Current surgery
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To determine whether interdepartmental educational and technical resources could be combined to successfully train surgery and emergency medicine residents in common diagnostic and therapeutic trauma skills outside the traditional hospital setting. ⋯ Interdepartmental collaboration between the Department of Surgery and Department of Emergency Medicine offered a unique training relationship that was a positive educational experience for all residents.
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The integrity of the hypothalamic-pituitary-adrenal (HPA) axis is a major determinant of the host response to stress. Recent studies have proven that low doses of hydrocortisone and fludrocortisone can significantly reduce mortality in patients with relative adrenal insufficiency (RAI) without increasing adverse events. ⋯ Relative adrenal insufficiency after trauma is rare. In RAI, clear signs and symptoms are usually absent. The clinical diagnostic clue may be the unexplained hypotension and the resistance to inappropriately high doses of inotropes and vasoactive agents. The hemodynamic profile often shows a hyperdynamic state of high cardiac output and a low systemic vascular resistance. Baseline serum cortisol levels did not correlate with injury severity scores in this group of patients, which suggests a defect in the HPA axis. An intensive care unit day stay of greater than or equal to 20 days, ventilator dependence/acute respiratory distress syndrome, and a hyperdynamic state mandates consideration of endocrine testing to exclude RAI. Physiologic doses of hydrocortisone can reverse this potentially life-threatening syndrome.
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The weekly Morbidity and Mortality (M&M) conference, a Residency Review Committee on Surgery required conference, is a hallmark of general surgery residency training. This conference has been used traditionally to teach and assess the ACGME General Competencies of patient care and medical knowledge. The author's department has changed the format of their weekly M&M conference so that it enables them to teach and assess residents also in terms of the ACGME General Competencies of practice-based learning and improvement, professionalism, interpersonal and communication skills, and systems-based practice. ⋯ The restructuring of the M&M conference so that a case is analyzed with all ACGME General Competencies has made the M&M conference more interesting and has improved the educational aspects of the conference. Analyzing a case according to the various ACGME General Competencies has provided another method to teach these competencies to their residents and a tool to determine whether the residents are meeting the competencies.