Medical evacuation from the Lake Kutubu region of Papua New Guinea

Abstract

Aims To review and analyse med ical evacuation data collected at the Chevron Niugini Ridge Hospital in the Lake Kutubu area of the Southern Highlands Province of Papua New Guinea. Setting The Kutubu oil field area in Southern Highlands Province including two camps and 51 local villages. Methods Medical evacuation records spanning the four year period 1993–1997 were reviewed for the Lake Kutubu area. Patient origin, age, sex, diagnostic category, referral destination and transfer modality were analysed. Results Seventy five percent of medical evacuations involved villagers. Trauma was the most common medical evacuation diagnostic category followed by complicated obstetric, respiratory and malaria diagnoses. Most medical evacuations (86%) were referred to the Ridge Hospital and Southern Highlands medical facilities. Methods of transport were evenly distributed between road, helicopter and fixed wing transfers. An above average number of medical evacuations occurred during November each year. Conclusion Further trauma research in Papua New Guinea will allow health planners to address this important cause of medical evacuation. Papua New Guinea Governments should consider developing a formal medical evacuation network.

Pneumoscrotum: Value as an early diagnostic sign of tension pneumothorax in blunt thoracic trauma

“…As shown in the literature, pneumoscrotum did not immediately develop in iatrogenic or traumatic causes and was only noted after various time points. [23456789101112131415] In our patient case, the continuous chest compressions likely exacerbated the air tracking, leading to the more rapid development compared to the literature cases.…”

“…Of these, 12 cases reported in the existing literature have been secondary to pneumothorax with six specifically reported to have blunt thoracic trauma as the inciting incident. [891011121314] Diagnosis of pneumoscrotum was made in four of these cases during the initial trauma assessment and before the diagnosis of a pneumothorax via physical examination or imaging including chest X-rays or computed tomographic scans, while the remaining two cases noted the presence of pneumoscrotum incidentally on imaging that captured the scrotal sac or on tertiary surely. However, none of these previous case reports describe the use of a rapidly expanding pneumoscrotum as a diagnostic sign of an acute tension pneumothorax and its potential usefulness and application during the initial resuscitative phase of trauma care such as ours.…”

“…[16] In the case of traumatic chest pathology resulting in conditions such as pneumothoraces, chest tubes should be placed to evacuate additional air from the thoracic cavity. [8910111213141516] For iatrogenic causes such as postlaparoscopic surgery or colonoscopy, all attempts should be made to evacuate air from the intestines or abdominal cavity to prevent tracking through subcutaneous tissue. Treatment of infectious causes such as Fournier gangrene with the appropriate surgical debridement and antibiotics will ultimately resolve the pneumoscrotum.…”

“…Of these etiologies, the true incidence of pneumoscrotum secondary to blunt thoracic trauma and tension pneumothorax is unknown due to the scarcity of literature on the specific topic, and on our review, there are only a handful of reported cases of pneumoscrotum overall in the English literature. [12345678910111213141516] Given the precedence for this pathophysiology and the life-threatening etiologies, such as pneumoperitoneum or pneumothorax, the importance of finding a cause for a pneumoscrotum in the setting of trauma should not be overlooked. As we witnessed, this finding can lead to earlier diagnosis, but more importantly, timely, life-saving intervention.…”