The impossible abdomen in a complex patient: treatment with novosorb biodegradable temporizing matrix (BTM) for frozen abdomen with entero-atmospheric fistula.

Managing patients with severe fixation of intra-abdominal contents, known as frozen abdomen, often creates a vicious cycle of tissue injury that further prolongs open abdomen resolution. We share the management course of a 28-year-old male status post motor vehicle accident with traumatic pancreatitis and complex liver injury. Following multiple laparotomies for abdominal wash out, he developed a frozen abdomen and an entero-atmospheric fistula (EAF) through granulated bowel.

Improving A Rapid Response System at a Teaching Hospital: Lessons Learned From Implementation of a Novel Performance Self-Evaluation Tool.

Rapid assessment and treatment (RAT) calls, facilitated by Rapid Response Teams (RRTs), have become vital to the care of hospitalized patients deteriorating outside of the intensive care unit in many institutions worldwide. A significant body of data has recognized the efficacy of rapid response systems (RRSs) in improving patient care; however, there is no standardized protocol that all RRSs practice. Even when the recognition of patient clinical deterioration is rapidly noted, further treatment may be delayed due to issues with clinical knowledge and communication between parties present, especially in training institutions.

Mortality association with extremity trauma and transferring patients for higher level of care.

Introduction: Rising healthcare costs and reduced Medicaid reimbursements pose lasting challenges for trauma centers. Various studies have highlighted the adverse effect of these cost-related circumstances on trauma center survival and the need for local hospitals to transfer patients to tertiary and quaternary care centers. Our study seeks to assess the relationship between patient transfer status to a higher-level health center and its association with mortality.

Management of Large Full-Thickness Burns Using Kerecis™ Acellular Fish Skin Graft and ReCell™ Autologous Skin Cell Suspension: A Case Report of Two Patients with Large Surface Area Burns.

Novel treatments for extensive full-thickness burns revolve around fluid control, addressing systemic inflammatory derangements, and achieving early skin coverage with acceptable cosmetic and functional results. Recent advances in the management of extensive burns include fish skin xenografts, such as Kerecis Omega-3 acellular dermal substitute. Reported to be non-allergenic and antimicrobial, this Atlantic Cod skin derivative has the potential to supplement the management of patients with large surface area burns.

Mesenteroaxial gastric volvulus in an elderly patient 5 years after Nissen fundoplication and hiatal hernia repair.

Gastric volvulus is a rare and potentially life-threatening condition that usually presents acutely and requires immediate intervention via either endoscopic or surgical detorsion. Most often, it presents secondary to a hiatal hernia, with herniation and torsion of the stomach through the hiatus. Only a small subset of patients present with gastric volvulus after Nissen fundoplication for hiatal hernia repair.

Quality of Life Assessment Four Years after a More than Ninety Percent Total Body Surface Area in Two Survivors with Burns: Case Report.

There are few reports in the literature detailing the Quality of Life (QOL) of survivors with greater than 90% total body surface area (TBSA) burns. The objective was to assess two such individuals seen at our center with the Burn Specific Health Scale-Brief (BSHS-B) survey four years after discharge. Subject responses were categorized into their respective BSHS-B health domains (heat sensitivity, affect, hand function, treatment regimens, work, sexuality, interpersonal relationships, simple abilities, and body image) and a raw score was calculated for each domain.

Lymphangiography and thoracic duct embolization for persistent chyle leak following augmentation mammoplasty and mastopexy.

Chyle leak is a relatively rare post-operative complication of breast and axilla surgery, and the majority of these cases can be managed conservatively. We present the case of a 42-year-old female with chyle leak within the external thoracic cavity following elective augmentation mammoplasty and mastopexy. This patient failed initial operative management consisting of implant removal, washout, suture plication, and intra-operative drain placement as well as subsequent conservative management including diet modification, total parenteral nutrition, and percutaneous aspiration.

Conservative Treatment of Empyema Formation Following Intrathoracic Rib Fixation With Antibiotics and Tissue Plasminogen Activator/Dornase.

Rib plating is a recommended intervention for patients with multiple rib fractures or flail chest to improve shortness of breath, significantly reduce pain, and shorten the length of hospital stay. Here, we report a unique and extremely rare finding in a patient with empyema following intrathoracic rib fixation. A 32-year-old male with a history of alcohol use disorder presented to the emergency department trauma bay after a motor vehicle accident.

Anterior and posterior surgical approach for vertebral lumbar osteomyelitis.

() infections primarily affect immunocompromised patients who commonly present with non-orthopedic infections. We present a case of a 63-year-old female presented with persistent back pain and radicular pain. Computed tomography and magnetic resonance imaging showed a large multiloculated anterior epidural abscess.

Prompt Identification and Intervention for Ischemic Monomelic Neuropathy in Preventing Major Patient Disability.

Ischemic monomelic neuropathy (IMN) is a rare complication of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs). Diagnosis of the condition is often delayed, with debilitating outcomes for patients. We present two cases of IMN in which prompt identification and intervention prevented major disability.

Intravascular Ultrasound-Guided Stenting of the Celiac Artery for Hepatic Hypoperfusion After Acute Type A Aortic Dissection: A Case Report.

Type A aortic dissection is a life-threatening emergency requiring prompt surgical treatment. The dissection itself and use of cardiopulmonary bypass can lead to further postoperative complications, including aortic branch occlusion, thrombosis, ischemia, and fatal end-organ damage. Celiac artery occlusion with consequent hepatic malperfusion is one feared complication of aortic dissection, which requires urgent surgical intervention.

The novel use of resuscitative endovascular balloon occlusion of the aorta for uncontrolled bleeding in a surgically inaccessible abdomen: The ruptured proper hepatic artery in a frozen abdomen.

Hemorrhage is among the leading causes of death for trauma patients. Adjunct techniques used to control bleeding include use of aortic cross clamping, application of a pelvic binder, rapidly expanding hemostatic sponges, and extra-peritoneal packing. Additionally, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) can provide life-saving proximal control for patients with massive internal hemorrhage.

Re-do Hybrid Deep Venous Arterialization via the Popliteal Venous System: Conversion From a Deep Venous Arterialization to a Superficial Venous Arterialization.

Deep venous arterialization (DVA) is a final option for limb salvage in patients with end stage arterial anatomy. We report a 66-year-old dialysis dependent male with forefoot gangrene, Rutherford class 6 chronic limb ischemia, who required a redo endovascular DVA. On initial presentation an angiogram was demonstrated a desert foot with absent tibial runoff to his bilateral lower extremities.

Increased Mortality in Patients Transferred to a Level 1 Trauma Center with Blunt and Penetrating Extremity Vascular Injuries.

Background: Trauma care depends on a complex transfer system to ensure timely and adequate management at major trauma centers. Patient outcomes depend on the reliability of triage in local or community hospitals and access to tertiary or quaternary trauma institutions. Patients with polytrauma, extremity trauma, or vascular injuries require multidisciplinary management at trauma hospitals.

The Use of Advanced Three-Dimensional Computed Tomography During Simple and Complex Endovascular Aortic Aneurysm Repairs.

Background: Endovascular aneurysm repair (EVAR) success depends on imaging technology both in the planning and operative phases. Endovascular repair requires intravenous contrast and radiation exposure to the patient as well as radiation exposure to the operator. Recent developments in imaging technology attempt to merge preoperative imaging with intraoperative imaging to improve the efficiency and accuracy of EVAR.

Use of the GORE Conformable Excluder Device in Highly Angulated Aortic Neck Anatomy: Mid-term Outcomes.

Introduction: Patients with complex aortic anatomy require meticulous surgical planning to optimize intraoperative and postoperative outcomes. The GORE Excluder Conformable Abdominal Aortic Aneurysm Endoprosthesis (CEXC Device, WL Gore and Associates, Flagstaff, AZ) allows for endovascular treatment of highly angulated and short proximal neck abdominal aortic aneurysms (AAA). Owing to its recent approval, short-term clinical outcomes of this device remain scarce.

Gender Differences With Ibutilide Effectiveness and Safety in Cardioversion of Atrial Fibrillation.

Introduction: Few studies have examined the use of ibutilide in noncardiac surgical populations. Our study considered the effectiveness and safety of ibutilide in cardioversion of atrial fibrillation (AF) in medical and surgical intensive care patients.

Methods: A retrospective chart review was performed for patients with a confirmed diagnosis of AF who were hemodynamically stable and received ibutilide after the initial diagnosis.

The Impact of Computed Tomography Scans on the Management and Wait Times in Perianal Abscess Diagnoses.

Background Diagnosis and management of perianal abscesses (PAA) are based on history and clinical examination. Imaging is not indicated except in complicated cases, as determined by the surgical team. The monetary, ionizing radiation, and resource utilization costs of a computed tomography (CT) scan in the emergency room must be considered when used for diagnostic purposes of PAAs.

Tracheal ulcer development from high volume, low-pressure cuffed endotracheal tubes.

Introduction: Iatrogenic injury to the larynx, particularly the vocal cords from prolonged intubation, has been well-studied; however, tracheal injuries are rarely reported. This study investigates the effectiveness of cuffed, high-volume, low-pressure endotracheal tubes in preventing the development of tracheal ulcers in intubated subjects.

Methods: A retrospective, IRB-approved review was performed on 1355 subjects who underwent percutaneous tracheostomy from 2002 to 2018.

The impact of impaired insulin regulation on severity of SARS-CoV-2 infection: a 2-year retrospective single-center analysis.

Background: The COVID-19 pandemic has caused an international healthcare crisis and produced a large healthcare burden. Diabetes mellitus (DM) is a common disease that can be controlled via pharmacologic agents; however, many patients have poor glycemic control, leading to disease-related complications. DM has been reported in the literature to be associated with increasing morbidity and mortality in COVID-19 patients.

ABO blood group and rhesus factor association with inpatient COVID-19 mortality and severity: a two-year retrospective review.

Background: Early reports have indicated a relationship between ABO and rhesus blood group types and infection with SARS-CoV-2. We aim to examine blood group type associations with COVID-19 mortality and disease severity.

Methods: This is a retrospective chart review of patients ages 18 years or older admitted to the hospital with COVID-19 between January 2020 and December 2021.