Since the introduction of shared electric scooters to Auckland in October 2018, there have been multiple reports of injuries. We aim to examine the pattern of injuries sustained while riding electric ...scooters in patients presenting to hospital.
We conducted a retrospective analysis of patients who presented to Auckland City Hospital Emergency Department (ED) between 15 October 2018 and 22 February 2019. Patients were firstly identified by ED staff and noted in a logbook, and secondly by searching the Trauma Registry database. Outcomes of interest were injuries, imaging, alcohol and helmet use, length of stay and interventions.
There were 180 patients identified. The median length of stay was 4.0 hours, interquartile range (IQR) 18.4 hours. One-third of patients were admitted or transferred. Common injuries were contusions, abrasions and lacerations (65.6%), fractures (41.7%) and head injuries (17.2%). One in five patients (22.2%) required an operation. Only three patients wore a helmet. Of all patients, 23.3% had consumed alcohol, and of those with head injuries; 41.9% had consumed alcohol.
This study highlights the significant number of electric scooter-related injuries, including severe head injuries. While the majority of presentations are categorised as minor trauma, these cases have placed additional demand on health system resources. This mode of transport would benefit from greater regulation, including a zero blood alcohol limit, night-time curfews, reduced speed limits and consideration of mandatory helmet use.
Background
Severe liver trauma can cause major haemorrhage and death. Haemostatic resuscitation principles are associated with improved survival in trauma patients with major haemorrhage. We ...hypothesised death from liver haemorrhage decreased in parallel with the introduction of haemostatic resuscitation.
Aim
To establish the incidence of haemorrhagic death in patients with severe liver trauma and review how outcomes in two time periods associate with changes in resuscitation practice.
Methods
A retrospective review of all adult patients admitted to Auckland City Hospital with liver trauma was undertaken for a 14‐year period. Resuscitation fluid for patients with grade V liver trauma or death from liver haemorrhage was compared between the first and second half of the study (2006–2013 vs. 2013–2020).
Results
Four hundred and fifty patients were admitted with liver trauma during the 14‐year period. Mortality from haemorrhage in patients with severe liver trauma (grade IV and V) decreased between the first and second half of the study (p = 0.009). Pre‐hospital and emergency department crystalloid fluid use decreased (p = 0.002). Fresh frozen plasma in ED (p = 0.076) and total cryoprecipitate use (p = 0.072) increased. Tranexamic acid use increased (p = 0.002). Use of colloid fluid was abandoned (p = 0.013). There was no significant difference in pre‐hospital time or time from hospital arrival until haemorrhage control laparotomy.
Conclusion
Death from liver haemorrhage decreased in association with the introduction of haemostatic resuscitation while the incidence, severity and surgical management of liver trauma was comparable.
This is a single centre retrospective cohort study on Liver Trauma. It describes a reduction in hemorrhagic death associated with haemostatic resuscitation.
Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and ...secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques may provide new options. Thus, we believe that a current position paper from World Society of Emergency Surgery (WSES) is warranted, in order to put forth the most recent and practical recommendations for diagnosis and treatment of AMI. This review will address the concepts of AMI with the aim of focusing on specific areas where early diagnosis and management hold the strongest potential for improving outcomes in this disease process. Some of the key points include the prompt use of CT angiography to establish the diagnosis, evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel, resection of necrotic intestine, and use of damage control techniques when appropriate to allow for re-assessment of bowel viability prior to definitive anastomosis and abdominal closure.
Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of ...previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups.
The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion.
Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are
per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO.Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention.
This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.
Liver trauma: WSES 2020 guidelines Coccolini, Federico; Coimbra, Raul; Ordonez, Carlos ...
World journal of emergency surgery,
03/2020, Volume:
15, Issue:
1
Journal Article
Peer reviewed
Open access
Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the ...associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.
Abstract
Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary ...inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.
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