A pregnant woman with long-standing, retained intraabdominal glass shards who gave birth to a live infant with no complications: a case report.

BACKGROUND: Most cases of traumatic injury during pregnancy involve blunt trauma, with penetrating trauma being uncommonly rare. In glass shard injuries, fragments often penetrate deeply, and multiple injuries may occur simultaneously; attention must be paid to the possibility of organ injury from the residual fragments. However, no case of this occurring during pregnancy has been reported yet. CASE PRESENTATION: We present the case of a 34-year-old pregnant Cameroonian woman who retained intraabdominal glass shards following a penetrating injury at 13 weeks gestation and not diagnosed until 22 weeks gestation. Notably, this patient continued the pregnancy without complications and gave birth via cesarean section at 36 weeks gestation. CONCLUSION: In pregnant women sustaining a penetrating glass trauma during pregnancy, careful attention should be paid to the fragments; in that case, computed tomography is a useful modality for accurately visualizing any remaining fragments in the body. Essentially, the foreign bodies in glass shard injuries during pregnancy should be removed immediately, but conservative management for term delivery is an important choice for patients at risk for preterm delivery.

El verdadero origen histórico del trauma cardíaco penetrante / The true historical origin of penetrating cardiac trauma

Introducción. Los traumatismos cardíacos son lesiones graves y con elevado índice de letalidad, aspecto que influye en el interés mostrado por los lectores cada vez que aparecen reportados en publicaciones científicas. En ocasiones existe cierto grado de incongruencia a la hora de establecer el origen histórico de sucesos o eventos ocurridos y relacionados con la historia de la medicina. En el caso del trauma cardíaco penetrante han sido descritos diversos orígenes en algunos de los artículos científicos publicados, lo cual puede generar un grado de duda en los lectores. Métodos. Se realizó una revisión de la literatura, médica y no médica, para buscar información que ayudara a esclarecer el verdadero origen histórico de esta entidad. Resultados. El trauma cardíaco penetrante fue descrito por primera vez en la obra griega titulada La Ilíada, escrita por Homero en el siglo VIII A.C., y no en El papiro quirúrgico de Edwin Smith, como varios autores mencionan. Conclusiones. De todos los eventos de trauma cardíaco penetrante descritos, el más irrefutable es el narrado en el canto XIII, donde se cuenta la muerte de Alcátoo, producto de una herida cardíaca ocasionada por una lanza arrojada por Idomeneo durante una batalla

Introduction. Cardiac traumatic injuries are serious injuries with a high lethality rate, an aspect that influences the interest shown by readers each time they appear reported in scientific publications. Sometimes there is a certain degree of inconsistency when it comes to establishing the historical origin of occurrences or events related to the history of medicine. In the case of penetrating cardiac trauma, different origins have been described in some of the published scientific articles, which may generate a degree of doubt in the readers. Methods. A review of the medical and non-medical literature was carried out to seek information that would help to clarify the true historical origin of this entity. Results. Penetrating cardiac trauma was first described in a Greek work entitled The Iliad, written by Homer in the 8th century B.C., and not in The Surgical Papyrus of Edwin Smith as several authors mention. Conclusions. Of all the events of penetrating cardiac trauma described, the most irrefutable is the one narrated in canto XIII, where it recounts the death of Alcathous product of a cardiac wound caused by a spear thrown by Idomeneo during a battle.

Lesión cardíaca por arma blanca inadvertida durante la evaluación inicial en el servicio de emergencia / Missed cardiac stab injury during initial evaluation in the Emergency Department

Introducción. La incidencia reportada de traumatismo cardíaco es baja y su grado de resolución es variable, dependiendo de la causa, el mecanismo de la lesión, el lugar donde ocurra y las características del sistema sanitario. Su incidencia ha aumentado recientemente debido al incremento de los accidentes de tránsito y la violencia, predominando los traumatismos penetrantes asociados a heridas por armas cortopunzantes y de fuego. Los traumatismos cardíacos se acompañan de un alto grado de letalidad. Caso clínico. Mujer de 35 años que consultó a emergencia por trauma torácico penetrante ocasionado por arma blanca y fue intervenida de urgencia por derrame pleural izquierdo, sin mejoría hemodinámica. Fue reevaluada detectándose derrame pericárdico con taponamiento cardíaco, ocasionado por lesión cardíaca. Fue tratada quirúrgicamente con resultados satisfactorios. Resultados. Las manifestaciones clínicas en los traumatismos penetrantes generalmente son graves y fatales, pero en algunos casos puede no comprometer tanto la hemodinamia del paciente. Para consolidar el diagnóstico clínico pueden realizarse variados estudios, siendo la ecografía FAST extendida uno de los más recomendados por su elevada sensibilidad y especificidad. Dependiendo del adelanto tecnológico del centro hospitalario y la estabilidad hemodinámica del paciente, el tratamiento quirúrgico es el más indicado. Conclusión. El conocimiento del trauma cardíaco penetrante resulta de gran importancia, no solo para el médico del servicio de emergencia sino también para el médico general. Un diagnóstico rápido y acertado, unido a un manejo adecuado, pueden ser decisivos para salvar la vida del paciente.

Introduction. The reported incidence of cardiac trauma is low and its degree of resolution is variable depending on the cause, the mechanism of injury, the place where it occurs and the characteristics of the health care system. Their incidence has currently increased due to the increase in traffic accidents and violence, with a predominance of penetrating trauma associated with stab wounds and firearms. Cardiac trauma is accompanied by a high degree of lethality. Clinical case. A 35-year-old female patient, evaluated in the emergency room for penetrating thoracic trauma caused by stab wound. She underwent emergency intervention due to left pleural effusion, but without hemodynamic improvement. She was reevaluated and pericardial effusion with cardiac tamponade caused by cardiac injury was detected. She was treated surgically with satisfactory results. Results.The clinical manifestations generally described in penetrating cardiac trauma are severe and fatal, but in some cases and due to the characteristics of the injury caused, the patient's hemodynamics may not be so compromised. To consolidate the clinical diagnosis, several complementary studies can be performed, with FAST ultrasound being one of the most recommended due to its high sensitivity and specificity. Surgical treatment is still the most indicated, depending on the technological progress of the hospital and the hemodynamic stability of the patient. Conclusions.Knowledge of penetrating cardiac trauma is of great importance, not only for the emergency department physician but also for the general practitioner. A quick and accurate diagnosis, together with adequate management can be decisive in saving the patient's life.

Clinical Experience of Surgical Treatment for Penetrating Pulmonary Gunshot Wound of a Civilian in Korea: A Case Report.

Gunshot-induced chest trauma is exceedingly rare among civilians in South Korea due to strong firearm control policies. In contrast to military reports emphasizing the use of emergent open thoracotomy to increase chances of survival, most penetrating non-cardiac injuries in civilian settings are managed conservatively, such as through chest tube insertion, as they typically result from lower-energy bullets. However, early surgical intervention for penetrating gunshot wounds can help reduce delayed fatalities caused by septic complications from pneumonia or empyema. The advent of minimally invasive thoracic surgery has provided cost-effective and relatively non-invasive treatment options, aided in the prevention of potential complications from undrained hematomas, and facilitated functional recovery and reintegration into society. We successfully treated a patient with a penetrating gunshot wound to the chest using video-assisted thoracoscopic surgery.

A Knife Penetrating the Right Ventricle, Interventricular Septum, and 2 Valves: A Case Report.

Penetrating chest trauma may result in significant intracardiac injury. A traumatic ventricular septal defect is a rare complication that requires surgical management, particularly if heart failure ensues. We report a case of delayed repair of an outlet-type ventricular septal defect and perforation of the aortic and pulmonary valve leaflets following a stab wound. This report highlights diagnostic and surgical considerations and also presents an opportunity to review the conotruncal anatomy, which may be relatively unfamiliar to many adult cardiac surgeons.

Trauma abdominal en pacientes del Hospital Universitario General Calixto García

Introducción: El trauma abdominal se considera un problema de salud significativo, debido a que su cinemática ocasiona lesiones tanto anatómicas como funcionales de los órganos del abdomen. Objetivo: Caracterizar el trauma abdominal en un grupo de pacientes lesionados del Hospital Universitario General Calixto García. Métodos: Se realizó un estudio observacional, descriptivo, prospectivo, de corte transversal en los pacientes con trauma abdominal atendidos en el Servicio de Cirugía General desde enero de 2017 hasta diciembre de 2019. La muestra fue de 879 pacientes. Resultados: Existió un mayor número de pacientes con trauma abdominal en el grupo etario de 19-29 años, con una prevalencia del sexo masculino. Predominaron los accidentes de tránsito como la principal causa de trauma abdominal con el 52 %. Prevalecieron las lesiones sobre órganos macizos, con mayor frecuencia en el hígado con un 33 %. El tratamiento que con mayor asiduidad se empleó fue el quirúrgico, lo que representa el 83 % con respecto al manejo conservador. Conclusiones: Por su ubicación y funcionalidad, las lesiones asociadas a trauma abdominal se convierten en un factor que representa gran riesgo para la vida del paciente. Los accidentes de tránsito continúan estando dentro de las primeras causas de trauma abdominal. Aunque la conducta conservadora ha ganado adeptos, existe un predominio en el tratamiento quirúrgico apoyado fundamentalmente en la sintomatología de los pacientes y en los medios diagnósticos.

Introduction: Abdominal trauma is considered a significant health problem due to the fact that its kinematics causes both anatomical and functional injuries to the abdominal organs. Objective: To characterize abdominal trauma in a group of injured patients from Hospital Universitario General Calixto García. Methods: An observational, descriptive, prospective and cross-sectional study was conducted in patients with abdominal trauma attended at the general surgery service from January 2017 to December 2019. The sample was 879 patients. Results: There was a higher number of patients with abdominal trauma within the age group 19-29 years, with a prevalence of the male sex. Road traffic accidents predominated as the main cause of abdominal trauma, accounting for 52 %. Injuries to solid organs prevailed, most frequently to the liver, accounting for 33 %. The most frequently used treatment was surgical, which represents 83 % with reference to conservative management. Conclusions: Due to their location and functionality, injuries associated with abdominal trauma become a factor that represents a great risk for the patient's life. Road traffic accidents continue to be among the first causes of abdominal trauma. Although the conservative approach has gained followers, there is a predominance of surgical treatment supported mainly by the patients' symptomatology and diagnostic means.

Lesiones mortales por armas traumáticas: reporte de caso / Fatal injuries due to traumatic weapons: Case report

Introducción. Las armas de energía cinética son diseñadas para generar lesiones dolorosas y superficiales. Sin embargo, las lesiones asociadas causan confusión al ser abordadas como heridas por proyectil de arma de fuego, convirtiendo el enfoque y el manejo correcto en un desafío. El caso presentado describe un paciente herido en el cuello por arma traumática con el objetivo de analizar factores que permitan identificar este tipo de heridas y sus implicaciones en el manejo. Caso clínico. Paciente masculino de 31 años que ingresó con intubación orotraqueal, remitido de una institución de nivel 2, con herida por aparente proyectil de arma de fuego con trayectoria transcervical. Se encontró hemodinámicamente estable, pero con dificultad para la valoración clínica, por lo que se realizaron exámenes complementarios que descartaron lesión aerodigestiva. La tomografía de cuello reportó proyectil alojado en musculatura paravertebral izquierda, descartando trayectoria transcervical. Discusión. El comportamiento de las lesiones asociadas a los proyectiles de armas depende de varios factores, como el tipo de material del proyectil, su velocidad y las propiedades del tejido impactado. Se presentó un caso en que inicialmente se sospechaba una lesión transcervical, pero con la evaluación se identificó el proyectil cinético en la musculatura paravertebral. Conclusión. En el abordaje de un paciente con sospecha de herida por proyectil de arma de fuego se debe considerar ante todo la respuesta clínica y la correlación del supuesto vector del proyectil con las lesiones sospechadas. La evaluación imagenológica permite identificar oportunamente los proyectiles y evitar procedimientos o terapias innecesarias que forman parte del manejo convencional del paciente con trauma penetrante

Introduction. Kinetic energy weapons are designed to produce superficial and painful injuries. Nevertheless, the approach of these patients in the emergency department can be confusing as they can be managed as gunshot wounds. This case describes a patient with an injury in the neck caused by kinetic energy gun. In addition, we analyzed factors that might identify these wounds and their implications in the management. Clinical case. A 31-year-old male patient who presented to the emergency department referred from a second level hospital with gunshot wound with suspected trans-cervical trajectory. They performed orotracheal intubation and transferred to our institution. Due to the patient ́s hemodynamic stability and impossibility for clinical evaluation, test and radiology tests were performed. These ruled out any aero-digestive injuries. The CT-scan reported a bullet hosted in the left paravertebral muscles, ruling out a trans-cervical trajectory. Discussion. Several factors contribute to the injuries produced by kinetic energy weapons. The injury patterns may vary according to the bullet material, muzzle velocity and impacted tissue characteristics. In this case, an initial trans-cervical injury was suspected and due to clinical evaluation we identified the bullet hosted in the paravertebral muscles. Conclusion. In the approach of a patient with suspicion of gunshot wound, as surgical team we must consider clinical manifestations and the correlation of the vector with suspected injuries. Evaluation of diagnostic imaging allows the identification of traumatic bullets, avoiding unnecessary procedures in the conventional management of patients with penetrating trauma

Predictive factors for nephrectomy in renal trauma; assessment of a 6-point score.

PURPOSE: To evaluate predictive and associated risk factors for nephrectomy in renal trauma and assess a 6-point score for surgical decision-making. PATIENTS AND METHODS: This multicenter, retrospective, and observational study assessed 247 subjects with blunt or penetrating kidney trauma. Kidney injuries were classified according to the American Association for the Surgery of Trauma (AAST) Injury Scoring Scale. Renal trauma was classified as "low-grade" (Grades I-III), Grade IV, and Grade V. Subjects were compared according to conservative treatment (CTrt.) or nephrectomy. Predictive factors were evaluated with a multiple regression model. A 6-point score was evaluated with a ROC analysis. RESULTS: Patients requiring nephrectomy had a lower mean arterial pressure MAP compared to CTrt, 64.71 mmHg (SD ± 10.26) and 73.86 (SD ± 12.42), respectively (p = < 0.001). A response to IV solutions was observed in 90.2% of patients undergoing CTrt. (p = < 0.001, OR = 0.211, 95%CI = 0.101-0.442). Blood lactate ≥ 4 mmol/L was associated with nephrectomy (p = < 0.001). A hematoma ≥ 25 mm was observed in 41.5% of patients undergoing nephrectomy compared to 20.1% of CTrt. (p = 0.004, OR = 9.29, 95% CI = 1.37-5.58). A logistic regression analysis (p = < 0.001) showed that blood lactate ≥ 4 mmol/L (p = 0.043), an inadequate response to IV solutions (p = 0.041) and renal trauma grade IV-V (p = < 0.001), predicted nephrectomy. A 6-point score with a cut-off value ≥ 3 points showed 83% sensitivity and 87% specificity for nephrectomy with an AUC of 89.9% (p = < 0.001). CONCLUSIONS: An inadequate response to IV solutions, a lactate level ≥ 4 mmol/L, and grade IV-V renal trauma predict nephrectomy. A score ≥ 3 points showed a good performance in this population.

[Management of blunt and penetrating laryngeal trauma]. / Management von stumpfen und scharfen Kehlkopfverletzungen.

Patients presenting with laryngotracheal trauma can be in a life-threatening situation. Early recognition of the severity of the injury and, if necessary, surgical intervention within the first 24-48 h increases the chance of achieving a good functional late result. Preservation or restoration of voice and swallowing function is the long-term therapeutic goal. Precise assessment of the extent of the injury can be achieved using a combination of computed tomography and flexible laryngotracheoscopy. Symptoms often do not reflect the extent of the injury, which can vary from endolaryngeal hemorrhage to complete laryngotracheal separation. Conservative treatment consists of observation with symptomatic therapy. On the other hand, surgery may include endolaryngeal repair and/or transcervical reconstruction; securing the airways is of utmost importance.

Management of Laryngotracheal Trauma During the COVID 19 Pandemic: Our Experience.

Objective To study the outcomes in terms of airway, voice and swallowing as well as the economic impact of the trauma on patients' finances and the constrained health infrastructure due to the pandemic. Materials and methods Study design Retrospective study. Setting: Tertiary care teaching hospital. Subjects and methods: A retrospective study was done of the 19 subjects who sustained acute laryngotracheal trauma during the SARS CoV-2 pandemic and was managed at our institution from January 2020 to September 2021. Results Change in voice was the most common presenting symptom and thyroid cartilage fractures were the commonest cartilage injury noted. It was found that 93% (decannulated) of the patients had good functional outcome and 90% of them required financial support to meet the medical expenses. Conclusion During the COVID 19 pandemic, it was not only, early presentation, timely detection and intervention by the treating team, but also the multidisciplinary teamwork and the support system that facilitated the recuperation and restoration of these traumatized individuals back into society with good laryngeal function.

Management of penetrating chest trauma in the context of major trauma networks.

Major trauma networks reduce mortality in critically injured patients. Trauma patients should be appropriately triaged straight from the scene of injury, avoiding secondary transfer from a trauma unit. Selection criteria in regionally agreed triage tools are designed to identify which patients should be taken directly to the major trauma centre. Patients with life-threatening injuries still arrive at 'trauma units' in circumstances such as self-presentation, under triage, physiological instability or long journey time to the major trauma centre. This article presents a theoretical case of a haemodynamically unstable patient with penetrating injuries, and discusses the management of chest trauma, including diagnosis of life-threatening injuries, resuscitation strategies and definitive surgical management. Secondary transfer to the major trauma centre should be considered after instituting the minimal life-saving interventions. What constitutes a life-saving intervention requires an individual dynamic risk assessment and an understanding of major trauma networks.

[Update on neck trauma]. / Update Halstraumata.

BACKGROUND: Important organs and structures are located in the cervical region. In case of blunt and penetrating trauma, emergency situations may arise. OBJECTIVE: Emergency management as well as diagnostic and therapeutic steps pertaining to neck injuries are presented. CONCLUSION: Shock therapy and airway management are essential, fast management of neck injuries highly relevant.

Quemadura química por sanguinaria canadensis / Chemical burn by Sanguinaria canadensis

La Sanguinaria canadensis, o Bloodroot, es una planta originaria de Norteamérica que contiene sustancias alcaloides y es ampliamente empleada en el tratamiento de lesiones y tumores de la piel en animales. Sin embargo, en los últimos años ha aumentado su uso en humanos como terapia alternativa en el tratamiento de lesiones precancerosas y cáncer de piel. Su uso inadecuado en humanos puede causar lesiones graves y profundas en la piel.Presentamos el caso de un paciente joven que por voluntad propia se aplicó un preparado de Sanguinaria canadensis (Bloodroot paste®) para eliminar dos nevus cutáneos, produciéndole lesiones extensas que requirieron tratamiento y curas hasta su cierre por segunda intención, dejando cicatrices hipertróficas como secuela.(AU)

Sanguinaria canadensis, or Bloodroot, is a plant native to North America, which contains alkaloid substances. It is widely used in the treatment of skin lesions and tumours in animals. However, over the past few years its use in humans has increased as an alternative therapy treatment for precancerous lesions and skin cancer. Its inappropriate use in humans can cause severe and deep skin wounds.We report the case of a young patient who willingly applied an extract of Sanguinaria canadensis (‘Bloodroot paste’) to remove two cutaneous nevi. This led to extensive wounds that required treatment and cures until they closed by second intention healing. Hypertrophic scars were left as sequelae.(AU)

Heridas por asta de toro, análisis de 138 casos.

OBJECTIVE: Bull-horn injuries (BHI) are unique and there is reduced published literature about it. We present an analysis of a 11-year BHI case series. METHOD: Study of 138 cases developed during a 11-year period with hospitalization admission greater than 24 hours with diagnosis of BHI/contusion. We classified patients in two groups: group A, patients undergoing procedures under general anaesthesia and group B undergoing procedures under local anaesthesia. Variables: age, sex, date, hospitalization length, main region affected, Comprehensive complication index (CCI, ISS, intensive care unit (ICU) admission, stay and mortality. Statistical analysis: t-Student test, ANOVA, χ2 and linear or logistic regression. RESULTS AND CONCLUSIONS: ISS was related to hospital stay, CCI, ICU admission and type of treatment applied. The comparative statistical analysis of variables between both groups determined a significant difference in age, ISS and hospitalization length, being greater in those belonging to group A. There is a more risk of undergoing surgery by increasing age, ISS and presenting the wounds in thorax-abdomen-pelvis area. CCI may be a good method of quantifying postoperatory morbidity in polytraumatized patients or in other areas besides the abdomen.

OBJETIVO: Las heridas por asta de toro (HAT) poseen características únicas y existe literatura escasa en esta área. Presentamos un análisis de 11 años de pacientes con HAT. MÉTODO: Estudio retrospectivo y analítico de 138 casos durante un periodo de 11 años, de pacientes ingresados durante más de 24 horas por HAT. Clasificamos a los pacientes en dos grupos: grupo A, sometidos a procedimientos bajo anestesia general, y grupo B, sometidos a procedimientos bajo anestesia local. Variables recogidas: edad, sexo, mes del suceso, hospitalización (días), región afectada, Comprehensive Complication Index (CCI), Injury Severity Score (ISS), ingreso y estancia en la unidad de cuidados intensivos (UCI) y mortalidad. Análisis estadístico: t de Student, ANOVA, χ2, regresión lineal y logística. RESULTADOS Y CONCLUSIONES: El ISS se relaciona directamente con la estancia hospitalaria, el CCI, el ingreso en UCI y el tratamiento recibido. Entre ambos grupos se evidenció una diferencia significativa en edad, ISS y estancia hospitalaria, siendo mayores en el grupo A. Existe un mayor riesgo de necesitar cirugía conforme aumentan la edad, el ISS y las heridas en tórax, abdomen o pelvis. El CCI puede ser un buen método para cuantificar la morbilidad posoperatoria en pacientes politraumatizados o con lesiones en otras áreas distintas del abdomen.

Concurrent hollow and visceral organs traumatic injury secondary to metal shrapnel penetration in a male with situs inversus totalis: A case report.

Situs inversus totalis (SIT) develops as a result of the embryological developmental anomaly. Managing this condition surgically is challenging as the anatomy will be mirror-imaged. A 42-year-old male had metal shrapnel broken loose from a hammer-head metal piece and pierced into his upper abdomen. A computed tomography scan of the abdomen revealed SIT with evidence of solid foreign body artefacts which were seen piercing through segment VIII of the liver and the anterior gastric wall. Exploratory laparotomy revealed a moderate amount of haemoperitoneum and a single perforation at the upper body of the stomach that was confirmed by on-table-endoscopy. The perforation was repaired with a modified Graham patch and the liver injury had stopped bleeding intraoperatively. The challenges arose during laparotomy assessment and endoscopic assessment due to inversed anatomy.

A Rare Case of Bacillus cereus Septic Arthritis.

Joint infections are rare in pediatrics, and those caused by Bacillus cereus are practically unheard of. In this case report, we examine a singular case of B. cereus septic arthritis in a child, with the purpose of educating clinicians on the presentation, inpatient and outpatient management, and clinical outcome. We report the case of a previously healthy pediatric patient who presented to the emergency department with symptoms of septic arthritis of the left knee. The orthopedics team performed arthroscopy and debridement, and the synovial fluid culture grew B. cereus. To our knowledge, this is the first case report on septic arthritis caused by B. cereus in the pediatric population. The treatment protocol consisted of intravenous vancomycin for one week, followed by three weeks of oral ciprofloxacin therapy. The patient had an excellent clinical outcome and returned to normal mobility without limitations. Despite being ubiquitous in the environment, extra-intestinal B. cereus infection is exceedingly rare in immunocompetent individuals. It is so rare, in fact, that it is often dismissed as a lab contaminant. In this case, we demonstrated that cooperation between multiple disciplines offers good clinical outcomes for rare infections, especially those in pediatrics.

Efficacy of topical honey compared to systemic gentamicin for treatment of infected war wounds in a porcine model: A non-inferiority experimental pilot study.

BACKGROUND: In armed conflicts, infected wounds constitute a large portion of the surgical workload. Treatment consists of debridements, change of dressings, and antibiotics. Many surgeons advocate for the use of honey as an adjunct with the rationale that honey has bactericidal and hyperosmotic properties. However, according to a Cochrane review from 2015 there is insufficient data to draw any conclusions regarding the efficacy of honey in treatment of wounds. We, therefore, decided to evaluate if honey is non-inferior to gentamicin in the treatment of infected wounds in a highly translatable porcine wound model. MATERIAL AND METHODS: 50 standardized wounds on two pigs were infected with S. aureus and separately treated with either topically applied Manuka honey or intramuscular gentamicin for eight days. Treatment efficacy was evaluated with quantitative cultures, wound area measurements, histological, immunohistochemical assays, and inflammatory response. RESULTS: Topically applied Manuka honey did not reduce bacterial count or wound area for the duration of treatment. Intramuscular gentamicin initially reduced bacterial count (geometric mean 5.59*¸0.37 - 4.27*¸0.80 log10 (GSD) CFU/g), but this was not sustained for the duration of the treatment. However, wound area was significantly reduced with intramuscular gentamicin at the end of treatment (mean 112.8 ± 30.0-67.7 ± 13.2 (SD) mm2). ANOVA-analysis demonstrated no variation in bacterial count for the two treatments but significant variation in wound area (p<0.0001). The inflammatory response was more persistent in the pig with wounds treated with topically applied Manuka honey than in the pig treated with intramuscular gentamicin. CONCLUSION: At the end of treatment S. aureus count was the same with topically applied Manuka honey and intramuscular gentamicin. The wound area was unchanged with topically applied Manuka honey and decreased with intramuscular gentamicin. Topically applied Manuka honey could consequently be non-inferior to intramuscular gentamicin in reducing S. aureus colonization on the wound's surface, but not in reducing wound size. The use of Manuka honey dressings to prevent further progression of a wound infection may therefore be of value in armed conflicts, where definite care is not immediately available.

Norwegian Emergency Medicine Systems' Training and Equipment for Penetrating Injuries: A National Survey-Based Study.

OBJECTIVE: Recent terror attacks led the Norwegian government to develop a procedure for emergency and law enforcement services cooperation during Active Violent Incidents (AVI, abbreviated PLIVO in Norwegian). To address further national initiatives to improve preparedness for mass casualty events and penetrating injuries among emergency medical services (EMS) in Norway, training and equipment status were mapped. METHODS: All EMS regions in Norway were invited to participate in an electronic nation-wide survey about practical medical training in PLIVO scenario training and specific training in hemorrhage control and penetrating injuries. RESULTS: Ninety percent (842/938) had attended at least 1 PLIVO training scenario. Of these, 76% (642/938) reported only evacuation training during the exercise, while only 20% (168/938) had practiced hemorrhage control. Eighty-one percent (760/938) respondents reported that they were equipped with tourniquets and 91% (853/938) were equipped with gauze to pack wounds. However, only 52% (487/938) and 48% (450/938) reported practical training in tourniquet application and wound packing, respectively, while 30% (280/938) reported that they had no training or only theoretical education in tourniquet application. Supervised practical training on penetrating thoracic injuries was reported by <20%, and <50% reported practical training in needle decompression of a tension pneumothorax. CONCLUSIONS: Enhanced focus on training in hemorrhage control and penetrating injuries is needed. This supports the recent decision from the Norwegian government to strengthen the training for EMS in AVI (PLIVO) exercises, by focusing on medical procedures in addition to evacuation training. Although the estimated response rate is 17%, we believe the large number of respondents still make the results valuable.

Fractures of the penis.

A penile fracture is a traumatic rupture of the tunica albuginea of the corpora cavernosa in an erect penis, usually as a result of blunt trauma during sexual activity. The aetiology varies with geographical region, with the USA and Europe having a higher incidence of sexual trauma and the Middle East having a higher rate of self-manipulation. Diagnosis is usually clinical, but numerous imaging modalities have been used to confirm the fracture site and to help plan appropriate surgical management. Clinical examination will find a detumescent penis with a diffuse penile swelling and ecchymosis: the classic eggplant sign. The penis will often deviate away from the side of the injury. A history of the patient's inability to pass urine after the injury or of blood at the urethral meatus suggests an associated urethral injury. Immediate surgical management is the mainstay of treatment, with many surgeons favouring a degloving approach. Penile fractures also carry a risk of urethral tears and urethral repair may be necessary. This article describes the aetiology, presentation and management of penile fractures to enable identification and treatment in daily clinical practice.

Provider Fatigue During Direct Manual Compression for Life-Threatening Bleeding.

Introduction Trauma is a leading cause of death throughout the world, with hemorrhage being responsible for more than 35% of pre-hospital trauma deaths and more than 40% of deaths within the first 24 hours after injury. Despite first aid having a demonstrable effect on mortality from trauma, relatively little research has compared the best methods for bleeding control in the prehospital first aid setting. The most common first-line therapy for external bleeding control in the pre-hospital first aid setting is direct manual compression (DMC). However, a prior study demonstrated that the primary cause of failure in a simulated model of life-threatening bleeding was the inability to maintain adequate direct pressure for three minutes. In this study, we evaluated the effect of fatigue on DMC for the duration of a typical urban emergency medical services (EMS) response time. Methods We conducted a prospective observational trial of 33 participants, 18 years of age or older to measure the pressure generated on a model of life-threatening bleeding over an eight-minute period using a "CPR posture" for applying pressure. The primary analyses were longitudinal two-level multilevel models (MLM) with repeated measures of outcome (i.e., CPR posture pressure) nesting within participants. The demographic factors of gender, age, and weight were included as moderators in the analyses and each was analyzed independently. Results The participants' average age was 31 (SD = 11) and the average weight was 161 pounds (SD = 31). The sample consisted of 18 female participants (54.5%) and 15 male participants (45.5%). Applied DMC pressure declined over time, more sharply initially from the beginning to approximately 250 seconds, at which point the decrease in pressure was gradual. Of the demographic factors, gender was associated with a difference in cardiopulmonary resuscitation (CPR) posture pressure over time. Conclusion Rescuers should be aware that fatigue may occur and may affect the quality of direct manual compression for control of life-threatening bleeding. Further research is needed to define the external pressures needed to control life-threatening bleeding and the extent that rescuer fatigue affects this pressure.