Current Issue : July - September Volume : 2018 Issue Number : 3 Articles : 5 Articles
Blunt trauma injuries to the pancreas are rare but are associated with significant overall mortality and a high complication rate.\nMotor vehicle collisions are the leading cause of blunt pancreatic trauma, followed by falls, and sports injuries. We discuss the\ndecision-making process used during the clinical courses of 3 patients with life-threatening blunt pancreatic injuries caused by\ntraumatic falls. We also discuss the utility of the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS),\nwhich provides a system for grading pancreatic trauma. Retrospectively, the cases reviewed were classified as AAST-OIS grade II,\nIII, and IV in each one patient. Although the nonoperative approach was initially preferred, surgery was required in each case due\nto pseudocyst formation, pancreatic necrosis, and posttraumatic pancreatitis. In each case, complete healing was achieved through\nexploratory laparotomy with extensive lavage and placement of abdominal drains for several weeks postoperatively. These cases show\nthat nonoperative management of pancreatic ductal trauma results in poor outcomes when initial therapy is less than optimal....
(1) Background: Remote communities in Canada lack an equitable emergency medical\nresponse capacity compared to other communities. Community-based emergency care (CBEC)\ntraining for laypeople is a model that has the potential to enhance the medical emergency response\ncapacity in isolated and resource-limited contexts. The purpose of this study was to understand\nthe characteristics of medical emergencies and to conceptualize and present a framework for what\na medical emergency is for one remote Indigenous community in northwestern Ontario, in order\nto inform the development of CBEC training. (2) Methods: This study adhered to the principles of\ncommunity-based participatory research and realist evaluation; it was an integrated component of the\nformative evaluation of the second Sachigo LakeWilderness Emergency Response Education Initiative\n(SLWEREI) training course in 2012. Twelve members of Sachigo Lake First Nation participated in\nthe training course, along with local nursing staff, police officers, community Elders, and course\ninstructors (n = 24 total), who participated in interviews, focus groups, and a collaborative discussion\nof local health issues in the development of the SLWEREI. (3) Results: The qualitative results are\norganized into sections that describe the types of local health emergencies and the informal response\nsystem of community members in addressing these emergencies. Prominent themes of health\nadversity that emerged were an inability to manage chronic conditions and fears of exacerbations,\nthe lack of capacity for addressing mental illness, and the high prevalence of injury for community\nmembers. (4) Discussion: A three-point framework of what constitutes local perceptions of an\nemergency emerged from the findings in this study: (1) a sense of isolation; (2) a condition with a\npotentially adverse outcome; and (3) a need for help....
Background. Fetal intracranial injury is a potentially devastating sequelae of maternal trauma, but there is little guidance regarding\nfetal evaluation in this setting. Case. A 23-year-old woman at 27-week gestation was admitted after a high-speed motor vehicle\naccident. The initial obstetrical ultrasound was unremarkable, but persistently minimal fetal heart rate variability was observed.\nUltrasound on day 3 after the accident showed an intracranial hyperechogenic lesion and subdural fluid collection. The neonate,\nfollowing an uneventful birth at 39 weeks, had seizures and abnormal muscle tone. MRI was consistent with in utero intracranial\nhemorrhage. Conclusion. Serial fetal imaging following maternal trauma, particularly when accompanied by abnormal fetal heart\nrate tracings, should be considered when fetal injury is a concern, even in the setting of a normal initial ultrasound....
Massive pulmonary embolism (PE) frequently leads to cardiac arrest (CA) which carries an extremely highmortality rate. Although\navailable, randomized trials have not shown survival benefits from thrombolytic use. Thrombolytics however have been used\nsuccessfully during resuscitation in clinical practice in multiple case reports and in retrospective studies. Recent resuscitation\nguidelines recommend using alteplase for PE related CA; however they do not offer a standardized treatment regimen. The most\nconsistently applied approach is an intravenous bolus of 50mg tissue plasminogen activator (t-PA) early during cardiopulmonary\nresuscitation (CPR). There is no consensus on the subsequent dosing. We present a case in which two 50mg boluses of t-PA\nwere administered 20 minutes apart during CPR due to persistent hemodynamic compromise guided by bedside echocardiogram.\nThe patient had an excellent outcome with normalization of cardiac function and no neurologic sequela. This case demonstrates\nthe benefit of utilizing bedside echocardiography to guide administration of a second bolus of alteplase when there is persistent\nhemodynamic compromise despite achieving return of spontaneous circulation after the initial bolus, and there is evidence of\npersistent right ventricle dysfunction. Future trials are warranted to help establish guidelines for thrombolytic use in cardiac arrest\nto maximize safety and efficacy....
North Korean refugees experience adaptation difficulties, along with a wide range of\npsychological problems. Accordingly, this study examined the associations between early traumatic\nexperiences, negative automatic thoughts, and depression among young North Korean refugees\nliving in South Korea. Specifically, we examined how different factors of negative automatic thoughts\nwould mediate the relationship between early trauma and depressive symptoms. A total of 109 North\nKorean refugees aged 13ââ?¬â??29 years were recruited from two alternative schools. Our path analysis\nindicated that early trauma was positively linked with thoughts of personal failure, physical threat,\nand hostility, but not with thoughts of social threat. The link with depressive symptoms was only\nsignificant for thoughts of personal failure. After removing all non-significant pathways, the model\nrevealed that early traumatic experiences were positively associated with depressive symptoms\n(Ã?Ÿ = 0.61, 95% CI = 0.48ââ?¬â??0.73) via thoughts of personal failure (Ã?Ÿ = 0.17, 95% CI = 0.08ââ?¬â??0.28), as well\nas directly (Ã?Ÿ = 0.44, 95% CI = 0.27ââ?¬â??0.59). Interventions that target negative cognitions of personal\nfailure may be helpful for North Korean refugees at risk of depression....
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