Browsing by Author "Himmler, Amber Nicole"

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Abdominal and thoracic wall closure: damage control surgery's cinderella
(2021) Ordoñez, Carlos A.
Damage control surgery principles allow delayed management of traumatic lesions and early metabolic resuscitation by performing abbreviated procedures and prompt resuscitation maneuvers in severely injured trauma patients. However, the initial physiological response to trauma and surgery, along with the hemostatic resuscitation efforts, causes important side effects on intracavitary organs such as tissue edema, increased cavity pressure, and hemodynamic collapse. Consequently, different techniques have been developed over the years for a delayed cavity closure. Nonetheless, the optimal management of abdominal and thoracic surgical closure remains controversial. This article aims to describe the indications and surgical techniques for delayed abdominal or thoracic closure following damage control surgery in severely injured trauma patients, based on the experience obtained by the Trauma and Emergency Surgery Group (CTE) of Cali, Colombia. We recommend negative pressure dressing as the gold standard technique for delayed cavity closure, associated with higher wall closure success rates and lower complication and mortality rates
Is the whole greater than the sum of its parts? the implementation and outcomes of a whole blood program in Ecuador
(2021) Himmler, Amber Nicole; Galarza Armijos, Monica Eulalia; Reinoso Naranjo, Jeovanni Homero; Peña Patiño, Sandra Gioconda; Sarmiento Altamirano, Doris; Flores Lazo, Nube Lucia; Pino Andrade, Raul Haldo; Sacoto Aguilar, Hernán; Fernández de Córdova, Lenin; Cevallos Agurto, Cecibel Yadira; Raykar, Nakul; Puyana, Juan Carlos
Background Hemorrhagic shock is a major cause of mortality in low-income and middle-income countries (LMICs). Many institutions in LMICs lack the resources to adequately prescribe balanced resuscitation. This study aims to describe the implementation of a whole blood (WB) program in Latin America and to discuss the outcomes of the patients who received WB. Methods We conducted a retrospective review of patients resuscitated with WB from 2013 to 2019. Five units of O+ WB were made available on a consistent basis for patients presenting in hemorrhagic shock. Variables collected included gender, age, service treating the patient, units of WB administered, units of components administered, admission vital signs, admission hemoglobin, shock index, Revised Trauma Score in trauma patients, intraoperative crystalloid (lactated Ringer's or normal saline) and colloid (5% human albumin) administration, symptoms of transfusion reaction, length of stay, and in-hospital mortality. Results The sample includes a total of 101 patients, 57 of which were trauma and acute care surgery patients and 44 of which were obstetrics and gynecology patients. No patients developed symptoms consistent with a transfusion reaction. The average shock index was 1.16 (±0.55). On average, patients received 1.66 (±0.80) units of WB. Overall mortality was 13.86% (14 of 101) in the first 24 hours and 5.94% (6 of 101) after 24 hours. Discussion Implementing a WB protocol is achievable in LMICs. WB allows for more efficient delivery of hemostatic resuscitation and is ideal for resource-restrained settings. To our knowledge, this is the first description of a WB program implemented in a civilian hospital in Latin America. Level of evidence Level IV.
The successful implementation of a trauma and acute care surgery model in Ecuador
(2020) Sarmiento Altamirano, Doris Adriana; Himmler, Amber Nicole; Chango Siguenza, Oscar Miguel; Pino Andrade, Raul Haldo; Flores Lazo, Nube Lucia; Reinoso Naranjo, Jeovanni Homero; Sacoto Aguilar, Hernan Patricio; Fernandez de cordova Rubio, German Lenin; Rodas, Edgar B.; Puyana, Juan Carlos; Salamea Molina, Juan Carlos
For years, surgical emergencies in Ecuador were managed on a case-by-case basis without significant standardization. To address these issues, the Regional Hospital Vicente Corral Moscoso adapted and implemented a model of “trauma and acute care surgery” (TACS) to the reality of Cuenca, Ecuador. A cohort study was carried out, comparing patients exposed to the traditional model and patients exposed to the TACS model. Variables assessed included number of surgical patients attended to in the emergency department, number of surgical interventions, number of surgeries performed per surgeon, surgical wait time, length of stay and in-hospital mortality.