Abdominal intercostal hernia: a rare complication after blunt trauma.

Abdominal intercostal hernia (AIH) is uncommonly reported in the literature with only 20 cases reported to date.1–3 We report a case of a delayed incarcerated AIH secondary to blunt trauma from a motor vehicle accident in which the colon and diaphragm herniated through an associated chest defect that was repaired successfully through a transabdominal approach using primary repair of the defect in combination with onlay porcine patch reinforcement

Spontaneous Intracranial Hemorrhage in a 29-Year-Old Male: A Case Report

Spontaneous intracranial hemorrhage is rare, especially in a young patient population. Signs and symptoms of intracranial hemorrhage include facial droop, vision loss, motor deficits with extraocular movements, deficits with tongue movement, weakness in the arms or legs, sensation loss, and mental status change. This is a case report of a 29-year-old male with no past medical history who presented for a spontaneous intracranial hemorrhage. This patient\u27s only neurologic deficit was the loss of visual field on the left inferior quadrant of his field of vision. The patient obtained a CT head non-contrast which showed 21 mm acute right occipital hemorrhage medially with mild surrounding vasogenic edema. The patient’s blood pressure was lowered with a blood pressure goal of less than 160 systolic blood pressure with a nicardipine drip of 5 mg/hr. The patient was admitted to the intensive care unit for further management of intracranial hemorrhage and neurosurgical evaluation. This case report helps to educate medical providers on the importance of a thorough neurologic exam and the possibility of an intracranial hemorrhage occurring despite age

Reduced Length of Stay in Major Hepatectomy Surgery After Implementation of an Enhanced Recovery Pathway in the United States Veteran Population

Introduction Enhanced recovery after surgery (ERAS) pathways are associated with better postoperative recovery, however, evidence is lacking in major liver surgery, .This study aimed to evaluate the impact of an ERAS pathway in U.S. veterans undergoing major hepatectomy surgery. We hypothesized that the adoption of an ERAS pathway reduces decreased length of stay (LOS). Methods After approval from the Hunter Holmes McGuire VA Medical Center IRB, we compared data from consecutive patients undergoing elective open hepatectomy within an ERAS pathway (January 2019-December 2019) to a previous cohort of patients before introduction of ERAS (July 2016-December 2017). One surgeon performed all the procedures. LOS and perioperative narcotic usage were analyzed for both cohorts. Pre-operative components of the protocol included patient education, avoidance of bowel preparation, and consumption of clear carbohydrate drinks until two hours prior to surgery. Intraoperative measures included standardized anesthetic management, minimizing the use of opiates, and favoring regional anesthesia. Post-operative components included avoidance of nasogastric tubes, encouragement of liquids immediately after surgery, and early ambulation. Results A total of 24 patients were evaluated. Eight completed the ERAS pathway versus sixteen in the traditional group. There was a clinically significant reduction in LOS in the ERAS group (7.5 days +/- 4.9) compared to traditional care (10 +/- 5.9, p=0.07). Patient in the ERAS group also had lower intraoperative morphine equivalent consumption (65.6mg +/-38.6) than the control group (104.7mg +/- 38.7, p=0.04) and less need for postoperative PCA (0% vs 73%, p=0.00046). Conclusion The implementation of ERAS for major hepatectomy in a U.S. Veteran population translates into decreased LOS and perioperative opioid consumption

Comparison of 18 and 20-Gauge Ultrasound-Guided Fine-Needle Aspiration in Detecting Persistent Nodal Disease after Chemoradiation

https://openworks.mdanderson.org/sumexp23/1065/thumbnail.jp

Assessment of Emergency Medicine Resident Performance in an Adult Simulation Using a Multisource Feedback Approach.

Introduction: The Accreditation Council for Graduate Medical Education (ACGME) specifically notes multisource feedback (MSF) as a recommended means of resident assessment in the emergency medicine (EM) Milestones. High-fidelity simulation is an environment wherein residents can receive MSF from various types of healthcare professionals. Previously, the Queen\u27s Simulation Assessment Tool (QSAT) has been validated for faculty to assess residents in five categories: assessment; diagnostic actions; therapeutic actions; interpersonal communication, and overall assessment. We sought to determine whether the QSAT could be used to provide MSF using a standardized simulation case. Methods: Prospectively after institutional review board approval, residents from a dual ACGME/osteopathic-approved postgraduate years (PGY) 1-4 EM residency were consented for participation. We developed a standardized resuscitation after overdose case with specific 1-5 Likert anchors used by the QSAT. A PGY 2-4 resident participated in the role of team leader, who completed a QSAT as self-assessment. The team consisted of a PGY-1 peer, an emergency medical services (EMS) provider, and a nurse. Two core faculty were present to administer the simulation case and assess. Demographics were gathered from all participants completing QSATs. We analyzed QSATs by each category and on cumulative score. Hypothesis testing was performed using intraclass correlation coefficients (ICC), with 95% confidence intervals. Interpretation of ICC results was based on previously published definitions. Results: We enrolled 34 team leader residents along with 34 nurses. A single PGY-1, a single EMS provider and two faculty were also enrolled. Faculty provided higher cumulative QSAT scores than the other sources of MSF. QSAT scores did not increase with team leader PGY level. ICC for inter-rater reliability for all sources of MSF was 0.754 (0.572-0.867). Removing the self-evaluation scores increased inter-rater reliability to 0.838 (0.733-0.910). There was lesser agreement between faculty and nurse evaluations than from the EMS or peer evaluation. Conclusion: In this single-site cohort using an internally developed simulation case, the QSAT provided MSF with excellent reliability. Self-assessment decreases the reliability of the MSF, and our data suggest self-assessment should not be a component of MSF. Use of the QSAT for MSF may be considered as a source of data for clinical competency committees

Injury Due to Mechanical Falls: Future Directions in Gender-specific Surveillance, Screening, and Interventions in Emergency Department Patients.

The Centers for Disease Control and Prevention report that among older adults (≥65 years), falls are the leading cause of injury-related death. Fall-related fractures among older women are more than twice as frequent as those for men. Gender-specific evidence-based fall prevention strategy and intervention studies show that improved patient-centered outcomes are elusive. There is a paucity of emergency medicine literature on the topic. As part of the 2014 Academic Emergency Medicine (AEM) consensus conference on Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes, a breakout group convened to generate a research agenda on priority questions to be answered on this topic. The consensus-based priority research agenda is presented in this article