The New World after COVID-19 and the First Issue of 2022 (English and Spanish)
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:2] [Pages No:1 - 2]
DOI: 10.5005/jp-journals-10030-1380 | Open Access | How to cite |
Adapting Hospital-based Intimate Partner Violence Programs to the COVID-19 Pandemic
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:6] [Pages No:3 - 8]
Keywords: Public health, Survey, Trauma
DOI: 10.5005/jp-journals-10030-1375 | Open Access | How to cite |
Hospital-based intimate partner violence (IPV) programs face a unique challenge in response to the surge of domestic and sexual violence during the COVID-19 pandemic. Project EMPOWER, an integrated hospital/trauma center program at Virginia Commonwealth University (VCU), combines a hospital- and wrap-around community-based services to survivors and leverages telemedicine to provide (1) in-depth follow-up and case management, (2) crisis and counseling support, and (3) extensive trauma-related screening and triaging to account for a myriad of changing needs during this unprecedented time. Since the COVID-19 pandemic, urban trauma centers have seen steady increases in violence-related injuries. With hospital restrictions in place, Project EMPOWER- a hospital-based community-linked trauma center program specific to sexual, domestic, and IPV, needed to adapt to meet patients’ needs. This study highlights the impact of the pandemic on EMPOWER and the effect of a hospital-based/community-linked adaptation.
Evaluating the use of Resuscitative Endovascular Balloon Occlusion of the Vena Cava (REBOVC) in Retrohepatic Vena Cava Injuries: Indications Technical Aspects and Outcomes
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:5] [Pages No:9 - 13]
Keywords: Keywords: Abdominal trauma, Endovascular procedures, Injury, Vena cava
DOI: 10.5005/jp-journals-10030-1366 | Open Access | How to cite |
Aim: Vena cava injuries are a major challenge for trauma surgeons due to their difficult-to-access anatomical site. In addition, their complex operative management often requires prohibitive time for damage control purposes. Considering this scenario, endovascular techniques, such as endovascular occlusion devices, have been increasingly applied to treat such injuries. Resuscitative endovascular balloon occlusion of the vena cava (REBOVC) stands out as a promising technique to manage hemodynamically unstable patients - depending on the anatomical site of the injuries and the complexity of the access to them—since it enables temporary bleeding control to stabilize patients’ conditions. Methods: Based on a literature review about the use of REBOVC to manage venous bleeding deriving from the inferior vena cava (IVC). Four experimental studies were conducted with animal models, one descriptive study about the principles of occlusion in artificial models and four case reports were evaluated. Results: REBOVC helped shorten the time necessary for bleeding control and increased the likelihood of achieving effective treatment in cases of potentially lethal bleeding, as well as reduced mortality rates. Conclusion: REBOVC is a promising endovascular technique that can be used in a safer and more objective way to promote a new paradigm in IVC trauma scenarios to help to control bleeding and reduce its consequences.
Trauma Vascular De La Region Poplitea: Evitar La Ligadura Y Repar La Vena Mejora Los Resultados Reporte Inicial
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:5] [Pages No:14 - 18]
Keywords: Keywords: Lesiones, Lesiones del Sistema vascular, Lesión vascular, Protocolos
DOI: 10.5005/jp-journals-10030-1367 | Open Access | How to cite |
Background: Traumatic vascular injuries of the popliteal region are associated with high morbidity, including limb amputation, especially when there are combined artery and vein injuries. There is controversy in the management of venous injury: repair vs ligation of the vessel, with literature in favor of both repair and ligation. Current evidence validates the use of any of these techniques. Objective: To describe the results of the management of vascular trauma of the popliteal vein, in which immediate or delayed repair of the popliteal vein is performed as the first option in all cases to avoid postligation edema and subsequent amputation. Methodology: Based on the review of the literature and due to the potential benefit of repairing the injured popliteal vein, a protocol is implemented whose guideline is immediate or delayed popliteal vein repair in all cases, and the results are described. Results: During the year 2020 and the first 3 months of 2021, eight cases with vascular injury of the popliteal region were documented. Five cases with venous injury. One was ligated and the result was amputation, four were repaired and had successful revascularization of the limb without consequences of amputation. Conclusion: Although ligation has been described as an option for a destructive popliteal vein injury, we believe that venous revascularization offers clear advantages, avoiding postligation edema, and arterial thrombosis due to severe edema due to lack of return. Our proposal is venous reconstruction for all cases.
Experiencia De Laparoscopia En Trauma Penetrante En El Hospital General San Juan De Dios
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:3] [Pages No:19 - 21]
Keywords: Laparoscopy, Penetrating abdominal trauma, Trauma
DOI: 10.5005/jp-journals-10030-1370 | Open Access | How to cite |
Introduction: The laparoscopic approach in polytraumatized patients continues to be infrequent. The objective of this study is to analyze our experience of the laparoscopic approach in the patient with hemodynamically stable thoracoabdominal and penetrating abdominal trauma because, in our institution, exploratory laparotomy is the treatment of choice for our patients. Non-therapeutic laparotomies are associated with 5% mortality and 20% morbidity. Material and methods: An observational, descriptive, cross-sectional, and retrospective study was carried out on all patients admitted with abdominal and thoracoabdominal trauma to the San Juan de Dios General Hospital from 2019 to February 2021. Selected all the patients who underwent a laparoscopic approach for diagnostic and therapeutic purposes. Results: Nine patients are described, with a mean age of 31.4 years; 67% of the patients are male. Six patients suffered a stab wound (67%), and conversion to exploratory laparotomy was required in two patients due to findings of complex lesions. In four cases (44%), the laparoscopic examination revealed no lesions. The procedures performed included diaphragmatic repair, transdiaphragmatic pericardial window, and pericardial biopsy. There were no cases of mortality. Conclusion: The laparoscopic approach remains infrequent in trauma patients, its diagnostic and therapeutic utility must be taken into account for selected cases. Its use in the diagnosis of diaphragm injuries due to penetrating abdominal injury in hemodynamically stable patients is widely accepted for its evaluation and repair, as long as they are hemodynamically stable patients and their life is not compromised by performing a minimally invasive procedure. We suggest that it should be carried out by surgeons with experience in the management of polytraumatized patients, who, based on their criteria, can select what type of case will be approached laparoscopically.
Queda Intra-Hospitalar E Danos Associados: Comparação Em Um Hospital Privado
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:4] [Pages No:22 - 25]
Keywords: queda, intra-hospitalar, evento adverso
DOI: 10.5005/jp-journals-10030-1364 | Open Access | How to cite |
Objetivo: Comparar os índices de queda e os danos associados de um hospital privado. Método: coorte retrospectiva que analisou os indicadores de queda e danos associados a este evento, de pacientes internados, entre Janeiro e Dezembro de 2020. Os pacientes que apresentaram queda em Pronto Socorro Adulto, Medicina Diagnóstica e Terapêutica, Centro Médico e transeuntes foram excluídos desta amostra. Os resultados do ano de 2020 foram divididos em trimestres e comparados entre si. Os testes t-student e Exato de Fisher foram aplicados em todas as comparações com nível de significância de 5%. Resultado: Em 2020 foram registradas 66 quedas, das quais 90,9% ocorreram nas Unidades de Internação (UI) e 9,1% em Unidade de Terapia Intensiva (UTI). A média do índice anual de quedas correspondeu a 0,89 quedas / 1000 pacientes internados. Ao comparar o índice dos quatro trimestres do ano de 2020 entre si, em todas as possibilidades; não houve diferença significativa entre eles (p > 0,05). Foram registrados 12 danos provenientes de quedas, dos quais a maioria ocorreram na UI (75,0%); 09 danos foram leves (75,0%) e 03 danos moderados (25,0%), sendo: 01 em Oncopediatria (33,3%), 01 na UTI (33,3%) e 01 na clínica cirúrgica (33,3%). Ao comparar o índice de danos em relação as quedas ocorridas em 2020, houve significância estatística (p < 0,001), do qual a média de danos anual foi de 0,13 danos/1000 pacientes internados. Conclusão: as quedas intra-hospitalares precisam de mais investigações e comparativos em hospitais privados como linha de cuidado no trauma, com a finalidade de definição de estratégias e barreiras para evitar a queda e consequentemente os dados. Significância clínica: a queda intra-hospitalar é o evento adverso que apresenta maiores relatos em literatura internacional, fato este, que ocorre devido a este processo envolver a adesão do paciente as medidas preventivas para que não ocorra o evento. Cabe as instituições de saúde, mediante a este contexto, desenvolver processos que mitiguem o evento e diminuam as probabilidades de danos oriundos de quedas.
Heridas Cardiacas 11 Años de Experiencia en tres Hospitales Universitarios de Uruguay/Penetrating Cardiac Injuries, 11 Years of Experience in three University Hospitals in Uruguay
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:5] [Pages No:26 - 30]
Keywords: Cardiac trauma, Penetrating cardiac injuries, Precordial injuries
DOI: 10.5005/jp-journals-10030-1379 | Open Access | How to cite |
Introduction: Cardiac injuries are a diagnostic and therapeutic challenge for the trauma surgeon. The survival of these patients is influenced by several factors, favored by a fast and protocolized decision-making process. With the aim to analyze the epidemiology, diagnostic, and therapeutic strategies, as well as the treatment results, we analyzed retrospectively the cardiac injuries in three university hospitals in Montevideo, over 11 years. Materials and methods: A retrospective, multicenter, descriptive, and observational study was out based on the medical records’ analysis of patients operated on for cardiac injuries in three public university hospitals. Results: A total of 173 patients (97.1% men) were included with a mean age of 34.7 ± 20.5 years. The mechanism of injury was associated with mortality in favor of gunshot wounds (p < 0.0001) as well as hemodynamic conditions at admission (p < 0.0001). Conclusion: In accordance with other authors, our results confirmed that the hemodynamic status at admission, the type of anatomical injury, and gunshot wounds seem to be closely related to mortality. The ultrasonography study on the evolution was abnormal in 46.3%.
Desafios na Implementação do registro de trauma em uma instituição da saúde suplementar no Brasil
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:3] [Pages No:31 - 33]
Keywords: Injury severity score, Patient safety, Trauma center, Trauma registry, Wounds and injuries
DOI: 10.5005/jp-journals-10030-1376 | Open Access | How to cite |
Introdução: Registros de trauma são uma ferramenta fundamental para o funcionamento dos centros de trauma e o monitoramento contínuo do cuidado. Objetivo: Apresentar os desafios na implementação do registro de trauma (RT) em um centro de trauma da saúde suplementar no Brasil, organizado de acordo com os critérios do Comitê de Trauma do Colégio Americano de Cirurgiões. Método: Trata-se de um estudo observacional, descritivo, que apresenta os desafios e as estratégias utilizadas para implementar o registro de trauma na instituição do estudo, um centro de trauma nível II. Resultados: Como não está disponível no Brasil um RT nacional, optou-se pela compra de um software utilizado em centros de trauma norte-americanos; este processo demorou cerca de seis meses. Uma das grandes barreiras foi o idioma do programa (inglês); como estratégias, foi desenvolvido um dicionário com a tradução e a definição de todos os elementos do registro; além disso, foi feita a tradução do National Trauma Data Standard Data Dictionary para o português para melhor entendimento dos registradores. Outro grande desafio foi a preparação dos registradores, visto não existir um programa de treinamento no país; considerando a necessidade de conhecimentos de anatomia, fisiologia e clínica, optou-se por treinar enfermeiros na utilização do registro e na codificação da gravidade das lesões; esse treinamento foi feito por uma enfermeira com conhecimento do registro e de codificação de lesões. Conclusão: No período de um ano, mais de 400 doentes foram inseridos no registro, com todos os elementos preenchidos e os dados validados seguindo diretrizes internacionais. É um grande desafio implementar um RT em um país em que bancos de dados de trauma locais e regionais não estão disponíveis. A disponibilização de produtos nacionais, em moeda e idioma locais, facilitaria as negociações e permitiria que mais instituições pudessem adquirir um RT. Programas locais de formação permitirão o treinamento de mais profissionais e o aprimoramento e a otimização de todo esse processo.
Fundamentos Para La Elaboración De Artículos Científicos En Trauma Y Cuidado Agudo De Emergencias (Parte 5-A): Bases Y Fundamentaciones De Metodología Estadística
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:11] [Pages No:34 - 44]
Keywords: Keywords: Descriptive statistics, Epidemiology, Statistical analysis, Statistical methods
DOI: 10.5005/jp-journals-10030-1365 | Open Access | How to cite |
Introduction: An appropriate use of statistical methodology to analyze data or to discriminate the methodological quality of relevant studies applicable to clinical practice is a fundamental skill for trauma and emergency acute care teams. Considering that these skills arise from the understanding and application of pre-established methodologies, the aim of this article is to provide the basis and foundations of statistical methodology in medical research, as an initial step for the correct analysis of ongoing studies and/or for the interpretation of results in clinical studies published in the scientific literature. Materials and methods: A narrative review of relevant literature available in databases was carried out and concepts available in gray literature sources such as traditional statistical reference texts were added. Results: Fourteen topics of relevance for the analysis and interpretation of results were defined, which, due to their length, will be presented in two deliveries (Part 5-A and Part 5-B). This first installment includes an introduction to statistics, epidemiological concepts and variables, probabilities and their distributions, hypothesis testing, types of error and validity, selection of statistical methods, methodological design of a study, types of clinical studies, and the methodology for determining the population and the sample. Conclusion: The fundamental concepts in statistics, including basic aspects of epidemiology and the types of study designs in clinical research are critical elements for the appropriate analysis of data in clinical research and for the correct evaluation of the quality of published articles to be implemented in the practice of trauma surgery and acute emergency care. Their knowledge is essential for the appropriate interaction between students and mentors involved in the elaboration of scientific manuscripts in this clinical subspecialty.
Aplana La Curva Del Trauma: Reflexiones Filosóficas Sobre La Violencia
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:6] [Pages No:45 - 50]
Keywords: Philosophy, Prevention, Public health, Violence
DOI: 10.5005/jp-journals-10030-1381 | Open Access | How to cite |
At this moment in the history of humanity, we have witnessed a restriction of our individual freedoms justified by a common good: the limitation of contagion by infection of the SARS-CoV-2 virus (COVID-19) in the context of this health emergency. In this article I propose to address the consequences of a stricter health policy in order to face a disease that has plagued us for more than 3 decades: violence. Through a brief historical review, it is intended to carry out a philosophical reflection on the theoretical foundations of decisions in bioethics and public health, as well as to understand the complex panorama of the increase in violence and its media and cultural apology in Mexico. Finally, a review is made of the work of Dr Gary Slutkin and his team of collaborators in Chicago who, through studies in the area of neuroscience, defend a shocking thesis: violence behaves like an infectious disease. The conclusions that emerge from this thesis depend on the reader, but we should ask ourselves: if violence is an infectious disease, what freedoms are we willing to give up to contain this public health problem?
Retroperitoneal Hematoma as a Complication of Anticoagulation Therapy with Heparin
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:3] [Pages No:51 - 53]
Keywords: Arterial embolization, Deep vein thrombosis, Heparin, Protamine, Spontaneous retroperitoneal hemorrhage
DOI: 10.5005/jp-journals-10030-1372 | Open Access | How to cite |
Aim: We report the case of a large spontaneous retroperitoneal hemorrhage in a patient receiving a heparin infusion. He was treated by blood transfusion, reversal with protamine, and angioembolization. Background: Spontaneous retroperitoneal hemorrhage can present as a rare life-threatening event characterized by sudden onset of bleeding into the retroperitoneal space, occurring in association with bleeding disorders, tumors, or anticoagulation. Case description: We report the case of a patient with central cord syndrome who was treated with heparin infusion for upper limb deep vein thrombosis. This was complicated by a large spontaneous retroperitoneal hemorrhage, which was treated by blood transfusion, reversal with protamine, and angioembolization. Retroperitoneal bleeding is a medical emergency that is often difficult to diagnose due to its rarity and the nonspecific symptoms with which it presents. Treatment may vary. In our case, blood transfusion, reversal of heparin with protamine, and interventional treatment were performed as active bleeding was recognized on angiography. Conclusion: Idiopathic retroperitoneal hemorrhage is an uncommon condition that may lead to shock if not promptly recognized. Timely diagnosis and treatment help improve outcomes. Clinical significance: This is a rare and challenging complication. Timely diagnosis requires high clinical suspicion. Management depends on hemodynamic stability. This case highlights the importance of early detection and treatment and opens the door for more studies to minimize related complications.
A Rare Cause of Renal Vein Thrombosis: A Progressive Zone I Retroperitoneal Hematoma following Blunt Trauma
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:2] [Pages No:54 - 55]
Keywords: Blunt trauma, Retroperitoneal hematoma, Renal vein thrombus
DOI: 10.5005/jp-journals-10030-1371 | Open Access | How to cite |
Renal vein thrombosis is a rare sequela of blunt trauma with the potential for significant morbidity and mortality. The physiology of the multitrauma victim is extremely dynamic on both the micro and macroscopic levels. Trauma-induced coagulopathy, together with anatomical changes due to injury, plays a significant role in the treatment and prognosis of the trauma victim. Here we show, with sequential computer tomography (CT) scans, the effect of an enlarging retroperitoneal hematoma on the renal venous system. The changes and external pressures, without direct compression, of the retroperitoneal hematoma, created a thrombogenic environment for the left renal vein leading to renal vein thrombosis. The measurement of the retroperitoneal hematoma, and its progression, might be a useful marker for prognosis and the potential need for invasive intervention in order to prevent further injury and morbidity.
The Overuse and Underuse of Healthcare in Neurotrauma
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:3] [Pages No:56 - 58]
Keywords: Keywords: Brain injuries, Neurocirugía, Traumatic
DOI: 10.5005/jp-journals-10030-1368 | Open Access | How to cite |
The overuse and underuse of resources in health systems can be a problem for patients with neurotrauma. The associated costs in developed countries (where the problem has been better studied) are immense. The use of inexpensive interventions can be a strategy to optimize healthcare without compromising quality. The fact that a device/strategy is cheaper, in general, is because it is of lower quality or whose therapeutic effects have not been proven in that population. In poor countries, many times they are out of options to use expired drugs or devices in public hospitals. An example is the use of shunts for hydrocephalus or osteosynthesis instruments without certification- risk/benefit, since they are more accessible due to cheaper for the institutions.
Rebound Intracranial Hypertension during Fluid Therapy in Neurointensive Care: A Proposal for Scheduled Discontinuation
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:2] [Pages No:59 - 60]
Keywords: Keywords: Critical care, Fluid therapy, Neurointensive care, Traumatic brain injury
DOI: 10.5005/jp-journals-10030-1369 | Open Access | How to cite |
The fluid administration for intensive care of critically ill patients is one of the pillars in intensive care medicine. The rational use of fluid therapy must include adequate knowledge of the pharmacological aspects of these agents whose characteristics frame the concept of fluid therapy. The same holds for neurological crisis patients that the fluid therapy strategies aim to guarantee requirements to maintain oxygenation and cerebral blood flow in physiological constants.
Stroke and SARS CoV-2 Infection: Lessons of Pandemic
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:2] [Pages No:61 - 62]
Keywords: Neurointensive care, Neurology, Stroke
DOI: 10.5005/jp-journals-10030-1373 | Open Access | How to cite |
Ischemic cerebrovascular disease has become one of the main causes of disability worldwide. The development of the pandemic of SARS CoV-2 has not decreased consultation for ischemic cerebrovascular events; on the contrary, neurotropism of the new coronavirus makes the central nervous system an affected area.2,3,4 This has directly caused increased presentation, consultations, and procedures on these patients. The coronavirus-associated thrombotic disease develops in the hyperinflammation phase that occurs between days 10 and 14. The risk of developing an acute ischemic stroke is greater in the context of the new pandemic.
Paroxysmal Sympathetic Hyperactivity in TBI: Unanswered Questions
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:3] [Pages No:63 - 65]
Keywords: Intensive care, Neurosurgery, Neurotrauma
DOI: 10.5005/jp-journals-10030-1374 | Open Access | How to cite |
Traumatic brain injury (TBI) is a complex management condition. Mild to moderate presentation is dealt with mostly in a non-ICU setting, while severe TBI ends up in intensive care units. The presentation and course of severe TBI is a team effort, and attempts are made to prevent complications and reduce morbidity. One condition which is still not clear and usually presents after initial stabilization is sympathetic overactivity. Here we will try to go over unanswered questions about this condition. We do not believe that the suggested answers to these questions are all set in stone and will change as we have a better understanding.
Prophylactic Infusion of 3% Saline in Intracranial Hypertension: Look before you Leap
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:2] [Pages No:66 - 67]
Keywords: Neurocritical care, Neurointensive care, Traumatic brain injury
DOI: 10.5005/jp-journals-10030-1378 | Open Access | How to cite |
Intracranial hypertension can be a direct cause of mortality in neurointensive care. One of the strategies that have proven effective is the use of hyperosmolar fluid therapy to reduce intracranial pressure. The preference for hypertonic saline solution over mannitol has been due to the potential complications of the mannitol. These complications include renal injury and rebound intracranial hypertension. This use of hypertonic saline is sometimes used as a prophylactic administration in anticipation of cerebral insult. Administration of hypertonic saline can be bolus or continuous infusion. There are certain issues that need to be mentioned in the planning of the care. Here, we would like to visit the need for this prophylactic infusion or protocol for hypertonic saline.
Traumatic Injuries and Early Pharmacological Intervention for Psychological Challenges: Is this the Best Option?
[Year:2022] [Month:January-April] [Volume:11] [Number:1] [Pages:2] [Pages No:68 - 69]
Keywords: Accidents traffic, Antidepressants, Depressed, Depression, Emotionally lowered, Psychological interventions, Trauma, Traumatic injuries, Trauma surgery care
DOI: 10.5005/jp-journals-10030-1377 | Open Access | How to cite |
Patients with traumatic injuries experience various psychological symptoms similar to depression, which do not meet the criteria for such diagnosis. Antidepressant medications should not be prescribed except after the correct diagnosis of depression, made by a qualified mental health professional. Psychological interventions should be used as first line of care for most injured patients. Psychological interventions, unlike antidepressants, have proven long-term efficacy and have been adequately established. At the same time, antidepressants may have known or lesser-known side effects with long-term implications on one's mental health and should only be used as the second line of intervention for patients with traumatic injuries. Spanish Translation Los pacientes con lesiones traumáticas experimentan diversos síntomas psicológicos similares a la depresión, que no cumplen los criterios para dicho diagnóstico. Los medicamentos antidepresivos no deben recetarse excepto después de un diagnóstico correcto de depresión, a menudo realizado por un profesional de la salud mental calificado. Las intervenciones psicológicas deben utilizarse como primera línea de atención para la mayoría de los pacientes lesionados. Las intervenciones psicológicas, a diferencia de los antidepresivos, han demostrado eficacia a largo plazo y se han establecido adecuadamente. Al mismo tiempo, los antidepresivos pueden tener efectos secundarios conocidos o menos conocidos con implicaciones a largo plazo en la salud mental y solo deben usarse como segunda línea de