Thoracic irrigation for prevention of secondary intervention after thoracostomy tube drainage for hemothorax: A Western Trauma Association multicenter study.

Background: Retained hemothorax (rHTX) requiring intervention occurs in up to 20% of patients who undergo chest tube (TT) placement for a hemothorax (HTX). Thoracic irrigation at the time of TT placement decreases the need for secondary intervention in this patient group but those findings are limited because of the single-center design. A multicenter study was conducted to evaluate the effectiveness of thoracic irrigation.

Airway risk associated with patients in halo fixation.

Background: The halo fixation device introduces a significant obstacle for clinicians attempting to secure a definitive airway in trauma patients with cervical spine injuries. The authors sought to determine the airway-related mortality rate of adult trauma patients in halo fixation requiring endotracheal intubation.

Methods: This study was a retrospective chart review of patients identified between 2007 and 2012.

Closed therapy of thoracic and lumbar vertebral body fractures in trauma patients.

Background: The failure rate for the closed/non-surgical treatment of thoracic and lumbar vertebral body fractures (TLVBF) in trauma patients has not been adequately evaluated utilizing computed tomography (CT) studies.

Methods: From 2007 to 2008, consecutive trauma patients, who met inclusion criteria, with a CT diagnosis of acute TLVBF undergoing closed treatment were assessed. The failure rates for closed therapy, at 3 months post-trauma, were defined by progressive deformity, vertebral body collapse, or symptomatic/asymptomatic pseudarthrosis.

Computed tomographic imaging in the pediatric patient with a seatbelt sign: still not good enough.

Purpose: Considering the improvements in CT over the past decade, this study aimed to determine whether CT can diagnose HVI in pediatric trauma patients with seatbelt signs (SBS).

Methods: We retrospectively identified pediatric patients with SBS who had abdominopelvic CT performed on initial evaluation over 5 1/2years. Abnormal CT was defined by identification of any intra-abdominal abnormality possibly related to trauma.

Goal directed enoxaparin dosing provides superior chemoprophylaxis against deep vein thrombosis.

Introduction: Optimal enoxaparin dosing for deep venous thrombosis (DVT) prophylaxis remains elusive. Prior research demonstrated that trauma patients at increased risk for DVT based upon Greenfield's risk assessment profile (RAP) have DVT rates of 10.8% despite prophylaxis.

Computed tomography localization of the appendix in the pediatric population relative to the lumbar spine.

Background: Computed tomography (CT) is commonly used to evaluate suspected acute appendicitis. Although very effective, CT uses ionizing radiation, exposing patients to an increased risk of cancer.

Objective: This study assessed the potential for decreasing the field of view of the CT (and therefore the dose to the patient) in the evaluation of suspected acute appendicitis in children.

Resuscitative endovascular balloon occlusion of the aorta with a low profile, wire free device: A game changer?

A 24 year old male arrived to our hospital after a motor cycle crash with evidence of a traumatic brain injury and in hemorrhagic shock not responsive to volume administration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) was performed in a timely fashion using a new, low profile, wire free device. This lead to rapid reversal of hypotension while his bleeding source was sought and controlled.

Computed tomographic imaging interpretation improves fetal outcomes after maternal trauma.

Background: Computed tomography (CT) has been validated to identify and classify placental abruption following blunt trauma. The purpose of this study was to demonstrate improvement in fetal survival when delivery occurs by protocol at the first sign of class III fetal heart rate tracing in pregnant trauma patients with a viable fetus on arrival and CT evidence of placental perfusion 50% or less secondary to placental abruption.

Methods: This is a retrospective review of pregnant trauma patients at 26 weeks' gestation or greater who underwent abdominopelvic CT as part of their initial evaluation.

Does Self-Assessment Improve the Effectiveness of Grand Rounds Lectures in a Community-Based Teaching Hospital?

Objective: To determine whether use of self-assessment (SA) questions affects the effectiveness of weekly didactic grand rounds presentations.

Design: From 26 consecutive grand rounds presentations from August 2013 to April 2014, a 52-question multiple-choice test was administered based on 2 questions from each presentation.

Setting: Community teaching institution.

Alternative dosing of prophylactic enoxaparin in the trauma patient: is more the answer?

Background: Inadequate anti-factor Xa levels and increased venous thromboembolic events occur in trauma patients receiving standard prophylactic enoxaparin dosing. The aim of this study was to test the hypothesis that higher dosing (40 mg twice daily) would improve peak anti-Xa levels and decrease venous thromboembolism.

Methods: A retrospective review was performed of trauma patients who received prophylactic enoxaparin and peak anti-Xa levels over 27 months.

Traumatic Abruptio Placenta Scale (TAPS): a proposed grading system of computed tomography evaluation of placental abruption in the trauma patient.

Placental abruption (PA) is one of the worst possible manifestations of injury in the pregnant trauma patient with ultrasound as the current initial imaging examination of choice, despite its known limitations in placental evaluation. Pregnant patients who undergo computed tomography (CT) for evaluation of potential maternal injuries provide an additional source of imaging for placental evaluation; however, few studies have delineated normal and abnormal placental appearance, therefore resulting in insufficient placental assessments on pregnant trauma patients. Retrospective literature analysis was performed to provide a structured descriptive classification of normal and abnormal placental appearance on CT.

The ability of computed tomography to diagnose placental abruption in the trauma patient.

Background: Fetal demise following trauma remains a devastating complication largely owing to placental injury and abruption. Our objective was to determine if abdominopelvic computed tomographic (CT) imaging can assess for placental abruption (PA) when obtained to exclude associated maternal injuries.

Methods: Retrospective review of pregnant trauma patients of 20-week gestation or longer presenting to a trauma center during a 7-year period who underwent CT imaging as part of their initial evaluation.

Incidence of blunt cerebrovascular injury in low-risk cervical spine fractures.

Background: It has been suggested that specific cervical spine fractures (CSfx) (location at upper cervical spine [CS], subluxation, or involvement of the transverse foramen) are predictive of blunt cerebrovascular injury (BCVI). We sought to determine the incidence of BCVI with CSfx in the absence of high-risk injury patterns.

Methods: We performed a retrospective study in patients with CSfx who underwent evaluation for BCVI.

Use of computed tomography in the initial evaluation of anterior abdominal stab wounds.

Background: The purpose of this study was to assess the ability of computed tomography (CT) to facilitate initial management decisions in patients with anterior abdominal stab wounds.

Methods: A retrospective review was conducted of patients with anterior abdominal stab wounds who underwent CT over 4.5 years.

Empiric, broad-spectrum antibiotic therapy with an aggressive de-escalation strategy does not induce gram-negative pathogen resistance in ventilator-associated pneumonia.

Background: Early, empiric, broad-spectrum antibiotics followed by de-escalation to pathogen-specific therapy is the standard of care for ventilator-associated pneumonia (VAP). In our surgical intensive care unit (SICU), imipenem-cilastatin (I-C) in combination with tobramycin (TOB) or levofloxacin (LEV) has been used until quantitative bronchoalveolar lavage results are finalized, at which time de-escalation occurs to pathogen-specific agents. With this practice, however, alterations in antimicrobial resistance remain a concern.

Post-traumatic Subserosal Small Bowel Herniation Leading to Obstruction in a Child with Acute Spinal Cord Injury.

The presentation of small bowel injury from lap belt use varies substantially, ranging from gross hemodynamic instability to insidious physiologic deterioration to simple failure of improvement. Rarely does small bowel injury manifest as an obstruction. This paper describes one such occurrence; in this case, herniation of intact mucosa/submucosa through a serosal tear caused a high-grade small bowel obstruction in a pediatric patient with an acute spinal cord injury and a virgin abdomen.

Significant pediatric morbidity and mortality from intracranial ballistic injuries caused by nonpowder gunshot wounds. A case series.

Nonpowder (ball-bearing and pellet) weapons derive their source of energy from compressed air or carbon dioxide. Such weapons are dangerous toys that cause serious injuries and even death to children and adolescents. A retrospective chart review study was undertaken to describe nonpowder gun injuries at a southwestern US urban level I adult and pediatric trauma center.

The utility of diagnostic laparoscopy in the evaluation of anterior abdominal stab wounds.

Background: To assess if diagnostic laparoscopy (DL) is superior to nonoperative modes (serial abdominal examination with/without computed axial tomography [CAT] and diagnostic peritoneal lavage) in determining the need for therapeutic laparotomy (TL) after anterior abdominal stab wound (ASW).

Methods: Retrospective review of ASW patients. Patients were divided into group A (DL/exploratory laparotomy) to identify peritoneal violation (PV) and group B (initial nonoperative modes).

The relationship of plasma glucose and glycosylated hemoglobin A1C levels among nondiabetic trauma patients.

Objective: : Hyperglycemia (blood glucose >/=110 mg/dL) in trauma patients without a known history of diabetes mellitus (DM) is often attributed to the metabolic stress response of injury. We studied whether this hyperglycemia may actually indicate the presence of occult DM (ODM) as demonstrated by elevated glycosylated hemoglobin A1C (gHbA1C).

Methods: : After obtaining approval from the Institutional Review Board, a prospective, sequential case series study of nondiabetic adult patients presenting to an urban Level I trauma center from September 2006 to February 2007 was performed.

Can empiric broad-spectrum antibiotics for ventilator-associated pneumonia be narrowed based on Gram's stain results of bronchoalveolar lavage fluid.

Background: Although Gram's stain (GS) of bronchoalveolar lavage fluid is routinely obtained, its usefulness remains unclear. Our purpose was to assess the value of the GS in diagnosing ventilator-associated pneumonia (VAP) and to determine whether early antibiotic narrowing was feasible.

Methods: Retrospective study of critically ill surgical patients with clinical and quantitative evidence of VAP.

Current management of common bile duct stones in a teaching community hospital.

The advent of laparoscopic cholecystectomy (LC) has complicated management of common bile duct (CBD) stones. While LC is routine, laparoscopic CBD exploration (LCBDE) is not, and an algorithm to manage suspected choledocholithiasis has not been uniformly accepted. We evaluated current management of choledocholithiasis.