Abstracted/ Indexed in: Ulrich's International Periodical Directory, Google Scholar, SCIRUS
Quarterly published in print and online "Inventi Impact: Emergency Medicine (Formerly Inventi Impact: Trauma)" publishes high quality unpublished as well as high impact pre-published research and reviews catering to the needs of researchers and professionals. This journal focuses on all the aspects of trauma care: prevention through prehospital management, accident and emergency medicine, surgery, anaesthetics and intensive care, and physical and psychiatric rehabilitation. Articles related to providing trauma care services in remote, rural or otherwise un-serviced/ unapproachable areas are given special emphasis.
Beginning a residency in Emergency Medicine is a daunting task, and the new physician must be\naware of what abnormal vital signs are and understand when to initiate emergency therapy. This\nmodule was created to teach the new physician about the vital sign of temperature. The module is\nblended to incorporate online learning via both direct and asynchronous methods, as well as faceto-\nface interactions using high fidelity simulation....
Transvaginal small bowel evisceration is a rare surgical emergency that requires urgent surgery to prevent bowel necrosis, sepsis,
and death. It was first reported in 1864 by Hyernaux with less than 100 cases reported since the original publication. The overall
mortality rate is reported as 5.6 percent. We present the case of a 49-year-old woman who presented to the emergency department
with a chief complaint of moderate abdominal pain and vaginal bleeding for 1 hour. The patient reported that she underwent a
robotic-assisted laparoscopic hysterectomy 11 weeks prior for uterine fibroids. Visual examination revealed a loop of the small
bowel coming from the superior aspect of her vagina. Literature reviews have noted a higher incidence of dehiscence following
robotic-assisted total laparoscopic hysterectomy. It is important for the emergency physician to make the diagnosis, initiate
prompt consultation with departments of obstetrics and gynecology and general surgery, and treat for potential infection....
Objective: Severe burns are devastating injuries that result in considerable systemic inflammation and often require\nresuscitation with large volumes of fluid. The result of massive resuscitation is often raised intra-abdominal pressures\nleading to Intra-abdominal hypertension (IAH) and the secondary abdominal compartment syndrome. The objective\nof this study is to conduct (1) a 10 year retrospective study to investigate epidemiological factors contributing to\nburn injuries in Alberta, (2) to characterize fluid management and incidence of IAH and ACS and (3) to review fluid\nresuscitation with a goal to identify optimal strategies for fluid resuscitation.\nDesign: A comprehensive 10-year retrospective review of burn injuries from 1999.\nOutcome Measures: Age, sex, date, mechanism of injury, location of incident, on scene vitals and GCS, type of\ntransport to hospital and routing, ISS, presenting vitals and GCS, diagnoses, procedures, complications, hospital LOS,\nICU LOS, and events surrounding the injury.\nResults: One hundred and seventy five patients (79.4% M, 20.6% F) were identified as having traumatic burn\ninjuries with a mean ISS score of 21.8 (Ã?Â±8.3). The mean age was 41.6 (Ã?Â±17.5) (range 14-94) years. Nearly half (49.7%)\nof patients suffered their injuries at home, 17.7% were related to industrial incidents and 14.3% were MVC related.\nOne hundred and ten patients required ICU admission. ICU LOS 18.5 (Ã?Â±8.8) days. Hospital LOS 38.0 (Ã?Â±37.8) days. The\nmean extent of burn injury was 31.4 (Ã?Â±20.9) % TBSA. Nearly half of the patients suffered inhalational injuries (mild\n12.5%, moderate 13.7%, severe 9.1%). Thirty-nine (22.2%) of patients died from their injuries. Routine IAP monitoring\nbegan in September, 2005 with 15 of 28 patients having at least two IAP measurements. The mean IAP was 16.5\n(Ã?Â±5.7) cm H2O (range: 1-40) with an average of 58 (Ã?Â±97) IAP measurements per patient. Those patients with IAP\nmonitoring had an average TBSA of 35.0 (Ã?Â±16.0)%, ISS of 47.5 (Ã?Â±7.5). The mean 48 hr fluid balance was 25.6 (Ã?Â±11.1)L\nexceeding predicted Parkland formula estimates by 86 (Ã?Â±32)%.\nConclusions: Further evaluation of IAP monitoring is needed to further characterize IAP and fluid resuscitation in\npatients with burn injuries....
Background: Ambulance paramedics play a critical role expediting patient access to emergency treatments.\nStandardised handover communication frameworks have led to improvements in accuracy and speed of\ninformation transfer but their impact upon time-critical scenarios is unclear. Patient outcomes might be improved\nby paramedics staying for a limited time after handover to assist with shared patient care. We aimed to categorize\nand synthesise data from studies describing development/extension of the ambulance-based paramedic role\nduring and after handover for time-critical conditions (trauma, stroke and myocardial infarction).\nMethods: We conducted an electronic search of published literature (Jan 1990 to Sep 2016) by applying a structured\nstrategy to eight bibliographic databases. Two reviewers independently assessed eligible studies of paramedics,\nemergency medical (or ambulance) technicians that reported on the development, evaluation or implementation of (i)\ngeneric or specific structured handovers applied to trauma, stroke or myocardial infarction (MI) patients; or (ii)\nparamedic-initiated care processes at handover or post-handover clinical activity directly related to patient care in\nsecondary care for trauma, stroke and MI. Eligible studies had to report changes in health outcomes.\nResults: We did not identify any studies that evaluated the health impact of an emergency ambulance paramedic\nintervention following arrival at hospital. A narrative review was undertaken of 36 studies shortlisted at the full text stage\nwhich reported data relevant to time-critical clinical scenarios on structured handover tools/protocols; protocols/enhanced\nparamedic skills to improve handover; or protocols/enhanced paramedic skills leading to a change in in-hospital transfer\nlocation. These studies reported that (i) enhanced paramedic skills (diagnosis, clinical decision making and administration\nof treatment) might supplement handover information; (ii) structured handover tools and feedback on handover\nperformance can impact positively on paramedic behaviour during clinical communication; and (iii) additional roles of\nparamedics after arrival at hospital was limited to Ã¢â?¬Ë?direct transportationÃ¢â?¬â?¢ of patients to imaging/specialist care facilities.\nConclusions: There is insufficient published evidence to make a recommendation regarding condition-specific handovers\nor extending the ambulance paramedic role across the secondary/tertiary care threshold to improve health outcomes.\nHowever, previous studies have reported non-clinical outcomes which suggest that structured handovers and enhanced\nparamedic actions after hospital arrival might be beneficial for time-critical conditions and further investigation is required...
Loss and dilution of coagulation factors have been observed following multiple trauma. Timely recognition of reduced clotting
factor activity might facilitate therapeutic action to restore normal coagulation function. This study investigates the potential
role of some well-known trauma scores in predicting coagulation factor activity after multiple injuries. A dataset comprising the
coagulation factor activities of 68 multiply injured adult patients was analyzed. The following trauma scores were evaluated: AIS,
ISS, NISS, GCS, RTS, TRISS, RISC, and TASH score. To investigate the effect of trauma severity with respect to a single
anatomic injury location, two groups according to the AIS (<3 vs. ≥3 points) were formed. Differences between these two
groups were analyzed for five different body regions (head, thorax, abdomen, pelvis, extremities) using the Mann–Whitney U
-test. Spearman’s rank correlation coefficient rho was calculated to reveal possible relationships between trauma scores and
clotting factor activities. The analysis showed clearly reduced clotting factor activities with a significant reduction of FII (83 vs.
50%; P = :021) and FV (83 vs. 46%; P = :008) for relevant (AIS ≥ 3 points) pelvic injuries. In contrast, traumatic brain injury
according to the AIS head or the GCS does not appear to lead to a significant decrease in coagulation factor activities.
Furthermore, the other scores studied show at best a fair correlation with coagulation factor activity. In this context, the RTS
score seems to be the most suitable. Additionally, the predictive value of the TASH score, which was specifically developed to
predict the need for mass transfusion, was also limited in this study. We would like to explicitly point out that this is not a
criticism of the trauma scores, since they were developed in a completely different context....
Objective: In 2003, we published a study on the Israeli workforce in emergency medicine (EM). We repeated the\nstudy in 2012 to assess changes in the workforce that have occurred in the interval decade.\nMethods: This is an observational cross-sectional study of the physician workforce in EM in Israel in 2012. An online\nsurvey was sent to the ED medical directors of all general hospitals in Israel querying the numbers of physicians\nworking in the ED, as well as the specialty and level of training of those manning the ED at various times during\nthe day. The workforce in 2012 was compared to that of 2003.\nResults: Twenty-four of 28 (86 %) EDs responded. Certified EM specialists have increased from 59 to 164 since 2003.\nDisparities continue regarding their presence in the ED. Most EM specialists are scheduled during the day whereas\nthey are virtually absent during the night. A total of 58 EM specialists were scheduled countrywide for the weekday\nday shift and only one overnight. The preponderance of EM specialists working during the day and the large number of\nsupervised and unsupervised residents working at night has not changed substantially since 2003. Eleven departments\nreported having an EM specialist present during the evenings whereas in 2003, only two departments reported so.\nConclusion: Since 2003, there are more certified EM specialists and more specialist coverage in the ED into the evening\nhours. Most ED providers are still not emergency physicians, and there is still a preponderance of EM specialist coverage\nduring the day and a lack thereof overnight....
Background: We conducted a systematic review of studies published in peer-reviewed journals on HIV screening
programs conducted in pediatric emergency departments (PEDs) in the United States (US) with the objective of
describing the methods, testing yields and challenges in these programs.
Methods: We searched for full-text, English-language, original research articles focused on the conduct, development,
initiation or implementation of any HIV screening program in a US PED through eight online databases
(Pubmed (MEDLINE), Scopus, Embase, Cochrane, Web of Science, CINAHL, PsycInfo and Google Scholar) from their
inception through July 2020. We also searched for articles on the websites of thirteen emergency medicine journals,
24 pediatric and adolescent health journals, and ten HIV research journals, and using the references of articles found
through these searches. Data on HIV testing program components and yield of testing was extracted by one investigator
independently and verified by a second investigator. Each program was summarized and critiqued.
Results: Of the eight articles that met inclusion criteria, most involved descriptions of their HIV testing program,
except for one that was focused on quality improvement of their program. Five described an opt-in and three an optout
approach to HIV screening. Programs differed greatly by type of HIV test utilized and who initiated or performed
testing. There were large variations in the percentage of patients offered (4.0% to 96.7%) and accepting (42.7% to
86.7%) HIV testing, and HIV seropositivity in the studies ranged from 0 to 0.6%. Five of the eight studies reported an
HIV seropositivity greater than 0.1%, above Centers for Disease Control and Prevention recommended threshold for
testing in a healthcare setting.
Conclusions: The studies illustrate opportunities to further optimize the integration of HIV screening programs
within US PEDs and reduce barriers to testing, improve efficiency of testing results and increase effectiveness of programs
to identify cases. Future research should focus on advancing the methodology of screening programs beyond
feasibility studies as well as conducting investigations on their implementation and longer-term sustainability....
Parallel screw alignment can be challenging. We describe a simple, reproducible technique for the fixation of the medial malleolar fragment with two parallel screws, using a 1.6mm K-wire and the small fragment AO drill-guide....
Abdominal pain is one of the most common complaints among patients admitted to the Emergency\nDepartment (ED). Diagnosis and management of abdominal pain may be a challenge and there are patients who\nrequire admission to the ED more than once in a short period of time. Our purpose was to assess the incidence of\nreadmissions among patients treated in the ED due to abdominal pain and to investigate the impact of\nreadmission on the further course of treatment.\nMethods: We conducted a prospective observational study, which included patients admitted to the ED in one\nacademic, teaching hospital presenting with non-traumatic abdominal pain in a three-month period. Analyzed\nfactors included demographic data, details related to first and subsequent visits in the ED and the course of\nhospitalization.\nResults: Overall, 928 patient................
Introduction: Damage control surgery and damage control resuscitation have reduced mortality in patients with\nsevere abdominal injuries. The shift towards non-operative management in haemodynamically stable patients\nsuffering blunt abdominal trauma has further contributed to the improved results. However, in many countries, low\nvolume of trauma cases and limited exposure to trauma laparotomies constitute a threat to trauma competence.\nThe aim of this study was to evaluate the institutional patient volume and performance for patients with abdominal\ninjuries over an eight-year period.\nMethods: Data from 955 consecutive trauma patients admitted in Oslo University Hospital Ulleval with abdominal\ninjuries during the eight-year period 2002-2009 were retrospectively explored. A separate analysis was performed\non all trauma patients undergoing laparotomy during the same period, whether abdominal injuries were identified\nor not. Variable life-adjusted display (VLAD) was used in order to describe risk-adjusted survival trends throughout\nthe period and the patients admitted before (Period 1) and after (Period 2) the institution of a formal Trauma\nService (2005) were compared.\nResults: There was a steady increase in admitted patients with abdominal injuries, while the number of patients\nundergoing laparotomy was constant exposing the surgical trauma team leaders to an average of 8 trauma\nlaparotomies per year. No increase in missed injuries or failures of non-operative management was detected.\nUnadjusted mortality rates decreased from period 1 to period 2 for all patients with abdominal injuries as well as\nfor the patients undergoing laparotomy. However, this apparent decrease was not confirmed as significant in\nTRISS-based analysis of risk-adjusted mortality. VLAD demonstrated a steady performance throughout the study\nperiod.\nConclusion: Even in a high volume trauma center the exposure to abdominal injuries and trauma laparotomies is\nlimited. Due to increasing NOM, an increasing number of patients with abdominal injuries was not accompanied by\nan increase in number of laparotomies. However, we have demonstrated a stable performance throughout the\nstudy period as visualized by VLAD without an increase in missed injuries or failures of NOM...
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