Global Survey of Demand-Side Factors and Incentives that Influence Advanced Trauma Life Support (ATLS) Promulgation.

Background: We aimed to identify and describe demand-side factors that have been used to support ATLS global promulgation, as well as current gaps in demand-side incentives.

Methods: We performed a cross-sectional survey about demand-side factors that influence the uptake and promulgation of ATLS and other trauma-related CME courses. The survey was sent to each of the four global ATLS region chiefs and 80 ATLS country directors.

American Association for the Surgery of Trauma Prevention Committee review: Family Justice Centers-a not-so-novel, but unknown gem.

The American College of Surgeons Committee on Trauma requires that trauma centers demonstrate adequate financial support for an injury prevention program as part of the verification process. With the ongoing challenges that arise with important social determinants of health, trauma centers have the important task of navigating a patient through the complex process of obtaining services and tools for success. This summary from the American Association for the Surgery of Trauma Prevention Committee focuses on a model that has been present for several years, but has not been brought to full awareness in the trauma world.

American Association for the Surgery of Trauma Prevention Committee topical update: Impact of community violence exposure, intimate partner violence, hospital-based violence intervention, building community coalitions and injury prevention program evaluation.

An effective injury prevention program is an important component of a successful trauma system. Maintaining support for a hospital-based injury prevention program is challenging, given competing institutional and trauma program priorities and limited resources. In light of those pressures, the American College of Surgeons Committee on Trauma mandates that trauma centers demonstrate financial support for an injury prevention program as part of the verification process, recognizing that hospital administrators might see such support as discretionary and ripe as a target for expense reduction efforts.

Does Pain Have a Role When It Comes to Tourniquet Training?

Background: One of the greatest conundrums with tourniquet (TQ) education is the use of an appropriate surrogate of hemorrhage in the training setting to determine whether a TQ has been successfully used. At our facility, we currently use loss of audible Doppler signal or loss of palpable pulse to represent adequate occlusion of vasculature and thus successful TQ application. We set out to determine whether pain can be used to indicate successful TQ application in the training setting.

Placenta to the Rescue: Limb Salvage Using Dehydrated Human Amnion/Chorion Membrane.

Reconstruction of skin and soft tissue wounds can pose a unique surgical challenge. This is especially true for cases of exposed bone and tendon where soft tissue loss is extensive and opportunities for tissue advancement or rotation are limited. A clinical case is presented describing an experience with dehydrated human amnion/chorion membrane (dHACM, EpiFix®/AmnioFix®, MiMedx Group, Marietta, GA) graft to obtain granulation over an open fracture with desiccated bone.

The "TRAUMA LIFE" initiative: The impact of a multidisciplinary checklist process on outcomes and communication in a Trauma Intensive Care Unit.

Background: Checklists have been advocated to improve quality outcomes/communication in the critical care setting, but results have been mixed. A new checklist process, "TRAUMA LIFE", was implemented in our Trauma Intensive Care Unit (TICU) to replace prior checklists. The purpose of this study was to evaluate the impact of the "TRAUMA LIFE" process implementation on quality metrics and on patient/family communication in the TICU.

Outcomes in traumatic brain injury for patients presenting on antiplatelet therapy.

An increasing number of patients are presenting to trauma units with head injuries on antiplatelet therapy (APT). The influence of APT on these patients is poorly defined. This study examines the outcomes of patients on APT presenting to the hospital with blunt head trauma (BHT).

Trans-abdominal wall traction as a universal solution to the management of giant ventral hernias.

Background: Domain loss following damage-control laparotomy is a challenging problem many surgeons face. The authors recently developed trans-abdominal wall traction, which closed 100 percent of domain loss abdomens in the acute setting. They hypothesized that it can be used successfully in patients with chronic giant ventral defects.

A description of cases of severe physical abuse in the elderly and 1-year mortality.

We conducted a case-control study to evaluate severe physical abuse of the elderly treated in two Chicago area Level I trauma centers. This report details whether physicians are adequately reporting cases of abuse to Adult Protective Services (APS), and assesses 1 year. The failure to report two-thirds of the cases and the substantially higher risk of death during the first year after hospitalization indicates the need for improved identification, reporting, and intervention.

Not so fast to skin graft: transabdominal wall traction closes most "domain loss" abdomens in the acute setting.

Background: Damage-control laparotomy (DCL) has revolutionized the surgery of injury. However, this has led to the dilemma of the nonclosable abdomen. Subsequently, there exists a subgroup of patients who after resuscitation and diuresis, remain nonclosable.

Screening for traumatic stress among survivors of urban trauma.

Objective: This study piloted the use of the Primary Care PTSD (PC-PTSD) screening tool in an outpatient setting to determine its utility for broader use and to gather data on traumatic stress symptoms among direct (patients) and indirect (families) survivors of traumatic injuries.

Methods: Using the PC-PTSD plus one question exploring openness to seeking help, participants were screened for PTSD in the outpatient clinic of an urban Level 1 trauma center. The survey was distributed during a 23-week period from April to September 2011.

Thiamine in nutrition therapy.

Clinicians involved with nutrition therapy traditionally concentrated on macronutrients and have generally neglected the importance of micronutrients, both vitamins and trace elements. Micronutrients, which work in unison, are important for fundamental biological processes and enzymatic reactions, and deficiencies may lead to disastrous consequences. This review concentrates on vitamin B(1), or thiamine.

A case-control study of severe physical abuse of older adults.

Unlabelled: To characterize the severity and outcome of traumatic injuries suffered by victims of elder abuse, describe the characteristics of the perpetrators, and identify risk factors associated with severe traumatic elder abuse.

Design: Case-control study.

Setting: Two Level I trauma units in the greater Chicago, Illinois, metropolitan area.

Youth violence prevention curriculum evaluation: outcomes of a Cook County, Illinois community based partnership.

The John H. Stroger, Jr. Hospital Departments of Trauma and Emergency created a youth violence prevention curriculum for healthcare providers and staff with a community partnership of practitioners and professionals.

CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison.

Background: An estimated 10,000 Americans suffer cervical spine injuries each year. More than 800,000 cervical spine radiographs (CSR) are ordered annually. The human and healthcare costs associated with these injuries are enormous especially when diagnosis is delayed.

Taser X26 discharges in swine: ventricular rhythm capture is dependent on discharge vector.

Background: Data from our previous studies indicate that Taser X26 stun devices can acutely alter cardiac function in swine. We hypothesized that most transcardiac discharge vectors would capture ventricular rhythm, but that other vectors, not traversing the heart, would fail to capture the ventricular rhythm.

Methods: Using an Institutional Animal Care and Use Committee (IACUC) approved protocol, four Yorkshire pigs (25-36 kg) were anesthetized, paralyzed with succinylcholine (2 mg/kg), and then exposed to 10 second discharges from a police-issue Taser X26.

Acute effects of MK63 stun device discharges in miniature swine.

Objective: Electromuscular incapacitation (EMI) devices are being used and evaluated by both military and law enforcement agencies. Although the gross muscular response is obvious, physiological responses to these devices are poorly understood. We hypothesized that the intense, repetitive, muscle contractions evoked by EMI devices would cause dose-dependent metabolic acidosis, accompanied by neuromuscular or cardiac injury.

TASER X26 discharges in swine produce potentially fatal ventricular arrhythmias.

Objectives: Data from the authors and others suggest that TASER X26 stun devices can acutely alter cardiac function in swine. The authors hypothesized that TASER discharges degrade cardiac performance through a mechanism not involving concurrent acidosis.

Methods: Using an Institutional Animal Care and Use Committee (IACUC)-approved protocol, Yorkshire pigs (25-71 kg) were anesthetized, paralyzed with succinylcholine (SCh; 2 mg/kg), and then exposed to two 40-second discharges from a TASER X26 with a transcardiac vector.

Acute effects of TASER X26 discharges in a swine model.

Background: Very little objective laboratory data are available describing the physiologic effects of stun guns or electromuscular incapacitation devices (EIDs). Unfortunately, there have been several hundred in-custody deaths, which have been temporally associated with the deployment of these devices. Most of the deaths have been attributed to specific cardiac and metabolic effects.

Neuromuscular effects of stun device discharges.

Background: Stun guns or electromuscular incapacitation devices (EMIs) generate between 25,000 and 250,000 V and can be discharged continuously for as long as 5 to 10 min. In the United States, over 200,000 individuals have been exposed to discharges from the most common type of device used. EMI devices are being used increasingly despite a lack of objective laboratory data describing the physiological effects and safety of these devices.

Repeated thoracic discharges from a stun device.

Background: Little objective laboratory data are available describing the physiologic effects of stun guns or electromuscular incapacitation (EMI) devices, but increasing morbidity and even deaths are associated with their use. We hypothesized that exposure to EMI discharges in a model animal system would induce clinically significant acidosis and cardiac arrhythmia.

Methods: Ten Yucatan mini-pigs, six experimental and four sham controls, were anesthetized with ketamine, xylazine, and glycopyrrolate.

The ultrasound screen for penetrating truncal trauma.

A prospective blinded pilot study was performed at an urban level 1 trauma center to evaluate the efficacy of ultrasound in ruling out penetrating visceral truncal injury. For 8 months, 49 nonconsecutive patients who presented with truncal gunshot and stab wounds were evaluated by a 10-MHz ultrasound tranducer probe. The deepest muscle bundle and the fascia enveloping it was examined by ultrasound.