Ultrasound plays a pivotal role in the evaluation of acute trauma patients through the use of multi-site scanning encompassing abdominal, cardiothoracic, vascular and skeletal scans. In a high-speed polytrauma setting, because exsanguinations are the primary cause of trauma morbidity and mortality, ultrasound is used for quick and accurate detection of hemorrhages in the pericardial, pleural, and peritoneal cavities during the primary Advanced Trauma Life Support (ATLS) survey. Volume status can be assessed non-invasively with ultrasound of the inferior vena cava (IVC), which is a useful tool in the initial phase and follow-up evaluations. Pneumothorax can also be quickly detected with ultrasound. During the secondary survey and in patients sustaining low-speed or localized trauma, ultrasound can be used to help detect abdominal organ injuries. This is particularly helpful in patients in whom hemoperitoneum is not identified on an initial scan because findings of organ injuries will expedite the next test, often computed tomography (CT). Moreover, ultrasound can assist in detection of fractures easily obscured on radiography, such as rib and sternal fractures.

BackgroundHigh-sensitivity troponin T (HS Trop T) plays an important role as a diagnostic marker for acute coronary syndrome. It is also related to cardiovascular outcomes. HS Trop T levels may be varied in individuals with renal dysfunction. This study aimed to find the appropriate HS Trop T cutoff points in chronic kidney disease (CKD) patients who had coronary artery occlusion.Patients and methodsThe study was conducted at the Emergency Department, Ramathibodi Hospital, Mahidol University, Thailand. CKD patients stage 3–5 who had HS Trop T levels after 2 hours of chest pain and had coronary angiographic results were enrolled. Patients were divided into two groups: those who had significant occlusion of more than 70% of a coronary artery as the coronary artery disease (CAD) group and the non-CAD group.ResultsIn total, 210 patients met the study criteria. There were 132 patients (62.86%) who had significant stenosis of coronary arteries by coronary angiograms. The average age (standard deviation) of all patients was 71.02 (9.49) years. HS Trop T levels were significantly higher in all CKD patients with CAD than the non-CAD group (0.4973 versus 0.0384 ng/mL). Sex and HS Trop T levels were significantly associated with CAD by multivariate logistic regression analysis. The HS Trop T level of 0.041 ng/mL gave sensitivity and specificity of 65.91% and 75.65%, respectively, for CAD.ConclusionThe HS Trop T level of 0.041 ng/mL provided diagnostic properties for established coronary artery occlusion in CKD patients.

Background. Overcrowding in the emergency department (ED) is a significant public health problem in the US, Europe, and Asia. Factors associated with prolonged length of stay in Thailand are still limited. Methods. This study was conducted at the ED, Ramathibodi Hospital, Mahidol University, Thailand, during July 2011. We selected 300 patients (5.77%) from a total of 5,202 who visited the ED during the study period by simple random sampling. Charts were retrospectively reviewed baseline characteristics, clinical factors, and duration of ED stay. Multivariate logistic regression analyses were performed to identify independent factors for an ED stay more than or equal to 8 hours. Results. We excluded 33 patients (11%) due to incomplete data or stroke fast track enrollment. In total, 267 patients were in the analysis and 53 patients (19.85%) had an ED visit time more than or equal to 8 hours. The number of rounds of blood testing and the type of insurance were associated with prolonged ED stay of more than or equal to 8 hours. Conclusion. ED physicians may need to consider appropriate investigations to shorten the length of stay in the ED.