Traumatology Research Articles

Knowledge survey regarding blast wound education of student doctors at a local academic medical university in Japan.

To improve knowledge about blast injury for medical student doctors or surgeons. In the modern uncertain era, education and training programs for blast injuries for medical student doctors or surgeons are recently necessary worldwide. To understand primary corresponding ability to treat blast injuries, leading to improvement of the trauma education curriculum, a retrospective study by a knowledge survey was performed between 2018 and 2019. The subject had the title of Student Doctor (SD) at university. The answers of 183 participants who answered the interview questionnaire with 16 questions were summarized. Although most SDs received basic lectures for trauma medicine and majority of SDs knew about mass casualty incidents and primary treatment, the existence of knowledge on soft targets is limited. One-fourth of the SDs knew the characteristics of blast wounds. Most SDs understood priority triage for a conscious person with massive bleeding from a limb with hemostasis to save lives. The 17% selected cardiopulmonary resuscitation first and 72% of SDs could explain hemorrhagic shock; however, only four could explain adequate hemostatic procedures. Most had no interest regarding necessity of their knowledge in the field of serious blast trauma wounds. Experience in trauma surgery training from stages in SDs and authorized education are important for raising students' knowledge of unexpected serious blast incidents.

International Trauma Capacity Building Programs: Modernizing Capabilities, Enhancing Lethality, Supporting Alliances, Building Partnerships, and Implementing Reform.

The Military Health System directly supports the National Security and Defense Strategy priorities of modernizing capabilities, enhancing lethality, supporting alliances, building partnerships, and implementing reform. Trauma medicine training programs with partner nations is a key lever that can be pulled, using a risk-based decision-making process, to scale up efforts toward these national priorities.

Nonoperative Care Including Rehabilitation Should Be Considered and Clearly Defined Prior to Elective Orthopaedic Surgery to Maximize Optimal Outcomes

Orthopaedic surgery has revolutionized the expectations for restoration of physical function after musculoskeletal injury and, along with physical therapy, has transformed the limits of recovery. Many orthopaedic procedures have a high success rate for improving quality of life and patient-reported outcomes, yet these procedures carry some level of risk, including postoperative complications. The stepped-care model of health care delivery, when applied to musculoskeletal care, recommends implementing less-intense and lower-risk treatments with known efficacy, such as promotion and education of self-management strategies and physical therapy, before more-invasive and higher-risk treatments such as surgery. This model of managing musculoskeletal disability can improve efficiency of care delivery and reduce medical costs at the health system level. Unfortunately, there is a documented lack of implementing an appropriate course of conservative care, especially physical therapy, prior to surgery across multiple orthopaedic disciplines including sports, spine, and trauma medicine and joint arthroplasty. Failure to respond to nonsurgical treatment has been suggested as a requisite component of the surgical appropriateness criteria, yet practical application can be elusive. Multiple barriers to adequate utilization of conservative treatment exist, including U.S. payment models that increase out-of-pocket expense for patients, negative patient perception of therapy, unreasonable patient expectations from therapy versus surgery, and communication barriers between patient, surgeon, and therapist. Surgeons should ensure that high-quality guideline-appropriate care is delivered early and adequately to their patients. Rehabilitation professionals have a responsibility to deliver high-value care, properly documenting the type and extent of treatment to improve surgical decision-making between surgeons and patients. Criteria to determine appropriateness for surgery should include a standardized and extensive assessment of failed therapies prior to certain elective surgeries. Improved collaboration between surgeons and rehabilitation professionals can result in improved outcomes for patients with musculoskeletal disorders. Level of EvidenceV, expert opinion

Need to review anaesthesia curriculum and education!

Need to review anaesthesia curriculum and education!

Born of war and walk towards war—Looking back on the development of trauma medicine under the leadership of the Communist Party of China in the past century

Born of war and walk towards war—Looking back on the development of trauma medicine under the leadership of the Communist Party of China in the past century

125th issue of Der Unfallchirurg and 100 years of the German Society for Trauma Surgery (1922-2022)-A mutual history

Die Zeitschrift Der Unfallchirurg und die Deutsche Gesellschaft für Unfallchirurgie (DGU) verbindet eine bewegte Geschichte, die 2022 in einem gemeinsamen Jubiläumsjahr einen Höhepunkt findet. Der Unfallchirurg, beginnend als Monatsschrift für Unfallheilkunde, hatte bereits 2019 als heutige Fachzeitschrift der DGU 125 Jahre Bestand, allerdings war der Druck 1944 im 51. Jahrgang durch die Wirren und schwerwiegenden Folgen des Zweiten Weltkriegs zum Erliegen gekommen und erst 1949 mit dem 52. Jahrgang wieder neu erschienen. Die DGU durchlief in ihrer 100-jährigen Geschichte inhaltlich, politisch und personell vier zeitlich abgrenzbare Phasen, denen ihre Vorphase als „Abtheilung für Unfallheilkunde“ innerhalb der Gesellschaft Deutscher Naturforscher und Ärzte (GDNÄ) hinzuzurechnen ist. In einer Zusammenschau mit dem Werdegang der Fachzeitschrift analysiert der vorliegende Beitrag die über 125-jährige Entwicklung der DGU.

A Complex Evaluation of the In-Vivo Biocompatibility and Degradation of an Extruded ZnMgSr Absorbable Alloy Implanted into Rabbit Bones for 360 Days.

The increasing incidence of trauma in medicine brings with it new demands on the materials used for the surgical treatment of bone fractures. Titanium, its alloys, and steel are used worldwide in the treatment of skeletal injuries. These metallic materials, although inert, are often removed after the injured bone has healed. The second-stage procedure—the removal of the plates and screws—can overwhelm patients and overload healthcare systems. The development of suitable absorbable metallic materials would help us to overcome these issues. In this experimental study, we analyzed an extruded Zn-0.8Mg-0.2Sr (wt.%) alloy on a rabbit model. From this alloy we developed screws which were implanted into the rabbit tibia. After 120, 240, and 360 days, we tested the toxicity at the site of implantation and also within the vital organs: the liver, kidneys, and brain. The results were compared with a control group, implanted with a Ti-based screw and sacrificed after 360 days. The samples were analyzed using X-ray, micro-CT, and a scanning electron microscope. Chemical analysis revealed only small concentrations of zinc, strontium, and magnesium in the liver, kidneys, and brain. Histologically, the alloy was verified to possess very good biocompatibility after 360 days, without any signs of toxicity at the site of implantation. We did not observe raised levels of Sr, Zn, or Mg in any of the vital organs when compared with the Ti group at 360 days. The material was found to slowly degrade in vivo, forming solid corrosion products on its surface.

CORR Insights®: Do Adhesive Drapes Have an Effect on Infection Rates in Orthopaedic Surgery? A Systematic Review and Meta-analysis.

Where Are We Now? For ideal surgical skin preparation and draping, plastic adhesive incisional drapes are placed on the skin directly over the incision site, and surgeons then make their incisions through the adhesive drape [7]. In orthopaedic surgery, these drapes are widely used in total joint arthroplasty because of their potential to reduce the risk of surgical site infections [4]. But despite improved infection prevention protocols, little progress has been made in decreasing the incidence of periprosthetic joint infection (PJI). In one population-based study, no improvement in infection rates was observed over a 15-year period [5]. The fact that the incidence of PJI remains unchanged over time means we have more work to do. Things seem no more promising on the treatment side; the survivorship of arthroplasties after irrigation and debridement, and after two-stage revisions, has not improved over the last two decades or so [8]. In the current study, Mundi et al. [6] performed a meta-analysis of MEDLINE and Embase databases and gathered evidence from randomized controlled trials that compared drapes with controls from 2000 to 2021. They had relatively little to work with; appropriately, they restricted the study to randomized trials, but only four were available in this massive database review that employed a 20-year data pull. Based on data from pooled wound swab cultures, Mundi et al. [6] found that four studies showed a reduction in wound contamination with the use of adhesive drapes. The findings of this meta-analysis suggest that adhesive drapes, including those with antimicrobial properties, decrease the risk of wound contamination during orthopaedic procedures. In circumstances where drape adhesion is compromised and peel back occurs at the wound edge, there is an increased risk of wound contamination with the use of adhesive drapes. In light of these findings, it’s fair to conclude that the best-available evidence is indeterminate as to the effect of adhesive drapes on the risk of surgical site infections; however, if used, care should be taken to avoid or minimize drape peel back. Where Do We Need To Go? Meta-analyses are most helpful when the source studies disagree. In my large, busy group practice, we generally use adhesive drapes in trauma, total joint arthroplasty, and sports medicine procedures. Do we have the data to justify this practice in these areas? The current study [6] found that two of the studies supported routine use of adherent drapes, while two randomized clinical trials showed no difference. The authors could not definitively prove that peeling back the drapes for closure or inadvertent peel back during the procedure was adverse. How might postoperative dressings protect against inadvertent skin contamination that occurs during surgery or dressing peel back? We don’t have a lot of experience to go on, despite this extensive meta-analysis. Personally, I have concerns that we are missing something, because in my practice, I am seeing an increase in unusual skin flora infections. Future studies need to further examine these gaps in our knowledge. Surgeons should look at all the ways to reduce infection. We need to be vigilant about antibiotic stewardship and draping. How Do We Get There? Randomized draping studies are realistically difficult to do because it would take a second study of more than 4000 patients to demonstrate a reduction from 2% PJI to 1% PJI by changing drapes. In our practice, we utilize barrier draping for trauma, adult reconstruction, and sports medicine procedures to try and isolate the skin flora from the deep wound. However, there is a paucity of data to support this practice. Other studies should focus on antibiotic stewardship, other barrier drapes, wound vacs, or antibiotic impregnated barriers to reduce contamination at the time of surgery [3]. There are few surgical draping studies available, but future studies should focus on decreasing the skin contamination, reducing risk of peel back, and combating the higher more insidious skin flora infections that seem to be on the rise.

Reevaluating The Role Of Obesity In Healthcare Outcomes

More than 130 million Americans visit emergency departments each year. Between 1996 and 2009, there was a 13-fold increase in documentation of obesity as the principal diagnosis. Fewer than 25% of these patients meet ACSM recommendations for aerobic and resistance exercise, and no more than a third are counseled on exercise behavior. For exercise counselling to become standard practice, we must improve the nature of reporting. PURPOSE: To examine how obesity is documented in a clinical setting and estimate its effect on patient outcomes. METHODS: We conducted a chart review of two patient samples over a 4-year period (2012-2015). Both samples were drawn from a single institution; 768 were treated at the trauma center (TC) and 2,106 were treated at the emergency department (ED). All patients in both samples were between 15 and 85 years of age and had a Glasgow Coma Scale score ≥ 14. We evaluated obesity reporting and the consequences of obesity on patient outcomes using logistic, linear, and negative binomial regressions as appropriate. RESULTS: In both samples, documenting of obesity increased each year (p < 0.001). In the TC group, 3.3% of patients were documented as obese in 2012, 9.4% in 2013, 30.0% in 2014, and 24.3% in 2015. In the ED sample, 1.1% of patients were documented as obese in 2012, 7.0% in 2013, 29.6% in 2014, and 34.0% in 2015. In 2014 and 2015, when reporting was sufficient, obese patients had lower oximetry (p = 0.020), higher heart rate (p = 0.010), higher systolic (p = 0.006) and diastolic (p = 0.027) blood pressure, more myocardial infarctions (p = 0.014), and higher rates of hypertension (p = 0.007) and diabetes (p < 0.001). Controlling or age, sex, and injury severity, patients categorized as obese cost $31 k more to the patient (p = 0.005) and $16 k more to the hospital (p = 0.002). Holding sex and age constant, the odds of experiencing a myocardial infarction were 3.1-fold higher in obese patients (p = 0.006) and the odds of being diagnosed with diabetes were 3.0-fold higher (p < 0.001). CONCLUSIONS: Obesity is a strong predictor of patient outcomes in both trauma and emergency medicine. These findings delineate the obesity trends in patient samples and emphasize the importance for obesity interventions using information from clinical settings. Physicians are well-positioned to emphasize exercise guidelines to patients.

Asymmetric composite wound nanodressing with superhydrophilic/superhydrophobic alternate pattern for reducing blood loss and adhesion

Wound dressings are of great importance in trauma medicine. However, such dressings are poor in hemostatic effect, and they easily adhere to the wound skin, leading to their unsatisfactory effects for clinical application. Herein, we developed a new concept of creating an asymmetric composite wound nanodressing (ACWN) with unique structure consisting of superhydrophilic/superhydrophobic alternate inner layer and superhydrophobic outer layer. Compared to traditional hemostatic materials, our fabricated material consisted of integration of alternate micropattern wettability of the inner layer and the asymmetric wettability of the inner/outer layers into simple gauze. This ACWN was verified to overcome the challenge of reducing blood loss and simultaneously reducing adhesion based on the results of rat experiments both in in vivo and in vitro. Importantly, the resulting ACWN exhibited efficient blood absorption and clotting abilities on the zone of superhydrophilic inner layer. Moreover, the zone of superhydrophobic inner layer with blood repellency could avoid pain and secondary injuries caused by forced removal of dressings, and its outer layer could further prevent blood extravasation and reduce the risk of infection. Undoubtedly, this effective strategy provides new insight into the practical application of hemostatic materials.

What Is New in Pediatric Bone Health.

This review paper aims to report on the last 5 years of relevant research on pediatric bone health in regard to nutrition and obesity, ethnic disparities, common orthopaedic conditions, trauma, spine, and sports medicine. A search of the PubMed database was completed using the following terms: bone health, Vitamin D, pediatric, adolescent, sports medicine, fractures, spine, scoliosis, race, ethnicity, obesity, Slipped Capital Femoral Epiphysis, Osteogenesis Imperfecta, Duchenne's Muscular Dystrophy, neuromuscular, and cancer. Resultant papers were reviewed by study authors and determined to be of quality and relevance for description in this review. Papers from January 1, 2015 to August 31, 2020 were included. A total of 85 papers were selected for review. General results include 7 key findings. (1) Obesity inhibits pediatric bone health with leptin playing a major role in the process. (2) Socioeconomic and demographic disparities have shown to have a direct influence on bone health. (3) Vitamin D deficiency has been linked to an increased fracture risk and severity in children. (4) Formal vitamin D monitoring can aid with patient compliance with treatment. (5) Patients with chronic medical conditions are impacted by low vitamin D and need ongoing monitoring of their bone health to decrease their fracture risk. (6) Vitamin D deficiency in pediatrics has been correlated to low back pain, spondylolysis, and adolescent idiopathic scoliosis. Osteopenic patients with AIS have an increased risk of curve progression requiring surgery. Before spine fusion, preoperative screening for vitamin D deficiency may reduce complications of fractures, insufficient tissue repair, loosening hardware, and postoperative back pain. (7) Increasing youth sports participation has resulted in increased bone health related injuries. However, improved understanding of Relative Energy Deficiency in Sport effects on bone health has recently occurred. Increasing awareness of bone health issues in children will improve their recognition and treatment. Further research is needed on diagnosis, treatment, outcomes, and most importantly prevention of pediatric bone health diseases.

Emerging approaches to pre-hospital hemorrhage control: a narrative review.

In the United States, trauma claims the lives of over 150,000 civilians each year. In military settings, trauma and exsanguination result in 50% of combat related deaths. The majority of these deaths result from uncontrolled non-compressible hemorrhage. Non-compressible hemorrhage often results from deep vascular injuries within the torso, however can also occur secondary to penetrating injuries that involve the extremities. Given the high mortality rates for non-compressible hemorrhage, rapid and effective management of patients suffering from hemorrhage is essential to good patient outcomes. Consequently, there has been increasing interest in solutions for point-of-injury hemorrhage control in trauma and military medicine. Undoubtedly there is a great need for prehospital hemostatic interventions that can be deployed by trained and untrained personnel. Since 2001, various hemostatic agents have been developed, each with its advantages based upon the type and severity of injury, wound size, wound location, accessibility to injury site, and the coagulation status of the patient. These agents are often used in the military setting as a temporizing measure prior to definitive therapy and include techniques such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and bioengineered agents including ResQFoam, RevMedx’s XSTAT, Tranexamic acid (TXA), and QuikClot Combat Gauze (QCG). Here, we review the indications, composition, technique, efficacy, and outcomes of these hemostatic agents.

Predeployment training of Army medics assigned to prehospital settings.

Medics have numerous responsibilities in the combat theater, which include performing lifesaving interventions, providing basic medical and nursing care, and caring for casualties in a variety of scenarios unique to the battlefield. An evaluation of the medic predeployment training paradigm is important and will help to understand its current state and identify areas for improvement. Therefore, the purpose of this study was to perform a focused assessment of Army medic predeployment training to identify patterns that might inform future medic training. A web-based survey was created using the Intelink.gov platform and sent by e-mail to Army medics who deployed since 2001. Medics were asked to reflect upon the predeployment training from their most recent deployment experience. There were multiple choice, Likert-type scale, and free-text response questions. Descriptive statistics were used to analyze the results. There were 254 respondents who met the study inclusion criteria. Most of the respondents had their clinical competency evaluated (68.5%, n = 174). Respondents reported several acute trauma, basic nursing, and battlefield medicine skills as being critical but also felt that many of these same skills would have benefited from additional predeployment training. Most of the respondents felt very or fully confident and prepared to provide combat casualty care (74.8%, n = 190 and 74.8%, n = 190). There were 64 respondents (25.2%) who reported feeling not at all, slightly, or moderately confident, and 54 (84.4%) of these respondents described in a free-text question wanting additional training before deployment. Respondents reported many skills as being critical to combat casualty care, but several of these skills would have benefited from additional predeployment training. Respondents with more deployment experience or completion of more predeployment training reported feeling more confident and prepared to provide combat casualty care. A common sentiment was the desire for more training of any form before deployment. Epidemiological, level IV.

2 Rates of Follow up After Burn Injury Are Disturbingly Low and Linked with Social Factors

Abstract Introduction Due to risks of scarring and difficulties with re-socialization, it is important that burn patients attend follow up appointments to minimize adverse sequelae. Studies in trauma and emergency medicine have shown a correlation between reduced follow up and low socioeconomic status. Our goal was to examine the factors leading to missed follow up appointments in the burn center population. Methods Following IRB approval, a retrospective chart review was conducted using electronic medical records of all adult patients admitted to the burn center from 2016–2018. Data collected included information on burn injury, social status, substance use, and zip code demographics. Exclusions included patients with non-burn injuries, who died in the hospital, who were transferred to another hospital, who did not have any scheduled outpatient follow up, who had insurance which precluded follow up at our institution, and prisoners. Data analysis was conducted using chi-square, t-test, linear, and logistic regression models. Results A total of 878 patients (mean age 45.1 ± 16.8 years, 646 males (73.6%), mean burn size (TBSA) 10.16±11.7%) were analyzed. In our population, 96 (10.93%) patients were homeless, 284 (32.35%) had drug dependence, 128 (14.58%) had alcoholism, and the mean poverty level was 17.7±8.34%. Of those analyzed, 224 (25.5%) failed to attend any follow up appointments and 492 (56.0%) had at least one missed appointment. Patients who did not attend any follow up appointments had smaller burns (8.2±9.5% vs. 10.8±12.3%), traveled farther (91.8±101.1 miles vs. 69.0±68.7 miles), were more likely to be homeless (22.8% vs. 6.9%) and to have drug dependence (47.3% vs. 27.2%). Patients who missed at least one appointment were younger (43.8±16.1vs. 46.8±17.4 years), more likely to be homeless (17.5% vs. 2.6%) and have drug dependence (42.5% vs. 19.4%). On multivariate analysis, factors associated with never returning to clinic were: Distance from hospital (odds ratio (OR) 1.004, p=0.0001), TBSA (OR 0.96, p= 0.0001), Drug Dependence (OR 0.49, p&amp;lt; 0.0001), and Homelessness (OR 0.31, p&amp;lt; 0.0001). Factors associated with missing at least one appointment were: Age (OR 0.99 p&amp;lt; 0.03), Drug Dependence (OR 0.51, p&amp;lt; 0.0001), Homelessness (OR 0.20, p&amp;lt; 0.0001), and ED visits (OR 0.57, p&amp;lt; 0.05). Conclusions In our population, a high percentage of patients fail to make any appointment following their injury and an even higher number miss at least one appointment. The factors that influence failure to return and missing at least one appointment are similar but not exactly the same. Both follow up and missed appointments are influenced by social determinants of health.

Acute Mild Traumatic Brain Injury Assessment and Management in the Austere Setting-A Review.

Traumatic brain injury (TBI) continues to be a major source of military-related morbidity and mortality. The insidious short- and long-term sequelae of mild TBIs (mTBIs) have come to light, with ongoing research influencing advances in patient care from point of injury onward. Although the DoDI 6490.11 outlines mTBI care in the deployed setting, there is currently no standardized training requirement on mTBI care in the far-forward deployed setting. As the Joint Trauma System (JTS) is considered to be one of the leaders in standard of care trauma medicine in the deployed environment and is often the go-to resource for forward-deployed medical providers, it is our goal that this review be utilized by the JTS with prominent mTBI resources to disseminate a clinical practice guideline (CPG) appropriate for the far-forward operational environment. The resources used for this review reflect the most current data, knowledge, and recommendations associated with research and findings from reputable sources as the Traumatic Brain Injury Center of Excellence (TBI CoE; formerly the Defense and Veterans Brain Injury Center), the Center for Disease Control and Prevention, as well as prominent journals such as Academic Emergency Medicine, British Journal of Sports Medicine, and JAMA. We searched for articles under keyword searches, limiting results to less than 5 years old, and had military relevance. About 1,740 articles were found using keywords; filters on our search yielded 707 articles, 100 of which offered free full text. The topic of far-forward deployed management of mTBI does not have a robust academic background at this time, and recommendations are derived from a combination of academic evidence in more traditional clinical settings, as well as author's direct experience in managing mTBI casualties in the austere environment. At the time of this writing, there is no JTS CPG for management of mTBI and there is no pre-deployment training requirement for medical providers for treating mTBI casualties in the far-forward deployed setting. The TBI CoE does, however, have a multitude of resources available to medical providers to assist with post-mTBI care. In this article, we review these clinical tools, pre-planning considerations including discussions and logistical planning with medical command, appropriate evaluation and treatment for mTBI casualties based on TBI CoE recommendations, the need for uniform and consistent documentation and diagnosis in the acute period, tactical and operational considerations, and other considerations as a medical provider in an austere setting with limited resources for treating casualties with mTBIs. Given the significant morbidity and mortality associated with mTBIs, as well as operational and tactical considerations in the austere deployed setting, improved acute and subacute care, as well as standardization of care for these casualties within their area of operations is necessary. The far-forward deployed medical provider should be trained in management of mTBI, incorporate mTBI-associated injuries into medical planning with their command, and discuss the importance of mTBI management with servicemembers and their units. Proper planning, training, standardization of mTBI management in the deployed setting, and inter-unit cooperation and coordination for mTBI care will help maintain servicemember readiness and unit capability on the battlefield. Standardization in care and documentation in this austere military environment may also assist future research into mTBI management. As there is currently no JTS CPG covering this type of care, the authors recommend sharing the TBI CoE management guideline with medical providers who will be reasonably expected to evaluate and manage mTBI in the austere deployed setting.

Sonographic Evaluation of Peripheral Sciatic Nerve Injury: A Case Study

Traumatic peripheral nerve injury is not a common finding in the general population but is increasingly being recognized and diagnosed in trauma and emergency medicine settings. Peripheral nerve injury can cause temporary or long-term motor and sensory loss, as well as intense pain and disability, if left untreated. The cause of peripheral nerve injury is diverse and often involves soft tissue damage, fractures, and hemorrhage in cases of traumatic injury. Peripheral nerve injury does not always heal spontaneously and, depending on severity, may warrant surgical intervention and repair. Although electrodiagnosic testing and surgical exploration are considered gold standards for peripheral nerve injury, high-resolution sonographic examination supplemented by clinical findings may be of value. The use of sonography demonstrated utility in determining a strategic management timeline and the efficacy of a surgical intervention.

Inexperienced but Confident: A Survey of Advanced Life Support Providers and Life-saving Interventions in the Israel Defense Forces.

The objective of this study was to assess the current experience of Israel Defense Forces' (IDF) advanced life support (ALS) providers in performing life-saving interventions (LSIs), the rate of doctors and paramedics achieving the Trauma and Combat Medicine Branch benchmarks, and the rate of providers feeling confident in performing the interventions although not achieving the benchmarks. This study was based on an online survey delivered to IDF ALS providers. The survey investigated demographics; experience in performing endotracheal intubation, cricothyroidotomy, tube thoracostomy, and intraosseous access on human patients; and confidence in performing these LSIs. All benchmarks chosen referred to the number of times performed in the previous year. The benchmarks were 20 for intubation, 3 for cricothyroidotomy, 4 for tube thoracostomy, and 3 for intraosseous access. During the survey period, 175 IDF ALS providers started the survey, but only 138 (79%) completed it, 93 (67%) of them were paramedics. Doctors had higher rates than paramedics of failing to achieve the benchmarks for intubation (96 vs. 57%, P < .001) and intraosseous access (100 vs. 66%, P < .001). All respondents failed to achieve the benchmark for cricothyroidotomy, and all but one paramedic failed to achieve the tube thoracostomy benchmark. Doctors had lower rates of high confidence when failing to achieve the benchmark for intubation (35 vs. 64%, P = .008) and intraosseous access (7 vs. 31%, P = .005) compared to paramedics. IDF ALS providers have alarmingly limited experience in performing LSIs. Many of them are confident in their ability despite not achieving evidence-based benchmarks. Additional training is required, maybe as a part of an annual medical fitness test.

Fatal and non-fatal injuries due to suspension trauma syndrome: A systematic review of definition, pathophysiology, and management controversies.

Suspension trauma syndrome is a life-threatening event that occurs when a person is "trapped" in a prolonged passive suspension. It is most commonly seen in people who engage in occupational or sport activities that require harness suspension. The aim of this study is to identify the predisposing factors, pathophysiology, and management of suspension trauma. A review and analysis of the literature published in English and Spanish from 1972 to 2020 on suspension trauma were performed. Search sources were PubMed, Medline, Cochrane Library, MeSH, UpToDate, and Google Scholar. Articles referring to suspension trauma associated with other injury mechanisms (traumatic impact injuries, drowning, asphyxiation, or bleeding), case reports, and pediatric population were excluded. Forty-one articles were identified. Of these, 29 articles related to mechanism, pathophysiology, and management of individuals who suffered prolonged suspension trauma without associated traumatic injuries were included in the study. We encountered several controversies describing the putative pathophysiology, ranging from blood sequestration in the lower extremities versus accumulation of metabolic waste and hyperkalemia to dorsal hook-type harness as a trigger cause of positional asphyxia; to vascular compression of femoral vessels exerted by the harness causing decreased venous return. Pstients suspended in a full-body harness with dorsal hook showed more hemodynamic alterations in response to the compressive effect on the rib cage, causing a reduction in perfusion by presenting a decrease in pulse pressure. Management strategies varied across studies. Progress has been made in individualizing the population at risk and in the management of suspension trauma. We recommend the formation of consensus definitions, larger cohort or registry studies to be conducted, and experimental animal models to better understand the mechanisms in order to develop management and life support guidelines from a trauma and emergency medicine perspective.

Artificial intelligence in musculoskeletal conditions.

Artificial intelligence (AI) is an iterative process by which information is captured, transformed into knowledge and processed to produce adaptive changes in the environment. AI is a broad concept, involving virtual (computing) and physical (robotics) elements. In this narrative literature review, we focus on the aspects of AI that present major opportunities for developing health care. Within a few years, AI will be part of our daily clinical practice. Although significant advances are being made, the application of AI in musculoskeletal medicine is still in its early stages compared with its implementation in other areas of medicine. AI is increasingly being employed in fields such as musculoskeletal radiology, skeletal trauma, orthopedic surgery, physical and rehabilitation medicine and sports medicine, as well as for "big data" and AI in gastrointestinal (GI) endoscopy related injuries. Among the limitations of IA are that it analyzes information based on the data it is supplied, which must therefore be well-labeled and that some algorithms such as DL uses more time, data, and computational power than other techniques. Moreover, AI currently does not solve the problem of causality that exists in medicine with observational data; information that physicians interpret within a broad clinical context. AI should therefore be integrated in a prudent and reasonable manner into the workflows of health professionals.

Medical students' perception of a trauma, resuscitation and emergency medicine interest group

Medical students' perception of a trauma, resuscitation and emergency medicine interest group