Defining the cervical spine clearance algorithm: A single-institution prospective study of more than 9,000 patients.

Background: Variability exists in the approach to cervical spine (c-spine) clearance after significant trauma. Using concurrently gathered data on more than 9,000 such patients, the current study develops an evidence-based and readily adoptable algorithm for c-spine clearance aimed at timely removal of collar, optimal use of imaging, and appropriate spine consultations.

Methods: Prospective study of adult blunt trauma team alert (TTA) patients presenting at a Level I trauma center who underwent screening computed tomography (CT) to diagnose/rule out c-spine injury (January 2008 to May 2014).

An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma.

Background: Within the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework, we performed a systematic review and developed evidence-based recommendations to answer the following PICO (Population, Intervention, Comparator, Outcomes) question: should patients who present pulseless after critical injuries (with and without signs of life after penetrating thoracic, extrathoracic, or blunt injuries) undergo emergency department thoracotomy (EDT) (vs. resuscitation without EDT) to improve survival and neurologically intact survival?

Methods: All patients who underwent EDT were included while those involving either prehospital resuscitative thoracotomy or operating room thoracotomy were excluded. Quantitative synthesis via meta-analysis was not possible because no comparison or control group (i.

The burden of the U.S. crisis in the surgical critical care workforce and workflow.

There will be a 46 per cent shortage of intensivists by 2030. Currently, only 3 per cent of U.S.

Open extremity fractures: impact of delay in operative debridement and irrigation.

Background: Early (<8 hours) operative debridement and irrigation (D&I) of open fractures are considered essential to reduce the risk of deep infection. With the advent of powerful antimicrobials, this axiom has been challenged. The current study evaluates the rates of deep infections of open fractures in relation to the time to the first D&I.

A review of the literature: direct and video laryngoscopy with simulation as educational intervention.

Introduction: A review of the literature was conducted to analyze the impact of simulation-based training for direct and video laryngoscopy (VL) skills for health care professionals and health care students.

Methods: This review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop airway management skills and identify pertinent literature by searching PubMed from inception of the database up to July 2013. This current review addresses the question of whether airway management simulation-based training improves the acquisition of resuscitation skills for health care profession learners.

Findings of a randomized controlled trial using limited transthoracic echocardiogram (LTTE) as a hemodynamic monitoring tool in the trauma bay.

Background: We hypothesize that limited transthoracic echocardiogram (LTTE) is a useful tool to guide therapy during the initial phase of resuscitation in trauma patients.

Methods: All highest-level alert patients with at least one measurement of systolic blood pressure less than 100 mm Hg, a mean arterial pressure less than 60 mm Hg, and/or a heart rate greater than 120 beats per minute who arrived to the trauma bay (TB) were randomized to have either LTTE performed (LTTEp) or not performed (non-LTTE) as part of their initial evaluation. Images were stored, and results were reported regarding contractility (good vs.

CT for all or selective approach? Who really needs a cervical spine CT after blunt trauma.

Background: Computed tomography (CT) is the standard to screen blunt trauma patients for cervical spine (c-spine) fractures, yet there remains a reluctance to scan all trauma team activations because of radiation exposure and cost. The purpose of this study was to identify predictors of positive CT in an effort to decrease future CT use without compromising patient care.

Methods: We performed a prospective study in which we documented 18 combined NEXUS and Canadian c-spine criteria on 5,182 patients before CT comparing those with and without fractures to identify predictors of injury.

Emergency tracheal intubation immediately following traumatic injury: an Eastern Association for the Surgery of Trauma practice management guideline.

Background: The ABCs of trauma resuscitation begin with the airway evaluation, and effective airway management is imperative in the care of a patient with critical injury. The Eastern Association for the Surgery of Trauma Practice Management Guidelines committee aimed to update the guidelines for emergency tracheal intubation (ETI) published in 2002. These guidelines were made to assist clinicians with decisions regarding airway management for patients immediately following traumatic injury.

Bladder pressure measurements and urinary tract infection in trauma patients.

Background: The purpose of this trial was to determine if using a closed technique for bladder pressure measurements (BPMs) would eliminate them as a risk factor for urinary tract infection (UTI) in trauma patients, as was shown previously using an open technique.

Methods: Data were collected prospectively from January 2006 until December 2009 by a dedicated epidemiology nurse and combined with trauma registry data at our Level 1 trauma center. All trauma patients admitted to the surgical trauma intensive care unit (STICU) with and without UTIs were compared for demographic and epidemiologic data.

Geriatric education for surgical residents: identifying a major need.

This study evaluated a program designed to test and enhance residents' knowledge of geriatrics. A 2-year prospective interventional trial was conducted. Surgical residents underwent pretesting (pre) in three areas: polypharmacy, delirium, and end of life.

Canadian Cervical Spine rule compared with computed tomography: a prospective analysis.

Background: The Canadian cervical spine rule (CCS) has been found to be an effective tool to determine the need for radiographic evaluation of the cervical spine (c-spine) incorporating both clinical findings and mechanism. Previously, it has been validated only through clinical follow-up or selective use of X-rays. The purpose of this study was to validate it using computed tomography (CT) as the gold standard to identify fractures.

National Emergency X-Radiography Utilization Study criteria is inadequate to rule out fracture after significant blunt trauma compared with computed tomography.

Background: EAST guidelines now recommend computed tomography (CT) to evaluate cervical spine (c-spine) fractures after blunt trauma in patients who do not meet National Emergency X-Radiography Utilization Study criteria (NC), yet no imaging is required in those patients who do meet these criteria. NC are based on patients with both minor and severe (trauma team activation [TTA]) trauma. The purpose of this study was to evaluate the NC using CT as the gold standard in TTA patients.

Do flexion extension plain films facilitate treatment after trauma?

We hypothesized that flexion extension (FE) films do not facilitate the diagnosis or treatment of ligamentous injury of the cervical spine after blunt trauma. From January 2000 to December 2008 we reviewed all patients who underwent FE films and compared five-view plain films (5 view) and cervical spine CTC with FE in the diagnosis of ligamentous injury. There were 22,929 patients with blunt trauma and of these, 271 patients underwent 303 FE films.

Flexion-extension cervical spine plain films compared with MRI in the diagnosis of ligamentous injury.

The purpose of this study was to compare flexion-extension (FE) plain films with MRI as the gold standard in the diagnosis of ligamentous injury (LI) of the cervical spine after trauma. A retrospective review of patients sustaining blunt trauma from January 2000 to December 2008 (n = 22929) who had both FE and MRI of the cervical spine was performed. Two hundred seventy-one patients had 303 FE films.

Current practice, demographics, and trends of critical care trained emergency physicians in the United States.

Objectives: Critical care medicine (CCM) is of growing interest among emergency physicians (EPs), but the number of CCM-trained EPs and their postfellowship practice is unknown. This study's purpose was to conduct a descriptive census survey of EPs who have completed or are currently in a CCM fellowship.

Methods: The authors created a Web-based survey, and requests to participate were sent to EPs who have completed or are currently in a CCM fellowship.

Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee.

Background: Injury to the cervical spine (CS) is common after major trauma. The Eastern Association for the Surgery of Trauma first published its Practice Management Guidelines for the evaluation of CS injury in 1998. A subsequent revision was published in 2000.

Blunt splenic injuries in the adolescent trauma population: the role of angiography and embolization.

Background: Splenic artery embolization (SAE) improves non-operative splenic salvage rates in adults, but its utility and safety in the pediatric population is less well defined.

Objective: Because adolescent trauma patients are often triaged to adult trauma centers, we were interested in evaluating SAE in this particular population. We hypothesize that angiography and embolization is a safe and effective adjunct to non-operative management in the adolescent population.

The effect of anemia and blood transfusions on mortality in closed head injury patients.

Background: The purpose of this study was to determine if anemia in isolated head trauma patients results in a higher mortality rate that would justify a more liberal use of blood transfusions.

Methods: A retrospective review of isolated blunt head trauma patients was performed between January 2001 and December 2006. Comparisons were made between survivors and nonsurvivors regarding demographics, laboratory values, transfusions received, and lengths of stay.

Aneurysm of aortocoronary saphenous vein graft: case report and literature review.

True aneurysms of aortocoronary saphenous vein bypass grafts are a relatively rare complication of bypass surgery, but because the complications of thrombosis, embolization, or rupture are potentially fatal, this condition requires immediate surgical intervention. We describe a 78-year-old man who had undergone coronary bypass 15 years previously and who presented with a saphenous vein graft that was severely degenerated and aneurysmally enlarged throughout its course, measuring as much as 5 to 6 cm in certain locations. Redo coronary artery bypass grafting using the right and left internal thoracic arteries and resection of the aneurysm were performed.