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Mashup Score: 4Use of barium for diagnosis of colonic perforation leads to challenging barium peritonitis - 3 day(s) ago
A patient in their 60s with obesity (body mass index 49.3) presented with abdominal pain after a screening colonoscopy. At the outside hospital, a barium enema was performed which demonstrated extravasation of barium into the peritoneum. Figure 1A demonstrates the patient’s scout film from their CT abdomen/pelvis (CTAP) scan after barium enema. They were transferred to our quaternary referral center for emergent evaluation, and on arrival, they were afebrile and tachycardic. Abdominal examination demonstrated lower abdominal peritonitis and prominent ventral hernia with overlying skin changes. (figure 2A) Figure 1 (A) Patient’s scout CT film on presentation to emergency department and (B) 1 month after initial operation. Figure 2 Intraoperative photos including (A) external abdomen prior to exploratory laparotomy and (B) adherent serosal silver-white barium deposits present upon entry into the abdomen. 1. CTAP with intravenous contrast 2. CTAP with oral contrast 3. CTAP with water-solu
Source: tsaco.bmj.comCategories: General Medicine News, CardiologistsTweet
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Mashup Score: 36Win or lose, nighttime transcystic laparoscopic common bile duct exploration is a win - 5 day(s) ago
Objectives Although controversial, recent data suggest nighttime versus daytime laparoscopic cholecystectomy (LC) have comparable outcomes. Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis decreases length of stay (LOS) as compared with LC with endoscopic retrograde cholangiopancreatography (ERCP) but increases case complexity/time. The influence of time of day on LCBDE outcomes has not been evaluated. Our aim was to examine outcomes and LOS for nighttime (PM) compared with daytime LC+LCBDE (DAY). Methods Consecutive patients who underwent LCBDE were reviewed. Demographics, operative duration, success of LCBDE, time to postoperative ERCP (if required), LOS, and complications were compared. PM procedures were defined as beginning 19:00–07:00 hours. Results Between 2018 and 2022, sixty patients underwent LCBDE (PM 42%). Groups had equivalent age/sex and preoperative liver function tests (LFTs). LCBDE success was 69% PM versus 71% DAY (p=0.78). Operative duration
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Mashup Score: 38Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management - 7 day(s) ago
The term “open abdomen” refers to a surgically created defect in the abdominal wall that exposes abdominal viscera. Leaving an abdominal cavity temporarily open has been well described for several indications, including damage control surgery and abdominal compartment syndrome. Although beneficial in certain patients, the act of keeping an abdominal cavity open has physiologic repercussions that must be recognized and managed during postoperative care. This review article describes these issues and provides guidelines for the critical care physician managing a patient with an open abdomen.
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Mashup Score: 53Homepage | Trauma Surgery & Acute Care Open - 11 day(s) ago
TSACO is an open access journal publishing high-quality epidemiological, educational, and socioeconomic research on trauma surgery and critical care.
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Mashup Score: 18Victory out of tragedy: organ donation - 20 day(s) ago
Major improvements in trauma care during the last decade have improved survival rates in the severely injured. The unintended consequence is the presentation of patients with non-survivable injuries in a time frame in which intervention is considered and often employed due to prognostic uncertainty. In light of this, discerning survivability in these patients remains increasingly problematic. Evidence-based cut-points of futility can guide early decisions for discontinuing aggressive treatment and use of precious resources in severely injured patients arriving in extremis.
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Mashup Score: 34
The last two decades have seen increased efforts at early identification of those likely to require life-saving interventions such as rapid response teams, massive transfusion delivery, extracorporeal membrane oxygenation, and emergent surgical procedures.1–3 However, it was not until recently that this same level of interest was directed at limiting early interventions in severely injured patients where such efforts might be futile. Not surprisingly, it was the COVID-19 pandemic and its disruption of vital supply chains that brought this to the forefront. During the early months of the COVID-19 pandemic, a 50% reduction in blood donations was offset by a significant drop in demand for products due to restrictions on elective surgery.4 However, as society and its institutions began reopening, with surgical schedules returning to ‘normal’ and trauma volumes rebounding, the supply of blood required was unable to keep up. Adding to this was an increase in trauma, particularly penetrating
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Mashup Score: 20You’ve Been Served, Now What? Malpractice tips and prevention for the acute care surgeon - 20 day(s) ago
Trauma and acute care surgeons commonly perform high acuity and emergent interventions on critically ill or injured patients. This often entails making life or death decisions rapidly and with incomplete and imperfect information, and in patients who may have a variety of comorbidities that contribute to the risk of adverse outcomes. In cases where there are real or perceived breaches of care, a medical malpractice claim may result. In the USA, approximately one-third to one-half of all physicians will be named in medical litigation at least once in their career. Among the various specialties, surgery remains among the highest risk for malpractice litigation, at an average of 10.6 defendants per 100 surgeons. These events can be extremely stressful, demoralizing, or even devastating to the career and well-being of the involved physicians. This can be made better or worse by the individual response and actions of the surgeon on notification of a real or potential claim, and the primary
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Mashup Score: 1Meshing around: high-risk hernias and infected mesh - 21 day(s) ago
Open laparotomy carries a risk up to 20% for an incisional hernia, making repair one of the most common operations performed by general surgeons in the USA. Despite a multitude of mesh appliances and techniques, no size fits all, and there is continued debate on what is the best mesh type, especially in high-risk patients with contaminated hernias. Infected mesh carries a significant burden to the patient, the surgeon and overall healthcare costs with medical legal implications. A stepwise approach that involves optimization of patient comorbidities, patient selective choice of mesh and technique is imperative in mitigating outcomes and recurrence rates. This review will focus on the avoidance of mesh infection and the selection of mesh in patients with contaminated wounds.
Source: tsaco.bmj.comCategories: General Medicine News, GastroenterologyTweet
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Mashup Score: 6
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) provides a new tool in selected patients for the management of non-compressible torso hemorrhage.1–3 Recent improvements in technology have facilitated more rapid placement through smaller femoral access sheaths, which may reduce access-related complications.4 However, high grade evidence to guide REBOA use is limited, and there is a substantial complication risk should this approach be used inappropriately.5 To address the current state of implementation of this new therapeutic strategy, the American College of Surgeons Committee on Trauma (ACS COT) has worked in collaboration with the American College of Emergency Physicians to issue this joint policy statement which addresses the current practice relevant to patient indications, potential complications, implementation, patient management, and training of providers. We urge trauma centers to consider these factors in the adoption of this approach.
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Mashup Score: 6Early and late complications of bariatric operation - 21 day(s) ago
Weight loss surgery is one of the fastest growing segments of the surgical discipline. As with all medical procedures, postoperative complications will occur. Acute care surgeons need to be familiar with the common problems and their management. Although general surgical principles generally apply, diagnoses specific to the various bariatric operations must be considered. There are anatomic considerations which alter management priorities and options for these patients in many instances. These problems present both early or late in the postoperative course. Bariatric operations, in many instances, result in permanent alteration of a patient’s anatomy, which can lead to complications at any time during the course of a patient’s life. Acute care surgeons diagnosing surgical emergencies in postbariatric operation patients must be familiar with the type of surgery performed, as well as the common postbariatric surgical emergencies. In addition, surgeons must not overlook the common causes
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RT @TSACO_AAST: Find out more on what these authors did: https://t.co/DLjjMLc2dv https://t.co/gGIN2weh5t