Journal of Emergencies, Trauma, and Shock
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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 15 | Issue 2
Page Nos. 75-114

Online since Monday, June 27, 2022

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EDITORIAL  

What's new in emergencies, trauma and shock – Burnout in emergency physicians p. 75
Murtuza Ghiya, William Wilson
DOI:10.4103/jets.jets_76_22  
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ORIGINAL ARTICLES Top

Compassion fatigue and satisfaction among turkish emergency medicine residents using the professional quality of life scale p. 77
Joshua Campbell, Abdul Wasey, Ibrahim Ulas Ozuturan, Rebecca Jeanmonod
DOI:10.4103/jets.jets_62_21  
Introduction: Emergency medicine (EM) residents are at high risk for burnout syndrome. The professional quality of life scale (ProQOL) is a validated survey that measures compassion satisfaction (CS) and compassion fatigue, which is comprised of burnout and secondary traumatic stress (STS) scales. This study sought to evaluate CS and fatigue among Turkish EM residents using the ProQOL survey. Methods: This was a cross-sectional study of Turkish EM residents who are part of the EM Residency Association of Turkey. The ProQOL survey version 5 was E-mailed in Turkish to all 150 EM residents. Participants were currently employed as EM residents. Demographics and satisfaction with quality of life were also collected. Results: Eighty residents completed the survey. Almost half of the respondents were either very dissatisfied or dissatisfied with their overall quality of life. Turkish EM residents not only had moderate levels of CS (scoring 33.9 ± 7.9), but also suffered moderate burnout (27.0 ± 5.9) and STS (24.7 ± 5.3). Conclusions: Turkish EM residents have moderate levels of CS and moderate levels of burnout and secondary traumatic stress.
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Opioid-related overdose fatality cases in two Florida counties p. 83
Anne T Powell, Marie M Bourgeois, Julie Lichterman, Giffe T Johnson, Sagar Galwankar, Raymond D Harbison
DOI:10.4103/jets.jets_130_21  
Introduction: This study evaluates trends in drug-related death cases within both Pasco and Pinellas County, Florida, from the calendar years 2011 to 2016. Specifically, it focuses on opioids and the role of fentanyl in overdose-related mortality in rural versus suburban populations. Methods: Two sets of data from each calendar year were obtained from a Medical Examiner's Office. These data were compared by year to assess differences using the nonparametric ANOVA test with the statistical software SAS, University Edition. Binary logistic regression was performed to assess which drugs occurred most frequently in the presence or absence of fentanyl. Results: There was not a significant difference in the month of the year or the day of the week that drug-related fatalities occurred. More drug-related mortalities occurred during daylight hours (e.g., 8:00 AM–4:00 PM) and more fentanyl-related mortalities occurred in Pinellas County compared to Pasco County. Fentanyl and heroin tended to co-occur in mortalities, while ethanol, hydrocodone, morphine, oxycodone, and methadone were negatively associated with fentanyl-related overdose cases. Conclusion: The characteristics of drug-related mortalities identified here may be used to better target interventions against drug abuse and overdose.
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Effect of the coronavirus disease 2019 pandemic on suicide-related trauma burden at a Level 1 trauma center p. 88
Claire M Eden, Roger Zhu, Shahenda Khedr, Konstantin Khariton
DOI:10.4103/jets.jets_142_21  
Introduction: In March 2020, the first coronavirus disease 2019 (COVID-19) cases were reported in New York and a stay-at-home order was enacted soon after. Social isolation combined with pandemic-related stressors profoundly affected mental health. We hypothesize that there was an increase in violent suicide attempt during the COVID-19 pandemic lockdown compared to previous years. Methods: We queried our institutional trauma registry for total number of trauma activations and identified adult patients with International Classification of Diseases-10 diagnosis of intentional self-harm. We compared incidence during the lockdown to corresponding time periods from previous years. Demographic and injury characteristics were compared, as were outcomes such as mortality. Results: We observe a significant uptrend in patients requiring trauma intervention after suicide attempts from July 2019 through July 2020 (r = 0.8, P < 0.001) despite a significant downtrend in trauma volume at our institution during the same period (r = ‒0.7, P = 0.003). Although not statistically significant, patients attempting violent suicide during lockdown were more likely to have preexisting psychiatric diagnoses, to live alone, to have injury severity score >9, and to require surgical intervention. Three COVID-period patients died in the emergency room compared to zero in the comparison group. Conclusion: Our data show a rise in violent suicide attempts during the pandemic lockdown despite an overall decrease in trauma volume. The ramifications of a stay-at-home order seem to have the most profound impact on individuals with preexisting mental health disease. Early establishment of mental health outreach programs may mitigate the reverberating psychosocial consequences of a pandemic.
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Identification of seniors at risk scoring in geriatric trauma: Exploring clinical outcome correlations p. 93
Stephen D Dingley, Wayne B Bauerle, Christine Ramirez, Holly Weber, Rebecca Wilde-Onia, Ann-Marie Szoke, Adam Benton, Danielle Frutiger, Alaa-Eldin Mira, William Hoff, Stanislaw P Stawicki
DOI:10.4103/jets.jets_19_22  
Introduction: Geriatric trauma patients (GTP) make up an increasing percentage of the overall trauma population. Due to frailty, GTP are at an increased risk of morbidity and readmission. Therefore, it is becoming increasingly important to prognosticate outcomes to assist with resource utilization. We hypothesized that the “Identification of Seniors at Risk” (ISAR) score may correlate with both clinical outcomes and resource utilization for geriatric trauma patients. Methods: Patients older than 65 years who were admitted to the trauma service were screened using an ISAR scoring algorithm. Outcomes, including 30-day mortality, all-cause morbidity, hospital length of stay (LOS), intensive care unit (ICU) LOS, functional independence measures (FIM) at discharge, and percent discharged to a facility, were analyzed. Both descriptive and data-appropriate parametric and non-parametric statistical approaches were utilized, with significance set at α = 0.05. Results: One thousand and two hundred seventeen GTP were included in this study. The average age was 81, median injury severity score was 9, and 99% had a blunt trauma mechanism. ISAR scores were generally associated with increasing 30-day mortality (0%, 1.9%, 2.4%, and 2.1% for ISAR 0, ISAR 1–2, ISAR 3–4, and ISAR 5–6, respectively), morbidity (2.6%, 7.6%, 14.7%, and 7.3% for respective categories), longer hospital (3.1, 4.6, 5.1, and 4.3 days, respectively) and ICU stays (0.37, 0.64, 0.81, and 0.67, respectively), lower FIM score at discharge (18.5, 17.1, 15.8, and 14.4, for respective categories), as well as increasing percentage of patients discharged to a facility (29.8%, 58.9%, 72.1%, and 78.8% for respective categories). Conclusions: This exploratory study provides important early insight into potential relationships between ISAR and geriatric trauma outcomes. ISAR screening is a quick and easy-to-use tool that may be useful in GTP triage, level-of-care determination, and disposition planning. Understanding populations at risk, especially those with more intricate discharge needs, is an important step in mitigating those risks and implementing appropriate care plans.
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Patterns and predictors of emergency medical services utilisation by patients attending the emergency medicine department of a tertiary care hospital in India p. 99
Prithvishree Ravindra, Rachana Bhat, Nisarg Karanth, William Wilson, BN Lavanya, Simran Umra, Shweta Mahesh
DOI:10.4103/jets.jets_83_21  
Introduction: Establishment of strong emergency medical services (EMS) systems plays a pivotal role in reducing morbidity and mortality, especially in low and middle-income countries. We aimed to study the EMS utilization and resources available in the ambulances to deliver prehospital care among patients presenting to the Emergency Medicine Department in a tertiary care hospital in south India. Methods: Data regarding prehospital transport practices such as mode of arrival, utilization of EMS, resources available in the ambulance, presenting complaints, triage category, and demographic details were collected and analyzed. Subgroup analysis for time-sensitive complaints was done. Variables were subjected to univariate and multivariate analysis to find the predictors of ambulance usage. Results: The study included 3935 patients. The most common time-sensitive complaints were trauma (17%) and chest pain (11.5%). The most preferred mode of transport was the personal vehicle (45.6%). 29.8% of patients arrived in the ambulance. 97.7% of ambulances were not Advanced Cardiac Life Support equipped and 87.1% did not have an accompanying health care provider. 64.5% inter-hospital patient transfers were through ambulance, 83.8% transfers were unaccompanied. Among patients with time-sensitive complaints, EMS utilization was inadequate (46.8% in acute coronary syndrome, 34% in trauma, and 56.5% in early acute ischemic stroke). Conclusion: There was underutilization of the EMS services. Majority of the ambulances were not adequately equipped/staffed to deliver prehospital interventions. Policies at national level are required to encourage EMS utilization by the public and urgent measures are needed to improve services provided by them.
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CASE REPORTS Top

Tension fecopneumothorax p. 105
Linu Abdullatheef, Manes Anil, Arjun Athmaram, Vishnu R Krishnan, Stalin J Roy, Yoganathan M N Namboothiry
DOI:10.4103/jets.jets_100_21  
Fecopneumothorax causing tension (hemodynamic compromise) is an extremely rare situation, mostly as a result of blunt trauma. Here, we present an 86-year-old gentleman who presented with tension fecopneumothorax, with an interesting backstory as to the development of fecopneumothorax.
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Military marking round injury to the globe p. 108
Patrick James Donegan, Matthew Allen De Niear, Janice C Law, Behin Barahimi
DOI:10.4103/jets.jets_108_21  
Marking cartridges are an increasingly popular form of nonlethal training munitions used primarily for military live-fire simulations. We report a case of ocular trauma due to such a projectile, resulting in the complete loss of vision and placement of a scleral shell. A 20-year-old man presented with decreased visual acuity in his right eye after being struck at close range by a marking cartridge during military training. Computed tomography imaging revealed a retained metallic foreign body within a deflated right globe, prompting emergent exploration and repair of the right globe. Postoperative course was complicated by pain and pruritis which resolved over a period of months. Nonlethal weapons, such as marking cartridges, are increasingly used for civilian crowd control as well as military and law enforcement training. Despite guidelines mandating the use of personal protective equipment with marking cartridges, eye protection may not be consistently used during simulated combat exercises. To the best of our knowledge, this is the first formal report of ocular injury due to this type of ammunition. Based on this case, we discuss other similar types of nonlethal munition used by military and law enforcement, their risks to the eye and orbit, and what steps may be undertaken to reduce future injury.
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LETTERS TO EDITOR Top

Nontraumatic splenic rupture during body boarding p. 111
Ken-Ichi Muramatsu, Yuta Murai, Mutsumi Sakurada, Youichi Yanagawa
DOI:10.4103/jets.jets_152_21  
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Myocardial infarction after ChAdOx1 nCoV-19 in a young male p. 112
V V. S. S. Sagar, Anil Wanjari, Sunil Kumar, Sourya Acharya
DOI:10.4103/jets.jets_20_22  
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Transient hemiplegia due to axis osteomyelitis with epidural abscess p. 113
Youichi Yanagawa, Hiroki Nagasawa
DOI:10.4103/jets.jets_51_22  
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