Belize Medical And Dental Association

Investigators derived rates of postsurgical sepsis and septic shock from national data on over 350,000 patients undergoing general surgery between 2005 and 2007. They compared those rates with those of two other complications — pulmonary embolism and MI — that are often used to measure quality of care.

Rates of sepsis and septic shock (2.3% and 1.6%, respectively) were much higher than those of pulmonary embolism and MI (0.3% and 0.2%, respectively). Sepsis-associated risks were highest among those 60 and older, those requiring emergency surgery, and those with any comorbidity.

The authors conclude that clinical "vigilance in identifying sepsis and septic shock needs to mimic, if not surpass" that for pulmonary embolism and MI.

Archives of Surgery article (Free abstract)

Hypotension in trauma patients typically occurs after loss of 30% of total blood and, if persistent, can lead to end-organ injury resulting from hypoperfusion and uncompensated shock. In a prospective observational study at a single level I trauma center, researchers determined the systolic blood pressure (SBP) cutpoint value that best predicts the need for therapeutic surgical or endovascular procedures; 145 adult patients (77% men; 54% with blunt mechanism of injury) who had at least one SBP measurement <110 mm Hg during initial trauma care were enrolled during a 6-month period. Exclusion criteria were transfer from another hospital, injury more than 2 hours before emergency department (ED) arrival, and isolated prehospital hypotension (<90 mm Hg) or more than two SBP readings <90 mm Hg in the ED.

Ms. J. was no stranger to medical students. The year before I came along, she'd worked with another student, and she took unabashed pleasure in sharing the teachable complexities of her health problems — diabetes, depression, obesity, and osteoarthritis. She arrived at our first appointment, in the fall of my third year, adorned in a hot-pink feathered hat with matching sweatshirt and oversized hoop earrings. She labored to the exam room using a walker, and as we chatted, the buoyancy of her Trinidadian lilt was undercut with a sadness that would take months for me to even begin to unpack.

Previously, the group recommended that a trial of labor after cesarean be attempted only in facilities with emergency staff "immediately available." Earlier this year, the NIH urged professional societies to revise this guideline because some hospitals stopped offering VBAC.