Scholars@Duke
Mark Donald Piehl

Mark Donald Piehl

Medical Associate Professor in the Department of Pediatrics
Pediatrics, Community Programs

Scholarly Works

Initial identification of severely injured pediatric trauma patients-Clinical signs, scoring systems, and anticipating acute intervention needs: What you need to know.

Journal article J Trauma Acute Care Surg · May 21, 2026 Severely injured children are often first evaluated at nonpediatric designated hospitals where high-acuity pediatric trauma is seldom encountered, and delays in recognition of physiologic compromise can adversely affect outcomes. While the general principl ... Full text Link to item Cite

Is There a Role for Prehospital Precision Resuscitation? A Prospective Multi-Institutional Blood Analysis.

Journal article J Am Coll Surg · April 1, 2026 BACKGROUND: Military experience has paved the way for the development of civilian prehospital (PH) blood programs. Although whole blood (WB) is considered the product of choice for prehospital transfusion, data comparing WB to packed RBC (pRBCs) are lackin ... Full text Link to item Cite

Prioritizing circulation over airway in trauma patients with exsanguinating injuries: What you need to know.

Journal article J Trauma Acute Care Surg · November 1, 2025 Hemorrhage remains a leading cause of preventable trauma-related mortality, with early resuscitation and hemorrhage control serving as crucial interventions. Emerging evidence suggests that prioritizing circulation before airway (Circulation, Airway, and B ... Full text Link to item Cite

The Association Between Time to Completion of at Least 30 mL/kg and Hospital Outcomes Among Patients With Septic Shock.

Journal article Crit Care Explor · May 1, 2025 IMPORTANCE: Sepsis is the leading cause of inpatient mortality in the United States. The optimal timing and volume of fluid resuscitation for septic shock remain a topic of debate. OBJECTIVES: This study evaluated the effect of time to completion of at lea ... Full text Link to item Cite

Every minute matters: Improving outcomes for penetrating trauma through prehospital advanced resuscitative care.

Journal article J Trauma Acute Care Surg · November 1, 2024 BACKGROUND: Prehospital resuscitation with blood products is gaining popularity for patients with traumatic hemorrhage. The MEDEVAC trial demonstrated a survival benefit exclusively among patients who received blood or plasma within 15 minutes of air medic ... Full text Link to item Cite

Faster refill in an urban emergency medical services system saves lives: A prospective preliminary evaluation of a prehospital advanced resuscitative care bundle.

Journal article J Trauma Acute Care Surg · May 1, 2024 INTRODUCTION: Military experience has demonstrated mortality improvement when advanced resuscitative care (ARC) is provided for trauma patients with severe hemorrhage. The benefits of ARC for trauma in civilian emergency medical services (EMS) systems with ... Full text Link to item Cite

Impact of Prehospital Exsanguinating Airway-Breathing-Circulation Resuscitation Sequence on Patients with Severe Hemorrhage.

Journal article J Am Coll Surg · April 1, 2024 BACKGROUND: At the 2023 ATLS symposium, the priority of circulation was emphasized through the "x-airway-breathing-circulation (ABC)" sequence, where "x" stands for exsanguinating hemorrhage control. With growing evidence from military and civilian studies ... Full text Link to item Cite

Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013-2020).

Journal article Pediatr Crit Care Med · February 1, 2024 OBJECTIVES: Extremes of patient body mass index are associated with difficult intubation and increased morbidity in adults. We aimed to determine the association between being underweight or obese with adverse airway outcomes, including adverse tracheal in ... Full text Link to item Cite

A CIRCULATION-FIRST APPROACH FOR RESUSCITATION OF TRAUMA PATIENTS WITH HEMORRHAGIC SHOCK.

Journal article Shock · January 1, 2023 The original guidelines of cardiopulmonary resuscitation focused on the establishment of an airway and rescue breathing before restoration of circulation through cardiopulmonary resuscitation. As a result, the airway-breathing-circulation approach became t ... Full text Link to item Cite

Adult presentation of hand, foot, and mouth disease

Journal article Visual Journal of Emergency Medicine · October 1, 2022 Full text Cite

Therapeutic systemic hypothermia for a pediatric patient with an isolated cervical spinal cord injury.

Journal article J Spinal Cord Med · March 2020 Context: While uncommon, spinal cord injuries most frequently occur in adolescent and young adult males. Established treatment options are limited and focused on supportive care. Therapeutic systemic hypothermia is an emerging experimental treatment curren ... Full text Link to item Cite

Intravenous and Intraosseous Blood Transfusion With Three Different Pediatric Pressure Transfusion Strategies in an Immature Swine (Sus scrofa) Model of Hemorrhagic Shock: A Pilot Study.

Conference Mil Med · January 7, 2020 INTRODUCTION: Exsanguination remains the leading cause of preventable death in military conflicts, and pediatric casualties are common. Transfusion is crucial to preserve life, but vascular access is challenging in children, so intraosseous (IO) access is ... Full text Link to item Cite

Improving Aseptic Technique During the Treatment of Pediatric Septic Shock: A Comparison of 2 Rapid Fluid Delivery Methods.

Journal article J Infus Nurs · 2019 Rapid fluid resuscitation is used to treat pediatric septic shock. However, achieving fluid delivery goals while maintaining aseptic technique can be challenging. Two methods of fluid resuscitation-the commonly used push-pull technique (PPT) and a new flui ... Full text Link to item Cite

Improving fluid resuscitation in pediatric shock with LifeFlow®: a retrospective case series and review of the literature.

Journal article Open Access Emerg Med · 2019 Rapid delivery of an intravenous fluid bolus is commonly used in pediatric emergency care for the treatment of shock and hypotension. Early fluid delivery targeted at shock reversal results in improved patient outcomes, yet current methods of fluid resusci ... Full text Link to item Cite

Barotrauma and Arterial Gas Embolism: A Diving Emergencies Simulation Case for Emergency Medicine Residents.

Journal article MedEdPORTAL · December 21, 2018 INTRODUCTION: Arterial gas embolism (AGE) is a rare but severe complication of scuba diving. While AGE is most commonly encountered in coastal areas with high volumes of recreational divers, at-risk populations exist throughout the United States, making ba ... Full text Link to item Cite

Potential mortality and cost reduction in adult severe sepsis and septic shock through the use of an innovative fluid delivery device.

Journal article Open Access Emerg Med · 2018 BACKGROUND: While early fluid resuscitation has been shown to significantly improve health and economic metrics in septic shock, providers are often unable to achieve fluid delivery guidelines using current techniques. PURPOSE: To examine expected clinical ... Full text Link to item Cite

Near fatal anaphylaxis from orally administered gelatin capsule.

Journal article J Allergy Clin Immunol Pract · January 2013 Full text Link to item Cite

Community-acquired MRSA infections in North Carolina children: prevalence, antibiotic sensitivities, and risk factors.

Journal article N C Med J · 2009 BACKGROUND: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children has increased dramatically over the past decade. CA-MRSA infections are often resistant to standard outpatient antibiotics and pres ... Link to item Cite

Pulse contour cardiac output analysis in a piglet model of severe hemorrhagic shock.

Journal article Crit Care Med · April 2008 OBJECTIVE: Pulse contour cardiac output (PCCO) analysis is a technique for continuous cardiac output (CO) monitoring through an arterial catheter after calibration by transpulmonary thermodilution (TPTD). Studies in adults show good correlation with pulmon ... Full text Link to item Cite

Interval laparoscopic appendectomy for appendicitis complicated by pylephlebitis.

Journal article JSLS · 2006 BACKGROUND: Although rare, portal mesenteric venous thrombosis and pylephlebitis remain potential life-threatening sequelae of ruptured appendicitis in children. Treatment recommendations from recent reports have included urgent exploratory laparotomy with ... Link to item Cite

"Narrowing the Gap": decreasing emergency department use by children enrolled in the Medicaid program by improving access to primary care.

Conference Arch Pediatr Adolesc Med · August 2000 OBJECTIVE: To evaluate the effectiveness of increased primary care access created by North Carolina's Medicaid managed care plan, Carolina Access (CA), in reducing unnecessary emergency department (ED) use in Guilford County. METHODS: Emergency department ... Full text Link to item Cite