RESUMEN
The current state of the literature for a bullet embolization to the heart and/or pulmonary vasculature indicates the occurrence is rare but could increase due to the rise in civilian low-kinetic-energy firearm acquisition and use. We present the case of an older teenage male who sustained a gunshot wound to the left flank. The bullet entered the iliac vein, travelled through the heart and lodged in the pulmonary artery. Successful relocation of the bullet to the internal iliac vein was performed by the interventional radiologist. This article highlights the advancement of interventional radiology as a successful non-invasive endovascular technique for bullet embolus removal.
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Procedimientos Endovasculares , Migración de Cuerpo Extraño , Arteria Pulmonar , Heridas por Arma de Fuego , Humanos , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/cirugía , Masculino , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/lesiones , Arteria Pulmonar/cirugía , Resultado del Tratamiento , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/terapia , Procedimientos Endovasculares/instrumentación , Adolescente , Radiografía Intervencional , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/lesiones , Vena Ilíaca/cirugía , Angiografía por Tomografía Computarizada , Embolia Pulmonar/etiología , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/cirugía , Embolia Pulmonar/terapiaRESUMEN
BACKGROUND: Timely angiographic embolization of abdominopelvic injuries is a hallmark of a high-functioning trauma center. Yet, the process depends on the timely mobilization of interventional radiology staff. Smartphone technology to notify and mobilize staff may be a viable option. OBJECTIVE: To describe the incorporation of a smartphone application into our trauma workflow process previously developed for stroke care. METHODS: In 2022, our Level I trauma center implemented a smartphone application with three simultaneously occurring functions: (a) high-definition image viewing on the phone; (b) text messaging thread for all parties; and (c) a single-call activation system for staff mobilization. The application was initially developed to notify interventional radiologists of large-vessel occlusions in victims of stroke and, at our request, was modified to fit our trauma workflow process. The smartphone application company developed a new program, installed the application on trauma service smartphones, and provided educational in-services over a 1-month period. The application was then integrated into our trauma workflow process. RESULTS: The trauma surgeon and the interventional radiologist can now simultaneously view high-definition images on their smartphones. Text messages are accessible to all team members. The staff is notified and mobilized with the singlecall smartphone application, preventing the placing and returning of phone calls. CONCLUSION: Smartphone technology enhances timely interventional radiology staff response for hemorrhagic patients requiring emergent angioembolization.
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Servicios Médicos de Urgencia , Accidente Cerebrovascular , Envío de Mensajes de Texto , Humanos , Teléfono InteligenteRESUMEN
OBJECTIVE: Mild traumatic brain injuries (MTBI) associated with intracranial haemorrhage are commonly transferred to tertiary care centres. Recent studies have shown that transfers for low-severity traumatic brain injuries may be unnecessary. Trauma systems can be overwhelmed by low acuity patients justifying standardisation of MTBI transfers. We sought to evaluate the impact of telemedicine services on mitigating unnecessary transfers for those presenting with low-severity blunt head trauma after sustaining a ground level fall (GLF). METHOD: A process improvement plan was developed by a task force of transfer centre (TC) administrators, emergency department physicians (EDP), trauma surgeons and neurosurgeons (NS) to facilitate the requesting EDP and the NS on-call to converse directly to mitigate unnecessary transfers. Consecutive retrospective chart review was performed on neurosurgical transfer requests between 1 January 2021 and 31 January 2022. A comparison of transfers preintervention and postintervention (1 January 2021 to 12 September 2021)/(13 September 2021 to 31 January 2022) was performed. RESULTS: The TC received 1091 neurological-based transfer requests during the study period (preintervention group: 406 neurosurgical requests; postintervention group: 353 neurosurgical requests). After consultation with the NS on-call, the number of MTBI patients remaining at their respective ED's with no neurological degradation more than doubled from 15 in the preintervention group to 37 in the postintervention group. CONCLUSION: TC-mediated telemedicine conversations between the NS and the referring EDP can prevent unnecessary transfers for stable MTBI patients sustaining a GLF if needed. Outlying EDPs should be educated on this process to increase efficacy.
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Lesiones Traumáticas del Encéfalo , Telemedicina , Humanos , Estudios Retrospectivos , Derivación y Consulta , Centros de Atención TerciariaRESUMEN
ABSTRACT: The advent of cellular network technology has increased the use of photography in the clinical setting. This article reviews several areas regarding protected health information (PHI) and the use of video: the 1996 Health Insurance Portability and Accountability Act (HIPAA); The Joint Commission requirements for the use of images; areas of concern for exchanging PHI with law enforcement at the bedside, and the need for the development of formal guidelines regarding the use of video in the clinical setting.
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Health Insurance Portability and Accountability Act , Fotograbar , Estados Unidos , Humanos , Grabación en Video , ConfidencialidadRESUMEN
BACKGROUND: Handling livestock can be dangerous, and livestock-related injuries are increasing. CASE PRESENTATION: An 83-year-old man who was gored and thrown by a bison bull during feeding is presented. The traumatic event resulted in two major injuries: an abdominal laceration with intestinal evisceration and cervical fractures after being lifted and forcefully thrown. The patient's hospital course included emergent surgery using the damage control approach resulting in an open abdomen, postoperatively, intensive care unit placement, and physiological management of the lethal diamond (acidosis, coagulopathy, hypothermia, and hypocalcemia). Finally, the patient's injuries required repeated abdominoplasties, colostomy, and surgical cervical stabilization. Despite a complicated hospitalization, the patient returned to his previous lifestyle within 2 months. CONCLUSION: The geriatric population, despite multiple comorbidities, is active, and their dynamic lifestyle can result in severe injuries. Positive outcomes for this population are possible. Even if severely injured, the geriatric population has the propensity to rebound and survive with early aggressive management.
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Bison , Hipotermia , Traumatismos del Cuello , Fracturas de la Columna Vertebral , Anciano , Animales , Humanos , Unidades de Cuidados IntensivosRESUMEN
INTRODUCTION: Establishing and maintaining peripheral intravenous access in patients with no visible or palpable veins can be arduous. Intravenous catheters placed with ultrasound do not survive as long as traditionally placed catheters. This study was performed to determine the relationship between the catheter length placed into the lumen of the vein using ultrasound and catheter survival. METHODS: This was a nonrandomized prospective observational study of admitted patients with difficult intravenous placement in 2017. Subjects had ultrasound-guided peripheral intravenous placement in the emergency department or intensive care unit. The main outcome was the time of catheter survival. Data were analyzed using descriptive statistics and Cox regression. RESULTS: A total of 98 patients with an average age of 63 years were enrolled. The total number of cases examined was 97 (N = 97), of which 29 intravenous catheters were removed for catheter-related problems (events). The mean (SD) survival time for catheters placed using ultrasound was 3,445 minutes (2,414) or 2.39 days. Peripheral catheter survival was not significantly related to the in-vein length of the catheter (X2 = 0.03, P = 0.86) nor was it significantly related to any of the covariates. DISCUSSION: The survival time of ultrasound-guided intravenous access doubled in the present study from 1674 minutes in a previous 2013 study. The results may have been due to clinician expertise and experience with the peripheral ultrasound-guided method and the use of updated equipment.