Unilateral rhino-orbital-cerebral mucormycosis with contralateral endogenous fungal endophthalmitis.

Rhino-orbital-cerebral mucormycosis (ROCM) is an uncommon but fatal fungal infection. We report a rare case of unilateral ROCM with ipsilateral central retinal artery occlusion and contralateral choroiditis, which later progressed to endogenous fungal endophthalmitis. The patient was successfully treated with sinuses debridement, systemic liposomal amphotericin B, and intravitreal amphotericin B.

Assessing teamwork in the trauma bay: introduction of a modified "NOTECHS" scale for trauma.

Background: A modified nontechnical skills (NOTECHS) scale for trauma (T-NOTECHS) was developed to teach and assess teamwork skills of multidisciplinary trauma resuscitation teams. In this study, T-NOTECHS was evaluated for reliability and correlation with clinical performance.

Methods: Interrater reliability (intraclass correlation coefficient) and correlation with the speed and completeness of resuscitation tasks were assessed during simulation-based teamwork training and during actual trauma resuscitations.

In situ, multidisciplinary, simulation-based teamwork training improves early trauma care.

Objective: Evaluate the impact of a team training curriculum for residents and multidisciplinary trauma team members on team communication, coordination and clinical efficacy of trauma resuscitation.

Design: Prospective, cohort intervention comparing pre- vs. post-training performance.

Visitor injuries in Hawai'i.

Background: Over seven million tourists visit the Hawaiian Islands each year. Popular visitor activities such as surfing, scuba diving, ocean kayaking, parasailing, bicycle tours and hiking each have risks of serious injury. This study reviews visitors' activities that led to serious injuries requiring treatment at the state's only trauma center while vacationing in Hawai'i.

Two cases of penetrating abdominal injury from needlefish impalement.

Background: Needlefish injuries to humans are extremely rare. An extensive review of the medical literature reveals only 22 cases previously reported. Most injuries reported have occurred in the Indo-Pacific region, but there are scattered reports worldwide.

Management of recurrent lymphocele after renal transplantation using the Tenckhoff catheter.

We use the double-cuff straight Tenckhoff catheter for internalized drainage of the lymphocele into the peritoneal cavity by a subcutaneous tunneling technique. This technique has been performed in a 53-year-old male patient with recurrent symptomatic lymphocele after renal transplantation. There was no evidence of lymphocele recurrence at 6-month follow-up.

Preventing loss of domain: a management strategy for closure of the "open abdomen" during the initial hospitalization.

Background: In the management of the abdominal compartment syndrome resulting in an open abdomen, the so-called "planned ventral hernia" is considered an acceptable outcome. We describe a technique of surgical management of the abdominal wound that allows fascial closure in most cases during the initial admission.

Methods: Consecutive trauma patients with abdominal compartment syndrome managed with an open abdomen over a 3-year period were identified.

The availability of circulating blood volume values alters fluid management in critically ill surgical patients.

Background: This study evaluated whether commercially available blood volume measurements in critically ill surgical patients altered fluid management.

Methods: Patients admitted to the surgical intensive care unit of a tertiary care teaching hospital were prospectively evaluated. The frequency of changes in fluid management when results of blood volume measurements were available was determined.

Using transcutaneous oxygen pressure measurements as selection criteria for activated protein C use.

Background: Limited resources and the expense of Activated Protein C (APC) (drotrecogin alfa) may contribute to the reluctance to utilize this drug in sepsis. Employing the PROWESS criteria resulted in absolute reduction in 28-day mortality of 6.1%, representing a relative risk reduction of 19.

Peripheral blood hematocrit in critically ill surgical patients: an imprecise surrogate of true red blood cell volume.

Background: Peripheral blood hematocrit (red blood cell volume/total blood volume) is conventionally used to determine the need for blood transfusions. In critically ill surgical patients, this variable may not accurately approximate true red blood cell volume. We compared peripheral blood hematocrit to (1) plasma volume, (2) estimated circulating blood volume, and (3) a normalized hematocrit to clarify their relationships.

Circulating blood volume measurements correlate poorly with pulmonary artery catheter measurements.

Background: Determination of the intravascular volume status of a critically ill surgical patient is paramount for appropriate fluid and cardiovascular management. Many clinical parameters have been utilized to estimate intravascular volume but none are precise indicators of circulating blood volume. The purpose of this observational pilot study was to compare measured blood volume with hemodynamic parameters obtained from the pulmonary artery catheter and to determine if incorporation of these measurements altered treatment decisions in critically ill surgical patients.

A prospective randomized trial comparing oxygen delivery versus transcutaneous pressure of oxygen values as resuscitative goals.

Transcutaneous pressure of oxygen (PtcO2) correlates with arterial pressure of oxygen (PaO2) in nonshock states, but in shock states, PtcO2 approximates cardiac output with no response to increasing fraction of inspired oxygen (FiO2) and PaO2. An incremental change of more than 21 mmHg in PtcO2 in response to an FiO2 of 1.0 (identified as the oxygen challenge test [OCT]) implies adequate tissue perfusion, and lack of response has been associated with mortality.

Hypothyroidism and adrenal insufficiency in sepsis and hemorrhagic shock.

Hypothesis: We hypothesized that hypothyroidism and adrenal insufficiency frequently occur together in critically ill patients.

Design: A prospective observational study.

Setting: Surgical intensive care unit of a university-affiliated tertiary referral center.