Association of Discontinuing Preinjury Beta-Adrenergic Blockade Medications With Mortality in Severe Blunt Traumatic Brian Injury.

Background: Beta-adrenergic receptor blocker (BB) administration has been shown to improve survival after traumatic brain injury (TBI). However, studies to date that observe a benefit did not distinguish between continuation of preinjury BB versus de novo initiation of BB.

Objectives: To determine the effect of continuation of preinjury BB and de novo initiation of BB on risk-adjusted mortality and complications for patients with TBI.

Preoperative Nutritional Optimization of the Oncology Patient: A Scoping Review.

Background: Malnutrition is common among patients with cancer and is a known risk factor for poor postoperative outcomes; however, preoperative nutritional optimization guidelines are lacking in this high-risk population. The objective of this study was to review the evidence regarding preoperative nutritional optimization of patients undergoing general surgical operations for the treatment of cancer.

Methods: A literature search was performed across the Ovid (MEDLINE), Cochrane Library (Wiley), Embase (Elsevier), CINAHL (EBSCOhost), and Web of Science (Clarivate) databases.

First Necrotizing Fasciitis Caused by Serotype a.

Necrotizing fasciitis (NF) is an infrequently encountered skin infection that has high morbidity and mortality, even with prompt medical and surgical intervention. We describe the case of a 67-year-old male presenting with significant NF in his left lower extremity, despite aggressive surgical intervention, and included multiple surgical debridements, ACell Matrix, split-thickness, and negative wound VAC therapy. Ultimately, this patient required a below the knee amputation.

Long-term functional and echocardiographic assessment after penetrating cardiac injury: 5-year follow-up results.

Background: There is almost no data describing the long-term functional outcome of patients after penetrating cardiac injury.

Methods: A retrospective study at a Level I trauma center from 2000 to 2009.

Results: Sixty-three patients had penetrating cardiac injuries from 28 stabbings and 35 gunshots.

Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions.

Background: Few good surgical options exist for the repair of complex anterior abdominal wall defects, particularly those in which bacterial contamination is present. The use of prosthetic mesh increases complication rates when the mesh is placed directly over viscera or when the surgical site is contaminated from a pre-existing infection or enteric spillage. The use of an acellular dermal matrix (ADM), which becomes vascularized and remodeled into autologous tissue after implantation, may represent a low-morbidity alternative to prosthetic mesh products in these complex settings.

Selective management of penetrating truncal injuries: is emergency department discharge a reasonable goal?

We undertook this retrospective review to examine the appropriateness of a protocol for the selective emergency department (ED) workup of asymptomatic penetrating truncal injuries. Records of consecutive patients presenting to our urban Level I trauma center with penetrating truncal injuries between January 1, 1997 and September 2000 were reviewed. Data obtained included: patient demographics, ED workup, ED disposition, complications, and follow-up.

Limb loss following lower extremity arterial trauma: what can be done proactively?

We performed a retrospective review of patients admitted to two Level I trauma centres over a 15-year period with arterial injuries (excluding primary amputations). Preoperative factors analysed included mechanism of injury, site and type of arterial and venous injury and repair, time to operating room, initial blood pressure, evidence of ipsilateral limb fracture and/or extensive tissue damage, status of preoperative pulses and angiographic data. One hundred and fifty-one arterial injuries were treated (80 penetrating).

Indicators for tracheostomy in patients with traumatic brain injury.

Our objective was to develop criteria to identify patients with traumatic brain injury (TBI) who require a tracheostomy (TR). From January 1994 to May 2000 all TBI patients requiring intubation on presentation and who survived >7 days were identified from our trauma registry. Demographics, Glasgow Coma Score (GCS), Injury Severity Score (ISS), and ventilator days, ICU days, hospital days, need for TR, and development of pneumonia were statistically analyzed.

Evaluation of vascular injury in penetrating extremity trauma: angiographers stay home.

The debate over the use of diagnostic angiography (DA) to exclude arterial injury in penetrating extremity trauma (PET) continues. This review evaluates our current protocol for PET and identifies indications for DA. Patients presenting to our urban Level I trauma center between January 1997 and September 2000 with PET were included.