Current Issue : October - December Volume : 2013 Issue Number : 4 Articles : 6 Articles
Background: The use of diagnostic imaging in medicine has changed with the advancement of technology ââ?¬â??\r\nnow faster, more detailed and more available. Advanced Trauma Life Support (ATLS) provides clear criteria for plain\r\nfilm assessment but the guidance on CT scanning in acute trauma is defined less well and depends upon national\r\nguidelines and local protocols. There has been a marked increase in the use of CT across the spectrum of trauma\r\npatients. This has paved the advent of multiple scans on admission and Whole-Body CT (WBCT) scans during\r\nresuscitation. The question is: Is it truly indicated?\r\nMethods: Over a ten-month period from June 2011 to April 2012, 100 adults admitted to the state trauma unit\r\nwere randomly selected for prospective data collection. Our primary outcome was mortality and our secondary\r\noutcome was identification of a Significant Injury (SI) on CT scanning. A significant injury was defined as; any finding\r\non CT which resulted in a change of management.\r\nResults: There were 100 patients recruited for prospective data collection during ten months, from June 2011\r\nand April 2012. The study population was predominantly males (79%), from the metropolitan area, involved in motor\r\nvehicle accidents. Mortality rate was 0% at three months follow up. The prevalence of significant injury demonstrated\r\non WBCT and regional body CT appear equivocal, with the exception of CT pelvis.\r\nConclusion: In the acute trauma setting CT of head and cervical spine delivers valuable clinical information in a\r\ntimely and low cost manner. With consideration for cost and long term implications on patient safety, we believe that\r\nfurther scanning of the Chest/Abdomen/Pelvis should be clinically driven. We propose that continued careful history\r\ntaking and physical examination remain a key component to assessing the indication for CT Chest/Abdomen/Pelvis\r\nin acute trauma patients....
Background: Out-of-hospital cardiac arrest (OHCA) is a frequent and acute medical condition that requires\r\nimmediate care. We estimate survival rates from OHCA in the area of Stockholm, through developing an analytical\r\ntool for evaluating Emergency Medical Services (EMS) system design changes. The study also is an attempt to\r\nvalidate the proposed model used to generate the outcome measures for the study.\r\nMethods and results: This was done by combining a geographic information systems (GIS) simulation of driving\r\ntimes with register data on survival rates. The emergency resources comprised ambulance alone and ambulance\r\nplus fire services. The simulation model predicted a baseline survival rate of 3.9 per cent, and reducing the\r\nambulance response time by one minute increased survival to 4.6 per cent. Adding the fire services as first\r\nresponders (dual dispatch) increased survival to 6.2 per cent from the baseline level. The model predictions were\r\nvalidated using empirical data.\r\nConclusion: We have presented an analytical tool that easily can be generalized to other regions or countries. The\r\nmodel can be used to predict outcomes of cardiac arrest prior to investment in EMS design changes that affect the\r\nalarm process, e.g. (1) static changes such as trimming the emergency call handling time or (2) dynamic changes\r\nsuch as location of emergency resources or which resources should carry a defibrillator....
Background: Many studies indicate rural location as a separate risk for dying from injuries. For decades, Finnmark,\r\nthe northernmost and most rural county in Norway, has topped the injury mortality statistics in Norway. The\r\npresent study is an exploration of the impact of rurality, using a point-by-point comparison to another Norwegian\r\ncounty.\r\nMethods: We identified all fatalities following injury occurring in Finnmark between 2000 and 2004, and in\r\nHordaland, a mixed rural/urban county in western Norway between 2003 and 2004 using data from the Norwegian\r\nCause of Death Registry. Intoxications and low-energy trauma in patients aged over 64 years were excluded. To\r\nassess the effect of a rural locale, Hordaland was divided into a rural and an urban group for comparison. In\r\naddition, data from Statistics Norway were analysed.\r\nResults: Finnmark reported 207 deaths and Hordaland 217 deaths. Finnmark had an injury death rate of 33.1 per\r\n100,000 inhabitants. Urban Hordaland had 18.8 deaths per 100,000 and rural Hordaland 23.7 deaths per 100,000. In\r\nFinnmark, more victims were male and were younger than in the other areas. Finnmark and rural Hordaland both\r\nhad more fatal traffic accidents than urban Hordaland, but fewer non-fatal traffic accidents.\r\nConclusions: This study illustrates the disadvantages of the most rural trauma victims and suggests an urban-rural\r\ncontinuum. Rural victims seem to be younger, die mainly at the site of injury, and from road traffic accident injuries.\r\nIn addition to injury prevention, the extent and possible impact of lay people�s first aid response should be\r\nexplored....
Objectives: Alexithymia involves difficulty identifying and describing emotions and has been linked to a variety\r\nof psychological problems, particularly exposure to trauma, interpersonal difficulties, and depression. Currently,\r\nalexithymia is most commonly assessed through self- report questionnaires. A neuropsychological test may be a\r\nmore valid assessment of alexithymia because it uses a performance-based design and focuses on the underlying\r\ncognitive process in question: affective-processing. This impaired processing may be useful in testing an explanatory\r\nmodel for the relationship between trauma exposure and the subsequent development of alexithymia, interpersonal\r\nproblems, and depression.\r\nParticipants and methods: Fifty-three undergraduate students pre-screened for trauma exposure, were\r\ngiven questionnaires measuring alexithymia, interpersonal problems, and depression, and then administered\r\na neuropsychological test of Auditory-Affective Perception (AAP). Correlational analyses compared the\r\nneuropsychological measure with the alexithymia questionnaire. A hierarchical regression tested a meditational\r\nmodel.\r\nResults: Performance on the neuropsychological measure of AAP did not significantly correlate with the\r\nalexithymia questionnaire (p>0.05). Alexithymia was found to partially mediate between trauma exposure and\r\ndepression (p=0.03). The over-all model was significant,\r\nF(2.50)=25.17, p<0.001, adjusted-R2=0.48.\r\nConclusions: Regression analyses supported self-reported alexithymia as a partial mediator of the relationship\r\nbetween trauma exposure and depression, suggesting that depressive symptoms developed following trauma\r\nexposure are partially related to the development of alexithymic symptoms. AAP performance was not significantly\r\ncorrelated with the measure of alexithymia suggesting self-reported alexithymic symptoms are independent of the\r\nability to recognize auditorially-presented emotions; possible explanations and theoretical implications are discussed....
Objectives: Trauma is the leading cause of death in children. Abdominal trauma with Injuries to the liver, spleen\r\nand kidneys are common in children and many of these injuries nowadays are treated non-operatively, where as\r\nPancreatic injuries are uncommon and its management still controversial. The aim of this study is to report the\r\noutcome of management in a series of children with pancreatic injury.\r\nMethods: Ten Children less than 10 years of age treated at our institution with pancreatic injury between the\r\nperiod of May 2000 and May 2010 and reviewed retrospectively. 8 cases admitted from the emergency room and\r\ntwo cases referred from another facility. Diagnosis made on clinical suspicion, biochemistry tests and radiological\r\nconfirmation (ultrasound and CT scan). Management was started according to the grade of Injury.\r\nResults: Seven boys and three girls aged between 2.5 and 10 years sustained pancreatic injuries: three cases\r\nhad grade I Pancreatic injury (minor contusion), three cases with grade II (major contusion without duct injury or\r\ntissue loss), two with grade III (distal transection and duct injury), one case with grade IV (proximal transection) and\r\none case with pancreatic transaction and extensive duodenal injury (grade IV with associated injury). Grade I and\r\nII injuries were successfully managed without surgery. Children with grade III injuries were treated conservatively,\r\nbut each developed a symptomatic pseudo cyst that failed to resolve with percutaneous drainage and underwent\r\nspleen-sparing distal pancreatectomy. The child with grade IV transected pancreatic neck was treated by Roux-en-Y\r\njejunostomy drainage and the last case with the Grade IV and associated duodenal injury treated with Whipple\r\nprocedure. Amylase level was normal in Grade I and II injuries and increased as the grade of injury is higher. All\r\nchildren made a full recovery. Median follow up was 45 days.\r\nConclusion: Pancreatic injuries in children are uncommon and its management still controversial, some\r\nInstitutions prefers conservative management, whereas others hold on the surgical option. Level of amylase is\r\ncorrelated with the severity of the injury when pancreatic injury is diagnosed. The management of pancreatic injuries\r\nin children depends on the grade of injury, presence of associated injuries and Hospital expertise....
Background: This study compares patient operated by thoracoscopy and thoracotomy in patients with\r\npenetrating chest wounds with massive hemothorax, hemodynamically stable.\r\nMaterials and methods: Retrospective study Cross sectional, type III level of evidence.45 patients were included\r\nin the study. In 24 of them were approached by thoracoscopy and the remaining 21 by thoracotomy and compared\r\nmorbidity, hospital stay, operative time, complications and conversion rate in patients with penetrating trauma\r\nmassive hemothorax managed by thoracotomy hemodynamically stable with those managed by thoracoscopy\r\nduring the period from September 1, 2008 until September 30, 2011 operated by the Department of General Surgery\r\nand Thoracic Surgery Hospital Santa Clara, Bogota, Colombia.\r\nResults: Thoracoscopy is associated with reduced blood loss, less operative time, shorter hospital stay by filing\r\na conversion rate of 12.5% video assisted surgery procedures and a lower rate of complications.\r\nConclusions: Thoracoscopy represents a therapeutic option and a safe approach in the right hands to the chest\r\ninjured patients with massive hemothorax, hemodynamically stable....
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