Anatomy of the lumbar interspinous ligament: findings relevant to epidural insertion using loss of resistance.

Background And Objectives: The 'loss of resistance' technique is used to determine entry into the epidural space, often by a midline needle in the interspinous ligament before the ligamentum flavum. Anatomical explanations for loss of resistance without entry into the epidural space are lacking. This investigation aimed to improve morphometric characterization of the lumbar interspinous ligament by observation and measurement at dissection and from MRI.

Does autotransfusion from a contaminated trauma laparotomy field increase the risk of complications?

Background: Autotransfusion (AT) in trauma laparotomy is limited by concern that enteric contamination (EC) increases complications, including infections. Our goal was to determine if AT use increases complications in trauma patients undergoing laparotomy with EC.

Methods: Trauma patients undergoing laparotomy from October 2011-November 2020 were reviewed.

Mortality in hypotensive trauma patients requiring laparotomy is related to degree of hypotension and provides evidence for focused interventions.

Background: Mortality in hypotensive patients requiring laparotomy is reported to be 46% and essentially unchanged in 20 years. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been incorporated into resuscitation protocols in an attempt to decrease mortality, but REBOA can have significant complications and its use in this patient group has not been validated. This study sought to determine the mortality rate for hypotensive patients requiring laparotomy and to evaluate the mortality risk related to the degree of hypotension.

Increased maternal body mass index is associated with prolonged anaesthetic and surgical times for caesarean delivery but is partially offset by clinician seniority and established epidural analgesia.

Background: Obesity is associated with higher surgical and anaesthetic morbidity and difficulties.

Aims: We aimed to investigate associations between maternal body mass index (BMI) and the in-theatre time taken to produce an anaesthetised state or to perform surgery for caesarean delivery.

Materials And Methods: Using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, we identified all women who underwent caesarean section at a single institution (2009-2015).

Admission base deficit is superior to lactate in identifying shock and resuscitative needs in trauma patients.

Background: Base Deficit (BD) and lactate have been used as indicators of shock and resuscitation. This study was done to evaluate the utility of BD and lactate in identifying shock and resuscitative needs in trauma patients.

Methods: A prospective observational study was performed from 3/2014-12/2018.

Gastrobronchial Fistula after Robotic Repair of Traumatic Diaphragmatic Hernia.

Gastrobronchial fistulas are a rare occurrence in the literature. We report a case of a gastrobronchial fistula after robotic repair of a chronic traumatic diaphragmatic hernia. The patient had severe respiratory symptoms with multiple studies that were inconclusive.

Intercostal Nerve Block with Liposomal Bupivacaine vs Epidural Analgesia for the Treatment of Traumatic Rib Fracture.

Background: Rib fractures are common among trauma patients and analgesia remains the cornerstone of treatment. Intercostal nerve blocks provide analgesia but are limited by the duration of the anesthetic. This study compares outcomes of epidural analgesia with intercostal nerve block using liposomal bupivacaine for the treatment of traumatic rib fractures.

Prospective evaluation of admission cortisol in trauma.

Background: A low cortisol level has been shown to occur soon after trauma, and is associated with increased mortality. The purpose of this study was to investigate the impact of low cortisol levels in acute critically ill trauma patients. We hypothesized that patients would require increase vasopressor use, have a greater blood product administration, and increased mortality rate.

Opportunities for improving patient experiences among medical travellers from Canada's far north: a mixed-methods study.

Objectives: This paper explores patient experiences and identifies barriers and opportunities for improving access to healthcare for patients from the Canadian north who travel to receive medical care in a Southern province.

Design: A mixed-methods, cross-sectional study involved one-on-one interviews, focus group discussions and key informant interviews.

Participants: 52 one-on-one interviews with Northwest Territories (NWT) patients and patient escorts and two focus group discussions (n=10).

Changes in splenic capsule with aging; beliefs and reality.

Background: Research describing the splenic capsule and its effect on non-operative management of splenic injuries is limited. The aim of this study is to identify the current beliefs about the splenic capsule thickness and investigate changes in the splenic capsule with age.

Methods: Trauma Medical Directors were surveyed on their beliefs regarding splenic capsule thickness changes with age.

A predictive grading scale for acute cholecystitis.

Background: Acute cholecystitis presents in a spectrum of severity, where acute disease may be complicated by severe inflammation, gangrene, and perforation. The goal of this study is to outline an evidence-based grading scale that predicts patient outcomes after laparoscopic cholecystectomy (LC).

Methods: A retrospective review of all patients with a preoperative diagnosis of acute cholecystitis who underwent LC from August 2011 until June 2015 at a tertiary-level hospital was performed.

The impact of obesity on severity of solid organ injury in the adult population at a Level I trauma center.

Background: The obese (body mass index, BMI > 30) have been identified as a subgroup of patients in regards to traumatic injuries. A recent study found that high-grade hepatic injuries were more common in obese than non-obese pediatric patients. This study seeks to evaluate whether similar differences exist in the adult population and examine differences in operative versus non-operative management between the obese and non-obese in blunt abdominal trauma.

Attempting to validate the overtriage/undertriage matrix at a Level I trauma center.

Background: The Optimal Resources Document mandates trauma activation based on injury mechanism, physiologic and anatomic criteria and recommends using the overtriage/undertriage matrix (Matrix) to evaluate the appropriateness of trauma team activation. The purpose of this study was to assess the effectiveness of the Matrix method by comparing patients appropriately triaged with those undertriaged. We hypothesized that these two groups are different, and Matrix does not discriminate the needs or outcomes of these different groups of patients.

Haddenham easywrap: the latest innovation in the management of lymphoedema.

The use of velcro compression wrapping devices in the management of lymphoedema and chronic oedema is not a new concept. Wraps have been available for many years and are being used widely in clinic and community settings where bandaging or traditional compression garments are not suitable. Furthermore, they are becoming more common when treating venous disease, patients with wounds and lipoedema.

Myths and Misinformation About Gunshot Wounds may Adversely Affect Proper Treatment.

Background: Poorly designed experiments and popular media have led to multiple myths about wound ballistics. Some of these myths have been incorporated into the trauma literature as fact and are included in Advanced Trauma Life Support (ATLS). We hypothesized that these erroneous beliefs would be prevalent, even among those providing care for patients with gunshot wounds (GSWs), but could be addressed through education.

Isolated free fluid on abdominal computed tomography in blunt trauma: watch and wait or operate?

Background: Isolated free fluid (FF) on abdominal CT in stable blunt trauma patients can indicate the presence of hollow viscus injury. No criteria exist to differentiate treatment by operative exploration vs observation. The goals of this study were to determine the incidence of isolated FF and to identify factors that discriminate between patients who should undergo operative exploration vs observation.

An acute care surgery fellowship benefits a general surgical residency.

Background: There has been a trend toward subspecialization among general surgery graduates, and many subspecialists are reticent to participate in trauma care. This has resulted in a gap in the provision of emergency surgical care. The Acute Care Surgery (ACS) fellowship, incorporating trauma, critical care, and emergency general surgery, was developed to address this need.

Post-extubation dysphagia in trauma patients: it's hard to swallow.

Background: There is a significant incidence of unrecognized postextubation dysphagia in trauma patients. The purpose of this study was to evaluate the incidence, ascertain the risk factors, and identify patients with postextubation dysphagia who will require clinical swallow evaluation.

Methods: A prospective observational study was performed on 270 trauma patients.

Promoting independence for children on long-term ventilation.

It is the responsibility of children's nurses to enable children and young people who are on long-term ventilation (LTV) to live independent and varied lives. This article considers the common challenges faced by such children and reflects on personal experience in planning and undertaking a respite week for a young person on LTV with Duchenne's muscular dystrophy without his parents.

Percutaneous tracheostomy: to bronch or not to bronch--that is the question.

Background: Percutaneous tracheostomy is a routine procedure in the intensive care unit (ICU). Some surgeons perform percutaneous tracheostomies using bronchoscopy believing that it increases safety. The purpose of this study was to evaluate percutaneous tracheostomy in the trauma population and to determine whether the use of a bronchoscope decreases the complication rate and improves safety.

Sports and games for post-traumatic stress disorder (PTSD).

Background: Traumatic experiences evoke emotions such as fear, anxiety and distress and may encourage avoidance of similar situations in the future. For a proportion of those exposed to a traumatic event, this emotional reaction becomes uncontrollable and can develop into Post Traumatic Stress Disorder (PTSD) (Breslau 2001). Most of those diagnosed with PTSD fully recover while a small proportion develop a chronic PTSD a year after the event (First 2004).

Prehospital hypotension in blunt trauma: identifying the "crump factor".

Background: Trauma activation for prehospital hypotension in blunt trauma is controversial. Some patients subsequently arrive at the trauma center normotensive, but they can still have life-threatening injuries. Admission base deficit (BD)≤-6 correlates with injury severity, transfusion requirement, and mortality.