Panamerican journal of trauma, critical care & emergency surgery最新文献

{"title":"Coronavirus Disease 2019 and Pregnancy: What An Anesthesiologist Needs to Know","authors":"Amarjeet Kumar, C. Sinha, Ajeet Kumar, P. Kumari","doi":"10.5005/JP-JOURNALS-10030-1313","DOIUrl":"https://doi.org/10.5005/JP-JOURNALS-10030-1313","url":null,"abstract":"","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"94 1","pages":"51-52"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74039500","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}

{"title":"Análisis y Determinación Del Conocimiento Anatomoquirurgico de Los Profesionales de La Salud Para La Realización de Acceso Vascular Intraoseo en La Urgencia","authors":"J. P. Fernández, Carolina C Brofman, M. Ferrante, Agustín Algieri, R. D. Algieri","doi":"10.5005/JP-JOURNALS-10030-1314","DOIUrl":"https://doi.org/10.5005/JP-JOURNALS-10030-1314","url":null,"abstract":"Introducción: El acceso vascular intraóseo se considera una opción rápida, segura y eficaz en situaciones en las que no es posible lograr el acceso venoso en un tiempo preestablecido, como ocurre en el shock grave o paro car-diorrespiratorio. En estas situaciones resulta dificultosa la colocación de accesos vasculares convenciona-les, por lo que es de suma importancia la adquisición de conocimientos relacionados con la colocación de accesos intraóseos. Metodos: Estudio descriptivo y transversal. Encuestas al personal de la salud y profesionales en formación sobre co-nocimientos del acceso vascular intraoseo y su utilización en las situaciones de emergencias Y urgencias Resultados: Se realizaron 444 encuestas. Médicos con formación 37 (8.3%) médicos residentes 23 (5.1%), estudiantes de medicina 206 (46.39%), enfermeros 92 (20.72%) y estudiantes de enfermería 86 (19.36%). El rango eta-rio fue de 21–59 años. 27.03% (120) conoce la vía intraósea como acceso vascular; 25% (111) han recibido algún tipo de formación acerca de la colocación de accesos intraóseos, siendo la misma cantidad de profe-sionales los que pudieron enumerar los sitios anatómicos correspondientes. Sólo un 13.06% (58) pudieron indicar precisamente los reparos anatómicos necesarios para su colocación y, por último, únicamente 23.42% (104) de los encuestados conocía si su lugar de desempeño disponía de sets para la colocación de dicha vía. Conclusione: Pocos profesionales de la salud poseen conocimientos relacionados con la colocación de accesos intra-óseos ya que son escasamente promovidos Durante la formación de grado. El acceso vascular intraoseo es una alternativa altamente utilizable y su entrenamiento puede ser implementado en los distintos niveles de formación siendo primordial la capacitación acerca de sus indicaciones, contraindicaciones, complicaciones y forma de colocación. Con el entrenamiento adecuado el acceso vascular intraoseo puede ser utilizado como herramienta en los servicios de urgencias para el tratamiento inicial de pacientes con dificultados para la colocación de accesos vasculares Palabras claves: Trauma, Acceso vascular, Capacitacion continua, Emergência, Educación en cirugía de cuidados agudos, Urgencias, Anatomia quirurgica.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"242 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74355904","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}

{"title":"Surgical Rescue in a High-volume Urban Emergency General Surgery Service at a Middle-income Country.","authors":"Maria F Jimenez,&nbsp;Andrés Isaza-Restrepo,&nbsp;Danny Conde,&nbsp;Alex Arroyo,&nbsp;Milcíades Ibánez-Pinilla,&nbsp;Felipe Borda,&nbsp;Daniel Colmenares,&nbsp;Juan C Puyana","doi":"10.5005/jp-journals-10030-1305","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1305","url":null,"abstract":"<p><strong>Introduction: </strong>The capacity for prompt \"rescue\" from death in patients with complications has become an important marker of the quality of care since mortality and morbidity have been identified as incongruous indicators. This study aims to describe the incidence of \"surgical rescue\" failure and the outcomes of emergency general surgery (EGS) patients at a large academic medical center.</p><p><strong>Materials and methods: </strong>In our high-volume surgical hospital, an electronic EGS registry was developed to automatically capture in-hospital information and outcomes from the Electronic Medical Record (EMR). Surgical complications were included in an online application and automatically captured in the electronic EGS registry, and prospectively screened from June to July 2017 for acute EGS surgical patients from operative procedures.</p><p><strong>Results: </strong>A total of 501 patients (average age: 53.9 ± 20.9, 56.5% female) underwent 882 EGS procedures. Thirteen patients (2.6%) of the 501 patients required \"surgical rescue\", mainly for uncontrolled sepsis (43%) and anastomotic leakage (30%). The surgical rescue failure rate (inability to prevent death after a surgical complication) was 15.4%. Patients requiring critical care (OR = 3.3, IC 95%: 1.04, 10.5), hospital admission (<i>p</i> = 0.038), and hospital LOS (days) (<i>p</i> = 0.004) were significantly higher for the surgical rescue patients than for those without complications.</p><p><strong>Conclusion: </strong>Surgical failure to rescue rate was similar among high-volume EGS services, as has recently been described in the United States. The latest development and implementation of an electronic automatic captured EGS registry database in our academic medical center will serve to build best practices for \"surgical rescue\" and drive quality improvement programs.</p>","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"10 1","pages":"16-19"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cf/8e/nihms-1815153.PMC9529028.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33487376","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}

{"title":"Development of an Inclusive Interhospital Resource Allocation to Mitigate States Hospital Capacity during COVID-19","authors":"J. Duchesne, D. Tatum, E. Toraih, M. Hussein","doi":"10.5005/jp-journals-10030-1281","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1281","url":null,"abstract":"The severe acute respiratory syndrome coronavirus (SARS-CoV-2), commonly known as COVID-19, has resulted in severe resource shortages in the areas that have become hot spots. A leading area of concern has been hospital bed and intensive care unit bed availability that would leave hospitals unable to treat the most severe cases and which would result in unnecessary additional loss of life. Here, we present a model based on prediction of cases by state to propose resource allocation to alleviate hospital bed shortages.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"128 1","pages":"147-154"},"PeriodicalIF":0.0,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88106414","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}

{"title":"Importance of the Epidemic Curve for Cross-country Comparison of COVID-19 Mortality: A Brief Analysis on Interpreting the Pandemic Numbers","authors":"S. Rizoli, G. Fraga, Bartolomeu Nascimento, Lorena T de Melo Rolim","doi":"10.5005/jp-journals-10030-1276","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1276","url":null,"abstract":"Our planet is experiencing an unprecedented public health crisis. The ongoing COVID-19 pandemic is ubiquitously making headlines daily. Currently, 216 countries, areas, or territories have documented COVID-19 cases. Many are publicizing numbers of deaths per population by country as a measure of a “country’s performance” in handling this global crisis. Indeed, death ranks are being created to ascertain a “nation’s failure or success.” Due to the pandemic, the World Health Organization (WHO) has made available daily data on COVID-19 cases and mortality.1 This is extremely valuable to inform countries on the spread of the disease and its lethality. This information can guide pandemic preparedness plans across the globe. However, caution should be exercised when using such data for unadjusted cross-country comparisons, particularly on disease lethality. Increasing death rates are naturally observed as an epidemic takes its course. The epidemic curve is a visual display of outbreak cases.2 It starts with the first confirmed case in a population. Then, it develops as an expression mainly of the incubation period, mode of transmission, and transmissibility. The number of cases and associated deaths of a disease grow exponentially on its epidemic curve. The goal of this brief analysis is to demonstrate that mortality rates are modifiable when considering the pandemic phase of each country. In order to adjust for the epidemic curve of COVID19 in countries with higher numbers of deaths according to the WHO available data, we calculated the time elapsed between the first reported case and May 16, 2020. All countries included had a minimum of 80 days into their epidemic curve. The Netherlands had the shortest epidemic curve with 80 days. Then, this was used as the reference epidemic curve for cross-country comparison. We also reported mortality rates per 1,000,000 inhabitants. On the WHO online dashboard, the absolute number of new deaths by country is reported daily as well as the number of cumulative deaths over the pandemic period. We included the top 10 countries with the highest cumulative numbers of deaths listed by the WHO on May 16, 2020. With 118 pandemic days, the United States had the highest absolute number of deaths for the period. Among the top 10 countries, the Netherlands reported the lowest absolute number of deaths (Table 1). However, considering the country population, the U.S. mortality dropped to 7° place and Brazil had the lowest mortality rate on the rank of all countries analyzed (Table 1). When accounting for the epidemic curve, we observed additional changes on the rank of countries by mortality rates (Table 2). Interestingly, the United States had the lowest mortality rate of all countries included. Belgium appeared as the country with the highest death rate among the top 10 countries. In this new scenario, the United States had a mortality rate of approximately 14 times lower than the one seen for Belgium. Brazil, the only South ","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"130 1","pages":"120-121"},"PeriodicalIF":0.0,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74605658","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}

{"title":"PTS Statement on Virtual Congress 2020","authors":"F. V. Rivera","doi":"10.5005/pajt-9-2-v","DOIUrl":"https://doi.org/10.5005/pajt-9-2-v","url":null,"abstract":"","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"7 1","pages":"00-00"},"PeriodicalIF":0.0,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90194906","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}

{"title":"Efficacy of the Basic Trauma Course in Family Medicine Resident Physicians in Southern Ecuador: It is Time to Innovate Education in Trauma","authors":"J. Salamea, J. Figueroa, C. Loyola, F. Martínez","doi":"10.5005/jp-journals-10030-1286","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1286","url":null,"abstract":"Introduction: In Ecuador, as in other Latin American countries, trauma has become one of the main reasons to seek medical care in the country. According to data obtained from the National Institute of Statistics and Censuses (INEC), the rate of homicides, car accidents, suicides, and burns, grouped together, represent the main cause of morbidity and mortality in people aged between 18 years and 40 years, surpassing mortality due to cardiovascular causes or diabetes. Additionally, one study on geolocation of calls made to the emergency services (SIS-ECU 9-1-1) indicated that trauma in the country is becoming more and more frequent in marginal urban and rural areas, where health services are scarce. Due to this emerging situation, it is necessary to evaluate the shortand long-term effectiveness of the Basic Trauma Course (BTC), a course designed to educate students, general practitioners, prehospital staff and primary healthcare physicians. Objective: To evaluate the effect of the BTC in family medicine residents who work in Health Centers in marginalurban and rural areas of the Azuay, Cañar, and Morona Santiago provinces in southern Ecuador. Materials and methods: Quasi-experimental study in which knowledge is evaluated at three stages in time (before the course, at the end of the course and one year later) in 39 family medicine residents. Comparison of means of the test scores was made using formulas in SPSS of analysis of variance (ANOVA) and Tukey HSD. Results: ANOVA brought significant differences between measurements (F = 8.38, p value < 0.0005). The increase in the score between the pretest and the immediate posttest was significant (p value < 0.01). The difference between pretest and late posttest was not significant. The comparison of the immediate and late posttest results showed a decrease in the mean, being statistically significant (p value < 0.01). Conclusion: The BTC, as a unique training course, does not guarantee the permanence of long-term knowledge in participants who do not regularly attend to the trauma patient, requiring constant training using spaced repetition methods, for adequate consolidation.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"3 1","pages":"97-100"},"PeriodicalIF":0.0,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81966582","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}

{"title":"Performance of Noncontrast Multidetector Computed Tomography Compared with a Reference Standard (Surgery/Pathology or Clinical Follow-up) in Diagnosing Acute, Nontraumatic Abdominal Pain","authors":"Milena Alcázar, Maria del Pilar Gutierrez, Santiago Rojas, T. Suárez, Carlos H. Morales","doi":"10.5005/jp-journals-10030-1287","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1287","url":null,"abstract":"Introduction: Computed tomography (CT) with intravenous (IV) contrast is the method of choice for diagnosing and selecting treatments for surgical pathologies in patients visiting the emergency room (ER) for acute, nontraumatic abdominal pain. However, there are risks, high costs, and delays in medical attention associated with this modality. Studies have suggested performance of CT without venous contrast for diagnosing appendicitis. Nevertheless, no methodologically rigorous studies have evaluated CT without IV contrast performance when used as the main diagnostic tool for patients with acute abdominal pain. Objective: This study aims to evaluate the diagnostic performance of noncontrast abdominal CT and compare it with a reference standard (surgery/pathology or clinical follow-up) to detect surgical diseases in patients with acute abdominal pain. Design: This is a cross-sectional, diagnostic test study. Place: Hospital Universitario San Vicente Foundation (Medellín, Colombia). Materials and methods: This is a cross-sectional convenience sample diagnostic test study of consecutively selected patients who underwent noncontrast CT of the abdomen. All patients were those who presented to the ER with abdominal complaints. All patients who consented underwent a noncontrast and IV contrast CT scans. Two radiologists with different levels of expertise independently evaluated the noncontrast tomography images to specify the diagnostic findings. Final diagnoses were collected independently from the patients’ clinical histories. Patients who did not undergo surgery, their clinical histories were reviewed during hospitalization. Those who were not hospitalized had their clinical course obtained by telephone 2 weeks after being discharged. Results: Of the 157 included patients, 19.1% underwent surgery because of an acute pathology. For noncontrast abdominal contrast tomography, values of 93.3% sensitivity (95% CI 82.7–100), 96.8% specificity (95% CI 93.4–100), 87.5% PPV (95% CI 74.4–100), 98.4% NPV (95% CI 95.8–100), 29.6 LR+ (95% CI 11.24–78.1), 0.07 LR− (95% CI 0.02–0.26), and 97.4% diagnostic accuracy were obtained. The interobserver concordance had a kappa value of 0.88. Conclusion: Noncontrast abdominal CT performs well in differentiating medical vs surgical diseases in patients with acute abdominal pain.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"9 1","pages":"91-96"},"PeriodicalIF":0.0,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75373000","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}

{"title":"Perspectives and Recommendations for Laparoscopic Surgery in the COVID-19 Era","authors":"Andres V. Ayala, Sofía A Zárate, A. Zabala, Luis Pacheco, Fernando I Narváez, M. Alvear, Jose R. Negrete","doi":"10.5005/jp-journals-10030-1279","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1279","url":null,"abstract":"A bstrAct A new human coronavirus called SARS-CoV-2 is currently causing a pandemic of the coronavirus disease 2019 (COVID-19). Healthcare institutions including surgical centers and their workers are in risk of contagion due to high exposure to SARS-CoV-2. The objective of the present manuscript is to review the available literature and elucidate the key points for maintaining safety in laparoscopic surgery during the pandemic. Currently, any patient who requires surgery and in whom the diagnosis of COVID-19 has not been ruled out should be treated as a positive patient and the correspondent safety measures should be taken. Surgical plume is a bioproduct that places healthcare workers who are exposed to it in a potential risk of acquiring different health conditions. There is no clear evidence to affirm that the exposure to surgical plume and pneumoperitoneum can cause COVID-19; nevertheless, as we do not know yet the real risk of transmission and infectivity of particles found in surgical smoke, it is recommended to take measures for a controlled evacuation of pneumoperitoneum and the use of a simple filtration system during laparoscopic surgery. We must understand that as our entire life changed with this pandemic, laparoscopic surgery should also change in particular aspects to give our patients the best treatment under the safest conditions as possible.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73873850","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}

{"title":"Effects of Social Distancing on the Incidence of Traumatic Injuries","authors":"J. Duchesne, S. Ninokawa, K. Nordham, D. Tatum","doi":"10.5005/jp-journals-10030-1277","DOIUrl":"https://doi.org/10.5005/jp-journals-10030-1277","url":null,"abstract":"Ab s t r Ac t Aim: To understand how social distancing orders impact the incidence of traumatic injuries. Background: In an attempt to blunt the spread of the novel coronavirus SARS-CoV-2, social distancing and stay home orders have been enforced. Here we analyze the effect that these public health measures have had on the rate of traumatic injury presenting to a level 1 trauma center. Materials and methods: This is a retrospective analysis of the number of trauma patients presenting to a level I trauma center from January 2019 through April 2020. Patients were identified using an institutional trauma registry and include trauma transfers, trauma activations, and admitted trauma patients. The independent samples t-test and the Mann–Whitney U test were used to assess differences between groups. Shapiro–Wilk and Levene’s tests were used to assess normality and variances, respectively. Results: When comparing daily admissions in 2020 before and after social distancing orders, there was a significant reduction in the median daily number of trauma patients (12 vs 8.5; p < 0.0001) after the social distancing order was put into place. Additionally, there was a significant decrease in the mean number of weekly trauma patients presenting to our hospital in 2020 before and after social distancing orders (86.1 vs 60.3; p < 0.0001). When looking at weekly patient counts, there was a significant reduction in blunt trauma patients when comparing preand post-social distancing (56.6 vs 35.7; p < 0.01). However, there was no change in the number of weekly penetrating injuries (17.0 vs 17.1). Conclusion: Social distancing orders have significantly reduced the number of blunt trauma patients presenting to our level 1 trauma center. Further studies will be needed to determine long-term effects of these measures.","PeriodicalId":74395,"journal":{"name":"Panamerican journal of trauma, critical care & emergency surgery","volume":"2013 1","pages":"122-125"},"PeriodicalIF":0.0,"publicationDate":"2020-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86334901","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}