6^th International Congress on Trauma, Critical Care and Emergency Medicine March 05-06, 2019 Holiday Inn Amsterdam – Arena Towers, Amsterdam | Netherlands

Biography:

Mira El-darazi is a fourth year Radiation Therapy student with Michener Institute and Laurentian University, Canada. Currently, she is working at the North East Cancer Centre in Sudbury Ontario, Canada. In Sudbury, she is treating patients using advanced techniques and machinery, such as linear accelerators for Cancer treatment. She has studied cancer treatment, and patient care, as well as a vast amount of medical physics.

Abstract:

Patients who are undergoing a cancer diagnosis, experience many psychological and psychosocial symptoms as a result of the stress caused by treatment and related side effects. Coping interventions are a crucial aspect of a breast cancer patient’s journey, and must be tailored to suit individuals’ needs in order to be successful. Meditation should be incorporated more frequently as an intervention for breast cancer patients undergoing radiation therapy. (Literature has demonstrated the adaptive qualities of meditation, and the benefits, such as accessibility, success of participants and diversity.) This program is highly effective in improving overall sense of well-being, stress, depression, fatigue, and quality of life, provided by its individualization and adaptive qualities. This research will be exploring the benefits of a mindfulness meditation based stress reduction interventions for breast cancer outpatient in terms of quality of life, mood and stress relief. Meditation is crucial as some of the symptoms that a patient may experience can be debilitating and distressing. This is caused by various factors that could lead to long lasting impacts on their psychological and psychosocial selves. In order for patients to keep their mental well-being and continue living as “normally” as possible, they require an effective intervention with components on education, social and physical life that they can control and manipulate to suit their needs. In order to obtain conclusions, a comparative study will be conducted analyzing various articles surrounding the topic and supportive objectives. Results are tentative, as report will be completed by March 2019.

Biography:

Shiv Shanker Tripathi is currently working as Associate Professor in the Department of Emergency Medicine at Ram Manohar Lohia Institute of Medical Sciences, India. His research interests are Critical Care, Trauma and Emergency Medicine.

Abstract:

Introduction & Aim: No association studies for the efficacy and safety of ticagrelor and Prasugrel have been published in India. Aim of the study was to compare the safety and efficacy of Prasugrel versus ticagrelor in patients with acute coronary syndrome treated with percutaneous coronary intervention.

Methods: This retrospective study was designed to compare the efficacy and safety of Prasugrel and ticagrelor in acute coronary syndromes (ACS) with percutaneous coronary intervention (PCI). A total of 480 patients were studied who had been prescribed either Prasugrel or ticagrelor during PCI. Primary end-point was defined as death, re-infarction, urgent target vessel revascularization, serious bleeding requiring transfusion.

Results: Primary endpoint was different between the groups receiving Prasugrel and ticagrelor (1.2% and 4.0%, respectively; OR (95% CI) 0.38 (0.098; 1.43); P=0.065). Difference was found in the need for urgent target vessel revascularization which was significantly lower in the Prasugrel group. Rest of the parameters were almost similar with no significant difference.

Conclusion: This study comparing Prasugrel and ticagrelor shows that Prasugrel is more effective than ticagrelor in lowering ischemic events in the acute coronary syndromes treated with PCI strategy, especially incidence of stent thrombosis. These observations need further analysis and follow-up.

Biography:

Md Majid Anwer is working as a Fellow in MCh Trauma Surgery and Critical Care at Jai Prakash Narayan Apex Trauma Center, AIIMS New Delhi, India. He is at a level 1 Trauma Center of North India catering to high volume of patients annually.

Abstract:

Introduction: Focused assessment with sonography for trauma is an important skill during trauma resuscitation. It has been the initial diagnostic modality of choice during trauma. Its use however may result in underdiagnoses of potentially life threatening injuries, which are otherwise picked up on contrast enhanced CT scan. Its diagnostic accuracy in pediatric trauma remained to be determined.

Aim: The aim of this study was to determine the accuracy of focused assessment with sonography for trauma and its comparative analysis with CECT torso in pediatrics in emergency trauma department of a level 1 trauma center of India.

Materials & Methods: A prospective study was done on pediatric age group in trauma emergency during primary survey of resuscitation in resuscitation bay or red area in the age group of 1-18 years of age. All cases are taken into study that has entered in our center (AIIMS Delhi) in period from April 2018 to July 2018. The fast examination was done by radiology residents. All those patients who had positive findings went for CECT. The data analysis was done using the latest version of SPSS.

Results: During the period from April 2018 to August 2018, a total of 200 pediatric patients were triaged in red areas using START triage protocol. Of the 200 pediatric patients examined, majority victims were males (63%), followed by females (37%). The present study revealed that the majority affected age group is 1-5 years in pediatric trauma. Fall from height (FFH) were the most common mode of trauma seen in 68.5% of our patients, followed by road traffic injuries. Chest compression defined as a crepitation or tenderness elicited on deep palpation of chest was found in 4.5% of patients. The pelvic compression test used to diagnose pelvic fracture and sacroiliac joint lesion were positive in four cases (2%). The sensitivity of FAST to detect abnormal findings relative to CT was 24 (true positive), 40% and specificity of FAST relative to CT was 128 (true negative), 91.40%. Twelve patients were false positive. Thirty six patients were false negative.

Discussion: The positive predictive value and the negative predictive value of the test is 66.70% and 78% respectively. Balanatrajan et al. showed sensitivity, specificity, positive and negative predictive values as 43%, 99%, 95% and 94% respectively. The sensitivity of FAST in the literature varies between 63% and 96% (23). Lee et al. evaluated the use of ultrasonography for the triage of blunt abdominal trauma patients for exploratory laparotomy. Their results for the normotensive patients showed sensitivity, specificity, negative and positive predictive values as 85%, 96%, 99%, and 96% respectively, for the FAST study. Our sensitivity, specificity and negative, positive predictive values could be low because of more children in one to five years of age.

Conclusion: The ultrasound missed some important findings which were later detected on CT scan. Given the low sensitivity, a negative focused assessment with sonography for trauma without confirmation by computerized tomography may result in missed intra-abdominal injuries in pediatric patients.

Biography:

Swagat Mahapatra is currently working as Assistant Professor in Orthopedics at Ram Manohar Lohia Institute of Medical Sciences, India. His research interests are Pediatric Trauma, Trauma & Reconstructive Surgery and Orthopedic Trauma.

Abstract:

Dislocation of the hip in infants, toddlers and adolescents can occur either as an isolated congenital abnormality or associated with a spectrum of other birth defects. Post-traumatic dislocations of the hip in children are very uncommon, and anterior dislocation of the hip joint is even rarer. We report such a case following road traffic accident in a five-year-old child. The patient underwent successful emergent closed reduction of right hip under general anesthesia. The clinical course and follow-up assessment of the patient were otherwise uneventful. At one year follow-up, there was no evidence of growth abnormalities in the head, no secondary arthritis and no signs of avascular necrosis.

Biography:

Abstract:

Introduction: Breakage and displacement of tracheostomy tube into the respiratory tract is a dangerous late complication after tracheostomy. We like to present a case of a patient with fractured tracheostomy tube with respiratory distress posted for bronchoscopic removal.

Case: The case study begins with a 42‑year‑old male patient was admitted to the emergency department with dyspnoea. He was a known case of airway stenosis and had a Fuller’s tube in situ. Fibrotic stenosis at the level of fifth and sixth tracheal ring with calcification was found. Vitals were stable but saturation was low. On inspection of the tube, the inner part was missing and outer part was intact. Radiographs revealed the broken part of the tube in the right main bronchus. Removal was done using right bronchoscopy and patient was discharged with tracheostomy tube with adequate counselling regarding tube care.

Discussion: The Fuller’s tracheostomy tube usually gets fractured at the junction of flanges and the collar of the tube. Possible etiology includes prolonged use and seasonal cracking; repeated boiling and mechanical stress; erosion caused by tracheobronchial secretions; and manufacturing defects. The right main bronchus is the most frequent site of lodgement of the fractured segment. The fracture of the tube is common at the junction of the collar with the neck plates because stagnation of secretions is more in this area and these two parts are welded together. Anaesthetic management during the removal of fractured tracheostomy tube is challenging. Most of these patients will be having a compromised airway anatomy because of the primary disease process and fracture, and dislodgment of the tube may lead to life‑threatening airway obstruction.

Conclusion: Fracture and displacement of the tracheostomy should always be considered as a differential diagnosis in the event of a sudden onset respiratory distress in a patient with tracheostomy of long duration.

Biography:

Abstract:

In Australia blunt trauma accounts for 90% of admitted trauma cases, 22% of who sustain a blunt abdominal trauma (BAT). At the Royal Melbourne Hospital in 2016, BAT accounted for 15% of all major trauma cases, of these 30% required a laparotomy and 18% required angioembolization. Through better understanding of blunt abdominal trauma and advancements in diagnostics and non-operative management techniques including angioembolization, more conservative approaches are utilized for treatment of BAT. Therefore, the morbidity associated with laparotomies has reduced. This poster presents the evidence based clinical practice guideline for the assessment, investigation and management of blunt abdominal trauma at a level 1 trauma center, with an updated review of relevant literature current to 2019. A decision making algorithm and practical points on the assessment, investigation and management of BAT, as well as common pitfalls to consider will be presented. Ongoing implementation and revision of this evidence based clinical practice guideline allows health professionals to be better informed to make decisions for the care of patients presenting with blunt abdominal trauma. This leads to benefits for the individual patient and the health system through reductions in non-therapeutic laparotomy, judicious use of computed tomography and appropriate selection of patients for non-operative management.

Biography:

Yeo Min Cho is currently working at Eastern Health Australia in the Department of Surgery. He is a Surgeon in the Royal Melbourne Hospital. His research interests are trauma and blunt trauma.

Abstract:

In Australia blunt trauma accounts for 90% of admitted trauma cases, 22% of who sustain a blunt abdominal trauma (BAT). At the Royal Melbourne Hospital in 2016, BAT accounted for 15% of all major trauma cases, of these 30% required a laparotomy and 18% required angioembolization. Through better understanding of blunt abdominal trauma and advancements in diagnostics and non-operative management techniques including angioembolization, more conservative approaches are utilized for treatment of BAT. Therefore, the morbidity associated with laparotomies has reduced. This poster presents the evidence based clinical practice guideline for the assessment, investigation and management of blunt abdominal trauma at a level 1 trauma center, with an updated review of relevant literature current to 2019. A decision making algorithm and practical points on the assessment, investigation and management of BAT, as well as common pitfalls to consider will be presented. Ongoing implementation and revision of this evidence based clinical practice guideline allows health professionals to be better informed to make decisions for the care of patients presenting with blunt abdominal trauma. This leads to benefits for the individual patient and the health system through reductions in non-therapeutic laparotomy, judicious use of computed tomography and appropriate selection of patients for non-operative management.

Biography:

Krystal Dinh is currently working as a Doctor at The University of Newcastle for Sydney, Australia. She has her interests in both vascular and trauma medicine.

Abstract:

A 72 year old female presented for an elective laminectomy under general anaesthesia. The patient’s only reported medical background was mild asthma irresponsive to a beta 2-adrenergic receptor agonist. Prior to the procedure, the anaesthetist attempted multiple times to intubate the patient without success. The airway was originally thought to be fractured and the airway proceeded to swell. The patient was unable to be ventilated via bag and mask and a decision was made to proceed to secure an airway via the creation of a tracheostomy. A tracheostomy was created without difficulties and patient was successfully ventilated. The elective laminectomy procedure was abandoned, the patient was transferred to recovery. A post-operative computed tomography illustrated a massive aortic arch aneurysm that compressed the patient’s trachea. Cardiothoracic surgery and vascular surgery were both consulted and due to the procedural high risk, a decision was made not to repair the patient’s thoracic arch aneurysm.