Interruptions of Trauma Resuscitations for Radiographic Procedures.

BACKGROUND: Although x-ray studies provide important diagnostic information during trauma resuscitations, they may also lead to significant interruptions in care. OBJECTIVES: We sought to determine the frequency and duration of interruptions for chest x-ray studies (CXR) and pelvic x-ray studies (PXR) and the frequency of lead apron use among providers who exited trauma rooms during resuscitation. METHODS: Using a convenience sampling method, we conducted a prospective, observational study from August 2013 to March 2014, enrolling adult trauma patients at a Level I trauma center who received CXR and PXR in the first 30 min of evaluation. An observer stood outside resuscitation rooms and recorded the time elapsed from the first provider exiting the room to the last provider returning. We recorded how many exiting providers wore lead aprons and whether unused aprons were available. RESULTS: Of the 156 trauma cases observed, 67.3% were of male patients with a mean age of 52 years (interquartile range [IQR] 34-67 years); 97.4% (184/189) of radiographs resulted in interruptions of trauma evaluation. Mean and median interruption times were 67 s and 50 s, respectively (IQR 25-95) for CXR; 37 s and 27 s, respectively (IQR 16-43) for PXR; and 160 s and 180 s, respectively (IQR 120-180) for combined CXR/PXR. A mean of 3.5 providers (IQR 3-5) left the immediate bedside and exited the room during x-ray studies. Most (91%) providers leaving the room were not wearing lead aprons, and extra aprons were available in the room 91% (167/184) of the time. CONCLUSIONS: Radiographic procedures often result in interruptions of trauma resuscitations despite the availability of lead aprons.

Sticky Business: a syndrome of mucoid bacterial spread.

A 70-year-old man presented with acute wrist pain concerning for septic arthritis. Shortly thereafter, he developed acute monocular vision loss and was diagnosed with endogenous endophthalmitis. Subsequent imaging revealed numerous visceral abscesses and a mycotic abdominal aortic aneurysm. Cultures, in conjunction with the clinical syndrome, were strongly suggestive of hypervirulent Klebsiella pneumoniae syndrome (hvKP). hvKP syndrome may present with multiple sites of infection or subsequent metastatic spread may develop; the liver, lungs, central nervous system and eye are most commonly involved. Prompt source control and intravenous antibiotic therapy leads to a cure in the majority of patients. This case highlights the risk factors, presentation, management and prognosis of this disease as well as its increasing incidence in North America and Europe.