Efficacy of a perfused cadaver model for simulated trauma resuscitation in advanced surgical skills training.

BACKGROUND: To develop a perfused cadaveric model for trauma surgery simulation, and to evaluate its efficacy in trauma resuscitation advanced surgical skills training. METHODS: Fourteen fourth-year general surgery residents attended this workshop at Siriraj Hospital (Bangkok, Thailand). Inflow and outflow cannulae and a cardiopulmonary bypass pump were used to create the perfusion circuit. Inflow was achieved by cannulating the right common carotid artery, and outflow by cannulation of both the right common femoral artery and the internal jugular vein. Arterial line monitoring was used to monitor resuscitation response and to control perfusion pressure. The perfusion solution comprised saline solution mixed 1:1 with glycerol (50%) and water with red food dye added. Advanced surgical skills during life-threatening injuries and damage control resuscitation operations were practiced starting from the airway to the neck, chest, peripheral vessels, abdomen, and pelvis. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was also practiced. Post-workshop survey questions were grouped into three categories, including comparison with previous training methods; the realism of anatomical correlation and procedures; and, satisfaction, safety, and confidence. All questions and tasks were discussed among all members of the development team, and were agreed upon by at least 90% of experts from each participating medical specialty/subspecialty. RESULTS: The results of the three main groups of post-workshop survey questions are, as follows: (1) How the training compared with previous surgical training methods-mean score: 4.26/5.00, high score: 4.73/5.00; (2) Realism of anatomical correlation and procedures-mean score: 4.03/5.00, high score: 4.60/5.00; and, (3) Satisfaction, safety, and confidence-mean score: 4.24/5.00, high score: 4.47/5.00. CONCLUSION: The developed perfused cadaveric model demonstrated potential advantages over previously employed conventional surgical training techniques for teaching vascular surgery at our center as evidenced by the improvement in the satisfaction scores from students attending perfused cadaveric training compared to the scores reported by students who attended earlier training sessions that employed other training techniques. Areas of improvement included 'a more realistic training experience' and 'improved facilitation of decision-making and damage control practice during trauma surgery'.

Prevalence of emergency medical service utilisation in patients with out-of-hospital cardiac arrest in Thailand.

BACKGROUND: Most patients with out-of-hospital cardiac arrest (OHCA) have grave outcomes. The efficacy of emergency medical services (EMS) may affect outcomes. However, no data exists in Thailand. OBJECTIVES: To ascertain the prevalence of EMS utilisation in patients with OHCA transferred to Siriraj Hospital and also to elucidate the rates of return of spontaneous circulation (ROSC), hospital admission and survival to hospital discharge. METHODS: This prospective cohort study was conducted in patients with OHCA at a university hospital in Bangkok, Thailand from May 2011 to February 2013. The data was gathered by interviewing bystanders. Data about the mode of transportation, reasons for EMS usage, response time, ROSC and 30-day mortality were collected. Patients with rigour mortis or livor mortis were excluded. The factors affecting ROSC and survival rate were determined by univariate analysis. RESULTS: One hundred and fifty-two patients were included. The prevalence of EMS usage was 14.5% (95% CI 9.3 to 21.0). The most common cause of non-usage of EMS was not knowing or forgetting an EMS number (49.2%). The proportion of bystanders having known an EMS number and using EMS was 34%. The ROSC and 30-day survival rates were 53.3% and 10.5%, respectively. Non-cardiac causes and witnessed arrests were associated with ROSC (p<0.05). CONCLUSIONS: The prevalence of EMS utilisation in OHCA at Siriraj Hospital was very low. This may affect the outcomes of patients with OHCA. Improving the EMS system by publicity to increase public awareness and providing life-support education nationwide may improve outcomes of patients with OHCA in Thailand.

Thoracic trauma at Siriraj Hospital 1997-2006.

Thoracic trauma is a common injury that has a high mortality rate. Fortunately, most can be treated by a simple maneuver as intercostal drainage (79.4%). During the decade 1997-2006, there were 897 admitted patients in the Trauma division of Siriraj Hospital. Most were men (85.5%) and the common age group was 21-30 years. Blunt trauma was the major type of injury (58.9%) and traffic accidents were common causes. Abdominal injury was the most common associated injury. After the management was improved, the overall mortality rate was reduced from 7.0% to 5.1%. Today, minimally invasive surgery such as laparoscopy can reduce hospital stays and pain in patients with thoracoabdominal injury.

Benefit of hydrocolloid SSD dressing in the outpatient management of partial thickness burns.

Silver sulfadiazine has been used as topical medication in the treatment of partial-thickness burns or secondary degree burns for many years. Pain during daily wound cleansing is the main problem. Urgotul SSD, a hydrocolloid dressing with silver sulfadiazine (SSD) has been reported to reduce infection and exhibit antimicrobial activity in burn wounds. The purpose of the present study was to compare the efficacy of Urgotul SSD and 1% silver sulfadiazine for treatment of partial thickness burn wounds. The authors reviewed 68 patients who had partial thickness burn wound less than 15% total body surface area (TBSA%) and were treated at Siriraj outpatient burn clinic during July 2005-December 2006. All patients were divided into two groups: Urgotul SSD treated group (34 patients) and 1% silver sulfadiazine treated group (34 patients). The two groups were compared by the demographic data including age, gender, % total body surface area (TBSA) burn, % TBSA deep burn, type of burn as well as percent of wound infection, total cost of wound dressing, pain medication, level of pain and time of wound healing. There were no differences in demographic data of age, % TBSA burn, % wound infection, total treatment cost of burn wound care (52 +/- 38 US$ for Urgotul SSD versus 45 +/- 34 US$ for silver sulfadiazine treated group). Time of wound closure was significantly shorter in the Urgotul SSD treated group (10 +/- 4 days in Urgotul SSD versus 12 +/- 6 in 1% silver sulfadiazine treated group) between both groups (p < 0.05). Average pain scores and pain medication in Urgotul SSD treated group was significantly lower than 1% silver sulfadiazine treated group (3 +/- 1 versus 6 +/- 2 and respectively, p < 0.05). All of the patients who developed wound infection responded well to targeted topical and oral antibiotic treatment. The authors conclude that Urgotul SSD has advantages of reducing pain symptom, pain medication requirement, increased patient convenience due to decreased time of follow-up at outpatient burn clinic, limiting the frequency of replacement of the dressing at comparable total cost and incidence of burn wound infection. The present study confirms the efficacy of Urgotul SSD in the treatment of partial thickness or secondary degree burn wound at the outpatient clinic.

The role of laparoscopic management in suspected traumatic diaphragmatic injury patients: a tertiary care center experience.

BACKGROUND: Management of posttraumatic diaphragmatic injury (DI) is still challenging. In suspected patients with stable hemodynamic, laparoscopy may aid in the diagnosis and treatment of DI. OBJECTIVE: To analyze and determine the role of laparosocopy in diagnosis and treatment of suspected diaphragmatic injury patients at Trauma Centre, Faculty of Medicine Siriraj Hospital. MATERIAL AND METHOD: A prospective descriptive study was conducted between 2001 and 2008 in Division of Trauma Surgery, Siriraj Hospital, Mahidol University, Thailand. Twenty-four suspected DI patients with stable hemodynamic were reviewed and analyzed Laparoscopy was performed in all patients. RESULTS: Of the patients, 95.8% were men with a mean age of 27.3 years (range, 14-54 yr). Twenty-three patients (95.8%) had a penetrating injury. Five patients (20.8%) presented with tachypnea and decreased breath sound Pneumohemothorax occurred in five patients (20.8%). Chest x-ray revealed diaphragmatic elevation in one patient (4.2%). Five cases (20.8%) were found DI. In one patient with right-sided DI, thoracoscopic repair was performed There were no procedure related complications. All patients were discharged 72 hours after the operation. CONCLUSION: Laparoscopy is an excellent diagnostic and therapeutic tool in hemodynamically stable patients. Left-sided DI can be successfully treated with laparoscopic repair However right-sided DI may be better with thoracoscopic repair.