Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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2018 | September-December | Volume 7 | Issue 3

CONSENSUS DOCUMENT

Michael W Parra, Joao B Rezende-Neto, Megan L Brenner, Todd E Rasmussen, Claudia Orlas

Resuscitative Endovascular Balloon Occlusion of the Aorta Consensus: The Panamerican Experience

[Year:2018] [Month:September-December] [Volume:7] [Number:3] [Pages:12] [Pages No:171 - 182]

Keywords: Consensus, Damage control, Endovascular procedures, Hemorrhage control, Resuscitative endovascular balloon occlusion of the aorta, Trauma

PDF  |  DOI: 10.5005/jp-journals-10030-1221  |  Open Access |  How to cite  | 

Abstract

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a tool of trauma surgeons used to obtain endovascular control of hemorrhage while ensuring the redistribution of blood flow to central organs such as the heart and brain. Its use in multiple trauma and non-trauma scenarios has been growing in the last decade; however, there are aspects within the indications, deployment technique and complications that continue to be controversial. Currently, there is no consensus among trauma surgeons in the Americas regarding the implementation of this tool for resuscitation and hemorrhage control. The Panamerican Trauma Society (PTS) in conjunction with the Colombian Association of Surgery recently convened 2018, XXXI Panamerican trauma, critical care, and emergency surgery Congress (August 14th to 17th) in Cartagena, Colombia. One main objective of the Congress was to create a consensus in trauma management via expert opinions of leading surgeons from North, Central and South America and the Caribbean. It is the first consensus that addresses the indications, deployment technique and complications of REBOA in the Americas.

EDITORIAL COMMENT

Rao Ivatury

EDITORIAL COMMENT

[Year:2018] [Month:September-December] [Volume:7] [Number:3] [Pages:1] [Pages No:182 - 182]

PDF  |  DOI: 10.5005/pajt-7-3-182  |  Open Access |  How to cite  | 

REVIEW ARTICLE

Andres M Rubiano, Raúl A Echeverri, Erica Johnson, Sandra Olaya, Laura Hernández

Fundamentos para la Elaboración de Artículos Científicos en Trauma y Cuidado Agudo de Emergencias (Parte 4): Recomendaciones para Organizacióny Publicación de la Escritura Científica en Lenguaje Nó Nativo

[Year:2018] [Month:September-December] [Volume:7] [Number:3] [Pages:6] [Pages No:183 - 188]

Keywords: Grammar rules, Native language, Scientific writing, Second Language, Translation

PDF  |  DOI: 10.5005/jp-journals-10030-1222  |  Open Access |  How to cite  | 

Abstract

Nearly to 70% of articles in high-impact journals are published in English, with a gradual increasing due to the explosion of open access biomedical publications. Publications in English within the scientific community. For the advancement of science, it is fundamental to allow communication in a language where all of us can generate comprehension and discussion of technical concepts, as in the case in biomedical articles. English has been accepted as one of the most widely used languages in international scientific activities. One of the main problems faced by Spanish-speaking scientists when publishing their work in a non-native language like English, is the difficulty in handling grammar rules, often requiring manuscripts be corrected by English-speaking people in order to have a better chance of acceptance in the different international journals. The objective of this article is to provide some general recommendations to take into account in the process of organization or in the writing process of a scientific article in English.

HISTORICAL REVIEW

Saptarshi Biswas

“Foggy Bottom Neighbourhood” Who Went on to Become the “Father of Modern Day Blood Banking”: Life and Times of Charles Drew—Surgeon, Researcher, Activist, and Physician Extraordinaire

[Year:2018] [Month:September-December] [Volume:7] [Number:3] [Pages:5] [Pages No:189 - 193]

Keywords: Blood bank, Blood mobile, Blood transfusion

PDF  |  DOI: 10.5005/jp-journals-10030-1223  |  Open Access |  How to cite  | 

Abstract

At a time when America was racially divided, Dr Charles Richard Drew broke barriers to become one of the pioneer scientists of the 20th century. His groundbreaking research and innovative developments in the use and preservation of blood plasma during World War II helped save thousands of lives, but also revolutionized the nation\'s blood banking process and standardized procedures for the preservation and storage techniques for a long period. This was later adopted by the American Red Cross. Hitler\'s invasion of Poland in September 1939 marked the beginning of World War II in Europe. American political leaders although had hoped to stay out of the war initially, but started assessing the nation\'s preparedness for war, including its medical and scientific resources. As Germany began the incessant bombing of England, the British were in dire need of medical supplies, including blood and plasma for transfusion. In response, a relief program “Blood for Britain” was set up. Besides providing valuable short-term aid to Britain, it was planned to gather the research, experience and administrative data needed to launch a countrywide “blood banking program” if the U.S. entered the war. In late 1940, Dr Charles Drew was chosen as the medical supervisor of the ‘Blood for Britain program’ by the Blood Transfusion Association (BTA). The goal was to help set up an early prototype program for blood storage and preservation. Several blood banks were set up and arrangements were made for large amounts of plasma to be flown to England. The program operated successfully for five months, (till its conclusion in January 1941) with approximately 15,000 people donating blood, and over 5,500 vials of plasma successfully shipped to Britain.

ORIGINAL ARTICLE

Adonis Nasr, Phillipe Abreu-Reis, Iwan A Collaco, Flavio S Tomasich, Joaquim L Andrade, Marina N Góes, Lucas M Sarquis, Jéssica RA de Souza, Luis FS Brunello, Thais Takamura, Caroline LBD Bosco, Lucas de S Benatti, Carolina Oldoni

Day off after Night Shift: Rest and Recovery?

[Year:2018] [Month:September-December] [Volume:7] [Number:3] [Pages:5] [Pages No:194 - 198]

Keywords: Day off, Doctor, Medicine, Perceptor, Quality of life, Residency, Stress, Student, Trauma

PDF  |  DOI: 10.5005/jp-journals-10030-1224  |  Open Access |  How to cite  | 

Abstract

Introduction: The medical profession has quite stressful aspects, such as requiring great dedication of time, the involvement of a lot of personal responsibility, as well as the constant contact with the suffering of patients and families. In view of the deleterious effects of uncontrolled stress on the physician, the patient and the public at large, definite steps are required to stem this tide and proffer solutions. So, we performed this study to assess if the possibility of having a day off after a night shift can change the level of stress between internship students, residents and doctors. Research methods: A descriptive cross-sectional comparative study was performed during the period from February to April 2016, internship students, residents, and doctors were subjected to a validated questionnaire voluntarily, with online filing. Results: Three hundred sixty-two people answered the online questionnaire About 56% of them have a day off after a night shift and 97,7% consider that having a day off would improve their quality of life. In the perceived stress scale they reached 19,926 points. Comparing the level of stress between interns, residents, and doctors that have a day off and those who do not have we did not found a statistic significance (p = 0.9886, p = 0.8014 and 0.0969 respectively). Conclusion: Stress is present in all the categories studied. Among the Medical students and doctors, most have a day after night shift off. Doctors, residents and medical students are more stressed than a population of the same age. Almost all subjects responded that they consider the day off important to quality of life, but we didn\'t found statistical significance between stress levels and the presence or absence of this rest period among doctors, residents and medical students

ORIGINAL ARTICLE

Adonis Nasr, Phillipe Abreu-Reis, Iwan A Collaco, Flavio S Tomasich, Thais Takamura, Caroline LBD Bosco, Lucas de S Benatti, Carolina Oldoni, Geovanna AL de Souza, Pedro A de A Goes, Ana L Bettega, Jean R Novais, Jessica Romanelli

Traffic Injuries: Peer-educational Prevention: Still the Best Solution?

[Year:2018] [Month:September-December] [Volume:7] [Number:3] [Pages:5] [Pages No:199 - 203]

Keywords: Basic school, Peer-educational prevention, Traffic injuries, Trauma

PDF  |  DOI: 10.5005/jp-journals-10030-1225  |  Open Access |  How to cite  | 

Abstract

Introduction: In 2013, there were 159.152 admissions to hospitals related to traffic injuries. Considering all sorts of external causes, traffic injuries constitute a significant portion, accounting for more than 20% of deaths. The aim of this study is to assess children\'s perception on traumatic events surveyed by medical students as well as identify if the peer-educational in private or public schools have the same impact. Methods of research: A prospective interventional comparative cohort study with children from a basic school in the city of Curitiba-PR. A survey with a large number of questions on road safety issues, traffic behavioral issue and 8 decision-making questions about traffic scenarios was applied from May to June 2016, before and after a peer-educational lecture on prevention of traffic injuries. Results: When comparing the results of public and private schools between themselves, it can be observed that on the private schools the average score on the first exam was of 77.62% and of 78.37% on the second one. However on public schools the average was of 68.75% on the first test and on the second exam the average was the exact same of the private schools result on it, 78.37%. Summing up, the public schools average had an improvement of 14% compared to the first test, with a significant difference, p = 0.01370. While on the pretest, t here was an average score of 6.21 in private schools and 5.5 in public ones, with p = 0.0000013, in the post-lecture, the average score on private and public schools was of 6.27, resulting in p < 0.0000001. Conclusion: Our prevention activity aiming to identify where we could have greater impact, resulted on us observing that private schools had lower results and the impact was better in public schools.

RESEARCH ARTICLE

Artur Pasternak, Maciej Matyja, Leszek Sulkowski

Aortic Injury: A Rare, Challenging Injury in Multiorgan Trauma Patients

[Year:2018] [Month:September-December] [Volume:7] [Number:3] [Pages:5] [Pages No:204 - 208]

Keywords: Aorta injury, Multiorgan trauma, Polytrauma, Surgery

PDF  |  DOI: 10.5005/jp-journals-10030-1226  |  Open Access |  How to cite  | 

Abstract

Introduction: Aortic rupture may follow penetrating or predominantly blunt injuries and results in a sudden hemorrhagic shock which commonly is lethal. AIs are classified in the organ injury scale proposed by American Association for the Surgery of Trauma (AAST-OIS), dividing aortic injuries into thoracic (grades IV–VI) and abdominal (grades IV–V) segments. Materials and results: The demographic data, concomitant injuries, and mortality rates were evaluated retrospectively. During 9 years 10191 patients have been hospitalized. The aortic injury was revealed in 4 of multiorgan trauma patients undergoing surgery. All patients were victims of blunt motor-vehicle accidents. The revealed injury was located in the thoracic or abdominal aorta. Laparotomy was the surgical approach for the management of abdominal aorta injury, while left thoracotomy or bilateral thoracotomy for thoracic aorta injuries. Discussion: Multiorgan trauma is a severe condition. When the aorta is involved the condition becomes exceptionally challenging. Aortic injuries are the second, after head injuries, most lethal conditions in blunt trauma patients. Both thoracic and abdominal aortic injuries among our patients were AAST-OIS grade IV. There are several repair modalities including open and endovascular technique. The hemodynamically unstable patients with multiple concomitant injuries should receive a damage control surgery allowing repair of life-threatening injuries and delayed definitive surgery. The surgery has to be done by highly experienced vascular and trauma surgeon. Conclusion: Traumatic rupture of the aorta is a rare, yet lifethreatening and commonly lethal condition. It usually follows blunt motor-vehicle trauma and predominantly concerns thoracic aorta. The optimal management of AIs requires a highly experienced trauma team and correct treatment protocols.

RESEARCH ARTICLE

Marissa A Boeck, J Esteban Foianini, Adil H Haider, Samuel D South, German Toledo, Jose C Camacho, Oscar M Gutiérrez, Lorena Jauregui, Pablo Mercado

Injuries in Bolivia: Initial Trauma Registry Results from Five Hospitals in Santa Cruz de la Sierra

[Year:2018] [Month:September-December] [Volume:7] [Number:3] [Pages:10] [Pages No:209 - 218]

Keywords: Big data, Bolivia, Burden of disease, Developing world, Health system strengthening, Injury prevention, Public health, Quality improvement, Trauma registry

PDF  |  DOI: 10.5005/jp-journals-10030-1227  |  Open Access |  How to cite  | 

Abstract

Aim: Trauma is a leading cause of global deaths. Many resource-limited settings, like Bolivia, lack data on injury mechanisms and outcomes, restricting targeted initiatives for prevention and quality improvement. We reviewed initial results from five hospital-based trauma registries in Santa Cruz de la Sierra to explore injury characteristics in this Bolivian region. Materials and methods: From October 2015 until May 2016 emergency department (ED) staff gathered trauma patient information, including personal and injury demographics, prehospital facts, and hospital disposition, with subsequent transfer into an online platform. Results: The registry captured N = 3,220 patients, of which 64% were male aged 21 years (IQR 6, 37). Hospital transport occurred via private car (37%), taxi (23%), or ambulance (15%), with many presenting on the day of injury (74%) within four hours (52%). Most injuries occurred at home (38%) or in the street (29%), were blunt (64%), and resulted from falls (43%), road traffic incidents (13%), or dog bites (8%). Common classifiable injuries (N = 2,874) included head/face/extremity contusions (43%), extremity fractures (12%), arm/hand penetrating injuries Conclusion: These data suggest trauma patients at registry hospitals frequently are not hospitalized and many injuries are preventable. A more complete trauma representation within the city requires data quality improvement, program expansion, and supplementary data source inclusion. Results will inform health system resource planning and preventative strategies, enabling evidence-based interventions that reduce injury morbidity and mortality in Bolivia. Clinical significance: These results qualify the injury burden in this Bolivian region, serving as the basis for future interventions to improve injured patient outcomes, and reduce morbidity and mortality.

CASE REPORT

Nancy N Wang, Craig E Stauffer, Jeffrey Sung, Catherine R Harris

Complex Uretero-arterial Fistula Following a Gunshot Wound

[Year:2018] [Month:September-December] [Volume:7] [Number:3] [Pages:5] [Pages No:219 - 223]

Keywords: Hematuria, Penetrating wounds, Urinary fistula, Vascular fistula

PDF  |  DOI: 10.5005/jp-journals-10030-1228  |  Open Access |  How to cite  | 

Abstract

Aim: To highlight and discuss the presentation, diagnosis and management of a complex uretero-arterial fistula following a penetrating trauma. Background: Uretero-arterial fistulas are a rare but dangerous connection, usually between the ureter and iliac artery. Gunshot wounds to the abdomen usually result in injuries to multiple intraabdominal structures. Despite a normal appearing ureter, delayed necrosis and subsequent fistulization can occur following a penetrating trauma. Patients may present with life-threatening hemorrhage and diagnosis is often imprecise. Case description: We report the case of a 52-year-old male who presented with a single gunshot wound to the right lower abdomen and was found to have multiple enterotomies as well as a right iliac vein injury. Although the ureter appeared uninjured during the intraoperative assessment, the patient developed a urine leak two weeks after the injury. A ureteral stent and nephrostomy tube were placed to facilitate healing and divert urine. However, the patient re-presented 46 days after initial injury with significant hematuria and diagnosis of a uretero-arterial fistula. Conclusion: Penetrating traumas, especially blast injuries such as gunshot wounds, have a higher risk for delayed injuries secondary to tissue devascularization or necrosis. Ureteral vascular supply is especially delicate and clinicians should have a high suspicion for delayed ureteral complications when a blast injury occurs nearby. It is important to maintain a low threshold for pre-emptive ureteral stenting or excision and repair of an at-risk segment even when the ureter appears intact on initial inspection. Clinical significance: Uretero-arterial fistulas can be fatal, especially as its presentation often occurs suddenly, with large volume blood loss, and diagnosis can be difficult. Prompt and appropriate treatment requires a high level of suspicion and awareness of its potential.

CASE REPORT

Saturnino Domínguez, Rafael Andrade-Alegre

Non-traumatic Resuscitative Thoracotomy

[Year:2018] [Month:September-December] [Volume:7] [Number:3] [Pages:3] [Pages No:224 - 226]

Keywords: Emergency, Hemothorax, Non-traumatic, Resuscitative thoracotomy

PDF  |  DOI: 10.5005/jp-journals-10030-1229  |  Open Access |  How to cite  | 

Abstract

Resuscitative thoracotomy (RT) is a heroic procedure that is generally associated with trauma. This surgical procedure may also save lives in non-trauma-related emergencies. We present the case of a patient who underwent resuscitative thoracotomy after developing cardiac arrest associated with massive hemothorax during an endovascular procedure.

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