scholarly journals Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

2021 ◽  
Author(s):  
Adel Hamed Elbaih ◽  
Maged El-Setouhy ◽  
Jon Mark Hirshon ◽  
Hazem Mohamed El-Hariri ◽  
Mohamed El-Shinawi
Keyword(s):  
Low Income ◽  
Life Support ◽  
University Hospital ◽  
Low Income Countries ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Education Programs ◽  
Missed Injuries ◽  
Polytrauma Patients ◽  
Trauma Education

Abstract IntroductionTrauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.AimImprove the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.MethodsThis interventional training study was conducted in the SCUH ED that adheres to CONSORT guidelines. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.ResultsOverall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.ConclusionSTEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.Trial RegistrationProject manager for the Pan African Clinical Trial Registry (www.pactr.org) database has been accepted with the date of approval:18/11/2020. Current Controlled Trials number for the registry is PACTR202011853914203. Please note that the article state Retrospectively registered that my study adheres to CONSORT guidelines.

scholarly journals Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

2020 ◽  
Author(s):  
Adel Hamed Elbaih ◽  
Maged El-Setouhy ◽  
Jon Mark Hirshon ◽  
Hazem Mohamed El-Hariri ◽  
Mohamed El-Shinawi
Keyword(s):  
Low Income ◽  
Life Support ◽  
University Hospital ◽  
Low Income Countries ◽  
Advanced Trauma Life Support ◽  
Significant Finding ◽  
Education Programs ◽  
Missed Injuries ◽  
Polytrauma Patients ◽  
Trauma Education

Abstract Introduction: Trauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.Aim: Improve the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.Methods: This interventional training study was conducted in the SCUH ED. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.Results: Overall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.Conclusion: STEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.

scholarly journals Advanced Trauma Life Support training. How useful it is?

2020 ◽  
Vol 4 (2.4) ◽  
Author(s):  
Agron Dogjani ◽  
Arben Gjata ◽  
Kastriot Haxhirexha ◽  
Sindi Shandro ◽  
Seimir Laqja
Keyword(s):  
Life Support ◽  
Educational Status ◽  
University Hospital ◽  
Medical Emergency ◽  
Advanced Trauma Life Support ◽  
Substantial Part ◽  
Trauma Patients ◽  
Trauma Service ◽  
Police Records ◽  
The Right

For more than 20 years, following the changes that took place in Albania in 1992, we receive information from trauma patients in the media about the delivery of trauma services. Police records are worthy of a war balance report. Trauma is estimated to be the cause of deaths in 13.7% / 100,000 people. Every two days three Albanian Citizens die because of Automobile Accidents… Changes have already taken place, but the question arises, who cares about the trauma and its management? Formerly and now the state ... ok ... but? Is this enough? The Ministry of Health should have a “Trauma Committee” if yes… is it active? Already of the three years at the heart of these medical emergency management networks is a National Center of Medical Emergency (NCME). The trauma service delivery is now evolving along the lines of a central and spoken model with a concentration of expertise and specialization in the center surrounded by smaller units that feed on the center. The study showed a 19% increase in the chances of survival since the introduction of these changes. Another 1,600 trauma victims are alive today due to developments in the administration of trauma patients in England over the past six years. In this system or mode of organizing what is today the NCME or organizing the transport of traumatized from the scene to the University Hospital of Trauma... by medical staff who have done a substantial part of the PhTLS® course ... How is the educational status of personal in other regions far from Capital? ATLS® student courses in our country have been implemented by few and individually… ASTES, by default rules, has acquired the right to organize ATLS® in Albania…

Case Report: FAST Ultrasound Interpretation in Trauma Resuscitation

POCUS Journal ◽  
2016 ◽  
Vol 1 (3) ◽  
pp. 13-14
Author(s):  
Stuart Douglas, PGY4 ◽  
Joseph Newbigging, MD ◽  
David Robertson, MD
Keyword(s):  
Case Report ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Life Support ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Ultrasound Probe ◽  
Trauma Resuscitation ◽  
Highly Sensitive ◽  
Pouch Of Douglas

FAST Background: Focused Assessment with Sonography for Trauma (FAST) is an integral adjunct to primary survey in trauma patients (1-4) and is incorporated into Advanced Trauma Life Support (ATLS) algorithms (4). A collection of four discrete ultrasound probe examinations (pericardial sac, hepatorenal fossa (Morison’s pouch), splenorenal fossa, and pelvis/pouch of Douglas), it has been shown to be highly sensitive for detection of as little as 100cm3 of intraabdominal fluid (4,5), with a sensitivity quoted between 60-98%, specificity of 84-98%, and negative predictive value of 97-99% (3).

scholarly journals Dr. James Styner and the development of Advanced Trauma Life Support

2021 ◽  
Author(s):  
Wesley Tin
Keyword(s):  
Trauma Patient ◽  
Educational System ◽  
Education System ◽  
Life Support ◽  
Standard Of Care ◽  
Support Program ◽  
Advanced Trauma Life Support ◽  
Significant Morbidity ◽  
Initial Management ◽  
Trauma Education

The Advanced Trauma Life Support program, or ATLS, is a trauma education system that has become the standard of care for initial management in emergent settings. Trauma is responsible for 10% of the world’s mortality, and comes at extensive cost, often with significant morbidity and rehabilitation1. ATLS provides an organized language and approach to the trauma patient that can be communicated globally and has been shown to significantly decrease mortality in the first hour post-admission2. It was originally designed for use in low resource settings after a devastating accident involving an orthopaedic surgeon’s family. The shortcomings in care that his family received spurred him to create an educational system that could be applied at any site.

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

2013 ◽  
Vol 33 (6) ◽  
pp. 18-24 ◽  
Author(s):  
Stavros Gourgiotis ◽  
George Gemenetzis ◽  
Hemant M. Kocher ◽  
Stavros Aloizos ◽  
Nikolaos S. Salemis ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Life Support ◽  
Operative Management ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Permissive Hypotension ◽  
Randomized Controlled Clinical Trials ◽  
Resuscitation Fluid ◽  
Crystalloid Solutions ◽  
Prehospital Trauma Life Support

Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient’s current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary.

Prehospital Care and In-hospital Mortality of Trauma Patients in Iran

2014 ◽  
Vol 29 (5) ◽  
pp. 473-477 ◽  
Author(s):  
Mohammad Paravar ◽  
Mehrdad Hosseinpour ◽  
Mahdi Mohammadzadeh ◽  
Azade Sadat Mirzadeh
Keyword(s):  
Hospital Mortality ◽  
Trauma Center ◽  
Injury Severity ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Publication Type ◽  
Transport Time ◽  
Severe Injuries

AbstractIntroductionThe aim of this study was to determine the effect of prehospital time and advanced trauma life support interventions for trauma patients transported to an Iranian Trauma Center.MethodsThis study was a retrospective study of trauma victims presenting to a trauma center in central Iran by Emergency Medical Services (EMS) and hospitalized more than 24 hours. Demographic and injury characteristics were obtained, including accident location, damaged organs, injury mechanism, injury severity score, prehospital times (response, scene, and transport), interventions and in-hospital outcome.ResultsTwo thousand patients were studied with an average age of 36.3 (SD = 20.8) years; 83.1% were male. One hundred twenty patients (6.1%) died during hospitalization. The mean response time, at scene time and transport time were 6.6 (SD = 3), 11.1 (SD = 5.2) and 12.8 (SD = 9.4), respectively. There was a significant association of longer transport time to worse outcome (P = .02). There was a trend for patients with transport times >10 minutes to die (OR: 0.8; 95% CI, 0.1-6.59). Advanced Life Support (ALS) interventions were applied for patients with severe injuries (Revised Trauma Score ⩽7) and ALS intervention was associated with more time on scene. There was a positive association of survival with ALS interventions applied in suburban areas (P = .001).ConclusionIn-hospital trauma mortality was more common for patients with severe injuries and long prehospital transport times. While more severely injured patients received ALS interventions and died, these interventions were associated with positive survival trends when conducted in suburban and out-of-city road locations with long transport times.HosseinpourM, ParavarM, MohammadzadehM, MirzadehAS. Prehospital care and in-hospital mortality of trauma patients in Iran. Prehosp Disaster Med. 2014;29(5):1-5.

scholarly journals Management of Open Fractures in Low-Income Countries: a Daunting Task

2021 ◽  
Vol 2 (3) ◽  
pp. 9-16
Author(s):  
Jean Baptiste Ramampisendrahova ◽  
Mamisoa Bodohasina Rasamoelina ◽  
Tsiahoana Jean Floris Tata ◽  
Rado Razafimahatratra ◽  
Gaëtan Duval Solofomalala
Keyword(s):  
Low Income ◽  
Bone Fractures ◽  
Insurance Coverage ◽  
Open Fractures ◽  
University Hospital ◽  
Low Income Countries ◽  
Long Bone ◽  
Definitive Treatment ◽  
Long Bones ◽  
Daunting Task

Abstract The management of open fractures was a challenge from antiquity to the present day. The objective of this study is to report the difficulties of the management of open fractures of long bones in low-income countries. This was a retrospective cohort study of the files of patients admitted for open fracture of long bones in the Department of Orthopedic Surgery and Traumatology of the Anosiala University Hospital Center for four years. Forty-two open long bone fractures were collected. The average age of the patients was 36.3 years of which 73.8% were subject of working age in the age group of 20 to 60 years and 73.8% of the cases were following the accident of the road. Most of the wounded had arrived at the hospital by bush taxi. The tibia was the most affected bone (71.4%). Gustilo IIIA type open fractures were the most observed (38.1%). Only 26.3% of patients had received surgical debridement before the sixth hour. 76.2% had no care before arriving at the hospital, 14.3% had emergency care at the basic health center and 9.5% were already being treated by the traditional healer. Definitive treatment of the fracture was dominated by the external fixator (38.1%) and orthopedic treatment (26.2%).               In low-income countries, the management of open fractures remains a daunting task. The main factors limiting the management of open fractures were the poverty of the population, the lack of health insurance coverage and the retard in arriving at the hospital. Keywords: open fractures, management, low-income, country 

“A-OK”: Chest Radiograph during Primary Survey Facilitates Faster, More Accurate Endotracheal Tube Position in Injured Children

2019 ◽  
Vol 85 (5) ◽  
pp. 479-487
Author(s):  
Andrea N. Doud ◽  
Michaela Gaffley ◽  
Olivia Hostetter ◽  
Jennifer W. Talton ◽  
John K. Petty
Keyword(s):  
Endotracheal Tube ◽  
Life Support ◽  
Pediatric Trauma ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Primary Survey ◽  
Breath Sounds ◽  
Before And After ◽  
Chest X Ray ◽  
Baseline Characteristics

The Advanced Trauma Life Support algorithm recommends bedside confirmatory techniques to confirm correct endotracheal tube (ETT) depth, a critical component in the care of pediatric trauma patients. We hypothesized that bedside confirmatory techniques are inaccurate and that early chest X-ray (CXR) would overcome such inaccuracies, allowing for faster intervention of malpositioned ETTs. An “A-OK” algorithm of immediate CXR following intubation in injured children aged <16 years was implemented. Eligible patients the years before and after implementation were identified. The accuracy of bedside confirmatory techniques (use of length-based depths and auscultation of breath sounds) was assessed. Post-“A-OK” patients were compared with pre-“A-OK” controls regarding the speed of malpositioned ETTrepositioning. Twenty-eight post-“A-OK” cases and 23 pre-“A-OK” controls were identified. The groups did not differ in baseline characteristics. Bedside confirmatory techniques were accurate in only 61 per cent (length-based depth) and 58 per cent (auscultation of breath sounds) of patients. Time to ETT repositioning was significantly longer in pre-“A-OK” controls than in post-“A-OK” cases (35.2 ± 15.9 minutes vs 21.1 ± 11.8 minutes, P = 0.03). Bedside confirmatory techniques to determine ETT positioning are inaccurate in children. Inclusion of CXR in the primary survey is safe and allows for more rapid repositioning of malpositioned ETTs.

Incidental Findings in Trauma Patients during Focused Assessment with Sonography for Trauma

2012 ◽  
Vol 78 (3) ◽  
pp. 366-372 ◽  
Author(s):  
Sophocles Lanitis ◽  
Constantinos Zacharioudakis ◽  
Paraskevi Zafeiriadou ◽  
Vasileios Armoutides ◽  
Charilaos Karaliotas ◽  
...  
Keyword(s):  
Incidental Findings ◽  
Life Support ◽  
Univariate Analysis ◽  
Biliary Tree ◽  
Initial Assessment ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Management Algorithm ◽  
Surgical Conditions ◽  
Mechanism Of Trauma

During the initial assessment of trauma patients they usually undergo a Focused Assessment with Sonography for Trauma (FAST) in which there are occasionally incidental findings of other surgical conditions. In this audit we discuss the incidence, demographics, and implications of these findings and we propose a management algorithm. Within 2 years we managed 6041 trauma patients in the emergency department based on the Advanced Trauma Life Support protocols, 95 per cent of which underwent a FAST ultrasound. Incidental findings were reported in 468 patients (7.8%), whereas in a further 11.2 per cent of these patients there was a second finding. The mean age of these patients was 57.55 years (15–105), and most of them were men (51.1%). The vast majority of the findings were related to the liver and biliary tree (52.1%) followed by the urinary track (27.1% 1 8%). In multivariate analysis only the age was a significant factor associated with incidental findings ( P < 0.001) whereas in univariate analysis both the gender [men (54.1%) vs women (45.9), P = 0.013] and the mechanism of trauma ( P < 0.001) were as important as the age ( P < 0.001). The patients who had incidental findings were 15 years older than the rest. The detection of unknown surgical conditions in FAST may lead to managerial and possible medico-legal issues rendering the development of a proper algorithm mandatory.

scholarly journals Trends in trauma care before and after the introduction of ‘Mukhyamantri Santwana Harish Scheme’ in a tertiary care hospital at Kolar

2018 ◽  
Vol 5 (5) ◽  
pp. 2072
Author(s):  
Vikas Sankar Kottareddygari ◽  
Vishwas S. ◽  
Praveen G. P. ◽  
Amal Abraham ◽  
Sreeramulu P. N.
Keyword(s):  
Critical Care ◽  
Low Income ◽  
Life Support ◽  
Road Traffic ◽  
Tertiary Care ◽  
Advanced Life Support ◽  
Low Income Countries ◽  
Care Hospital ◽  
Number Of Patients ◽  
Before And After

Background: Road traffic injuries (RTI) are responsible for 1.2 million global deaths and rank 9th as cause of death in both the high and low income countries. Polytrauma cases make the bulk of emergencies in our centre and the victims were previously given only first aid and critical care before being referred to a government aided institute for further management due to monetary issues. After the introduction of Mukhyamantri Santwana - 'Harish' Scheme (MSHS), all the patients are entitled for cashless treatment for the first 48 hoursand this improved the quality of care they received.Methods: All the polytrauma cases brought to the emergency and critical care department for a period of 7months before the introduction of MSHS (October 2015- April 2016) and for a period of 7 months from the introduction of MSHS (May 2016- November 2016) were studied retrospectively. Data on the number of patients referred, admitted and underwent intervention during the time periods were collected and compared.Results: The number of cases that were admitted and given intervention in our centre increased considerably and number of cases referred to other centres decreased after the introduction of MSHS.Conclusions: Introduction of MSHS lead to patients receiving more advanced life support and interventions as necessary. However this cannot be generalised to all the centres as data is still lacking. Multicentric studies need to be done in this aspect.

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