Isolated Hyoid Fracture Associated with Blunt Trauma

Trauma-related hyoid fractures are rare entities. These fractures represent only 0.002% of head and neck region fractures. Victims of hanging and strangling constitute the great majority of cases. Fractures associated with trauma are extremely rare. These fractures are difficult to diagnose and can easily be overlooked during physical examination. However, they are also important traumas since airway safety is endangered in these rare cases. We describe a case of a young male presenting with isolated neck injury associated with hitting an electric cable while riding a motorbike. Tenderness was present in the anterior neck region at physical examination, but movement was not restricted and no respiratory difficulty was determined. Isolated hyoid fracture was detected at tomography of the neck performed in the emergency department. Hyoid bone fractures should not be forgotten in patients with pain and tenderness in the anterior neck region following blunt trauma to the neck.©Copyright 2020 by Emergency Physicians Association of Turkey - Available online at www.jemcr.com.

Trauma: a stress during pandemic?

Introduction: Coronavirus disease 2019 pandemic significantly impacted on trauma systems, since emergency departments (ED) suddenly were overwhelmed by patients requiring intensive care unit (ICU) admission. Once, trauma volume was supposed to decrease due to lockdown policies, we aimed to describe ICU trauma admissions during this period. Method(s): Retrospective observational study of all trauma patients admitted to the ICU of a Portuguese Trauma Center between January 2020 and December 2021. Data were collected from clinical hospital records. Result(s): 437 trauma patients (15% of all admissions), mostly male (71%), with a median age of 59 years-old (42-74) were included. At least one comorbidity was present in 71% of the patients. Median severity scores were: SAPS II 26 (19-38), SOFA 3 (1-6), ISS 13 (9-22), RTS 8 (6-8) and TRISS 96,75 (81.1-98.6). The most frequent mechanisms of injury were falls (59%) and road traffic accidents (25%). The majority consisted of blunt trauma (88%), 65% of brain trauma and 35% of musculoeskeletal trauma. Trauma Team assessment was started in < 3 min in all cases and median length of stay (LOS) in the ED was 261 min (154-418). Surgical intervention was performed in < 4 h in 56% of surgical brain trauma injuries, in < 6 h in 67% of extremity open fractures and in < 1 h in 6% of a penetrating trauma. Shock, mainly hemorrhagic, was present in 8% of the patients on hospital admission. 38% were submitted to invasive mechanical ventilation and 34% to vasopressors. The most common complication was nosocomial infection (18%). The median LOS in the UCI was 12 days (5-24). Only 8% of the patients died in the ICU and 11% in the hospital. Conclusion(s): During pandemic, trauma persisted a major health problem with a significant consumption of time and critical care resources. The high influx of patients may have influenced the LOS in the ED before ICU admission and the time until the surgical intervention. Despite it, mortality remained low.

The State of the Obesity Paradox in 2020

Purpose of Study The detrimental long-term effects of obesity are well-described in literature;however, there has been recently emerging evidence describing a possible mortality benefit in obese patients with acute injury. The scope of this review is to provide an overview of the ongoing debate surrounding this observation. We focused our discussion on evaluating the evidences suggesting an impact of obesity and overweight on multiple acute medical conditions. Methods Used We searched the PubMed database with the keywords 'obesity', 'paradox', 'trauma', 'mortality', 'BMI', 'cancer', 'sepsis', 'lung injury', 'stroke', 'COVID', and 'myocardial infarct' from inception to 2020 and selected 40 relevant papers discussing the relationship between mortality and BMI in the setting of these stressors, and the mechanisms behind them. Summary of Results Amongst the fields of blunt trauma, cardiovascular disease, cancer, and critical care admissions for sepsis and lung injury, there are a growing amount of evidences supporting the existence of a paradoxical mortality benefit with overweight and mild obesity compared to normal and lean BMI. These findings must be attenuated with study design and BMI limitations, as well as biases prevalent throughout these studies. Although several hypotheses have been proposed, the exact mechanisms behind this relationship are largely unknown. Conclusions This survey of the obesity paradox shows promise in regard to overweight and mild obesity helping with survival post-acute illness, possibly due to metabolic reserves, antiinflammatory, and anti-oncogenic conditions seen in obesity. We recommend addressing current major limitations by having future studies prospectively designed to evaluate alternative body weight metrics such as waist-to-hip ratio or waist circumference, with special attention to the timing of body weight measurements and its progression in the patient's life. In the future, elucidating the biological mechanisms of this relationship may allow us to adapt our recommendations to the patients and help direct optimal therapeutic approach in the management of certain acute pathologies.

Occlusive Explosion

Clinical Information Patient Initials or Identifier Number: A Relevant Clinical History and Physical Exam: 47yr old man, suffered a blast injury at the workplace after an O2 tank exploded while he was transferring liquid gas into a tank for welding purposes. The impact has caused him to temporary loss of consciousness. Upon awakening, he had severe chest pain associated with shortness of breath. On examination, superficial partial thickness injury on the chest wall, and lungs: reduced breath sound bi-basally, no murmur heard. BP:106/77mmHg, HR:100/min, SPO2 100% on HFM 15L/min. [Formula presented] [Formula presented] [Formula presented] Relevant Test Results Prior to Catheterization: Serial ECGs were done and showed dynamic changes in the anterior leads Bedside echo before invasive coronary angiograms shows mild LVSD, normal valves, and no pericardial effusion [Formula presented] [Formula presented] Relevant Catheterization Findings: Right radial approach 6F system Opitorque catheter for diagnostic angiogram LMS: smooth LAD: ATO mid LAD, DG1 prox ATO LCx: smooth RCA: smooth Impression: ATO to LAD and Diagonal 1 ( Dual ATO) [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: Right radial coronary angiogram via 6F system EBU 3.0 engaged with good support Sion blue wired into LAD, export catheter delivered, and aspirated red thrombus Pre-dilated with Sapphire 3 SC 2.5x15mm @ 6-10ATM Flow established in LAD, however, decided to interrogate DG1 as it shows ATO BMW wired into the DG1 and pre-dilated with Sapphire 3 SC 2.0x15mm Noted nonflow limiting dissection and decided to stent DG1 with 2.25x34mm@12ATM, dissection sealed and TIMI III flow established Stented mid LAD with 2.5x30mm @12ATM just before LAD/DG1 bifurcation, then stented proximal LAD with 2.5x 26mm@ 12ATM. Post-dilated LAD with 2.75x15mm@ 14-20ATM TIMI II-III flow IV Tirofiban has been given a loading dose due to a high thrombus burden and sluggish flow [Formula presented] [Formula presented] [Formula presented] Conclusion(s): Myocardial infarction is a rare complication of blunt chest trauma. This case demonstrates how blast shock waves result in the dissection of the coronary vessel leading to total occlusion of the two vessels. It also promotes red thrombus within the coronary vessels. Percutaneous coronary intervention is the most suitable way to treat this condition. Intravascular imaging such as IVUS or OCT would be beneficial to demonstrate the physiology behind this MI and would also be helpful in planning and optimizing the lesions. Unfortunately, intravascular imaging was not used for this patient to reduce procedural time as he was treated during the height of the COVID pandemic.Copyright © 2023

Evaluating the Regional Differences in Pediatric Injury Patterns During the COVID-19 Pandemic.

INTRODUCTION: Reports of pediatric injury patterns during the COVID-19 pandemic are conflicting and lack the granularity to explore differences across regions. We hypothesized there would be considerable variation in injury patterns across pediatric trauma centers in the United States. MATERIALS AND METHODS: A multicenter, retrospective study evaluating patients <18 y old with traumatic injuries meeting National Trauma Data Bank criteria was performed. Patients injured after stay-at-home orders through September 2020 ("COVID" cohort) were compared to "Historical" controls from an averaged period of equivalent dates in 2016-2019. Differences in injury type, intent, and mechanism were explored at the site level. RESULTS: 47,385 pediatric trauma patients were included. Overall trauma volume increased during the COVID cohort compared to the Historical (COVID 7068 patients versus Historical 5891 patients); however, some sites demonstrated a decrease in overall trauma of 25% while others had an increase of over 33%. Bicycle injuries increased at every site, with a range in percent change from 24% to 135% increase. Although the greatest net increase was due to blunt injuries, there was a greater relative increase in penetrating injuries at 7/9 sites, with a range in percent change from a 110% increase to a 69% decrease. CONCLUSIONS: There was considerable discrepancy in pediatric injury patterns at the individual site level, perhaps suggesting a variable impact of the specific sociopolitical climate and pandemic policies of each catchment area. Investigation of the unique response of the community during times of stress at pediatric trauma centers is warranted to be better prepared for future environmental stressors.

Acute Isolated Diastolic Hypotension and History of Substance Abuse in the Development of Delirium

INTRODUCTION: In a prior analysis, delirium was seen more often in patients with at least one incident of IDH in the first 48 hours compared to those who remained normotensive (8.1 vs 3.0%). Here we explored events over the entire hospital stay and focused on a subpopulation of patients with a history of substance abuse (SA). Their treatment would include a narcotic or benzodiazepine, as potential vasodilators they could increase the likelihood of IDH. METHOD(S): We performed Aa retrospective chart review of patients >18 years with blunt trauma, Glascow Coma Scale >= 14 and head/neck Abbreviated Injury Score <= 1 admitted to our Level I trauma center from 8/1/16 to 4/1/20, to avoid potential confounding from COVID-19., was doneperformed. This study focused on two groups: normotensive (systolic blood pressure (SBP) >100 and diastolic blood pressure (DBP) >60) throughout their stay and IDH (SBP > 100 and DBP < 60) at any point during their admission. We compared them these two groups on the occurrence of delirium after an IDH episode using. The statistical comparisons were done using chi-square tests and logistic regressions, which included other patient characteristics associated with IDH and delirium. RESULT(S): A total of 1656 patients met inclusion criteria and were assessed for delirium (613 normotensive and 1043 IDH). As hypothesized, delirium was significantly more likely in the IDH than in the normotensive group (5.1 vs 1.5%;p < 0.001). As predicted patients with SA history were more likely to have IDH (62.2 vs 56.0%) and were more likely to develop delirium (6.2% vs. 3.4%) although these differences were not statistically significant. The IDH effect on delirium was significant only for patients without SA history and SA history was significant for delirium only in the normotensive group (both p <.0.001). The effect of IDH and its interaction with SA remained significant in multivariate analysis. Age also remained an independent risk factor for delirium. CONCLUSION(S): These results confirm our prior work on the association of IDH and delirium and suggest that SA has an impact on IDH. Surprisingly, these two factors do not appear to compound each other. This pattern remains significant in a multivariate approach. More exploration of the interaction of substance abuse on IDH and other factors is needed.

Mental health and addiction diagnoses are linked to increased violent injuries and gaps in provision of resources during the COVID-19 pandemic

Background: The COVID-19 pandemic has been linked to increased mental health issues and interpersonal violence. Both psychiatric diagnoses and young males are overrepresented in the trauma population. Our objective was to characterize injury characteristics and their relationship to psychiatric diagnoses after the COVID-19 lockdown at a trauma centre in Edmonton, Alberta. Specifically, we queried relationships between gender, age, length of stay and intentionally violent injuries, and we reviewed access to inpatient and outpatient mental health and addiction resources. Method(s): We performed a retrospective chart audit for trauma patients aged 18-64 years admitted to the University of Alberta Hospital Trauma Service from June 1 to Aug. 31, 2020. Variables included demographics, injury characteristics, psychiatric history, substance use disorder history and presence of psychiatry and addictions consultations. Treatment plans and follow-up were assessed. Frequencies and basic descriptives were calculated. Univariate analyses were performed to identify relationships between psychiatric or addiction diagnosis (or both) and injury patterns. Result(s): A total of 176 patients met the inclusion criteria. Patients were young (mean age 39.7 yr) and male (73%), and blunt injury was most common (82%). Sixty-three patients (36%) had a psychiatric (29 patients) or addiction (59 patients) history. Twenty-eight patients (15%) received consults to the psychiatry service. At discharge, follow-up included mental health team (10 patients, 36%), family physician (2 patients, 7%) or self-referral resources (8 patients, 29%). Eight patients were not provided follow-up. Fifty-nine patients (34%) had 1 or more addictions history. Nineteen patients (32%) received consultations to psychiatry (18 patients) or addictions (1 patient). Otherwise, 6 patients (10%) were provided community resources at tertiary survey, 6 patients (10%) declined offered resources and 6 patients (10%) had traumatic brain injury (addiction resources deferred). Twenty-five patients (42%) either were not offered resources or documentation was unclear. On univariate analysis of patients with psychiatry consult, age was similar, but females were more likely to be represented (42% v. 24%, p = 0.06). Average length of stay was 17 days versus 9.7 days (p = 0.05). Having a psychiatric consultation or addictions history (or both) was associated with a violent mechanism of injury (35% v. 18%, p < 0.02). Conclusion(s): Over one-third of trauma patients aged 18-64 years had a psychiatric or addiction history (or both) and were significantly more likely to have a violent injury mechanism. Psychiatric consultation was common, more so in female patients, and linked to increased length of stay. Community follow-up was suboptimal, especially for patients with addiction history. Resource access and provision must be optimized to improve care, reduce recidivism and target interpersonal violence during this time of increased individual and system stress..

Alcohol use and trauma in Alberta after COVID-19 lockdown: Overrepresentation and undertreatment are opportunities for improvement

Background: Alcohol is a major factor in traumatic injuries. Accreditation bodies recommend alcohol screening and intervention programs as trauma quality indicators. Previous research in Alberta reported increasing alcohol use prevalence in major trauma. The COVID-19 pandemic has also been linked to increased alcohol consumption. Our objective was to characterize injury characteristics and their relationship to alcohol use during the summer trauma season after the COVID-19 lockdown, and compliance with alcohol misuse screening, at a level 1 trauma centre in Edmonton, Alberta. Method(s): We conducted a retrospective chart audit for trauma patients aged 18-64 years who were admitted to the University of Alberta Hospital Trauma Service from June 1 to Aug. 31, 2020. Variables included demographics, injury characteristics, ethanol level on presentation, history of substance use and screening or intervention. Tertiary surveys as well as psychiatry and addictions consultations were reviewed to assess compliance with screening and intervention. Frequencies and basic descriptives were calculated. Logistic regression was performed to identify relationships between alcohol use and injury patterns. Result(s): A total of 176 patients met the inclusion criteria. The mean age was 40 (standard deviation [SD] 13.8) years, and 128 (72.7%) were male. Blunt injuries were most common (144 patients [81.8%] had a blunt injury, 27 [15.3%] had a penetrating injury and 3 [1.7%] had a burn), with average Injury Severity Score 13 (1-45) and average length of stay 10.6 (SD 14.6) days. Motor vehicle crashes (MVCs) predominated (66 patients, 37.5%) followed by falls (33 patients, 18.8%), sport-related injuries (30 patients, 17.1%) and stabbings (17 patients, 9.7%). A total of 156 patients (88.6%) had an ethanol level drawn on presentation;50 (32%) were positive, and 33 of these (66%) were legally intoxicated. Forty-five patients (25.6%) had a documented addiction history with alcohol use disorder, 29 of whom presented with a positive ethanol level. Of the 50 patients with elevated ethanol level on presentation, the average age was 36 (SD 12.1) years and the mean ethanol level was 36.9 (SD 23.3) mmol/L. MVCs were the most common mechanism (18 patients, 36%). Screening for alcohol use disorder was performed in 39 (78%) of these 50 patients who presented with a positive ethanol level (unclear documentation in the remainder). Addiction services were offered to 10 of 50 patients (20%). Positive ethanol level was associated with younger age (36 v. 41 yr, p = 0.02). Logistic regression revealed that positive ethanol level was significantly associated with stab mechanism of injury (odds ratio [OR] 3.75, 96% confidence interval [CI] 1.1-11.6, p < 0.05);intoxication further increased association with stab injury (OR 4.4, 95% CI 1.4-15, p < 0.01). Conclusion(s): The prevalence of positive ethanol level in trauma patients is rising: 32% currently, compared with 24% from Alberta 2010 data. Over one-quarter of MVC patients had a positive ethanol level, and intoxication increased the odds of stab injury. Compliance with alcohol misuse screening was 78% with only 20% of patients offered intervention, despite 58% having alcohol use disorder. Interventions to reduce preventable injuries and alcohol misuse at the population and hospital levels are needed..

Autopsy (Forensic) Pathology

Increasing Traumatic Brain Injury Incidence during COVID-19 Pandemic in the Emergency Department of Cipto Mangunkusumo National General Hospital-A National Referral Hospital in Indonesia. Incidence of methamphetamine use in homicide victims - a retrospective study L Tan SP 1 sp , L Stephenson SP 2 sp , R Byard SP 3 sp SP I 1 i sp I Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia;i SP I 2 i sp I School of Biomedicine, The University of Adelaide, Adelaide, South Australia, Australia;and i SP I 3 i sp I Forensic Science South Australia, Adelaide i B Background: b Methamphetamine use is increasing in the Australian community. B Result: b There was a decrease in admission rate due to TBI during COVID-19 pandemic compared with the previous year (135 (54.9%) vs 111 (45.1%)). [Extracted from the article] Copyright of Histopathology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

IT'S NEXT TO THE PLEURA

SESSION TITLE: Pneumothorax, Chylothorax, and Pleural Effusion Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Chest tube placement is generally done to drain air (Pneumothorax) or fluid (Effusion or Hemothorax) from the pleural cavity. The incidence of complications related to such intervention varies between 1 to 6 percent (1), and includes but not limited to malposition, injuring chest wall structures, injuring intrathoracic structures, bleeding, and infection. In this case we present an unusual complication to surgical chest tube placement. CASE PRESENTATION: Our patient is a 59-year-old male, long term resident of a nursing facility with past medical history of alcohol use disorder in remission, alcoholic cirrhosis, seizure disorder, protein-calorie malnutrition and a recent COVID-19 infection. He presented with worsening shortness of breath and was admitted with acute hypoxemic respiratory failure. Initial CT scan showed fibrotic, reticular and cystic changes, traction bronchiectasis and diffuse bilateral ground glass opacities. He was admitted to the medical ICU;he was treated initially with broad spectrum antibiotics and diuresis with minimal response. Eventually steroid therapy was started for Covid related organizing pneumonia, and he improved. Later in his hospital state he developed bilateral small pneumothoraxes that enlarged overtime and a surgical chest tube was placed on the right side. Post procedure chest x ray showed that the tube was kinked, and the pneumothorax was still present. A follow up CT chest confirmed the presence of an extra-pleural hematoma with the tube kinked inside it. CT angiography of the chest was done and showed active extravasation of contrast into the extra-pleural space likely from the intercostal arterial branches. Interventional radiology took the patient to see if they could cauterize the bleeding vessel but they were unable to identify the source of bleeding. Thoracic surgery was also consulted and was planning to take the patient to the OR, remove the tube, evacuate the hematoma and control the bleeding. However, the patient opted against this. DISCUSSION: Extra-pleural hematoma is a rare complication of surgical chest tube placement. It is usually seen after blunt trauma or rib fracture, but can still occur after subclavian vein central line placement or chest tube placement. Bleeding is usually arterial in origin and treatment is often surgical. Radiological characteristics include biconvex shape and the extra-pleural fat sign (2,3,);hypodense rim medial to the hematoma due to the inward displacement of the extra-pleural fat by the hematoma. CONCLUSIONS: Chest tube placement remains a routine procedure that is done in emergency departments and hospital wards. Generally, a safe intervention but clinicians should be aware of the possible complications and their management including extra-pleural hematomas. Reference #1: Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010 Tom Havelock1, Richard Teoh2, Diane Laws3, Fergus Gleeson4 on behalf of the BTS Pleural Disease Guideline Group. Correspondence to Dr Tom Havelock, Wellcome Trust Clinical Research Facility, Southampton General Hospital, Southampton SO16 6YD, UK;t.havelock@soton.ac.uk Reference #2: Journal of Trauma and Injury 2017;30(4): 202-205. Published online: December 30, 2017 DOI: https://doi.org/10.20408/jti.2017.30.4.202 Traumatic Extrapleural Hematoma Mimicking Hemothorax Yong Seon Choi, M.D., Soon Jin Kim, M.D., Sang Woo Ryu, Seung Ku Kang Department of Thoracic and Cardiovascular Surgery, Mokpo Hankook Hospital, Mokpo, Korea Correspondence to: Soon Jin Kim, M.D., Department of Thoracic and Cardiovascular Surgery, Mokpo Hankook Hospital, 483 Yeongsan-ro, Mokpo 58643, Korea, Tel: +82-61-270-5574, Fax: +82-61-277-0199, E-mail : innocent-blood@hanmail.net Reference #3: The Journal of Emergency Medicine Volume 51, Issue 2, August 2016, Pages 159-163 Nonoperative Management of a Large Extrapleural Hematom after Blunt Chest Trauma LuisGorospe MD, María Ángeles Fernández-Méndez MD, AnaAyala-Carbonero MD, AlbertoCabañero-Sánchez MD, Gemma MaríaMuñoz-Molina MD, PhD DISCLOSURES: No relevant relationships by Ahmad Allaham No relevant relationships by Elyce Sheehan

Pattern of admission and outcome of patients admitted to dedicated trauma intensive care unit (ticu), emergency department, teaching hospital, north-eastern malaysia

Background: The role of dedicated Trauma ICU (TICU) in Emergency Department is vital in the chain of trauma care to ensure rehabilitation and sustainable critical care for a better survival outcome. This study is conducted to find out demographic patterns and predictors that can affect the outcomes of trauma patients.Methods: A retrospective review of all patients admitted to TICU, Hospital Universiti Sains Malaysia (HUSM) was carried out from January 1st, 2016 till December 31st, 2018. Data were collected from TICU admission and discharge registers and were analyse using SPSS version 23.0. Results: A total of 108 trauma patients were included in this study. All cases were exclusively blunt trauma (99.1%) and mainly attributed by road traffic injuries (92.6%). In terms of trauma clinical scoring, 25%(p= 0.001) presented with GCS score < 4, 46.9% (p=0.001) with RTS score <5.5 and 15.6% (p=0.012) with APACHE II score > 28had demonstrated prolonged ICU stay (> 7 days). Meanwhile 62.5% (p= 0.000) with GCS < 4, 75% (p= 0.000) with RTS < 5.5 and 75% (p= 0.000) with APACHE II > 28 were died in TICU. Besides that, those who had prolonged ICU stay (> 7 days) were 8.5 times higher odds to get sepsis (adj OR= 8.532;95% CI: 2.710, 26.863;p= 0.000) and 7 times higher odds to get acute kidney injury (AKI) (adj OR= 7.131;95% CI: 1.464, 34.733;p= 0.015). Meanwhile, patient who received blood transfusion led to 5 folds higher odds ofassociation with rhabdomyolysis (adj OR= 4.968;95% CI: 1.821, 13.549;p= 0.002).Conclusion: In the midst of pandemic COVID-19 it is important for ED physician to early identify and prioritise high risk trauma patient based on predictors and allows for targeted monitoring and intervention that may improve their outcome and also optimise resources accordingly.

JEJUNAL PERFORATION SECONDARY TO KICK DURING KICK-BOXING PRACTICE: LAPAROSCOPIC MANAGEMENT

Small bowel injury in a sports setting is a rare occurrence with a paucity of reported cases. A 30-year old male patient consulted for generalized abdominal pain subsequent to secondary blunt abdominal trauma during kick-boxing practice. A computed tomography scan of the abdomen and pelvis revealed a moderate amount of free fluid in both the parietocolic space and the rectovesical pouch, with perihepatic pneumoperitoneum. Emergency laparoscopy was indicated and a closure of small bowel defect was performed. Diagnosis of small bowel injuries is difficult, resulting in delayed treatment and increased mortality and morbidity.

Abstract Journal Cardiothoracic Surgery

CS020P TRANSCATHETER MITRAL VALVE-IN-VALVE REPLACEMENT IN A YOUNG ABORIGINAL PATIENT WITH SEVERE SOC... Abbey Knox, Damian Gimpel, Ajay Sinhal and Jayme Bennetts Flinders Medical Centre, SA B Purpose: b Transcatheter mitral valve-in-valve (TMVIV) replacement has emerged as an alternative to redo surgery in high-risk patients with degenerated mitral bioprosthesis. Demographic data, number of grafts, type of surgery (e.g., isolated CABG, CABG and valvular surgery), comorbidities, in-hospital stay post-surgery, and complications within 6 weeks of surgery were tabulated. To inform clinical decision-making for high-risk surgical patients, we performed a systematic review and meta-analysis aiming to characterise the outcomes of COVID-19 positive patients undergoing cardiac surgery. CARDIAC SURGERY FOR PATIENTS WITH COVID-19 - A SYSTEMATIC REVIEW AND META-ANALYSIS Aashray Gupta, Alasdair Leslie, Joseph Hewitt, Joshua Kovoor, Christopher Ovenden, Suzanne E... University of Adelaide, SA B Purpose: b The COVID-19 pandemic has had significant impact on global surgery. [Extracted from the article] Copyright of ANZ Journal of Surgery is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Cardiac arrest secondary to subclavian artery injury in blunt chest trauma: A lifesaving emergency surgery in COVID crises.

A 25-year-old male vehicle driver had a road traffic accident and sustained a blunt chest injury. His chest x-ray in the emergency department showed left hemithorax opacification. A chest drain Fr32 was inserted, and 1300ml of Blood drained out. While having a computed tomographic scan of the thorax scan, he had a cardiac arrest and after Cardiopulmonary Resuscitation (CPR) he was transferred to our tertiary care hospital on a mechanical ventilator and massive ionotropic support (adrenaline and noradrenaline) with a blood pressure of 50/24 mmHg. We performed a lifesaving emergency thoracotomy in a supine position with all COVID precautions, as COVID status was not available before hospitalization. After the repair of the Subclavian artery patient recovered completely and was discharged for follow-up in outpatient.

Blunt Trauma Associated With Bilateral Diaphragmatic Rupture: A Case Report.

Background: A bilateral diaphragmatic rupture is a rare event that occurs in cases of blunt thoracic-abdominal trauma. Case Presentation: We report the case of a 56-year-old female patient with pelvic fracture and second-stage bilateral rupture of the diaphragm due to a car accident. After a chest and abdominal contrast-enhanced computed tomography (CT) scan, the patient underwent emergency suturing of the left hemidiaphragm. On postoperative day (POD) 4, a CT scan performed due to the sudden onset of dyspnea revealed rupture of the right hemidiaphragm, which was not detected on the preoperative CT scan. On POD 9, the right hemidiaphragm was repaired with mesh during a right thoracotomy. The patient recovered 14 days after surgery. However, the postoperative course was complicated by an asymptomatic COVID-19 infection that significantly delayed her discharge from the hospital. Conclusions: Difficulties in preoperative diagnosis and treatment, together with the lack of data in the literature, make this type of trauma a challenge for all acute care and general surgeons.

Predicting Acute Respiratory Distress Syndrome in Severe Blunt Trauma: The Utility of Interleukin-18.

Background: In trauma, direct pulmonary injury and innate immune response activation primes the lungs for acute respiratory distress syndrome (ARDS). The inflammasome-dependent release of interleukin-18 (IL-18) was recently identified as a key mediator in ARDS pathogenesis, leading us to hypothesize that plasma IL-18 is a diagnostic predictor of ARDS in severe blunt trauma. Patients and Methods: Secondary analysis of the Inflammation and Host Response to Injury database was performed on plasma cytokines collected within 12 hours of severe blunt trauma. Trauma-related cytokines, including IL-18, were compared between patients with and without ARDS and were evaluated for association with ARDS using regression analysis. Threshold cytokine concentrations predictive of ARDS were determined using receiver-operating curve (ROC) analysis. Results: Cytokine analysis of patients without ARDS patients (n = 61) compared with patients with ARDS (n = 19) demonstrated elevated plasma IL-18 concentration in ARDS and IL-18 remained correlated with ARDS on logistic regression after confounder adjustment (p = 0.008). Additionally, ROC analysis revealed IL-18 as a strong ARDS predictor (area under the curve [AUC] = 0.83), with a threshold IL-18 value of 170 pg/mL (Youden index, 0.3). Unlike in patients without ARDS, elevated IL-18 persisted in patients with ARDS during the acute injury phase (p ≤ 0.02). Other trauma-related cytokines did not correlate with ARDS. Conclusions: In severe blunt trauma, IL-18 is a robust predictor of ARDS and remains elevated throughout the acute injury phase. These findings support the use of IL-18 as a key ARDS biomarker, promoting early identification of trauma patients at greater risk of developing ARDS. Timely recognition of ARDS and implementation of advantageous supportive care practices may reduce trauma-related ARDS morbidity and costs.

Surgical stabilization of rib fractures in symptomatic COVID-19: A case report.

Severe chest wall injury following trauma is a significant contributing factor to respiratory failure and need for mechanical ventilation in multiply injured patients. Surgical stabilization of rib fractures (SSRF) is increasingly considered to be advantageous in this population. Surgical stabilization has been shown to improve multiple outcomes including ventilator avoidance, liberation from mechanical ventilation, and diminished pulmonary complications in the trauma population, particularly when performed early. During the coronavirus disease 2019 (COVID-19) pandemic, ventilators have become a scarce resource, and conservative strategies have become a critical component of intensive care. We present a report of the perioperative outcome of SSRF in a geriatric polytrauma patient who initially presented after a mechanical fall and co-existing symptomatic COVID-19.

Multiple Approaches for Managing Complex Ophthalmic Blunt Trauma: A Case Report.

INTRODUCTION: Ophthalmic trauma is defined as injuries affecting the ocular structures, including the globe, eyelid, lacrimal system, and surrounding orbital walls. Blunt trauma acts as the leading cause of injury and it may affect both the anterior and posterior parts of the globe. Prompt diagnosis, early management, and sustained follow-up are mandatory for an optimal outcome. PURPOSE: This report presents a one-step surgery management process for an intricate case of blunt facial trauma with complex ophthalmic and nasal injury. PATIENTS AND METHODS: A 45-year-old male with blunt force trauma of the left eye from a wooden block, suffered from naso-orbital-ethmoidal fractures, eyelid laceration with canalicular, close-globe injuries of traumatic cataract and vitreous hemorrhage with retinal detachment. A simultaneous one-step surgery was performed by a trauma team of ophthalmological and ENT surgeons during the height of the COVID-19 pandemic to lessen the risk of cross-transmission. After ruling out the possibility of open-globe rupture, traumatic cataract extraction, retinal detachment surgery, the repair of an eyelid laceration with canalicular involvement, and septorhinoplasty were performed on concomitantly. RESULTS: Anatomical success was achieved for the repair of the nasoorbitoethmoidal (NOE) type II fracture and close-globe injuries, including the anatomical reattachment of the retina. However, the functional outcome remained unsatisfactory. Visual acuity failed to show further improvement at a later follow-up. Traumatic optic neuropathy was, at the final follow-up, considered to be the cause of the suboptimal visual acuity. CONCLUSION: A single-step multi-procedure for a complex ophthalmic blunt trauma, as demonstrated in this case, may be beneficial for reducing the complications that might arise due to treatment delay. The complex nature of the injury, however, creates the higher possibility for residual post-operative complications. Risks of residual functional impairment should be considered in such complex trauma prior to surgery, to determine the surgical prognostic value and provide appropriate consent to the patient.

Surviving traumatic cardiac arrest: Identification of factors associated with survival.

INTRODUCTION: The endpoint of resuscitative interventions after traumatic injury resulting in cardiopulmonary arrest varies across institutions and even among providers. The purpose of this study was to examine survival characteristics in patients suffering torso trauma with no recorded vital signs (VS) in the emergency department (ED). METHODS: The National Trauma Data Bank was analyzed from 2007 to 2015. Inclusion criteria were patients with blunt and penetrating torso trauma without VS in the ED. Patients with head injuries, transfers from other hospitals, or those with missing values were excluded. The characteristics of survivors were evaluated, and statistical analyses performed. RESULTS: A total of 24,191 torso trauma patients without VS were evaluated in the ED and 96.6% were declared dead upon arrival. There were 246 survivors (1%), and 73 (0.3%) were eventually discharged home. Of patients who responded to resuscitation (812), the survival rate was 30.3%. Injury severity score (ISS), penetrating mechanism (odds ratio [OR] 1.99), definitive chest (OR 1.59) and abdominal surgery (OR 1.49) were associated with improved survival. Discharge to home (or police custody) was associated with lower ISS (OR 0.975) and shorter ED time (OR 0.99). CONCLUSION: Over a recent nine-year period in the United States, nearly 25,000 trauma patients were treated at trauma centers despite lack of VS. Of these patients, only 73 were discharged home. A trauma center would have to attempt over one hundred resuscitations of traumatic arrests to save one patient, confirming previous reports that highlight a grave prognosis. This creates a dilemma in treatment for front line workers and physicians with resource utilization and consideration of safety of exposure, particularly in the face of COVID-19.