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BACKGROUND: It is crucial to identify the pivotal factors for transferring patients with major trauma. We aim to delineate the clinical features and required aids of severe trauma patients and identify the differences between those who were admitted directly to a trauma center and those transferred from other hospitals. METHODS: We retrospectively reviewed all hospitalized trauma patients discharged from the ward in Chi-Mei Medical Center from January 1, 2017 to December 31, 2018. Of 5,846 patients, we identified 1,061 patients with Injury Severity Score >15, of which 92 patients were transferred from two branch hospitals (branch group), 172 patients were transferred from other hospitals (other group), and 797 patients were admitted directly through the emergency department (control group). We compared the clinical variables between control and the other two groups. RESULTS: The branch group included a high proportion of pediatric patients (control: 1.8%, other: 2.3%, and branch: 6.5%). The branch group demonstrated higher requirements for life-saving interventions and arterial embolization (branch vs. control, life-saving interventions: 26.1% vs. 17.6%, p = 0.046; arterial embolization: 9.8% vs. 3.5%, p = 0.004). However, no statistically significant differences were observed between the control group and other group in terms of requirements of life-saving interventions. The prognoses were similar between the groups. CONCLUSIONS: Our trauma center can provide pediatric trauma care and timely life-saving interventions to help severe trauma patients transferred from other hospitals. The branch hospitals benefit mostly from the aid. Better network connection and information sharing between hospitals might play crucial roles in the management of transferred severe trauma patients.

BackgroundDengue is one of the most important mosquito-borne diseases. Taiwan is located in an epidemic area for dengue, and several dengue outbreaks have been reported in southern Taiwan. Therefore, we conducted this study to determine the incidence and clinical manifestations of symptomatic dengue infection.MethodsWe reviewed the medical records of 177 pediatric patients (age < 16 years) who underwent serum tests for dengue (polymerase chain reaction or capture enzyme-linked immunosorbent assay for dengue immunoglobulin M and immunoglobulin G antibodies) in the pediatric outpatient clinic, the pediatric ward, or the emergency department of the Chi-Mei Medical Center from January 1, 2007 to December 31, 2007. We evaluated the differences in the clinical characteristics and laboratory data between the dengue and nondengue patients.ResultsMost of the dengue cases appeared starting in July and peaked during November. In the dengue group, there were more school-age patients (age > 7 years) and a more frequent history of mosquito contact. There was no difference in the sex distribution. Most of the dengue patients had obvious symptoms including skin rash (79.0%), nausea/vomiting (47.4%), high fever (> 39°C; 44.7%), diarrhea (26.3%), abdominal pain (23.7%), and petechiae (15.8%). Leukopenia, thrombocytopenia, elevated aspartate aminotransferase levels, and elevated alanine aminotransferase levels were found in 78.4%, 79.3%, 34.5%, and 29.0% of the patients, respectively. Nondengue patients showed elevated C-reactive protein levels (57.5%).ConclusionDengue is commonly found in older pediatric patients and is rare in infants. High fever and skin and gastrointestinal manifestations were usually found in dengue patients. The laboratory findings of leukopenia, thrombocytopenia, elevated levels of liver enzymes, and low C-reactive protein levels were common in dengue patients, and these markers could help confirm the suspicion of pediatric dengue infection.

Objective The β-adrenergic effects of tracheal adrenaline include a decrease in initial arterial pressure, and those of tracheal vasopressin include bradycardia. Both of these deleterious effects influence the outcome of resuscitation. We conducted an animal study to test whether tracheal administration of adrenaline and vasopressin results in synergic effects and abolishes the undesirable individual effects of each drug. Methods Twenty-four pigs were intubated, anesthetized, and divided into four groups. The control group received 5 mL of water. Group A received 0.05 mg/kg adrenaline. Group V received 0.8 U/kg vasopressin. Group AV received 0.05 mg/kg adrenaline plus 0.8 U/kg vasopressin. For all animals, the heart rate and arterial pressure were recorded before drug administration, at 0.25, 0.5, 0.75, and 1 minute after administration, and then every 0.5 minutes for 14 minutes. Results The heart rate decreased from 4 to 15 minutes postinjection in group V. In contrast, Groups A and AV had increases in heart rate. In Group A, the arterial pressure decreased initially after adrenaline administration and then gradually increased. Group V demonstrated an increase in arterial pressure postinjection that then plateaued. Group AV initially demonstrated a nonsignificant arterial pressure decrease and then an elevation in arterial pressure. Conclusions A combination of adrenaline and vasopressin eliminates the bradycardic effects of tracheal vasopressin and minimizes the β-adrenergic effects of tracheal adrenaline. In addition, simultaneous administration of these drugs results in higher arterial pressures, which would have a positive influence on resuscitation.

In the adult population, the occurrence of cerebral venous thrombosis (CVT) had been related to a number of risk factors, including genetic and acquired prothrombotic conditions, infections, inflammatory diseases, hematologic disorders, trauma, and drug use. However, dehydration has never been reported as a predisposing factor. We reported a man with CVT that was provoked by acute gastroenteritis-induced dehydration. Notably, headache was the only sign of CVT. This rare case presentation is a reminder to emergency physicians that, in both pediatric and adult patients, severe dehydration might induce CVT. In addition, we discuss the direct signs of CVT as revealed by noncontrast computed tomography and report that a subtle subarachnoid hemorrhage may develop secondary to CVT.