surgical critical care
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2022 ◽  
Vol 102 (1) ◽  
pp. xvii-xviii
Author(s):  
Brett H. Waibel

2022 ◽  
Vol 102 (1) ◽  
pp. i
Author(s):  
BRETT H. WAIBEL

2021 ◽  
Vol 50 (1) ◽  
pp. 67-67
Author(s):  
Elizabeth Sheridan ◽  
Niels Martin ◽  
Melissa Dunlop ◽  
Jason Saucier ◽  
Christopher Huot ◽  
...  

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Amira Shamsiddinova ◽  
Joanne Kiang ◽  
James Jegard ◽  
Abhijit Bajracharya ◽  
Rebecca Himpson ◽  
...  

Abstract Aims The National Emergency Laparotomy Audit (NELA) results show that only 28.8% of all patients over 65years having emergency laparotomy had Geriatrician input. Advancing age predisposes to more complex medical needs due to a higher prevalence of co-morbidities, polypharmacy, cognitive impairment, and physiological frailty. Introduction of perioperative geriatrician input has been demonstrated to significantly reduce post-operatively mortality (national average 9.5%, rising to 20-40% in older age). We introduced a Geriatrician led liaison team with the initial aim to reduce 30-day mortality in older patients undergoing emergency laparotomy. Methods Prospective database was maintained of all eligible patients reviewed by the new service. Data on Rockwood Clinical Frailty Score (CFS), NELA risk prediction score, length of stay, mortality and complications were analysed. In this service development pilot we specifically assessed age and frailty demographics, expected mortality, and actual mortality in the cohort. Results All NELA patients 65 and over were reviewed by the service between September and December 2020, 35 in total. Median age 77 years; Median CFS 3 (range 2-6); Median NELA mortality risk 12% (range 0.9%-55.8%). Inpatient mortality was 2.9% and 30-day mortality 2.9% during this study period, compared to 18% in the previous year.  Conclusion Our pilot study demonstrates that development of an embedded Geriatrician liaison service for patients undergoing emergency laparotomy is achievable in a district general hospital. Consistent with other larger scale studies we demonstrated significant mortality reduction in older adults undergoing emergency laparotomy with the new service offering enhanced inter-disciplinary Surgical, Critical Care and Geriatrician team-working.


2021 ◽  
pp. 25-29
Author(s):  
B. Santhi ◽  
A. Ramprasath ◽  
R. Saradha

BACKGROUND: Mesenteric ischemia is a frequently lethal condition resulting from critically reduced perfusion to the gastrointestinal tract. It accounts for 1-2% of hospital admissions for abdominal pain. Mortality due to mesenteric ischemia ranges from 24% to 96% with an average of 69%. AIM: The aim of this case series is to outline the clinical presentation and challenges in diagnosis of acute mesenteric ischemia and emphasize the importance of early diagnosis and intervention in reducing the mortality and morbidity. This article presents a series of 4 cases of the 3 major types of acute mesenteric ischemia – 2 cases of Acute Mesenteric Arterial Thrombosis(AMAT), one case of Acute Mesenteric Arterial Embolism(AMAE) and one case of Mesenteric Venous Thrombosis(MVT). MATERIALS AND METHODS: A total number of 4 patients who had undergone emergency laparotomy for acute mesenteric ischemia during the month of December 2020 in the Department of General Surgery, Government Kilpauk Medical College were studied. All 4 cases have been analysed during this study period of one month and followed up until discharge from the hospital. RESULTS: This case series consisted of 4 cases. Out of 4 cases, 3 were cases of Superior Mesenteric Arterial Occlusion due to thrombus and emboli and 1 was a case of Superior Mesenteric Vein Occlusion by thrombus. All 4 were male patients. All 4 patients presented with sudden onset of abdominal pain with or without vomiting. Abdominal distension, constipation and clinical features suggestive of bowel gangrene was not seen in all cases. Out of 4 cases, 2 cases were diagnosed early and taken up for immediate surgery and had a better outcome postoperatively with shorter hospital stay. Denitive diagnosis could not be made at time of admission for one case and was taken up for surgery late after the general condition of the patient deteriorated and extensive gangrene of the small bowel was seen during surgery. One case succumbed to septic shock after surgery following delayed presentation. This case series attempts to highlight that the key to successful management in acute mesenteric ischemia is a high index of suspicion leading to early diagnosis, aggressive resuscitation and early mesenteric revascularization. CONCLUSION: Despite the remarkable advances in in vascular surgical technique, vascular imaging, percutaneous intervention and surgical critical care, mesenteric ischemia remains a complex and often disheartening disease. Acute mesenteric ischemia is a life threatening vascular emergency that requires a high degree of clinical suspicion and early intervention to avoid a poor outcome. As Acute Mesenteric Ischemia often affects elderly patients, we have to consider the possibility of acute mesenteric ischemia in all elderly patients presenting with abdominal pain that is out of proportion to the ndings on physical examination


2021 ◽  
pp. 000313482110111
Author(s):  
Haley Ehrlich ◽  
Jackie Nguyen ◽  
Mason Sutherland ◽  
Mark McKenney ◽  
Adel Elkbuli

As women surgeons continue to represent a minority within the surgical field while also holding lower ranked positions, gaining a sub-specialized set of clinical skills through surgical fellowships, like surgical critical care (SCC), is one approach to advance within the surgical field. A cross-sectional analysis was performed investigating the websites of all 106 US-based SCC fellowships. A total of 116 SCC fellows were included in this analysis, comprising 67 (59.3%) men and 46 (40.7%) women. There were 977 SCC fellowship faculty were evaluated, comprising 619 (67.9%) men and 292 (32.1%) women. Additionally, 103 SCC fellowship program directors were analyzed, consisting of 77 (74.8%) men and 26 (25.2%) women. There is a significantly lower proportion of women fellows and faculty members (P < .001) compared to men. SCC programs with female program directors on average have higher proportions of female fellows and faculty compared to programs with male program directors (52% and 36% vs 31% and 29%, respectively). There is a stable yet unbalanced gender distribution throughout all positions in SCC fellowship programs. Actively supporting women surgeons pursuing SCC fellowship and removing barriers to their advancement through effective interventions can disrupt the persistently low prevalence of women SCC fellows, faculty, and program directors.


2021 ◽  
Vol 12 ◽  
Author(s):  
Charles J. Gerardo ◽  
Elizabeth Silvius ◽  
Seth Schobel ◽  
John C. Eppensteiner ◽  
Lauren M. McGowan ◽  
...  

BackgroundThe immunologic pathways activated during snakebite envenoming (SBE) are poorly described, and their association with recovery is unclear. The immunologic response in SBE could inform a prognostic model to predict recovery. The purpose of this study was to develop pre- and post-antivenom prognostic models comprised of clinical features and immunologic cytokine data that are associated with recovery from SBE. Materials and MethodsWe performed a prospective cohort study in an academic medical center emergency department. We enrolled consecutive patients with Crotalinae SBE and obtained serum samples based on previously described criteria for the Surgical Critical Care Initiative (SC2i)(ClinicalTrials.gov Identifier: NCT02182180). We assessed a standard set of clinical variables and measured 35 unique cytokines using Luminex Cytokine 35-Plex Human Panel pre- and post-antivenom administration. The Patient-Specific Functional Scale (PSFS), a well-validated patient-reported outcome of functional recovery, was assessed at 0, 7, 14, 21 and 28 days and the area under the patient curve (PSFS AUPC) determined. We performed Bayesian Belief Network (BBN) modeling to represent relationships with a diagram composed of nodes and arcs. Each node represents a cytokine or clinical feature and each arc represents a joint-probability distribution (JPD).ResultsTwenty-eight SBE patients were enrolled. Preliminary results from 24 patients with clinical data, 9 patients with pre-antivenom and 11 patients with post-antivenom cytokine data are presented. The group was mostly female (82%) with a mean age of 38.1 (SD ± 9.8) years. In the pre-antivenom model, the variables most closely associated with the PSFS AUPC are predominantly clinical features. In the post-antivenom model, cytokines are more fully incorporated into the model. The variables most closely associated with the PSFS AUPC are age, antihistamines, white blood cell count (WBC), HGF, CCL5 and VEGF. The most influential variables are age, antihistamines and EGF. Both the pre- and post-antivenom models perform well with AUCs of 0.87 and 0.90 respectively.DiscussionPre- and post-antivenom networks of cytokines and clinical features were associated with functional recovery measured by the PSFS AUPC over 28 days. With additional data, we can identify prognostic models using immunologic and clinical variables to predict recovery from SBE.


2021 ◽  
Author(s):  
Mazyar Kanani ◽  
Simon Lammy

2020 ◽  
Vol 49 (1) ◽  
pp. 266-266
Author(s):  
Kristine Lombardozzi ◽  
William Miles ◽  
Salman Ahmad ◽  
Niels Martin ◽  
Matthew Lissauer ◽  
...  

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