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JAYPEE JOURNALS
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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 : 573]
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.  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 : 889]
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

 
3.  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 : 722]
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

 
4.  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 : 659]
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

 
5.  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 : 506]
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

 
6.  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 : 501]
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

 
7.  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 : 501]
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

 
8.  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 : 1985]
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

 
9.  Original Research
Epidemiologia Del Trauma en Dos Hospitales de Primer Nivel de Atencion Del Suroccidente de Colombia. Reporte Preliminar Del Registro Internacional deTrauma de la Sociedad Panamericana de Trauma
Carlos A Ordonez, Jaime Rubiano, Marisol Badiel, Luis F Pino, Fernando D Minan-Arana, Jorge W Tejada, Monica Morales, Juan C Puyana, Lina Mata, Michael Aboutanos, Cristina Vernaza, Rao R Ivatury
[Year:2014] [Month:January-April] [Volume:3 ] [Number:1] [Pages:41] [Pages No:11-15] [No of Hits : 1878]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1079 | FREE

ABSTRACT

Background: In Colombia, external and violent injuries are leading death causes on the population under 44 years. The purpose of this study was to describe and to compare trauma epidemiology, severity and mortality between a private and a public level I hospitals on Colombian Southwest.

Methods: Between January 2012 and August 2012, we implemented International Trauma Registry (ITR) from Panamerican Trauma Society (ITR-PTS) in two levels: one hospital in Cali, Colombia, one is a public hospital (PUB) and other is a private hospital (PRI). The registry includes sociodemographic information, trauma mechanism, severity by ISS (Injury Severity Score) and the clinical outcomes.

Results: In this period, 9,927 patients were registered, age mean was 30 ± 20.2 years, 67% were males. Most frequently causes of trauma were 29.7% falls, 19.3% penetrating injuries (PI) and 11.5% traffic accidents. By severity scores, 86.4% patients had ISS < 9.8% patients had ISS 9 to 14 and 5.6% had ISS >=15. The overall mortality rate 3.4% (n = 339) [PUB 6.6% (n = 268) vs PRI 1.2% (n = 71), p < 0.001].

Conclusion: Real time trauma registry implementation was feasible in the noninterrupted registry seven months period, almost 10,000 data patients were analyzed. These data are enough to establish preliminary tendencies, but still are insufficient to answer the factors related, by systematic data capture tools. We observed that trauma causes were similar in both hospitals. Mortality in severe patients with GSW was more frequently observed in public hospital. More studies and complementary analysis are required to assess patient's related factor in each hospital.

Keywords: Trauma registry, Panamerican Trauma Society, Falls, Penetrating injuries, Traffic accidents.

How to cite this article: Ordonez C, Rubiano J, Badiel M, Pino LF, Miñan-Arana FD, Tejada JW, Morales M, Puyana JC, Mata L, Aboutanos M, Vernaza C, Ivatury RR. Epidemiología Del Trauma en Dos Hospitales de Primer Nivel de Atención Del Suroccidente de Colombia. Reporte Preliminar Del Registro Internacional de Trauma de la Sociedad Panamericana de Trauma. Panam J Trauma Crit Care Emerg Surg 2014;3(1): 11-15.

Source of support: Nil

Conflict of interest: None

 
10.  Case Reports
Pneumoperitoneum Secondary to Emphysematous Cholecystitis: An Unusual Presentation
Shailender Singh, KL Surendra
[Year:2014] [Month:January-April] [Volume:3 ] [Number:1] [Pages:41] [Pages No:39-41] [No of Hits : 1713]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10030-1085 | FREE

ABSTRACT

We herein report a case of emphysematous cholecystitis (EC) causing pneumoperitoneum with gross ascites, which is a very rare entity. A 64-year-old diabetic man was admitted with diffuse abdominal pain, abdominal distension and fever of 1 week duration. On examination, patient was febrile (38.7°C) and abdominal guarding noted. Laboratory investigations revealed total leukocyte count of 16000/µl with 90% neutrophils, total bilirubin level of 2 mg/dl (direct 0.60 mg/dl). In erect X-ray abdomen, there was no significant finding. Ultrasonography (USG) abdomen showed cholelithiasis with thickened edematous gallbladder (GB) wall and few reflective echoes in GB fossa. Computed tomography (CT) axial sections revealed the presence of small stones in the gallbladder neck and small amount of intraluminal as well as intramural air. Tiny pockets of free intraperitoneal air was also noted. On intravenous (IV) contrast, there was minimal wall enhancement. Preoperative diagnosis of emphysematous cholecystitis with pneumoperitoneum was made and the same was confirmed in the intraoperative findings. Patient underwent emergency exploratory laparotomy with cholecystectomy and was given required medical management, the postoperative course was uneventful.

Keywords: Computed tomography scan, Emphysematous cholecystitis, Pneumoperitoneum.

How to cite this article: Singh S, Surendra KL. Pneumoperitoneum Secondary to Emphysematous Cholecystitis: An Unusual Presentation. Panam J Trauma Crit Care Emerg Surg 2014;3(1):39-41.

Source of support: Nil

Conflict of interest: None

 
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