Status of functional capacity of the emergency care system in Cambodia: a cross-sectional survey

Objective@#The establishment of a proper emergency care system can significantly decrease the number of deaths and disabilities. However, this is neglected in many low- and middle-income countries, including Cambodia. At present, many Cambodian hospitals lack designated emergency departments, formal triage systems, and staff trained in emergency medicine. This study sought to measure the functional capacity of the Cambodian emergency care system corresponding to each hospital level using the Emergency Care Assessment Tool (ECAT). @*Methods@#We conducted a survey from April 19, 2021, to April 27, 2021, by distributing survey sheets to a total of eight Cambodian medical staff who were invited to a hospital in South Korea for an educational program. The ECAT comprises items evaluating the capability of hospitals to perform signal functions for each of the six emergent sentinel conditions that could occur prior to death. We analyzed the data by categorizing the hospitals into basic, intermediate, and advanced levels. @*Results@#Basic-level hospitals had weaknesses in signal functions related to altered mental status and trauma care. The intermediate-level hospital showed weaknesses in signal functions related to respiratory failure, altered mental status, shock, and trauma care. Advanced-level hospitals had weaknesses in signal functions related to respiratory failure, trauma, and shock. @*Conclusion@#Our survey shows that most Cambodian hospitals lack the capability to perform the emergency signal functions expected at each level. We believe that this gap can be bridged with proper customized education targeting medical staff based on the level of their hospital and ensuring a proper supply of medical devices.

Analysis of Accident Mechanisms in Unhelmeted Motorcycle Accident Victims

PURPOSE: Due to their vulnerability and relatively high driving speed, motorcycles have been associated with a high risk of sustaining multiple severe injuries after traffic accidents. We sought to investigate sustained injuries and the association of accident mechanisms with injury severity for unhelmeted motorcycle accident victims. METHODS: This study was conducted as an observational retrospective study. Unhelmeted motorcycle accident victims who visited the study hospital from January 2010 to December 2011 were included. Data were obtained from medical records, ambulance run-sheets, and telephone interviews. Accident mechanisms were divided into collision with an obstacle, single vehicle accident, collision with another vehicle, collision by another vehicle, and falling accident from the viewpoint of energy. Glasgow coma scale (GCS), Revised trauma score (RTS), and Injury Severity Score (ISS) were analyzed for comparison of injury severity according to the accident mechanisms. RESULTS: Of 404 patients who visited the study hospital, 165 patients were included; 87.3%(144/165) were male, and 78.8%(130/165) were drivers. The incidence of motor cycle accident showed the highest in the teenager and in time during 18:00~24:00 o'clock. Lower extremity was the most common site of injury, followed by upper extremity, head, and face etc. Injury due to falling was the most severe injury mechanism, followed by collision with another vehicle, collision by another vehicle, and a single vehicle and an obstacle (p=0.013). CONCLUSION: Lower extremity injury was the most common injury site in unhelmeted motorcycle accidents, and motorcycle accidents by fall and collision with another vehicle should be considered as a severe mechanism of injury.

Coagulase-Positive Staphylococcal Necrotizing Fasciitis Subsequent to Shoulder Sprain in a Healthy Woman

Necrotizing fasciitis (NF) is a deep infection of the subcutaneous tissue that progressively destroys fascia and fat; it is associated with systemic toxicity, a fulminant course, and high mortality. NF most frequently develops from trauma that compromises skin integrity, and is more common in patients with predisposing medical conditions such as diabetes mellitus, atherosclerosis, alcoholism, renal disease, liver disease, immunosuppression, malignancy, or corticosteroid use. Most often, NF is caused by polymicrobial pathogens including aerobic and anaerobic bacteria. NF caused by Staphylococcus aureus as a single pathogen, however, is rare. Here we report a case of NF that developed in a healthy woman after an isolated shoulder sprain that occurred without breaking a skin barrier, and was caused by Staphylococcus aureus as a single pathogen.

Operative Treatment for Ulnar Styloid Process Fractures with Unstable Intraarticular Distal Radius Fractures

PURPOSE: To evaluate the radiological and clinical outcomes of the operative treatment for the unstable distal radius fractures with displaced ulnar styloid process fractures. MATERIALS AND METHODS: From 2002 to 2005, 17 patients with unstable distal radius fractures with displaced ulnar styloid process fractures were treated operatively, using external fixation or internal fixation for distal radius and open reduction with tension band wiring for ulnar styloid process fractures. We evaluated postoperative outcomes with Mayo wrist score, range of motion, ulnar side wrist pain, wrist stress test, grip strength as well as radiological evaluation. RESULTS: All ulnar styloid process fractures were completely united, and according to Mayo wrist score, 7 cases(41%) were excellent, 8 cases(47%) were good. 14 cases(82%) had no ulnar wrist pain and 15 cases(88%) had grip strength more than 50% when compared with the normal side. Posterior instability of ulnar head occurred at 1 case. CONCLUSION: We got acceptable clinical and radiological results of operative treatment of ulnar styloid process fractures and concluded that ulnar styloid process fractures combined with distal radius fractures should be carefully evaluated and treated operatively according to their fracture types.