Desirability of Outcome Ranking and Response Adjusted for Antibiotic Risk (DOOR/RADAR) Post Hoc Analysis Supports Equipoise for Antibiotic Initiation Strategies in Intensive Care Unit-Acquired Pneumonia.

Pneumonia is the most common intensive care unit (ICU)-acquired infection and source of potential sepsis in ICU populations but can be difficult to diagnose in real-time. Despite limited data, rapid initiation of antibiotic agents is endorsed by society guidelines. We hypothesized that a post hoc analysis of a recent randomized pilot study would show no difference between two antibiotic initiation strategies.

Provider Perceptions of Antibiotic Initiation Strategies for Hospital-Acquired Pneumonia.

The practice of rapidly initiating antibiotic therapy for patients with suspected infection has recently been criticized yet remains commonplace. Provider comfort level has been an understudied aspect of this practice. We hypothesized that there would be no significant differences in provider comfort level between the two treatment groups.

Type-O Blood Is Not Associated With Elevated Mortality After Trauma: A North American Cohort Study.

Background: Recent studies have presented contradictory findings on the relationship between blood type and mortality in trauma patients. Using the largest population in a study of this type to date, we hypothesized that ABO genotype and Rhesus status would influence trauma-related mortality and morbidity given the relationship between blood type and hemostasis.

Methods: Data from all trauma patients admitted to level I and level II trauma centers in one city over a five-year period was retrospectively analyzed.

Trial of antibiotic restraint in presumed pneumonia: A Surgical Infection Society multicenter pilot.

Background: Pneumonia is the most common intensive care unit-acquired infection in the trauma and emergency general surgery population. Despite guidelines urging rapid antibiotic use, data supporting immediate antibiotic initiation in cases of suspected infection are limited. Our hypothesis was that a protocol of specimen-initiated antibiotic initiation would have similar compliance and outcomes to an immediate initiation protocol.

Burn patient decontamination outside of mass casualties.

Objective: Decontamination protocols for victims of mass casualty events are well documented and emphasized to protect physicians, nurses and facilities. Decontamination practices outside of mass casualty events are unknown. This pilot study was undertaken to assess the current practices of burn patient decontamination outside of mass casualty events within level I and II trauma center emergency departments in the state of Michigan.

Ten Years of Equine-related Injuries: Severity and Implications for Emergency Physicians.

Background: The size, speed, and unpredictable nature of horses present a significant risk for injury in all equine-related activities.

Objective: We sought to examine the mechanism, severity, frequency, body regions affected, surgical requirements, rehabilitation needs, safety equipment utilization, and outcomes of equine-related injured patients.

Methods: Records of inpatients who sustained an equine-related injury from 2002-2011 with International Classification of Diseases, Ninth Revision codes E828 and E906 were retrospectively reviewed for pertinent data.

Preparation for mass casualty incidents.

Mass casualty incidents are events where the number of injured patients exceeds the resources of the health care institution to the degree that care may not be available or may be limited for a portion of the casualties. Mass casualty incidents are increasing in frequency throughout the United States. Managing mass casualty incidents has not traditionally been part of the nursing curriculum; however, our changing world requires us to become educated and prepared to respond to these scenarios.

Percutaneous tracheostomy: a new approach to the emergency airway.

Background: Endotracheal intubation is the preferred method of airway control. Current surgical standard of care for the emergent airway when endotracheal intubation cannot be performed is cricothyroidotomy. Percutaneous tracheostomy (PT) is a widely accepted technique for elective long-term airway management in the critical care setting.

Resurgence of methamphetamine related burns and injuries: a follow-up study.

Purpose: Legislation enacted to curb methamphetamine production has only temporarily succeeded. Experiencing a recent increase in burns as a result of the new one-pot method, we compared methamphetamine related burn patients who utilized the previous anhydrous ammonia method of production to current patients who largely used the new one-pot method of production.

Basic Procedures: Patients who were burned as a result of methamphetamine production were retrospectively reviewed.

Imaging utilization during explosive multiple casualty incidents.

Background: Emergency radiology is a vital tool in the evaluation of victims of explosive multiple casualty incidents (MCIs). Prior reports estimate that approximately 50% of explosive MCI patients required imaging, including 7% to 22% who required computed tomography (CT) studies. This report describes the contemporary utilization of emergency radiology during the evaluation of explosive MCI victims in a modern US military trauma hospital in Iraq.

Surgical response to multiple casualty incidents following single explosive events.

Background: Modern publications on response to single explosive events are from non-US hospitals, predate current resuscitation guidelines and lack detail on surgical and intensive care unit (ICU) requirements. The objective of this study is to provide a contemporary account of surge response to multiple casualty incidences following explosive events managed at a US trauma hospital in Iraq.

Methods: Observational study and retrospective chart review of 72-hour transfusion, operating room, and ICU resource utilization from 3 multiple casualty incidences managed at the US Air Force Theater Hospital, Balad AB, Iraq between February and April 2008.

Methamphetamine production is hazardous to your health.

Background: To describe the thermal injuries related to methamphetamine (METH) production, characterize patients' courses, and compare patients with matched controls and to the previously published series.

Methods: Trauma registry data from January 2001 to November 2005 was retrospectively reviewed. METH patients were compared with other burn patients of similar age and total body surface area burn size for toxicology, injury extent, therapies, hospital course, outcomes, and hospital charges.