4^th Annual Congress and Medicare Expo on Trauma & Critical Care February 22-23, 2018 Hotel Holiday Inn Paris – Paris, France

Biography:

Julin F Tang is an Anesthesiologist/Intensivist in San Francisco, California and affiliated with UCSF Medical Center and San Francisco VA Medical Center. He is boarded in Anesthesia and Critical Care Medicine. He has received his Medical degree from China Medical College, Taichung, Taiwan in 1978. His clinical research interests involved in the understanding of hemodynamics and pulmonary physiology in both anesthetized and intensive care unit patients.

Abstract:

Ultrasonography in Acute Care Medicine:

The use of portable ultrasonic echocardiography has become a powerful tool in the trauma, critical care and perioperative setting in the hands of non-cardiologist that can provide non-invasive, real-time information that will transform the practice of medicine in time-critical situations. I will present a case series of application of ultrasonography in acute care medicine with findings that affected perioperative management. This is a presentation from a single institution. A well-designed prospective study is needed to validate our findings and improve patient’s outcome.

Biography:

Ossama H Salman is presently working as an Assistant Professor in the Department of Anesthesia, ICU and Pain Management in South Valley University, Egypt. During his Fellowship at the Department of Anesthesia and ICU, Nagoya University, Japan, he has completed his PhD degree on the contribution of neuropeptide Y to edema occurrence, in neurogenic and hydrostatic pulmonary edema (rat models). He has also investigated role of nitric oxide in the rat brain. He is the Head of the Pain Management Unit. He also works as Visiting Pain Consultant at Ministry of Electricity Central Hospital in Cairo.

Abstract:

Background: Intravenous regional anesthesia (IVRA) is an effective procedure for various short trauma surgical interventions on the upper limbs. It provides favorable patient recovery profile with shorter postoperative recovery time and less hemodynamic derangement.
Aim: To investigated the quality of analgesia and hemodynamics when dexmedetomidine or nitroglycerine (NTG) added to lidocaine for Intravenous Regional Anesthesia (IVRA) for traumatic hand and forearm surgery.
Method: Sixty ASA I and II patients undergoing hand and forearm surgery after trauma under, were divided into three groups (20 patients each). Group Dexmedetomidine received IVRA 40 ml lidocaine 0.5% plus 1μg/kg dexmedetomidine. Group Nitroglycerine received IVRA 40 ml lidocaine 0.5% plus 200 μg NTG. Group Control received IVRA 40 ml lidocaine 0.5%. Onset and recovery of sensory and motor block, quality of analgesia, time to tourniquet pain, time to first postoperative analgesic request, the total intraoperative and postoperative analgesic consumption and adverse effects were recorded.

Results: Sensory and motor block onset times were significantly shorter in group Nitroglycerine compared to group Dexmedetomidine and group Control. Sensory and motor block recovery times were significantly prolonged in group Dexmedetomidine and group Nitroglycerine compared to group Control. Sensory and motor block recovery times were significantly prolonged in group Dexmedetomidine compared to group Nitroglycerine (P<0.05). Time to tourniquet pain was higher in group Control compared to both Dexmedetomidine and Nitroglycerine groups. Postoperative VAS and analgesic consumption intra and postoperative were statistically lower in group Dexmedetomidine and group Nitroglycerine compared to group Control (P<0.05). These variables were significantly lower in group Dexmedetomidine in comparison to group Nitroglycerine (P<0.05).
Conclusion: NTG 200 μg added to lidocaine for IVRA shorten sensory and motor block onset times. Dexmedetomidine 1 μg/kg improves the quality of anesthesia and improves intra-operative tourniquet pain and postoperative pain with less intra-operative and postoperative analgesic consumption or hemodynamic instability.

Biography:

Mahdi Asadi is currently working in the Department of Emergency Medicine in Azad Medical University, Qom, Iran. He has received his Medical degree from Tehran University of Medical Sciences. Later, he has worked in Emergency Medicine Resident at Shahid Beheshti University of Medical Sciences from 2011-2014. He is the Representative of Jahrom University of Medical Sciences in association of emergency medicine in Tehran. He was also a Member of Research Council at Jahrom University of Medical Sciences.

Abstract:

Aim: This small pilot study aims to evaluate the role of seating position arrangement in Injury Severity Score (ISS) in traffic coach accidents.
Method: A total of 106 cases representing of 2 traffic coach accidents with similar specification from April 2017 to September 2017 enrolled in this matched case-control study. All included patients were treated at the Emergency Department of the Trauma Center. The injury severity of passengers was determined by ISS calculation. We categorized ISS to 2 group of severe (ISS≥25) and non-severe (ISS≤24) and seating position to front and rear group. Data was analyzed by SPSS.
Result: The case and control group consisted of 16 persons with ISS≥25 and 90 persons with ISS<25, respectively. About 11 persons of the cases seated at front of coach and 5 persons at rear position. In control group, 43 and 47 persons seated at front and rear position, respectively. The risk of severe injury was two times more likely in passengers seating in front of coach (OR=2.405, CI=0.773 to 7.482). Patient’s distribution according to ISS was minor (45.3%), moderate (21.7%), serious (17.9%), severe (8.5%) and critical (6.6%).
Conclusion: As the passengers seated in front of the coach had more likely to sustain severe traumatic injury, so injury severity could be declined by simple intervention such as arrange susceptible passengers in rear seating positions.

Biography:

Hend Mohamed El-Azzazy has completed her PhD from College of Nursing, Alexandria University (1995) and Postdoctoral studies from Tanta University, College of Nursing. She has published more than 15 papers in reputed journals, supervised 7 master’s and doctorate thesis and has been working as Acting Dean of College of Nursing, Sultanate of Oman, Vice Dean of Postgraduates and Research Affairs and the Head of Quality Assurance and Medical Surgical Department and Member of Faculty Council of College of Nursing, Egypt.

Abstract:

Pressure ulcers (PU) are a common problem across all health care settings and the incidence is one of the quality signs of health centers. Critically ill patients are at a high risk for pressure ulcer than are patients in general care areas. The protocol of nursing care provides the intensive care unit (ICU) staff with a decision-making structure that allows immediate response to patients identified as at high risk for pressure ulcers. The study aimed to evaluate the effect of protocol of nursing care for early detection and prevention of pressure ulcer in ICU. The study was carried out in Anesthesia Care Unit at Tanta Emergency Hospital. A convenient sample of 40 adult critically ill patients meeting the inclusion criteria were selected and divided into two equal groups. The control group consisted of 20 critically ill patients undergoing routine care of the unit. Another 20 critically ill patients in the study group were undergoing the protocol of nursing care for pressure ulcer prediction and prevention applied by the researchers. Three tools were used for data collection. Tool-1: Patient assessment tool. It consists of three parts: (1) includes bio-socio-demographic data, (2) includes patient’s medical and nutritional history and (3) includes assessment of critically ill patients related to level of consciousness, level of mobility and skin assessment. Tool-2: Braden Scale risk assessment tool that identifies patients at risk for pressure ulcer development. Tool-3: Ulcer development evaluation. The main result of this study showed that 30% of the control group undergoing routine care of ICU developed pressure ulcer stage-1 at the 7^th day of admission and 60% of them developed stage-2 pressure ulcer at the 15^th day of admission. On the other hand, it was observed that only 10% of study group developed pressure ulcer grade 1 at 15^th day of admission and none of them developed stage-2 pressure ulcer at any time of the study period. It is recommended that periodic clinical assessment of critically ill patients at risk for ulcer development should become a routine for Intensive Care Unit by using Braden scale. Also, the protocol of nursing care for early detection and prevention of pressure ulcer should be generalized at ICUs and other acute care setting.

Biography:

Min Tan is a graduate student of nursing school, West China hospital in Sichuan University. Her research direction is geriatric nursing and has enough expertise in evaluation and passion in improving the health and quality of life among elderly patients. She focused on the relationship between health situation and medication adherence of the diabetic older patients and did her best to find a better method which elderly patients can accept and be easy to implement so as to solve those problems disturbing chronic patients and manage disease process and condition efficiently.

Abstract:

Background: Medication non-adherence and risk factors related to diabetic patients have been investigated widely in prior studies all over the world. However, those studies mainly focused on adults and conducted in developed countries and high-income cities. It is necessary to find information about the prevalence and correlates of medication non-adherence among older patients with diabetes mellitus in western China in order to achieve optimal glycemic control and prevent diabetes-related complications.

Method and materials: A cross-sectional descriptive study was conducted in 1559 older diabetic adults. Our study used a multistage sampling method and conducted in 21 community health centers in 7 cities of western China located in Sichuan Province, Chongqing Municipality, Xinjiang Uygur Autonomous Region, Guizhou Province, Gansu Province, Shanxi Province and Qinghai Province. The variables investigated in the study were demographic, clinical characteristics and medication adherence. Descriptive and Binary logistic regression analysis were performed to determine factors that related to medication non-adherence. 

Results: The results illustrated that 75.5% of participants were medication adherents and that 24.5% of patients were non-adherents. About 23% of elderly patients suffered from at least four chronic diseases and 11% of patients took more than four prescribed medications for treatment. Multivariate logistic regression demonstrated that number of comorbidity (OR=2.194, 95%CI=1.003, 4.803), number of oral medications (OR=2.088, 95%CI=1.198, 3.638), household income (OR=0.452, 95%CI =0.312, 0.656) and marital status (OR=0.684, 95%CI =0.505, 0.927) were associated with medication non-adherence.

Conclusion: Medication non-adherence among elderly patients with diabetes mellitus is a common and vital concern in western China. More attention to geriatric patients with high risk for medication non-adherence is necessary. And strategies should be designed to improve medication adherence especially in those who suffered from comorbidities, taken poly-pharmacy for treatment, had lower household income and married patients.

Biography:

Xie Caixia has completed her Master’s degree from the Third Military Medicine College of China and started her PhD in 2016 in West China School of Medicine, Sichuan University. She is a Head-Nurse of Sichuan Provincial People’s Hospital, who had 6 years’ experience in nursing management and 7 years’ experience in clinical nursing. She has published more than 20 papers in reputed journals.

Abstract:

Background: The emotional intelligence of nurses is closely related to occupational burnout, and mindfulness can improve emotional intelligence. Theory and preliminary evidence suggest that emotional intelligence may mediate the relationship between ICU nurses’ mindfulness and occupational burnout, but further study is needed to validate this finding.

Objectives: The aim of this study was to test the mediating role of emotional intelligence between ICU nurses’ mindfulness and occupational burnout.

Design: A cross sectional study.

Settings: 29 ICUs in seven tertiary hospitals in domain city of Chengdu, China.

Participants: A sample of 883 ICU nurses.

Methods: Data on occupational burnout, mindfulness and emotional intelligence were collected by trained research assistants using the Meshach burnout inventory, mindful attention awareness scale and emotional intelligence scale, respectively. Socio-demographic data were collected by self-report. Pearson’s correlation coefficient was used to analyze correlations between variables. Mediation analysis was performed with structural equation modeling and indirect effects were evaluated with bootstrapping.

Results: The correlations between mindfulness, emotional intelligence, emotional exhaustion, depersonalization and personal achievement were significant. In mediation models, emotional intelligence plays part mediating role in the relationship between mindfulness and emotional exhaustion, mindfulness and depersonalization. That is, the mindfulness factor cannot only influence emotional exhaustion or DE personification through emotional intelligence, but also directly influence emotional exhaustion or DE personification. Emotional intelligence plays a total mediating role in the relationship between mindfulness and personal achievement, that is, mindfulness does not have a direct impact on personal accomplishment, but indirectly affects personal accomplishment through emotional intelligence.

Conclusion: Mindfulness and emotional intelligence appears to be an important factor influencing occupational burnout of ICU nurses. Interventions addressing mindfulness and emotional intelligence should be considered as a way to improve occupational burnout in this population.

Biography:

Neringa Bagdonaite is currently pursuing his PhD in Mykolas Romeris University, Institute of Psychology. He has completed his graduation in Mykolas Romeris University and did research in the field of psychology. His research interests are psychology, psychological trauma, etc.

Abstract:

Aims: The current study aimed to systematically analyze various research done in the area of female posttraumatic stress disorder (PTSD) and alcohol abuse and to critically review these results on the basis of theoretical models as well as answering following questions: (1) What is the reciprocal relationship between trauma/PTSD and alcohol abuse among females; (2) What are the moderating factors/variables of this relationship?

Methods: The computer bibliographic databases EBSCO, Scopus, Springer, Web of Science, Medline, Science Direct were used to search for scientific publications. Systematic analyses sample consisted of peer reviewed, English written papers addressing mixed gender and female PTSD and alcohol abuse issues from 2012-2017 May.

Results: Total of 1011 articles was found in scientific databases related to search keywords of which 29 met the selection criteria and were analyzed. The results of longitudinal research indicate that various traumas especially sexual abuse trauma exposure in childhood is linked with increased risk of problematic alcohol use and re-victimization in adulthood, re-victimization in adolescence, rather than victimization in childhood has a greater impact on the onset and progression of problematic alcohol use in adulthood. Cross-sectional and epidemiological studies also support significant relationships between female PTSD and alcohol abuse. Regards to negative impact of alcohol use on PTSD symptoms results are yet controversial. Some studies suggest that alcohol does not exacerbate symptoms of PTSD over time, while others argue that alcohol abuse worsens PTSD symptoms and is linked to chronicity of both disorders. Motivational and emotional factors have an important impact on alcohol abuse in women with PTSD, when increase in both negative and positive feelings and various motives, specifically coping motives is linked to alcohol use in response to PTSD symptoms. Regards to theoretical models, results of longitudinal studies tend to systematically demonstrate mutual maintenance model perspective, however studies of cross-sectional design reveals self-medication aspects of alcohol use behavior and emphasizes proximal relationship between PTSD symptoms and alcohol abuse.

Conclusions: In general, the results are in line with previous systematic analyses. Findings have important clinical implications, as treatment of comorbid conditions is more complex and time-consuming than those with a single disorder. Therefore, it is important for clinicians working with both disorders to pay enough attention to identification and integration of traumatic events. Likewise teaching effective emotional regulation strategies for coping with distress as well as strategies for experiencing and increasing positive affect, such as mindfulness or engaging in positive visual imagery, would help to reduce problematic alcohol use and the probability of re-victimization in the future.

Biography:

Sandeep Inchanalkar is presently a leading Neurosurgeon in Maharashtra, India. His widely acclaimed mission is to bring healthcare of international standards within the reach of individual. He is an MBBS, MS, DNB and MCh (Neurosurgery) at Bombay Hospital and has done Fellowship in Minimal Invasive Brain and Spine Surgery. He is a Member of Neurological Society of India and presented paper in several national conferences. He was Organizing Secretary and Joint Secretary of Neurological Surgeon’s Conference 2015 and 2016.

Abstract:

Approximately, one million patients present to hospital each year having suffered a head injury. The majority of these patients have minor (GCS 13-15) or moderate injuries (GCS 9-12) and approximately half or less than 16 years. Old males are 2-3 times more likely to have a head injury than females. Head injury is associated with tremendous mortality and morbidity. The head injuries are classified according to the nature of insult (penetrating or blunt) concomitant injuries (isolated or multiple traumas) and the timing (primary or secondary). The Glasgow coma scale (GCS) remains the most commonly used method of assessing the severity of the head injury. Pathophysiologically, it can be cerebral contusions, diffuse axonal injury, subarachnoid hemorrhage, fracture and epidural and subdural hematomas. The five key principles that should guide the management of the head injury patients in ICU are norm tension, normoxia, normocapnia, normothermia and normoglycemia, management involves medical and surgical treatment. Medical management includes positioning, sedation ventilation, ABG management, mannitol (ICP reduction agents), sugar control, temperature regulation and good nursing care. Surgical management includes CSF drainage, craniotomy, lobectomy decompression, etc. Head injury is not a static event that occurs at time zero and recovers to normal at defined later time point. It is a dynamic process that changes over days, weeks and months after the event and outcome cannot be assessed at least 6 months after the head injury. Management of head injury needs a disciplined and team approach for better outcome.

Biography:

Gibril Ceesay is a student and Nurse at the Serrekunda Health Center, Banjul, Gambia. He started his professional nursing career after graduating from The Gambia University at the end of 2016.

Abstract:

Traumatic​ ​brain​ ​injury​ ​(TBI)​ ​is​ ​a​ ​head​ ​injury​ ​that​ ​may​ ​have​ ​many​ ​different​ ​causes,​ ​including​ ​a blow​ ​or​ ​jolt​ ​to​ ​the​ ​head,​ ​penetration​ ​of​ ​the​ ​skull​ ​by​ ​a​ ​bullet​ ​or​ ​other​ ​foreign​ ​object,​ ​fast acceleration​ ​or​ ​deceleration​ ​of​ ​the​ ​head,​ ​or​ ​exposure​ ​to​ ​a​ ​blast​ ​resulting​ ​in​ ​a​ ​disrupted functioning​ ​of​ ​the​ ​brain.​ ​Primary​ ​brain​ ​injury​ ​occurs​ ​at​ ​the​ ​time​ ​of​ ​injury​ ​and​ ​results​ ​from​ ​the physical​ ​stress​ ​(force)​ ​within​ ​the​ ​tissue​ ​caused​ ​by​ ​open​ ​or​ ​closed​ ​trauma​ ​and​ ​requires​ ​emergency treatment​ ​to​ ​prevent​ ​secondary​ ​injuries.​ ​Secondary​ ​injury​ ​to​ ​brain​ ​injury​ ​includes​ ​any​ ​processes that​ ​occur​ ​after​ ​the​ ​initial​ ​injury​ ​and​ ​worsen​ ​or​ ​negatively​ ​influence​ ​patient​ ​outcomes.​ ​The damage​ ​occurs​ ​primarily​ ​because​ ​the​ ​delivery​ ​of​ ​oxygen​ ​and​ ​glucose​ ​to​ ​the​ ​brain​ ​is​ ​interrupted due​ ​to​ ​hypotension,​ ​hypoxia,​ ​ischemia and​ ​cerebral​ ​edema. ​According​ ​to​ ​research,​ ​there​ ​are​ ​millions​ ​of​ ​people​ ​living​ ​with​ ​a​ ​disability​ ​as​ ​a​ ​result​ ​of a​ ​TBI​ ​around​ ​the​ ​world.​ ​Regardless​ ​of​ ​the​ ​severity​ ​of​ ​brain​ ​damage,​ ​injuries​ ​have​ ​both​ ​short​ ​and long-term​ ​effects​ ​on​ ​health,​ ​ranging​ ​from​ ​symptoms​ ​that​ ​have​ ​a​ ​minimal​ ​interference​ ​on lifestyle,​ ​through​ ​to​ ​emotional,​ ​physical​ ​and​ ​psychosocial​ ​changes​ ​that​ ​may​ ​affect​ ​daily activities.​ In addition​ ​to​ ​the​ ​burden​ ​to​ ​the​ ​individual,​ ​brain​ ​injuries​ ​also​ ​have​ ​an​ ​annual economic​ ​burden​ ​on​ ​society,​ ​due​ ​to​ ​both​ ​direct​ ​and​ ​indirect​ ​costs,​ ​such​ ​as​ ​loss​ ​of​ ​productivity. The​ ​age​ ​of​ ​the​ ​individual​ ​is​ ​a​ ​factor​ ​in​ ​brain​ ​injury;​ ​for​ ​example,​ ​more​ ​than​ ​one-third​ ​of​ ​brain injuries​ ​are​ ​due​ ​to​ ​people​ ​falling,​ ​which​ ​is​ ​the​ ​leading​ ​cause​ ​of​ ​TBI​ ​among​ ​the​ ​elderly, whereas transportation-related​ ​brain​ ​injuries​ ​are​ ​the​ ​leading​ ​cause​ ​for​ ​individuals​ ​aged​ ​15​ ​to​ ​30. Studies​ ​have​ ​shown​ ​that​ ​the​ ​decreased​ ​in​ ​mortality​ ​rate​ ​and​ ​improved​ ​outcome​ ​for patients​ ​with​ ​severe​ ​traumatic​ ​brain​ ​injury​ ​can​ ​be​ ​attributed​ ​to​ ​the​ ​approach​ ​of​ ​“squeezing oxygenated​ ​blood​ ​through​ ​a​ ​swollen​ ​brain”.​ According​ ​to​ ​research​ ​adequate​ ​cerebral​ ​perfusion by​ ​monitoring​ ​of​ ​intracranial​ ​pressure​ ​and​ ​treatment​ ​of​ ​cerebral​ ​hypo-perfusion​ ​decrease secondary​ ​injury.​ ​Before​ ​the​ ​individual​ ​with​ ​brain​ ​injury​ ​reaches​ ​a​ ​hospital,​ ​a​ ​structured​ ​trauma system​ ​that​ ​allows​ ​rapid​ ​resuscitation​ ​and​ ​transport​ ​directly​ ​to​ ​an​ ​experienced​ ​trauma​ ​center significantly​ ​lowers​ ​mortality​ ​and​ ​morbidity.​ ​Additionally,​ ​in​ ​order​ ​to​ ​achieve​ ​further improvements​ ​in​ ​outcome​ ​for​ ​patients​ ​with​ ​traumatic​ ​brain​ ​injuries,​ ​sufficient​ ​training​ ​and education​ ​of​ ​medical​ ​personnel​ ​and​ ​the​ ​institution​ ​of​ ​trauma​ ​hospital​ ​systems​ ​should​ ​be implemented.