Journal of Emergencies, Trauma, and Shock
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  Citation statistics : Table of Contents
   2014| January-March  | Volume 7 | Issue 1  
    Online since January 23, 2014

 
 
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CASE REPORTS
Coronary sinus and atrioventricular groove avulsion after motor vehicle crash
Bradley M Dennis, Leigh Anne Dageforde, Rashid M Ahmad, Matthew J Eckert
January-March 2014, 7(1):35-37
DOI:10.4103/0974-2700.125637  PMID:24550628
Simultaneous cardiac and pericardial rupture from blunt chest trauma is a highly lethal combination with rarely reported survival. We report of a case of young patient with a right atrioventricular groove injury, pericardial rupture and a unique description of a coronary sinus avulsion following blunt chest trauma. Rapid recognition of this injury is crucial to patient survival, but traditional diagnostic adjuncts such as ultrasound, echocardiography and computed tomography are often unhelpful. Successful repair of these injuries requires high suspicion of injury, early cardiac surgery involvement of and possible even placement of the patient on cardiopulmonary bypass.
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BRIEF REPORT
Clinical profile of bronchiolitis in infants younger than 90 days in Saudi Arabia
Syed Amir Ahmad, Quais Mujawar, Mohammed Al Othman, Hashim Bin Salleh, Mahmoud Abdelhadi Alsarfandi
January-March 2014, 7(1):49-52
DOI:10.4103/0974-2700.125641  PMID:24550632
Background: Bronchiolitis is a self-limiting disease of children caused by viral infections of the small airways with a wide spectrum of illness severity. Search of the literature reveals a need for refinement of criteria for testing for concomitant severe bacterial infections as well as appropriate therapeutic interventions for patients <90-day-old diagnosed with clinical bronchiolitis. We believe that a better understanding of the disease spectrum will help optimize health-care delivery to these patients. Aims: The aim of this study was to determine the clinical profile at presentation, disease course and outcome of bronchiolitis in <3-month-old infants who presented to our Pediatric Emergency Department (PED) during one disease season. Settings: Retrospective chart review during one bronchiolitis season, from November 1, 2011 to April 20, 2012. Subjects: All <90-day-old infants presenting with clinical bronchiolitis presenting to Urban PED of a tertiary care university hospital during one bronchiolitis season. Materials and Methods: A retrospective chart review based on computer records of all emergency department visits of infants less than 90 days with a clinical diagnosis of bronchiolitis, covering the period between November 1, 2011 and April 30, 2012. Results: Out of the total of 1895 infants <90 days of age, 141 had a clinical diagnosis of bronchiolitis and 35 needed admission to hospital. Blood for culture was obtained from 47 infants, urine for culture was obtained from 46 infants and cerebrospinal fluid for culture was obtained from eight infants. One case of bacteremia was documented, but this was found to be a contaminant. No cases of meningitis occurred among these infants. However, one infant had a positive urine culture consistent with infection (Escherichia coli ). Conclusion: Based on the results, it can be conclude that the risk of bacteremia or meningitis among infants <90 days of age with fever and bronchiolitis is low. The risk of urinary tract infection in this age group is also low, but it is higher than the risk for meningitis or bacteremia. Our data for admission and treatment guidelines are similar to those published from other countries.
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CASE REPORTS
Migrating bullet: A case of a bullet embolism to the pulmonary artery with secondary pulmonary infarction after gunshot wound to the left globe
Eugene Duke, Andrew A Peterson, William K Erly
January-March 2014, 7(1):38-40
DOI:10.4103/0974-2700.125638  PMID:24550629
Bullet embolism is a rare phenomenon following gunshot injuries. We present a case of a 25-year-old male who sustained a gunshot wound to his left globe with the bullet initially lodged in his right transverse sinus. The bullet ultimately embolized to a left lower lobe pulmonary artery resulting in a pulmonary infarct. A discussion of select prior cases, pathophysiology, and management strategies follows.
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A case of neck pain: The presentation of Chairi 1 malformations in children
John P Haran, Lina Pezzella
January-March 2014, 7(1):32-34
DOI:10.4103/0974-2700.125636  PMID:24550627
Chiari 1 malformations (CIM) in children can develop into a debilitating disease, however, they usually present with apparently benign symptoms, such as moderate headache and neck pain. Early identification and treatment of this condition can lead to an overall decrease in morbidity and mortality associated with this disease. We are reporting on a child that initially presented with neck pain and no neurological findings.
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CLINICAL CHALLENGES
Traumatic bilateral carotid and vertebral artery dissection
Issam Koleilat, Ravi Gandhi, Alan Boulos, Daniel Bonville
January-March 2014, 7(1):47-48
DOI:10.4103/0974-2700.125640  PMID:24550631
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CLINICAL INVESTIGATIONS
A comparison of rural versus urban trauma care
Ari M Lipsky, Larry L Karsteadt, Marianne Gausche-Hill, Sharon Hartmans, Frederick S Bongard, Henry Gill Cryer, Patricia B Ekhardt, Anthony J Loffredo, Patricia D Farmer, Susan C Whitney, Roger J Lewis
January-March 2014, 7(1):41-46
DOI:10.4103/0974-2700.125639  PMID:24550630
Objective: We compared the survival of trauma patients in urban versus rural settings after the implementation of a novel rural non-trauma center alternative care model called the Model Rural Trauma Project (MRTP). Materials and Methods: We conducted an observational cohort study of all trauma patients brought to eight rural northern California hospitals and two southern California urban trauma centers over a one-year period (1995-1996). Trauma patients with an injury severity score (ISS) of >10 were included in the study. We used logistic regression to assess disparities in odds of survival while controlling for Trauma and Injury Severity Score (TRISS) parameters. Results: A total of 1,122 trauma patients met criteria for this study, with 336 (30%) from the rural setting. The urban population was more seriously injured with a higher median ISS (17 urban and 14 rural) and a lower Glasgow Coma Scale (GCS) (GCS 14 urban and 15 rural). Patients in urban trauma centers were more likely to suffer penetrating trauma (25% urban versus 9% rural). After correcting for differences in patient population, the mortality associated with being treated in a rural hospital (OR 0.73; 95% CI 0.39 to 1.39) was not significantly different than an urban trauma center. Conclusion: This study demonstrates that rural and urban trauma patients are inherently different. The rural system utilized in this study, with low volume and high blunt trauma rates, can effectively care for its population of trauma patients with an enhanced, committed trauma system, which allows for expeditious movement of patients toward definitive care.
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EDITORIAL
What's new in emergencies, trauma and shock? Mechanical ventilation in trauma patients: A tight-rope walk!
Medha Mohta
January-March 2014, 7(1):1-2
DOI:10.4103/0974-2700.125630  PMID:24550621
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LETTERS TO EDITOR
Emergent free flow-through anterolateral thigh flaps for Gustilo-Anderson III fracture of the upper extremity
Masaki Fujioka, Kenji Hayashida, Chikako Murakami
January-March 2014, 7(1):53-55
DOI:10.4103/0974-2700.125642  PMID:24550633
  - 1,954 21
Novel emergency management of descending colon cancer presenting with retroperitoneal perforation
Jashodeep Datta, Julie A Caplow, Robert T Lewis, Benjamin M Braslow
January-March 2014, 7(1):55-56
DOI:10.4103/0974-2700.125643  PMID:24550634
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Analysis of patients with cardiopulmonary arrest after recreational scuba diving at Eastern Shizuoka in Japan
Teruhiro Inoue, Kazuhiko Omori, Hiromichi Ohsaka, Youichi Yanagawa
January-March 2014, 7(1):56-57
DOI:10.4103/0974-2700.125644  PMID:24550635
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Westermark's and Palla's signs in acute and chronic pulmonary embolism: Still valid in the current computed tomography era
Jorge A Brenes-Salazar
January-March 2014, 7(1):57-58
DOI:10.4103/0974-2700.125645  PMID:24550636
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Double trouble: Testicular dislocation associated with hip dislocation
Sanjay Meena, Nilesh Barwar, Buddhadev Chowdhury
January-March 2014, 7(1):58-59
DOI:10.4103/0974-2700.125646  PMID:24550637
  - 1,375 18
Surgical digestive emergencies in prisoners, about a prospective study
Youssef Narjis
January-March 2014, 7(1):59-61
DOI:10.4103/0974-2700.125647  PMID:24550638
  - 1,235 17
ORIGINAL ARTICLES
Status epilepticus: Our experience in a tertiary care centre in Northwestern India
Ashish Bhalla, Biplab Das, Rimi Som, Sandeep Prabhakar, Parampreet S Kharbanda
January-March 2014, 7(1):9-13
DOI:10.4103/0974-2700.125632  PMID:24550623
Introduction: Status epilepticus (SE) is a medical emergency. Aim of this study was to examine the etiology and outcome of adult patients in status epilepticus presenting to our center. Patients and Methods: A prospective study was conducted from January 2009 to December 2010. Newly diagnosed patients as well as known case of seizure disorder presenting with status epilepticus were included. Detailed history, clinical examination, baseline investigation, neuroimaging electroencephalogram findings were recorded. Patients were treated using a standard protocol and were followed-up for 2 weeks after discharge. Quantification of precipitating factors was done using proportion, mean and standard deviation. Results: 80 consecutive patients were studied. Mean age was 38.43 ± 16.56 years (range 13 to 78 years). Male to female ratio was 4:1. 57.5% were known cases of seizure disorders. Generalized tonic-clonic seizure was commonest presentation in 91.30%. Majority (97.5%) had convulsive SE. Poor drug compliance was found to be the commonest precipitant (50% patients), followed by central nervous system infection (20% patients. Alcohol intake contributed in 12.5% cases, whereas, precipitating factor couldn't be traced in 7.5% patients'. In 55% patients, SE was controlled with no recurrence or complication and in 25% there was recurrence after control of SE. 15% patients ended up with persistent sequel (cognitive and psychosomatic dysfunction, neurological deficit etc.) lasting for 2 weeks or more. The mortality was 5%. Conclusion: Poor compliance with drugs (in established cases of seizure disorders) and central nervous systems infections/structural lesions (in new onset cases) were commonest causes of SE in our study group. Conventional first line antiepileptics were able to control seizures in only 55% patients.
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Illinois trauma centers and community violence resources
Bennet Butler, Ogo Agubuzu, Luke Hansen, Marie Crandall
January-March 2014, 7(1):14-19
DOI:10.4103/0974-2700.125633  PMID:24550624
Background: Elder abuse and neglect (EAN), intimate partner violence (IPV), and street-based community violence (SBCV) are significant public health problems, which frequently lead to traumatic injury. Trauma centers can provide an effective setting for intervention and referral, potentially interrupting the cycle of violence. Aims: To assess existing institutional resources for the identification and treatment of violence victims among patients presenting with acute injury to statewide trauma centers. Settings and Design: We used a prospective, web-based survey of trauma medical directors at 62 Illinois trauma centers. Nonresponders were contacted via telephone to complete the survey. Materials and Methods: This survey was based on a survey conducted in 2004 assessing trauma centers and IPV resources. We modified this survey to collect data on IPV, EAN, and SBCV. Statistical Analysis: Univariate and bivariate statistics were performed using STATA statistical software. Results: We found that 100% of trauma centers now screen for IPV, an improvement from 2004 (P = 0.007). Screening for EAN (70%) and SBCV (61%) was less common (P < 0.001), and hospitals thought that resources for SBCV in particular were inadequate (P < 0.001) and fewer resources were available for these patients (P = 0.02). However, there was lack of uniformity of screening, tracking, and referral practices for victims of violence throughout the state. Conclusion: The multiplicity of strategies for tracking and referring victims of violence in Illinois makes it difficult to assess screening and tracking or form generalized policy recommendations. This presents an opportunity to improve care delivered to victims of violence by standardizing care and referral protocols.
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Free air on plain film: Do we need a computed tomography too?
Carolina V Solis, Yuchiao Chang, Marc A De Moya, George C Velmahos, Peter J Fagenholz
January-March 2014, 7(1):3-8
DOI:10.4103/0974-2700.125631  PMID:24550622
Context: Standard teaching is that patients with pneumoperitoneum on plain X-ray and clinical signs of abdominal pathology should undergo urgent surgery. It is unknown if abdominal computed tomography (CT) provides additional useful information in this scenario. Aims: The aim of this study is to determine whether or not CT scanning after identification of pneumoperitoneum on plain X-ray changes clinical management or outcomes. Settings and Design: Retrospective study carried out over 4 years at a tertiary care academic medical center. All patients in our acute care surgery database with pneumoperitoneum on plain X-ray were included. Patients who underwent subsequent CT scanning (CT group) were compared with patients who did not (non-CT group). Statistical Analysis Used: The Wilcoxon rank-sum test, t-test and Fisher's exact test were used as appropriate to compare the groups. Results: There were 25 patients in the non-CT group and 18 patients in the CT group. There were no differences between the groups at presentation. All patients in the non-CT group underwent surgery, compared with 83% (n = 15) of patients in the CT group (P = 0.066). 16 patients in the non-CT and 11 patients in the CT group presented with peritonitis and all underwent surgery regardless of group. For patients undergoing surgery, there were no differences in outcomes between the groups. After X-ray, patients undergoing CT required 328.0 min to arrive in the operating room compared with 136.0 min in the non-CT group (P = 0.007). Conclusions: In patients with pneumoperitoneum on X-ray and peritonitis on physical exam, CT delays surgery without providing any measurable benefit.
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REVIEW ARTICLES
Current concepts, which effect outcome following major hemorrhage
David W Shields, Timothy P Crowley
January-March 2014, 7(1):20-24
DOI:10.4103/0974-2700.125634  PMID:24550625
There are a multitude of factors, which effect outcome following major trauma. The recent conflict in the middle-east has advanced our knowledge and developed clinical practice, here within the UK. This article reviews the current and emerging concepts, which effect the outcome of patients sustaining major hemorrage in trauma.
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Ventilatory strategies in trauma patients
Shubhangi Arora, Preet Mohinder Singh, Anjan Trikha
January-March 2014, 7(1):25-31
DOI:10.4103/0974-2700.125635  PMID:24550626
Lung injury in trauma patients can occur because of direct injury to lung or due to secondary effects of injury elsewhere for example fat embolism from a long bone fracture, or due to response to a systemic insult such as; acute respiratory distress syndrome (ARDS) secondary to sepsis or transfusion related lung injury. There are certain special situations like head injury where the primary culprit is not the lung, but the brain and the ventilator strategy is aimed at preserving the brain tissue and the respiratory system takes a second place. The present article aims to delineate the strategies addressing practical problems and challenges faced by intensivists dealing with trauma patients with or without healthy lungs. The lung protective strategies along with newer trends in ventilation are discussed. Ventilatory management for specific organ system trauma are highlighted and their physiological base is presented.
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