scholarly journals Insidious bleeding; the danger of complacency: Case Report

2019 ◽  
Vol 1 (1) ◽  
pp. 1-5
Author(s):  
Aldon Delport ◽  
Timothy Makrides ◽  
Shannon Delport ◽  
Hannah Makrides
Keyword(s):  
The United States ◽  
Control Measures ◽  
Acute Care Surgery ◽  
Warming Blanket ◽  
Haemorrhage Control ◽  
Partial Amputation ◽  
Low Levels ◽  
Care Surgery ◽  
Tree Branch ◽  
Related Mortality

Background: A recent publication in the Journal of Trauma and Acute Care Surgery reported that patients who received a tourniquet (TQ) for severe extremity bleeding had a fourfold decrease in overall shock related mortality (Scerbo et al., 2017). A systematic review conducted in the United States (US) by Beaucreux, Vivian, Miles, Sylvain, and Pasquier (2018) showed that tourniquets are an effective tool for haemorrhage control in civilian populations with low levels of associated complications. Not a lot is known about the attitudes of Australian paramedics toward TQ’s or their use thereof, but anecdotal evidence suggests that their use is contentious. Case: We present a case of severe extremity haemorrhage involving a 90-year-old male who sustained a partial amputation to the lower aspect of the left leg proximal to the ankle whilst cutting a tree branch with a 5-inch toothed garden saw. Conclusion: In this case, the paramedics who attended to this patient believed that the use of a TQ was extreme. Standard trauma management and haemorrhage control measures that included a pressure bandage, vacuum splint and warming blanket served as confounding factors in obscuring an ongoing insidious bleed. Based on the injury profile, the patients advanced age, medications for comorbidities and associated decrease in physiological reserves this patient was a candidate for early TQ application. Failure to apply a TQ may have contributed to coagulopathy and the need for postoperative transfusions.

scholarly journals Insidious bleeding; the danger of complacency: Case Report

2019 ◽  
Vol 1 (1) ◽  
pp. 1-5
Author(s):  
Aldon Delport ◽  
Timothy Makrides ◽  
Shannon Delport ◽  
Hannah Makrides
Keyword(s):  
The United States ◽  
Control Measures ◽  
Acute Care Surgery ◽  
Warming Blanket ◽  
Haemorrhage Control ◽  
Partial Amputation ◽  
Low Levels ◽  
Care Surgery ◽  
Tree Branch ◽  
Related Mortality

Background: A recent publication in the Journal of Trauma and Acute Care Surgery reported that patients who received a tourniquet (TQ) for severe extremity bleeding had a fourfold decrease in overall shock related mortality (Scerbo et al., 2017). A systematic review conducted in the United States (US) by Beaucreux, Vivian, Miles, Sylvain, and Pasquier (2018) showed that tourniquets are an effective tool for haemorrhage control in civilian populations with low levels of associated complications. Not a lot is known about the attitudes of Australian paramedics toward TQ’s or their use thereof, but anecdotal evidence suggests that their use is contentious. Case: We present a case of severe extremity haemorrhage involving a 90-year-old male who sustained a partial amputation to the lower aspect of the left leg proximal to the ankle whilst cutting a tree branch with a 5-inch toothed garden saw. Conclusion: In this case, the paramedics who attended to this patient believed that the use of a TQ was extreme. Standard trauma management and haemorrhage control measures that included a pressure bandage, vacuum splint and warming blanket served as confounding factors in obscuring an ongoing insidious bleed. Based on the injury profile, the patients advanced age, medications for comorbidities and associated decrease in physiological reserves this patient was a candidate for early TQ application. Failure to apply a TQ may have contributed to coagulopathy and the need for postoperative transfusions.

scholarly journals The economic footprint of acute care surgery in the United States

2019 ◽  
Vol 86 (4) ◽  
pp. 609-616 ◽  
Author(s):  
Lisa M. Knowlton ◽  
Joseph Minei ◽  
Lakshika Tennakoon ◽  
Kimberly A. Davis ◽  
Jay Doucet ◽  
...  
Keyword(s):  
United States ◽  
Acute Care ◽  
The United States ◽  
Acute Care Surgery ◽  
Care Surgery

Changing Paradigms in Acute Care Surgery: A Shift to the Hindgut

2014 ◽  
Vol 80 (1) ◽  
pp. 76-80
Author(s):  
Nitin Mishra ◽  
Patricia L. Roberts ◽  
Peter W. Marcello ◽  
Thomas E. Read ◽  
Jason F. Hall ◽  
...  
Keyword(s):  
Acute Care ◽  
Surgical Procedures ◽  
Nationwide Inpatient Sample ◽  
The United States ◽  
Gastrointestinal Perforation ◽  
Acute Care Surgery ◽  
The Past ◽  
Care Surgery ◽  
Upper Gastrointestinal ◽  
Colorectal Procedures

In this study we sought to identify changes in the etiology and surgical treatment of acute gastrointestinal perforations in the United States over the past 20 years. We performed a retrospective review of the Nationwide Inpatient Sample from January 1, 1988, through December 31, 2007. We first identified all patients with gastrointestinal perforations, the perforated organ, and treatment rendered. During the study period, 550,132 patients experienced a gastrointestinal perforation for a mean rate of 3.9 cases per 1,000 discharges. Total number of perforations rose significantly over the study period, yet surgical procedures were performed in less than half of the patients (47.6%). The most common surgical procedures for gastrointestinal perforation were colorectal in origin (38.3%), upper gastrointestinal tract (30.0%), small intestine (29.2%), esophagus (3.0%), and anus (0.1%). At study end, colorectal procedures for perforation were the most commonly performed (40.4%), whereas upper gastrointestinal procedures experienced the greatest decline. In conclusion, our data demonstrate a decline in procedures for upper gastrointestinal perforation and an increase in colorectal procedures during the two-decade study period. These data should be used to assist in the training of acute care surgeons.

COVID-19 Pandemic Significantly Decreases Acute Surgical Complaints

2020 ◽  
Vol 86 (11) ◽  
pp. 1492-1500
Author(s):  
John S. Riley ◽  
Valerie L. Luks ◽  
Luis Filipe de Pina ◽  
Ziad Al Adas ◽  
Jordan B. Stoecker ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Elective Surgery ◽  
The United States ◽  
Chief Complaint ◽  
University Of Pennsylvania ◽  
Acute Care Surgery ◽  
Academic Hospital ◽  
Care Surgery ◽  
The University ◽  
The Impact

Background The coronavirus disease 2019 (COVID-19) pandemic significantly reduced elective surgery in the United States, but the impact of COVID-19 on acute surgical complaints and acute care surgery is unknown. Study design A retrospective review was performed of all surgical consults at the Hospital of the University of Pennsylvania in the 30 days prior to and 30 days following confirmation of the first COVID-19 patient at the institution. Consults to all divisions within general surgery were included. Results Total surgical consult volume decreased by 43% in the post-COVID-19 period, with a significant reduction in the median daily consult volume from 14 to 8 ( P < .0001). Changes in consult volume by patient location, chief complaint, and surgical division were variable, in aggregate reflecting a disproportionate decrease among less acute surgical complaints. The percentage of consults resulting in surgical intervention remained equal in the 2 periods (31% vs 28%, odds ratio 0.85, 95% CI 0.61-1.21, P = .38) with most but not all operation types decreasing in frequency. The rise in the COVID-19 inpatient census led to increased consultation for vascular access, accommodated at our center by the creation of a new surgical procedures team. Conclusion The COVID-19 pandemic significantly altered the landscape of acute surgical complaints at our large academic hospital. An appreciation of these trends may be helpful to other Departments of Surgery around the country as they deploy staff and allocate resources in the COVID-19 era.

Acute Care Surgery: A New Training and Practice Model in the United States

2008 ◽  
Vol 32 (8) ◽  
pp. 1630-1635 ◽  
Author(s):  
David B. Hoyt ◽  
Hubert D. Kim ◽  
Cristobal Barrios
Keyword(s):  
United States ◽  
Acute Care ◽  
The United States ◽  
Acute Care Surgery ◽  
Practice Model ◽  
Care Surgery

scholarly journals Gastrointestinal involvement attenuates COVID-19 severity and mortality

2020 ◽  
Author(s):  
Alexandra E. Livanos ◽  
Divya Jha ◽  
Francesca Cossarini ◽  
Ana S. Gonzalez-Reiche ◽  
Minami Tokuyama ◽  
...  
Keyword(s):  
The United States ◽  
Intestinal Infection ◽  
Disease Pathogenesis ◽  
Viral Loads ◽  
Gi Symptoms ◽  
Inflammatory Proteins ◽  
Low Levels ◽  
Intestinal Enterocytes ◽  
Related Mortality

AbstractGiven that gastrointestinal (GI) symptoms are a prominent extrapulmonary manifestation of coronavirus disease 2019 (COVID-19), we investigated intestinal infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and its effect on disease pathogenesis. SARS-CoV-2 was detected in small intestinal enterocytes by immunofluorescence staining or electron microscopy, in 13 of 15 patients studied. High dimensional analyses of GI tissues revealed low levels of inflammation in general, including active downregulation of key inflammatory genes such as IFNG, CXCL8, CXCL2 and IL1B and reduced frequencies of proinflammatory dendritic cell subsets. To evaluate the clinical significance of these findings, examination of two large, independent cohorts of hospitalized patients in the United States and Europe revealed a significant reduction in disease severity and mortality that was independent of gender, age, and examined co-morbid illnesses. The observed mortality reduction in COVID-19 patients with GI symptoms was associated with reduced levels of key inflammatory proteins including IL-6, CXCL8, IL-17A and CCL28 in circulation but was not associated with significant differences in nasopharyngeal viral loads. These data draw attention to organ-level heterogeneity in disease pathogenesis and highlight the role of the GI tract in attenuating SARS-CoV-2-associated inflammation with related mortality benefit.One Sentence SummaryIntestinal infection with SARS-CoV-2 is associated with a mild inflammatory response and improved clinical outcomes.

scholarly journals Global Research Trends in Pediatric Trauma From 1968 to 2021: A Bibliometric Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Tauseef Ahmad ◽  
Linlin Hua ◽  
Muhammad Khan ◽  
Ghulam Nabi ◽  
Suliman Khan ◽  
...  
Keyword(s):  
Bibliometric Analysis ◽  
Research Output ◽  
Pediatric Trauma ◽  
The United States ◽  
World Health ◽  
Acute Care Surgery ◽  
Prolific Author ◽  
The Usa ◽  
Care Surgery ◽  
Global Research

Introduction: Every year, millions of children die from preventable causes worldwide. According to World Health Organization, injuries are the leading cause of disability and death among all age groups below 60 years.Aim: This study aimed to evaluate the global research outcomes and trends, and some key bibliometric indicators in pediatric trauma.Methods: A descriptive bibliometric analysis study was designed. On June 14, 2021, an electronic search was performed in the Web of Science Core Collection database using the potential searching keywords “Pediatric AND Trauma” in the title field without any limitations. The search was performed using the Boolean search query method. The data were downloaded in plaintext and comma-separated values format. The required graphs were generated using OriginPro 2018. Furthermore, the data were transferred to HistCite™ software for bibliometric analysis. In addition, the obtained data were plotted for network visualization mapping using VOSviewer software version 1.6.15 for windows.Results: A total of 2,269 documents were included in the final analysis. The included documents were authored by 7,894 authors and published in 395 research and academic journals, mainly in the English language (n = 2,222). The main document types were articles (n = 1,276, citations = 18,244), and meeting abstracts (n = 331, citations = 19). Pediatric (n = 2,269) and trauma (n = 2,257) were the most widely used keywords. The most productive year was 2019 (n = 184, citations = 527). The most prolific author was Upperman JS (n = 29, citations = 202). The most attractive journals in pediatric trauma research were The Journal of Trauma and Acute Care Surgery (n = 290, citations = 5,199) and the Journal of Pediatric Surgery (n = 256, citations = 5,088). The most active institute was the University of California System (n = 110). The most dominant country was the United States of America (USA) (n = 1,620, citations = 22,983). The USA and Canada had the highest total link strength, 103 and 70, respectively.Conclusion: This study provides a comprehensive overview of research output in pediatric trauma. The USA continues to dominate scientific research and funding in pediatric trauma. Findings of the current study will help the researchers and clinicians to understand the recent achievements and research frontiers. Collaborative research initiative needs to be established between institutions in developed and developing countries and among researchers.

Perceptions and Attitudes of Critical Care Training and Careers among United States Surgical Residents: Who Wants to be a Surgical Intensivist?

2007 ◽  
Vol 73 (5) ◽  
pp. 433-437 ◽  
Author(s):  
Stephen M. Cohn ◽  
Michelle A. Price ◽  
Ronald M. Stewart ◽  
Basil A. Pruitt ◽  
Daniel L. Dent
Keyword(s):  
United States ◽  
Critical Care ◽  
Acute Care ◽  
Trauma Surgery ◽  
The United States ◽  
Acute Care Surgery ◽  
Surgical Residents ◽  
Perceptions And Attitudes ◽  
Surgical Critical Care ◽  
Care Surgery

Less than 50 per cent of surgical critical care (SCC) fellowship positions are filled each year. We surveyed senior surgical residents to determine their opinions regarding a career in SCC and acute care surgery. A survey was sent to 1348 postgraduate year 3, 4, and 5 residents in the United States. Two hundred fifty-one surveys were returned (19% response rate). Whereas 78 per cent were planning to complete a fellowship, 21 per cent expressed interest in SCC. Fifty-six per cent plan to handle SCC problems only for their own patients, whereas 39 per cent plan to turn this management over to a critical care provider. SCC fellowships were considered to be potentially more appealing if the following changes could be made to the existing structure: adding more general surgery (70% of respondents); adding more trauma experience (50%); adding emergency neurosurgery (44%); adding more emergency orthopedics (42%); or decreasing months of critical care (36%). Increasing salary enhanced appeal for 82 per cent. SCC has limited appeal for most senior surgical residents. Theoretical expansion of surgical critical fellowships to include more general or trauma surgery (acute care surgery) increased the level of interest among senior surgical residents.

scholarly journals Operative Hemostasis in Trauma and Acute Care Surgery: The Role of Biosurgical Agents

2020 ◽  
Author(s):  
Kyle Dammann ◽  
Amanda Gifford ◽  
Kathryn Kelley ◽  
Stanislaw P. Stawicki
Keyword(s):  
Acute Care ◽  
The United States ◽  
Functional Restoration ◽  
Acute Care Surgery ◽  
Emergency General Surgery ◽  
Contamination Control ◽  
Suture Ligation ◽  
Surgical Emergencies ◽  
Care Surgery ◽  
Surgical Energy

Trauma and acute care surgery (TACS) constitutes the foundation of emergency surgical services in the United States. Blunt and penetrating traumatic injuries are a leading cause of death worldwide. Non-trauma general surgical emergencies are also a major source of morbidity and mortality. Operative interventions performed within the scope of TACS often revolve around the core principles of contamination control, hemostasis, surgical repair, and subsequent functional restoration. Hemorrhage control is an integral part of emergent operative interventions, and while most instances of surgical bleeding require direct suture ligation or some other form of direct tissue intervention, some circumstances call for the use of adjunctive means of hemostasis. This is especially applicable to situations and settings where direct applications of surgical energy, suture ligation, or direct compression are not possible. Difficult-to-control bleeding can be highly lethal and operative control can be very challenging when confounded by the lethal triad of acidosis, coagulopathy and hypothermia. Topical biosurgical materials (BSM) are of great value in such scenarios, and their use across a variety of settings, from pre-hospital trauma application to emergency general surgery operations, represents an important adjunct to improve patient outcomes. Here we present the different BSMs, discuss their various uses, and provide insight on future applications and developments in this important area.

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