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Airway management in penetrating neck trauma at a Canadian tertiary trauma centre.

https://arctichealth.org/en/permalink/ahliterature164412
Source
CJEM. 2007 Mar;9(2):101-4
Publication Type
Article
Date
Mar-2007
Author
John M Tallon
Jennifer M Ahmed
Beth Sealy
Author Affiliation
Department of Emergency Medicine, Dalhousie University, Halifax, NS. jtallon@dal.ca
Source
CJEM. 2007 Mar;9(2):101-4
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Airway Obstruction - etiology - therapy
Canada
Child
Female
Humans
Incidence
Intubation, Intratracheal - methods
Male
Middle Aged
Neck Injuries - complications - epidemiology
Trauma Centers
Wounds, Penetrating
Abstract
The optimal approach to airway management in penetrating neck injuries (PNIs) remains controversial. The primary objective of this study was to review the method of endotracheal intubation in PNI at a Canadian tertiary trauma centre. Secondarily, we sought to determine the incidence of PNI in our trauma population and to describe the epidemiologic elements of this population.
We conducted a review of patients with PNIs who were enrolled in the Nova Scotia Trauma Registry database. We included all penetrating injuries of the neck in patients > or = 16 years of age from April 1, 1994 to March 31 2005 with an Injury severity Score (ISS) > or = 9 or who underwent Trauma Team activation at our Tertiary Trauma Centre (regardless of ISS) and/or who were identified upon admission as a "major" trauma case. The variables of interest were patient age and sex, injury mechanism, injury location, place of intubation and method of intubation.
There were 19 people who met inclusion criteria and they were enrolled in our study. The injury mechanisms involved knife (n = 13) or gunshot (n = 5) wounds (one patient's injuries were categorized as "other"). Three patients (15.8%) were not intubated. The remaining 16 patients were intubated during prehospital care (n = 5), in the emergency department (n = 6) or in the operating room (n = 5). Of these, 8 patients (42.1%) underwent awake intubation and 8 (42.1%) underwent rapid sequence intubation.
There is clear variability of airway management in PNI. We believe that such patients represent a heterogeneous group where the attending physician must have a conservative yet varied approach to airway management based on the individual clinical scenario.
Notes
Erratum In: CJEM. 2007 May;9(3):181
PubMed ID
17391580 View in PubMed
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Trauma management outcomes associated with nonsurgeon versus surgeon trauma team leaders.

https://arctichealth.org/en/permalink/ahliterature166464
Source
Ann Emerg Med. 2007 Jul;50(1):7-12, 12.e1
Publication Type
Article
Date
Jul-2007
Author
Jennifer M Ahmed
John M Tallon
David A Petrie
Author Affiliation
Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Source
Ann Emerg Med. 2007 Jul;50(1):7-12, 12.e1
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Causality
Emergency Medicine - organization & administration - statistics & numerical data
Female
General Surgery - organization & administration - statistics & numerical data
Humans
Leadership
Length of Stay - statistics & numerical data
Male
Middle Aged
Nova Scotia - epidemiology
Outcome and Process Assessment (Health Care)
Registries
Retrospective Studies
Survival Analysis
Trauma Centers - organization & administration - statistics & numerical data
Wounds and Injuries - epidemiology - therapy
Wounds, Nonpenetrating - epidemiology - surgery
Wounds, Penetrating - epidemiology - surgery
Abstract
We compare the effectiveness of surgeon and nonsurgeon trauma team leaders.
This retrospective study was conducted using data from a Canadian trauma registry database. Data from April 1, 1998, to March 31, 2005, from blunt and penetrating trauma patients aged 16 years or older and with trauma team activation (and without major burns) were included. Patient age, sex, trauma team leader (surgeon or nonsurgeon), mechanism of injury, Injury Severity Score, survival to 3 hours and to discharge, length of stay in the hospital, and Trauma and Injury Severity Score (TRISS) z scores were tabulated.
Data from 807 patients were included. Because of the limited number of penetrating trauma cases, analyses focused on blunt trauma. Surgeon and nonsurgeon trauma team leader groups did not differ on injury severity, age, or sex. No difference was noted in survival to discharge (nonsurgeon 84.8%-surgeon 81.8%=3%; 95% confidence interval [CI] -3.5% to 9.5%), survival to 3 hours (nonsurgeon 96.8%-surgeon 96%=0.8%; 95% CI -2.2% to 3.8%), length of stay (median 13 days for nonsurgeon and 12 days for surgeon groups), or difference between actual and predicted survival (TRISS z scores nonsurgeon 0.64; surgeon 0.99). No trend toward group differences on any outcome variable was observed in penetrating trauma cases.
No differences were found in the outcome of trauma patients treated by nonsurgeon versus surgeon trauma team leaders. These findings support a more collaborative approach to resuscitative trauma management with involvement of nonsurgeons as trauma team leaders.
Notes
Comment In: Ann Emerg Med. 2007 Jul;50(1):15-717178171
PubMed ID
17112634 View in PubMed
Less detail