L D Britt

..Although there are no guarantees that widening the spectrum of the specialty will improve the overall financial status of the role, adoption of this new specialty concept will, undoubtedly, enhance the appeal of a dying profession...

..The role of endovascular stent insertion in the management of these injuries is currently being debated. [table: see text]..

..Also, the specific choice of management should be institution- and resource dependent...

..The use of weaning and sedation protocols affects the intensive care unit (ICU) course of a trauma population...

..Finally, the evolution from angiography to the use of helical CT for the diagnosis of thoracic aortic injuries is reviewed in detail...

..Ventilator-associated pneumonia (VAP) remains a major source of morbidity, mortality, and expense in the ICU despite therapies directed against it...

..Despite the disinterest of the vast majority of the State Board of Medical Examiners, we would recommend that this updated VIS be implemented immediately to educate our society on the information in the VIS...

..Because the majority of burn injuries are due to occupational electrical injuries, the regional burn centers must work effectively with industry to prevent these potentially life-threatening accidents...

..Relative adrenal insufficiency appears to be common in hemorrhagic shock. Future research is warranted to elucidate the pathophysiology, as well as to prospectively determine which patients may benefit from steroid replacement...

..Application of differing definitions of VAP results in markedly different VAP rates. The difference has significant implications as infection rates are increasingly reported as a quality metric...

..Six patients had concurrent appendicitis. Colonic and appendiceal neoplasia are not unusual etiologies of appendicitis. These patients tend to present at an older age and with longer duration of symptoms...

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..Although hyperglycemia on admission appears to correlate with a worse outcome, early glucose normalization did not affect morbidity and mortality in our critically ill population...

..A localizing physical examination in conjunction with normal CS CT safely precludes a CS injury requiring cervical fixation. MRI does not add substantially to this decision-making and the cervical collar can be safely removed...

..Low albumin predicts a low cortisol. Hemodynamically stable occult adrenal insufficiency should not be treated with steroid replacement in the critically ill trauma patient, as survival in our series was 100 per cent without replacement...

..We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees...

..5 U/hr D2 and 3.1 U/hr D1. Infection does seem to be preceded by escalating insulin demands in many patients. A prospective study to evaluate the value of increased insulin demand as a marker for developing infection is warranted...

..004). CSCIs after a BSA do better than their counterparts without an associated ND. CSCIs associated with ND appear to be isolated injuries with minimal pulmonary involvement despite submersion injuries...

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..We introduced an acute care surgery (ACS) service in July 2007 to address all new consults. This study examines the impact on treatment of biliary disease...

..Second, those exposed to hazmats must be treated at the scene of contamination as well as in the hospital and rehabilitation setting...

..This study is designed to evaluate the impact on patient care and describe the case-mix experienced...

..A strict ARDS Network ventilation strategy (VT < 6 mL/kg) is not followed, rather a low plateau/peak pressure strategy is used, which is a form of lung protective ventilation...

..Corticosteroid use has a significant effect on morbidity and mortality in the intensive care unit (ICU)...

..This study was designed to evaluate whether resident performance of placing central lines improved after simulation training on newly available partial-task simulators...

..However, these patients should be monitored at least for 24 hours. Patients suspicious for cardiac contusions who have normal troponins and no other serious injuries may be safely discharged to go home from the emergency department...

..Investigating the demographics of the U.S. plastic surgery residents and faculty can bring attention to a deficit that, if corrected, could benefit the field and improve the entire health care system...

..Performing anal cytology on patients with anal condyloma did not increase the rate of positive results. Patients with AIN often had disease in more than two quadrants, making surgical excision problematic...

..40). The CL test does not reliably identify those patients who will require reintubation in our trauma population. In addition, the ratio of ETT and tracheal diameter is not predictive of successful extubation...

..Our study aims at identifying these individuals early in their course and placing an intra-abdominal catheter to reduce intra-abdominal pressure before the serious hemodynamic consequences of ACS occur...

..UL) and National Fire Protection Association Class A fire-rated roof system...

..We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees...

..The outcome study is intended to correlate time with death from esophageal causes, overall complications, esophageal related complications, and surgical intensive care unit length of stay...

..California and other states are preparing to (re)introduce legislation in January 2005. A national, industry-specific policy is essential to quell the outflow of nursing personnel to disability from manual patient lifting...

..A phantom model was created to teach surgical residents basic breast ultrasound and biopsy skills and to evaluate the resident's response when incorporated into the curriculum...

..The operative volume of chief residents would decrease with work-hour reform by the Accreditation Council for Graduate Medical Education (ACGME)...

..S. surgical residents and faculty could provide outstanding information, yielding insight into a possible deficit that, if rectified by the medical education system, could change the face of surgery and the entire health care system...

..To review current knowledge of hemorrhagic shock and reperfusion injury...

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..In our previous study, resident case coverage remained constant with the institution of the restricted duty hours. Several years later, we hypothesized that the level of resident coverage would be less appropriate...

..All of these predictive factors for mortality must be taken into account in the surgical management of these injuries...

..Because removal of these films would minimize cost we recommend the elimination of routine pelvic films for the awake and alert blunt trauma patient...

..Prospective evaluation is needed to further determine the impact of simulation on resident performance as well as patient outcomes...

..5 +/- 2%). CONCLUSIONS: Resistance arterioles pretreated with IL-10 maintain vascular tone during endotoxin exposure. We conclude that IL-10 pretreatment prevents loss of vascular tone of isolated arterioles exposed to endotoxin...

..More recently, carbon dioxide laser treatment, with healing by secondary intention, is proving to be a rapid, efficient, and economic treatment of this difficult wound...

..The Mendoza plan, and the process leading to its development, may provide insightful information for other surgical residency programs planning to meet work hour guidelines...

..Our nation and practicing physicians must be awakened to the importance of the use of VISs to ensure that every vaccinated individual receives this statement at the time of vaccination...

..The newest revolutionary advancement in the treatment of neonatal purpura fulminans is the use of activated protein C...

..A closer examination of medical school curriculums was undertaken to determine how the need for cultural competency and humility (CCH) training in medical education is being addressed...

..The best treatment of lightning injuries is prevention. The Lightning Safety Guidelines devised by the Lightning Safety Group should be instituted in the United States and other nations to prevent these devastating injuries...

..We report a case of massive upper gastrointestinal bleeding related to duodenal ulcer penetration of the cystic artery and discuss potential management strategies...

..In patients who have all of these risk factors, we recommend starting with an open cholecystectomy. This will save operative time and overall cost...

..Socioeconomic factors and differences in access to health care systems, perhaps more so than physiologic differences, play a significant role in race-based differences faced by acute care practitioners...

..These results suggest that CSA or a similar compound may be useful in the treatment of septic shock...

..Prompt recognition and treatment are mandatory for survival of ACS. We recommend routine bladder pressure monitoring for patients with ongoing resuscitation greater than 500 cc/hr...

..c-Jun Kinase promotes tumor necrosis factor (TNF)-alpha mediated apoptosis in nuclear factor (NF)-KB deficient cells. Minimal NF-KB expression may be enough to abrogate c-Jun Kinase-mediated apoptosis during reperfusion injury...

..Further research may enable clinicians to discern earlier which patients will benefit from adrenal corticoid replacement...

..Respiratory insufficiency secondary to atelectasis was the most common complication. Diagnostic laparoscopy is an essential and safe modality for the evaluation of diaphragmatic injuries in penetrating thoracoabdominal trauma...

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..The authors examine the current state of residency education in surgery and explore efforts underway to reform this educational model...

..A continuum of the prospective evaluation process is required by the RRC-S and other surgical specialties to ensure that requisite surgical volume is maintained throughout the entire 5 years of clinical surgery...

..The use of this modality will decrease the need for thoracic angiograms and invariably increase the yield...

..Federal authorities must devise national emergency medical and organized trauma programs to save the lives of injured Americans...

..This type of intervention assumes that lifting is a specialized skill to be performed only by expert professional patient movers who have been thoroughly trained in the latest lifting device techniques...

..We hypothesized that clinical factors accurately identify those trauma patients at high risk for pelvic fractures making routine films unnecessary...

..This effort has the potential to positively impact residency education in surgery, help surgical program directors address the core competencies, and enhance patient safety...

..The freezing of the corneas has been reported to occur in individuals who keep their eyes open in high wind-chill situations without protective goggles (e.g., snowmobilers, cross-country skiers)...