American journal of surgery
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Trauma surgery has changed significantly over the past decade. Nonoperative evidence-based algorithms have become common and surgical trauma volume has become increasingly difficult to maintain. The acute care surgery (ACS) model, which integrates trauma, critical care, and emergency surgery, has been proposed as a future model of trauma practice. ⋯ Surgical practice in a county-run trauma hospital can be similar to the ACS model, with positive results in terms of clinical volume and physician satisfaction. As clinical practices shift to the ACS model, there are lessons to be learned from currently existing, thriving, long-standing similar prototypes.
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We hypothesized that early use of external mechanical compression (EMC) reduces hemorrhage and mortality associated with pelvic fractures. ⋯ Early EMC with pelvic binders does not reduce hemorrhage or mortality associated with pelvic fractures.
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Multicenter Study
Ultrasound facilitates minimally invasive parathyroidectomy in patients lacking definitive localization from preoperative sestamibi scan.
Sestamibi scanning is commonly used for preoperative localization in patients with hyperparathyroidism. However, 12% to 15% of these studies are equivocal or negative. Ultrasound may also be used to identify patients suitable for a minimally invasive parathyroidectomy. ⋯ In patients with nonlocalizing sestamibi scans, neck ultrasound increases the number of patients suitable for minimally invasive parathyroidectomy.
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Focused assessment with sonography for trauma (FAST) has become commonplace in the management of blunt abdominal trauma. However, newer computed tomography (CT) scanners have decreased imaging time for trauma patients and provide more detailed examination of abdominal contents. It was the aim of the current study to evaluate practice patterns of FAST and abdominal CT in blunt trauma victims. ⋯ FAST examinations can identify patients at risk for hemorrhage and in whom operation may be needed and, therefore, can guide mobilization of hospital resources. FAST-negative patients can be managed expectantly, using more specific imaging techniques.