TQIP mortality reporting system case reports: Unanticipated mortality due to airway loss.

The Trauma Quality Improvement Program Mortality Reporting System is an online anonymous case reporting system designed to share experiences from rare events that may have contributed to unanticipated mortality at contributing trauma centers. The Trauma Quality Improvement Program Mortality Reporting System Working Group monitors submitted cases and organizes them into emblematic themes. This report summarizes unanticipated mortality from 3 cases of airway loss in injured patients and presents strategies to mitigate these events locally, with the hope of decreasing unanticipated mortality nationwide.

Evaluation of Cervical Spine Clearance by Computed Tomographic Scan Alone in Intoxicated Patients With Blunt Trauma.

Importance: Current trauma guidelines dictate that the cervical spine should not be cleared in intoxicated patients, resulting in prolonged immobilization or additional imaging. Modern computed tomography (CT) technology may obviate this and allow for immediate clearance.

Objective: To analyze cervical spine clearance practices and the utility of CT scans of the cervical spine in intoxicated patients with blunt trauma.

Lung protective ventilation strategies: have we applied them in trauma patients at risk for acute lung injury and acute respiratory distress syndrome?

Lung protective ventilation strategies for patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are well documented, and many medical centers fail to apply these strategies in ALI/ARDS. The objective of this study was to determine if we apply these strategies in trauma patients at risk for ALI/ARDS. We undertook a retrospective review of trauma patients mechanically ventilated for > or = 4 days with an ICD-9 for traumatic pneumothorax, hemothorax, lung contusion, and/or fractured ribs admitted from May 1, 1999 through April 30, 2000 (Group 1), the pre-ARDS Network study, and from May 1, 2003 through April 30, 2004 (Group 2), the post-ARDS Network study.

Aggressive surveillance and early catheter-directed therapy in the management of intra-abdominal hypertension.

Introduction: Trauma patients represent a heterogeneous group at risk for the development of both primary and secondary abdominal compartment syndrome (ACS). Our study aims at identifying these individuals early in their course and placing an intra-abdominal catheter to reduce intra-abdominal pressure before the serious hemodynamic consequences of ACS occur.

Methods: During a 10-month period, 12 patients were identified who developed intra-abdominal hypertension.

Corticosteroid use in the intensive care unit: at what cost?

Hypothesis: Corticosteroid use has a significant effect on morbidity and mortality in the intensive care unit (ICU).

Design: Case-control study.

Setting: Burn-trauma ICU in a level 1 trauma center.

Duodenal ulceration into the cystic artery with resultant massive hemorrhage.

Anterior duodenal ulceration with erosion into the cystic artery is an extremely rare source of upper gastrointestinal hemorrhage. Interventions that have previously been reported include open exploration with cholecystectomy, open exploration while leaving the gallbladder in situ, and angiographic management. We report a case of massive upper gastrointestinal bleeding related to duodenal ulcer penetration of the cystic artery and discuss potential management strategies.

Nonoperative trauma management: has the pendulum swung too far? The distinguished Dr. William Matory lecture.

Over the last decade, the role of nonoperative management has revolutionized the specialty of trauma. However, this management paradigm has generated substantial controversy in several areas, including penetrating neck and abdominal trauma. Evidence-based analysis will be the ultimate guideline to determine what is optimal management.

Protocol-driven ventilator management in a trauma intensive care unit population.

Hypothesis: The use of weaning and sedation protocols affects the intensive care unit (ICU) course of a trauma population.

Design: Nonrandomized before-after trial.

Setting: A level I trauma center.

Blunt trauma and the role of routine pelvic radiographs: a prospective analysis.

Background: We hypothesized that clinical factors accurately identify those trauma patients at high risk for pelvic fractures making routine films unnecessary.

Methods: Blunt trauma patients were prospectively analyzed both with and without a clinical protocol. The protocol group had pelvic films obtained only if they had a Glasgow Coma Scale score < 13 or had signs and symptoms of pelvic or back injury.