Journal of Emergencies, Trauma, and Shock
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  Citation statistics : Table of Contents
   2012| January-March  | Volume 5 | Issue 1  
    Online since February 22, 2012

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The role of bedside ultrasound in the diagnosis of pericardial effusion and cardiac tamponade
Adam Goodman, Phillips Perera, Thomas Mailhot, Diku Mandavia
January-March 2012, 5(1):72-75
DOI:10.4103/0974-2700.93118  PMID:22416160
This review article discusses two clinical cases of patients presenting to the emergency department with pericardial effusions. The role of bedside ultrasound in the detection of pericardial effusions is investigated, with special attention to the specific ultrasound features of cardiac tamponade. Through this review, clinicians caring for patients with pericardial effusions will learn to rapidly diagnose this condition directly at the bedside. Clinicians will also learn to differentiate between simple pericardial effusions in contrast to more complicated effusions causing cardiac tamponade. Indications for emergency pericardiocentesis are covered, so that clinicians can rapidly determine which group of patients will benefit from an emergency procedure to drain the effusion.
  10 24,024 37
Teamwork in the trauma room evaluation of a multimodal team training program
Bradley Peckler, Matthew S Prewett, Tabitha Campbell, Michael Brannick
January-March 2012, 5(1):23-27
DOI:10.4103/0974-2700.93106  PMID:22416150
Introduction: Poor teamwork leads to preventable medical errors, and thus negatively impacts medical care. One way to improve teamwork is training. A multimodality team training program was designed to impact the attitudes and behavior of first-year residents who will encounter medical situations in the trauma room. The training program included low-fidelity role plays, lectures, and high-fidelity simulation with feedback. Materials and Methods: The training program was a one-day workshop that was conducted twice, once for each of the two groups over two days at the beginning of the academic year in July. A total of 41 first-year interns (10 Emergency Medicine and 31 Surgery) were recruited for participation. Participants completed a Situational judgment test (SJT) on trauma teamwork before training. The training began with a low-fidelity simulation that served as an icebreaker to team concepts. Subsequently, a lecture with discussion provided key points regarding teamwork in the trauma room. A high-fidelity simulation then allowed participation in one of four trauma room scenarios with medical expert debriefing. The course concluded with a course summary and an assessment of participant attitudes regarding training along with a second administration of SJT. Results: Participant reactions to the training were positive overall. Results of SJT showed a positive effect for team training in three of the four possible comparisons. Conclusion: The program was well received by the residents. Results suggest that a comprehensive training approach using role play, lecture, and simulation can positively affect behavioral choices for teamwork in the trauma room.
  6 3,752 21
Feasibility and safety of ultrasound-guided nerve block for management of limb injuries by emergency care physicians
Sanjeev Bhoi, Tej P Sinha, Mahaveer Rodha, Amit Bhasin, Radhakrishna Ramchandani, Sagar Galwankar
January-March 2012, 5(1):28-32
DOI:10.4103/0974-2700.93107  PMID:22416151
Background: Patients require procedural sedation and analgesia (PSA) for the treatment of acute traumatic injuries. PSA has complications. Ultrasound (US) guided peripheral nerve block is a safe alternative. Aim: Ultrasound guided nerve blocks for management of traumatic limb emergencies in Emergency Department (ED). Setting and Design: Prospective observational study conducted in ED. Materials and Methods: Patients above five years requiring analgesia for management of limb emergencies were recruited. Emergency Physicians trained in US guided nerve blocks performed the procedure. Statistical analysis: Effectiveness of pain control, using visual analogue scale was assessed at baseline and at 15 and 60 minutes after the procedure. Paired t test was used for comparison. Results: Fifty US guided nerve blocks were sciatic- 4 (8%), femoral-7 (14%), brachial- 29 (58%), median -6 (12%), and radial 2 (4%) nerves. No patients required rescue PSA. Initial median VAS score was 9 (Inter Quartile Range [IQR] 7-10) and at 1 hour was 2(IQR 0-4). Median reduction in VAS score was 7.44 (IQR 8-10(75%), 1-2(25%) (P=0.0001). Median procedure time was 9 minutes (IQR 3, 12 minutes) and median time to reduction of pain was 5 minutes (IQR 1,15 minutes). No immediate or late complications noticed at 3 months. Conclusion: Ultrasound-guided nerve blocks can be safely and effectively performed for upper and lower limb emergencies by emergency physicians with adequate training.
  5 4,286 41
Strategies for coping with stress in emergency medicine: Early education is vital
Gillian R Schmitz, Mark Clark, Sheryl Heron, Tracy Sanson, Gloria Kuhn, Christina Bourne, Todd Guth, Mitch Cordover, Justin Coomes
January-March 2012, 5(1):64-69
DOI:10.4103/0974-2700.93117  PMID:22416158
Introduction: Physician burnout has received considerable attention in the literature and impacts a large number of emergency medicine physicians, but there is no standardized curriculum for wellness in resident education. A culture change is needed to educate about wellness, adopt a preventative and proactive approach, and focus on resiliency. Discussion: We describe a novel approach to wellness education by focusing on resiliency rather than the unintended endpoint of physician burnout. One barrier to adoption of wellness education has been establishing legitimacy among emergency medicine (EM) residents and educators. We discuss a change in the language of wellness education and provide several specific topics to facilitate the incorporation of these topics in resident education. Conclusion: Wellness education and a culture of training that promotes well-being will benefit EM residents. Demonstrating the impact of several factors that positively affect emergency physicians may help to facilitate alert residents to the importance of practicing activities that will result in wellness. A change in culture and focus on resiliency is needed to adequately address and optimize physician self-care.
  5 6,900 23
Venous thromboembolic events in isolated severe traumatic brain injury
Shahin Mohseni, Peep Talving, Lydia Lam, Linda S Chan, Crystal Ives, Demetrios Demetriades
January-March 2012, 5(1):11-15
DOI:10.4103/0974-2700.93102  PMID:22416148
Objective: The purpose of this study was to investigate the effect of prophylactic anticoagulation on the incidence of venous thromboembolic events (VTE) in patients suffering from isolated severe traumatic brain injury (TBI). Materials and Methods: Retrospective matched case-control study in adult patients sustaining isolated severe TBI (head AIS ≥3, with extracranial AIS ≤2) receiving VTE prophylaxis while in the surgical intensive care unit from 1/2007 through 12/2009. Patients subjected to VTE prophylaxis were matched 1:1 by age, gender, glasgow coma scale (GCS) score at admission, presence of hypotension on admission, injury severity score, and head abbreviated injury scale (AIS) score, with patients who did not receive chemical VTE prophylaxis. The primary outcome measure was VTE. Secondary outcomes were SICU and hospital length of stay (HLOS), adverse effects of anticoagulation, and mortality. Results: After propensity matching, 37 matched pairs were analysed. Cases and controls had similar demographics, injury characteristics, rate of craniotomies/craniectomies, SICU LOS, and HLOS. The median time of commencement of VTE prophylaxis was 10 days. The incidence of VTE was increased 3.5-fold in the controls compared to the cases (95% CI 1.0-12.1, P=0.002). The mortality was higher in patients who did not receive anticoagulation (19% vs. 5%, P=0.001). No adverse outcomes were detected in the anticoagulated patients. Conclusion: Prophylactic anticoagulation decreases the overall risk for clinically significant VTE in patients with severe isolated TBI. Prospective validation of the timing and safety of chemical VTE prophylaxis in these instances is warranted.
  4 4,047 21
Sonographic diagnosis of pneumothorax
Lubna F Husain, Laura Hagopian, Derek Wayman, William E Baker, Kristin A Carmody
January-March 2012, 5(1):76-81
DOI:10.4103/0974-2700.93116  PMID:22416161
Lung sonography has rapidly emerged as a reliable technique in the evaluation of various thoracic diseases. One important, well-established application is the diagnosis of a pneumothorax. Prompt and accurate diagnosis of a pneumothorax in the management of a critical patient can prevent the progression into a life-threatening situation. Sonographic signs, including 'lung sliding', 'B-lines' or 'comet tail artifacts', 'A-lines', and 'the lung point sign' can help in the diagnosis of a pneumothorax. Ultrasound has a higher sensitivity than the traditional upright anteroposterior chest radiography (CXR) for the detection of a pneumothorax. Small occult pneumothoraces may be missed on CXR during a busy trauma scenario, and CXR may not always be feasible in critically ill patients. Computed tomography, the gold standard for the detection of pneumothorax, requires patients to be transported out of the clinical area, compromising their hemodynamic stability and delaying the diagnosis. As ultrasound machines have become more portable and easier to use, lung sonography now allows a rapid evaluation of an unstable patient, at the bedside. These advantages combined with the low cost and ease of use, have allowed thoracic sonography to become a useful modality in many clinical settings.
  4 10,353 36
Ketotic hyperglycemia with movement disorder
Disha Awasthi, Akhilesh Kumar Tiwari, Abhinav Upadhyaya, Balwinder Singh, Gaurav Singh Tomar
January-March 2012, 5(1):90-91
DOI:10.4103/0974-2700.93095  PMID:22416165
Chorea, hemichorea-hemiballismus and severe partial seizures may be the presenting features of nonketotic hyperglycemia in older adults with type 2 diabetes, but cases in young adults with type 1 diabetes are rare. We hereby report a very rare case of diabetic ketosis with movement disorder in a young patient.
  3 3,230 19
Different causes of referral to ophthalmology emergency room
Alireza Keshtkar Jafari, Shima Bozorgui, Nooshin Shahverdi, Ahmad Ameri, Mohammad Reza Akbari, Hojat Salmasian
January-March 2012, 5(1):16-22
DOI:10.4103/0974-2700.93104  PMID:22416149
Background: Eye-related complaints compose approximately 1-6% of complaints of patients referring to general emergency ward around the world. Eye injuries are the most common cause of referral to eye emergency ward. To understand the impact of eye injuries in Iran and to plan preventive strategies, it is important to understand the complete magnitude of the problem with regard to true population-based data and standard reproducible definitions. Aim: The main goal of this study was to identify the major causes of referrals to eye emergency ward in patients with eye-related complaints in an eye referral Hospital in Iran. Settings and Design: In a cross-sectional study, 3150 patients who referred to Farabi Hospital emergency ward, Tehran, Iran, from January to December 2007 were included in the study and their detailed information were recorded. Materials and Methods: The patients' demographic data, medical history and final diagnosis were recorded in a questionnaire. Results: The mean age of patients was 33.2±16.8 years and 2380 patients (75.6%) were males. While 299 patients (9.5%) were referred for non-urgent reasons, work-related injuries were the most common cause of referral (955 patients; 30.3%). In patients referred due to trauma (1950 patients), work-related injuries occurred in 955 patients (49%) and occurred accidentally (by chance) in 819 patients (42%). The majority of patients referred with traumatic injuries were males (1708 patients; 87.6% versus 242 patients; 12.4%). The most common etiologies of eye trauma (1950 patients) were metal filings (814 patients; 41.8%), blunt trauma (338 patients; 17.3%), fireworks (236 patients; 12.1%) and sharp objects (222 patients; 11.4%). Globe injury was diagnosed in 1865 patients (95.7%) of trauma cases. In patients referred due to non-traumatic reason (1200 patients), eye infection occurred in 482 patients (40.2%) and 299 patients (24.9%) were referred for non-urgent reasons. There was little difference between the frequency of non-trauma-related problems among genders (672 male patients; 56% versus 528 female patients; 44%). Conclusions: This study identified multiple risk factors whose presence significantly increases severity of an eye injury. Male gender, youth and unprotected eyes during high-risk activities such as sports and certain jobs are risk factors for eye injuries. In patients referred due to non-traumatic reasons, males and females are similar. Considerable proportion of non-trauma-related problems was due to eye infection, that one of the most important reasons may be connected to the increasing use of contact lenses in our target population. Thereupon, we need for further educative and preventive interventions at the level of general population.
  3 3,959 16
Point-of-care ultrasound in critically ill patients: Where do we stand?
Fikri M Abu-Zidan
January-March 2012, 5(1):70-71
DOI:10.4103/0974-2700.93120  PMID:22416159
Experience over the last 25 years has shown that point-of-care ultrasound is a very useful tool when used by nonradiologists. Its value will be optimized by understanding its limitations and by adopting a focused binary decision making approach to answer specific questions without going into detailed radiological studies. Point-of-care ultrasound became an extension of the clinical examination. There are extensive efforts trying to design low-cost portable ultrasound systems by changing the transducer design, the transmission and reception circuitry needs, or the beam forming algorithms which may lead to horizontal expansion of the use of reliable non expensive portable ultrasound machines. The successful story of using ultrasound by nonradiologists, the advanced technology, and the refinement of the educational methods will encourage future clinicians to use ultrasound in their domains.
  3 3,398 16
Cerebral microdialysis and PtiO2 to decide unilateral decompressive craniectomy after brain gunshot
Boret Henry, Carre Emilie, Prunet Bertrand, D'Aranda Erwan
January-March 2012, 5(1):103-105
DOI:10.4103/0974-2700.93101  PMID:22416170
Decompressive craniectomy (DC) following brain injury can induce complications (hemorrhage, infection, and hygroma). It is then considered as a last-tier therapy, and can be deleteriously delayed. Focal neuromonitoring (microdialysis and PtiO2) can help clinicians to decide bedside to perform DC in case of intracranial pressure (ICP) around 20 to 25 mmHg despite maximal medical treatment. This was the case of a hunter, brain injured by gunshot. DC was performed at day 6, because of unstable ICP, ischemic trend of PtiO2, and decreased cerebral glucose but normal lactate/pyruvate ratio. His evolution was good despite left hemiplegia due to initial injury.
  2 4,500 22
The role of ultrasound in the management of intestinal obstruction
Ashraf F Hefny, Peter Corr, Fikri M Abu-Zidan
January-March 2012, 5(1):84-86
DOI:10.4103/0974-2700.93109  PMID:22416163
Intestinal obstruction (IO) is a common cause of acute abdominal pain. The recent increased use of sonography in the initial evaluation of abdominal pain has made point-of-care ultrasound a valuable tool for the diagnosis of IO. Sonography is as sensitive, but more specific, than plain abdominal X-ray in the diagnosis of IO. Point-of-care ultrasound can answer specific questions related to IO that assist the acute care physician in critical decision making. Sonography can also help in the resuscitation of patients by serial measurement of the IVC diameter. We review the sonographic findings of IO and the role of point-of-care ultrasound in the management of patients having IO.
  2 8,483 33
Humoral hypercalcemic crisis in a pregnant woman with uterine leiomyoma
Ali Rahil, Fahmi Yousef Khan
January-March 2012, 5(1):87-89
DOI:10.4103/0974-2700.93093  PMID:22416164
We report a case of parathyroid hormone-related protein-mediated hypercalcemic crisis in a 36-year-old pregnant woman, who was admitted to women hospital with recurrent vomiting and epigastric pain. She was diagnosed with uterine fibroid since the first month of her pregnancy, but the pregnancy had been uneventful. Serum calcium was 4.8 mmol/l, while parathyroid hormone was low. Hypercalcemia was attributed to humoral hypercalcemia associated with uterine fibroid as other causes of hypercalcemia were excluded.
  1 3,117 18
Bilateral dacryoadenitis
Charlotte Derr, Ankit Shah
January-March 2012, 5(1):92-94
DOI:10.4103/0974-2700.93096  PMID:22416166
Acute dacryoadenitis is an uncommon condition that involves inflammation of the lacrimal gland. In rare instances, dacryoadenitis may be bilateral. A delay in proper treatment of an otherwise simple case of dacryoadenitis may lead to significant soft tissue morbidity such as cellulitis, lacrimal gland abscess, or orbital abscess. We report the case of a 24-year-old male who presented to the emergency department with acute bilateral dacryoadenitis. The patient's symptoms did not respond to oral antibiotics and he subsequently required admission for intravenous antibiotics. During his hospitalization the patient had diagnostic testing to try to determine the etiology for his symptoms. The unique aspects of managing a case of bilateral dacryoadenitis as well as treatment recommendations are discussed in this case report.
  1 4,988 13
Broken tracheostomy tube: A fractured mandate
Arvind Krishnamurthy, R Vijayalakshmi
January-March 2012, 5(1):97-99
DOI:10.4103/0974-2700.93098  PMID:22416168
Tracheostomy is a common airway procedure for life support. This procedure is safe, although occasional early and late complications are known to occur. Fracture and hence aspiration of a tracheostomy tube in the tracheobronchial tree is a rare late complication, which can be potentially life threatening. Published reports of a fractured tracheostomy tube presenting as a foreign body in the tracheobronchial tree are few. The most common dislodged sites reported were the trachea and the right main bronchus, the inner flange in our patient was lodged in the trachea and the left main bronchus. Foreign-body aspiration is a serious medical emergency demanding timely recognition and prompt action as was successfully done in our patient. Therapeutic rigid bronchoscopic removal is the mainstay of treatment. A periodic review of the techniques of tracheostomy care including timely check-ups for signs of wear and tear can possibly eliminate such avoidable late complications.
  1 4,508 22
Hemoperitoneum from splenic rupture in an expatriate
Massimo Tonolini, Roberto Bianco
January-March 2012, 5(1):100-102
DOI:10.4103/0974-2700.93100  PMID:22416169
Splenic rupture with hemoperitoneum represents a life-threatening surgical emergency. Malaria should be highly suspected as the probable underlying disease in returning travellers, expatriates, or recent immigrants from endemic countries. Malarial complications involving the spleen occur even with appropriate prophylaxis or during antimalarial therapy. Among them, splenic infarction has a favourable course and is treated conservatively, whereas life-threatening rupture requires immediate or delayed splenectomy. Computed tomography (CT) allows confident differentiation between these two complications by identifying ruptured spleen with clotted hematoma and associated high-density peritoneal effusion; furthermore, CT allows differential diagnosis from other causes of spontaneous hemoperitoneum.
  1 4,698 16
Who killed Rambhor?: The state of emergency medical services in India
Rajesh H Garg
January-March 2012, 5(1):49-54
DOI:10.4103/0974-2700.93113  PMID:22416155
In India, the healthcare delivery system starts up from the sub-center at the village level and reaches up to super specialty medical centers providing state of the art emergency medical services (EMS). These highest centers, located in big cities, are considered the last referral points for the patients from nearby cities and states. As the incidents of rail and road accidents have increased in recent years, the role of EMS becomes critical in saving precious lives. But when the facilities and management of these emergency centers succumbs before the patient, then the question arises regarding the adequate availability and quality of EMS. The death of an unknown common man, Rambhor, for want of EMS in three big hospitals in the national capital of India put a big question on the "health" of the emergency health services in India. The emergency services infrastructure seems inadequate and quality and timely provision of EMS to critical patients appears unsatisfactory. There is lack of emergency medicine (EM) specialists in India and also the postgraduation courses in EM have not gained foot in our medical education system. Creation of a Centralized Medical Emergency Body, implementation of management techniques, modification of medical curriculum, and fixing accountability are some of the few steps which are required to improve the EMS in India.
  1 3,617 22
Pediatric trauma in sub-Saharan Africa: Challenges in overcoming the scourge
Adesoji O Ademuyiwa, Usang E Usang, Kehinde S Oluwadiya, Dare I Ogunlana, Hope Glover-Addy, Chris O Bode, AS Arjan B Van
January-March 2012, 5(1):55-61
DOI:10.4103/0974-2700.93114  PMID:22416156
All over the world, pediatric trauma has emerged as an important public health problem. It accounts for the highest mortality in children and young adults in developed countries. Reports from Africa on trauma in the pediatric age group are few and most have been single center experience. In many low-and middle-income countries, the death rates from trauma in the pediatric age group exceed those found in developed countries. Much of this mortality is preventable by developing suitable preventive measures, implementing an effective trauma system and adapting interventions that have been implemented in developed countries that have led to significant reduction in both morbidity and mortality. This review of literature on the subject by pediatric and orthopedic surgeons from different centers in Africa aims to highlight the challenges faced in the care of these patients and proffer solutions to the scourge.
  1 3,804 20
Complications of bystander cardiopulmonary resuscitation for unconscious patients without cardiopulmonary arrest
Yoshihiro Moriwaki, Mitsugi Sugiyama, Yoshio Tahara, Masayuki Iwashita, Takayuki Kosuge, Nobuyuki Harunari, Shinju Arata, Noriyuki Suzuki
January-March 2012, 5(1):3-6
DOI:10.4103/0974-2700.93094  PMID:22416146
Background: Insufficient knowledge of the risks and complications of cardiopulmonary resuscitation (CPR) may be an obstructive factor for CPR, however, particularly for patients who are not clearly suffering out of hospital cardiopulmonary arrest (OH-CPA). The object of this study was to clarify the potential complication, the safety of bystander CPR in such cases. Materials and Methods: This study was a population-based observational case series. To be enrolled, patients had to have undergone CPR with chest compressions performed by lay persons, had to be confirmed not to have suffered OHCPA. Complications of bystander CPR were identified from the patients' medical records and included rib fracture, lung injury, abdominal organ injury, and chest and/or abdominal pain requiring analgesics. In our emergency department, one doctor gathered information while others performed X-ray and blood examinations, electrocardiograms, and chest and abdominal ultrasonography. Results: A total of 26 cases were the subjects. The mean duration of bystander CPR was 6.5 minutes (ranging from 1 to 26). Nine patients died of a causative pathological condition and pneumonia, and the remaining 17 survived to discharge. Three patients suffered from complications (tracheal bleeding, minor gastric mucosal laceration, and chest pain), all of which were minimal and easily treated. No case required special examination or treatment for the complication itself. Conclusion: The risk and frequency of complications due to bystander CPR is thought to be very low. It is reasonable to perform immediate CPR for unconscious victims with inadequate respiration, and to help bystanders perform CPR using the T-CPR system.
  1 4,295 26
Sonography of gangrenous cholecystitis
Peter Corr
January-March 2012, 5(1):82-83
DOI:10.4103/0974-2700.93112  PMID:22416162
Gangrenous cholecystitis is an acute surgical emergency, which requires early cholecystectomy. Differentiation of patients with gangrenous cholecystitis from those with non-gangrenous cholecystitis can be difficult, both clinically and with imaging. Careful attention to the following sonographic signs suggests the presence of gangrenous cholecystitis decreased focal wall perfusion on Color Doppler, irregular gall bladder mucosal outline, gall bladder wall thickening with signs of de-lamination, gas within the gall bladder, absence of calculi, and large peri-cholecystic collections. Both sonogram with color flow imaging and contrast-enhanced Computed tomography are complementary investigations to establish this important diagnosis in critically ill patients.
  1 5,564 16
An unusual differential for a pulseless trauma patient
Babita Gupta, Pramendra Agrawal, Kapil Dev Soni, Nita D'souza, Kamran Farooque
January-March 2012, 5(1):95-96
DOI:10.4103/0974-2700.93097  PMID:22416167
Hemorrhagic shock is the most common reason to explain the inability to feel pulse in a trauma patient. However, clinicians should always suspect atypical causes for differential pulses in this population and Takayasu's arteritis (TA) is one such example. We report a case of aorto-arteritis in a patient who presented with trauma and was later diagnosed with TA. She had blood pressure discrepancy between upper and lower limbs noted upon her initial trauma evaluation.
  - 2,687 13
What's new in Emergencies, Trauma and Shock? Resuscitation guidelines update in 2010: Implications for bystander CPR
Hunniya Waseem
January-March 2012, 5(1):1-2
DOI:10.4103/0974-2700.93092  PMID:22416145
  - 3,035 20
The injured child in Africa
Timothy C Hardcastle
January-March 2012, 5(1):62-63
  - 1,911 20
Improvized management of lumbar disc prolapse in Antarctica
Abhijeet Bhatia, Ranabir Pal, Anil Dhal
January-March 2012, 5(1):106-107
DOI:10.4103/0974-2700.93103  PMID:22416171
  - 2,064 15
Need for encouraging translational research in India
Dhanashree Kelkar, Sheela Galwankar, Shrikant Kelkar
January-March 2012, 5(1):107-107
DOI:10.4103/0974-2700.93105  PMID:22416172
  - 1,982 16
Evaluating conservative treatment for acute appendicitis with lump formation
Ajaz Ahmad Malik, Mohd Lateef Wani, Shadab Nabi Wani, Fazl Qadir Parray, Nayeem-Ul-Hassan , IfatIrshad
January-March 2012, 5(1):33-35
DOI:10.4103/0974-2700.93108  PMID:22416152
Background: Interval appendectomy after acute appendicitis with lump formation (phlegmon) remains controversial. We conducted this study to determine the risk of recurrent appendicitis following initial non-operative treatment for appendicitis, and evaluate factors associated with recurrence. Secondarily, we evaluate the efficacy of interval appendectomy versus no appendectomy. Materials and Methods: Patients who received conservative treatment for appendicitis with lump formation were prospectively studied from June 2006 to June 2008. These patients were followed for recurrence of appendicitis. Results: Of 763 patients with acute appendicitis some 220 patients had lump formation (28.8%). Median age was 28 years. Conservative treatment was successful in 213 (96.8%) patients. The rate of recurrence was 13.1%, all occurring within six months after the index admission. Mean follow-up was 26±18 months. Conclusion: Conservative treatment of appendicitis with lump formation is efficient and the recurrence rate is low. Routine interval appendectomy after initial conservative treatment for lump formation is not a cost-effective intervention and not recommended.
  - 4,294 25
The results of the three-month co-operation between a German and a Greek surgical team in a role II military hospital in Afghanistan
Stavros Gourgiotis, Christos Triantafyllou, Athanasios Karamitros, Katrin Thinnes, Wolfgang Thüringen, Roland Schmidt
January-March 2012, 5(1):36-41
DOI:10.4103/0974-2700.93110  PMID:22416153
Background and Aim: There are a lot of unique challenges for the military medical personnel assigned to Afghanistan. We evaluate the results of the co-operation between a German and a Greek surgical team during a 3-month period in a role II hospital. Materials and Methods: Patients who were admitted to the role II German hospital of Kunduz were evaluated. We reviewed the type of diseases, mechanism and location of injuries, management, types of surgical procedures, blood supply, and outcome. Results: The data included 792 ISAF patients, 18 NGOs patients, and 296 local patients. Out of them, 71.6% of the patients were ISAF personnel; 51 patients underwent a surgical operation; 35 of them were operated in an emergency base. Fifty-five surgical procedures were performed. In 22 (43.1%) of these patients, orthopedic procedures were performed, while in the rest 29 (56.9%) patients the operations were of general surgery interest. Gunshot injuries were the main mechanism of injury for locals, whereas ISAF personnel were usually presented with injuries after IEDs and rocket attacks. A total number of 11 patients were transferred to role III military hospitals for further treatment within 24 hours. Conclusions: The co-operation between surgical teams from different countries, when appropriately trained, staffed, and equipped, can be highly effective in a combat environment.
  - 2,601 13
Injury-related mortality audit in a regional trauma center at Puducherry, India
Angeline Neetha Radjou, Dillip Kumar Balliga, Ranabir Pal, Preetam Mahajan
January-March 2012, 5(1):42-48
DOI:10.4103/0974-2700.93111  PMID:22416154
Background: There is an alarming trend of injuries leading to poor outcome of victims in India. Objective: To study the profile of patients who died due to trauma and to identify factors involved in both pre-hospital and hospital care. Materials and Methods: A hospital-based study was performed at a trauma center in Puducherry from June 2009 to May 2010. Patients who had at least one sign of life on admission and later died were included. The demographic characteristics, injury mechanism, nature and site of injury, influence of alcohol, pre-hospital time and care, distance traveled, number of referrals, time spent in study hospital, cause of death, and missed injuries revealed at post mortem were noted. Results: Of the 204 fatal cases, most were between 25-65 years of age (77%); sustained injuries over weekends (36%) and between 4 pm and midnight (41%); had at least one halt in a medical facility before reaching definitive care (56%); and died within a week (63%). Adults (25-65 y) sustained most injuries (77%) on two wheelers. In those aged over 65 years, 79 percent were pedestrians. Road traffic injuries were responsible for 82 % of deaths; 16 percent were reportedly under the influence of alcohol at the time of injury. Mean delay from the time of accident to admission was 14.9 hours and median distance traveled was 30 kilometers. Head injury was the most common (66%) cause of death. Post mortem revealed skull fractures (37%), while missed injuries were noted in 8 percent, mostly involving the cervical spine and chest wall. Conclusion: The problem of trauma care needs to be addressed urgently in this part of southern India to reduce mortality and morbidity.
  - 3,115 20
Transforming trauma healthcare delivery in rural areas by use of an integrated call center
Deepak Agrawal
January-March 2012, 5(1):7-10
DOI:10.4103/0974-2700.93099  PMID:22416147
Introduction: There is poor penetration of trauma healthcare delivery in rural areas. On the other hand, mobile penetration in India is now averaging 80% with most families having access to mobile phone. Aims and Objectives: The aim of this study was to assess the implementation and socioeconomic impact of a call center in providing healthcare delivery for patients with head and spinal injuries. Materials and Methods: This was a prospective observational study carried out over a 6-month period at a level I trauma Center in New Delhi, India. A nine-seater call center was outsourced to a private company and the hospital's electronic medical records were integrated with the call-center operations. The call center was given responsibility of maintaining appointments and scheduling clinics for the whole hospital as well as ensuring follow-up visits. Trained call-center staff handled simple patient queries and referred the rest via email to concerned doctors. A telephonic survey was done prior to the start of call-center operations and after 3 months to assess for user satisfaction. Results: The initial cost of outsourcing the call center was Rs 1.6 lakhs (US$ 4000), with a recurring cost of Rs 80,000 (US$ 2000) per month. A total of 484 patients were admitted in the department of Neurosurgery during the study period. Of these, 63% (n=305) were from rural areas. Patients' overall experience for clinic visits improved markedly following implementation of call center. Patient satisfaction for follow-up visits increased from a mean of 32-96%. Ninety-five percent patients reported a significant decrease in waiting time in clinics 80.4% reporting improved doctor-patient interaction. A total of 52 visits could be postponed/cancelled for patients living in far flung areas resulting in major socioeconomic benefits to these families. Conclusions: As shown by our case study, call centers have the potential to revolutionize delivery of trauma healthcare to rural areas in an extremely cost-effective manner.
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