THE THAI JOURNAL OF TRAUMA

Optimizing Intraoperative Vital Signs Surveillance in Patients Receiving Local Anesthesia

2025-12-26T13:01:12+07:00

Monitoring vital signs for monitor adverse reaction during local anesthesia was alert in all patients, whereas each patient has a difference risk of adverse event. Over-frequency monitoring of vital signs, especially blood pressure, such as every 5 minutes continuously throughout surgery can cause discomfort to the patients. Squeezed by the blood pressure measuring device can cause redness, pressure sores, or injury to the skin. Therefore, appropriately monitoring patient vital signs based on individual risk factors will help ensure patient safety, reduce preventable complications, and improve patient comfort and satisfaction during surgery.

Delayed Occlusion of the Left Superficial Femoral Artery Following High-Energy Lower Extremity Trauma: A Case Report

2025-11-23T09:56:28+07:00

Background:
Peripheral vascular injury is a serious but sometimes underrecognized complication in patients with high-energy extremity trauma. Intimal disruption of the artery may lead to delayed thrombosis and subsequent limb ischemia if early signs are missed. Prompt recognition and timely surgical management are crucial to optimize limb salvage outcomes.

Case Presentation:
A 19-year-old male sustained bilateral femoral fractures and an open right tibial fracture with palpable distal pulses following a motorcycle collision. Initial management included debridement and open reduction with internal fixation of the right tibia. Two days postoperatively, the patient developed pallor, coldness, and loss of distal pulses in the left leg. Computed tomographic angiography demonstrated distal superficial femoral artery (SFA) occlusion. Twenty hours after symptom onset, the patient underwent exploration and revascularization with a 4.5-cm. PTFE interposition graft, accompanied by fasciotomy and external fixation of the femur. Subsequent debridement of necrotic posterior compartment muscle was required. Definitive fixation with intramedullary nails was later performed, and the limb was successfully salvaged. The patient achieved partial weight-bearing ambulation upon recovery.

Discussion:
This case highlights the importance of serial vascular examinations in trauma patients, as palpable pulses do not exclude vascular injury. In the presence of hard signs of vascular injury, immediate surgical intervention should be prioritized over advanced imaging to prevent treatment delay with few exceptions such as patient with multilevel injury. Assessment of ischemic severity using Rutherford classification may be unreliable in cases with concomitant nerve injury. Partial muscle necrosis does not always necessitate amputation if viable tissue remains. Multidisciplinary collaboration among trauma, vascular, and orthopedic teams, together with effective communication with the patient’s family, is essential to optimize outcomes and mitigate reperfusion-related complications.

Conclusion:
Delayed arterial occlusion can occur even in the presence of initially palpable pulses. Serial assessment and coordinated multidisciplinary management are key to achieving successful limb salvage and minimizing morbidity in vascular trauma.

Penetrating Anterior Neck Injury with Through-and-Through Right Common Carotid Artery (CCA) Injury: A Case Report

2025-11-20T11:24:32+07:00

Penetrating neck trauma is not uncommon
in Thailand. Whether accidental or intentional, the
management depends on presenting signs and
symptoms. Immediate control of hemorrhage and
airway protection of the airway compromise are
paramount, followed by timely decisions regarding
definitive surgical repair. Traditional management
using the three‑zone approach has increasingly
given way to the “no‑zone” strategy, guided by
modern diagnostic imaging. This report highlights
emergency decision‑making for airway and bleeding
control, zone‑based versus no‑zone evaluation
with computed tomography angiography (CTA),
operative findings of a through‑and‑through CCA
injury, and postoperative care and follow‑up.

Modification of the Ventilation fan mask with a Mechanical Ventilator in an accident patient, Hamilton G5 model

2025-09-24T10:47:04+07:00

Mechanical Ventilators are very important in accident patients because they can save lives and support breathing in patients who have been injured in an emergency accident and cannot breathe on their own or have acute respiratory failure. The Hamilton G5 ventilator is a high-end device used in hospitals. However, the unit found a problem with the fan cover on the back of the machine breaking after continuous use. As a result, the air filter could not be installed firmly because of the breakage. Dust may enter the ventilator system, damage the main circuit board, especially affecting the patient's respiratory system, and risk of pneumonia caused by infection after wearing the ventilator for a long time. Although there was an initial repair with epoxy glue, because the mask had to be removed frequently for cleaning, and the glue repair could not withstand the pressure from prying it open from the machine, it was damaged again. To reduce costs and waiting for spare parts from abroad, the unit modified it by using spare parts from old computers with accessories such as iron grills, nuts, and nut washers, etc. to create a replacement mask. From the trial, it was found that it works well, is strong, easy to remove and remove, and does not break again even after continuous use for more than 5 years. This modification is therefore one way to increase the efficiency of medical equipment maintenance in a time of limited resources. It also effectively reduces the budget burden of the unit.

The Effect of Interhospital Transfer Time on Mortality in Severe Trauma Patients

2025-04-03T20:50:24+07:00

Background
Trauma is a time-sensitive condition, with improved outcomes traditionally believed to occur when definitive care is delivered within the first 60 minutes, known as the “golden hour.” In Thailand, many severely injured patients initially receive treatment at rural hospitals before being transferred to trauma centers. This study aimed to assess how interhospital transfer time affects mortality rates among patients with severe trauma.

Methods
We conducted a retrospective cohort study using records from the Khon Kaen Trauma Center, Thailand, from January 2022 to December 2022. Severe trauma patients (Injury Severity Score [ISS] > 15) who were transferred from rural hospitals were identified. Transfer time from rural hospital to trauma center was the main exposure. The primary outcome was overall and 24-hour mortality.

Results
Among 776 severe trauma patients, those in the delayed transfer group had significantly lower overall mortality (12.92% vs. 22.61%, p = 0.002) and 24-hour mortality (5.26% vs. 10.73%, p = 0.012) than patients in the optimal transfer group. Delayed transfer was associated with higher Revised Trauma Score (RTS) and greater distance from the trauma center. In multivariable analysis, lower Trauma and Injury Severity Score (TRISS) and road traffic injury were independently associated with increased 24-hour mortality. Longer transfer time was associated with decreased 24-hour mortality, although this association was borderline significant (adjusted risk ratio [RR] 0.89; 95% confidence interval [CI], 0.79–1.00; p = 0.052).

Conclusion
Delayed transfer time was associated with lower mortality, suggesting that greater physiological patient stability and prolonged initial care at rural hospitals may reduce immediate mortality risk. These findings indicate that not all trauma patients benefit equally from rapid transfer and highlight the importance of assessing patient stability and transfer timing to optimize outcomes.

Message from the President of the Thai Association for Trauma Physicians

2025-12-31T17:40:59+07:00

สวัสดีครับท่านสมาชิก และบุคลากรทางการแพทย์ วารสารอุบัติเหตุ ของสมาคมฯ ฉบับนี้เป็นวารสารฉบับที่เผยแพร่ในรูปแบบ Online เป็นฉบับที่สอง เป็นฉบับที่ 2 ของปี 2568 (กรกฎาคม-ธันวาคม) ซึ่งในฉบับนี้มีเนื้อหางานวิจัยที่น่าสนใจด้านอุบัติเหตุในหัวข้อ การดัดแปลงหน้ากากครอบพัดลมระบายอากาศเพื่อใช้กับเครื่องช่วยหายใจ ในหอผู้ป่วยอุบัติเหตุ ยี่ห้อ Hamilton รุ่น G5 ซึ่งเป็นการประยุกต์ใช้อุปกรณ์พื้นฐานเพื่อลดต้นทุนค่าใช้จ่ายในการดูแลผู้ป่วย ถัดมาคือ The effect of time during interfacility transfer on mortality rate in severe trauma patients จากรพ.ขอนแก่น นอกจากนี้ยังมีตัวอย่างเคสน่าสนใจจำนวนทั้งสิ้น2เคสคือ Delayed Occlusion of the Left Superficial Femoral Artery Following High-Energy Lower Extremity Trauma: A Case Report และ Penetrating Anterior Neck Injury with Through-and-Through Right Common Carotid Artery (CCA) Injury : A Case Report จากรพ.ศิริราชและรพ.ขอนแก่นตามลำดับ ปิดท้ายด้วยงานการพยาบาลผู้ป่วยในเรื่อง การเพิ่มประสิทธิภาพการเฝ้าระวังสัญญาณชีพผู้ป่วยขณะผ่าตัดภายใต้การฉีดยาชาเฉพาะที่ เพื่อช่วยพัฒนาคุณภาพการดูแลรักษาผู้ป่วยให้ดียิ่งขึ้น ทุกบทความล้วนเป็นบทความที่น่าสนใจและน่าจะมีประโยชน์มากต่อท่านสมาชิก

และผมขอประชาสัมพันธ์เชิญชวนสมาชิกเข้าร่วมประชุมวิชาการประจำปีอีกรายการหนึ่ง คือการประชุมวิชาการประจำปี 2569 จัดโดยสมาคมแพทย์อุบัติเหตุแห่งประเทศไทย ในหัวข้อ “Trauma Update 2026” ระหว่างวันที่ 29-30เมษายน และ 1พฤษภาคม 2569 ณ โรงแรมเดอะ เบอร์เคลีย์ ประตูน้ำ มีเนื้อเรื่องที่น่าสนใจ และ workshop ให้เลือกเข้าร่วมได้มากมาย จึงอยากขอเชิญชวนท่านสมาชิกและบุคลากรทางแพทย์ทุกท่านเข้าร่วมประชุมวิชาการครั้งนี้ครับ

สมาชิกและผู้สนใจทุกท่านสามารถติดตามรายละเอียด ข่าวสารของทางสมาคม และเนื้อหาวิชาการ อีกช่องทาง ได้ทาง Facebook ของสมาคมแพทย์อุบัติเหตุแห่งประเทศไทย

ด้วยความเคารพ

ผู้ช่วยศาสตราจารย์ นายแพทย์ธีระชัย อุกฤษฎ์มโนรถ

นายกสมาคมแพทย์อุบัติเหตุแห่งประเทศไทย

Editorial

2025-12-31T17:34:15+07:00

In modern times, the management of trauma patients has become increasingly complex, requiring speed, precision, and the integration of multidisciplinary knowledge. The development of treatment protocols and medical innovations is therefore of paramount importance. This issue of the journal brings together articles that reflect the progress and dedication of healthcare professionals in enhancing the quality and safety of trauma care.

The first article presents a modification of a fan cover mask for use with the Hamilton G5 ventilator, serving as an example of resourceful adaptation to maximize available resources in critical patient care.

This is followed by a study examining the impact of interfacility transfer time on mortality rates in severely injured patients, an essential topic related to referral systems and efficient resource management.

Additionally, this issue includes noteworthy case reports: delayed occlusion of the superficial femoral artery following severe lower extremity trauma, and a penetrating anterior neck injury involving the right carotid artery, both of which highlight the diagnostic and therapeutic challenges in managing complex trauma cases.

Finally, the issue concludes with an article focusing on enhancing intraoperative vital sign monitoring under local anesthesia, aiming to elevate safety standards and operational efficiency in the operating room.

We hope that all articles in this issue will serve as an inspiration and a valuable resource for physicians and healthcare professionals, fostering continuous improvement in trauma care.

Editorial Board