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2 results

  • Chapter 3 - Penetrating Trauma

  • Edited by Mark Curato, Weill Cornell Medicine, New York, Kaushal Shah, Weill Cornell Medicine, New York, Christopher Reisig, Weill Cornell Medicine, New York
  • Book:
    Urban Emergency Medicine
    Published online:
    20 July 2023
    Print publication:
    03 August 2023, pp 26-38

  • Summary

    Gun violence is a public health crisis. In 2020, America had the highest number of deaths due to gun violence on record. Gun violence and stabbings were the second and fifth causes of violence-related deaths in the United States, respectively. There were 45,222 gun deaths in the United States, with suicide comprising 54% and homicides comprising 43% of those deaths. While 30% of American adults report owning a gun, 52% of non-gun owners could see themselves owning a gun in the future. Urban areas are particularly affected by gun violence. In 2015, 81% of the 12,979 firearm homicides that occurred in the US occurred in cities. In the urban trauma setting, penetrating trauma disproportionately impacts the pre-existing violence in these areas. During the COVID-19 global pandemic, emergency departments have seen a rise in trauma admissions. This exacerbation of violence may correlate with the economic devastation caused by the COVID-19 pandemic. Higher poverty rates in these areas contribute to the crime and increased prevalence of penetrating injury. This upsurge of trauma is particularly salient in urban hospital settings, where there is a concentration of violent injuries.

  • A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services

  • Joshua Nackenson, Amado A. Baez, Jonathan P. Meizoso
  • Journal:
    Prehospital and Disaster Medicine / Volume 32 / Issue 6 / December 2017
    Published online by Cambridge University Press:
    15 August 2017, pp. 631-635
    Print publication:
    December 2017
  • Study Objectives

    Traction splinting has been the prehospital treatment of midshaft femur fracture as early as the battlefield of the First World War (1914-1918). This study is the assessment of these injuries and the utilization of a traction splint (TS) in blunt and penetrating trauma, as well as intravenous (IV) analgesia utilization by Emergency Medical Services (EMS) in Miami, Florida (USA).

    Methods

    This is a retrospective study of patients who sustained a midshaft femur fracture in the absence of multiple other severe injuries or severe physiologic derangement, as defined by an injury severity score (ISS) <20 and a triage revised trauma score (T-RTS)≥10, who presented to an urban, Level 1 trauma center between September 2008 and September 2013. The EMS patient care reports were assessed for physical exam findings and treatment modality. Data were analyzed descriptively and statistical differences were assessed using odds ratios and Z-score with significance set at P≤.05.

    Results

    There were 170 patients studied in the cohort. The most common physical exam finding was a deformity +/- shortening and rotation in 136 patients (80.0%), followed by gunshot wound (GSW) in 22 patients (13.0%), pain or tenderness in four patients (2.4%), and no findings consistent with femur fracture in three patients (1.7%). The population was dichotomized between trauma type: blunt versus penetrating. Of 134 blunt trauma patients, 50 (37.0%) were immobilized in traction, and of the 36 penetrating trauma victims, one (2.7%) was immobilized in traction. Statistically significant differences were found in the application of a TS in blunt trauma when compared to penetrating trauma (OR=20.83; 95% CI, 2.77-156.8; P <.001). Intravenous analgesia was administered to treat pain in only 35 (22.0%) of the patients who had obtainable IV access. Of these patients, victims of blunt trauma were more likely to receive IV analgesia (OR=6.23; 95% CI, 1.42-27.41; P=.0067).

    Conclusion

    Although signs of femur fracture are recognized in the majority of cases of midshaft femur fracture, only 30% of patients were immobilized using a TS. Statistically significant differences were found in the utilization of a TS and IV analgesia administration in the setting of blunt trauma when compared to penetrating trauma.

    NackensonJ, BaezAA, MeizosoJP. A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services.Prehosp Disaster Med. 2017;32(6):631–635.