Journal of Emergencies, Trauma, and Shock
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   2014| October-December  | Volume 7 | Issue 4  
    Online since October 13, 2014

 
 
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REVIEW ARTICLES
Capnography during cardiopulmonary resuscitation: Current evidence and future directions
Bhavani Shankar Kodali, Richard D Urman
October-December 2014, 7(4):332-340
DOI:10.4103/0974-2700.142778  PMID:25400399
Capnography continues to be an important tool in measuring expired carbon dioxide (CO 2 ). Most recent Advanced Cardiac Life Support (ACLS) guidelines now recommend using capnography to ascertain the effectiveness of chest compressions and duration of cardiopulmonary resuscitation (CPR). Based on an extensive review of available published literature, we selected all available peer-reviewed research investigations and case reports. Available evidence suggests that there is significant correlation between partial pressure of end-tidal CO 2 (PETCO 2 ) and cardiac output that can indicate the return of spontaneous circulation (ROSC). Additional evidence favoring the use of capnography during CPR includes definitive proof of correct placement of the endotracheal tube and possible prediction of patient survival following cardiac arrest, although the latter will require further investigations. There is emerging evidence that PETCO 2 values can guide the initiation of extracorporeal life support (ECLS) in refractory cardiac arrest (RCA). There is also increasing recognition of the value of capnography in intensive care settings in intubated patients. Future directions include determining the outcomes based on capnography waveforms PETCO 2 values and determining a reasonable duration of CPR. In the future, given increasing use of capnography during CPR large databases can be analyzed to predict outcomes.
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CASE SERIES
Severe esophageal injuries caused by accidental button battery ingestion in children
Sara Fuentes, Indalecio Cano, María Isabel Benavent, Andrés Gómez
October-December 2014, 7(4):316-321
DOI:10.4103/0974-2700.142773  PMID:25400396
Introduction: Button batteries represent a low percentage of all foreign bodies swallowed by children and esophageal location is even less frequent. However, these cases are more likely to develop severe injuries. The aim of this essay is to report three cases treated in our institution and review previous reports. Material and Methods: Chart review and literature search. Case Reports: We treated three children between 2-7- years old with button batteries lodged at esophagus. They all presented esophageal burns (EB), which evolved in esophageal stenosis in two out of the three cases. Results: We found 29 more cases in literature and the injuries included EB, esophageal perforation (EP) and tracheoesophageal fistula (TEF). Discussion: Swallowed button batteries rarely remain in esophagus, but these cases present a higher risk of tisular damage. Injuries can take place even after few hours; and therefore, endoscopy must be performed as soon as possible. Further study on button batteries' safety and the establishment of a maximum size for them would be good preventive measures.
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ORIGINAL ARTICLES
A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients after normal cervical spine CT
Iyore AO James, Ahmad Moukalled, Elizabeth Yu, David B Tulman, Sergio D Bergese, Christian D Jones, Stanislaw PA Stawicki, David C Evans
October-December 2014, 7(4):251-255
DOI:10.4103/0974-2700.142611  PMID:25400384
Clearance of cervical spine injury (CSI) in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT), magnetic resonance imaging of the cervical spine (CS-MRI) is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT) scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI) website (www.ncbi.nlm.nih.gov) for keywords: "cervical spine injury," "obtunded," and "MRI." The search was limited to studies published within the last 10 years and with populations of patients older than 18 years old. Eleven studies were included in the analysis yielding data on 1535 patients. CS-MRI detected abnormalities in 256 patients (16.6%). The abnormalities reported on CS-MRI resulted in prolonged rigid c-collar immobilization in 74 patients (4.9%). Eleven patients (0.7%) had unstable injury detected on CS-MRI alone that required surgical intervention. In the obtunded blunt trauma patient with unreliable clinical examination and a normal CT scan, there is still a role for CS-MRI in detecting clinically significant injuries when MRI resources are available. However, when a reliable clinical exam reveals intact gross motor function, CS-MRI may be unnecessary.
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Abdominal injury patterns in patients with seatbelt signs requiring laparotomy
Seema Biswas, Mohamed Adileh, Gidon Almogy, Miklosh Bala
October-December 2014, 7(4):295-300
DOI:10.4103/0974-2700.142764  PMID:25400391
Aims: We analyzed our series of patients with seatbelt signs (bruising) that underwent laparotomy in order to correlate injury pattern with clinical course and outcome. Materials and Methods: Retrospective analysis of patients with seatbelt signs presenting to the level 1 Trauma Unit between 2005 and 2010 was performed. We evaluated the nature of injuries during laparotomy associated with seatbelt signs and their treatment and complications. Results: There were 41 patients, 25 (61%) male, with a median age of 26 years. Median injury severity score (ISS) was 25 (range 6-66) and overall mortality was 10% (four patients). Patients were classified into three groups according to time from injury to surgery. Median time to surgery for the immediate group (n = 12) was 1.05 h, early group (n = 22) was 2.7 h, and delayed group (n = 7) was 19.5 h. Patients in the immediate group tended to have solid organ injuries; whereas, patients in the delayed group had bowel injury. Patients with solid organ injuries were found to be more seriously injured and had higher mortality (P < 0.01) and morbidity compared with patients with the "classic" bowel injury pattern associated with a typical seatbelt sign. Conclusion: Our data suggest that there is a cohort of patients with seatbelt injury who have solid organ injury requiring urgent intervention. Solid organ injuries associated with malpositioned seatbelts lying higher on the abdomen tend to result in hemodynamic instability necessitating immediate surgery. They have more postoperative complications and a greater mortality. Seatbelt signs should be accurately documented after any car crash.
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CASE SERIES
The intramedullary nailing using a single knee incision for treatment of extraarticular floating knee (nine cases)
Omar Dahmani, Amine Elrhazi, Mohamed Elidrissi, Mohamed Shimi, Abdelhalim Elibrahimi, Abdelmajid Elmrini
October-December 2014, 7(4):322-326
DOI:10.4103/0974-2700.142774  PMID:25400397
Context: Floating knee injuries are uncommon and complex injuries. Management of this injury has been variously described in the literature. Aims: We present the outcome of the intramedullary nailing using a single knee incision for treatment of extraarticular floating knee. Materials and Methods: We report a retrospective series of nine patients with extraarticular floating knee. Results: There were seven men and two women with an average age of 35 years. At least one of the fractures was open in three cases. The average Injury Severity Score was 17. According to Fraser's classification, 100% of the cases are type I. All our patients were treated by the intramedullary nailing using a single knee incision. The mean operating time was 146 min. The mean follow-up is 19 months. According to the Karlstrφm criteria, the end results were excellent in two cases, good in four, acceptable in two, and poor in one. Bone union was achieved in eight cases with an average period of 93 days. Conclusions: The intramedullary nailing using a single knee incision has shown in this series better results.
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REVIEW ARTICLES
PTSD in post-road traffic accident patients requiring hospitalization in Indian subcontinent: A review on magnitude of the problem and management guidelines
Chaitanya Undavalli, Piyush Das, Taru Dutt, Sanjeev Bhoi, Rahul Kashyap
October-December 2014, 7(4):327-331
DOI:10.4103/0974-2700.142775  PMID:25400398
Traumatic events after a road traffic accident (RTA) can be physical and/or psychological. Posttraumatic stress disorder (PTSD) is one of the major psychological conditions which affect accident victims. Psychological issues may not be addressed in the emergency department(ED) immediately. There have been reports about a mismatch between the timely referrals from ED to occupational or primary care services for these issues. If left untreated, there may be adverse effects on quality of life (QOL) and work productivity. Hospital expenses, loss of income, and loss of work could create a never ending cycle for financial difficulties and burden in trauma victims. The aim of our review is to address the magnitude of PTSD in post-RTA hospitalized patients in Indian subcontinent population. We also attempted to emphasis on few management guidelines. A comprehensive search was conducted on major databases with Medical Subject Headings (MeSH) term 'PTSD or post-traumatic stress' and Emergency department and vehicle or road or highway or automobile or car or truck or trauma and India. Out of 120 studies, a total of six studies met our inclusion criteria and were included in the review. Our interpretation of the problem is that; hospital expenditure due to trauma, time away from work during hospitalization, and reduction in work performance, are three major hits that can lead RTA victims to financial crisis. Proposed management guidelines are; establish a coordinated triage, implementing a screening tool in the ED, and provide psychological counseling.
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ORIGINAL ARTICLES
Outpatient follow-up after traumatic injury: Challenges and opportunities
Luke Hansen, Aisha Shaheen, Marie Crandall
October-December 2014, 7(4):256-260
DOI:10.4103/0974-2700.142612  PMID:25400385
Background: It has been shown that rates of ambulatory follow-up after traumatic injury are not optimal, but the association with insurance status has not been studied. Aims: To describe trauma patient characteristics associated with completed follow-up after hospitalization and to compare relative rates of healthcare utilization across payor types. Setting and Design: Single institution retrospective cohort study. Materials and Methods: We compared patient demographics and healthcare utilization behavior after discharge among trauma patients between April 1, 2005 and April 1, 2010. Our primary outcome of interest was outpatient provider contact within 2 months of discharge. Statistical Analysis: Multivariate logistic regression was used to determine the association between characteristics including insurance status and subsequent ambulatory and acute care. Results: We reviewed the records of 2906 sequential trauma patients. Patients with Medicaid and those without insurance were significantly less likely to complete scheduled outpatient follow-up within 2 months, compared to those with private insurance (Medicaid, OR 0.67, 95% CI 0.51-0.88; uninsured, OR 0.29, 95% CI 0.23-0.36). Uninsured and Medicaid patients were twice as likely as privately insured patients to visit the Emergency Department (ED) for any reason after discharge (uninsured patients (Medicaid, OR 2.6, 95% CI 1.50-4.53; uninsured, OR 2.10, 94% CI 1.31-3.36). Conclusion: We found marked differences between patients in scheduled outpatient follow-up and ED utilization after injury associated with insurance status; however, Medicaid seemed to obviate some of this disparity. Medicaid expansion may improve outpatient follow-up and affect patient outcome disparities after injury.
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CASE REPORTS
Successful use of N-acetyl cysteine and activated recombinant factor VII in fulminant hepatic failure and massive bleeding secondary to dengue hemorrhagic fever
Edirisooriya Maddumage Manoj, Gayan Ranasinghe, MK Ragunathan
October-December 2014, 7(4):313-315
DOI:10.4103/0974-2700.142771  PMID:25400395
Consensus on management of complicated cases of dengue infection is evolving. Dengue hemorrhagic fever (DHF) occasionally progress to fulminant liver failure with high fatality rate. Inadvertent use of blood products to control massive bleeding in dengue shock syndrome may worsen fluid overload and subsequently the multi-organ dysfunction. We report a case of 37-years-old Sri Lankan man who developed fulminant liver failure and massive bleeding associated with DHF, subsequently recovered completely with supportive measures including administration of N-acetyl cysteine and activated recombinant factor VII. In conclusion, prevention of ischemic injury to liver and adoption of early aggressive supportive measures in complicated cases of dengue hemorrhagic fever is crucial for a favorable outcome. Indications for rFVIIa to arrest uncontrolled internal bleeding and use of NAC in non-acetaminophen-induced acute liver failure in complicated DHF are a platform for discussion.
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ORIGINAL ARTICLES
Patterns and outcomes of medical admissions in the accident and emergency department of a tertiary health center in a rural community of Ekiti, Nigeria
Olarinde Jeffrey Ogunmola, Michael A Olamoyegun
October-December 2014, 7(4):261-267
DOI:10.4103/0974-2700.142744  PMID:25400386
Background: Low and middle-income countries like Nigeria face many challenges in emergency medical care owing to poor treatment facilities and inadequately trained personnel. Most Nigerians live in rural areas. The disease and death burdens in accident and emergency departments in this setting have not been closely studied. Aim: To determine the basic demographics, disease burden, and outcomes for accident and emergency admissions. Settings and Design: This retrospective study was carried out on patients admitted to an accident and emergency department. Materials and Methods: A retrospective review of medical admissions to the accident and emergency wards of the Federal Medical Centre, Ido-Ekiti, Ekiti State, southwest Nigeria, between January 2010 and December 2012. Statistical analysis used: The data were analyzed using SPSS Version 16 software. The results were presented in descriptive and tabular forms. Result: In all, 2922 patients were admitted during the study period (age range, 11-100 years; mean, 51.89 ± 20.11 years). There were 1679 (57.5%) males and 1243 (42.5%) females, with a ratio of 1.4:1. Young adults (aged 40 years and under) formed the highest age group (46.8%). The number of patients admitted for non-communicable diseases were high (1989 patients: 68.07%). Among non-communicable diseases, cardiovascular disorders were the most frequent (797; 27.28%). The most common cause of deaths was cardiovascular disease (33.5%). Conclusion: Young adults and males were the groups most commonly admitted. Non-communicable diseases were more frequent than communicable diseases. The proportion of patients discharged against medical advice and fatalities requires urgent attention.
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Does intrapleural length and position of the intercostal drain affect the frequency of residual hemothorax? A prospective study from north India
Sunil Kumar, Nitin Agarwal, Amulya Rattan, Vinita Rathi
October-December 2014, 7(4):274-279
DOI:10.4103/0974-2700.142761  PMID:25400388
Context: Thoracic trauma causes significant morbidity; however, many deaths are preventable and few patients require surgery. Intercostal chest drainage (ICD) for hemo/pneumothorax is simple and effective; the main problem is residual hemothorax, which can cause lung collapse and empyema. Aims: Our study aimed to analyze the relationship between radiological chest tube parameters (position and intrathoracic length) and the frequency of residual hemothorax. Settings and Design: This prospective analytical study was conducted in a large tertiary care hospital in north India over 2 years till March 2013. Materials and Methods: Patients of chest trauma aged 18-60 years, with hemothorax or hemopneumothorax requiring ICD insertion were included in the study. Bedside ICD insertion was performed as per current standards. Immediate post-ICD chest radiographs were used to record lung status and ICD position (chest tube zone and intrapleural length). Residual hemothorax was defined as any collection identified on radiological investigations after 48 hours of ICD placement. Statistical Analysis: Univariate analysis was performed with the chi-square test or Student's t-test as appropriate, while multivariate analysis using stepwise logistic regression; a P-value < 0.05 was significant. Results: Out of 170 patients of chest trauma, 154 underwent ICD insertion. Most patients were young (mean age: 31.7 ± 12 years) males (M:F = 14:1). Ninety-seven patients (57.1%) had isolated chest injuries. Blunt trauma (n = 119; 77.3%) and motor vehicle accidents (n = 72; 46.7%) were the commonest causes. Mean hospital stay was 9 ± 3.94 days, and mortality 2/154 (1.1%). Residual hemothorax was seen in 48 (31%). No ICD zone or length was significantly associated with residual hemothorax on univariate or multivariate analysis. Conclusion: Intrapleural ICD zone or length does not affect the frequency of residual hemothorax.
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Effectiveness of local anesthesia with lidocaine in chronic opium abusers
Amir Masoud Hashemian, Ali Omraninava, Ali Darvishpoor Kakhki, Mohammad Davood Sharifi, Koorosh Ahmadi, Babak Masoumi, Omid Mehrpour
October-December 2014, 7(4):301-304
DOI:10.4103/0974-2700.142765  PMID:25400392
Context: It had been demonstrated that chronic opium abusers have lower pain thresholds compared with than non-abusers. Aims: This study aimed to compare the required dose of lidocaine, a common local anesthetic drug, with regard to the onset of anesthesia in opium abusers with that in non-abusers undergoing similar suturing of minor hand lacerations. Materials and Methods: In this study, 109 opium abusers and 91 non-abusers underwent similar suturing for hand lacerations known as digital block. We explained the patients that their case records would remain confidential and admitting to any history of opioid abuse could assist in alleviating any pain associated with the procedure. Results: There was no statistically significant difference between the two groups with regard to age, gender, and cause of injury (P > 0.05). We found a significantly longer duration of onset of analgesia in nonopioid abusers (5.42 ± 1.93 min) than that in abusers (10.30 ± 1.79 min) (P < 0.001). In addition, the lidocaine dose administered to abusers (6.67 ± 1.21 ml) was higher (4.07 ± 1.26) as well as statistically significant (P < 0.001) than that in non-abusers. Conclusion: The findings from this study suggest a longer duration of onset of anesthesia and requirement of a higher lidocaine dose in opium abusers compared with nonopioid abuser. Moreover, chronic opium abusers (4-5 years) experienced significantly higher time of onset of anesthesia compared with nonchronic abusers. This outcome may be useful in selecting a more suitable local anesthetic protocol in such patients.
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Prevalence and consequences of positive blood alcohol levels among patients injured at work
Caitlin A Foster, Sharmila D Dissanaike
October-December 2014, 7(4):268-273
DOI:10.4103/0974-2700.142748  PMID:25400387
Aims: The aim of this study was to characterize positive blood alcohol among patients injured at work, and to compare the severity of injury and outcome of blood alcohol concentration (BAC) positive and negative patients. Settings and Design: A retrospective cohort study was performed at a Level 1 academic trauma center. Patients injured at work between 01/01/07 and 01/01/12 and admitted with positive (BAC+) vs negative (BAC-) blood alcohol were compared using bivariate analysis. Results: Out of 823, 319 subjects were tested for BAC (38.8%), of whom 37 were BAC+ (mean 0.151 g/dL, range 0.015-0.371 g/dL). Age (41 years), sex (97.2% men), race, intensive care unit (ICU) and hospital length of stay (LOS), and mortality were similar between groups. Nearly half of BAC+ cases were farming injuries (18, 48.6%): Eight involved livestock, five involved all-terrain vehicles (ATVs), three involved heavy equipment, one fell, and one had a firearm injury. Eight (21.6%) were construction site injuries involving falls from a roof or scaffolding, five (13.5%) were semi-truck collisions, four (10.8%) involved falls from a vehicle in various settings, and two (5.4%) were crush injuries at an oilfield. BAC+ subjects were less likely to be injured in construction sites and oilfields, including vehicle-related falls (2.3 vs 33.9%, P < 0.0001). Over half of BAC+ (n = 20, 54%) subjects were alcohol dependent; three (8.1%) also tested positive for cocaine on admission. No BAC+ subjects were admitted to rehabilitation compared to 33 (11.7%) of BAC- subjects. Workers' compensation covered a significantly smaller proportion of BAC+ patients (16.2 vs 61.0%, P < 0.0001). Conclusions: Alcohol use in the workplace is more prevalent than commonly suspected, especially in farming and other less regulated industries. BAC+ is associated with less insurance coverage, which probably affects resources available for post-discharge rehabilitation and hospital reimbursement.
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Pre-injury beta blocker use does not affect the hyperdynamic response in older trauma patients
David C Evans, Kendrick M Khoo, Andrei Radulescu, Charles H Cook, Anthony T Gerlach, Thomas J Papadimos, Steven M Steinberg, Stanislaw PA Stawicki, Daniel S Eiferman
October-December 2014, 7(4):305-309
DOI:10.4103/0974-2700.142766  PMID:25400393
Purpose: Trauma dogma dictates that the physiologic response to injury is blunted by beta-blockers and other cardiac medications. We sought to determine how the pre-injury cardiac medication profile influences admission physiology and post-injury outcomes. Materials and Methods: Trauma patients older than 45 evaluated at our center were retrospectively studied. Pre-injury medication profiles were evaluated for angiotensin-converting enzyme inhibitors / angiotensin receptor blockers (ACE-I/ARB), beta-blockers, calcium channel blockers, amiodarone, or a combination of the above mentioned agents. Multivariable logistic regression or linear regression analyses were used to identify relationships between pre-injury medications, vital signs on presentation, post-injury complications, length of hospital stay, and mortality. Results: Records of 645 patients were reviewed (mean age 62.9 years, Injury Severity Score >10, 23%). Our analysis demonstrated no effect on systolic and diastolic blood pressures from beta-blocker, ACE-I/ARB, calcium channel blocker, and amiodarone use. The triple therapy (combined beta-blocker, calcium channel blocker, and ACE-I/ARB) patient group had significantly lower heart rate than the no cardiac medication group. No other groups were statistically different for heart rate, systolic, and diastolic blood pressure. Conclusions: Pre-injury use of cardiac medication lowered heart rate in the triple-agent group (beta-blocker, calcium channel blocker, and ACEi/ARB) when compared the no cardiac medication group. While most combinations of cardiac medications do not blunt the hyperdynamic response in trauma cases, patients on combined beta-blocker, calcium channel blocker, and ACE-I/ARB therapy had higher mortality and more in-hospital complications despite only mild attenuation of the hyperdynamic response.
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Carbon monoxide poisoning in Beirut, Lebanon: Patient's characteristics and exposure sources
Mazen J El Sayed, Hani Tamim
October-December 2014, 7(4):280-284
DOI:10.4103/0974-2700.142762  PMID:25400389
Background: Carbon monoxide (CO) poisoning is a preventable disease. Patients present with nonspecific symptoms post CO exposure. Causal factors are well described in developed countries, but less in developing countries. Objectives: This study examined the characteristics of patients with CO poisoning treated at a tertiary care center in Beirut, Lebanon, and their association with the CO poisoning source. Materials and Methods: A retrospective chart review of all patients who presented to the Emergency Department (ED) of the American University of Beirut Medical Center (AUBMC) over 4-year period and for whom a carboxyhemoglobin (CO-Hb) level was available. Patients with CO poisoning diagnosis were included in the study. Patients' characteristics and their association with CO poisoning source were described. Results: Twenty-seven patients were treated for CO poisoning during the study period, 55% of whom were males. Headache was the most common presenting symptom (51.9%). Burning charcoal indoors was the most common causal factor (44.4%), whereas fire-related smoke was another causal factor. The median arterial CO-Hb level on presentation for all cases was 12.0% (interquartile range (IQR) 7.3-20.2). All patients received normobaric oxygen therapy. No complications were documented in the ED. All patients were discharged from the ED with a median ED length of stay of 255 min (IQR 210-270). Young females were more likely to present with CO poisoning from burning charcoal indoors than from another cause. Conclusion: CO poisoning in Beirut, Lebanon is mainly due to charcoal burning grills used indoors and to fire-related smoke. A clinically significant association was present between gender and CO poisoning source. An opportunity for prevention is present in terms of education and increased awareness regarding CO emission sources.
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EDITORIAL
What's new in emergencies trauma and shock? Outpatient follow-up after traumatic injury: Challenges and opportunities
Anthony O Asemota, Eric B Schneider
October-December 2014, 7(4):249-250
DOI:10.4103/0974-2700.142610  PMID:25400383
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ORIGINAL ARTICLES
Risky locations for out-of-hospital cardiopulmonary arrest in a typical urban city
Yoshihiro Moriwaki, Yoshio Tahara, Masayuki Iwashita, Takayuki Kosuge, Noriyuki Suzuki
October-December 2014, 7(4):285-294
DOI:10.4103/0974-2700.142763  PMID:25400390
Background: The aim of this study is to clarify the circumstances including the locations where critical events resulting in out-of-hospital cardiopulmonary arrest (OHCPA) occur. Materials and Methods: Subjects of this population-based observational case series study were the clinical records of patients with nontraumatic and nonneck-hanging OHCPA. Results: Of all 1546 cases, 10.3% occurred in a public place (shop, restaurant, workplace, stations, public house, sports venue, and bus), 8.3% on the street, 73.4% in a private location (victim's home, the homes of the victims' relatives or friends or cheap bedrooms, where poor homeless people live), and 4.1% in residential institutions. In OHCPA occurring in private locations, the frequency of asystole was higher and the outcome was poorer than in other locations. A total of 181 OHCPA cases (11.7%) took place in the lavatory and 166 (10.7%) in the bathroom; of these, only 7 (3.9% of OHCPA in the lavatory) and none in the bath room achieved good outcomes. The frequencies of shockable initial rhythm occurring in the lavatory and in bath room were 3.7% and 1.1% (lower than in other locations, P = 0.011 and 0.002), and cardiac etiology in OHCPA occurring in these locations were 46.7% and 78.4% (the latter higher than in other locations, P < 0.001). Conclusions: An unignorable population suffered from OHCPA in private locations, particularly in the lavatory and bathroom; their initial rhythm was usually asystole and their outcomes were poor, despite the high frequency of cardiac etiology in the bathroom. We should try to treat OHCPA victims and to prevent occurrence of OHCPA in these risky spaces by considering their specific conditions.
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CASE REPORTS
Unexpected traumatic rupture of left atrium mimicking aortic rupture
Abdallah K Alameddine, Victor K Alimov, Carlos Alvarez, John A Rousou
October-December 2014, 7(4):310-312
DOI:10.4103/0974-2700.142767  PMID:25400394
Left atrial (LA) rupture is rare following blunt chest injury. We describe a case of blunt LA rupture that was treated surgically. This report is intended to alert practitioners for a need of a close multiple disciplinary collaborations among them for optimal management of patients with this type of trauma; because other non-cardiac injuries involving the head, abdomen, or extremities are considered covariates for in-hospital mortality. As in the present case, the patient eventually died from associated extrathoracic injuries. The diagnosis of LA rupture is by exclusion. However, the initial radiological reading may be misinterpreted, because this injury can easily be mistaking for an aortic rupture. The final reappraisal of the chest imaging studies should be interpreted by a skilled radiologist to avoid misdiagnosis. Subtle radiological features can help distinguish aortic thoracic injury as illustrated in this patient. These factors may be useful to the practicing surgeon in deciding surgical approach.
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LETTERS TO EDITOR
Ultrasound witnessed cardiac arrest in the ICU
Eric J Adkins, David P Bahner
October-December 2014, 7(4):341-342
DOI:10.4103/0974-2700.142782  PMID:25400401
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Analysis of trauma cases after a record snowfall in a rural district in Japan
Hiromichi Ohsaka, Kazuhiko Omori, Mariko Obinata, Kouhei Ishikawa, Yasumasa Oode, Youichi Yanagawa
October-December 2014, 7(4):341-341
DOI:10.4103/0974-2700.142780  PMID:25400400
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