The American surgeon
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Pancreatic injuries are rare, with penetrating mechanisms being causative in majority of cases. They can create major diagnostic and therapeutic challenges and require multiple diagnostic modalities, including multislice high-definition computed tomography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, ultrasonography, and at times, surgery and direct visualization of the pancreas. Pancreatic trauma is frequently associated with duodenal and other severe vascular and visceral injuries. ⋯ Wide surgical drainage is a key to any surgical trauma technique and access for enteral nutrition, or occasionally parenteral nutrition, are important adjuncts. Morbidity associated with pancreatic trauma is high and can be quite severe. Treatment of pancreatic trauma-related complications often requires a combination of interventional, endoscopic, and surgical approaches.
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The American surgeon · Dec 2008
ReviewCurrent evidence based guidelines for factor VIIa use in trauma: the good, the bad, and the ugly.
Recombinant factor VII (rFVIIa) has arisen as an option for the control of life-threatening traumatic bleeding unresponsive to other means. The timing of administration, dosage, mortality, units of blood transfusion saved, risk of thrombotic events, and risk/benefits ratio are presently poorly defined. A Medline search from 1995 through March 2008 was conducted. ⋯ There is Level I supporting the use of rFVIIa for blunt trauma patients only. There is no Class I evidence supporting decreased mortality or differences in thromboembolic events. Minimal effective dosing regimens and cost/benefit analyses have not yet been examined.
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The American surgeon · Dec 2008
Does fever at the time of discharge have any impact on the incidence of readmission?
Most physicians believe that patients who have fever within 24 hours of the planned date of discharge should be kept in the hospital until the fever resolves. A search of the literature revealed very few articles addressing this topic. The object of this study was to review a number of patient discharges from the surgical service and to document the presence or absence of fever within 24 hours of the time of discharge. ⋯ The rate of readmission for fever and nonfever patients was not statistically significantly different (P = 0.697). Similarly, the rate of related versus nonrelated diagnoses in both the fever and nonfever groups was not statistically significantly different (P = 0.351). The presence or absence of fever within 24 hours of patient discharge seems to have no impact on the rate of readmission within 30 days.
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The American surgeon · Nov 2008
On-scene intravenous line insertion adversely impacts prehospital time in rural vehicular trauma.
Fatality rates from rural vehicular trauma are almost double those found in urban settings. Increased emergency medical services (EMS) prehospital time has been implicated as one of the causative factors for higher rural fatality rates. Advanced Trauma Life Support guidelines suggest scene time should not be extended to insert an intravenous catheter (IV). ⋯ Excluding dead on-scene patients, mean EMS time on-scene when mortalities occurred in rural and urban settings was 18.9 minutes and 10.8 minutes, respectively (P < 0.005). On-scene IV insertion occurred with significantly greater frequency in rural than urban settings. This incurs greater EMS time on-scene and prehospital time that may be associated with increased vehicular fatality rates in rural settings.