Early Chemoprophylaxis in Severely Injured Trauma Patients Reduces Risk of Venous Thromboembolism.

Background: Venous thromboembolism (VTE) remains a serious complication for trauma patients. While early VTE prophylaxis has gained traction, the timing of prophylaxis remains uncertain. We hypothesized that VTE prophylaxis within 24 hours of admission would have lower VTE rates and similar rates of adverse events in seriously injured patients.

Safety of high-dose intravenous labetalol in hypertensive crisis.

Purpose: The study assesses the safety of high-dose intravenous (i.v.) labetalol in adults.

Strangulated gastric prolapse through a gastrostomy site requiring emergent partial gastrectomy.

Strangulated gastric prolapse through a percutaneous endoscopic gastrostomy tract is a rare and potentially life-threatening complication that requires surgical intervention. We describe a case of a 74-year-old woman who was debilitated and ventilator-dependent and who presented with acute gastric prolapse with resultant ischaemic necrosis. The patient underwent an emergent exploratory laparotomy, partial gastrectomy, repair of gastrostomy defect and placement of a gastrojejunostomy feeding tube remote to the previous location.

A literature review of the military uses of silver-nylon dressings with emphasis on wartime operations.

Medical support of military operations involves treatment of massive soft tissue wounds, thermal burns, open fractures, blast injuries and traumatic amputations under conditions that are often austere and far from supply lines. Military hospitals, as recently deployed in Iraq and Afghanistan, are designed and equipped for stabilization and rapid transfer of injured patients back to their home nation. These austere facilities are often tasked with the emergency or long-term treatment of local populations when injured or burned, further stressing the medical resupply system.

Tissue oxygen saturation for the risk stratification of septic patients.

Purpose: Peripheral tissue oxygen saturation (Sto2) has shown promise as an early indicator of tissue hypoperfusion and as a risk stratification tool in various forms of shock. The purpose of this study was to determine if Sto2 would predict admission to an intensive (ICU) or progressive care unit in patients with early signs of sepsis.

Methods: In this prospective observational study, a rapid response team measured Sto2 levels in patients screening positive for sepsis.

Are general surgeons behind the curve when it comes to disaster preparedness training? A survey of general surgery and emergency medicine trainees in the United States by the Eastern Association for the Surgery for Trauma Committee on Disaster Preparedness.

Purpose: We think that general surgeons are underprepared to respond to mass casualty disasters. Preparedness education is required in emergency medicine (EM) residencies, yet such requirements are not mandated for general surgery (GS) training programs. We hypothesize that EM residents receive more training, consider themselves better prepared, and are more comfortable responding to disaster events than are GS residents.

A tight glycemic control initiative in a surgical intensive care unit and hospitalwide.

Background: In 2002, tight glycemic control (TGC) was mandated at Henry Ford Hospital (Detroit) to reduce surgical site infections (SSIs). THE FIVE STEPS FOR IMPROVEMENT: The TGC initiative was developed in terms of the five primary steps of the Institute for Healthcare Improvement (IHI) framework for leadership for improvement to drive practice change and maintain continuous improvement. In terms of Steps 1-3 (set direction, establish the foundation, and build will), in April 2002 the chief executive officer of the Henry Ford Hospital (Detroit) announced a hospitalwide initiative to reduce SSIs.

Resuscitation bundle compliance in severe sepsis and septic shock: improves survival, is better late than never.

Unlabelled: While clinicians' management of severe sepsis and septic shock has been positively influenced by a number of clinical research studies in the last decade, challenges remain regarding early hemodynamic optimization as envisioned in the Surviving Sepsis Campaign's (SSC) resuscitation bundle (RB). We examined the impact of a hospital-wide continuous quality improvement (CQI) initiative on patients presenting with severe sepsis and septic shock, and the impact of the sepsis RB on patient outcomes when completed beyond the 6-hour recommendation period. The study was an 18-month, prospective cohort study enrolling patients who met the definition of severe sepsis or septic shock.

A hospital-based violence prevention tour: a collaborative approach to empower youth.

Background: Youth violence is a significant problem in the United States with high recidivism rates. Considering these high recidivism rates in youths after an initial injury, we hypothesized a hospital-based violence prevention program aimed at increasing awareness, empowering positive conflict resolution, and promoting future vocational goals would benefit at-risk youth before they are injured.

Methods: A feasibility study was completed on our Violence and Injury Prevention (VIP) tour program at our urban Level I trauma center.

Transfusion insurgency: practice change through education and evidence-based recommendations.

Background: In 2000, we implemented an evidence-based guideline in the surgical intensive care unit (SICU) using a transfusion threshold of hemoglobin <8 g/dL. We hypothesized that continual education on the transfusion protocol would decrease transfusions.

Methods: We analyzed 2-month samples of admissions in even-numbered years from 1998 to 2006.

Acute renal failure in cardiothoracic surgery patients: what is the best definition of this common and potent predictor of increased morbidity and mortality.

Background: Universal agreement on criteria for acute renal failure (ARF) is lacking. The purpose of the current study was to determine which of 6 definitions for ARF best predicted clinical outcomes in postoperative cardiothoracic surgery (CTS) patients.

Methods: Criteria for ARF were retrospectively applied to 1,085 CTS patients.

Hyperbilirubinemia: a risk factor for infection in the surgical intensive care unit.

Background: Hyperbilirubinemia in intensive care unit (ICU) patients is common. We hypothesized that hyperbilirubinemia in the surgical ICU predisposes patients to infection.

Methods: Patients with bilirubin < or = 3 mg/dL were compared to patients with bilirubin > 3 mg/dL.

The impact of mild renal dysfunction on postoperative mortality in the surgical intensive care unit.

The negative impact of mild to moderate renal dysfunction on patient outcome is often under-estimated. Any amount of renal dysfunction is deleterious in the surgical intensive care unit (SICU). We evaluated all surgery patients admitted to our SICU.

Renal dysfunction in trauma: even a little costs a lot.

Background: Acute renal failure (ARF) is a devastating complication in critically ill patients. There is a paucity of data that describes the impact of ARF on the outcome of trauma patients admitted to the intensive care unit.

Methods: We studied trauma patients admitted to the surgical intensive care unit to determine the effect of increases in serum creatinine on the number of ventilator days, length of stay, mortality, and cost.

Diagnosis and management of bile leaks after blunt liver injury.

Background: Nonoperative management (NOM) of blunt liver injuries (BLIs) is common, but little data exist on the management of complications related to NOM. Furthermore, bile leaks are emerging as frequent complications of NOM. The goal of this study was to determine which BLI patients are at greatest risk for bile leaks and how to manage this complication.

Burn support for Operation Iraqi Freedom and related operations, 2003 to 2004.

Thermal injury historically constitutes approximately 5% to 20% of conventional warfare casualties. This article reviews medical planning for burn care during war in Iraq and experience with burns during the war at the US Army Burn Center; aboard the USNS Comfort hospital ship; and at Combat Support Hospitals in Iraq and in Afghanistan. Two burn surgeons were deployed to the military hospital in Landstuhl, Germany, and to the Gulf Region to assist with triage and patient care.

Bronchoalveolar lavage in diagnosis of ventilator-associated pneumonia in patients with burns.

Ventilator-associated pneumonia (VAP) remains a major cause of morbidity and mortality for patients with burns. In nonburn populations, bronchoalveolar lavage (BAL) excludes other pathology such as systemic inflammatory response syndrome. We hypothesized that BAL would decrease our false-positive VAP rate.

Computed tomographic scanning reduces cost and time of complete spine evaluation.

Background: We hypothesize that data collected from computed tomographic (CT) scans obtained for workup of chest or abdominal injuries provide data that are sufficient to screen for spinal fractures and will decrease the cost and time of spine evaluation after trauma.

Methods: We reviewed plain radiographs from 55 selected trauma patients who also underwent CT scanning of the chest, abdomen, and pelvis. We also timed the radiologic workup of 50 consecutive trauma patients to determine the time required to complete radiographic spine evaluation.

Beta-blocker use is associated with improved outcomes in adult burn patients.

Background: There is no direct evidence that beta-blockers improve mortality in burn victims. Beta-blockers attenuate hypermetabolic states in burned children, and perioperative use in elective adult cases has beneficial effects, which suggests that beta-blockers may also improve burn outcomes. However, beta-blockers decrease cardiac output and may decrease oxygen delivery, and theoretically may increase mortality.

Delayed repair for blunt thoracic aortic injury: is it really equivalent to early repair?

Background: Blunt thoracic aortic injury (BTAI) is a severe injury that traditionally has mandated immediate surgical repair. Delaying operative intervention for BTAI can allow other life-threatening injuries to be managed first, but potentially increases the risk of aortic rupture and death. The objective of this study was to evaluate the outcome of delayed repair (DR) compared with early repair (ER) for BTAI and to assess the effectiveness of a protocol for medical control of systolic blood pressure and heart rate in those patients whose repairs were delayed.

Normal D-dimer levels do not exclude thrombotic complications in trauma patients.

Background: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are common complications in trauma patients. These diagnoses can be difficult and expensive to make. Recent studies report that a negative D-dimer test excludes thrombotic complications.

Liberal use of CT scanning helps to diagnose appendicitis in adults.

Appendicitis can be difficult to diagnose as patients get older and the incidence of other intra-abdominal processes increases. We hypothesize that with the use of helical computed tomography (CT), we will be better at diagnosing appendicitis in adults. We reviewed all the medical records of patients 18 years and older who were admitted to our service with the diagnosis of appendicitis (ICD-9: 540.