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Portland, OR, United States

Cook J.O.,Legacy Emanuel Medical Center
Current Respiratory Medicine Reviews | Year: 2015

Point-of-care ultrasound is an increasingly utilized technology in the management of the acutely injured patient. Ultrasonography has demonstrated utility and improved outcomes in rapidly detecting pnemothorax, intrapericardial blood and assessing cardiac function in the hemodynamically unstable patient. Examination of the thorax incorporated into the FAST exam (termed E-FAST, or extended FAST exam) enables rapid recognition of pathology within the trauma bay, permitting earlier intervention. © 2015, Bentham Science Publishers.

Nadler O.A.,Legacy Emanuel Medical Center | Finkelstein M.J.,Center for Care Innovation and Research | Reid S.R.,Pediatric Emergency Medicine
Pediatric Emergency Care | Year: 2011

Objective: The objective of the study was to determine whether serum bicarbonate (HCO 3) concentration can accurately predict venous pH in the evaluation of diabetic ketoacidosis (DKA). Methods: A retrospective review of patients who presented to a children's hospital emergency department and received an International Classification of Diseases, Ninth Revision code related to DKA or diabetes mellitus was performed. To be eligible for inclusion and data abstraction, patients had blood sampled simultaneously for venous blood gas and metabolic panel. A linear regression model was created using pH (dependent variable) and HCO 3 (predictor). The diagnostic performance and accuracy of HCO 3 to discriminate abnormal pH were evaluated using receiver operating characteristic curve analysis. Results: Three hundred patients met the inclusion criteria. The linear relationship between pH and HCO 3 using the Pearson correlation coefficient was found to be R = 0.89 (confidence interval [CI], 0.83-0.95; R 2 = 0.79). Receiver operating characteristic curve analysis that maximized sensitivity and specificity demonstrated that a HCO 3 18.5 or less predicts pH less than 7.3 (area under the curve = 0.97; CI, 0.94-0.99; sensitivity, 93%; specificity, 91%), and a HCO 3 10.5 or less predicts pH less than 7.1 (area under the curve = 0.97; CI, 0.95-0.99; sensitivity, 97%; specificity, 88%). Conclusions: Serum bicarbonate accurately predicts abnormal venous pH in children with DKA. Venous pH determination may not be necessary for all patients being evaluated for DKA. Copyright © 2011 by Lippincott Williams & Wilkins.

Markiewicz M.R.,Oregon Health And Science University | Bell R.B.,Oregon Health And Science University | Bell R.B.,Providence Cancer Center | Bell R.B.,Legacy Emanuel Medical Center
Facial Plastic Surgery Clinics of North America | Year: 2011

The authors present an overview of 3D computer-aided design and computer-aided modeling tools available to the facial plastic surgeon. They describe the role of 3D tools in all phases of computer-aided surgery including: data acquisition, planning, surgery, and assessment. Applications of these tools include obtaining 3D measurements, using mirror imaging to reconstruct missing areas of the head and neck, and 3D sizing or segmentation of bone and soft tissue. They review of clinical outcomes obtained from studies reviewing 3D tools. These systems have potential value for education, reducing operating room time, and improving clinical outcomes. © 2011 Elsevier Inc.

Markiewicz M.R.,Oregon Health And Science University | Bell R.B.,Oregon Health And Science University | Bell R.B.,Providence Cancer Center | Bell R.B.,Legacy Emanuel Medical Center
Current Opinion in Otolaryngology and Head and Neck Surgery | Year: 2011

Purpose of review: To review the past year's literature regarding current computer-assisted reconstruction techniques and their outcomes. Recent findings: Current computer-assisted craniofacial reconstruction research is focused on data acquisition, planning, surgical and assessment phases. The major areas of interest among researchers include cosmetic surgery; cleft and craniofacial surgery; traumatic reconstruction, head and neck tumor reconstruction; and orthognathic surgery and distraction osteogenesis. Recent advances in the fields include facial analysis and planning in rhinoplasty, facial surface and bone graft volume analysis in cleft surgery, computer-guided tumor ablation and osteocutaneous reconstruction in tumor surgery, and preoperative planning and surgical assistance in orthognathic and distraction osteogenesis surgery. Summary: Research in computer-aided craniofacial surgery is progressing at a rapid rate. Rather than just the latest innovation, sound research studies are proving computer assistance to be invaluable in producing superior outcomes, especially in the fields of head and neck surgery, orthognathic surgery, and craniomaxillofacial trauma surgery. Further outcome studies and cost-benefit analyses are still needed to show the superiority of these methods to contemporary techniques. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Martin M.J.,Legacy Emanuel Medical Center | Martin M.J.,U.S. Army | Hatch Q.,U.S. Army | Cotton B.,University of Texas Health Science Center at Houston | Holcomb J.,University of Texas Health Science Center at Houston
Journal of Trauma and Acute Care Surgery | Year: 2012

BACKGROUND: Temporary abdominal closure (TAC) has become a widely used technique in severely injured patients. However, there is growing concern that TAC is being overutilized. We sought to identify less severely injured patients who underwent TAC and to compare their outcomes with patients managed with a single-stage laparotomy (SSL). METHODS: This is a analysis of all trauma patients who underwent immediate laparotomy from 2005 to 2009. Risk modeling identified TAC patients who met all low-risk criteria: systolic blood pressure >90, no severe head injury, no combined solid + hollow viscus injury, or vascular injury. The low-risk cohort (LR-TAC) was compared with a matched similarly injured cohort managed with SSL using univariate and multivariate regression analysis. RESULTS: Among the 282 patients undergoing TAC, 62 (22%) met low-risk criteria and were included in the LR-TAC group. There were 566 patients identified in the SSL group. There was no significant difference between groups for age, mechanism, Injury Severity Scores, associated injuries, base deficit, temperature, blood transfusion, solid organ injury, or bowel resection. The LR-TAC group had more hospital and ventilator days and increased complications rates (all p < 0.05). This included a higher rate of bowel ischemia/perforation with LR-TAC (7% vs. 0.7%). The use of TAC in the low-risk group was independently associated with increased complications (odds ratio 3.0, p = 0.01) and prolonged hospital stays (odds ratio 9.6, p < 0.01). CONCLUSIONS: TAC was associated with increased morbidity and resource utilization when applied to less severely injured patients. Further study is indicated to clarify populations that may be harmed or benefitted by TAC. Copyright © 2012 by Lippincott Williams & Wilkins.

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