The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient.

The recognition and management of life-threatening hemorrhage in the polytrauma patient poses several challenges to prehospital rescue personnel and hospital providers. First, identification of acute blood loss and the magnitude of lost volume after torso injury may not be readily apparent in the field. Because of the expression of highly effective physiological mechanisms that compensate for a sudden decrease in circulatory volume, a polytrauma patient with a significant blood loss may appear normal during examination by first responders.

Optimizing transfusion strategies in damage control resuscitation: current insights.

From clinical and laboratory studies of specific coagulation defects induced by injury, damage control resuscitation (DCR) emerged as the most effective management strategy for hemorrhagic shock. DCR of the trauma patient who has sustained massive blood loss consists of 1) hemorrhage control; 2) permissive hypotension; and 3) the prevention and correction of trauma-induced coagulopathies, referred to collectively here as acute coagulopathy of trauma (ACOT). Trauma patients with ACOT have higher transfusion requirements, may eventually require massive transfusion, and are at higher risk of exsanguinating.

Gender differences in academic surgery, work-life balance, and satisfaction.

Background: An increasing number of women are pursuing a career in surgery. Concurrently, the percentage of surgeons in dual-profession partnerships is increasing. We sought to evaluate the gender differences in professional advancement, work-life balance, and satisfaction at a large academic center.

Prevalence of cardiovascular and respiratory complications following trauma in patients with obesity.

Background: It is generally accepted that obesity puts patients at an increased risk for cardiovascular and respiratory complications after surgical procedures. However, in the setting of trauma, there have been mixed findings in regards to whether obesity increases the risk for additional complications.

Objective: The aim of this study was to identify whether obese patients suffer an increased risk of cardiac and respiratory complications following traumatic injury.

Infectious complications in obese patients after trauma.

Background: Obesity is a public health concern in the United States due to its increasing prevalence, especially in younger age groups. Trauma is the most common cause of death for people under aged 40 y. The purpose of this study is to determine the association between obesity and specific infectious complications after traumatic injury.

Understanding the Barriers to Hiring and Promoting Women in Surgical Subspecialties.

Background: The objective of this study was to characterize potential disparities in academic output, NIH-funding, and academic rank between male and female surgical faculty and identify subspecialties in which these differences may be more pronounced.

Study Design: Eighty metrics for 4,015 faculty members at the top-55 NIH-funded departments of surgery were collected. Demographic characteristics, NIH funding details, and scholarly output were analyzed.

Trends in Emergency Department Visits for Nonfatal Violence-Related Injuries Among Adolescents in the United States, 2009-2013.

Purpose: Violence-related injuries are a major cause of death and disability among adolescents in the United States. The objective of this study was to examine trends in adolescent violence-related injuries between 2009 and 2013.

Methods: This study examined data from the National Electronic Injury Surveillance System-All Injury Program for years 2009-2013.

Factors associated with pulmonary embolism within 72 hours of admission after trauma: a multicenter study.

Background: Recent studies using thromboelastography indicate that patients are at risk for hypercoagulability early after injury. Pulmonary embolism (PE) is also well known to cause significant morbidity and mortality after injury and can occur within 72 hours of admission (early PE). Despite this risk, prophylactic anticoagulation is often delayed in patients with certain injuries due to concerns about bleeding.

Unplanned intubation: when and why does this deadly complication occur?

Background: Risk factors for unplanned intubation have been delineated, but details regarding when and why reintubations occur as well as strategies for prevention have not been defined.

Methods: Over a 2-year period, 104 of 3,141 patients (3.3%) monitored via the American College of Surgeons-National Surgical Quality Improvement Program required unplanned intubation.

Hemodynamic monitoring in the intensive care unit.

Patients in the intensive care unit are often critically ill with inadequate tissue perfusion and oxygenation. This inadequate delivery of substrates at the cellular level is a common definition of shock. Hemodynamic monitoring is the observation of cardiovascular physiology.

Optimizing outcomes in emergency room thoracotomy: a 20-year experience in an urban Level I trauma center.

Emergency room thoracotomy (ERT) has remained a last resort tool of resuscitation in the management of patients with major trauma. The medical records of all patients undergoing ERT for penetrating chest trauma from January 1, 2000 through April 30, 2008 were retrospectively reviewed. The data from this study were added to data collected in two previous studies conducted at our institution for meta-analysis.

Attacking the problem of hospital diversion: a report of success.

Hospital diversion is a critical issue for hospitals that affects safety and overall patient care. At Wishard Hospital, a public hospital with a level 1 trauma center, we critically reviewed our diversion policies and implemented a series of changes. This hospital-wide process significantly decreased our diversion rates, thereby providing consistent and safe care to our community.

Mediastinal bronchogenic cyst.

A 29 year old woman was found to have a chest mass as part of routine screening with a chest x-ray for an unrelated neurosurgical procedure. Further investigation with a chest CT raised the suspicion of a paravertebral neurogenic tumor. The patient underwent bronchoscopy and resection of the lesion by Video Assisted Thoracic Surgery (VATS).

Cardiac operations in patients with hematologic malignancies.

Objectives: Patients with hematologic malignancies are frequently in need of major cardiac operations. Previous reports suggest an increased risk for perioperative complications in these immunodeficient patients.

Methods: Patients diagnosed with any type of hematologic malignancy who underwent open-heart surgery at our institution between 7/1996 and 6/2002 were identified.