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 approach for START triage in disaster management

Disaster is defined by the World Health Organization (WHO) as a sudden phenomenon of sufficient magnitude to overwhelm the resources of a hospital, region, or location requiring external support. Therefore, we aim to look into START Triage for both medical students and new physicians face in the recognition, diagnosis and management of primary survey in trauma patients. START Triage newly as a part of primary survey requiring urgent tools in disaster ER management, So Emergency Physicians needs teaching protocol of START Triage. Appropriate approach of START Triage by training protocol to Emergency Physicians. Based to practice gap for preventive death and adverse long-term complications of major disaster. START Triage guidelines are the processes of sorting the patients; it is a dynamic process aim to identify life threating conditions from cases that not require urgent transfer and intervention. START triage use 4 colors codding approach black for dead, red for immediate, green for walking and yellow for remaining cases. [Med-Science 2020; 9(4.000): 1109-12

Approach to critical ill child

Critically ill children are the children whom requiring, or potentially requiring, high reliance or serious consideration whether in medical, surgical or trauma- related fields. Pediatric ill cases regularly increase the incidence of Emergency Department (ED) Presentation in addition, induced a high percent of ED visitors. All child patients who are requiring urgent management in the ED, hospital wards, Intensive Care Unit (ICU) and Neonatal Intensive Care Unit (NICU). Initial assessment and management with a priority-based methodology to recognize potentially life-threatening conditions and to convey life-saving treatment. Collection of all possible available data about Critical ill child in the ED. By many research questions to achieve these aims so a midline literature search was performed with the keywords Critical ill child ECG, cardiac arrest in child, emergency medicine, principals of resuscitations skills", "pediatric life support. All studies introduced that the initial therapy is a serious condition that face patients of the emergency and critical care departments. Literature search included an overview of recent definition, causes and recent therapeutic strategies. Conclusion: Practitioners experts should check that all the fitting equipment and supplies for various age bunches are accessible. It is pivotal to begin with Pediatric Assessment Triangle (PAT) trailed by Airway, Breathing, Circulation, Disability and Environment /Exposure (ABCDE) evaluation. After completing the initial evaluation and resuscitation, the pre-hospital specialist ought to perform progressing assessment to watch the intervention reaction and to manage changes in treatment. [Med-Science 2021; 10(2.000): 664-9

Patterns and Outcome of Missed Injuries in Egyptians Polytrauma Patients

Introduction: “polytrauma” patients are higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, missed injuries still significant affect modern trauma services and its outcome. Aim: to improve outcome and determine the incidence and nature of missed injuries in polytrauma patients. Methods: the study is a cross-sectional, prospective study included 600 polytraumatized patients admitted in Suez Canal University Hospital. Firstly assessed and treated accordingly to Advanced Trauma Life Support (ATLS) guidelines and treat the life threading conditions if present with follow-up short outcome for 28 days. Results: The most common precipitate factor for missed injuries in my study was clinical evaluation error due to Inadequate diagnostic workup in 42.9%. And the second risk factor was Deficiency in Physical Examination in 35.7%. Lastly Incomplete assessment due to patient instability in 10.7% and incorrect interpretation of imaging10.7%.low rates of missed injuries (40.8%) in patients arriving during the day compared with (59.2%) of night arrivals. Conclusion: the incidence of missed injuries in the study is 9.0 % which is still high compared to many trauma centers. And mostly increase the period of stay in the hospital and affect the outcome of polytrauma patients

A Comparative Study of Risk Stratifications Scores for Acute Heart Failure Patients in the Emergency Department, Egypt

Diagnosis of heart failure according to Framingham criteria which is. a) Major criteria. b) Minor criteria for establishing a definite diagnosis of HF, two major or one major and two minor criteria had to be present. In this study two risk stratification models will be used among heart failure patients who present to emergency room, The Seattle heart failure model and the Canadian predictor mortality of HF model. Aim: comparison will be done according to accuracy and easiness in predicting risk of death in 48hr and 28day from hospital admission among HF patient. Methods: This study is cross-sectional, observational study on adults presenting to the emergency department with Acute Heart Failure with short term follow up in cardiology care unit (CCU) and Cardiology inpatient ward for MACE. Patients will be divided into two groups. Each group will include 30 patients their cardiac risk determined by one of the two methods of risk stratification utilizing findings on presentation. Results: The studied patients in Canadian model was 20.0%, acute renal failure was 23.3%, stroke was 10.0%, cardiogenic shock was 36.7% and significant arrhythmia was 10.0%. While according Seattle heart failure model, 57% of the patients were at very high risk, 16.7% were at high risk, 16.7% were at intermediate risk and 10% were at low risk of mortality Conclusion: Sensitivity, specificity and +PV of Seattle heart failure model was significantly higher than Canadian predictive model with very high area under the ROC curve ( AUC) and very low standard error (SE)

Predictive value of focused assessment with sonography for trauma (FAST) for laparotomy in unstable polytrauma Egyptians patients

Purpose: The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department (ED). The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma (FAST) is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED. This study aims to evaluate the accuracy of FAST in hemodynamically unstable polytraumatized patients and to determine its role as an indication of laparotomy. Methods: This study is a cross-sectional study included 150 polytrauma patients with a blunt mechanism admitted in Suez Canal University Hospital. Firstly primary survey by airway check, cervical spine securing with neck collar, maintenance of breathing/circulation and management of life threading conditions if present were conducted accordingly to ATLS (advanced trauma life support) guidelines. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra-abdominal collection. Results: A total of 150 patients, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6% and 100%, respectively. The negative predictive value was 92%, while the positive predictive value of FAST was 100%. The accuracy of FAST was 96%. Conclusion: FAST is an important method to detect intra-abdominal fluid in the initial assessment in hemodynamically unstable polytrauma patients with high accuracy

EVALUATION OF THORACIC TRAUMA SEVERITY SCORE IN PREDICTING THE OUTCOME OF ISOLATED BLUNT CHEST TRAUMA PATIENTS

Background: Chest trauma is a significant cause of mortality and morbidity, especially in the younger population. Injuries to the thorax are the third most common injuries in trauma patients, next to injuries to the head and extremities. Outcome and prognosis for the great majority of patients with chest trauma are excellent. There are many predictors of mortality in chest trauma patients however; the present standards for assessing thoracic trauma vary widely. For this in 2000 Pape et al developed the Thoracic Trauma Severity Score (TTSS), which combines the patient's age, resuscitation parameters, and radiological assessment of the thorax. Aim of this study: was to assess the validity if any; of the Thorax trauma severity score and its ability to predict mortality in blunt chest trauma patients. Methodology: this was a cross sectional study, the study included 30 patients. Results: the (TTSS) was found to be a good predictor for mortality among the studied patients on initial evaluation; with a score larger than (7), the score is 100% sensitive and 100% specific for prediction of poor outcome (Death and ICU admission) versus good outcome (Discharge from ER and inpatient admission) with 100% positive predictive value and 100% negative predictive value. Conclusio: This study supports the use of the TTSS for predicting mortality in thoracic injury patients, as higher scores were associated with higher mortality and morbidity

Evaluate the incidence, topography, management, and outcomes in patients with polytrauma in the Suez Canal and Sinai areas

Introduction: The global prevalence of trauma-related mortality ranges from 2% to 32%; however, In Egypt, it reaches 8%. Trauma chiefly affects people in the productive age group; seriously ill patients with multiple injuries present with various levels of polytrauma. Application of incorrect triage systems and improperly trained trauma teams increase mortality and morbidity rates in non-dedicated institutions; however, these rates can decrease with appropriate infrastructure. This study aimed to improve the quality of care for patients with polytrauma through improved knowledge of the different severity levels of polytrauma and defined databases, using a suitable triage trauma system, well-trained trauma team, and appropriate infrastructure. Methods: This observational cross-sectional study was conducted at the emergency department (ED), over a study period of 7 months, from August 10, 2019, to March 09, 2020. This study included 458 patients with polytrauma who had met the inclusion and exclusion criteria and attended the ED of Suez Canal University Hospital. Results: The incidence of trauma among all emergency cases in the ED was 5.3%. However, most multiple injuries are mild, accounting for 44.4%, while 27.3% of the cases had life-threatening injuries. Moreover, 41.9% of the patients were managed non-operatively, whereas 58.1% of the patients required surgical interventions. Concerning the outcome, 56% and 6.9% of patients with and without life-threatening injuries respectively, died. Conclusion: Facilities of the highest quality should be available for patients with polytrauma, especially those with life-threatening injuries. In addition, training emergency medical service staff for trauma triage is essential, and at least one tertiary hospital is required in every major city in the Suez Canal and Sinai areas to decrease trauma-related mortality

Accuracy and outcome of rapid ultrasound in shock and hypotension (RUSH) in Egyptian polytrauma patients

Purpose: “Polytrauma” patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of care–rapid ultrasound in shock and hypotension (RUSH) significantly affects modern trauma services and patient outcomes. This study aims to evaluate the accuracy of RUSH and patient outcomes by early detection of the causes of unstable polytrauma. Methods: This cross-sectional, prospective study included 100 unstable polytrauma patients admitted in Suez Canal University Hospital. Clinical exam, RUSH and pan-computed tomography (pan-CT) were conducted. The result of CT was taken as the standard. Patients were managed according to the advanced trauma life support (ATLS) guidelines and treated of life threatening conditions if present. Patients were followed up for 28 days for a short outcome. Results: The most diagnostic causes of unstability in polytrauma patients by RUSH are hypovolemic shock (64%), followed by obstructive shock (14%), distributive shock (12%) and cardiogenic shock (10%) respectively. RUSH had 94.2% sensitivity in the diagnosis of unstable polytrauma patients; the accuracy of RUSH in shock patients was 95.2%. Conclusion: RUSH is accurate in the diagnosis of unstable polytrauma patients; and 4% of patients were diagnosed during follow-up after admission by RUSH and pan-CT. Keywords: Polytrauma, Shock, Rapid ultrasound in shock and hypotensio