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1.
Nursing (Säo Paulo) ; 25(287): 7528-7539, abr.2022.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1372416

ABSTRACT

Objetivo: caracterizar os vídeos do YouTube sobre o transporte aeromédico do politraumatizado. Método: estudo descritivo e quantitativo, realizado mediante acesso à plataforma de vídeos YouTube, entre julho e setembro de 2021, com utilização de instrumento composto por 13 variáveis que foram tabuladas e analisadas de maneira descritiva por software. Resultados: foram encontrados quatro vídeos, postados entre 2018 e 2021, dos quais a maioria foi postada em canais pessoais, em sua maior parte destinados aos profissionais da saúde, com predominância de médicos na narração. Os vídeos com mais inscritos nos canais e aqueles mais curtos obtiveram maior número de visualizações. Conclusão: os vídeos da plataforma YouTube sobre o transporte aeromédico do politraumatizado foram voltados aos profissionais da saúde, no entanto, há carência de citação de portarias, conselhos profissionais, legislações, além de atribuições dos profissionais que atuam no cuidado de saúde ao paciente com múltiplos traumas nesse tipo de transporte(AU)


Objective: to characterize YouTube videos about the aeromedical transport of polytraumatized patients. Method: descriptive and quantitative study, carried out through access to the YouTube video platform, between July and September 2021, using an instrument composed of 13 variables that were tabulated and analyzed in a descriptive way by software. Results: four videos were found, posted between 2018 and 2021, most of which were posted on personal channels, mostly aimed at health professionals, with a predominance of doctors in the narration. The videos with the most subscribers on the channels and the shortest ones got the most views. Conclusion: the videos on the YouTube platform about the aeromedical transport of polytraumatized patients were aimed at health professionals, however, there is a lack of citation of ordinances, professional advice, legislation, in addition to the attributions of professionals who work in health care for patients with multiple trauma in this type of transport(AU)


Objetivo: caracterizar videos de YouTube sobre el transporte aeromédico de pacientes politraumatizados. Método: estudio descriptivo y cuantitativo, realizado a través del acceso a la plataforma de videos YouTube, entre julio y septiembreVde 2021, utilizando un instrumento compuesto por 13 variables que fueron tabuladas y analizadas de forma descriptiva porVsoftware. Resultados: se encontraron cuatro videos, publicados entre 2018 y 2021, la mayoría de los cuales fueron publicadosVen canales personales, en su mayoría dirigidos a profesionales de la salud, con predominio de médicos en la narración. LosVvideos con más suscriptores en los canales y los que eran más cortos tenían la mayor cantidad de vistas. Conclusión: los videosVen la plataforma de YouTube sobre el transporte aeromédico de pacientes politraumatizados fueron dirigidos a los profesionalesVde la salud, sin embargo, falta la citación de ordenanzas, consejos profesionales, legislación, además de las atribuciones de losVprofesionales que actúan en la atención de la salud para pacientes politraumatizados en este tipo de transporte.(AU)


Subject(s)
Multiple Trauma , Air Ambulances , Prehospital Care
2.
Rev. bras. cir. plást ; 36(4): 485-489, out.-dez. 2021. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1365590

ABSTRACT

■ RESUMO Introdução: A pandemia de COVID-19 se espalhou rapidamente pelo mundo trazendo a necessidade de ações emergenciais para o controle da doença em nível coletivo e individual. Assim, a Divisão de Cirurgia Plástica e Queimaduras do maior complexo hospitalar da América Latina foi fisicamente destinada aos infectados. Neste contexto, encontramos os desafios de tratar um paciente grande queimado e politraumatizado, que apresentou trombose arterial em membro inferior, uma rara complicação associada à queimadura térmica. Todo tratamento foi realizado em hospital não especializado ao atendimento de trauma. Relato de Caso: Paciente masculino, 18 anos, sem comorbidades, com queimaduras predominantemente de 3º grau de 50% de superfície corpórea queimada e neurotrauma grave, que apresentou trombose arterial em perna direita 24 horas após a queimadura. Paciente submetido à amputação do membro e a seriadas intervenções cirúrgicas para desbridamento e enxertia de pele. Apesar dos protocolos de prevenção, paciente foi infectado pela COVID-19 durante a internação. Conclusão: Este caso enfoca uma complicação rara relacionada à lesão por queimadura, que ainda não possui critérios de diagnóstico e medidas profiláticas definidas. Além disso, a pandemia de COVID-19 trouxe impactos em diversos âmbitos nos serviços de saúde, sendo fundamental o compartilhamento de conhecimentos durante esta pandemia pela busca de adaptações à situação de crise.


■ ABSTRACT Introduction: The COVID-19 pandemic spread rapidly worldwide, bringing the need for emergency actions to control the disease at the collective and individual level. Thus, the Division of Plastic Surgery and Burns of the largest hospital complex in Latin America was physically aimed at the infected. In this context, we find the challenges of treating a large burned and polytraumatized patient, who presented arterial thrombosis in the lower limb, a rare complication associated with the thermal burn. All treatment was performed in a hospital not specialized in trauma care. Case Report: Case Report: Male patient, 18 years old, without comorbidities, with predominantly third-degree burns of 50% of body surface burned and severe neurotrauma. He presented arterial thrombosis in his right leg 24 hours after the burn. The patient underwent limb amputation and serial surgical interventions for debridement and skin grafting. Despite the prevention protocols, the patient was infected by COVID-19 during hospitalization. Conclusion: This case focuses on a rare complication related to burn injury, which does not yet have diagnostic criteria and defined prophylactic measures. Besides, the COVID-19 pandemic has impacted various health services areas, and it is essential to share knowledge during this pandemic by seeking adaptations to the crisis situation.

3.
CES med ; 35(2): 175-184, mayo-ago. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1364613

ABSTRACT

Resumen El síndrome de embolia grasa es una complicación inusual del trauma ortopédico. Las manifestaciones clínicas son inespecíficas y no hay una prueba diagnóstica de oro, por lo que se debe tener un alto índice de sospecha. Se describen cuatro pacientes quienes, luego de presentar fractura de huesos largos, se complicaron con síndrome de embolia grasa. La manifestación común en todos ellos fue la hipoxemia. Los hallazgos más frecuentes en la tomografía de tórax fueron opacidades en vidrio esmerilado, compromiso del pulmón derecho y de los lóbulos inferiores y derrame pleural laminar. La evolución clínica fue satisfactoria en tres pacientes; el cuarto presentó extenso compromiso pulmonar, requirió ventilación mecánica invasiva y tuvo una hospitalización prolongada. Ningún paciente falleció ni quedó con secuelas. Esta es la primera serie de casos en Colombia que muestra el comportamiento clínico e imagenológico de pacientes con síndrome de embolia grasa.


Abstract Fat embolism syndrome is an unusual complication of orthopedic trauma. The clinical manifestations are non-specific and there is no gold standard diagnostic test, so a high index of suspicion is required. Four patients are described who after presenting long bone fracture were complicated with fat embolism syndrome. The common manifestation in all of them was hypoxemia. The most frequent findings in chest tomography were ground-glass opacities, involvement of the right lung and lower lobes, and laminar pleural effusion. The clinical evolution was satisfactory in three patients; the fourth had extensive pulmonary involvement, required invasive mechanical ventilation and had a prolonged hospitalization. None of the patients died or had sequelae. This is the first case series in Colombia showing the clinical and imaging behavior of patients with fat embolism síndrome.

4.
Rev. colomb. cir ; 36(3): 421-426, 20210000. tab
Article in Spanish | LILACS | ID: biblio-1253955

ABSTRACT

Introducción. La mayoría de las lesiones de carótida cervical en nuestra institución se manejan por vía endovascular. El objetivo de este estudio fue describir los desenlaces del manejo de las lesiones de carótida cervical en un hospital de cuarto nivel en la ciudad de Cali, Colombia. Métodos. Estudio de series de casos, retrospectivo, descriptivo, en pacientes con trauma de carótida (penetrante y cerrado), admitidos en un centro de alta complejidad de la ciudad de Cali, en el periodo comprendido desde enero de 2018 hasta enero de 2020. Resultados. Se evaluaron 20 pacientes con lesión de carótida, de los cuales 90 % tenía trauma penetrante, en su mayoría por proyectil de arma de fuego. La zona más frecuentemente afectada fue la carótida interna (65 %) y el 40 % de los pacientes presentaban síntomas neurológicos al ingreso. Se realizó manejo endovascular en 13 pacientes, con un 75 % de éxito en el manejo endovascular al ingreso. La mortalidad general fue del 20 %, que en su mayoría estuvo relacionada con traumatismo en otros órganos. El 69 % de los pacientes quedaron sin secuelas neurológicas al alta y el 25 % con secuelas mínimas. Discusión. Se muestra una serie de casos con lesión de carótida donde, teniendo en cuenta las variables de mal pronóstico para hacer una selección adecuada de los pacientes candidatos a este tipo de terapia, el resultado del manejo endovascular fue exitoso


Introduction. Most cervical carotid injuries in our institution are managed by endovascular approach. The objective of this study was to describe the outcomes of the endovascular management of cervical carotid lesions in at a I Level Trauma Center in Cali, Colombia. Methods. Retrospective, descriptive case series study in patients with both penetrating and blunt carotid trauma who were admitted to a I Level Trauma Center between January 2018 and January 2020. Results. Twenty patients with carotid injury were evaluated, of which 90% had penetrating trauma, mostly from a firearm projectile. The most frequently affected area was the internal carotid (65%) and 40% of the patients had neurological symptoms on admission. Endovascular management was performed in 13 patients, with a 75% success rate in endovascular management on admission. Overall mortality was 20%, most of which was related to trauma to other organs; 69% of the patients were left without neurological sequelae at discharge and 25% with minimal sequelae.Discussion. We describe a case series of patients with cervical carotid injury, taking into account the variables of poor prognosis to make an adequate selection of patients for endovascular management, the result of endovascular management was successful


Subject(s)
Humans , Carotid Artery Injuries , Endovascular Procedures , Wounds and Injuries , Multiple Trauma , Angiography , Embolization, Therapeutic
5.
Med. U.P.B ; 40(1): 46-54, 03/03/2021. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1177497

ABSTRACT

El trauma sigue siendo una de las principales causas de morbimortalidad mundial. Entre las causas de muerte de estos pacientes cabe destacar el paro cardiaco traumático (PCT). Múltiples autores afirman que, a pesar de los avances médicos, los esfuerzos de resucitación de estos pacientes pueden llevar a malos desenlaces, ya que aquellos que sufren PCT tienen gran mortalidad y pronóstico neurológico poco alentador. Este artículo hace una recopilación de la evidencia disponible, que, a pesar de ser poca, señala los avances recientes en el enfoque y manejo de estos pacientes. Se busca que con esta revisión se logre un consenso sobre el abordaje de los pacientes en paro en el contexto de trauma, basado en la literatura y evidencia más reciente.


Trauma is still one of the main causes of morbidity and mortality worldwide. Traumatic cardiac arrest (TCA) stands out among the causes of death of these patients. Multiple authors claim that, despite medical advances, resuscitation efforts in these patients may lead to poor outcomes, since those suffering from TCA have high mortality rates and poor neurological prognosis. This article compiles the available evidence, which despite being limited, points to recent advances in the management and approach of these patients. The aim of this review is to reach a consensus on the approach to patients in cardiac arrest in the context of trauma, based on the most recent literature and evidence.


O trauma continua sendo uma das principais causas de morbimortalidade em todo o mundo. Dentre as causas de óbito nesses pacientes, vale destacar a parada cardíaca traumática (PCT). Vários autores afirmam que, apesar dos avanços médicos, os esforços de ressuscitação nesses pacientes podem levar a resultados ruins, uma vez que aqueles que sofrem de PCT apresentam alta mortalidade e prognóstico neurológico ruim. Este artigo faz uma compilação das evidências disponíveis, que, apesar de poucas, apontam para avanços recentes na abordagem e manejo desses pacientes. O objetivo desta revisão é chegar a um consenso sobre a abordagem do PCT com base na literatura e nas evidências mais recentes.


Subject(s)
Heart Arrest , Resuscitation , Wounds and Injuries , Indicators of Morbidity and Mortality , Cause of Death , Death , Consensus , Emergencies
6.
Rev. colomb. cir ; 36(1): 42-50, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1148507

ABSTRACT

Introducción. El trauma es una de las entidades con mayor morbimortalidad en el mundo. Los equipos especializados en la atención del paciente traumatizado son llamados «equipos de trauma¼. Dichos equipos surgieron de la necesidad de brindar tratamiento oportuno multidisciplinario a individuos con heridas que condicionan gran severidad en la guerra; sin embargo, con el paso del tiempo se trasladaron al ámbito civil, generando un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. El objetivo de este estudio fue describir el proceso de desarrollo de los equipos de trauma a nivel mundial y la experiencia en nuestra institución en el suroccidente colombiano. Métodos. Se realizó una búsqueda en la base de datos PUBMED, que incluyó revisiones sistemáticas, metaanálisis, revisiones de Cochrane, ensayos clínicos y series de casos. Resultados. Se incluyeron 41 estudios para esta revisión narrativa, y se observó que el tiempo de permanencia en Emergencias, el tiempo de traslado a cirugía, la mortalidad y las complicaciones asociadas al trauma fueron menores cuando se implementan equipos de trauma. Discusión. El diseño de un sistema de atención y valoración horizontal de un paciente con traumatismos severos produce un impacto positivo en términos de tiempos de atención, mortalidad y morbilidad. Se hace necesario establecer los parámetros operativos necesarios en las instituciones de salud de alta y mediana complejidad en nuestro país para implementar dichos equipos de trabajo


Introduction. Trauma is one of the entities with the highest morbidity and mortality in the world. Teams specialized in trauma patient care are called «trauma teams¼. These teams arose from the need to provide timely multidisciplinary treatment to individuals with severe injuries in war; however, with time they moved to the civilian arena, generating a positive impact in terms of care times, mortality and morbidity. The objective of this study was to describe the process of development of trauma teams worldwide and the experience in our institution in southwestern Colombia. Methods. A search of the PUBMED database was carried out, which included systematic reviews, metaanalyses, Cochrane reviews, clinical trials, and case series.Results. Forty-one studies were included for this narrative review, and it was observed that the length of stay in the ER, the time of transfer to surgery, mortality and complications associated with trauma were lower when trauma teams are implemented. Discussion. The design of a horizontal care and assessment system for a patient with severe trauma produces a positive impact in terms of care times, mortality and morbidity. It is necessary to establish operational parameters in high and medium complexity health institutions in our country to implement such work teams


Subject(s)
Humans , Trauma Centers , Patient Care Team , Wounds and Injuries , Trauma Severity Indices , Advanced Trauma Life Support Care
7.
Chinese Journal of Trauma ; (12): 1057-1061, 2021.
Article in Chinese | WPRIM | ID: wpr-909976

ABSTRACT

Severe trauma is almost caused by a high energy damage, with a high incidence rate of multiple injuries. Reasonable assessment and resuscitation in hospital at early stage is key to successful care. Trauma resuscitation bay(TRB)is the primary area for early assessment and resuscitation in hospital, which can ensure the rapid rescue to the greatest extent. At present, the early treatment for patients with severe trauma is mainly conducted in the emergency room, which presents many disadvantages that may lead to a decline in the quality of early treatment of trauma. For example, in the limited space, a resucue team is unable to carry out, and bedside radiographic examinations, life-saving operations and rescue for internal emergency patients are affected. With the development of trauma center construction, TRB specifically for early assessment, resuscitation and emergency management of severe trauma comes into being. According to the characters of China's trauma rescue system, the authors illustrate the characteristics, advantages, functions and operational requirements of TRB, the components of TRB at different levels of trauma centers, and the status of TRB construction in China, so as to provide a reference for the construction of TRB at various levels.

8.
Chinese Journal of Trauma ; (12): 11-14, 2021.
Article in Chinese | WPRIM | ID: wpr-909826

ABSTRACT

Trauma score, trauma registry and construction of trauma database are the cornerstones for the quality improvement of trauma centers. Abbreviated injury scale (AIS)/injury severity score (ISS) has been used as the basis for evaluation of trauma centers in lots of countries since 2008, and has now developed into a globally recognized trauma scoring system. The authors introduce the changes in the number of codes and the setting of scores in the nine versions of AIS released since 1971, as well as the application effects of the AIS/ISS scoring system in recent years. Combined with the actual clinical cases, the errors in the current clinical application of AIS/ISS are analyzed. The construction of trauma registry and database in China has just started. The current focus is not to propose new trauma scores, but to correctly and accurately apply AIS/ISS scores first.

9.
Article in Chinese | WPRIM | ID: wpr-908733

ABSTRACT

Objective:To analyze the value of serum gelsolin (GSN), procalcitonin(PCT), homocysteine (Hcy), cardiac troponin I(cTnI) in diagnosis of multiple trauma severity and prognosis evaluating.Methods:A retrospective analysis of 60 patients with multiple trauma from January 2019 to May 2020 in Liaocheng People′s Hospital were enrolled. According to injury severity score (SSA), the patients were divided into mild group (ISS ≤ 25 scores, 22 cases) and severe group (ISS>25 scores, 38 cases); according to prognosis, the patients were divided into survival group (38 cases) and death group(32 cases); 60 cases (control group) were included in the same period healthy volunteers. The levels of GSN, PCT, Hcy, cTnI were detected by enzyme-linked immunosorbent assay. The patients were followed up to 7 d, and the relationship between the above four serum items andinjury severity and survival rate were analyzed.Results:Before treatment, the level of GSN from low-to-high was severe group, mild group and control group; the levels of PCT, Hcy, cTnI from low-to-high was control group, mild group and severe group, and the differences were statistically significant ( P<0.05). After treatment, the level of GSN in mild group and severe group was increased, and the levels of PCT, Hcy, cTnI were decreased. Compared with those before treatment, the differences were statistically significant ( P<0.05). The level of GSN in the death group was lower than that in the survival group: (137.87 ± 9.54) mg/L vs. (190.32 ± 9.32) mg/L, the levels of PCT, Hcy, cTnI in the death group were higher than those in the survival group: (2.95 ± 0.32) μg/L vs. (0.44 ± 0.12) μg/L, (31.29 ± 8.54) μmol/L vs. (13.95 ± 2.19) μmol/L, (0.081 ± 0.007) μg/L vs.(0.020 ± 0.003) μg/L, and the differences were statistically significant ( P<0.05). The correlation analysis showed that the level of GSN had negative correlation with scale for the assessment of positive symptoms Ⅱ(SAPSⅡ) ( r = - 0.65, P<0.05) and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)( r = - 0.74, P<0.05), and the levels of PCT, Hcy, cTnI had positive correlation with SAPSⅡ( r = 6.18, 7.09, 9.15, P<0.05) and APACHEⅡ( r = 6.93, 7.32, 10.03, P<0.05). Multiple-factor analysis showed that serum GSN was a protective factor for survival rate, and serum PCT, Hcy, and cTnI were risk factors for survival rate ( P<0.05). Conclusions:The levels of serum GSN, PCT, Hcy, CTNl can assist in judging the severity and prognosis of multiple trauma. It is recommended to use it in combination with SAPSⅡ and APACHEⅡ.

10.
Article in Chinese | WPRIM | ID: wpr-907738

ABSTRACT

Objective:To investigate the predictive value of estimated renal perfusion pressure (eRPP) for acute kidney injury (AKI) in severe multiple trauma patients.Methods:Severe multiple trauma patients were collected based on the inclusion criteria and exclusion criteria from the Trauma Center, the Third Xiangya Hospital, Central South University. Subsequently, patients were divided into the AKI group and non-AKI group according to the occurrence of AKI during 72 h admission to hospital. Further clinical information, ISS score, SOFA score, APACHE Ⅱ score, mean arterial pressure (MAP), central venous pressure (CVP) and intra-abdominal pressure (IAP) were collected, and eRPP were calculated. Additionally, the differences of parameters in the AKI group and non-AKI group were analyzed and logistic regression analysis was performed to identify the independent predicted risk factors for AKI. Finally, ROC curve was conducted to identify specificity, sensibility and best cut-off point.Results:A total of 173 severe multiple trauma patients were finally analyzed. Compared with the non-AKI group, the serum albumin [(32.21±5.20)g/L vs. (34.83±4.20)g/L, P =0.001] and 24 h urine output [(711.90±241.38)mL vs. (1 101.21±509.86)mL, P =0.001] were significantly lower and serum lactate [(2.80±0.96)mmol/L vs. (1.89±0.63)mmol/L, P<0.001], ISS score [(29.05±5.91) vs. (22.17±4.02), P <0.001], APACHEⅡ score [(38.84±21.47) vs. (31.45±18.24), P <0.001] and SOFA score [(5.26±2.08) vs. (3.14±1.34), P <0.001], in-hospital mortality (9.52% vs. 2.29%, P=0.038), and ICU stay [(8.43±6.46)d vs. (6.42±3.78) d, P =0.01) were significantly higher in the AKI group. Moreover, 6, 12 and 24 h of CVP and eRPP after admission were associated with the incidence of AKI. Logistic regression analysis showed that 24 h urine output, CVP and eRPP were the independent predictive factors (P <0.05) and 24 h of eRPP after admission applied a better predictive value of the incidence in AKI. Conclusions:24 h of eRPP might be the most suitable independent predictive factor for AKI in severe multiple trauma patients.

11.
Chinese Journal of Traumatology ; (6): 153-158, 2021.
Article in English | WPRIM | ID: wpr-879679

ABSTRACT

PURPOSE@#Injuries are one of the leading causes of death and lead to a high social and financial burden. Injury patterns can vary significantly among different age groups and body regions. This study aimed to evaluate the relationship between mechanism of injury, patient comorbidities and severity of injuries.@*METHODS@#The study included trauma patients from July 2016 to June 2018, who were admitted to Sina Hospital, Tehran, Iran. The inclusion criteria were all injured patients who had at least one of the following: hospital length of stay more than 24 h, death in hospital, and transfer from the intensive care unit of another hospital. Data collection was performed using the National Trauma Registry of Iran minimum dataset.@*RESULTS@#The most common injury mechanism was road traffic injuries (49.0%), followed by falls (25.5%). The mean age of those who fell was significantly higher in comparison with other mechanisms (p < 0.001). Severe extremity injuries occurred more often in the fall group than in the vehicle collision group (69.0% vs. 43.5%, p < 0.001). Moreover, cases of severe multiple trauma were higher amongst vehicle collisions than injuries caused by falls (27.8% vs. 12.9%, p = 0.003).@*CONCLUSION@#Comparing falls with motor vehicle collisions, patients who fell were older and sustained more extremity injuries. Patients injured by motor vehicle collision were more likely to have sustained multiple trauma than those presenting with falls. Recognition of the relationship between mechanisms and consequences of injuries may lead to more effective interventions.

12.
Article in English | WPRIM | ID: wpr-879662

ABSTRACT

PURPOSE@#It is a challenge for the primary hospitals to manage multiple trauma patients. In this article, we explored the advantage of establishing a surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in the early management of multiple trauma.@*METHODS@#This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups, based on time period and treat modes: group A (retrospective observation group) where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B (study group) where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018. Clinical data including demographics, injury severity score (ISS), causes of injury, time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected. Data were analyzed by SPSS 20.0 software. Categorical variables were presented as number and/or frequency and continuous variables as mean ± SD.@*RESULTS@#Altogether 406 patients were included in this study, including 217 patients in group A and 189 patients in group B. General data between the two groups revealed no significant difference: mean age (years) (35.51 ± 12.97 vs. 33.62 ± 13.61, p = 0.631), gender distribution (mean/female, 130/87 vs. 116/73, p = 0.589) and ISS (15.92 ± 7.95 vs. 16.16 ± 6.89, p = 0.698). Fall from height were the dominant mechanism of injury, with 135 cases in group A (71.4%) and 121 cases in group B (55.8%), followed by traffic accidents. Injury mechanism showed no significant differences between two groups (p = 1.256). Introduction of the SICU significantly improved the care of trauma patients, regarding speed and mortality. Time intervals between reception and entering SICU or operating room was (108.23 ± 6.72) min and (45.67 ± 7.96) min in group A and B, respectively (p = 0.001). Mortality three days after injuries was 13.89% and 5.53% in group A and B, respectively (p = 0.005).@*CONCLUSION@#Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.

13.
Rev. Col. Bras. Cir ; 48: e20202783, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155358

ABSTRACT

ABSTRACT Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.


RESUMO Introdução: o uso de torniquete em extremidades (TQ) aumentou no ambiente civil; os resultados benéficos observados nas forças armadas influenciaram a aceitação por equipes de pré-hospitalar (PH) assim como pela população leiga. Esta revisão teve como objetivo analisar os tipos de TQ de extremidades usados em ambiente civil, local da lesão, indicações e complicações. Métodos: revisão sistemática foi conduzida com base em artigos originais publicados no PubMed, Embase e Cochrane seguindo as diretrizes do PRISMA de 2010 a 2019. Extração de dados focada no uso de TQ de extremidade para controle de hemorragia em ambiente civil, dados demográficos, tipo de estudo e duração, mecanismo de lesão, indicações de uso, local da lesão, tipo de TQ, tempo de TQ e complicações. Resultados: dos 1.384 artigos identificados, 14 foram selecionados para revisão com total de 3.912 vítimas civis com hemorragia nas extremidades e 3.522 colocações de extremidades TQ analisadas. A maioria foi aplicado em pacientes do sexo masculino (79%), com trauma contuso ou penetrante. Entre as indicações estavam choque hemorrágico, suspeita de lesões vasculares, sangramento contínuo e amputações traumáticas parciais ou completas. A aplicação na extremidade superior foi o local de aplicação mais comum (56%), quase todos aplicados a uma única extremidade (99%), e apenas 0,6% requereram aplicações nas extremidades superior e inferior. 80% dos TQs aplicados eram dispositivos comerciais e 20% improvisados. Conclusões: o uso de TQ em ambientes civis está associado a traumas. Os TQs comerciais são mais utilizados, com tempo menor que uma hora de uso e poucas complicações.


Subject(s)
Humans , Male , Adult , Tourniquets/statistics & numerical data , Vascular System Injuries/therapy , Exsanguination/prevention & control , Hemorrhage/prevention & control , Emergency Medical Services , Emergency Treatment , Extremities/injuries , Vascular System Injuries/complications , Vascular System Injuries/mortality , Exsanguination/etiology , Exsanguination/mortality , Hemorrhage/etiology , Hemorrhage/mortality
14.
Rev. Col. Bras. Cir ; 48: e20202769, 2021. tab, graf
Article in English | LILACS | ID: biblio-1155366

ABSTRACT

ABSTRACT Purpose: to analyze the relation between Trauma Quality Indicators (QI) and death, as well as clinical adverse events in severe trauma patients. Methods: analysis of data collected in the Trauma Register between 2014-2015, including patients with Injury Severity Score (ISS) > 16, reviewing the QI: (F1) Acute subdural hematoma drainage > 4 hours with Glasgow Coma Scale (GCS) <9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours; (F4) Admission-laparotomy time greater than 60 min in hemodynamically instable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time > 6 hours; (F10) Surgery > 24 hours. T the chi-squared and Fisher tests were used to calculate statistical relevance, considering p<0.05 as relevant. Results: 127 patients were included, whose ISS ranged from 17 to 75 (28.8 + 11.5). There were adverse events in 80 cases (63%) and 29 died (22.8%). Twenty-six patients had some QI compromised (20.6%). From the 101 patients with no QI, 22% died, and 7 of 26 patients with compromised QI (26.9%) (p=0.595). From the patients with no compromised QI, 62% presented some adverse event. From the patients with any compromised QI, 18 (65.4%) had some adverse event on clinical evolution (p=0.751). Conclusion: the QI should not be used as death or adverse events predictors in severe trauma patients.


RESUMO Objetivo: analisar relação entre comprometimento de Filtros de Qualidade (FQ) com complicações e mortalidade entre vítimas de trauma grave. Métodos: análise dos dados coletados para o Registro de Trauma entre 2014 e 2015, sendo incluídos os traumatizados com Injury Severity Score (ISS) > 16 e analisados os FQ: (F1) drenagem de Hematoma Subdural Agudo (HSA) > 4 horas com Escala de Coma de Glasgow (ECG) <9, (F2) transferência da sala de emergência sem via aérea definitiva e com ECG<9, (F3) reintubação traqueal em até 48 horas, (F4) tempo entre admissão e laparotomia exploradora maior que 60 minutos em pacientes instáveis com foco abdominal, (F5) reoperação não programada, (F6) laparotomia > 4 horas, (F7) fratura de diáfise de fêmur não fixada, (F8) tratamento não operatório em Ferimento por Arma de Fogo (FAF) abdominal, (F9) tempo entre admissão e tratamento de fraturas expostas de tíbia > 6 horas, (F10) operação > 24 horas. Testes de Chi quadrado e Fisher para a análise estatística, considerando significativo p<0,05, foram usados. Resultado: foram incluídos 127 pacientes com ISS entre 17 a 75 (28,8 + 11,5). As complicações ocorreram em 80 casos (63%) e 29 morreram (22,8%). Vinte e seis pacientes apresentaram algum FQ comprometido (20,6%). Dos 101 doentes sem FQ comprometido, 22% faleceram, o que ocorreu em 7 dos 26 doentes com comprometimento dos FQ (26,9%) (p=0,595). Dos doentes sem FQ comprometido, 62% tiveram alguma complicação. Entre os pacientes com FQ comprometido, 18 (65,4%) tiveram complicações (p=0,751). Conclusão: os FQs não devem ser utilizados como preditor de mortes ou complicações evitáveis nas vítimas de traumas graves.


Subject(s)
Humans , Adolescent , Adult , Aged , Young Adult , Quality Indicators, Health Care , Emergency Service, Hospital/statistics & numerical data , Hemorrhage , Glasgow Coma Scale , Injury Severity Score , Trauma Severity Indices , Retrospective Studies , Middle Aged
15.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 295-301, jan.-dez. 2021. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1151198

ABSTRACT

Objetivo: caracterizar os aspectos epidemiológicos das vitimas de trauma atendidas por um Serviço de Atendimento Móvel de Urgência 192. Método: estudo exploratório, descritivo e quantitativo, realizado no pronto socorro de um hospital de referencia. A população alvo foram as vitimas de trauma atendidas pelo Serviço de Atendimento Móvel de Urgência, transportadas para o referido hospital. Resultados: observou-se que 5,9% deram entrada na urgência por Ferimentos por Arma de Fogo, 4,9% por Ferimento por Arma Branca, 23,8% por queda, e 60,4% por acidentes de transito. Conclusão: o perfil identificado foi de homens, vitimas de acidente de transito, nas idades de 18 a 35 anos, com segundo grau completo, sendo o tórax a região mais atingida. Esse estudo pode subsidiar a elaboração de estratégias para enfrentamento desses agravos, pois a grande quantidade de óbitos por causas externas são considerados um problema de saúde publica, causando sequelas irreparáveis


Objective: to characterize the epidemiological aspects of the victims of trauma treated by a Mobile Emergency Care Service 192. Method: an exploratory, descriptive and quantitative study, carried out in the first aid hospital of a reference hospital. The target population was the victims of trauma treated by the Mobile Emergency Care Service, transported to the referred hospital. Results: It was observed that 5.9% were admitted to the emergency due to Firearm Injuries, 4.9% to White Weapon Injury, 23.8% to fall, and 60.4% due to trafficaccidents. Conclusion: the identified profile was of men, victims of traffic accident, in the ages of 18 to 35 years, with full second degree, being the thorax the most affected region. This study may support the development of strategies to deal with these diseases, since the large number of deaths from external causes are considered a public health problem, causing irreparable sequelae


Objetivo: caracterizar los aspectos epidemiologicos de las victimas de trauma atendidas por un Servicio de Atencion Movil de Urgencia 192. Método: estudio exploratorio, descriptivo y cuantitativo, realizado en el pronto socorro de un hospital de referencia. La poblacion objetivo fueron las victimas de trauma atendidas por el Servicio de Atencion Movil de Urgencia, transportadas al referido hospital. Resultados: se observo que el 5,9% ingreso en la urgencia por Feridas por Arma de Fuego, 4,9% por Lesion por Arma Blanca, 23,8% por caida, y 60,4% por accidentes de transito. Conclusión: el perfil identificado fue de hombres, victimas de accidente de transito, en las edades de 18 a 35 anos, con segundo grado completo, siendo el torax la region mas afectada. Este estudio puede subsidiar la elaboracion de estrategias para enfrentar esos agravios, pues la gran cantidad de muertes por causas externas son consideradas um problema de salud publica, causando secuelas irreparables


Subject(s)
Humans , Male , Adult , Young Adult , Multiple Trauma , Emergency Relief , Health Services Research , External Causes
16.
Rev. bras. cir. plást ; 35(4): 412-419, out.dez.2020. ilus
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1367920

ABSTRACT

Introdução: Ocasionalmente não há possibilidade de se cobrir uma ferida com enxertos ou retalhos locais. O objetivo deste trabalho foi avaliar a resolutividade da transferência de retalho à distância com secção do pedículo vascular em segundo tempo para cobertura de região que sofreu perda de substância. Métodos: Cinco pacientes com perda de substância, sem opção de reconstrução com enxertos ou retalhos locais, tiveram suas feridas cobertas por retalhos transferidos à distância, com secção dos pedículos vasculares em segundo tempo. Resultados: Os retalhos transferidos foram eficazes na cobertura das feridas. Conclusão: A transferência de retalho à distância com secção do pedículo vascular em segundo tempo é procedimento simples e eficaz, que deve ser dominado por todo cirurgião plástico.


Introduction: Occasionally, there is no possibility of covering a wound with local grafts or flaps. This study aimed to evaluate the capacity of the distant flap transfer with the vascular pedicle section in second stage to cover the region that suffered a loss of substance. Methods: Five patients with substance loss, with no reconstruction option using grafts or local flaps, had their wounds covered by distant flap transfer with the vascular pedicle section in second stage. Results: The transferred flaps were useful in covering the wounds. Conclusion: distant flap transfer with the vascular pedicle section in second stage is a simple and effective procedure. Every plastic surgeon must master that.

17.
Rev. bras. cir. plást ; 35(4): 479-482, out.dez.2020. ilus
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1367943

ABSTRACT

Introdução: A prevalência de malformações da orelha chega a 5% quando considerada toda a população mundial. Primariamente descrita em 1975 a orelha constricta representa um grupo de deformidades envolvendo o terço superior da cartilagem auricular com características em comum. O impacto estético e o estigma social dessas deformidades podem levar a danos psicológicos ao paciente quando não corrigidos. Métodos: Descrevemos a seguir a técnica utilizada no serviço de cirurgia plástica do Hospital de Clínicas de Porto Alegre. Resultados: O resultado pode ser evidenciado com 30 dias de pós-operatório. Conclusão: O método descrito, de reacomodação da cartilagem, é uma opção para o tratamento dessa deformidade com adequado resultado estético.


Introduction: The prevalence of ear malformations reaches 5% when considering the entire world population. Primarily presented in 1975, the constricted ear represents a group of deformities of the upper third of the auricular cartilage with common features. The aesthetic impact and social stigma of these deformities can cause psychological harm to the patient when not corrected. Methods: We describe below the technique used in the plastic surgery department of the Hospital de Clínicas de Porto Alegre. Results: Result can be evidenced with 30 days postoperatively. Conclusion: The described method, cartilage resettlement, is an option for treatment of this deformity with adequate aesthetic result.

18.
Colomb. med ; 51(3): e504386, July-Sept. 2020. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1142824

ABSTRACT

Abstract Case Description: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. Clinical Findings: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. Treatment and outcome: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae Clinical Relevance: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient's improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.


Resumen Descripción del caso: Varón de 24 años que sufre accidente automovilístico con trauma penetrante de cuello y trauma cerrado cervico torácico izquierdo concomitante. Hallazgos clínicos: Shock hipovolémico, trauma en zona I cuello izquierdo, isquemia por trauma cerrado de vasos axilares y lesión por trauma cerrado del plexo braquial; producto de trauma de alto impacto. Sección de arteria vertebral por angiotomografia. Se diagnostica disociación escapulo-torácica y trauma de arteria vertebral. Tratamiento y resultado: Reconstrucción vascular arterio-venosa axilar, fasciotomías y abordaje no operatorio del trauma de arteria vertebral, con manejo diferido del trauma del plexo braquial. Sobrevida del paciente y su extremidad, con secuelas neurológicas mayores. Relevancia clínica: Es un caso de disociación escapulotorácica y lesión de arteria vertebral concomitante, siendo esta una asociación infrecuente y de alta morbi-mortalidad. El reconocimiento temprano de las lesiones y un abordaje multidisciplinario de este escenario de complejidad por medio de juntas quirúrgicas en varios niveles del proceso de atención, fueron determinantes para cambiar el pronóstico del paciente. Se presenta un análisis del diagnóstico, manejo y evolución; considerando el proceso de atención hospitalaria, toma consensuada de decisiones y el pronóstico en un paciente politraumatizado.

19.
Rev. peru. med. exp. salud publica ; 37(2): 297-301, abr.-jun. 2020. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1127157

ABSTRACT

RESUMEN El objetivo fue describir las características de la muerte de mujeres por violencia según las necropsias realizadas en la morgue del Callao desde el 2016 al 2018. Se revisaron los registros forenses de 83 mujeres y se encontró que la muerte de mujeres por violencia ocurrió con mayor frecuencia en la etapa adulta, el suceso de tránsito fue el agente causante más implicado, la lesión mortal se ubicó mayormente en el segmento cabeza, se realizaron más levantamientos de cadáveres en la vía pública y el distrito con más casos fue el Callao. Es importante que las autoridades se comprometan a crear, instalar y seguir un plan de acción para prevenir la muerte de mujeres por violencia en el Callao.


ABSTRACT The objective was to describe the characteristics of women's deaths by violence according to autopsies performed at the Callao morgue from 2016 to 2018. The forensic records of 83 women were reviewed and it was found that women's deaths by violence occurred most often in adulthood. Traffic accidents were found to be the most common cause. The most frequent location of the fatal injury was in the head segment. Most of the corpse removal took place on the public road. The district with the most cases was Callao. It is important that the authorities commit to creating, installing and following an action plan to prevent women's deaths by violence in Callao.

20.
Acta ortop. bras ; 28(2): 97-99, Mar.-Apr. 2020.
Article in English | LILACS-Express | LILACS | ID: biblio-1098034

ABSTRACT

ABSTRACT Objective: To evaluate the epidemiological profile of motorcycle accident victims in a metropolis with more than one million inhabitants attended in a university hospital of reference in 2017. Methods: a retrospective study through the analysis of medical records of 105 motorcycle accident victims in Campinas (SP) attended in a university hospital of reference and who needed surgical procedure in 2017. Results: 87 patients (82.9%) were men. Multiple fractures were observed in 61 patients (58.1%) and polytrauma was found in 14 patients (13.3%). Tibial fracture was the most frequent, present in 65 cases (61.9%). Exposed fractures occurred in 68 patients (64.7%). Among the polytrauma victims, the most frequent injury was traumatic brain injury (TBI), present in seven patients (6.6%). The mean age was 29.8 years (range 6-63 years). The average length of hospital stay was 14 days (1-87). Conclusion: It is essential to investigate and evaluate the victims' epidemiological profile, as well as the resulting injuries, in order to provide adequate support for the implementation of measures aimed at primary prevention and awareness of the most affected groups. Level of Evidence II, Prognostic studies - Investigating the effect of a patient characteristic on the outcome of disease.


RESUMO Objetivo: Avaliar o perfil epidemiológico das vítimas de acidentes motociclísticos ocorridos em uma metrópole com mais de 1 milhão de habitantes atendidas em um hospital universitário de referência no ano de 2017. Métodos: Estudo retrospectivo através da análise de prontuários de 105 vítimas de acidentes motociclísticos ocorridos em Campinas, SP, Brasil, no ano de 2017 atendidas em um hospital universitário de referência que necessitaram de procedimento cirúrgico. Resultados: Oitenta e sete pacientes (82,9%) eram do sexo masculino. Foram verificadas polifraturas em 61 pacientes (58,1%) e politraumatismo em quatorze (13,3%). A fratura de tíbia foi a mais frequente, presente em 65 casos (61,9%). Fraturas expostas ocorreram em 68 pacientes (64,7%). Entre as vítimas de politraumatismo, a lesão mais recorrente foi o traumatismo cranioencefálico (TCE), presente em sete pacientes (6,6%). A média de idade foi 29,8 anos (variando de 6-63 anos). O tempo de internação médio foi 14 dias (1-87). Conclusão: É fundamental investigar e avaliar o perfil epidemiológico das vítimas, assim como os agravos resultantes, de modo a propiciar subsídio adequado para implementação de medidas de prevenção primária e conscientização, especialmente direcionadas para os grupos mais acometidos. Nível de Evidência II, Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.

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