Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 3rd Annual Congress and Medicare Expo on Trauma & Critical Care London, UK.

Day 1 :

Keynote Forum

Dimitrios Karakitsos

Keck medical school USC(University of Southern California), USA

Keynote: Trauma Team Dynamics

Time : 10:00-10:40 AM

Trauma 2017 International Conference Keynote Speaker Dimitrios Karakitsos photo
Biography:

Dimitrios Karakitsos is an Associate Professor in Medicine at University of South Carolina, School of Medicine and an Adjunct Associate Professor in Critical Care at Keck Medical School, University of Southern California. He is an international, well-published expert and Researcher in “Critical care ultrasound and crisis resource management in trauma”. Currently, he is also affiliated to the Trauma Center of King Saud Medical City (KSMC) in the Kingdom of Saudi Arabia.

Abstract:

Background: In trauma care, teams of experts are using modern technology and techniques to secure life and limb, conserve organs in acute peril and manage chronic complications. Trauma care also requires the coordination of individuals with different biases, priorities, personalities, skill sets and timelines. Although the American College of Surgeons’ Advanced Trauma Life Support (ATLS) course has been the backbone of trauma care, it focuses on the sole practitioner, rather than how we function in larger teams and complex situations.

Methods: In 1977, a large aviation disaster has led NASA to the development of crew resource management training. These ideas have been adapted to medicine and resulted in crisis resource management (CRM) training. Human errors in medicine are estimated to contribute to approximately 100,000 annual deaths in the United States alone. Simulation trauma team training typically encompasses five keys areas: communication, leadership and followership, resource utilization, problem solving and situational awareness. While even routine civilian trauma can be challenging, add to this the potential for natural disasters, terrorist attacks, and other such fluid environments and CRM training becomes imperative. Finally, CRM logistics have led to the development of temporary constructs such as Emerging Multi-Organizational Networks (EMON) which consist of task-oriented and mission specific collaborations of individuals and resources.

Conclusions: The addition of CRM skills to modern trauma care is of growing interest. Whether the former may improve team performance, team empathy and patient outcomes is an area of on-going research. 

Keynote Forum

Lynne Moore

Laval University in Quebec City, Canada

Keynote: Canadian Benchmarks For Acute Injury Care

Time : 11:00-11:40 AM

Trauma 2017 International Conference Keynote Speaker Lynne Moore photo
Biography:

Lynne Moore is an Associate Professor of Epidemiology and Biostatistics in Department of Social and Preventative Medicine at Laval University in Québec City. She is recipient of a Research Career award and has published 140 peer-reviewed papers over her research career. Her research interests include “Improving the quality of acute injury care”. She has led the development, validation, implementation and evaluation of a comprehensive quality tool assessment for acute injury care which has been implemented across Canada. She is Co-leader of International Injury Care Improvement Initiative.

Abstract:

Statement of the Problem: In response to evidence of variation in patient outcomes across providers and growing financial pressures, healthcare authorities in high-income countries have emphasized the urgent need to develop tools to monitor quality of care.

Aim: Aim of this study is to develop Canadian benchmarks to monitor mortality and hospital length of stay (LOS) for injury admissions.

Method: Benchmarks were derived from data from the Canadian National Trauma Registry on patients with major trauma admitted to any level I or II trauma center in Canada and the following patient subgroups: isolated traumatic brain injury (TBI), isolated thoracoabdominal injury, multisystem blunt injury, aged ≥65 years. Predictive validity was assessed using measures of discrimination and calibration. Extensive sensitivity analyses were performed to assess the impact of replacing analytically complex methods (multiple imputation, shrinkage estimates and flexible modelling) with simple models that can be implemented locally.

Results: The mortality risk adjustment model had excellent discrimination and calibration (area under the receiver operating characteristic curve=0.883; Hosmer-Lemeshow=122). The LOS risk-adjustment model predicted 31% of the variation in LOS. Overall, observed-to-expected ratios of mortality and mean LOS generated by an analytically simple model were highly correlated to those generated by analytically complex models (r>0.95; kappa on outliers>0.90).

Conclusion & Significance: We propose Canadian benchmarks that can be used to monitor quality of care in Canadian trauma centers using a simple Excel program (provided) that can be implemented using local trauma registries. We observed significant variation in mortality and LOS across Canadian trauma centers indicating room for improvement in the quality of acute care for Canadian injury admissions.

Keynote Forum

Cuong Tran Chi

University of Medicine and Pharmacy at HCM city, Vietnam

Keynote: Direct Traumatic Carotid Cavernous Fistula: Angiographic Classification and Treatment Strategies. Study of 172 Cases

Time : 11:40-12:20

Trauma 2017 International Conference Keynote Speaker Cuong Tran Chi photo
Biography:

Cuong Tran Chi is a Medical Director of Stroke International Services System, Vietnam. He is the President of Interventional Neuroradiology Society of HCM city, Vietnam and Senior Consultant of Interventional Neuroradiology of Vietnam. He has been a member of World Federation of Interventional and Therapeutic Neuroradiology (WFITN) since 2007. He has performed more than 2000 Neuro-interventional procedures including: Carotid cavernous fistula, intracranial and spinal dural fistula, and treatment aneurysm by coiling, treatment AVM, carotid stenting and intracranial stenting, flow-diverter stenting, percutaneous vertebroplasty.

 

Abstract:

Objectives: We report our experience in treatment of traumatic direct carotid cavernous fistula (CCF) via endovascular intervention. We hereof recommend an additional classification system for type A CCF and suggest respective treatment strategies.

Methodology: Only type A CCF patients (Barrow’s classification) would be recruited for the study. Based on the angiographic characteristics of the CCF, we classified type A CCF into three subtypes including small size, medium size and large size fistula depending on whether there was presence of the anterior carotid artery (ACA) and/or middle carotid artery (MCA). Angiograms with opacification of both ACA and MCA were categorized as small size fistula. Angiograms with opacification of either ACA or MCA were categorized as medium size fistula and those without opacification of neither ACA nor MCA were classified as large size fistula. After the confirm angiogram, endovascular embolization would be performed impromptu using detachable balloon, coils or both. All cases were followed up for complication and effect after the embolization.

Results: A total of 172 direct traumatic CCF patients were enrolled. The small size fistula was accountant for 12.8% (22 cases), medium size 35.5% (61 cases) and large size fistula accountant for 51.7% (89 cases). The successful rate of fistula occlusion under endovascular embolization was 94% with preservation of the carotid artery in 70%. For the treatment of each subtype, a total of 21/22 cases of the small size fistulas were successfully treated using coils alone. The other single case of small fistula was defaulted. Most of the medium and large size fistulas were cured using detachable balloons. When the fistula sealing could not be obtained using detachable balloon, coils were added to affirm the embolization of the cavernous sinus via venous access. There were about 2.9% of patient experienced direct carotid artery puncture and 0.6% puncture after carotid artery cut-down exposure. About 30% of cases experienced sacrifice of the parent vessels and it was associated with sizes of the fistula. Total severe complication was about 2.4% which included one death (0.6%) due to vagal shock; one transient hemiparesis post-sacrifice occlusion of the carotid artery but the patient had recovered after three months; one acute thrombus embolism and the patient was completely saved with recombinant tissue plasminogen activator (rTPA); one balloon dislodgement then got stuck at the anterior communicating artery but the patient was asymptomatic.

Conclusion: Endovascular intervention as the treatment of direct traumatic CCF had high cure rate and low complication with its ability to preserve the carotid artery. It also can supply flexible accesses to the fistulous site with various alternative embolic materials. The new classification of type A CCF based on angiographic features was helpful for planning for the embolization. Coil should be considered as the first embolic material for small size fistula meanwhile detachable balloons was suggested as the first-choice embolic agent for the medium and large size fistula.

 

Trauma 2017 International Conference Keynote Speaker Mohamed Abbasy photo
Biography:

Mohamed E Abbasy is currently working as an Emergency Medicine Clinical Fellow at Hamad Medical Corporation, Qatar. He successfully completed his Injury Prevention Research and Training Program at University of Maryland, School of Medicine, Maryland, USA. He has attended R Adams Shock Trauma Center, University of Maryland, School of Medicine, Maryland in 2008. He completed his training in Emergency Medicine and successfully awarded the fellowship of Egyptian Board of Emergency Medicine in 2009. He has a good experience of working in Gulf region and worked as an Assistant Program Director of Saudi Board of Emergency Medicine in Eastern region, KSA in 2013. He successfully passed his membership examination of Royal College of Emergency Medicine UK in 2014 and European Board of Emergency Medicine in 2016. His research interest includes Critical Care, Trauma and Emergency Ultrasound.

 

Abstract:

Background & Aim: As one of the leading causes of death and disability in the world, human trauma and injury disproportionately affects individuals in developing countries. During initial program development, senior MOHP physicians stated, there was a critical need for a portable and flexible educational course on the clinical care of injured patients. To meet the need for
improved trauma care in Egypt, the Sequential Trauma Emergency/Education Program S (STEPS) course was created through the collaborative effort of Egyptian and US expert physicians. The objective of course development was to create a high-quality, modular, adaptable, and sustainable trauma care course that could be readily adopted by a lower- or middle-income country.
Methods: We describes the course development from 2006 to 2016, highlighting the challenges and solutions of creating a successful, flexible and sustainable in-country trauma care training program that suits low and middle income countries.
Results: STEPS was developed at the University of Maryland, based in part on World Health Organization’s Emergency and Trauma Care materials, and introduced to the Egyptian Ministry of Health and Population and Ain Shams University in May 2006. The program is designed to adapt low cost and limited resources with maintaining high fidelity and unified standard. In 2008, the course transitioned completely to the leadership of Egyptian academic physicians. To date, more than 730 physicians from eight countries have taken the course through the Ministry of Health and Population or public/governmental universities.
For the first time, the course was held in Sudan on January 2016.
Conclusion: STEPS has rapidly become a desired trauma care training program proved by sustainability based on 10 years of course conduct. Success of this collaborative educational program is demonstrated by the numbers of physicians trained, and program continuance after transitioning to in-country leadership and trainers.

  • Trauma Care
    Trauma in Nursing & Midwifery
    Critical Care in Trauma
    Trauma-Emergency Medicine
    Trauma Therapy
    Pediatric Trauma
Speaker

Chair

Tim Collins

Teleflex Medical UK Ltd, UK

Speaker

Co-Chair

Mohammed Yunus

NEIGRIHMS, India

Session Introduction

Tim Collins

Teleflex Medical, UK

Title: Clinical Principles of Intra-Nasal Atomisation

Time : 13:50-14:40 (WORKSHOP)

Speaker
Biography:

Tim Collins has 20 years of experience in Critical Care. He holds the position of Consultant Nurse, Lead Nurse, Charge Nurse, ICU Educator and Senior Lecturer. He is currently a British Association of Critical Care Nurses (BACCN) elected national board member and Editorial Board Member of Nursing in Critical Care Journal (Wiley). He has given a number of presentations at European & international conferences and has published a number of papers in peer reviewed journals and book chapters. He completed his Doctorate Degree and MSc in Critical Care. He is an Instructor in both Adult and Pediatric Advanced Life Support. His interests include Sepsis, Clinical Shock, Vascular Access, Resuscitation, Organ Donation and Hemodynamic monitoring. 

Abstract:

Target Participants: This will be applicable to all emergency and critical care providers.

Contents of Workshop:

Anatomy and physiology relating to nasal absorption.Evaluation of the literature relating to nasal atomization.How nasal absorption of medications works; appraisal on the benefits and limitations of the nasal medication route.Bioavailability of medications and the significance of first pass metabolism.Practical demonstration for achieving best practice techniques for nasal atomization; application of theory to a practical demonstration using nasal atomization and an interactive quiz to facilitate discussion, reflection and learning relating to nasal atomization.

Participant Involvement: This workshop will provide attendees with the theory and practical application relating to intra-nasal atomization. Demonstration and application of best practice nasal atomization techniques will be simulated. Attendees will be able to practice nasal atomization techniques and apply theory to clinical practice. The workshop will provide opportunity for attendees to reflect upon nasal atomization and provide facilitated discussion within a supportive environment. An interactive nasal atomization case study relating to the use of atomization will be simulated and an attendee quiz will facilitate discussion and reflection among participants.

Flow of Workshop: Visual power point slides evaluating the theory of nasal absorption. Visual power point slides relating to anatomy and physiology and evidence based atomisation.A video demonstrating nasal atomisation theory.Critique of the benefits and limitations of nasal atomisation.Demonstration of best practice techniques for achieving effective nasal atomisation.Participants having the opportunity to demonstrate nasal atomisation techniques. Application of nasal atomisation for a patient requiring topical anaesthesia following an acute cerebral event.Interactive quiz with facilitated group discussion and reflection.

Intended learning outcome:

This practical workshop aims to provide an overview of the theory relating to nasal atomisation and provide emergency providers with the opportunity to demonstrate best practice nasal atomisation techniques that can be applied to clinical practice.

Awaneesh Katiyar

Institute of Medical Sciences, BHU, India

Title: A New trauma score “Trauma Severity Score”- to predict the outcome in trauma patients

Time : 14:40-15:10

Speaker
Biography:

Awaneesh Katiyar is a Post-graduate student in Master of Surgery. He is working as Junior Resident at Sir Sunder Lal Hospital and Trauma Centre and Super
Specialty Hospital. He has special interest in Trauma Surgery and Evaluation of Trauma Patients. During his Post-graduation, he developed a trauma score for
proper assessment and prognosis of trauma patients in terms of mortality and morbidity.

Abstract:

Background: - Multiple factors have been implicated by various workers around the world to predict the outcome in the patients of polytrauma. A numbers of trauma scoring systems also prevail. We conducted a study in a tertiary level trauma centre so as to find out various factors and formulate a clinical scoring system which can be used as a tool for exact prediction of outcome of trauma patients in terms of mortality and morbidity.

Material and methods:-A prospective study was done at Trauma Centre, Institute of Medical Sciences, BHU. Five hundred trauma patients were enrolled in the study depending upon inclusion and excluding criteria. The patients were assessed clinically and management started as per protocol. HR, RR, SBP, MBP, GCS, AIS, delay in arrival, mode of trauma was recorded. A clinical scoring system based on organ systems injured and severity of injury was used for scoring. Further the management done, course during hospital stay, complications and final outcome were also recorded. Final correlation and analysis was done. 

Result and discussion: - It was found that patients those who met with high velocity trauma and associated with head injury have high mortality rate. Mortality has also been more when head injury was associated with chest trauma. Spine trauma was found to be associated with high morbidity in form of para or quadriparesis. Patient having associated extremity fracture along and degloving injuries have prolonged hospital stay.

Conclusion:- In polytrauma patients various physiological, anatomical, biochemical parameters are important to predict the outcome of trauma patients. The scoring system used was also validated and found rational and useful.

Speaker
Biography:

Ahad Alhassan Saud Abdulaziz Al Saud completed her Bachelor Degree of Medicine & Surgery (MBBS) at King Saud University, Riyadh (2008). She has been involved in training and teaching medical students and interns in the disciplines of Emergency Medicine since 2003. Her research interest includes “ECMO, trauma, disaster care, emergency medicine in a global health context, education and skills development”. "Currently, she's a double board certified Emergency Medicine Physician Educator at King Saud University Medical City in Riyadh, Saudi Arabia."

 

Abstract:

Aim: We studied whether any aortic flow changes could be observed in the early stage of septic (warm) shock.

Patients and Methods: Computed tomography data and image reconstruction software packages to analyze patient-specific aortic flow patterns based on computational fluid dynamics models (non-Newtonian Navier-Stokes equations) were used. Boundary conditions were extracted from hemodynamic monitoring of trauma patients. Ten stable trauma patients [35 ± 9.9 years of age, 6 males, injury severity score (ISS) 26 ± 3.9] served as controls. Ten trauma septic patients [37 ± 8.7 years of age, 5 males, ISS 27 ± 4.2] were studied.  Hemodynamic monitoring was performed using a pulmonary artery catheter.

Results: In warm shock, the model depicted: 1. increased asymmetry of the three-dimensional aortic vortex (Dean number increased 77%), 2. reduction of secondary flow in the peripheral blood vessels (Reynolds number increased 78%), 3. Increased aortic wall shear stress; while no pathology in aortic flow geometry was documented (Womersley number unchanged).

Conclusion: In warm shock, a severely distorted aortic vortex may be responsible for reduction of secondary flow to peripheral arteries and increased aortic wall shear stress.

 

Torath Ameen

St Mary’s Hospital, UK

Title: Urological trauma - Where do urologists fit into the trauma team?

Time : 16:00-16:30

Biography:

Torath Ameen is a Urology trainee at Chelsea and Westminster Hospital. He has interest in Surgical Innovation; currently, working with the urological robotics
research team at St Mary’s Hospital, London’s North West Major Trauma Centre. His background includes research in Translational Stem Cell Therapy and
Reconstructive Microsurgery.

Abstract:

Urologists are not typically considered part of the emergency trauma team. These old connotations continue to fade; with increasing importance on the input of reconstructive urology in individuals with abdominal and pelvic trauma.

Novel therapies in the management of renal trauma are considered; with focus on the acute control of hemorrhage with view to preservation surgery as opposed to emergency total nephrectomy. We review modern imaging techniques which are increasingly used as diagnostic adjuncts and important therapeutic devices, with an increasingly important role for urologists alongside interventional radiology.

Bladder trauma remains poorly understood; we explore the varied opinion of experts when considering conservative and invasive management of traumatic bladder perforation.

Urethral and ureteric trauma can propagate to complex sequelae in patients beyond the immediate management stage. We review the importance of isolating areas of tubular damage and instigating appropriate management to restore urinary flow and act as a prophylactic agent against future complications.

Urology remains at the forefront of technological advancement; and as such, has a pivotal role in the maintenance of the current best standard of trauma management.

 

Speaker
Biography:

Kawther Gaber Mohammed Tolba has completed her PhD at Alexandria University, Faculty of Nursing. Currently, she is a Professor Emiretus of Medical Surgical Nursing, Faculty of Nursing, Alexandria University. She worked as Vice Dean of Learning and Students Affairs for four years at Tabuk University, KSA. She has published more than 30 papers in reputed journals and has been serving as an Editorial Board Member of Alexandria Scientific Nursing Journal.

Abstract:

Diabetic lower limb amputation remains the serious outcome of diabetic foot complications. It has been consistently shown that the best results of diabetic stump care occur when clinical pathway/an inetrdisciplinary approach is taken toward treatment. The aim of the study is to determine the effect of implementing a clinical pathway on healing of post lower limb amputation for
diabetic patients. The study was carried out in the vascular unit, Department of Surgery at Alexandria Main University Hospital and Private Alexandria Vascular Center (AVC) using a quasi experimantal research design. The study’s subjects included 40 diabetic patients undergoing first exposure to unilateral lower limb amputation and free from vital organ failure. Study’s subjects are randomly divided into control and study groups (20 patients each). Three tools were used for data colection: Preoperative diabetic lower limb amputation assessment, clinical pathway variances observation checklist and patient satisfaction scale. The study’s results imply satisctical significance diffrenece in favor of the study group regarding wound healing during the second to the sixth week in post operative follow-up period. The results also imply that the study group has significantly higher satisfaction level as compared to the
control one. In conclusion, diabetic patients undrewent lower limb amputation exhibited significantly better post clinical pathway health outcomes comparing with control one. The study recommended to apply the clinical pathway for diabetic patients undergoing lower limb amputation rather than the hospital routine care.