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Sinking skin flap syndrome in the multi-trauma patient: a paradoxical management to TBI post craniectomy [Case Report]
Hakmi, Hazim; Joseph, D'Andrea K; Sohail, Amir; Tessler, Lee; Baltazar, Gerard; Stright, Adam
Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported in trauma patients. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients' head, diuresis and hyperventilation. However, after craniectomy for trauma, a partially boneless cranium may be compressed by the higher atmospheric pressure, that intracranial pressure rises to dangerous levels. For such cases, paradoxical supportive management with intravenous fluid infusion, and reverse Trendelenburg positioning, is used to counteract the higher atmospheric pressure, as a bridge to definitive treatment with cranioplasty. These steps constitute an urgent and easily applied intervention to reduce further neurological deterioration, of which every trauma healthcare provider should be aware.
PMCID:7303104
PMID: 32595925
ISSN: 2042-8812
CID: 4807052
Osteopathic Manipulative Treatment Relieves Post-concussion Symptoms in a Case of Polytrauma [Case Report]
Baltazar, Gerard A; Kolwitz, Christine; Petrone, Patrizio; Stright, Adam; Joseph, D'Andrea
Optimal management of post-concussion symptoms (PCS) remains ill-defined but includes multimodal, symptom-guided plans of care. Osteopathic manipulative treatment (OMT) may be used as an adjunct treatment for PCS. We present a case of a motor vehicle collision victim whose PCS improved directly and progressively after OMT. To our knowledge, this is the first report of OMT utilized for PCS management after polytrauma and as part of an organized trauma system. Previous studies discuss potential benefits of OMT for patients with PCS after sports-related injuries, and none account for management of multiply injured patients as part of an organized trauma system. Further study of OMT for PCS is warranted and would benefit by recruiting patients from trauma centers in order to observe a range of mechanisms of injury that result in concussion.
PMCID:7164692
PMID: 32313758
ISSN: 2168-8184
CID: 4402132
Does Size Matter? Outcomes in Obese vs Non-Obese Injured Patients at an American College of Surgeons-Verified Level I Trauma Center and Bariatric Surgery Center of Excellence [Meeting Abstract]
Petrone, Patrizio; Howell, Raelina S.; Akerman, Meredith; Baltazar, Gerard Anthony; Joseph, D\Andrea K.; Brathwaite, Collin E. M.
ISI:000582798100003
ISSN: 1072-7515
CID: 4686612
Recurrent Cutaneous Rosai-Dorfman Disease [Case Report]
Michaeli, Oren; Elassa, Mohammed; Williams, Richard; Baltazar, Gerard
Rosai-Dorfman disease (RDD) is a rare proliferative histiocytic disorder, most commonly presenting with cervical lymphadenopathy. When extranodal, a rare manifestation of the disease is the presence of cutaneous lesions. Surgical excision has shown promising results in patients with cutaneous RDD; however, no optimal management has been elucidated. We present a 60-year-old female with recurrence of left thigh cutaneous lesions consistent with extranodal RDD whose optimal management required combined used of excision and chemotherapy.
PMCID:6892574
PMID: 31828001
ISSN: 2168-8184
CID: 4252162
Combined Blunt and Penetrating Neck Trauma: Diagnostic and Treatment Complexities [Case Report]
Amoo, Kweku; Mahan, Mark; Mensah, Dennis; Mascia, Angelo; Baltazar, Gerard
ORIGINAL:0013484
ISSN: n/a
CID: 3972212
EFFECT OF HOSPITAL PROTOCOL IMPLEMENTATION, ENFORCEMENT, AND PERFORMANCE IMPROVEMENT TRACKING ON OUTCOMES IN HIP FRACTURE PATIENTS
Baltazar, Gerard; Fisher, Kristy A; Akella, Krishna; Chendrasekhar, Akella
ORIGINAL:0013487
ISSN: 2277-8179
CID: 3973122
72-Hour Clinical Pulmonary Infection Score May Have Prognostic Value among Trauma Patients with Ventilator Associated Pneumonia
Baltazar, Gerard; Pate, Amy; Pinto, Frederique; Chendrasekhar, Akella
ORIGINAL:0013486
ISSN: 2277-8179
CID: 3973112
Integration of Geriatrician Consultation for Trauma Admissions May Benefit Patient Outcomes
Saha, Sumit; DiRusso, Stephen M; Welle, Scott; Lieberman, Benjamin; Sender, Joel; Shabsigh, Ridwan; Baltazar, Gerard A
Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integrated geriatrician consultation with the management of admitted patients. Our goal is to describe our experience with increasing geriatric fall volume to help inform organized geriatric trauma programs. Method: We retrospectively analyzed admitted trauma patients ≥65 years old, suffering falls from January 1, 2006, to December 31, 2017. We examined descriptive statistics and changes in outcomes after integration. Results: A total of 1,335 geriatric trauma patients were admitted, of which 1,054 (79%) had suffered falls. Falls increased disproportionately (+280%) compared with other mechanisms of injury (+97%). After 2013, patient discharge disposition to skilled nursing facility decreased significantly (-67%, p < .001), with a concomitant increase in safe discharges home with outpatient services. Regression analysis revealed association between integration of geriatrician consultation and outcomes. Discussion: Geriatrician consultation is associated with optimized discharge disposition of trauma patients. We recommend geriatrician consultation for all geriatric trauma activations.
PMCID:6589989
PMID: 31259206
ISSN: 2333-7214
CID: 3967682
Grade IV Splenic LAXeration: An Unusual but Potentially Mortal Sports Injury [Case Report]
Lieberman, Benjamin; Caughey, Megan; Nicholas, Michael; DiRusso, Stephen; Baltazar, Gerard
ORIGINAL:0013485
ISSN: n/a
CID: 3972222
Splenic hematoma may present as large bowel obstruction: A case report
Kolwitz, Christine; Esposito, Christopher; Gauvin, Caitlin; Gaduputi, Vinaya; Chiong, Brian; Sunkara, Tagore; Baltazar, Gerard A
INTRODUCTION/BACKGROUND:Large bowel obstruction (LBO) warrants prompt evaluation and management. Although causes of LBO are most commonly intrinsic to the colon (e.g. malignancy, diverticular stricture, intussusception or volvulus), rare extrinsic etiologies exist. An extremely rare extrinsic etiology of LBO described only once, is compressive splenic hematoma. PRESENTATION OF CASE/METHODS:A 64-year-old female presented to the emergency department complaining of two days of diffuse abdominal pain and distension, watery diarrhea and nausea subsequent to a mechanical fall to her left side. Computed tomography demonstrated a grade 3 splenic hematoma with active extravasation, causing extrinsic compression and obstruction of the colon. Embolization of the splenic artery was performed, and non-operative LBO management resulted in resumption of normal bowel function after six days. DISCUSSION/CONCLUSIONS:To our knowledge, the only other case of colonic compression by splenic hematoma (a case report in the radiology literature from 1994) describes a 62-year-old male whose symptoms similarly spontaneously resolved. Increasing frequency of non-operative management of splenic trauma may result in increased frequency of splenic hematoma complications. Physicians and surgeons who treat LBO should be aware of this rare etiology and its potential for non-operative management. CONCLUSION/CONCLUSIONS:Our case demonstrates the importance of considering splenic hematoma as an etiology of LBO, particularly in the setting of trauma and that management of this entity can be successfully non-operatively.
PMID: 30599304
ISSN: 2210-2612
CID: 3568222