Pub Date : 2019-12-01DOI: 10.5005/jp-journals-10030-1250
The difficulty in diagnosing injuries to the duodenum and pancreas is attributed to the fact that they are retroperitoneal structures, therefore, well protected by the surrounding viscera. As a result, injuries to these organs are rare and also easily missed. Most trauma surgeons have limited experience in treating them. The epidemiologic study from Trauma Audit and Research in the UK found a combined incidence of 4.7% for pancreatic and duodenal injuries among patients with abdominal trauma.1 The retroperitoneal location of these organs results in a delay of symptomatology and frequently diagnosis. Injuries requiring surgical repair are more common as a consequence of a penetrating mechanism. In most cases, trauma to the duodenum and pancreas is associated with other injuries potentially changing the surgical approach. Moreover, in patients with pancreatic or duodenal injury, a complete evaluation must be performed in order to rule out an associated visceral injury. Injuries caused by blunt or penetrating trauma with high mechanisms can continue to evolve over time such as contusion of the mesentery or blunt trauma to the bowel. This is particularly important when evaluating injuries to the pancreas and the duodenum, since injuries that might have appeared insignificant can result in ischemia and perforation if not treated appropriately.2 There are significant implications of a joint pancreatic and duodenal injury. Injury to the pancreatic duct results in uncontrolled leak of pancreatic enzymes that become a threat to any repair. Secretion of pancreatic enzymes increases morbidity and mortality secondary to suture line dehiscence and secondary intra-abdominal sepsis.3 The outcomes of these injuries have improved over the years secondary to increased awareness, earlier diagnosis and treatment, appropriate resuscitation to euvolemia avoiding secondary physiological insult to the patient, and advances in adjuncts for nutritional support.4 The following chapter will focus on clinical presentation and operative techniques that can help the surgeon treat these complicated patients. An Ato m I c A l co n s I d e r At I o n s Vascular Supply The vascular supply to the duodenum and pancreas is provided by the superior and inferior pancreaticoduodenal arteries, which are branches from celiac and superior mesenteric arteries, respectively. Both pancreaticoduodenal arteries provide anterior and posterior branches. In turn these branches have several small vessels entering the duodenal wall and the head of the pancreas. Therefore, dissecting and isolating the duodenum from the pancreas is a difficult maneuver due to bleeding. Duodenal devascularization is always a concern. The right gastric artery and the splenic artery give rise to additional arterial branches to the duodenum and the body and tail of the pancreas. The venous drainage follows the arteries and provides tributaries to the splenic vein and superior mesenteric vein. Both drain into the portal ve
{"title":"Duodenal and Pancreatic Trauma","authors":"","doi":"10.5005/jp-journals-10030-1250","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1250","url":null,"abstract":"The difficulty in diagnosing injuries to the duodenum and pancreas is attributed to the fact that they are retroperitoneal structures, therefore, well protected by the surrounding viscera. As a result, injuries to these organs are rare and also easily missed. Most trauma surgeons have limited experience in treating them. The epidemiologic study from Trauma Audit and Research in the UK found a combined incidence of 4.7% for pancreatic and duodenal injuries among patients with abdominal trauma.1 The retroperitoneal location of these organs results in a delay of symptomatology and frequently diagnosis. Injuries requiring surgical repair are more common as a consequence of a penetrating mechanism. In most cases, trauma to the duodenum and pancreas is associated with other injuries potentially changing the surgical approach. Moreover, in patients with pancreatic or duodenal injury, a complete evaluation must be performed in order to rule out an associated visceral injury. Injuries caused by blunt or penetrating trauma with high mechanisms can continue to evolve over time such as contusion of the mesentery or blunt trauma to the bowel. This is particularly important when evaluating injuries to the pancreas and the duodenum, since injuries that might have appeared insignificant can result in ischemia and perforation if not treated appropriately.2 There are significant implications of a joint pancreatic and duodenal injury. Injury to the pancreatic duct results in uncontrolled leak of pancreatic enzymes that become a threat to any repair. Secretion of pancreatic enzymes increases morbidity and mortality secondary to suture line dehiscence and secondary intra-abdominal sepsis.3 The outcomes of these injuries have improved over the years secondary to increased awareness, earlier diagnosis and treatment, appropriate resuscitation to euvolemia avoiding secondary physiological insult to the patient, and advances in adjuncts for nutritional support.4 The following chapter will focus on clinical presentation and operative techniques that can help the surgeon treat these complicated patients. An Ato m I c A l co n s I d e r At I o n s Vascular Supply The vascular supply to the duodenum and pancreas is provided by the superior and inferior pancreaticoduodenal arteries, which are branches from celiac and superior mesenteric arteries, respectively. Both pancreaticoduodenal arteries provide anterior and posterior branches. In turn these branches have several small vessels entering the duodenal wall and the head of the pancreas. Therefore, dissecting and isolating the duodenum from the pancreas is a difficult maneuver due to bleeding. Duodenal devascularization is always a concern. The right gastric artery and the splenic artery give rise to additional arterial branches to the duodenum and the body and tail of the pancreas. The venous drainage follows the arteries and provides tributaries to the splenic vein and superior mesenteric vein. Both drain into the portal ve","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74966290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.5005/jp-journals-10030-1251
Introduction: Motorcycles have become a popular choice of transport in Tanzania, hence there is an increase in motorcycle crashes. Considering the high rate of motorcycle crashes, magnitude and seriousness of the injuries in the head and neck region, studying the pattern of maxillofacial injuries in motorcycle crash victims (MCV) is inevitable. The aim of the study was to investigate the occurrence, types, and treatment of maxillofacial fractures in MCV at Muhimbili, a tertiary national hospital in Tanzania. Materials and methods: This was a descriptive, cross-sectional, and hospital-based study that included all MCV. These were received, interviewed (including the use or nonuse of helmets and alcohol intake), physically examined, and investigated for maxillofacial injuries. Maxillofacial fractures were categorized as mandibular, midface, and upper third of face (frontal) fractures. Management of the injuries included supportive, medical, and surgical treatment. The data were analyzed using Statistical Package for Social Sciences (SPSS) Version 20. Results: A total of 116 MCV predominantly (113, 97.4%) men were included in this study with a male-to-female ratio of 37.7:1. The crash victims were aged between 14 years and 66 years (mean of 29.43 ± 8.88), and the 20 years and 39 years age group was the most affected. More than half (53.4%) of the victims had not put on helmets and only 18.1% of the victims were under the influence of alcohol during the crashes. The majority (89.7%) of MCV sustained maxillofacial fractures whereby 71.2% had mandibular fractures, 66.3% had midface fractures, and 9.6% had frontal bone fractures. The severity of injuries significantly correlated with the speed of motorbikes during crashes. Maxillomandibular fixation (MMF) was the commonest treatment modality of the fractures employed. Conclusion: The findings of this study revealed that young men (14–39 years) were more prone to motorcycle crashes. The majority of MCV did not wear helmets and only a few were under the influence of alcohol during the crashes. The mandible and zygoma were the frequently fractured bones and the odds of multiple fractures increased with increased speed of motorbikes. Clinical significance: The results of this study cast light on the pattern and burden of oral and maxillofacial injuries in Tanzania, thus serving as the basis for future interventions to improve the injured patient outcomes, and reduce morbidity and mortality. The information obtained from this study can be used by public health researchers to improve health policies on road traffic crash prevention.
{"title":"Maxillofacial Fractures among Motorcycle Crash Victims Attended at a Tertiary Hospital in Tanzania","authors":"","doi":"10.5005/jp-journals-10030-1251","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1251","url":null,"abstract":"Introduction: Motorcycles have become a popular choice of transport in Tanzania, hence there is an increase in motorcycle crashes. Considering the high rate of motorcycle crashes, magnitude and seriousness of the injuries in the head and neck region, studying the pattern of maxillofacial injuries in motorcycle crash victims (MCV) is inevitable. The aim of the study was to investigate the occurrence, types, and treatment of maxillofacial fractures in MCV at Muhimbili, a tertiary national hospital in Tanzania. Materials and methods: This was a descriptive, cross-sectional, and hospital-based study that included all MCV. These were received, interviewed (including the use or nonuse of helmets and alcohol intake), physically examined, and investigated for maxillofacial injuries. Maxillofacial fractures were categorized as mandibular, midface, and upper third of face (frontal) fractures. Management of the injuries included supportive, medical, and surgical treatment. The data were analyzed using Statistical Package for Social Sciences (SPSS) Version 20. Results: A total of 116 MCV predominantly (113, 97.4%) men were included in this study with a male-to-female ratio of 37.7:1. The crash victims were aged between 14 years and 66 years (mean of 29.43 ± 8.88), and the 20 years and 39 years age group was the most affected. More than half (53.4%) of the victims had not put on helmets and only 18.1% of the victims were under the influence of alcohol during the crashes. The majority (89.7%) of MCV sustained maxillofacial fractures whereby 71.2% had mandibular fractures, 66.3% had midface fractures, and 9.6% had frontal bone fractures. The severity of injuries significantly correlated with the speed of motorbikes during crashes. Maxillomandibular fixation (MMF) was the commonest treatment modality of the fractures employed. Conclusion: The findings of this study revealed that young men (14–39 years) were more prone to motorcycle crashes. The majority of MCV did not wear helmets and only a few were under the influence of alcohol during the crashes. The mandible and zygoma were the frequently fractured bones and the odds of multiple fractures increased with increased speed of motorbikes. Clinical significance: The results of this study cast light on the pattern and burden of oral and maxillofacial injuries in Tanzania, thus serving as the basis for future interventions to improve the injured patient outcomes, and reduce morbidity and mortality. The information obtained from this study can be used by public health researchers to improve health policies on road traffic crash prevention.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73259871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.5005/jp-journals-10030-1256
Background: While extensive research has been conducted on healthcare utilization after severe penetrating trauma events, there is a dearth of information on healthcare utilization prior to these events. This study examined the emergency department (ED) utilization patterns to determine if prior ED visits for injury were a risk factor for severe penetrating trauma. Materials and methods: This retrospective cohort study examined the ED visit records of 215,800 patients with 489,800 ED visits and 3,322 trauma registry patients from November 2010 to February 2015 at Grady Memorial Hospital, a large, urban hospital with a level I trauma center. Data analysis was conducted using logistic regression and Cox proportional hazard models. Results: Among 215,800 ED patients, 224 patients with prior ED visits experienced severe penetrating trauma (as reported to the trauma registry). After adjustment for age, sex, employment, insurance, high utilization, and admission status, prior ED visits for injury were associated with severe penetrating trauma (OR 1.60, CI 1.21–2.10, p = 0.001). Cox proportional hazard models were used to estimate hazard ratios (HR) for factors associated with time to a penetrating trauma event following a patient’s last ED visit. After adjusting for age, sex, employment status, admission status, high utilization, and insurance status, patients with an injury diagnosis at their last ED visit had a HR of 1.43 (CI 1.07–1.93, p = 0.016). Conclusion: After adjusting for confounders, a previous ED visit for injury remained a significant risk factor for severe penetrating trauma and an elevated rate of time to penetrating trauma. These findings suggest a need for targeted violence intervention programs and improved ED injury surveillance.
背景:虽然对严重穿透性创伤事件后的医疗保健利用进行了广泛的研究，但缺乏这些事件之前的医疗保健利用信息。本研究调查了急诊科(ED)的使用模式，以确定先前的外伤就诊是否是严重穿透性创伤的危险因素。材料和方法:本回顾性队列研究调查了2010年11月至2015年2月格雷迪纪念医院(一家拥有一级创伤中心的大型城市医院)215,800名患者的急诊记录，其中489,800例急诊和3,322例创伤登记患者。数据分析采用logistic回归和Cox比例风险模型。结果:在215,800例急诊科患者中，224例急诊患者经历了严重的穿透性创伤(据创伤登记处报告)。在调整了年龄、性别、就业、保险、高使用率和入院状况后，因损伤而去急诊室就诊的患者与严重穿透性创伤相关(OR 1.60, CI 1.21-2.10, p = 0.001)。Cox比例风险模型用于估计患者最后一次急诊科就诊后发生穿透性创伤事件的时间相关因素的风险比(HR)。在调整了年龄、性别、就业状况、住院状况、高使用率和保险状况后，最后一次急诊室就诊时诊断为损伤的患者的HR为1.43 (CI 1.07-1.93, p = 0.016)。结论:在调整混杂因素后，以前因损伤而去急诊室就诊仍然是严重穿透性创伤的重要危险因素，并且穿透性创伤的时间增加。这些发现表明需要有针对性的暴力干预计划和改进ED损伤监测。
{"title":"Prior Emergency Department Utilization as a Predictor for Severe Penetrating Trauma: A Retrospective Cohort Study","authors":"","doi":"10.5005/jp-journals-10030-1256","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1256","url":null,"abstract":"Background: While extensive research has been conducted on healthcare utilization after severe penetrating trauma events, there is a dearth of information on healthcare utilization prior to these events. This study examined the emergency department (ED) utilization patterns to determine if prior ED visits for injury were a risk factor for severe penetrating trauma. Materials and methods: This retrospective cohort study examined the ED visit records of 215,800 patients with 489,800 ED visits and 3,322 trauma registry patients from November 2010 to February 2015 at Grady Memorial Hospital, a large, urban hospital with a level I trauma center. Data analysis was conducted using logistic regression and Cox proportional hazard models. Results: Among 215,800 ED patients, 224 patients with prior ED visits experienced severe penetrating trauma (as reported to the trauma registry). After adjustment for age, sex, employment, insurance, high utilization, and admission status, prior ED visits for injury were associated with severe penetrating trauma (OR 1.60, CI 1.21–2.10, p = 0.001). Cox proportional hazard models were used to estimate hazard ratios (HR) for factors associated with time to a penetrating trauma event following a patient’s last ED visit. After adjusting for age, sex, employment status, admission status, high utilization, and insurance status, patients with an injury diagnosis at their last ED visit had a HR of 1.43 (CI 1.07–1.93, p = 0.016). Conclusion: After adjusting for confounders, a previous ED visit for injury remained a significant risk factor for severe penetrating trauma and an elevated rate of time to penetrating trauma. These findings suggest a need for targeted violence intervention programs and improved ED injury surveillance.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79554913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.5005/jp-journals-10030-1252
Ab s t r Ac t Introduction: Optimal cuff pressure for intubated patients is 20–30 cm H2O as routinely measured by manometry. This methodology is associated with elevated costs due to equipment requirements. The objective of this study was to evaluate another methodology, i.e., the minimal leak testing (MLT). Materials and methods: Initial cuff pressures were measured by manometry for all mechanically ventilated patients in a surgical intensive care unit (ICU). Two critical care physicians separately performed an MLT for each subject and cuff pressure was then remeasured by manometry. The rate of ventilator-associated pneumonia (VAP) was determined. Results: Thirty subjects with 100 patient events were evaluated. The post-MLT measured cuff pressures were highly consistent between physicians, with a Pearson correlation coefficient of 0.770 (p = 0.01). Average initial cuff pressures were not significantly different between manometry and MLT (25 cm H2O vs 14 cm H2O, p = 0.1894). Manometry had a higher incidence of elevated cuff pressures (n = 13/50 vs 2/100, p < 0.0001), while MLT had higher incidences low cuff pressures (n = 72/100 vs 17/50, p < 0.0001). No difference was observed in the VAP rate (2.8 vs 3.0 per 1,000 ventilator days, p = 0.96). Conclusion: Minimal leak testing is a known method of cuff pressure monitoring that was demonstrated in this study to provide a reproducible technique.
简介:插管患者的最佳袖带压力为20-30 cm H2O，常规测压。这种方法与设备需求导致的成本上升有关。本研究的目的是评估另一种方法，即最小泄漏测试(MLT)。材料和方法:对外科重症监护病房(ICU)所有机械通气患者进行初始袖带压力测量。两名重症监护医生分别对每位受试者进行MLT，然后通过测压仪重新测量袖带压力。测定呼吸机相关性肺炎(VAP)发生率。结果:30名受试者，100例患者事件被评估。mlt后测量的袖带压力在医生之间高度一致，Pearson相关系数为0.770 (p = 0.01)。平均初始袖带压力在测压和MLT之间没有显著差异(25 cm H2O vs 14 cm H2O, p = 0.1894)。测压术的袖带压力升高发生率较高(n = 13/50 vs 2/100, p < 0.0001)，而MLT的袖带压力降低发生率较高(n = 72/100 vs 17/50, p < 0.0001)。VAP率无差异(2.8 vs 3.0 / 1000呼吸机日，p = 0.96)。结论:最小泄漏测试是一种已知的袖带压力监测方法，在本研究中证明了它提供了一种可重复的技术。
{"title":"Minimal Leak Test vs Manometry for Endotracheal Cuff Pressure Monitoring: A Pilot Study","authors":"","doi":"10.5005/jp-journals-10030-1252","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1252","url":null,"abstract":"Ab s t r Ac t Introduction: Optimal cuff pressure for intubated patients is 20–30 cm H2O as routinely measured by manometry. This methodology is associated with elevated costs due to equipment requirements. The objective of this study was to evaluate another methodology, i.e., the minimal leak testing (MLT). Materials and methods: Initial cuff pressures were measured by manometry for all mechanically ventilated patients in a surgical intensive care unit (ICU). Two critical care physicians separately performed an MLT for each subject and cuff pressure was then remeasured by manometry. The rate of ventilator-associated pneumonia (VAP) was determined. Results: Thirty subjects with 100 patient events were evaluated. The post-MLT measured cuff pressures were highly consistent between physicians, with a Pearson correlation coefficient of 0.770 (p = 0.01). Average initial cuff pressures were not significantly different between manometry and MLT (25 cm H2O vs 14 cm H2O, p = 0.1894). Manometry had a higher incidence of elevated cuff pressures (n = 13/50 vs 2/100, p < 0.0001), while MLT had higher incidences low cuff pressures (n = 72/100 vs 17/50, p < 0.0001). No difference was observed in the VAP rate (2.8 vs 3.0 per 1,000 ventilator days, p = 0.96). Conclusion: Minimal leak testing is a known method of cuff pressure monitoring that was demonstrated in this study to provide a reproducible technique.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90846894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.5005/jp-journals-10030-1253
El riñón es un órgano frecuentemente afectado en niños con trauma abdominal. Aproximadamente 1 de cada 10 pacientes tendrá una lesión del parénquima renal, los hilios vasculares o los sistemas colectores. El objetivo de este trabajo fue analizar una serie de pacientes pediátricos con trauma renal, evaluar su comportamiento y el resultado de las conductas mediante un estudio retrospectivo y descriptivo. Se incluyeron pacientes menores de 15 años ingresados con sospecha y/o diagnóstico de trauma renal entre enero 2013 y marzo de 2019 al Hospital Universitario San Vicente Fundación de la ciudad de Medellín, Colombia. Los criterios de exclusión fueron todos aquellos pacientes con historia clínica incompleta, mayores de 15 años, lesiones iatrogénicas y malformación renal conocida. Se identificaron 144 pacientes con diagnóstico de trauma abdominal y sospecha de compromiso renal; en el 29.9% se pudo confirmar el diagnóstico. De los 43 pacientes, el 65.1% fueron hombres y la edad promedio fue de 9.4 años. El trauma cerrado correspondió al 93% siendo la principal etiología las caídas (27.9%) seguidas del trauma contuso (20.9%). Los síntomas principales fueron el dolor lumbar, abdominal y la hematuria. El trauma grado III fue el más frecuente (40.2%) seguido del IV (30.2%). La conducta más frecuente fue la observación clínica (76.7%) con una efectividad del 100%. El 16.3% requirió cirugía y el 7% angioembolización como manejos iniciales con una efectividad del 100% y 66% respectivamente. La tasa de complicaciones fue del 7% y no se presentaron muertes en el presente estudio. Palabras clave: Angioembolización, Conservadora, Riñón, No operativo, Pediátrica, Trauma.
{"title":"Análisis de una serie de trauma renal en pacientes menores de 15 años en un centro hospitalario de alta complejidad de la ciudad de Medellín, Colombia","authors":"","doi":"10.5005/jp-journals-10030-1253","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1253","url":null,"abstract":"El riñón es un órgano frecuentemente afectado en niños con trauma abdominal. Aproximadamente 1 de cada 10 pacientes tendrá una lesión del parénquima renal, los hilios vasculares o los sistemas colectores. El objetivo de este trabajo fue analizar una serie de pacientes pediátricos con trauma renal, evaluar su comportamiento y el resultado de las conductas mediante un estudio retrospectivo y descriptivo. Se incluyeron pacientes menores de 15 años ingresados con sospecha y/o diagnóstico de trauma renal entre enero 2013 y marzo de 2019 al Hospital Universitario San Vicente Fundación de la ciudad de Medellín, Colombia. Los criterios de exclusión fueron todos aquellos pacientes con historia clínica incompleta, mayores de 15 años, lesiones iatrogénicas y malformación renal conocida. Se identificaron 144 pacientes con diagnóstico de trauma abdominal y sospecha de compromiso renal; en el 29.9% se pudo confirmar el diagnóstico. De los 43 pacientes, el 65.1% fueron hombres y la edad promedio fue de 9.4 años. El trauma cerrado correspondió al 93% siendo la principal etiología las caídas (27.9%) seguidas del trauma contuso (20.9%). Los síntomas principales fueron el dolor lumbar, abdominal y la hematuria. El trauma grado III fue el más frecuente (40.2%) seguido del IV (30.2%). La conducta más frecuente fue la observación clínica (76.7%) con una efectividad del 100%. El 16.3% requirió cirugía y el 7% angioembolización como manejos iniciales con una efectividad del 100% y 66% respectivamente. La tasa de complicaciones fue del 7% y no se presentaron muertes en el presente estudio. Palabras clave: Angioembolización, Conservadora, Riñón, No operativo, Pediátrica, Trauma.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88703851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.5005/jp-journals-10030-1249
Re s u m e n Introducción: Onda explosiva se define como la liberación violenta de energía que es transferida hacia el ambiente; siendo esta capaz de empujar columnas de aire, material particulado y gases calientes que al encontrarse con el cuerpo humano ocasionan lesiones que pueden llegar a comprometer la vida. Materiales y métodos: Se presenta una revisión narrativa de la literatura con herramientas de revisión sistemática sobre el tema de trauma por onda expansiva. Excluyendo artículos no relacionados con trauma por onda expansiva publicados en idiomas diferentes al español y al inglés y aquellos cuya temática central es diferente de lo tratado por la cirugía general y sus subespecialidades. Discussion: Se describe cada uno de los 5 mecanismos de lesión descritos para este tipo de trauma, y se hace un resumen del diagnóstico y manejo de las lesiones más frecuentes a nivel torácico, abdominal y vascular periférico. Conclusión: Es esencial conocer los mecanismos de lesión para dar el manejo adecuado a los pacientes víctimas de este tipo de lesiones de una manera multidisciplinaria. Palabras clave: Cirugía general, Onda explosiva, Poli-trauma, Terrorismo, Trauma, Trauma de explosión.
{"title":"Trauma Por Onda Explosiva La Mirada Del Cirujano General En La Práctica Civil","authors":"","doi":"10.5005/jp-journals-10030-1249","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1249","url":null,"abstract":"Re s u m e n Introducción: Onda explosiva se define como la liberación violenta de energía que es transferida hacia el ambiente; siendo esta capaz de empujar columnas de aire, material particulado y gases calientes que al encontrarse con el cuerpo humano ocasionan lesiones que pueden llegar a comprometer la vida. Materiales y métodos: Se presenta una revisión narrativa de la literatura con herramientas de revisión sistemática sobre el tema de trauma por onda expansiva. Excluyendo artículos no relacionados con trauma por onda expansiva publicados en idiomas diferentes al español y al inglés y aquellos cuya temática central es diferente de lo tratado por la cirugía general y sus subespecialidades. Discussion: Se describe cada uno de los 5 mecanismos de lesión descritos para este tipo de trauma, y se hace un resumen del diagnóstico y manejo de las lesiones más frecuentes a nivel torácico, abdominal y vascular periférico. Conclusión: Es esencial conocer los mecanismos de lesión para dar el manejo adecuado a los pacientes víctimas de este tipo de lesiones de una manera multidisciplinaria. Palabras clave: Cirugía general, Onda explosiva, Poli-trauma, Terrorismo, Trauma, Trauma de explosión.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88469446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.5005/jp-journals-10030-1255
E. Utiyama, Leonardo Ks Koyama, Alissom Vitti Cincoto, Adriano Rm Pflug, F. D. S. C. E. Silva
Perforating pancreatic injury (PPI) is an uncommon event in trauma centers. In rare cases, it can complicate with pancreatic fluid collections (PFC). Although it is well known in cases of acute pancreatitis, there are few described cases in trauma patients. Another feared complication is the disconnection of the major pancreatic duct (MPD), which most authors recommend to be treated immediately. We hereby report a successful case of PPI that was initially approached by videolaparoscopy, coursed with an infected PFC formation and a MPD disconnection. This case analysis suggests that videolaparoscopy may be feasible in patients with PPI and that minimally invasive approaches in the acute phase might postpone more aggressive procedures to an elective and well-planned approach.
{"title":"Perforating Pancreatic Injury: New Approaches and Unexpected Complications","authors":"E. Utiyama, Leonardo Ks Koyama, Alissom Vitti Cincoto, Adriano Rm Pflug, F. D. S. C. E. Silva","doi":"10.5005/jp-journals-10030-1255","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1255","url":null,"abstract":"Perforating pancreatic injury (PPI) is an uncommon event in trauma centers. In rare cases, it can complicate with pancreatic fluid collections (PFC). Although it is well known in cases of acute pancreatitis, there are few described cases in trauma patients. Another feared complication is the disconnection of the major pancreatic duct (MPD), which most authors recommend to be treated immediately. We hereby report a successful case of PPI that was initially approached by videolaparoscopy, coursed with an infected PFC formation and a MPD disconnection. This case analysis suggests that videolaparoscopy may be feasible in patients with PPI and that minimally invasive approaches in the acute phase might postpone more aggressive procedures to an elective and well-planned approach.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"130 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79605490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.5005/jp-journals-10030-1248
Aim: To assess the impact of international surgical observership, the level of satisfaction of past participants and obtain their feedback on their experience. Since 2011, the international observership program (IOP) is offered in partnership with the Panamerican Trauma Society (PTS) and the Virginia Commonwealth University (VCU), Division of Acute Care Surgery Services. The IOP has facilitated knowledge exchange opportunities on trauma care and emergency medical systems (EMSs) for physicians in training from Latin America countries. Materials and methods: An online survey using REDCap was conducted among past participants (n = 36). The 14-question survey had a combination of dichotomous, multiple-choice, open-ended, and Likert scale questions. To keep the survey anonymous, participant identifiers were not used. Descriptive analysis was carried out. Results: The response rate was 53% (n = 19). The overall effect of IOP should be considered as positive, as 17 (89%) respondent alumni consider the IOP exceeded or met their expectations and 18 (95%) would recommend it to a friend and colleague. Similarly, 89% of the IOP’s alumni believe that the observership helped them with their career growth. Most of the observers commented that the experience was inspiring, opened their minds, and broadened their horizons. Conclusion: The present survey adds further evidence of the positive impact that international observerships offer to physicians in training coming from lowand middle-income countries. The IOP introduces students to new knowledge for comprehensive care of trauma patients that would be advantageous to their future professional roles.
{"title":"Impact of Participation in an International Surgical Observership Program: Results of an Online Survey","authors":"","doi":"10.5005/jp-journals-10030-1248","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1248","url":null,"abstract":"Aim: To assess the impact of international surgical observership, the level of satisfaction of past participants and obtain their feedback on their experience. Since 2011, the international observership program (IOP) is offered in partnership with the Panamerican Trauma Society (PTS) and the Virginia Commonwealth University (VCU), Division of Acute Care Surgery Services. The IOP has facilitated knowledge exchange opportunities on trauma care and emergency medical systems (EMSs) for physicians in training from Latin America countries. Materials and methods: An online survey using REDCap was conducted among past participants (n = 36). The 14-question survey had a combination of dichotomous, multiple-choice, open-ended, and Likert scale questions. To keep the survey anonymous, participant identifiers were not used. Descriptive analysis was carried out. Results: The response rate was 53% (n = 19). The overall effect of IOP should be considered as positive, as 17 (89%) respondent alumni consider the IOP exceeded or met their expectations and 18 (95%) would recommend it to a friend and colleague. Similarly, 89% of the IOP’s alumni believe that the observership helped them with their career growth. Most of the observers commented that the experience was inspiring, opened their minds, and broadened their horizons. Conclusion: The present survey adds further evidence of the positive impact that international observerships offer to physicians in training coming from lowand middle-income countries. The IOP introduces students to new knowledge for comprehensive care of trauma patients that would be advantageous to their future professional roles.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75512538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Ordoñez, A. García, M. Parra, J. Herrera-Escobar, M. Guzmán-Rodríguez, Carlos García, Hernán E. Munevar, C. Navarro, Alejandra de las Salas, Laura Ibarra, A. Holguín, Ana Milena del Valle
Background Single Pass Whole-Body Computed Tomography (WBCT) has been used as a high yield diagnostic tool in trauma. However, increased exposure to radiation and delay in treatment, have been cited as challenges to its widespread use. We hypothesized that WBCT has at least the same radiation exposure compared to Organ-Selective CT and it does not inflict further delays in treatment. Methods We retrospectively review all trauma patients in whom CT-scans were performed on arrival at a Level I Trauma Center from January, 2016 to December, 2017. Results 123 patients were included: 53 in the OSCT group and 70 in the WBCT group. In the OSCT group, 64.1% of the patients had penetrating trauma and chest injuries were the most common injured body cavity (79.3%). In the WBCT group, 65.7% had blunt trauma and head injuries were the most common (71.9%) injured organ. The OSCT group required subsequent trips to the scanner suite for follow-up studies to rule out other potential injuries which in turn did not occur in the WBCT group (47.2% vs 0%, p< 0.001). The total radiation exposure dose was higher in the OSCT group compared to the WBCT group [22 mSv (IQR 6-31) vs 15.1 mSv (IQR 9.9-24.8) p<0.001]. Conclusion OSCT has the potential of missing potentially life threatening injuries that require subsequent follow-up scans. This, in turn, would increase the patient’s overall radiation exposure and potentially delay definitive surgical treatment. Trauma patients undergoing WBCT had lower total radiation exposure with no delay in treatment.
背景:单次全身计算机断层扫描(WBCT)已被用作创伤的高诊断工具。然而，暴露于辐射的增加和治疗的延迟，被认为是对其广泛使用的挑战。我们假设，与器官选择性CT相比，WBCT至少具有相同的辐射暴露，并且不会造成进一步的治疗延误。方法回顾性分析2016年1月至2017年12月在一级创伤中心接受ct扫描的所有创伤患者。结果共纳入123例患者，其中OSCT组53例，WBCT组70例。在OSCT组中，64.1%的患者有穿透性损伤，胸部损伤是最常见的体腔损伤(79.3%)。在WBCT组中，65.7%为钝性创伤，头部损伤是最常见的器官损伤(71.9%)。OSCT组需要随后前往扫描仪套件进行随访研究，以排除其他潜在的损伤，而这些损伤在WBCT组中没有发生(47.2% vs 0%， p< 0.001)。与WBCT组相比，OSCT组的总辐射暴露剂量更高[22 mSv (IQR 6-31) vs 15.1 mSv (IQR 9.9-24.8) p<0.001]。结论OSCT有可能遗漏潜在的危及生命的损伤，需要后续扫描。反过来，这将增加患者的总体辐射暴露，并可能延迟最终的手术治疗。创伤患者接受WBCT有较低的总辐射暴露，没有延迟治疗。
{"title":"Single-pass Whole-body vs Organ-selective Computed Tomography for Trauma—Timely Diagnosis vs Radiation Exposure: An Observational Study","authors":"C. Ordoñez, A. García, M. Parra, J. Herrera-Escobar, M. Guzmán-Rodríguez, Carlos García, Hernán E. Munevar, C. Navarro, Alejandra de las Salas, Laura Ibarra, A. Holguín, Ana Milena del Valle","doi":"10.21203/rs.2.14656/v1","DOIUrl":"https://doi.org/10.21203/rs.2.14656/v1","url":null,"abstract":"\u0000 Background Single Pass Whole-Body Computed Tomography (WBCT) has been used as a high yield diagnostic tool in trauma. However, increased exposure to radiation and delay in treatment, have been cited as challenges to its widespread use. We hypothesized that WBCT has at least the same radiation exposure compared to Organ-Selective CT and it does not inflict further delays in treatment. Methods We retrospectively review all trauma patients in whom CT-scans were performed on arrival at a Level I Trauma Center from January, 2016 to December, 2017. Results 123 patients were included: 53 in the OSCT group and 70 in the WBCT group. In the OSCT group, 64.1% of the patients had penetrating trauma and chest injuries were the most common injured body cavity (79.3%). In the WBCT group, 65.7% had blunt trauma and head injuries were the most common (71.9%) injured organ. The OSCT group required subsequent trips to the scanner suite for follow-up studies to rule out other potential injuries which in turn did not occur in the WBCT group (47.2% vs 0%, p< 0.001). The total radiation exposure dose was higher in the OSCT group compared to the WBCT group [22 mSv (IQR 6-31) vs 15.1 mSv (IQR 9.9-24.8) p<0.001]. Conclusion OSCT has the potential of missing potentially life threatening injuries that require subsequent follow-up scans. This, in turn, would increase the patient’s overall radiation exposure and potentially delay definitive surgical treatment. Trauma patients undergoing WBCT had lower total radiation exposure with no delay in treatment.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90169285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01Epub Date: 2019-12-01DOI: 10.5005/jp-journals-10030-1254
Maria F Jimenez, Andrés Becerra, Sergio Cervera, Elio F Sánchez, Jorge Ospina, Francisco J Henao, Alexander Paz, Gabriel Paredes, María I Gutiérrez, Juan C Puyana
Background: Assembling an effective medical response for an overwhelming number of casualties has become a priority worldwide. Terrorist attacks have been part of the Colombian contemporaneous history. On February 7, 2003, a terrorist car bomb explosion occurred inside a private club in Bogotá, causing the largest number of casualties of all terrorist attacks for over 15 years. The present study analyses the hospital and prehospital responses to this mass casualty event by characterizing the patterns of injury, resource allocation, and outcome in a tertiary-level hospital where most of the casualties were treated.
Materials and methods: This is a retrospective chart review of the patients brought to a single hospital (La Clínica del Country), which was the nearest to the terrorist attack. Demographics, severity of injury, patterns of injury, prehospital care, and outcomes were determined from the hospital medical records and government registries.
Results: Of the 240 victims, 35 died at the explosion site (immediate mortality 17%). The 205 survivors were dispersed throughout the city, of whom 63 patients came to La Clínica del Country hospital. Most of these patients were evaluated only clinically and deemed not serious. The main mechanism of trauma was blunt (81.4%). The mean injury severity score (ISS) was 5.6 ± 8.3. Ten patients required emergent surgical intervention and 14 patients were admitted. The in-hospital mortality was 20%.
Conclusion: This mass casualty event was a true test for the Colombian emergency medical system and disaster preparedness. The medical response and resource optimization resulted in an overall mortality rate similar to those observed in the recent European and North American bombings. Despite the limited resources, the continuous challenge of terrorist's attacks in Colombia made the country feel the need for training and preparing the healthcare professionals, allowing effective delivery of medical care.
背景:为数量庞大的伤亡人员组织有效的医疗反应已成为全世界的优先事项。恐怖袭击已经成为哥伦比亚当代历史的一部分。2003年2月7日，波哥大一家私人俱乐部内发生恐怖汽车炸弹爆炸事件，造成15年来伤亡人数最多的恐怖袭击事件。本研究分析了医院和院前对这一大规模伤亡事件的反应，描述了一家三级医院的伤害模式、资源分配和结果，其中大部分伤亡都是在三级医院接受治疗的。材料和方法:这是一个回顾性的图表审查的病人被送到一家医院(La Clínica del Country)，这是最近的恐怖袭击。统计数据、损伤严重程度、损伤模式、院前护理和结果由医院医疗记录和政府登记确定。结果:240名受伤者中，35人在爆炸现场死亡(当场死亡率17%)。205名幸存者分散在城市各处，其中63名患者来到La Clínica del Country医院。这些患者大多只进行了临床评估，认为不严重。创伤机制以钝性为主(81.4%)。平均损伤严重程度评分(ISS)为5.6±8.3。10例需要紧急手术治疗，14例住院。住院死亡率为20%。结论:这次大规模伤亡事件是对哥伦比亚紧急医疗系统和灾难准备的真正考验。医疗反应和资源优化使总死亡率与最近欧洲和北美爆炸事件的死亡率相似。尽管资源有限，但哥伦比亚境内恐怖主义袭击的持续挑战使该国感到有必要对保健专业人员进行培训和准备，以便有效地提供医疗服务。
{"title":"Prehospital and First Hospital System Response to a Terrorist Attack in Bogotá, Colombia.","authors":"Maria F Jimenez, Andrés Becerra, Sergio Cervera, Elio F Sánchez, Jorge Ospina, Francisco J Henao, Alexander Paz, Gabriel Paredes, María I Gutiérrez, Juan C Puyana","doi":"10.5005/jp-journals-10030-1254","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1254","url":null,"abstract":"<p><strong>Background: </strong>Assembling an effective medical response for an overwhelming number of casualties has become a priority worldwide. Terrorist attacks have been part of the Colombian contemporaneous history. On February 7, 2003, a terrorist car bomb explosion occurred inside a private club in Bogotá, causing the largest number of casualties of all terrorist attacks for over 15 years. The present study analyses the hospital and prehospital responses to this mass casualty event by characterizing the patterns of injury, resource allocation, and outcome in a tertiary-level hospital where most of the casualties were treated.</p><p><strong>Materials and methods: </strong>This is a retrospective chart review of the patients brought to a single hospital (La Clínica del Country), which was the nearest to the terrorist attack. Demographics, severity of injury, patterns of injury, prehospital care, and outcomes were determined from the hospital medical records and government registries.</p><p><strong>Results: </strong>Of the 240 victims, 35 died at the explosion site (immediate mortality 17%). The 205 survivors were dispersed throughout the city, of whom 63 patients came to La Clínica del Country hospital. Most of these patients were evaluated only clinically and deemed not serious. The main mechanism of trauma was blunt (81.4%). The mean injury severity score (ISS) was 5.6 ± 8.3. Ten patients required emergent surgical intervention and 14 patients were admitted. The in-hospital mortality was 20%.</p><p><strong>Conclusion: </strong>This mass casualty event was a true test for the Colombian emergency medical system and disaster preparedness. The medical response and resource optimization resulted in an overall mortality rate similar to those observed in the recent European and North American bombings. Despite the limited resources, the continuous challenge of terrorist's attacks in Colombia made the country feel the need for training and preparing the healthcare professionals, allowing effective delivery of medical care.</p>","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"8 3","pages":"143-147"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9a/f8/nihms-1815163.PMC9529020.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33487394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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