Pelvic trauma : WSES classification and guidelines

Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.Peer reviewe

Incidence of adverse events among elderly vs younger adult patients during procedural sedation with propofol

Background: Propofol has been used for procedural sedation and analgesia (PSA) in all age groups. Due to the narrow therapeutic index, propofol has a potentially high risk of adverse events (AE), particularly in elderly patients; however, the incidence of AE in elderly patients has not been well described. We aimed to determine the incidence of AEs during PSA with propofol in elderly patients and hypothesized that elderly patients have higher incidence of AE compared to younger adults. Methods: We conducted a 6-center prospective observational study in Japan, the Japanese Procedural SedaTion and Analgesia Registry(JPSTAR). We prospectively collected data on all patients undergoing PSA in the ED from May 2017 through December 2018. We included all adult patients (18 years or older) who received propofol for PSA and excluded patients who received multiple sedatives. AEs included both serious (e.g., cardiac arrest) and other less serious AEs (e.g., transient hypoxia). We compared the incidence of AE for elderly patients (65 years or older) to non-elderly adults. We used Fisher\u27s exact test for categorical data and Wilcoxon Rank Sum tests for continuous data for statistical comparisons. Results: Among 570 patients in the registry, 122 patients received propofol. Fifty-eight (47.5%) of patients were 65 years or older. The most common indication was reduction of joint dislocations or fracture in both elderly and younger adult groups (46.5% vs 65.6%, p=0.04). The elderly group received significantly lower doses of propofol compared to the younger adult group, but the incidence of AE was higher in the elderly group (32.8% vs. 15.6%, p=0.03). There were no serious AE in either groups Conclusion: Elderly patients had higher incidence of AE during PSA with propofol despite the fact they received lower dose. Emergency physicians should be cautious in using propofol for PSA in elderly patients

Does supplemental oxygen reduce the incidence of hypoxia during procedural sedation in elderly patients?

Background: The use of supplemental oxygen (SO) for procedural sedation and analgesia (PSA) is still controversial. Although SO might prevent hypoxia during PSA, it also could delay detection of hypoxia. The number of visits to EDs by elderly patients is increasing globally, including in the US. It is not uncommon to perform PSA on elderly patients in the ED. Although elderly patients are at high risk for respiratory depression and hypoxia, the efficacy of SO to reduce the incidence of hypoxia for these patients during ED PSA has not been well described. We aimed to determine the incidence of hypoxia during ED PSA in elderly patients and whether SO prevents hypoxia or not. We hypothesize that SO reduces the incidence of hypoxia during ED PSA. Methods: We conducted a 6-center prospective observational study, the Japanese Procedural SedaTion and Analgesia Registry (JPSTAR). We prospectively collected data on all patients undergoing PSA in the ED from May 2017 through December 2018. We included patients who were 65 years or older. We excluded patients who received sedation for airway management or excited delirium. The primary outcome was the incidence of hypoxia (SpO