Primary Splenic Ectopic Pregnancy Managed With Angioembolization and Splenectomy.

A primary splenic ectopic pregnancy is an extremely rare entity; one that is fraught with life-threatening risks due to potential for acute hemorrhage. The diagnosis is challenging to make, and once detected, there is a distinct sense of urgency to perform operative intervention (splenectomy) prior to any impending rupture. This report describes the case of a 34-year-old female, gravida 5, para 3013, at estimated 4 weeks gestation with a 2.1 × 1.3 cm ectopic pregnancy abutting the splenic hilum. Through multidisciplinary management with Obstetrics/Gynecology (OB/GYN), Interventional Radiology (IR), and General Surgery teams, the patient received preoperative non-elective splenic artery embolization to mitigate risk of rupture, followed by open splenectomy while remaining hemodynamically stable throughout the course of her treatment. As evidenced by this case, a multidisciplinary approach to this unusual clinical presentation leads to successful patient outcomes and prevents the devastating complication of acute hemorrhage.

Emergency Trauma Providers as Equal Partners: From "Proof of Concept" to "Outcome Parity".

Enmeshment of emergency trauma providers (ETPs) into the United States health-care fabric resulted in the establishment of a formalized surgical critical care fellowship and certification for emergency medicine trainees. The aim of this study was to compare trauma outcomes for surgery-trained providers (STPs) and ETPs at our institution, hypothesizing patient outcome equivalency. We performed an institutional review board-exempt institutional registry review (January 1, 2004 to August 1, 2018), comparing 74 STPs and 6 ETPs. Comparator variables included all-cause mortality, all-cause morbidity, CT imaging studies per provider, time in ED (min), hospital/ICU lengths of stay, ICU admissions, and functional outcomes on discharge. Statistical comparisons included chi-square test for categorical data and analysis of covariance for continuous data (adjustments made for patient age, Injury Severity Score, and trauma mechanism; all P < 0.20). Statistical significance was set at P < 0.05, with an equivalence study design. A total of 33,577 trauma resuscitations were reviewed (32,299 STP-led and 1,278 ETP-led). Except for patient age (STP 50.2 ± 25.9 vs ETP 54.9 ± 25.3 years), Injury Severity Score (8.47 ± 8.14 vs 9.22 ± 8.40), and ICU admissions (16.1% vs 18.8%), we noted no significant intergroup differences. ETPs' performance was equivalent to that of STPs for all primary comparator variables (mortality, morbidity, CT utilization, time in the ED, lengths of stay, and functional outcomes). Incorporation of ETPs into our trauma center resulted in outcome parity between ETPs and STPs, while simultaneously expanding the expertise and experiential diversity within our multidisciplinary team. This study provides support for further incorporation of ETPs as equal partners across the growing network of United States regional trauma centers.