Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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2020 | September-December | Volume 9 | Issue 3

EDITORIAL

Sandro Rizoli

Last Issue of 2020: Hope 2021 will be a Great Year

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:2] [Pages No:165 - 166]

Keywords: Critical care, Emergency, Trauma

PDF  |  DOI: 10.5005/jp-journals-10030-1299  |  Open Access |  How to cite  | 

Guest Editorial

Cristiane de Alencar Domingues

A Importância da Enfermagem no Cuidado dos Pacientes Traumatizados

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:2] [Pages No:167 - 168]

Keywords: Nursing, Trauma nursing, Trauma nursing care

PDF  |  DOI: 10.5005/jp-journals-10030-1300  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

William Teeter, Jacob J Glaser, Alexander J Burdette, William B Gamble, Dawn Parsell, Leslie Neidert, Yosuke Matsumura, Thomas Scalea, Rosemary Kozar

Monitoring Organs Susceptible to Ischemia/Reperfusion Injury after Prolonged Resuscitative Endovascular Balloon Occlusion of the Aorta in a Hemorrhagic Shock Swine Model

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:12] [Pages No:169 - 180]

Keywords: Experimental hemorrhagic shock, Noncompressible torso hemorrhage REBOA, Shock, Swine, Trauma

PDF  |  DOI: 10.5005/jp-journals-10030-1298  |  Open Access |  How to cite  | 

Abstract

Background: Despite advancements in critical care, hemorrhage remains a leading cause of potentially survivable deaths in civilian and military settings. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a viable technology that could be used in the pre-hospital setting. However, the potential complications of prolonged REBOA use, especially in the military setting where the prehospital phase could exceed 2 hours, are not completely understood with regards to organ damage susceptibility to prolonged REBOA use. Materials and methods: Fifteen male Yorkshire swine underwent a 40% volume-controlled hemorrhage over 20 minutes. Animals were then randomly assigned (n = 5/group) to REBOA inflation times of 120, 180, and 240 minutes, followed by 1 hour of resuscitation with shed whole blood and crystalloid before euthanasia. Samples were collected for blood gas analysis, chemistry, Luminex, enzyme-linked immunosorbent assays (ELISAs), and histology. Results: Metabolic acidosis increased with prolonged REBOA inflation times along with inflammation as shown by increases in interleukin (IL)-6 and neutrophil levels. Organs most susceptible to prolonged REBOA inflation times were the liver and intestines as demonstrated by histology. Conclusion: While REBOA has been shown to effectively staunch hemorrhage and improves survival, complications exist for prolonged REBOA inflation times. The results of this study demonstrate that the liver and intestines are particularly susceptible to prolonged REBOA inflation out to 4 hours, in addition to increased metabolic acidosis and systemic inflammation. These findings should help guide clinicians while using REBOA over a prolonged period of time to improve survival and mitigate potential REBOA-associated ischemic organ damage.

PERSPECTIVE

Carlos Yánez Benítez, José Fernando, Antonio Güemes, José Aranda, Fernando Turegano, Luca Ponchietti, Felipe Pareja, Virginia Durán, Juan L Blas

Personal Protection Equipment and Emergency Surgery during the COVID-19 Pandemic in Spain

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:5] [Pages No:181 - 185]

Keywords: COVID-19, Pandemic, Personal protective equipment, Survey study

PDF  |  DOI: 10.5005/jp-journals-10030-1292  |  Open Access |  How to cite  | 

Abstract

Introduction: In December 2019, in Wuhan, China, a new viral disease, COVID-19, was diagnosed, and in January 2020, the first case was diagnosed in Spain. In April, Spain had reported more than 200,000 cases, 38,000 of which were health workers, representing more than 16% of the volume of contagion in the general population. The objective of our study was to determine the availability, characteristics of use, and the need for improvisation of personal protective equipment (PPE) during the first wave of the COVID-19 pandemic in Spain. Materials and methods: An online, anonymous, prospective survey was carried out from April 2 to 15 by an e-mail invitation to 562 of the Trauma and Emergency Surgery sections of the Spanish Association of Surgeons. The survey collected demographic data, the region of clinical practice, patterns of PPE use in emergency surgeries, and the improvisation of equipment. Results: Total 58 health workers from 12 communities completed the survey, 95% surgeons. Total 28% received training with PPE during the pandemic, and 44% rated it as insufficient. The PPE used in surgery were double glove (74%), face shield (72%), surgical glasses (67%), waterproof gown (67%), and boot covers (32%). Lack of N95/FPP2/3 was reported by 82% and other elements of PPE by 68%. More than half of the respondents (51%) improvised PPE. Conclusion: The results reflect a low degree of training on PPE use before and during the first wave of the pandemic, the lack of PPE, especially masks, and the need to use nonapproved material as a protection mechanism.

PERSPECTIVE

Patrizio Petrone, D’Andrea K Joseph, Collin EM Brathwaite

Civil Liberties and Surveillance Programs in Times of COVID-19 Pandemic

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:3] [Pages No:186 - 188]

Keywords: Civil liberties, COVID-19, Surveillance programs

PDF  |  DOI: 10.5005/jp-journals-10030-1294  |  Open Access |  How to cite  | 

Abstract

There are extreme situations in human history, such as the current one of the coronavirus disease-2019 (COVID-2019) pandemic, where governments must take extraordinary measures. Although the initial intent would be the noble goal of protecting the health of people, these measures could also be used for other purposes that have nothing to do with the original plan.

PERSPECTIVE

Felipe A Fraga, Evelyn Eisenstein, Luiz A Messina, Max P Moraes, Cristiane Kopacek, Denise de C M Zornoff, David Cirigussi, Gustavo P Fraga

Creation and Expansion of a Virtual COVID-19 Information Exchange Platform Using the Brazilian University Telemedicine Network (RUTE)

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:6] [Pages No:189 - 194]

Keywords: COVID-19, Distance learning, Medical education, Pandemy, Telemedicine, Web conferences

PDF  |  DOI: 10.5005/jp-journals-10030-1291  |  Open Access |  How to cite  | 

Abstract

Introduction: Due to Brazil’s alarming situation, Brazilian professionals decided to create a Special Interest Group about coronavirus disease-2019 (SIG COVID-19 Brazil RUTE—the Brazilian University Telemedicine Network) with the objective of promoting training sessions by web conference for professional and medical students. Aim and objective: To describe the experience of rapidly organizing this professional network based on telemedicine activity and share its initial results. Materials and methods: The structure adopted was MConf, a web conference platform that provides a virtual conference channel for 75 active participants and online video streaming for an additional unlimited number of attendees. The agenda started with meetings occurring 3 times a week, which were changed to weekly encounters in July, and are scheduled to be monthly in August. The interactive presentations lasted 30–40 minutes, with approximately 20 minutes for written or spoken debate. After each presentation, all participants were invited to register their presence and answer brief evaluation questions about the quality of the presentation, with an evaluation score ranging from 1 (poor) to 10 (excellent). Results: From March 23 to June 30, 2020, forty-one web conferences were presented in the areas of epidemiology, medicine (different specialties), nursing, physiotherapy, dentistry, and new technologies, with the participation of 52 speakers from 12 Brazilian states and 12 international guest speakers from 9 countries: Israel, Italy, United States of America, Spain, Switzerland, Portugal, Canada, Ecuador, and Qatar. The program had in its coverage 2,170 registrations by 857 participants from 135 distinct institutions. The conference’s attendance average reached up to 100 participants. Around 60% of the attendees answered the program’s quality survey; the average evaluation score for quality of transmission, professional contribution; and topic relevance were 9.0, 9.5, and 10, respectively. Conclusion: The experience of working with telemedicine was determinant to create the innovative SIG COVID-19 Brazil RUTE, providing an important learning experience on diagnosis, treatments, and outcomes for the COVID-19 crisis management.

PERSPECTIVE

Tulika M Agarwal, Talat Chughtai

Perspective on Experience of Being an Asymptomatic COVID-19-positive Healthcare Professional

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:3] [Pages No:195 - 197]

Keywords: Coronavirus, COVID-19, Emergency physicians, Entrapped, Experiences, Level 1 trauma center, Pandemics, Quality of life, Stress, Trauma surgery

PDF  |  DOI: 10.5005/jp-journals-10030-1301  |  Open Access |  How to cite  | 

Abstract

The pandemic of coronavirus disease-2019 (COVID-19) has moved the whole world. Uncertainty generates vulnerability and a loss of control in patients who are diagnosed as COVID-19 positive while they are still asymptomatic. There is a tendency to experience guilt, fear stigma, and speculate future symptoms. Isolation could have a deeply distressing impact on human beings and the sooner one finds the means to cope with the same, he starts regaining the lost sense of control. Sharing such experiences helps answer a lot of questions that one may have in his mind about what could possibly happen if he is diagnosed positive for COVID-19, while he is still feeling normal, thereby reducing the associated stress. Sharing experiences and learning from each other’s experience has been a psychological skill that we human beings have used time and again to derive a sense of control when confronted with challenging situations in life. Experiences of a healthcare professional who is a surgeon, completely asymptomatic, but diagnosed positive for COVID-19, have been shared in this article to bring forth how one’s journey into something unknown and distressing can sometimes have a positive impact in his life. This article could be comforting to people who may have to go through a similar experience in the times to come.

ORIGINAL RESEARCH

Padmakumar V Arayamparambil, Garud S Chandan, Pooja P Sarada, Megha Sharma

Prevention of Hospital-acquired Pressure Ulcers in Patients with Prone Ventilation: A Retrospective Observational Study

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:4] [Pages No:198 - 201]

Keywords: Hypoxic respiratory failure, Intensive care, Pressure ulcer, Prone ventilation, Retrospective study

PDF  |  DOI: 10.5005/jp-journals-10030-1296  |  Open Access |  How to cite  | 

Abstract

Aim: Prone positioning improves oxygenation in patients with hypoxic respiratory failure. A pressure ulcer is a disturbing complication of prone positioning. The use of air mattresses and soft silicone dressing reduces the incidence of pressure ulcers in supine patients and prone intraoperative cases. We have compared the effect of two different strategies on the incidence of hospital-acquired pressure ulcers in patients undergoing prone ventilation for hypoxic respiratory failure. Materials and methods: We retrospectively analyzed the records of patients who underwent prone ventilation for hypoxic respiratory failure. Patients were divided into groups based on the hospital-acquired pressure ulcer prevention strategy used for prone patients. Patients in group S (Standard) were prone to the use of pillow support, headrest, and gel pads for pressure areas, while those in group O (Observation) were prone to air mattress along with soft silicone dressing and gel pads for pressure areas. The primary outcome was the incidence of pressure ulcers in both groups. The secondary outcomes were hemodynamic changes, oxygenation, and ventilatory parameters. Results: A total of 40 patients were included in the study, with equal distribution of 20 patients in each group. The incidence of hospital-acquired pressure ulcers was lower in group O as compared to group S (15 vs 25%, p = 0.35). No difference was seen in oxygenation, ventilation, or hemodynamic parameters. Conclusion: Use of air mattress and soft silicone dressing instead of pillow supports and headrest reduces the incidence of pressure ulcers in patients with prone ventilation (15 vs 25%, p = 0.35), which, in our opinion, is clinically significant. Albeit, there is no statistical difference in our study, we believe that a larger, well-designed, prospective study will show clinical and statistical difference. Reduced incidence of pressure ulcers will prevent facial scars, improves patient comfort, and will significantly contribute to better patient outcomes.

ORIGINAL RESEARCH

Kevin D Long, Francisco J Bonilla-Escobar, Cristina Rodriguez, Juan C Puyana

Injury Profile of Children 0–14 Years Old in Honduras

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:7] [Pages No:202 - 208]

Keywords: Child, Honduras, Public Health Surveillance, Road traffic accidents, Wounds and Injuries

PDF  |  DOI: 10.5005/jp-journals-10030-1297  |  Open Access |  How to cite  | 

Abstract

Aim: At the University Medical School Hospital in Honduras, a paper-based injury surveillance system (InSS) registered all injury cases in the emergency department in 2013. This is the first study to identify the injury profiles of children in Honduras, using the InSS data. Materials and methods: A case-series study was carried out using the InSS. Children aged 0–14 years were identified in the data set, and the descriptive statistics and bivariate analyzes were completed using this data. Results: Of 17,971 study patients, 5,873 (32.7%) patients were 0–14 years old with an average age of 7.3 ± 4.1 years. Unintentional injuries, most commonly road traffic incidents, falls, and blunt force trauma, constituted 94.2% of the total injuries. In all, 1.9% (109) self-inflicted injuries and 3.9% (230) deliberate interpersonal injuries with 35.8% due to blunt force trauma and 22.6% due to gunshot wounds. The mortality rate was 0.2%, and 84% of children spent 3 or fewer days in the hospital. Firearm injuries were more severe and resulted in a longer hospital stay. Conclusion: Childhood injuries are highly prevalent and a public concern throughout Honduras. This study profiles these injuries of over an entire year and provides insight into the types of interventions that could be effective in preventing and managing the high burden of pediatric injuries in this region. Clinical significance: This study provides the groundwork to profiling the high burden of injuries in Honduran children. Targeted injury prevention strategies and interventions can begin to be developed and implemented using the profile.

ORIGINAL RESEARCH

Juan P Fernandez, Rubén D Algieri, Maria S Ferrante, Carolina C Brofman, Agustín D Algieri

B-CON Course: Skills Acquired at Training in Bleeding Control Techniques for the Prevention of Exsanguinating Hemorrhage

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:4] [Pages No:209 - 212]

Keywords: Bleeding control, Continuous training, Military trauma, Preventable deaths, Trauma

PDF  |  DOI: 10.5005/jp-journals-10030-1302  |  Open Access |  How to cite  | 

Abstract

Introduction: Bleeding is one of the main causes of death associated with trauma. In the general population, knowledge of techniques to control bleeding is scarce or null in most situations, as well as the tools needed to perform them. The American College of Surgeons (ACS) “Stop the Bleed” campaign has the objective of training nonmedical personnel to perform lifesaving maneuvers to control bleeding in emergency and trauma situations. Materials and methods: A prospective, observational study. Surveys were conducted on knowledge of maneuvers to control bleeding among nonmedical personnel. The training was done using the “Stop the Bleeding” B-CON Course of the ACS followed by evaluations. Results: Four hundred and twelve nonmedical military personnel were trained, of whom 320 were medical students 27 surgical assistants, 35 nursing assistants, and 30 members of the armed forces. 92.7% (382) had no previous knowledge of any of the maneuvers. 73.3% (302) had some familiarity with tourniquets, of whom 6.55% (27) knew how to apply it. One hundred percent reported being unprepared to perform the maneuvers on their own before the course. Evaluation: after taking the course, 401 (92.3%) were able to correctly place the tourniquet on others, while 223 (54.1%) were able to apply on themselves. All participants (100%) performed wound compression correctly. Three hundred and forty-one (82.7%) reported feeling fully capable to perform the maneuvers after the course, while 71 (17.2%) requested to repeat it. One hundred percent of the respondents reported that the acquired skills and knowledge were beneficial. Conclusion: The training of nonmedical military personnel, as well as the general population, may be valuable to reduce deaths caused by exsanguinating hemorrhage. The authors believe educational programs are recommended and should be implemented in the general civilian and military communities as well as making the necessary tools widely available. The active participation of the medical community and their continuous interaction with the general population via injury prevention activities are important to reduce deaths caused by trauma.

ORIGINAL RESEARCH

Mónica Martínez-Mardones, Heinz Dauelsberg, Vicente Hernández-Peña, Anamaría Pacheco, Veronica Azabache, Josseline Peña, Valentina Garlaschi, Bárbara Valle, Paula Cornejo, Paz Alejandra Rodríguez

¿Ha cambiado la epidemiología de la Diverticulitis Aguda en los servicios de urgencia? Experiencia en un hospital de alto nivel de complejidad de Sur América

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:5] [Pages No:213 - 217]

Keywords: Acute diverticulitis, Complicated diverticulitis, Diverticular disease epidemiology, Emergency diverticulitis

PDF  |  DOI: 10.5005/jp-journals-10030-1290  |  Open Access |  How to cite  | 

Abstract

Introduction: Acute diverticulitis (AD) is a frequent diagnosis in the emergency services. In recent years, there has been a change in the epidemiology profile of this disease. The main objective is to assess whether there has been a change in the epidemiology of AD in our center, with an emphasis on complicated acute diverticulitis (CAD). Materials and methods: Retrospective descriptive study of patients admitted with diagnosis of acute diverticulitis to the Public Assistance Emergency Hospital, between January 2011 and December 2016. Demographic, clinical, and mortality variables are described. Results: Of 54,454 total discharges, 368 (0.7%) cases correspond to AD; 65% are women, with a median age of 61 years; 24.7% of AD occur in those younger than 50 years, with male predominance (78%); and 88 patients (24%) correspond to complicated acute diverticulitis (CAD). Of these, 45 (51.13%) patients presented with peritonitis, 22.2% corresponding to those under 50 years of age. Regarding Hinchey, 26 (29.54%) patients were classified as Hinchey I; 19.31% in Hinchey II, 34.09% Hinchey III and 17.04% Hinchey IV. The treatment of CAD included medical management was performed in 39.8% of cases and invasive procedures, the most frequent being Hartmann´s procedure (31.8%). Conclusion: The increase in perforated diverticulitis and the incidence under 50 years of age stand out, being mainly men. This accounts for the epidemiological change in CAD, with an increase in cases in younger patients, with more serious complications, however, with a better prognosis.

ORIGINAL RESEARCH

Saptarshi Biswas, Heather Rhodes, Kirklen Petersen, Kyle Schwarz, Gaukhar Amandossova

Hanging in There. Living beyond Hanging: A Retrospective Review of the Prognostic Factors from a Regional Trauma Center

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:5] [Pages No:218 - 222]

Keywords: Hanging, Near-hanging, Trauma

PDF  |  DOI: 10.5005/jp-journals-10030-1295  |  Open Access |  How to cite  | 

Abstract

Background: A common cause of suicide in the United States is hanging, which is increasing in incidence. Patients with near-hanging injuries survive long enough to present to the emergency department for resuscitative care. Identifying prognostic factors that can predict survival is needed to improve emergency management in this patient population. Materials and methods: A retrospective review of all patients diagnosed with an attempted suicide by hanging that presented to a regional level 2 trauma center was studied, inclusive years January 2013 to December 2017. The patients who died upon arrival were excluded. The data collected for comparison included demographic with prognostic characteristics, trauma center admission vitals, type and frequency of injuries, and near-hanging outcomes. Results: Several statistically significant findings were presented. Associations between systolic blood pressure (BP) upon admission of <90 Hg in patients <65 years of age and survival were statistically significant (Fisher’s exact test, p = 0.005). The association between Glasgow coma scale (GCS) category and survival was statistically significant (Fisher’s exact test, p = 0.012). Further, there was a weak positive association between the GCS category on admission vitals and survival (F = 0.554, p = 0.006). Associations between cervical spine injury with fracture and survival were significant (Fisher’s exact test, p = 0.024). A strong negative relationship was found between cerebral anoxia and survival (F = –0.772, p = 0.001). The association between cerebral injury and survival was statistically significant (Fisher’s exact test, p = 0.002). Finally, a strong negative relationship was found between pulmonary edema and survival (F = –0.592, p = 0.004). Conclusion: Independent risk factors for poor outcomes in near-hanging trauma were identified. These factors include relationships between systolic BP, GCS categories, admission vitals, cervical spine injures with fracture, cerebral anoxia, cerebral injury, and pulmonary edema with survival.

Trauma Abstracts

Trauma Abstracts

[Year:2020] [Month:September-December] [Volume:9] [Number:3] [Pages:12] [Pages No:223 - 234]

PDF  |  DOI: 10.5005/jp-journals-10030-1293  |  Open Access |  How to cite  | 

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