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BACKGROUND: Tension pneumothorax following trauma is a life-threatening emergency and radiological investigation is normally discouraged prior to treatment in traditional trauma doctrines such as ATLS. Some trauma patients may be physiologically stable enough for diagnostic imaging and occult tension pneumothorax is discovered radiologically. We assessed the outcomes of these patients and compared them with those with clinical diagnosis of tension pneumothorax prior to imaging. METHODS: A multicentre civilian-military collaborative network of six major trauma centres in the UK collected observational data from adult patients who had a diagnosis of traumatic tension pneumothorax during a 33-month period. Patients were divided into 'radiological' (diagnosis following CT/CXR) or 'clinical' (no prior CT/CXR) groups. The effect of radiological diagnosis on survival was analysed using multivariable logistic regression that included the covariates of age, gender, comorbidities and Injury Severity Score. RESULTS: There were 133 patients, with a median age of 41 (IQR 24-61); 108 (81%) were male. Survivors included 49 of 59 (83%) in the radiological group and 59 of 74 (80%) in the clinical group (p=0.487). Multivariable logistic regression showed no significant association between radiological diagnosis and survival (OR 2.40, 95% CI 0.80 to 7.95; p=0.130). There was no significant difference in mortality between the groups. CONCLUSION: Radiological imaging may be appropriate for selected trauma patients at risk of tension pneumothorax if they are considered haemodynamically stable. Trauma patients may be physiologically stable enough for radiological imaging but have occult tension pneumothorax because they did not have the typical clinical presentation. The historical dogma of the 'forbidden scan' no longer applies to such patients.
RESUMO
INTRODUCTION: The idea of implementing theatrical acts in medical education has recently been gaining attention, with the inclusion of art-based programs in medical curricula being a growing trend. This study aimed to present an innovative pilot program of presenting medical emergencies through theatrical presentation. MATERIALS AND METHODS: Students-members of the theatrical team of Democritus University of Thrace and the Scientific Society of Hellenic Medical Students were appointed into eight groups, supervised by a clinical tutor. The groups were given four weeks to prepare scenarios for eight different medical emergencies and organize a theatrical sketch accordingly. A 25-item questionnaire was formed and distributed to the audience. Each theatrical act lasted 10 min, followed by a 10 min discussion between the tutors and the audience. After the event, the impressions of the attendees were documented in the questionnaire as responses on a Likert scale from one (strongly disagree) to five (strongly agree). RESULTS: Two hundred and thirty-two fully completed questionnaires were returned. The contribution of theatrical presentation to medical education was widely acknowledged (Likert score 4.14 ± 0.68). Theatrical seminars were not deemed insufficient to provide medical information (disagreed or strongly disagreed 53.8 % and 12.1 %, respectively). Most students were optimistic about the long-term maintenance of the theatrical-aided knowledge, with the majority of attendees (52.1 %) adapting a more favorable response after the seminar (p <0.001). The students' efficacy to recognize medical emergencies was improved (from 2.96 to 3.43, p <0.001). CONCLUSION: Students find the theatrical approach of emergency cases entertaining and educational, facilitating teaching in medicine and enhancing their efficacy to recognize medical emergencies and the commonest pitfalls in their diagnosis and management. Such events may be established as a supplementary educational tools to the classical amphitheatric didactic lectures. Future studies with specific objective tools are needed to validate the abovementioned tasks. HIPPOKRATIA 2020, 24(3): 127-132.
