American journal of surgery
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Hemoglobin is a frequently obtained test in hospital settings. We analyzed accuracy of a noninvasive device compared to standard laboratory analyzers in a variety of settings. ⋯ Overall, the noninvasive spot-check hemoglobin device is reliable and highly correlates to standard hemoglobin analysis. Use in an austere setting requires further study.
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Gastroschisis is a newborn anomaly requiring emergent surgical intervention. We review our experience with gastroschisis to examine trends in contemporary surgical management. ⋯ Following introduction of a less invasive technique for gastroschisis repair, most infants with gastroschisis were able to be repaired primarily. Primary repair should be considered in all babies with gastroschisis and favorable anatomy.
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A hypercoagulable state following intra-abdominal malignant resections has been reported. Whether this is because of the operation or the malignancy, a known cause of hypercoagulability, remains unclear. We determined if malignancy status affected the coagulation profile following liver resection by assessing perioperative thromboelastogram (TEG) values. ⋯ Following liver resection, no differences in TEG values existed between patients with benign and malignant disease; the relative hypercoagulable state is more likely driven by postoperative coagulopathy rather than the malignancy status of the patient.
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Observational Study
Effect of paravertebral nerve blocks on narcotic use after mastectomy with reconstruction.
Pain control outcomes using local anesthetic delivery systems vs usual narcotics at our institution revealed that use of local anesthetic delivery systems decreased narcotic use greater than 40% in patients with no reconstruction but had very little effect in patients receiving reconstruction. As part of our quality improvement program, the anesthesiology department trained and began offering paravertebral blocks (PVBs) to patients having reconstruction. We reviewed pain control outcomes to understand how the use of paravertebral nerve blocks affected narcotic use in reconstructed patients. ⋯ Institution of the PVB for patients undergoing mastectomy with reconstruction lowered average MSE use. We will continue to offer paravertebral blocks in this cohort of patients.
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Standard triage systems result in high rates of overtriage to achieve acceptably low undertriage. We previously validated optimal triage variables and used these to implement a new simplified triage system (NEW) at our hospital. ⋯ The NEW simplified triage system significantly reduced the rate of overtriage, while safely maintaining a low undertriage rate.