Optimal Timing for Initiation of Thromboprophylaxis After Hepatic Angioembolization.

Objective: To evaluate the optimal timing of thromboprophylaxis (TPX) initiation after hepatic angioembolization in trauma patients.

Background: TPX after hepatic trauma is complicated by the risk of bleeding, but the relative risk after hepatic angioembolization is unknown.

Methods: Patients who underwent hepatic angioembolization within 24 hours were retrospectively identified from the 2017 to 2019 American College of Surgeons Trauma Quality Improvement Project data sets.

Initial Hemorrhage Control Procedure for Splenic Injuries May Affect Risk of Venous Thromboembolism.

Introduction: Venous thromboembolism (VTE) continues to be a major cause of morbidity in trauma. It is unclear whether the type of hemorrhage control procedure (i.e.

Survival of In-Hospital Cardiopulmonary Arrest in Trauma Patients.

Introduction: Relative to other hospitalized patients, trauma patients are younger with fewer comorbidities, but the incidence and outcomes of in-hospital cardiopulmonary arrest (IHCA) with cardiopulmonary resuscitation (CPR) in this population is unknown. Therefore, we aimed to investigate factors associated with survival in trauma patients after IHCA to test the hypothesis that compared to other hospitalized patients, trauma patients with IHCA have improved survival.

Methods: Retrospective review of the Trauma Quality Improvement Program database 2017 to 2019 for patients who had IHCA with CPR.

When is it safe to start thromboprophylaxis after splenic angioembolization?

Background: Thromboprophylaxis after blunt splenic trauma is complicated by the risk of bleeding, but the risk after angioembolization is unknown. We hypothesized that earlier thromboprophylaxis initiation was associated with increased bleeding complications without mitigating venous thromboembolism events.

Methods: All blunt trauma patients who underwent splenic angioembolization within 24 hours of arrival were identified from the American College of Surgeons Trauma Quality Improvement Program datasets from 2017 to 2019.

Effectiveness of the Global Surgical and Medical Support Group (GSMSG) activities in Ukraine.

Objective: Targeting of healthcare infrastructures in Ukraine has served as a tactical warfare strategy. The goal of the Global Surgical and Medical Support Group (GSMSG) is to provide sustainable, high quality medical and surgical care in war zones.

Interventions: GSMSG deployed United States (US) Special Operations veterans and highly specialized licensed medical experts.

Umbilical cord mesenchymal stem cells for COVID-19 acute respiratory distress syndrome: A double-blind, phase 1/2a, randomized controlled trial.

Acute respiratory distress syndrome (ARDS) in COVID-19 is associated with high mortality. Mesenchymal stem cells are known to exert immunomodulatory and anti-inflammatory effects and could yield beneficial effects in COVID-19 ARDS. The objective of this study was to determine safety and explore efficacy of umbilical cord mesenchymal stem cell (UC-MSC) infusions in subjects with COVID-19 ARDS.

Miami-Dade County Juvenile Weapons Offenders Program (JWOP): a potential model to reduce firearm crime recidivism nationwide.

Introduction: Youth firearm violence has been a growing problem in the USA. Several programs across the country aimed at reducing recurrent gun violence in this vulnerable population have published recidivism rates of 40% to 50%. For the past 18 years, the Juvenile Weapons Offenders Program (JWOP) in Miami-Dade County has provided a unique multidisciplinary intervention encompassing 100 hours of violence education, behavioral modification, and social mentoring.

Readmission for venous thromboembolism after emergency general surgery is underreported and influenced by insurance status.

Background: Prior studies of venous thromboembolism (VTE) after emergency general surgery (EGS) are not nationally representative nor do they fully capture readmissions to different hospitals. We hypothesized that different-hospital readmission accounted for a significant number of readmissions with VTE after EGS and that predictive factors would be different for same- and different-hospital readmissions.

Methods: The 2014 Nationwide Readmissions Database was queried for nonelective EGS hospitalizations.

Global Surgery Pro-Con Debate: A Pathway to Bilateral Academic Success or the Bold New Face of Colonialism?

Global surgery, especially academic global surgery, is of tremendous interest to many surgeons. Classically, it entails personnel from high-income countries going to low- and middle-income countries and engaging in educational activities as well as procedures. Academic medical personnel have included students, residents, and attendings.

Use of Telemedicine in Surgical Education: A Seven-Year Experience.

Uniformity in surgical education is challenging because surgical experience is based on rotation assignments. With work hour restrictions, the likelihood of residents being exposed to rare or unusual cases is diminished. Telemedicine may create a new learning paradigm for surgical education and supplement exposure for rare or unusual cases.

Hidden burden of venous thromboembolism after trauma: A national analysis.

Background: Trauma patients are at increased risk for venous thromboembolism (VTE). One in four trauma readmissions occur at a different hospital. There are no national studies measuring readmissions to different hospitals with VTE after trauma.

The Impact of an Advanced ECMO Program on Traumatically Injured Patients.

In June 2016, an advanced extracorporeal membrane oxygenation (ECMO) program consisting of a multidisciplinary team was initiated at a large level-one trauma center. The program was created to standardize management for patients with a wide variety of pathologies, including trauma. This study evaluated the impact of the advanced ECMO program on the outcomes of traumatically injured patients undergoing ECMO.

A simplified stratification system for venous thromboembolism risk in severely injured trauma patients.

Background: The objective of this study was to re-evaluate and simplify the Greenfield risk assessment profile (RAP) for venous thromboembolism (VTE) in trauma using information readily available at the bedside.

Methods: Retrospective review of 1233 consecutive admissions to the trauma intensive care unit from August 2011-January 2015. Univariate analyses were performed to determine which RAP risk factors were significant contributors to VTE.

Effect of time to operation on mortality for hypotensive patients with gunshot wounds to the torso: The golden 10 minutes.

Introduction: Timely hemorrhage control is paramount in trauma; however, a critical time interval from emergency department arrival to operation for hypotensive gunshot wound (GSW) victims is not established. We hypothesize that delaying surgery for more than 10 minutes from arrival increases all-cause mortality in hypotensive patients with GSW.

Methods: Data of adults (n = 309) with hypotension and GSW to the torso requiring immediate operation from January 2004 to September 2013 were retrospectively reviewed.

Anti-Xa-guided enoxaparin thromboprophylaxis reduces rate of deep venous thromboembolism in high-risk trauma patients.

Background: Appropriate prophylaxis against venous thromboembolism (VTE) remains undefined. This study evaluated an anti-Xa-guided enoxaparin thromboprophylaxis (TPX) protocol on the incidence of VTE in high-risk trauma patients based on Greenfield's Risk Assessment Profile (RAP) score.

Methods: This is a retrospective observational study of patients admitted to a trauma intensive care unit over a 12-month period.

Surveillance and Early Management of Deep Vein Thrombosis Decreases Rate of Pulmonary Embolism in High-Risk Trauma Patients.

Background: Venous duplex ultrasound (VDU) is the modality of choice for surveillance of venous thromboembolism (VTE), but there is controversy about its appropriate implementation as a screening method. We hypothesize that VDU surveillance in trauma patients at high risk for VTE decreases the rate of pulmonary embolism (PE).

Study Design: One thousand two hundred and eighty-two trauma ICU admissions were screened with Greenfield's Risk Assessment Profile from August 2011 to September 2014.

Coagulation Profile Changes Due to Thromboprophylaxis and Platelets in Trauma Patients at High-Risk for Venous Thromboembolism.

We hypothesize there are coagulation profile changes associated both with initiation of thromboporphylaxis (TPX) and with change in platelet levels in trauma patients at high-risk for venous thromboembolism (VTE). A total of 1203 trauma intensive care unit patients were screened with a VTE risk assessment profile. In all, 302 high-risk patients (risk assessment profile score ≥ 10) were consented for weekly thromboelastography.

Risk of pulmonary embolism with repair or ligation of major venous injury following penetrating trauma.

Background: There are many benefits of repair over ligation of major venous injuries (MVIs) following penetrating trauma, but the risk of pulmonary embolism (PE) is not well defined. We hypothesized that rates of PE are comparable between repair and ligation of MVI.

Methods: All penetrating trauma patients with MVI requiring an operation from 2003 to 2012 (n = 158) were retrospectively reviewed.

Spontaneous massive splenic infarction in the setting of renal transplant and septic shock: a case report and review of the literature.

Massive splenic infarction (MSI) is a rare phenomenon that results from compromised blood flow to more than half of the spleen. Causes of MSI include hematological disorders, coagulopathies, infection, and embolization, and, rarely, MSI is spontaneous. The mainstay of treatment is splenectomy.

Thromboelastogram-guided enoxaparin dosing does not confer protection from deep venous thrombosis: a randomized controlled pilot trial.

Background: The incidence of deep venous thrombosis (DVT) remains high in general surgery and trauma patients despite widespread prophylaxis with enoxaparin. A recent study demonstrated decreased incidence of DVT if patients on enoxaparin had a change in R time (ΔR) of greater than 1 minute when heparinase-activated thromboelastography (TEG) was compared with normal TEG. We hypothesized that using ΔR-guided dosing would result in decreased DVT rates.

Prevention of venous thrombotic events in brain injury: review of current practices.

Venous thromboembolic event after traumatic brain injury represents a unique clinical challenge. Physicians must balance appropriate timing of chemoprophylaxis with risk of increased cerebral hemorrhage. Despite an increase in the literature since the 1990s, there are clear disparities in treatment strategies.

Developing a trauma critical care and rehab hospital in Haiti: a year after the earthquake.

Objective: Prior to the devastating earthquake in Haiti, January 12, 2010, a group of Haitian physicians, leaders and members of Project Medishare for Haiti, a Non-governmental Organization, had developed plans for a Trauma Critical Care Network for Haiti.

Design: One year after the earthquake stands a 50-bed trauma critical care and rehab hospital that employs more than 165 Haitian doctors, nurses and allied healthcare professionals, and administrative and support staff in Port-Au-Prince. Hospital Bernard Mevs Project Medishare (HBMPM) has been operating with the following two primary goals: 1) to provide critical-care- and trauma-related medical and rehabilitation services and 2) to provide clinical education and training to Haitian healthcare professionals.