Snakebite management: Experiences from Gulu Regional Hospital Uganda

Background: The objective of this study was to document our experience with supportive therapy without antivenom in snakebite management.Methods: In a prospective study undertaken at Gulu Regional Hospital, Northern Uganda from January to December 2002 the outcome of supportive therapy in management of 108 cases of snakebite was assessed.Results: The lower extremity was involved in 106 patients (98.1%) and the upper extremity in the remaining two cases. Sixty-two patients (57.4 %) did not get any First Aid prior to admission. All Patients received supportive therapy. None of the patients received snake antivenom since it was unavailable at the hospital. All the 108 patients (100 %) improved and were discharged. The duration of hospital stay was 2 to 17 days with a mean of 3.8 days. Conclusion: Supportive therapy is simple, safe and effective treatment for snakebite without serious systemic poisoning

Use of urethral catheters for diagnostic peritoneal lavage in blunt abdominal trauma

Background: Diagnostic peritoneal lavage (DPL) has been reported to be a reliable  diagnostic tool in assessing the need for liparotomy in blunt abdominal trauma (BAT) with a diagnostic accuracy of more thin 95% when using a peritoneal lavage catheter (PLC). The aim of this study was to determine the diagnostic accuracy of the procedure when small urethral catheters are used as an alternative to the PLC.Methods: Open diagnostic peritoneal lavage was performed in 115 patients with blunt abdominal trauma in whom clinical assessment for intra-abdominal injury was uninformative. Two-way silicon-coated rubber Foley urethral catheters size 12Fr  were used as substitutes for peritoneal lavage catheter. Peritoneal effluent fluid was analysed both macroscopically and by the laboratory estimation of the white and red blood cell counts and amylase levels.Results: A total of 27 Patients (23.5%) had positive DPL results while three  (2.6%) had clinically doubtfur equivocal DPL results. Both groups were subjected to exploratory laparotomy. The rest of cases (73.9%) improved on non-operative   (conservative) management. The diagnostic accuracy was 97.6% for macroscopic  and 99.1% for laboratory assessment. There were no complications attributed to DPL. There was a significant association between the DPL results and the laparotomy   findings <p=0.000). Macroscopic assessment of DPL results was also found to be a reliable diagnostic method in blunt abdominal trauma (p<0.001).Conclusion: In emergency situations, small urethral catheters size 12Fr are a useful and safe alternative to peritoneal lavage catheters as diagnostic tools in blunt abdominal trauma.Key words: Urethral catheter, diagnostic, peritoneal lavage, emergency

Emergency Ultrasound Predicting the Need for Therapeutic Laparotomy among Blunt Abdominal Trauma Patients in a Sub-Saharan African Hospital

Background. The trauma burden globally accounts for high levels of mortality and morbidity. Blunt abdominal trauma (BAT) contributes significantly to this burden. Patient's evaluation for BAT remains a diagnostic challenge for emergency physicians. SSORTT gives a score that can predict the need for laparotomy. The objective of this study was to assess the accuracy of SSORTT score in predicting the need for a therapeutic laparotomy after BAT. Method. A prospective observational study. Eligible patients were evaluated for shock and the presence of haemoperitoneum using a portable ultrasound machine. Further evaluation of patients following the standard of care (SOC) protocol was done. The accuracy of SSORTT score in predicting therapeutic laparotomy was compared to SOC. Results. In total, 195 patients were evaluated; M : F ratio was 6 : 1. The commonest injuries were to the head 80 (42%) and the abdomen 54 (28%). A SSORTT score of >2 appropriately identified patients that needed a therapeutic laparotomy (with sensitivity 90%, specificity 90%, PPV 53%, and NPV 98%). The overall mortality rate was 17%. Conclusion. Patients with a SSORTT score of 2 and above had a high likelihood of requiring a therapeutic laparotomy. SSORTT scoring should be adopted for routine practice in low technology settings

First Things First: Effectiveness and Scalability of a Basic Prehospital Trauma Care Program for Lay First-Responders in Kampala, Uganda

BACKGROUND: We previously showed that in the absence of a formal emergency system, lay people face a heavy burden of injuries in Kampala, Uganda, and we demonstrated the feasibility of a basic prehospital trauma course for lay people. This study tests the effectiveness of this course and estimates the costs and cost-effectiveness of scaling up this training. METHODS AND FINDINGS: For six months, we prospectively followed 307 trainees (police, taxi drivers, and community leaders) who completed a one-day basic prehospital trauma care program in 2008. Cross-sectional surveys and fund of knowledge tests were used to measure their frequency of skill and supply use, reasons for not providing aid, perceived utility of the course and kit, confidence in using skills, and knowledge of first-aid. We then estimated the cost-effectiveness of scaling up the program. At six months, 188 (62%) of the trainees were followed up. Their knowledge retention remained high or increased. The mean correct score on a basic fund of knowledge test was 92%, up from 86% after initial training (n = 146 pairs, p = 0.0016). 97% of participants had used at least one skill from the course: most commonly haemorrhage control, recovery position and lifting/moving and 96% had used at least one first-aid item. Lack of knowledge was less of a barrier and trainees were significantly more confident in providing first-aid. Based on cost estimates from the World Health Organization, local injury data, and modelling from previous studies, the projected cost of scaling up this program was $0.12 per capita or$25-75 per life year saved. Key limitations of the study include small sample size, possible reporter bias, preliminary local validation of study instruments, and an indirect estimate of mortality reduction. CONCLUSIONS: Lay first-responders effectively retained knowledge on prehospital trauma care and confidently used their first-aid skills and supplies for at least six months. The costs of scaling up this intervention to cover Kampala are very modest. This may be a cost-effective first step toward developing formal emergency services in Uganda other resource-constrained settings. Further research is needed in this critical area of trauma care in low-income countries

Snakebite Management: Experiences From Gulu Regional Hospital Uganda

Background: The objective of this study was to document our experience with supportive therapy without antivenom in snakebite management. Methods: In a prospective study undertaken at Gulu Regional Hospital, Northern Uganda from January to December 2002 the outcome of supportive therapy in management of 108 cases of snakebite was assessed. Results: The lower extremity was involved in 106 patients (98.1%) and the upper extremity in the remaining two cases. Sixty-two patients (57.4 %) did not get any First Aid prior to admission. All Patients received supportive therapy. None of the patients received snake antivenom since it was unavailable at the hospital. All the 108 patients (100 %) improved and were discharged. The duration of hospital stay was 2 to 17 days with a mean of 3.8 days. Conclusion: Supportive therapy is simple, safe and effective treatment for snakebite without serious systemic poisoning

Use of urethral catheters for diagnostic peritoneal lavage in blunt abdominal trauma.

Background: Diagnostic peritoneal lavage (DPL) has been reported to be a reliable diagnostic tool in assessing the need for laparotomy in blunt abdominal trauma (BAT) with a diagnostic accuracy of more than 95% when using a peritoneal lavage catheter (PLC). The aim of this study was to determine the diagnostic accuracy of the procedure when small urethral catheters are used as an alternative to the PLC. Methods: Open diagnostic peritoneal lavage was performed in 115 patients with blunt abdominal trauma in whom clinical assessment for intra-abdominal injury was uninformative. Two-way silicon-coated rubber Foley urethra catheters size l2Fr were used as substitutes for peritoneal lavage catheter. Peritoneal effluent fluid was analysed both macroscopically and by the laboratory estimation of the white and red blood cell counts and amylase levels. Results: A total of 27 Patients (23.5%) had positive DPL results while three (2.6%) had clinically doubtful equivocal DPL results. Both groups were subjected to exploratory laparotomy. The rest of cases (73.9%) improved on non-operative (conservative) management. The diagnostic accuracy was 97.6% for macroscopic and 99.1% for laboratory assessment. There were no complications attributed to DPL. There was a significant association between the DPL results and the laparotomy findings (p=0.000). Macroscopic assessment of DPL results was also found to be a reliable diagnostic method in blunt abdominal trauma (p<0.001). Conclusion: In emergency situations, small urethral catheters size l2Fr are a useful and safe alternative to peritoneal lavage catheters as diagnostic tools in blunt abdominal trauma

Annual cost of training 3000 lay first-responders (Base case).

<p>Annual cost of training 3000 lay first-responders (Base case).</p

Reported reasons for not providing assistance.

*<p>n = 179 unless otherwise noted</p>†<p>by paired t test</p

Participants' fund of knowledge at six months compared to after initial training.

*<p>by paired t test.</p

Cost per death averted and per life year saved of training 9000 lay first responders.

<p>Cost per death averted and per life year saved of training 9000 lay first responders.</p