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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

A rare consequence of trauma: Chylothorax


Chylothorax is defined as the lymphatic fluid accumulation in the pleural space due to the obstruction or injuries in the ductus thoracicus. The incidence of chylothorax due to blunt and penetrating traumas is low at a rate of 0.2-3%. This case presentation intends to evoke chylothorax as a rare cause of pleural effusion due to injuries.

A 27-day-old infant was brought to the emergency department with the complaint of a sudden respiratory distress developing after falling off the couch. The respiratory rate was 62, the pulse rate was 174, and the oxygen saturation rate was 68%. In the physical examination, the respiratory sounds were diminished bilaterally. The patient was intubated. As the saturation levels did not improve after intubation, a needle aspiration was performed bilaterally in the anterior axillary line with a prediagnosis of massive haemothorax. A yellowish fluid was aspirated from the pleural space bilaterally. Chest tubes were inserted bilaterally to treat respiratory distress due to mass effect of chylothorax. Massive chylothorax cases may result in serious complications leading to respiratory distress and cardiac dysfunction. An early diagnosis and appropriate treatment can be life-saving in these patients.

Key words: chylothorax, trauma, pleural effusion

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Impact of prehospital rapid sequence intubation and mechanical ventilation on prehospital vital signs and outcome in trauma patients


Introduction. Medications during rapid sequence intubation (RSI) have known detrimental side effects. Prehospital mechanical ventilation after successful endotracheal intubation also increases mortality due to hyperventilation and positive pressure ventilation. The aim of this retrospective analysis was to determine the impact of RSI on prehospital hemodynamic parameters and prehospital ventilation status on mortality rate and functional outcome in trauma patients.

Methods. Charts of 73 trauma patients, who underwent prehospital RSI over a 12-year period, were retrospectively reviewed. Prehospital vital signs, before and after RSI, were compared. Patients were divided, according to ventilation status, into three groups based on initial PaCO2: hypocarbic/hyperventilated (PaCO2<35mmHg), normocarbic/normoventilated (PaCO2 35-45 mmHg) and hypercarbic/hypoventilated (PaCO2>45mmHg).

Results. Seventy-three patients were enrolled in the retrospective analysis. There was a significant difference in respiratory rate (p=0.046), arterial oxygen saturation (p<0.001), mean arterial pressure (p<0.001) and Glasgow Coma Scale (GCS) (p<0.001) before and after RSI. GCS at discharge (p=0.003) and arterial oxygen saturation (p=0.05) were significantly higher in the normoventilated group. There was no significant difference in survival to hospital discharge among compared groups.

Conclusion. Our retrospective analysis suggests that prehospital RSI has no detrimental hemodynamic side effects and that normoventilation leads to a favorable neurological outcome.

Key words: intubation, prehospital, mechanical ventilation, trauma, hemodynamics

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Most frequent interventions involving children in prehospital emergency medicine


A retrospective study of interventions involving children in the period from 2011 to 2015 was conducted at the Teaching Institute for Emergency Medicine of Zagreb. During this period a total of 18,356 interventions involving children occurred in the field. From 2011 to 2013, 11,576 interventions occurred, which makes up 4.56 % of all interventions in that period. During 2014 and 2015 there were 6,780 interventions which make up 3.69 % of all interventions in the field during that period. There was a 20 % reduction in the number of emergency interventions involving children in the last two years of the study in comparison to the previous period. The greatest number of these emergency interventions is due to injury. From 2011 to 2013, the total number of interventions involving injured children was 24.59 % as opposed to 19.94 % from 2014 to 2015. There is a statistically significant decrease in the number of occurring injuries by 19%, whereas the number of head injuries went down from 12.48 % to 10.01 %. That marks a decrease of 20 % in the second part of the studied period. This is most probably a result of better injury prevention as a result of education programs in preschools, schools, media campaigns, and the use of protective equipment (protective helmets for cyclist, skaters, skiers etc.)

Key words: children, trauma, emergency medical service

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Radiation exposure from computed tomography in blunt trauma patients


Introduction. Computed tomography (CT) has many diagnostic advantages, spurring growth in the number of CT examinations. As the use of CT increases, the potential for radiation-induced adverse effects has become an issue. The primary objective of this study was to assess the liberal use of CT induced radiation exposure in patients with multiple blunt traumas. The secondary objective was to investigate the factors affecting the estimated effective dose resulting from CTs unrelated to final diagnosis.

Methods. Using data from our hospital information system, we selected patients assigned a trauma code, according to the Korean Standard Classification of Diseases, and with three or more body lesions assessed by CT at the same time in the emergency department. Each CT conducted was categorized into ‘CT related to the final diagnosis’ or ‘CT unrelated to final diagnosis’. The characteristics and estimated effective dose of CTs unrelated to the final diagnosis were analyzed. The factors affecting the estimated effective dose of CTs unrelated to final diagnosis were investigated.

Results. More than half of all CT examinations were not associated with the final diagnosis. The additional estimated effective dose due to CTs being unrelated to the final diagnosis in each patient was a sufficient amount of radiation exposure to increase the possibility of fatal cancer.

Conclusion. A considerable number of CT scans were unrelated to the patient’s final diagnosis, which exposes the patient to additional radiation exposure.

Key words: radiation, trauma, computed tomography

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Sex Hormones and Gender Effects following Trauma-Hemorrhage


Trauma is the leading cause of death in the industrialized world between the ages of one and 40. A number of risk factors including age and gender have been implicated in this regard. It is therefore not surprising that the majority of trauma victims are young males. Their mortality rate following trauma is not only higher compared to females, but they are also more prone to subsequent sepsis. Age and gender are therefore important factors in the prevalence of traumatic injury as well as in susceptibility to subsequent septic complications.

Key words: trauma, mortality, age, gender, sex hormones, sepsis, cardiovascular/immunological alterations

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