Helicopter-Based Search and Rescue Operations in the Dutch Caribbean: A Retrospective Analysis.

INTRODUCTION: Search and rescue (SAR) operations in the Dutch Caribbean offer basic and advanced prehospital care and transport for definitive care. Helicopter-based SAR in this geographic area has not been previously studied. Data from the Dutch Caribbean Coast Guard were analyzed with the aim of describing the current operational setting and optimizing SAR operations in the future. METHODS: Data were collected retrospectively from March 2018 through April 2021. Epidemiologic data, patient demographics, details of flight operations, medical interventions, and outcomes were collected and analyzed for this period. RESULTS: A total of 91 individuals were assisted through SAR, of whom 40 (44%) had a medical emergency. Most incidents occurred during high-tourism seasons. A yearly increase in helicopter tasking was observed. Boating was the most common activity (25%) requiring SAR. Injuries to the extremities were the most common injury (27%). The median time to reach the scene of SAR was 46 (interquartile range [IQR], 33-66) min. The most frequent reason for delay was the unavailability of a winch operator (15%). Of 16 fatalities, most (63%) were attributed to drowning. A total of 18 persons were transported to a hospital, with a median travel time of 63 (IQR, 47-79) min. CONCLUSIONS: The number of SAR missions in the Dutch Caribbean is increasing. The response times might be reduced by the inclusion of an on-call winch operator. A hospital helipad would likely decrease the time to definitive care. Stand-by physicians might improve the quality of medical care. Collection of data should be optimized in the future.

The Use of CT Scan in Hemodynamically Stable Children with Blunt Abdominal Trauma: Look before You Leap.

We set out to determine the diagnostic value of computed tomographic (CT) scans in relation to the radiation dose, tumor incidence, and tumor mortality by radiation for hemodynamically stable pediatric patients with blunt abdominal injury. We focused on the changes in management because of new information obtained by CT. CT scans for suspected pediatric abdominal injury performed in our accident and emergency department were retrieved from the radiology registry and analyzed for: injury and hemodynamic parameters, changes in therapy, and radiological interventions. The dose length product (DLP) was used to calculate the effective dose (ED) and with the BEIR VII report we calculated the estimated induced lifetime tumor and mortality risk. Seventy-two patients underwent abdominal CT scanning for suspicion of abdominal injury and eight patients were excluded for hemodynamic instability, leaving 64 hemodynamically stable patients. Four patients died (6%). On the remaining 60 patients, only one laparotomy was performed for suspicion of duodenal perforation. Only in three out of the 64 hemodynamically stable cases (5%), a CT scan brought forward an indication for intervention or change in management. One patient was suspected of a duodenal perforation and underwent a laparotomy. A grade II hepatic laceration, but no duodenal, injury was found. Two patients underwent embolization of the splenic artery. One for an arterial blush caused by splenic laceration as was observed on the contrast enhanced-CT. Patient remained stable and during the angiogram the blush had disappeared. The second patient underwent (prophylactic) selective arterial embolization for having sustained a grade V splenic injury. The median radiation dosage was 11.43 mSv (range 1.19-23.76 mSv) in our patients. The use of the BEIR VII methodology results in an estimated increase in the lifetime tumor incidence of 0.17% (range, 0.05-0.67%) and an estimated increase in lifetime tumor incidence of 0.08% (0.02-0.28%). The results of our data suggest that the use of CT scans can largely be avoided in hemodynamically stable children with blunt abdominal injury.

Gastric pneumatosis in a small-for-gestational-age neonate.

We describe a dysmature (small-for-gestational-age) neonate born at term with multiple congenital defects, who presented with bloody diarrhoea. The abdominal X-ray showed gastric pneumatosis. The patient was treated conservatively with intravenous fluids and antibiotics, and recovered uneventfully. The patient underwent genetic investigation, and was diagnosed with Cornelia de Lange syndrome. Gastric pneumatosis is rare, and may be the result of neonatal sepsis, gastritis, pyloric stenosis, necrotising enterocolitis of the stomach, misplacement of nasogastric tubes, or non-invasive positive pressure ventilation. Furthermore, it is speculated that gastric pneumatosis might more frequently occur with congenital, cardiac or genetic disorders.

Simultaneous occurrence of Meckel's diverticulum and patent urachus.

The simultaneous occurrence of a Meckel's diverticulum and a patent urachus is very uncommon. We describe the occurrence and surgical treatment of Meckel's diverticulum and an urachal anomaly in a 1-year-old boy. The patient had intermittent production of clear fluid from the patent urachus, which disappeared after surgical resection.

Haemorrhagic rupture of hepatic simple cysts.

Haemorrhagic rupture is a life-threatening complication of a hepatic simple cyst. A 63-year-old man presented with severe acute abdominal pain and a massive haemoperitoneum resulting from haemorrhagic rupture of a large hepatic cyst. The haemorrhagic rupture was aggravated by an overdose of vitamin K-antagonist treatment. CT scans revealed a large hepatic simple cyst. The patient was successfully treated conservatively with resuscitation, transfusion therapy and administration of coagulation agents. To date, there is no clear evidence regarding optimal treatment of haemorrhagic hepatic cyst rupture. The risk of recurrent bleeding from the haemorrhagic hepatic simple cyst, and the need for final treatment to avoid rebleeding either by percutaneous sclerotherapy, endovascular embolisation, surgical cyst resection, or surgical deroofing, is discussed.

External validation of the Blunt Abdominal Trauma in Children (BATiC) score: ruling out significant abdominal injury in children.

BACKGROUND: The aim of this study was to validate the use of the Blunt Abdominal Trauma in Children (BATiC) score. The BATiC score uses only readily available laboratory parameters, ultrasound results, and results from physical examination and does therefore not carry any risk of additional radiation exposure. METHODS: Data of pediatric trauma patients admitted to the shock room between 2006 and 2010 were retrospectively analyzed. Blunt abdominal trauma was defined radiologically or surgically. The BATiC score was computed using 10 parameters as follows: abnormal abdominal ultrasound finding, abdominal pain, peritoneal irritation, hemodynamic instability, aspartate aminotransferase greater than 60 U/L, alanine aminotransferase greater than 25 U/L, white blood cell count greater than 10 × 10/L, lactate dehydrogenase greater than 330 U/L, amylase greater than 100 U/L, and creatinine greater than 110 µmol/L. Sensitivity, specificity, negative predictive value, and positive predictive value were computed. Missing values were replaced using multiple imputation, and BATiC scores were calculated based on imputed values. RESULTS: Included were 216 patients, with 144 males, 72 females, and a median age of 12 years. Eighteen patients (8%) sustained abdominal injury. Median BATiC scores of patients with and without intra-abdominal injury were 9.2 (range, 6.6-15.4) and 2.2 (range, 0.0-10.6) respectively (p < 0.001). When the BATiC score is used with a cutoff point of 6, the test showed a sensitivity of 100% and a specificity of 87%. Negative and positive predictive values were 100% and 41% respectively. The area under the curve was 0.98. CONCLUSION: The BATiC score can be a useful adjunct in the assessment of the presence of abdominal trauma in children and can help determine which patients might benefit from a computed tomographic scan and/or further treatment and which might not. LEVEL OF EVIDENCE: Prognostic study, level II.

Acute acalculous cholecystitis after abdominal wall repair (Rives-Stoppa).

Acute acalculous cholecystitis (AAC) is a rare condition normally occurring in critically ill patients. Compared to acute calculous cholecystitis, AAC is associated with complications and has a worse outcome. Hence, knowledge of this condition is very important. We describe a case of a 31-year-old man who developed AAC after abdominal wall repair with mesh (Rives-Stoppa procedure) 1 day after discharge from the hospital. To the best of our knowledge, this is the first paper to report AAC after abdominal incisional hernia repair. Although it is known to be more common in critically ill patients, AAC can also occur postoperatively in outpatients. Early recognition and treatment of AAC may improve outcome.

Case report: Painless chronic liner dissociation of a total hip arthroplasty.

BACKGROUND: Dislocation or liner dissociation of a total hip prosthesis usually results in pain and discomfort. Although several reports describe chronic dislocation and its treatment, chronic liner dissociation is an unreported complication. CASE DESCRIPTION: We report an unrecognized dissociation and displacement of the liner of a total hip prosthesis after revision THA. The patient had virtually no pain or functional restrictions. The patient's only complaint was pain on the contralateral side, associated with a leg-length discrepancy. Since the patient had no complaints relative to the liner dissociation we elected not to pursue further treatment. The contralateral pain was treated successfully with a shoe lift. LITERATURE REVIEW: Chronic dislocation of a THA is a rare complication and we found reports of only seven cases in the literature. We found no reports of chronic liner dissociation. CLINICAL RELEVANCE: Orthopaedic surgeons should be aware of the possibility of this rare complication. Our case and the literature suggest treatment can be nonsurgical or surgical.

[Does CT scan for blunt abdominal trauma in children amount to a lot of radiation for little yield?]. / CT-scan bij stomp buiktrauma bij kinderen: veel stralen en weinig opbrengst?

Blunt abdominal trauma in children occurs fairly frequently. Although computed tomography scanning is considered by many to be the gold standard, in children who are hemodynamically stable, CT images do not usually result in new perspectives that lead to changes in treatment management. However, the burden of radiation for the child is considerable. CT scanning for blunt abdominal trauma should therefore be avoided in children who are hemodynamically stable. Novel algorithms, using parameters from the patient's history, physical examination, and possibly ultrasound and laboratory tests, seem to be sufficient for ruling out intra-abdominal injury in more than 95% of cases.

[Pancreatic injury in abdominal trauma in children: difficult to diagnose and treat]. / Pancreasletsel na buiktrauma bij kinderen: lastig te diagnosticeren en te behandelen.

Traumatic injury of the pancreas is rare in children. It is often difficult to diagnose due to the lack of signs and symptoms, and shortly after trauma laboratory values may be normal. In addition, ultrasound and CT are often not specific. The treatment of grade 1 and 2 injury is non-operative. Although there seems to be a shift towards non-operative management of grade 3-5 injuries (with injury of the pancreatic duct), this is still a matter of debate. We describe 3 children, a girl of 2.5 years-old and a boy of 7 years-old, with grade 3 pancreatic injuries and an 8-year-old boy with a grade 2 injury. We demonstrate that the diagnosis is hard to establish, while the consequences of this injury can be serious. Thinking of pancreatic injury is most important to its diagnosis. We advocate referral to or consultation of specialized centres in these cases.