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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Massive transfusion protocol: the reason it is necessary

Abstract

Objective. The purpose of this study is to identify problems of emergency transfusion at the bedside and to determine need for massive transfusion protocol.

Methods. We included patients who met the criteria for “trauma team activation” and were admitted to division of trauma. The amount of blood product transfused in each unit was investigated for balanced transfusion. We also investigated the compliance with assessment of blood consumption score. The correlation between the time elapsed from patient visit to first transfusion order and time elapsed from first transfusion order to transfusion start was analyzed. Finally, we investigated various factors which serve to influence the decision-making process regarding early transfusion order.

Results. Ratio of packed Red blood cells (pRBC): Fresh frozen plasma (FFP) was well-balanced, but platelet transfusion done was much lower than pRBC and FFP in emergency room. The application of emergency blood release did not match the criteria of assessment of blood consumption (ABC) score. The time from the first transfusion order to the transfusion start was found to be constant irrespective of time from patient visit to first transfusion order. And, the time from the first transfusion order to transfusion start did not differ significantly among patients with early transfusion order and delayed transfusion order. Only systolic blood pressure of < 90 mmHg was identified as a major predictor for early transfusion order.

Conclusion. Balanced transfusion is not easy and emergency transfusion could be delayed at the bedside. Integrated and systematic structures for massive transfusion protocol would be invaluable and indispensable.

Key words: transfusion, emergency, protocol

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Using age, arterial lactate level and sequential organ failure assessment score in risk stratification of sepsis syndromes

Abstract

Introduction: In low income countries, ICU places are limited and not all sepsis patients will benefit from ICU admission. Stratification is an important step to identify patients who require ICU treatment from patients who can be treated on general ward setting. Improper stratification results in increased length of stay, costs, morbidity and mortality.
Objective: The aim of this study was to stratify the risk of mortality in patients with sepsis syndrome using age, arterial lactate level and SOFA score.
Methods: In this prospective observational study, 250 patients with sepsis were enrolled and followed up until discharge. They were categorized into 2 groups according to 7-days mortality.
Results: SOFA score (≥5) was the only good tool (AUC=0.722) while age (≥65 years) (AUC=0.650) and arterial lactate (≥3.25 mmol/L) (0.690) were fair tools to predict 7-days mortality. A new score “ALSOFA score” (≥10) was an excellent tool for prediction (AUC =0.912, 95%CI: 0.851 to 0.940, p<0.0001). It showed an excellent sensitivity (90.9%) and specificity (85.1%).
Conclusion: In critically ill patients with sepsis syndromes, age, arterial lactate and SOFA score are fair tools of stratification. No single marker/score can be used alone to stratify such patients.

Keywords; Emergency, Critical, Sepsis, SOFA, Arterial Lactate, Stratification

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Role of Redcell Distribution Weight in Predicting Disease Severity, Mortality and Complication in Patients With Acute Pancreatitis

Abstract

The goal of the present study was to investigate the significance of the Red Cell Distribution Width (RDW) in identifying the severity, mortality and complications of the disease at an early stage in patients with acute pancreatitis (AP).

343 patients with AP presented to the emergency department during one year were included in this retrospective study. Demographic, laboratory and imaging results were recorded. Bedside Index for Severity in AP (BISAP) score was calculated. The patients who developed pancreatitis-related mortality were recorded.

The diagnostic powers of RDW values in the diagnosis of BISAP Score (≥3), exitus, severe pancreatitis and pancreatitis with complication were analysed by means of Receiver Operating Characteristic Curve (ROC) analysis. p<0,05 was considered statistically significant.

The mean age of the subjects was 59,7 ± 18,0 years. Area under curve (AUC) in ROC analysis conducted for RDW in patients with BISAP score≥ 3 was 0,649 (95% Cl 0,576-0,722) and p <0,001. For developed complications, AUC for RDW was 0,558 (95% Cl 0,454-0,662) and p was 0,243. For RDW<14,4 cut-off value; the sensitivity was 66,25%, specificity was 71,48% in the prediction of BISAP≥ 3, sensitivity was 87,5%, specificity was 65,14% in the prediction of mortality, sensitivity was 72,73%, specificity was 71,12% in the prediction of severe AP.

RDW is as significant as the BISAP score in predicting the severity and mortality of pancreatitis in the patients with acute pancreatitis in the emergency department(ED). But it cannot predict the complications in AP.

Keywords: Emergency, acute pancreatitis, mortality, severity, complications, redcell distribution weight.

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Murdered women’s children: A social emergency and gloomy reality

Abstract

Femicide, defined as the killing of females by males because they are females, is becoming recognized worldwide as an important ongoing manifestation of gender inequality. Actual or imminent separation, abuser’s access to firearms, prior threats with a weapon, prior threats to kill the victim, a stepchild in the household, problematic alcohol and illicit drug use, as well as mental health problems, are associated with a substantially higher risk of femicide. Little is known about the number of orphaned children who have instantaneously lost both parents. Sparse attention has been focused on children whose mother was murdered: these are difficult cases for child psychiatry teams. Decisions about protection could be made by judges, the police, social workers or officers that attend victims, on the basis of empirical data and not merely by using intuitive criteria.

Key words: child, emergency, femicide

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The new types of child maltreatment: a public and social emergency no longer negligible

Abstract

Child abuse and neglect is a common problem that is potentially damaging to long-term physical and psychological health of children. As society and culture have progressively changed different configurations of child abuse and neglect have emerged. Few attention has been focused on these types of child maltreatment that represent the new emergency in this field. Pediatricians should be trained to play a major role in caring for and supporting the social and developmental well-being of children raised in variously conditions and in new types of problems. Pediatric care has been based on the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health.

Keywords: Child abuse, neglect, emergency

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