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Introduction: Recent studies investigating emergency department (ED) thoracotomies (EDTs) focus on patient outcomes to identify optimal candidates for this procedure. However, there is limited but concerning literature regarding healthcare workers occupational exposures resulting from EDT. In this study, we compare rates of blood-borne exposure to immediate procedural success (i.e., regaining pulses) as well as patient outcome., Methods: A retrospective chart review of the trauma registry was performed from January 2019 to January 2023. We included all trauma patients who underwent EDT during the study period. 58 patients met the inclusion criteria and were reviewed, and no patients were excluded. The primary endpoint was the rate of occupational exposure as defined by mucous membrane or percutaneous exposure to the patient's blood during the procedure. Additional endpoints include rate of survival to operating room, intensive care unit (ICU), and discharge, type of exposure, Glasgow Coma Score score, and blood products transfused., Results: Of the 58 patients, 10 EDTs (17%) had reported healthcare occupational exposure, 24 patients (41%) were resuscitated in the ED and moved to the OR or the ICU. 9 patients (16%) survived the OR, with 2 patients (3%) surviving to discharge from the hospital. Of the 10 patients with reported exposures, 4 (40%) regained spontaneous circulation in the ED, 2 patients (20%) survived the OR to the post anesthesia care unit and ICU, but neither survived to discharge (0%). Of the 48 patients without exposures reported, 20 (42%) regained spontaneous circulation in the ED, 7 (15%) survived to the ICU after the OR, and 2 (4%) survived to discharge. Of the 9 patients that survived the OR, 3 showed improvement in neurologic status shown by an improved Glasgow Coma Score., Conclusions: The noted rate of healthcare worker exposures during these procedures is higher than expected. The rate of survival to the operating room and subsequently to the ICU was higher than current reported rates. Further research needs to be done to investigate ways to improve training and protocols to make this procedure safer for the patient and the team of providers., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Traumatic duodenal injuries are complex in nature and pose major challenges to trauma surgeons. These injuries are associated with high mortality rates ranging from 18% to 30% and require prompt, comprehensive care. Traumatic injury induces a hypercatabolic state that mobilizes body energy stores, leading to muscle wasting, delayed healing, and potential multi-organ failure. Nutritional support is vital in keeping up with the metabolic demands of traumatically injured patients. However, exactly when and how nutrition should be provided for traumatic duodenal injuries is unclear. We hypothesize that patients who sustain high-grade duodenal injuries (grades III-V) will be unable to tolerate enteral nutrition (EN) and may benefit from early initiation of total parenteral nutrition (TPN)., Methods: In this retrospective chart review study, we queried the trauma registry for patients admitted between January 2018 and December 2022 with duodenal injury. Individuals under the age of 18 and individuals who were pregnant were excluded. Twenty-eight patients met the inclusion/exclusion criteria. The primary endpoint was median number of days from initial injury to supplemental nutrition. We also evaluated the route used to achieve adequate nutrition based on duodenal injury grade (I-V), mortality based on duodenal injury grade, morbidity based on route of nutrition supplementation (hospital length of stay [LOS], intensive care unit LOS, and ventilator days), and complications based on route of nutrition supplementation., Results: Of the 28 patients analyzed, 11 received EN, 10 received TPN (6 of which survived to transition to EN), and 7 died within 3 d of admission and did not receive any form of nutrition. The median number of days post-trauma to toleration of enteral feeding (defined as by mouth or tube feeding that meet total caloric needs based on nutritionist recommendations) was 4 d for those who did tolerate and maintained tolerance of enteral feeding, compared to 7.5 d post-trauma to initiate total parenteral feeding (P = 0.061). Injury grades I and II tolerated EN within a median of 6 d, whereas injury grades III and IV showed inability to tolerate EN until after a median of 22 d or longer (P = 0.02). Mortality increased as injury grade increased. Patients who received TPN were more likely to develop abscesses than those receiving EN (80% vs 27%, P = 0.03) but not more likely to develop a duodenal leak (P = 0.31). Patients who received TPN had longer hospital LOS (35.5 d vs 9 d, P = 0.008), longer intensive care unit LOS (17 d vs 4 d, P = 0.005), and increased ventilator days (9 d vs 1 d, P = 0.005) when compared to patients who received EN., Conclusions: Individuals with higher grade duodenal injuries showed inability to tolerate EN until after a median of 22 d, and therefore, consideration should be given to initiating TPN early to mitigate the catabolic effects of malnutrition. Further studies need to be done with a larger number of patients to evaluate the effects of malnutrition in these patients., (Copyright © 2024 Elsevier Inc. All rights reserved.)