Consequences of Legal Infractions on the General Surgery Residency Application Process.

Objective: Alcohol and drug-related legal infractions are common among college and medical students. The objective of this work is to quantify the influence of these legal infractions on program directors (PDs) when making decisions on applicants to general surgery residencies.

Design: A convenience sample of 72 PDs with publicly accessible email addresses were electronically sent a previously piloted survey tool.

Kids gone wild - Alcohol use and patient characteristics in pediatric trauma during the coronavirus disease 2019 pandemic.

Importance: Reported coronavirus disease 2019 (COVID-19) pandemic effects on pediatric trauma have been variable.

Objective: We investigated the characteristics of pediatric trauma including alcohol use during the pandemic at our urban trauma center.

Methods: The trauma database of our adult level 1 trauma center was queried for all pediatric (age ≤ 18 years) patients presenting between March 1, 2020, and October 30, 2020.

Visual Misrepresentations: The Lack of Skin Tone and Sex Equity in General Surgical Textbooks.

Objective: Lack of racial and ethnic diversity in educational material contributes to health disparities. This study sought to determine if images of skin color and sex in general surgery textbooks were reflective of the U.S.

Increase in Alcohol Use Among the Geriatric Trauma Population During the COVID-19 Pandemic.

The COVID-19 pandemic has had profound effects on the everyday behaviors of all patients. At the same time, the United States population is aging, and an increasing portion of traumatically injured patients are geriatric. Our study aims to examine the effects of the COVID-19 pandemic on the geriatric trauma population.

Emergent initial presentation of congenital malrotation with midgut volvulus in 68-year-old.

Congenital malrotation is a pathology nearly exclusive to the infant population. In the rare instance when it is diagnosed in an adult, it is typically associated with a longstanding history of gastrointestinal symptoms. Unfortunately, this unique presentation in an unexpected population has the potential to be confounding, leading to delayed or mismanaged care.

Sternal fixation for isolated traumatic sternal fractures improves pain and upper extremity range of motion.

Introduction: Sternal fractures are debilitating due to intractable pain, constant fracture movement and limited range of motion (ROM) of the upper extremities (UE). Traditional treatment comprises mainly of pain control, delaying return to daily activities. Recently, sternal fixation has gained popularity.

Spontaneous Diaphragmatic Rupture in Hypermobile Type Ehlers-Danlos Syndrome.

Ehlers-Danlos Syndrome refers to a spectrum of connective tissue disorders that have a variety of clinical manifestations. In this case, we present a spontaneous diaphragmatic rupture in a patient with type III Ehlers-Danlos Syndrome. The patient presented with worsening shortness of breath after failure of medical therapy for a presumed pneumonia.

Ventilator-Associated Pneumonia in Trauma Patients: Different Criteria, Different Rates.

Background: No consensus exists regarding the definition of ventilator-associated pneumonia (VAP). Even within a single institution, inconsistent diagnostic criteria result in conflicting rates of VAP. As a Level 1 trauma center participating in the Trauma Quality Improvement Project (TQIP) and the National Healthcare Safety Network (NHSN), our institution showed inconsistencies in VAP rates depending on which criteria was applied.

Permissive Hypotension: Potentially Harmful in the Elderly? A National Trauma Data Bank Analysis.

Permissive hypotension is a component of damage control resuscitation that aims to provide a directed, controlled resuscitation, while countering the "lethal triad." This principle has not been specifically studied in elderly (ELD) trauma patients (≥55 years). Given the ELD population's lack of physiologic reserve and risk of inadequate perfusion with "normal" blood pressures, we hypothesized that utilized a permissive hypotension strategy in ELD trauma patients would result in worse outcomes compared with younger patients (18-54 years).

An Unusual Presentation of a Posterior Mediastinal Schwannoma Associated with Traumatic Hemothorax.

Schwannomas of the thoracic cavity are typically an asymptomatic, benign neurogenic neoplasm of the posterior mediastinum. In this case, we present a traumatic hemothorax as the initial presentation for a previously undiscovered mediastinal mass. The patient presented with shortness of breath and right-sided chest pain after being struck in the chest with a soccer ball.

Perioperative management of obese patients.

Obesity prevalence has quadrupled since the 1980s in the United States. It is estimated that 30% of the population is obese or has a body mass index of greater than or equal to 30 as defined by the World Health Organization. Surgeons are likely to engage in the care of obese patients and need to be adept in every aspect of the patients' care in order to have a successful hospital course.

When birds can't fly: an analysis of interfacility ground transport using advanced life support when helicopter emergency medical service is unavailable.

Background: Helicopter emergency medical service (HEMS) transport of trauma patients is costly and of unproven benefit. Recent retrospective studies fail to control for crew expertise and therefore compare highly trained advance life support with less-trained basic life support crews. The purpose of our study was to compare HEMS with ground, interfacility transport while controlling for crew training.

Hypothermia in trauma patients: predicting the big chill.

Physicians commonly ignore hypothermia, an often-underappreciated event associated with mortality in trauma patients, in general due to its prevalence and belief that it is secondary to the injury itself (secondary hypothermia). Over the past several decades, hypothermia in trauma has been studied concerning its effects on mortality; however, very little has been done to identify the major risk factors associated with it. The study by Lapostolle and colleagues has attempted to incorporate environmental risk factors and prehospital care along with more traditional variables for the prediction of hypothermia at admission.

An objective study of the impact of the electronic medical record on outcomes in trauma patients.

It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury.

Damage control surgery: it's evolution over the last 20 years.

In less than twenty years, what began as a concept for the treatment of exsanguinating truncal trauma patients has become the primary treatment model for numerous emergent, life threatening surgical conditions incapable of tolerating traditional methods. Its core concepts are relative straightforward and simple in nature: first, proper identification of the patient who is in need of following this paradigm; second, truncation of the initial surgical procedure to the minimal necessary operation; third, aggressive, focused resuscitation in the intensive care unit; fourth, definitive care only once the patient is optimized to tolerate the procedure. These simple underlying principles can be molded to a variety of emergencies, from its original application in combined major vascular and visceral trauma to the septic abdomen and orthopedics.

Resident perceptions of the impact of paging on intraoperative education.

Our purpose was to evaluate the impact of paging on perceptions of intraoperative learning. Intraoperative logs of pager interruptions were kept by surgical residents at a university hospital over a 30-day period. The postgraduate year, number of pages, category of caller, reason for call, and level of urgency were recorded during each operation.

Damage control for intra-abdominal sepsis.

With the success of damage-control surgery for the treatment of exsanguinating truncal trauma, it has been adapted to other surgical diseases associated with shock states, such as severe secondary peritonitis. The structured approach of damage control is easily adapted to and can incorporate the fundamental elements of the Surviving Sepsis Campaign. It is not meant to replace tried and true surgical principles, such as source control, but is a usable framework in managing the complicated circumstances seen with these patients.

Disparity between resident and faculty surgeons' perceptions of preoperative preparation, intraoperative teaching, and postoperative feedback.

Purpose: The education occurring within the operating room is fundamental to the development of a surgical resident. The purpose of this study was to investigate differing perceptions of surgical residents and faculty in regard to preoperative preparation, intraoperative teaching, and postoperative feedback.

Methods: A validated survey tool was slightly adapted, piloted, and then administered to the surgical residents and faculty of a university-based general surgery residency program.

Impact of pancreatic cancer and subsequent resection on glycemic control in diabetic and nondiabetic patients.

The incidence of new onset or worsening diabetes is surprisingly low in patients after partial pancreatectomy for cancer, leading us to question what factors predict diminished glycemic control in those undergoing resection. All patients undergoing pancreatectomy for cancer at a large, rural university teaching hospital between 1996 and 2010 were identified. The incidence of new onset, or worsening, existing diabetes was determined based on pre and postoperative medication requirement.

Open fractures: it doesn't come out in the wash.

Background: Six hours from injury to washout is considered the gold standard in the treatment of open traumatic fractures. Despite this being our hospital policy, the rural nature of our Level I trauma center causes delays in discovery and transport, creating a unique randomization of time to washout. We hypothesized that orthopedic complications after open fractures are related to the severity of the fractures, not the timing of the washout.

"Damage control" in the elderly: futile endeavor or fruitful enterprise?

Background: Damage control laparotomy (DCL) provides effective management in carefully selected, exsanguinating trauma patients. However, the effectiveness of this approach has not been examined in the elderly. The purpose of this study was to characterize elderly DCL patients.

Damage control in trauma and abdominal sepsis.

Damage control surgery, initially formalized <20 yrs ago, was developed to overcome the poor outcomes in exsanguinating abdominal trauma with traditional surgical approaches. The core concepts for damage control of hemorrhage and contamination control with abbreviated laparotomy followed by resuscitation before definitive repair, although simple in nature, have led to an alteration in which emergent surgery is handled among a multitude of problems, including abdominal sepsis and battlefield surgery. With the aggressive resuscitation associated with damage control surgery, understanding of abdominal compartment syndrome has expanded.