Alcir Escocia Dorigatti

Tratamento não operatório de lesão esplênica grau IV é seguro usando-se rígido protocolo

OBJECTIVE To demonstrate the protocol and experience of our service in the nonoperative management (NOM) of grade IV blunt splenic injuries. METHODS This is a retrospective study based on trauma registry of a university hospital between 1990-2010. Charts of all patients with splenic injury were reviewed and patients with grade IV lesions treated nonoperatively were included in the study. RESULTS ninety-four patients with grade IV blunt splenic injury were admitted during this period. Twenty-six (27.6%) met the inclusion criteria for NOM. The average systolic blood pressure on admission was 113.07 ± 22.22 mmHg, RTS 7.66 ± 0.49 and ISS 18.34 ± 3.90. Ten patients (38.5%) required blood transfusion, with a mean of 1.92 ± 1.77 packed red cells per patient. Associated abdominal injuries were present in two patients (7.7%). NOM failed in two patients (7.7%), operated on due to worsening of abdominal pain and hypovolemic shock. No patient developed complications related to the spleen and there were no deaths in this series. Average length of hospital stay was 7.12 ± 1.98 days. CONCLUSION Nonoperative treatment of grade IV splenic injuries in blunt abdominal trauma is safe when a rigid protocol is followed.

Trauma Leagues—A Novel Option to Attract Medical Students to a Surgical Career

BackgroundIn Brazil, most medical schools do not offer trauma surgery in their undergraduate curriculum. The Trauma Leagues arose in Brazil as an important promoter of trauma education and stimulated activities related to surgical skills and practices. In recent decades, studies have demonstrated that the number of surgical residency applicants has decreased worldwide. Strategies to motivate medical students to choose surgery are needed.ObjectiveTo evaluate the impact of participation in the Unicamp Trauma League (UTL) during a 20-year period in the choice for a surgical career.MethodsThe study included 276 students in a Brazilian university hospital who were part of the Trauma League. Research of records in universities and medical societies about the specialties chosen during residency were evaluated. A Likert questionnaire was sent to participants to evaluate the impact of participating in the Trauma League in the student’s professional career.ResultsThe questionnaire was answered by 76% of the participants. Of those, 38.4% chose general surgery. About 55.1% did not know what medical career to choose when joined the league. Participation in the league had an influence on specialty choice in 79.1% of the students. Of those choosing surgery, 93.2% believed that participating in the league had positively influenced their career choice. Overall, 93.1% believed that participating in the league provided knowledge and information that the medical school curriculum was not able to provide.ConclusionParticipation in Trauma League has been an effective strategy to encourage medical students to choose a career in general surgery in Campinas, Brazil.

Is Bedside Ultrasound Useful for Chest Tube Removal? Description of an Initial Experience

1General Surgery Resident, University of Campinas (Unicamp), Campinas, SP, Brazil 2Emergency Medicine Resident, University of Campinas (Unicamp), Campinas, SP, Brazil 3Division of Trauma Surgery, Department of Surgery, University of Campinas (Unicamp), Campinas, SP, Brazil *Corresponding author Alcir Escocia Dorigatti, MD Department of Surgery School of Medical Sciences University of Campinas Rua Alexander Fleming 181 Cidade Universitária Prof. Zeferino Vaz Campinas, SP 13.083-970, Brazil Tel. +55 19 3521 9450 E-mail: alcir.dorigatti@gmail.com

The role of point-of-care ultrasound in intra-abdominal hypertension management

BACKGROUND Intra-abdominal hypertension is a common complication in critically ill patients. Recently the Abdominal Compartment Society (WSACS) developed a medical management algorithm with a stepwise approach according to the evolution of the intra-abdominal pressure and aiming to keep IAP ≤ 15 mm Hg. With the increased use of ultrasound as a bedside modality in both emergency and critical care patients, we hypothesized that ultrasound could be used as an adjuvant point-of-care tool during IAH management. This may be particularly relevant to the first and second basic stages of the algorithm. The objective of this paper is to test the use of POCUS as an adjuvant tool in the management of patients with IAH/ACS. METHODS Seventy-three consecutive adult critically ill patients admitted to the surgical intensive care unit (ICU) of a single urban institution with risk factor for IAH/ACS were enrolled. Those who met the inclusion criteria were allocated to undergo POCUS as an adjuvant tool in their IAH/ACS management. RESULTS A total of 50 patients met the inclusion criteria and were included in the study. The mean age of study participants was 55 ± 22.6 years, 58% were men, and the most frequent admission diagnosis was post-operative care following abdominal intervention. All admitted patients presented with a degree of IAH during their ICU stay. Following step 1 of the WSACS IAH medical management algorithm, ultrasound was used for NGT placement, confirmation of correct positioning, and evaluation of stomach contents. Ultrasound was comparable to abdominal X-ray, but shown to be superior in determining the gastric content (fluid vs. solid). Furthermore, POCUS allowed faster determination of correct NGT positioning in the stomach (antrum), avoiding bedside radiation exposure. Ultrasound also proved useful in: 1) evaluation of bowel activity; 2) identification of large bowel contents; 3) identification of patients that would benefit from bowel evacuation (enema) as an adjuvant to lower IAP; 4) and in the diagnosis of moderate to large amounts of free intra-abdominal fluid. CONCLUSION POCUS is a powerful systematic ultrasound technique that can be used as an adjuvant in intra-abdominal hypertension management. It has the potential to be used in both diagnosis and treatment during the course of IAH.

Current Specialist Awareness on Ultrasound Use for Central Venous Catheterization

Page 1 Obtaining central venous access is a fundamental clinical skill for managing patients in a wide variety of clinical situations. The role of routine portable Ultrasound (US) in the placement of Central Venous Catheters (CVCs) has been debated and some important evidence-based guidelines supporting the liberal use of ultrasound for this specific procedure have been published.1-3 The use of ultrasound to help on central venous catheterization has shown to improve success rates with reduced complications, however the ultrasound has not been adopted worldwide for this specific end. Also, specialists’ response to new publications on this subject is unknown. It is our feeling that, although many manuscripts have already proven that the US is safe and effective, its use is not routinely observed in a daily practice.