J Trauma
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Almost 10 years ago, the Careers in Trauma Committee of the Eastern Association for the Surgery of Trauma (EAST) identified four main problems with trauma fellowships: (1) lack of specified educational objectives, (2) undefined curricula, (3) inconsistent emphasis on research, and (4) inconsistent surgical exposure. These perceived problems still exist and may threaten the future of trauma surgery as a career. The objective of this study was to examine these issues in a profile of the current active clinical trauma care fellowship training programs. ⋯ There is steady growth in trauma fellowship training, with an emphasis on direct clinical management. An RRC-approved surgical critical care program is an important link, but one not essential to the trauma fellowship. Expected radical changes in surgical and trauma training are on the horizon. It is imperative that leaders in trauma surgery continue to monitor these trends for successful integration of trauma care training into surgical residency redesign efforts, and for facilitation of programmatic improvement in trauma care as a career.
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Characteristics and rates of shooting injuries associated with hunting various game species are unreported. ⋯ The rates and characteristics of hunting-related shooting injuries varied by hunted species. Hunter orange clothing regulations appeared to reduce fall turkey hunting injury rates.
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Positive end-expiratory pressure (PEEP) can be effective in improving oxygenation, but it may worsen or induce intracranial hypertension. The authors hypothesized that the intracranial effects of PEEP could be related to the changes in respiratory system compliance (Crs). ⋯ In patients with low Crs, PEEP has no significant effect on cerebral and systemic hemodynamics. Monitoring of Crs may be useful for avoiding deleterious effects of PEEP on the intracranial system of patients with normal Crs.
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After conventional resuscitation from hemorrhagic shock, splanchnic microvessels progressively constrict, leading to impairment of blood flow. This occurs despite restoration and maintenance of central hemodynamics. The authors' recent studies have demonstrated that topical and continuous ex vivo exposure of the gut microvasculature to a glucose-based clinical peritoneal dialysis solution (Delflex), as a technique of direct peritoneal resuscitation (DPR), can prevent these postresuscitation events when initiated simultaneously with conventional resuscitation. This study aimed to determine whether DPR applied after conventional resuscitation reverses the established postresuscitation intestinal vasoconstriction and hypoperfusion. ⋯ Delayed DPR reverses the gut postresuscitation vasoconstriction and hypoperfusion regardless of the initiation time. This occurs without adverse effects on hemodynamics. Direct peritoneal resuscitation-mediated enhancement of tissue perfusion results from the local effects from the vasoactive components of the Delflex solution, which are hyperosmolality, lactate buffer anion, and, to a lesser extent, low pH. The molecular mechanism of this vasodilation effect needs further investigation.