Journal of Emergency Medicine, Trauma and Acute Care - Current Issue

Simultaneous fractures of the acetabular and subtrochanteric femur are relatively uncommon and present a complex clinical challenge. These fractures are often the result of high-energy trauma, such as automobile accidents or falls from a height. Managing both fractures simultaneously is challenging and requires a comprehensive surgical plan to optimize patient outcomes. We highlight the successful management of simultaneous acetabular and subtrochanteric femur fractures through a single surgical approach in a single sitting.

Introduction: Catamenial pneumothorax is a rare but potentially life-threatening condition that affects women of reproductive age. It is characterized by the recurrent occurrence of pneumothorax during or around the menstrual period. The pathophysiology of catamenial pneumothorax is not well understood, but is thought to be related to the presence of endometrial tissue in the pleural cavity.

Case Presentation: A 42-year-old woman was referred to our outpatient department for further thoracic surgical treatment. She already had two previous episodes of pneumothorax that occurred during her menstrual period. A chest X-ray revealed a right-sided pneumothorax and she was admitted to the hospital where a chest tube was placed to treat the pneumothorax. CT scan revealed the presence of endometrial tissue under the right diaphragm. The patient underwent a total laparoscopic hysterectomy to remove the source of endometrial tissue. The subdiaphragmatic endometrial tissue was also removed. She subsequently underwent thoracoscopic treatment to treat the pneumothorax.

Conclusion: The aim of this study was to review the clinical features, diagnostic criteria, and treatment options for catamenial pneumothorax. In addition, the study highlights the importance of a multidisciplinary approach to the management of catamenial pneumothorax, involving pulmonologists, gynecologists, and thoracic surgeons. Further studies are needed to optimize the management of this rare condition.

Background: Pain associated with rib fractures can last particularly long. While it is commonly advised in the outpatient setting to anticipate rib fracture pain to improve relatively within a few weeks, there is no evidence to support this statement. The aim of this study was to examine the duration of pain-related disability following single rib fractures based on the objective clinical records.

Methods: This study retrospectively reviews the clinical inpatient and outpatient records of 37 patients with single rib fractures treated conservatively at our multi-hospital healthcare system from January to December 2022. The duration of pain-related disability was deduced based on several criteria documented in the patients' clinical records. Univariate and multivariate analyses of risk factors (patient age, sex, injury severity score, smoking status, fractured rib, and side) were performed to find a potential correlation with the time to pain improvement.

Results: In this study, the clinical data of 22 males and 15 females with a single rib fracture and a mean age of 54.4 years (range 18.3–81.5 years) were assessed. According to the available clinical records, the mean duration of pain-related disability was 3.12 weeks (range 4–54 days). Analysis of risk factors showed a significant correlation between duration of pain and increased injury severity scores.

Conclusion: While prolonged chest pain is common with rib fractures, a patient with a single rib fracture may be advised that their chest pain and associated disability would significantly improve within an average of 3–4 weeks. The severity of associated injuries was associated with a longer time to pain improvement.

Introduction: The COVID-19 pandemic posed significant global challenges to healthcare systems, necessitating rapid education and training adaptations for frontline workers. In Qatar, Hamad Medical Corporation Ambulance Service (HMCAS) has transitioned to distance learning platforms to ensure the continuing professional development of paramedics. The aim of this study was to evaluate the effectiveness of these online learning platforms in meeting the educational needs of HMCAS paramedics in pre-hospital care.

Methods: A retrospective observational study design was followed using an online survey. Data were collected using a validated tool focused on accessibility, feasibility, and perception of online learning during the pandemic. Descriptive and inferential statistics (ANOVA) were used to estimate differences in satisfaction scores across themes and analyze the data.

Results: The findings revealed that HMCAS paramedics reported high levels of satisfaction (mean 3.93 out of 5) with online learning, citing its ability to meet their educational needs, enhance academic performance, and provide a safe learning environment. However, challenges such as poor internet connectivity, financial constraints, and lack of face-to-face interactions were identified as limitations. ANOVA results indicated that there was higher satisfaction with the online learning program, and that it met their patient care management expectations.

Conclusion: This study highlights the potential of online learning to meet the educational needs of paramedics during a global health crisis. The findings suggest that online learning can be an effective and resilient approach to education and training in future public health emergencies with appropriate quality control measures, improved feedback mechanisms, and strategies to enhance interaction and engagement.

Purpose: Effective face mask ventilation is a life-saving skill. Loss of muscle tone under general anesthesia may lead to tongue fall and pharyngeal collapse and reduce the efficiency of face mask ventilation. It has been suggested that lateral head rotation may improve the efficiency of face mask ventilation. The aim of this study was to compare face mask ventilation in neutral and head-rotated positions in adult patients under general anesthesia.

Methods: This randomized crossover study was conducted on 42 patients of both genders, aged 18–60 years, who were randomly assigned to group NRN (face mask ventilation performed in neutral–rotated–neutral head positions for one minute each) and group RNR (face mask ventilation performed in rotated–neutral–rotated head positions for one minute each). The primary outcome was the expired tidal volume (VTE) measured in both head positions during pressure control mode of ventilation with a peak inspiratory pressure of 15 cmH2O. Secondary outcomes included the number of patients with airway obstruction or low VTE during mask ventilation and the effects of age, height, Mallampati class, and airway obstruction or low VTE on VTE in the head-rotated position.

Results: The mean VTE was significantly higher in the neutral position (637.93 ± 186.62 ml) compared to the head-rotated position (625.30 ± 183.52 ml) (p = 0.036). The VTE was comparable in group NRN and group RNR in neutral (p = 0.455) and head-rotated positions (p = 0.464). The incidence of airway obstruction was similar in both positions and no patient had low VTE during mask ventilation. Age, height, Mallampati class, and airway obstruction or low VTE in neutral position had no effect on VTE in the head-rotated position.

Conclusion: There was a significant decrease in the VTE in the rotated head position compared to the neutral head position during mask ventilation in patients under general anesthesia.

Background: There is a scarcity in the literature on the management of retained bullet injuries (RBIs), and there are no comprehensive treatment guidelines. This study reports a single-center experience in the management of thoracoabdominal RBIs in resource-limited settings.

Patients and Methods: A retrospective study of 103 patients diagnosed with RBIs was conducted between January 2004 and December 2020 at Al-Nasar Hospital in Ibb, Yemen. Clinical demographic data, RBI occurrence and settings, injury characteristics, management, and outcomes were collected and analyzed.

Results: The mean age was 36.0 ± 16.2 years, and most cases (75.7%) were men. Most RBIs occurred during wedding ceremonies (52.4%), while 37 (35.9%) occurred during war and political rallies, and 12 (11.7%) occurred during usual times. RBIs during wedding ceremonies were statistically significant compared with other injury times (p < 0.001). Among the victims, 42.7% were unaware of the injury. The chest wall was the most common site of RBIs (n = 42, 40.8%), followed by the thoracoabdominal area in 28 (27.2%) cases and the back in 15 (14.6%) cases. All patients underwent surgical exploration except for four (3.9%) cases, and chest tube insertion was the most common procedure (n = 42, 40.8%). Four patients (3.9%) were permanently disabled, while nine (8.7%) died in the hospital during or after surgery. Mortality rates were significantly associated with time to hospital arrival, with longer delays resulting in death (p < 0.001).

Conclusion: In this study, RBIs primarily affected adult men during wedding ceremonies, with chest wall injuries being the most common and chest tube insertion being the most common procedure. Mortality rates were higher with delayed hospital admissions. Strategies of prevention initiatives should focus on raising awareness, vigilant law enforcement, and improving prehospital care.