Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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2019 | January-April | Volume 8 | Issue 1

Announcement

ANNOUNCEMENT

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/PAJT/8-1-i  |  Open Access |  How to cite  | 

PTS Presidential Address, Mexico City, Mexico 2017

El Cirujano de Trauma y Emergencias: Pasado, Presente y Futuro

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:11] [Pages No:1 - 11]

PDF  |  DOI: 10.5005/jp-journals-10030-1230  |  Open Access |  How to cite  | 

PTS Presidential Address, Colombia, 2018

Discurso Presidencial: Ciência, Pessoas e Justiça. Uma Visão da Sociedade Panamericana de Trauma

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:7] [Pages No:12 - 18]

PDF  |  DOI: 10.5005/jp-journals-10030-1231  |  Open Access |  How to cite  | 

Original Article

Carmen Echevarria-Ruiz de Vargas, Pablo Gordillo-Fernández, Jose Antonio Exposito-Tirado, Virginia Duran Muñoz-Cruzado

“Proyecto Sobre Ruedas”: Importancia De La Prevencion De Accidentes De Trafico En La Poblacion Juvenil Andaluza

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:5] [Pages No:19 - 23]

Keywords: Adolescents, Education, Prevention, Trauma

PDF  |  DOI: 10.5005/jp-journals-10030-1232  |  Open Access |  How to cite  | 

Abstract

Background: Prevention is one of the main therapeutic weapons in trauma. Within the Andalusian Accident Plan, there is a specific line of work dedicated to it. Its star measure is the “Project on Wheels” aimed at adolescents, the main risk group: young people between 15 years and 24 years of age, male gender. Our objective is to carry out a descriptive and results analysis of this preventive action from its implementation to the present day. Study design: An analysis of the project has been carried out since its implementation in 2009, analyzing the number of events developed, population it has reached, and the results that it entails in terms of accident reduction and type of injuries (deceased, minor injuries, and serious injuries). Results: During this period (2009–2018), there have been more than 150 events with a population impact of more than 600,000 people. The “Road Show” has reached more than 100,000 teenagers. Almost all events are focused on the prevention of traffic accidents, the main mechanism of injury in this population group. Performing a comparative analysis between the data prior to the plan and later, the number of deaths has fallen by 53%, the seriously injured by 60%, and the mild by 16%. In this population group, the mortality rate drops by 66%, being the highest of all the groups analyzed. Conclusion: Prevention plays a key role, being necessary a special attention to the population groups at risk and an adaptation to their peculiarities. Although up to now, the effectiveness of these has been demonstrated, we must insist on this aspect, as well as others (training, assistance, research, and management), with the aim of minimizing injuries secondary to accidents

Original Article

Alan R Ziroldo, Joao B Rezende-Neto, Estevao Pardi, Andrew Beckett, Jameel Ali

Hemorrhage Control in Penetrating Cardiac Injury: A New Device Put to the Test in the Advanced Trauma Operative Management (ATOM) Course

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:5] [Pages No:24 - 28]

Keywords: Cardiac, Device, Hemorrhage control, Trauma

PDF  |  DOI: 10.5005/jp-journals-10030-1233  |  Open Access |  How to cite  | 

Abstract

Objective: We recently developed a new device to temporize bleeding from penetrating cardiac injuries. To further understand the usefulness of the device, we put it to the test by less experienced physicians. Methods: General surgery residents participating in the “Advanced Trauma Operative Management (ATOM)” course tested the device. Each participant had to control bleeding from a cardiac injury in a swine. A questionnaire was completed and analyzed. Results: The number (n) of participants is 20; 95% of the participants stated that the device controlled the bleeding, 100% considered it easy to use, 80% of the participants had previously seen a cardiac injury, and 35% had experience using a hemorrhage control device in a human heart. Only 15% of the participants had sutured a human heart and 55% an animal heart; 90% responded that they would use the new device clinically. Conclusion: The new device was easy to use and effectively controlled the bleeding in penetrating cardiac injuries regardless of the level of experience of the physician.

Original Article

Savo Bou Zein Eddine, Kelly A Boyle, Christopher M Dodgion, Christopher S Davis, Travis P Webb, Jeremy S Juern, David J Milia, Thomas W Carver, Marshall A Beckman, Colleen Trevino, Marc A de Moya

Observing Pneumothoraces: The 35 Millimeter Rule is Safe in Ventilated Patients

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:7] [Pages No:29 - 35]

Keywords: Chest tube, Observation, Pneumothorax, Pneumothoraces, Trauma

PDF  |  DOI: 10.5005/jp-journals-10030-1234  |  Open Access |  How to cite  | 

Abstract

Background: Observing pneumothoraxes (PTXs) identified on chest computed tomography (CT) in mechanically ventilated patients remains highly debated. Despite the comorbidities associated with tube thoracotomy (TT), clinicians are inclined to perform this invasive procedure prophylactically. We hypothesize that PTX measuring ≤35 mm on chest CT can be safely observed in ventilated patients. Study design: A retrospective review was conducted of all patients diagnosed with PTX by chest CT between January 2011 and December 2016. Patients were excluded if they had an associated hemothorax (HTX), were not intubated, or had a TT placed before the initial chest CT. PTXs were measured as the radial distance between the parietal and the visceral pleura/mediastinum in a line perpendicular to the chest wall on axial imaging. Based on the previous work, a cutoff of 35 mm on the initial CT was used to dichotomize the groups. Failure of observation was defined as the need for a TT during the first week. A univariate analysis was performed to identify predictors of failure of observation in both groups. Results: A total of 116 patients met our inclusion criteria. Of those, 96 (83%) were successfully observed until discharge. Of those successfully observed, 88 (92%) patients had a measurement of ≤35 mm. In the univariate analyses, only the size of the PTX (≤35 mm or > 35 mm) (p = 0.001) was significantly associated with failing observation. The negative predictive value for 35 mm as a cutoff was 96.7% to predict successful observation. Conclusion: The 35 mm cutoff is safe as a general guide for ventilated patients with only 3% of stable patients failing initial observation.

Original Article

Cheryl K Zogg, Tarsicio Uribe-Leitz, Nizar Bhulani, Shahid Shafi, Carlos A Ordóñez, Kimberly A Davis, Adil H Haider

The “Hispanic Paradox” Exists in Emergent Conditions: Better or Equivalent Surgical Outcomes Among US Hispanic Emergency General Surgery Patients

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:16] [Pages No:36 - 51]

Keywords: Emergency general surgery, Hispanic Paradox, Morbidity, Mortality, Race/ethnicity, United States, Unplanned readmission

PDF  |  DOI: 10.5005/jp-journals-10030-1235  |  Open Access |  How to cite  | 

Abstract

Objective: In the United States, Hispanic patients tend to present with similar risk profiles to non-Hispanic black (NHB) patients but experience better outcomes for chronic conditions and elective operations, similar to those of non-Hispanic white (NHW) patients.a phenomenon known as the “Hispanic Paradox.” The finding is thought to be the result of selective migration among foreign-born Hispanic patients, making it theoretically less likely to occur when care is urgent. The objective of this study is to determine whether the “Hispanic Paradox” exists in emergency situations requiring operative emergency general surgery (EGS) care. Methods: Age-specific differences (pediatric/adult/older adult) in mortality, major morbidity, and unplanned readmission at ≤30, 90, 180, and 365 days among NHW, NHB, and Hispanic patients from three US states with large Hispanic populations were assessed using survival analysis. Data were abstracted from state inpatient claims from 2007 to 2015. Models accounted for clustering of patients within hospitals and states and potential confounding associated with operation type, diagnosis, patient demographics (age, admission year, gender, Charlson Comorbidity Index, income, and insurance), and hospital-level factors (operative volume, rurality, teaching status, and registered nurses (RNs)/bed). Results: Relative to Hispanic patients, adult NHB and NHW EGS patients fared significantly worse (e.g., ≤365-day mortality hazard ratios (HR) [95% CI]: 1.74 [1.72.1.76], 1.25 [1.24.1.26]). The trend persisted for pediatric (HR [95% CI]: 1.57 [1.50.1.64]) and older adult (1.31 [1.30.1.32]) NHB patients. In contrast, when comparing pediatric NHW vs Hispanic patients, no significant differences in EGS outcomes were found. Among older adults, the apparent protective influence of the Hispanic Paradox waned, pointing to marginally better outcomes among NHW patients aged ≥65 years (HR [95% CI]: 0.94 [0.93.0.95]). Identical patterns were found in major morbidity and unplanned readmission. Differences were most pronounced in adult patients from more ethnically diverse Hispanic states (e.g., Florida vs California) and were markedly reduced by access to insurance. Conclusion: Outcomes similar to or better than outcomes of US NHW patients were found among US Hispanic patients for EGS. Our findings provide evidence that the “Hispanic Paradox” exists under emergent conditions in contrast to expectations and that its effects appear to decrease with age.

Original Article

Ana M Cuellar, Jose D Charry, Rolando Medina, Oliver Chávarro

Complicaciones del Manejo Quirúrgico De Los Pacientes Con Trauma Penetrante De Tórax En Un Hospital Universitario Al Sur De Colombia

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:4] [Pages No:52 - 55]

Keywords: Penetrating trauma, Postsurgical complications, Thorax

PDF  |  DOI: 10.5005/jp-journals-10030-1236  |  Open Access |  How to cite  | 

Abstract

Introduction and objectives: Trauma is considered a public health problem. It is one of the pathologies which lead to a greater level of disability and mortality in Latin America, and Colombia is not an exception. The aim of this study is to describe the main complications of surgical management of patients with penetrating thoracic trauma in a university hospital in southern Colombia. Materials and methods: A descriptive study was conducted on patients who were the victims of penetrating chest trauma, admitted from January 2013 to March 2015. Clinical, sociodemographic, complications, risk factors, and severity of lesions were evaluated; univariate analysis was performed; measures of central tendency and dispersion for continuous variables were calculated; the Chi-square test was used to measure statistical significance in the online software R version 2.15.2. Results: A total of 485 patients were analyzed, 8.65% (42) developed some complications. Among patients with some type of complications related to the surgical management of penetrating chest trauma, empyema was the main complication 59.52% (25), followed by pneumonia 28.57% (12) and ARDS 14, 91% (5). The mean age was 34.2 ± 8.23 years, and the mean ISS was 16.4 ± 2.91. Around 88.1% of the injuries were stabbing wounds, 61.9% cases presented hemothorax, 30.95% pneumothorax, and 7,14% hemopneumothorax respectively. The average hospital stay was 14.8 ± 2.45 days. Conclusion: Surgical complications after the operation in penetrating chest trauma are presented in a university hospital in southern Colombia. Posttraumatic empyema is the main complication that occurs in patients with penetrating chest trauma. One of the most important risk factor is coagulated hemothorax which could be identified and treated in time, avoiding comorbidities during the hospital stay.

Original Article

William Rothstein, Kristine Kenning, Karen Shipman, Rob Lawrence, Alan Rossi, Michel Aboutanos, Edgar Rodas

Tourniquets in the Era of “Stop the Bleed”—Are Simple Pressure Maneuvers Being Bypassed for Tourniquets in Non-arterial Bleeding?

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:5] [Pages No:56 - 60]

Keywords: Emergency medical services, Extremity trauma, Hemorrhage, Prehospital, Tourniquet

PDF  |  DOI: 10.5005/jp-journals-10030-1237  |  Open Access |  How to cite  | 

Abstract

Aim: Tourniquets are a well-studied method of temporary hemostasis for life-threatening bleeding. Previous studies place the rate of true arterial injuries among applied tourniquets in civilian populations between 44% and 70.1%. Materials and methods: We conducted a single center, retrospective, case-control study of all patients with prehospital applied tourniquet between May 2016 and November 2017. Criteria for true arterial injury were traumatic amputation or arterial injury requiring immediate surgery. We pooled reported civilian data to be utilized as a reference population. Results: In an 18-month period, 66 patients presented with tourniquets. True arterial injury existed in 36% vs 53% in the reference population (chi square = 7.3, p = 0.0068). There was no significant difference between blunt vs penetrating mechanism (35% vs 37%, p = 0.85). Gun-shot wounds (GSW) were more likely to have no arterial injury than all other injury types (81% vs 56%, p = 0.046, OR = 3.4). There was no significant difference in tourniquet application between paramedics and other first responders (74% vs 75%, p = 0.48). Conclusion: Injury type appears to be a factor; in patients with a tourniquet, those with a GSW were 3.4 times as likely to have no arterial injury as other injury types. This data reflects a high frequency of prehospital tourniquet application without arterial injury. Multi-institutional, prospective studies are necessary to evaluate tourniquet utilization.

CASE REPORT

Saptarshi Biswas, Arpit Amin, Ashley Graziano, Shekhar Gogna

Carotid Cavernous Fistula: An Easily Missed Complication of Blunt Traumatic Brain Injury

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:3] [Pages No:61 - 63]

Keywords: Blunt trauma, Carotid cavernous fistula, Head injury

PDF  |  DOI: 10.5005/jp-journals-10030-1238  |  Open Access |  How to cite  | 

Abstract

A carotid cavernous fistula (CCF) is an abnormal vascular connection between the carotid arterial system and the cavernous sinus. Traumatic head injury, particularly basilar skull fractures, can result in a type A CCF. Type A CCFs are direct, high-flow shunts between the internal carotid artery and the cavernous sinus. Significant neuro-ophthalmologic sequela can result from such connections, including visual loss. These fistulas are commonly missed on the routine imaging completed following head trauma. If suspected, a cerebral angiography is the gold standard imaging modality, with endovascular coiling being the preferred treatment. Physicians should have a high index of suspicion for CCFs in trauma patients presenting with basilar skull fractures. Prompt recognition and treatment can resolve symptoms and prevent permanent sequela.

CASE REPORT

Saptarshi Biswas

Primary Closure of a Complex Facial Wound with Underlying Fractures. Deconstructing Dogmas

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:6] [Pages No:64 - 69]

Keywords: Dog bite, Maxillofacial fractures, Soft tissue injury

PDF  |  DOI: 10.5005/jp-journals-10030-1239  |  Open Access |  How to cite  | 

Abstract

Canine bites present a major public health concern worldwide. Facial fractures due to dog bites are rare, although the exact incidence is unknown. Most reports in the literature comprises of pediatric population with a majority of the patients less than 5 years of age. Zygomatic, nasal, and orbital are the most frequently fractured bones. The dog breeds commonly responsible are American Pittbull and Rottweiler. The injuries can present as punctures, abrasions, tears, or avulsions. The intense kinematics of the crush injury can result in devitalized tissue, thus management becomes complex. Primary repair of these complex facial wounds can provide good cosmetic results. Controversy remains whether dog bites should be closed primarily and the indication for prophylactic antibiotics. Complex facial injuries cause functional and cosmetic impairment together with potential polymicrobial infections. They can also leave behind emotional scarring that can last long after the wound has healed. Antibiotics are indicated for infected bite wounds only and those of complex nature involving underlying bones, vascular structures, or joints. Tetanus immunization and potential risk of rabies should be considered in these patients.

LETTER TO THE EDITOR

Jeffrey Skubic, Otilda Valderrama

PTS Travelling Fellow to Panama 2018

[Year:2019] [Month:January-April] [Volume:8] [Number:1] [Pages:3] [Pages No:70 - 72]

PDF  |  DOI: 10.5005/jp-journals-10030-1240  |  Open Access |  How to cite  | 

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