A reference guide to rapidly implementing an institutional dashboard for resource allocation and oversight during COVID-19 pandemic surge.

Objectives: We develop a dashboard that leverages electronic health record (EHR) data to monitor intensive care unit patient status and ventilator utilization in the setting of the COVID-19 pandemic.

Materials And Methods: Data visualization software is used to display information from critical care data mart that extracts information from the EHR. A multidisciplinary collaborative led the development.

D-Dimer-Driven Anticoagulation Reduces Mortality in Intubated COVID-19 Patients: A Cohort Study With a Propensity-Matched Analysis.

Examine the possible beneficial effects of early, D-dimer driven anticoagulation in preventing thrombotic complications and improving the overall outcomes of COVID-19 intubated patients. To address COVID-19 hypercoagulability, we developed a clinical protocol to escalate anticoagulation based on serum D-dimer levels. We retrospectively reviewed all our first 240 intubated patients with COVID-19.

An Evolving Clinical Need: Discordant Oxygenation Measurements of Intubated COVID-19 Patients.

Since the first appearance of the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) earlier this year, clinicians and researchers alike have been faced with dynamic, daily challenges of recognizing, understanding, and treating the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2. Those who are moderately to severely ill with COVID-19 are likely to develop acute hypoxemic respiratory failure and require administration of supplemental oxygen. Assessing the need to initiate or titrate oxygen therapy is largely dependent on evaluating the patient's existing blood oxygenation status, either by direct arterial blood sampling or by transcutaneous arterial oxygen saturation monitoring, also referred to as pulse oximetry.

Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients With Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting.

Background: A novel coronavirus (COVID-19) erupted in the latter part of 2019. The virus, SARS-CoV-2 can cause a range of symptoms ranging from mild through fulminant respiratory failure. Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority of those requiring mechanical ventilation.

Surgical boot camp for fourth-year medical students: Impact on objective skills and subjective confidence.

Background: Within surgical education, there has been a recent emphasis on preparing medical students for the rigors of residency in an effort to improve confidence and technical preparedness throughout postgraduate training. The aim of this study is to test the impact of a boot camp course using the American College of Surgeons-based curriculum and objective, observer-based rating tools on both subjective confidence and objective skills of fourth-year medical students.

Materials And Methods: Informed consent was obtained on the first day of the boot camp.

Spinal Fractures in Older Adult Patients Admitted After Low-Level Falls: 10-Year Incidence and Outcomes.

Objectives: To evaluate the incidence of spinal fractures and their outcomes in the elderly who fall from low-levels in a suburban county.

Design: Retrospective county-wide trauma registry review from 2004 to 2013.

Setting: Suburban county with regionalized trauma care consisting of 11 hospitals.

Tranexamic Acid Use in United States Trauma Centers: A National Survey.

Tranexamic acid (TXA) is an antifibrinolytic agent that is listed as an essential medication by the World Health Organization for traumatic hemorrhage. We determined United States-based surgeons' familiarity with TXA and their use of TXA. An online survey was sent to the 1291 attending surgeon members of a national trauma organization.

Preadmission Do Not Resuscitate advanced directive is associated with adverse outcomes following acute traumatic injury.

Background: Do Not Resuscitate (DNR) orders have been associated with poor outcomes in surgical patients. There is limited literature on admitted trauma patients with advanced directives indicating DNR status before admission (preadmission DNR [PADNR]).

Methods: A retrospective review of the trauma registry of a suburban county was carried out for admitted trauma patients with age ≥41 years, who were admitted between 2008 and 2013.

Outcomes following prolonged mechanical ventilation: analysis of a countywide trauma registry.

Background: The care of mechanically ventilated patients at high-volume centers in select nontrauma populations has variable effects on outcomes. We evaluated outcomes for trauma patients requiring prolonged mechanical ventilation (PMV). We further hypothesized that the higher mechanical ventilator volume trauma center would have better outcomes.

Early unplanned hospital readmission after acute traumatic injury: the experience at a state-designated level-I trauma center.

Background: There is limited literature on early unplanned hospital readmission after acute traumatic injury, especially at suburban facilities.

Methods: A retrospective review of the trauma registry at a suburban, state-designated, level-I academic trauma center from July 2009 to June 2012 was performed for all admitted (≥24 hours) adult (age ≥18 years) trauma patients who were discharged alive, including unplanned readmissions within 30 days of discharge.

Results: Of 3,622 admitted adult trauma patients, 6.

Experience with retroperitoneoscopy in pediatric surgical oncology.

Background: Retroperitoneoscopy (RS) has been successfully introduced in adult oncology for diagnostic procedures, staging, and surgical treatment. Its value for children has rarely been reported. This report describes the authors' experience using RS in the diagnosis and staging of cancer for children and adolescents.

Outcomes following thoracoabdominal resection of neuroblastoma.

Objective: To evaluate the intraoperative and postoperative care of children following thoracoabdominal resection of neuroblastoma.

Design: Retrospective chart review.

Setting: Pediatric intensive care unit (PICU) of major pediatric cancer center.

Experience with aortic grafting during excision of large abdominal neuroblastomas in children.

Background: Total or near total resection of high-risk, stage 4 abdominal neuroblastoma has been correlated with improved local control and overall survival but may be complicated by vascular injury. We describe our experience in the management of significant aortic injuries during this procedure.

Methods: With the institutional review board waiver, medical records of children who had major abdominal aortic reconstruction during neuroblastoma resection from 1996 to 2006 were retrospectively reviewed.

The use of preoperative chemotherapy in Wilms' tumor with contained retroperitoneal rupture.

Purpose: The National Wilms Tumor Study currently describes 3 indications for the use of preoperative chemotherapy: extensive caval involvement, bilateral tumors, and patients who only have a single kidney. However, the management of patients who present with a contained retroperitoneal rupture is not specifically addressed. This is relevant because of the strong possibility of peritoneal contamination when performing a primary resection and the resultant requirement for total abdominal radiation.

Mucoepidermoid carcinoma as a secondary malignancy in pediatric sarcoma.

Purpose: Children diagnosed with osteosarcoma (OS) and Ewing sarcoma (ES) have greatly benefited from the addition of alkylator therapy. However, with greater numbers of long-term survivors, the rising incidence of secondary malignant neoplasms (SMNs) is concerning. Herein we report on 2 patients with sarcoma who developed a case of secondary mucoepidermoid carcinoma after chemotherapy treatment without associated radiation therapy.

Hepatic metastasectomy in children.

Background: There are little data regarding the safety and efficacy of hepatic metastasectomy for solid tumors in childhood. We reviewed our institutional experience to assess operative mortality and morbidity, technique of resection, local control, and survival in pediatric patients undergoing liver resection for metastases.

Methods: All pediatric patients who underwent hepatic resection for metastatic disease from August 1988 to July 2005 were retrospectively identified and clinical data were collected.

Ureteral reconstruction for retroperitoneal tumors in children.

Purpose: Removal of solid tumors of the pelvis and abdominal cavity may require resection of an involved ureteral segment. Ureteral stricture can also be a result of intense therapy. We present our experience with urinary reconstruction in this situation.

Decompressive craniectomy in pediatric patients with traumatic brain injury with intractable elevated intracranial pressure.

Background: Care of pediatric traumatic brain injury (TBI) has placed emphasis on maximizing cerebral perfusion to prevent ischemia and reperfusion injury. A subset of patients with TBI will continue to have refractory intracranial pressure (ICP) elevation despite aggressive therapy including ventriculostomy, pentobarbital coma, hypertonic saline, and diuretics. Decompressive craniectomy (DC) is a controversial treatment of severe TBI.