After the Haiti 2021 Earthquake: Triage and treatment data for a cohort of patients transported for higher level of care

Intro: On August 14, a magnitude 7.2 earthquake occurred in the South of Haiti, killing over 2,200 people and leaving at least 12,000 injured. On August 17th, a joint task force coordinated the triage, treatment, and transport for patients arriving at the Port-au-Prince airport from the South. Methods: From August 17th-27th, approximately 243 patients were encountered at the Port-au-Prince airport. For the first three days of operations, written notes, reports, and various chat logs from WhatsApp were used to compile this data. Results: 243 patents were encountered at the airport Triage and Treatment from August 17 to August 27. Orthopedic injuries were the most common presenting injury with 20% of patients having a pelvis fracture (the most prevalent injury). Of the 174 with known transfer destinations, 118 (68%) were transported to one of three tertiary care hospitals, with 99 going via ground ambulance to the two in Port au Prince, and 19 going via HAA helicopter to Mirebalais, 32 miles away. Once treatment operations were initiated, 106 patients received some form of treatment at the airport while awaiting transport. Discussion: Interagency coordination was the key to rapid scale up. To address the most prevalent patient issues, a treatment bundle was conceptualized a few days into operations that consisted of IV fluids, analgesia, IV antibiotics, wound debridement and cleaning, and tetanus prophylaxis.

Successful xenotransfusion from a domestic dog (Canis familiaris) to an Andean fox (Lycalopex culpaeus)

An Andean fox was transferred to the Wildlife Hospital of the Universidad San Francisco de Quito for evaluation ofinjuries caused by a run over. Clinical signs of hypovolemic shock were detected. Radiographies showed multiple pelvicfractures and free fluid in retroperitoneal cavity. The presumptive diagnosis was hemorrhagic shock caused by bloodloss secondary to a pelvis fracture. An emergency xenotransfusion using blood from a domestic dog was performedwithout acute transfusion reactions observed. This is the first report of successful xenotransfusion between a domesticdog and an Andean fox presenting a procedure that could be applied in emergency situations.

A biomechanics study about ligaments injury in anterior posterior compression type Ⅱ pelvic injury

Background Anterior posterior compression(APC)type II pelvis fracture is considered to be a typical one caused by the destruction of pelvic ligaments, while the mechanism of ligaments injury is still controversial. This study aims to explore ligaments injury in APC type II pelvic injury. Method: Fourteen human cadaveric pelvis samples with sacrospinous ligament (SPL), sacrotuberous ligament (SBL), anterior sacroiliac ligament (ASL) and partial bone retaining unilaterally were made for this study. They were divided into hemipelvis restricted group and unrestricted group randomly. Record the separation distance of pubic symphysis and anterior sacroiliac joint, external rotation angle and force when the ASL ruptured. Continuing external rotation violence, observing bone and pelvic ligaments change. Result When ASL failed, there were no significant differences in mean separation distance of pubic symphysis (28.6 ± 8.4 mm to 23.6 ± 8.2 mm,P = 0.11) and anterior sacroiliac joint (11.4 ± 3.8 mm to 9.7 ± 3.9 mm ,P = 0.30) between restricted group and unrestricted group, but external rotation angle(33.9 ± 5.5° to 48.9 ± 5.2°,P < 0.01) and force(553.9 ± 82.6 N to 756.6 ± 41.4 N,P < 0.01) were not. In restricted group, both of SAL and SPL injury occurred, which was different in unrestricted group. Besides, separation distance of pubic symphysis between two groups ranged from 14 mm to 40 mm. With external rotation violence continuing, SPL ruptured firstly, then SBL ruptured and the interosseous sacroiliac ligament was damaged while posterior ligament was not; in another group, interosseous sacroiliac ligament, posterior sacroiliac ligaments were damaged while SAC and SPL were not. When all of ASL, SBL, SPL failed, mean separation distance of pubic symphysis and anterior sacroiliac joint between two groups increased significantly (from 28.6 ± 8.4 to 42.0 ± 7.6 mm, 11.4 ± 3.8 to 16.7 ± 4.2 mm respectively, all P < 0.05). Conclusion First, pelvic external rotation injury can divide into hemipelvis is restricted and unrestricted, which result into different outcomes; When ASL ruptures, the unrestricted group needs more external rotation angle and force, without SBL or SPL injury. But in restricted group, both of two ligaments are injured. Second, when ASL fails, pubic symphysis displacement has a high fluctuation. Third, ASL rupture does not mean SBL and SPL are injured inevitably.

Asymptomatic Trauma Patients Screened for Venous Thromboembolism Have a Higher Risk Profile with Lower Rate of Pulmonary Embolism: A Five-Year Single-Institution Experience

Deep vein thrombosis (DVT) is linked to reimbursements and publicly reported metrics. Some hospitals discourage venous duplex ultrasound (VDUS) screening in asymptomatic trauma patients because they often find higher rates of DVT. We aim to evaluate the association between lower extremity (LE) VDUS screening and pulmonary embolism (PE) in trauma patients. Trauma patients admitted to an urban Level-1 trauma center between 2010 and 2015 were retrospectively analyzed. We characterized the association of asymptomatic LE VDUSs with PE, upper extremity DVT, proximal LE DVT, and distal LE DVT by univariate and multivariable logistic regression controlling for confounders. Of the 3959 trauma patients included in our study—after adjusting for covariates related to patient demographics, injury, and procedures—there was a significantly lower likelihood of PE in screened patients (odds ratio (OR) = 0.02, P < 0.001) and a higher rate of distal LE DVT (OR 11.1, P = 0.004). Screening was not associated with higher rates of proximal LE DVTafter adjustment for covariates (OR = 1.8, P = 0.193). PE was associated with patient transfer status, pelvis fracture, and spinal procedures in unscreened patients. After adjusting for covariates, we have shown that LE VDUS asymptomatic screening is associated with lower rates of PE in trauma patients and not associated with higher rates of proximal LE DVT. Our detailed institutional review of a large cohort of trauma patients over five years provides support for ongoing asymptomatic screening and better characterizes venous thromboembolism outcomes than similarly sized purely administrative data reviews. As a retrospective cohort study with a large sample size, no loss to follow-up, and a population with low heterogeneity, this study should be considered as level III evidence for care management.

Pelvis fracture: up to date

Pelvic fractures are very frequent in the emergency department. Its diagnosis and its treatment sometimes can be difficult, specially in the junior orthopaedic surgeons. This up to date has the aim of making easier to understand how do the behave and how to treat them

A stress ulcer duodenal perforation complicating diaphragmatic rupture with multiple bone fracture in a polytrauma patient due to fall from a tree

Polytrauma in a 55 years male due to blunt trauma like fall from a height involving fracture of long bones, undisplaced fracture pelvis, fracture multiple ribs with a preliminary diagnosis of eventration of the hemidiaphragm in a apparently hemodynamically stable patient with a normal CT scan of brain, though poses a major physiological challenge, however runs a better prognosis. But with the passing of hours as patient develops respiratory distress and chest and abdomen CECT confirms a large lacerated hemidiaphragm with herniation of abdominal visceras occupying the hemithorax with lung collapse, alarms the gravity of the injury. An uncommon stress ulcer duodenal perforation on the 2nd day of admission with ensuing pyoperitoneum further threatens the hemodynamics and enhances the morbidity and mortality. This warrants an active and prompt action by multispecialty involvement. Emergency laparotomy to address the pyoperitoneum, closure of the duodenal perforation, reduction of the herniated abdominal visceras from the hemithorax, thorough saline lavage of the abdominal and involved chest cavity, placement of intrathoracic chest tube drain, repair of the lacerated diaphragm, placement of peritoneal cavity drains and closure of the abdomen settles the issue of damage control surgery in this case. Postoperative care in the ICU with ventilator support, higher antibiotics and supportive medications, repeated laboratory and radiological tests helps in overcoming the hemodynamic crisis in such critically ill patients. Our patient subsequently developed pneumonitis and had a postoperative protracted course in the ICU and finally shifted to the general ward on 7th day of his admission.

PHYSICAL SYMMETRY AND VIRTUAL PLANE-BASED REDUCTION REFERENCE: A PRELIMINARY STUDY FOR ROBOT-ASSISTED PELVIC FRACTURE REDUCTION

Traditional pelvis fracture reduction suffers from some disadvantages. Robot-assisted pelvis fracture reduction offers some promise in solving these problems. However, the reduction reference to guide robot motion is a key issue that must be resolved. In this paper, we propose a physical symmetry and virtual plane-based reduction reference and adopt the method of registration to calculate the virtual plane for the reference, which were verified via experiments. The results of the position symmetry experiments of the original pelvis and virtual plane-based position symmetry experiments were similar; both showed that the symmetry errors of the pelvis were less than 4[Formula: see text]mm and 2.5[Formula: see text]. The results indicated that the proposed method could be used as a reference for robot-assisted pelvis fracture reduction.