Summary: The scope of this special issue covers recent trends in neurotrauma research in different regions of the world, including studies in cranial and spinal trauma from epidemiological studies to clinical studies. Cross sectional and transversal studies, systematic reviews and meta-analysis are also welcome in order to present the different approaches that experts in the field are actually using for generating science at global level, filling gaps in knowledge independent of the level of available resources. This topic is urgently needed due to the actual background were neurotrauma care guidelines and protocols are required in order to decrease heterogeneity of care and the related mortality and disability associated with this disease independent of the level of resources available for care.
Objectives: Presenting and showing to the international community recent advances in neurotrauma research from different regions of the world, performed in local contexts and framed in the new concepts of global neurosurgery.
Aim: Pay homage to three of the eminent creators of surgical retractors.
Materials and Methods: Literature review.
Background: Good exposure is the key to good surgery and all successful operations. Hand-held and self-retaining retractors are so essential for exposure that we use them every day. Hardly ever, though, the innovators of these indispensable tools receive a second thought.
Clinical significance: Surgical heritage review.
Clinical relevance: Surgical heritage.
Background: The Royal College of Surgeons of Edinburgh, established in 1505 as the Barber Surgeons of Edinburgh was one of the oldest medical organizations in the world.
Materials and methods: Literature review of the history of great Scottish surgeons of the 18th and 19th centuries and their accomplishments.
Conclusion: Edinburgh and Scotland in the 18th and 19th centuries were renowned for their cutting-edge medicine and surgery.
Clinical significance: A history of our surgical heritage.
Maria F Jimenez,
Juan C Puyana
How to cite this article:
Jimenez MF, Isaza-Restrepo A, Conde D, Arroyo A, Ibánez-Pinilla M, Borda F, Colmenares D, Puyana JC. Surgical Rescue in a High-volume Urban Emergency General Surgery Service at a Middle-income Country. Panam J Trauma Crit Care Emerg Surg 2021; 10 (1):16-19.
Introduction: 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.
Materials and methods: 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.
Results: 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 (p = 0.038), and hospital LOS (days) (p = 0.004) were significantly higher for the surgical rescue patients than for those without complications.
Conclusion: 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.
Juan Carlos Puyana,
Juan Carlos Molina
How to cite this article:
Sarmiento D, Himmler A, Flores N, Puyana JC, Molina JC. Risk Factors and Complications Associated with Difficult Emergency Cholecystectomies: Experience of a Single Urban Center. Panam J Trauma Crit Care Emerg Surg 2021; 10 (1):20-25.
Aim and objective: The aim and objective of this study is to determine the prevalence, risk factors, and complications of difficult cholecystectomy in our population.
Materials and methods: A retrospective study was conducted from January 2016 through March 2017. Difficult cholecystectomy was the primary endpoint as defined by the surgeon in the operative report. Preoperative risk factors evaluated included: age, sex, obesity, pregnancy, resolved pancreatitis, choledocholithiasis resolved by endoscopic retrograde cholangiopancreatography (ERCP), and surgical wait time. Intraoperative factors evaluated including the presence of anatomical variants, operative time >90 minutes, and the presence of liver disease. We measured the rate of conversion from laparoscopic to open, the incidence of postoperative complications, and overall mortality in this population.
Results: Of 585 patients, 77.9% were admitted for acute cholecystitis, and 22.1% for symptomatic cholelithiasis, acute pancreatitis, or choledocholithiasis treated by ERCP. The prevalence of difficult cholecystectomy in our population was 37.6%. Preoperative risk factors correlating with difficult cholecystectomy included: male sex, and age >65 years. Intraoperative risk factors included: the presence of an anatomic variant and surgical time >90 minutes.
Conclusion: The prevalence of difficult emergency cholecystectomy at our institution is high. There was a low rate of complications and conversion among patients with difficult cholecystectomies.
Juan P Fernandez,
Carolina C Brofman,
Maria S Ferrante,
Rubén D Algieri
How to cite this article:
Fernandez JP, Brofman CC, Ferrante MS, Algieri A, Algieri RD. Análisis y Determinación Del Conocimiento Anatomoquirurgico de Los Profesionales de La Salud Para La Realización de Acceso Vascular Intraoseo en La Urgencia. Panam J Trauma Crit Care Emerg Surg 2021; 10 (1):26-30.
Introduction: Intraosseous vascular access is considered a quick, safe, and effective option in situations in which it is not possible to achieve venous access in a pre-established time, such as in severe shock or cardiorespiratory arrest. In these situations, it is difficult to place conventional vascular accesses, which is why it is extremely important to acquire knowledge related to the placement of intraosseous accesses.
Materials and methods: Descriptive and cross-sectional study. Surveys of health personnel and professionals in training on knowledge of intraosseous vascular access and its use in emergencies AND emergencies.
Results: Four hundred and forty-four surveys were conducted. Doctors with training 37 (8.3%) resident doctors 23 (5.1%), students of medicine 206 (46.39%), nurses 92 (20.72%), and nursing students 86 (19.36%). The range eta-Rio was 21–59 years old. 27.03% (120) know the intraosseous route as vascular access; 25% (111) have received some type of training on the placement of intraosseous accesses, with the same number of professionals who were able to list the corresponding anatomical sites. Only 13.06% (58) were able to indicate precisely the anatomical repairs necessary for their placement and, finally, only 23, 42% (104) of the respondents knew if their place of performance had been set for the placement of said route.
Conclusion: Few health professionals have knowledge related to the placement of intraosseous accesses since they are scarcely promoted during undergraduate training. Intraosseous vascular access is a highly usable alternative and its training can be implemented at different levels of training, with training on its indications, contraindications, complications, and method of the placement being essential. With adequate training, intraosseous vascular access can be used as a tool in the emergency services for the initial treatment of patients with difficulties in the placement of vascular accesses.
Gabriel A Roberto,
Carolina M Britto Rodrigues,
Sthefano A Gabriel,
Rodrigo A Sardenberg
How to cite this article:
Roberto GA, Britto Rodrigues CM, Gabriel SA, Sardenberg RA. Epidemiological Profile of Thoracic Trauma in Brazil: A Systematic Review. Panam J Trauma Crit Care Emerg Surg 2021; 10 (1):31-38.
Background: One of the main injuries found in traumatized patients is thoracic trauma (TT) and corresponds to 25% of deaths in polytrauma patients. According to the World Health Organization, more than nine people die per minute from some type of trauma, with an expense equivalent to 12% for all diseases.
Materials and methods: This is a study that addresses the epidemiology of TT in Brazil through a systematic review of the literature on TT in Brazil, conducted in electronic databases following the guidelines of Preferred Notification Items for Systematic Reviews and Meta-analyses (PRISMA). Exclusion criteria were: case reports of other causes of trauma, animal studies, literature reviews, and studies that did not cover chest trauma. The Statistical Package for Social Sciences (SPSS) version 21.0 was used to analyze the results.
Results: Initially, 760 studies were found, of which 36 articles were selected as relevant to the study on the epidemiological characteristics of TT. With a high global prevalence, trauma is considered a public health problem, associated with high morbidity and mortality, in developed and developing countries.
Interpretation: The Southeast Region had greater statistical relevance (p = 0.033) for mechanisms and causes of TT. The penetrating chest trauma [gunshot wounds (GSW) and stab wounds (SW)], showed greater statistical relevance in the South (p = 0.04) and Midwest (p = 0.04), among the other regions, the value was (p ≥ 0.5).
Maria S Ordonez,
Jorge A Arteaga,
Amber N Himmler,
Juan C Salamea
Introduction: Stenosing papillitis is rare. It can be primary or secondary and occurs due to the presence of stones in the common bile duct. The initial treatment of choledocholithiasis is endoscopic retrograde cholangiopancreatography (ERCP). However, when ERCP is unsuccessful, the transduodenal sphincteroplasty is an alternative strategy that obtains satisfactory results in select patients.
Case description: A 27-year-old female patient presents right-upper quadrant pain associated with scleral icterus. She had choledocholithiasis and cholestasis. The ERCP performed was failed, so an open cholecystectomy with common bile duct exploration was undertaken. As the ampulla could not be cannulated, a “T” tube was placed. On a postoperative day 15, a cholangiography was performed without evidence of contrast passage into the duodenum. A re-exploration of the bile duct was undertaken 30 days after and a papillary exploration through a transduodenal approach was performed. A new cholangiography was done on postoperative day 9, at which point adequate passage of contrast into the duodenum was appreciated.
Conclusion: Transduodenal sphincteroplasty is a procedure rarely performed in the era of endoscopy. Nonetheless, when these cases do come up, knowing the appropriate surgical technique is crucial to obtain satisfactory results for the patient.
Carlos A Lozano De Avila,
Giovanna M Rivas Zuñiga,
Katty C Square Nieves,
Nayib De J Zurita Medrano,
Jaime M Iglesias Medrano
The term body packer refers to the carrying of illegals in the body of a person with the aim of contraband. It is estimated that around 5% of the world\'s adult population used illicit drugs at least once in 2015. While most body packers are asymptomatic, a small percentage requires a surgical intervention due to complications such as intestinal obstruction. In the current report, we will present the case of a patient admitted with this complication to the emergency unit of a hospital in the city of Cartagena.
Adriana M Simons,
Pilar A Lopez,
How to cite this article:
Simons AM, Monteverde E, Francavilla A, Gattari A, Turina D, Costas A, Lopez PA, Neira P. Herida Penetrante Cervical En Pediatría. Panam J Trauma Crit Care Emerg Surg 2021; 10 (1):46-50.
Penetrating neck trauma (PNT) is infrequent in children. Penetrating neck trauma-related vascular injuries contribute significantly to morbidity and mortality, with severe bleeding being the most common cause of early death. Scarcity of information on the subject, and the diagnostic and therapeutic complexity that these patients present, motivate the consideration for presentation of the following cases admitted to a pediatric intensive care unit (PICU) in a 5-year period. These cases showed different evolution and mechanism of injury. Two of them required emergency surgical exploration with final procedures derived from intraoperative findings. In the third case, given his good general condition and hemodynamic stability, it was decided to maintain a non-operative approach with satisfactory results. The mortality of these patients is high during the golden hour, since the therapeutic results depend on a high-degree suspicion index.
Coronavirus disease 2019 (COVID-19) is a pandemic, has emerged as a public health crisis for the entire world. In contrast to other areas of healthcare which can be delayed to priorities treatment of COVID-19 patients, the care of obstetric patients remains a clinical priority. All the patients and their support persons having suspected consistent symptoms of COVID-19 should be completed the screening via phone or video conferencing. The CDC has issued notifications that labor and delivery floors be identified for those pregnant patients with known or suspected positive cases and allow the staff to make the proper arrangements for isolation rooms and personal protective equipment (PPE). Due to uncertainty about the severity of COVID-19 and no clear evidence of vertical transmission, obstetric care is directed toward social distancing as a protective mechanism, and mother/baby separation to avoid contact transmission.
Palliative care patients might be at an increased risk of acquiring the infection due to their poor clinical status. Every care is been taken by the hospital authorities to prevent the spread of infection among healthcare workers and other patients. Somehow, the acute psychological impact of this disease on non-COVID emergency patients is not often addressed. Here, we discuss a scenario that emphasizes the stress an operated cancer patient was undergoing because of this pandemic. The psychological impact of this pandemic cannot be understated. We need measures like an interdisciplinary approach to counsel patients and their relatives in the perspective of COVID-19 at an early stage itself.
We report a situation of leaking peripheral intravenous cannula (PIVC) due to dysfunction of the injection port valve. After shifting the patient to the operating room, anesthesia monitors were attached. The patient was having a 20-G peripheral intravenous cannula (Vygonule V, Vygon Haryana India Pvt. Ltd.) in situ over the dorsum of the right hand. We noticed that fluid is coming out freely through the injection port (Fig. 1). The PIVC was removed and the puncture site was properly dressed. Another PIVC was secured over the dorsum of the left hand. However, we did not have a suitable guidewire to replace it and had to place it afresh. Also, using such a set to replace the PIVC would involve significant costs which might be more than the cost of the cannula. The quality control unit of the manufacturing company should be notified of such an incident as was done in our case.