Leslie Ray Matthews

Using Augmented Reality as a Clinical Support Tool to Assist Combat Medics in the Treatment of Tension Pneumothoraces

This study was to extrapolate potential roles of augmented reality goggles as a clinical support tool assisting in the reduction of preventable causes of death on the battlefield. Our pilot study was designed to improve medic performance in accurately placing a large bore catheter to release tension pneumothorax (prehospital setting) while using augmented reality goggles. Thirty-four preclinical medical students recruited from Morehouse School of Medicine performed needle decompressions on human cadaver models after hearing a brief training lecture on tension pneumothorax management. Clinical vignettes identifying cadavers as having life-threatening tension pneumothoraces as a consequence of improvised explosive device attacks were used. Study group (n = 13) performed needle decompression using augmented reality goggles whereas the control group (n = 21) relied solely on memory from the lecture. The two groups were compared according to their ability to accurately complete the steps required to decompress a tension pneumothorax. The medical students using augmented reality goggle support were able to treat the tension pneumothorax on the human cadaver models more accurately than the students relying on their memory (p < 0.008). Although the augmented reality group required more time to complete the needle decompression intervention (p = 0.0684), this did not reach statistical significance.

Benefit of a Tiered-Trauma Activation System to Triage Dead-on-Arrival Patients

Introduction Although national guidelines have been published for the management of critically injured traumatic cardiopulmonary arrest (TCPA) patients, many hospital systems have not implemented in-hospital triage guidelines. The objective of this study was to determine if hospital resources could be preserved by implementation of an in-hospital tiered triage system for patients in TCPA with prolonged resuscitation who would likely be declared dead on arrival (DOA). Method We conducted a retrospective analysis of 4,618 severely injured patients, admitted to our Level I trauma center from December 2000 to December 2008 for evaluation. All of the identified patients had sustained life-threatening penetrating and blunt injuries with pre-hospital TCPA. Patients who received cardiopulmonary resuscitation (CPR) for 10 minutes were assessed for survival rate, neurologic outcome, and charge-for-activation (COA) for our hospital trauma system. Results We evaluated 4,618 charts, which consisted of patients seen by the MSM trauma service from December 2001 through December 2008. We identified 140 patients with severe, life-threatening traumatic injuries, who sustained pre-hospital TCPA requiring prolonged CPR in the field and were brought to the emergency department (ED). Group I was comprised of 108 patients sustaining TCPA (53 blunt, 55 penetrating), who died after receiving < 45 minutes of ACLS after arrival. Group II, which consisted of 32 patients (25 blunt, 7 penetrating), had resuscitative efforts in the ED lasting > 45 minutes, but all ultimately died prior to discharge. Estimated hospital charge-for-activation for Group I was approximately

Vitamin D3 Suppresses Class II Invariant Chain Peptide Expression on Activated B-Lymphocytes: A Plausible Mechanism for Downregulation of Acute Inflammatory Conditions

540,000, based on standard charges of

Cecal volvulus with gangrene following Mitrofanoff procedure

5000 per full-scale trauma system activation (TSA). Conclusion Full-scale trauma system activation for patients sustaining greater than 10 minutes of prehospital TCPA in the field is futile and economically depleting.

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

Class II invariant chain peptide (CLIP) expression has been demonstrated to play a pivotal role in the regulation of B cell function after nonspecific polyclonal expansion. Several studies have shown vitamin D3 helps regulate the immune response. We hypothesized that activated vitamin D3 suppresses CLIP expression on activated B-cells after nonspecific activation or priming of C57BL/6 mice with CpG. This study showed activated vitamin D3 actively reduced CLIP expression and decreased the number of CLIP+ B-lymphocytes in a dose and formulation dependent fashion. Flow cytometry was used to analyze changes in mean fluorescent intensity (MFI) based on changes in concentration of CLIP on activated B-lymphocytes after treatment with the various formulations of vitamin D3. The human formulation of activated vitamin D (calcitriol) had the most dramatic reduction in CLIP density at an MFI of 257.3 [baseline of 701.1 (P value = 0.01)]. Cholecalciferol and alfacalcidiol had no significant reduction in MFI at 667.7 and 743.0, respectively. Calcitriol seemed to best reduce CLIP overexpression in this ex vivo model. Bioactive vitamin D3 may be an effective compliment to other B cell suppression therapeutics to augment downregulation of nonspecific inflammation associated with many autoimmune disorders. Further study is necessary to confirm these findings.

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

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.

Hospital-based, Multidisciplinary, youth mentoring and medical exposure program positively influences and reinforces health care career choice: “The Reach One Each One Program early Experience”

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.

Laparoscopic Repair of a Ruptured Diaphragm: Avoiding a Trauma Laparotomy

Highlights • We present a case of a 19 year 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 < 3 cm 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.

Combination therapy with vitamin D3, progesterone, omega­3 fatty acids and glutamine reverses coma and improves clinical outcomes in patients with severe traumatic brain injuries: A case series

BACKGROUND According to the National Center for Educational Statistics, underrepresented minorities (URMs) are more likely to leave science, technology, engineering and mathematics (STEM) fields at higher rates than their peers during undergraduate studies. Many institutions of higher learning have implemented pipeline programs aimed at preparing and inspiring high school and college aged students in select careers in health sciences with varying levels of success. Research has shown that a health care workforce that mirrors the community they serve is more effective in reducing health disparities and increasing positive health outcomes. We hypothesize that a hospital-based, multidisciplinary youth mentoring and medical exposure program will enhance the decision of URM high school students to choose healthcare careers. MATERIALS AND METHOD A retrospective analysis of the Reach One Each One Program (ROEO) was performed. ROEO is a hospital based, 11-week multidisciplinary youth mentoring and medical exposure program for inner-city high school students. The analysis was based on a phone survey of the twenty-six (26) seniors who completed the program and subsequently graduated from high school between May 2013 and May 2015 to assess the following: 1) College enrollment/attendance, 2) Health profession majors, and 3) Pre-med status. The study was approved by the Morehouse School of Medicine Institutional Review Board. RESULTS Of the twenty-six students, 23 were female and 3 were male; 25 (96%) of the students were African American and one student was a Caucasian female. Twenty-four (92.3%) of the students were enrolled in college and 2 (7.7%) were scheduled to begin in the spring semester of 2016. Twenty-one of the 24 attending college at the time of the survey (87.5%) were enrolled in a health science degree program and 16 (66.7%) confirmed that they were enrolled in pre-medical (Pre-med) curriculum. CONCLUSION Hospital-based, multidisciplinary medical mentoring programs can have a positive impact on the lives and health care career decisions of aspiring URM high school students. Further study will be necessary to validate the most influential components needed for the success of such programs.

Incidence of Myocardial Infarctions and Hospital Costs in Surgical Intensive Care Unit Patients Reduced by Fifty Percent Using Daily, High Dose Vitamin D Supplementation

Background: A traumatic diaphragm rupture presents a unique obstacle to a minimally invasive surgical approach; most repairs are performed during an emergency laparotomy. Diaphragm injuries are diagnosed in the acute phase of blunt-force trauma in only 10% of cases, and a high index of suspicion must be maintained to avoid strangulation of the abdominal organs that have herniated into the thoracic cavity. A laparoscopic evaluation and repair of an acute blunt-force rupture of the diaphragm can be diagnostic and curative, mimicking the outcome of an open procedure. Case Description: A 23-year-old woman had a left-side blunt-force rupture of the diaphragm sustained in a high-impact motor vehicle collision. The focused assessment with sonography for trauma (FAST) was negative. The survey chest radiograph identified only streaky opacities that were read as atelectasis. Computed tomography of the abdomen revealed the presence of a congenital abnormality versus a ruptured diaphragm. A diagnostic trauma laparoscopy was performed to evaluate for the possibility of a left-side rupture, and at that point, the spleen and the stomach were found to be located in the left chest, herniating through a rupture in the left diaphragm. A grade I splenic laceration was present. The abdominal structures were reduced and the traumatic rupture was successfully repaired laparoscopically. Discussion: Traumatic rupture of the left diaphragm can occur as an occult injury after blunt-force trauma to the torso. The liver lends protection to the diaphragm and a right-side rupture is far less common than one on the left side. The initial diagnostic plain chest x-ray may not reveal the tear in the diaphragm and the herniation of abdominal viscera into the thoracic cavity. Laparoscopy has been used to evaluate the possibility of a rent in the diaphragm when the patient is hemodynamically stable and the diagnosis is uncertain. Although initial laparoscopic or thorascopic evaluation of a potential rupture of the diaphragm is the standard of care in the trauma literature, laparoscopic repair is not widely accepted. However, laparoscopic evaluation of acute torso trauma with reduction of abdominal viscera and subsequent laparoscopic repair of the diaphragm can be successful.