A5061463195- Trauma and Emergency Care Studies
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Cardiac Arrest and Resuscitation
- Mechanical Circulatory Support Devices
- Antifungal resistance and susceptibility
- Trauma Management and Diagnosis
- Thyroid and Parathyroid Surgery
- Pituitary Gland Disorders and Treatments
- Traumatic Brain Injury and Neurovascular Disturbances
- Peripheral Artery Disease Management
- Bacillus and Francisella bacterial research
- Blood donation and transfusion practices
- Abdominal Trauma and Injuries
- Musculoskeletal pain and rehabilitation
- Hemostasis and retained surgical items
- Diabetic Foot Ulcer Assessment and Management
- Immune Response and Inflammation
- Case Reports on Hematomas
- Hemodynamic Monitoring and Therapy
- Esophageal and GI Pathology
- Nosocomial Infections in ICU
- Foreign Body Medical Cases
- Body Contouring and Surgery
- Cancer survivorship and care
- Immunodeficiency and Autoimmune Disorders
Walter Reed National Military Medical Center
2012-2024
Uniformed Services University of the Health Sciences
2012-2023
Brooke Army Medical Center
2021-2023
American Association for the Surgery of Trauma
2023
Joint Base San Antonio
2021-2023
University of Maryland, Baltimore
2019-2020
Blanchfield Army Community Hospital
2018
Unity Hospital
2016
Naval Medical Research Command
2012-2015
Walter Reed Army Institute of Research
2011
The clinical importance of extrathyroidal extension (ETE) on outcome papillary thyroid cancer (PTC), particularly with respect to disease extending the surgical margin is not well established. This study assessed and invasion relative local control oncologic outcome.A retrospective analysis a prospective institutional endocrine database was conducted 276 patients PTC treated between 1955 2004 determine impact margin-negative resection (n=199, 72%), up within 1 mm (n=19, 7%), microscopic...
Traumatic hemorrhage is the leading cause of preventable battlefield death and hemostatic agents can improve survival. We compared a novel, amorphous, silica dioxide-based fiber (SBF) matrix to criterion standard QuikClot Combat Gauze (QCCG) in treating junctional arterial injury hypocoagulable swine. Vascular access was obtained 16 anesthetized swine, hemodilution achieved with 50% blood exchange saline. A 5-mm arteriotomy made common femoral artery. After 30 seconds free bleeding, SBF or...
Military experience has shown low-titer O whole blood (LTOWB) to be safe and beneficial in the resuscitation of hemorrhaging trauma patients. However, few civilian centers use LTOWB for resuscitation. We evaluated early safety a program at level 1 center.We retrospectively reviewed our registry from January 2018 June 2020 patients admitted shock (defined as ≥1 following: heart rate, >120 beats per minute; systolic pressure, <90 mm Hg; or index, >0.9) who received products within 24 hours....
Abstract Low titer type O Rh‐D + whole blood (LTO WB) has become a first‐line resuscitation medium for hemorrhagic shock in many centers around the World. Showing early effectiveness on battlefield, LTO WB is used both pre‐hospital and in‐hospital settings traumatic non‐traumatic hemorrhage resuscitation. Starting 2018, San Antonio Whole Blood Collaborative worked to provide across Southwest Texas, initially form of remote damage control followed by trauma This program since expanded include...
Background: Invasive mucormycosis or aspergillosis is a life-threatening infection. The disease typically occurs in immunocompromised patients (e.g., those with diabetes mellitus burns) but rarely serious otherwise-healthy young trauma patients. Methods: Case report and literature review. Results: A previously-healthy 22-year-old United States Marine who sustained large soft tissue injuries support of Operation Enduring Freedom underwent multiple operations theater to stabilize his wounds....
Normal esophageal bolus transport in asymptomatic healthy older adults has not been well defined, potentially leading to ambiguity differentiating swallowing patterns of dysphagic and individuals. This pilot study 24 young (45–64 years) old (65+years) men women was designed assess radiographic movement using videofluoroscopic recording. Healthy, underwent esophagram evaluate for the presence ineffective clearance, namely, intraesophageal stasis reflux. Intraesophageal reflux were visualized...
Disparity between patient report and physician perception of pain from radiotracer injection for sentinel node biopsy is thought to center on the severity intervention, ethnic composition population queried, socioeconomic factors.The objectives this study were, first, explore agreement physicians' their breast cancer patients' assessment during subareolar radionucleotide injection; second, evaluate potential differences in ratings.A trial was conducted, January 2006 April 2009, where 140...
BACKGROUND Patients with traumatic intracranial hemorrhage (ICH) and concomitant pulmonary embolus (PE) have competing care needs demand a careful balance of anticoagulation (AC) versus potential worsening their ICH. The goal this study is to determine the safety therapeutic AC for PE in patients METHODS This retrospective single-center older than 16 years ICH occurring between June 2013 December 2017. Early was defined as within 7 days injury or less; late after days. Primary outcomes...
Splenic embolization for traumatic vascular abnormalities in stable patients is a common practice. We hypothesize that modern contrast-enhanced computed tomography (CT) over diagnoses posttraumatic splenic lesions, such as intraparenchymal pseudoaneurysms (PSA) may not require embolization.
The application of lessons learned on the battlefield for timely surgical control lower extremity hemorrhage secondary to blast injuries civilian practice similar wounding patterns from industrial accidents or terrorist activities is imperative. Although simple cut-down procedures are commonly sufficient blood vessels distal traumatic amputations, high-thigh disarticulation often require more complex methods. following details both decision-making process and operative techniques controlling...
Invasive fungal infection (IFI) is described increasingly in individuals experiencing high-energy military trauma. Hallmarks of successful treatment involve aggressive surgical debridement and early initiation systemic antimicrobial therapy. Currently, intravenous anti-fungal therapy commences based on appearance wounds patient's clinical course. Whereas some protocols exist to predict which critically injured patients should receive therapies, there are no established serum markers...
Trauma-induced hemorrhagic shock produces hemodynamic changes that often result in a systemic inflammatory response can lead to multiple organ failure and death. In this prospective study, the pathophysiology of nonhuman primate uncontrolled model is evaluated with goal creating an acute syndrome reproducible hemorrhage.Nonhuman primates were divided into 2 groups. A laparoscopic left hepatectomy was performed groups B, 60% 80%, respectively, resulting hemorrhage. Resuscitation during...
Acute limb ischemia is a common cause of morbidity and mortality following trauma both in civilian centers combat related injuries. Rapid determination tissue viability surgical restoration blood flow are desirable, but not always possible. We sought to characterize the response increasing periods hind porcine model such that we could define period critical (the point after which irreversible neuromuscular injury occurs), evaluate non-invasive methods for characterizing ischemia, establish...
A woman in her late 50s on mycophenolate for limited systemic sclerosis presented with abdominal pain. Vital signs and investigative evaluations were normal. Cross-sectional imaging identified gastric small bowel wall thickening, free fluid, pneumoperitoneum. In the operating room, a perforation was found resected. Postoperatively, immunosuppression held she completed course of amoxicillin/clavulanate. She discharged home re-presented postoperative day 8 seizures to have frontal brain mass...
ABSTRACT Introduction Protective ballistic body armor (BA) may be needed during certain threat postures while deployed. This requirement often adds between 35 and 45lbs of extra weight carried by the service member (SM) for multiple hours day. The physical toll that effect it have on deployed medical resources has not been clearly characterized in literature. We sought to evaluate association a protective BA wear with musculoskeletal (MSK) complaints better characterize how these effects are...
Introduction Acute intoxication (AI) related morbidity and mortality are increasing in the United States. For patients with severe respiratory failure setting of an acute ingestion, veno-venous extracorporeal membrane oxygenation (VV ECMO) can provide salvage therapy. The purpose this study was to evaluate outcomes overdose-related need for VV ECMO. Methods: We performed a retrospective review all admitted specialty ECMO unit between August 2014 2018. Patients were stratified by those whose...
Over 70% of military casualties resulting from the current conflicts sustain major extremity injuries. Of these majority are caused by blasts improvised explosive devices. The injuries include traumatic amputations, open fractures, crush injuries, and acute vascular disruption. Critical tissue ischemia—the point at which ischemic tissues lose capacity to recover—is therefore a concern, as lack blood flow rapidly leads deoxygenation necrosis. If left undetected or unaddressed, potentially...
ABSTRACT Introduction : COVID-19–induced coagulopathy (CIC) can increase the risk of thromboembolism without underlying clotting disorders, even when compared with other respiratory viruses. Trauma has a known association hypercoagulability. patients concurrent COVID-19 infection potentially have an greater thrombotic events. The purpose this study was to evaluate venous (VTE) rates in trauma COVID-19. Methods This reviewed all adult (≥18 years age) admitted Service from April through...
The accidental ingestion of a foreign object often presents difficult scenario for the clinician. This includes not only decision to retrieve material but also appropriate technique use. We present case young asymptomatic girl who swallowed magnetic activity watch, which was then successfully retrieved with an endoscopic snare. To our knowledge, this is first documented salvaging operational watch from stomach using technique.