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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 10 | Issue 1
Page Nos. 1-43

Online since Monday, March 9, 2020

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EDITORIAL  

What's new in critical illness and injury science? A look into trauma airway management p. 1
Jennifer L Stahl, Andrew C Miller
DOI:10.4103/IJCIIS.IJCIIS_14_20  
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EXPERT COMMENTARY Top

Operating room trauma simulation: The St. Luke's University Health Network experience p. 4
Victoria Marcks, Kathryn Hayes, Stanislaw P Stawicki
DOI:10.4103/IJCIIS.IJCIIS_17_20  
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ORIGINAL ARTICLES Top

Epidemiology and outcome of trauma victims admitted in trauma centers of tertiary care hospitals – A multicentric study in India p. 9
Manoj Kashid, SK Rai, SK Nath, TP Gupta, Omna Shaki, Pramod Mahender, Rohit Varma
DOI:10.4103/IJCIIS.IJCIIS_77_19  
Background: Roadside trauma in India is an increasingly significant problem, particularly because of bad roads, irregular road signs, overcrowding, overspeeding, and bad traffic etiquettes. Adequate information on the characteristics of victims, causes of accidents, frequency, vehicles involved, alcohol intake, and outcome of management is essential for understanding and planning for better management. Aim: This study aimed to determine the characteristics of trauma (roadside accidents) victims admitted to various trauma centers in India. The purpose of this study is to examine the epidemiology of trauma within a local community in India through data gained from the different emergency centers and to analyze trauma patients to find the predictors that led to the deaths of trauma patients. Materials and Methods: The present observational study involved trauma victims over 1-year period in three centers. Demographical details recorded were age, sex, alcohol intake, systolic blood pressure on arrival, respiratory rate, Glasgow Coma Scale (GCS) score, the interval between injury and admission, Injury Severity Score (ISS) risk factors, hospital stay, and outcome. Results: A total of 2650 injuries were recorded in 2466 patients. The mean age was 42.45 ± 15.7 years, the mean ISS was 13.82 ± 6.2, and the mean GCS was 12.20 ± 4.1. The mean time to admission at different trauma centres was 48.41 ± 172.8 h. The head injury was the most common (29.52%). Conclusion: Road side accidents due to overspeeding was the most common cause whereas driving under the effect of alcohol was the second most common cause. Accidents are common because of bad traffic etiquette on Indian roads.
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Cervical spinal stenosis and risk of pulmonary dysfunction p. 16
Esraa M Fahad, Zainab M Hashm, Ihsan M Nema
DOI:10.4103/IJCIIS.IJCIIS_83_19  
Background: Cervical spinal stenosis (CSS) is defined as an abnormal narrowing of the cervical spinal canal. The essential clinical challenges with CSS are altered cervical spinal cord function and cervical radiculopathy. Phrenic nerve palsy leading to hemidiaphragmatic paresis may be a temporary or persistent phenomenon after cervical cord injury and CSS. Objective: The objective of the study is to elucidate the potential effect of CSS on the pulmonary functions. Methods: This is a case–control study which included 40 patients divided into two groups 30 females and 10 males patients with CSS (C5 and above) and 60 healthy volunteers with body mass index (BMI) <30 Kg/m2. Pulmonary function tests have been done for all the patients. Results: The present study showed that VC in expiration (VC EX%), forced expiratory volume (FEV%), forced vital capacity % (FVC%), PEF%, and mean voluntary ventilation % (MVV%), were low in patients CSS compared with the control groups; P < 0.001, P < 0.001, P < 0.001, P = 0.042, and P = 0.037, respectively. As well, VC EX%, FEV1%, and FVC% were low in male patients in comparison to the controls P < 0.05. Besides, there were no significant differences regarding age, BMI, VC in inspiration (VC IN%), PEF%, FEV1/FVC%, and MVV%. Moreover, VC EX%, FEV1%, and FVC% were low in female patients compared to the controls, P < 0.001. Whereas, there were no significant differences that had been identified between female patients and female controls regarding age, BMI, VC IN%, PEF%, FEV1/FVC%, and MVV%. On the other hand, weight, height, and MVV% were low in female patients compared to male patients, P < 0.001. Conclusion: Chronic CSS leads to subclinical pulmonary dysfunction due to the involvement of the phrenic nerve. FEV% is the most sensitive parameter in the detection these disorders.
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Airway management at Level 1 trauma center in the era of video laryngoscopy p. 20
Jack Louro, Roman Dudaryk, Yvette Rodriguez, Richard P , Richard H Epstein
DOI:10.4103/IJCIIS.IJCIIS_14_19  
Background: Rapid sequence induction and tracheal intubation through direct laryngoscopy (DL) has been the most common approach to secure the airway in trauma patients. The introduction of video laryngoscopy (VL) has changed airway management in many clinical settings. In this retrospective study, we assessed if immediate availability of VL in the trauma suite has changed the approach and outcomes of airway management during acute resuscitation at a dedicated trauma center. Materials and Methods: We retrospectively collected data from emergency intubation in the 6 resuscitation bays at a high-volume, academic, Level 1 trauma center over a 42-month period following the introduction of immediately available VL in the resuscitation bay. We divided the data into 13-week bins to assess the trend in the use of VL over time. Our measured outcomes were the incidence of failed intubations requiring a surgical airway and the frequency of VL use for airway management. Results: Among 1328 airway management events in the resuscitation bays when intubation was attempted, the failure rate resulting in the placement of a surgical airway was 0.38% (95% confidence interval [CI], 0.12% –0.88%). This was consistent with the surgical airway rate before the introduction of VL into trauma practice (0.3%). VL use (primary or as a rescue technique) throughout the study period was 4.14% (95% CI, 2.76%–5.74%), with no temporal trend. Conclusion: The immediate availability of VL in the resuscitation bay has not changed the prevalence of its use during emergency airway management at our trauma center. DL remains a preferred primary modality for airway management by the trauma anesthesiologists working at this facility, with an acceptably low incidence of both primary failure and the need to establish a surgical airway.
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Characteristics of scene trauma patients discharged within 24-hours of air medical transport p. 25
Christopher Gilliam, David C Evans, Chance Spalding, Josh Burton, Howard A Werman
DOI:10.4103/IJCIIS.IJCIIS_75_19  
Introduction: Helicopters play an important role in trauma; however, this service comes with safety risks, high transport costs, and downstream care charges. Objective: Our objective was to determine the characteristics of early discharged trauma patients (<24 h length of stay) in order to reduce overtriage. Methodology: Data were obtained from the trauma registries at one of two Level 1 trauma centers. Eligible patients included all scene trauma patients transported by helicopter to the Level 1 trauma centers from January 1, 2016, to December 31, 2017, who had a length of stay of 24 h or less. Patient factors such as age, gender, scene location, loaded miles, and transportation costs were collected. Trauma type, mechanism of injury, Abbreviated Injury Scale (AIS), Injury Severity Score, Revised Trauma Score, and prehospital vital signs were documented. Driving distances between the accident scene to local hospital, home of record to local hospital, and home of record to the Level I trauma center were also calculated for patients transported to Level 1 trauma center. Results: Two hundred and twenty-six of 1042 total patients (21.7%) were discharged within 24 h of helicopter transport from the accident scene to trauma center. Less than 2% of patients were in the age group of 70 years or older. Only 2 (0.88%) patients discharged within 24 h had a prehospital systolic blood pressure <90 mmHg. For patients transported to Level 1 trauma center, the average loaded miles were 50.51 ± 14.99, with average transport charges being $27,921.19± $3536.61. Twenty-one percent of Level 1 trauma center patients were self-pay, and families typically drove 71.7 ± 123.23 miles to Level 1 trauma center versus 28.74 ± 40.62 to their local emergency department. Conclusions: A significant number of patients transported from the scene are discharged within 24 h of admission to a trauma center. These patients rarely have prehospital hypotension, do not receive significant volumes of crystalloid resuscitation, and are infrequently over 70 years of age. One in five patients has no third-party coverage and assumes $27,921.19 in average transport charges.
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A comparison of cardiopulmonary resuscitation with standard manual compressions versus compressions with real-time audiovisual feedback: A randomized controlled pilot study p. 32
Amir Vahedian-Azimi, Farshid Rahimibashar, Andrew C Miller
DOI:10.4103/IJCIIS.IJCIIS_84_19  
Background: Strategies that improve cardiopulmonary resuscitation (CPR) guideline adherence may improve in-hospital cardiac arrest (IHCA) outcomes. Real-time audiovisual feedback (AVF) is one strategy identified by the American Heart Association and the International Liaison Committee on Resuscitation as an area needing further investigation. The aim of this study was to determine if in patients with IHCA, does the addition of a free-standing AVF device to standard manual chest compressions during CPR improve sustained return of spontaneous circulation (ROSC) rates (primary outcome) or CPR quality or guideline adherence (secondary outcomes). Methods: This was a prospective, randomized, controlled, parallel study of patients undergoing resuscitation with chest compressions for IHCA in the mixed medical-surgical intensive care units (ICUs) of two academic teaching hospitals. Patients were randomized to receive either standard manual chest compressions or compressions using the Cardio First Angel™ feedback device. Results: Sixty-seven individuals were randomized, and 22 were included. CPR quality evaluation and guideline adherence scores were improved in the intervention group (P = 0.0005 for both). The incidence of ROSC was similar between groups (P = 0.64), as was survival to ICU discharge (P = 0.088) and survival to hospital discharge (P = 0.095). Conclusion: The use of the Cardio First Angel™ compression feedback device improved adherence to publish CPR guidelines and CPR quality. The insignificant change in rates of ROSC and survival to ICU or hospital discharge may have been related to small sample size. Further clinical studies comparing AVF devices to standard manual compressions are needed, as are device head-to-head comparisons.
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CASE REPORT Top

Thyroid storm with encephalopathy and cardiovascular symptoms refractory to medical management in an adolescent p. 38
Jigar C Chauhan, Meg Frizzola, Kimberly McMahon, Sarah Perry, James H Hertzog
DOI:10.4103/IJCIIS.IJCIIS_58_19  
Thyroid storm (TS) is rare in pediatrics, most cases reported in literature responded well to medical therapy. We report the case of an adolescent female presented with TS refractory to anti-thyroid medical management. She had refractory hypertension, tachycardia, and progressive encephalopathy despite aggressive medical management. She underwent subtotal thyroidectomy after 2 weeks of failed medical management with a complete resolution of symptoms within days of surgery. We also learned sodium nitroprusside with its direct vasodilatory effect on conduit vessels, verapamil with its rate control properties, and labetalol with its dual sympathetic blockage property were beneficial in the management of this patient.
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CLINICAL IMAGE Top

Complex re-operative surgery: A good physical exam could be critical p. 42
Michael S Firstenberg, William Novick, Jennifer Hanna, Dianne McCallister
DOI:10.4103/1995-7645.280229  
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