The American surgeon
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The American surgeon · Mar 2005
Comparative StudyA burn mass casualty event due to boiler room explosion on a cruise ship: preparedness and outcomes.
The purpose of this study was to review our experience with a mass casualty incident resulting from a boiler room steam explosion aboard a cruise ship. Experience with major, moderate, and minor burns, steam inhalation, mass casualty response systems, and psychological sequelae will be discussed. Fifteen cruise ship employees were brought to the burn center after a boiler room explosion on a cruise ship. ⋯ Fluid requirements far exceeded those predicted by the Parkland (Baxter) formula. Abdominal compartment syndrome proved to be a significant complication of this fluid resuscitation. A coordinated effort by the facility and preparation for mass casualty events are needed to respond to such events.
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The American surgeon · Mar 2005
Comparative StudySurgical complications and causes of death in trauma patients that require temporary abdominal closure.
Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. ⋯ The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.
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The American surgeon · Mar 2005
Case ReportsDiverticular abscess presenting as an incarcerated inguinal hernia.
Acute diverticulitis may present with an abscess that is usually pericolonic or pelvic and can be treated with urgent surgery or percutaneous drainage. We present a case of a diverticular abscess presenting as a left inguinal hernia. This is analogous to an Amyand's hernia in which an inflamed appendix is found in a right inguinal hernia. The patient presented was managed with open drainage of the hernia and subsequent laparoscopic sigmoid resection in the same hospitalization.
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The American surgeon · Mar 2005
Case ReportsSmall bowel ischemia after Roux-en-Y gastric bypass complicated by pregnancy: a case report.
Small bowel obstruction is an unusual complication of pregnancy. Its occurrence after Roux-en-Y gastric bypass (RYGB) for morbid obesity complicated by pregnancy is rare. Morbid obesity describes body weight at least 100 lb over the ideal weight, or a body mass index (BMI) > or = 40. ⋯ Gastrointestinal continuity was achieved by fashioning a gastro-gastrostomy and a jejuno-jejunostomy, thus reversing the original gastric bypass procedure. The immediate postoperative period was complicated by fetal demise. With the increase in bariatric surgery, small bowel ischemia after Roux-en-Y gastric bypass will most likely become more prevalent, particularly in women of childbearing age.
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Physicians and other advanced medical personnel commonly perform subclavian vein cannulation. Success depends on adequate knowledge of the anatomy. With this knowledge subclavian vein cannulation can be performed with low complication rates. The manuscript reviews the anatomy and the literature of subclavian vein cannulation.