J Trauma
-
Modern surgical care must meet high standards of quality but must also be cost-effective. Critical care uses huge amounts of resources, and strategies for effective use of scarce, expensive intensive care unit beds must be implemented. Previously, we demonstrated that ancillary expenditures can be decreased without compromising care. The present study was performed to determine whether our cost-containment strategies were durable and could be extended to areas, such as chest roentgenography, where savings previously proved elusive. ⋯ Durable reductions in physician-ordered ancillary expenditures are possible without compromising the standard of care of critically ill patients, but active management and daily reinforcement are necessary to the process. Shorter length of stay and lower costs benefit the patient, the surgeon, the intensivist, and the institution.
-
As nonoperative management of blunt abdominal trauma has become more popular, reliable models for predicting the likelihood of concomitant hollow viscus injury in the hemodynamically stable patient with a solid viscus injury are increasingly important. ⋯ A model of organ injury scaling predicted hollow viscus injury. Multiple solid viscus injuries, particularly pancreatic, or abdominal solid viscus injuries with an AIS score > or = 6, were predictive of hollow viscus injury. Identification of these injury patterns should prompt consideration for early operative intervention.
-
Case Reports
Posterior fracture-dislocation of the shoulder with infraspinatus interposition: the buttonhole phenomenon.
We present a case with a posterior fracture-dislocation in which interposition of the infraspinatus precluded closed reduction by means of standard manipulation. The fractured greater tuberosity included the lesser tuberosity, allowing the infraspinatus to dislocate anterior to the dislocated humeral head and interpose between the humeral head and the glenoid cavity. ⋯ Traction in the zero-position was thus required for resolution of constriction and subsequent reduction. Computed tomography was useful to demonstrate interposition of the infraspinatus and to plan the treatment.
-
Case Reports
Aortoventricular fistula secondary to blunt trauma: a case report and review of the literature.
An aorto-right ventricular fistula secondary to nonpenetrating trauma is described. Review of the literature is reported. ⋯ Blunt cardiac injury is a frequent concomitant injury and contributes to the high mortality of this lesion. Prompt surgical intervention is required for survival.