Investigation of Medical Student and Resident Physician Palliative Care Consulting Practices.

Palliative care (PC) underutilization stems from provider conflicts and the belief that PC involvement may confuse patients. We hypothesized medical students, less exposed to these barriers and misconceptions, would be more likely to consult PC than residents/fellows. A survey of 88 medical students, residents, and fellows was conducted, querying the appropriateness of PC utilization in clinical scenarios. Students were more likely to consult PC than trainees when PC was not indicated (47.2% vs 22.9%, P = .02). In the two cases where PC was indicated, there was no difference in PC utilization among students and trainees (92.5% vs 91.4%, P = .86; 90.6% vs 100%, P = .06). When stratifying participants into medical and surgical specialties, or career interests regarding students, there was no difference in rates of PC consultation. This suggests medical education advancements are producing physicians adept at identifying patients needing PC and willing to integrate a PC service into patient care.

Surgical Site Infections in Trauma Exploratory Laparotomies Preoperative Ceftriaxone and Metronidazole Versus Cefoxitin.

Surgical site infections (SSIs) remain a significant cause of morbidity and mortality in patients undergoing traumatic exploratory laparotomy. The goal of this study was to compare antibiotic usage and subsequent outcomes in patients undergoing traumatic exploratory laparotomy. A retrospective chart analysis and a chi-square test of independence were performed to examine the relation between preoperative cefoxitin versus ceftriaxone and metronidazole and the rate of SSI development. 323 patients were analyzed, 111 patients receiving cefoxitin and 212 patients receiving ceftriaxone and metronidazole. The proportion of patients who developed SSI was 16.2% for the cefoxitin group and 9.9% for the ceftriaxone and metronidazole group, X2 (1, N = 323) = 2.7, P = .098, thus displaying no statistical difference in the development of SSIs between patients in the cefoxitin group when compared to the ceftriaxone and metronidazole group.

Injury Patterns Associated With Electronic Scooter Crashes: An Institutional Observational Study.

With the rising popularity of electronic scooters, an increase in trauma and injuries related to these scooters has been observed. The objective of this study was to evaluate all electronic scooter-related traumas at our institution to characterize common injuries and educate the public around the safety of these scooters. We constructed a retrospective review of patients evaluated by the trauma service at Sentara Norfolk General Hospital with documented electronic scooter trauma. In our study, subjects were primarily male, typically between the ages of 24 and 64. The most commonly observed injuries were soft tissue, orthopedic, and maxillofacial in nature. Nearly half (45.1%) of subjects required admission, and thirty injuries (29.4%) required operative intervention. Alcohol use was not associated with the rate of admission or operative intervention. The benefits of easily accessible transportation offered by electronic scooters must be considered in context with the health risks when conducting future research.

Erector Spinae Plane Blocks for Traumatic Rib Fractures: A Prospective, Interventional Study.

BACKGROUND: Rib fractures are present in 10% of all trauma patients and 30% of patients with significant chest trauma. Pain from rib fractures results in decreased respiratory effort which can lead to atelectasis and potentially pneumonia and death. Pain control is therefore of utmost importance in preventing the complications of rib fractures by improving respiratory function. Erector spinae plane blocks (ESPB) have been effectively used in elective surgery with subjective and objective improvements in pain. MATERIALS AND METHODS: We sought to evaluate subjective pain and objective evaluation of respiratory effort by way of incentive spirometry levels after administration of an ESPB for patients with rib fractures. Our trauma service applied ESPB over 2 years in patients with rib fractures. Ultrasound guidance was used to administer 50cc of a long-acting local anesthetic at the transverse process underneath the erector spinae muscle group. Evaluation of pain scores and incentive spirometry levels were measured prior to and after the ESPB. RESULTS: In total, we obtained data from 45 patients. Mean pre-pain scores were 7.93 with post-pain scores of 4.47 (p < 0.001). Mean pre-block incentive spirometry volumes were 1160 cc with post-block IS of 1495cc (p 0.035). There were no associated complications. DISCUSSION: ESPBs are safe and significantly reduce pain scores and increased incentive spirometry volumes after administration. They are easy to perform and can be done by the trauma service, including trainees. ESPB has the potential to reduce pulmonary complications of rib fractures, as well as subjectively improving pain experienced by our trauma patients. Based on our results, we recommend this block as an adjunct to multimodal analgesia for patients with rib fractures.

Outcomes of Trauma Patients with Flail Chest and Surgical Rib Stabilization.

The goal of this project was to describe the current practices of this institution and identify which patients benefit from surgical stabilization of rib fractures (SSRF). A total of 1429 trauma patients admitted to our Level 1 center with rib fractures between January 1, 2014 and June 22, 2020 were retrospectively reviewed. Flail chest was observed in 43 (3.01%) patients. Surgical stabilization of rib fractures was pursued in 27 of all patients (1.89%). Twenty-four flail chest patients required intubation (ETT). Nineteen were not intubated (NoET). Of the ETT group, 8 underwent SSRF and 16 did not. Those who had SSRF had a shorter ventilator Length of Stay (7.1 vs 15.7 d) and Intensive Care Unit Length of Stay (9.8 vs 11.9 d). Surgical stabilization of rib fractures has shown success in managing flail chest. In intubated patients with flail chest, fixation seems to decrease Intensive Care Unit stays and the duration of ventilation. We believe we need to perform SSRF on more patients with flail chest.