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1.  Original Article
Panamerican Trauma Society Basic Trauma Education Course Administration in Resource-limited Areas
Lina V Mata, Francisco E Mora, Martha Quiodettis, Jaime Fischer, Gustavo M Machain, Juan C Salamea, Edgar B Rodas, Michel B Aboutanos
[Year:2016] [Month:May-August] [Volume:5 ] [Number:2] [Pages:51] [Pages No:83-87] [No of Hits : 760]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1149 | FREE

ABSTRACT

Introduction and objectives: Injuries and noncommunicable diseases account for greater than 73% deaths and 76% disability adjusted life years (DALYs) in Latin America, where trauma care is challenging especially when resources are scarce. Education and training is a basic step in trauma systems development, which was shown to improve survival. Except for urban areas, trauma courses are unavailable and unaffordable in the Latin region. The aim of this study is to evaluate the feasibility of implementation of a basic trauma education course (BTC) for resource-limited areas adopted and promulgated by the Panamerican Trauma Society (PTS) since 2011.

Materials and methods: Basic trauma education course was administered in Paraguay, Medellin, Chile, and Panama during the PTS congresses (2011–2013). The two-day course was based on the patient’s pathway system, addressing the management of the patient through various echelon of care from rural health centers to local provincial hospital and tertiary treatment facilities. It contained 20 hours of didactic lectures and hands on skill labs on basic trauma resuscitation, stabilization, and transport, as well as trauma system-oriented teaching (triage, EMS, kinematics, trauma registries). Panamerican Trauma Society international and national instructors administered the courses. Course logistics and coordination were carried out by international and local coordinators and by trauma league medical students. Pre and post (30 multiple-choice questions) tests were used to assess participants. Paired t-test was used to compare scores.

Results: Fifty-four students (rural physicians, EMS providers, students, nurses, and administrators) participated. Pre and posttest score comparison showed significant improvement 74% vs 85% respectively, p-value < 0.0001.

Conclusion: A tailored trauma course and evaluation can be feasible in educating local providers. The PTS can promulgate the application of BTCs that may serve as a model for continuing trauma care education in developing countries. Course follow-up evaluation is pending.

Keywords: Basic trauma course, Trauma care in low and middle income countries, Trauma education.

How to cite this article: Mata LV, Mora FE, Quiodettis M, Fischer J, Machain GM, Salamea JC, Rodas EB, Aboutanos MB. Panamerican Trauma Society Basic Trauma Education Course Administration in Resource-limited Areas. Panam J Trauma Crit Care Emerg Surg 2016;5(2):83-87.

Source of support: Nil

Conflict of interest: None

 
2.  Original Research
Abdomen Abierto y Presión Subatmosférica: Experiencia con un Sistema Artesanal
Helena Facundo, Juan Manuel Troncoso
[Year:2016] [Month:January-April] [Volume:5 ] [Number:1] [Pages:63] [Pages No:11-17] [No of Hits : 505]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1137 | FREE

ABSTRACT

Background: The need to keep an open abdominal cavity has been recognized and employed for 35 years ago. The development of continuous vacuum system has formed a new surgical approach to this problem.
Commercial systems are expensive, which limits its use. Several groups have reported local manufacturing systems with satisfactory results. Here, we report our experience in this regard and the technical details of the system we use.

Materials and methods: We described the technical aspects of artisanal vacuum system and a retrospective descriptive observational study in patients treated with abdominal continuous suction between January 2007 and March 2013.

Results: We described 77 cases. The first three diagnoses on admission were abdominal penetrating trauma (25 cases), intestinal obstruction (7 cases), and acute pancreatitis (6 cases). There were 42 cases with enterostomal fistula, 41 before the start of therapy. In 12 cases (28.6%), the fistula closed with medical treatment and in 14 (33.3%) with surgery. The percentage of closure of the abdominal cavity is 31%.

Conclusion: The complexity of patients with open abdomen and enterostomal fistulas, determined a significant morbidity and mortality. We consider the general principle of management with continuous vacuum system in the abdominal cavity and particularly to our system, is a valuable tool that enables skin protection, permanent drainage of the cavity and quantification of drainage; decreases the time to achieve abdominal closure and the number of surgeries.

Keywords: Intestinal fistula, Open abdomen, Subatmospheric pressure, Vacuum system.

How to cite this article: Facundo H, Troncoso JM. Abdomen Abierto y Presión Subatmosférica: Experiencia con un Sistema Artesanal. Panam J Trauma Crit Care Emerg Surg 2016;5(1): 11-17.

Source of support: Nil

Conflict of interest: None

 
3.  CASE SERIES
Descending Necrotizing Cervicomediastinitis Secondary to Esophageal Perforation: Management in a Hospital with Limited Resources
Sofia Arízaga, Edgar Bruck Rodas, Raul Pino, Jeovanni Reinoso, Juan Carlos Salamea
[Year:2015] [Month:January-April] [Volume:4 ] [Number:1] [Pages:42] [Pages No:23-29] [No of Hits : 1143]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1111 | FREE

ABSTRACT

The esophageal perforation is the result of an iatrogenic cause, spontaneous cause or external trauma. The injury belonging to trauma can have different etiologies, such as the ones that are caused because of strange bodies or caustic substances. Within complications that can appear in esophageal perforation, we have the descending necrotizing mediastinitis, which is a mediastinal infection that starts in the oropharyngeal area. The spread of the infection through the anatomical spaces to the mediastinum can produce a mortality of 67%.

Keywords: Esophageal perforation, Trauma, Mediastinitis, Infection.

How to cite this article: Arízaga S, Rodas EB, Pino R, Reinoso J, Salamea JC. Descending Necrotizing Cervicomediastinitis Secondary to Esophageal Perforation: Management in a Hospital with Limited Resources. Panam J Trauma Crit Care Emerg Surg 2015;4(1):23-29.

Source of support: Nil

Conflict of interest: None

 
4.  REVIEW ARTICLE
Anemia y Traumatismo Craneoencefálico: Implicaciones Fisiopatologicas Para El Tratamiento Neurocritico
Luis Rafael Moscote-Salazar, Juan Camilo Pulido-Gutierrez, Sandy Zuleica Navas-Marrugo, Hernando Raphael Alvis-Miranda, Marticela Cabeza-Morales, Dagoberto Duarte-Misol, Gabriel Alcala-Cerra
[Year:2015] [Month:January-April] [Volume:4 ] [Number:1] [Pages:42] [Pages No:16-22] [No of Hits : 896]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1110 | FREE

ABSTRACT

Background: Traumatic brain injury (TBI) is a common entity worldwide, in the human body a series of events occur in the context of TBI, some occurimmediately and others are generated by the evolution of the injury and are, therefore, consequence of the severity. Within this contest, in this narrative review we will talk about the anemia associated to TBI, a highly alteration described in patients who have suffered TBI.

Keywords: Traumatic brain injury, Anemia, Hypoxia, Hemoglobin, Critical care, Transfusion.

How to cite this article: Moscote-Salazar LR, Pulido-Gutierrez JC, Navas-Marrugo SZ, Alvis-Miranda HR, Cabeza-Morales M, Duarte-Misol D, Alcala-Cerra G. Anemia y Traumatismo Craneoencefálico: Implicaciones Fisiopatologicas Para El Tratamiento Neurocritico. Panam J Trauma Crit Care Emerg Surg 2015;4(1):16-22.

Source of support: Nil

Conflict of interest: None

 
5.  ORIGINAL RESEARCH
Nonoperative Management of Blunt Renal Trauma
Aparecida Andrade Ribeiro Franciscani, Camila Issa Azevedo, Amanda Baraldi Souza, Maria Helena Almeida Costa, Sizenando Vieira Starling, Domingos André Fernandes Drumond
[Year:2015] [Month:January-April] [Volume:4 ] [Number:1] [Pages:42] [Pages No:6-10] [No of Hits : 712]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1108 | FREE

ABSTRACT

Objective: To analyze patients with blunt renal trauma who were managed conservatively, with emphasis on clinical presentation, grade of injury, complication and failure rates.

Materials and methods: A prospective observational study was conducted in Hospital João XXIII, between January and December 2013. Patients with blunt renal trauma and nonoperative management (NOM) were analyzed during this period. Data were collected in respect to: age, gender, mechanism of trauma, grade of injury, clinical presentation, revised trauma score (RTS), associated abdominal injuries, length of hospital stay and failure, complication and mortality rates.

Results: During this period, 27 patients with blunt renal trauma were suitable for nonoperative approach. The most common mechanisms of trauma were motor vehicle accidents (59.2%) and falls (22.2%) and the mean length of hospital stay was 10.5 days. The majority of the patients had grade II (48.1%) and III (29.6%) injuries, with mean RTS of 6.93. The complication rate was 3.7% and the mortality rate was 7.4%. All deaths were related to associated injuries. One patient with grade II injury required nephrectomy. This patient had concurrent injuries.

Conclusion: Blunt renal trauma can be successfully managed conservatively, with low complication rates. Nonoperative management is safe in stable patients and in environments with appropriated protocol for this approach.

Keywords: Kidney, Blunt injuries, Renal trauma, Nonoperative.

How to cite this article: Franciscani AAR, Azevedo CI, Souza AB, Costa MHA, Starling SV, Drumond DAF. Nonoperative Management of Blunt Renal Trauma. Panam J Trauma Crit Care Emerg Surg 2015;4(1):6-10.

Source of support: Nil

Conflict of interest: None

 
6.  CASE REPORT
Cheek Hematoma: A Rare Presentation
Niveditha J Sagar, Chidananda Ramappa Devasamudra
[Year:2015] [Month:January-April] [Volume:4 ] [Number:1] [Pages:42] [Pages No:39-42] [No of Hits : 681]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1114 | FREE

ABSTRACT

Background: A 28-year-old lady presented with cheek hematoma on the right side after the self-fall. This patient had severe facial disfigurement due to diffuse swelling of cheek, discoloration of facial skin and sclera. The facial expressions were also compromised.

Materials and methods: Detailed history taken, examination done to rule out motor vehicle accident (MVA), domestic violence and central nervous system (CNS) involvement. Computed tomography scan was done to know the extent of hematoma and to rule out the oromaxillofacial bone fractures. Incision and drainage was done to remove the blood clot from the buccal space. Incision was given in the buccal mucosa to avoid external scar.

Result: Swelling was completely reduced on 3rd postoperative day. Facial movements and expressions were regained.

Conclusion: Intraoral Incision and drainage is the treatment of choice for cheek hematoma to reduce the size of the swelling and avoid external scar.

Keywords: Hematoma, Incision and drainage, External scar.

How to cite this article: Sagar NJ, Devasamudra CR. Cheek Hematoma: A Rare Presentation. Panam J Trauma Crit Care Emerg Surg 2015;4(1):39-42.

Source of support: Nil

Conflict of interest: None

 
7.  ORIGINAL RESEARCH
Blunt Hepatic Trauma: Suggested Algorithm for Surgical and Nonoperative Management
Camila Issa Azevedo, Aparecida Andrade Ribeiro Franciscani, Amanda Baraldi Souza, Fabio Mendes Botelho Filho, Sizenando Vieira Starling, Domingos André Fernandes Drumond
[Year:2015] [Month:January-April] [Volume:4 ] [Number:1] [Pages:42] [Pages No:1-5] [No of Hits : 601]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1107 | FREE

ABSTRACT

Objective: This study aims to analyze the outcomes of blunt hepatic trauma, and compare operative treatment (OT) and nonoperative management (NOM) emphasizing the stratified results by grade of injury and failure rate.

Materials and methods: This is a prospective study of cases admitted to João XXIII Hospital, located in Belo Horizonte, Brazil, from January 2013 to December 2013. Patients were admitted with blunt hepatic trauma on emergency room (ER) and were divided into two groups. One group contained patients who met the criteria for NOM, and the other group was formed by patients with surgical indication.

Results: During the study period, 47 patients were admitted with blunt liver injury and 43 (91.4%) met the inclusion criteria for NOM. The rate of NOM failure was 9.3%: 50% of them had grade II injury and 50% had grade V. The patients with grade II injury had also extrahepatic lesions and, in those with grade V, the failure was due to bleeding.

Conclusion: Nonoperative management has become the standard of care for patients with blunt liver injuries in trauma centers. However, as grade V injuries have a higher failure rate, they might receive special attention from the surgical team.

Keywords: Liver, Wounds, Wounds and injuries, Nonoperative, Laparotomy.

How to cite this article: Azevedo CI, Franciscani AAR, Souza AB, Filho FMB, Starling SV, Drumond DAF. Blunt Hepatic Trauma: Suggested Algorithm for Surgical and Nonoperative Management. Panam J Trauma Crit Care Emerg Surg 2015;4(1):1-5.

Source of support: Nil

Conflict of interest: None

 
8.  CASE REPORT
Incidente de Múltiples Víctimas, Una Prueba Para un Sistema de Emergencias Nuevo, Sur de Ecuador, 2014
Leonardo Serrano, Daniel Sacoto, Hernán Sacoto, Juan Carlos Salamea
[Year:2015] [Month:January-April] [Volume:4 ] [Number:1] [Pages:42] [Pages No:30-35] [No of Hits : 565]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1112 | FREE

ABSTRACT

Background: As cities grow, managing security is more complex, the government has invested more than 6 times in security, the creation of the integrated security system SIS ECU-911, articulates all agencies to respond to any situation contingency.1 Nevertheless, road safety statistics of national transit agency (ANT) indicate an increase in traffic accidents.2 The present study attempts to show the flaws that still has the security system in terms of operational coordination of response.

Design: Observational descriptive: a case report.

Results: The incident occurred 44 injured. The SIS ECU-911 was alerted. The first ambulance arrived 45 minutes. Triage and initial management was performed by paramedics, but this could not take control of the other victims, producing a nonsystematic evacuation of the remaining injured through the use of private vehicles. The SIS ECU-911 failed, causing delays in the transmission of information between them and the trauma center. In the reference hospitals, there was the unexpected arrival of the injured without prior training of personnel; while it could make proper initial in-hospital triage, was evident lack of material resources. In this case, the patient is the motor and driver, with a list of problems: (1) Lack of maintenance, (2) imprudence and inexperience and (3) excessive passengers.

Conclusion: The SIS ECU-911 in our country is new. There are shortcomings, to be resolved; however, we consider that targets on track. The implementation of periodic drills helps to detect flaws in the system in order to have a safer society. Equally, prevention campaigns, such as those currently being developed with the draft leagues trauma, could prevent future accidents.

Keywords: Accidents, Traffic, Trauma center, Emergency plans, Emergency medical services.

How to cite this article: Serrano L, Sacoto D, Sacoto H, Salamea JC. Incidente de Múltiples Víctimas, Una Prueba Para un Sistema de Emergencias Nuevo, Sur de Ecuador, 2014. Panam J Trauma Crit Care Emerg Surg 2015;4(1):30-35.

Source of support: Nil

Conflict of interest: None

 
9.  REVIEW ARTICLE
Pediatric and Adult Blunt Traumatic Bladder Rupture: A Comparative Review
Alan Henry Tyroch, Kinzie Matlock
[Year:2015] [Month:January-April] [Volume:4 ] [Number:1] [Pages:42] [Pages No:11-15] [No of Hits : 539]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1109 | FREE

ABSTRACT

Background: To determine the incidence, features and associated injuries of pediatric bladder rupture (BR) vs adult BR due to blunt trauma.

Materials and methods: A retrospective study from 1st January 2001 to 31st December 2012 was performed for blunt traumatic BR in pediatric and adult patients. Demographics, mean injury severity score, mean length of stay, incidence, mortality, diagnostic modality, management and associated injuries were evaluated.

Results: Of 4,884 pediatric blunt trauma admissions, eight children had BR. Sixty-six adults sustained BR out of 18,283 blunt trauma admissions. Gross hematuria was present in a majority of both groups. Computed tomography (CT) cystogram was the most frequent diagnostic modality utilized. Pelvic fracture and intra-abdominal injury were the most commonly associated injuries in both groups.

Conclusion: Although blunt traumatic BR is extremely rare, BR is associated with high injury severity score, prolonged length of stay and associated injuries. Diagnosis and treatment are essentially identical for both population. All patients with gross hematuria (with or without pelvic fracture), microscopic hematuria with anterior pelvic fracture and pelvic fracture with pelvic fluid on CT scan warrant evaluation with cystography. Intraperitoneal BR and combined intraperitoneal and extraperitoneal BR should be repaired operatively. Most extraperitoneal BR may be treated nonoperatively with transurethral catheter.

Keywords: Bladder rupture, Bladder injury, Urologic trauma, Urologic injury, Pediatric, Adult, Trauma.

How to cite this article: Tyroch AH, Matlock K. Pediatric and Adult Blunt Traumatic Bladder Rupture: A Comparative Review. Panam J Trauma Crit Care Emerg Surg 2015;4(1):11-15.

Source of support: Nil

Conflict of interest: None

 
10.  Original Research
Epidemiologia de Lesiones Relacionadas con Colisiones de Vehiculos Motorizados en dos Centros de Referencia del Suroccidente Colombiano. Reporte del Registro Internacional de Trauma de la Sociedad P
Juan Sebastian Calle-Toro, Carlos Ordonez, Alvaro I Sanchez, Juan Sanjuan, Marisol Badiel, Luis Pino, Rao R Ivatury, Michael Aboutanos
[Year:2014] [Month:January-April] [Volume:3 ] [Number:1] [Pages:41] [Pages No:16-22] [No of Hits : 2111]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1080 | FREE

ABSTRACT

Background: Injuries related to motor vehicle crashes (MVCs) are an important source of preventable morbidity and mortality, generating significant social and economic burdens and increased costs to the health system. The objective of this study was to describe demographic, injury-related, and clinical information of patients admitted at two trauma centers in Cali, Colombia.

Study design: Descriptive observational study, using trauma registries implemented in two trauma centers in Cali, Colombia, between January 1st and August 31st 2012.

Results: From 11,889 trauma admissions, there were 1395 (11.6%) injuries were related to MVCs. Injury severity scores <9 were found in 86% (n = 1200) of the patients; from these, 48.4% (n = 675) were injured in motorcyclists, 26.8% (n = 374) were bicyclists, and 10.3% (n = 144) were vehicle occupants. Blunt trauma was the most frequent type of injury (93.5%, n = 1304). After stratification by age, it was observed that motorcyclists were the most often associated to injuries related to MVCs, with regards of patients between 5 and 14 years of age. There were 777 (55.7%) patients injured because of MVCs that required hospitalization and there were 114 (14.7%) patients admitted to intensive care units. Overall mortality was 2.7% (53 patients).

Conclusion: In Cali, Colombia, injuries related to motor vehicle crashes are mostly young men, economically active, driving motorcycles and suspected to have drinking alcohol prior the events. We hope these findings will contribute to control and prevention strategies against traffic-related injuries in the local context and in contexts similar to those of Cali.

Keywords: Trauma, Vehicular, Motorcycle, Alcohol, Motor vehicle crash.

How to cite this article: Calle-Toro JS, Ordonez C, S´nchez ÁI, Sanjuan J, Badiel M, Pino L, Ivatury RR, Aboutanos M. Epidemiología de Lesiones Relacionadas con Colisiones de Vehículos Motorizados en dos Centros de Referencia del Suroccidente Colombiano. Reporte del Registro Internacional de Trauma de la Sociedad P. Panam J Trauma Crit Care Emerg Surg 2014;3(1):16-22.

Source of support: Nil

Conflict of interest: None

 
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