ABSTRACT
Objective: To investigate the presentation, management and outcomes of left and right-sided traumatic diaphragmatic injury [TDI] in a single level I trauma center
Methods: This cross-sectional study was conducted during a 7-year period from 2008 to 2015 in a level I trauma center in Qatar. We included all the patients who presented with TDIs during the study period. Data included demographics, mechanism of injury, associated injuries, initial vitals, emergency department disposition, length of ICU and hospital stay, ventilator days, management, and outcomes. The variables were analyzed and compared for patients with left [LTDI] and right [RTDI]
Results: A total of 52 TDI cases [79% LTDI and 21% RTDI] were identified with a mean age of 31 +/- 11. LTDI patients were more likely to have higher Injury severity scores [p=0.50] and greater AAST organ injury scoring [p=0.661 for all] than RTDI patients. Surgical repair was performed for 85% LTDI vs. 73% RTDI [p=0.342]. Recurrent DIs was reported only in LTDI [5.1% vs. 0.0%; p=0.911]. Twelve patients died [9 LTDI and 3 RTDI], of them 5 had associated head injury
Conclusion: This single-institution study confirms that LTDI are more commonly diagnosed than RTDI. Exploratory laparotomy is the most frequent procedure considered for the management of diaphragmatic injuries in the emergency settings. To improve outcomes in patients presenting with TDI, large prospective multicenter studies are needed to standardize the TDI management protocols including the diagnostic workup, timing of surgical intervention, and the most appropriate approach of treatment
ABSTRACT
Succinylcholine remains the drug of choice for satisfactory rapid-sequence tracheal intubation. It is not clear from the literature why the 1 mg/kg dose of succinylcholine has been traditionally used. The effective dose [ED95] of succinylcholine is less than 0.3 mg/kg. The dose of 1 mg/kg represents 3.5 to 4 times the ED95. To compare the effect of the traditionally used 1 mg/kg of succinylcholine with lower doses of 0.6 mg/kg and 0.45 mg/kg on intubation condition regarding the onset time, duration of action, duration of abdominal fasciculation, and the intubation grading. This retrospective comparative study was carried into three groups of ASA III and IV [American Society of Anesthesiologist's Physical Status III and IV] non-prepared emergency patients who were intubated at emergency department of Hamad General Hospital, Doha, Qatar during January 1st 2007 to August 31, 2010. The Institutional Research Board [IRB] approval was obtained. This study was limited to 88 patients who received fentanyl 1 micro g/kg followed by etomidate 0.3 mg/kg intravenously as induction agents and succinylcholine as a muscle relaxant agent in doses of 0.45 mg/kg, 0.6 mg/kg, or 1 mg/kg. Increasing the succinylcholine dosage shortened the onset time, prolonged the duration of action, and prolonged the duration of abdominal fasciculation significantly [P<.001]. Tracheal intubation was 100% successful in the three groups of patients. Succinylcholine dose of 0.45 mg/kg provides an optimal intubation condition in ASA III and IV emergency non-prepared patients. Duration of action of succinylcholine is dose dependent; reducing the dose allows a more rapid return of spontaneous respiration and airway reflexes