Asher Hirshberg

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BACKGROUND Previous published clinical observations claim that Gastrografin, a hyperosmolar gastrointestinal water-soluble contrast agent, speeds the resolution of postoperative ileus, barium impaction ileus, adhesive small-bowel obstruction, and intestinal obstruction caused by parasites and bezoars. However, no objective data exist that support the(More)
Planned reoperation is a new approach to severe truncal trauma. A review of 124 patients treated over two years was undertaken. Penetrating injuries predominated (78%) involving primarily the abdomen or abdomen and chest. An abbreviated procedure was performed when direct hemostasis was impossible (102 patients), abrupt termination was required (56(More)
The critical decisions in patients with thoracoabdominal trauma are establishing the need to explore either or both cavities and determining appropriate sequencing. The causes and patterns of management difficulties were analyzed in 82 consecutive patients with penetrating thoracoabdominal injuries. Nine thoracotomies (11%) and 16 laparotomies (22%) were(More)
BACKGROUND Current massive transfusion guidelines are derived from washout equations that may not apply to bleeding trauma patients. Our aim was to analyze these guidelines using a computer simulation. METHODS A combined hemodilution and hemodynamic model of an exsanguinating patient was developed to calculate the changes in prothrombin time (PT),(More)
BACKGROUND The aim of this series is to describe a new and aggressive approach to definitive closure of the open abdomen. METHODS A retrospective review of 37 patients who underwent definitive abdominal closure using a combination of vacuum pack, vacuum-assisted wound management and human acellular dermal matrix (HADM). RESULTS All patients' open(More)
The decision to insert an intercostal drain in chest injury must occasionally be made without a chest radiograph. A prospective analysis of the reliability of physical examination in penetrating pleural injuries was undertaken. A total of 51 consecutive patients were examined before obtaining a chest radiograph. The presumptive diagnosis and decision to(More)
During a multiple-casualty incident, a large casualty caseload adversely affects the quality of trauma care given to individual patients. From a trauma care perspective, the goal of the hospital emergency plan is to provide severely injured patients with a level of care that approximates the care given to similar patients under normal conditions. Therefore,(More)
BACKGROUND The aim of this modeling study was to examine how casualty load affects the level of trauma care in multiple casualty incidents and to define the surge capacity of the hospital trauma assets. METHODS The disaster plan of a U.S. Level I trauma center was translated into a computer model and challenged with simulated casualties based on 223(More)