Journal of Emergency Medicine, Trauma and Acute Care - Volume 2020, Issue 1

Background: Currently, pulse pressure variation (PPV) is considered the gold standard dynamic variable for predicting fluid responsiveness. Distensibility index of inferior vena cava (dIVC) is also considered a good predictor of fluid responsiveness. However, information from literature comparing the performance of both variables is still patchy and insufficient. Therefore, we aimed to investigate the accuracy of dIVC and PPV in predicting fluid responsiveness and compare the predictive power of both techniques. Methods: We conducted our study in shocked patients receiving mechanical ventilation requiring fluid challenge. Hemodynamic variables, such as PPV and dIVC, were recorded before and after fluid challenges. Fluid responders were identified when cardiac output increased more than 15% after the first fluid challenge. Only the non-responders received a second fluid challenge (SFC) to define delayed responders. Results: A total of 38 shocked patients were enrolled in this study. Twenty-one patients (55.3%) were fluid responders. The area under the receiver operating characteristic (AUROC) curve of PPV was 0.78 ± 0.08 with a best cutoff of 10.5 (sensitivity: 76.2%; specificity: 70.6%). The AUROC curve of dIVC was 0.75 ± 0.07, and the best cutoff value to predict fluid responsiveness was 16.5% with a sensitivity of 71.43% and specificity of 76.5%. Four patients from the non-responder group became responders after the SFC. No statistically significant difference was observed between the predictive performance of PPV and dIVC. Conclusions: Our findings indicate that the performance of PPV for predicting fluid responsiveness was similar to that of dIVC. PPV and dIVC are moderately predictive of fluid responsiveness.

Mass casualty incidents (MCIs) in disasters across the globe are inevitable, and the emergency medical services (EMS) system has played a significant role during such events. This historical review seeks to examine the history of EMS response to MCIs in disasters in Saudi Arabia. Since the first recorded disaster in 1964, the Kingdom has witnessed a range of catastrophic events, causing many deaths and injuries and related economic damage. The country's EMS system dates back to 1934 when it was first incorporated into the health care system. Since then, EMS have responded to various MCIs by providing critical pre-hospital care to casualties during disasters. However, barriers affecting the service delivery often complicate those responses. Additionally, elderly people manifest unique challenges due to their age, which constrains EMS system effectiveness. Therefore, future studies should focus on such barriers to ascertain future EMS system efficiency.

Background: Traumatic cerebral hemorrhage is a common type of traumatic brain injury. This medical condition exists in two phases: primary, which occurs at the time of trauma, and secondary, which occurs later as a result of multiple biochemical, metabolic, and inflammatory changes that develop over time. The secondary injury is mainly irreversible and worsens the primary injury. Single nucleotide polymorphism (SNP) in RETN gene − 420 C/G is involved in the secondary injury by enhancing the inflammatory process. This study aims to find out the association of − 420 C/G RETN genotypes with C-reactive protein (CRP), brain edema, Glasgow Coma Scale (GCS), and Glasgow Outcome Score (GOS) among traumatic cerebral hemorrhagic contusions. Methods: Ninety patients with traumatic cerebral hemorrhagic contusion were enrolled in this study. Patients with hemorrhagic contusion associated with other types of brain bleeding and those with chronic diseases were excluded. GCS score was assessed upon admission and GOS was assessed upon discharge. CRP level was measured in serum by a Nyco-Card Reader II system. RETN genotypes were defined by using PCR-RFLP. Results: Ninety patients were included, 93.3% were males, and 78.9% of the patients were below 44 years old. The most common mechanism of trauma was RTA constituting 68.9%. The RETN genotypes were 25.6%, 41.1%, and 33.3% for CC, GG, and CG, respectively. G mutant allele was significantly associated with brain edema (P = 0.019) but not significantly associated with CRP, GCS, and GOS. Conclusions: SNP in RETN − 420 C/G gene was significantly associated with brain edema (P = 0.019).

Background: The incidence of indirect inguinal hernia in young children ranges from 0.8% to 4.4%. Infants are at a high risk of testicular ischemia from indirect inguinal hernia due to their delicate vascular supply. Case report: A 5-year-old patient presented with a rare case of acute testicular ischemia secondary to an incarcerated inguinal hernia. He underwent surgery that successfully salvaged his testicle. Conclusion: Emergency medicine providers need to clinically suspect for testicular ischemia even in the presence of examination findings suggestive of an alternative diagnosis, such as inguinal hernia.

Trauma is a major public health problem in Saudi Arabia and a leading cause of mortality and morbidity in young age groups. In 2018, traumatic injuries caused by road traffic accidents were the leading cause of death after ischemic heart diseases. Therefore, a new road safety system is important to reduce the incidence of road accident trauma. First aid care by bystanders to road accidents must be improved to become an effective part of pre-hospital care and avoid aggravation. Moreover, trauma centers need further training and education to provide a high level of trauma care. However, literature about trauma care in Saudi Arabia is lacking. Thus, this paper aims to provide an overview of the Saudi trauma system, emergency medical services, and healthcare providers’ training and education efforts.

Objectives: This study aimed to assess the knowledge and attitude of babysitters and nursemaids toward providing basic life support (BLS) to infants. Setting: This study was conducted at registered nurseries and daycare centers in rural northern Jordan. Participants: The study involved a convenience sample of 77 child caretakers who were looking after infants. Results: Findings showed that majority of participants were unaware of skills needed to manage foreign body aspiration or administer cardiopulmonary resuscitation on infants. More than two-thirds of the participants had never attended any training or educational session on managing foreign body aspiration among infants. Conclusions: The findings indicated that caregivers in kindergartens and nurseries in rural areas in Jordan lacked awareness of safe infant care. Basic resuscitation skills for urgent cases were insufficient, which could increase the risk of sudden and unexpected child death. Thus, this study strongly recommends training, such as a course on infant life support, for babysitters and care center staff.