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Clinical Advances in Trauma and Emergency Medicine
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Clinical Advances in Trauma and Emergency Medicine

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: 30 April 2025 | Viewed by 1569

Special Issue Editor

Prof. Dr. Viktoria Bogner-Flatz

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Guest Editor
Ludwig Maximilian University Hospital, Munich, Germany
Interests: emergency medicine; major trauma management; post-trauma immune dysfunction; resuscitation; disaster management

Special Issue Information

Dear Colleagues,

This Special Issue of our medical journal is dedicated to the latest advancements in trauma and emergency medicine, showcasing cutting-edge research and innovations that are transforming the field. As trauma care continues to evolve, the integration of new technologies, improved protocols, and evidence-based practices is crucial in enhancing patient outcomes. This Special Issue brings together contributions from leading experts to provide a comprehensive overview of the most significant developments, addressing both the challenges and opportunities in trauma management.

We will explore a wide range of topics, including the latest approaches to diagnostics, major trauma management, and patient stabilization techniques. This Special Issue also delves into the critical aspects of emergency care, such as rapid decision-making, resource allocation, and the application of multidisciplinary strategies to improve care in acute settings.

In particular, we highlight advancements in mass disaster management, the nuanced treatment of minor head injuries, major trauma management, and innovative resuscitation techniques as key examples of areas where significant progress has been made. By presenting this collection of research, we aim to advance scientific inquiry, enhance the understanding of trauma care, and inspire future studies that will continue to improve clinical practices in emergency medicine, particularly in the areas of disaster response, head injury management, and resuscitation.

Prof. Dr. Viktoria Bogner-Flatz
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • resuscitation
  • trauma emergency management
  • disaster response
  • mild traumatic brain injury emergency management
  • critical emergency care

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Research

12 pages, 2190 KiB  
Article
Prevalence and Potential Impact of Gastrointestinal Insufflation During Cardiopulmonary Resuscitation
by Maximilian Andreas Fichtl, Sophia Anna Henne, Viktoria Bogner-Flatz, Michael Dommasch, Philipp Zehnder, Karl Georg Kanz and Wilhelm Flatz
J. Clin. Med. 2025, 14(7), 2511; https://doi.org/10.3390/jcm14072511 - 7 Apr 2025
Viewed by 210
Abstract
Background/Objectives: Insufflation of the gastrointestinal tract, as a side effect of improper ventilation, is a known complication in resuscitation patients. As animal studies have shown, this can be associated with an increase in intra-abdominal pressure with adverse effects on hemodynamics and respiratory mechanics. [...] Read more.
Background/Objectives: Insufflation of the gastrointestinal tract, as a side effect of improper ventilation, is a known complication in resuscitation patients. As animal studies have shown, this can be associated with an increase in intra-abdominal pressure with adverse effects on hemodynamics and respiratory mechanics. In this study, we investigated the prevalence and severity of insufflation and discussed the potential impact on the outcome of resuscitation. Methods: This study was based on computed tomography (CT) images from two university hospitals in Munich, Germany, which were taken as part of the trauma room care of out-of-hospital cardiac arrest (OHCA) patients. According to local resuscitation protocol, CT performed during ongoing cardiopulmonary resuscitation or after the return of spontaneous circulation (ROSC) was archived to determine the potentially reversible cause of cardiac arrest. CT images from 2014 to 2018 were analyzed in this study. Using an advanced visualization and analysis platform for medical image data, the gas volume within the gastrointestinal tract was determined and compared between resuscitations with lethal and secondary survival outcomes. Results: A total of 92.44% of included OHCA patients (n = 172) showed signs of increased gastrointestinal gas volume in comparison to the physiologically prevalent gas volume. In OHCA patients with a lethal outcome, significantly more gas was detected in the gastrointestinal tract with a median of 757.40 mL compared to 380.65 mL in resuscitations with secondary survival (p ≤ 0.05; W = 4278). Furthermore, Cohen’s r was used to calculate the effect size, indicating a weak association with the outcome of resuscitation (r = 0.24). In addition, a logistic regression analysis was performed to examine the influence of age, gender (female), and the gas volume of the intestines and stomach on the dependent variable “death”. The analysis shows that the model, as a whole, is significant (Chi2 = 17.67; p 0.02; n = 172) and supports the hypothesis that intestinal insufflation correlates with a lethal outcome from resuscitation (b = 0.001; OR 1.001 (95% CI [1.000–1.002]; p = 0.021). Conclusions: Insufflation in resuscitation patients is a common phenomenon with potential consequences for the outcome. Even if the effect we have shown appears small, the outcome of resuscitation patients can possibly be improved by preventing or correcting insufflation. To understand its potential impact on resuscitation outcomes fully, further work must be performed to investigate causality. Full article
(This article belongs to the Special Issue Clinical Advances in Trauma and Emergency Medicine)
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10 pages, 617 KiB  
Article
Emergency Point-of-Care Blood Gas Analysis During Mass Gathering Events: Experiences of the Vienna City Marathon
by Roman Brock, Mario Krammel, Andrea Kornfehl, Christoph Veigl, Benedikt Schnaubelt, Marco Neymayer, Daniel Grassmann, Andrea Zeiner, Patrick Aigner, Regina Gabriel, Susanne Drapalik and Sebastian Schnaubelt
J. Clin. Med. 2025, 14(7), 2504; https://doi.org/10.3390/jcm14072504 - 7 Apr 2025
Viewed by 242
Abstract
Background: Long-distance running impacts many organ systems. Aside from musculoskeletal and cardiopulmonary events, the gastrointestinal and renal system as well as metabolic homeostasis and electrolyte balance can be affected. A respective medical support strategy enabling rapid diagnosis, triage, and treatment in the [...] Read more.
Background: Long-distance running impacts many organ systems. Aside from musculoskeletal and cardiopulmonary events, the gastrointestinal and renal system as well as metabolic homeostasis and electrolyte balance can be affected. A respective medical support strategy enabling rapid diagnosis, triage, and treatment in the context of large sports events is thus of utmost importance. Incidents can be assessed and graded via point-of-care (POC) blood gas analysis (BGA). We thus aimed to evaluate the feasibility and benefits of its use during a large sports event. Methods: All documented patient contacts during the race of the Vienna City Marathon (VCM) 2023 were retrospectively assessed. Additionally, the BGAs conducted in all patients requiring intravenous access were analyzed. Data are presented in a descriptive manner. Results: There were 39,871 participants at the VCM 2023. Of these, 277 (0.7%) required medical support, localized most commonly in the finishing area of the race (n = 239, 86% of all incidents). Fifty-eight (20.9%) patients had to be hospitalized. The most frequent chief complaints were syncope or collapse (24.9%), followed by general pain (20.6%) and trauma (14.8%). Five patients (1.8%) suffered from seizures, and one experienced (0.4%) from spontaneous pneumothorax. Thirty-one patients (11.2%) received venous blood gas analyses, showing mean creatinine levels of 1.82 (±0.517) mg/dL, mean lactate concentrations of 6.03 (±4.5) mmol/L, mean pH of 7.42 (±0.0721), and a mean base excess of −0.72 (±3.72) mmol/L. No cases of hyponatremia occurred in the documented samples. In eight cases (25.8%), sodium concentrations were above 145 mmol/L, with a maximum of 149 mmol/L. No cardiac arrests occurred. Conclusions: The physical exertion during the assessed long-distance running race resulted in numerous contacts with the medical support teams. The use of POC BGA at a large-scale marathon event was shown to be easy and feasible, allowing for more extensive diagnostics on-site. It can be integrated into a medical support strategy and might be beneficial for decision-making regarding patient triage, treatment, hospitalization, or patient discharge. Full article
(This article belongs to the Special Issue Clinical Advances in Trauma and Emergency Medicine)
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11 pages, 408 KiB  
Article
Munich cCT Rule for Patients with Recreational Drug and Ethanol Poisoning
by Tobias Zellner, Felix Wegscheider, Michael Dommasch, Florian Eyer, Rebecca Dieminger and Sabrina Schmoll
J. Clin. Med. 2024, 13(23), 7096; https://doi.org/10.3390/jcm13237096 - 24 Nov 2024
Viewed by 733
Abstract
Background: Patients with recreational drug and ethanol poisoning often present with reduced consciousness, coma, or disorientation. It is often unclear if there was recent head trauma. Algorithms to perform cranial computed tomography (cCT) like the Canadian CT Head Rule (CCHR), the National Emergency [...] Read more.
Background: Patients with recreational drug and ethanol poisoning often present with reduced consciousness, coma, or disorientation. It is often unclear if there was recent head trauma. Algorithms to perform cranial computed tomography (cCT) like the Canadian CT Head Rule (CCHR), the National Emergency X-Radiography Utilization Study Head CT Decision Instrument (NEXUS DI), or the New Orleans Criteria (NOC) exist for patients with head trauma. It is unclear whether these algorithms can be applied to this patient collective. Methods: This is a retrospective data analysis of patients admitted to our emergency department with drug or ethanol poisoning in 2019. Minors < 16 years were excluded. The primary outcome was fracture/bleeding in cCT, the secondary outcome was neurosurgical intervention. These results were calculated: 1. Sensitivity and negative predictive value (NPV) of the CCHR, NEXUS DI, and NOC. 2. Uni- and multivariate analysis of risk factors for critical findings. 3. The Munich cCT Rule sensitivity and NPV. Results: A total of 420 patients were included. cCT was performed in 120 patients. Eight patients had fracture/bleeding in cCT, two required neurosurgical intervention. The number of patients at risk, sensitivity, and NPV for critical cCT findings were as follows: CCHR 57/25%/98.3%, NEXUS DI 239/100%/100%, NOC 420/100%/100%. The sensitivity and NPV for neurosurgical intervention were as follows: CCHR 50%/99.7%, NEXUS DI 100%/100%, NOC 100%/100%. In univariate analysis, these findings correlated significantly with the following critical findings: accident, injury, injury above clavicle, head wound, anisocoria, ethanol in serum > 2 g/L, hypotension, drug ingestion, GCS < 8, focal neurological deficit, age > 60, and cerebellar symptoms. Via chi-square recursive partitioning analysis, we created the Munich cCT Rule which is positive for intoxicated patients if both an accident and an ethanol level > 2 g/L are present. This identified 70 patients at risk. It excluded fracture/bleeding and neurosurgical intervention with a sensitivity and NPV of 100%. Conclusions: Fracture/bleeding in cCT in intoxicated patients is rare. Performing unnecessary cCTs should be avoided. The Munich cCT Rule for patients with recreational drug and ethanol poisoning may help rule out critical findings and is superior to the NEXUS DI and NOC. It also has a 100% sensitivity which the CCHR (25%) is lacking. Full article
(This article belongs to the Special Issue Clinical Advances in Trauma and Emergency Medicine)
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