Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
Background: Traffic accident is when only material damage is caused to the vehicle, track or environment, and there are no casualties. Traffic disaster is such an event in which, besides the material damage, there are human casualties. Traffic disaster is such an event in which, besides the material damage, there are human casualties. Aim: Provision of emergency medical care in all phases of the management of injured persons in traffic accidents with basic and abnormal trauma support in order to reduce: morbidity, validity and mortality and increasing the quality of EMS. Materials and methods: Samples of the survey were only injured in traffic accidents and the main causes were; age, sex, place of residence, seasons, weekdays and months, sleepwalking, drug use, alcohol consumption, and medical assessment, poor quality of roads, speed overtaking, car testing, illness, mobile phone use, eating in the car radio CD player. Result: The research material was obtained from the UCCK -Clinic Clinic in Pristina archive were only injured in traffic accidents. In Kosovo, the Emergency Clinic for January-December was 55.294 / 9.32% and 66 injured / 0.11%. Over 3 400 people die in the world's streets every day and tens of millions of people are injured. Conclusions: EMS should be equipped with medical staff, medicines, medical equippment, concrete materials, ambulances with the aim of providing basic and advanced care to the nearest hospital. Educate and train emergency medical professionals with basic and advanced trauma training courses, especially the hospital and prehospital level, and be incorporated as a first class subject at all levels of school.
Introduction: Sudden OHCA (Out of hospital cardiac arrest) is the third leading cause of death in industrialized nations. With more than 60% of cardiovascular deaths resulting from cardiac arrest, it remains the leading cause of death worldwide. Heart rhythms associated with cardiac arrest are divided into two groups: shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) and non-shockable rhythms (asystole and pulseless electrical activity (PEA)). VF is the most commonly identified arrhythmia in cardiac arrest patients. Urgent medical treatment includes cardiopulmonary resuscitation and early defibrillation. Material and Methods: Materials for this case report are data collected from the medical records of the Emergency Medical Center of Sarajevo protocol of patients. Case report: Our case report is presented with 59 years old man who had OHCA in his apartment. The initial rhythm was VF, and cardiopulmonary resuscitation was provided due to the Advanced life support guidelines to shockable rhythms. It was delivered 3 DC Shock-s (200J, 300J, 360 J) with the biphasic defibrillator, it was administered 1mg Adrenalin and performed endotracheal intubation. After the third DC shock, we got the return of spontaneous circulation ROSC. The patient was transferred to the University hospital, were he was stabile, and PCI of the LAD was performed as per the standard protocol. Echocardiography performed in the CCU revealed hypokinesia of RV, with preserved systolic function. On hospital day 7 he had a full neurological recovery. He was conscious, oriented, with normal breathing, blood pressure 125/79mmHg, sPO2 99, ECG: sinus rhythm, fr 87/min, without pathological signs. Echocardiography revealed the reduced systolic function of the left ventricle, with mitral regurgitation MR+2. Discussion: Out-of-hospital cardiac arrest (OHCA) is a major health problem in Europe and in the United States. The numbers of patients who have OHCA annually in these two parts of the world have traditionally been reported to be 275,000 and 420,000 respectively. The success of resuscitation depends on many factors: well-organized health care, organization of outpatient emergency services, but primarily when it comes to OHCA, education of the population on Basic life support, and early Cardiopulmonary resuscitation and use of AED (automated external defibrillator).
After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have something to learn, discuss, debate, and agree with updated methods, techniques, and protocols.I hope you will join us on Friday morning, and continue the journey of our two-day event together.
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