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2.
Int J Surg Case Rep ; 79: 172-177, 2021 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-33482443

RESUMO

INTRODUCTION: Blunt thoracic aortic injuries (BTAIs) are an uncommon traumatic injury that if not treated promptly, can result in death. We present the case of a BTAI with aberrant aortic anatomy. PRESENTATION OF CASE: A 60-year-old female was involved in a motor vehicle crash where she suffered significant polytrauma including a BTAI. She was also found to have an aberrant right subclavian artery originating from the aortic arch. Thoracic Endovascular Aortic Repair (TEVAR) with a right common carotid artery to right subclavian artery bypass was accomplished. She required three more vascular surgical interventions, two for persistent type II endoleak and the third for left upper extremity acute limb ischemia. She had a 2-month hospital course for her devastating injuries and was eventually discharged home. A follow-up CT angiogram showed a stable thoracic aortic arch stent. DISCUSSION: BTAIs are uncommon in the trauma population. In our patient who had an aberrant right subclavian artery, further procedures were required in the form of a right common carotid artery to right subclavian artery bypass and embolizations to resolve endoleaks. CONCLUSION: Blunt thoracic aortic injuries are life threatening and require urgent intervention. TEVAR is associated with better outcomes. An aberrant right subclavian artery originating from the aortic arch, distal to the left subclavian artery is an anatomic variant that adds significant complexity to TEVAR. TEVAR is still an option for repair of blunt thoracic aortic injuries despite anatomic variations as open repair still carries an increased risk of morbidity and mortality.

5.
J Emerg Trauma Shock ; 13(3): 201-207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33304070

RESUMO

Background: Complication rates may be indicative of trauma center (TC) performance. The complication rates between Level 1 and 2 TCs at the national level are unknown. Our study aimed to determine the relationship between American College of Surgeons (ACS)-verified and state-designated TCs and complications. Study Design and Methods: This was a cohort review of the National Sample Program (NSP) from the National Trauma Data Bank, the world's largest validated trauma database. TCs were categorized by ACS or state Level 1 or 2. TCs not categorized as Level 1 or 2 were excluded. All 22 complications provided by the NSP were analyzed. Chi-squared analysis was used with statistical significance defined as P < 0.05. Results: Of the 94 TCs in the NSP, 67 had ACS and 80 had state designations of Level 1 or 2. There were 38 ACS Level 1 TCs treating 87,340 patients and 29 ACS Level 2 TCs treating 35,763. There were 45 state Level 1 TCs treating 106,640 and 35 state Level 2 TCs treating 43,290. ACS Level 1 TCs had significantly higher complications compared to ACS Level 2 TCs (13.5% [11,776/87,340] vs. 10.1% [3,606/35,763], P < 0.0001). In addition, state Level 1 TCs had significantly more complications compared to state Level 2 TCs (4.4% [4,681/106,640] vs. 1.6% [673/43,290], P < 0.0001). Conclusion: Both ACS and state Level 2 TCs had significantly lower complication rates than ACS and state Level 1 TCs. Further investigations should look for the source and impact of this difference.

7.
Ann Med Surg (Lond) ; 60: 304-307, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33204421

RESUMO

•These two cases highlight the limitations in current grading systems, particularly in the context of gallbladder size.•We propose modifications to the PGS to include not only abnormal anatomy but instances of distorted gallbladder anatomy due to inflammation and/or the large to giant size in order to account for the increased risk of complications.•Both distorted gallbladder anatomy and giant gallbladder size can make laparoscopic cholecystectomy a challenge, and thus warrant contribution to overall clinical grade.•While the PGS, Tokyo Guidelines, and AAST grading scales are validated grading scales for acute cholecystitis, additional modifications can further characterize different types of acute cholecystitis to better guide patient management.

8.
Ann Med Surg (Lond) ; 60: 41-43, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33101672

RESUMO

As seasons come and go throughout the year, so does the rise and fall of influenza-like illnesses. The next wave of influenza will occur as the novel coronavirus 19 (COVID-19), caused by the SARS CoV-2 virus, continues to afflict the US. Both viruses, while from different families, have similar risk factors and symptoms such as fever, cough, headache, muscle aches, and fatigue. Since both viruses carry similar patient presentations and target similar patient populations, the ability of physicians to make a clinical diagnosis of influenza without testing is impaired. Obtaining the correct diagnosis for a patient presenting with a viral illness is paramount for determining the best course of treatment, particularly since the treatment for influenza has not been shown to be effective in treating COVID-19 patients. Another diagnosis that must be kept in mind is the possibility of co-infection with both influenza and COVID-19. With COVID-19 already placing patients in the Intensive Care Unit, additional pathogens causing similar severe manifestations can worsen patient outcomes. The compounding cumbersome additions of Influenza-Like-Illnesses can further burden the already stressed healthcare system, highlights the importance of proactive measures. Increasing influenza vaccination rates is a supported proactive measure that can be promoted through social media platforms, infomercials, and short informational videos physicians can play prior to the start of a telemedicine visit. Through the implementation of education and support for vaccination, this imminent danger may be avoided, allowing healthcare providers to effectively navigate the crossroads built by incoming patients presenting with viral illnesses.

9.
Am J Emerg Med ; 38(11): 2405-2415, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33041111

RESUMO

INTRODUCTION: There is a pressing need for COVID-19 transmission control and effective treatments. We aim to evaluate the safety and effectiveness of SARS-CoV-2 pharmacologic therapies as of August 2, 2020 according to study level of evidence. METHODS: PubMed, ScienceDirect, Cochrane Library, JAMA Network and PNAS were searched. The following keywords were used: ((COVID-19) OR (SARS-CoV-2)) AND ((((((therapeutics) OR (treatment)) OR (vaccine)) OR (hydroxychloroquine)) OR (antiviral)) OR (prognosis)). Results included peer-reviewed studies published in English. RESULTS: 15 peer-reviewed articles met study inclusion criteria, of which 14 were RCTs and one was a systematic review with meta-analysis. The following pharmacologic therapies were evaluated: chloroquine (CQ), hydroxychloroquine (HCQ), antivirals therapies, plasma therapy, anti-inflammatories, and a vaccine. CONCLUSION: According to level 1 evidence reviewed here, the most effective SARS-Co-V-2 pharmacologic treatments include remdesivir for mild to severe disease, and a triple regimen therapy consisting of lopinavir-ritonavir, ribavirin and interferon beta-1b for mild to moderate disease. Also, dexamethasone significantly reduced mortality in those requiring respiratory support. However, there is still a great need for detailed level 1 evidence on pharmacologic therapies.

10.
Int J Surg Case Rep ; 76: 315-319, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33068857

RESUMO

INTRODUCTION: Gallbladder disease is a common surgical pathology. Gallstones can remain asymptomatic or develop into an acute cholecystitis and need for surgical intervention. Significant enlargement of the gallbladder well beyond the normal volume is rare. Such "giant" gallbladders can affect feasibility of subsequent management options. PRESENTATION OF CASE: An 80-year-old female presented to the emergency department with a two-day history of acute on chronic gastric reflux with nausea and vomiting. On examination, she had right upper quadrant abdominal pain. CT imaging identified an enormous gallbladder creating mass effect and compression on the distal stomach. She underwent successful laparoscopic cholecystectomy and was discharged from the hospital the next day, doing well. On two-week follow up, her reflux symptoms had completely resolved and she had no complaints. DISCUSSION: Giant gallbladders are a rare entity. Our patient's case is unique in both its occurrence as well as presentation with predominant reflux symptoms secondary to mass effect by the enlarged gallbladder. Current cholecystitis grading systems do not utilize size as a means of predicting severity and risk of operative complications or difficulty of procedure. Laparoscopic cholecystectomy was a successful approach in managing this extreme pathology. CONCLUSION: Updated classifications systems that include size and mass effect as a predictive measure are needed to better assess surgical outcomes, especially in "giant" gallbladder disease. Despite the large size and potential mass effect on surrounding structures, laparoscopic cholecystectomy can still be attempted if no other contraindications exist.

11.
Am J Emerg Med ; 2020 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-33071074

RESUMO

BACKGROUND: Acute blood loss in trauma requires quick identification and action to restore circulating volume and save the patient. Massive transfusion protocols (MTPs) have become standard at Trauma Centers, in order to rapidly deliver blood products to bleeding patients. This literature review presents current standards of transfusion ratios, as well as insights into adjuncts during massive transfusions. METHODS: PubMED was searched for articles from 2005 to 2020 on MTPs, the article were assessed for single vs. multi-institutional, mechanism of injury, type of MTP, timing in which blood products should be administered, timing of delivery of blood products to trauma bay, pre-hospital treatment and adjuncts, and outcomes. RESULTS: Eleven studies addressed transfusion ratios. Seven studies looked at timing of blood products. Nine studies addressed MTP pre-hospital treatment and adjuncts. Prior to 2015, studies supported the benefits of a balanced transfusion ratio, which was then confirmed by the PROPPR randomized controlled trial. The shorter the time to blood product delivery the better the outcomes. New advances in technology have allowed us to measure different patterns of coagulation, allowing more individualized approaches to the bleeding patient. CONCLUSION: Current massive transfusion protocols should utilize between 1:1:1 and 1:1:2 ratios of the 3 main products; plasma, platelets, and red blood cells. Massive transfusion protocols are effective in decreasing mortality. Better resuscitation efforts were seen when blood products were readily available in the trauma bay when the patient arrived and the faster the replacement of blood, the better the outcomes.

12.
Int J Surg Case Rep ; 76: 372-376, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33080529

RESUMO

INTRODUCTION: Trauma remains the leading cause of mortality in the pediatric population. Penetrating thoracic injuries can result in devastating trauma to multiple organ systems. When these injuries occur, prompt diagnosis and swift treatment of internal organ injury are of utmost importance. CASE PRESENTATION: A 13-year-old male presented to our Trauma Center after sustaining a gunshot wound (GSW) to the left chest. Despite his hemodynamic stability on presentation, CT scan revealed multiple injuries including splenic and renal lacerations. Exploratory laparotomy resulted in splenectomy, but no intervention was performed for the renal laceration. Instead, clinical monitoring alone was sought. Patient was discharged on hospital day 13 in stable condition. DISCUSSION: Pediatric penetrating injuries secondary to GSWs can impact multiple organ systems. Despite hemodynamic stability on presentation, adequate staging of internal damage with CT allowed a targeted approach. In our case, non-operative management of the renal injury was implemented after hemorrhage control of his additional injuries. Failure to have done so would have inevitably complicated his overall management and made kidney salvage not feasible. CONCLUSION: Prompt diagnosis and treatment are required in order to prevent significant morbidity and mortality in the pediatric patient from GSW-mediated penetrating thoracic injuries. Despite hemodynamic stability on presentation, patients should be emergently assessed for severe injury, with immediate surgical management as needed. Failure to do so could lead to rapid clinical deterioration, and inability to enact other conservative measures that lead to positive outcomes.

13.
Am Surg ; : 3134820950289, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32927993

RESUMO

BACKGROUND: Twitter at conferences facilitates remote interaction and spread of ideas. Through the use of hashtags, conference information can be gathered, referenced, disseminated, and discussed in 1 electronic location by attendees and nonattendees from remote locations. The aim of this study is to analyze the American College of Surgeons Clinical Congress (ACSCC) Twitter hashtag activities and evaluate its impact on meeting participation and engagement for the last 5 annual meetings. METHODS: Twitter hashtags #ACSCC15, #ACSCC16, #ACSCC17, #ACSCC18, and #ACSCC19 were studied to determine tweets, retweets, users, and impressions. Data regarding top influencers and the most tweeted links were analyzed. Symplur Signals, a software that specializes in hashtags, was utilized for the analyses. RESULTS: Between 2015 and 2017, there was a consistent increase in tweets from 12 800 to 18 300 to 24 700, respectively. However, in 2018 and 2019, tweets dropped significantly to 19 700 and 19 300, respectively (P < .05). Additionally, impressions dropped significantly by 24 million impressions from 2017 to 2019 (115.1M to 91.1M, P < .05) despite the growth of users from 2700 in 2015 to 4100 in 2016 and ~6500 in 2017-2019. This change occurred despite no change in meeting attendance rates, regardless of specialty (P > .05). The most influential organizations in hashtag use were the American College of Surgeons (ACS) and Association of Women Surgeons (AWS). CONCLUSION: Despite the significant reduction in views and online engagement activities in the past 2 years, the use of Twitter at the ACS CC has greatly increased the potential dissemination of information but not meeting attendance rates.

14.
Int J Surg Case Rep ; 75: 231-234, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966932

RESUMO

INTRODUCTION: Ocular trauma is a common occurrence in trauma settings but often occurs with little to no effect on the vision of the patient. Traumatic enucleation is a rare but devastating injury. CASE PRESENTATION: A 40-year-old male presented to our trauma center after an assault resulting in right globe enucleation. CT confirmed absence of the globe with disruption of the ipsilateral orbital contents and distal optic nerve disruption. The patient was started on intravenous antibiotics and the right orbit was packed. He was taken to the operating room for exploration of the right orbit and placement of an implant. His remaining hospital course was unremarkable. DISCUSSION: Documented mechanisms of injury for traumatic enucleation are diverse, but often involve significant retro-ocular force to completely dislodge the globe from the orbit. Optic nerve avulsion may cause associated optic nerve chiasm damage leading to temporal hemianopia in the uninjured contralateral eye. Treatment involves stabilization and preparation for future implant placement. CONCLUSION: Traumatic enucleation is extremely rare. Development of a grading system applicable to traumatic enucleation may be helpful in guiding management in this complex patient population.

15.
Ann Med Surg (Lond) ; 58: 151-155, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32922770

RESUMO

Background: The use of Twitter hashtags at medical conferences has revolutionized the way healthcare professionals interact and advance their education. We aim to investigate the scope of the Academic Surgical Congress's online reach and engagement through the use of Twitter hashtags #ASC from 2015 to 2019, by analyzing the number of impressions and tweets and retweets. Methods: A cross sectional study of Twitter data through Symplur with the following conference hashtags for the Academic Surgical Congress annual meetings for years 2015-2019: #ASC2015, #ASC2016, #ASC2017, #ASC2018, and #ASC2019. Data on tweets, retweets, users, and impressions was reviewed along with information on the top 10 influencers and the most frequently tweeted links. Symplur Signals software was utilized to extract and assimilate data. Statistical Significance was defined as p < 0.05. Results: Twitter engagement metrics significantly increased from 11,400 to 32,100 from 2015 to 2017 (p < 0.05). However, from 2017 to 2019, there was a significant decline in engagement metrics from 32,100 to 26,100 (p < 0.05). Impressions increased significantly from 13,100 in 2015 to 71,800 impressions in 2019 (p < 0.05). Users grew significantly from 1500 in 2015 to peak at 4600 in 2017 before dropping back to 3300 in 2019 (p < 0.05). The most influential organizations during these years were the organizers of the conference: Association for Academic Surgery and the Society of University Surgeons. Conference attendance progressively increased from approximately 1700 in 2016 to about 2100 in 2019 (p < 0.05). Conclusions: Twitter engagement metrics at the Academic Surgical Congress 2015-2019 has fluctuated, while impressions significantly increased through the years indicating the consistent dissemination of conference content.

16.
Trauma Surg Acute Care Open ; 5(1): e000496, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32923681

RESUMO

Background: Social media amplifies the accessibility, reach and impact of medical education and conferences alike. The use of hashtags at medical conferences allows material to be discussed and improved on by the experts via online conversation on Twitter. We aim to investigate the utilization of hashtags at the American Association for the Surgery of Trauma (AAST) meetings from 2016 to 2019 and its potential role in knowledge dissemination and meeting participations. Methods: Symplur Signals software was used to analyze hashtags for the AAST meetings by year: #AAST2016, #AAST2017, #AAST2018, #AAST2019. Results: Number of tweets decreased significantly from 2016 to 2019 (4500 to 4400 to 3600 to 2600, respectively, p<0.05). Retweets also decreased significantly from 2016 to 2019 (3600 to 3300 to 2600 to 1900, respectively, p<0.05). Users decreased from 2016 to 2019 (1600 to 1400 to 937 to 743, respectively, p<0.05). Despite this decrease, impressions were 5.8 million in 2016, increasing to 8.6 million in 2017, then 9.6 million in 2018 and finally peaking in 2019 where impressions reached 10 million (p<0.05). The top influencer for 2016-2019 was the AAST Twitter account. Conclusion: Twitter #AAST 2016-2019 online engagement and interactions have declined during the last 4 years while impressions have grown steadily indicating potential widespread dissemination of trauma-related knowledge and evidence-based practices, and increased online utilization of conference material to trauma surgeons, residents and fellows, trauma scientists, other physicians and the lay public. #AAST online engagement and impressions did not have influence on meeting attendance rates.

18.
J Surg Res ; 256: 536-542, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32799002

RESUMO

Antithrombin deficiency (ATD) was described in 1965 by Olav Egeberg as the first known inherited form of thrombophilia. Today, it is understood that ATDs can be congenital or acquired, leading to qualitative, quantitative, or mixed abnormalities in antithrombin (AT). All ATDs ultimately hinder AT's ability to serve as an endogenous anticoagulant and antiinflammatory agent. As a result, ATD patients possess higher risk for thromboembolism and can develop recurrent venous and arterial thromboses. Because heparin relies on AT to augment its physiologic function, patients with ATD often exhibit profound heparin resistance. Although rare as a genetic disorder, acquired forms of ATD are seen with surprising frequency in critically ill patients. This review discusses ATD in the context of surgical critical care with specific relevance to trauma, thermal burns, cardiothoracic surgery, and sepsis.

20.
Ann Med Surg (Lond) ; 57: 163-165, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32765846

RESUMO

•Compares obtaining informed consent from a non-COVID-19 patient versus a COVID-19 person under investigation or confirmed positive in order to maintain healthcare workers safety and minimize PPE use.•Explains the use of technology in the form of video chat to aid in informed consent from healthcare surrogates of patients who are unable to provide their own informed consent.•Discusses alternative solutions to obtaining informed consent from a COVID-19 person under investigation or confirmed positive.

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