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Cancelled elective surgery: an evaluation

Lacqua, M J; Evans, J T
Cancelled elective surgical cases result in wasted operating room time and additional hospital expense. We prospectively reviewed 1063 scheduled cases that resulted in 184 (17%) cancellations. For outpatient surgery, urology had significantly more, and orthopedic and pediatric surgery significantly fewer cancellations. For inpatient surgery, plastic surgery had significantly more and orthopedic surgery and obstetrics and gynecology significantly fewer cancellations. Lack of medical clearance and outpatient "no shows" accounted for the majority of avoidable cancellations. Case cancellations can be decreased by improved preoperative patient evaluation, improved communication between physician and patient, and modified schedule design.
PMID: 7978670
ISSN: 0003-1348
CID: 1910002

Widened mediastinum in acute trauma: a complication of central venous catheterization [Case Report]

Lacqua, M J; Sahdev, P
We report a case of mediastinal widening simulating aortic rupture and resulting from fluid infused into the mediastinum via a percutaneously placed subclavian pulmonary artery introducer sheath in an acutely injured patient. The use of such catheters for resuscitation of acutely injured patients is presented, along with reported complications and their diagnosis. Necessary precautions during the use of these catheters are discussed.
PMID: 7989686
ISSN: 0736-4679
CID: 1910012

Road traffic fatalities in Delhi: causes, injury patterns, and incidence of preventable deaths

Sahdev, P; Lacqua, M J; Singh, B; Dogra, T D
India reported nearly 50,000 traffic accident deaths in 1989. Yet, literature addressing the causes, timing, and preventability of these deaths is sparse. We undertook an autopsy study of road traffic fatalities in South Delhi to determine the injury patterns and incidence of deaths that could be prevented by optimal utilization of available medical resources. Among the 177 autopsies reviewed, neurological injury caused death in 60% of patients and hemorrhagic shock in 25%. Twenty-three percent of the deaths were felt to be preventable, 41% possibly preventable, and the rest not preventable. The majority of preventable deaths resulted from a failure to diagnose or treat a treatable injury. Adherence to establish principles in the hospital management of intracavitory hemorrhage could have salvaged 70% of preventable deaths.
PMID: 8011050
ISSN: 0001-4575
CID: 1910022

Barrier precautions in trauma resuscitations: multivaried analysis of factors affecting use

Sahdev, P; Lacqua, M J; Harrigan, N; Evans, J T; Vaish, A K
STUDY OBJECTIVES: To determine the relative importance of factors affecting use of barrier precautions by trauma team members. DESIGN: Prospective, nonblinded review of barrier precaution use by trauma team members over three periods. A multivaried analysis of factors affecting use then was conducted. SETTING: A 615-bed Level I trauma center in New York State with an accredited surgical residency program. TYPE OF PARTICIPANTS: Trauma team members involved in resuscitating multitrauma patients in the trauma room. INTERVENTIONS: Period 1: June to August 1991, barrier precaution use before interventions; period 2: September 1991 to January 1992, educational seminars held and material access improved by designated cart; period 3: February to June 1992, legislation mandating barrier precaution use introduced. MAIN RESULTS: Barrier precaution compliance improved significantly in periods 2 and 3. The improvement was seen in all providers studied. Improvement in barrier precaution use correlated significantly with education, materials access, and legislation. CONCLUSION: Improved compliance with barrier precaution use can be affected by education, improving materials access, and legislation. The relative importance of education versus materials access requires further study.
PMID: 8161054
ISSN: 0196-0644
CID: 1910032

The epidemic of penetrating trauma: a national dilemma

Lacqua, M J; Sahdev, P
Available literature on penetrating trauma in the USA was reviewed to determine the prevalence, etiological factors, and societal cost of penetrating trauma. Penetrating injuries accounted for 39,888 deaths in 1989 and was the eighth leading cause of death. Etiological factors include increasing ownership of firearms, alcohol consumption, recreational drug use and trafficking, occupational risks, and socioeconomic factors. These injuries account for the fourth leading cause of estimated years of potential life lost. Corrective strategies and research are severely limited by the disproportionately low research funding.
PMID: 8157914
ISSN: 0736-4679
CID: 1910042

Effective management of penetrating abdominal trauma

Lacqua, M J; Sahdev, P
PMID: 8509480
ISSN: 8750-2836
CID: 1910052

Effective management of penetrating head injury

Lacqua, M J; Sahdev, P
Although head injuries are usually easily recognized, other, less obvious lesions should also be promptly investigated. In either case, outcome is often determined in the first few minutes and hours of management.
PMID: 1522162
ISSN: 8750-2836
CID: 1910062