American journal of surgery
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Most trauma centers incorporate mechanistic criteria (MC) into their algorithm for trauma team activation (TTA). We hypothesized that characteristics of the crash are less reliable than restraint status in predicting significant injury and the need for TTA. ⋯ Improper restraint is an independent predictor of necessitating TTA in this single-institution study.
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Clostridium difficile-associated infection (CDI) can have varying severity from asymptomatic carriage to fulminant colitis. Its incidence and virulence in North America are increasing. The increase in virulence is associated with emergence of the highly toxigenic North American pulsed field gel electrophoresis-1 strain. ⋯ Another major risk factor is hospitalization. The spectrum of CDI ranges from asymptomatic carriers to fulminant disease. Although asymptomatic carriers require no treatment, fulminant disease carries a substantial mortality regardless of management strategy.
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The open abdomen is a necessary sequela after damage-control surgery or abdominal compartment syndrome. Management of the patient in the intensive care unit continues to evolve, with considerations of fluid resuscitation, enteral nutrition, and supportive care. Management of the abdominal contents incorporates several basic techniques and considerations: appropriate temporary covering, enteric injury repair in most patients, placement of an anastomosis in an area of the abdomen with minimal manipulation without exposure to the atmosphere, acquiring enteral access for initiation of enteral nutrition, and ultimate abdominal closure. An understanding of these complex factors is instrumental for the practicing surgeon.
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Enteral feeding tube placement has been performed by nurses, gastroenterologists using endoscopy, and interventional radiologists. We hypothesized that midlevel providers placed feeding tubes at bedside using fluoroscopy safely, rapidly, and cost-effectively. ⋯ The placement of feeding tubes under fluoroscopy by nurse practitioners is safe, timely, and cost-effective.