RESUMEN
BACKGROUND: Resuscitative thoracotomies are a time-sensitive emergency surgical procedure with an immediate risk of mortality. We hypothesize that a high-fidelity whole-body donor simulation model, referred to as a Knowledge Donor (KD), with mechanical lung ventilation and expired human blood perfusion could increase learner confidence in performing this critical procedure. METHODS: General surgery residents and faculty were invited to participate in KD training. Surveys were collected to track participation and confidence. RESULTS: Simulated resuscitative thoracotomies were performed involving PGY levels I-IV. Mean confidence was highest for residents with both KD and Live Patient experience (5.6 â± â1.7), followed by Live Patient only (4.3 â± â2.5), and KD only (2.6 â± â1.3). The mean confidence rating for residents with neither training opportunity was 1.4 â± â1.0. CONCLUSIONS: The KD platform is a hyper-realistic training modality that closely replicates live surgery. This platform allows residents to practice complex surgical procedures in a safe environment, without risking patient safety. This pilot program yielded early results in improving resident procedural confidence for high-risk surgical procedures, specifically resuscitative thoracotomies.
RESUMEN
INTRODUCTION: Delta-9-tetraydrocannabinol (THC) usage is associated with venous thromboembolic events (VTE) in trauma patients. We hypothesized that THC â+ âtrauma patients would have less platelet inhibition than THC - patients using thromboelastography with platelet mapping (TEG-PM). METHODS: Results from initial TEG- PM assays and patient's UDS were reviewed between 2019 and 2023. Mean levels of arachidonic acid (AA) and adenosine diphosphate (ADP) percent inhibition were compared by THC status. RESULTS: 793 patients had TEG-PM and UDS data. Mean levels of arachidonic acid (AA) percentage inhibition were 32.6 â± â34.2. AA inhibition was lower for THC â+ âvs THC- patients (THC+ 23.9 â± â27.0 vs THC- 34.3 â± â35.3, P â< â0.001). There was no association between THC status and ADP inhibition (THC+ 32.5 â± â27.1 vs THC- 30.8 â± â28.4, P â= â0.536). DISCUSSION: To our knowledge, our data are the first to suggest a clinically measurable increase in platelet reactivity in THC â+ âtrauma patients. More work is needed to determine if addition of aspirin to the chemoprophylaxis strategy for THC â+ âpatients would mitigate the known association of THC with VTE.
RESUMEN
BACKGROUND: Although helmets are associated with reduction in mortality from motorcycle collisions, many states have failed to adopt universal helmet laws for motorcyclists, in part on the grounds that prior research is limited by study design (historical controls) and confounding variables. The goal of this study was to evaluate the association of helmet use in motorcycle collisions with hospital charges and mortality in trauma patients with propensity score analysis in a state without a universal helmet law. METHODS: Motorcycle collision data from the Arizona State Trauma Registry from 2014 to 2017 were propensity score matched by regressing helmet use on patient age, sex, race/ethnicity, alcohol intoxication, illicit drug use, and comorbidities. Linear and logistic regression models were used to evaluate the impact of helmet use. RESULTS: Our sample consisted of 6849 cases, of which 3699 (54.0%) were helmeted and 3150 (46.0%) without helmets. The cohort was 88.1% male with an average age of 40.9±16.0 years. Helmeted patients were less likely to be admitted to the intensive care unit (20.3% vs. 23.7%, OR 0.82 (0.72-0.93)) and ventilated (7.8% vs. 12.0%, OR 0.62 (0.52-0.75)). Propensity-matched analyses consisted of 2541 pairs and demonstrated helmet use to be associated with an 8% decrease in hospital charges (B -0.075 (0.034)) and a 56% decrease in mortality (OR 0.44 (0.31-0.58)). DISCUSSION: In a state without mandated helmet use for all motorcyclists, the burden of the unhelmeted rider is significant with respect to lives lost and healthcare charges incurred. Although the helmet law debate with respect to civil liberties is complex and unsettled, it appears clear that helmet use is strongly associated with both survival and less economic encumbrance on the state. LEVEL OF EVIDENCE: Level III, prognostic and epidemiological.