Journal of Emergencies, Trauma, and Shock
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  Citation statistics : Table of Contents
   2010| January-March  | Volume 3 | Issue 1  
    Online since January 5, 2010

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A biomarker panel to discriminate between systemic inflammatory response syndrome and sepsis and sepsis severity
Chamindie Punyadeera, E Marion Schneider, Dave Schaffer, Hsin-Yun Hsu, Thomas O Joos, Fabian Kriebel, Manfred Weiss, Wim FJ Verhaegh
January-March 2010, 3(1):26-35
DOI:10.4103/0974-2700.58666  PMID:20165718
Introduction: In this study, we report on initial efforts to discover putative biomarkers for differential diagnosis of a systemic inflammatory response syndrome (SIRS) versus sepsis; and different stages of sepsis. In addition, we also investigated whether there are proteins that can discriminate between patients who survived sepsis from those who did not. Materials and Methods: Our study group consisted of 16 patients, of which 6 died and 10 survived. We daily measured 28 plasma proteins, for the whole stay of the patients in the ICU. Results: We observed that metalloproteinases and sE-selectin play a role in the distinction between SIRS and sepsis, and that IL-1α, IP-10, sTNF-R2 and sFas appear to be indicative for the progression from sepsis to septic shock. A combined measurement of MMP-3, -10, IL-1α, IP-10, sIL-2R, sFas, sTNF-R1, sRAGE, GM-CSF, IL-1β and Eotaxin allows for a good separation of patients that survived from those that died (mortality prediction with a sensitivity of 79% and specificity of 86%). Correlation analysis suggests a novel interaction between IL-1a and IP-10. Conclusion: The marker panel is ready to be verified in a validation study with or without therapeutic intervention
  31 7,038 215
Assessment of community healthcare providers ability and willingness to respond to emergencies resulting from bioterrorist attacks
Jeffery S Crane, James D McCluskey, Giffe T Johnson, Raymond D Harbison
January-March 2010, 3(1):13-20
DOI:10.4103/0974-2700.55808  PMID:20165716
Introduction: Previous findings have demonstrated that preparedness and planning within the public health system are inadequately developed to respond to an act of biological or chemical terrorism. Methods:This investigation used Internet-based surveys to assess the level of preparedness (PL) and willingness to respond (WTR) to a bioterrorism attack, and identify factors that predict PL and WTR among Florida community healthcare providers. Invitations were sent to 22,800 healthcare providers in Florida, which resulted in 2,279 respondents. Results: Respondents included physicians (n=604), nurses (n=1,152), and pharmacists (n=486). The results indicated that only 32% of Florida healthcare providers were competent and willing to respond to a bioterrorism attack, 82.7% of providers were willing to respond in their local community, and 53.6% within the State. Respondents were more competent in administrative skills than clinical knowledge (62.8% vs. 45%). Areas in which respondents had the highest competency were the initiation of treatment and recognition of their clinical and administrative roles. Areas in which respondents showed the lowest competency were the ability to identify cases and the ability to communicate risk to others. About 55% of the subjects had previous bioterrorism training and 31.5% had conducted emergency drills. Gender, race, previous training and drills, perceived threats of bioterrorism attack, perceived benefits of training and drills, and feeling prepared were all predictors of overall preparedness. Conclusions: The findings suggest that only one-third of Florida community healthcare providers were prepared for a bioterrorism attack, which is an insufficient response rate to effectively respond to a bioterrorism incident.
  11 6,323 76
Symptomatic Morgagni's hernia in an elderly patient
Santosh PV Rai, Madhav Kamath, Ashok Shetty, Suresh Shenoy, Ashvini Kumar
January-March 2010, 3(1):89-91
DOI:10.4103/0974-2700.58654  PMID:20165730
Hernia of Morgagni occurs through an anterior defect in the diaphragm. Symptoms of these hernias are attributable to the herniated viscera. In our case, there was partial obstruction due to herniation of the distal stomach and pylorus into the right hemithorax that was reduced surgically through a right thoracolapaorotomy. Of special emphasis are the various modalities used to diagnose this condition in our case.
  9 4,663 44
Isolated perforation of a duodenal diverticulum following blunt abdominal trauma
Matthew J Metcalfe, Tanwir G Rashid, Richard le R Bird
January-March 2010, 3(1):79-81
DOI:10.4103/0974-2700.58656  PMID:20165728
Only 10% of duodenal diverticula are symptomatic. We present the case of a man who fell from a height of 6 ft, landing on his abdomen and presenting 4 h later with severe back pain and a rigid abdomen. At laparotomy, a perforated retroperitoneal duodenal diverticulum was found and repaired with an omental patch. No other injury was noted. Not only is this perforation unusual, but the absence of other injuries sustained during this minor blunt trauma makes this case unique. This case highlights the need for a high index of suspicion when managing patients with back or abdominal pain following minor trauma.
  5 3,877 30
Analyzing sociodemographic factors amongst blood donors
Namgay Shenga, KR Thankappan, CC Kartha, Ranabir Pal
January-March 2010, 3(1):21-25
DOI:10.4103/0974-2700.58667  PMID:20165717
Introduction: Blood transfusion is a fundamental and requisite part of any National Health Service for optimum management of emergency conditions like severe trauma shock and resuscitation with the optimum stock of its different components. The objective of the present study was to analyze the factors of knowledge of prospective blood donors that may influence their perception and awareness about blood donation. Materials and Methods: This population-based cross-sectional study was conducted at Gangtok in the state of Sikkim, India, on 300 subjects of the adult population selected by two-stage cluster sampling. The main outcome variables were the socioeconomic and demographic variables of knowledge of blood donation. By interview technique, using the pre-tested structured close-ended questionnaire, the principal investigator collected the data. Results: In our study population, 46% of the study population was found to have a high knowledge score. The knowledge about blood donation was found to be statistically significant with the occupational status and the education levels, both in the bivariate and in the multivariate analyses. Knowledge about blood donation was not significantly related to age, sex, marital status, religion, community status and per capita monthly family income. Conclusion: The study suggested that the perceptions toward voluntary blood donation could be influenced to a large extent by sociodemographic variables of knowledge among the general population.
  5 5,728 64
Ultrasound-guided nerve blocks in the emergency department
Sanjeev Bhoi, Amit Chandra, Sagar Galwankar
January-March 2010, 3(1):82-88
DOI:10.4103/0974-2700.58655  PMID:20165729
Peripheral nerve blocks preclude the need for procedural sedation and provide adequate anesthesia during painful procedures. This technique can be performed in the emergency department with the aid of ultrasound imaging to identify target nerves. We describe eight cases of upper and lower extremity nerve blocks performed under ultrasound guidance in the emergency department of the Jai Prakash Narayan Trauma Centre, All India Institute of Medical Sciences, New Delhi. Only two of the patients, both with extensive injuries, required any additional anesthesia during the subsequent procedures and all of them reported significant pain control and muscle relaxation.
  4 6,478 81
Traumatic brain injury complicated by environmental hyperthermia
Erik Hermstad, Bruce Adams
January-March 2010, 3(1):66-69
DOI:10.4103/0974-2700.58660  PMID:20165724
Temperature variations after traumatic brain injury are common and devastating. This has been shown most clearly with hypothermia, but the complications associated with hyperthermia in the setting of traumatic brain injury can be just as problematic. We present the case of a soldier with traumatic brain injury exposed to environmental temperatures of 115-120° F with a core temperature of over 108° F. The complications of his conditions are discussed as well as potential treatments for the deadly combination of traumatic brain injury and environmental hyperthermia.
  4 4,319 59
Difficult airway management and the novice physician
Noble L Aikins, Rajpaul Ganesh, Kurt E Springmann, Jeffrey J Lunn, Joanne Solis-Keus
January-March 2010, 3(1):9-12
DOI:10.4103/0974-2700.58668  PMID:20165715
Background: Selection of the ideal airway device in patients with difficult airways (DA) or potentially difficult airways remains controversial, especially, for a novice anesthesia physician (NP) who must deviate from conventional direct laryngoscopy with a rigid laryngoscope following a failed intubation and employ one of the several alternative devices. The author determines and compares tracheal intubation success rates, times to success and complications of a novice physician using four alternative airway devices in 20 obese (BMI more than 27.5) patients who may be more difficult to intubate than normal weight patients. Materials and Methods: In this prospective randomized experimental study the author investigates a novice physician's use of the Bullard™, Fiberoptic™, Fastrach™and Trachlight™ comparing reliability, rapidity and safety of orotracheal intubations. Following induction of anesthesia the NP was allowed up to a maximum of two attempts per device at oral intubation. Mean intubation times plus/minus SD, per cent success rates and postoperative complications were evaluated for each device. Results: The Fastrach™ was successful 100% of the time on the first attempt requiring a mean time of 55 seconds plus/minus 6.6. All intubations were unsuccessful following two attempts with the Fiberoptic™. A success rate of 20% (one of five) was achieved with the Trachlight™ on first attempt after 95 seconds. The Bullard™ was successful in 40 % (two of five) of the patients after a mean time 60 seconds plus/minus five, but was the only device to result in mild oral discomfort one day post operatively. Conclusions: In the hands of a novice physician managing a difficult or potentially difficult airway, often encountered in obese patients, the Fastrach™ demonstrated the highest success rate.
  4 5,000 97
An obstetric emergency called peripartum cardiomyopathy!
Nissar Shaikh
January-March 2010, 3(1):39-42
DOI:10.4103/0974-2700.58664  PMID:20165720
Peripartum cardiomyopathy (PPCM) is a rare obstetric emergency affecting women in late pregnancy or up to five months of postpartum period. The etiology of PPCM is still not known. It has potentially devastating effects on mother and fetus if not treated early. The signs, symptoms and treatment of PPCM are similar to that of heart failure. Early diagnosis and proper management is the corner stone for better outcome of these patients. The only way to prevent PPCM is to avoid further pregnancies.
  4 5,866 96
Acute lung injury and acute respiratory distress syndrome
Maximillian Ragaller, Torsten Richter
January-March 2010, 3(1):43-51
DOI:10.4103/0974-2700.58663  PMID:20165721
Every year, more information accumulates about the possibility of treating patients with acute lung injury or acute respiratory distress syndrome with specially designed mechanical ventilation strategies. Ventilator modes, positive end-expiratory pressure settings, and recruitment maneuvers play a major role in these strategies. However, what can we take from these experimental and clinical data to the clinical practice? In this article, we discuss substantial options of mechanical ventilation together with some adjunctive therapeutic measures, such as prone positioning and inhalation of nitric oxide.
  4 6,952 194
Blunt rupture of the right hemidiaphragm with herniation of the right colon and right lobe of the liver
Anjana Bairagi, Saundrarajen R Moodley, Timothy C Hardcastle, David J Muckart
January-March 2010, 3(1):70-72
DOI:10.4103/0974-2700.58659  PMID:20165725
Acute right hemidiaphragm rupture with abdominal visceral herniation is reportedly less common than on the left. We present a complex case of blunt rupture of the right hemidiaphragm with herniation of the right colon and right lobe of the liver in a multiply injured patient. The diagnostic approach, with specific reference to the imaging studies, and surgical management is discussed, followed by a brief literature review highlighting the complexities of the case.
  3 4,215 46
Emergency neurological care of strokes and bleeds
Dale Birenbaum
January-March 2010, 3(1):52-61
DOI:10.4103/0974-2700.58662  PMID:20165722
Ischemic stroke and brain hemorrhage are common and challenging problems faced by emergency physicians. In this article, important details in the diagnosis and clinical management of these neurological emergencies are presented with the following goals: 1) To provide a more comprehensive understanding of the approach to the identification and management of patients who have sustained ischemic and hemorrhagic strokes; 2) to explain the importance and application of commonly used national stroke scoring and outcome scales; 3) to improve the ability to recognize important aspects in the approach and comprehensive treatment of ruptured and unruptured intracranial aneurysms; and 4) to demonstrate the difficulties in the neurological, neurosurgical, and endovascular treatment of these catastrophic diseases.
  3 4,752 66
A complicated true sliding hernia presenting as a spontaneous enteroscrotal fistula in an adult
Saravana Rajamanickam, Ashok Yadav, Anurag Rai, Devendra Singh, Abhinav Arun Sonkar
January-March 2010, 3(1):62-65
DOI:10.4103/0974-2700.58661  PMID:20165723
A 26-year-old man presented with an irreducible right inguino-scrotal swelling and fecal discharge from the scrotum. Exploratory laparotomy and inguinal exploration revealed that the caecum, appendix, and terminal ileum had herniated into the scrotum and had perforated through the skin forming a fecal fistula. The herniated gangrenous bowel was resected and a stoma fashioned. Spontaneous entero-scrotal fistulae are very rare and eight pediatric cases have been mentioned in literature till date. We report the first case of true sliding hernia presenting as spontaneous entero-scrotal fistula in an adult.
  2 5,062 34
Traumatic dural sinus thrombosis causing persistent headache in a child
Bhavana Lakhkar, Bhushan Lakhkar, Brij Raj Singh, Amit Agrawal
January-March 2010, 3(1):73-75
DOI:10.4103/0974-2700.58658  PMID:20165726
Dural venous sinus thrombosis following a mild head injury is increasingly recognized. We report case of a 9-year-old male child presented with progressive headache and vomiting following a minor fall. A diagnosis of sinus venous thrombosis was suspected on nonenhancing computed tomography, and that was confirmed with magnetic resonance venography. The child was managed with intravenous fluids, anticoagulation (injection heparin followed by oral anticoagulants-tab coumarin), antiedema measures (mannitol), and antiepileptics (phenytoin) with good outcome.
  2 4,685 41
Levosimendan use in the emergency management of decompensated peripartum cardiomyopathy
Alina Uriarte-Rodriguez, Luciano Santana-Cabrera, Manuel Sanchez-Palacios
January-March 2010, 3(1):94-94
DOI:10.4103/0974-2700.58651  PMID:20165732
  2 3,753 54
What's new in emergencies, trauma and shock? Coagulation is in the focus!
Max Ragaller
January-March 2010, 3(1):1-3
DOI:10.4103/0974-2700.58649  PMID:20165713
  1 4,945 95
Pyruvate dehydrogenase enzyme dipstick test in traumatic brain injury: A concern
Viroj Wiwanitkit
January-March 2010, 3(1):95-95
DOI:10.4103/0974-2700.58650  PMID:20165734
  1 2,470 31
A lucky catch: Fishhook injury of the tongue
Karen A Eley, Daljit K Dhariwal
January-March 2010, 3(1):92-93
DOI:10.4103/0974-2700.58653  PMID:20165731
Fishhook injuries, particularly those involving the upper limbs, are frequently encountered in recreational and commercial fishing settings. The oral cavity is rarely a site for such injury. We present the case of a 13-month-old male child who sustained a fishhook injury to the tongue whilst 'playing' with an unused fishhook at home. In this case there was minimal swelling, and the fishhook could be uneventfully removed under general anesthesia. Penetrating injuries to the tongue carry the risk of swelling and hematoma formation, which may result in airway compromise. These injuries therfore call for early intervention.
  1 3,342 37
Biomarkers in SIRS and sepsis: Quo vadis?
Alexander R Novotny
January-March 2010, 3(1):36-38
DOI:10.4103/0974-2700.58665  PMID:20165719
  - 5,008 108
Pancreatic transection due to blunt trauma
Amal Ankouz, Hicham Elbouhadouti, Jihane Lamrani, Khalid Ait Taleb, Abdelatif Louchi
January-March 2010, 3(1):76-78
DOI:10.4103/0974-2700.58657  PMID:20165727
Blunt fractures of the pancreas are rare and serious lesions. An isolated injury to the pancreas is uncommon. Physical signs and laboratory parameters are often inaccurate, and missing the diagnosis can cause serious clinical problems. We report a case of a 28-year-old woman with blunt pancreatic trauma in whom computed tomography revealed a fracture through the tail of the pancreas. It was complicated by pseudocyst formation. She was treated surgically with good outcome. This case is a reminder that pancreatic injuries should be considered in the differential diagnosis in cases of blunt abdominal trauma. Also, the clinician should be aware that when pancreatic injuries are managed conservatively, the clinical, radiological, and laboratory parameters need to be monitored till resolution.
  - 3,991 60
Author's reply
Pushpa Sharma, Brandi Benford, Zhao-Zhang Li
January-March 2010, 3(1):95-96
  - 2,078 22
Cricoid pressure - A misnomer in pediatric anaesthesia
Ahmed Syed Moied, Jyotishka Pal
January-March 2010, 3(1):96-97
DOI:10.4103/0974-2700.58647  PMID:20165735
  - 4,352 85
Coagulation studies in patients with orthopedic trauma
Kanchana Rangarajan, Arulselvi Subramanian, Jatin S Gandhi, Namit Saraf, Vijay Sharma, Kamran Farooque
January-March 2010, 3(1):4-8
DOI:10.4103/0974-2700.58652  PMID:20165714
Background : Head injury, severe acidosis, hypothermia, massive transfusion and hypoxia often complicate traumatic coagulopathy. First line investigations such as prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen level, platelet count and D-dimer levels help in the initial assessment of coagulopathy in a trauma victim. Aim : To study the coagulation profile in patients of orthopedic trauma. Settings and Design : Prospective study. Patients and Methods : Patients with head injury, severe acidosis, massive transfusion and severe hypoxia were excluded from the study. Coagulation parameters were evaluated at three intervals, at the time of admission, intra operatively and in the postoperative period. Statistical Analysis : Chi-square test was used for analysis of categorical variables. For comparison between groups, two- way ANOVA was used. Results and Conclusions : Of the 48 patients studied, 38 (80%) had normal DIC scores upon admission and only 10 (20%) had mild DIC scores at the time of admission. The median Injury Severity Score was 34 and they did not correlate with DIC scores. Fibrinogen levels alone were significantly different, increased progressively (mean pre op, intra op and post op levels 518 ± 31,582 ± 35 and 643 ± 27 respectively; P ≤ 0.02) since the time of admission in these patients. All the other parameters remained unchanged. Further large scale prospective studies would be required to correlate elevated fibrinogen levels with the type of trauma or surgery.
  - 4,420 68
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