9534-cm-52-02-e4084794.PMC8216056.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39121696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Helmer Emilio Palacios-Rodríguez, Nao Hiroe, Mónica Guzmán-Rodríguez, Yaset Caicedo, Luis Saldarriaga, Carlos A Ordoñez, Tomohiro Funabiki
Trauma damage control seeks to limit life-threatening bleeding. Sequential diagnostic and therapeutic approaches are the current standard. Hybrid Room have reduced hemostasis time by integrating different specialties and technologies. Hybrid Rooms seek to control bleeding in an operating room equipped with specialized personnel and advanced technology including angiography, tomography, eFAST, radiography, endoscopy, infusers, cell retrievers, REBOA, etc. Trauma Hybrid Service is a concept that describes a vertical work scheme that begins with the activation of Trauma Code when admitting a severely injured patient, initiating a continuous resuscitation process led by the trauma surgeon who guides transfer to imaging, angiography and surgery rooms according to the patient's condition and the need for specific interventions. Hybrid rooms integrate different diagnostic and therapeutic tools in one same room, reducing the attention time and increasing all interventions effectiveness.
{"title":"Hybrid trauma service: on the leading edge of damage Control.","authors":"Helmer Emilio Palacios-Rodríguez, Nao Hiroe, Mónica Guzmán-Rodríguez, Yaset Caicedo, Luis Saldarriaga, Carlos A Ordoñez, Tomohiro Funabiki","doi":"10.25100/cm.v52i2.4686","DOIUrl":"https://doi.org/10.25100/cm.v52i2.4686","url":null,"abstract":"<p><p>Trauma damage control seeks to limit life-threatening bleeding. Sequential diagnostic and therapeutic approaches are the current standard. Hybrid Room have reduced hemostasis time by integrating different specialties and technologies. Hybrid Rooms seek to control bleeding in an operating room equipped with specialized personnel and advanced technology including angiography, tomography, eFAST, radiography, endoscopy, infusers, cell retrievers, REBOA, etc. Trauma Hybrid Service is a concept that describes a vertical work scheme that begins with the activation of Trauma Code when admitting a severely injured patient, initiating a continuous resuscitation process led by the trauma surgeon who guides transfer to imaging, angiography and surgery rooms according to the patient's condition and the need for specific interventions. Hybrid rooms integrate different diagnostic and therapeutic tools in one same room, reducing the attention time and increasing all interventions effectiveness.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f5/22/1657-9534-cm-52-02-e4014686.PMC8216051.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39121691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carlos A Ordoñez, Michael W Parra, Mauricio Millán, Yaset Caicedo, Natalia Padilla, Alberto García, María Josefa Franco, Gonzalo Aristizábal, Luis Eduardo Toro, Luis Fernando Pino, Adolfo González-Hadad, Mario Alain Herrera, José Julián Serna, Fernando Rodríguez-Holguín, Alexander Salcedo, Claudia Orlas, Mónica Guzmán-Rodríguez, Fabian Hernández, Ricardo Ferrada, Rao Ivatury
The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5%. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently managed via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques without significant favorable outcomes and a consequential increase in mortality rates. This article aims to delineate the experience in the surgical management of penetrating duodenal injuries via the creation of a practical and effective algorithm that includes basic principles of damage control surgery that sticks to the philosophy of "Less is Better". Surgical management of all penetrating duodenal trauma should always default when possible to primary repair. When confronted with a complex duodenal injury, hemodynamic instability, and/or significant associated injuries, the default should be damage control surgery. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated and the diamond of death has been corrected.
{"title":"Damage control in penetrating duodenal trauma: less is better - the sequel.","authors":"Carlos A Ordoñez, Michael W Parra, Mauricio Millán, Yaset Caicedo, Natalia Padilla, Alberto García, María Josefa Franco, Gonzalo Aristizábal, Luis Eduardo Toro, Luis Fernando Pino, Adolfo González-Hadad, Mario Alain Herrera, José Julián Serna, Fernando Rodríguez-Holguín, Alexander Salcedo, Claudia Orlas, Mónica Guzmán-Rodríguez, Fabian Hernández, Ricardo Ferrada, Rao Ivatury","doi":"10.25100/cm.v52i2.4509","DOIUrl":"10.25100/cm.v52i2.4509","url":null,"abstract":"<p><p>The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5%. Approximately 80% of these cases are secondary to penetrating trauma, commonly associated with vascular and adjacent organ injuries. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently managed via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques without significant favorable outcomes and a consequential increase in mortality rates. This article aims to delineate the experience in the surgical management of penetrating duodenal injuries via the creation of a practical and effective algorithm that includes basic principles of damage control surgery that sticks to the philosophy of \"Less is Better\". Surgical management of all penetrating duodenal trauma should always default when possible to primary repair. When confronted with a complex duodenal injury, hemodynamic instability, and/or significant associated injuries, the default should be damage control surgery. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated and the diamond of death has been corrected.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/33/1657-9534-cm-52-02-e4104509.PMC8216054.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39121095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carlos A Ordoñez, Michael W Parra, Yaset Caicedo, Natalia Padilla, Edison Angamarca, José Julián Serna, Fernando Rodríguez-Holguín, Alberto García, Alexander Salcedo, Luis Fernando Pino, Adolfo González-Hadad, Mario Alain Herrera, Laureano Quintero, Fabian Hernández, María Josefa Franco, Gonzalo Aristizábal, Luis Eduardo Toro, Mónica Guzmán-Rodríguez, Federico Coccolini, Ricardo Ferrada, Rao Ivatury
Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma. Currently, isolated small or large bowel injuries are commonly managed via primary anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring damage control surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, actually increases morbidity. The aim of this article is to delineate the experience obtained in the management of combined hollow viscus injuries of patients suffering from penetrating trauma. We sought out to determine if primary and/or deferred bowel injury repair via anastomosis is the preferred surgical course in patients suffering from combined small and large bowel penetrating injuries. Our experience shows that more than 90% of all combined penetrating bowel injuries can be managed via primary or deferred anastomosis, even in the most severe cases requiring the application of damage control principles. Applying this strategy, the overall need for an ostomy (primary or deferred) could be reduced to less than 10%.
{"title":"Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent?","authors":"Carlos A Ordoñez, Michael W Parra, Yaset Caicedo, Natalia Padilla, Edison Angamarca, José Julián Serna, Fernando Rodríguez-Holguín, Alberto García, Alexander Salcedo, Luis Fernando Pino, Adolfo González-Hadad, Mario Alain Herrera, Laureano Quintero, Fabian Hernández, María Josefa Franco, Gonzalo Aristizábal, Luis Eduardo Toro, Mónica Guzmán-Rodríguez, Federico Coccolini, Ricardo Ferrada, Rao Ivatury","doi":"10.25100/cm.v52i2.4425","DOIUrl":"https://doi.org/10.25100/cm.v52i2.4425","url":null,"abstract":"<p><p>Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma. Currently, isolated small or large bowel injuries are commonly managed via primary anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring damage control surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, actually increases morbidity. The aim of this article is to delineate the experience obtained in the management of combined hollow viscus injuries of patients suffering from penetrating trauma. We sought out to determine if primary and/or deferred bowel injury repair via anastomosis is the preferred surgical course in patients suffering from combined small and large bowel penetrating injuries. Our experience shows that more than 90% of all combined penetrating bowel injuries can be managed via primary or deferred anastomosis, even in the most severe cases requiring the application of damage control principles. Applying this strategy, the overall need for an ostomy (primary or deferred) could be reduced to less than 10%.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1b/9b/1657-9534-cm-52-02-e4114425.PMC8216049.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39121096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To the editor Related article: https://colombiamedica.univalle.edu.co/...iew/4613 We read with interest the paper by Guerrero et al “COVID-19: The Ivermectin African Enigma” . In an ecological study they compared COVID-19 related mortality and infection rates between APOC (African Programme for Onchocerciasis Control) and non-APOC countries. After adjusting for Human Development Index (HDI) and number of performed test, COVID-19 mortality and infection rate were respectively 28% and 8% lower in non-APOC countries compared to APOC countries. The authors suggested that this difference may be related to the community directed treatment with ivermectin (CDTI) programs established in APOC countries. We agree that it remains to be explained why a lower COVID-19 mortality is observed in many APOC countries compared to other parts of the world. However, we do not believe that this is related to CDTI programs. Indeed, in APOC countries ivermectin is distributed only once (most countries) or twice a year 2. Moreover, April 1st 2020, because of the COVID-19 pandemic, CDTI programs were interrupted and were only recently restarted. Ivermectin has an in vitro anti-COVID-19 effect and also certain clinical trials suggested a beneficial effect of ivermectin on COVID-19 disease outcome. However, in a recent small double blind, randomized control trial in Colombia, five days of ivermectin, at a 10 times the recommended dose, did not reduce the duration of symptoms of mild COVID-19 disease compared to placebo. Given the half-life of ivermectin, approximately 18h, it is unlikely that CDTI, only one dose of ivermectin once or twice a year, may be able to reduce COVID-19 related mortality. Many factors could explain the lower COVID-19 mortality in APOC countries. One of them could be exposure to parasitic infections and the immune response induced by these infections. For example, for P. falciparum, a parasitic infection highly prevalent in APOC countries, it has been hypothesised that the immunological memory against P. falciparum merozoites primes SARS-CoV-2 infected cells for early phagocytosis and therefore may protect persons with a recent P. falciparum infection against severe COVID-19 disease. Helminth infections, such as onchocerciasis, may down regulate immune responses and potentially inactivate the inflammatory signalling pathways that may induce acute respiratory distress syndrome (ARDS), one of the causes of death in COVID-19 infected persons
{"title":"COVID-19: The African enigma.","authors":"Robert Colebunders","doi":"10.25100/cm.v52i2.4816","DOIUrl":"https://doi.org/10.25100/cm.v52i2.4816","url":null,"abstract":"To the editor \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000Related article: https://colombiamedica.univalle.edu.co/...iew/4613 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000We read with interest the paper by Guerrero et al “COVID-19: The Ivermectin African Enigma” . In an ecological study they compared COVID-19 related mortality and infection rates between APOC (African Programme for Onchocerciasis Control) and non-APOC countries. After adjusting for Human Development Index (HDI) and number of performed test, COVID-19 mortality and infection rate were respectively 28% and 8% lower in non-APOC countries compared to APOC countries. The authors suggested that this difference may be related to the community directed treatment with ivermectin (CDTI) programs established in APOC countries. \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000We agree that it remains to be explained why a lower COVID-19 mortality is observed in many APOC countries compared to other parts of the world. However, we do not believe that this is related to CDTI programs. Indeed, in APOC countries ivermectin is distributed only once (most countries) or twice a year 2. Moreover, April 1st 2020, because of the COVID-19 pandemic, CDTI programs were interrupted and were only recently restarted. \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000Ivermectin has an in vitro anti-COVID-19 effect and also certain clinical trials suggested a beneficial effect of ivermectin on COVID-19 disease outcome. However, in a recent small double blind, randomized control trial in Colombia, five days of ivermectin, at a 10 times the recommended dose, did not reduce the duration of symptoms of mild COVID-19 disease compared to placebo. Given the half-life of ivermectin, approximately 18h, it is unlikely that CDTI, only one dose of ivermectin once or twice a year, may be able to reduce COVID-19 related mortality. \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000Many factors could explain the lower COVID-19 mortality in APOC countries. One of them could be exposure to parasitic infections and the immune response induced by these infections. For example, for P. falciparum, a parasitic infection highly prevalent in APOC countries, it has been hypothesised that the immunological memory against P. falciparum merozoites primes SARS-CoV-2 infected cells for early phagocytosis and therefore may protect persons with a recent P. falciparum infection against severe COVID-19 disease. Helminth infections, such as onchocerciasis, may down regulate immune responses and potentially inactivate the inflammatory signalling pathways that may induce acute respiratory distress syndrome (ARDS), one of the causes of death in COVID-19 infected persons","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ff/e1/1657-9534-cm-52-02-e7014816.PMC8216052.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39121099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rodrigo Guerrero, L. Bravo, E. Muñoz, Elvia Karina Grillo Ardila, E. Guerrero
We thank Dr. Colebunders for his comments regarding our manuscript. Our study was an ecological study prompted by the low frequency of cases and deaths from the SARS-CoV-2 COVID-19 virus in some African countries. We agree with Dr. Colebunders that other factors could explain the observed association between APOC countries and COVID-19 mortality. However, these unmeasured confounders would have to be strongly associated with Covid-19 mortality to explain the observed 28% reduction. In updated information, as of 12-17-20, APOC countries had a 42% lower risk of death than the non-APOC countries, adjusted for confounders. (Not published) Hellwig et al., in addition to reporting similar findings to ours for African and Asian countries, surmised that they may be connected to ivermectin’s ability to inhibit SARS-CoV-2 replication suggesting other pathways must exist to explain the persistence of such an inhibitory effect after serum levels of ivermectin have declined. As mentioned by Mbow et al. “, it is increasingly recognized that the immune system is shaped not only by genetics but also by environmental factors, such as exposure to microorganisms and parasites. This educates the immune system to protect against invading pathogens not only specifically but also nonspecifically through, for example, “trained immunity,” which involves the reprogramming of innate cells that, on secondary encounter with a pathogen, can show a stronger response.” Those infections, such as onchocerciasis, may downregulate immune responses and potentially inactivate the inflammatory signalling pathways that may induce acute respiratory distress syndrome (ARDS), one of the causes of death in COVID-19 infected persons, seems very attractive explanation.
{"title":"Reply to a letter from Robert Colebunders entitled COVID-19: The African Enigma","authors":"Rodrigo Guerrero, L. Bravo, E. Muñoz, Elvia Karina Grillo Ardila, E. Guerrero","doi":"10.25100/CM.V52I2.4833","DOIUrl":"https://doi.org/10.25100/CM.V52I2.4833","url":null,"abstract":"We thank Dr. Colebunders for his comments regarding our manuscript. Our study was an ecological study prompted by the low frequency of cases and deaths from the SARS-CoV-2 COVID-19 virus in some African countries. We agree with Dr. Colebunders that other factors could explain the observed association between APOC countries and COVID-19 mortality. However, these unmeasured confounders would have to be strongly associated with Covid-19 mortality to explain the observed 28% reduction. In updated information, as of 12-17-20, APOC countries had a 42% lower risk of death than the non-APOC countries, adjusted for confounders. (Not published) \u0000Hellwig et al., in addition to reporting similar findings to ours for African and Asian countries, surmised that they may be connected to ivermectin’s ability to inhibit SARS-CoV-2 replication suggesting other pathways must exist to explain the persistence of such an inhibitory effect after serum levels of ivermectin have declined. As mentioned by Mbow et al. “, it is increasingly recognized that the immune system is shaped not only by genetics but also by environmental factors, such as exposure to microorganisms and parasites. This educates the immune system to protect against invading pathogens not only specifically but also nonspecifically through, for example, “trained immunity,” which involves the reprogramming of innate cells that, on secondary encounter with a pathogen, can show a stronger response.” Those infections, such as onchocerciasis, may downregulate immune responses and potentially inactivate the inflammatory signalling pathways that may induce acute respiratory distress syndrome (ARDS), one of the causes of death in COVID-19 infected persons, seems very attractive explanation. ","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72803544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mario Alain Herrera, Mauricio Millán, Ana Milena Del Valle, Mateo Betancourt-Cajiao, Yaset Caicedo, Isabella Caicedo, Linda M Gallego, Diego Rivera, Michael W Parra, Carlos A Ordoñez
Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient's life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed post-operatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.
{"title":"Damage control of peripheral vascular trauma - Don't be afraid of axillary or popliteal fosses.","authors":"Mario Alain Herrera, Mauricio Millán, Ana Milena Del Valle, Mateo Betancourt-Cajiao, Yaset Caicedo, Isabella Caicedo, Linda M Gallego, Diego Rivera, Michael W Parra, Carlos A Ordoñez","doi":"10.25100/cm.v52i2.4735","DOIUrl":"https://doi.org/10.25100/cm.v52i2.4735","url":null,"abstract":"<p><p>Peripheral vascular injuries are uncommon in civilian trauma but can threaten the patient's life or the viability of the limb. The definitive control of the vascular injury represents a surgical challenge, especially if the patient is hemodynamically unstable. This article proposes the management of peripheral vascular trauma following damage control surgery principles. It is essential to rapidly identify vascular injury signs and perform temporary bleeding control maneuvers. The surgical approaches according to the anatomical injured region should be selected. We propose two novel approaches to access the axillary and popliteal zones. The priority should be to reestablish limb perfusion via primary repair or damage control techniques (vascular shunt or endovascular approach). Major vascular surgeries should be managed post-operatively in the intensive care unit, which will allow correction of physiological derangement and identification of those developing compartmental syndrome. All permanent or temporary vascular procedures should be followed by a definitive repair within the first 8 hours. An early diagnosis and opportune intervention are fundamental to preserve the function and perfusion of the extremity.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/54/5f/1657-9534-cm-52-02-e4074735.PMC8216047.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39121695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mauricio Millán, Carlos A Ordoñez, Michael W Parra, Yaset Caicedo, Natalia Padilla, Luis Fernando Pino, Fernando Rodríguez-Holguín, Alexander Salcedo, Alberto García, José Julián Serna, Mario Alain Herrera, Laureano Quintero, Fabian Hernández, Carlos Serna, Adolfo González Hadad
Penetrating torso trauma is the second leading cause of death following head injury. Traffic accidents, falls and overall blunt trauma are the most common mechanism of injuries in developed countries; whereas, penetrating trauma which includes gunshot and stabs wounds is more prevalent in developing countries due to ongoing violence and social unrest. Penetrating chest and abdominal trauma have high mortality rates at the scene of the incident when important structures such as the heart, great vessels, or liver are involved. Current controversies surround the optimal surgical approach of these cases including the use of an endovascular device such as the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) and the timing of additional imaging aids. This article aims to shed light on this subject based on the experience earned during the past 30 years in trauma critical care management of the severely injured patient. We have found that prioritizing the fact that the patient is hemodynamically unstable and obtaining early open or endovascular occlusion of the aorta to gain ground on avoiding the development of the lethal diamond is of utmost importance. Damage control surgery starts with choosing the right surgery of the right cavity in the right patient. For this purpose, we present a practical and simple guide on how to perform the surgical approach to penetrating torso trauma in a hemodynamically unstable patient.
{"title":"Hemodynamically unstable non-compressible penetrating torso trauma: a practical surgical approach.","authors":"Mauricio Millán, Carlos A Ordoñez, Michael W Parra, Yaset Caicedo, Natalia Padilla, Luis Fernando Pino, Fernando Rodríguez-Holguín, Alexander Salcedo, Alberto García, José Julián Serna, Mario Alain Herrera, Laureano Quintero, Fabian Hernández, Carlos Serna, Adolfo González Hadad","doi":"10.25100/cm.v52i2.4592","DOIUrl":"https://doi.org/10.25100/cm.v52i2.4592","url":null,"abstract":"<p><p>Penetrating torso trauma is the second leading cause of death following head injury. Traffic accidents, falls and overall blunt trauma are the most common mechanism of injuries in developed countries; whereas, penetrating trauma which includes gunshot and stabs wounds is more prevalent in developing countries due to ongoing violence and social unrest. Penetrating chest and abdominal trauma have high mortality rates at the scene of the incident when important structures such as the heart, great vessels, or liver are involved. Current controversies surround the optimal surgical approach of these cases including the use of an endovascular device such as the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) and the timing of additional imaging aids. This article aims to shed light on this subject based on the experience earned during the past 30 years in trauma critical care management of the severely injured patient. We have found that prioritizing the fact that the patient is hemodynamically unstable and obtaining early open or endovascular occlusion of the aorta to gain ground on avoiding the development of the lethal diamond is of utmost importance. Damage control surgery starts with choosing the right surgery of the right cavity in the right patient. For this purpose, we present a practical and simple guide on how to perform the surgical approach to penetrating torso trauma in a hemodynamically unstable patient.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/e8/1657-9534-cm-52-02-e4024592.PMC8216055.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39121692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adolfo González-Hadad, Carlos A Ordoñez, Michael W Parra, Yaset Caicedo, Natalia Padilla, Mauricio Millán, Alberto García, Jenny Marcela Vidal-Carpio, Luis Fernando Pino, Mario Alain Herrera, Laureano Quintero, Fabian Hernández, Guillermo Flórez, Fernando Rodríguez-Holguín, Alexander Salcedo, José Julián Serna, María Josefa Franco, Ricardo Ferrada, Pradeep H Navsaria
Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.
{"title":"Damage control in penetrating cardiac trauma.","authors":"Adolfo González-Hadad, Carlos A Ordoñez, Michael W Parra, Yaset Caicedo, Natalia Padilla, Mauricio Millán, Alberto García, Jenny Marcela Vidal-Carpio, Luis Fernando Pino, Mario Alain Herrera, Laureano Quintero, Fabian Hernández, Guillermo Flórez, Fernando Rodríguez-Holguín, Alexander Salcedo, José Julián Serna, María Josefa Franco, Ricardo Ferrada, Pradeep H Navsaria","doi":"10.25100/cm.v52i2.4519","DOIUrl":"10.25100/cm.v52i2.4519","url":null,"abstract":"<p><p>Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/82/85/1657-9534-cm-52-02-e4034519.PMC8216058.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39121693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jon Ortiz de Salido-Menchaca, Manuel Antonio Tazón-Varela, David de la Hera-Vegas, Rosa Herreras-Martínez, Sergio Andrés Álvarez-Agudelo, Nuria Arencibia-Hernández
Case description: Case of lipemia retinalis secondary to hyperchylomicronemia in a 40-year-old man with a history of total body irradiation and immunosuppressive treatment that was attended in this hospital due to decreased visual acuity and abdominal pain.
Clinical findings: Hyperchylomicronemia caused the development of acute pancreatitis and lipemia retinalis. The latter is an infrequent ocular manifestation that reflects excessive triglyceride blood levels in the organism (>2,000 mg/dL). Lipemia retinalis is characterized by the accumulation of chylomicrons in the retinal vessels, which gives them a white and creamy appearance in direct retinal ophthalmoscopy. The initial clinical suspicion of hyperchylomicronemia was based on the visualization of the supernatant in the analytical tube.
Treatment and result: In the absence of definitive biochemical results, and owing to the need for special processing of the sample, lipid-lowering treatment and serum therapy were established after ophthalmological confirmation of lipemia retinalis, with subsequent full recovery of visual acuity.
Clinical relevance: Given the initial difficulty to determine the accurate triglyceride levels in this kind of patient, early visualization of milky-colored retinal vessels on a salmon-colored eye fundus can help develop an early clinical suspicion of severe hyperchylomicronemia and contribute to limit the severity of complications.
{"title":"Retinal lipemia as expression of hyperchylomicronemia syndrome.","authors":"Jon Ortiz de Salido-Menchaca, Manuel Antonio Tazón-Varela, David de la Hera-Vegas, Rosa Herreras-Martínez, Sergio Andrés Álvarez-Agudelo, Nuria Arencibia-Hernández","doi":"10.25100/cm.v52i1.4059","DOIUrl":"https://doi.org/10.25100/cm.v52i1.4059","url":null,"abstract":"<p><strong>Case description: </strong>Case of lipemia retinalis secondary to hyperchylomicronemia in a 40-year-old man with a history of total body irradiation and immunosuppressive treatment that was attended in this hospital due to decreased visual acuity and abdominal pain.</p><p><strong>Clinical findings: </strong>Hyperchylomicronemia caused the development of acute pancreatitis and lipemia retinalis. The latter is an infrequent ocular manifestation that reflects excessive triglyceride blood levels in the organism (>2,000 mg/dL). Lipemia retinalis is characterized by the accumulation of chylomicrons in the retinal vessels, which gives them a white and creamy appearance in direct retinal ophthalmoscopy. The initial clinical suspicion of hyperchylomicronemia was based on the visualization of the supernatant in the analytical tube.</p><p><strong>Treatment and result: </strong>In the absence of definitive biochemical results, and owing to the need for special processing of the sample, lipid-lowering treatment and serum therapy were established after ophthalmological confirmation of lipemia retinalis, with subsequent full recovery of visual acuity.</p><p><strong>Clinical relevance: </strong>Given the initial difficulty to determine the accurate triglyceride levels in this kind of patient, early visualization of milky-colored retinal vessels on a salmon-colored eye fundus can help develop an early clinical suspicion of severe hyperchylomicronemia and contribute to limit the severity of complications.</p>","PeriodicalId":50667,"journal":{"name":"Colombia Medica","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/19/1657-9534-cm-52-01-e7024059.PMC8054710.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38917991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}