EFFICACY OF DICLOFENAC SODIUM VERSUS SOMATOSTATIN FOR THE PREVENTION OF PANCREATITIS IN PATIENTS UNDERGOING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is an endoscopic procedure performed with a side view scope that can be either diagnostic or therapeutic. Endoscopic procedure as with other medical procedures has both minor and major complications. The most common major complication of ERCP is pancreatitis, with a prevalence of 1% to 40%. Aim: to assess the efficacy of diclofenac sodium versus somatostatin for prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Methods: the present study was carried out as an interventional study on 75 patients with evidence of biliary obstruction accepted for ERCP, divided into 3 groups. Group I included 25 patients as control group, group II included 25 patients who were administered 100 mg of diclofenac sodium administered rectally 30 minutes before ERCP and group III included 25 patients who were administered a single bolus injection of 250 mcg somatostatin 30 minutes before ERCP and these groups were compared regarding efficacy of diclofenac sodium versus somatostatin for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Results: there was no statistically difference between the study groups as regards the occurrence of post-ERCP pancreatitis. The incidence of post-ERCP pancreatitis was 13.3%. Post-ERCP pancreatitis occurred in 5 cases (20%) of the first group, 2 cases (8%) of the second group, 3 cases (12%) of the third group. No risk factors for post-ERCP pancreatitis were statistically significant. Conclusion: there was no statistically difference between the study groups as regards the occurrence of post-ERCP pancreatitis

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Patterns and management of chest injuries patients and its outcome in Emergency Department in Suez Canal University Hospital, Egypt

Chest trauma is a common cause of morbidity and mortality, especially in the young patients. Road traffic crushes (RTCs) are the commonest cause of blunt chest injuries. Chest trauma may be due to penetrating trauma produced by knife or gunshot and its incidence increases with use of firearms Successful management of thoracic trauma depends on effective resuscitation by the ABCDE approaches with rapid detection and treatment of life-threatening complications outcome and prognosis for the great majority of patients with chest trauma are excellent. to improve management process and outcome of chest trauma patients. This study is a cross-sectional study included 200traumatic patients admitted in Suez Canal University Hospital. Firstly Start primary survey by check Airway, secure cervical spine by neck collar, Breathing and circulation (A B C) and treat the life threading conditions if present. Blunt thoracic trauma was found in 144 patients, while penetrating injuries in only 56 patients. Patients suffered blunt trauma,(87.5%) were males and (12.5%) females, no mortalities were recorded in penetrating trauma patients since all patients were discharged after treatment and improvement. Rib fractures were the commonest injuries in blunt chest trauma, haemothorax is the commonest injury in penetrating chest trauma, tube thoracostomy is the most common surgical interference done. [Med-Science 2017; 6(2.000): 328-37

Teaching Review on Approach of Esophageal Intubation as Complications in Emergency Airway Management

Background: Intubation is daily process in hospitals, it’s insertion of tube to secure an airway, nonemergent intubation is done in well controlled circumstances, while emergent intubation is not. Most emergency intubated are cardiac or respiratory arrest patients. Intubation helps to secure airway for patient breathing, also could protect from aspiration. Most common complications are: esophagus intubation and hypotension. This research will be divided into two main topics, emergency intubation as a whole, and unrecognized esophagus intubation as a complication. Emergency intubation discuss: knowledge about the procedure, equipment needed, airway assessment, preoxygenation, difficulties and risks, outcomes. While Unrecognized esophagus intubation will be discussed as complication in ER settings, point to clear: Epidemiology, tools of detection, equipment, human and environmental bias and consideration for cardiac arrest patients. Finishing with a conclusion and recommendation. Therefore, we aim to look into the common pitfalls that both medical students and new physicians face in the recognition, diagnosis, and Emergency Airway Management. Targeted Population: Airway cardiorespiratory arrest patients who are requiring urgent management in the ED, with emergency physicians for teaching approach protocol. Aim of the Study: Appropriate for assessment and priorities for Airway cardiorespiratory arrest patients by training protocol to emergency physicians. Based on patients’ causes of Airway injuries. Methods: Collection of all possible available data about the Esophageal Intubation as Complications in the Emergency department. By many research questions to achieve these aims so a midline literature search was performed with the keywords “critical care”, “emergency medicine”, “principals of airway management”, “Esophageal Intubation as Complications”. Literature search included an overview of recent definition, causes and recent therapeutic strategies. Results: All studies introduced that the initial diagnosis of Esophageal Intubation as Complications is a lifesaving conditions that face patients of the emergency and critical care departments. Conclusion: Intubation in emergency settings require a good preparation, available equipment (e.g. ready cart for all time), and supportive anatomical airway of the patient. Following a checklist will improve outcomes, prevent malpractice and complications. Preoxygenation and RSI play major roles for successful intubations with decrease risk of complications. Follow procedure steps, and expect difficult intubation for any patient, so consider LEMON mnemonic to evaluate risk of difficulty, and after 3 attempts try a different technique or equipment. More training and education are essential to decrease congenital and equipotential mistakes/errors.</jats:p