Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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2022 | May-August | Volume 11 | Issue 2

SPECIAL ISSUE INVITATION

Special Issue Invitation

[Year:2022] [Month:May-August] [Volume:11] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/pajt-11-2-vi  |  Open Access |  How to cite  | 

EDITORIAL

Sandro Rizoli

The Congress is Coming in November 2022 – Se viene el Congreso en Noviembre 2022

[Year:2022] [Month:May-August] [Volume:11] [Number:2] [Pages:2] [Pages No:71 - 72]

   DOI: 10.5005/jp-journals-10030-1392  |  Open Access |  How to cite  | 

Original Article

Rodrigo Olvera, Sara S Solano, Antonio Marttos, Daniel D Yeh, Patricia M Byers, Gabriel Ruiz, Shevonne S Satahoo, Enrique Ginzburg, Nicholas Namias, Gerd D Pust

Accident Mechanisms and Demographic Distribution of Train-related Accidents in the United States

[Year:2022] [Month:May-August] [Volume:11] [Number:2] [Pages:5] [Pages No:73 - 77]

Keywords: Suicide, Trains, Traumatic injuries

   DOI: 10.5005/jp-journals-10030-1385  |  Open Access |  How to cite  | 

Abstract

Introduction: There is little information in the literature about the most critical demographic patterns on train accidents. We attempt to assess demographic patterns associated with railway injuries in the US. Materials and Methods: Using the 2017 National Trauma Data Bank (NTDB), we identified adults who suffered train-related injuries. Data collected included age, sex, ethnicity, restraint devices, prehospital and emergency department (ED) vital signs and Glasgow Coma Scale (GCS), time of response and transportation, prehospital cardiac arrest, mechanism of injury, death in crash and in ED, pregnancy more than 20 weeks when applicable, burn injuries, supplemental oxygen, height, weight, ED discharge disposition, history of alcoholism and drug abuse, need of intensive care unit (ICU), length of stay (LOS) at the ICU and hospital, ventilator use in days, hemorrhage control surgery, blood products received, and Abbreviated Injury Scale (AIS) score. For all statistical analyses, a p-value of <0.05 was considered significant. Results: We identified 4,545 patients, of whom 68% were male, and the mean age was 37 ± 16.5 years. The racial distribution was 64% White, 19% Black, 12% Hispanic, 11% Hispanic, and 6% others. The most common mechanisms of injury were intentional self-harm by jumping or lying in front of the train (30%), followed by pedestrian struck by train (26%), intentional collision of motor vehicle with train (19%), and accidental motor vehicle collision with train (14%). Compared to females, males had lower GCS 12 vs 12.7 (p = 0.005). Alcohol intoxication was present in 13% of patients who had longer LOS 13.4 vs 10 days (p = 0.001). Drug involvement was present in 19% of patients who had lower GCS 11.9 vs 12.6 (p = 0.001). Overall mortality was 17% and was greater in suicide attempts (19%) and pedestrian struck (35%). Mortality for car occupants injured by train collision vs intentional collision of motor vehicle was 5.9 vs 3.4%. Conclusion: The most frequent train-related injuries are secondary to suicide attempts. The second most common incidents occur on railway crossings with pedestrians and motor vehicle occupants. Further public care research is needed to improve safety measures and public awareness associated with railway crossings.

Original Article

Claudia Alejnadra Anton, Napoleon Mendez, Mario Andrés Flores, Rudy Alejandro Herrera

Experiencia en reparaciones de lesión de vía biliar en un servicio de urgencia en el Hospital General San Juan de Dios

[Year:2022] [Month:May-August] [Volume:11] [Number:2] [Pages:4] [Pages No:78 - 81]

Keywords: Bile duct, Cholecystectomy, Injury

   DOI: 10.5005/jp-journals-10030-1388  |  Open Access |  How to cite  | 

Abstract

Introduction: The objective of this study is to describe the experience in the management of surgical injury of the bile duct in an emergency service in a Latin American country with limited resources. The study also epidemiologically characterizes the type of injuries that were managed and their evolution. Biliary tract injuries represent an infrequent complication; the bibliography on the matter is little because the world's casuistry is limited. Materials and methods: A retrospective, descriptive, and observational cross-sectional study of patients with surgical bile duct injury treated in the emergency department and who were operated on at Hospital General San Juan de Dios with bile duct injuries between the years 2019 and April 2021. Results: A total of seven cases are described, with a mean age of 32.6 years, and 86% are female. Of the seven patients, five (71%) were injuries referred from other hospitals in Guatemala, and 86% were due to open cholecystectomy. Intraoperative diagnosis was given only in two cases where biliodigestive surgery was performed at the same surgical time. Six patients had a Bismuth II type of injury, and one had a Bismuth I injury. All seven patients underwent Roux-en-Y hepatojejunal anastomosis. Mortality was two cases due to intra-abdominal sepsis. One of the cases underwent reoperation 7 months later due to 100% stenosis of the hepatojejunal anastomosis. Conclusion: This study describes the experience of the surgical emergency service of the Hospital General San Juan de Dios in treating injuries of the bile ducts. The hospital is a national reference center, and despite limited resources, most patients with postcholecystectomy injuries are admitted for diagnosis and surgical treatment. The hospital has extensive experience in the management of biliary tract injuries. Our experience shows a predominance of the female sex, that early diagnoses had a better success rate, while late diagnoses have a connection with significant mortality.

REVIEW ARTICLE

Juan Jose Beltran-Ruiz, Juan Sebastian Reyes-Bello, Claudia Marcela Restrepo-Lugo, Luis Rafael Moscote-Salazar

Pathobiology of the Glymphatic System in the Traumatic Brain Injury: A Narrative Review

[Year:2022] [Month:May-August] [Volume:11] [Number:2] [Pages:6] [Pages No:82 - 87]

Keywords: Brain trauma, Craniocerebral trauma, Glymphatic system

   DOI: 10.5005/jp-journals-10030-1389  |  Open Access |  How to cite  | 

Abstract

The glymphatic system (GS) is responsible in the brain for transporting substances toward the interstitium and then out of it; it is essential for neuronal functioning and even more so after any brain injury. It is a fragile system, its functioning is altered with age, sleep disorders, and neuronal damage as in head trauma, causing a decrease in the clearance of neurotoxic and inflammatory substances, which triggers neurodegeneration and alterations in neuro repair, despite having different mechanisms that allow the flow of nutrients and clearance of harmful substances for neuronal survival and rehabilitation. This article describes the relationship between head trauma and dysfunction of the GS, as well as the negative effects on the brain parenchyma and secondary neuroinflammation. This system is not only affected by the change in the “polarization” of the aquaporin (AQP) four channels of the astrocytes but also by the characteristics of the substances in the neuronal environment, that opt for a different transport mechanism from the GS.

COMMENTARY

Tariq Janjua, Benoit Blondeau, Scott Meyer, Fotis Souslian, Atilio Palma, Luis Rafael Moscote-Salazar

Spinal Trauma and Indications for Advanced Imaging: Unanswered Questions

[Year:2022] [Month:May-August] [Volume:11] [Number:2] [Pages:2] [Pages No:88 - 89]

Keywords: Neurosurgery, Neurotrauma, Spinal trauma

   DOI: 10.5005/jp-journals-10030-1390  |  Open Access |  How to cite  | 

Abstract

Spinal trauma is one of the most devastating trauma emergencies. Imaging evaluation is a fundamental part of knowing the type of injury associated with trauma and is necessary to establish treatment and outcome. We briefly discuss some questions regarding spinal trauma and imaging evaluation.

CASE REPORT

Nuray Colapkulu-Akgul, Ozgur Ekinci, Orhan Alimoglu

Early and Delayed Presentation of Left-sided Diaphragmatic Rupture Secondary to Blunt Trauma: Report of Three Cases

[Year:2022] [Month:May-August] [Volume:11] [Number:2] [Pages:5] [Pages No:90 - 94]

Keywords: Blunt trauma, Diaphragmatic injury, Minimal invasive surgery

   DOI: 10.5005/jp-journals-10030-1391  |  Open Access |  How to cite  | 

Abstract

Aim: The aim is to present three cases of left-sided diaphragmatic hernias due to blunt trauma that were treated by surgical repair. Background: Diaphragmatic rupture with herniation of abdominal organs is an uncommon injury after blunt trauma. Patients may present with acute respiratory distress or without any symptoms. After an appropriate diagnostic workup, surgical repair is the treatment of choice. Case description: Three patients presented with a left-sided diaphragmatic hernia after falling from heights in the early and late periods following the trauma. Two patients with early presentations had respiratory symptoms and one patient with late presentation was admitted with acute mechanical intestinal obstruction. All patients were treated with surgery via an abdominal approach. Conclusion: Left-sided diaphragmatic injuries carry a high risk for herniation of intra-abdominal organs and should be immediately surgically repaired. Clinical significance: Diaphragmatic hernia is rare after blunt trauma and should not be missed in the initial evaluation. The techniques of surgical repair may vary according to the experience of the surgeons and the general condition of the patients.

CASE REPORT

Juan Manuel Lopez Lopez

Are Post-COVID-19 Sequelae a Challenge for Chest Wall Reconstruction in Flail Chest? A Case Report

[Year:2022] [Month:May-August] [Volume:11] [Number:2] [Pages:4] [Pages No:95 - 98]

Keywords: ARDS, COVID-19, Flail chest, Lung injury, Pulmonary fibrosis, Rib fixation, Rib fracture, SARS-CoV-2

   DOI: 10.5005/jp-journals-10030-1383  |  Open Access |  How to cite  | 

Abstract

Background: The SARS coronavirus-2 (SARS-CoV-2), responsible for COVID-19, with millions of infections that continue to accumulate, as well as the growing concern about chronic respiratory symptoms and changes in pulmonary fibrosis in recovered population. Rib fixation is indicated in patients with a flail chest who do not require mechanical ventilation, since they may develop chronic pain and thoracic deformity with a decrease in quality of life and incapacity for work. Selective mechanical ventilation with double-lumen tubes helps to collapse the lung on the side to be fixed, allowing the surgeon to preserve anatomical structures, making a better dissection. Case description: A 60-year-old male, diabetic, history of COVID-19, previous 3 months, later depression; cyclist, fell on a retaining wall on 20th October 2020, assessed in a hospital where he was discharged from the emergency room with analgesics, without improvement, for which he went to the social security hospital where they found right rib fractures, monitored in the emergency room for 72 hours with poor analgesic response [Numeric Pain Intensity (NPI) 8–9/10], depending on oxygen at 5 L/min for SatO2 = 90%. He was transferred to our hospital on 23rd October 2020, tomography with bilateral rib fractures (1°–9° right and 2°–5° left), right flail chest, bilateral pulmonary fibrosis (post-COVID-19), and right pleural effusion. The third, fourth, fifth, sixth, seventh, eight, and ninth right ribs with the StraCos system; it was impossible to perform surgery with right lung exclusion since, due to pulmonary fibrosis, the patient presented desaturations <80% with hemodynamic repercussions. He removed supplemental oxygen at 96 hours postoperatively and endopleural catheter at 7 days. Conclusion: The SARS-CoV-2 infection has left many lessons, and a great way to discover; it has collapsed health systems and has also had a negative impact on the quality of care for the polytraumatization of the chest in the emergency room. We face real challenges when operating patients with unusual ventilatory parameters for trauma patients, with slow postoperative recovery, and increased costs.

CASE REPORT

Napoleon Mendez, Mario Andrés Flores, Hamilton Aldany Gamarro

Trauma Cardiaco Penetrante. Es Posible el Manejo Conservador?

[Year:2022] [Month:May-August] [Volume:11] [Number:2] [Pages:3] [Pages No:99 - 101]

Keywords: Cardiac injuries, Cardiac trauma, Case report, Conservative treatment, Precordial wound, Penetrating heart injury

   DOI: 10.5005/jp-journals-10030-1384  |  Open Access |  How to cite  | 

Abstract

Background: Opening the chest is the accepted standard for a positive pericardial window in patients with wounds in the cardiac area, in all cases. However, in recent years there have been some reports of good results without opening the chest, only draining the hemopericardium in stable patients and nonpersistent hemopericardium. Selection should be made exclusively in patients with stable hemodynamics, without active bleeding, and without signs of tamponade, under controlled conditions with monitoring capacity and experience. Description of the case: A 23-year-old female patient is reported, with stab wounds in the precordial region who is admitted to emergency services. Patient with stable hemodynamics, it is decided to take a laparoscopic pericardial window to the operating room to rule out cardiac injury, evidencing nonactive bleeding from a cardiac injury, it is managed without opening the chest after washing the pericardium and evidencing that the bleeding subsides spontaneously. The patient was discharged without complications, documenting success with conservative management, and avoiding thoracotomy. Conclusion: The management of penetrating cardiac injury can be conservative without opening the chest in the stable patient, and the injury has stopped actively bleeding. Although this management is feasible, these cases should be managed only by experts and should not yet be considered as the standard, until sufficient evidence is obtained.

CASE REPORT

Álvaro Castro, Alejandra Liz, Déborah Delgado, Fernando González

Empaquetamiento Cardíaco En Trauma: Un Último Recurso Que Puede Salvar La Vida. Reporte De Un Caso Y Revisión De La Literatura

[Year:2022] [Month:May-August] [Volume:11] [Number:2] [Pages:5] [Pages No:102 - 106]

Keywords: Cardiac injury, Cardiac packing, Damage control, Trauma surgery

   DOI: 10.5005/jp-journals-10030-1387  |  Open Access |  How to cite  | 

Abstract

Cardiac injuries continue to be a challenge for trauma and emergency surgeons. Most of these patients arrive extremely grave, so they require immediate action by the surgeon repairing the wound to avoid death. In this context, patients may arrive even in cardiac arrest, associating severe homeostatic alterations with hypothermia, acidosis, and coagulopathy. The later can lead to the continuous bleeding despite several intents of surgical hemostasis. In this distressing situation, cardiac packing can be the last resource to save the life of an agonic patient. This is a well-known technique in cardiac surgery for stopping incontrollable bleeding. We believe that it's a procedure that can be applied to severe patients with cardiac injuries. We report the case of a patient with cardiac injury who arrived at our Emergency Service and review the available literature.

CASE REPORT

Manuel Alejandro Hajali, Laura Elena Medina, Pedro Guillermo Monsalve, Ángel Leonardo Valente, Daniela Valentina Noriega

Obstrucción intestinal por hernia diafragmática derecha estrangulada: Caso Clínico

[Year:2022] [Month:May-August] [Volume:11] [Number:2] [Pages:6] [Pages No:107 - 112]

Keywords: Blunt thoracoabdominal trauma, Intestinal obstruction, Right diaphragmatic hernia

   DOI: 10.5005/jp-journals-10030-1386  |  Open Access |  How to cite  | 

Abstract

Introduction: Post-traumatic diaphragmatic injury occurs in less than 1% of patients with thoracoabdominal trauma, especially after high-energy injuries, which can break or avulse the diaphragm of their insertions. The late manifestation of this type of injury can result in a hernia of the abdominal organs, a pathology that is associated with a high rate of morbidity and mortality. Case report: We present the case of a 49-year-old male patient, who begins symptoms 5 days before admission, characterized by abdominal pain located in the epigastrium and right hypochondrium, absence of bowel movements, and vomiting; a chest X-ray was performed, showing the presence of colonic handles in the right pulmonary field; so it was necessary to perform laparoscopic cure of the diaphragmatic hernia, and later an exploratory laparotomy. Obtaining the postoperative finding of grade IV right diaphragmatic hernia. Conclusion: A high suspicion rate is required to diagnose this entity; a late diagnosis is associated with greater morbidity and mortality; the ideal therapeutic approach will depend on the degree of injury and the experience of the surgeon.

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