Nonoperative Management of Multiple Penetrating Cardiac and Colon Wounds from a Shotgun: A Case Report and Literature Review.

INTRODUCTION: Surgery for cardiac trauma is considered fatal and for wounds of the colon by associated sepsis is normally considered; however, conservative management of many traumatic lesions of different injured organs has progressed over the years. PRESENTATION OF THE CASE: A 65-year-old male patient presented with multiple shotgun wounds on the left upper limb, thorax, and abdomen. On evaluation, he was hemodynamically stable with normal sinus rhythm and normal blood pressure, no dyspnea, or abdominal pain. Computed tomography (CT) scan of the chest shows hematoma around the aorta without injury to the blood vessel wall with an intramyocardial projectile without pericardial effusion. CT scan of the abdomen showed pellets in the transverse colon and descending colon endoluminal without extravasation of contrast medium or intra-abdominal fluid. The patient remains hemodynamically stable, and nonsurgical procedure was established. DISCUSSION: Patients with asymptomatic intramyocardial projectiles can be safely managed without surgery. Nonsurgical management is only possible in asymptomatic patients with trauma of the colon through close surveillance and with very selective patients since standard management is surgery. CONCLUSION: Nonsurgical management of cardiac trauma, as well as colon penetrating trauma, can be performed in carefully selected patients with proper clinical follow-up, imaging, and laboratory studies.

Computed tomography in hemodynamically unstable severely injured blunt and penetrating trauma patients.

BACKGROUND: Dynamic and efficient resuscitation strategies are now being implemented in severely injured hemodynamically unstable (HU) patients as blood products become readily and more immediately available in the trauma room. Our ability to maintain aggressive resuscitation schemes in HU patients allows us to complete diagnostic imaging studies before rushing patients to the operating room (OR). As the criteria for performing computed tomography (CT) scans in HU patients continue to evolve, we decided to compare the outcomes of immediate CT versus direct admission to the OR and/or angio suite in a retrospective study at a government-designated regional Level I trauma center in Cali, Colombia. METHODS: During a 2-year period (2012-2013), blunt and penetrating trauma patients (≥ 15 years) with an Injury Severity Score (ISS) greater than 15 who met criteria of hemodynamic instability (systolic blood pressure [SBP] <100 mm Hg and/or heart rate >100 beats/min and/or ≥ 4 U of packed red blood cells transfused in the trauma bay) were included. Isolated head trauma and patients who experienced a prehospital cardiac arrest were excluded. The main study outcome was mortality. RESULTS: We reviewed 171 patients. CT scans were performed in 80 HU patients (47%) immediately upon arrival (CT group); the remaining 91 patients (53%) went directly to the OR (63 laparotomies, 20 thoracotomies) and/or 8 (9%) to the angio suite (OA group). Of the CT group, 43 (54%) were managed nonoperatively, 37 (46%) underwent surgery (15 laparotomies, 3 thoracotomies), and 2 (5%) underwent angiography (CT OA subgroup). None of the mortalities in the CT group occurred in the CT suite or during their intrahospital transfers. CONCLUSION: There was no difference in mortality between the CT and OA groups in HU patients. CT scan was attainable in 47% of HU patients and avoided surgery in 54% of the cases. Furthermore, CT scan was helpful in deciding definitive/specific surgical management in 46% scanned HU patients who necessitated surgery after CT. LEVEL OF EVIDENCE: Therapy/care management study, level IV.

Understanding and supporting lightweight communication in hospital work.

Informal communication is an essential resource in hospital work; it is used as a means to collaborate and coordinate the way in which work is performed, as well as to locate and gather the artifacts and human resources required for patient care. The need of physical proximity to establish and hold informal communications has motivated the development of tools that support remote informal interaction. However, this kind of technology has not been widely adopted in hospitals, where workers experience intense mobility. In this paper, we present the results of an observational study in a hospital aimed at understanding how local mobility changes the rules in the provision of support for informal communication, and how technology could improve this form of communication. We found that local mobility fosters opportunities for colocated communication; however, it faces some inconveniences related to the affordances of the physical environment. We address these issues through the design of SOLAR, a collaborative application that supports colocated interactions in hospital work through the implementation and integration of five services that form a ubicomp infrastructure. Additionally, we present a discussion about the perception of users related to the usefulness of this tool.

Integrating smoking cessation into worker training among Latino immigrant workers: development of a program.

The prevalence of smoking among Latino immigrant workers needs to be addressed with culturally and linguistically appropriate smoking cessation programs. One innovative approach to reaching these workers is through worker health and safety training programs. These programs offer multiple opportunities to provide smoking cessation messages, a "teachable moment" to focus on health issues, and the likelihood that peers and family members will share these messages. A collaborative effort between an occupational health and safety training facility and a university utilizing Latino and non-Latino personnel developed a smoking cessation program integrated with worker health and safety training. Preliminary results of an evaluation of the program indicate that the program was able to reach a wide range of immigrant workers and improve their knowledge of the risks of smoking and the effectiveness of different methods of quitting smoking.