New Methods of Reconstruction for Old Challenges: The Use of the Integra Graft in Necrotizing Soft Tissue Infections of the Male Genitalia.

In this paper, we describe two cases of Fournier's gangrene (FG) in which Integra grafting was used for reconstruction. FG is a progressive necrotizing infection occurring in the perineal region and on the external genitalia. Reconstructive options using local tissue are limited due to the destruction this infection imposes on the soft tissue.

Brugada Pattern Manifesting During Hyperkalemia, Diabetic Ketoacidosis, and Acute Alcohol Intoxication.

BACKGROUND Brugada syndrome is a rare ion channelopathy that can lead to sudden cardiac death and lethal arrhythmias in patients without a structural cardiac defect, the most common of which being the gain-of-function mutation of the SCN5a sodium ion channel involving phase 0 of the cardiac action potential. In 2012, BrS electrocardiogram findings were redefined and classified as either congenital Brugada syndrome (BrS) or Brugada phenocopies (BrP). Several etiologies of BrP have been reported, such as metabolic derangements, electrolyte abnormalities, cardiovascular diseases, and pulmonary embolism.

Efficacy of New Long-Acting Bupivacaine HTX-011 in Providing Pain Relief for Patients Undergoing Elective Surgery - A Meta-analysis of Prospective Randomized Controlled Trials.

Background: The aim of the present meta-analysis is to critically analyze the various prospective randomized controlled trials comparing the safety and efficacy of a new, yet unapproved long-acting local anesthetic HTX-011. This is a combination of bupivacaine and meloxicam, and like its predecessors' liposomal bupivacaine and SABER bupivacaine, the combination slowly releases bupivacaine and provides therapeutic analgesic concentrations at the site of infiltration.

Methods: We performed a meta-analysis of 7 randomized clinical trials comparing the use of HTX-011 with placebo and/or bupivacaine in patients undergoing abdominoplasty, bunionectomy, and herniorrhaphy.

Case Report: Traumatic Tension Pneumothorax in a Pediatric Patient.

Unlabelled: This case demonstrates the importance of quickly identifying a pediatric patient in acute respiratory distress secondary to pneumothorax and highlights the emergent management of these patients. The 16-year-old male patient presented to the emergency department (ED) with a chief complaint of right-sided rib pain and shortness of breath that began acutely after an all-terrain vehicle (ATV) accident. The patient was in respiratory distress upon presentation and had diminished right-sided breath sounds.

Perception of Illness and Its Association with Treatment Willingness in Patients with Newly Diagnosed Nonalcoholic Fatty Liver Disease.

Background: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease of immense public health relevance. Understanding illness perceptions in the NAFLD population will provide sound scientific evidence for planning high-quality patient-centered care and implementing effective interventions. The Brief Illness Perception Questionnaire (BIPQ) is a robust psychometric tool to systematically assess the dimensions of illness perceptions in various chronic ailments.

Pericardial decompression syndrome: A comprehensive review.

Pericardial decompression syndrome (PDS) is an infrequent, life-threatening complication following pericardial drainage for cardiac tamponade physiology. PDS usually develops after initial clinical improvement following pericardiocentesis and is significantly underreported and may be overlooked in the clinical practice. Although the precise mechanisms resulting in PDS are not well understood, this seems to be highly associated with patients who have some underlying ventricular dysfunction.

Imaging Modalities in Genitourinary Emergencies.

Emergency physicians rely on a multitude of different imaging modalities in the diagnosis of genitourinary emergencies. There are many considerations to be taken into account when deciding which imaging modality should be used first, as oftentimes several diagnostic tools can be used for the same pathologic condition. These factors include radiation exposure, sensitivity, specificity, age of patient, availability of resources, cost, and timeliness of completion.

Operation continued care: A large mass-casualty, full-scale exercise as a test of regional preparedness.

Background: Our regional trauma organization, which comprises 7 trauma centers, 30 acute care hospitals and free-standing emergency departments, and 42 emergency medical services agencies, conducted possibly the largest mass-casualty drill to date, totaling 445 victims at 3 sites involving 11 hospitals and 25 agencies and organizations.

Methods: The drill was preceded by a tabletop exercise 4 months beforehand called Operation Continued Care Full-Scale Exercise, which consisted of simulated terrorist events at 3 sites to wound 445 moulaged patients. Four law enforcement and 5 fire and emergency medical services departments and 16 supporting organizations and agencies were involved in transporting patients to 11 different hospitals.

Multiple Evanescent White Dot Syndrome Presenting in Possibly Contracted Hand-Foot-and-Mouth Disease: A Rare Presentation.

Multiple evanescent white dot syndrome (MEWDS), an inflammatory retinal condition seen predominantly in young adult patients, is characterized by unilateral vision loss with variable scotomas. The etiology of MEWDS is currently elusive and the formal mechanism is unknown. However, it must be differentiated from other white dot syndromes (WDS).

Collaboration, Not Calculation: A Qualitative Study of How Hospital Executives Value Hospital Medicine Groups.

Background: Hospital medicine groups (HMGs) typically receive financial support from hospitals. Determining a fair amount of financial support requires negotiation between HMG and hospital leaders. As the hospital medicine care model evolves, hospital leaders may regularly challenge HMGs to demonstrate the financial value of activities that do not directly generate revenue.

Transverse sinus fat pad may masquerade as left atrial appendage thrombus.

Transesophageal echocardiography (TEE) is a commonly utilized investigation in patients with atrial fibrillation to study the left atrial appendage (LAA) and exclude an appendage thrombus before proceeding with cardioversion. Although TEE is considered the procedure of choice for this purpose, it may sometimes offer a limited specificity due to common anatomical variations associated with either the LAA or the adjoining cardiac structures. We herewith present a patient with atrial fibrillation who underwent TEE and was found to have an echodensity in the vicinity of left atrial appendage that mimicked a thrombus.

Electromagnetic Transthoracic Nodule Localization for Minimally Invasive Pulmonary Resection.

Background: Increased use of chest computed tomography and the institution of lung cancer screening have increased the detection of ground-glass and small pulmonary nodules. Intraoperative localization of these lesions via a minimally invasive thoracoscopic approach can be challenging. We present the feasibility of perioperative transthoracic percutaneous nodule localization using a novel electromagnetic navigation platform.

Concussion in Theater: A Cross-Sectional Survey of Prevalence and Management in Actors and Theater Technicians.

Objective: Determine the history of occupational head impacts, concussion symptoms, and concussion management in theater personnel.

Methods: Personnel working in theater environments completed a survey about head impacts that occurred in theater activities and how they were managed.

Results: Lifetime prevalence of sustaining at least one theater-related head impact was 67%.

Isolated Limb Infusion as a Limb Salvage Strategy for Locally Advanced Extremity Sarcoma.

Background: Treatment-resistant, locally advanced soft tissue sarcomas often require amputation for complete tumor extirpation. Isolated limb infusion (ILI) selectively delivers high-dose chemotherapy to the extremity in an attempt to achieve limb salvage. The aim of this study was to report perioperative and oncologic outcomes after ILI in patients with extremity soft tissue sarcomas.

Establishing Standards for Trauma Nursing Education: The Central Ohio Trauma System's Approach.

Trauma nursing requires mastering a highly specialized body of knowledge. Expert nursing care is expected to be offered throughout the hospital continuum, yet identifying the necessary broad-based objectives for nurses working within this continuum has often been difficult to define. Trauma nurse leaders and educators from 7 central and southeastern Ohio trauma centers and 1 regional trauma organization convened to establish an approach to standardizing trauma nursing education from a regional perspective.