Journal of the American College of Surgeons
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In July 2007, we introduced an acute care surgery service to an academic department of surgery staffed in a prearranged, dedicated rotation by critical care-trained surgeons to address all emergency department, inpatient, and transfer consultations. This study is designed to evaluate the impact on patient care and describe the case-mix experienced. ⋯ Implementation of an acute care surgery service has been positive in terms of facilitating the ability to provide more timely care by increasingly using the daytime operating room and providing a breadth of consultative and operative experience to the participating academic surgeons and trainees.
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Service in the deployed military environment carries risks for accidental (noncombat-related) burns. Examining these risks can assist in the development of military burn prevention measures. This study endeavored to examine noncombat burn epidemiology in the context of similar civilian data. ⋯ Deployed service members have a greater risk of unintentional burns than a similar civilian cohort does. This is in part because of the specific dangers of military activities. More attention to deployed military burn prevention is needed, especially early in combat support operations.
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Shock is a prime inciting event for postinjury multiple organ failure (MOF), believed to induce a state of injurious systemic inflammation. In animal models of hemorrhagic shock, early (< 24 hours) changes in cytokine production are an index of the systemic inflammatory response syndrome. However, their predictive value in trauma patients remains to be fully elucidated. ⋯ These data provide insight into cytokine expression during traumatic shock that can enable earlier identification of patients at risk for development of MOF.
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The concept of increased medical errors in July, secondary to new residents (the "July phenomenon"), often receives considerable attention without supporting evidence. A recent study reported a 41% increase in mortality during July and August in general surgery patients. The objective of this study was to determine if a July phenomenon existed in a Level I trauma center with an attending present at all times. ⋯ The July phenomenon does not exist at this Level I trauma center with in-hospital attending supervision.