Aim and background: Trauma registries have been developed to track patient characteristics and outcomes to develop clinical decision tools. However, maintenance of trauma registries can be time-intensive and expensive, particularly in resource-limited areas. This qualitative study aims to assess the feasibility of implementing a real-time electronic data capture system and clinical practice guideline (CPG) platform, T6 Health Systems Mobile Application (T6), in the Calixto-Garcia Hospital's (CGH) emergency and trauma department in Havana, Cuba. Materials and methods: Our qualitative study utilized six 8-hour focus groups with nine participants each over 4 months to determine which aspects of T6 would be best adapted for CGH and to identify challenges to its use. Focus group participants were chosen via convenience sampling, and a grounded theory approach for thematic analysis was used to identify common themes. Transcripts were reviewed by two independent reviewers. Results: Four major priorities for the implementation of T6 at CGH were identified: prehospital-hospital communication, T6 customization, training on trauma scoring systems, and incorporation of CPG for education and clinical decision-making. Challenges to the integration of this system include language barriers, unreliable internet connectivity, and prohibitive costs. Conclusion: Our study reveals the complexities of integrating an electronic trauma registry and guidelines in a resource-limited setting. Implementation of T6, although challenging, highlights the potential to enhance patient outcomes, interdisciplinary communication, and hospital efficiency. Clinical significance: This study demonstrated facilitators and barriers to implementing a real-time electronic data capture system and CPG platform for trauma patients in a major trauma center in Cuba.

Introduction: Pancreatic trauma in children accounts for only a small proportion (0.2–2%) of blunt abdominal trauma, with unique clinical and therapeutic implications. Main ductal involvement and hemodynamic stability are the main determinants in defining management. Despite its importance, the lack of solid evidence in the literature has made it difficult to develop effective and standardized treatment strategies for this age-group. Methods: We present the results of a retrospective descriptive study that included 10 pediatric patients with complex pancreatic trauma attended between 2015 and 2024 in a referral hospital in Medellín. Most cases involved the main pancreatic duct. The clinical variables, interventions performed, complications, and main outcomes are described. Tomographic or intraoperative criteria were used to classify the severity of trauma. The variables analyzed were the following: mechanism of associated trauma, clinical characteristics, imaging findings, involvement or not of the pancreatic duct, and management performed. In addition, outcomes in terms of mortality, length of hospital stay, reoperation, collection, presence of pancreatic fistula, need for additional endoscopic or percutaneous procedures, and sequelae were evaluated. Results: The age range was 19 months to 12 years. The mechanism of trauma was blunt in all cases. The cardinal symptoms were abdominal pain and vomiting. Diagnosis was made by tomography in eight cases and as a surgical finding in two cases. Most patients presented with grade III or IV trauma according to the American Association for the Surgery of Trauma (AAST) classification. Seven patients required surgical management, and three patients required endoscopic management. No inhospital mortality was noted. In five cases, there were pancreatic fistulae, one with collection, and two with pseudocysts. Conclusion: The general condition and location of pancreatic grade lesions determine the management of pediatric patients with pancreatic trauma. Preserving as much pancreatic tissue as possible is essential for surgical resection.

Introduction: In Chile, pelvic trauma secondary to high-energy blunt trauma represents a significant cause of morbidity and mortality. Although its incidence is low, its impact is considerable due to the consequences it causes in adjacent structures. Understanding its epidemiology is essential in order to develop effective management strategies, thereby improving the quality of life for those affected. Methods: A population-based study was conducted using hospital discharge records from the Department of Statistics and Health Information and the National Institute of Statistics. Patients with primary hospitalization codes S31.0, S32.2-S32.5, S32.7, S32.8, S33.2, S33.4, S33.6, S35.5, S37.0, S38.0, and S38.2 from the ICD-10 were considered. The variables analyzed included sex, age group, trauma type and mechanism, length of hospital stay, and discharge condition. Incidence rates (IR) were calculated per 1,00,000 inhabitants. The results were analyzed using analytical statistics to evaluate statistical significance (p < 0.05, 95% CI) (Stata-16). An ethics committee approval was not required. Results: A total of 29,505 pelvic trauma discharges were recorded, with a male predominance (61%). The average incidence rate was 8.35, showing no significant upward or downward trend. The highest frequency was observed in the 20–29 year age group. The most common fractures were those of other parts and unspecified fractures of the lumbar spine and pelvis (45.29%), followed by acetabular fractures (12.39%). The regions with the highest incidence rates were Los Ríos (11.91) and Araucanía (10.94). Conclusions: Although the incidence of pelvic trauma has not shown significant variation over the years, it has not decreased and primarily affects men of working age, which is of particular relevance as it leads to a loss of potential years of life and a decreased quality of life for those affected.

Introduction: Hemorrhagic shock (HS) is one of the leading potentially preventable causes of death in patients who have suffered some type of trauma. Despite the importance of blood banks (BB), there are no studies in Chile evaluating their impact on mortality due to shock. Recently, an attempt has been made to centralize BB into four centers to improve the national supply. The objective of this study is to characterize the association of the distribution of BB with mortality due to hemorrhagic and hypovolemic shock (hVS) in Chile. Materials and methods: Correlational ecological population study using official data from the Department of Health Statistics and Information of Chile, the Chilean Society of Hematology, and the National Institute of Statistics; the period from 1997 to 2023 was evaluated. Patients whose cause of death was associated with hemorrhagic or hVS and various types of hemorrhages were identified. Mortality due to HS and the relationship with the number of BB in the regions were analyzed using Pearson correlation with 95% confidence intervals and p-value < 0.05 (Stata-16). Ethics Committee approval was not required. Results: There were 668 deaths due to HS, hVS, and massive hemorrhages in Chile between 2014 and 2023. Mortality decreased as the number of BB in a city increased, with the lowest observed in the Metropolitan, Valparaíso, and Biobío regions significantly. The most affected regions were Aysén, Los Ríos, and Magallanes, which coincide with those having fewer institutions for managing blood products. Conclusion: There is a relationship between the availability of BB and mortality due to HS in Chile, indicating an inequitable distribution of these resources. It is vital to conduct more research to determine how the distribution of BB affects the survival of patients with HS.

Introduction: Trauma in older adults (TOA) is a major cause of mortality, especially due to falls. In Chile, the aging population is increasing, but there are still no studies on TOA as a primary cause of death. Physical frailty and health issues associated with aging make injuries more severe in this group, highlighting the need for studies and specialized care. The main objective is to study TOA mortality in Chile during the period 1997–2023. Materials and methods: Ecological descriptive study. Deaths from trauma as the primary cause in adults over 60 years of age from January 1997 to December 2023 in Chile were studied using databases from the Department of Statistics and Health Information. A descriptive analysis of TOA characteristics in Chile was conducted by sex, age-group, type and mechanism of trauma, and region of death. The TOA mortality analysis in Chile by region was conducted using rates per 100,000 inhabitants with Stata-18. No ethics committee approval was required. Results: A total of 48,579 TOA deaths. Men: 29,357 (60.4%). The overall mortality rate for the period was 77.22. Average age: 76.6 ± 10.7 years (range 60–121). The most common cause is falls, with 12,293 deaths (25.3%). The region with the highest rate is Los Ríos, with 24.94%, and the lowest rate is Los Lagos, with 6.37%. Conclusion: Most TOAs in Chile are due to falls. This type of trauma has been increasing in frequency as age increases. In Chile, it is likely that as the demographic aging process accelerates, its incidence will increase, becoming a health problem in Chile. Thus, public policies are needed to focus on this age-group to reduce mortality.

Proper airway management begins by determining the best airway strategy for the patient. The primary goal of airway management is to deliver adequate ventilation and oxygenation to prevent the progression to cardiopulmonary arrest. Effective and timely airway management is also essential to successful cardiopulmonary resuscitation. Given the lack of consensus and the evolving landscape of perioperative care for obese patients, this review article aims to investigate the ease of mask ventilation in obese patients. It is of paramount importance due to the unique anatomical and physiological challenges posed by obesity. This review article provides an understanding of the nasopharyngeal airway, oropharyngeal airway, and various mask ventilation approaches performed for these airway adjuncts for obese patients. Noninvasive methods should be prioritized for airway maintenance unless invasive management is needed. This precise review aimed to ensure that the body can overcome an intrinsic positive end-expiratory pressure threshold necessary to start breathing and raise lung compliance through noninvasive ventilation. Evidence shows that nasopharyngeal airway length is related to height, not sex. Nasopharyngeal airway insertion causes a stronger response than oropharyngeal insertion. The oropharyngeal airway helps with tongue-related obstructions, especially when lying supine. The C-E technique is generally more effective and comfortable than the V-E technique. For unconscious, obese, apneic adults, the modified V-E technique is more effective than the C-E technique, but the V-E technique can often succeed where the C-E technique fails. The main objective is to ensure a comparative review of various airway devices in aiding ventilation without intubation.

Background: Injuries are a frequent cause of mortality worldwide. Trauma registries help identify the characteristics of attention to trauma in specialized centers and institutions not explicitly dedicated to trauma. The study aimed to identify factors associated with mortality caused by major trauma in a general hospital in the Orinoco region of Colombia. Study design: Researchers designed a cross-sectional trial based on the revision of an institutional trauma database collected from January to August 2023. They collected demographic, clinical, and severity variables and analyzed the outcomes. Results: Two hundred fifty admission records to the emergency department were reviewed, mainly men (80%), with a median age of 31 years. Road traffic accidents (RTA) accounted for 64% of the admissions, with 58% involving motorcycles. Approximately, 66% of the incidents occurred in Villavicencio, and admission within the first 6 hours occurred in 87.2% of cases. The injury severity score (ISS) had a median of 20. The analysis identified head and neck injuries in 54.8% of cases. Immediate surgery was necessary in 42.8%. The mortality rate was 10%, and the median length of stay was 5 days. Factors associated with a lethal outcome included severity and injuries in multiple anatomical regions. Conclusion: The study revealed that the population affected by major trauma is predominantly young, especially due to accidents involving motorcycles. Educational and control measures are required to reduce accidents, mortality, and disabilities caused by the resulting sequelae.

The Arapaima gigas, also known as Pirarucú in Colombia and Brazil, is the largest freshwater scaled fish in the world. It inhabits the Amazon River and holds significant economic value, being farmed in both artificial and natural ponds for commercial purposes. This article presents the case of a fisherman who sustained blunt abdominal trauma caused by this remarkable animal. The patient was admitted 6 days after the incident without immediate surgical indications. A computed tomography (CT) scan revealed a perforation of the sigmoid colon. During surgery, a 1200 mL hemoperitoneum, a contained mesenteric hematoma with devascularization, necrosis, and a 5 mm perforation of the sigmoid colon were identified. A resection and Hartmann's colostomy were performed. Injuries involving the hollow viscera (HVI) and mesentery are commonly associated with penetrating trauma but are rare in cases of blunt trauma. Diagnosing these injuries can be challenging, and delays in diagnosis may lead to significant morbidity and mortality, particularly in rural settings where access to timely care is limited.

Introduction: The duplicated appendix is a rare condition, with an incidence of 0.004–0.009%, first reported in 1892. Case description: In this context, we present the case of an 18-year-old female patient admitted with acute gangrenous appendicitis with the presence of fecalith and duplicated appendix confirmed by anatomopathological examination. Discussion: Diagnosis can be challenging with imaging exams like computed tomography (CT) and ultrasound (US), often only identified during surgery. If detected, both appendices should be removed to prevent complications. Conclusion: Surgeons must be aware of this condition to avoid repeated appendicitis episodes, ensure accurate diagnosis, and prevent medico-legal issues.