Improving Intraoperative Communication in Trauma: The Educational Effect of the Joint DSTC™-DATC™ Courses.

BACKGROUND: Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC-DATC courses in candidates' self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario. METHODS: Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC-DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most. RESULTS: All participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course. CONCLUSIONS: Joint training in the DSTC-DATC courses improved candidates' perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care.

Wilkie's syndrome: a case report of favourable minimally invasive surgery.

Wilkie's syndrome, or superior mesenteric artery syndrome (SMAS), is a rare clinical entity caused by compression of the third portion of the duodenum between the abdominal aorta and superior mesenteric artery, leading to duodenal obstruction and severe malnutrition. The authors report a case of a female patient with years of chronic intestinal obstruction with abdominal pain, vomits and weight loss. Contrast intestinal series showed dilation of stomach and duodenum. Abdominal computed tomography study revealed findings compatible with SMAS. After initial nutritional support, she was successfully treated by laparoscopic duodenojejunostomy. Surgical treatment of SMAS may be necessary in most cases with chronic symptoms or conservative treatment failure. A minimally invasive approach can be considered a safe surgical option with favourable outcomes. Clinical details, diagnostic studies and treatment are discussed.

Pyoderma Gangrenosum: An Uncommon Case Report and Review of the Literature.

BACKGROUND: Pyoderma gangrenosum (PG) is a rare ulcerative condition that is diagnostically and therapeutically challenging, as debridement leads to ulcer deterioration (pathergy phenomenon); immunosuppression is considered the gold standard therapy. CASE REPORT: The authors present the case of a 42-year-old woman with PG and uncontrolled iatrogenic diabetes, secondary to a total pancreatectomy performed in another hospital in 1998 due to nesidioblastosis. In 2008, she was referred to the diabetic foot consultation at Centro Hospitalar Tondela-Viseu (Viseu, Portugal) due to an infected wound on the left leg thought to be related to a trauma from footwear, but the injury worsened despite treatment. Characteristics of the lesion led to the diagnosis of PG and treatment was adjusted. The patient was followed-up weekly at the diabetic foot consultation; at 2-months follow-up, the leg ulcer was closed but additional lesions emerged in multiple areas of her body. Therapy included local antiseptics, antibiotics, pain control, systemic corticosteroids, immunosuppressors, intravenous immunoglobulin, and surgical debridement. Due to her noncompliance, this proved to be a challenging case. CONCLUSION: Although PG is rare, clinicians should suspect it in the presence of purplish wound edges with a necrotic center. Surgical debridement, while necessary in other ulcers, can worsen the condition and should only be applied to self-detachable necrotic plaques.

Spontaneous Massive Hemothorax Secondary to Ectopic Diaphragmatic Varicose Veins.

The article reports a clinical case of a 39-year-old male patient who was admitted in the emergency room in shock. The clinical exams and additional tests identified a right massive hemothorax, without apparent etiological factors. He was submitted to an emergency right thoracotomy. A bulky varicose formation in the diaphragmatic surface, with evident laceration and haemorrhage was identified. The article describes this case due to its rarity. The varicose formation was simply ligated and the evolution, as well as the outcome of this clinical case was uneventful.