J Trauma
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Vibrio species are a rare cause of necrotizing soft-tissue infections and primary septicemia, which are likely to occur in patients with hepatic disease, diabetes, adrenal insufficiency, and immunocompromised conditions. These organisms thrive in warm seawater and are often present in raw oysters, shellfish, and other seafood. This study examined fulminating clinical characteristics of Vibrio vulnificus and Vibrio cholerae non-O1 soft-tissue infections and identified outcome predictors. ⋯ Vibrio necrotizing soft-tissue infections should be suspected in patients with appropriate clinical findings and history of contact with seawater or seafood. V. cholerae non-O1 may cause bacteremia more often than V. vulnificus in patients with liver cirrhosis. Early fasciotomy and culture-directed antimicrobial therapy are aggressively recommended in patients with hypotensive shock, leukopenia, high band forms of white blood cells, decreased platelet counts, severe hypoalbuminemia, and underlying chronic illness, such as hepatic dysfunction and diabetes mellitus.
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The Heimlich maneuver is a well-described emergency procedure for management of foreign body airway obstructions. Although rare, complications of the Heimlich maneuver do exist. ⋯ Additionally, we present a rare case of acute pancreatitis with associated pseudocyst formation after the administration of the Heimlich maneuver on a healthy 3-year-old boy. Although life saving, the Heimlich maneuver may be associated with significant complications; thus, symptomatic patients after this maneuver should be thoroughly evaluated with appropriate laboratory and radiographic studies.
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The association of methamphetamine exposure and outcomes after trauma is not known. ⋯ Patients exposed to Methamphetamines do not have increased mortality or complications or lengths of ICU and hospital stay. However, they are more likely to require admission to the ICU.
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To improve utilization of scarce surgical resources, we changed from a single tier trauma paging system (TPS) to a three tiered TPS at a tertiary pediatric trauma center. We investigated if patients were appropriately classified into the three levels of trauma team activation. ⋯ Our results suggest that a three tiered TPS more efficiently utilizes limited surgical resources without leading to major misclassifications.
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Firearms are a major cause of injury and death. We sought to determine (1) the prevalence of movie scenes that depicted firearms and verbal firearm safety messages; (2) the context and health outcomes in firearm scenes; and (3) the association between the Motion Picture Association of America ratings and firearm scene characteristics. ⋯ Depictions of firearms in top revenue-grossing movies were common, but safety messages were exceedingly rare. Major motion pictures present an under-used opportunity for education about firearm safety.