Lesão da artéria ilíaca interna bilateral associada com trauma pélvico, tratada por intervenção arteriografia com embolização

Pelvic ring ruptures are a cause of great mortality and morbidity in trauma patients. The fatalities are, in general, consequence of the retroperitoneal hemorrhage and other associated damages due to the great force necessary to rip the pelvic ring. The mortality in theses cases are between 15 and 25%. The hemorrhage is usually due to the posterior pelvis venous plexus and the bony surface sponge bleedings. Less than 10% of the cases its caused by the bleeding of a known artery and in only 1% by iliac or femoral arteries. The objectives of this study is to report a case of a patient victim of a blunt trauma, with a complex pelvic fracture and hypotension by a bilateral iliac artery injury that was diagnosed and treated by interventionist radiology.Ruptura traumática do anel pélvico resulta geralmente de impacto com grande dispêndio de energia levando à ruptura do complexo ósteo-ligamentar levando a hemorragia retroperitoneal oriunda do plexo venoso posterior da pelve e de superfícies ósseo-esponjosas, que juntamente com lesões associadas acarreta cerca de 15% a 25% de mortalidade nos pacientes com lesão do anel pélvico(1).  Em menos de 10% dos casos ocorre sangramento de artérias conhecidas, e em menos de 1% é relatado sangramento de vasos ilíacos ou femorais(2,3,4). O objetivo do presente estudo é relatar o caso de um paciente vítima de trauma contuso com fratura pélvica e instabilidade hemodinâmica persistente após fixação pélvica externa, tendo se diagnosticado por arteriografia lesão artérial ilíaca interna bilateral, e tratado por radiologia inervencionista com embolização

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Enhancing trauma education worldwide through telemedicine

Abstract Advances in information and communication technologies are changing the delivery of trauma care and education. Telemedicine is a tool that can be used to deliver expert trauma care and education anywhere in the world. Trauma is a rapidly-evolving field requiring access to readily available sources of information. Through videoconferencing, physicians can participate in continuing education activities such as Grand Rounds, seminars, conferences and journal clubs. Exemplary programs have shown promising outcomes of teleconferences such as enhanced learning, professional collaborations, and networking. This review introduces the concept of telemedicine for trauma education, and highlights efforts of programs that are utilizing telemedicine to unite institutions across the world.</p

Enhancing trauma education worldwide through telemedicine

Advances in information and communication technologies are changing the delivery of trauma care and education. Telemedicine is a tool that can be used to deliver expert trauma care and education anywhere in the world. Trauma is a rapidly-evolving field requiring access to readily available sources of information. Through videoconferencing, physicians can participate in continuing education activities such as Grand Rounds, seminars, conferences and journal clubs. Exemplary programs have shown promising outcomes of teleconferences such as enhanced learning, professional collaborations, and networking. This review introduces the concept of telemedicine for trauma education, and highlights efforts of programs that are utilizing telemedicine to unite institutions across the world

Global Connections: Telemedicine as a Tool to extend Trauma Education

ABSTRACT Introduction Telemedicine is revolutionizing the delivery of trauma care and education. The International Trauma Tele- Grand Rounds is a series that unites institutions worldwide to discuss complex clinical cases and advanced trauma and critical care topics. Materials and methods Multiple remote institutions connect simultaneously to discuss the management of a trauma patient from the prehospital phase to discharge. Weekly, a case is presented in English by one institution on a rotating basis. Key points include mechanism of injury, resuscitation, laboratory and imaging diagnostics, surgical interventions, postoperative patient care, evaluation of treatment decisions and review of the literature. The highly interactive format allows participants to evaluate differences in trauma care across international health systems. Results During 2010 to 2011, 68 sessions were documented. Cases include blunt (42.6%), penetrating (48.5%), blast (7.4%) and crushing (1.5%) traumas. Gunshot wounds were the most frequent (25%). A holistic range of injuries were represented including injuries to major arteries, veins, lungs, heart, pericardium, esophagus, diaphragm, abdominal wall, stomach, intestines, liver, kidneys, pelvis, and the extremities. A variety of surgical and nonsurgical interventions were explored. To date, there have been 42 participating institutions from the United States, Brazil, Colombia, Bahamas, Canada, Mexico, Venezuela, Argentina, Panama, Puerto Rico, Dominican Republic, British Virgin Islands, Spain, Thailand, Turkey and Iraq; ranging from academic medical centers military hospitals, community hospitals, and rural hospitals. In 2011, the series received accreditation by the Accreditation Council for Continuing Medical Education. Conclusion Telemedicine offers a solution to address the disparities in access to trauma care and education. The diversity of institutional settings allows participants to learn from others on how to best treat trauma patients, despite differences in resources and expertise. In addition to serving as an educational tool, the series provides a mechanism for physicians to network and collaborate on future endeavors. How to cite this article Marttos AC, Kuchkarian FM, Rojas DF, Fraga GP, Collet-Silva FS, de Almeida Costa C, Garcia GD, Ginzburg E, Schulman CI, Namias N. Global Connections: Telemedicine as a Tool to extend Trauma Education. Panam J Trauma Critical Care Emerg Surg 2013;2(1):62-66