Evaluating the Utility of High Sensitivity Troponin in Blunt Cardiac Injury.

Introduction: Screening for blunt cardiac injury (BCI) includes obtaining a serum troponin level and an electrocardiogram for patients diagnosed with a sternal fracture. Our institution has transitioned to the use of a high sensitivity troponin I (hsTnI). The aim of this study was to determine whether hsTnI is comparable to troponin I (TnI) in identifying clinically significant BCI.

Assessment of Detectable Serum Tobramycin Concentrations in Patients Receiving Inhaled Tobramycin for Ventilator-Associated Pneumonia.

Background: Inhaled tobramycin can be used for empiric or definitive therapy of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. This is believed to minimize systemic exposure and potential adverse drug toxicities including acute kidney injury (AKI). However, detectable serum tobramycin concentrations have been reported after inhaled tobramycin therapy with AKI.

Evaluation of Vasopressor Exposure and Mortality in Patients With Septic Shock.

Objectives: The objectives of this study were to: 1) determine the association between vasopressor dosing intensity during the first 6 hours and first 24 hours after the onset of septic shock and 30-day in-hospital mortality; 2) determine whether the effect of vasopressor dosing intensity varies by fluid resuscitation volume; and 3) determine whether the effect of vasopressor dosing intensity varies by dosing titration pattern.

Design: Multicenter prospective cohort study between September 2017 and February 2018. Vasopressor dosing intensity was defined as the total vasopressor dose infused across all vasopressors in norepinephrine equivalents.

Variation in Fluid and Vasopressor Use in Shock With and Without Physiologic Assessment: A Multicenter Observational Study.

Objectives: To characterize the association between the use of physiologic assessment (central venous pressure, pulmonary artery occlusion pressure, stroke volume variation, pulse pressure variation, passive leg raise test, and critical care ultrasound) with fluid and vasopressor administration 24 hours after shock onset and with in-hospital mortality.

Design: Multicenter prospective cohort study between September 2017 and February 2018.

Settings: Thirty-four hospitals in the United States and Jordan.

Retrospective Evaluation of Venous Thromboembolism Prophylaxis in Elderly, High-Risk Trauma Patients.

Background: Venous thromboembolism (VTE) risk increases with age. Scarce data exist for patients age ≥65 y. This study evaluated VTE incidence in elderly, high-risk trauma patients receiving unfractionated heparin (UFH) or enoxaparin chemoprophylaxis.

Chalcone Derivatives Enhance ATP-Binding Cassette Transporters A1 in Human THP-1 Macrophages.

Atherosclerosis is a process of imbalanced lipid metabolism in the vascular walls. The underlying pathology mainly involves the deposition of oxidized lipids in the endothelium and the accumulation of cholesterol in macrophages. Macrophages export excessive cholesterol (cholesterol efflux) through ATP-binding cassette transporter A1 (ABCA1) to counter the progression of atherosclerosis.

Tube Feed Necrosis after Major Gastrointestinal Oncologic Surgery: Institutional Lessons and a Review of the Literature.

Background: Small bowel necrosis after enteral feeding through a jejunostomy tube (tube feed necrosis, TFN) is a rare, serious complication of major abdominal surgery. However, strategies to reduce the incidence and morbidity of TFN are not well established. Here, in the largest series of TFN presented to date, we report our institutional experience and a comprehensive review of the literature.

Accuracy of noninvasive hemoglobin monitoring in patients at risk for hemorrhage.

Background: Monitoring for acute blood loss is critical in surgical patients, and delays in identifying hemorrhage can result in poor outcomes. The current standard of care for monitoring patients at risk for bleeding is serial measurement of hemoglobin (Hgb) by standard laboratory complete blood count (CBC). Point-of-care testing (i.

A practical approach to the use of prone therapy in acute respiratory distress syndrome.

In this article we propose a practical approach to the use of prone therapy for acute respiratory distress syndrome (ARDS). We have attempted to provide information to improve the understanding and implementation of prone therapy based on the literature available and our own experience. We review the basic physiology behind ARDS and the theoretical mechanism by which prone therapy can be of benefit.

Early treatment of blunt cerebrovascular injury with concomitant hemorrhagic neurologic injury is safe and effective.

Background: Early pharmacologic treatment for blunt cerebrovascular injury (BCVI) is often withheld when concomitant traumatic brain injury or cervical spinal cord injury occurs. This study examines the safety and efficacy of early treatment for patients with both BCVI and traumatic neurologic injury (TNI).

Methods: Ten-year retrospective review of patients with BCVI and a TNI was performed.

Development of a novel method of progressive temporary abdominal closure.

Background: This paper describes our experience with a novel method of temporary abdominal closure that permits frequent reassessment of the abdominal contents and progressive reapproximation of the fascial edges without compromising definitive fascial closure outcomes.

Methods: We developed a novel method of temporary abdominal closure, which we have named the frequent assessment temporary abdominal closure (FASTAC). The records of patients who underwent planned relaparotomy during 5 years were reviewed.

Emergency airway placement by EMS providers: comparison between the King LT supralaryngeal airway and endotracheal intubation.

Introduction: The ever-present risk of mass casualties and disaster situations may result in airway management situations that overwhelm local emergency medical services (EMS) resources. Endotracheal intubation requires significant user education/training and carries the risk of malposition. Furthermore, personal protective equipment (PPE) required in hazardous environments may decrease dexterity and hinder timely airway placement.

Risk factors for relapse of ventilator-associated pneumonia in trauma patients.

Background: Our goal was to define risk factors for ventilator-associated pneumonia (VAP) relapse and examine the implications, if any, for initial therapy in trauma patients.

Methods: Trauma patients cared for in the surgical intensive care unit during a 48-month period with confirmed VAP recurrence were evaluated. Recurrent VAP was defined as a positive quantitative culture (> or = 10(4) colony-forming units/mL in a bronchoalveolar lavage or protected catheter lavage specimen) > or = 4 days after initiation of antibiotics for the primary episode.

Close is dead: determinants of firearm injury lethality in women.

Background: Accurate data regarding intimate partner violence is difficult to obtain, particularly when examining only homicides or trauma registries. This study characterizes firearm violence against women by examining data from both the county coroner and an urban level I trauma center.

Methods: The Trauma Registry and Coroners database were reviewed for female victims of firearm assault from 1998 to 2006.

The devil is in the details: maximizing revenue for daily trauma care.

Background: Falling reimbursement rates for trauma care demand a concerted effort of charge capture for the fiscal survival of trauma surgeons. We compared current procedure terminology code distribution and billing patterns for Subsequent Hospital Care (SHC) before and after the institution of standardized documentation.

Methods: Standardized SHC progress notes were created.

An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay.

Background: Analgesics and sedatives are required to maintain a calm and comfortable mechanically ventilated injured patient. Continuous sedative infusions have been shown to lengthen mechanical ventilation and hospital length of stay. Daily interruption of sedative infusions may reduce both of these variables.

Equine-related injury: a retrospective analysis of outcomes over a 10-year period.

Background: Morbidity and financial loss caused by equine-related injuries may be significant. The purposes of this study were to determine the patterns of equine-related injury and the impact on outcomes.

Methods: A 10-year retrospective review of equine-related injuries was performed.

Trends concerning a common medical school interview question, revisited.

Purpose: To assess the validity of asking prospective medical school students about their planned field of practice during their admissions interview at one United States allopathic medical school, and to compare and contrast the results with the results from a similar study conducted in 2004.

Methods: Anonymous one-page surveys were voluntarily filled out and immediately collected from matriculated freshman medical students who wished to participate in this Institutional Review Board (IRB) approved study.

Results: Ninety five medical students voluntarily completed and returned the anonymous survey; 82 were filled out correctly.

Impact of language barrier on acute care medical professionals is dependent upon role.

Communication with patients is essential to providing quality medical care. The study was conducted to evaluate the effects of language barriers on health care professionals. It is hypothesized that these language barriers are commonly perceived by health care professionals and they are a source of workplace stress in acute care environments.

Assessment of the pregnant trauma patient.

Although less than 10% of pregnant patients are likely to experience some type of physical trauma, injury is the leading non-obstetric cause of maternal mortality. The assessment and resuscitation of the injured pregnant patient must take into account the specific needs of both the mother and the foetus. This paper will review the physiology of pregnancy, discuss recent changes in assessment and resuscitation, and identify special injuries and issues specific to the pregnant trauma patient.

Defining and assessing tolerance in enteral nutrition.

Nutrition support has become widely recognized as an essential component of optimal care for acutely ill patients. Enteral nutrition is preferred over parenteral routes when possible. However, prescribed enteral nutritional regimens are sometimes met with side effects and even complications.

Enteral nutrition in patients with an open peritoneal cavity.

Recent surgical advances have led to the increased survival of critically ill patients requiring postoperative nutritional supplementation. One technique, which has been increasingly used, is that of the open peritoneal cavity. In these cases, the peritoneum is left open, and the viscera are protected with a temporary dressing until the abdomen can be closed.

Supplemental enteral arginine is metabolized to ornithine in injured patients.

Background: Arginine has been added to immune enhancing diets that may improve patient outcomes, but little is known about the metabolic fate of supplemental arginine. We hypothesize that supplemental enteral arginine in injured patients is metabolized to ornithine by increased activity of the enzyme arginase.

Materials And Methods: Twenty-five adult patients with injury severity scores > or =20 received up to 14 days of enteral nutrition supplemented with arginine (30 g/day) or placebo in a prospective, randomized, blinded study.

The open peritoneal cavity: etiology correlates with the likelihood of fascial closure.

The use of laparostomy in damage control surgery and uncontrolled intra-abdominal infection has been well described. We examined 71 patients who required laparostomy to see if trends in management and outcome could be identified based on the underlying disease state. The underlying etiology included gastrointestinal sepsis (n = 25), pancreatitis (n = 21), or trauma (n = 25).

Regulation of arginase expression by T-helper II cytokines and isoproterenol.

Background: Trauma causes a release of catecholamines, transforming growth factor-beta (TGF-beta), and T-helper II cytokines (TH2). Individually, these substances also induce arginase in macrophages. The purpose of this study was to determine the synergistic interactions between isoproterenol, TGF-beta, and TH2 cytokines on arginase expression in macrophages.