Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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2021 | May-August | Volume 10 | Issue 2

EDITORIAL

Sandro Rizoli

Social Distancing for Patients and Doctors? A New Post-COVID World

[Year:2021] [Month:May-August] [Volume:10] [Number:2] [Pages:2] [Pages No:59 - 60]

PDF  |  DOI: 10.5005/jp-journals-10030-1325  |  Open Access |  How to cite  | 

Original Article

Nancy Valencia-Rojas, Michel B Aboutanos, Edgar B Rodas

Fostering Knowledge Transfer to Strengthen the Surgical Workforce in LMIC: Lessons Learned from an International Observership Program

[Year:2021] [Month:May-August] [Volume:10] [Number:2] [Pages:5] [Pages No:61 - 65]

Keywords: Global surgery, International observership, International training experiences, Knowledge sharing, Surgical training, Surgical workforce

PDF  |  DOI: 10.5005/jp-journals-10030-1324  |  Open Access |  How to cite  | 

Abstract

Introduction: Virginia Commonwealth University and the Panamerican Trauma Society have worked collaboratively for 10 years in strategies focused on facilitating knowledge transfer and sharing with the ultimate goal of enhancing knowledge-base in the field of surgery, trauma, acute care, and EMS for physicians-in-training from Latin America countries. The International Observership Program (IOP) allows participants to rotate in a level 1 trauma facility and to observe all the interconnected components of a comprehensive trauma care cycle. This article describes and analyzes the limitations and lessons learned while running the IOP and offers a path for other academic institutions in high-income countries that may are interested in supporting knowledge-sharing initiatives and career development of the surgical workforce in LMICs. Conclusion: LMIC surgical trainees can benefit from international rotations. Knowledge-sharing initiatives targeting foreign medical providers can be effective in increasing awareness of best practices for emergency and acute care and the importance of the components of comprehensive trauma systems. The goal should always be to tailor training efforts to meet the needs of LMICs and not merely to replicate the highly specialized care offered in U.S. institutions.

Original Article

Jacob Kirkorowicz, Nichole Atherton, Yueqi Yan

Trauma Outcomes in Methamphetamine-positive Patients vs Matched Methamphetamine-negative Controls in a Central Valley California Trauma Center

[Year:2021] [Month:May-August] [Volume:10] [Number:2] [Pages:5] [Pages No:66 - 70]

Keywords: Abdominal trauma, Celiotomy, Critical care, Mortality rate, Outcomes, Penetrating injuries

PDF  |  DOI: 10.5005/jp-journals-10030-1323  |  Open Access |  How to cite  | 

Abstract

Aim and objective: Our objective was to determine whether patients presenting as activated traumas to a trauma center serving a high methamphetamine (meth) prevalence region differed in outcomes based on whether they tested positive vs negative for methamphetamine at the time of presentation. Materials and methods: A case-control design was used to examine the trauma outcomes among patients who tested meth-positive vs matched controls. The trauma outcomes evaluated were needed for laparotomy, rate of inpatient admission, rate of ICU admission, hospital length of stay, ICU length of stay, ventilation status, ventilation time, injury severity score, and mortality. Propensity score matching was used to match meth-positive cases and comparison cases on sex, age (in years), race, primary financial resources to pay for the visit, presentation time, and the county where s/he lived at the time of presentation. Results: Meth-positive patients and matched comparison cases did not differ in the need for laparotomy. Meth-positive patients experienced a longer hospital stay (p = 0.011), longer duration of ventilator use (p = 0.05), and a higher injury severity score (p < 0.001). Positive cases were more likely than matched comparison cases to be admitted to the ICU (p < 0.001) and to be placed on mechanical ventilation (p < 0.001). Meth-positive patients had a marginally significantly higher rate of inpatient admission (p = 0.066). No significant difference was found between the two groups in mortality rate at discharge and length of ICU stays. Conclusion: Meth positivity is notably associated with an increased injury severity score on presentation. If meth use is known or suspected before arrival, trauma resources should be mobilized appropriately to prepare for a severe traumatic injury. The fact that meth positivity increases the likelihood of ICU admission and ventilator use, with increased hospital length of stay and increased ventilator time, indicates that meth positivity in trauma patients places a large burden on hospital staffing and resources.

Original Article

Celeste Echavarria, Sofia Bou, Favio Guzman, Cristian Assell, Juliana Nazaretto, Andrea Potes, Guillermo Barillaro

Traumatismo Toracoabdominal Penetrante: Que Cavidad Operar Primero?

[Year:2021] [Month:May-August] [Volume:10] [Number:2] [Pages:7] [Pages No:71 - 77]

Keywords: Abdominal penetrating trauma, Decision making, Mortality analysis, Open thoracic trauma, Quality in trauma management, Ultrasonography

PDF  |  DOI: 10.5005/jp-journals-10030-1318  |  Open Access |  How to cite  | 

Abstract

Background: Patients with penetrating thoracoabdominal trauma (PTAT) by gunshot wounds (GSW) or by stab wounds (SW) pose the challenge of deciding which cavity to operate first. Initiating surgery in the cavity with less severe injuries may delay the management of a fatal hemorrhage or cardiac tamponade. Aim and objective: The objective of this work was the analysis of: • Characteristics of patients with PTAT with a sequence of combined surgical interventions. • Characteristics of the error due to inappropriate sequence of said operative procedures. • Relationship of these previous factors with mortality. Design: Observational retrospective. Materials and methods: Review of the medical records of the patients assisted in our institution between January 2005 and December 2018, with PTAT that required operative procedures both in the chest (pleural drainage or thoracotomy) and in the abdomen (laparotomy or laparoscopy). Results: Seventy-nine patients with PTAT, 48 with normal hemodynamics (group I) and 31 with hypovolemic shock (group II) were assisted. In group I, SW (40) predominated over GSW (8), and lesions on the left side (42) (87.5%). In this group, there were no errors in sequential surgical management and no mortality was recorded. In group II, transfixing GSW of the midline predominated. In eight cases, an error was recorded when first approaching the cavity with less serious injuries (in four cases the thorax and in four cases the abdomen), seven of them died and determining mortality of 25.8% for group II. The analysis of the error in these eight cases found that in five it was potentially preventable and that it was related to erroneous results of the ultrasound and/or underestimation of the output of the pleural drainage and of the post-pleural drainage chest radiograph. Conclusion: Patients with PTAT and hemodynamically compensated presented a predominance of left-sided SW and had no errors in the sequential management of cavities or mortality. On the other hand, in those with PTAT and shock, GSW and transfixing paths of the midline predominated, and this group was the one that had exclusively the handling errors and mortality. Most of the errors in management were considered potentially preventable since they were related to false results of the ultrasound and underestimation of the output of the pleural drainage and of the post-pleural drainage chest radiograph.

REVIEW ARTICLE

Ariana A Chacón-Aponte, Érika A Durán-Vargas, Jaime A Arévalo-Carrillo, Amit Agrawal, Ivan D Lozada-Martinez, Tariq Janjua, Luis R Moscote-Salazar, Ved P Maurya, Rakesh Mishra, Mohammed M Al-Salihi, Moshiur Rahman

Talk and Die Syndrome: A Narrative Review

[Year:2021] [Month:May-August] [Volume:10] [Number:2] [Pages:4] [Pages No:78 - 81]

Keywords: Brain concussion, Brain contusion, Talk and die syndrome, Traumatic brain injuries

PDF  |  DOI: 10.5005/jp-journals-10030-1322  |  Open Access |  How to cite  | 

Abstract

The level of consciousness following head trauma generally correlates with the overall prognosis of an individual. It is a consensus that following a head injury, patients able to talk (Glasgow coma scale verbal of 3 or 4) perform well over time. However, there is a subset of patients who suddenly deteriorates and succumb despite talking after trauma. Such an event was labeled as “talk and die”. This review aims to summarize the published literature on talk and die syndrome, considering the relevance of this condition, especially in Latin America and the Caribbean, where there are high rates of traumatic brain injury.

CASE REPORT

Olival CL da Fonseca Neto, Luiz ER Moutinho, Ludmila RO Costa

Early Traumatic Hepatothorax: An Underdiagnose Complication of High Energy Blunt Trauma

[Year:2021] [Month:May-August] [Volume:10] [Number:2] [Pages:3] [Pages No:82 - 84]

Keywords: Blunt trauma, Laparotomy, Traumatic diaphragmatic hernia

PDF  |  DOI: 10.5005/jp-journals-10030-1321  |  Open Access |  How to cite  | 

Abstract

Aim and objective: This paper reports a case of early traumatic hepatothorax and discusses diagnosis and treatment according to an updated literature review. Background: Hepatothorax is the abnormal displacement of the liver to the chest. It is a rare condition, which may be challenging to diagnose, and is associated with high energy blunt trauma. Hepatothorax may evolve in different phases: initial, latent, and obstructive; and lead to significant complications and death. Case description: This paper reports the case of a female patient, 35-year-old, diagnosed with hepatothorax due to a car crash causing a high-energy thoracoabdominal trauma. Due to poor clinical progress after chest drainage, a subsequent helical computerized tomography was done and diagnosed a right diaphragmatic injury and hepatic herniation to the chest. The patient underwent early surgical correction of the diaphragmatic injury and she was later successfully discharged home without complications after a 1-year follow-up. Conclusion: The literature reports numerous underdiagnosed cases and later surgical correction of traumatic hepatothorax. In this case, persistent dyspnea, despite chest drainage, following a high-energy trauma led to the search and identification of the hepatothorax. Clinical significance: Physicians should have a high index of suspicion for traumatic hepatothorax in high-energy blunt thoracoabdominal trauma and consider early surgical repair, which is associated with lower morbidity and mortality in this type of injury.

COMMENTARY

Tariq Janjua, Fawad Bangash, Luis R Moscote-Salazar

Airway Management of Massive Hemoptysis in a Tracheostomized Patient: A Clinical Approach

[Year:2021] [Month:May-August] [Volume:10] [Number:2] [Pages:2] [Pages No:85 - 86]

Keywords: Critical care, Hemoptysis, Tracheostomy

PDF  |  DOI: 10.5005/jp-journals-10030-1320  |  Open Access |  How to cite  | 

Abstract

Airway management in a critical care environment is one of the most important and difficult procedures. This procedure is usually complicated with marked derangements in patients. These derangements lead to minimal time to act and maneuver intubation with no or minimal impact on the underlying condition. One of these conditions is the continued critical care need for tracheotomized patients. The complications of tracheostomy and airway management are challenging tasks. One of the complications is airway compromise due to hemorrhage requiring airway control. Here, we describe two cases with a proposed pathway.

PERSPECTIVE

Amber N Himmler

Una Extranjera en el Extranjero

[Year:2021] [Month:May-August] [Volume:10] [Number:2] [Pages:2] [Pages No:87 - 88]

PDF  |  DOI: 10.5005/jp-journals-10030-1319  |  Open Access |  How to cite  | 

LETTER TO EDITOR

Luis R Moscote-Salazar, Amit Agrawal, Moshiur Rahman

Coronavirus Disease (SARS-CoV-2) and Neurocritical Care: Challenges for Neurosurgeons

[Year:2021] [Month:May-August] [Volume:10] [Number:2] [Pages:2] [Pages No:89 - 90]

Keywords: Neurocritical care, Trauma, Trauma surgery

PDF  |  DOI: 10.5005/jp-journals-10030-1317  |  Open Access |  How to cite  | 

Abstract

Neurocritical care is an important and integral part of neurosurgical management. In this global war without any smoke, it is a pivotal need for a holistic effort, as a health unit, in combating the virus. In this new era of SARS-CoV-2, neurosurgeons must acknowledge the insights regarding neurocritical care to safeguard our patients and quest for their best possible clinical outcome, working in harmony and sync with other clinical specialties. SARS-CoV-2 has very similar properties to the already known SARS-CoV, demonstrating in animal models its ability to invade neural tissues, with a high preponderance to neurons in the respiratory centers. The exact cause must be differentiated from nonspecific causes from those caused valid or indirect way by the infection, including infectious, para-infectious, and post-infectious encephalitis, hyper-coagulable states prompting stroke. To improve the quality of life of patients, roping in of the neurological manpower is mandatory in ICU, ward, research as well as neurological, neuropsychological, and neurocognitive rehabilitation including domiciliary care in search of a SARS-CoV-2 free world.

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