Damage control surgery, initially formalized <20 yrs ago, was developed to overcome the poor outcomes in exsanguinating abdominal trauma with traditional surgical approaches. The core concepts for damage of hemorrhage and contamination abbreviated laparotomy followed by resuscitation before definitive repair, although simple nature, have led an alteration which emergent surgery is handled among a multitude problems, including sepsis battlefield surgery. With aggressive associated...

To evaluate the steady-state pharmacokinetic and pharmacodynamic parameters of piperacillin in morbidly obese, surgical intensive care patients.Open-label single-center prospective study.Level I trauma center university-affiliated teaching institution.Nine obese (body mass index [BMI] 40.0 kg/m² or higher) hospitalized patients admitted to service who were treated with piperacillin-tazobactam between December 15, 2010, April 18, 2012.Patients received intravenous 4.5 g every 6 hours,...

Helicopter emergency medical service (HEMS) transport of trauma patients is costly and unproven benefit. Recent retrospective studies fail to control for crew expertise therefore compare highly trained advance life support with less-trained basic crews. The purpose our study was HEMS ground, interfacility while controlling training. We hypothesized that transported by would experience shorter interhospital time reduced mortality.Our National Trauma Registry the American College Surgeons...

Objective: Hypothermia is an independent predictor of mortality in adult trauma studies. However, the impact hypothermia on pediatric population has not been described. The purpose this study to evaluate as a cofactor mortality, complications, and among survivors, hospital length stay parameters population. Design: Retrospective review prospectively collected database (National Trauma Registry American College Surgeons) over 5-yr period (July 2002 June 2007). Setting: A rural, level I...

The cost of care in elderly (ELD) trauma patients is high compared with younger patients, but the association between age and reimbursement relative to less clear. purpose this study was explore relationship total costs (TC) young (YNG) ELD patients.The National Trauma Registry American College Surgeons queried for admitted a level I center January 2002 December 2004. YNG (18-64 years) were (> or =65 mechanism injury, Injury Severity Score, outcome variables. Data obtained from hospital...

Intimate partner violence (IPV) is a significant cause of intentional injury among women but remains underrecognized, and its relationship to other risk factors for all-cause poorly defined. This study aimed assess IPV association with alcohol abuse, illicit substance use, selected mental illnesses, injury.This cross-sectional prospectively collected data adult females admitted rural, Level I trauma center. Well-validated instruments assessed IPV, illness. Bivariate relationships were χ,...

Background: No consensus exists regarding the definition of ventilator-associated pneumonia (VAP). Even within a single institution, inconsistent diagnostic criteria result in conflicting rates VAP. As Level 1 trauma center participating Trauma Quality Improvement Project (TQIP) and National Healthcare Safety Network (NHSN), our institution showed inconsistencies VAP depending on which was applied. The purpose this study to compare definitions, defined by culture-based criteria, Data Bank...

The incidence of new onset or worsening diabetes is surprisingly low in patients after partial pancreatectomy for cancer, leading us to question what factors predict diminished glycemic control those undergoing resection. All cancer at a large, rural university teaching hospital between 1996 and 2010 were identified. onset, worsening, existing was determined based on pre postoperative medication requirement. Univariate analysis undertaken identify that worsened control. One hundred one (1...

BACKGROUND Concomitant lung/brain traumatic injury results in significant morbidity and mortality. Lung protective ventilation (Acute Respiratory Distress Syndrome Network [ARDSNet]) has become the standard for managing adult respiratory distress syndrome; however, resulting permissive hypercapnea may compound brain injury. Airway pressure release (APRV) offers an alternative strategy management of this patient population. APRV was hypothesized to retard progression acute a degree greater...

Background: Damage control laparotomy (DCL) provides effective management in carefully selected, exsanguinating trauma patients. However, the effectiveness of this approach has not been examined elderly. The purpose study was to characterize elderly DCL Methods: National Trauma Registry American College Surgeons queried for patients admitted our Level I center between January 2003 and June 2008. Patients who underwent a were included study. Elderly (55 years or older) young (16–54 years)...

Permissive hypotension is a component of damage control resuscitation that aims to provide directed, controlled resuscitation, while countering the "lethal triad." This principle has not been specifically studied in elderly (ELD) trauma patients (≥55 years). Given ELD population's lack physiologic reserve and risk inadequate perfusion with "normal" blood pressures, we hypothesized utilized permissive strategy would result worse outcomes compared younger (18-54 A retrospective review National...

Background: Resource utilization in medicine is becoming a more and urgent issue with ongoing national discussions on healthcare coverage. In the management of trauma system, large amounts resources money are expended individual patients hope "great save." addition, those us caring for these required to estimate outcomes daily family an effort choose best course care patient. Hence, we undertook study analyze accuracy predictions various members team. Methods: During period 38 months (July...

It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there scant published literature to support this claim and no studies in any surgical population. Our hypothesis was EMR would not objective outcome measures patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center retrospectively reviewed. Demographic, injury severity as well outcomes complications were compared for all admitted over a...

The Rural Trauma Team Development Course (RTTDC) is designed to help rural hospitals better organize and manage trauma patients with limited resources. Although RTTDC well-established, literature exists regarding improvement in the overall objectives for which course was designed. aim of this study analyze goals RTTDC, hypothesizing improvements after completion.

Background: Six hours from injury to washout is considered the gold standard in treatment of open traumatic fractures. Despite this being our hospital policy, rural nature Level I trauma center causes delays discovery and transport, creating a unique randomization time washout. We hypothesized that orthopedic complications after fractures are related severity fractures, not timing Methods: Patients were reviewed retrospectively over 6.3 years, evaluating for demographics, severity, location...

Our purpose was to evaluate the impact of paging on perceptions intraoperative learning. Intraoperative logs pager interruptions were kept by surgical residents at a university hospital over 30-day period. The postgraduate year, number pages, category caller, reason for call, and level urgency recorded during each operation. At conclusion operation, also completed two-item survey with responses 5-point scale (1 = strongly disagree 5 agree), querying if negatively impacted experience message...

Although acute care general surgery (ACS) coverage by trauma surgeons may help re-invigorate the field of surgery, introducing additional responsibilities to an already overburdened system negatively impact patient. Our purpose was determine on patient a progressive integration ACS into service. Data from university, Level I registry retrospectively reviewed compare demographics, injury severity, complications, and outcomes over 6-year period. During this study period, service treated only...