Jonathan Nguyen

High Dose Vitamin D, Digoxin, and BiDil Reverse Congestive Heart Failure in a Critically ILL Trauma Patient and a Severely Obese Male Patient

Presently, the prevalence of congestive heart failure in the United States is 6.5 million people. We report two cases of severe congestive heart failure patients with a very poor prognosis, treated successfully with a combination of high dose vitamin D, digoxin, and BiDil (Matthews’ Two Inotrope Protocol).

Vitamin D, Glutamine, Evidence-Based Medicine, and Close Staff Supervision Reduce Mortality Rate at a Level I Trauma Center

Background: It has been estimated that over 400,000 patients die each year from medical errors in the United States.

Cecal volvulus with gangrene following Mitrofanoff procedure

The appendico-vesicostomy (Mitrofanoff procedure) is a procedure for continent urinary tract reconstruction usually in children and young adults. This conduit originally fashioned from the appendix is easily catheterized through an abdominal wall stoma. It is most commonly indicated for neurogenic bladder but has also been performed for exstrophy and epispadias. The most frequent complications are stomal stenosis and leakage which sometimes require revisional procedures. Bowel obstruction is rare following this procedure. To our knowledge there are no reports of cecal volvulus following the Mitrofanoff procedure. We report on a case of cecal volvulus which progressed to frank gangrene with perforation, peritonitis and sepsis.

Variations in institutional review board processes and consent requirements for trauma research: an EAST multicenter survey

Oversight of human subject research has evolved considerably since its inception. However, previous studies identified a lack of consistency of institutional review board (IRB) determination for the type of review required and whether informed consent is necessary, especially for prospective observational studies, which pose minimal risk of harm. We hypothesized that there is significant inter-institution variation in IRB requirements for the type of review and necessity of informed consent, especially for prospective observational trials without blood/tissue utilization. We also sought to describe investigators’ and IRB members’ attitudes toward the type of review and need for consent. Eastern Association for the Surgery of Trauma (EAST) and IRB members were sent an electronic survey on IRB review and informed consent requirement. We performed descriptive analyses as well as Fisher’s exact test to determine differences between EAST and IRB members’ responses. The response rate for EAST members from 113 institutions was 13.5%, whereas a convenience sample of IRB members from 14 institutions had a response rate of 64.4%. Requirement for full IRB review for retrospective studies using patient identifiers was reported by zero IRB member compared with 13.1% of EAST members (p=0.05). Regarding prospective observational trials without blood/tissue collection, 48.1% of EAST members reported their institutions required a full IRB review compared with 9.5% of IRB members (p=0.01). For prospective observational trials with blood/tissue collection, 80% of EAST members indicated requirement to submit a full IRB review compared with only 13.6% of IRB members (p<0.001). Most EAST members (78.6%) stated that informed consent is not ethically necessary in prospective observational trials without blood/tissue collection, whereas most IRB members thought that informed consent was ethically necessary (63.6%, p<0.001). There is significant variation in perception and practice regarding the level of review for prospective observational studies and whether informed consent is necessary. We recommend future interdisciplinary efforts between researchers and IRBs should occur to better standardize local IRB efforts. Level of evidence IV.

“Black Esophagus” and Gastric Volvulus Following Slipped Laparoscopic Adjustable Gastric Band

To review the entity “black esophagus” and sequela of a slipped laparoscopic adjustable band. The patient’s history, physical examination, imaging, and endoscopic findings were reviewed. Detailed review of pathophysiology, presentation, diagnosis, management, and natural history was conducted. “Black esophagus,” also known as acute esophageal necrosis (AEN), is a rare condition resulting in black discoloration of the mid to distal esophagus with less than a hundred reported cases. It has not been previously documented in bariatric surgery or following laparoscopic adjustable gastric banding. The volvulus was reduced at surgery, and the esophageal changes resolved without sequela. “Black esophagus” is an acute, ominous-appearing condition with a spectrum ranging from superficial mucosal disease to transmural involvement with perforation. Fortunately, esophageal resection is rarely required.

Trauma and Surgical Critical Care Fellowship

The field of trauma and critical care has been gaining momentum in the last few decades in terms of dynamic changes in practice, scope of practice, and its popularity among young surgeons to enter the field. It is important to gain insight on its history and its evolving scope of practice before making a decision to enter the field. Application and interview process has become easier in the last few years with easy access to fellowship program information. It is important to choose a fellowship based on the needs of the surgeon entering the field.

Navigating Electronic Medical Records

Since the initial development of electronic medical records (EMRs), EHRs have come to provide physicians an unparalleled advantage in the care of patients. There are many levels of complexity and challenges associated with EHRs. As the primary users and caretakers of this information, it is critical that we help shape the way these tools are used in our hospitals and to mold the way EHR systems are deployed universally.

Where to Look for a Job After Residency

Finding a job after finishing training can be a daunting process at first but can certainly be facilitated by the utilization of several resources. Figuring out what type of practice and geographical location first may help narrow down to help your decision process. Using headhunters or signing up for a short-term locums position may also be options. Utilizing your professional contacts is always helpful.

Applying for Privileges and Licensure

Applying for state licensure, hospital privileges, and insurance enrollment is time-consuming process that will be helped by your organizational skills. Starting the paperwork as early as possible and employing the help of your hospital administrative staff will be the key.

Successful treatment of massive hemothorax with class IV shock using aortography with transcatheter embolization of actively bleeding posterior left intercostal arteries after penetrating left chest trauma: A case for the hybrid OR

Highlights • We present a case of a 19u202fyear old male with massive hemothorax and refractory, class IV hemorrhagic shock due to proximal left posterior intercostal artery injury with uncontrollable bleeding secondary to a left chest gunshot wound in the 4th intercostal space (ICS).• The patient was emergently taken to the operating room for thoracotomy and left chest exploration and found to have massive ongoing massive from his left posterior chest with severe hemodynamic instability and profound levels of hemorrhagic shock. Despite multiple attempts to surgically stop the bleeding intraoperatively as well as using various hemostatic measures, we were unable to control the excessive bleeding.• The patient developed refractory class IV hemorrhagic shock with sinus tachycardia to the 170′s and persistent hypotension with systolic blood pressures in the 70′s, which was not amenable to surgical control.• Consequently, the patient was taken to the angiography suite in radiology where thoracic aortography was performed and revealed active bleeding from the left 7th posterior intercostal artery <u202f3u202fcm from the aorta.• The patient underwent thoracic angiography with percutaneous catheter-based embolization of the bleeding intercostal artery. The bleeding arterial segment was controlled with coils and gelfoam along with the vessels immediately above and below the area of extravasation.• The patients hemodynamics significantly stabilized. He was transferred to the surgical ICU for ongoing resuscitation. The patient survived and was ultimately discharged to home in satisfactory condition.• This is the first report in the literature of using thoracic angiography with selective catheter based embolization to arrest bleeding of an injured posterior intercostal artery due to penetrating injury or gunshot wound of the chest.