Personal protective equipment for reducing the risk of COVID-19 infection among healthcare workers involved in emergency trauma surgery during the pandemic: An umbrella review protocol

Introduction Many healthcare facilities in low-income and middle-income countries are inadequately resourced and may lack optimal organisation and governance, especially concerning surgical health systems. COVID-19 has the potential to decimate these already strained surgical healthcare services unless health systems take stringent measures to protect healthcare workers (HCWs) from viral exposure and ensure the continuity of specialised care for patients. The objective of this broad evidence synthesis is to identify and summarise the available literature regarding the efficacy of different personal protective equipment (PPE) in reducing the risk of COVID-19 infection in health personnel caring for patients undergoing trauma surgery in low-resource environments. Methods We will conduct several searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials and over 30 other sources. The search results will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. This review will preferentially consider systematic reviews of experimental and quasi-experimental studies, as well as individual studies of such designs, evaluating the effect of different PPE on the risk of COVID-19 infection in HCWs involved in emergency trauma surgery. Critical appraisal of eligible studies for methodological quality will be conducted. Data will be extracted using the standardised data extraction tool in Covidence. Studies will, when possible, be pooled in a statistical meta-analysis using JBI SUMARI. The Grading of Recommendations, Assessment, Development and Evaluation approach for grading the certainty of evidence will be followed and a summary of findings will be created. Ethics and dissemination Ethical approval is not required for this review. The plan for issemination is to publish review findings in a peer-reviewed journal and present findings at high-level conferences that engage the most pertinent stakeholders

Fluid therapy in neurotrauma: basic and clinical concepts

The patient with head trauma is a challenge for the emergency physician and for the neurosurgeon. Currently traumatic brain injury constitutes a public health problem. Knowledge of the various therapeutic strategies to provide support in the prehospital and perioperative are essential for optimal care. Rapid infusion of large volumes of crystalloids to restore blood volume and blood pressure quickly is now the standard treatment for patients with combined TBI and HS The fluid in patients with brain and especially in the carrier of brain injury is a critical topic; we present a review of the literature about the history, physiology of current fluid preparations, and a discussion regard the use of fluid therapy in traumatic brain injury and decompressive craniectomy

El síndrome compartimental intracraneal: un modelo propuesto para la monitorización y el tratamiento de la lesión cerebral aguda

Durante décadas, uno de los principales objetivos en el tratamiento de la lesión cerebral aguda (LCA) grave ha sido el control de la hipertensión intracraneal (HIC). Sin embargo, la determinación de la HIC ha sufrido variaciones en sus umbrales a lo largo del tiempo sin que existan pruebas claras de ello. Mientras tanto, los avances en la comprensión de la dinámica del contenido intracraneal (cerebro, sangre y líquido cefalorraquídeo) y el desarrollo reciente de las técnicas de monitorización sugieren que centrarse en la distensibilidad intracraneal (CCI) podría ser un enfoque más fiable que guiar las acciones por valores predeterminados de presión intracraneal. Se sabe que el deterioro de la CCI pronostica la HI, ya que el volumen intracraneal puede aumentar rápidamente dentro del cráneo, una caja ósea cerrada con una expansibilidad irrisoria. Por lo tanto, puede producirse un síndrome compartimental intracraneal (ICCS) con efectos cerebrales deletéreos, precipitando una reducción de la perfusión cerebral, induciendo así una isquemia cerebral. El objetivo de la presente revisión en perspectiva es debatir el concepto de ICCS y sugerir un modelo integrador para la combinación de técnicas modernas invasivas y no invasivas para la evaluación de IH e ICC. La teoría y la lógica sugieren que la combinación de múltiples métodos auxiliares puede mejorar la predicción del deterioro de la ICC, señalando acciones proactivas y mejorando los resultados de los pacientes.For decades, one of the main targets in the management of severe acute brain injury (ABI) has been intracranial hypertension (IH) control. However, the determination of IH has sufered variations in its thresholds over time without clear evidence for it. Meanwhile, progress in the understanding of intracranial content (brain, blood and cerebrospinal fuid) dynamics and recent development in monitoring techniques suggest that targeting intracranial compliance (ICC) could be a more reliable approach rather than guiding actions by predetermined intracranial pressure values. It is known that ICC impairment forecasts IH, as intracranial volume may rapidly increase inside the skull, a closed bony box with derisory expansibility. Therefore, an intracranial compartmental syndrome (ICCS) can occur with deleterious brain efects, precipitating a reduction in brain perfusion, thereby inducing brain ischemia. The present perspective review aims to discuss the ICCS concept and suggest an integrative model for the combination of modern invasive and noninvasive techniques for IH and ICC assessment. The theory and logic suggest that the combination of multiple ancillary methods may enhance ICC impairment prediction, pointing proactive actions and improving patient outcomes

An Umbrella Review With Meta-Analysis of Chest Computed Tomography for Diagnosis of COVID-19: Considerations for Trauma Patient Management

BackgroundRT-PCR testing is the standard for diagnosis of COVID-19, although it has its suboptimal sensitivity. Chest computed tomography (CT) has been proposed as an additional tool with diagnostic value, and several reports from primary and secondary studies that assessed its diagnostic accuracy are already available. To inform recommendations and practice regarding the use of chest CT in the in the trauma setting, we sought to identify, appraise, and summarize the available evidence on the diagnostic accuracy of chest CT for diagnosis of COVID-19, and its application in emergency trauma surgery patients; overcoming limitations of previous reports regarding chest CT accuracy and discussing important considerations regarding its role in this setting.MethodsWe conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. The review was conducted following the JBI methodology for systematic reviews. The Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267).ResultsThirty studies that fulfilled selection criteria were included; 19 primary studies provided estimates of sensitivity (0.91, 95%CI = [0.88–0.93]) and specificity (0.73, 95%CI = [0.61; 0.82]) of chest CT for COVID-19. No correlation was found between sensitivities and specificities (ρ = 0.22, IC95% [–0.33; 0.66]). Diagnostic odds ratio was estimated at: DOR = 27.5, 95%CI (14.7; 48.5). Evidence for sensitivity estimates was graded as MODERATE, and for specificity estimates it was graded as LOW.ConclusionThe value of chest CT appears to be that of an additional screening tool that can easily detect PCR false negatives, which are reportedly highly frequent. Upon the absence of PCR testing and impossibility to perform RT-PCR in trauma patients, chest CT can serve as a substitute with increased value and easy implementation.Systematic Review Registration[www.crd.york.ac.uk/prospero], identifier [CRD42020198267]

Effect of cervical collars on intracranial pressure in patients with head neurotrauma

Trauma patients are at high risk of cervical and associated injuries. The standard protocol includes immobilization of the cervical spine in a polytrauma as it will help to prevent spinal injuries in the prehospital settings. Hard cervical collar (or alternatives) is routinely used until the cervical spine clearance is obtained . In patients with traumatic brain injury avoiding any kind of maneuver may lead to increased intracranial pressure

Unilateral traumatic hemorrhage of the basal ganglion and bihemisferic cerebral infarction

Among the various injuries caused by the cerebral tramatic lesion are trau- matic brain contusions. Hemorrhagic contusions of the basal ganglia are unusual. Different injuries such as cranial fractures, epidural hemorrhage, subdural hematoma, subarachnoid hemorrhage among others may be associated with brain contusions. In some cases traumatic brain injury arises. We present a case of a patient with unilateral cerebral contusion associated with bihemispheric cerebral infarction

Post-traumatic cerebellar infarction due to vertebral artery foramina fracture: Case report

Posttraumatic cerebral infarction is an uncommon cause of morbidity and mortality and many studies have highlighted that trauma needs to considered as causative factor for cerebellar infarction. We present a case of cerebellar infarction in a 35 year old young patient secondary to vertebral fracture involving the vertebral foramen and vertebral artery injury. CT scan cervical spine showed C2-3 fracture on left side with fracture extending into the left vertebral foramen. A CT scan angiogram could not be performed because of poor neurological status. Possibly the infarction was due to left vertebral artery injury. Without surgical intervention prognosis of these patients remain poor. Prognosis of patients with traumatic cerebellar infarction depends on the neurological status of the patient, intrinsic parenchymal damage and more importantly extrinsic compression of the brainstem by the edematous cerebellar hemispheres

Non traumatic fractures of the lumbar spine and seizures: Case report

Injury-induced seizures may appear clinically asymptomatic and can be easily monitored by the absence of trauma and post-ictal impairment of consciousness. Patients with epilepsy have a higher risk of compression fractures, leading to serious musculoskeletal injuries, this type of non-traumatic compression fractures of the spine secondary to seizures are rare lesions, and is produced by the severe contraction of the paraspinal muscles that can achieve the thoracic spine fracture. Seizures induced lesions may appear clinically asymptomatic and can be easily monitored by the absence of trauma and post-ictal impairment of consciousness. We present a case report

The five preferences for post-traumatic SAH

Acute traumatic brain injury is a worldwide public health crisis. Post-traumatic subarachnoid hemorrhage (SAH) is a finding that is present at a frequency of 40% according to data from American TCDB (1,2). Among the mechanisms that have been implicated as causes of post-traumatic SAH is the cortical bleeding through the subarachnoid space. It is estimated that the incidence of post-traumatic SAH is 11% to 60% in patients with traumatic brain injury. The brain CT is considered a technique with good sensitivity, economical and available in many hospitals worldwide. We have reviewed the literature and found some imaging characteristics of post-traumatic subarachnoid hemorrhage. We have called “the five preferences for post-traumatic SAH”

Therapeutic hypothermia in brain trauma injury: controversies

Traumatic brain injury (TBI) is a common cause of death and disability in developed countries. It is a major cause of mortality in young patients worldwide. Intracranial hypertension is the cause of death in more than 80% of patients with TBI. When secondary lesions occur, start a number of mechanisms that increase the metabolic injury to brain tissue. Induction of hypothermia has been shown to alter the natural course of the disease process. The biological foundations suggest that hypothermia may have a potential benefit, although some publications have shown no improvement, it is clear that in a group of mostly young patients, early hypothermia may be beneficial. We present a practical review of the literature on this subject