Blunt cardiac injury in the hemodynamically stable patient.

Blunt cardiac injury (BCI) describes a spectrum of problems including severe, potentially life-threatening injuries from trauma. Pericardial effusion is an example of a BCI that has generally been assumed to imply serious underlying injury to the heart and should be considered hemopericardium until proven otherwise. A standard of care has been established to screen for BCI and treat hemodynamically unstable patients with an acute pericardial effusion presumably related to BCI.

Validation of the American Association for the Surgery of Trauma Emergency General Surgery Grading System for Colorectal Resection: An EAST Multicenter Study.

Background: The American Association for the Surgery of Trauma (AAST) has developed a grading system for emergency general surgery (EGS) conditions. We sought to validate the AAST EGS grades for patients undergoing urgent/emergent colorectal resection.

Methods: Patients enrolled in the "Eastern Association for the Surgery of Trauma Multicenter Colorectal Resection in EGS-to anastomose or not to anastomose" study undergoing urgent/emergent surgery for obstruction, ischemia, or diverticulitis were included.

Colorectal resection in emergency general surgery: An EAST multicenter trial.

Objective: Evidence comparing stoma creation (STM) versus anastomosis after urgent or emergent colorectal resection is limited. This study examined outcomes after colorectal resection in emergency general surgery patients.

Methods: This was an Eastern Association for the Surgery of Trauma-sponsored prospective observational multicenter study of patients undergoing urgent/emergent colorectal resection.

Non-Trauma Service Admissions: Should We Care?

The American College of Surgeons Committee on Trauma requires that trauma centers with greater than 10 per cent injured patients admitted to non-trauma services (NTSs) have processes to review these for appropriateness of care. We previously described an algorithm to determine the appropriateness of NTS admissions. Our objective was to determine if the outcome and process of care was similar between TS- and NTS-admitted patients.

Effect of American College of Surgeons Trauma Center Designation on Outcomes: Measurable Benefit at the Extremes of Age and Injury.

Background: American College of Surgeons (ACS) verification is believed to provide benefits for trauma patients, but is associated with direct costs.

Study Design: We performed a 1-year retrospective review of the National Trauma Data Bank (NTDB) for 2012. Patients were separated into 3 age groups; Pediatric (PEDS), 0 to 14 years; adult, 15 to 65 years; and elderly (ELD), older than 65 years.

Long-term survival after major trauma in geriatric trauma patients: the glass is half full.

Background: The objective is to examine the long-term survival status of geriatric trauma patients (GTPs) after major trauma.

Methods: A 10-year retrospective review at a Level I trauma center was performed. GTP were defined as age ≥ 65 years, with Injury Severity Score ≥ 30.

Civilian nuclear incidents: An overview of historical, medical, and scientific aspects.

Given the increasing number of operational nuclear reactors worldwide, combined with the continued use of radioactive materials in both healthcare and industry, the unlikely occurrence of a civilian nuclear incident poses a small but real danger. This article provides an overview of the most important historical, medical, and scientific aspects associated with the most notable nuclear incidents to date. We have discussed fundamental principles of radiation monitoring, triage considerations, and the short- and long-term management of radiation exposure victims.

The role of emergency medicine physicians in trauma care in North America: evolution of a specialty.

The role of Emergency Medicine Physicians (EMP) in the care of trauma patients in North America has evolved since the advent of the specialty in the late 1980's. The evolution of this role in the context of the overall demands of the specialty and accreditation requirements of North American trauma centers will be discussed. Limited available data published in the literature examining the role of EMP's in trauma care will be reviewed with respect to its implications for an expanded role for EMPs in trauma care.

Emergency traumatologists as partners in trauma care: the future is now.

Background: Decreasing manpower available to care for trauma patients both in and out of the ICU has led to a number of proposed solutions, including increasing involvement of emergency medicine-trained physicians in the care of these patients. We performed a descriptive comparative study in an effort to define the role of fellowship-trained emergency medicine physicians as full-time traumatologists.

Study Design: We performed a retrospective review of concurrent and prospectively collected data comparing process of care and outcomes for the resuscitative phase of trauma patients cared for by full-time fellowship-trained trauma surgeons (TS), a fellowship-trained emergency medicine physician (ET), and a first-year fellowship-trained trauma surgeon (TS1).

Methylene blue and vasoplegia: who, when, and how?

Systemic inflammatory response can be associated with clinically significant and, at times, refractory hypotension. Despite the lack of uniform definitions, this condition is frequently called vasoplegia or vasoplegic syndrome (VS), and is thought to be due to dysregulation of endothelial homeostasis and subsequent endothelial dysfunction secondary to direct and indirect effects of multiple inflammatory mediators. Vasoplegia has been observed in all age groups and in various clinical settings, such as anaphylaxis (including protamine reaction), sepsis, hemorrhagic shock, hemodialysis, and cardiac surgery.

Postmortem computed tomography, "CATopsy", predicts cause of death in trauma patients.

Background: The autopsy remains the gold standard for evaluating traumatic deaths. The number of autopsies performed has declined dramatically. This study examines whether postmortem computed tomography ("CATopsy") can be used to determine cause of death in trauma patients.

The impact of human immunodeficiency virus (HIV) on outcome and practice in trauma: past, present and future.

Since the initial description of a concentrated outbreak of pneumocystis carnii pneumonia in 1981, the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) pandemic has accounted for nearly 25 million deaths worldwide. This review focuses on estimations of prevalence by geographic region and identification of high-risk populations within each region, outcome for trauma patients with HIV and AIDS and risk management for health care workers who sustain occupational exposures. Trauma surgeons are more likely to encounter patients infected with HIV in geographic areas where HIV prevalence is high or in areas where intravenous drug use, high-risk sexual behaviours and penetrating trauma are more common.

Ovarian torsion associated with appendicitis in a 5-year-old girl: a case report and review of the literature.

Acute ovarian torsion is an uncommon cause of abdominal pain in female children and is often difficult to differentiate from other conditions causing lower abdominal pain. Acute adnexal pathology associated with appendicitis is very rare, with only a handful of reports available in the literature. Reported is a case of ovarian torsion associated with appendicitis in a 5-year-old girl along with a comprehensive literature review.

Deep venous thrombosis and pulmonary embolism in trauma patients: an overstatement of the problem?

Deep venous thrombosis (DVT) and pulmonary embolism (PE) affect high-risk trauma patients (HRTP). Accurate incidence and clinical importance of DVT and PE in HRPT may be overstated. We performed a ten-year retrospective analysis of HRTP of the Pennsylvania Trauma Outcome Study.

A proposed algorithm for managing the open abdomen.

Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Multiple techniques were devised to promote safe, uncomplicated, expeditious fascial closure. We retrospectively reviewed patient records between September 22, 2001 and June 30, 2004.

Human immunodeficiency virus infection in trauma patients: where do we stand?

Objective: The human immunodeficiency virus (HIV) epidemic is a growing health care problem. The purpose of this study was to examine the relationship between HIV infection and trauma patient treatment, complications, and mortality.

Methods: The Pennsylvania Trauma Outcome Study database was used to identify trauma patients with known HIV-positive status (HP) and randomly selected age-matched controls (CL).

Early experience with retrievable inferior vena cava filters in high-risk trauma patients.

Background: This study describes the use of retrievable IVC filters in a select group of trauma patients at high risk for deep vein thrombosis (DVT) and pulmonary embolism (PE).

Study Design: Retrievable IVC filters were placed in selected trauma patients who met high-risk criteria for deep vein thrombosis and PE according to institutional clinical management guidelines. All filters were placed percutaneously in the interventional radiology suite.

Rib fractures in the elderly: a marker of injury severity.

Objectives: To examine the relationship between the number of rib fractures (RIBFs) and mortality, injury severity, and resource consumption in elderly patients admitted to trauma centers.

Design: Thirteen-year retrospective statewide database analysis.

Setting: Participating trauma centers in Pennsylvania.

Nonoperative management of abdominal gunshot wounds.

Mandatory surgical exploration for gunshot wounds to the abdomen has been a surgical dictum for the greater part of this past century. Although nonoperative management of blunt solid organ injuries and low-energy penetrating injuries such as stab wounds is well established, the same is not true for gunshot wounds. The vast majority of patients who sustain a gunshot injury to the abdomen require immediate laparotomy to control bleeding and contain contamination.