Day 1 :
Keynote Forum
Mohammed N Albaraesi
The Libyan International Medical University, Libya
Keynote: Local wound in ltration versus bilateral super cial cervical plexus block for prevention of postthyroidectomy pain
Time : 10:20-11:05
Biography:
Mohammed Naji has completed his MBBS from University of Benghazi, Libya and Post-graduate studies from The Arab Board of Medical specility. He has published more than 20 papers in reputed journals.
Abstract:
Background: Regional anesthesia for post-thyroidectomy pain management has recently become as a new trend that provides a good quality of analgesia with more prolonged duration and lesser side effects than IV analgesia.
Aim of the Study: We aimed to assess the bilateral superficial cervical plexus block (BSCB) versus local wound infiltration (LWI) after thyroid surgery with regard to postoperative analgesic efficacy.
Patients & Methods: Sixty adult patients of both sexes scheduled for elective thyroid surgery were randomly categorized into three equal groups. In the first group no regional block was performed (group-C), in the second group (group-L) the wound was infiltrated with 0.5% bupivacaine at the end of surgery, and the third group (group-B) received BSCB immediately after the induction of general anesthesia. Pain intensity was evaluated by the eleven-category numerical rating scale (NRS) and the four-category verbal rating scale (VRS) at the first hour after surgery, and then every 4 hours for the 24 hours postoperatively.
Results: NRS and VRS mean scores were significantly lower in groups (L) and (B) compared with the (C) group. The mean (± SD) of postoperative NRS scores was 3.82 (± 0.65), 2.01 (± 0.61), and 1.36 (± 0.70) in the (C), (L), and (B) groups respectively. The corresponding values measured by VRS were 2.49 (± 0.20), 1.71 (± 0.22), and 1.55 (± 0.23).
Conclusion: Although both techniques are effective for post-thyroidectomy pain management during the first postoperative 24 hours, BSCB provides a better analgesia and effectively decreases postoperative pethidine consumption more than LWI.
Networking & Refreshments Break 11:10-11:30 @ Foyer
Keynote Forum
Swagat Mahapatra
Dr Ram Manohar Lohia Institute of Medical Sciences, India
Keynote: Functional analysis of ulnar collateral ligament reconstruction of thumb using free tendon graft by pull out suture technique in neglected skiers thumb
Time : 11:30-12:15
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:
Injury to the ulnar collateral ligament (UCL) is referred to as game keeper’s thumb and is a rare injury in paediatric age group. Excessive valgus stress to the base of the thumb may result in disruption of the (UCL) complex with or without an avulsion fracture of the base of the proximal phalanx. We present a 14 years old girl with history of twisting injury to the right thumb two years back. She had a weakness of pincer grip, holding a pen, grasping objects and unscrewing jar lids. On clinical examination, tenderness was present in MCP joint, thumb instability test was positive. There was laxity of <35° on stressing the thumb without a firm end point. Stress radiograph showed opening up of the joint. MRI showed complete tear of ulnar collateral ligament. Patient underwent UCL reconstruction with palmaris longus graft using a pull-out suture technique with a transosseous non absorbable suture tied over a button on the radial side of the MCP Joint. Intra operatively thumb was stable. Thumb spica was applied for six weeks. After six weeks button was removed. At the final follow up of six months, joint was stable and she was able to do her daily activities. A pull-out suture technique UCL reconstruction has a satisfactory fixation, faster healing rate and results in good joint stability. We report this case due to the rarity of ulna collateral ligament injury of thumb in children.
Keynote Forum
Gayatri Lekshmi Madhavan
VIMS Hospital, India
Keynote: Point-of-care transcranial sonography for detection of midline shift in Neuro-emergencies in the emergency department
Time : 12:15-13:00
Biography:
Gayatri L Madhavan is a final year Emergency Medicine Resident at Vinayaka Institute of Medical Sciences, Salem, India. In addition to MEM, she has also completed her fellowship in Intensive Care Medicine, and is currently working on her fellowship in Clinical Cardiology.
Abstract:
Introduction: Midline shift (MLS) in the brain is a life-threatening emergency, which requires immediate intervention following prompt diagnosis. Currently, CT brain is accepted as the gold standard in detection of MLS. Frequent CT is not possible due to various factors like radiation exposure, transport difficulties, unavailability of bedside CT in most hospitals, and challenges in the micro-economics. This has led to a constant endeavour to identify and develop other methods for detection of MLS, among which Transcranial Sonography (TCS) is included.
Objective: The objective of the study is to validate point-of-care TCS for detection of MLS in neuro-emergency patients in the Emergency Department, and compare it to CT values of MLS.
Methodology: This prospective double-blinded study was conducted from March 2018 to October 2018 in the Emergency Department of VIMS Hospital, Salem. All patients who required a CT brain were included, and a TCS was performed. MLS on TCS was calculated by measuring the distance between the outer table of the skull and the third ventricle on both sides, through the temporal window using a 2.8 MHz Sector Probe. TCS was done by a trained Emergency Physician who was unaware of the patient’s clinical status, prior to doing CT brain. CT report was obtained, and another Emergency Physician who was blinded to the patient’s status compared both values. MLS on CT was defined as the difference between the ideal midline and the septum pellucidum.
Observations: A total of 87 patients were included in this study. The MLS (mean±SD) was 0.21cm±0.31cm using TCS, and 0.20cm±0.34cm using CT. The Pearson’s and Spearman’s correlation co-efficient between CT and TCS was 0.971 and 0.87 respectively (p<0.01). The area under the ROC curve for detection of a significant MLS using TLS was 83.7%. Using 0.5cm as a cut-off (significant MLS), the sensitivity, specificity and positive likelihood ratio were 86.7%, 98.6% and 61.92 respectively.
Conclusion: This study concludes that Transcranial Sonography could detect Midline Shift with a reasonable accuracy, and can be used as a point-of-care tool in the Emergency Department to facilitate early diagnosis of MLS and intervene accordingly in neuro-emergencies.
Keynote Forum
Shiv Shanker Tripathi
Dr Ram Manohar Lohia Institute of Medical Sciences, India
Keynote: Therapeutic evaluation of tranexamic acid in reducing perioperative blood loss in total hip replacement
Time : 14:00-14:45
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:
Objective & Design: This study was conducted to evaluate the efficacy of tranexamic acid in relation to blood loss in total hip arthroplasty surgery. This was a prospective, randomized, double-blind, placebo-controlled study.
Materials & Methods: Fifty patients of ASA 1 and 2 were included in the study. Test group
(T) was administered tranexamic acid 30 min before surgical incision and was repeated three hrs later. Control group (C) was given equal amount of 0.9% normal saline. We measured vitals pre and post administration in test group and compared hemoglobin, hematocrit, blood loss, transfusions needed in test and control group. Side effects after tranexamic acid administration were also noted.
Results: Pre-operative values for hemoglobin and hematocrit were almost equal in both groups. Post operatively the control group showed a marked decrease with extremely significant p value of <0.0001. Intraoperative and post-operative blood loss was found to be significantly less in the test group. Post-operative transfusion requirements were less in test group by approximately 50%. Post-operative nausea, vomiting or complications such as pulmonary embolism or deep venous thrombosis were absent in test group.
Conclusion: Tranexamic acid is a cost-effective and safe means of minimizing blood loss and reductions in hemoglobin concentrations reduces the need for allogenic blood transfusion, without increasing the risk of thromboembolic events.
- Trauma | Critical Care | Emergency Medicine | Emotional & Physiological Trauma | Pediatric Trauma | Urological Trauma | Orthopedic Trauma | Blunt Trauma | Obstetric Trauma | Sexual Trauma | Post Traumatic Stress Disorder | Trauma in Nursing And MidWifery | Trauma in Critical Care Nursing
Location: Conference Hall Name @ Rembrandt 1
Chair
Ramachandran Madhavan
Ramachandra Hospital Private Limited, India
Co-Chair
Shiv Shanker Tripathi
Dr Ram Manohar Lohia Institute of Medical Sciences, India
Session Introduction
Mira El-darazi
Michener Institute, Canada
Title: The benefits of mindfulness meditation as a psychosocial intervention for breast cancer patients
Time : 14:45-15:15
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.
Shiv Shanker Tripathi
Dr Ram Manohar Lohia Institute of Medical Sciences, India
Title: Prasugrel versus ticagrelor in patients with acute coronary syndrome treated with percutaneous coronary intervention
Time : 15:15-15:45
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.
Md Majid Anwer
Jai Prakash Narayan Apex Trauma Center, India
Title: 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
Time : 15:45-16:15
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.
Poster-1: Swagat Mahapatra
Dr Ram Manohar Lohia Institute of Medical Sciences, India
Title: Post traumatic anterior dislocation of hip in a  ve year old child– a case report
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.
Poster-2: Shiv Shanker Tripathi
Dr Ram Manohar Lohia Institute of Medical Sciences, India
Title: Fractured tracheostomy tube removal with rigid bronchoscope- A rare case report
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.
Poster-3: Yeo Min Cho
The Royal Melbourne Hospital, Australia
Title: Fractured tracheostomy tube removal with rigid bronchoscope- A rare case report
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.
Poster-3: Yeo Min Cho
The Royal Melbourne Hospital, Australia
Title: Updates in the management of blunt abdominal trauma
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.
Krystal Dinh
Prince of Wales Hospital, Australia
Title: Vascular tracheobronchial compression Syndrome, a rare case
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.