Impact of Standardized Multidisciplinary Critical Care Training on Confidence with Critical Illness and Attitudes Towards Interprofessional Education and Multidisciplinary Care.

Introduction: The Fundamental Critical Care Support Course (FCCS) is a standardized multidisciplinary program designed to educate participants on the basics of identification and management of patients with critical illness. Our objective was to evaluate the effect of FCCS participation on confidence in the assessment and management of critically ill patients and attitudes towards multidisciplinary education and interprofessional care in a multidisciplinary group of participants.

Methods: Participants enrolled in the FCCS course from May 2018 to November 2019 were solicited to participate in a series of surveys evaluating their course experience and confidence in critical care.

Standardizing Opioids Prescribed at Discharge in Trauma Surgery.

Introduction: Excessive opioid use after sustaining trauma has contributed to the opioid epidemic. Standardizing the quantity of opioids prescribed at discharge can improve prescribing behavior. We hypothesized that adopting new electronic medical record order sets would be associated with decreased morphine milligram equivalents (MME) prescribed at discharge for trauma patients.

Ethical Implications of Nutrition Therapy at the End of Life.

Purpose Of Review: Provide an evidence-based resource to inform ethically sound recommendations regarding end of life nutrition therapy.

Recent Findings: • Some patients with a reasonable performance status can temporarily benefit from medically administered nutrition and hydration(MANH) at the end of life. • MANH is contraindicated in advanced dementia.

When Should the Appropriateness of PEG be Questioned?

Purpose Of Review: This review aims to analyze the evidence regarding the appropriateness of PEG placement in the following clinical situations: short bowel syndrome, head and neck cancer, dementia and palliative use in malignant bowel obstruction.

Recent Findings: Percutaneous endoscopic gastrostomy (PEG) tubes are placed for a variety of clinical indications by numerous different specialties. First described in 1980, PEG tubes are now the dominant method of enteral access.

Early feeding after percutaneous endoscopic gastrostomy tube placement in patients who require trauma and surgical intensive care: A retrospective cohort study.

Background: Critically ill patients experience interruptions in enteral nutrition (EN). For ventilated patients who undergo percutaneous endoscopic gastrostomy (PEG) tube placement, postprocedure fasting times vary from 1 to 24 h depending on the surgeon's preference. There is no evidence to support delayed feeding (DF) after PEG placement.

Tracheostomy and Gastrostomy in Geriatric Trauma Associated With High Postdischarge Mortality.

Objectives: Identify 5-year mortality rates in trauma patients greater than 18 years old who undergo tracheostomy and/or gastrostomy tube placement.

Design: Retrospective convenience sample with two cohorts.

Setting: Academic level 1 trauma center.

Different Perceptions Exist Between Health Care Providers and the General Population Regarding the Importance of Findings on Additional Imaging for Trauma Consults.

Background: Approximately one-third of additional imaging for trauma consults results in the discovery of new injuries. No studies have addressed the perception of these findings in non-health care providers. Our hypothesis was that significant differences in perception of the importance of injuries would exist between health care providers (HCPs) and the general population.

Direct Peritoneal Resuscitation: A Novel Adjunct to Damage Control Laparotomy.

Direct peritoneal resuscitation is a validated resuscitation strategy for patients undergoing damage control surgery for hemorrhage, sepsis, or abdominal compartment syndrome with open abdomen and planned reexploration after a period of resuscitation in the intensive care unit. Direct peritoneal resuscitation can decrease visceral edema, normalize body water ratios, accelerate primary abdominal wall closure after damage control surgery, and prevent complications associated with open abdomen. This review article describes the physiological benefits of direct peritoneal resuscitation, how this technique fits within management priorities for the patient in shock, and procedural components in the care of open abdomen surgical patients receiving direct peritoneal resuscitation.

The Prevalence of Beers Criteria Medication Use and Associations with Falls in Geriatric Patients at a Level 1 Trauma Center.

The Beers Criteria for Potentially Inappropriate Medication (PIM) use is a list of medications with multiple risks in older patients. Approximately 24 per cent use rate is reported in prior studies. Our objective was to determine the local PIM use and subsequent fall risk in geriatric trauma patients.

Trauma Recidivism Postdischarge Mortality: Important Differences Exist between the Adult and Geriatric Populations.

Trauma recidivists are a high-risk patient population. The effects of recidivism on Geriatric trauma mortality have not been investigated. Our hypothesis is that trauma recidivism is associated with high postdischarge mortality after the initial index admission in both the geriatric and adult trauma populations.

The two faces of intentional self-inflicted injury: High in-hospital mortality, low postdischarge mortality, but high readmission rates.

Background: Intentional self-inflicted injuries present unique challenges in treatment and prevention. We hypothesized intentional self-inflicted injuries would have higher in-hospital and postdischarge mortality than nonintentional self-inflicted injuries trauma.

Methods: Adult patients evaluated 2008 to 2012 were identified in our trauma registry and matched with mortality data from the National Death Index.

The Beers criteria: Not just for geriatrics anymore? Analysis of Beers criteria medications in nongeriatric trauma patients and their association with falls.

Background: It has been well established that many classes of medications on the Beers list of Potentially Inappropriate Medications (PIMs) are associated with falls and injuries in the geriatric population, but little work has been performed to understand if similar relationships exist among the nongeriatric adult population.

Methods: A retrospective chart review of 32 months of trauma encounters at our Level I trauma center was performed in nongeriatric adults aged 18 years to 64 years. Encounters were reviewed by mechanism of injury and intake medication reconciliation.

Small Bowel Obstruction.

Identifying patients with small bowel obstruction who need operative intervention and those who will fail nonoperative management is a challenge. Without indications for urgent intervention, a computed tomography scan with/without intravenous contrast should be obtained to identify location, grade, and etiology of the obstruction. Most small bowel obstructions resolve with nonoperative management.