Presenter : Michael Zwank Contact Email

Abstract

Introduction: Operative management of displaced trimalleolar ankle fractures is indicated; however, controversy exists on the optimal strategy for the posterior malleolar (PM) fragment. Two common techniques for PM fixation include posterolateral buttress plating (PL) and fixation with anterior to posterior percutaneous lag screws (AP). To date no study has compared patient and surgical outcomes. Methods: Between October 2002 and January 2010, 45 patients sustained trimalleolar ankle fractures and underwent operative fixation of all three fragments. Twenty-five patients underwent PL plate fixation of the PM and 20 patients were treated with AP lag screws. These patients were asked to participate in an IRB approved study, in which they were recalled for functional and physical assessment. Results: Overall, study consent was successful for 29/45(64%) patients at a mean duration of 45months (range=15-99). The follow-up in the posterolateral (PL) group was 68% and AP lag screws was 60% (p=0.76). While the mean duration of follow-up was 54 months in the PL group and 32 months in the AP group (p=0.08).The PL cohort had significantly better scores for the SMFA bother index (p=0.05). There was also a trend toward improved outcomes for the PL cohort in the SMFA functional index (p=0.11), as well as, the mobility sub score (p=0.11). Conclusion: Both PL and AP fixation appears to be effective constructs for bony union; however, the PL technique resulted in a significantly better SMFA bother index score and a trend towards better SMFA functional index score and mobility sub score. Poster Presenter: Michael Zwank Contact Email: michael.d.zwank@healthpartners.com Abstract Title: Treatment of Accidental Hypothermia at a Level I Trauma Center: A Retrospective Cohort Authors: Zwank MD, Mohr WJ, Endorf FW, Atwood, DT, Muhar AA Collaborators: Wewerka SS, Critical Care Research Center Funding Agency: Regions Emergency Department and Burn Department Abstract: Study Objectives: Accidental hypothermia causes significant morbidity and mortality in cold climates. There is some controversy about how to best treat hypothermia mostly focused on the method of rewarming and the rate of rewarming. We sought to describe the experience at Regions Hospital where a unique option exists to immerse patients in a large bath of warm water. Methods: Research assistants reviewed the medical records of all patients age =18 seen at Regions Hospital from 2003-2012. Patient demographics, vital signs, method and rate of rewarming and other clinical parameters were gathered. Descriptive statistics were used. Results: 123 patients were included (81 male, 42 female). Median age was 51. 104 were outdoor exposures including 9 water immersions and 4 drownings while 14 were indoor exposures. Alcohol or drugs were known to be present in 74 patients. Median initial temperature was 32.8 (min=24.7, max=36.6). Most patients received external rewarming including warm lamps, warm blankets, warm IV fluids and warm air circulation (Bair Hugger). Internal catheter (Coolgard) was utilized in 12 patients and 17 patients were immersed in the hot water bath (Hubbard Tank). The rate of rewarming could be ascertained for 65 patients median 1.47 oC/hour (min 0.38, max 5.81). The external rewarming rate was 1.2 oC/hour, the Coolgard Catheter was 1.90 oC/hour and the Hubbard Tank was 1.89 oC/hour (P<0.05). 26 patients died. Conclusion: More aggressive methods of rewarming patients with hypothermia led to statistically quicker rates of rewarming. The clinical significance of this is unclear. Study Objectives: Accidental hypothermia causes significant morbidity and mortality in cold climates. There is some controversy about how to best treat hypothermia mostly focused on the method of rewarming and the rate of rewarming. We sought to describe the experience at Regions Hospital where a unique option exists to immerse patients in a large bath of warm water. Methods: Research assistants reviewed the medical records of all patients age =18 seen at Regions Hospital from 2003-2012. Patient demographics, vital signs, method and rate of rewarming and other clinical parameters were gathered. Descriptive statistics were used. Results: 123 patients were included (81 male, 42 female). Median age was 51. 104 were outdoor exposures including 9 water immersions and 4 drownings while 14 were indoor exposures. Alcohol or drugs were known to be present in 74 patients. Median initial temperature was 32.8 (min=24.7, max=36.6). Most patients received external rewarming including warm lamps, warm blankets, warm IV fluids and warm air circulation (Bair Hugger). Internal catheter (Coolgard) was utilized in 12 patients and 17 patients were immersed in the hot water bath (Hubbard Tank). The rate of rewarming could be ascertained for 65 patients median 1.47 oC/hour (min 0.38, max 5.81). The external rewarming rate was 1.2 oC/hour, the Coolgard Catheter was 1.90 oC/hour and the Hubbard Tank was 1.89 oC/hour (P<0.05). 26 patients died. Conclusion: More aggressive methods of rewarming patients with hypothermia led to statistically quicker rates of rewarming. The clinical significance of this is unclear. Poster Presenter: Sandi Wewerka Contact Email: sandi.s.wewerka@healthpartners.com Abstract Title: On the Spot: Implementation of a Trauma Team Activation Timeout in a Level I Trauma Center Authors: McGonigal MD, Forrest N, Guiton JB, Wewerka SS Collaborators: Trauma Department, Emergency Department Abstract: Introduction/Purpose: Effective provider communication during care transitions is a key component of patient care. Handoffs between paramedics and emergency department staff during trauma cases can be particularly chaotic. This study examined provider perceptions of a new communication tool used during transfer of trauma patient care at an urban Level I Trauma Center. Methods: The local RTAC led the implementation of a new communication process called a Trauma Team Activation Timeout (TTA Timeout). Prior to implementation of this project, over 800 EMS providers completed training on the protocol. Paramedics were trained to deliver their report in the MIST format (mechanism, injuries, symptoms, treatments). Immediately following transfer of care, the lead paramedic and the trauma team leader completed a 7-item survey assessing their experience. Responses to survey questions were compared between EMS providers and trauma team leaders using rank sum correlation. Results: Data were collected from 51 paramedics (17 EMS agencies) and 45 team leaders between 3/01/13-4/30/13. Paramedics believed the benefit of the TTA timeout was higher to the EMS provider (100% v. 77%, p<0.001), patient (100% v. 75%, p<0.001), and team leader (100% v. 80%, p<0.001) than the trauma team leader's evaluation. Paramedics perceived the TTA Timeout to result in higher effectiveness in the transfer of the patient than trauma team leaders (Spearman's rho = -0.2; p = 0.04). Conclusion: Paramedics report greater benefit of the TTA Timeout process than the in-hospital trauma team leaders. Inhospital personnel may require more education about the importance of the EMS report with the criticallyinjured patient. Introduction/Purpose: Effective provider communication during care transitions is a key component of patient care. Handoffs between paramedics and emergency department staff during trauma cases can be particularly chaotic. This study examined provider perceptions of a new communication tool used during transfer of trauma patient care at an urban Level I Trauma Center. Methods: The local RTAC led the implementation of a new communication process called a Trauma Team Activation Timeout (TTA Timeout). Prior to implementation of this project, over 800 EMS providers completed training on the protocol. Paramedics were trained to deliver their report in the MIST format (mechanism, injuries, symptoms, treatments). Immediately following transfer of care, the lead paramedic and the trauma team leader completed a 7-item survey assessing their experience. Responses to survey questions were compared between EMS providers and trauma team leaders using rank sum correlation. Results: Data were collected from 51 paramedics (17 EMS agencies) and 45 team leaders between 3/01/13-4/30/13. Paramedics believed the benefit of the TTA timeout was higher to the EMS provider (100% v. 77%, p<0.001), patient (100% v. 75%, p<0.001), and team leader (100% v. 80%, p<0.001) than the trauma team leader's evaluation. Paramedics perceived the TTA Timeout to result in higher effectiveness in the transfer of the patient than trauma team leaders (Spearman's rho = -0.2; p = 0.04). Conclusion: Paramedics report greater benefit of the TTA Timeout process than the in-hospital trauma team leaders. Inhospital personnel may require more education about the importance of the EMS report with the criticallyinjured patient. Poster Presenter: Chad House Contact Email: chad.m.house@healthpartners.com Abstract Title: Normalization of Left Ventricular Ejection Fraction is Associated with the Absence of Appropriate Anti-Tachycardia Therapy in Patients Receiving Implantable Defibrillators for the Primary Prevention of Sudden Death Authors: House CM; Nguyen D, Nelson WB, Zhu DWX Collaborators: Cardiology Funding Agency: Cardiology Department Abstract: Background: Patients with severely depressed left ventricular ejection fractions (LVEF) receive implantable cardiac defibrillators (ICD) for the primary prevention of sudden death. Limited data are available on 1) the incidence of late recovery of LVEF in these patients and 2) the incidence of appropriate anti-tachycardia therapy including pacing and shock in patients with normalized LVEF. Methods: We retrospectively identified 154 consecutive patients with an ICD for primary prevention who had LVEF available at initial implantation and prior to generator replacement. The incidence of appropriate anti-tachycardia therapy after generator replacement was assessed. Results: Of the 154 patients (65 ± 14 years, females 25%), 19 (12%) had improvement in their LVEF from 26 ± 9% to = 55%. None of these individuals experienced any appropriate anti-tachycardia therapy during a follow-up period of 28 ± 18 months. Among the remaining 135 patients, with depressed LVEF (25 ± 7%), 30 individuals (22%) had at least one appropriate anti-tachycardia therapy during a follow-up period of 25 ± 18 months. The difference in appropriate anti-tachycardia therapy between the two groups was highly significant (p = 0.02). Compared to patients whose LVEF remained depressed, patients with normalized LVEF trended towards being female (37% vs. 24%, p =0.26), with a lower prevalence of ischemic cardiomyopathy (53% vs. 73%, p = 0.1). Conclusion: 12% of the patients with depressed LVEF, who received ICD initially for primary prevention of sudden death, had normalized LVEF at the time of generator replacement. None of these patients received appropriate anti-tachycardia therapy during a follow-up period of 28 ± 18 months. The practice of routine replacement of generator in these patients may need to be reassessed on an individual basis. Longer follow-up in a larger population is needed to confirm these findings. Background: Patients with severely depressed left ventricular ejection fractions (LVEF) receive implantable cardiac defibrillators (ICD) for the primary prevention of sudden death. Limited data are available on 1) the incidence of late recovery of LVEF in these patients and 2) the incidence of appropriate anti-tachycardia therapy including pacing and shock in patients with normalized LVEF. Methods: We retrospectively identified 154 consecutive patients with an ICD for primary prevention who had LVEF available at initial implantation and prior to generator replacement. The incidence of appropriate anti-tachycardia therapy after generator replacement was assessed. Results: Of the 154 patients (65 ± 14 years, females 25%), 19 (12%) had improvement in their LVEF from 26 ± 9% to = 55%. None of these individuals experienced any appropriate anti-tachycardia therapy during a follow-up period of 28 ± 18 months. Among the remaining 135 patients, with depressed LVEF (25 ± 7%), 30 individuals (22%) had at least one appropriate anti-tachycardia therapy during a follow-up period of 25 ± 18 months. The difference in appropriate anti-tachycardia therapy between the two groups was highly significant (p = 0.02). Compared to patients whose LVEF remained depressed, patients with normalized LVEF trended towards being female (37% vs. 24%, p =0.26), with a lower prevalence of ischemic cardiomyopathy (53% vs. 73%, p = 0.1). Conclusion: 12% of the patients with depressed LVEF, who received ICD initially for primary prevention of sudden death, had normalized LVEF at the time of generator replacement. None of these patients received appropriate anti-tachycardia therapy during a follow-up period of 28 ± 18 months. The practice of routine replacement of generator in these patients may need to be reassessed on an individual basis. Longer follow-up in a larger population is needed to confirm these findings. Poster Presenter: Joseph Walter Contact Email: joseph.w.walter@healthpartners.com Abstract Title: Morbidity and Mortality in Necrotizing Soft Tissue Infections: Hyperbaric Oxygen Versus Standard Therapy in Two Urban Hospitals Authors: Westgard BC, Walter JW Collaborators: Chris Anderson, Gabriela Vazquez-Benitez, Andy Nelson (the Institute)

Cite this paper

@inproceedings{Rizkala2013PresenterM, title={Presenter : Michael Zwank Contact Email}, author={Amir R Rizkala and Michael D Zwank}, year={2013} }