Therezia Bokor-Billmann

Reduction of Acute Shoulder Dislocations in a Remote Environment: A Prospective Multicenter Observational Study

OBJECTIVE Acute dislocations of the glenohumeral joint are common in wilderness activities. Emergent reduction should take place at the site of trauma to reduce the patients pain and the risk of vascular and neurological complications. A limited number of reduction methods are applicable in remote areas. The aim of this study is to present our method of reduction of anterior shoulder luxation that is easily applicable in remote areas without medication, adjuncts, and assistants and is well tolerated by patients. METHODS A prospective observational study was conducted during a 5-year period. The patients included underwent closed manual reduction with our technique. After each reduction, the physician who performed the reduction completed a standardized detailed history, and reexamined the patient (for acute complications). The patients were contacted 6 months after the trauma to investigate long-term postreduction complications. RESULTS Reduction was achieved with our method in 39 (100.0%) of 39 patients. The mean pain felt during our reduction procedure was rated 1.7 ± 1.4 (on a scale of 10) using the visual analog scale scoring system. No complications were noted before or after the reduction attempts. We did not find any long-term complications. CONCLUSIONS The reduction method presented in the present study is an effective method for the reduction of acute shoulder luxations in remote places. Our data suggest that this method could be applied for safe and effective reduction of shoulder dislocation.

Effect of Advanced Trauma Life Support (ATLS) on the time needed for treatment in simulated mountain medicine emergencies

OBJECTIVE The number of tourists exploring mountainous areas continues to increase. As a consequence, rescue operations are increasing, especially for trauma and polytrauma victims. The outcome of such patients depends greatly on the duration of the prehospital stabilization. Limited medical training of mountain rescuers may adversely affect the outcome of patients. There is no study investigating high altitude trauma treatment. The aim of this study is to analyze the impact of advanced trauma life support (ATLS) principles in mountain trauma, and to discuss a possible role of ATLS in mountain medicine education programs. METHODS We designed 5 tasks representing life-threatening trauma problems encountered in mountain rescue. They were used to evaluate the physicians ability to adequately diagnose and react to trauma situations. We created 2 groups: 1) the ATLS group, consisting of physicians who passed the ATLS course and the mountain medicine course, and 2) the non-ATLS group, consisting of physicians who did not obtain the ATLS training but who did pass the mountain medicine course. We compared the time spent to complete the tasks in both groups. RESULTS In 4 of the 5 tasks (airway, breathing, circulation, and combination), the ATLS group completed the task significantly faster. In the environment task, however, the ATLS group was slower. This was the only not significant result. CONCLUSIONS ATLS principles adapted and implemented for high altitude medicine education may have a positive impact on high altitude trauma treatment and outcomes.

Colicky Epigastric and Right Upper Quadrant Pain

Awoman inher50spresented toouremergencydepartmentwitha3-hourhistoryof sudden epigastric and right upper quadrant pain. She did not report any previous abdominal surgery. The colicky pain did not migrate during that period and occurred in paroxysms at 9to 10-minute intervals. The patient was afebrile and had no nausea or vomiting. Physical examination revealedmild tachycardia (96/min)andmoderateabdominal distension without signs of peritonism; the bowel soundswerehyperactive.Careful examination ruledout incarcerated hernias in the groin, femoral triangle, and obturator foramen. Blood analysis results showedmild leukocytosis (total white blood cell count, 10.5 × 103/μL [to convert to ×109 per liter, multiply by 0.001]) without elevation of theC-reactiveprotein level (<3mg/L [to convert tonanomolesper liter,multiplyby9.524]). Serum electrolyte levels were within the normal range. Computed tomography of the abdomenwas conducted (Figure). Video at jamasurgery.com