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8. Pediatric emergency resuscitative thoracotomy: A Western Trauma Association, Pediatric Trauma Society, and Eastern Association for the Surgery of Trauma collaborative critical decisions algorithm

Author

Martin, Matthew J., Brasel, Karen J., Brown, Carlos V.R., Hartwell, Jennifer L., de Moya, Marc, Inaba, Kenji, Ley, Eric J., Moore, Ernest E., Peck, Kimberly A., Rizzo, Anne G., Rosen, Nelson G., Weinberg, Jordan A., Coimbra, Raul, Crandall, Marie, Mukherjee, Kaushik, Ignacio, Romeo, Longshore, Shannon, Flynn-O’Brien, Katherine T., Ng, Grace, Selesner, Leigh, and Jafri, Mubeen

Published
2023
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9. EQIP's First Year: A Step Closer to Higher Quality in Surgical Education

Author

Edhayan, Elango, DiSiena, Michael, Kent, Tara, Rubino, Matthew, Prabhu, Ajita, Rosenkranz, Kari, Brown, Carlos, Edelman, David, Srinivasan, Jahnavi, Cagir, Burt, Surick, Burton, Neville, Angela, Choi, Jennifer N., Yeung, Louise, Cassaro, Sebastiano, Iverson, Kyle, Nepomnayshy, Dmitry, Namm, Jukes, Dorion, Heath, Truitt, Michael, Hope, William, Berman, Russell, Harzman, Alan, Kothuru, Ravi, Feinman, Marcie, Hoey, Brian, Dresner, Lisa, Williams, Mark, Chojnacki, Karen, Schroll, Rebecca, Nehler, Mark, Sarosi, George, Porter, Michael, Kavic, Stephen, LaFemina, Jennifer, Lees, Jason, Kempenich, Jason, Daley, Brian, Bailey, Christina, Chang, Lily, Hildreth, Amy, Borgstrom, David, Tuttle, Rebecca M., Mpinga, Ebondo, Rivera, Nancy, Hai, Shaikh, Zera, Richard, Halverson, Amy, Schurr, Michael, Bradley, Matthew, Sirsi, Sandeep, Fuhrman, George, Brasel, Karen, Palesty, Alexander, Nehler, Mark R., Crandall Crandall, Marie, Thambi-Pillai, Thav, O'Rourke, Ann P., Joshi, Amit R.T., Nfonsam, Valentine, Relles, Daniel M., Murphy, Shawn, Ciolkosz, John, Fise, Tom, Klingensmith, Mary E., Hickey, Mark, Brunsvold, Melissa E., Korndorffer, James R., Jr., Jarman, Benjamin T., Smink, Douglas S., Terhune, Kyla, Kmiec, Kathryn, and Harrington, David T.

Published
2022
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10. Resident Readiness for Senior Level Decision Making: Identifying the Domains for Formative Assessment and Feedback

Author

AbdelFattah, Kareem R., Alam, Hasan B., Brown, Carlos V.R., Choi, Jennifer N., Cochran, Amalia, Delman, Keith A., Demetriades, Demetrios, Dort, Jonathan M., Frey, E. Shields, Gauvin, Jeffrey, Hildreth, Amy N., Jarman, Benjamin T., Johnson, Jason M., Jung, Enjae, Katz, Steven G., Kooby, David A., Korndorffer, James R., Jr., LaFemina, Jennifer, Lau, James N., Lazar, Eric L., Lipsett, Pamela A., Maier, Ronald V., Maker, Ajay V., Maker, Vijay K., Mellinger, John D., Meyerson, Shari Lynn, Morrissey, Shawna Lynn, Napolitano, Lena M., Narayan, Mayur, Reilly, Linda M., Sanfey, Hilary, Salcedo, Edgardo S., Schropp, Kurt P., Stuke, Lance E., Tracy, Thomas F., Jr., Vaporciyan, Ara A., Verrier, Edward D., Vetto, John T., Yang, Stephen C., Park, Keon Min, Gesbeck, Melissa M., Alseidi, Adnan A., Park, Yoon Soo, Sullivan, Maura E., Blair, Patrice Gabler, Liscum, Kathy, and Sachdeva, Ajit K.

Published
2022
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20. Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury

Author

Vu, Megan, Todd, Samual Rob, Rainey, Evan E., Allen, Ladona, Agrawal, Vaidehi, Walker, Kendra, Gandhi, Raj, Podbielski, Jeanette M., Teixeira, Pedro G.R., Brown, Carlos V.R., Emigh, Brent, Long, Michael, Foreman, Michael, Eastridge, Brian, Gale, Stephen, Truitt, Michael S., Dissanaike, Sharmila, Duane, Therese, Holcomb, John, Eastman, Alex, and Regner, Justin

Published
2018
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21. Trends in prehospital cervical collar utilization in trauma patients: Closer, but not there yet.

Author

Muzyka, Logan, Bradford, James M., Teixeira, Pedro G., DuBose, Joseph, Cardenas, Tatiana C. P., Bach, Michelle, Ali, Sadia, Robert, Michelle, and Brown, Carlos V. R.

Subjects
CERVICAL vertebrae injuries, CERVICAL vertebrae, PHYSICAL diagnosis, BLUNT trauma, PENETRATING wounds, PATIENTS, RETROSPECTIVE studies, THERAPEUTIC immobilization, COMPARATIVE studies, EMERGENCY medical services, DESCRIPTIVE statistics, GLASGOW Coma Scale, NECK injuries, CERVICAL collars, EMERGENCY medicine
Abstract

Objective: This study aims to assess the change in cervical spine (C‐spine) immobilization frequency in trauma patients over time. We hypothesize that the frequency of unnecessary C‐spine immobilization has decreased. Methods: A retrospective chart review of adult trauma patients transported to our American College of Surgeons–verified Level I trauma center from January 1, 2014, to December 31, 2021, was performed. Emergency medical services documentation was manually reviewed to record prehospital physiology and the application of a prehospital cervical collar (c‐collar). C‐spine injuries were defined as cervical vertebral fractures and/or spinal cord injuries. Univariate and year‐by‐year trend analyses were used to assess changes in C‐spine injury and immobilization frequency. Results: Among 2906 patients meeting inclusion criteria, 12% sustained C‐spine injuries, while 88% did not. Patients with C‐spine injuries were more likely to experience blunt trauma (95% vs. 68%, p < 0.001), were older (46 years vs. 41 years, p < 0.001), and had higher Injury Severity Scores (31 vs. 18, p < 0.001). They also exhibited lower initial systolic blood pressures (108 mm Hg vs. 119 mm Hg, p < 0.001), lower heart rates (92 beats/min vs. 97 beats/min, p < 0.05), and lower Glasgow Coma Scale scores (9 vs. 11, p < 0.001). In blunt trauma, c‐collars were applied to 83% of patients with C‐spine injuries and 75% without; for penetrating trauma, c‐collars were applied to 50% of patients with C‐spine injuries and only 8% without. Among penetrating trauma patients with C‐spine injury, all patients either arrived quadriplegic or did not require emergent neurosurgical intervention. The proportion of patients receiving a c‐collar decreased in both blunt and penetrating traumas from 2014 to 2021 (blunt—82% in 2014 to 68% in 2021; penetrating—24% in 2014 to 6% in 2021). Conclusions: Unnecessary C‐spine stabilization has decreased from 2014 to 2021. However, c‐collars are still being applied to patients who do not need them, both in blunt and in penetrating trauma cases, while not being applied to patients who would benefit from them. [ABSTRACT FROM AUTHOR]

Published
2024
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22. Sigh Ventilation in Patients With Trauma: The SiVent Randomized Clinical Trial.

Author

Albert, Richard K., Jurkovich, Gregory J., Connett, John, Helgeson, Erika S., Keniston, Angela, Voelker, Helen, Lindberg, Sarah, Proper, Jennifer L., Bochicchio, Grant, Stein, Deborah M., Cain, Christian, Tesoriero, Ron, Brown, Carlos V. R., Davis, James, Napolitano, Lena, Carver, Thomas, Cipolle, Mark, Cardenas, Luis, Minei, Joseph, and Nirula, Raminder

Subjects
ARTIFICIAL respiration, TRAUMA centers, ADULT respiratory distress syndrome, VENTILATION, CLINICAL trials, DISEASE risk factors
Abstract

Key Points: Question: Does adding sigh breaths to the usual care of trauma patients receiving mechanical ventilation increase ventilator-free days? Findings: In this randomized clinical trial among 524 trauma patients with risk factors for developing acute respiratory distress syndrome, the addition of sigh breaths did not significantly increase ventilator-free days compared with usual care alone (median ventilator-free days, 18.4 vs 16.1, respectively). Although not adjusted for multiple testing, sigh breaths were associated with improvement in secondary outcomes including all-cause mortality. There was no evidence of harm. Meaning: Sigh breaths added to usual care did not significantly increase ventilator-free days among trauma patients who received mechanical ventilation but may improve clinical outcomes. Importance: Among patients receiving mechanical ventilation, tidal volumes with each breath are often constant or similar. This may lead to ventilator-induced lung injury by altering or depleting surfactant. The role of sigh breaths in reducing ventilator-induced lung injury among trauma patients at risk of poor outcomes is unknown. Objective: To determine whether adding sigh breaths improves clinical outcomes. Design, Setting, and Participants: A pragmatic, randomized trial of sigh breaths plus usual care conducted from 2016 to 2022 with 28-day follow-up in 15 academic trauma centers in the US. Inclusion criteria were age older than 18 years, mechanical ventilation because of trauma for less than 24 hours, 1 or more of 5 risk factors for developing acute respiratory distress syndrome, expected duration of ventilation longer than 24 hours, and predicted survival longer than 48 hours. Interventions: Sigh volumes producing plateau pressures of 35 cm H2O (or 40 cm H2O for inpatients with body mass indexes >35) delivered once every 6 minutes. Usual care was defined as the patient's physician(s) treating the patient as they wished. Main Outcomes and Measures: The primary outcome was ventilator-free days. Prespecified secondary outcomes included all-cause 28-day mortality. Results: Of 5753 patients screened, 524 were enrolled (mean [SD] age, 43.9 [19.2] years; 394 [75.2%] were male). The median ventilator-free days was 18.4 (IQR, 7.0-25.2) in patients randomized to sighs and 16.1 (IQR, 1.1-24.4) in those receiving usual care alone (P =.08). The unadjusted mean difference in ventilator-free days between groups was 1.9 days (95% CI, 0.1 to 3.6) and the prespecified adjusted mean difference was 1.4 days (95% CI, −0.2 to 3.0). For the prespecified secondary outcome, patients randomized to sighs had 28-day mortality of 11.6% (30/259) vs 17.6% (46/261) in those receiving usual care (P =.05). No differences were observed in nonfatal adverse events comparing patients with sighs (80/259 [30.9%]) vs those without (80/261 [30.7%]). Conclusions and Relevance: In a pragmatic, randomized trial among trauma patients receiving mechanical ventilation with risk factors for developing acute respiratory distress syndrome, the addition of sigh breaths did not significantly increase ventilator-free days. Prespecified secondary outcome data suggest that sighs are well-tolerated and may improve clinical outcomes. Trial Registration: ClinicalTrials.gov Identifier: NCT02582957 This randomized clinical trial compares the efficacy of sighs in addition to usual care vs usual care alone in improving clinical outcomes among trauma patients receiving mechanical ventilation and are at risk for developing acute respiratory distress syndrome. [ABSTRACT FROM AUTHOR]

Published
2023
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32. Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians.

Author

Patel, Anish B., Osterberg, E. Charles, Satarasinghe, Praveen N., Wenzel, Jessica L., Akbani, Sabah T., Sahi, Saad L., Emigh, Brent J., Wolf Jr., J. Stuart, and Brown, Carlos V. R.

Subjects
MEDICAL personnel, CRITICAL care medicine, PENETRATING wounds, CYSTOSTOMY, BLUNT trauma, URINARY catheterization, GUNSHOT wounds
Abstract

Urologic trauma is a well-known cause of urethral injury with a range of management recommendations. Retrograde urethrogram remains the preferred initial diagnostic modality to evaluate a suspected urethral injury. The management thereafter varies based on mechanism of injury. Iatrogenic urethral injury is often caused by traumatic catheterization and is best managed by an attempted catheterization performed by an experienced clinician or suprapubic catheter to maximize urinary drainage. Penetrating trauma, most commonly associated with gunshot wounds, can cause either an anterior and/or posterior urethral injury and is best treated with early operative repair. Blunt trauma, most commonly associated with straddle injuries and pelvic fractures, can be treated with either early primary endoscopic realignment or delayed urethroplasty after suprapubic cystostomy. With any of the above injury patterns and treatment options, a well thought out and regimented follow-up with a urologist is of utmost importance for accurate assessment of outcomes and appropriate management of complications. [ABSTRACT FROM AUTHOR]

Published
2023
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48. Neck Injuries

Author

Demetriades, Demetrios, Salim, Ali, Brown, Carlos, Martin, Matthew, and Rhee, Peter

Published
2007
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50. DEI-03 PERSISTENT EFFECTS OF HISTORICAL REDLINING ON TRAUMATIC UROLOGIC INJURIES: A GEOSPATIAL ANALYSIS IN A SOUTHERN US CITY.

Author

Eldin, Maya Malak, Bradford, James, Woodle, Tarah, Ancha, Niru, Gereta, Sofia, Butler, Imani, Khanna, Prachi, Mery, Marissa, Robert, Michelle, Ali, Sadia, Salvo, Deborah, Brown, Carlos V., and Laviana, Aaron

Subjects
GEOGRAPHIC information systems, WOUNDS & injuries, LOCATION data, RESIDENTIAL segregation, GEOSPATIAL data
Published
2024
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