Modified version of the American College of Cardiology's recommendation for low-dose prothrombin complex concentrate is effective for warfarin reversal.

Background: Dosing of four factor prothrombin complex concentrate (4PCC) for warfarin reversal remains controversial. Recently, the American College of Cardiology (ACC) recommended a low-dose PCC regimen as an option for warfarin reversal in acute major bleeding. We performed a retrospective study evaluating if a modified version of the ACC guideline recommendations was effective for warfarin reversal in acute major bleeds when compared to traditional variable dosing.

Lung ultrasound for detecting pneumothorax in injured children: preliminary experience at a community-based Level II pediatric trauma center.

Background: Ultrasound (US) has been used in the adult trauma population with reported moderate to high sensitivities, but data are scarce in the pediatric trauma population.

Objective: The purpose of this study was to specifically examine the sensitivity and specificity of one lung US methodology (single-point anterior exam) in the pediatric trauma population when compared to chest radiography or CT.

Materials And Methods: We conducted a retrospective review of pediatric trauma patients who received lung US as an extension of the focused assessment with sonography for trauma (FAST) exam.

A 360° Rotational Positioning Protocol of Organ Donors May Increase Lungs Available for Transplantation.

Objectives: To evaluate the improvement in lung donation and immediate lung function after the implementation of a 360° rotational positioning protocol within an organ procurement organization in the Midwest.

Design: Retrospective observational study.

Setting: The Midwest Transplant Network from 2005 to 2017.

Evaluation of process variations in noncompliance in the implementation of evidence-based sepsis care.

Introduction: Sepsis is recognized as an often-lethal disease. Recommended guidelines are complex and time sensitive. Response teams (RTs) have demonstrated success in implementation of quality initiatives.

Conspicuous vs customary location of hand hygiene agent dispensers on alcohol-based hand hygiene product usage in an intensive care unit.

Context: Hand washing is considered the single most important nosocomial infection-control strategy, yet compliance rarely meets levels recommended by infection control authorities.

Objectives: To determine whether placement of hand hygiene foam dispensers in more conspicuous positions and closer proximity to patients would increase use of infection control agents as measured by volume of product used. Further, to ascertain the influence of dispenser placement vs the number of dispensers available on usage by volume.

Outcomes of tube thoracostomies performed by advanced practice providers vs trauma surgeons.

Background: The role of advanced registered nurse practitioners and physician assistants in emergency departments, trauma centers, and critical care is becoming more widely accepted. These personnel, collectively known as advanced practice providers, expand physicians' capabilities and are being increasingly recruited to provide care and perform invasive procedures that were previously performed exclusively by physicians.

Objectives: To determine whether the quality of tube thoracostomies performed by advanced practice providers is comparable to that performed by trauma surgeons and to ascertain whether the complication rates attributable to tube thoracostomies differ on the basis of who performed the procedure.

Percutaneous tracheostomy placement with external laser light transillumination identifies proper tracheal orientation and improves surgeon insertion confidence.

Complications of percutaneous tracheostomy include bleeding, loss of airway control, inadvertent injury to surrounding structures, and equipment damage, all of which can be attributed to poor visualization and inaccurate orientation. Initially, we performed percutaneous tracheostomy in the intensive care unit setting using the single-dilator technique with video bronchoscopy without external transillumination. During our first 30 procedures, the video bronchoscope was damaged in four instances, requiring costly repairs each time.

Influence of semi-recumbent position on intra-abdominal pressure as measured by bladder pressure.

Background: Intra-abdominal pressure (IAP) obtained by bladder pressure measurement is used to detect impending abdominal compartment syndrome (ACS), but, while it is recommended to use a supine position, the literature describes IAP measurement in varying positions. This study evaluated the impact of body position at differing head-of-bed (HOB) elevations on bladder pressure when planned to be used as a surrogate IAP measurement.

Materials And Methods: Forty-five trauma patients admitted to a surgical intensive care unit underwent bladder pressure measurements at 0, 15, 30, 45 degrees HOB position and 30 degrees HOB position plus 15 degrees of reverse Trendelenburg tilt; these measurements were performed in counterbalanced fashion and assessed by built-in angle indicators on the bed rails of each bed.