Journal of surgical education
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Comparative Study
ACGME duty-hour restrictions decrease resident operative volume: a 5-year comparison at an ACGME-accredited university general surgery residency.
We compared the operative experience of chief residents at the Michigan State University Integrated Residency Program in General Surgery before and after duty-hour restrictions mandated by the Accreditation Council for Graduate Medical Education. ⋯ Our data suggest that restriction of resident duty hours is associated with a significant decrease in operative experience.
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Decisions regarding admissions/discharges in the surgical intensive care unit (SICU) can potentially strain the relationship between the critical care team and the primary surgery service. We hypothesized that a multidisciplinary system of arbitration, led by an intensivist, is a safe and workable solution to SICU patient triage, which leads to consensus between critical care team and primary services. ⋯ A dedicated intensivist, supported by a multidisciplinary team, can make arbitration decisions in the SICU that seem to be safe and generally concordant with the primary surgical team of the patient. Additional larger-scale investigation of arbitration in the SICU is warranted.
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Tourniquet use for extremity hemorrhage control is common in military trauma. Tourniquet use may be accompanied by systemic hypotension, but this phenomenon has not been studied. We aimed to define the muscle effects of the combined insult of tourniquet-induced skeletal muscle ischemia-reperfusion injury (I-R) and hemorrhagic hypotension. ⋯ Systemic hypotension modulates the impact of 4 hours of tourniquet ischemia by decreasing muscle edema but minimally altering measures of muscle viability. Compartment anatomy and muscle fiber type both influence muscle response to the combined insult of hypotension and I-R. In this model, hypotension did not worsen the skeletal muscle I-R observed after the use of a tourniquet for 4 hours.