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Trauma, Critical Care Medicine, Acute Surgery, Emergency Surgery, Trauma Surgery

Thomas McLaughlin, Osbert Blow, John Herrick, Peter Richman
BACKGROUND: CHRISTUS Spohn Hospital Corpus Christi - Memorial began an Emergency Medicine Residency Program in March 2007. During each of the three years of their residency, residents are required to complete a trauma surgery rotation. These emergency medicine residents are the only residents participating on this rotation as there is no surgical residency. The Department of Acute Care Surgery, Trauma and Surgical Critical Care analyzed the impact of the residents on trauma patient care outcomes with the hypothesis that there were no differences...
February 2016: Journal of Clinical Medicine Research
Adil H Haider, Eric B Schneider, N Sriram, Deborah S Dossick, Valerie K Scott, Sandra M Swoboda, Lia Losonczy, Elliott R Haut, David T Efron, Peter J Pronovost, Pamela A Lipsett, Edward E Cornwell, Ellen J MacKenzie, Lisa A Cooper, Julie A Freischlag
IMPORTANCE: Significant health inequities persist among minority and socially disadvantaged patients. Better understanding of how unconscious biases affect clinical decision making may help to illuminate clinicians' roles in propagating disparities. OBJECTIVE: To determine whether clinicians' unconscious race and/or social class biases correlate with patient management decisions. DESIGN, SETTING, AND PARTICIPANTS: We conducted a web-based survey among 230 physicians from surgery and related specialties at an academic, level I trauma center from December 1, 2011, through January 31, 2012...
May 2015: JAMA Surgery
Brent C Pottenger, Joseph M Galante, David H Wisner
BACKGROUND: Trauma and emergency surgery continues to evolve as a surgical niche. The simple fact that The Journal of Trauma is now entitled The Journal of Trauma and Acute Care Surgery captures this reality. We sought to characterize the niche that trauma and emergency surgeons have occupied during the maturation of the acute care surgery model. METHODS: We analyzed the University Health System Consortium-Association of American Medical Colleges Faculty Practice Solutions Center database for the years 2007 to 2012 for specific current procedural terminology (CPT) codes...
January 2015: Journal of Trauma and Acute Care Surgery
Francesca Mobilia, Michelangelo B Casali, Maurizio Gallieni, Umberto R Genovese
CONTEXT: Pulmonary thromboembolism (PTE) is the severe end stage of many different diseases producing prolonged patient immobilization or a hypercoagulative state. Lethal PTE is also one of the most frequent topics for suspected medical malpractice, especially when dealing with patients originally affected by non-critical illnesses and suddenly killed by a non-prevented embolic event. The crucial forensic question about a lethal PTE is the following one: was this lethal PTE an unpreventable complication or was it a consequence of real medical malpractice? MATERIALS AND METHODS: The authors analyzed the 1999-2009 autopsy archive of the Institute of Forensic Medicine of Milan University and selected all the cases where PTE was the cause of death...
April 2014: Medicine, Science, and the Law
Samuel A Tisherman, Lewis Kaplan, Vicente H Gracias, Gregory J Beilman, Christine Toevs, Matthew C Byrnes, Craig M Coopersmith
Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record...
July 2013: JAMA Surgery
Shine Raju, Anupam Kumar, Ranjit Joseph, Bimalin Lahiri
SESSION TYPE: Critical Care Student/Resident Case Report Posters IIPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Bacterial pericarditis, a rare entity in the modern antibiotic era, has high mortality rates. We describe a case of purulent pericarditis and tamponade caused by Methicillin-Resistant Staphylococcus aureus (MRSA) secondary to MRSA urosepsis.CASE PRESENTATION: A 67-year-old male was brought to the Emergency Department after being found unresponsive. He was hypothermic and hypotensive...
October 1, 2012: Chest
Jamie J Coleman, Thomas J Esposito, Grace S Rozycki, David V Feliciano
BACKGROUND: Concern over lack of resident interest caused by the nonoperative nature and compromised lifestyle associated with a career as a "trauma surgeon" has led to the emergence of a new acute care surgery (ACS) specialty. This study examined the opinions of current general surgical residents about training and careers in this new field. METHODS: A 36-item online anonymous survey regarding ACS was sent to the program directors of 55 randomly selected general surgery (GS) training programs for distribution to their categorical residents...
February 2013: Journal of Trauma and Acute Care Surgery
Jill R Cherry-Bukowiec, Barbra S Miller, Gerard M Doherty, Melissa E Brunsvold, Mark R Hemmila, Pauline K Park, Krishnan Raghavendran, Kristen C Sihler, Wendy L Wahl, Stewart C Wang, Lena M Napolitano
BACKGROUND: To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. METHODS: An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007...
November 2011: Journal of Trauma
William C Chiu, Evie G Marcolini, Dell E Simmons, Dale J Yeatts, Thomas M Scalea
BACKGROUND: The Leapfrog Group initiative has led to an increasing public demand for dedicated intensivists providing critical care services. The Acute Care Surgery training initiative promotes an expansion of trauma/surgical care and operative domain, redirecting some of our focus from critical care. Will we be able to train and enforce enough intensivists to care for critically ill surgical patients? METHODS: We have been training emergency physicians (EPs) alongside surgeons in our country's largest Trauma/Surgical Critical Care Fellowship Program annually for more than a decade...
July 2011: Journal of Trauma
Matthew D Stanley, Daniel L Davenport, Levi D Procter, Jacob E Perry, Paul A Kearney, Andrew C Bernard
BACKGROUND: Surgical resident rotations on trauma services are criticized for little operative experience and heavy workloads. This has resulted in diminished interest in trauma surgery among surgical residents. Acute care surgery (ACS) combines trauma and emergency/elective general surgery, enhancing operative volume and balancing operative and nonoperative effort. We hypothesize that a mature ACS service provides significant operative experience. METHODS: A retrospective review was performed of ACGME case logs of 14 graduates from a major, academic, Level I trauma center program during a 3-year period...
March 2011: Journal of Trauma
Samuel A Tisherman, Michael E Ivy, Spiros G Frangos, Orlando C Kirton
HYPOTHESIS: The acute care surgery (ACS) 2-year training model, incorporating surgical critical care (SCC), trauma surgery, and emergency general surgery, was developed to improve resident interest in the field. We believed that analysis of survey responses about the new training paradigm before its implementation would yield valuable information on current practice patterns and on opinions about the ACS model. DESIGN: Two surveys. PARTICIPANTS: Members of the Surgery Section of the Society of Critical Care Medicine and SCC program directors...
January 2011: Archives of Surgery
Andres Missair, Ralf Gebhard, Edgar Pierre, Lebron Cooper, David Lubarsky, Jeffery Frohock, Ernesto A Pretto
The 12 January 2010 earthquake that struck Port-au-Prince, Haiti caused >200,000 deaths, thousands of injuries requiring immediate surgical interventions, and 1.5 million internally displaced survivors. The earthquake destroyed or disabled most medical facilities in the city, seriously hampering the ability to deliver immediate life- and limb-saving surgical care. A Project Medishare/University of Miami Miller School of Medicine trauma team deployed to Haiti from Miami within 24 hours of the earthquake. The team began work at a pre-existing tent facility in the United Nations (UN) compound based at the airport, where they encountered 225 critically injured patients...
November 2010: Prehospital and Disaster Medicine
P Broos, J Jaekers, B Dupont
BACKGROUND: The golden age of trauma has gone. 25 years ago the trauma surgeon was the life saver in the emergency department. He was the leader of the resuscitation team and made the important decisions in the process. Nowadays different factors have diminished the role of the trauma surgeon. DISCUSSION: Thanks to the decrease of severely injured patients in Europe and the advances in diagnostic and treatment possibilities the approach to trauma victims is less often operative...
September 2010: Acta Chirurgica Belgica
Lena M Napolitano, Gerard J Fulda, Kimberly A Davis, Dennis W Ashley, Randall Friese, Charles W Van Way, J Wayne Meredith, Timothy C Fabian, Gregory J Jurkovich, Andrew B Peitzman
Critical care workforce analyses estimate a 35% shortage of intensivists by 2020 as a result of the aging population and the growing demand for greater utilization of intensivists. Surgical critical care in the U.S. is particularly challenged by a significant shortfall of surgical intensivists, with only 2586 surgeons currently certified in surgical critical care by the American Board of Surgery, and even fewer surgeons (1204) recertified in surgical critical care as of 2009. Surgical critical care fellows (160 in 2009) represent only 7...
December 2010: Journal of Trauma
Brendan G Carr, J Matthew Edwards, Ricardo Martinez
The 2010 Academic Emergency Medicine (AEM) consensus conference "Beyond Regionalization" aimed to place the design of a 21st century emergency care delivery system at the center of emergency medicine's (EM's) health policy research agenda. To examine the lessons learned from existing regional systems, consensus conference organizers convened a panel discussion made up of experts from the fields of acute care surgery, interventional cardiology, acute ischemic stroke, cardiac arrest, critical care medicine, pediatric EM, and medical toxicology...
December 2010: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Wakako Eklund
Japan is currently at a historic moment to recognize the significance of the team approach in medicine. There is a mismatch between the supply of physicians and demand for expert care that our patients expect and deserve. The acute care setting including surgery is considering adopting non-physician professionals such as nurse practitioners (NPs) in order to deliver a high quality of care. The NPs in acute care setting have evolved in the United States to meet the medical needs of the society over the last four decades...
July 2010: Nihon Geka Gakkai Zasshi
C G W├Âlfl, B Gliwitzky, A Wentzensen
INTRODUCTION: Standardised management improves treatment results in seriously injured patients. For conditions like stroke or acute coronary syndrome (ACS) there are set treatment pathways which have been established for prehospital and primary hospital care. The treatment of critical trauma patients, however, follows varying procedures in both the prehospital and primary hospital phases. From an analysis of the trauma register of the German Society for Trauma Surgery (DGU), we know that a seriously injured patient remains on the road for 70 min on average before transferral to hospital...
October 2009: Der Unfallchirurg
Hema J Thakar, Paul E Pepe, Rod J Rohrich
Awareness of large-scale disasters among members of the medical community and the public at large has been heightened by recent events such as the 1995 Oklahoma City bombing incident, the 2001 World Trade Center attack, and the 2005 London Underground bombings. Experience with these events has highlighted the critical role of surgical specialists, including plastic surgeons. As part of their residency, plastic surgeons are trained in acute trauma management. In addition, they also are required to demonstrate expertise in the assessment and treatment of soft-tissue injuries, upper extremity trauma, facial fractures, and both operative and nonoperative burn management...
September 2009: Plastic and Reconstructive Surgery
Amram Hadary, William Schecter, Oscar M Embon, Sharon Einav
OBJECTIVE: To study the impact of war on the workload/finances of a community hospital adjacent to the front. SUMMARY BACKGROUND DATA: Community hospitals located nearby/within military conflict zones treat trauma casualties while providing routine surgical services to the community. METHODS: Observational study conducted in Ziv hospital (1 of 3 designated receiving hospitals during the second Lebanon War (12/7/2006-14/8/2006). Data were documented in real-time and retrieved retrospectively from computerized databases...
March 2009: Annals of Surgery
Andrew B Peitzman
Acute Care Surgery (ACS) is an evolving specialty. The components, as defined by the American Association for the Surgery of Trauma are trauma, surgical critical care and emergency surgery. As documented by the recent reports from the Institute of Medicine, the shortage of surgical specialists who make themselves available for emergency care in the United States, the overcrowding of emergency departments and lack of surge capacity are reaching crisis conditions. The Institute of Medicine has recommended the development of regional centers of surgical specialists, analogous to trauma systems...
January 2008: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
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