The Journal of surgical research
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Goal-directed hemostatic resuscitation based on thrombelastography has a survival benefit compared to conventional coagulation assays. While thrombelastography transfusion thresholds for patients at risk for massive transfusion (MT) have been defined, similar cutoffs do not exist for the other commonly used viscoelastic assay, rotational thromboelastometry (ROTEM). The purpose of this study was to develop ROTEM blood product thresholds in patients at risk for MT. ⋯ We have identified ROTEM thresholds for transfusion of blood components in severely injured patients requiring an MT. Based on our analysis, we propose plasma transfusion for EXTEM CT > 78.5 s, fibrinogen for angle <64.5°, platelet transfusion for CA10 < 40.5 mm, and antifibrinolytics for CLI60 < 74%.
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Nonoperative management (NOM) of penetrating solid organ injuries (SOI) has not been well described in the pediatric population. The objective of this study was to characterize the epidemiology, injury patterns, and factors associated with trial and failure of NOM. ⋯ NOM can be safe in a carefully selected group of pediatric patients with penetrating SOI. Future prospective studies are warranted to validate its feasibility.
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The purpose of this study was to identify factors during trauma evaluation that increase the likelihood of errors in cervical spine immobilization ('lapses'). ⋯ Errors in cervical spine immobilization were frequently observed during the initial evaluation of injured children. Strategies to reduce these errors should target approaches to head and neck management during the primary and secondary phases of trauma evaluation.
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Surgical residents increasingly seek global surgery (GS) experiences during training. Understanding their motives and goals is important to develop the optimal educational programs. A survey for surgical residents was developed to explore this interest. ⋯ Institutional interest in GS remains high among surgical residents, motivated primarily by a desire for volunteerism. Following training, most residents plan to participate in short-term volunteer commitments, though a small group envisions GS as part of their long-term career goals. Prior global health experience is associated with interest in GS both in the present and long term. Providing these experiences early may be a strategy to support academic interest.
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Randomized Controlled Trial
Chlorhexidine bathing and Clostridium difficile infection in a surgical intensive care unit.
Clostridium difficile is the most common causative pathogen for hospital-acquired infections in the intensive care unit. This study evaluated the effect of chlorhexidine bathing every other day in preventing hospital-acquired C. difficile infection (CDI) using data from the CHlorhexidine Gluconate BATHing (CHG-BATH) randomized trial. ⋯ It is inconclusive if there was an association between chlorhexidine bathing and incidence of CDI among surgical intensive care unit patients in this study as statistical power was limited. There are limited published data evaluating the association between chlorhexidine bathing and CDI, and this study provides data for future systematic reviews and meta-analyses.