Aetiology and Prognostic Implication of Severe Jaundice in Surgical Trauma Patients

Abstract Background: Physical trauma is associated with mortality, long-term pain and morbidity. Effective pain management is fundamental in trauma care and opioids are indispensable for treating acute pain; however, the use and misuse of prescribed opioids is an escalating problem. Despite this, few studies have been directed towards trauma patients in an early phase of rehabilitation with focusing on experiences and perspectives of health and recovery including pain and persistent use of prescribed opioids with abuse potential. To explore pre- and post-discharge trauma care experiences, including exposure to opioids, physical trauma survivors were recruited from a major trauma center in Norway that provides the highest level of surgical trauma care. Method: Qualitative exploratory study. Individual semi-structured interviews were conducted among 13 trauma patients with orthopedic injuries, known to be associated with severe pain, six weeks post-discharge. The interviews were recorded, transcribed verbatim, and thematically analyzed with an interdisciplinary approach. Results: The overarching theme was that discharge from the trauma hospital and the period that immediately followed were associated with feelings of insecurity. The three main themes that were identified as contributing to this was a) unmet information needs about the injury, b) exposure to opioids, and c) lack of follow-up after discharge from the hospital. Participants experienced to be discharged with prescribed opioids, but without information about their addictive properties or tapering plans. This, and lack of attention to mental health and psychological impact of trauma, gave rise to unmet treatment needs of pain management and mental health problems during hospitalization and following discharge. Conclusion: The findings from this study suggest that in addition to delivery of high-quality biomedical trauma care, health professionals should direct more attention to psychosocial health and safe pain management, including post-discharge opioid tapering and individually tailored follow-up plans for physical trauma survivors.

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Impact of Multiprofessional Rounds on Critical Care Outcomes in the Surgical Trauma Intensive Care Unit

The American Surgeon ◽

10.1177/000313481908500108 ◽

2019 ◽

Vol 85 (1) ◽

pp. 15-22

Author(s):

Michael R. Nahouraii ◽

Colleen H. Karvetski ◽

Rita A. Brintzenhoff ◽

Gaurav Sachdev ◽

Susan L. Evans ◽

...

Keyword(s):

Injury Severity ◽

Statistical Significance ◽

Outcome Data ◽

Surgical Trauma ◽

Trauma Patients ◽

Linear Regression Models ◽

Icu Length Of Stay ◽

Severity Scores ◽

Mortality Difference ◽

The Impact

Multiprofessional rounds (MPR) represent a mechanism for the coordination of care in critically ill patients. Herein, we examined the impact of MPR on ventilator days (Vent-day), ICU length of stay (LOS), hospital LOS (HLOS), and mortality. A team developed guidelines for MPR, which began in February 2016. Patients admitted between November 2015 and March 2017 with Acute Physiology and Chronic Health Evaluation (APACHE) IV and injury severity scores were included. Outcome data consisted of Vent-day, Vent-day observed/expected ratio (O/E), ICU LOS, ICU LOS O/E, HLOS, HLOS-O/E, and mortality. Linear regression models are constructed to assess statistical significance. A total of 3372 patients were included. Among surgical patients (n = 343 pre-MPR, n = 1675 post-MPR), MPR was associated with decreases in Vent-day O/E (0.74 pre, 0.59 post, P = 0.03), ICU LOS O/E (0.67 pre, 0.61 post, P = 0.01), and HLOS-O/E (1.47 pre, 1.22 post, P = 0.0005). No mortality difference was observed. For trauma patients (n = 221 pre, n = 1133 post), MPR resulted in a reduction in Vent-days (2.2 days pre, 1.6 days post, P = 0.05). However, no differences were observed for Vent-day O/E, ICU LOS O/E, HLOS-O/E, and mortality. Implementation of MPR was associated with improved outcomes for surgical trauma ICU patients. Sustainability of MPR remains a challenge and requires education and engagement.

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Prevention and Diagnosis of Infection

DeckerMed Surgery ◽

10.2310/surg.2226 ◽

2013 ◽

Author(s):

Sara M. Demola ◽

Taylor S Riall

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Clinical Signs ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Surgical Trauma ◽

Trauma Patients ◽

Biochemical Tests ◽

Diagnosis Of Infection

Infections are common complications treated in surgical and trauma intensive care units. Identification of infections in surgical patients is rarely incidental; it is sought most often in response to clinical signs. The presence of surgical infectious disease is usually determined clinically and confirmed microbiologically. Precision in terminology is vital; though similar in connotation, infection is not interchangeable with similar terms like sepsis and bacteremia. This chapter describes the signs and symptoms of infection, including the key signs of inflammation, pain, vital sign changes, and confusion. The approach to diagnosing infections is provided and includes an evaluation for the presence of infection, a history and physical examination, and various diagnostic tests, including hematologic and biochemical tests, microbiologic studies, and radiology. The various surgical/trauma infections are described and include the diagnostic approach to specific surgical infection like appendicitis, diverticulitis, and skin and soft tissue infections; postoperative infections referred to as surgical site infections; and nosocomial infections such as urinary tract infection, vascular catheter infection, septic shock, pulmonary infection, and Clostridium difficile infection. Figures show the interrelationships among infection, sepsis, and the systemic inflammatory response syndrome, and the percentage of critically ill trauma patients with fever or leukocytosis in the first week after admission, and the cardinal signs of localized inflammation. A table shows the fundamental approach to diagnosis of infection. Algorithms include diagnosis of superficial surgical site infection, Diagnosis of catheter-associated urinary tract infection, and diagnosis of central line–associated and catheter-related bloodstream infections. This review contains 8 figures, 4 diagnostic algorithms, 5 tables, and 58 references.

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Prevention and Diagnosis of Infection

10.2310/vasc.2226 ◽

2013 ◽

Author(s):

Sara M. Demola ◽

Taylor S Riall

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Clinical Signs ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Surgical Trauma ◽

Trauma Patients ◽

Biochemical Tests ◽

Diagnosis Of Infection

Infections are common complications treated in surgical and trauma intensive care units. Identification of infections in surgical patients is rarely incidental; it is sought most often in response to clinical signs. The presence of surgical infectious disease is usually determined clinically and confirmed microbiologically. Precision in terminology is vital; though similar in connotation, infection is not interchangeable with similar terms like sepsis and bacteremia. This chapter describes the signs and symptoms of infection, including the key signs of inflammation, pain, vital sign changes, and confusion. The approach to diagnosing infections is provided and includes an evaluation for the presence of infection, a history and physical examination, and various diagnostic tests, including hematologic and biochemical tests, microbiologic studies, and radiology. The various surgical/trauma infections are described and include the diagnostic approach to specific surgical infection like appendicitis, diverticulitis, and skin and soft tissue infections; postoperative infections referred to as surgical site infections; and nosocomial infections such as urinary tract infection, vascular catheter infection, septic shock, pulmonary infection, and Clostridium difficile infection. Figures show the interrelationships among infection, sepsis, and the systemic inflammatory response syndrome, and the percentage of critically ill trauma patients with fever or leukocytosis in the first week after admission, and the cardinal signs of localized inflammation. A table shows the fundamental approach to diagnosis of infection. Algorithms include diagnosis of superficial surgical site infection, Diagnosis of catheter-associated urinary tract infection, and diagnosis of central line–associated and catheter-related bloodstream infections. This review contains 8 figures, 4 diagnostic algorithms, 5 tables, and 58 references.

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AAST Critical Care Committee clinical consensus: ECMO, nutritionExtracorporeal membrane oxygenation (ECMO)Nutrition

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000304 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000304 ◽

Cited By ~ 1

Author(s):

David Zonies ◽

Panna Codner ◽

Pauline Park ◽

Niels D Martin ◽

Matthew Lissauer ◽

...

Keyword(s):

Critical Care ◽

Extracorporeal Membrane Oxygenation ◽

Trauma Patient ◽

Critically Ill ◽

American Association ◽

Expert Consensus ◽

Surgical Trauma ◽

Trauma Patients ◽

Membrane Oxygenation

The American Association for the Surgery of Trauma Critical Care Committee has developed clinical consensus guides to help with practical answers based on the best evidence available. These are focused in areas in which the levels of evidence may not be that strong and are based on a combination of expert consensus and research. Overall, quality of the research is mixed, with many studies suffering from small numbers and issues with bias. The first two of these focus on the use of extracorporeal membrane oxygenation in trauma patients and nutrition for the critically ill surgical/trauma patient.

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