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Background Emergency medical personnel must expeditiously triage acutely injured patients to the appropriate medical facility. Efficient and objective variables to facilitate this process and provide information to the receiving trauma center are needed. Currently, multiple variables are used to prognosticate injury severity and risk of mortality including vital signs, mental status, lactate, and base excess. We investigated the prehospital use of end-tidal carbon dioxide (ETCO2) as a noninvasive physiologic measure that can be obtained in the acutely injured patient.Methods We performed a retrospective analysis of 557 acutely injured patients over 2 years at a Level 1 trauma center. All patients arriving as trauma activations with ETCO2measurements were included in analysis. End-tidal carbon dioxide measurements were categorized as low, normal, and high based on reference levels. Mortality was the primary outcome. Secondary receiver operator curves (ROC) for base excess, venous lactate, blood pressure, and venous pH were compared. We hypothesized ETCO2levels would be able to predict mortality.Results End-tidal carbon dioxide levels conferred a mortality rate of 38%, 17.3%, and 2.9% for low, normal, and high, respectively (P< .001). Receiver operator curve analysis produced an area under the curve predictive value for ETCO2(.748) which was superior to lactate (.660), SBP (.578), pH (.560), and base excess (.497).Discussion End-tidal carbon dioxide is a more sensitive and specific predictor of mortality in the acutely injured patient compared to venous lactate, base deficit, blood pressure, or venous pH. Additional studies are needed to determine if ETCO2can be used as an effective prehospital adjunct to prevent mortality in acutely injured patients.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2008.07.032 Byline: Thomas M. Schmelzer, A. Britton Christmas, Dennis A. Taylor, B. Todd Heniford, Ronald F. Sing Keywords: Pulmonary embolism; Inferior vena cava filter; Vena cava filter retrieval; Anticoagulation Abstract: Vena cava filters (VCFs) are indicated in patients with active venous thromboembolism and are a contraindication to therapeutic anticoagulation. When patients can be anticoagulated, VCFs can be removed; however, patients often have anticoagulation discontinued during the retrieval procedure, leaving them at risk for pulmonary embolism (PE). The authors evaluated their experience with retrieving VCFs in therapeutically anticoagulated patients. Author Affiliation: Carolinas Medical Center, Department of Surgery, Division of Minimally Invasive and Gastrointestinal Surgery, Charlotte, NC, USA Article History: Received 3 May 2008; Revised 8 July 2008

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2006.08.068 Byline: B. Lauren Paton, David G. Jacobs, B. Todd Heniford, Kent W. Kercher, Marc Zerey, Ronald F. Sing Keywords: Inferior vena cava filters; Deep vein thrombosis; Pulmonary embolism; Bedside procedures Abstract: Vena cava filter insertion (VCF) is traditionally performed in a radiology suite or in the operating room. We reviewed our experience of bedside VCF insertion in the intensive care unit (ICU) performed by general surgeons. Author Affiliation: Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Medical Education Bldg 6A, Charlotte, NC 28203, USA Article History: Received 15 April 2006; Revised 10 August 2006

Background Operative management of emergency general surgery (EGS) diagnoses involves a range of procedures which can carry high morbidity and mortality. Little is known about the impact of obesity on patient outcomes. The aim of this study was to examine the association between body mass index (BMI) >30 kg/m2and mortality for EGS patients. We hypothesized that obese patients would have increased mortality rates.Methods A regional integrated health system EGS registry derived from The American Association for the Surgery of Trauma EGS ICD-9 codes was analyzed from January 2013 to October 2015. Patients were stratified into BMI categories based on WHO classifications. The primary outcome was 30-day mortality. Longer-term mortality with linkage to the Social Security Death Index was also examined. Univariate and multivariable analyses were performed.Results A total of 60 604 encounters were identified and 7183 (11.9%) underwent operative intervention. Patient characteristics include 53% women, mean age 58.2 ± 18.7 years, 64.2% >BMI 30 kg/m2, 30.2% with chronic obstructive pulmonary disease, 19% with congestive heart failure, and 31.1% with diabetes. The most common procedure was laparoscopic cholecystectomy (36.4%). Overall, 90-day mortality was 10.9%. In multivariable analysis, all classes of obesity were protective against mortality compared to normal BMI. Underweight patients had increased risk of inpatient (OR = 1.9, CI = 1.7-2.3), 30-day (OR = 1.9, CI = 1.7-2.1), 90-day (OR = 1.8, CI 1.6-2.0), 1-year (OR = 1.8, CI = 1.7-2.0), and 3-year mortality (OR = 1.7, CI = 1.6-1.9).Conclusions When stratified by BMI, underweight EGS patients have the highest odds of death. Paradoxically, obesity appears protective against death, even when controlling for potentially confounding factors. Increased rates of nonoperative management in the obese population may impact these findings.