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SYMPOSIUM ON PEDIATRIC TRAUMA
Vascular access, fluid resuscitation, and blood transfusion in pediatric trauma
Nathaniel Greene, Sanjay Bhananker, Ramesh Ramaiah
September-December 2012, 2(3):135-142
DOI:10.4103/2229-5151.100890  PMID:23181207
Trauma care in the general population has largely become protocol-driven, with an emphasis on fast and efficient treatment, good team communication at all levels of care including prehospital care, initial resuscitation, intensive care, and rehabilitation. Most available literature on trauma care has focused on adults, allowing the potential to apply concepts from adult care to pediatric care. But there remain issues that will always be specific to pediatric patients that may not translate from adults. Several new devices such as intraosseous (IO) needle systems and techniques such as ultrasonography to cannulate central and peripheral veins have become available for integration into our pre-existing trauma care system for children. This review will focus specifically on the latest techniques and evidence available for establishing intravenous access, rational approaches to fluid resuscitation, and blood product transfusion in the pediatric trauma patient.
  20,226 567 14
SYMPOSIUM: CRITICAL AIRWAY MANAGEMENT
Pediatric airway management
Jeff Harless, Ramesh Ramaiah, Sanjay M Bhananker
January-March 2014, 4(1):65-70
DOI:10.4103/2229-5151.128015  PMID:24741500
Securing an airway is a vital task for the anesthesiologist. The pediatric patients have significant anatomical and physiological differences compared with adults, which impact on the techniques and tools that the anesthesiologist might choose to provide safe and effective control of the airway. Furthermore, there are a number of pathological processes, typically seen in the pediatric population, which present unique anatomical or functional difficulties in airway management. The presence of one of these syndromes or conditions can predict a "difficult airway." Many instruments and devices are currently available which have been designed to aid in airway management. Some of these have been adapted from adult designs, but in many cases require alterations in technique to account for the anatomical and physiological differences of the pediatric patient. This review focuses on assessment and management of pediatric airway and highlights the unique challenges encountered in children.
  15,611 1,186 36
Extraglottic airway devices: A review
Ramesh Ramaiah, Debasmita Das, Sanjay M Bhananker, Aaron M Joffe
January-March 2014, 4(1):77-87
DOI:10.4103/2229-5151.128019  PMID:24741502
Extraglottic airway devices (EAD) have become an integral part of anesthetic care since their introduction into clinical practice 25 years ago and have been used safely hundreds of millions of times, worldwide. They are an important first option for difficult ventilation during both in-hospital and out-of-hospital difficult airway management and can be utilized as a conduit for tracheal intubation either blindly or assisted by another technology (fiberoptic endoscopy, lightwand). Thus, the EAD may be the most versatile single airway technique in the airway management toolbox. However, despite their utility, knowledge regarding specific devices and the supporting data for their use is of paramount importance to patient's safety. In this review, number of commercially available EADs are discussed and the reported benefits and potential pitfalls are highlighted.
  13,294 587 2
POSITION PAPER
The 2017 Academic College of Emergency Experts and Academy of Family Physicians of India position statement on preventing violence against health - care workers and vandalization of health - care facilities in India
Vivek Chauhan, Sagar Galwankar, Raman Kumar, Sunil Kumar Raina, Praveen Aggarwal, Naman Agrawal, S Vimal Krishnan, Sanjeev Bhoi, OP Kalra, Santosh T Soans, Vandana Aggarwal, Mohan Kubendra, R Bijayraj, Sumana Datta, RP Srivastava
April-June 2017, 7(2):79-83
DOI:10.4103/IJCIIS.IJCIIS_28_17  PMID:28660160
There have been multiple incidents where doctors have been assaulted by patient relatives and hospital facilities have been vandalized. This has led to mass agitations by Physicians across India. Violence and vandalism against health-care workers (HCWs) is one of the biggest public health and patient care challenge in India. The sheer intensity of emotional hijack and the stress levels in both practicing HCWs and patient relative's needs immediate and detail attention. The suffering of HCWs who are hurt, the damage to hospital facilities and the reactionary agitation which affects patients who need care are all together doing everything to damage the delivery of health care and relationship between a doctor and a patient. This is detrimental to India where illnesses and Injuries continue to be the biggest challenge to its growth curve. The expert group set by The Academic College of Emergency Experts and The Academy of Family Physicians of India makes an effort to study this Public Health and Patient Care Challenge and provide recommendations to solve it.
  12,127 98 1
SYMPOSIUM - ICU & TRAUMA PROCEDURE COMPLICATIONS
Central line complications
Craig Kornbau, Kathryn C Lee, Gwendolyn D Hughes, Michael S Firstenberg
July-September 2015, 5(3):170-178
DOI:10.4103/2229-5151.164940  PMID:26557487
Central venous access is a common procedure performed in many clinical settings for a variety of indications. Central lines are not without risk, and there are a multitude of complications that are associated with their placement. Complications can present in an immediate or delayed fashion and vary based on type of central venous access. Significant morbidity and mortality can result from complications related to central venous access. These complications can cause a significant healthcare burden in cost, hospital days, and patient quality of life. Advances in imaging, access technique, and medical devices have reduced and altered the types of complications encountered in clinical practice; but most complications still center around vascular injury, infection, and misplacement. Recognition and management of central line complications is important when caring for patients with vascular access, but prevention is the ultimate goal. This article discusses common and rare complications associated with central venous access, as well as techniques to recognize, manage, and prevent complications.
  11,128 659 69
SYMPOSIUM: CRITICAL AIRWAY MANAGEMENT
Rapid-sequence intubation and cricoid pressure
Joshua C Stewart, Sanjay Bhananker, Ramesh Ramaiah
January-March 2014, 4(1):42-49
DOI:10.4103/2229-5151.128012  PMID:24741497
Airway management is the most important clinical skill for anesthesiologist, emergency physician, and other providers who are involved in oxygenation and ventilation of the lungs. Rapid-sequence intubation is the preferred method to secure airway in patients who are at risk for aspiration because it results in rapid unconsciousness (induction) and neuromuscular blockade (paralysis). Application of cricoid pressure (CP) for patients undergoing rapid-sequence intubation is controversial. Multiple specialty societies have recommended that CP is not effective in preventing aspiration; rather it may worsen laryngoscopic view and impair bag-valve mask ventilation. Some experts think that CP should be applied in trauma and patients at risk for aspiration; however CP, if necessary, should be altered or removed to facilitate intubation.
  10,732 646 6
SYMPOSIUM ON TRENDS IN TRAUMA
Trends in trauma transfusion
Sanjay M Bhananker, Ramesh Ramaiah
January-June 2011, 1(1):51-56
DOI:10.4103/2229-5151.79282  PMID:22096774
Trauma is the leading cause of death in young adults and acute blood loss contributes to a large portion of mortality in the early post-trauma period. The recognition of lethal triad of coagulopathy, hypothermia and acidosis has led to the concepts of damage control surgery and resuscitation. Recent experience with managing polytrauma victims from the Iraq and Afghanistan wars has led to a few significant changes in clinical practice. Simultaneously, transfusion practices in the civilian settings have also been extensively studied retrospectively and prospectively in the last decade. Early treatment of coagulopathy with a high ratio of fresh frozen plasma and platelets to packed red blood cells (FFP:platelet:RBC), prevention and early correction of hypothermia and acidosis, monitoring of hemostasis using point of care tests like thromoboelastometry, use of recombinant activated factor VII, antifibrinolytic drugs like tranexamic acid are just some of the emerging trends. Further studies, especially in the civilian trauma centers, are needed to confirm the lessons learned in the military environment. Identification of patients likely to need massive transfusion followed by immediate preventive and therapeutic interventions to prevent the development of coagulopathy could help in reducing the morbidity and mortality associated with uncontrolled hemorrhage in trauma patients.
  10,304 483 12
SYMPOSIUM: CURRENT CONCEPTS IN CRITICAL CARE
Thoracostomy tubes: A comprehensive review of complications and related topics
Michael Kwiatt, Abigail Tarbox, Mark J. Seamon, Mamta Swaroop, James Cipolla, Charles Allen, Stacinoel Hallenbeck, H. Tracy Davido, David E. Lindsey, Vijay A. Doraiswamy, Sagar Galwankar, David Tulman, Nicholas Latchana, Thomas J. Papadimos, Charles H. Cook, Stanislaw P. A. Stawicki, Michael Kwiatt, Abigail Tarbox, Mark J. Seamon, Mamta Swaroop, James Cipolla, Charles Allen, Stacinoel Hallenbeck, H. Tracy Davido, David E. Lindsey, Vijay A. Doraiswamy, Sagar Galwankar, David Tulman, Nicholas Latchana, Thomas J. Papadimos, Charles H. Cook, Stanislaw P. A. Stawicki
April-June 2014, 4(2):143-155
DOI:10.4103/2229-5151.134182  PMID:25024942
Tube thoracostomy (TT) placement belongs among the most commonly performed procedures. Despite many benefits of TT drainage, potential for significant morbidity and mortality exists. Abdominal or thoracic injury, fistula formation and vascular trauma are among the most serious, but more common complications such as recurrent pneumothorax, insertion site infection and nonfunctioning or malpositioned TT also represent a significant source of morbidity and treatment cost. Awareness of potential complications and familiarity with associated preventive, diagnostic and treatment strategies are fundamental to satisfactory patient outcomes. This review focuses on chest tube complications and related topics, with emphasis on prevention and problem-oriented approaches to diagnosis and treatment. The authors hope that this manuscript will serve as a valuable foundation for those who wish to become adept at the management of chest tubes.
  10,251 356 12
POSITION PAPER
The 2014 Academic College of Emergency Experts in India's INDO-US Joint Working Group (JWG) White Paper on "Developing Trauma Sciences and Injury Care in India"
Ranabir Pal, Amit Agarwal, Sagar Galwankar, Mamta Swaroop, Stanislaw P Stawicki, Laxminarayan Rajaram, Lorenzo Paladino, Praveen Aggarwal, Sanjeev Bhoi, Sankalp Dwivedi, Geetha Menon, MC Misra, OP Kalra, Ajai Singh, Angeline Neetha Radjou, Anuja Joshi
April-June 2014, 4(2):114-130
DOI:10.4103/2229-5151.134151  PMID:25024939
It is encouraging to see the much needed shift in the understanding and recognition of the concept of "burden of disease" in the context of traumatic injury. Equally important is understanding that the impact of trauma burden rivals that of nontraumatic morbidities. Subsequently, this paradigm shift reinstates the appeal for timely interventions as the standard for management of traumatic emergencies. Emergency trauma care in India has been disorganized due to inadequate sensitivity toward patients affected by trauma as well as the haphazard, nonuniform acceptance of standardization as the norm. Some of the major hospitals across various regions in the country do have trauma care units, but even those lack protocols to ensure that all trauma cases are handled by those units, largely owing to lack of structured referral system. As a first step to reform the state of trauma care in the country, a detailed overview is needed to gain insight into the prevailing reality. The objectives of this paper are to thus weave a foundation based on the statistical and qualitative burden of trauma in the country; the available infrastructure of trauma care centers equipped to deal with trauma; the need and scope of standardized protocols for intervention; and most importantly, the application of these in shaping educational initiatives in advancing emergency trauma care in the country.
  10,160 309 10
REVIEW ARTICLE
Intensive Care Unit issues in eclampsia and HELLP syndrome
Melissa Teresa Chu Lam, Elizabeth Dierking
July-September 2017, 7(3):136-141
DOI:10.4103/IJCIIS.IJCIIS_33_17  PMID:28971026
Preeclampsia, eclampsia and HELLP syndrome are life-threatening hypertensive conditions and common causes of ICU admission among obstetric patients The diagnostic criteria of preeclampsia include: 1) systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg on two occasions at least 4 hours apart and 2) proteinuria ≥300 mg/day in a woman with a gestational age of >20 weeks with previously normal blood pressures. Eclampsia is defined as a convulsive episode or altered level of consciousness occurring in the setting of preeclampsia, provided that there is no other cause of seizures. HELLP syndrome is a life-threatening condition frequently associated with severe preeclampsia-eclampsia and is characterized by three hallmark features of hemolysis, elevated liver enzymes and low platelets. Early diagnosis and management of preeclampsia, eclampsia and HELLP syndrome are critical with involvement of a multidisciplinary team that includes Obstetrics, Maternal Fetal Medicine and Critical Care. Expectant management may be acceptable before 34 weeks with close fetal and maternal surveillance and administration of corticosteroid therapy, parenteral magnesium sulfate and antihypertensive management. Worsening condition requires delivery. Complications that can be related to this spectrum of disease include disseminated Intravascular coagulation (DIC), acute respiratory distress syndrome, stroke, acute renal failure, hepatic dysfunction with hepatic rupture or liver hematoma and infection/sepsis.
  8,786 1,387 11
SYMPOSIUM: CRITICAL AIRWAY MANAGEMENT
Airway management in cervical spine injury
Naola Austin, Vijay Krishnamoorthy, Arman Dagal
January-March 2014, 4(1):50-56
DOI:10.4103/2229-5151.128013  PMID:24741498
To minimize risk of spinal cord injury, airway management providers must understand the anatomic and functional relationship between the airway, cervical column, and spinal cord. Patients with known or suspected cervical spine injury may require emergent intubation for airway protection and ventilatory support or elective intubation for surgery with or without rigid neck stabilization (i.e., halo). To provide safe and efficient care in these patients, practitioners must identify high-risk patients, be comfortable with available methods of airway adjuncts, and know how airway maneuvers, neck stabilization, and positioning affect the cervical spine. This review discusses the risks and benefits of various airway management strategies as well as specific concerns that affect patients with known or suspected cervical spine injury.
  9,300 631 23
SYMPOSIUM: EMBOLISM IN THE INTENSIVE CARE UNIT
Septic embolism in the intensive care unit
Stanislaw P Stawicki, Michael S Firstenberg, Michael R Lyaker, Sarah B Russell, David C Evans, Sergio D Bergese, Thomas J Papadimos
January-March 2013, 3(1):58-63
DOI:10.4103/2229-5151.109423  PMID:23724387
Septic embolism encompasses a wide range of presentations and clinical considerations. From asymptomatic, incidental finding on advanced imaging to devastating cardiovascular or cerebral events, this important clinico-pathologic entity continues to affect critically ill patients. Septic emboli are challenging because they represent two insults-the early embolic/ischemic insult due to vascular occlusion and the infectious insult from a deep-seated nidus of infection frequently not amenable to adequate source control. Mycotic aneurysms and intravascular or end-organ abscesses can occur. The diagnosis of septic embolism should be considered in any patient with certain risk factors including bacterial endocarditis or infected intravascular devices. Treatment consists of long-term antibiotics and source control when possible. This manuscript provides a much-needed synopsis of the different forms and clinical presentations of septic embolism, basic diagnostic considerations, general clinical approaches, and an overview of potential complications.
  9,551 281 13
SYMPOSIUM ON TRENDS IN TRAUMA
Perioperative management of traumatic brain injury
Parichat Curry, Darwin Viernes, Deepak Sharma
January-June 2011, 1(1):27-35
DOI:10.4103/2229-5151.79279  PMID:22096771
Traumatic brain injury (TBI) is a major public health problem and the leading cause of death and disability worldwide. Despite the modern diagnosis and treatment, the prognosis for patients with TBI remains poor. While severity of primary injury is the major factor determining the outcomes, the secondary injury caused by physiological insults such as hypotension, hypoxemia, hypercarbia, hypocarbia, hyperglycemia and hypoglycemia, etc. that develop over time after the onset of the initial injury, causes further damage to brain tissue, worsening the outcome in TBI. Perioperative period may be particularly important in the course of TBI management. While surgery and anesthesia may predispose the patients to new onset secondary injuries which may contribute adversely to outcomes, the perioperative period is also an opportunity to detect and correct the undiagnosed pre-existing secondary insults, to prevent against new secondary insults and is a potential window to initiate interventions that may improve outcome of TBI. For this review, extensive Pubmed and Medline search on various aspects of perioperative management of TBI was performed, followed by review of research focusing on intraoperative and perioperative period. While the research focusing specifically on the intraoperative and immediate perioperative TBI management is limited, clinical management continues to be based largely on physiological optimization and recommendations of Brain Trauma Foundation guidelines. This review is focused on the perioperative management of TBI, with particular emphasis on recent developments.
  8,899 878 11
SYMPOSIUM ON PEDIATRIC TRAUMA
Pediatric burn injuries
Vijay Krishnamoorthy, Ramesh Ramaiah, Sanjay M Bhananker
September-December 2012, 2(3):128-134
DOI:10.4103/2229-5151.100889  PMID:23181206
Pediatric burns comprise a major mechanism of injury, affecting millions of children worldwide, with causes including scald injury, fire injury, and child abuse. Burn injuries tend to be classified based on the total body surface area involved and the depth of injury. Large burn injuries have multisystemic manifestations, including injuries to all major organ systems, requiring close supportive and therapeutic measures. Management of burn injuries requires intensive medical therapy for multi-organ dysfunction/failure, and aggressive surgical therapy to prevent sepsis and secondary complications. In addition, pain management throughout this period is vital. Specialized burn centers, which care for these patients with multidisciplinary teams, may be the best places to treat children with major thermal injuries. This review highlights the major components of burn care, stressing the pathophysiologic consequences of burn injury, circulatory and respiratory care, surgical management, and pain management of these often critically ill patients.
  9,132 570 24
SYMPOSIUM: CURRENT CONCEPTS IN CRITICAL CARE
Catheter-related bloodstream infections
Rupam Gahlot, Chaitanya Nigam, Vikas Kumar, Ghanshyam Yadav, Shampa Anupurba, Rupam Gahlot, Chaitanya Nigam, Vikas Kumar, Ghanshyam Yadav, Shampa Anupurba
April-June 2014, 4(2):162-167
DOI:10.4103/2229-5151.134184  PMID:25024944
Central-venous-catheter-related bloodstream infections (CRBSIs) are an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. Consequences depend on associated organisms, underlying pre-morbid conditions, timeliness, and appropriateness of the treatment/interventions received. We have summarized risk factors, pathogenesis, etiology, diagnosis, and management of CRBSI in this review.
  8,904 569 86
SYMPOSIUM ON TRENDS IN TRAUMA
Damage control in the injured patient
Jeremy M Hsu, Tam N Pham
January-June 2011, 1(1):66-72
DOI:10.4103/2229-5151.79285  PMID:22096776
The damage control concept is an essential component in the management of severely injured patients. The principles in sequence are as follows: (1) abbreviated surgical procedures limited to haemorrhage and contamination control; (2) correction of physiological derangements; (3) definitive surgical procedures. Although originally described in the management of major abdominal injuries, the concept has been extended to include thoracic, vascular, orthopedic, and neurosurgical procedures, as well as anesthesia and resuscitative strategies.
  8,681 552 11
CASE REPORT
Complications of post-injury decompressive craniectomy
Luciano Santana-Cabrera, Guillermo Pérez-Acosta, Cristina Rodríguez-Escot, Rosa Lorenzo-Torrent, Manuel Sánchez-Palacios
September-December 2012, 2(3):186-188
DOI:10.4103/2229-5151.100937  PMID:23181215
Decompressive craniectomy (DC) is a useful technique for the treatment of traumatic brain injuries (TBI) with intracranial hypertension (ICHT) resistant to medical treatment, increasing survival, although its role in the functional prognosis of patients is not defined. It is also a technique that is not without complications, and may increase the patient's morbidity and mortality. We report two cases of patients with TBI who required DC and suffered complications from the technique
  8,874 179 5
SYMPOSIUM ON TRENDS IN TRAUMA
Anesthetic considerations in acute spinal cord trauma
Neil Dooney, Armagan Dagal
January-June 2011, 1(1):36-43
DOI:10.4103/2229-5151.79280  PMID:22096772
Patients with actual or potential spinal cord injury (SCI) are frequently seen at adult trauma centers, and a large number of these patients require operative intervention. All polytrauma patients should be assumed to have an SCI until proven otherwise. Pre-hospital providers should take adequate measures to immobilize the spine for all trauma patients at the site of the accident. Stabilization of the spine facilitates the treatment of other major injuries both in and outside the hospital. The presiding goal of perioperative management is to prevent iatrogenic deterioration of existing injury and limit the development of secondary injury whilst providing overall organ support, which may be adversely affected by the injury. This review article explores the anesthetic implications of the patient with acute SCI. A comprehensive literature search of Medline, Embase, Cochrane database of systematic reviews, conference proceedings and internet sites for relevant literature was performed. Reference lists of relevant published articles were also examined. Searches were carried out in October 2010 and there were no restrictions by study design or country of origin. Publication date of included studies was limited to 1990-2010.
  8,183 804 5
REVIEW ARTICLES
Infections of the nervous system
Vevek Parikh, Veronica Tucci, Sagar Galwankar
May-August 2012, 2(2):82-97
DOI:10.4103/2229-5151.97273  PMID:22837896
Infections of the nervous system are among the most difficult infections in terms of the morbidity and mortality posed to patients, and thereby require urgent and accurate diagnosis. Although viral meningitides are more common, it is the bacterial meningitides that have the potential to cause a rapidly deteriorating condition that the physician should be familiar with. Viral encephalitis frequently accompanies viral meningitis, and can produce focal neurologic findings and cognitive difficulties that can mimic other neurologic disorders. Brain abscesses also have the potential to mimic and present like other neurologic disorders, and cause more focal deficits. Finally, other infectious diseases of the central nervous system, such as prion disease and cavernous sinus thrombosis, are explored in this review.
  8,128 491 14
ORIGINAL ARTICLES
Procalcitonin versus C-reactive protein: Usefulness as biomarker of sepsis in ICU patient
Waheeda Nargis, Md Ibrahim, Borhan Uddin Ahamed
July-September 2014, 4(3):195-199
DOI:10.4103/2229-5151.141356  PMID:25337480
Background: Early diagnosis and appropriate therapy of sepsis is a daily challenge in intensive care units (ICUs) despite the advances in critical care medicine. Procalcitonin (PCT); an innovative laboratory marker, has been recently proven valuable worldwide in this regard. Objectives: This study was undertaken to evaluate the utility of PCT in a resource constrained country like ours when compared to the traditional inflammatory markers like C - reactive protein (CRP) to introduce PCT as a routine biochemical tool in regional hospitals. Materials and Methods: PCT and CRP were simultaneously measured and compared in 73 medico-surgical ICU patients according to the American College of Chest Physicians (ACCP) criteria based study groups. Results: The clinical presentation of 75% cases revealed a range of systemic inflammatory responses (SIRS). The diagnostic accuracy of PCT was higher (75%) with greater specificity (72%), sensitivity (76%), positive and negative predictive values (89% and 50%), positive likelihood ratio (2.75) as well as the smaller negative likelihood ratio (0.33). Both serum PCT and CRP values in cases with sepsis, severe sepsis and septic shock were significantly higher from that of the cases with SIRS and no SIRS (P < 0.01). Conclusion: PCT is found to be superior to CRP in terms of accuracy in identification and to assess the severity of sepsis even though both markers cannot be used in differentiating infectious from noninfectious clinical syndrome.
  8,141 405 38
CASE REPORTS
Treatment of an intraoral bleeding in hemophilic patient with a thermoplastic palatal stent - A novel approach
Nidhi Madan, Arun Rathnam, Neeti Bajaj
January-June 2011, 1(1):79-83
DOI:10.4103/2229-5151.79288  PMID:22096778
This is a case report of a 13-year old child diagnosed with hemophilia A. He reported with a bleeding wound in the middle part of the hard palate, due to trauma from a lead pencil. An intraoral palatal stent was planned to provide continuous pressure, stabilize the clot and allow local delivery of hemostatic agent. The stent was fabricated with a thermoplastic silicone rubber (biostar) under vacuum. The hemostatic agent used was one 500 mg capsule of tranxemic acid that was crushed and applied as a paste every 6 hourly. The patient was admitted under supervision for 3 days, where Recombinant factor VIII (rFVIII) intravenous infusion of 15-25 U/kg twice a day was given. Complete healing was observed in the traumatized area within 10 days. This article emphasizes on prenatal diagnosis, carrier screening and counseling of parents born with hemophilic children.
  8,300 205 -
ORIGINAL ARTICLES
Compliance with the Eastern Association for the Surgery of Trauma guidelines for prophylactic antibiotics after open extremity fracture
Cassie A Barton, Wesley D McMillian, Bruce A Crookes, Turner Osler, Craig S Bartlett
May-August 2012, 2(2):57-62
DOI:10.4103/2229-5151.97268  
Context: Prophylactic antibiotics, paired with wound care and surgical intervention, is considered the standard of care for patients with open fracture. Guidelines from the Eastern Association for the Surgery of Trauma (EAST) recommend specific prophylactic antimicrobial therapy based on the type of open fracture. Aims: We quantified adherence to EAST guideline recommendations and documented the incidence of infection in patients with open fracture. Settings and Design: A retrospective, observational study of all patients with open fracture admitted to our facility from January 2004 to December 2008 was conducted. Materials and Methods: Patients were divided into compliant and noncompliant groups according to the EAST guideline recommendations. Compliance was defined as an appropriate spectrum of therapy for guideline suggested duration. We assessed for surgical and non-surgical site infections, and morbidity outcomes. Statistical Analysis: Nominal data were explored using summary measures. Continuous variables were compared using the Student t-test or the Mann-Whitney U-test. Dichotomous data were compared using χ2 statistic or Fisher's exact test. Results: The final analysis included 214 patients. Prophylactic antibiotics were guideline compliant in 28.5% of patients, and ranged from 10.0% in type 3b fractures to 52.7% in type 1 fractures. The most common reason for non-compliance was the use of guideline recommended coverage that exceeded the suggested duration (71.2%). Patients who received non-compliant therapy required prolonged hospital lengths of stay (6 vs. 3 days, P = 0.0001). The overall incidence of infection was similar regardless of guideline compliance (17.0% vs. 11.5%, P = 0.313). Conclusions: Prophylactic antibiotics for open fracture frequently exceeded guideline recommendations in duration and spectrum of coverage, especially in more severe fracture types. Non-compliance with EAST recommendations was associated with increased in-hospital morbidity.
  8,198 163 13
CASE REPORTS
Blunt traumatic abdominal wall disruption with evisceration
Ellen McDaniel, Stanislaw PA Stawicki, David P Bahner
July-December 2011, 1(2):164-166
DOI:10.4103/2229-5151.84807  PMID:22229144
Blunt traumatic abdominal wall disruptions associated with evisceration are very rare. The authors describe a case of traumatic abdominal wall disruption with bowel evisceration that occurred after a middle-aged woman sustained direct focal blunt force impact to the lower abdomen. Abdominal exploration and surgical repair of the abdominal wall defect were performed, with good clinical outcome. A brief overview of literature pertinent to this rare trauma scenario is presented.
  7,978 116 1
REVIEW ARTICLE
Complications during intrahospital transport of critically ill patients: Focus on risk identification and prevention
Patrick H Knight, Neelabh Maheshwari, Jafar Hussain, Michael Scholl, Michael Hughes, Thomas J Papadimos, Weidun Alan Guo, James Cipolla, Stanislaw P Stawicki, Nicholas Latchana
October-December 2015, 5(4):256-264
DOI:10.4103/2229-5151.170840  PMID:26807395
Intrahospital transportation of critically ill patients is associated with significant complications. In order to reduce overall risk to the patient, such transports should well organized, efficient, and accompanied by the proper monitoring, equipment, and personnel. Protocols and guidelines for patient transfers should be utilized universally across all healthcare facilities. Care delivered during transport and at the site of diagnostic testing or procedure should be equivalent to the level of care provided in the originating environment. Here we review the most common problems encountered during transport in the hospital setting, including various associated adverse outcomes. Our objective is to make medical practitioners, nurses, and ancillary health care personnel more aware of the potential for various complications that may occur during patient movement from the intensive care unit to other locations within a healthcare facility, focusing on risk reduction and preventive strategies.
  7,461 556 21
SYMPOSIUM: EMBOLISM IN THE INTENSIVE CARE UNIT
Fat embolism syndrome
Michael E Kwiatt, Mark J Seamon
January-March 2013, 3(1):64-68
DOI:10.4103/2229-5151.109426  PMID:23724388
Fat embolism syndrome (FES) is an ill-defined clinical entity that arises from the systemic manifestations of fat emboli within the microcirculation. Embolized fat within capillary beds cause direct tissue damage as well as induce a systemic inflammatory response resulting in pulmonary, cutaneous, neurological, and retinal symptoms. This is most commonly seen following orthopedic trauma; however, patients with many clinical conditions including bone marrow transplant, pancreatitis, and following liposuction. No definitive diagnostic criteria or tests have been developed, making the diagnosis of FES difficult. While treatment for FES is largely supportive, early operative fixation of long bone fractures decreases the likelihood of a patient developing FES.
  7,325 606 25
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