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8 results

  • Chapter 15 - The Changing Face of Traumatic Injury

  • from Section 2 - Clinical Aspects of Traumatic Injuries, Epidemics, and Pandemics
  • Edited by Richard Williams, University of South Wales, Verity Kemp, Independent Health Emergency Planning Consultant, Keith Porter, University of Birmingham, Tim Healing, Worshipful Society of Apothecaries of London, John Drury, University of Sussex
  • Book:
    Major Incidents, Pandemics and Mental Health
    Published online:
    11 January 2024
    Print publication:
    01 February 2024, pp 99-106

  • Summary

    Injuries caused by knives and bullets frequently produce life-threatening and life-changing injuries, often in urban environments and associated with the abuse of alcohol and drugs. The development of pre-hospital care includes introducing critical care paramedics and critical care response teams, and enhanced assessment techniques. Its success is driven by the concept of scoop and play that is intended to deliver the right patient, with the right treatment, utilising the right transport modality, to the right hospital. Bespoke trauma networks and systems help to meet these objectives. The war in Afghanistan has driven rapid innovation and clinical advances embracing resuscitation, life-saving surgery, and new techniques in trauma reconstruction. These advances have now been introduced into civilian practice and are the backbone of the management of critically injured patients with knife and bullet injuries. Where and when possible, these advances are underpinned by research and delivered by inclusive trauma training.

  • 51 - Solid Organ Abdominal Trauma

  • from Section 11 - Trauma
  • Edited by Kaushal Shah, Weill Cornell Medical Center, New York, Jarone Lee, Massachusetts General Hospital, Boston
  • Edited in association with Clark G. Owyang, Weill Cornell Medical Center, New York, Benjamin Christian Renne, Massachusetts General Hospital, Boston
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 552-560

  • Summary

    • Injuries are generally classified based on mechanism as either blunt or penetrating. Each has a different method of evaluation and treatment.

    • In blunt injuries, solid organs are commonly injured with acceleration/deceleration injuries (i.e., motor vehicle collisions [MVC], falls from height) and crush injuries. Blunt injuries are associated with greater mortality than penetrating ones. The spleen is the most commonly injured solid organ, followed by the liver.

    • A stab wound, one such penetrating injury, is less likely to cause intra-abdominal injury and penetrate the peritoneum requiring surgical intervention when compared with projectile wounds.

  • Chapter 3 - Penetrating Trauma

  • Edited by Mark Curato, Weill Cornell Medicine, New York, Kaushal Shah, Weill Cornell Medicine, New York, Christopher Reisig, Weill Cornell Medicine, New York
  • Book:
    Urban Emergency Medicine
    Published online:
    20 July 2023
    Print publication:
    03 August 2023, pp 26-38

  • Summary

    Gun violence is a public health crisis. In 2020, America had the highest number of deaths due to gun violence on record. Gun violence and stabbings were the second and fifth causes of violence-related deaths in the United States, respectively. There were 45,222 gun deaths in the United States, with suicide comprising 54% and homicides comprising 43% of those deaths. While 30% of American adults report owning a gun, 52% of non-gun owners could see themselves owning a gun in the future. Urban areas are particularly affected by gun violence. In 2015, 81% of the 12,979 firearm homicides that occurred in the US occurred in cities. In the urban trauma setting, penetrating trauma disproportionately impacts the pre-existing violence in these areas. During the COVID-19 global pandemic, emergency departments have seen a rise in trauma admissions. This exacerbation of violence may correlate with the economic devastation caused by the COVID-19 pandemic. Higher poverty rates in these areas contribute to the crime and increased prevalence of penetrating injury. This upsurge of trauma is particularly salient in urban hospital settings, where there is a concentration of violent injuries.

  • Association between Mode of Transportation and Survival in Adult Trauma Patients with Penetrating Injuries: Matched Cohort Study between Police and Ground Ambulance Transport

  • Samer A. Abou Arbid, Rana H. Bachir, Mazen J. El Sayed
  • Journal:
    Prehospital and Disaster Medicine / Volume 37 / Issue 2 / April 2022
    Published online by Cambridge University Press:
    08 March 2022, pp. 171-178
    Print publication:
    April 2022
  • Introduction:

    Police transport (PT) of penetrating trauma patients has the potential to improve survival rates. There are no well-established guidelines for PT of penetrating trauma patients.

    Study Objective:

    This study examines the association between survival rate to hospital discharge of adult penetrating trauma patients and mode of transport (PT versus ground ambulance [GA]).

    Methods:

    A retrospective, matched cohort study was conducted using the United States (US) National Trauma Data Bank (NTDB). All adult penetrating injury patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by GA for analysis. Descriptive analysis was carried out. The patients’ demographic and clinical characteristics were tabulated and stratified by the transport mode.

    Results:

    Out of the 733 patients with penetrating injuries, ground Emergency Medical Services (EMS) transported 513 patients and police transported 220 patients. Most patients were 16-64 years of age with a male (95.6%) and Black/African American race (79.0%) predominance. Firearm-related injuries (68.8%) were the most common mechanism of injury with the majority of injuries involving the body extremities (62.9%). Open wounds were the most common nature of injury (75.7%). The overall survival rate to hospital discharge was similar for patients transported by GA and by police (94.5% versus 92.7%; P = .343).

    Conclusion:

    In this study, patients with penetrating trauma transported by police had similar outcomes to those transported by GA. As such, PT in penetrating trauma appears to be effective. Detailed protocols should be developed to further improve resource utilization and outcomes.

  • Abdominal Aortic and Iliac Artery Compression Following Penetrating Trauma: A Study of Feasibility

  • Matthew Douma, Peter George Brindley
  • Journal:
    Prehospital and Disaster Medicine / Volume 29 / Issue 3 / June 2014
    Published online by Cambridge University Press:
    10 June 2014, pp. 299-302
    Print publication:
    June 2014
  • Introduction

    Penetrating junctional trauma is a leading cause of preventable death on the battlefield. Similarly challenging in civilian settings, exsanguination from the vessels of the abdomen, pelvis, and groin can occur in moments. Therefore, iliac artery or abdominal aortic compression has been recommended. Based on prior research, 120 lbs (54 kg) or 140 lbs (63 kg) of compression may be required to occlude these vessels, respectively. Whether most rescuers can generate this amount of compression is unknown.

    Objective

    To determine how many people in a convenience sample of 44 health care professionals can compress 120 lbs and 140 lbs.

    Methods

    This study simulated aortic and iliac artery compression. Consent was obtained from 44 clinicians (27 female; 17 male) from two large urban hospitals in Edmonton, Alberta, Canada. Participants compressed the abdominal model, which consisted of a medical scale and a 250 ml bag of saline, covered by a folded hospital blanket and placed on the ground. In random order, participants compressed a force they believed maintainable for 20 minutes (“maintainable effort”) and then a maximum force they could maintain for two minutes (“maximum effort”). Compression was also performed with a knee. Descriptive statistics were used to evaluate the data.

    Results

    Compression was directly proportional to the clinician's body weight. Participants compressed a mean of 55% of their body weight with two hands at a maintainable effort, and 69% at a maximum effort. At maintainable manual effort, participants compressed a mean of 86 lbs (39 kg). Sixteen percent could compress over 120 lbs, but none over 140 lbs. At maximum effort, participants compressed a mean of 108 lbs (48 kg). Thirty-four percent could compress greater than 120 lbs and 11% could compress greater than 140 lbs. Using a single knee, participants compressed a mean weight of 80% of their body weight with no difference between maintainable and maximum effort.

    Conclusion

    This work suggests that bimanual compression following penetrating junctional trauma is feasible. However, it is difficult, and is not likely achievable or sustainable by a majority of rescuers. Manual compression (used to temporize until device application and operative rescue) requires a large body mass. To maintain 140 lbs of compression (for example during a lengthy transport), participants needed to weigh 255 lbs (115 kg). Alternatively, they needed to weigh 203 lbs (92 kg) to be successful during brief periods. Knee compression may be preferable, especially for lower-weight rescuers.

    DoumaM , BrindleyPG . Abdominal Aortic and Iliac Artery Compression Following Penetrating Trauma: A Study of Feasibility. Prehosp Disaster Med. 2014;29(3):1-4.

  • 22 - Bradyarrhythmias

  • from Section 4 - Cardiovascular emergencies
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 153-157

  • Summary

    This chapter discusses the diagnosis, evaluation and management of solid organ abdominal trauma. It presents special circumstances which make diagnosis and management of solid organ abdominal trauma difficult in pediatric patients. The primary survey for solid organ abdominal trauma should be aimed at determining which patients need immediate laparotomy versus those that are stable for further diagnostic workup. Vital signs provide a key to hemodynamic stability. Unstable patients with blunt or penetrating trauma to the abdomen require immediate laparotomy. All patients after significant trauma, both blunt and penetrating, should receive screening AP chest radiography. Given small anteroposterior diameter and developing abdominal musculature, children are more vulnerable to blunt forces. The most likely reason for sudden deterioration in a trauma patient with solid organ injury is hemorrhagic shock; therefore more aggressive resuscitation has to be considered and the process to get patient to the OR for laparotomy is facilitated.

  • Penetrating craniofacial trauma from a vice clamp: case report and discussion

  • Colleen Kjelland, Warren Thirsk
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 13 / Issue 1 / January 2011
    Published online by Cambridge University Press:
    11 May 2015, pp. 57-61
    Print publication:
    January 2011
    • Article
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  • Penetrating craniofacial trauma, although uncommon, has a high potential for death or serious morbidity from injury to vital neurovascular structures. An in situ facial foreign body, particularly if large, presents significant challenges beyond safe and timely removal. Airway management, stabilization of the object, management of increased intracranial pressure, and identification of injuries to local structures are all issues that may require addressing. We present a case of penetrating facial trauma from a vice clamp, with an in situ foreign body, that illustrates several of these challenges and provides a forum for their discussion.

  • Penetrating spinal cord injuries with retained canal fragments

  • David T. Williams, Danny L. Chang, Matthieu P. DeClerck
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 11 / Issue 2 / March 2009
    Published online by Cambridge University Press:
    21 May 2015, pp. 172-173
    Print publication:
    March 2009
    • Article
      • You have access
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  • Case 1: A previously healthy 15-year-old boy was brought by paramedics to the emergency department (ED) after suffering multiple penetrating gunshot wounds (GSWs) to the lower extremities and a single entry to the left suprascapular region. Vital signs were within normal limits upon presentation.

    Case 2: A previously healthy 19-year-old man was brought by paramedics to the ED after suffering multiple stab wounds to the back. The patient was hypoxic and in severe respiratory distress upon arrival. A left thoracostomy tube was placed. Clinically the patient improved and vital signs returned to normal.