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.
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Case Reports
Bloodless surgery in a Jehovah's Witness patient with a 12.7-kg uterine leiomyosarcoma.
Bloodless surgery aims to optimize outcomes in patients undergoing surgical procedures who wish to avoid allogeneic transfusion. Using a series of interventions and management strategies related to this goal, patients who were previously considered extremely high risk or inoperable without a blood transfusion can now undergo complex surgical procedures with acceptable outcomes. The techniques of bloodless surgery have been incorporated in order to care for a patient with a large uterine sarcoma with involvement and invasion into adjacent organs. ⋯ Bloodless surgery in patients with a potential for large-volume intraoperative blood loss requires a well-organized systematic, multidisciplinary approach to achieve the best possible outcome.
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Acute limb compartment syndrome (LCS) is a limb-threatening and occasionally life-threatening condition caused by bleeding or edema in a closed muscle compartment surrounded by fascia and bone, which leads to muscle and nerve ischemia. Well-known causative factors are acute trauma and reperfusion after treatment for acute arterial obstruction. Untreated compartment syndrome usually leads to muscle necrosis, limb amputation, and, if severe, in large compartments, renal failure and death. ⋯ The techniques of measuring ICP have advantages and disadvantages, whereas the pressure level that mandates fasciotomy is controversial. Increased awareness of the syndrome and the advent of measurements of ICP pressure have raised the possibility of early diagnosis and treatment. This review reports LCS, including etiology, pathophysiology, diagnosis, ICP measurement, management, and outcome.