The unborn fetus: The unrecognized victim of trauma during pregnancy.

Background: Trauma is the leading cause of non-obstetric death in pregnancy. While maternal management is defined, few studies have examined the effects on the fetus.

Methods: Following IRB approval, all pregnant females (2010-2017) at a level-1 trauma center were retrospectively reviewed.

Pexy of intraperitoneal LVAD driveline to relieve small bowel obstruction.

Background: Left ventricular assist device (LVAD) implantation is a lifesaving intervention in advanced heart failure. However, LVAD is not without complication. In this case, an inadvertent intraperitoneal driveline caused small bowel obstruction, subsequently requiring pexy of the driveline to the abdominal wall to avoid future complications.

Outcomes of Pediatric Pelvic Fractures: A Level I Trauma Center's 20-Year Experience.

Background: Pediatric pelvic fractures are rare. The contribution of pelvic fracture pattern, risk factors for associated injuries, and mortality are poorly defined in this population.

Methods: Patients aged 0-17 with pelvic fractures at a level I trauma center over a 20-y period were reviewed.

Risk Factors and Clinical Outcomes Associated With Augmented Renal Clearance in Trauma Patients.

Background: Augmented renal clearance (ARC; i.e., creatinine clearance [CL] ≥ 130 mL/min) has an incidence of 14%-80% in critically ill patients and has been associated with therapy failures for renally cleared drugs.

Electrical Burns During Fruit Harvesting.

Electrocutions during tree trimming or fruit harvesting are occasionally reported in the public media, but the actual incidence is unknown. Some fruit trees (eg, mango and avocado) can exceed 30 feet, with dense foliage concealing the fruit and overlying power lines so burns associated with harvesting these fruits are often exacerbated with falls. However, there are limited data on this subject.

A Significant Proportion of Small Bowel Obstructions Require >48 Hours to Resolve After Gastrografin.

Background: Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon after 8 h is predictive of the need for operation, and a recent trial used 48 h to prompt operation. We hypothesize that a significant number of patients receiving the GG challenge require >48 h before an effect is seen.

Spontaneous massive splenic infarction in the setting of renal transplant and septic shock: a case report and review of the literature.

Massive splenic infarction (MSI) is a rare phenomenon that results from compromised blood flow to more than half of the spleen. Causes of MSI include hematological disorders, coagulopathies, infection, and embolization, and, rarely, MSI is spontaneous. The mainstay of treatment is splenectomy.

Novel prehospital monitor with injury acuity alarm to identify trauma patients who require lifesaving intervention.

Background: A miniature wireless vital signs monitor (MWVSM, www.athena.gtx.

The value of cholangiography through Jackson-Pratt drains in the management of postoperative biliary injuries.

Iatrogenic biliary injury is the most significant complication after laparoscopic cholecystectomy. We present our experience with an alternative diagnostic approach using transcatheter cholangiography (TCC) through a Jackson-Pratt (JP) drain and discuss potential benefits and limitations of the technique. From March 2002 to February 2012, 40 patients with major postoperative biliary injury underwent biliary reconstruction at our institution.

Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism.

Background: Thromboelastography (TEG) on hospital admission can identify hypercoagulable trauma patients at risk for venous thromboembolism (VTE), but the value of TEGs obtained after multiple interventions, including tranexamic acid (TXA), has not been defined. We test the following hypotheses. (1) TEG on intensive care unit (ICU) admission can help stratify patients screened with Greenfield's risk assessment profile (RAP) for VTE.

Biliary-colonic fistula caused by cholecystectomy bile duct injury.

Biliary-colonic fistula is a rare complication after laparoscopic cholecystectomy. We present a case of post-cholecystectomy iatrogenic biliary injury that resulted in a fistula between the common hepatic duct and large bowel. Magnetic resonance cholangiopancreatography provided good visualization of injury even with concurrent normal level of alkaline phosphatase.

Hypercoagulability after burn injury.

Background: Hypercoagulability is a homeostatic response to trauma, but relatively little information is available about coagulation changes after burn injury. Therefore, we tested the hypothesis that burn patients are hypercoagulable at admission and/or during recovery.

Methods: A prospective observational trial was conducted at an American Burn Association verified Burn Center.

Change in hematocrit during trauma assessment predicts bleeding even with ongoing fluid resuscitation.

This study tests the hypothesis that a change in hematocrit (ΔHct) during initial trauma work-up is as reliable as conventional vital signs for detecting bleeding, even with ongoing fluid resuscitation. Consecutive trauma patients admitted to a Level I trauma center receiving two Hct measurements during initial resuscitation between January 2010 and January 2011 were stratified based on estimated blood loss greater than 250 mL (bleeding) or nonbleeding. Sensitivity, specificity, and receiver operating characteristic curves were calculated for systolic blood pressure (SBP), heart rate, base deficit, and ΔHct.

Repeat head computed tomography after minimal brain injury identifies the need for craniotomy in the absence of neurologic change.

Background: In this era of cost containment, the value of routine repeat head computed tomography (CT) in patients with mild TBI (mTBI) and no interval neurologic change has been challenged. The purpose of this study was to test the hypothesis that routine repeat head CT provides critical information after mTBI even with no neurologic change.

Methods: From January 1996 to May 2010, records from all patients admitted to our Level I trauma center with an arrival Glasgow Coma Scale (GCS) score of 13 to 15 and at least one head CT were retrospectively reviewed.

Persistence of hypercoagulable state after resection of intra-abdominal malignancies.

Background: The hypercoagulable state associated with cancer imparts considerable risk for venous thromboembolism. Surgical resection of malignancies should theoretically reverse tumor-induced hypercoagulability. However, coagulation changes in cancer patients postresection have not been described thoroughly.

Admission hematocrit and transfusion requirements after trauma.

Background: The decision to transfuse packed RBCs (PRBC) during initial resuscitation of trauma patients is based on physiologic state, evidence for blood loss, and potential for ongoing hemorrhage. Initial hematocrit (Hct) is not considered an accurate marker of blood loss. This study tests the hypothesis that admission Hct is associated with transfusion requirements after trauma.

Does hemopericardium after chest trauma mandate sternotomy?

Background: Recently, three patients with hemopericardium after severe chest trauma were successfully managed nonoperatively at our institution. This prompted the question whether these were rare or common events. Therefore, we reviewed our experience with similar injuries to test the hypothesis that trauma-induced hemopericardium mandates sternotomy.