T. O'Keeffe

Initial experiences and outcomes of telepresence in the management of trauma and emergency surgical patients

BACKGROUND Teletrauma programs allow rural patients access to advanced trauma and emergency medical services that are often limited to urban areas. METHODS A retrospective analysis of 59 teleconsults between 5 rural hospitals and a level I trauma center was performed. The objectives of this study were to report the initial experience with a telemedicine program connecting 5 rural hospitals with a level I trauma center. RESULTS A total of 59 trauma and general surgery patients were evaluated. Of those, 35 (59%) were trauma patients, and 24 (41%) were general surgery patients. Fifty patients (85%) were from the first hospital at which teletrauma was established. For 6 patients, the teletrauma consults were considered potentially lifesaving; 17 patients (29%) were kept in the rural hospitals (8 trauma and 9 general surgery patients). Treating patients in the rural hospitals avoided transfers, saving an average of

Total parenteral nutrition in critically ill and injured patients

19,698 per air transport or

Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience

2,055 per ground transport. CONCLUSIONS The telepresence of a trauma surgeon aids in the initial evaluation, treatment, and care of patients, improving outcomes and reducing the costs of trauma care.

QS220. Nocturnal Care Interactions and Sleep Disruption in the Intensive Care Unit

ZusammenfassungGRUNDLAGEN: Beim kritisch Kranken und Schwerverletzten kommt es oft zu Mangelernährung, wofür zahlreiche Gründe (hyperkataboler Stress, Trauma, Sepsis, häufige Operationen, fehlende parenterale Ernährung) verantwortlich sind. Seit 1968 Stanley J. Dudrick die totale parenterale Ernährung (TPN) in die klinische Praxis einführte, wird diese bei jenen, die nicht essen und trinken können, zur Ernährung verwendet. METHODIK: Übersicht der Literatur. ERGEBNISSE: TPN ist wirksam bei unterernährten Personen und jenen, welche oral nicht oder nicht ausreichend Nahrung aufnehmen können (Kurzdarmsyndrom, mesenterielle Ischämie, Darmfunktionsstörungen, hoch Volumen-Fisteln, Sepsis etc.). SCHLUSSFOLGERUNGEN: TPN ist eine primäre Methode zur Ernährung und Kaloriengabe, bis der Darm dafür zur Verfügung steht.SummaryBACKGROUND: Malnutrition is common in critically ill and severely injured patients. Many factors are responsible for the development of malnutrition in critically ill and injured patients, including the hypercatabolic states associated with trauma, sepsis, often repeated surgical intervention, long periods of inability to take nutrition by mouth and many other factors. While oral or enteral nutrition is the preferable technique of provision nutrition support, often this is impossible, impractical or ill advised. To this end, the total parenteral nutrition (TPN), in clinical practice since 1968, as developed by Dr. Stanley J. Dudrick, has been an instrumental technique in providing all needed nutrient substrates and calories intravenously to all those patients who cannot eat, will not eat or should not eat. METHODS: Review of literature. RESULTS: TPN is efficacious in patients who are malnourished and unable to receive adequate oral or enteral nutrients in particular in short gut syndromes, severe gut dysfunction, mesenteric vascular insufficiency, prolonged bowel obstruction, high volume fistulas, sepsis with hemodynamic instability, and many other conditions. CONCLUSIONS: TPN can remain the primary technique of providing all nutrient substrates and caloric needs until the GI tract can safely and effectively be used.