Journal of Emergencies, Trauma, and Shock
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   2010| October-December  | Volume 3 | Issue 4  
    Online since September 28, 2010

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Acute gastric dilatation in a patient with anorexia nervosa binge/purge subtype
Ailis M Tweed-Kent, Peter J Fagenholz, Hasan B Alam
October-December 2010, 3(4):403-405
DOI:10.4103/0974-2700.70774  PMID:21063567
Acute gastric dilatation is a rare complication of anorexia nervosa binge/purge subtype that results from gastrointestinal abnormalities, including decreased gastric motility and delayed gastric emptying. Early diagnosis and intervention is critical since delay may result in gastric necrosis, perforation, shock, and death. We report a 26-year-old female with anorexia nervosa binge/purge subtype, who presented with abdominal pain and nausea after a binge episode. Abdominal radiography and computed tomography showed a grossly dilated stomach measuring 32 cm Χ 17.9 cm consistent with acute gastric dilatation. She underwent exploratory laparotomy with gastrotomy and gastric decompression, and recovered uneventfully. Initially, the patient denied the binge episode, as many patients with eating disorders do, but later revealed an extensive history of anorexia nervosa binge/purge subtype. This case stresses the importance of obtaining a thorough history of eating disorders and maintaining a high index of suspicion for acute gastric dilatation in young women who present with abdominal pain and distention.
  21,202 59 12
Simulation-based learning: Just like the real thing
Fatimah Lateef
October-December 2010, 3(4):348-352
DOI:10.4103/0974-2700.70743  PMID:21063557
Simulation is a technique for practice and learning that can be applied to many different disciplines and trainees. It is a technique (not a technology) to replace and amplify real experiences with guided ones, often "immersive" in nature, that evoke or replicate substantial aspects of the real world in a fully interactive fashion. Simulation-based learning can be the way to develop health professionals' knowledge, skills, and attitudes, whilst protecting patients from unnecessary risks. Simulation-based medical education can be a platform which provides a valuable tool in learning to mitigate ethical tensions and resolve practical dilemmas. Simulation-based training techniques, tools, and strategies can be applied in designing structured learning experiences, as well as be used as a measurement tool linked to targeted teamwork competencies and learning objectives. It has been widely applied in fields such aviation and the military. In medicine, simulation offers good scope for training of interdisciplinary medical teams. The realistic scenarios and equipment allows for retraining and practice till one can master the procedure or skill. An increasing number of health care institutions and medical schools are now turning to simulation-based learning. Teamwork training conducted in the simulated environment may offer an additive benefit to the traditional didactic instruction, enhance performance, and possibly also help reduce errors.
  20,911 246 128
Simulation-based team training at the sharp end: A qualitative study of simulation-based team training design, implementation, and evaluation in healthcare
Sallie J Weaver, Eduardo Salas, Rebecca Lyons, Elizabeth H Lazzara, Michael A Rosen, Deborah DiazGranados, Julia G Grim, Jeffery S Augenstein, David J Birnbach, Heidi King
October-December 2010, 3(4):369-377
DOI:10.4103/0974-2700.70754  PMID:21063560
This article provides a qualitative review of the published literature dealing with the design, implementation, and evaluation of simulation-based team training (SBTT) in healthcare with the purpose of providing synthesis of the present state of the science to guide practice and future research. A systematic literature review was conducted and produced 27 articles meeting the inclusion criteria. These articles were coded using a low-inference content analysis coding scheme designed to extract important information about the training program. Results are summarized in 10 themes describing important considerations for what occurs before, during, and after a training event. Both across disciplines and within Emergency Medicine (EM), SBTT has been shown to be an effective method for increasing teamwork skills. However, the literature to date has underspecified some of the fundamental features of the training programs, impeding the dissemination of lessons learned. Implications of this study are discussed for team training in EM.
  18,990 75 33
Acute scrotal bleeding
Sudip Kumar Ghosh, Debabrata Bandyopadhyay
October-December 2010, 3(4):416-417
DOI:10.4103/0974-2700.70778  PMID:21063571
We report a case of acute scrotal hemorrhage from multiple angiokeratomas on scrotum, because of the rarity of the condition and to emphasize the importance of considering this condition in the evaluation of acute scrotal bleeding.
  18,717 53 -
Tools for evaluating team performance in simulation-based training
Michael A Rosen, Sallie J Weaver, Elizabeth H Lazzara, Eduardo Salas, Teresa Wu, Salvatore Silvestri, Nicola Schiebel, Sandra Almeida, Heidi B King
October-December 2010, 3(4):353-359
DOI:10.4103/0974-2700.70746  PMID:21063558
Teamwork training constitutes one of the core approaches for moving healthcare systems toward increased levels of quality and safety, and simulation provides a powerful method of delivering this training, especially for face-paced and dynamic specialty areas such as Emergency Medicine. Team performance measurement and evaluation plays an integral role in ensuring that simulation-based training for teams (SBTT) is systematic and effective. However, this component of SBTT systems is overlooked frequently. This article addresses this gap by providing a review and practical introduction to the process of developing and implementing evaluation systems in SBTT. First, an overview of team performance evaluation is provided. Second, best practices for measuring team performance in simulation are reviewed. Third, some of the prominent measurement tools in the literature are summarized and discussed relative to the best practices. Subsequently, implications of the review are discussed for the practice of training teamwork in Emergency Medicine.
  13,020 111 17
Breaking bad news education for emergency medicine residents: A novel training module using simulation with the SPIKES protocol
Inchoel Park, Amit Gupta, Kaivon Mandani, Laura Haubner, Brad Peckler
October-December 2010, 3(4):385-388
DOI:10.4103/0974-2700.70760  PMID:21063562
Breaking bad news (BBN) in the emergency department (ED) is a common occurrence. This is especially true for an emergency physician (EP) as there is little time to prepare for the event and likely little or no knowledge of the patients or family background information. At our institution, there is no formal training for EP residents in delivering bad news. We felt teaching emergency medicine residents these communication skills should be an important part of their educational curriculum. We describe our experience with a defined educational program designed to educate and improve physician's confidence and competence in bad news and death notification. A regularly scheduled 5-h grand rounds conference time frame was dedicated to the education of EM residents about BBN. A multidisciplinary approach was taken to broaden the prospective of the participants. The course included lectures from different specialties, role playing for three short scenarios in different capacities, and hi-fidelity simulation cases with volatile psychosocial issues and stressors. Participants were asked to fill out a self-efficacy form and evaluation sheets. Fourteen emergency residents participated and all thought that this education is necessary. The mean score of usefulness is 4.73 on a Likert Scale from 1 to 5. The simulation part was thought to be the most useful (43%), with role play 14%, and lecture 7%. We believe that teaching physicians to BBN in a controlled environment is a good use of educational time and an important procedure that EP must learn.
  10,254 91 34
Retroperitoneal-necrotizing fasciitis due to chronic pyelonephritis
JE EL Ammari, M Ahssaini, MJ EL Fassi, MH Farih
October-December 2010, 3(4):419-420
DOI:10.4103/0974-2700.70763  PMID:21063573
  8,805 34 2
Perianal abscesses due to ingested foreign bodies
Mbarek Doublali, Ali Chouaib, Mohammed Jamal Elfassi, Mly Hassan Farih, Bachir Benjelloun, Younes Agouri, FZ Zahid, A Louchi
October-December 2010, 3(4):395-397
DOI:10.4103/0974-2700.70769  PMID:21063564
The clinical presentation of perianal abscesses due to foreign bodies (FBs) impacted in the anal canal mimics common causes of acute anal pain. The diagnosis can be established by digital rectal examination and/or proctoscopy, but may miss the presence of an FB. Incision and drainage of the abscess, along with removal of the FB, results in immediate pain relief and cure. Impacted FB must not be overlooked as an unusual cause of perianal abscess. One case of perianal abscesses due to FB impacted in the anal canal is reported.
  8,039 42 4
Pain management in the emergency department and its relationship to patient satisfaction
La Vonne A Downey, Leslie S Zun
October-December 2010, 3(4):326-330
DOI:10.4103/0974-2700.70749  PMID:21063553
Background : Pain is the most common reason due to which patients come to the emergency department (ED). Aim : The purpose of this study was to measure the correlation, if any, between pain reduction and the level of satisfaction in patients who presented to the ED with pain as their chief complaint. Materials and Methods : This study used a randomly selected group of patients who presented to the ED with pain of 4 or more on the Visual Analogue Pain Scale (VAS) as their chief complaint to a level one adult and pediatric trauma center. Instruments that were used in this study were the VAS, Brief Pain Inventory (BPI), and the Medical Interview Satisfaction Scale (MISS). They were administered to patients by research fellows in the treatment rooms. Statistical analysis included frequencies, descriptive, and linear regression. This study was approved by the Internal Review Board. Results : A total of 159 patients were enrolled in the study. All patients were given some type of treatment for their pain upon arrival to the ED. A logistic regression showed a significant relationship to reduction in pain by 40% or more and customer service questions. Conclusions : A reduction in perceived pain levels does directly relate to several indicators of customer service. Patients who experienced pain relief during their stay in the ED had significant increases in distress relief, rapport with their doctor, and intent to comply with given instructions.
  7,880 86 22
Comparison of severity of illness scoring systems in the prediction of hospital mortality in severe sepsis and septic shock
Colleen A Crowe, Erik B Kulstad, Chintan D Mistry, Christine E Kulstad
October-December 2010, 3(4):342-347
DOI:10.4103/0974-2700.70761  PMID:21063556
Background : New scoring systems, including the Rapid Emergency Medicine Score (REMS), the Mortality in Emergency Department Sepsis (MEDS) score, and the confusion, urea nitrogen, respiratory rate, blood pressure, 65 years and older (CURB-65) score, have been developed for emergency department (ED) use in various patient populations. Increasing use of early goal directed therapy (EGDT) for the emergent treatment of sepsis introduces a growing population of patients in which the accuracy of these scoring systems has not been widely examined. Objectives : To evaluate the ability of the REMS, MEDS score, and CURB-65 score to predict mortality in septic patients treated with modified EGDT. Materials and Methods : Secondary analysis of data from prospectively identified patients treated with modified EGDT in a large tertiary care suburban community hospital with over 85,000 ED visits annually and 700 inpatient beds, from May 2007 through May 2008. We included all patients with severe sepsis or septic shock, who were treated with our modified EGDT protocol. Our major outcome was in-hospital mortality. The performance of the scores was compared by area under the ROC curves (AUCs). Results : A total of 216 patients with severe sepsis or septic shock were treated with modified EGDT during the study period. Overall mortality was 32.9%. Calculated AUCs were 0.74 [95% confidence interval (CI): 0.67-0.81] for the MEDS score, 0.62 (95% CI: 0.54-0.69) for the REMS, and 0.59 (95% CI: 0.51-0.67) for the CURB-65 score. Conclusion : We found that all three ED-based systems for scoring severity of illness had low to moderate predictive capability. The MEDS score demonstrated the largest AUC of the studied scoring systems for the outcome of mortality, although the CIs on point estimates of the AUC of the REMS and CURB-65 scores all overlap.
  7,699 67 9
Human factors in resuscitation: Lessons learned from simulator studies
S Hunziker, F Tschan, NK Semmer, MD Howell, S Marsch
October-December 2010, 3(4):389-394
DOI:10.4103/0974-2700.70764  PMID:21063563
Medical algorithms, technical skills, and repeated training are the classical cornerstones for successful cardiopulmonary resuscitation (CPR). Increasing evidence suggests that human factors, including team interaction, communication, and leadership, also influence the performance of CPR. Guidelines, however, do not yet include these human factors, partly because of the difficulties of their measurement in real-life cardiac arrest. Recently, clinical studies of cardiac arrest scenarios with high-fidelity video-assisted simulations have provided opportunities to better delineate the influence of human factors on resuscitation team performance. This review focuses on evidence from simulator studies that focus on human factors and their influence on the performance of resuscitation teams. Similar to studies in real patients, simulated cardiac arrest scenarios revealed many unnecessary interruptions of CPR as well as significant delays in defibrillation. These studies also showed that human factors play a major role in these shortcomings and that the medical performance depends on the quality of leadership and team-structuring. Moreover, simulated video-taped medical emergencies revealed that a substantial part of information transfer during communication is erroneous. Understanding the impact of human factors on the performance of a complex medical intervention like resuscitation requires detailed, second-by-second, analysis of factors involving the patient, resuscitative equipment such as the defibrillator, and all team members. Thus, high-fidelity simulator studies provide an important research method in this challenging field.
  7,378 82 28
Simulation in resuscitation teaching and training, an evidence based practice review
Sandeep Sahu, Indu Lata
October-December 2010, 3(4):378-384
DOI:10.4103/0974-2700.70758  PMID:21063561
In the management of a patient in cardiac arrest, it is sometimes the least experienced provider giving chest compressions, intubating the patient, and running the code during the most crucial moment in that patient's life. Traditional methods of educating residents and medical students using lectures and bedside teaching are no longer sufficient. Today's generation of trainees grew up in a multimedia environment, learning on the electronic method of learning (online, internet) instead of reading books. It is unreasonable to expect the educational model developed 50 years ago to be able to adequately train the medical students and residents of today. One area that is difficult to teach is the diagnosis and management of the critically ill patient, specifically who require resuscitation for cardiac emergencies and cardiac arrest. Patient simulation has emerged as an educational tool that allows the learner to practice patient care, away from the bedside, in a controlled and safe environment, giving the learner the opportunity to practice the educational principles of deliberate practice and self-refection. We performed a qualitative literature review of the uses of simulators in resuscitation training with a focus on their current and potential applications in cardiac arrest and emergencies.
  7,302 69 20
Peritoneal free air due to evacuation of pneumobilia in blunt abdominal trauma
Isaac Howley, Shea C Gregg, Daithi S Heffernan, Charles A Adams
October-December 2010, 3(4):412-415
DOI:10.4103/0974-2700.70777  PMID:21063570
Pneumobilia is mostly observed on computed tomography (CT) following surgical biliary-enteric anastomosis and biliary manipulation through endoscopic procedures. Although pneumobilia can be seen in pathological conditions, post-surgical pneumobilia is typically not associated with morbidity. In the present article, we report a case in which blunt abdominal trauma led to the evacuation of pre-existing pneumobilia causing pneumoperitoneum. Given that the subsequent laparotomy proved to be non-therapeutic, this report adds to the few cases of intra-peritoneal free air not helped by surgical intervention.
  7,090 29 -
Prevalence and patterns of combat sport related maxillofacial injuries
Gholamreza Shirani, Mohammad Hosein Kalantar Motamedi, Alireza Ashuri, Pooyan Sadr Eshkevari
October-December 2010, 3(4):314-317
DOI:10.4103/0974-2700.70744  PMID:21063551
Aim: This study was designed to assess the prevalence, distribution, and patterns of injury among athletes engaged in combat sports and compare the prevalence, pattern, and types of oral and maxillofacial trauma in these athletes. Materials and Methods: A total of 120 male athletes engaged in four combat sports (boxing, taekwondo, kickboxing, and Muay Thai) who had sustained bodily trauma were studied; 95 subjects with at least one traumatic injury to the face requiring treatment were referred to us by the physician team. The type of injury (facial laceration, facial fractures, jaw dislocation, etc.), site of facial injury (jaw, nose, malar bone, teeth, etc.), dental injuries (tooth fracture, displacement, luxation, and avulsion), causative sport (boxing, taekwondo, kickboxing, and Muay Thai) as well as demographic data were recorded. Injuries were examined clinically and radiographically, and treated accordingly by a specialist. Treatment data and demographics were recorded for each subject. Recorded data were assessed, and c2 , ANOVA, and Kruskal-Wallis tests were used to statistically analyze and compare the data. Results: Of 120 subjects, 95 male subjects (79.2%), aged 18-25 years (avg. 20 years), had at least one traumatic injury to the face requiring medical treatment. These injuries included facial laceration, bone fractures (nose, mandible, and zygoma), dental injuries (displacement, luxation, fracture, and avulsion), and mandibular dislocation which were recorded in 83 (69.2%), 55 (45.1%), 53 (44.2%), and 8 (6.7%) cases respectively. Statistically significant differences were encountered among various injuries and the sports; kickboxing caused the most maxillofacial injuries and was identified as more injurious. Tooth fractures (59.7%) were the most common dental injuries, and the nose (84.7%) was the most frequently fractured facial bone. Lacerations were more common in Thai-boxers (93.3%). Injuries were significantly greater in professional rather than amateur athletes. Conclusion: In this study, prevalence of facial injuries from combat sports professionals was significantly high (roughly 80%), especially in kickboxing (in part due to use of less protective gear). Because the nose and teeth sustained the most injuries, they require more attention with regard to prevention. Kickboxing was the most injurious of these combat sports and caused the most significant number of maxillofacial trauma. More safety apparel and protective guards seem warranted in athletes of combat sports if facial injury is to be prevented.
  6,986 87 13
Tramadol toxicity-induced rhabdomyolysis
Fahmi Yousef Khan, Hind Yousef, Mehdi Errayes
October-December 2010, 3(4):421-422
DOI:10.4103/0974-2700.70766  PMID:21063575
  6,728 57 5
Analyzing intra-abdominal pressures and outcomes in patients undergoing emergency laparotomy
Shehtaj Khan, Akshay Kumar Verma, Syed Moied Ahmad, Reyaz Ahmad
October-December 2010, 3(4):318-325
DOI:10.4103/0974-2700.70747  PMID:21063552
Background : Studies have documented the impact of intra-abdominal hypertension (IAH) on virtually every organ. However, it still remains strangely underdiagnosed. The aims of the study were to assess, in patients undergoing emergency laparotomy, whether intra-abdominal pressure (IAP) is an independent predictor of morbidity and mortality, to evaluate the effects of IAH, and to identify hidden cases of abdominal compartment syndrome (ACS). Materials and Methods : The study comprised 197 patients undergoing emergency laparotomy. IAP was measured preoperatively and then postoperatively at 0, 6, and 24 hours. Duration of hospital stay, occurrence of burst abdomen, and mortality were noted as outcomes. Results : At admission, incidence of IAH was 80%. No significant association was found between IAP and occurrence of burst abdomen (P > 0.1). IAP was found to be a significant predictor of mortality in patients undergoing laparotomy (P < 0.001). Elevated IAP was found to affect all the organ systems adversely. The incidence of post-op ACS was 3.05% in the general population and 13.16% in trauma patients. The mortality rate for this subgroup was 100%. Conclusions : IAP is a significant predictor of mortality in patients undergoing laparotomy. IAH has detrimental effects on various organ systems. A more frequent monitoring with prompt decompression may be helpful in decreasing the mortality rate. Further studies are required to establish a screening protocol in patients undergoing laparotomy to detect and manage cases of IAH and ACS.
  6,580 54 8
Traumatic testicular dislocation: A reminder for the unwary
Pawan Vasudeva, Divakar Dalela, Dharamveer Singh, Apul Goel
October-December 2010, 3(4):418-419
DOI:10.4103/0974-2700.70762  PMID:21063572
  6,397 32 4
Simulation-based education for building clinical teams
Stuart D Marshall, Brendan Flanagan
October-December 2010, 3(4):360-368
DOI:10.4103/0974-2700.70750  PMID:21063559
Failure to work as an effective team is commonly cited as a cause of adverse events and errors in emergency medicine. Until recently, individual knowledge and skills in managing emergencies were taught, without reference to the additional skills required to work as part of a team. Team training courses are now becoming commonplace, however their strategies and modes of delivery are varied. Just as different delivery methods of traditional education can result in different levels of retention and transfer to the real world, the same is true in team training of the material in different ways in traditional forms of education may lead to different levels of retention and transfer to the real world, the same is true in team training. As team training becomes more widespread, the effectiveness of different modes of delivery including the role of simulation-based education needs to be clearly understood. This review examines the basis of team working in emergency medicine, and the components of an effective emergency medical team. Lessons from other domains with more experience in team training are discussed, as well as the variations from these settings that can be observed in medical contexts. Methods and strategies for team training are listed, and experiences in other health care settings as well as emergency medicine are assessed. Finally, best practice guidelines for the development of team training programs in emergency medicine are presented.
  5,545 64 14
Jejunogastric intussusception presenting as tumor bleed
Shiraz Ahmad Rather, Tanveer Iqbal Dar, Rauf A Wani, Asima Khan
October-December 2010, 3(4):406-408
DOI:10.4103/0974-2700.70775  PMID:21063568
Jejunogastric intussusception (JGI) is a rare but serious complication of previous gastrectomy or gastrojejunostomy, and a delayed diagnosis can lead to catastrophe. It can present as hematemesis, and an endoscopist aware of the condition can diagnose it early. We present a case of JGI presenting as hematemesis and diagnosed as tumor bleed on endoscopy. Diagnosis of JGI was confirmed on laparotomy, gangrenous efferent limb was resected and a fresh gastrojejunostomy performed.
  5,524 33 3
Coecal volvulus: An acute complication of pregnancy
Youssef Narjis, Khalid Rabbani, Sanaa Largab, Abderaouf Soumani, Benacer Finech, Abdelhamid El Idrissi Dafali
October-December 2010, 3(4):426-427
DOI:10.4103/0974-2700.70771  PMID:21063579
  4,981 28 2
Is intensive care the only answer for high risk pregnancies in developing nations?
Sukhwinder Kaur Bajwa, Sukhminder Jit Singh Bajwa, Jasbir Kaur, Kamaljit Singh, Jasleen Kaur
October-December 2010, 3(4):331-336
DOI:10.4103/0974-2700.70752  PMID:21063554
Background : Management of high risk obstetric patients. Aim : The present study was conducted to evaluate the primary causes of the admission of obstetric patients to Intensive Care Unit (ICU), the presence of co-morbid diseases, outcome of such patients, their survival rate as well as the factors which contribute to the maternal mortality. Settings and Design : A retrospective study was conducted in the Department of Obstetrics and Gynaecology and Anaesthesiology/ICU of our Institute. Materials and Methods : Sixty-one obstetric patients, who were admitted to ICU between 20 December 2006 and 31 January 2010, were evaluated for various factors responsible for their admission as well as their outcome. Statistical Analysis : At the end of study, the data were arranged systematically and subjected to statistical analysis using nonparametric tests and P value <0.05 was considered significant. Results : Majority of the 61 patients admitted in ICU were referred from the peripheral health centers, smaller nursing homes/hospitals and some even without proper primary care and mainly comprising uneducated and rural population. Hemorrhage, pregnancy induced hypertension, cardiac diseases, respiratory insufficiency and sepsis were the main causes for admission. A total of 18 patients among 61 died during their ICU stay in the hospital. Conclusions : In the developing countries, high risk pregnancy should be managed at peripheral centers with proper facilities, antenatal visits and timely referral. The intensive care help should be reserved for very high risk pregnancies with co-morbid diseases.
  4,920 86 3
Obstetric medical emergency teams are a step forward in maternal safety!
Hanan M.F Al Kadri
October-December 2010, 3(4):337-341
DOI:10.4103/0974-2700.70755  PMID:21063555
Background and Aim : The medical emergency team (MET) system was introduced successfully worldwide. With the exception of a few research publications, most of the described teams are based on patients' medical rather than obstetric management. The objective of this study was to review literature on the outcome of obstetric MET implementation. Materials and Methods : Systematic review has been done through searching MEDLINE, the Cochrane Library, relevant articles references, and contact with experts. The author and one other researcher independently selected literature on the establishment or implementation of obstetric MET. There were no restrictions on language, sample size, type of publication, or duration of follow up. Results : Three publications were identified: Catanzarite et al., Gosman et al., and Skupski et al. They were heterogeneous in terms of the method of implementation and the outcomes discussed. None of them discussed obstetric MET implementation in developing countries. Conclusion: In the literature, there is a lack of reporting and probably of implementation of Obstetrics METs. Therefore, there is a need for more standardized experiences and reports on the implementation of various types of Obstetrics METs. We propose here a design for Obstetrics METs to be implemented in developing countries, aiming to reduce maternal mortality and morbidity resulting from obstetric hemorrhage.
  4,716 36 5
A retropharyngeal-mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management
Torsten Birkholz, Stefanie Kröber, Christian Knorr, Albert Schiele, Klaus Bumm, Joachim Schmidt
October-December 2010, 3(4):409-411
DOI:10.4103/0974-2700.70776  PMID:21063569
A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal-mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal-mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation.
  4,497 33 1
Isolated, traumatic posterior dislocation of the radial head in an adult: A new case treated conservatively
Abdelhalim El Ibrahimi, Mohammed Shimi, Abdelkrim Daoudi, Abdelmajid Elmrini
October-December 2010, 3(4):422-424
DOI:10.4103/0974-2700.70767  PMID:21063576
  3,908 25 5
An unusual presentation of toothpick penetration of colon
Imtiaz Wani, Shamima A Wani, Shabir Mir, Khursheed Parra
October-December 2010, 3(4):401-402
DOI:10.4103/0974-2700.70773  PMID:21063566
This case report presents the delayed unusual presentation of plastic toothpick penetrating transverse colon 3 months after ingestion with localized peritonitis. Role of omentum "policeman of abdomen" for salvage is highlighted. Careful observation and long-term lookup for any neglected ingested foreign body are stressed. The delayed presentation can be sometimes proving as a surgical emergency.
  3,860 33 3
Traumatic urologic injuries in Ile-Ife, Nigeria
Abdulkadir Ayo Salako, Adewale Oluseye Adisa, Amogu K Eziyi, Oluseyi O Banjo, Tajudeen A Badmus
October-December 2010, 3(4):311-313
DOI:10.4103/0974-2700.70742  PMID:21063550
Background: In a developing country with limited healthcare resources, traumatic injuries and their management pose a significant challenge to healthcare delivery. Aim: To highlight the challenges in the management of traumatic urologic injuries in patients in our setting. Setting and Design: Patients presenting with traumatic injuries to the urinary tract, between January 1996 and December 2005, in a University Teaching Hospital in Southwestern Nigeria were the subjects of this study. Patients and Methods: Clinical records of patients who had such injuries were reviewed. Results: Ninety injuries occurred in 86 patients including 77 males and 9 females aged 14-68 years. Fourteen (15.5%) of the injuries involved the kidneys, urinary bladder was involved in 23 (25.6%) and the male urethra in 53 (58.9%) injuries. The mechanisms of injury were road traffic accidents in 52 (60.5%) patients, straddle injuries in 18 (20.9%), trauma to the back in 8 (9.3%), falls from a height in 6 (7.0%) and gunshot injuries in 2 (2.3%) patients. Associated injuries include pelvic fractures in 33 (38.4%) patients, limb bone fractures in 13 (14.1%), intestinal injuries in 12 (13.0%) and spinal injuries in 8 (8.7%) patients. In most patients, diagnosis was made based on clinical suspicion and minimal investigations such as abdominal ultrasound, urethrocystoscopy and/or urethrocystography. The outcome was good in most patients and mortality was recorded in only 2 (2.3%) patients who had concomitant spinal and burns injuries. Conclusion: Prompt management instituted on clinical suspicion of injuries presents a good outcome in patients in a limited resource setting.
  3,357 61 2
What's new in Emergencies Trauma and Shock? Still searching for a scoring system for sepsis!
Michael D Grossman
October-December 2010, 3(4):309-310
DOI:10.4103/0974-2700.70740  PMID:21063549
  3,025 78 -
Prognosis of patients with traumatic intractable intracranial hypertension based on the time at which craniectomy was performed
Luciano Santana-Cabrera, Alina Uriarte-Rodríguez, Lorea Ugalde-Jáuregui, Rosa Lorenzo-Torrent, Manuel Sánchez-Palacios
October-December 2010, 3(4):424-425
DOI:10.4103/0974-2700.70768  PMID:21063577
  2,838 26 -
Delayed perforation of the sigmoid colon following a major pelvic fracture
Luciano Santana-Cabrera, Fayna Rodríguez González, Manuel Sánchez Palacios
October-December 2010, 3(4):425-426
DOI:10.4103/0974-2700.70770  PMID:21063578
  2,645 31 -
Mass envenomation by honey bee-speed thrills
N Balamurgan, S Senthilkumaran, P Thirumalaikolundusubramanian
October-December 2010, 3(4):420-421
DOI:10.4103/0974-2700.70765  PMID:21063574
  2,339 27 1
Cardiogenic shock following blunt chest trauma
Fayna Rodríguez-González, Efrén Martínez-Quintana
October-December 2010, 3(4):398-400
DOI:10.4103/0974-2700.70772  PMID:21063565
Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent cause of cardiac contusions resulting from a direct blow to the chest. Other causes of blunt cardiac injury are numerous and include violent fall impacts, interpersonal aggression, explosions, and various types of high-risk sports. Myocardial contusion is difficult to diagnose; clinical presentation varies greatly, ranging from lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. We present a case of cardiac contusion due to blunt chest trauma secondary to a fall impact, which manifested as cardiogenic shock.
  2,326 7 -
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