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

Team dynamics in emergency surgery teams: results from a first international survey

Background: Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma\u2019s causes or the patient\u2019s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods: An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients\u2019 and stakeholders\u2019 engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion: Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey\u2019s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions

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

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Background: Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods: Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results: A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion: Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions

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