Current and Desired Practice Patterns of Trauma and Acute Care Surgeons (T/ACS)

Resident hour restrictions and the addition of emergency general surgery (EGS) have changed how the T/ACS team functions and their work patterns. The purpose of our study is to report current practice patterns of T/ACS and compare those to desired practice patterns of the future workforce in the field (residents/fellows)

Early Goal-Directed Therapy in Severe Sepsis and Septic Shock: A Contemporary Review of the Literature

Purpose of review: Aggressive approaches to acute diseases such as acute myocardial infarction, trauma, and stroke have improved outcomes. Early goal-directed therapy for severe sepsis and septic shock represents a similar approach. An analysis of the literature assessing external validity and generalizability of this intervention is lacking. Recent findings: Eleven peer-reviewed publications (1569 patients) and 28 abstracts (4429 patients) after the original early goal-directed therapy study were identified from academic, community and international settings. These publications total 5998 patients (3042 before and 2956 after early goal-directed therapy). The mean age, sex, APACHE II scores and mortality were similar across all studies. The mean relative and absolute risk reduction was 0.46 ± 26% and 20.3 ± 12.7%, respectively. These findings are superior to the original early goal-directed therapy trial which showed figures of 34% and 16%, respectively. A consistent and similar decrease in healthcare resource consumption was also found. Summary: Early goal-directed therapy modulates systemic inflammation and results in significant reductions in morbidity, mortality, and healthcare resource consumption. Early goal-directed therapy has been externally validated and is generalizable across multiple healthcare settings. Because of these robust findings, further emphasis should be placed on overcoming logistical, institutional, and professional barriers to implementation which can save the life of one of every six patients presenting with severe sepsis and septic shock

Early Goal-Directed Therapy in Severe Sepsis and Septic Shock: A Contemporary Review of the Literature

Purpose of review: Aggressive approaches to acute diseases such as acute myocardial infarction, trauma, and stroke have improved outcomes. Early goal-directed therapy for severe sepsis and septic shock represents a similar approach. An analysis of the literature assessing external validity and generalizability of this intervention is lacking. Recent findings: Eleven peer-reviewed publications (1569 patients) and 28 abstracts (4429 patients) after the original early goal-directed therapy study were identified from academic, community and international settings. These publications total 5998 patients (3042 before and 2956 after early goal-directed therapy). The mean age, sex, APACHE II scores and mortality were similar across all studies. The mean relative and absolute risk reduction was 0.46 ± 26% and 20.3 ± 12.7%, respectively. These findings are superior to the original early goal-directed therapy trial which showed figures of 34% and 16%, respectively. A consistent and similar decrease in healthcare resource consumption was also found. Summary: Early goal-directed therapy modulates systemic inflammation and results in significant reductions in morbidity, mortality, and healthcare resource consumption. Early goal-directed therapy has been externally validated and is generalizable across multiple healthcare settings. Because of these robust findings, further emphasis should be placed on overcoming logistical, institutional, and professional barriers to implementation which can save the life of one of every six patients presenting with severe sepsis and septic shock

Management of severe musculoskeletal trauma following a dog mauling attack in a nonagenarian

Dog bites are increasingly common injuries and pose a significant public health concern. We present a case of a 92-year-old woman who sustained severe musculoskeletal trauma to the bilateral upper and lower extremities following a mauling attack by her two pet Boston Terriers. Patterns of injury and risk factors for dog bite-related injuries, as well as important clinical considerations in the medical and surgical management of dog bite injuries are discussed

L'alternative biocarburant pour les pays tropicaux enclavés importateurs de pétrole : modèle d'analyse de l'alternative huile de coprah carburant pour une île du Pacifique Sud (Vanuatu)

Dans le contexte actuel du marché mondial du coprah, le Vanuatu cherche des pistes de désertification de son agriculture. D'autre part, le développement économique général est fortement handicapé par le coût et la difficulté d'approvisionnement en carburants pétroliers, due à la dispersion des îles de l'archipel. La fabrication d'huile de coco à petite échelle, pour le marché intérieur, en substitution aux importations de produits pétroliers serait une innovation intéressante. On élabore dans cette étude un modèle d'analyse simple des déterminants, du déroulement et des conséquences économiques de cette alternative dans le contexte du Vanuatu, à partir des typologies des exploitations agricoles, de l'analyse de la filière, de statistiques nationales et d'études techniques. On peut tester la possibilité et les conséquences de l'introduction de l'activité de la production d'huile en optimisant les objectifs attribués à chacun des acteurs dans ce nouveau contexte technologique. Le modèle se présente sous la forme d'un programme informatique utilisant le logiciel GAMS d'optimisation sous contrainte

Management of Sepsis: Early Resuscitation

Key links in the chain of survival for the management of severe sepsis and septic shock are early identification and comprehensive resuscitation of high-risk patients. Multiple studies have shown that the first 6 hours of early sepsis management are especially important from a diagnostic, pathogenic, and therapeutic perspective, and that steps taken during this period can have a significant impact on outcome. The recognition of this critical time period and the robust outcome benefit realized in previous studies provides the rationale for adopting early resuscitation as a distinct intervention. Sepsis joins trauma, stroke, and acute myocardial infarction in having “golden hours,” representing a critical opportunity early on in the course of disease for actions that offer the most benefit