Missed injuries in pre-hospital trauma patients.

BACKGROUND: During primary survey of trauma patients, missed injuries and delayed diagnosis can be a potential source of morbidity and mortality. OBJECTIVE: To assess type and frequency of missed injuries in prehospital care in trauma patients and to analyze their contributing factors and implications. METHODS:   It is a descriptive and analytic prospective study. It was performed over six months which had included 200 trauma patients. The initial assessment made by the out-of hospital team of Sousse was compared to the second survey made in the emergency room and intensive care unit after the radiological assessment. RESULTS: Sixty seven (67) missed injuries were discovered in 51 patients, so 25.5% missed injuries incidence. These injuries were avoidable in 35.82% of cases. Twenty (20) injuries (29.85%) had clinically significant outcomes. Injuries are missed in the abdomen in 62.5% of cases, in the pelvis in 61.11% of cases, in the chest in 41.66% of cases, in the spine in 38.06 % of cases and in 20% of cases in the limbs. Multiple contributing factors were assigned, the most important were: the hemodynamic instability (Systolic blood pressure less than 90 mmHg), the tachycardia and the low RTS. Altered level of consciousness (GCS of twelve or lower), multiple and violence of the trauma were observed but not retained as predictive factors of missing injuries. CONCLUSION:   Our study showed higher rates of severe missed injuries mainly in abdomen and pelvis. Circulatory instability and low RTS were assigned as significant factors predicting of this obviousness. Various solutions are proposed to prevent missed during the first assessment in prehospital care.

A Qualitative Study on the Use of the Hospital Safety Index and the Formulation of Recommendations for Future Adaptations.

The Hospital Safety Index is a tool developed by the World Health Organization and the Pan American Health Organization in 2008 and updated in 2015. Although it is the most widely used instrument of its kind to assess the level of hospital preparedness, scientific literature on its application in real life is scarce. This study aimed to investigate the use of the Hospital Safety Index to assess disaster preparedness in healthcare facilities. A retrospective, qualitative study employing semi-structured online interviews was conducted to gather the opinions and perspectives of professionals who have experience in applying the Hospital Safety Index. Authors of scientific publications using the Hospital Safety Index were recruited. A semi-structured interview guide was developed. It addressed different phases of data collection with the Hospital Safety Index, the challenges and facilitators of using it, and recommendations for future adaptations. Data were analysed using inductive thematic analysis. Nine participants who were from three countries (Serbia, Sri Lanka, and Indonesia) and had different professional backgrounds (medical doctors, engineers, spatial planners, etc.) participated in this study. A total of 5 themes and 15 subthemes emerged during data analysis. Most of the participants reported their reasons for choosing the Hospital Safety Index as being its comprehensiveness and the fact that it was issued by the World Health Organization. The tool appears to be very specific and allows investigators to spot details in hospitals; however, it is not easy to use, and training is highly encouraged to learn how to navigate the different components of the tool. Governmental support is a crucial facilitator for investigators to be able to enter hospitals and conduct their evaluations. Overall, the tool has a lot of potential, and it should be used to reach a broader audience, such as community members, and assess the preparedness of other facilities that can take part in the response to disasters (hotels, stadiums, schools, etc.). Nevertheless, it still needs more adaptations to be tailored to different contexts and settings.

Evaluating the level of disaster preparedness of Tunisian University Hospitals using the Hospital Safety Index: a nationwide cross-sectional study.

Background: Mid-way through the 'Sendai Framework for Disaster Risk Reduction 2015-2030', many nations are spending time, money and effort to enhance their level of preparedness facing disasters, on the other hand communities, countries and even continents are being left behind. Objectives: This study was conducted aiming at evaluating the level of disaster preparedness and response of Tunisian University Hospitals. Methods: This is a cross-sectional nationwide study conducted in Tunisia, from November 2020 to April 2021. Including 9 Tunisian University Hospitals and using the Hospital Safety Index. The data were analysed using the 'Module and safety index calculator'. Results: This study showed that 7 out of the 9 University Hospitals were assigned the 'B' category of safety with overall safety indexes that ranges between 0.37 and 0.62. Also, 4 out of 9 University Hospitals had safety scores less than 0.20 regarding their emergency and disaster management. Conclusions: This is the first study to evaluate disaster preparedness and response of university hospitals in Tunisia and in north Africa. It showed that the lack of knowledge, resources and willingness, are the most important issues that needs to be addressed in order to enhance the preparedness of Tunisian hospitals.

Acute methanol poisoning in Tunisia: clinical features, biological and associated factors for mortality.

BACKGROUND: Acute Methanol Poisoning (MP) is rare but potentially serious. OBJECTIVES: To study the clinical and biological characteristics of acute MP and its associated factors of mortality. METHODS: We conducted a cross-sectional study including case series of MP which took place in Kairouan, Tunisia. Cases started consulting the emergency room on a festive day (1st day of Eid al- Fitr) corresponding to May 24, 2020. RESULTS: We included 65 male victims of MP. The median [interquartile] age was 28.0 [21.0 - 35.0] years with extremes ranging from 17 to 75 years. The median [interquartile] time between the ingestion of methanol and the medical consultation was 48.0 [24.0 - 50.0] hours. On admission, the majority of patients described neurological (98.4%) and gastrointestinal symptoms (51.4%). Four patients remained visually impaired and 8 patients (12.3%) had died. The univariate analysis reported an association between mortality and age, amount of methanol ingested, co-ingestion of cannabis, delay to consultation, neurological distress, seizures, lower systolic and diastolic blood pressure, metabolic acidosis, lower levels of potassium, higher levels of sodium, hematocrit, glycemia, creatinine, anion gap, and high Acute Physiology and Chronic Health Evaluation II score. CONCLUSION: Mortality rate following MP was high and was associated with several factors.

Magnesium Sulfate as Adjuvant in Prehospital Femoral Nerve Block for a Patient with Diaphysial Femoral Fracture: A Randomized Controlled Trial.

Introduction: Prehospital management of traumatic pain is commonly based on morphine while locoregional analgesia techniques, especially the femoral nerve block (FNB), can be safely and efficiently used. Adjuvants uses can reduce local anesthetic doses and decrease their related risk. The aim of the study was to assess the analgesic effect of magnesium sulfate when used as an adjuvant in prehospital FNB. Methods: This is a randomized double-blinded trial conducted in a prehospital medical department of an academic hospital. Patients with isolated diaphysial femoral fracture and eligible to participate were randomized into 2 groups. Group C had a FNB with 15 ml of lidocaine with epinephrine (300 mg) and 3 ml of normal saline solution. Group I had a FNB with 15 ml of lidocaine with epinephrine (300 mg) and 3 ml of MgS 15% (450 mg). The FNB was performed according to the WINNIE technique. Primary endpoints were morphine consumption and pain intensity during the first 6 hours. Secondary endpoints were the duration of the sensory block, time to the first analgesic request, and side effects occurrence. Results: Twenty-four patients were enrolled in each group. Both groups were comparable according to demographic characteristics, initial pain scores, and vital constants. In group I, morphine requirements were significantly lower (2 ± 2 mg versus 5 ± 3 mg, p < 10-3), analgesic onset was significantly faster, and the average time to the first analgesic request was longer (276 ± 139 min versus 160 ± 79 min, p < 10-3). The average duration of sensory block was longer in group I (226 ± 64 min versus 116 ± 70 min p < 10-3). No side effects were recorded. Conclusion: Magnesium sulfate should be considered as an efficient and safe adjuvant to lidocaine in prehospital FNB. This trial is registered with (NCT03597945).

Management of Kounis syndrome: two case reports.

BACKGROUND: Kounis syndrome corresponds to the occurrence of myocardial injury following an allergic insult. This syndrome is infrequent, and is not well known. In consequence, it is usually misdiagnosed leading to inappropriate treatment. The current literature is limited to case studies and there are no international recommendations concerning this topic. CASE PRESENTATION: We discussed, through two case reports, the clinical presentation and the management of a 60-year-old North African man and a 45-year-old North African man presenting with chest pain suggesting acute coronary syndrome following anaphylactic reaction. Triggering factors were a drug in the first case and herbal dermal exposure in the second. A clinical examination and electrocardiogram revealed anaphylactic reaction associated with myocardial infarction. Appropriate management of these two life-threatening conditions allowed an improvement in our patients' condition and their transfer to specialized units. CONCLUSIONS: Although Kounis syndrome is a rare phenomenon, physicians should be aware of its physiopathological mechanisms in order to treat it appropriately. The difficulty lies in the fact that the treatment of either of the two associated entities may worsen the other injury.