Journal of Emergency Medicine, Trauma and Acute Care - Volume 2025, Issue 1

Background: Induction of labor (IOL) is the iatrogenic stimulation of uterine contractions before the onset of spontaneous labor, and it is used as a therapeutic option when the potential maternal and/or fetal benefits outweigh the associated risks. Given that IOL as an intervention can be detrimental to both mother and child, it is crucial to ensure that the benefits of the shift in clinical practice exceed the risks. Since little is known about IOL in Yemen, this study was conducted to identify the predictive factors of IOL success or failure.

Methods: A retrospective cross-sectional study was conducted on laboring mothers who gave birth following IOL at Al-Thora General Hospital, Ibb, Yemen, over a three-year period, from June 2019 to January 2022. All eligible participants were enrolled at admission using structured questionnaires and quota sampling techniques until the desired sample size was achieved. Data on the parturient’s sociodemographic characteristics, induction methods, and outcomes were taken from personal case files and the hospital’s maternity/delivery register. The factors influencing IOL outcomes were determined using a logistic regression analysis.

Results: The average age of the 505 individuals induced into labor was 26.99 ± 6.24 years, and the majority of them (46.1%) were in the 25–34 age range. A significant proportion (74.3%) lived in urban areas, and the majority (66.1%) regularly attended perinatal care. Premature rupture of membranes (PROM) was the main cause of IOL at 65.1%. Following IOL, 444 women (87.9%) gave birth vaginally. A total of 61 (12.1%) cases had cesarean deliveries. Multivariate logistic regression analysis revealed that the odds ratio (OR) for significantly predicting IOL success for mothers aged 25–34 years was 0.46 (95% CI: 0.26–0.84, p = 0.013). The adjusted OR (AOR) indicated that multiparity (AOR: 0.24; 95% CI: 0.12–0.49, p < 0.001), misoprostol use for induction (AOR: 0.34; 95% CI: 0.18–0.65, p < 0.001), PROM (AOR: 0.34; 95% CI: 0.15–0.78, p = 0.011), and oligohydramnios cases (OR: 0.19, 95% CI: 0.04–1.00, p = 0.050) significantly predicted IOL success. Conversely, maternal complications (OR: 1.41; 95% CI: 0.13–15.13), maternal age exceeding 34 years (OR: 1.23; 95% CI: 0.48–3.19), gestational age between 37 and 40 weeks (OR: 1.28; 95% CI: 0.48–3.41) or beyond 40 weeks (OR: 1.42; 95% CI: 0.36–5.53), baby weight between 2 and 4 kg (OR: 1.39; 95% CI: 0.64–3.04), and post-term pregnancies (OR: 1.07; 95% CI: 0.32–3.49) all increased the risk of IOL failure.

Conclusion: Mothers between the ages of 25 and 34 years, those with multiparity, misoprostol users, PROM cases, and oligohydramnios cases had higher rates of IOL success. In contrast, advanced maternal age, advanced gestational age, advanced baby weight, and post-term pregnancies were all associated with IOL failure. Therefore, in order to provide safe IOL care, healthcare professionals should take these factors into account. The majority of failed IOL determinants were associated with unjustified and inconsistent IOL indications. Therefore, developing well-established practical guidelines and avoiding unjustified case selection may help reduce IOL failure rates.

Background: The aim of this study was to present the rationale behind field interventions aimed at enhancing the functioning of emergency medicine services by analyzing field visits conducted by Emergency Medical Service (EMS) teams of Health Center Barajevo (HCB), Belgrade, Serbia. It also aims to assess the adequacy of current telephone triage in determining the need for field interventions. Other objectives include identifying the most common diagnoses and the most commonly prescribed drugs in order to aid in disease prevention and improve the overall healthcare system. Together, these aims also serve an important educational purpose.

Methods: For the purposes of this study, patient field protocols for 2023 were used, which include data about the patients, mainly their medical history, diagnoses, and therapy administered during the visit. Data on interventions by EMS teams from January 1, 2023 at 00:00:00 hours to December 31, 2023 at 23:59:59 hours were used. Patients were divided into eight age groups. Statistical data were analyzed using SPSS v. 21.

Results: EMS HCB made 3,345 field interventions in 2023. The total number of patients consisted of 1,501 males (44.9%) and 1,803 females (53.9%). The patients’ mean age was 67.54 years, with a median age of 72 years. The age range was 0–98 years. The total number of diagnoses was 5,776, with an average of 1.7 diagnoses per patient.

Conclusions: The results of our research partially align with those of other studies available in the literature. The most common individual reason for the intervention by EMS HCB teams was arterial hypertension (I10).

Objectives: Due to high mortality rates, cardiac trauma management is a major challenge for emergency trauma teams. Patients’ clinical presentations vary according to the type and severity of injury. Despite optimal interventions, death may be unavoidable if the left heart is severely injured.

Methods: Between January 2012 and January 2022, 24 patients were evaluated in the emergency department with a diagnosis of penetrating left heart injury and underwent urgent surgery. Patients in the survival and non-survival groups were retrospectively evaluated based on preoperative prognostic factors and statistically analyzed.

Results: Gunshot wounds, left ventricular injuries, and injury severity were found to be associated with mortality. In addition, cardiac tamponade and the preoperative pH and lactate levels associated with tamponade were found to determine mortality. Hemodynamic shock status was found to be more favorable than tamponade status despite the associated unstable hemodynamics. Transfer time to surgery was found to be highly predictive of mortality.

Conclusion: Since penetrating heart injuries are life-threatening emergencies, their immediate transport to the hospital and prompt intervention are important. If a cardiac injury is suspected, immediately transferring the patient to the operating room without wasting time on further diagnostic tests can be life-saving.

Background: Identifying acute ischemic stroke (AIS) risk factors is crucial in risk stratification and prevention measures. Here, we conducted a gender-based analysis of AIS in resource-limited settings.

Method: This retrospective study included 80 AIS patients (40 male and 40 female) who were admitted to Al-Thora General Hospital in Ibb, Yemen, between June and September 2023. Clinical characteristics and laboratory findings were obtained from patient medical records. Univariate analyses were conducted by analyzing factors associated with AIS between different genders using odds ratio (OR) and 95% confidence interval (CI).

Results: The mean age of females and males were 55.5 ± 17.6 years and 67.2 ± 12.4 years, respectively. According to the results of the univariate analysis, the following factors were statistically significant predictors of stroke in males: age >60 years (OR: 9.06; 95% CI: 2.11–63.31, p = 0.008), history of hypertension (OR: 3.78; 95% CI: 1.34–11.84, p = 0.024), active smoking (OR: 9.00; 95% CI: 3.39–26.00, p < 0.001), Khat chewing (OR:12.67; 95% CI: 3.23–84.73, p = 0.001), history of cardiovascular disease (CVD) (OR: 5.67; 95% CI: 2.04–17.71, p = 0.001), and severe stroke as measured by the National Institutes of Health Stroke Scale (NIHSS) (OR: 3.84; 95% CI: 1.18–14.16, p = 0.032). In contrast, shortened activated partial thromboplastin time (APTT) =28.4 seconds (OR: 0.22; 95% CI: 0.08–0.56, p = 0.002) was statistically significantly associated with AIS in women.

Conclusion: Our study reveals that males aged over 60 years were at a higher risk of experiencing strokes, particularly those with a history of hypertension, smoking, Khat chewing, CVD, and severe scores on the NIHSS. Conversely, females with shorter APTTs (≤28.4 seconds) were more vulnerable. Effective preventive measures and risk management can prevent the occurrence of most AIS, particularly in environments with limited resources.

Objective: This study aims to present a single-center experience in the management of “intertrochanteric fractures” using Gamma intramedullary (IM) nailing, while also assessing the outcome and complications associated with this approach.

Method: In this prospective study, 72 patients diagnosed with “intertrochanteric fractures” were treated with Gamma IM nails from April 2021 to March 2023. The main outcome was hip function one year following surgery, using the Harris hip score (HHS). The second aim was to identify the factors associated with postoperative complications.

Results: The mean age of the participants was 64.4 ± 4.6 years, and the majority of the patients were female (n = 44, 61.1%). The mean time to union was 15.69 ± 2.72 weeks. At the one-year follow-up, the mean HHS was 84 ± 6.1 points, with a majority of patients (n = 43, 59.7%) achieving a good HHS. An excellent HHS was observed in 11 (15.3%) patients, while a fair score was noted in 15 (20.8%) patients and a poor score was observed in 3 (4.2%) patients. Postoperative mechanical complications were identified in 14 (19.4%) patients, which included failure of osteosynthesis in 4 (5.6%) cases, surgical site infection in 3 (4.2%) cases, nonunion in 3 (4.2%) cases, mal-union in 2 (2.8%) cases, cut-out in one (1.4%) case, and local pain in 1 (1.4%) case. The factors associated with these complications included high-energy trauma (p = 0.028), longer time to surgery (>48 hours) (p < 0.001), the presence of diabetes mellitus (p = 0.001), hypertension (p = 0.037), increased intraoperative blood loss (p = 0.012), and a higher AO classification (p < 0.001).

Conclusion: Our study indicates that Gamma IM nails may effectively manage “intertrochanteric fractures", leading to satisfactory hip function in the majority of patients.

Background: The Glasgow Coma Scale (GCS) has been a prominent tool for assessing the severity of traumatic brain injury (TBI) since its inception in 1974 and continues to be regarded as the gold standard. Research indicates that ambiguous interpretations of terminology may lead to inaccurate patient’s inter-user scoring. The GCS-P (Glasgow Coma Scale-Pupils) tool was introduced in 2018, yet it has not been tested in prehospital settings. Therefore, the aim of this study was to assess the accuracy of scores reported by paramedics using the traditional GCS tool compared to those using the revised GCS-P tool. In addition, the study aimed to evaluate the perceived ease of use of these tools among paramedics in Qatar.

Methods: This quantitative study focused on comparing the scores given by two groups of paramedics who were randomly assigned to use one of the two GCS tools while assessing two video scenarios depicting TBI. The participants (n = 202) were randomly divided into groups: one using the traditional GCS tool (n = 115) and the other using the revised GCS-P tool (n = 87) to assess TBI video scenarios with simulated patients. Data collection was conducted through online questionnaires, with the GCS-P group receiving additional information on pupil reactivity score (PRS). Descriptive statistics were used for data analysis.

Results: A total of 202 paramedics participated in this study. In scenario 1, 40.9% of GCS users and 21.8% of GCS-P users accurately assessed the patient’s condition. In scenario 2, correct assessments were made by 68.7% of GCS users and 17.2% of GCS-P users. Only 30.4% of GCS users and 8% of GCS-P users were able to correctly assess both scenarios. Despite the lower accuracy rates, 99.1% of GCS users and 92% of GCS-P users reported that their respective tools were easy to use. Among the GCS-P users, 65.5% were familiar with the tool, and 88.5% expressed a preference for a simplified calculation method that involved subtracting unreactive pupils from the total GCS score.

Conclusion: The results show that the GCS tool yielded more accurate scores than the GCS-P tool. Enhancing the GCS-P training or revising the GCS-P tool could improve its reliability.

Snakebite envenoming is a neglected tropical disease that causes significant suffering, disability, and early death across all continents. In countries with low- and middle-income economies, there is an insufficiency of antivenins both in quantity and quality. This report aims to highlight hemotoxicity and nephrotoxicity manifestations and the rarely reported tetanus complications that may occur following a Trimeresurus insularis viper bite. A 61-year-old male presented to the emergency room with a swollen left arm a day after he was bitten by a viper on his left index finger. The patient was vomiting and experiencing pain. During hospitalization, laboratory findings showed a progressive decline in platelet count with no sign of bleeding and increased levels of urea and creatinine. However, after eight days of hospitalization, the patient began to show signs of tetanus, and we then had to refer him to a more advanced hospital. T. insularis is commonly found in East Java, Bali, and the Lesser Sunda Islands, and is a common cause of snakebites in lowland East Java. The mechanism of thrombocytopenia in snake envenomation is unclear. Metalloproteinases in snake venom can cause microvascular damage followed by bleeding. In conclusion, severe thrombocytopenia from a T. insularis bite can occur alone without a sign of other coagulopathies that can be improved by the only antivenin available in Indonesia and optimal supportive care. Although rare, tetanus from snakebite should be recognized as a possibility. It should be taken into account that one antivenom does not correspond to all species of snakes. Therefore, the type of antivenom procurement should follow the most common species distribution in each region.

Human echinococcosis (hydatidosis or hydatid) disease is a worldwide neglected zoonotic larval infection typically caused by cestodes of the Echinococcus genus. It affects 1 million people worldwide, predominantly reported in Central Asia, the Middle East, and South America. In this paper, we report a patient who underwent a successful laparoscopic partial pericystectomy and omentoplasty with simultaneous cholecystectomy in the treatment of cystic echinococcosis and cholelithiasis, respectively. There are many challenges to treating complicated hepatic hydatid cysts. It is crucial for surgeons to have knowledge of the range of possibilities of each surgical modality and its expanding advancements that can reduce complication risks and increase a patient’s quality of life. The art of sharing techniques and management possibilities between professionals in this field provides a bridge in further crafting the best-tailored treatment plan for patients. This report illustrates the successful usage of laparoscopy in the management of a section IV hydatid cyst with simultaneous cholecystectomy. This case aims to expand the knowledge and prospects of laparoscopic surgery in cystic echinococcosis.

For multidisciplinary treatment, intrahospital transfer of seriously injured patients is considered a challenging and risky process. Here we describe the successful treatment of a 38-year-old male who was involved in a motor vehicle collision and sustained multiple severe injuries. He was admitted with hemorrhagic shock due to intra-abdominal and retroperitoneal bleeding, in addition to lung contusion, an unstable fracture of the pelvis, a thoracic spine fracture, and lower long-bone fractures. A prompt resuscitation was carried out, and the patient was transferred to the hybrid operating theater for treatment of multiple intra-abdominal hemorrhage sites (spleen, mesentery, and liver), including the angioembolization of multiple bleeding vessels in the retroperitoneal space. The combination of emergency surgery and intraoperative interventional radiology in the hybrid theater provides a rapid and appropriate management approach in unstable trauma patients with severe multiple injuries. It reduces complications related to intrahospital transfer of patients and improves clinical outcomes.