Damage Control Surgery in the Era of Globalization of Health Care - Military and International Outcomes: A SystematicReview.

Introduction: Damage Control Surgery (DCS) is a surgical technique used to manage critically ill and injured patients. This study examines the most recent 10-y outcomes related to DCS, with the secondary goal of scrutinizing the outcomes after DCS across surgical theaters.

Methods: Studies published between 2012 and 2021 that described adult patients undergoing Abdominal DCS after traumatic injury were included.

Does Trauma Center Volume Matter? An Analysis of Trauma Center Volume on Outcome Using the TQIP/NTDB Database.

Increasing trauma center admission volume is said to decrease mortality. Evidence supporting this position is dependent upon patient groups and the time period studied, and gaps remain. We evaluated the effect of annual volume of critically injured patients on hospital mortality, comparing two time periods.

Perimortem cesarean section after severe injury: What you need to know.

When pregnant patients are involved in traumatic incidents, the trauma clinician encounters two patients-both the mother and the unborn child. Advanced trauma life support dictates that the first priority is the life of the mother; however, there are rare situations where to provide the greatest chance of survival for both the mother and baby, an emergency cesarean section (perimortem cesarean delivery [PMCD]) must be performed. The decision to perform this procedure must occur quickly, and the reality is that a board-certified obstetrician is rarely present, particularly in rural areas.

THE ROLE OF TRANEXAMIC ACID IN POSTPARTUM HEMORRHAGE: A NARRATIVE REVIEW.

Postpartum hemorrhage is the leading cause of preventable maternal illness and death globally and carries a disproportionately high burden of mortality in low- to middle-income countries. Tranexamic acid, an antifibrinolytic drug, has been widely adopted to control bleeding in trauma and other surgical conditions. Within the last decade, the World Health Organization updated their guidelines for the treatment of postpartum hemorrhage to include the use of tranexamic acid in all cases of postpartum hemorrhage.

Tranexamic Acid Use in the Surgical Arena: A Narrative Review.

Introduction: Tranexamic acid (TXA) is a potent antifibrinolytic drug that inhibits the activation of plasmin by plasminogen. While not a new medication, TXA has quickly gained traction across a variety of surgical subspecialties to prevent and treat bleeding. Knowledge on the use of this drug is essential for the modern surgeon to continue to provide excellent care to their patients.

So You Want to Do Trauma Research? A Practical Guide to Creating a Research Program at Your Home Institution.

Background: There are 3 pillars upon which the foundation of a teaching program in health care is founded: research, education, and clinical care. However, in a busy academic trauma practice, the unfortunate reality is that research is often a low priority in the frenzy of mandates for clinical productivity.

Objective: The purpose of this report is to advise hospitals on how to create a modest trauma research program that supports research interests without significantly impacting the overall clinical productivity of the department.

Brain death/death by neurologic criteria: What you need to know.

Since the beginning of time, man has been intrigued with the question of when a person is considered dead. Traditionally, death has been considered the cessation of all cardiorespiratory function. At the end of the last century a new definition was introduced into the lexicon surrounding death in addition to cessation of cardiac and respiratory function: Brain Death/Death by Neurologic Criteria (BD/DNC).

American Trauma Care: A System of Systems.

Objective: The benefits of organized trauma systems have been well-documented during 50 years of trauma system development in the United States. Unfortunately, despite this evidence, trauma system development has occurred only sporadically in the 50 states.

Methods: The relevant literature related to trauma system design and development was reviewed based on relevance to the study.

Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians.

Rib fractures are present in 15% of all traumas and 60% of patients with chest traumas. Rib fractures are not life-threatening in isolation, but they can be quite painful which leads to splinting and compromise of respiratory function. Splinting limits the ability of a patient to take a deep breath, which leads to atelectasis, atelectasis to poor secretion removal, and poor secretion removal leads to pneumonia.

Cancer Provider and Survivor Experiences With Telehealth During the COVID-19 Pandemic.

Purpose: The COVID-19 pandemic led to rapid shifts in cancer survivorship care, including the widespread use of telehealth. Given the swift transition and limited data on preferences and experiences around telehealth, we surveyed oncology providers and post-treatment survivors to better understand experiences with the transition to telehealth.

Methods: We distributed provider (MD, PA or NP, nurse, navigator, and social worker) and survivor surveys through the American College of Surgeons Commission on Cancer in mid-October 2020.

Evaluation and Management of Malignant Biliary Obstruction.

There is no reason to be pollyannaish when approaching patients with malignant biliary obstruction (MBO). Although technology has allowed refining diagnosis and resectability of cancers causing biliary obstruction, outcomes have not improved significantly. The previous preponderant place of surgical procedures now is replaced by endoluminal and percutaneous techniques for the management of symptoms of MBO.

Variability in the timeliness of interventional radiology availability for angioembolization of hemodynamically unstable pelvic fractures: a prospective survey among U.S. level I trauma centers.

Background: Patients with hemodynamically unstable pelvic fractures have high mortality due to delayed hemorrhage control. We hypothesized that the availability of interventional radiology (IR) for angioembolization may vary in spite of the mandated coverage at US Level I trauma centers, and that the priority treatment sequence would depend on IR availability.

Methods: This survey was designed to investigate IR availability and pelvic fracture management practices.

Variability in pelvic packing practices for hemodynamically unstable pelvic fractures at US level 1 trauma centers.

Background: Mortality from hemodynamically unstable pelvic fractures remains high. Guidelines offer varying care approaches including the use of pelvic packing (PP), which was recently adopted for potential control of bleeding for this condition. However, the implementation of PP is uncertain as the debate on the optimal resuscitation strategy, angioembolization or PP continues.

Implementing successful strategic plans: a simple formula.

Strategic planning is a process. One way to think of strategic planning is to envision its development and design as a framework that will help your hospital navigate through internal and external changing environments over time. Although the process of strategic planning can feel daunting, following a simple formula involving five steps using the mnemonic B.

Anatomic segmental resection compared to major hepatectomy in the treatment of liver neoplasms.

Background: Familiarity with liver anatomy and refinements in operative technique have led to interest in liver conservation when dealing with hepatic tumors. There is thought to be less morbidity, less blood loss (EBL), a shorter hospital stay (LOS), and no penalty for long-term survival with segmental hepatectomy.

Methods: One hundred ninety-six patients who underwent segmental (SEG group) (N=70) or major (MAJOR group) (N=126) hepatectomy for liver neoplasms were retrospectively reviewed.

Pretransplant immunomodulation of highly sensitized small bowel transplant candidates with intravenous immune globulin.

Presence of preformed lymphocytotoxic antibodies may represent a barrier to isolated intestinal transplantation (IITx). We developed an intravenous immunoglobulins (IVIg) based desensitization protocol for candidates with high panel-reactive antibodies (PRA). Six patients with a mean PRA of 72+/-22% were included in a four-level (L) protocol with escalating doses of IVIg (L1, L2), addition of mycophenolate mofetil (MMF) or plasmapheresis (L3); and anti-CD20 (Rituximab) (L4).