No small dilemma: small bowel volvulus mimicking acute coronary syndrome.

Acute abdominal pathologies can cause electrocardiogram (ECG) changes mimicking an acute coronary syndrome (ACS), resulting in diagnostic uncertainty and delay. We report a 65-year-old male with multiple risk factors for ACS who presented with four hours of progressive epigastric and chest pain that resolved in the emergency department. ECG findings were concerning for new deeply inverted T-waves with normal troponins, raising concerns for Wellens Syndrome.

From Blunt Cardiac Injury to Heart Transplant Following Motorcycle Collision.

Traumatic coronary artery occlusion and dissection is an exceedingly rare complication of blunt cardiac injury (BCI), though it has been previously noted in a number of case reports. However, it can also lead to heart transplant, which to our knowledge has not been previously described in the literature. We present a case of a healthy 24-year-old man without significant past medical history who was in a motorcycle accident, resulting in sternal fracture and BCI.

Surgeons' knowledge regarding perioperative pain management in patients with opioid use disorder: a survey among 260 members of the American College of Surgeons.

Background: Patients with opioid use disorder (OUD) are increasing, challenging surgeons to adjust post-operative pain management guidelines. A literature review identified limited information on how to best care for these patients. The purpose of this study was to determine surgical perioperative management of OUD, challenges, and support needed for optimal care.

Intravenous Versus Rectal Contrast in CT Imaging for Abdominal Gunshot Wounds.

CT imaging with rectal contrast historically has been a useful tool to help identify potential colon/rectal injuries; however, recent trends have shown less utilization of rectal contrast, in favor of IV contrast CT imaging alone. A retrospective review of patients with abdominal gunshot wounds was carried out to compare the two CT imaging techniques. An analysis of patients with colorectal injuries was conducted.

Postoperative Analgesia in Enhanced Recovery After Surgery Protocols: Trends and Updates.

Multimodal analgesia is an effective strategy to decrease opioid use after surgery and has been a mainstay of the surgical contribution to combat the opioid epidemic. Postoperative multimodal analgesia in Enhanced Recovery After Surgery (ERAS) continues to evolve as different adjuncts are added and removed based on the most up to date literature. This review examines recent trends in ERAS analgesia and what current evidence and research supports as well as those adjuncts that may not be as beneficial as once thought.

Ground Level Falls in Patients Over 60, Do Race and Socioeconomic Status Affect Outcome?

Background: Falls are a significant source of morbidity, mortality, and health care spending in the elderly. The objective was to identify whether race, insurance status, and median income by zip code were associated with discharge disposition, readmission within 90 days, or mortality within 1 year of ground-level falls in patients aged 60-90.

Materials And Methods: We conducted a retrospective chart review of 926 patients aged 60-90 treated for ground-level falls.

The Development of Acute Kidney Injury in Burn Patients Undergoing Computed Tomography With Intravenous Contrast.

Acute kidney injury (AKI) is a major complication of significant burn injuries and a significant cause of patient morbidity and mortality. Patients that sustain traumatic burn injuries may require computed tomography (CT) imaging as part of their initial trauma management. This multicenter retrospective chart review of patients admitted to two level I trauma centers with ≥10% TBSA burns between 2014 and 2017 aims to determine if patients with greater than 10% TBSA burns that received CT imaging with intravenous contrast were more likely to develop acute kidney injury during their admission.

Differences in Outcome Between Open vs Laparoscopic Insertion of Ventriculoperitoneal Shunts.

Background: Abdominal access during ventriculoperitoneal (VP) shunt insertion has historically been obtained by neurosurgeons via an open abdominal approach. With recent advances in laparoscopy, neurosurgeons frequently consult general surgery for aid during the procedure. The goal of this study is to identify if laparoscopic assistance improves the overall outcomes of the procedure.

Long term outcomes in older trauma patients admitted to the ICU: A prospective study.

Background: Prior studies have shown an increase in mortality in elderly patients when compared to their younger cohort.

Methods: Level 1 trauma patients ≥50 years old were recruited upon admission to the ICU and prospectively followed. After an initial survey, inpatient data were collected and phone surveys were completed at 3 and 6 months.

Preferences and Predictions Regarding Palliative Care in the Trauma Intensive Care Unit.

Introduction: In the older intensive care unit (ICU) trauma population, it is common to have to make decisions about end-of-life. We sought to demonstrate uncertainty of patients and providers in this area.

Methods: Our study is a prospective observational study of trauma patients 50 years and older admitted to the ICU.

Identification of Sarcopenia in Elderly Trauma Patients: The Value of Clinical Competency and Experience.

Introduction: There is currently no standard definition of sarcopenia, which has often been associated with frailty. A commonly cited surrogate measure of sarcopenia is psoas muscle size. The purpose of this prospective study is to assess medical providers' capabilities to identify frail elderly trauma patients and consequent impact on outcomes after intensive care unit admission.

Failure of Nonoperative Management of Splenic Injuries in Trauma Patients on Anticoagulation.

Although nonoperative management or embolization with preservation of splenic tissue is preferable, there is a significant risk of continued bleeding ultimately requiring splenectomy. It has been established that elderly patients on anticoagulation (AC) have an increased risk of splenic injury, but there are little data to show whether AC plays a role in outcomes of splenic injury in the setting of trauma. This is a retrospective cohort study, including 168 adults aged 50 to 79 years who presented as a trauma patient to Sentara Norfolk General Hospital from January 1, 2010, to March 31, 2018.

Health education through mass media announcements by loudspeakers about malaria care: prevention and practice among people living in a malaria endemic area of northern Myanmar.

Background: Interventions to raise community awareness about malaria prevention and treatment have used various approaches with little evidence on their efficacy. This study aimed to determine the effectiveness of loudspeaker announcements regarding malaria care and prevention practices among people living in the malaria endemic villages of Banmauk Township, Sagaing Region, Myanmar.

Methods: Four villages among the most malaria-burdened areas were randomly selected: two villages were assigned as the intervention group, and two as the control.

Bedside Incentive Spirometry Predicts Risk of Pulmonary Complication in Patients with Rib Fractures.

This retrospective chart review demonstrates the relationship between bedside incentive spirometry (ICS) volumes and risk of pulmonary complications. Two hundred patients admitted for rib fractures between April and October 2016 were reviewed. The inclusion criteria were age 18-98 years, diagnosis of rib or sternal fractures, and no procedures requiring postoperative intubation within 48 hours of admission.

Thromboelastogram-Guided Resuscitation for Patients with Traumatic Brain Injury on Novel Anticoagulants.

Traumatic brain injuries in patients on antithrombotic agents carry significant morbidity. Initial therapy is centered around reversal of these agents. The thromboelastogram (TEG) maps the clotting cascade to guide reversal.

Genetic Variations Associated with Drug Resistance Markers in Asymptomatic Infections in Myanmar.

The emergence and spread of drug resistance is a problem hindering malaria elimination in Southeast Asia. In this study, genetic variations in drug resistance markers of were determined in parasites from asymptomatic populations located in three geographically dispersed townships of Myanmar by PCR and sequencing. Mutations in dihydrofolate reductase (), dihydropteroate synthase (), chloroquine resistance transporter (), multidrug resistance protein 1 (), multidrug resistance-associated protein 1 (), and Kelch protein 13 () were present in 92.

Infection after penetrating brain injury-An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas.

Background: Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown.

Early Use of a Chest Trauma Protocol in Elderly Patients with Rib Fractures Improves Pulmonary Outcomes.

Rib fractures are among the most common injuries identified in blunt trauma patients. Morbidity increases with increasing age and increasing number of rib fractures. The use of noninvasive ventilation has been shown to be helpful as a rescue technique avoiding intubation in patients who have become hypoxemic but little data with regard to its use to prophylactically prevent worsening respiratory status are available.

Barriers to Colonoscopy in an Uninsured Patient Population-A Quality Improvement Project.

Colorectal cancer remains common, with the "80 per cent by 2018" initiative proposed by the National Colorectal Cancer Roundtable. This study was designed to examine obstacles for patients who did not receive their scheduled colonoscopy, focusing on the impact of insurance status. Retrospective chart review was carried out on patients who did not complete their colonoscopy as scheduled from January 2013 to June 2017.

Optimization of Resource Allocation after Implementation of Mild Traumatic Brain Injury Treatment Protocol.

The purpose of this study was to assess resource utilization after implementation of a mild traumatic brain injury (TBI) treatment protocol. A retrospective review was conducted of patients with isolated mild TBI before and after implementation of a mild TBI treatment protocol in May 2015. Patients admitted from June 2014 to February 2017, aged 18 to 89 years, presenting with a Glasgow coma score of 13 to 15, with an isolated small intracerebral hemorrhage on CT without midline shift, and not coagulopathic were evaluated.

Moderate Sedation or Monitored Anesthesia Care for Colonoscopies: Is There a Difference?

To determine whether monitored anesthesia care (MAC) results in shorter colonoscopy time. A retrospective chart review from electronic medical records at Sentara Norfolk General Hospital was performed of all patients seen by the Eastern Virginia Medical School Department of Surgery who underwent a screening or diagnostic colonoscopy from December 2015 to July 2017. The primary end point is procedure time, with secondary end point of sedation time.