Peripheral Hospital Research Articles

TIME TO SURGERY FOR ELDERLY HIP FRACTURES: A RETROSPECTIVE COMPARATIVE REVIEW OF DIRECT ADMISSIONS VERSUS PERIPHERAL HOSPITAL TRANSFER

Current recommendations advocate for surgery within 48 hours from time of injury as a keystone in care for elderly patients with hip fractures. A spare population density within regional Australia provides physical challenges to meet time critical care parameters. This study aims to review the impact of delays to timely surgery for elderly hip fracture patients within a regional Australian population.A retrospective, comparative analysis was undertaken of 140 consecutive hip fracture patients managed at a single rural referral hospital, from June 2020 until June 2021. Factors such as age, time to transfer, time to surgery, 30-day complication and 6-month complication rates were collected. Statistical analysis was performed where applicable.Mean time to surgery was 33.9 hours. A greater proportion of patients whom directly presented underwent surgery within the recommended 48 hours (91.5% vs 75.3%). The statistically significant delay in time to surgery was found to be 6.4 hours. Lower 180-day morbidity and mortality rates were observed in patients undergoing surgery within 48 hours (13.8% vs 36%), This is in comparison to the overall mortality rate of 19.2%.Delay to surgery for elderly hip fracture patients was associated with an increase 30-day and 180-day morbidity and mortality rate. A greater proportion of patients transferred from peripheral hospitals experienced a delay in surgery. Early transfer and prioritization of such patients is recommended to achieve comparative outcomes for rural and remote Australians.

Academic Careers in Medicine: a Sex-Related Analysis of Career Goals

For female and male physicians of the clinical-academic mid-level staff, working conditions as well as the attitude towards profession and career play a decisive role. For years, there has been an increasing proportion of women in medicine. Despite this increase, a significant sex incongruence is still evident, especially in academic medicine. The aim of this work was to analyze current opinions of female and male physicians on sex-related aspects for career. By means of an online survey, medical mid-level staff from university and peripheral hospitals were asked about professional biographical as well as career-related topics and the data analyzed in terms of the sexes. Compared to their male counterparts, female physicians had lower career goals and mainly aimed to qualify as senior physicians. Women planned to have families and raise children earlier in their careers. Men were more likely to have their professional careers in mind during the same time period. Although only just under 47% of respondents considered an academic career to be worthwhile, 65% continued to rate the acquisition of an academic title highly. When evaluating equal treatment by superiors, female physicians tended to feel disadvantaged in their professional careers compared to male physicians. Thus, physicians rated the treatment by their respective superiors as characterized by the quality of the work (44% for both genders of superiors) or dependent on sympathy (female superiors 30%; male superiors 24%). Female physicians, however, saw a preference for male colleagues in 37% of male superiors. Despite a significantly larger proportion of women in medicine for decades, there is still an incongruence in sexes in favor of men in management positions. The professional and private goals of women and men differ significantly depending on their age decade. The academic career per se is increasingly losing importance, although the acquisition of academic degrees still seems to be desirable. Therefore, to improve the future of academic medicine, significant structural changes are needed to enable projectable career paths (e. g., tenure track, assistant professorship, young medical professionals model) for mid-level academic staff.

Successful Primary Percutaneous Coronary Intervention in a young patient in peripheral hospital and its out come.

Among all coronary artery disease (CAD) ST-T elevated MI is the most emergency condition to treat within time. but in our country all peripheral hospital has no enough scope for the recommended treatment, that is primary percutaneous coronary intervention (PCI) due to lake of infrastructure and trained cardiologist. Most of our patients does not reach to hospital within the golden time. In most of these patients are treated with pharmacological revascularization by Streptokinase or Tenecteplase. Few patients are saved who are with no other risk factors and can reach in hospital within the time frame of myocardial infarction cascade. For this consequence most of our patients suffers from the sequalae of myocardial infarction, that may be arrhythmias, cardiomyopathy to death. We performed primary PCI in peripheral hospital in a young patient successfully and the outcome is satisfactory. We want to continue this service in our hospital for preventing mortality and morbidity of our cardiac patients. J Inv Clin Cardiol 2023; 5(1): 24-28

Transfer status may not be associated with worse outcomes in elderly trauma patients

PurposeTo compare outcomes of elderly patients who arrive directly to a lead trauma centre to those who are transferred from a peripheral hospital. MethodsThis study used a retrospective cohort design and data obtained from the local trauma registry. The study population was patients 65 years and older who presented with an Injury Severity Score (ISS) of 12 or greater, or for whom the trauma team was activated, over a 10-year period. Patients were excluded from the study if they arrived direct from the scene and died within 3 hours of arrival, they were found to have no injuries, or they were directly admitted more than 2 days from the time of injury. Following the use of multiple imputation, multivariable logistic regression analysis was used to evaluate the relationship between in-hospital mortality and directness of transport, while adjusting for potentially confounding variables. ResultsOf the 1619 patients included in the analyses over half (54.2%) were transported directly from the scene of injury to the lead trauma hospital (LTH). The remaining 45.8% initially presented to a non-tertiary hospital and were later transferred to the LTH. Crude mortality was 18.7% in the direct group and 14.0% in the transfer group (p = 0.015). The unadjusted odds of death for patients arriving to LTH by referral was 0.71 (95% confidence interval, 0.54, 0.93), compared to patients arriving to the LTH directly. After adjustment for age, ISS, presence of severe head injury, Charlson Comorbidity Index, shock, initial GCS, and ICU admission from the emergency department, the mortality risk did not differ significantly for transferred patients compared to those arriving directly (OR = 0.77 (95% confidence interval, 0.54, 1.09). ConclusionThere was no significant difference in in-hospital mortality between elderly patients transported directly to the trauma centre and those who were transferred from peripheral hospitals.

A comparative study of head circumference and foot length as a measure of low birth weight in neonates

Background: Birth weight is the single most important indicator of survival, growth and overall development of the child. New-borns with less than 2.5 kg birth weight are termed as low birth weight (LBW). Approximately 28% babies in India are LBW. LBW is associated with high neonatal morbidity and mortality. Early diagnosis of LBW and apt intervention can lead to favourable outcome. The 70-80% of births take place either at home or at peripheral hospitals. Measuring birth weight is difficult in India due to resource limited set up. There is a need of alternative methods to detect LBW which should be simple, handy, quick and cost effective. Hence, we decided to do study of correlation of calf muscle circumference and chest circumference with birth weight to determine LBW in new-borns. Aim of the study was to study head circumference and foot length in diagnosing LBW babies. Objectives were to correlate above-said anthropometric parameters with birth weight and to decide indicator with better correlation with birth weight amongst head circumference and foot length Method: Its a cross sectional study conducted in tertiary care centre in North Maharashtra. The 162 new-borns (34- 42 weeks gestation) were included in Study. Birth weight, head circumference, and foot length were measured with appropriate scientific method. Results are analyzed with SPSS software and Microsoft excel. Results: Cut-off value to detect LBW is 31cm and 8.2 cm for head circumference and foot length respectively. Head circumference had better correlation (r=0.73) as compared to foot length (r=0.30). Head circumference has 87% sensitivity and 68% specificity as compare to foot length which has 74.8% sensitivity and 46.8% specificity respectively. Conclusions: Head circumference and foot length circumference can be used to determine LBW, though larger study with a greater number of patients is needed to establish precise correlation.

General Surgery and Spinal Anesthesia

Anesthesia and anesthetist are the co-worker to surgery. Surgeon and anesthetist with other subordinates is the surgical team. Patient satisfaction, surgical comfort to surgeon, patient, anesthetist and surgical team is the main stray and key point to select the type anesthesia to be given to particular individual. We had been doing a lot of general surgery under spinal anesthesia. Here main focus is laid down on gall bladder and renal surgery, which are relatively difficult to get done in spinal anesthesia without good co-operation of anesthetist. We had been doing renal and gall bladder surgery under spinal for the last more than 40 years, as there used to have no anesthetist in peripheral hospitals of Nepal, so giving spinal anesthesia by self and then doing surgery was the trend, which is now changed, as well-trained anesthetists are now available even in every big peripheral hospital of the country. We are presenting a record of last 10 years of renal and gall bladder surgery done under spinal anesthesia. We have done total 248 cases of renal stones including 12 nephrectomies for gross hydronephrosis with nonfunctional kidney big mass and 355 cases of open cholecystectomy through classical transverse subcostal incision.

Door-in-door-out times for patients with large vessel occlusion ischaemic stroke being transferred for endovascular thrombectomy: a Victorian state-wide study

BackgroundTime to reperfusion is an important predictor of outcome in ischaemic stroke from large vessel occlusion (LVO). For patients requiring endovascular thrombectomy (EVT), the transfer times from peripheral hospitals in...

Isolated tricuspid valve infective endocarditis: A report of three cases

Abstract This is a case report of three patients who were managed for right sided infective endocarditis, each posing diagnostic challenges due to atypical clinical presentations and negative blood culture results. Case 1 is a 20-year-old female intravenous (IV) drug user who presented with septic emboli to the lung. Case 2 is a 43-year-old woman with a tunnel catheter for dialysis who had huge vegetations on the tricuspid valve which turned out to be fungal in origin. Case 3 is a 45-year-old female with background Ehlers-Danlos syndrome who developed tricuspid endocarditis following IV injections/line in a peripheral hospital. In this report, we discussed the factors causing late diagnosis of isolated tricuspid valve infective endocarditis in our environment, challenges of diagnosing this condition in patients with underlying health issues and the difficulties of obtaining blood culture results.

Solated Pneumopericardium in a Neonate: A Case Report

Pneumopericardium (PPC) is a rare but life-threatening condition that mostly accompanies air leak syndromes in neonates receiving positive pressure ventilation. PPC results from the rupture of the alveoli and subsequent dissection of air through the tissue planes into the mediastinum, pleura, or pericardial sac. This report describes the case of a term low birth weight neonate born in a peripheral hospital who developed respiratory distress soon after birth. She was transported with manual bag and tube ventilation, and was found to have air leak syndrome in the form of isolated PPC. The neonate was managed conservatively with spontaneous resolution of the PPC.

Tek ürolog tarafından kısmen modifiye giyotin tekniği ile yapılan sünnet sonuçları

OBJECTIVE: Circumcision which has a history nearly same with the history of humanity has been being applied in many different techniques over the centuries. Over the times, by the increasing developments in science especially medicine, the circumcision applied in operating room and in appropriate sterilization conditions is one of the oldest known surgical procedures. In this retrospective study, we aimed to discuss the results of the modified guillotine method. MATERIAL and METHODS: Between December 2015 and July 2021, 1295 cases who were circumcised using modified guillotine technique were reviewed retrospectively. Their mean age, duration of surgery and surgical intervention results were evaluated. RESULTS: The mean age of the patients was 4.48±2.7. The mean procedure time was calculated as 15.9±3.3 minutes. In 7 (0%.54) patients complications due to anesthesia, in 25 (1%.93) patients complications due to surgical intervention were observed. Mortal or morbid complications were not observed. CONCLUSION: The modified guillotine method with low complication rates in children who underwent circumcision is a successful surgical procedure which can be used in a second step peripheral district governmental hospital. Keywords: circumcision, guillotine method, child

Amitraz poisoning – A rare and uncommon case of poisoning and its management

A 25-year-old male presented to the peripheral hospital with an alleged history of ingestion of amitraz toxin 12.5% (approximately 150 mL), and presented with complaints of nausea, vomiting, abdominal pain, and weakness. On examination, he was conscious but disoriented and agitated, oxygen saturation (SpO2) was 89%–90% on room air, pulse rate was 40/min, blood pressure (BP) was 110/70 mmHg, and bilateral (B/L) crepitations were present on auscultation. Emergency treatment included – intravenous(IV) fluid, atropine 0.6 mg IV, and gastric lavage. Oxygen was given through an oxygen mask with a reservoir bag at 10 L/min. After some time, the patient's Glasgow Coma Scale (GCS) started deteriorating, and arterial blood gas (ABG) analysis revealed severe acidosis with pH of 7.109, pCO2 – 73, and HCO3 – 23.1, and immediately, the patient was transferred to a higher center given falling GCS, decreased saturation, and ABG finding. On presentation in the emergency department in our tertiary care center, the patient was unconscious, SpO2 was 69% on oxygen nonrebreathing mask – NRBM Mask at 15 L, BP was 128/78 mmHg, pulse rate was 104/min, and B/L crepitations were present on auscultation. The patient was immediately intubated in casualty and shifted to the intensive care unit for further management. Amitraz is a triazapentadiene, 1,5 di (2,4 dimethylphenyl) 3 methyl 1,3,5 triaza penta 1,4 diene, a formamidine pesticide, α2 adrenergic agonist in the central nervous system belongs to the amidine chemical family. The systemic effect of amitraz toxin is due to the activation of the pure α2-adrenergic agonist. It is a rare kind of poisoning in humans, and there exists a paucity of literature on the management of the aforementioned poisoning. Only a limited number of case reports of human intoxication have been published and most of them are of accidental ingestion by children. Due to insubstantial data on its management, this case report will be advantageous for practitioners working in emergency and intensive care departments.

Bacteriobilia frequency in patients afflicted by biliary obstruction at a tertiary care center

Background: Bile typically remains sterile within individuals possessing a normal biliary tract, but bacterial colonization arises with biliary obstruction. Infections often stem from ascending duodenal infection or bacterial translocation from the portal vein. Elevated common bile duct pressure due to obstruction, combined with infected bile, can lead to bacterial backflow into lymphatics, fostering cholangitis. In this study, 30 sequential bile samples were examined, scrutinizing the occurrence of bacteriobilia and comparing its incidence between benign and malignant etiologies. Aims and Objectives: Bacteriobilia typically manifests without symptoms. This study aimed to assess the prevalence of bacteriobilia in patients with obstructive jaundice undergoing endoscopic retrograde cholangiopancreatography (ERCP) at our institution, investigating associated risk factors. Furthermore, the study aimed to elucidate the microbiological profile of bile in obstructed biliary systems, make a comparative analysis of bacteriobilia frequency between benign and malignant obstructions, and delve into the drug sensitivity patterns of bacteria cultured from bile at our center. Materials and Methods: In a prospective, observational, and diagnostic study conducted at the Department of Digestive Health and Diseases, Government Peripheral Hospital, Anna Nagar, Chennai, from September 2011 to February 2012, with ethical committee approval and informed consent from all participants, we investigated 30 consecutive patients who underwent ERCP for biliary obstruction. The study cohort comprised 13 males and 17 females. Following successful biliary cannulation, bile samples were collected and subjected to microbiological analysis. Results revealed positive bile cultures in 16 patients, with 10 exhibiting benign etiology and 6 malignant. Gram-negative organisms, predominantly Klebsiella, were identified, displaying favorable susceptibility to cephalosporins while demonstrating resistance to ciprofloxacin. Results: Bile cultures yielded positive results in 16 patients, with 10 cases attributed to benign etiology and 6 to malignant etiology. The cultured organisms were predominantly Gram-negative, with Klebsiella exhibiting significant growth. Notably, these organisms exhibited favorable susceptibility to cephalosporins while displaying resistance to ciprofloxacin. Conclusion: Bile culture serves as a valuable tool for prompt diagnosis and pre-emptive management of complications. Gram-negative bacilli infections prevail within obstructed biliary systems. This study underscores the pivotal role of routine bile sampling during ERCP in obstructed biliary systems, offering predictive insights to avert complications like cholangitis.

Mitral Valve Endocarditis in Patient Awaiting TAVI: A Case Report

The current literature focuses on the risk of infective endocarditis (IE) following transcatheter aortic valve implantation (TAVI). However, the risk of IE in patients waiting for TAVI is not well-studied. We present a unique case of a patient waiting for TAVI with decompensated heart failure who was found to have a large mitral vegetation, and consider risk factors for the development of IE in this population. We report the case of an 85-year-old male with severe aortic stenosis and recurrent small bowel angiodysplasias, requiring frequent blood transfusions and intravenous iron. He presented to a peripheral hospital in decompensated heart failure. Transfer was arranged to our center to expedite TAVI, under the premise that worsening aortic stenosis precipitated his decompensated state. Prior to TAVI, an echocardiogram was done, and demonstrated a 30 × 18 mm mass on the mitral valve with anterior leaflet perforation and severe mitral regurgitation. The findings were consistent with IE, and the TAVI was cancelled. Despite antibiotic therapy, the patient unfortunately deteriorated and palliative care was provided. This case highlights the need for further research regarding the risk of IE in patients waiting for TAVI. Current literature focuses on the development and management of IE following TAVI. Clinicians must understand that TAVI candidates have multiple risk factors for IE, including valvular disease, age, and comorbidities. IE should be considered as a possible cause for decompensated heart failure in patients awaiting TAVI.

A Study On Utility of Web-Based Drug Warehouse Management System (E-Aushadhi) In A Peripheral Hospital of Metropolitan City of Maharashtra

Introduction: An E-Aushadhi management system based on database was introduced in urban health centre for managing stock outs. This study was conducted to assess utility of web-based drug warehouse management system in a peripheral hospital. Objectives: The objectives of this study were to assess the perceived benefits and difficulties by health care providers expected in introducing a web-based Supply Chain Management System (E-aushadhi) and to identify the factors which will govern successful transition from current system of drug logistics management to web-based system. Methods and materials: In this study Focus Group Discussion was conducted with the staff members of an urban health centre who were working on a similar web-based platforms. There are four teams each comprising 3-5 members. Results: Themes and subthemes were made based on the transcripts analysed. It is perceived that with introduction of web-based drug warehouse system, accuracy of the data can be well assured as manual errors can be reduced a lot. Quality of stock maintenance will increase and will prevent stock outs Conclusion: The accuracy and transparency of drug stock maintenance will be increased while technical challenges such as internet availability, technician availability and training of personnel are perceived barriers.

Tracheo-oesophageal fistula - A disastrous complication of endotracheal intubation!

A 28-year old man required invasive mechanical ventilation in view of organophosphorus poisoning in a peripheral hospital. His trachea was extubated ten days later following which he presented with dysphagia, voice change, burping, fever and cough. He was referred to our hospital for further management. His barium swallow radiograph showed a large tracheo-oesophageal fistula. Therefore, he was scheduled for oesophageal transection and colonic transposition. Following induction of anaesthesia, despite easy laryngoscopy view (Cormack Lehane grade 1), the tracheal intubation was found to be difficult as the tube tended to pass through the fistula into the oesophagus repeatedly as confirmed by absence of capnogram trace. Attempts to bypass the fistula using a fibreoptic scope and even a double lumen tube also failed. Identification of oesophageal intubation would have been missed or possibly detected late in this case with disastrous consequences but for absence of capnogram. Finally, the tracheal tube was successfully negotiated beyond the fistula with the help of a gum elastic bougie directed anteriorly into the trachea and a good capnogram was obtained. The surgery was uneventful and the trachea was extubated 24 h later in the intensive care unit following which the patient developed stridor requiring permanent tracheostomy. This case report illustrates the novel use for gum elastic bougie during tracheal intubation. This also highlights the importance of repeated measurement of tracheal cuff pressure in patients especially those receiving long duration mechanical ventilation.

Preliminary assessment of antivenom availability and management in the public health system of Costa Rica: An analysis based on a survey to pharmacists in public health facilities.

Availability and accessibility of safe and effective antivenoms are key elements for the successful treatment of snakebite envenoming (SBE). This study provides a preliminary analysis on the way antivenoms are managed by the public health system in Costa Rica and on the role played by pharmacists in the overall management of antivenoms. This was an observational, cross-sectional study based on an online survey sent to pharmacists working at Caja Costarricense de Seguro Social (Costa Rican Social Security System; CCSS) in different locations in Costa Rica. Characteristics and location of health facilities, as well as antivenom availability and management details, were analyzed. Responses from a total of 96 pharmacists, corresponding to 55 different healthcare facilities, were included in this study. Most respondents worked at pharmacies located in urban communities (69.0%) and in the secondary level of care, which includes clinics, and regional and peripheral hospitals (55.2%). Overall, participants reported antivenom availability at all levels of care and in centers having various operating schedules, although they were not available in some facilities in regions where SBE is uncommon or do not attend SBE cases because of the proximity of more complex health centers. On average, the stocks of anticoral and polyvalent antivenoms per health facility were compatible with the dose of antivenom required for treating a SBE case. More than half of participants reported knowing the availability of protocols for the management of SBE and the correct use of antivenom at their healthcare facilities. Of the total respondents, 49% agreed on possessing all the resources needed for the correct management of these medicines at their facilities, and 65.6% indicated that they know the procedures for antivenom storage and management. Our findings provide a first description of the availability of antivenoms in the public health system of Costa Rica, including the primary care level. Results also underscore the perceived role of participating pharmacists in the management of these life-saving drugs and the need to improve their knowledge on this topic.

Subacute invasive pulmonary aspergillosis misdiagnosed as tuberculosis in a Nigerian man: A case report

Subacute invasive pulmonary aspergillosis is a form of chronic pulmonary aspergillosis (CPA) with rapid progression. The clinical features of CPA mimic tuberculosis (TB) and may lead to delayed and/or misdiagnosis. We report a 39-year-old Nigerian previously managed in a peripheral hospital as a case of TB despite negative Gene-X pert results with no resolution of symptoms. Chest X-ray and computer tomography findings were suggestive of CPA and galactomannan assay positive. Symptoms resolved 2 months into itraconazole treatment. There is a dire need to drive awareness of CPA among clinicians, especially in our primary and secondary healthcare facilities where the knowledge base and expertise in the management of fungal infections is still at a rudimentary level or perhaps not available at all.

Insulin initiation in Type 2 diabetes mellitus outpatients – data from the multicentre evaluation of type 2 diabetes mellitus outpatients on insulin therapy in Nigeria (METOIN study)

People living with type 2 diabetes mellitus (T2DM) have relative insulin deficiency and, therefore, have options to insulin therapy. To be on insulin alone or in combination with other therapies in type 2 DM outpatients is a choice made personalized for each patient. Published literature on the insulin initiation patterns among T2DM outpatients in Nigeria is scanty. The objective of this study, therefore, is to bridge this gap in knowledge. This was a prospective cross sectional study conducted in five tertiary health facilities in Nigeria in which consenting type 2 DM outpatients on insulin therapy alone or in combination with other therapies and who meet the inclusion criteria for the study were recruited. Relevant data relating to insulin use initiation by the patients were analyzed using Statistical Package for Social Sciences (SPSS) version 23.0 software. A total of 268 outpatients living with type 2 DM on insulin therapy, made up of 116 (43.3%) male and 152 (56.7%) females participated in the study. Only 55 (20.5%) of the patients started insulin at onset of diagnosis of T2DM while 46 (17.2%) of the patients started insulin therapy after 5 years of living with T2DM. The duration of living with DM before insulin initiation and the patient's highest level of education were not statistically significant. Insulin initiation was delayed several months to years after diagnosis of T2DM by predominantly endocrinologists in tertiary health facilities but it was initiated in 19 (7.1%) of the T2DM outpatients by primary care physicians (GPs) in peripheral hospitals. It is recommended that diabetes education be intensified for T2DM patients to appreciate the key role of insulin therapy in diabetes care.
 Keywords: insulin initiation, type 2 diabetes mellitus outpatients, Nigeria.

One hundred ECMO retrivals before and during the Covid-19 pandemic: an observational study

ObjectivesPatients with severe acute respiratory distress syndrome may require veno-venous extracorporeal membrane oxygenation (V-V ECMO) support. For patients in peripheral hospitals, retrieval by mobile ECMO teams and transport to high-volume centers is associated with improved outcomes, including the recent COVID-19 pandemic. To enable a safe transport of patients, a specialised ECMO-retrieval program needs to be implemented. However, there is insufficient evidence on how to safely and efficiently perform ECMO retrievals. We report single-centre data from out-of-centre initiations of VV-ECMO before and during the COVID-19 pandemic. Design & settingSingle-centre retrospective study. We include all the retrievals performed by our ECMO centre between January 1st, 2014, and April 30th, 2021. ResultsOne hundred ECMO missions were performed in the study period, for a median retrieval volume of 13 (IQR: 9–16) missions per year. the cause of the acute respiratory distress syndrome was COVID-19 in 10 patients (10 %). 98 (98 %) patients were retrieved and transported to our ECMO centre. To allow safe transport, 91 of them were cannulated on-site and transported on V-V ECMO. The remaining seven patients were centralised without ECMO, but they were all connected to V-V ECMO in the first 24 hours. No complications occurred during patient transport. The median duration of the ECMO mission was 7 hours (IQR: 6–9, range: 2 – 17). Median duration of ECMO support was 14 days (IQR: 9–24), whereas the ICU stay was 24 days (IQR:18–44). Overall, 73 patients were alive at hospital discharge (74 %). Survival rate was similar in non-COVID-19 and COVID-19 group (73 % vs 80 %, p = 0.549). ConclusionIn this single-centre experience, before and during COVID-19 era, retrieval and ground transportation of ECMO patients was feasible and was not associated with complications. Key factors of an ECMO retrieval program include a careful selection of the transport ambulance, training of a dedicated ECMO mobile team and preparation of specific checklists and standard operating procedures.

Traumatic Femoral Neck Fracture in a Child After a Motor Vehicle Accident: A Case Report

Femoral neck fractures in children are extremely rare. They are usually unilateral and the product is of a high-velocity impact. The presence of a femoral neck fracture in a child should prompt the attending physician to look for other serious injuries and continuous monitoring should commence in a high care setting. Early surgery (open reduction and internal fixation) is key to preventing avascular necrosis. We present an 11-year-old, previously well, female who sustained a right hip dislocation and femoral neck fracture after a motor vehicle accident. The patient was stabilized at a nearby peripheral hospital and a closed reduction of the hip was attempted under sedation. The post-reduction x-ray showed a femoral neck fracture with the femoral head displaced posteriorly.