Mobilization of the obese patient and prevention of injury.

Objectives And Background: Obese patients are difficult to transport between emergency departments, imaging facilities, operating rooms, intensive care units, acute care units, and rehabilitation facilities. Each move, along with turning, bathing, and access to bathrooms, poses risks of injury to patients and personnel. Similarly, inadequate mobilization raises the risk of pressure ulcers.

Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker's vacuum packing technique.

Background: The open abdomen has become a common procedure in the management of complex abdominal problems and has improved patient survival. The method of temporary abdominal closure (TAC) may play a role in patient outcome.

Methods: A prospective, observational, open-label study was performed to evaluate two TAC techniques in surgical and trauma patients requiring open abdomen management: Barker's vacuum-packing technique (BVPT) and the ABThera(TM) open abdomen negative pressure therapy system (NPWT).

Penetrating neck trauma: a review of management strategies and discussion of the 'No Zone' approach.

The evaluation and management of hemodynamically stable patients with penetrating neck injury has evolved considerably over the previous four decades. Algorithms developed in the 1970s focused on anatomic neck "zones" to distinguish triage pathways resulting from the operative constraints associated with very high or very low penetrations. During that era, mandatory endoscopy and angiography for Zone I and III penetrations, or mandatory neck exploration for Zone II injuries, became popularized, the so-called "selective approach.

Damage control surgery: it's evolution over the last 20 years.

In less than twenty years, what began as a concept for the treatment of exsanguinating truncal trauma patients has become the primary treatment model for numerous emergent, life threatening surgical conditions incapable of tolerating traditional methods. Its core concepts are relative straightforward and simple in nature: first, proper identification of the patient who is in need of following this paradigm; second, truncation of the initial surgical procedure to the minimal necessary operation; third, aggressive, focused resuscitation in the intensive care unit; fourth, definitive care only once the patient is optimized to tolerate the procedure. These simple underlying principles can be molded to a variety of emergencies, from its original application in combined major vascular and visceral trauma to the septic abdomen and orthopedics.

Damage control for intra-abdominal sepsis.

With the success of damage-control surgery for the treatment of exsanguinating truncal trauma, it has been adapted to other surgical diseases associated with shock states, such as severe secondary peritonitis. The structured approach of damage control is easily adapted to and can incorporate the fundamental elements of the Surviving Sepsis Campaign. It is not meant to replace tried and true surgical principles, such as source control, but is a usable framework in managing the complicated circumstances seen with these patients.

Physician behavior: not ready for 'Never'land.

Disruptive physician behavior, particularly by surgeons, is a common perception. Increasing awareness and regulatory oversight is being felt in medical practice; however, little data exist regarding the frequency of these behaviors. This study was undertaken to determine the prevalence and type of reported behavioral issues.

Open fractures: it doesn't come out in the wash.

Background: Six hours from injury to washout is considered the gold standard in the treatment of open traumatic fractures. Despite this being our hospital policy, the rural nature of our Level I trauma center causes delays in discovery and transport, creating a unique randomization of time to washout. We hypothesized that orthopedic complications after open fractures are related to the severity of the fractures, not the timing of the washout.

Surgical resident education: what is the department's price for commitment?

Objective: The current recession has impacted all aspects of our economy. Some residency programs have experienced faculty salary cuts, furlough days, and cessation of funding for travel to academic meetings. This milieu forced many residency programs to reevaluate their commitment to resident education, particularly for those expenses not provided for by Direct Medical Education (DME) and Indirect Medical Education (IME) funds.

"Damage control" in the elderly: futile endeavor or fruitful enterprise?

Background: Damage control laparotomy (DCL) provides effective management in carefully selected, exsanguinating trauma patients. However, the effectiveness of this approach has not been examined in the elderly. The purpose of this study was to characterize elderly DCL patients.