3 articles
Traumatic brain injury remains a leading global health concern with significant social and economic impact. The main causes include traffic accidents, falls, and violence, especially affecting young adults. In the Republic of Moldova, TBI incidence is rising, particularly during the prehospital phase. TBI involves both primary and secondary brain injuries, the latter often resulting from hypoxia, hypotension, or hyperglycemia. These secondary insults critically influence outcomes and are associated with high mortality. Effective prehospital management – focused on stabilizing oxygenation and hemodynamics – is essential in reducing neurological deterioration. Emergency teams play a key role in preventing secondary injury and improving survival.
This study, conducted from 2020 to 2024, analyzed 486 patients with acute traumatic brain injury (TBI) assessed in both prehospital and emergency department settings. It aimed to evaluate injury severity and prognosis using clinical tools and structured observation forms, developed specifically for this research.
Significant correlations were found between increased age, low systolic blood pressure, prehospital hypoxia, and both TBI severity and mortality (p < 0.0001). While hyperglycemia was not significantly associated with injury severity, it showed a moderate negative correlation with mortality (p < 0.01). Findings emphasize the importance of early monitoring and stabilization of vital signs in the prehospital phase to improve TBI outcomes.
This study emphasizes the importance of systematic prehospital monitoring and management of physiological parameters to mitigate secondary brain injury and improve patient prognosis. Early intervention targeting hypoxia and hypotension remains vital in the acute management of TBI.
The traumatized patient with signs of shock remains a major cause of morbidity and mortality, requiring rapid diagnosis and multidisciplinary management. This study evaluates clinical, paraclinical, and therapeutic aspects of trauma patients admitted with shock signs in the red zone of the Emergency Department of the Institute of Emergency Medicine during 2024.
A prospective analysis of 60 polytrauma patients in shock was performed. Demographic data, trauma mechanisms, Glasgow Coma Score, vital signs, imaging, emergency interventions, and outcomes were evaluated. The patients were managed according to an experimental protocol developed at the institutional level, which provides for a multidisciplinary approach to the traumatized patient. This protocol was developed based on the international protocol for Advanced Trauma Life Support. It will later be implemented at the institutional level.
The cohort included 79% males, with a mean age of 49.7 ± 15.2 years; 75% urban residents. Grade III and IV shock were diagnosed in 40% and 28.3%, respectively. Causes of trauma included physical aggression (29.5%), road traffic accidents (28.5%), and accidental trauma (21.0%), falls from height (21.0%). Radiological lesions were detected in 63.3%, positive findings on Focused Assessment with Sonography for Trauma in 40%, and cranial lesions identified by computed tomography in 60%. Intraglotic intubation was required in 80% of patients, vasopressor support was administered in 50%, antibiotic therapy in 95%, and emergency surgery was performed in 30%. Mortality was 1.7%.
Protocol-driven multidisciplinary care facilitated effective stabilization of traumatized patients presenting with shock. Early diagnosis, the use of advanced imaging techniques, and timely therapeutic interventions significantly contributed to improved patient outcomes. These findings underscore the critical role of structured trauma life support protocols in emergency medical settings.
Stroke remains a major cause of mortality and disability in Moldova and globally. Rapid prehospital intervention is critical for improving outcomes. The adoption of standardized protocols and checklists has enhanced the efficiency of emergency medical services (EMS), especially in stroke recognition and initial management.
A systematic review of the literature and analysis of statistical data from the National Prehospital Emergency Medical Service were conducted. The study focused on evaluating the use and impact of checklists during prehospital stroke interventions.
Between 2022 and 2023, over 12,000 stroke cases were recorded annually. The implementation of national checklists, in conjunction with the Face, Arm, Speech, Time scale, significantly improved early identification, triage, and transport to specialized centers. Notable outcomes included a higher rate of thrombolysis and thrombectomy, improved coordination, and a modest reduction in overall response time. However, delays due to inter-hospital transfers remain a challenge.
The systematic use of checklists in prehospital stroke management in Moldova proved effective in standardizing care, accelerating intervention, and improving patient outcomes. Continued training and system reorganization are crucial to fully capitalize on these tools and to reduce stroke-related morbidity and mortality.