Soft tissue compartment bleed-the iceberg phenomenon:a case report

Introduction:Hemorrhage control is the essence of trauma care.Conventional teaching is 1 on the floor(ie,external bleeding)and 4 more(thoracic cavity,abdomen,retroperitoneum,and long bones).In this case report,we present a unique case with concealed bleeding into the soft tissue compartment leading to shock.This case triggered to consider the soft tissue compartment as the sixth potential bleeding site in trauma patients in hemorrhagic shock.Case presentation:We present the case with concealed bleeding into the soft tissue compartment posing a challenge in management.On presentation,he had a pulse rate of 117 beats/min,a blood pressure of 90/60mmHg,and a Glasgow Coma Scale(GCS)score of 9.During resuscitation,the patient's blood pressure dropped to 70/46 mmHg with a GCS of 7 of 15.He was then intubated and reevaluated.Contrast-enhanced computed tomography of the torso revealed a right scapular fracture with a large soft tissue hematoma along the right side of the neck and chest wall,extending up to the right lumbar region.Conclusion:We suggest that the soft tissue compartment is the sixth potential site of internal bleeding in trauma patients,which should not be overlooked after having ruled out the other 5 sites.

Management and outcome of pancreatic trauma:a 6-year experience at a level I trauma center

Background: Pancreatic trauma (PT) accounts for less than 1% of all trauma admissions. Occasionally, PT is undetected during theprimary survey and becomes apparent only when complications arise. It occurs in up to 5% of blunt abdominal trauma cases and 12%of individuals with penetrating abdominal injuries. Management is determined by the status of the main pancreatic duct and associatedinjuries.Methods: This was an ambispective study conducted at the Jai Prakash Narayan Apex Trauma Center, All India Institute ofMedical Sciences,New Delhi, from January 2015 to December 2017 (retrospective), and January 2019 to December 2020 (prospective). In total, 113patients with PT were included in this study.Results:We analyzed the data of 113 patients with PT included in this study, of whichmales predominated (93.7%). Blunt PT was presentin 101 patients (89.4%) and penetrating PT in 12 patients (10.6%). Half of the patients (51.3%) had the American Association for theSurgery of Trauma grade III PT, followed by grade II (18.6%), and grade I (15%). Of the total 113 patients, 68 (60.2%) were treated withoperative management, and 45 (39.8%) with nonoperative management. Distal pancreatectomy, with or without splenectomy, was themost common procedure performed in our study, followed by drainage. There were 27 mortalities (23.8%) during the study period, ofwhich 7 were directly related to PT and 20 were due to other organ-related sepsis and hemorrhagic shock.Conclusion: Pancreatic trauma is rare but challenging for trauma surgeons, with persistent management controversies. Early diagnosisis important for favorable results;however, a delay in diagnosis has been associated with higher morbidity and mortality. Low-grade pancreaticinjuries can be successfully managed nonoperatively, whereas high-grade pancreatic injuries require surgical intervention.

Focused research in emergency medical systems in Asia: a necessity for trauma system advancement

Since trauma is a growing health problem worldwide,emergency trauma care including emergency medical services(EMS)is becoming an integral part of the healthcare system.The optimal EMS which will improve access to trauma care,will be different in each country because of different healthcare systems,trauma etiology,and economic situations.To adopt models that have succeeded in developed countries is not always appropriate.In order to identify the optimal EMS model in developing countries,comparing the systems among many countries in detail and examining their advantages and disadvantages would be necessary.Therefore,this article tries to identify important elements of EMS to achieve mature EMS systems based on comparisons of 7 Asian countries,and discusses the need to conduct more detailed and extensive comparisons.

Varied presentations, magnitude, and outcome of traumatic neck injuries at a level I trauma center

Introduction:Traumatic neck injuries(TNIs)constitute 5%–10%of all trauma cases.These injuries can be caused by either penetrating or blunt trauma.Patients can have a varied presentation like cut injury over the neck,bleeding,neck swelling,breathing difficulty,dysphagia,etc.Methods:This was a retrospective observational study conducted at a level I trauma center in India from January 2016 to March 2020.One hundred thirty patients who required admission and intervention due to TNIs were included in this study.Results:One hundred thirty patients with neck injuries were included in this study.Males were predominant(91.5%)with the age ranging from 10 to 70years.The most common mechanism of injury was physical assault(40.7%),followed by road traffic injury(23.8%)and self-inflicted injuries(18.4%).Penetrating trauma was predominant.Open neck wound with bleeding was the most common presenting symptom.Zone II injuries were more common(83.8%)followed by zone I(12.3%)and zone III(3.8%).Soft tissue injury including skin,platysma breach,and strap muscle injury was present in 46.9% of patients.Laryngopharyngeal injury was present in 13.8%,tracheal injury in 28.5%,vascular injury in 13.8%,and esophageal injury in 4.6% of patients.Conclusion:Penetrating neck trauma is more common than blunt in developing countries like India.Advanced Trauma Life Support(ATLS)protocol guides the initial management.The definitive management depends on the type and mechanism of injury,anatomical level,severity,and the organ injured.