Antibiotic Prophylaxis for Grade 3 Open Fractures: A Retrospective Comparison of Ceftriaxone Plus Vancomycin Versus Cefazolin Plus Gentamicin.

Because of the established path of bacterial entry and contamination-associated mechanisms, grade 3 open orthopedic fractures represent a substantial infection risk. The Eastern Association for the Surgery of Trauma (EAST) guidelines recommended covering and adding aminoglycoside gram-negative coverage. Local institutional guidelines rely on ceftriaxone for gram negative coverage and add methicillin-resistant coverage with vancomycin.

Administration of andexanet alfa for traumatic intracranial hemorrhage in the setting of massive apixaban overdose: A case report.

Purpose: Apixaban is a direct-acting oral anticoagulant that selectively inhibits factor Xa. Reversal strategies utilized to treat factor Xa inhibitor-associated bleeding include andexanet alfa, prothrombin complex -concentrate (PCC), and activated PCC (aPCC). The optimal treatment of traumatic intracranial hemorrhage in the setting of an apixaban overdose is unknown.

Traumatic Parafalcine Subdural Hematoma: A Clinically Benign Finding.

Background: Guidelines for management of intracranial hemorrhage do not account for bleed location. We hypothesize that parafalcine subdural hematoma (SDH), as compared to convexity SDH, is a distinct clinical entity and these patients do not benefit from critical care monitoring or repeat imaging.

Methods: We identified patients presenting to a single level I trauma center with isolated head injuries from February 2016 to August 2017.

Therapeutic Hypothermia and Targeted Temperature Management for Traumatic Arrest and Surgical Patients.

Therapeutic hypothermia (TH) and targeted temperature management (TTM) have been shown to improve outcomes in survivors of cardiac arrest, but prior research has excluded trauma and postoperative patients. We sought to determine whether TH/TTM is safe in trauma and surgical patients. A retrospective cohort study was conducted at a single level I trauma center reviewing adults presenting as a traumatic arrest or cardiac arrest in the postoperative period with a Glasgow Coma Scale <8 after return of circulation who were treated with either TH or TTM.

Mild hyperglycemia, but not glucagon-like peptide 1 predicts poor outcome after injury.

Background: Loss of glucose homeostasis occurs frequently in injured patients. Glucagon-like peptide-1 (GLP-1) is a gut-derived incretin hormone that stimulates insulin and decreases glucagon secretion. The impact of the incretin system on glycemic control in injured patients has not been extensively studied.

Predicting outcome of patients with chest wall injury.

Background: Rib fractures occur in 10% of injured patients, are associated with morbidity and mortality, and frequently necessitate intensive care unit (ICU) care. A scoring system that identifies the risk for respiratory failure early in the evaluation process may allow early intervention to improve outcomes. The aim of this study was to test the hypothesis that a scoring system based on initial clinical findings can identify patients with rib fractures at greatest risk for morbidity and mortality.

Teamwork training improves the clinical care of trauma patients.

Objectives: We investigated these questions: Does formal team training improve team behaviors in the trauma resuscitation bay? If yes, then does improved teamwork lead to more efficiency in the trauma bay and/or improved clinical outcomes?

Design: This intervention study used a pretraining/posttraining design. The intervention was TeamSTEPPS augmented by simulation. The evaluation instrument, which was the Trauma Team Performance Observation Tool (TPOT), was used by trained evaluators to assess teams' performance during trauma resuscitations.

40-slice multidetector CT: is MRI still necessary for cervical spine clearance after blunt trauma?

We have recently demonstrated that 16-slice multidetector CT (MDCT) is insufficient for cervical spine (CS) clearance in patients with unreliable examinations after blunt trauma. The purpose of this study was to determine if a negative CS CT using 40-slice MDCT is sufficient for ruling out CS injury in unreliable blunt trauma patients or if MRI remains necessary for definitive clearance. In addition, we sought to elucidate the frequency by which MRI alters treatment in patients with a negative CS CT who have a reliable examination with persistent clinical symptoms.

An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study.

Background: Efforts to determine the suitability of low-grade pancreatic injuries for nonoperative management have been hindered by the inaccuracy of older computed tomography (CT) technology for detecting pancreatic injury (PI). This retrospective, multicenter American Association for the Surgery of Trauma-sponsored trial examined the sensitivity of newer 16- and 64-multidetector CT (MDCT) for detecting PI, and sensitivity/specificity for the identification of pancreatic ductal injury (PDI).

Methods: Patients who received a preoperative 16- or 64-MDCT followed by laparotomy with a documented PI were enrolled.

Computed tomography alone for cervical spine clearance in the unreliable patient--are we there yet?

Background: Injuries to the cervical spine (CS) occur in 2% to 6.6% of blunt trauma patients. Studies have suggested that computed tomography (CT) alone is sufficient for CS clearance in unreliable patients based on follow-up magnetic resonance (MR) imaging not altering management.