Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 7th International Congress on Trauma, Critical Care and Emergency Medicine Florence, Italy.

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Scientific Program Day 1

Day 1 :

  • Urological Trauma | Blunt Trauma | Trauma Care | Trauma Diagnosis | Emergency Medicine | Orthopedic Trauma | New Technology In Trauma
Location: Florence, Italy

Session Introduction

SHAHAB SHAHID

Royal London Hospital, UK

Title: Thumb and First Web Space Trauma: Education of the Surgical Trainee
Speaker
Biography:

Shahab Shahid is a junior doctor working in Emergency Medicine in London.

 

Abstract:

Intro

Opportunities to operate are reduced in the workplace and simulation is becoming an ever expanding source of experience for the surgical trainee. Many cases present out of hours leading to trainees handling complex procedures with little consultant input. We identify the most frequently damaged structures with an aim to focussing training toward the demands of the patient population.

Methods

We conducted a prospective study which involved the collection of patients with thumb and first web space (excluding the nail beds) injuries over two years. Data from 102 such injuries were collected from operative notes at the Royal London Hospital.  All injured and repaired structures were documented in the operative notes by a senior registrar or consultant. The details of the operative techniques and procedures were also noted.

Results

68% of cases were male with an average age of 29. Injuries to the volar aspect were more common (58%) than the dorsal aspect (27%). 55% of cases were same day procedures with a further 16% of cases required 1 day of hospital stay. 70% of injuries were lacerations and 8% were abscesses. The vast majority (78%) of extensor injuries occurred in zone 6. Thumb injuries were a major component of the cases with flexor thumb injuries in zone 2 (42%) and zone 3 (42%).

70% of operations were performed under general anaesthesia only and 24% were under local anaesthesia only. The average tourniquet time was 46.3 minutes. Hand therapy was performed in 48% of cases.  

Damaged structures include the abductor pollicus brevis (17%), the flexor pollicus longus (14%), the ulnar digital nerve of thumb (14%), the opponens pollicus (13%), the extensor pollicus longus (10%), the flexor pollicus brevis (10%), the extensor pollicus brevis (7%), the adductor pollicus transverse head (6%) and the adductor pollicus oblique head (6%).  All these structures were repaired in 100% of cases.

The radial digital nerve of the thumb was damaged in 11% yet only repaired in 93% of cases. Similarly the volar skin was damaged in 9% yet only repaired in 88% of cases.

Conclusion

In conclusion we identify the abductor pollicus brevis, flexor pollicus longus and ulnar digital nerve of the thumb as some of the most commonly damaged structures. Focussing simulation training on repair of these structures will likely improve surgical practice.

 

Nisha Chauhan

Queen Mary’s University of London, UK

Title: An evaluation of the interventions used in post-concussion syndrome: A systematic review
Speaker
Biography:

Dr Nisha Chauhan completed her Msc in Trauma Sciences with Queen Mary’s University London in June 2019. Her medical training was completed in 2014 from the University of Liverpool medical school and she is currently undertaking emergency medicine speciality training in the Merseyside area of the United Kingdom, with the view to become an emergency medical consultant.

 

Abstract:

Background: Post-concussion syndrome (PCS) affects 15-25% of mild traumatic brain injury (mTBI) patients resulting in such symptoms as memory loss, dizziness and headache. This review focuses on the three interventions most used in clinical practice: rest, information giving and cognitive behavioural therapy (CBT). Rest is increasingly being questioned as a treatment in many areas of medicine but is still promoted in concussion management. Information giving is an integral part of a medical consultation but has not proven to help PCS symptoms. Lastly, CBT has a firm founding in psychiatry and is increasingly used in mTBI. This review will look at the evidence available for all three of these interventions in the context of PCS. 

Method: Systematically reviewing studies from; MEDLINE, Embase, PsycINFO and PubMed for original, non-observation studies published 1998-2019 including adults with mTBI in relation to the intervention of rest, CBT or information giving. Excluding sports concussion studies.

Results: Of the 20,902 studies identified, 14 were included in this review. Three rest papers, four CBT papers and seven for information giving. Two of the three rest studies showed no effect of rest on PCS. The CBT studies that focused on acute PCS all found the intervention effective. The information giving studies yielded inconclusive results. 

Conclusions: Of the three interventions assessed, only CBT has proven effective in the treatment of PCS. Rest does not have sufficient evidence to support its promotion. Information giving will remain common practice, but inadequate evidence was found to support its use in reducing PCS symptoms.

 

Chonlada Krutsri

Mahidol University, Thailand

Title: Traumatic blunt renal artery injury in horseshoe kidney disease with successful of embolization for treatment of active bleeding : A case report and review literature
Speaker
Biography:

My name is Dr.Chonlada Krutsri. I am a young staff of Trauma and Acute Care Surgery surgeon of Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Faculty of Medicine, Ramathibodi hospital, Mahidol University, Bangkok, Thailand.

 

Abstract:

Background : A blunt injury in pre-existing kidneys disease can be found 19% and more vulnerable than normal kidneys. A horseshoe kidney is a rare anomaly with an overall prevalence of 0.2%. This challenge to non-operative management especially in high grade injury with active bleeding injury. A surgical reconstruction and preserve of damaged horseshoe kidney is difficult due to variation of vascular anatomy. This article is report a successful of non-operative management of blunt horseshoe kidney injury with active bleeding, review outcome and complication after treatment.

Method : We reported our case and review literature from international database.

Results : A 57 year-old male, motorcycle accident, suffer from transient responsive of hypovolemic shock. A whole body computed tomography(CT) scan shows high volume of retroperitoneal hematoma, and multiple laceration of lower pole kidney with compatible to pre-existing horseshoe kidney disease with active contrast extravasation from accessory right renal artery. An embolization was performed. A transient impair of renal function occurred in 2 days after embolization and normalised in day 7.  Infected hematoma occur in day 7 with successfully control by antibiotics. A previous report of blunt horseshoe kidney injury found that non-operative management has performed in 5/8 cases(62.5%) with 100% clinical success rate. A complication occurred in 75% comprise of fluid collection, infected hematoma and retroperitoneal compartment syndrome. None of the patient has impair renal function in long term follow up.

Conclusion : A pre-existing horseshoe kidneys disease are prone to injury even low velocity impact. An embolization can be a gold management due to very high clinical success rate leads to decrease surgical repair which is difficult due to variation of vascular anatomy and parenchymal pathology. A high rate of complication can occur from non-removal hematoma. If embolization is fail to stop bleeding, a surgical exploration should mandate for life saving.

 

Chunlaches Chaijareenont

Mahidol University, Thailand

Title: The FAST accuracy in major pelvic fracture for decision making of abdominal exploration : systematic review and meta-analysis
Speaker
Biography:

Dr.Chunlaches Chaijareenont is a second year General Surgery resident from Ramathibodi  Hospital, Mahidol University, Bangkok, Thailand

 

 

Abstract:

 

Background : In blunt trauma patients, major pelvic fracture is often associated with abdominal organ injury. According to ATLS, Focused Assessment with Sonography for Trauma (FAST) is typically used to assess the presence of hemoperitoneum, and when combined with the patient’s hemodynamics, this will facilitate in making the decision to perform abdominal exploration. However, hemoperitoneum in major pelvic fracture is sometimes caused by the extension of a pelvic hematoma into the abdominal cavity. If an abdominal exploration is performed in these situations, patients will loss the tamponade effect in the pelvic cavity and will progress to exsanguinous bleeding, so negative abdominal exploration should be avoided. 
 
Objective : Aim of the study is to determine accuracy of FAST in the diagnosis of significant intraabdominal haemorrhage  and whether to do abdominal exploration in major pelvic fracture.
Method : Systematic review of the literature studies from PUBMED and SCOPUS databases during 2009 to 2019. Original published only human study were included. Two researcher independently performed extraction of the data and agreement of results using consensus. We also included the accuracy of FAST from retrospective review of the patients who admitted in Acute Care Surgery service at Ramathibodi Hospital from 2016 to 2019. The meta-analysis was done for sensitivity and specificity combining with our institution data using the random effect model. We attempted to identify significant factor associated accuracy of FAST using meta-regression. We consider the definition of significant intraabdominal haemorrhage is haemorrhage that mandate abdominal exploration.
Results : We concluded a total of 6 retrospective studies with 677 patients. A mean patients age is 40.8 year-old. Mechanism of injury is motor vehicle commission(MVC) 39.44%, fall from height 9.45%, motorcycle collisions(MCC) 5.91%, bicycle accident 3.69%, pedestrain injury 3.69%, and body assault 0.3%. Average ISS score is 32.5(24.1-50). Overall mortality rate is 5.32%. The pooled sensitivity and specificity of FAST is 81% and 89%, repectively. The accuracy of FAST that has significant intraabdominal haemorrhage is 92% (95% CI 89%,94%). Meta-regression did not show significant effect of injury severity score(ISS) on accuracy of FAST.
 
Conclusion : Our meta-analysis reveals that FAST in major pelvic fracture is accurate to detect significant intraabdominal hemorrhage (hemorrhage needs surgical control). And, when used in conjunction with the presence of unstable hemodynamics, we can make a decision to perform abdominal exploration with expectation to find significant intraabdominal organ injury.
 

 

RADHAKRISHNAN JAYAKRISHNAN

Cecilia Makiwane Hospital, Eastern Cape in South Africa

Title: Trauma Care
Speaker
Biography:

Dr Radhakrishnan Jayakrishnan is a Surgeon at Cecilia Makiwane Hospital.

Abstract:

Background: Globally, 8.5% of global deaths are as a result of trauma and injuries while 90% of these deaths occur in the low and middle-income countries. South Africa records six times the global injury-related mortality rates while road traffic-related injuries in South Africa is double the global average. Often times, there is an under-reporting of the burden of trauma and injuries in many resource-limited settings and this serves as a barrier to development of an effective trauma care system. This study sought to describe the profile of trauma cases seen at the emergency department of a provincial hospital in the Eastern Cape Province of South Africa.

Results: Almost all (98.0%) the trauma patients were males. Most (98.25) of the trauma cases were intentional injuries (assault), which were majorly penetrative (92.7%) in nature, with all resulting from stabbing. Also, 82.8% of the patients were admitted between Fridays and Sundays with over half (51.0%) arriving overnight (7pm to 7am). Over half (59.0%) of the injuries took place on the streets while 23.0% of them took place at the taverns. On examination, 47.2% developed haemopneumothorax while 33.0% developed pneumothorax. Almost all (99.1%) the patients were admitted and the mean duration of admission was 3 days. On the average, most patients report at the health facility within 20 hours of incidence.

Conclusion: There is a high rate of intentional injuries in the study setting, particularly among the males. Over half of the patients presented on weekends and at night times when there are limited personnel. There is a need for a more stringent measures of security to prevent intentional injuries and its related healthcare burden in the setting.