An update on nonoperative management of the spleen in adults

Many patients with blunt splenic injury are considered for nonoperative management and, with proper selection, the success rate is high. This paper aims to provide an update on the treatments and dilemmas of nonoperative management of splenic injuries in adults and to offer suggestions that may improve both consensus and patient outcomes

To Sleep, Perchance to Dream: Acute and Chronic Sleep Deprivation in Acute Care Surgeons

Background Acute and chronic sleep deprivation are significantly associated with depressive symptoms and felt to be contributors to the development of burnout. In-house call (IHC) inherently includes frequent periods of disrupted sleep and is common amongst acute care surgeons (ACS). The relationship between IHC and sleep deprivation (SD) amongst ACS has not been previously studied. The goal of this study was to determine prevalence and patterns of SD in ACS. Study Design: A prospective study of ACS with IHC responsibilities from two Level I trauma centers was performed. Participants wore a sleep tracking device continuously over a 3-month period. Data collected included age, gender, schedule of IHC, hours and pattern of each sleep stage (light, slow wave (SWS), and REM), and total hours of sleep. Sleep patterns were analyzed for each night excluding IHC and categorized as normal (N), acute sleep deprivation (ASD), or chronic sleep deprivation (CSD). Results 1421 nights were recorded amongst 17 ACS. (35.3% female; ages 37-65, mean 45.5 years). Excluding IHC, average amount of sleep was 6.54 hours with 64.8% of sleep patterns categorized as ASD or CSD. Average amount of sleep was significantly higher on post-call day 1 (6.96 hours, p=0.0016), but decreased significantly on post-call day 2 (6.33 hours, p=0.0006). Sleep patterns with ASD and CSD peaked on post-call day 2, and returned to baseline on post-call day 3 (p=0.046). Conclusion Sleep patterns consistent with ASD and CSD are common amongst ACS and worsen on post-call day 2. Baseline sleep patterns were not recovered until post-call day 3. Future study is needed to identify factors which impact physiologic recovery after IHC and further elucidate the relationship between SD and burnout

A Prospective Study of a Focused, Surgeon-Performed Ultrasound Examination for the Detection of Occult Common Femoral Vein Thrombosis in Critically Ill Patients

Hypothesis A focused, surgeon-performed ultrasound examination of the common femoral veins is an accurate screening tool for the detection of common femoral vein thrombosis in high-risk, critically ill patients. Design A prospective study using a focused ultrasound examination for findings consistent with deep vein thrombosis of the common femoral veins. The results of these examinations were compared with those of duplex imaging or computed tomographic venography studies. Setting Surgical intensive care unit. Patients All critically ill patients who were admitted to the surgical intensive care unit and considered to be at high risk for the development of deep vein thrombosis. Main Outcome Measure Presence of deep vein thrombosis in the common femoral veins. Results During a 16-month period, surgeons performed 306 ultrasound examinations on 220 critically ill surgical patients. The results included 295 true negative, 9 true positive, 1 false negative, and 1 false positive, yielding a 90.0% sensitivity, 99.6% specificity, and 99.3% accuracy. Conclusion A focused, surgeon-performed ultrasound examination is a rapid and accurate screening method to detect common femoral vein thrombosis in critically ill patients as well as to examine those patients in whom pulmonary embolism is strongly suspected. The development of deep vein thrombosis (DVT) with its potential complications significantly increases morbidity and mortality for critically ill surgical patients. Although prophylactic agents and regimens have been shown to prevent DVT in most patients, they are not completely effective.1- 5 Therefore, additional measures such as sequential compression devices for prevention and serial duplex imaging of the lower extremities for early detection are used in select patients. Although sequential compression devices are widely available, serial duplex imaging, especially in a busy surgical intensive care unit (SICU), may be difficult to do routinely because of limited resources. Furthermore, the frequency with which such a study should be done to detect occult DVT is unknown. Considering the successful use of surgeon-performed, focused ultrasound examinations in patients with multiple acute conditions, it seems reasonable to use this technology as a screening tool for the detection of occult DVT in critically ill patients.6- 9 We hypothesized that serial focused ultrasound examinations performed by surgeons could accurately detect common femoral vein (CFV) thrombosis in critically ill surgical patients. The purpose of this study was to evaluate the efficacy of a limited ultrasound examination for the detection of occult CFV thrombosis

A Prospective Study of a Focused, Surgeon-Performed Ultrasound Examination for the Detection of Occult Common Femoral Vein Thrombosis in Critically Ill Patients

Hypothesis A focused, surgeon-performed ultrasound examination of the common femoral veins is an accurate screening tool for the detection of common femoral vein thrombosis in high-risk, critically ill patients. Design A prospective study using a focused ultrasound examination for findings consistent with deep vein thrombosis of the common femoral veins. The results of these examinations were compared with those of duplex imaging or computed tomographic venography studies. Setting Surgical intensive care unit. Patients All critically ill patients who were admitted to the surgical intensive care unit and considered to be at high risk for the development of deep vein thrombosis. Main Outcome Measure Presence of deep vein thrombosis in the common femoral veins. Results During a 16-month period, surgeons performed 306 ultrasound examinations on 220 critically ill surgical patients. The results included 295 true negative, 9 true positive, 1 false negative, and 1 false positive, yielding a 90.0% sensitivity, 99.6% specificity, and 99.3% accuracy. Conclusion A focused, surgeon-performed ultrasound examination is a rapid and accurate screening method to detect common femoral vein thrombosis in critically ill patients as well as to examine those patients in whom pulmonary embolism is strongly suspected. The development of deep vein thrombosis (DVT) with its potential complications significantly increases morbidity and mortality for critically ill surgical patients. Although prophylactic agents and regimens have been shown to prevent DVT in most patients, they are not completely effective.1- 5 Therefore, additional measures such as sequential compression devices for prevention and serial duplex imaging of the lower extremities for early detection are used in select patients. Although sequential compression devices are widely available, serial duplex imaging, especially in a busy surgical intensive care unit (SICU), may be difficult to do routinely because of limited resources. Furthermore, the frequency with which such a study should be done to detect occult DVT is unknown. Considering the successful use of surgeon-performed, focused ultrasound examinations in patients with multiple acute conditions, it seems reasonable to use this technology as a screening tool for the detection of occult DVT in critically ill patients.6- 9 We hypothesized that serial focused ultrasound examinations performed by surgeons could accurately detect common femoral vein (CFV) thrombosis in critically ill surgical patients. The purpose of this study was to evaluate the efficacy of a limited ultrasound examination for the detection of occult CFV thrombosis

Rapid Detection of Traumatic Effusion Using Surgeon-Performed Ultrasonography

BACKGROUNDIn the injured patient, rapid assessment of the thorax can yield critical information for patient management and triage. OBJECTIVESThe objectives of this prospective study were (1) to determine if experienced surgeon sonographers could successfully use a focused thoracic ultrasonographic examination to detect traumatic effusion, and (2) to compare the accuracy and efficiency of ultrasonography with supine portable chest radiography. METHODSSurgeon-sonographers performed thoracic ultrasonographic examinations on patients with blunt and penetrating torso injuries during the Advanced Trauma Life Support secondary survey. All patients also underwent portable chest radiography. Performance times for ultrasonography and chest radiography were recorded. Comparisons were made of the performance times and accuracy of both tests in detecting traumatic effusion. RESULTSIn 360 patients, there were 40 effusions, 39 of which were detected by ultrasonography and 37 of which were detected by chest radiography. The 97.5% sensitivity and 99.7% specificity observed for thoracic ultrasonography were similar to the 92.5% sensitivity and 99.7% specificity for portable chest radiography. Performance time for ultrasonography was significantly faster than that for chest radiography (1.30 +/- 0.08 vs. 14.18 +/- 0.91 minutes, p < 0.0001). CONCLUSIONSurgeons can accurately perform and interpret a focused thoracic ultrasonographic examination to detect traumatic effusion. Surgeon-performed thoracic ultrasonography is as accurate but is significantly faster than supine portable chest radiography for the detection of traumatic effusion