3rd Annual Congress and Medicare Expo on Trauma & Critical Care March 13-14, 2017 London, UK

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.

Biography:

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.

Biography:

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.

Biography:

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.

Biography:

Abstract:

Biography:

Calvin Mak is a Neurosurgeon specialist, working as an Associate Consultant at Queen Elizabeth Hospital in Hong Kong. After completing his graduation at University of Hong Kong, he worked at several neurosurgery centers in Hong Kong during Neurosurgical training, and completed the fellowship of FRCSEd (SN) in 2014. His current clinical and research interest includes “Traumatic brain injury, skull base surgery, neuro-endoscopy, and minimal access brain and spine operations”. He is also interested in implementing information technology in postgraduate training and medical practice.

Abstract:

Introduction: Traumatic acute subdural hematoma (ASDH) in elderly suffering from moderate and severe head injury is associated with poor outcome. The effect of surgical evacuation of traumatic ASDH in absence of other hematoma is not well studied.

Material & Method: We retrospectively review the data from the trauma registry of a regional trauma centre, from 2007 to 2010. Patients with isolated traumatic ASDH aged between 65 and 90, with Glasgow Coma Scale (GCS) not more than 13 on admission, were included.

Results: There were 31 patients with mean age 77 (65–89), and 55% were men. GCS on admission was not more than eight in 36%, and 24% had one or both pupils being non-reactive. The mean thickness of subdural hematoma was 15 mm (2.9–29.1), and mean midline shift was 7.6 mm (0–20.7). At least, one significant comorbidity was present in 80% of patients, while 45% were on antiplatelets and/or anticoagulants. Ten patients (32.3%) underwent craniotomy for evacuation of hematoma. 21 patients was treated conservatively. The operated group had more midline shift on imaging than the conservative group (p=0.012). Patient baseline characteristics and clinical status upon admission were similar between the two groups. 30 days mortality was associated with increased ASDH thickness (p=0.000), more midline shift (p=0.011) and worse revised trauma score (p=0.038). Good outcome at six months (Glasgow outcome score 4-5) was associated with younger age (p=0.049) and evacuation of ASDH (p=0.015). Multivariate analysis showed evacuation of hematoma (OR 7.1, 95% CI 1.1–43.5, p=0.036) was an independent predictor for good outcome. 60% of operated group could live independently at six months, whereas only 14.3% of conservative group had good outcome at six months.

Conclusions: Surgical evacuation of isolated traumatic ASDH is beneficial in elderly patients suffering from moderate and severe head injury.

Biography:

Alessandra Falco has completed her PhD in Social and Personality Psychology from Padua University. She is now Researcher and Adjunct Professor of Work and Organizational Psychology at Padua University. Her research areas are: (a) work-related stress risk assessment, with particular reference to the development of “integrated” tools, based on subjective, objective, and physiological indicators; (b) the role of specific individual and behavioral dimensions (workaholism, negative affectivity, mindfulness, PsyCap resources, perfectionism, presenteeism) in the etiology of organizational well-being/disease; (c) social marketing, communication and change, with particular reference to traffic psychology.               

Abstract:

Biography:

Dr Tim Collins has around 20 years’ experience within critical care working in a variety of positions within Intensive Care, Critical Care Outreach and Higher Education.  Holding positions as Consultant Nurse, Lead Nurse, Charge Nurse, ICU Educator & Senior Lecturer.  Tim is currently a British Association of Critical Care Nurses (BACCN) elected national board member and sits on the editorial board for Nursing in Critical Care Journal (Wiley). Tim has undertaken a number of presentations at European & International conferences and has published a number of papers in peer reviewed journals and book chapters. Tim holds a Doctorate in Education and a MSc in Critical Care and is an Instructor in both Adult and Paediatric Advanced Life Support.  Tim has specialist interests in Sepsis, Clinical shock, vascular access, Resuscitation, Organ Donation and Haemodynamic monitoring. 

Abstract:

Contents of workshop:

Evaluation of the literature relating to Intraosseous Access (IO).Indications & contraindications for IO access.Critical Appraisal of the benefits and limitations of IO access.Correct land marking for IO access sites.Evidence based recommendations for IO practice and care management.Practical demonstration of gaining IO access with simulation bones and IO equipment. Application of theory to a clinical simulation scenario involving a patient with difficult vascular access.An interactive quiz to facilitate discussion and learning relating to IO theory.

Participant involvement:

The workshop will involve attendees demonstrating practical application of gaining IO access with simulation bones & IO equipment. Demonstration and application of correct land marking for IO access. Application of pit crew CPR simulation for enabling an IO inserter to achieve access during a medical emergency. The workshop will involve attendees to reflect upon difficult vascular access patients and share their experiences within a supportive environment. An interactive case study relating to difficult vascular access and a quiz will facilitate discussion and reflection amongst the group.

Flow of workshop:

Visual power point slides evaluating the literature relating to IO theory. Critique of the benefits and limitations of IO access.Demonstration of land marking techniques.Pit Crew CPR simulation. Attendee’s undertaking practical application of IO simulation.Application of IO access to a clinical scenario.Interactive quiz, reflection and discussion.

Intended learning outcome:

This interactive workshop aims to enhance emergency provider’s knowledge, practice and confidence with Intraosseous Vascular access.

Biography:

Melanie Berube is pursuing her PhD at McGill University. She completed an Acute Care Post-master’s Nurse Practitioner diploma at University of Toronto and a Master’s degree at Université de Montréal. She has worked as an Advanced Practice Nurse in Orthopedics and Trauma for five years and she is a Clinical Nurse Specialist in the fields of Trauma and Critical Care. She currently holds the positions of Trauma Co-ordinator and Research Coordinator in Department of Nursing at Hôpital du Sacré-Coeur de Montreal, a level one trauma center. Her research interest includes “Prevention of adverse events in trauma including the acute to chronic pain transition”.

Abstract:

Up to 86% of patients with serious extremity trauma (ET) develop chronic pain. People affected by chronic pain report a worse quality of life than individuals affected by common chronic disease. Moreover, chronic pain imposes a high socio-economic burden. Several psychological risk factors have been disclosed to be involved in the development of chronic pain including pain catastrophizing, pain-related fear as well as anxiety and depression symptoms. Some empirical evidence has revealed that interventions based on a cognitive-behavioral approach which aims to increase self-management behaviors could prevent chronic pain by addressing psychological risk factors. Consequently, we developed a self-management intervention tailored to patients with serious ET. Clinicians from various disciplines (n=10) and patients’ (n=6) assessed intervention acceptability according to the following criteria: effectiveness, appropriateness, suitability and convenience. Data was collected through the treatment acceptability and preference (TAP) questionnaire and a focus group. The TAP questionnaire mean scores indicated that clinicians and patients assessed positively to very positively (score≥2/4) the preliminary version of the intervention. Improvements such as breaking up sessions and integrating an e-health component to the intervention were discussed during the focus group with clinicians. Patients proposed modifications to intervention activities and identified the necessity to better tailor activities and dose to each individual during the intervention pre-test. This study provided information about the refinements that need to be made to the preventive intervention to improve its acceptability. The next step will be to assess the feasibility of the improved intervention in the context of a pilot RCT.

Biography:

Calvin Mak is a Neurosurgeon specialist, working as an Associate Consultant at Queen Elizabeth Hospital in Hong Kong. After completing his graduation at University of Hong Kong, he worked at several neurosurgery centers in Hong Kong during Neurosurgical training, and completed the fellowship of FRCSEd (SN) in 2014. His current clinical and research interest includes “Traumatic brain injury, skull base surgery, neuro-endoscopy, and minimal access brain and spine operations”. He is also interested in implementing information technology in postgraduate training and medical practice.

Abstract:

Introduction: Traumatic acute subdural hematoma (ASDH) in elderly suffering from moderate and severe head injury is associated with poor outcome. The effect of surgical evacuation of traumatic ASDH in absence of other hematoma is not well studied.

Material & Method: We retrospectively review the data from the trauma registry of a regional trauma centre, from 2007 to 2010. Patients with isolated traumatic ASDH aged between 65 and 90, with Glasgow Coma Scale (GCS) not more than 13 on admission, were included.

Results: There were 31 patients with mean age 77 (65–89), and 55% were men. GCS on admission was not more than eight in 36%, and 24% had one or both pupils being non-reactive. The mean thickness of subdural hematoma was 15 mm (2.9–29.1), and mean midline shift was 7.6 mm (0–20.7). At least, one significant comorbidity was present in 80% of patients, while 45% were on antiplatelets and/or anticoagulants. Ten patients (32.3%) underwent craniotomy for evacuation of hematoma. 21 patients was treated conservatively. The operated group had more midline shift on imaging than the conservative group (p=0.012). Patient baseline characteristics and clinical status upon admission were similar between the two groups. 30 days mortality was associated with increased ASDH thickness (p=0.000), more midline shift (p=0.011) and worse revised trauma score (p=0.038). Good outcome at six months (Glasgow outcome score 4-5) was associated with younger age (p=0.049) and evacuation of ASDH (p=0.015). Multivariate analysis showed evacuation of hematoma (OR 7.1, 95% CI 1.1–43.5, p=0.036) was an independent predictor for good outcome. 60% of operated group could live independently at six months, whereas only 14.3% of conservative group had good outcome at six months.

Conclusions: Surgical evacuation of isolated traumatic ASDH is beneficial in elderly patients suffering from moderate and severe head injury.

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:

Many diagnostic and therapeutic interventions were pulled down to emergency department in the last two decades like point-of-care applications of ultrasound (PoCUS). Fiberoptic bronchoscopy is another fundamental tool which can provide essential lifesaving interventions to critically ill patients in emergency department. Here, we report a 47 year old male patient, known to have chronic bronchitis and alcoholic liver disease, he presented to the emergency department with a circulatory collapse due to an acute pancreatitis. In Trendelenburg position, right IJ CVC was inserted under ultrasound guidance. Post procedure chest X-ray showed right upper lobe lung collapse which progressed after 2 hours into a total lung collapse and hypoxia. Endotracheal intubation with mechanical ventilation was required and subsequent computed tomographic angiography confirmed in place catheter with no extravasation but a large volume pleural effusion associated with complete lung collapse on the right side. Bedside flexible bronchoscopy, done at ICU by critical care physician, revealed a large mucous plug occluding the right main bronchus with a smaller one at the right upper branching bronchus both were removed immediately. Repeated chest X-ray after 6 hours showed lung expansion with a dramatic decrease of the volume of pleural effusion. Patient was extubated on day three of admission and left the hospital with a full neurological and respiratory recovery on the seventh day. Such a complication was never reported before. The delay of diagnostic and therapeutic bedside flexible bronchoscopy due to unavailability or lack of trained operator could results in potential significant morbidity or mortality. We recommend expansion of training of bedside flexible bronchoscopy to all emergency physicians starting its basics during residency training years.

Biography:

Delvene Soares is a 4^th year Resident in General Surgery. Currently, she is pursuing her training at Aga Khan University Hospital in Karachi, Pakistan. Her research interest includes Trauma Surgery and Clinical Research. She is an author of two publications. She is a member of Pakistan Medical and Dental Council.

Abstract:

Introduction: Patients admitted to the surgical intensive care units (SICUs) pose a significant burden on both the health care services and the economy. In our institution and moreover in our part of the world, data concerning the morbidity and mortality in these patients is unknown. With an increasing number of patients admitted to the service, figures need to be calculated to establish guidelines and quality indicators.

Aim: This study aims to calculate the risk of infectious complications in the SICU, and to calculate the mortality rate and ratio.

Materials & Methods: This is a retrospective review of patients admitted to the SICU at Aga Khan University Hospital from January 2010 to December 2014. Only adult general surgery and trauma patients were included. Data was collected about the types of morbidities, the mortality rate and different factors that affect this rate. The standardized mortality ratio (SMR) was also calculated.

Results: A total of 243 patients were included. The mean age was 49±18 years. ER admissions comprised of 89% of patients with 67% having planned ICU admission. The average length of ICU stay was 5.57 days. The mean APACHE II score was 19.59. Hospital/ventilator-associated pneumonia was seen in 33%, blood stream infections in 27%, central line infections in 4% and catheter-associated urinary tract infections in 13%. The mortality rate was 45.3%. Age, unplanned ICU admissions and non-trauma admissions were found to be significantly associated with mortality (P<0.05). The SMR was 1.81 for operative cases and 1.36 for non-operative cases.

Conclusion: Our mortality rate and SMR is high when compared to international institutions. This could be due to the paucity of regional data for comparison. Our study highlights the benefit of a planned ICU admission and criteria should be established to define which patients need critical care.

Biography:

Linda L Herrmann has more than 20 years of Clinical experience providing care to older adults with acute neurological injury. Her research and clinical practice are closely intertwined. Her research examines “Recovery of older adults following traumatic brain injury”. Findings from her work propose provocative insights into the factors contributing to the recovery of older adults following a mild to moderate traumatic brain injury. These findings offer new knowledge to geriatric trauma with implications affecting clinical management, outcomes and health care policy.

Abstract:

This study describes the impact of modifiable variables (discharge destination and intensity of rehabilitation) on early functional recovery of adults 65 and older following mild and moderate traumatic brain injury (TBI). Previous studies demonstrate that greater intensity of inpatient rehabilitation in TBI patients contribute to improved rates of functional recovery; however, studies are limited by exclusion of/limited number of adults over age 65, and inclusion of patients who only received rehabilitation in the inpatient setting. Functional recovery was measured by clinician rated functional independence measure (FIM^TM) and by participant self-report using the river mead head injury follow up questionnaire (RHFUQ). The sample consisted of 70 community dwelling adults aged 65 and older hospitalized for a mild or moderate TBI. A descriptive longitudinal cohort design was used to explore discharge destination and trajectory of early functional recovery; intensity of rehabilitative services and their relative contribution to early functional recovery at two and six weeks post discharge. Correlations, regression, and repeated measures analysis of covariance (ANCOVA) were used. Major findings from this study indicate that intensity of rehabilitation significantly and positively affected the trajectory of recovery of motor function over time; greater improvement in motor and cognitive function was noted in the high intensity group; and, patterns of self-reported difficulties varied by intensity of rehabilitation. Severity of TBI and presence of co-morbidities were significant predictors of discharge destination to home or skilled nursing facility. The trajectory of recovery of motor function and self-reported difficulties in older adults following mild and moderate TBI is significantly affected by intensity of rehabilitation. Additional research is necessary to examine rehabilitation intensity as it occurs in all settings and its longitudinal effect on the trajectory of motor, cognitive and psychosocial recovery and are essential if losses are to be integrated meaningfully into a person’s daily life.

Biography:

Md Yunus is an Emergency Physician from NEIGRIHMS, Shillong. He is the Head of Department of Emergency Medicine & Traumatology. He has put forward all the efforts to initiate, develop and establish the Department of Emergency Medicine in this part of the Country. His goal in life is to make available the emergency patient-care services to all the citizens of this country and that emergency care should be equal without delay, efficient and reasonably cost effective. He has keen interest in Bio-Medical Research & Academic in Medical Sciences. He is a renowned Trainer & Researcher being as Dean (Research) & Coordinator of Department of Medical Education at centre of Excellence which is also known as AIIMS of North-East which is designated as Autonomous Tertiary care Super specialty Medical Institute known as North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS), Shillong, Meghalaya under the Government of India (Ministry of Health & Family Welfare).

Abstract:

Biography:

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.