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Mass casualty events (MCE) are an infrequent occurrence to most daily healthcare systems however these incidents are the causation for new hospital preparedness and the development of coordinated emergency services. The broad support and operational plans outside the hospital include emergency medical services, local law enforcement, government agencies, and city officials. Modern-day hospital disaster preparedness goals include scheduled training for healthcare personnel to ensure effective and accurate triage for a high-volume of injured patients. This MDT collaboration strengthens the emergency response to optimize the delivery of life-saving care during MCEs. This review identifies the clinical importance of the interdisciplinary team interactions and the lessons learned from past MCE experiences, strengthening healthcare system readiness for such critical incidents.

Introduction In trauma patients with pelvic fractures, computed tomography (CT) scans are a critical tool to evaluate life-threatening hemorrhage. Contrast extravasation, or “blush”, on CT may be a sign of bleeding, prompting a consult for angiography and possible embolization. However, the utility of blush on CT is controversial. We sought to evaluate our experience with patients who sustained pelvic fractures and had blush on CT. Method A retrospective review was performed for all patients with blunt pelvic fractures between January 1, 2017 and December 31, 2018. Demographic, clinical, radiographic, and injury data were obtained. Comparison of mortality, hospital length of stay (LOS), and intensive care unit (ICU) LOS was performed for 3 subgroups: angio versus no angio; embo versus no embo; prophylactic embo versus therapeutic embo. We also calculated the sensitivity, specify, positive predictive value (PPV), and negative predictive value (NPV) of CT blush to predict the need for embolization. Results 889 patients were found to have a blunt pelvic fracture. 51 patients had blush on CT scan. 29 (56.9%) underwent angiography. 17 (58.6%) of these 29 patients were found to have extravasation and were embolized. 12 patients had an angio with no extravasation, and 6 of these patients (50%) underwent prophylactic embolization. No significant difference was found for hospital LOS, ICU LOS, or mortality in our 3 groups. Sensitivity, specificity, PPV, and NPV for CT blush were 74%, 96%, 33%, 99%, respectively. Conclusion Patients with active extravasation undergoing embolization had similar outcomes to patients without active extravasation. Blush on CT scan had low sensitivity and low PPV but high specificity and high NPV. Future studies need to include careful attention to the CT protocol utilized as well as patient selection.

Visceral vascular injuries are relatively uncommon even in busy urban trauma centers. The inferior vena cava (IVC) is the most frequently injured visceral vein and can be a complex operative challenge. Despite advances in early volume resuscitation, improved transport times, prompt operative intervention, and hemorrhage control, mortality rates have remained largely unchanged. This article conducts an in-depth review of the literature surrounding IVC injuries and a detailed discussion of operative strategies and management as survivability is ultimately dependent on the grade of injury, location, and the presence of hemorrhagic shock.

Radiographic evaluation confirmed a closed distal femur fracture and a closed fracture of the fibula. Because of his normal hemodynamic status, he was taken for trauma pan-scan, as per hospital protocol, and computed tomographic angiography of the right lower extremity. Because of the rarity of traumatic vascular injury in the civilian population, the clinician must maintain a high index of suspicion for these injuries. Lower extremity arterial injury: results of 550 cases and review of risk factors associated with limb loss.

Fat embolism syndrome is a potentially life-threatening condition characterized by respiratory distress, altered mental status, and skin petechiae.1 Fat emboli are common after long bone fractures (>80%), but fat embolism syndrome in long bone fractures is relatively rare, with a reported incidence of 0.9 to 2.2 per cent of cases.2 The diagnosis of fat embolism syndrome is primarily clinical and manifests with an adult respiratory distress syndrome-like respiratory distress. At this time, the patient's hemoglobin began to trend down and she required transfusion of 4 units of packed red blood cells to maintain hemoglobin levels greater than 7 over the next 24 hours, despite no obvious source of bleeding. Use of corticosteroids to provide an anti-inflammatory effect has been reported,3 but this is not considered the standard of care. Because of the low incidence of the fat embolism syndrome as a whole, it is essential to have a high index of suspicion in any patient who develops mental status changes and respiratory distress hours to days after a long bone fracture.

PurposeThere are limited data comparing the severity of traumatic adrenal injury (TAI) and the need for interventions, such as transfusions, hospitalization, or incidence of adrenal insufficiency (AI) and other clinical outcomes. The aim of this study was to analyze the relationship between the grade of TAI and the need for subsequent intervention and clinical outcomes following the injury.MethodsAfter obtaining Institutional Review Board approval, our trauma registry was queried for patients with TAI between 2009 and 2017. Contrast-enhanced computed tomography (CT) examinations of the abdomen and pelvis were evaluated by a board-certified radiologist with subspecialty expertise in abdominal and trauma imaging, and adrenal injuries were classified as either low grade (American Association for the Surgery of Trauma (AAST) grade I–III) or high grade (AAST grade IV–V). Patients without initial contrast-enhanced CT imaging and those with indeterminate imaging findings on initial CT were excluded.ResultsA total of 129 patients with 149 TAI were included. Eight-six patients demonstrated low-grade injuries and 43 high grade. Age, gender, and Injury Severity Score (ISS) were not statistically different between the groups. There was an increased number of major vascular injuries in the low-grade vs. high-grade group (23% vs. 5%, p < 0.01). No patient required transfusions or laparotomy for control of adrenal hemorrhage. There was no statistical difference in hospital length of stay (LOS), ventilator days, or mortality. Low-grade adrenal injuries were, however, associated with shorter ICU LOS (10 days vs. 16 days, p = 0.03).ConclusionThe need for interventions and clinical outcomes between the low-grade and high-grade groups was similar. These results suggest that, regardless of the TAI grade, treatment should be based on a holistic clinical assessment and less focused on specific interventions directed at addressing the adrenal injury.

A patient with a previous history of neck cancer and carotid endarterectomy presents with a pulsatile cervical mass. Further evaluation reveals the presence of a pseudoaneurysm of the common carotid artery. The endovascular treatment options and techniques employed to exclude the pseudoaneurysm are presented and discussed.

Several studies have demonstrated IER is associated with reduced stricture and erectile dysfunction rates as well as im- proved time to spontaneous voiding.3, 4 The IER tech- nique can be applied regardless of the pattern or anatomic location of the injury with success rates reportedashighas78percent.3 Furthermore, recent studies have shown that failed attempts at IER do not preclude formal delayed urethroplasty (DU).3, 4 This case was more complex based on the presence of a missile lodged in the posterior urethra. [...]the emerging use of IER for urethral trauma may obviate the complications of SPC and DU.