Possible Predictive Factor of Acute Respiratory Distress Syndrome Development After Mild Traumatic Brain Injury: A Single Rural Trauma Center Preliminary Study.

Introduction Acute respiratory distress syndrome (ARDS) after mild traumatic brain injury (TBI) can be associated with significant morbidity and mortality. This study aimed to evaluate the potential predictive factors of ARDS development following mild TBI in trauma patients. Methods A retrospective chart review was done for adult trauma patients with mild TBI (GCS 13-15) requiring admission at our center from 2012 to 2020. Linear regression analysis and chi-square test were utilized to identify independent predictors of the association with ARDS in adults with mild TBI.  Results A total of 784 mild TBI patients were admitted during the time of interest; 34 patients developed ARDS during their index hospitalization. Patients who had ARDS were more likely to have acute kidney injury (AKI; p < 0.0001), sepsis (p < 0.01), rib fractures (p < 0.05), use of anticoagulants (p < 0.001), deep vein thrombosis (p < 0.001), transfusion during the first 4four hours upon admission (p = 0.01), intravenous fluid (IVF) resuscitation during the first four hours (p <0.05), the first eight hours (p = 0.01), the first 12 hours (p = 0.03), and intubation upon the admission (p < 0.0001). ARDS associated with mild TBI demonstrated a statistically significant increase in mortality during the index hospitalization (p < 0.0001). Conclusion ARDS after mild TBI can be associated with significant morbidity and mortality. Key risk factors identified include AKI, sepsis, anticoagulant use, deep vein thrombosis (DVT), transfusion in the first four hours, IVF resuscitation in the first four, eight, and 12 hours, and intubation upon admission.

Rare pathology in a trauma patient: air embolism following peripheral intravenous access.

A 62-year-old man presented as a trauma alert after a farm tractor accident. He was managed according to ATLS protocol. During initial trauma resuscitation, he developed an iatrogenic air embolus. The patient was treated conservatively by positioning him head down and tilted to the left (Durant's manoeuvre). Repeat CT scan performed 4 hours later showed resolution of the air embolus. He had no sequelae.

Rolling a trauma patient onto the right side increases sensitivity of FAST examination.

PURPOSE: Hemoperitoneum in the hypotensive trauma patient is an indication for emergent laparotomy. Focused assessment sonography in trauma (FAST) is a widely used tool for detecting hemoperitoneum. The usefulness of FAST is currently limited by low sensitivity. We hypothesize rolling patients onto their right side will pool small volumes of fluid into the right upper quadrant of the abdomen leading to increased sensitivity. METHODS: Peritoneal dialysis patients were recruited for voluntary participation in a small pilot prospective clinical trial. Each participant first underwent a supine FAST followed by a 30-second roll onto the right side. Once back in the supine position, the FAST was repeated (FASTeR or FAST examination after right-sided roll). About 50 mL aliquots of dialysate were sequentially infused into the abdomen and the imaging sequence repeated until a positive finding was obtained. RESULTS: Seven patients were consented for the study. One patient was found to have an equivocal examination secondary to renal cysts. All six remaining participants converted to a positive FASTeR at an intra-abdominal fluid volume at which standard FAST was negative. CONCLUSIONS: Rolling patients to the right side increased FAST sensitivity, converting false-negative to true positives examinations. A larger study is needed to validate our preliminary data.

Rethinking the Use of Routine Platelet Transfusions for Head Injured Patients on Antiplatelet Therapy.

Traumatic brain injury is responsible for over one million hospital visits, and thousands of deaths annually. The aging population is associated with an increased use of anticoagulation and antiplatelet agents which complicates traumatic brain injury. The use of antiplatelet agents significantly increases baseline risk of intracranial hemorrhage. However, routine platelet transfusion in an attempt to reverse the effects of antiplatelet agents may be detrimental. Here, we report a case of an elderly woman with mild traumatic brain injury, who suffered a tragic demise after platelet transfusion.

Successful Retrieval of a Retained Rectal Foreign Body in the Emergency Department.

Rectal foreign bodies are a common presenting complaint in the emergency department. Anal eroticism is the major reason for the majority of cases of rectal foreign bodies. A high index of suspicion is required to accurately diagnose a rectal foreign body as patients are often embarrassed about their condition and may not present in a timely fashion to be evaluated or volunteer their history. Extraction techniques include transanal, endoscopic, and laparotomy with repair of complications. Here, we present the case of successful transanal manual removal of a retained dumbbell in the rectum of a middle-aged man.

Successful use of resuscitative endovascular balloon occlusion of the aorta in the treatment of ruptured 8.5-cm splenic artery aneurysm.

Spontaneous rupture of splenic artery aneurysm is a rare cause of acute abdomen with hemorrhagic shock that is a life-threatening surgical emergency. We report a case of a spontaneous rupture of an 8.5-cm splenic artery aneurysm managed using resuscitative endovascular balloon occlusion of the aorta (ER-REBOA Catheter; Prytime Medical Inc, Boerne, Tex) for proximal control of the aorta before laparotomy. This is a minimally invasive technique that can be used as an adjunct to massive transfusion resuscitation and laparotomy for life-threatening intraperitoneal hemorrhage.