Physician-Led Thoracic Trauma Management in a Specialist Emergency Care Centre

Introduction: Falls cause 75% of trauma in patients above 65 years of age, and thoracic trauma is the second commonest injury; rib fractures are the most common thoracic injury. These patients have up to 12% mortality, with 31% developing pneumonias. There is wide variation in care. Northumbria Healthcare has a team of respiratory consultants, physiotherapists, specialist nurses and anesthetists for thoracic-trauma management on a respiratory support unit. Methods: With Caldicott approval, basic demographics and clinical outcomes of patients admitted with thoracic trauma between 20 August 20–21 Aprilwere analyzed. A descriptive statistical methodology was applied. Results: A total of 119 patients were identified with a mean age of 71.1 years (range 23–97). Of the 119 patients, 53 were male, 66 females. The main mechanism of injury was falls from standing (65) and falls down stairs/bed or in the bath (18). Length of stay was 7.3 days (range 1–54). In total, 85 patients had more than one co-morbidity, 26 had a full trauma assessment and 75 had pan CTs. The mean number of rib fractures was 3.6 and 31 (26%) patients had a pneumothorax and/or haemothorax. A total of 18 chest drains were inserted (all small bore) and one needle aspiration was performed. No cardiothoracic input was required. Isolated chest trauma was present only in 45 patients. All patients had a pain team review, 22 erector spinae catheters were inserted with 2 paravertebral blocks. Overall, 82 patients did not require oxygen, 1 required CPAP and 1 HFNC. 7 needed intensive care transfer. Furthermore, 20 (17%) developed pneumonias and 16 (14%) deaths occurred within 30 days—all were in those with falls from standing. There was no correlation between number of fractured ribs, length of stay and mortality. Conclusions: High level care for thoracic trauma can be performed by a physician led team. Overall, 42% pneumothoraces/haemothoraces were observed. Further large scale randomised trials are warranted for definitive outcomes.

EPPOCRATIS: A Point-of-Care Utilization of Virtual Surgical Planning and Three-Dimensional Printing for the Management of Acute Craniomaxillofacial Trauma

While virtual surgical planning (VSP) and three-dimensional planning (3DP) have become important tools in acute craniomaxillofacial surgery, the incorporation of point of care VSP and 3DP is crucial to allow for acute facial trauma care. In this article, we review our approach to acute craniomaxillofacial trauma management, EPPOCRATIS, and discuss current challenges and future directions in acute facial trauma management.

Knowledge and skills of emergency physicians in managing traumatic dental injuries

Purpose Emergency departments are frequently confronted with traumatic dental injuries (TDIs). The prognosis of the injured tooth is related to early dental trauma management. For this reason, physicians must be familiar with the appropriate management of TDI. This study aimed to investigate the knowledge and skills of German emergency physicians regarding TDI. Methods An electronic questionnaire was sent to 438 emergency departments throughout Germany. Four hundred and twenty seven questionnaires were evaluated and included in the analysis. The survey contained questions about physician characteristics and assessed their knowledge and skills of managing dental trauma. For statistical analysis, the Kruskal–Wallis, Mann–Whitney U test or ANOVA test was used as appropriate. Rank correlations were performed with the Spearman’s rank correlation. Results Out of 427 participants, 256 (59.95%) stated they had no or insufficient knowledge, and 266 (71.12%) stated they had no skills in dental trauma management. Almost 76% of the participants had no previous knowledge of dentistry. Only 7.28% knew the right procedure for replanting an avulsed tooth. Just 26.06% would choose the right medium for temporary tooth storage. Having a dentist in the family (p = 0.0074) or clinical exposure to patients with dental trauma (p = 0.0384) influenced the results of the knowledge score. Conclusion The knowledge and skills in dental trauma management among German emergency physicians are generally inadequate. Targeted training courses are necessary to ensure early and adequate TDI treatment to reduce the resulting medical and societal costs as much as possible.

TP8.2.26 A new simulation-based course to improve trauma management by junior doctors

Aims Trauma calls at small hospitals are often attended by small and/or junior teams, especially overnight. The quality of primary surveys was subjectively observed to be extremely variable, sufficient to cause concern about patient safety. In addition, the introduction of the ‘ward trauma call’ for falls was generating anxiety amongst juniors. I recognised an unmet need and gained permission from the Director of Medical Education to create a half-day ‘Introduction to Trauma’ simulation-based course. Method A sample group of Foundation doctors attended a pilot course. Confidence in aspects of trauma management was assessed using Likert scales. Results Pre-course results indicated doctors were reasonably confident with their A-E assessments (63% moderately or very confident) but lacked confidence in trauma skills such as using a scoop. After the course 100% reported increased confidence about what will happen in a trauma call, and 63% reported increased confidence in their A-E assessments. Increased confidence was also widely reported in trauma skills (e.g. log roll 88%), how to manage a ward trauma call (100%), and where to find further guidance (100%). Conclusions This pilot demonstrated that a small group simulation-based teaching intervention can significantly increase the confidence of foundation doctors in all aspects of their role in trauma management. The most notable increases were in trauma equipment use and in managing ward trauma, suggesting these are areas where foundation doctors lack guidance or experience. The course is now part of trust induction for new foundation doctors.

Tatalaksana Trauma Wajah dengan Panfasial Fraktur

AbstrakFraktur pada wajah dapat menyebabkan defisit fungsional dan estetika jika tidak ditangani dengan baik. Tatalaksana akut yang tepat dari fraktur wajah harus didasarkan pada evaluasi cepat dan menyeluruh. Keberhasilan rekontruksi wajah merupakan keadaan darurat yang perlu dievaluasi dalam waktu 24 jam dari trauma. Berbagai jenis reduksi dan fiksasi tergantung pada fungsi, lokasi, jenis fraktur, dan usia pasien. Kasus ini diajukan untuk memperlihatkan keberhasilan tatalaksana trauma akut maksilofasial. Dilaporkan seorang laki-laki 37 tahun dengan panfasial fraktur yang dilakukan reduksi dan fiksasi 3 hari setelah trauma dengan pemasangan plat dan sekrup, serta fiksasi mukoginggival kombinasi antara arch bardan quickfix. Reduksi, reposisi dan fiksasi dilakukan setelah edema mukosa hebat disertai kombinasi antara arch bar dan quickfix pada mukoginggival merupakan salah satu alternatif untuk mengurangi risiko perdarahan dan memudahkan reposisi.Kata kunci: fraktur wajah, panfasial fraktur,edema mukosa.Management of Maxillofacial Traumawith Panfacial FractureAbstractFacial fractures can cause functional and aesthetic deficits if not treated properly. Appropriate acute management of facial fractures should be based on a rapid and thorough evaluation. Successful facial reconstruction is an emergency that needs to be evaluated within 24 hours of trauma. Different types of reduction and fixation depend on the function, location, type of fracture, and the age of the patient. This case is presented to demonstrate the success of acute maxillofacial trauma management. Reported a 37-year-old man with a facial fracture who underwent reduction and fixation 3 days after trauma with plate and screw installation, and combination mucogingival fixation between arch bar and quickfix. Reduction, reposition and fixation performed after severe mucosal edema accompanied by a combination of arch bar and quickfix on the mucogingival is an alternative to reduce the risk of bleeding and facilitate repositioning.Keywords: facial fracture, panfacial fracture, mucosal edema.