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Rapid sequence induction(RSI) in trauma patients: Insights from healthcare providers

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World journal of Emergency Medicine 2019年第1期10卷 19-26页

作者： Bianca M.Wahlen Ayman El-Menyar Mohammad Asim Hassan al-thani Department of Anesthesia Hamad General Hospital Clinical Research Trauma & Vascular Surgery Hamad General Hospital Clinical Medicine Weill Cornell Medical College Department of Surgery Trauma Surgery Hamad General Hospital

BACKGROUnD: We aimed to describe the current practice of emergency physicians and anaesthesiologists in the selection of drugs for rapid-sequence induction(RSI) among trauma ***: A prospective survey audit was conducted based on a self-administered questionnaire among two intubating specialties. The preferred type and dose of hypnotics, opioids, and muscle relaxants used for RSI in trauma patients were sought in the questionnaire. Data were compared for the use of induction agent, opioid use and muscle relaxant among stable and unstable trauma patients by the intubating ***: A total of 102 participants were included; 47 were anaesthetists and 55 were emergency physicians. Propofol(74.5%) and Etomidate(50.0%) were the most frequently used induction agents. Significantly higher proportion of anesthesiologist used Propofol whereas, Etomidate was commonly used by emergency physicians in stable patients(P=0.001). Emergency physicians preferred Etomidate(63.6%) and Ketamine(20.0%) in unstable patients. The two groups were comparable for opioid use for stable patients. In unstable patients, use of opioid differed significantly by intubating specialties. The relation between rocuronium and suxamethonium use did change among the anaesthetists. Emergency physicians used more suxamethonium(55.6% vs. 27.7%, P=0.01) in stable as well as unstable(43.4 % vs. 27.7%, P=0.08) ***: There is variability in the use of drugs for RSI in trauma patients amongst emergency physicians and anaesthesiologists. There is a need to develop an RSI protocol using standardized types and dose of these agents to deliver an effective airway management for trauma patients.

关键词： Rapid-sequence induction Trauma Emergency physicians Anaesthetists Drugs

Predisposing factors, clinical assessment, management and outcomes of agitation in the trauma intensive care unit

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World journal of Emergency Medicine 2018年第2期9卷 105-112页

作者： Saeed Mahmood Omaima Mahmood Ayman El-Menyar Mohammad Asim Hassan al-thani Trauma Surgery Section Department of Surgery Hamad General Hospital (HGH) Doha Qatar College of Pharmacy Qatar University Doha Qatar Clinical Research Trauma Surgery Section Department of Surgery HGH Doha Qatar Clinical Medicine Weill Cornell Medical School Doha Qatar

BACKGROUnD: Agitation occurs frequently among critically ill patients admitted to the intensive care unit(ICU). We aimed to evaluate the frequency, predisposing factors and outcomes of agitation in trauma ICU. METHODS: A retrospective analysis was conducted to include patients who were admitted to the trauma ICU between April 2014 and March 2015. Data included patient's demographics, initial vitals, associated injuries, Ramsey Sedation Scale, Glasgow Coma Scale, head injury lesions, use of sedatives and analgesics, head interventions, ventilator days, and ICU length of stay. Patients were divided into two groups based on the agitation ***: A total of 102 intubated patients were enrolled; of which 46(45%) experienced agitation. Patients in the agitation group were 7 years younger, had significantly lower GCS and sustained higher frequency of head injuries(Pnts who developed agitation were more likely to be prescribed propofol alone or in combination with midazolam and to have frequent ICP catheter insertion, longer ventilatory days and higher incidence of pneumonia(Pn multivariate analysis, use of propofol alone(OR=4.97; 95% CI=1.35–18.27), subarachnoid hemorrhage(OR=5.11; 95% CI=1.38–18.91) and ICP catheter insertion for severe head injury(OR=4.23; 95% CI=1.16–15.35) were independent predictors for agitation(PnCLUSIOn: Agitation is a frequent problem in trauma ICU and is mainly related to the type of sedation and poor outcomes in terms of prolonged mechanical ventilation and development of nosocomial pneumonia. Therefore, understanding the main predictors of agitation facilitates early risk-stratification and development of better therapeutic strategies in trauma patients.

关键词： Trauma Intensive care unit Agitation Head injury Propofol Outcome

Case Study: Reviewing Methods of Assessing Community Adaptive Capacity for jefferson County, Texas

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American journal of Climate Change 2016年第1期5卷 8-14页

作者： Faye Anderson najla n. j. al-thani Center for Advances in Water and Air Quality Lamar University Beaumont Texas USA

With the increased attention on community sustainability and resilience, different poles have developed voicing similarities and/or differences of the two concepts. This study quantifies adaptive capacity of jefferson County, Texas, one of the coastal communities at the Gulf of Mexico having some of the worse adverse effects. Review of existing methods is presented. Analyses were conducted for the last ten years: from 2005 to 2014. Interestingly, statistical analyses showed that the County’s socio-economic profile or indicators have not changed throughout the ten years, but the environmental, institutional, and infrastructure indicators have. Focusing on one location magnifies the adaptive capacity of jefferson County, the temporal aspect of both perspectives, and the relevance of existing methods to this community with its peculiarities. Future assessments need to be based on primary data collected through participatory engagement of all stakeholders. This calls for attempts to quantify adaptive capacity using the comparatively more challenging deductive reasoning, which would allow for incorporation of more risks and thus higher readiness.

关键词： Climate Change Resilience Risk jefferson County Texas Flooding Adaptive Capacity Upper Scale System

Exploratory Analyses for Water Quality of the Gulf of Mexico Basin, Texas, 2005-2014

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journal of Geoscience and Environment Protection 2016年第1期4卷 58-63页

作者： Faye Anderson najla n. j. al-thani Center for Advances in Water and Air Quality Lamar University Beaumont TX USA

With the increased demand for more water sources, the issues of water quality have become more important. This study presents exploratory data analyses on water quality issues related to the Gulf of Mexico Basin in Texas for the last decade: 2005-2014. Dissolved oxygen, water temperature, specific conductance, PH, transparency, sampling depth and Enterococci observations for the ten years from 2005 to 2014 were analyzed. Statistical testing showed that the observations followed similar distributions between the years. Thus they were combined for each of the variables. Throughout the ten years transparency, water temperature, specific conductance, and Enterococci showed higher variances. Pair-wise correlations were negligible but they had positive spatial autocorrelation. Sampling was constantly conducted in the four months of February, May, August, and november. Water temperature, dissolved oxygen and Enterococci concentrations varied significantly during these four months. Univariate spatial regressions showed that Enterococci is predicted to increase whereas dissolved oxygen, PH, water temperature, specific conductances were predicted to decrease.

关键词： Surface Water Water Quality Gulf of Mexico Basin Texas Multivariate Spatial Stormwater Flooding Community Adaptive Capacity Resilience

Risk factors for ventilator-associated pneumonia in trauma patients:A descriptive analysis

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World journal of Emergency Medicine 2018年第3期9卷 203-210页

作者： Suresh Kumar Arumugam Insolvisagan Mudali Gustav Strandvik Ayman El-Menyar Ammar al-Hassani Hassan al-thani1 Trauma Surgery Section Department of SurgeryHamad General HospitalDohaQatar Clinical Research Trauma Surgery SectionHamad General HospitalDohaQatar Clinical Medicine Weill Cornell Medical CollegeDohaQatar

BACKGROUnD:We sought to evaluate the risk factors for developing ventilator-associated pneumonia(VAP)and whether the location of intubation posed a risk in trauma ***:Data were retrospectively reviewed for adult trauma patients requiring intubation for>48 hours,admitted between 2010 and ***’demographics,clinical presentations and outcomes were compared according to intubation location(prehospital intubation[PHI]*** room[TRI])and presence *** of *** regression analysis was performed to identify predictors of ***:Of 471 intubated patients,332 patients met the inclusion criteria(124 had PHI and208 had TRI)with a mean age of 30.7±14.8 *** group had lower GCS(P=0.001),respiratory rate(P=0.001),and higher frequency of head(P=0.02)and chest injuries(P=0.04).The rate of VAP in PHI group was comparable to the TRI group(P=0.60).Patients who developed VAP were 6 years older,had significantly lower GCS and higher ISS,head AIS,and higher rates of *** overall mortality was 7.5%,and was not associated with intubation location or pneumonia *** the early-VAP group,gram-positive pathogens were more common,while gram-negative microorganisms were more frequently encountered in the late VAP *** regression analysis and modeling showed that the impact of the location of intubation in predicting the risk of VAP appeared only when chest injury was included in the ***:In trauma,the risk of developing VAP is ***,the location of intubation and presence of chest injury could play an important role.

关键词： Ventilator-associated pneumonia Trauma Mechanical ventilation Intubation location Intensive care unit

Female Head, Food Stamps, Ethnicity and Air Pollution: Confounders or Causes of Heart Disease in Texas

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Open journal of Epidemiology 2016年第2期6卷 146-153页

作者： Faye Anderson najla n. al-thani Independent Scholars Houston TX USA

One in every four deaths in the United States is attributed to heart disease. While the ethnic variations have not been momentous, the socioeconomic disparities of heart disease incidence need to be further investigated. Moreover, exposure to air pollutants has been documented to cause heart disease. This secondary-data study investigates the effects of air pollutants as well as socioeconomic factors on hospitalization rate of heart disease in Texas. The rates for the five sub-diagnoses of cardiovascular disease, heart attack, stroke, hypertension and heart disease were linked to ozone, fine particulate matter, carbon monoxide, nitrogen dioxide, sulphur dioxide and socioeconomic status factors at the county level. These were college education attainment, households with female heads, percentage of users of food stamps, ethnicities, living near a park and living in houses with severe housing problems. Spatial lag modelling was conducted to estimate the statistical significance of the independent variables on the five sub-diagnoses of heart disease. Fine particulate matter, sulphur dioxide and being African American were significant to all the outcomes. Living in a household with female head was significant to stroke and hypertension. Using food stamps was significant to cardiovascular disease, heart attack and heart disease. Fine particulate matter and sulphur dioxide increase the risk of heart disease by a factor of three to twenty two times, respectively. Whereas low socioeconomic status increases the risk of heart disease by a factor of up to four times. The results of the effect of particulate air and sulphur dioxide pollution among people in low social class especially African Americans. The vicious cycle of heart disease and low socioeconomic status call for societal and policy makers’ attention through methodical interventions to address the two significant issues of industrial facilities site allocation and stationary emission resources.

关键词： Heart Disease Female Head Food Stamps Sulphur Dioxide Particulate Matter

Feasibility Study of a national Web-Based GIS Application to Assess the Risk of Pesticide Drift in the U.S.

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journal of Geoscience and Environment Protection 2015年第7期3卷 20-24页

作者： Faye Anderson najla n. j. al-thani Independent Scholars Houston TX USA

Agricultural pollution is a major issue in the United States (U.S.) and the world. Biotic and abiotic farming byproducts adversely affect the ecosystem and human health. While pesticides and fertilizers are the primary sources of agricultural pollution, organic agriculture can help remediate the negative effects on humans and the ecosystem. However, many factors like chemical drift can limit this advantage. This paper presents a feasibility study of a web-based (Geografic Information System) GIS application which can model and predict the areas affected by agricultural chemicals drift. Other applications exist with limited assumptions that make their outcomes far from reality. A root definition and a rich picture are developed as well as a Strengths Weaknesses Opportunities and Threats (SWOT) analysis. Because of the huge geographical context, data requirements and analyses requirements are expected to be massive. nonetheless, despite the expected challenges, the advantages of the proposed application outweigh the risks.

关键词： Risk of Chemical Drift Organic Farming Conventional Farming Agricultural Pollution U.S. GIS Web-Based Application SWOT Root Definition Rich Picture

The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study

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World journal of Emergency Medicine 2023年第2期14卷 96-105页

作者： Ahmed Faidh Ramzee Ayman El-Menyar Mohammad Asim Ahad Kanbar Khalid Ahmed Bahaa Daoud Saji Mathradikkal Ahmad Kloub Hassan al-thani Sandro Rizoli Trauma Surgery Section Hamad General Hospital(HGH)Doha P.O Box 3050Qatar Clinical Research Trauma&Vascular Surgery SectionHGHDoha P.O Box 3050Qatar Clinical Medicine Weill Cornell Medical CollegeDoha P.O Box 3050Qatar

BACKGROUnD: We aimed to explore the impact of the emergency department length of stay(EDLOS) on the outcome of trauma ***: A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS(nd >24 h). Data were analyzed using Chi-square test(categorical variables), Student’s t-test(continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital ***: The study involved 7,026 patients with a mean age of 32.1±15.6 years. Onefifth of patients had a short EDLOS(nd had higher level trauma team T1 activation(TTA-1), higher Injury Severity Score(ISS), higher shock index(SI), and more head injuries than the other groups(P=0.001). Patients with an EDLOS >24 h were older(P=0.001) and had more comorbidities(P=0.001) and fewer deaths(P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1(odds ratio [OR]=4.081, 95%CI: 2.364–7.045), head injury(OR=3.920, 95%CI: 2.413–6.368), blood transfusion(OR=2.773, 95%CI: 1.668–4.609), SI(OR=2.132, 95%CI: 1.364–3.332), ISS(OR=1.077, 95%CI: 1.057–1.096), and age(OR=1.040, 95%CI: 1.026–1.054). COnCLUSIOnS: Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes;however, the burden of prolonged boarding in the ED needs further elaboration.

关键词： Emergency department Length of stay Trauma Management Outcomes Trauma activation criteria

A Rapid Assessment of Scleractinian and non-Scleractinian Coral Growth Forms along the Saudi Arabian Coast, Red Sea

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journal of Ocean University of China 2014年第2期13卷 243-248页

作者： Abdulmohsin A.al-Sofyani n.Marimuthu j.jerald Wilson Department of Marine Biology Faculty of Marine SciencesKing Abdulaziz University

In this study we assessed the current status of coral reefs along the Saudi Arabian coast of the Red Sea. Among the three growth forms of Acroporid corals, the branching forms were found to dominate in the Farassan Islands （44.55%±11.10% cover） fol-lowed by tabular forms in the Doga Islands （ranging between 18%±6.47% and 18.30%±9.47% cover）. Digitate forms were rarely found along the coast except at Maqna. Among the five growth forms of non-Acroporid corals, we observed maximum cover of branching forms in the Yanbu offshore area （58.89%±15.11% cover） followed by the jeddah coast （24.76%±14.04% cover）. The Millepora spp., a non-Scleractinian coral, was abundant at all the near-shore sites, such as jeddah （10.70%±8.21%） and A1-Wajh （9.81%±6.69%）. The live coral cover （including both Scleractinian and non-Scleractinian corals） of Saudi Red Sea coast was seen to be higher in the north and gradually decrease towards the south. Principal Component analysis showed that the contribution of Acro- porid corals was greater in the southern region than in the northem and middle regions, but vice-versa in the case of non-Acroporid corals. Bray-Curtis cluster analysis categorized all the study sites into two major clusters with 60% similarity. Among them, one cluster-forming sites from Maqna to Masturah （northem region） and the second one comprised the middle and southem regions （jeddah to Farassan Islands）, and one outlier Rabigh.

关键词： coral reef growth forms Saudi Arabia coral diversity scleractinian coral Red Sea