Contamination of ground red pepper with fungi and mycotoxin

http://orl-medicine.blogspot.com/2016/11/mycobiota-of-ground-red-pepper-and.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Paediatric spinal cord infarction : A previously healthy 14-year-old female who began having difficulty breathing at school immediately after experiencing a burning sensation down her neck and back.

http://orl-medicine.blogspot.gr/2016/11/paediatric-spinal-cord-infarction.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

High performance CPR demonstration

Fire department personnel practice CPR.

from EMS via xlomafota13 on Inoreader http://ift.tt/2fSwCet

High performance CPR demonstration

Fire department personnel practice CPR.

from EMS via xlomafota13 on Inoreader http://ift.tt/2fSwCet

Photo: Good Samaritans buy IHOP meal for Calif. EMTs

By EMS1 Staff

RIVERSIDE COUNTY, Calif. — Two EMTs were treated to a free pancake breakfast this week after Good Samaritans paid for their meal.

Two families, noted as the Gladwells and Millers, left a napkin message for the EMTs after paying for their breakfast at IHOP.

A photo of the napkin surfaced on Reddit, posted by the user EnMT.

The note thanked them for protecting and keeping their community safe.

“You save lives and help those around you on a daily basis. There is nothing I could do that would match what you’ve done for others, but I hope this is at least a start to showing our deepest gratitude for you both!” read the note.

Some citizens paid for our breakfast at iHop this morning. Feel appreciated in the job is rare, This made my week! from ems

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High performance CPR demonstration

Fire department personnel practice CPR.

from EMS via xlomafota13 on Inoreader http://ift.tt/2fSwCet

High performance CPR demonstration

Fire department personnel practice CPR.

from EMS via xlomafota13 on Inoreader http://ift.tt/2fSwCet

Inside EMS Podcast: Why EMS should treat opioid exposure as a hazmat scene

Download this podcast on iTunes, SoundCloud or via RSS feed

​​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson are joined by Art Hsieh, a member of the EMS1 Editorial Advisory Board and columnist, to discuss his latest article on carfentanil exposure. With the potency of this drug, does EMS have to consider exposure as well as making these hazmat scenes" Join the discussion and sound off in the comments.

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Photo: Good Samaritans pay for Calif. EMTs IHOP meal

By EMS1 Staff

RIVERSIDE COUNTY, Calif. — Two EMTs were treated to a free pancake breakfast this week after Good Samaritans paid for their meal.

Two families, noted as the Gladwells and Millers, left a napkin message for the EMTs after paying for their breakfast at IHOP.

A photo of the napkin surfaced on Reddit, posted by the user EnMT.

The note thanked them for protecting and keeping their community safe.

“You save lives and help those around you on a daily basis. There is nothing I could do that would match what you’ve done for others, but I hope this is at least a start to showing our deepest gratitude for you both!” read the note.

Some citizens paid for our breakfast at iHop this morning. Feel appreciated in the job is rare, This made my week! from ems

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Community raises funds for EMT student shot while aiding victim

By EMS1 Staff

BATON ROUGE, La. — After a 17-year-old EMT student put his life on the line to save a shooting victim, his community has begun raising funds to pay for his medical bills.

Daniel Wesley was on his way home from a Sunday shopping trip with his mother when he saw a shooting victim lying on the side of the road. Wesley rushed to the victim, April Peck, and attempted to aid her. 

During the incident, the shooter, Terrell Walker, shot Wesley in the arm and leg, and ran over him twice as he fled from the scene, reported WBRZ. Peck did not survive. Walker was killed later Sunday night in a shootout with East Baton Rouge sheriff's deputies.

Wesley was transported to the hospital, where he underwent surgery on his leg and arm, which “shattered into 18 pieces,” his mother, Kathy Wesley, said.

Wesley comes from an EMS family; his father was a longtime paramedic and his mother is also a first responder. 

Wesley’s high school has started to sell bracelets to help raise funds for his medical expenses. The school’s principal, David Prescott, said, “We’re very proud of him. He’s always in service to some else. He’s come to me before this year with a fundraiser of his own to help someone out.”

A GoFundMe page has also been created and it has raised over $6,000.

“Daniel wants to tell all of his friends out there, he’s sending a shout out to them, and he’s thinking of them as well during this time,” Wesley’s mother said. 

Heroic, selfless effort by this incredible young man. Strong work Daniel Wesley. https://t.co/SfRMYhYCzY

— MONOC EMS (@MONOCEMS) November 29, 2016

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Rapid reaction: EMT student shot, run over for caring

What happened: Emergency Medical Responder and EMT student Daniel Wesley, 17, is recovering from two gunshot wounds, a broken arm and a broken leg after he was attacked Sunday evening caring for a woman who had been shot and tossed in a road.

Wesley came to the aid of April Peck, 30. While donning gloves and preparing to apply pressure to Peck's wounds, the shooter returned to the scene. Terrell Walker, 48, drove Peck's car directly at Wesley, other bystanders and an ambulance crew. Wesley was struck and thrown against the ambulance, the impact breaking his arm. Walker got out of the vehicle, shot Wesley twice and ran him over a second time as he fled the scene. Walker, the gunman, was killed later Sunday night in a shootout with East Baton Rouge sheriff's deputies.

Kathy Wesley, Daniel's mother, reported that Wesley had surgery Sunday night and Tuesday. "He's a tough kid. He's silly and has a sense of humor you wouldn't believe," she said. "He's cracking jokes and trying his best to keep the pain in. He's been surrounded by friends and family all afternoon."

Why it's significant: Daniel Wesley is a caregiver. As a teenager, the son of an EMT is already a certified Emergency Medical Responder, capable of recognizing a person in need and providing care. Wesley is one of us. He is our brother who like the Good Samaritan saw a person injured in the road and gave care, but Wesley was attacked for taking action and doing the right thing.

Top takeaways: Since Wesley is one of us, a young man called to care, we all can learn from his experience.

1. Combined risks are exponentially more dangerous.
A routine roadway incident, if there is such a thing, is a hazardous hot zone for EMS providers and public safety personnel. Fire apparatus blocking scenes are regularly struck accidentally or intentionally, police officers are injured or killed and medical helicopters waiting for a patient to be loaded have been hit by drunk drivers twice in 2016.

Domestic violence incidents can be just as dangerous for EMS providers and law enforcement. If the assailant has fled the scene before EMS arrival, there is a constant worry that the assailant still enraged, armed and hopeless will return at any moment.

Wesley and other emergency responders were confronted by the combined danger of initiating care in the roadway as the assailant returned to the scene to attack Wesley and other caregivers. The combined risks were not twice as dangerous. This incident was 20 or 200 times more dangerous for everyone.

2. Anything is a weapon.
It's OK to know this and be reminded it is true. Anything is a weapon when it is wielded with malice and intent to main, injure or kill.

Sunday night, Wesley was attacked with a vehicle before being shot. Monday morning, an Ohio State University student drove onto a crowded sidewalk before attacking people with a knife. Body armor is partial defense for one type of weapon. Other shielding, along with distance, cover and concealment are partial defense for any type of weapon.

3. Targeted for caring.
Caregivers have been and will continue to be a target of violence for the simple act of caring. This year started with the fatal shooting of an Arkansas volunteer firefighter who responded to a medical call. In April, a Maryland firefighter-paramedic was fatally wounded and a volunteer firefighter was seriously wounded after being shot by a man they had been called to perform a welfare check. Throughout the year, paramedics, EMTs and other caregivers are violently attacked, assaulted and verbally abused by patients and bystanders. The risk of violence is unrelenting and unpredictable.

Your prayers, thoughts and even financial support for Wesley are important and appreciated. Reflecting on this incident, discussing it with your partner and squad and learning from it are also critical.

What are your top takeaways from this incident as an EMS provider, educator and advocate? 

from EMS via xlomafota13 on Inoreader http://ift.tt/2gVNlPp

Rapid reaction: EMT student shot, run over for caring

What happened: Emergency Medical Responder and EMT student Daniel Wesley, 17, is recovering from two gunshot wounds, a broken arm and a broken leg after he was attacked Sunday evening caring for a woman who had been shot and tossed in a road.

Wesley came to the aid of April Peck, 30. While donning gloves and preparing to apply pressure to Peck's wounds, the shooter returned to the scene. Terrell Walker, 48, drove Peck's car directly at Wesley, other bystanders and an ambulance crew. Wesley was struck and thrown against the ambulance, the impact breaking his arm. Walker got out the vehicle, shot Wesley twice and ran him over a second time as he fled the scene. Walker, the gunman, was killed later Sunday night in a shootout with East Baton Rouge sheriff's deputies.

Kathy Wesley, Daniel's mother, reported that Wesley had surgery Sunday night and Tuesday. "He's a tough kid. He's silly and has a sense of humor you wouldn't believe," she said. "He's cracking jokes and trying his best to keep the pain in. He's been surrounded by friends and family all afternoon."

Why it's significant: Daniel Wesley is a caregiver. As a teenager, the son of an EMT is already a certified Emergency Medical Responder, capable of recognizing a person in need and providing care. Wesley is one of us. He is our brother who like the Good Samaritan saw a person injured in the road and gave care, but Wesley was attacked for taking action and doing the right thing.

Top takeaways: Since Wesley is one of us, a young man called to care, we all can learn from his experience.

1. Combined risks are exponentially more dangerous.
A routine roadway incident, if there is such a thing, is a hazardous hot zone for EMS providers and public safety personnel. Fire apparatus blocking scenes are regularly struck accidentally or intentionally, police officers are injured or killed and medical helicopters waiting for a patient to be loaded have been hit by drunk drivers twice in 2016.

Domestic violence incidents can be just as dangerous for EMS providers and law enforcement. If the assailant has fled the scene before EMS arrival, there is a constant worry that the assailant still enraged, armed and hopeless will return at any moment.

Wesley and other emergency responders were confronted by the combined danger of initiating care in the roadway as the assailant returned to the scene to attack Wesley and other caregivers. The combined risks were not twice as dangerous. This incident was 20 or 200 times more dangerous for everyone.

2. Anything is a weapon.
It's OK to know this and be reminded it is true. Anything is a weapon when it is wielded with malice and intent to main, injure or kill.

Sunday night, Wesley was attacked with a vehicle before being shot. Monday morning, an Ohio State University student drove onto a crowded sidewalk before attacking people with a knife. Body armor is partial defense for one type of weapon. Other shielding, along with distance, cover and concealment are partial defense for any type of weapon.

3. Targeted for caring.
Caregivers have been and will continue to be a target of violence for the simple act of caring. This year started with the fatal shooting of an Arkansas volunteer firefighter who responded to a medical call. In April, a Maryland firefighter-paramedic was fatally wounded and a volunteer firefighter was seriously wounded after being shot by a man they had been called to perform a welfare check. Throughout the year, paramedics, EMTs and other caregivers are violently attacked, assaulted and verbally abused by patients and bystanders. The risk of violence is unrelenting and unpredictable.

Your prayers, thoughts and even financial support for Wesley are important and appreciated. Reflecting on this incident, discussing it with your partner and squad and learning from it are also critical.

What are your top takeaways from this incident as an EMS provider, educator and advocate"

from EMS via xlomafota13 on Inoreader http://ift.tt/2fR0yY8

Reality Training: Handguns in the fire service

Chief Wylie discusses a host of issues surrounding firefighters being armed. If you're going to carry a weapon on duty, one of your primary jobs has to be care and custody of that weapon.

from EMS via xlomafota13 on Inoreader http://ift.tt/2gStalG

EMT student shot, run over while aiding shooting victim

By Bryn Stole
The Advocate

BATON ROUGE, La. — A 17-year-old Central High senior is in the hospital with a list of painful injuries — a pair of bullet wounds, a broken arm and a broken leg — after being shot and run over twice Sunday evening while trying to save a woman fatally shot on Essen Lane.

Daniel Wesley, a trained emergency medical responder who's currently studying for his EMT certification, spotted 30-year-old April Peck lying in the roadway while driving home from a shopping trip at the Mall of Louisiana, said his mother, Kathy Wesley.

The son of a retired East Baton Rouge EMT, Wesley pulled to the side of the road, grabbed his father's medic bag and rushed to the woman, who'd been shot and tossed from her car minutes earlier by her 48-year-old boyfriend, Terrell Walker.

Daniel Wesley pulled on a pair of gloves and was preparing to put pressure on the woman's bullet wound when Walker came speeding back, aiming his car for Wesley and a group of other passers-by — including a physician and the crew of an EMS ambulance — who'd also stopped to help.

The impact threw Wesley against the ambulance, his mother said, shattering his arm. Then Walker stepped out of Peck's Chevy Malibu and shot Wesley.

"If you help her, I'm going to kill you," Kathy Wesley said Walker told her son as he turned to chase after the others trying to save Peck's life.

Wesley managed to crawl away toward the Essen Lane median, his mother said, but when Walker returned he shot him again, then climbed in his car and ran over Wesley a second time as he attempted to escape.

The ordeal left Wesley, who was rushed along with Peck to Our Lady of the Lake Regional Medical Center, with a shattered right arm, a broken thigh bone and a pair of gunshot wounds from bullets that passed straight through his body, his mother said.

Peck was pronounced dead not long afterward. Walker, the gunman, died later Sunday night in a shootout with East Baton Rouge sheriff's deputies.

Wesley spent part of Sunday night in surgery to place rods and pins around his broken femur, Kathy Wesley said. A second surgery to repair his shattered arm is scheduled for Tuesday.

"He's a tough kid. He's silly and has a sense of humor you wouldn't believe," she said. "He's cracking jokes and trying his best to keep the pain in. He's been surrounded by friends and family all afternoon."

Copyright 2016 The Advocate

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EMTs: Don't just do something, stand there

In every resuscitation room at one of our local emergency departments, there are large, comfortable wooden rocking chairs. They aren't for family or mothers comforting their children. In fact, they look like they belong on the front porch of your local Cracker Barrel, occupied by elderly folks playing checkers while they digest their meals.

They are not something one expects to find in a modern emergency department decorated in glass, tile and stainless steel. But they have a very real purpose.

During a cardiac arrest or critical trauma, the physician sits in the chair and manages the resuscitation. They don't actively participate, unless the resuscitation requires a procedure only a physician can perform. The chair allows them to be objective and dispassionately consider what needs to be done next, without being tied up in the mechanics of how it gets done.

One of the best emergency physicians I have ever met works a resuscitation by standing off to one side at the foot of the bed, arms folded across her chest, sometimes speculatively tapping her chin with a finger. Rarely does she do an intervention herself.

The respiratory therapists intubate, nurses get the vascular access and provide most of the interventions and care. Occasionally, she'll step out of her place at the foot of the bed and start a central line or insert a chest tube. Mainly, she quietly asks questions and gives orders, occasionally pointing at someone like a maestro conducting a symphony.

She does not raise her voice. There is no drama, her voice as even and conversational as if she were ordering lunch at her favorite bistro. It would probably make for very boring television, but I could easily envision her in one of those rocking chairs, orchestrating a complex resuscitation while she knits a sweater.

She knew that often, the best approach is not to just do something, but to stand there.

When I wrote about being the stand-back, big-picture, non-interventional paramedic, I pointed out that the maturation of an EMS provider is often reflected in the restraint he practices, but let's not forget the first two parts of that description: stand back and big picture. A brief pause in the doorway to dispassionately consider what you're seeing and what needs to be done is more important than doing something immediately. If your role on a scene is to be the EMT in charge, you're being paid for what goes on between your ears rather than what you do with your hands.

Don't just do something, stand there
In my experience, that seems to be one of the biggest hurdles for new medics to clear; how to transition from being one of the dancers to choreographing the entire routine.

What got me ruminating on the subject was a story related by a colleague, who was called to back up a flight medic and a ground crew on a challenging call. What he walked in on was a call about to go south in a big way, and much of it due to the proposed course of treatment by two experienced, otherwise talented paramedics.

The patient was an adolescent girl with difficulty breathing and a history of asthma. The ground medic, presented with this information from dispatch, fell prey to confirmation bias as soon as he made patient contact, and promptly went down the status asthmaticus pathway with scarcely a thought as to other differential diagnoses. When the flight medic arrived and was briefed by the ground crew, he promptly fell victim to the bandwagon effect and agreed that this was indeed the worst case of asthma in the history of ever.

Tachycardia? Check.

Tachypnea? Check.

Chest tightness? Check.

Wheezes and diminished lung sounds? Check.

Anxiety and restlessness indicative of hypoxia? Check.

They were so sure of themselves that they had already given an albuterol/ipratropium nebulizer, an IV injection of methylprednisolone, and were getting ready to hang a magnesium sulfate drip and administer 0.3 mg of epinephrine.

When my colleague arrived, because he was the third-in medic and the fourth EMS crewmember in the room, he didn't do anything. He just stood there and took it all in.

… and noticed what had escaped everyone else's attention; her heart rate was 270.

Now, an asthma attack may elevate your heart rate, as will a beta-adrenergic medication like albuterol, but it isn't likely to cause a heart rate of 270.

One emergent synchronized cardioversion later, the patient was dramatically improved, and once everyone took a moment to think, they realized her "asthma attack" was not an asthma attack at all. She was in respiratory distress due to an unstable tachycardia, and two experienced paramedics were left to contemplate the dangers of tunnel vision and what might have happened in they gave their Wolff-Parkinson-White patient a dose of epinephrine.

The ground crew and the flight medic let the panicky school staff and the gravity of the patient’s condition get inside their OODA Loop, and from then on, were too busy reacting to each new piece of information to see where it fit in the patient’s clinical presentation. The school nurse and principal said asthma, and the patient was too distressed to talk. She had already had two doses of her inhaler without improvement, which is why they summoned EMS. Everyone in the room was screaming at them, "Don't just stand there, DO something!"

And so they did. The wrong thing.

The lesson we can learn is there are few interventions so urgent that they must be done without sufficient information; information to guide the intervention, information to determine which intervention is appropriate, information to determine if the last interventions was effective and yes, information to determine whether any intervention is needed in the first place.

Scene sense to think fast
I have often jokingly said that paramedics do not run. Paramedics mosey. We saunter, we stroll and we occasionally swagger when we can't keep our egos in check. But we do not run. The reason is twofold: we want to convey the impression that the emergency ends when we arrive, and we never want to move faster than we can think.

I think pretty fast. When the situation demands, I can move much faster than you'd think possible for a guy my size. Funny thing is, I have discovered that the faster (and better) I think, the less I encounter situations that demand I move fast. The same was true when I played volleyball in college (intramural, my school didn't have a men's NCAA team). I was never the most athletically gifted person on the floor, but I found myself in the proper position more often than not to make a play. I didn't have to be athletically gifted, because I had court sense.

There are myriad clichés devoted to this concept, like "slow is smooth, smooth is fast," or "when you find yourself ass-deep in alligators, it is hard to remember that the original objective was to drain the swamp," but sayings become clichés because they hold a grain of truth.

When you find yourself overwhelmed by events and it feels as if your thought processes are mired in molasses, slow down. That pause to reflect and dispassionately consider your next act is often all it takes to allow you to manage your scene, instead of your scene managing you.

Don't just do something, stand there.

from EMS via xlomafota13 on Inoreader http://ift.tt/2fIEADq

Three-year mortality in 30-day survivors of critical care with acute kidney injury: data from the prospective observational FINNAKI study

The role of an episode of acute kidney injury (AKI) in long-term mortality among initial survivors of critical illness is controversial. We aimed to determine whether AKI is independently associated with decre...

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Extracorporeal membrane oxygenation for pheochromocytoma-induced cardiogenic shock

Pheochromocytoma, a rare catecholamine-producing tumor, might provoke stress-induced Takotsubo-like cardiomyopathy and severe cardiogenic shock. Because venoarterial-extracorporeal membrane oxygenation (VA-ECM...

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2g2tCtv

EMTs: Don't just do something, stand there

In every resuscitation room at one of our local emergency departments, there are large, comfortable wooden rocking chairs. They aren't for family or mothers comforting their children. In fact, they look like they belong on the front porch of your local Cracker Barrel, occupied by elderly folks playing checkers while they digest their meals.

They are not something one expects to find in a modern emergency department decorated in glass, tile and stainless steel. But they have a very real purpose.

During a cardiac arrest or critical trauma, the physician sits in the chair and manages the resuscitation. They don't actively participate, unless the resuscitation requires a procedure only a physician can perform. The chair allows them to be objective and dispassionately consider what needs to be done next, without being tied up in the mechanics of how it gets done.

One of the best emergency physicians I have ever met works a resuscitation by standing off to one side at the foot of the bed, arms folded across her chest, sometimes speculatively tapping her chin with a finger. Rarely does she do an intervention herself.

The respiratory therapists intubate, nurses get the vascular access and provide most of the interventions and care. Occasionally, she'll step out of her place at the foot of the bed and start a central line or insert a chest tube. Mainly, she quietly asks questions and gives orders, occasionally pointing at someone like a maestro conducting a symphony.

She does not raise her voice. There is no drama, her voice as even and conversational as if she were ordering lunch at her favorite bistro. It would probably make for very boring television, but I could easily envision her in one of those rocking chairs, orchestrating a complex resuscitation while she knits a sweater.

She knew that often, the best approach is not to just do something, but to stand there.

When I wrote about being the stand-back, big-picture, non-interventional paramedic, I pointed out that the maturation of an EMS provider is often reflected in the restraint he practices, but let's not forget the first two parts of that description: stand back and big picture. A brief pause in the doorway to dispassionately consider what you're seeing and what needs to be done is more important than doing something immediately. If your role on a scene is to be the EMT in charge, you're being paid for what goes on between your ears rather than what you do with your hands.

Don't just do something, stand there
In my experience, that seems to be one of the biggest hurdles for new medics to clear; how to transition from being one of the dancers to choreographing the entire routine.

What got me ruminating on the subject was a story related by a colleague, who was called to back up a flight medic and a ground crew on a challenging call. What he walked in on was a call about to go south in a big way, and much of it due to the proposed course of treatment by two experienced, otherwise talented paramedics.

The patient was an adolescent girl with difficulty breathing and a history of asthma. The ground medic, presented with this information from dispatch, fell prey to confirmation bias as soon as he made patient contact, and promptly went down the status asthmaticus pathway with scarcely a thought as to other differential diagnoses. When the flight medic arrived and was briefed by the ground crew, he promptly fell victim to the bandwagon effect and agreed that this was indeed the worst case of asthma in the history of ever.

Tachycardia" Check.

Tachypnea" Check.

Chest tightness" Check.

Wheezes and diminished lung sounds" Check.

Anxiety and restlessness indicative of hypoxia" Check.

They were so sure of themselves that they had already given an albuterol/ipratropium nebulizer, an IV injection of methylprednisolone, and were getting ready to hang a magnesium sulfate drip and administer 0.3 mg of epinephrine.

When my colleague arrived, because he was the third-in medic and the fourth EMS crewmember in the room, he didn't do anything. He just stood there and took it all in.

… and noticed what had escaped everyone else's attention; her heart rate was 270.

Now, an asthma attack may elevate your heart rate, as will a beta-adrenergic medication like albuterol, but it isn't likely to cause a heart rate of 270.

One emergent synchronized cardioversion later, the patient was dramatically improved, and once everyone took a moment to think, they realized her "asthma attack" was not an asthma attack at all. She was in respiratory distress due to an unstable tachycardia, and two experienced paramedics were left to contemplate the dangers of tunnel vision and what might have happened in they gave their Wolff-Parkinson-White patient a dose of epinephrine.

The ground crew and the flight medic let the panicky school staff and the gravity of the patient’s condition get inside their OODA Loop, and from then on, were too busy reacting to each new piece of information to see where it fit in the patient’s clinical presentation. The school nurse and principal said asthma, and the patient was too distressed to talk. She had already had two doses of her inhaler without improvement, which is why they summoned EMS. Everyone in the room was screaming at them, "Don't just stand there, DO something!"

And so they did. The wrong thing.

The lesson we can learn is there are few interventions so urgent that they must be done without sufficient information; information to guide the intervention, information to determine which intervention is appropriate, information to determine if the last interventions was effective and yes, information to determine whether any intervention is needed in the first place.

Scene sense to think fast
I have often jokingly said that paramedics do not run. Paramedics mosey. We saunter, we stroll and we occasionally swagger when we can't keep our egos in check. But we do not run. The reason is twofold: we want to convey the impression that the emergency ends when we arrive, and we never want to move faster than we can think.

I think pretty fast. When the situation demands, I can move much faster than you'd think possible for a guy my size. Funny thing is, I have discovered that the faster (and better) I think, the less I encounter situations that demand I move fast. The same was true when I played volleyball in college (intramural, my school didn't have a men's NCAA team). I was never the most athletically gifted person on the floor, but I found myself in the proper position more often than not to make a play. I didn't have to be athletically gifted, because I had court sense.

There are myriad clichés devoted to this concept, like "slow is smooth, smooth is fast," or "when you find yourself ass-deep in alligators, it is hard to remember that the original objective was to drain the swamp," but sayings become clichés because they hold a grain of truth.

When you find yourself overwhelmed by events and it feels as if your thought processes are mired in molasses, slow down. That pause to reflect and dispassionately consider your next act is often all it takes to allow you to manage your scene, instead of your scene managing you.

Don't just do something, stand there.

from EMS via xlomafota13 on Inoreader http://ift.tt/2gthQJm

Reality Training: Handguns in the fire service

Chief Wylie discusses a host of issues surrounding firefighters being armed. If you're going to carry a weapon on duty, one of your primary jobs has to be care and custody of that weapon.

from EMS via xlomafota13 on Inoreader http://ift.tt/2gStalG

Reality Training: Handguns in the fire service

Chief Wylie discusses a host of issues surrounding firefighters being armed. If you're going to carry a weapon on duty, one of your primary jobs has to be care and custody of that weapon.

from EMS via xlomafota13 on Inoreader http://ift.tt/2gStalG

Reality Training: Handguns in the fire service

Chief Wylie discusses a host of issues surrounding firefighters being armed. If you're going to carry a weapon on duty, one of your primary jobs has to be care and custody of that weapon.

from EMS via xlomafota13 on Inoreader http://ift.tt/2gStalG

Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre

Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of ...

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2fyGGKZ

Outcomes after helicopter versus ground emergency medical services for major trauma--propensity score and instrumental variable analyses: a retrospective nationwide cohort study

Because of a lack of randomized controlled trials and the methodological weakness of currently available observational studies, the benefits of helicopter emergency medical services (HEMS) over ground emergenc...

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Products based on olive oil, betaine, and xylitol in the post-radiotherapy xerostomia

http://ent-crete.blogspot.com/2016/11/products-based-on-olive-oil-betaine-and.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Surgical rescue: The next pillar of acute care surgery.

Background: The evolving field of Acute Care Surgery (ACS) traditionally includes trauma, emergency general surgery, and critical care. However, the critical role of ACS in the rescue of patients with a surgical complication has not been explored. We here describe the role of 'surgical rescue' in the practice of Acute Care Surgery (ACS). Methods: A prospective, electronic medical record-based ACS registry spanning January 2013 to May 2014 at a large urban academic medical center was screened by ICD-9 codes for acute surgical complications of an operative or interventional procedure. Long-term outcomes were derived from the Social Security Death Index. Results: Of 2,410 ACS patients, 320 (13%) required 'surgical rescue': most commonly, from wound complications (32%), uncontrolled sepsis (19%), and acute obstruction (15%). The majority of complications (85%) were related to an operation; 15% were related to interventional procedures. The most common rescue interventions required were bowel resection (23%), wound debridement (18%), and source control of infection (17%); 63% of patients required operative intervention, and 22% required surgical critical care. Thirty-six percent of complications occurred in ACS primary patients ('local'), while 38% were referred from another surgical service ('institutional') and 26% referred from another institution ('regional'). Hospital length of stay was longer, and in-hospital and 1-year mortality were higher in rescue patients compared to those without a complication. Outcomes were equivalent between 'local' and 'institutional' patients, but hospital length of stay and discharge to home were significantly worse in 'institutional' referrals. Conclusions: We here describe the distinct role of the acute care surgeon in the surgical management of complications; this is an additional pillar of Acute Care Surgery. In this vital role, the acute care surgeon provides crucial support to other providers as well as direct patient care in the 'surgical rescue' of surgical and procedural complications. Level of evidence: Level III, epidemiological study (C) 2016 Lippincott Williams & Wilkins, Inc.

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A position paper: The convergence of aging and injury and the need for a Geriatric Trauma Coalition (GeriTraC).

No abstract available

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Routine surveillance cholangiography following percutaneous cholecystostomy delays drain removal and cholecystectomy.

Introduction: Percutaneous cholecystostomy (PC) is often performed for patients with acute cholecystitis who are at high risk for operative morbidity and mortality. However, the necessity for routine cholangiography following PC remains unclear. We hypothesized that routine surveillance cholangiography (RSC) following PC would provide no benefit compared to on-demand cholangiography (ODC) triggered by signs or symptoms of biliary pathology. Methods: We performed a three-year retrospective cohort analysis of patients managed with PC for acute cholecystitis at two tertiary care hospitals. Patients who had routine surveillance cholangiography (RSC, n=43) were compared to patients who had on-demand cholangiography (ODC, n=41) triggered by recurrent biliary disease. Results: RSC and ODC groups were similar by severity of acute cholecystitis, presence of gallstones, systemic inflammatory response syndrome (SIRS) criteria at the time of PC, SIRS criteria 72 hours following PC, and hospital length of stay. Two patients in the ODC group developed clinical indications for cholangiography. All 44 RSC patients had cholangiography, and 67 total cholangiograms were performed in this group. Surveillance cholangiography identified six patients (14%) with cystic duct filling defect and seven patients (16%) with a common bile duct filling defect, all of whom were asymptomatic. Fifteen patients (35%) in the RSC group had 32 ERCP procedures; five patients (12%) in the ODC group had 7 ERCPs (p = 0.021). The ODC group had fewer days to drain removal (35 vs. 61, p

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COMPARISON OF NONOPERATIVE AND SURGIAL MANAGEMENT OF RENAL TRAUMA; CAN WE PREDICT WHEN NONOPERATIVE MANAGEMENT FAILS?.

BACKGROUND: Limited data exists on risk factors for the failure of nonoperative management of renal trauma. Our study objective was to determine the incidence, salvage procedure, and risk factors for failure of nonoperative management of renal trauma. METHODS: The National Trauma Data Bank research datasets admission year 2010 - 2014 were queried for renal injury by Abbreviated Injury Score (AIS) code. Patients were stratified by interventional therapy (renal procedure code

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Early percutaneous dilational tracheostomy does not lead to an increased risk of surgical site infection following anterior spinal surgery.

Background: Most patients suffering cervical spinal cord injuries require tracheostomy. The optimal timing is still a matter of debate. Previous studies showed that patients receiving early tracheostomy had fewer ventilator days, decreased rates of pneumonia, and were mobilized earlier. Due to the proximity of the anterior approach to the tracheostoma, there is concern about an increased risk of surgical site infection related to tracheostomy. Methods: Retrospective analysis at a Level 1 trauma center of patient records from 2008-2014, identifying all patients with spinal cord injury who received anterior cervical spinal surgery and had early percutaneous dilational tracheostomy. Follow-up for surgical site infection was performed throughout hospital stay (mean 110 days, median 96 days with lower quartile 89 days and upper quartile 119 days) and at 6 weeks and 3 months (clinical examination and computed tomography scans). Results: Fifty-one patients underwent anterior spinal surgery with percutaneous dilational tracheostomy performed within a median of 5 days (range 1 to 18 days). Seventy-eight percent (n=40) of patients had anterior spinal surgery, whereas 22% (n=11) had a combined anterior-posterior repair. All percutaneous dilational tracheostomies were performed using the Ciaglia single step dilation technique. Despite a surgical site infection of one patient's cannulation site, no surgical site infection of the anterior approach was observed. Conclusion: Performing a percutaneous dilational tracheostomy in a timely fashion after anterior spinal surgery does not increase the risk of surgical site infection. Background: Most patients suffering cervical spinal cord injuries require tracheostomy. The optimal timing is still a matter of debate. Previous studies showed that patients receiving early tracheostomy had fewer ventilator days, decreased rates of pneumonia, and were mobilized earlier. Due to the proximity of the anterior approach to the tracheostoma, there is concern about an increased risk of surgical site infection related to tracheostomy. Methods: Retrospective analysis at a Level 1 trauma center of patient records from 2008-2014, identifying all patients with spinal cord injury who received anterior cervical spinal surgery and had early percutaneous dilational tracheostomy. Follow-up for surgical site infection was performed throughout hospital stay (mean 110 days, median 96 days with lower quartile 89 days and upper quartile 119 days) and at 6 weeks and 3 months (clinical examination and computed tomography scans). Results: Fifty-one patients underwent anterior spinal surgery with percutaneous dilational tracheostomy performed within a median of 5 days (range 1 to 18 days). Seventy-eight percent (n=40) of patients had anterior spinal surgery, whereas 22% (n=11) had a combined anterior-posterior repair. All percutaneous dilational tracheostomies were performed using the Ciaglia single step dilation technique. Despite a surgical site infection of one patient's cannulation site, no surgical site infection of the anterior approach was observed. Conclusion: Performing a percutaneous dilational tracheostomy in a timely fashion after anterior spinal surgery does not increase the risk of surgical site infection. Background: Most patients suffering cervical spinal cord injuries require tracheostomy. The optimal timing is still a matter of debate. Previous studies showed that patients receiving early tracheostomy had fewer ventilator days, decreased rates of pneumonia, and were mobilized earlier. Due to the proximity of the anterior approach to the tracheostoma, there is concern about an increased risk of surgical site infection related to tracheostomy. Methods: Retrospective analysis at a Level 1 trauma center of patient records from 2008-2014, identifying all patients with spinal cord injury who received anterior cervical spinal surgery and had early percutaneous dilational tracheostomy. Follow-up for surgical site infection was performed throughout hospital stay (mean 110 days, median 96 days with lower quartile 89 days and upper quartile 119 days) and at 6 weeks and 3 months (clinical examination and computed tomography scans). Results: Fifty-one patients underwent anterior spinal surgery with percutaneous dilational tracheostomy performed within a median of 5 days (range 1 to 18 days). Seventy-eight percent (n=40) of patients had anterior spinal surgery, whereas 22% (n=11) had a combined anterior-posterior repair. All percutaneous dilational tracheostomies were performed using the Ciaglia single step dilation technique. Despite a surgical site infection of one patient's cannulation site, no surgical site infection of the anterior approach was observed. Conclusion: Performing a percutaneous dilational tracheostomy in a timely fashion after anterior spinal surgery does not increase the risk of surgical site infection. Background: Most patients suffering cervical spinal cord injuries require tracheostomy. The optimal timing is still a matter of debate. Previous studies showed that patients receiving early tracheostomy had fewer ventilator days, decreased rates of pneumonia, and were mobilized earlier. Due to the proximity of the anterior approach to the tracheostoma, there is concern about an increased risk of surgical site infection related to tracheostomy. Methods: Retrospective analysis at a Level 1 trauma center of patient records from 2008-2014, identifying all patients with spinal cord injury who received anterior cervical spinal surgery and had early percutaneous dilational tracheostomy. Follow-up for surgical site infection was performed throughout hospital stay (mean 110 days, median 96 days with lower quartile 89 days and upper quartile 119 days) and at 6 weeks and 3 months (clinical examination and computed tomography scans). Results: Fifty-one patients underwent anterior spinal surgery with percutaneous dilational tracheostomy performed within a median of 5 days (range 1 to 18 days). Seventy-eight percent (n=40) of patients had anterior spinal surgery, whereas 22% (n=11) had a combined anterior-posterior repair. All percutaneous dilational tracheostomies were performed using the Ciaglia single step dilation technique. Despite a surgical site infection of one patient's cannulation site, no surgical site infection of the anterior approach was observed. Conclusion: Performing a percutaneous dilational tracheostomy in a timely fashion after anterior spinal surgery does not increase the risk of surgical site infection. Background: Most patients suffering cervical spinal cord injuries require tracheostomy. The optimal timing is still a matter of debate. Previous studies showed that patients receiving early tracheostomy had fewer ventilator days, decreased rates of pneumonia, and were mobilized earlier. Due to the proximity of the anterior approach to the tracheostoma, there is concern about an increased risk of surgical site infection related to tracheostomy. Methods: Retrospective analysis at a Level 1 trauma center of patient records from 2008-2014, identifying all patients with spinal cord injury who received anterior cervical spinal surgery and had early percutaneous dilational tracheostomy. Follow-up for surgical site infection was performed throughout hospital stay (mean 110 days, median 96 days with lower quartile 89 days and upper quartile 119 days) and at 6 weeks and 3 months (clinical examination and computed tomography scans). Results: Fifty-one patients underwent anterior spinal surgery with percutaneous dilational tracheostomy performed within a median of 5 days (range 1 to 18 days). Seventy-eight percent (n=40) of patients had anterior spinal surgery, whereas 22% (n=11) had a combined anterior-posterior repair. All percutaneous dilational tracheostomies were performed using the Ciaglia single step dilation technique. Despite a surgical site infection of one patient's cannulation site, no surgical site infection of the anterior approach was observed. Conclusion: Performing a percutaneous dilational tracheostomy in a timely fashion after anterior spinal surgery does not increase the risk of surgical site infection. Level of evidence: V, Study design: Retrospective case control study (C) 2016 Lippincott Williams & Wilkins, Inc.

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Western Trauma Association Critical Decisions in Trauma: Management of adult blunt splenic trauma - 2016 updates.

No abstract available

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Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures.

Background: A 2015 AAST trial reported a 32% mortality for pelvic fracture patients in shock. Angioembolization (AE) is the most common intervention; the Maryland group revealed time to AE averaged 5 hours. The goal of this study was to evaluate the time to intervention and outcomes of an alternative approach for pelvic hemorrhage. We hypothesized preperitoneal pelvic packing (PPP) results in a shorter time to intervention and lower mortality. Methods: In 2004 we initiated a PPP protocol for pelvic fracture hemorrhage. Results: During the 11-year study, 2293 patients were admitted with pelvic fractures; 128 (6%) patients underwent PPP (mean age 44 +/- 2 years and ISS 48 +/- 1.2). The lowest emergency department SBP was 74 mmHg and highest heart rate was 120. Median time to operation was 44 minutes and 3 additional operations were performed in 109 (85%) patients. Median RBC transfusions prior to SICU admission compared to the 24 postoperative hours were 8 versus 3 units (p

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Acute right heart failure after hemorrhagic shock and trauma pneumonectomy - a management approach: A blinded randomized controlled animal trial using inhaled nitric oxide.

Background: Hemorrhagic shock and pneumonectomy causes an acute increase in pulmonary vascular resistance (PVR). The increase in PVR and right ventricular (RV) afterload leads to acute RV failure, thus reducing left ventricular (LV) preload and output. iNO lowers PVR by relaxing pulmonary arterial smooth muscle without remarkable systemic vascular effects. We hypothesized that with hemorrhagic shock and pneumonectomy, iNO can be used to decrease PVR and mitigate right heart failure. Methods: A hemorrhagic shock and pneumonectomy model was developed using sheep. Sheep received lung protective ventilatory support and were instrumented to serially obtain measurements of hemodynamics, gas exchange and blood chemistry. Heart function was assessed with echocardiography. After randomization to study gas of iNO 20 ppm (n = 9) or nitrogen as placebo (n = 9), baseline measurements were obtained. Hemorrhagic shock was initiated by exsanguination to a target of 50% of the baseline mean arterial pressure. The resuscitation phase was initiated, consisting of simultaneous left pulmonary hilum ligation, via median sternotomy, infusion of autologous blood and initiation of study gas. Animals were monitored for 4 hours. Results: All animals had an initial increase in PVR. PVR remained elevated with placebo; with iNO, PVR decreased to baseline. Echo showed improved RV function in the iNO group while it remained impaired in the placebo group. After an initial increase in shunt and lactate and decrease in SvO2, all returned towards baseline in the iNO group but remained abnormal in the placebo group. Conclusion: These data indicate that by decreasing PVR, iNO decreased RV afterload, preserved RV and LV function, and tissue oxygenation in this hemorrhagic shock and pneumonectomy model. This suggests that iNO may be a useful clinical adjunct to mitigate right heart failure and improve survival when trauma pneumonectomy is required. (C) 2016 Lippincott Williams & Wilkins, Inc.

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Cervical spine MRI in patients with negative CT: A prospective, multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT).

Background: Although cervical spine CT (CSCT) accurately detects bony injuries, it may not identify all soft tissue injuries. While some clinicians rely exclusively on a negative CT to remove spine precautions in unevaluable patients or patients with cervicalgia, others use MRI for that purpose. The objective of this study was to determine the rates of abnormal MRI after a negative CSCT. Methods: Blunt trauma patients who either were unevaluable or had persistent midline cervicalgia and underwent an MRI of the C-spine after a negative CSCT were enrolled prospectively in 8 Level I and II New England trauma centers. Demographics, injury patterns, CT and MRI results, and any changes in cervical spine management as a result of MRI imaging were recorded. Results: 767 patients had MRI because of cervicalgia (43.0%), inability to evaluate (44.1%) or both (9.4%). MRI was abnormal in 23.6% of all patients, including ligamentous injury (16.6%), soft tissue swelling (4.3%), vertebral disc injury (1.4%) and dural hematomas (1.3%). Rates of abnormal neurological signs or symptoms were not different among patients with normal vs. abnormal MRI. (15.2 vs. 18.8%, p=0.25). The c-collar was removed in 88.1% of patients with normal MRI and 13.3% of patients with an abnormal MRI. No patient required halo placement but 11 patients underwent cervical spine surgery after the MRI results. Six of the eleven had neurological signs or symptoms. Conclusions: In a select population of patients MRI identified additional injuries in 23.6% of patients despite a normal CSCT. It is uncertain if this is a true limitation of CT technology or represents subtle injuries missed in the interpretation of the scan. The clinical significance of these abnormal MRI findings cannot be determined from this study group. Level of Evidence: Diagnostic test, level III. (C) 2016 Lippincott Williams & Wilkins, Inc.

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Arteriovenous fistula between the common femoral artery and vein secondary to transpelvic gunshot wound.

No abstract available

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Effect of oxygen therapy on myocardial salvage in ST elevation myocardial infarction: the randomized SOCCER trial.

Objective: Recent studies suggest that administration of O2 in patients with acute myocardial infarction may have negative effects. With the use of cardiac MRI (CMR), we evaluated the effects of supplemental O2 in patients with ST elevation myocardial infarction (STEMI) accepted for acute percutaneous coronary intervention (PCI). Materials and methods: This study was a randomized-controlled trial conducted at two university hospitals in Sweden. Normoxic STEMI patients were randomized in the ambulance to either supplemental O2 (10 l/min) or room air until the conclusion of the PCI. CMR was performed 2-6 days after the inclusion. The primary endpoint was the myocardial salvage index assessed by CMR. The secondary endpoints included infarct size and myocardium at risk. Results: At inclusion, the O2 (n=46) and air (n=49) patient groups had similar patient characteristics. There were no significant differences in myocardial salvage index [53.9+/-25.1 vs. 49.3+/-24.0%; 95% confidence interval (CI): -5.4 to 14.6], myocardium at risk (31.9+/-10.0% of the left ventricle in the O2 group vs. 30.0+/-11.8% in the air group; 95% CI: -2.6 to 6.3), or infarct size (15.6+/-10.4% of the left ventricle vs. 16.0+/-11.0%; 95% CI: -4.7 to 4.1). Conclusion: In STEMI patients undergoing acute PCI, we found no effect of high-flow oxygen compared with room air on the size of ischemia before PCI, myocardial salvage, or the resulting infarct size. These results support the safety of withholding supplemental oxygen in normoxic STEMI patients. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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End Points of Sepsis Resuscitation

Resuscitation goals for the patient with sepsis and septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal resuscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable and reproducible. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient’s overall response to therapy. This review will discuss the role and limitations of central venous pressure (CVP), mean arterial pressure (MAP), and cardiac output/index as macrocirculatory resuscitation targets along with lactate, central venous oxygen saturation (ScvO2), central venous-arterial CO2 gradient, urine output, and capillary refill time as microcirculatory resuscitation endpoints in patients with sepsis.

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Defining and Diagnosing Sepsis

Sepsis is a heterogeneous clinical syndrome that encompasses infections of many different types and severity. Not surprisingly, it has confounded most attempts to apply a single definition, which has also limited the ability to develop a set of reliable diagnostic criteria. It is perhaps best defined as the different clinical syndromes produced by an immune response to infection that causes harm to the body beyond that of the local effects of the infection.

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Index

Note: Page numbers of article titles are in boldface type.

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Sepsis in Special Populations

Sepsis is recognized by the presence of physiologic and laboratory changes that reflect the inflammatory response to infection on cellular and systemic levels. Comorbid conditions, such as cirrhosis, end-stage renal disease, and obesity, alter patients’ susceptibility to infection and their response to it once present. Baseline changes in vital signs and chronic medications often mask clues to the severity of illness. The physiologic, hematologic, and biochemical adjustments that accompany pregnancy and the puerperium introduce similar challenges. Emergency providers must remain vigilant for subtle alterations in the expected baseline for these conditions to arrive at appropriate management decisions.

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Forthcoming Issues

Wilderness and Environmental Medicine

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Vasopressors and Inotropes in Sepsis

Vasopressor and inotropes are beneficial in shock states. Norepinephrine is considered the first-line vasopressor for patients with sepsis-associated hypotension. Dobutamine is considered the first-line inotrope in sepsis, and should be considered for patients with evidence of myocardial dysfunction or ongoing signs of hypoperfusion. Vasopressor and inotrope therapy has complex effects that are often difficult to predict; emergency providers should consider the physiology and clinical trial data. It is essential to continually reevaluate the patient to determine if the selected treatment is having the intended result.

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Contents

Amal Mattu

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Pediatric Sepsis

Pediatric sepsis is distinct from adult sepsis in its definitions, clinical presentations, and management. Recognition of pediatric sepsis is complicated by the various pediatric-specific comorbidities that contribute to its mortality and the age- and development-specific vital sign and clinical parameters that obscure its recognition. This article outlines the clinical presentation and management of sepsis in neonates, infants, and children, and highlights some key populations who require specialized care.

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Contributors

AMAL MATTU, MD, FAAEM, FACEP

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Sepsis Resuscitation in Resource-Limited Settings

Our evolving understanding of the physiologic processes that lead to sepsis has led to updated consensus guidelines outlining priorities in the recognition and treatment of septic patients. However, an enormous question remains when considering how to best implement these guidelines in settings with limited resources, which include rural US emergency departments and low- and middle-income countries. The core principles of sepsis management should be a priority in community emergency departments. Similarly, cost-effective interventions are key priorities in low- and middle-income countries; however, consideration must be given to the unique challenges associated with such settings.

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Copyright

ELSEVIER

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CME Accreditation Page

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Severe Sepsis Care in the Emergency Department

EMERGENCY MEDICINE CLINICS OF NORTH AMERICA

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Ready for Prime Time? Biomarkers in Sepsis

Sepsis is a common condition managed in the emergency department. Current diagnosis relies on physiologic criteria and suspicion of a source of infection using history, physical examination, laboratory studies, and imaging studies. The infection triggers a host response with the aim to destroy the pathogen, and this response can be measured. A reliable biomarker for sepsis should assist with earlier diagnosis, improve risk stratification, or improve clinical decision making. Current biomarkers for sepsis include lactate, troponin, and procalcitonin. This article discusses the use of lactate, procalcitonin, troponin, and novel biomarkers for use in sepsis.

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Severe Sepsis Care in the Emergency Department

A senior medical student was recently telling me about a lecture he did just 2 years ago for his medical school classmates. He talked about early goal-directed therapy, ScVO2, the use of Edwards catheters, transfusion and steroid protocols, and the use of normal saline and dopamine for shock. This was an impressive work by a student, and by all rights, it was as cutting edge as it gets…for 2 years ago. He was disappointed to find out, however, that sepsis care is now completely different. The changing landscape of sepsis care during just the past few years has been quite extraordinary, with new updates and recommendations arriving almost monthly.

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Prehospital Sepsis Care

Prehospital care providers are tasked with the delivery of time-sensitive care, and emergency medical services (EMS) systems must match patients to appropriate clinical resources. Modern systems are uniquely positioned to recognize and treat patients with sepsis. Interventions such as administration of intravenous fluid and transporting patients to the appropriate level of definitive care are linked to improved patient outcomes. As EMS systems refine their protocols for the recognition and stabilization of patients with suspected or presumed sepsis, EMS providers need to be educated about the spectrum of sepsis-related presentations and treatment strategies need to be standardized.

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An Introduction to the Most Complex Disease in Emergency Medicine

Sepsis is one of the most complex and challenging diseases in medicine. Timely diagnosis and initiation of therapy are required in order to prevent unnecessary increases in patient morbidity and mortality. Unfortunately, the clinical presentation of sepsis is often nonspecific and may lead to delays in diagnosis and treatment. Since the majority of patients with sepsis initially present to the emergency department, it is imperative for the emergency provider (EP) to be knowledgeable regarding current concepts and controversies in sepsis management.

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The New Usual Care

Recent literature continues to refine which components of the early goal-directed therapy (EGDT) algorithm are necessary. Given it utilizes central venous pressure, continuous central venous oxygen saturation, routine blood transfusions, and inotropic medications, this algorithm can be timely, invasive, costly, and potentially harmful. New trials highlight early recognition, early fluid resuscitation, appropriate antibiotic treatment, source control, and the application of a multidisciplinary evidence-based approach as essential components of current sepsis management. This article discusses the landmark sepsis trials that have been published over the past several decades and offers recommendations on what should currently be considered ‘usual care’.

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Pitfalls in the Treatment of Sepsis

Sepsis is a challenging, dynamic, pathophysiology requiring expertise in diagnosis and management. Controversy exists as to the most sensitive early indicators of sepsis and sepsis severity. Patients presenting to the emergency department often lack complete history or clinical data that would point to optimal management. Awareness of these potential knowledge gaps is important for the emergency provider managing the septic patient. Specific areas of management including the initiation and management of mechanical ventilation, the appropriate disposition of the patient, and consideration of transfer to higher levels of care are reviewed.

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Source Identification and Source Control

Identifying sources of infection and establishing source control is an essential component of the workup and treatment of sepsis. Investigation with history, physical examination, laboratory tests, and imaging can in identifying sources of infection. All organ systems have the potential to develop sources of infection. However, there are inherent difficulties presented by some that require additional diligence, namely, urinalysis, chest radiographs, and intraabdominal infections. Interventions include administration of antibiotics and may require surgical or other specialist intervention. This is highlighted by the Surviving Sepsis Campaign with specific recommendations for time to antibiotics and expeditious time to surgical source control.

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Ultrasound transducers, angles and modes explained for EMS providers

In this video by Clarius Mobile Health, the basics of ultrasound, the various parts of an ultrasound system and how they can be used on a patient are explained.

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Ultrasound transducers, angles and modes explained for EMS providers

In this video by Clarius Mobile Health, the basics of ultrasound, the various parts of an ultrasound system and how they can be used on a patient are explained.

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Ultrasound transducers, angles and modes explained for EMS providers

In this video by Clarius Mobile Health, the basics of ultrasound, the various parts of an ultrasound system and how they can be used on a patient are explained.

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Ultrasound transducers, angles and modes explained for EMS providers

In this video by Clarius Mobile Health, the basics of ultrasound, the various parts of an ultrasound system and how they can be used on a patient are explained.

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Pa. patrol car, ambulance transporting patient collide

The ambulance sustained minor damage, and the patient was transferred to another ambulance for the remainder of the transport.

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Podcast 187 – Hypernatremia (Uggggh!)

Hypernatremia -- not sexy, but we gotta get 'im done

EMCrit by Scott Weingart.

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Podcast 187 – Hypernatremia (Uggggh!)

Hypernatremia -- not sexy, but we gotta get 'im done

EMCrit by Scott Weingart.

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Md. paramedic haunted by call helps raise funds for injured toddlers

By EMS1 Staff

PRINCE GEORGE’S COUNTY, Md. — After an emotionally heavy call, one paramedic decided to take an extra step in helping two children in need. 

Prince George’s County  paramedic Lt. Pamela Graham responded to a call of two toddlers who had been stabbed by their father Nov. 11. 

“We got the call as ‘children stabbed,’ so you think, ‘No, this cannot be. Something’s wrong,’” Graham told NBC Washington. 

The 2- and 3-year-old boys were transported by first responders to the hospital, where they were treated for non-life threatening injuries. The boys’ father, Christian Diller, was arrested and charged with first-degree murder and assault. 

Weeks after the call, Graham set up a YouCaring page in order to raise funds for the family, who is trying to relocate and move forward. She also set up a Christmas party for the family, which Graham plans to hold at her house with members of the fire and police department. 

“Two-year-olds and 3-year-olds are supposed to be running around, jumping off the couch and playing with the toys,” Graham said. 

Almost $3,000 of a $10,000 goal has been raised for the family. 

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A statistical analysis protocol for the time-differentiated target temperature management after out-of-hospital cardiac arrest (TTH48) clinical trial

The TTH48 trial aims to determine whether prolonged duration (48 hours) of targeted temperature management (TTM) at 33 (±1) °C results in better neurological outcomes compared to standard duration (24 hours) a...

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NC first responders receive pink ambulance

The idea behind a pink ambulance sporting breast cancer awareness ribbons is that it will strike up conversations and spread a pro-mammogram message to the community.

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Minimally invasive implantation of a novel flexible intramedullary nail in patients with displaced midshaft clavicle fractures

Abstract

Purpose

We report our initial experiences with use of a new technique we developed for implantation of Sonoma Crx intramedullary rod in patients with displaced clavicle fractures.

Methods

A total of 35 patients (mean age 41.82 ± 13.65, male:female ratio = 21:14) having Robinson Types 1b, 2b and 3b displaced midshaft fractures with >2 cm clavicle shortening were included into the study. A single small incision (~1 cm) was made over the anteromedial aspect of the involved clavicle and an appropriate sized intramedullary nail was inserted in reverse (mirror) configuration of that has been suggested by the manufacturer. Functional assessment was made using Constant shoulder and disability of the arm shoulder and hand scoring.

Results

Mean time of operation was 51.20 ± 10.56 min and mean time of fluoroscopy was 2.33 ± 1.12 min. One patient had implant failure 2 months after the operation and was revised to a new implant. Superficial or deep wound infection, hematoma, neurovascular complication, substance irritation or implant failure did not occur. Follow-up ranged from 12 to 45 months (mean 28.5 ± 9.95 months). At the latest follow-up, mean Constant shoulder score was 93.14 ± 4.06 (ranging from 84.00 to 100.00) and mean disability of the arm shoulder and hand score was 3.68 ± 1.73 (ranging from 0.0 to 6.80).

Conclusion

The technique we described herein provided successful procedural outcomes, eliminated the need for deep dissection of the fracture site and reduced the operation time. Further study on larger populations is warranted to confirm these findings.

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DC Fire and EMS donate food to homeless before Thanksgiving

The day before Thanksgiving, DC Fire and EMS stopped by a homeless encampment to distribute some food.

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DC Fire and EMS donate food to homeless before Thanksgiving

The day before Thanksgiving, DC Fire and EMS stopped by a homeless encampment to distribute some food.

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DC Fire and EMS donate food to homeless before Thanksgiving

The day before Thanksgiving, DC Fire and EMS stopped by a homeless encampment to distribute some food.

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DC Fire and EMS donate food to homeless before Thanksgiving

The day before Thanksgiving, DC Fire and EMS stopped by a homeless encampment to distribute some food.

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Veteran EMS provider dies, remembered for his passion to serve

By Joe Napsha
Tribune-Review

LIGONIER, Pa. — George D. “Skeeter” Craig loved serving his community of Ligonier, serving on council and with the fire department, working for the Ligonier Valley Ambulance, delivering meals to shut-ins or helping with the American Red Cross blood drives.

“He was very active in the community,” said his childhood sweetheart and wife of 66 years, Helen Weller Craig.

Mr. Craig, 87, died Tuesday, Nov. 22, 2016, at his home.

He was born Jan. 1, 1929, in Unity, a son of the late Kenneth and Regina Palmer Craig, and grew up near what was then Mountain Inn along Route 30, east of Laughlintown, his wife said.

“The (Ligonier) mountains were his playground,” Mrs. Craig said.

He loved to hunt in those woods and taught his sons how to hunt, she said.

He was known to many as Skeeter, a nickname his grandfather gave him because of a patch of hair that stood up on his head, she said.

After graduating from Ligonier High School, he and his brother Robert enlisted in the Pennsylvania Army National Guard, which was activated during the Korean War. He remained stateside during the war, his wife said.

Mr. Craig drove an ambulance for Ligonier Valley Ambulance for more than 24 years, retiring in 1991.

He served eight years on Ligonier Council in the 1960s, service he enjoyed, she said. He was the foreman of the construction crew that built the original Friendship Park near the Ligonier Valley High School football field.

He dedicated many hours to the American Red Cross Blood Service and Disaster Unit and was a board member of the Ligonier Valley Historical Society and the Ligonier Valley Endowment.

As a volunteer with Ligonier Valley Meals on Wheels, Mr. Craig was the one who took the meals to the elderly and shut-ins living in the mountains because he had a pick-up truck, his wife said. He was a retired firefighter with Ligonier Volunteer Hose Company No. 1.

Mr. Craig loved the outdoors and was a warden for the Laughlintown office of the state Bureau of Forestry.

“When a hunter was lost in the woods, they would call Skeeter because he knew the mountains so well,” Mrs. Craig said.

He was such an avid fan of the Pittsburgh Steelers that when the team was losing, he would turn off the television and head for the mountains, his wife said.

After finally retiring at the age of 80, the couple traveled the world.

“We did have a full, wonderful life,” she said.

In addition to his wife, he is survived by three sons, Scott, Jeff and Doug Craig, all of Ligonier; three daughters, Susan Woolridge of Ligonier, Marcie Post of Oxford, and Jennifer Dorff of Colorado Springs, Colo.; 12 grandchildren, five great-grandchildren; three sisters, Gerry Turin of Greensburg and Betty Roberts and Audrey Boyd, both of Ligonier.

He was preceded in death by a grandson, Adam Roberts, and a brother, Robert Craig.

Friends will be received from noon to 5 p.m. Friday and 10 a.m. to noon Saturday at the J. Paul McCracken Funeral Home Chapel Inc., 144 E. Main St., Ligonier. A funeral service will be held at 2 p.m. Saturday at Heritage United Methodist Church. The Ligonier Volunteer Hose Company No. 1 will hold services at 11 a.m. Saturday in the funeral chapel.

Memorial contributions may be made to Heritage United Methodist Church or Ligonier Valley Library.

Copyright 2016 Tribune-Review 

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Agreement between arterial and venous lactate in emergency department patients: a prospective study of 157 consecutive patients.

Introduction: In the emergency department (ED), lactate is routinely used for risk stratification. Whether venous or arterial lactate measured on blood gas is interchangeable is not known. We hypothesized that venous lactate can be used instead of arterial lactate for the evaluation of acute patients in the ED. Patients and methods: This was a prospective single-center study. All patients requiring a lactate measurement were enrolled and we simultaneously drew arterial and venous blood. We followed up all patients to hospital discharge. Our primary aim was to evaluate agreements between the two measurements using Bland and Altman plots with the report of bias (mean difference) and limits of agreements. We also aimed to determine the rate of misclassification (defined as one measurement2.2). Our secondary aim was to evaluate their respective prognostic value to predict in-hospital death or admission in the ICU longer than 72 h. Results: The mean age of the 132 analyzed patients was 62 years (SD: 18 years), and 59% were men. The mean difference (bias) between arterial and venous lactate was -0.6 mmol/l (limits of agreement: -1.7 to 0.6 mmol/l). The rate of misclassification was 8% (95% confidence interval: 3-2%). Both methods present similar performances for the prediction of poor outcomes, with an area under the receiving operator characteristic curves of 0.67 for both. Results were similar when focused only on septic patients. Conclusion: Venous and arterial lactates do not agree well, and there is a high misclassification rate. Venous lactate does not appear to be interchangeable with arterial sampling. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Mental health promotion for junior physicians working in emergency medicine: evaluation of a pilot study.

Objectives: Work-related stress is highly prevalent among physicians working in emergency medicine. Mental health promotion interventions offer the chance to strengthen physicians' health, work ability, and performance. The aim of this study was to implement and evaluate a mental health promotion program for junior physicians working in emergency medicine. Methods: In total, 70 junior physicians working in emergency medicine were randomized to either the mental health promotion program (n=35) or a waitlist control arm (n=35). The training involved 90-min sessions over a time period of 3 months. The primary outcome was perceived stress. The secondary outcomes included emotional exhaustion, emotion regulation, work engagement, and job satisfaction. Self-report assessments for both groups were scheduled at baseline, after the training, after 12 weeks, and 6 months. Results: The intervention group showed a highly significant reduction in perceived stress and emotional exhaustion from baseline to all follow-up time points, with no similar effects found in the comparison group. The benefit of the mental health promotion program was also evident in terms of improved emotion regulation skills, job satisfaction, and work engagement. Participating physicians evaluated the training with high scores for design, content, received outcome, and overall satisfaction. Conclusion: The results suggest that this health promotion program is a promising intervention to strengthen mental health and reduce perceived work stress. It is suitable for implementation as a group training program for junior physicians working in emergency medicine. Comparable interventions should be pursued further as a valuable supportive offer by hospital management. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Physician-provided prehospital critical care, effect on patient physiology dynamics and on-scene time.

Introduction: Improved physiologic status can be seen as a surrogate measure of improved outcome and a field-friendly prognostic model such as the Mainz Emergency Evaluation Score (MEES) could quantify the effect on physiological response. We aim to examine the dynamic physiological profile as measured by this score on patients managed by physician-manned helicopter emergency medical services and how this profile was related to on-scene time expenditure and critical care interventions. Materials and methods: Data including patient characteristics, physiological data, and description of diagnostic and therapeutic interventions were prospectively collected over two 14-day periods, summer and winter, at six participating Norwegian bases. The MEES score was utilized to examine the difference between a score measured at first patient contact (MEES 1) and end-of-care (MEES 2), (MEES 2-MEES 1=[INCREMENT]MEES). Results: A total of 240 primary missions with patient-on-scene form the basis of the study. In total, 43% were considered severely ill or injured, of whom 59% were medical patients. Twenty-nine percent were severely deranged physiologically. The most common advanced procedure performed was advanced airway management (15%), followed by defibrillation (8.8%). Using [INCREMENT]MEES as an indicator, 1% deteriorated under care, whereas 66% remained unchanged and 33% showed an improvement in their physiological status. With increasing on-scene time, fewer patients deteriorated and a greater proportion of patients improved. Conclusion: Restoring deranged physiology remains a mantra for all critical care practitioners. We have shown that this is also possible in the prehospital context, even when prolonging on-scene time, and after initiating advanced procedures. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Do emergency medicine journals promote trial registration and adherence to reporting guidelines? A survey of “Instructions for Authors”

The aim of this study was to evaluate the current state of two publication practices, reporting guidelines requirements and clinical trial registration requirements, by analyzing the “Instructions for Authors”...

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Post-traumatic acute kidney injury: a cross-sectional study of trauma patients

The causes of post-traumatic acute kidney injury (AKI) are multifactorial, and shock associated with major trauma has been proposed to result in inadequate renal perfusion and subsequent AKI in trauma patients...

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Prognostic value of procalcitonin in patients after elective cardiac surgery: a prospective cohort study

Procalcitonin (PCT) is a well-known prognostic marker after elective cardiac surgery. However, the impact of elevated PCT in patients with an initially uneventful postoperative course is still unclear. The aim...

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Fla. firefighter-paramedics receive holiday cookies

By Harriet Howard Heithaus
Naples Daily

NORTH NAPLES, Fla. — When firefighter-paramedics opened the door of Station No. 46 in North Naples on Tuesday, they found themselves looking at Christmas cookie heaven. Delivered by a Bunny. For Thanksgiving.

It wasn't a season warp. The cookie cache was being brought to them by Bunny Brooks, a Vineyards resident and board member of the Collier County 100 Club, part of a national organization that supports firefighter, paramedic and police families.

Brooks was making the first delivery of a route to 48 stations that house police officers, sheriff's deputies and firefighters, to be finished, with the help of three other drivers, by sometime Friday. The mission: a sweet thank-you to first responders.

"They put their lives on the line for us," declared Brooks, who says she's outraged by the current targeting of first responders, whose work is to help their communities. ”Thank you, gentlemen, for all you do for us."

She had visited a friend in Michigan who was baking cookies for Grosse Pointe police, and the inspiration came to Brooks to try it here. She began by suggesting it to her fellow 100 Club board members, then to the women's golf league in the Vineyards.

Then the Vineyards activity director asked if she could email it out to the entire community. And several of Brooks’ friends in her DAR chapter asked if they could bake, too.

By Tuesday afternoon the counters of the Regency Reserve clubhouse at the Vineyards were heaped with plates, tins and trays of cookies, probably more than 100 dozen sweet contributions.

Brooks had already created a number of assortment plates — several chocolate chip cookies, a frosted Christmas tree, perhaps several brownies, Italian wedding cakes, pizzelles, snickerdoodles — when she decided to inaugurate the journey with a stop at her own fire station.

By all accounts, it was a welcome one.

“We don’t usually get as many of these as other stations that are more centrally located,” said Capt. Ryan Paige, the foremost of a quartet of beaming firefighters.

“I’m the official cookie taster,” firefighter Daniel Jackson teased his benefactor, ready to sample his second cookie. He would get no argument from fellow firefighter Victor Yedra.

“I’m a brownie guy,” he explained. For Chris Perry, the fourth firefighter to dig into the cache of cookies, it was all good: “Sugar!” he exulted.

It was clear the homemade sweets were a hit. “Sometimes people don’t know the services are even out there,” Paige said.

That’s exactly what Brooks is hoping to combat. Back in the club kitchen, fragrant with the scent of cinnamon, vanilla and spices, Brooks said she is hoping some other organizations in Naples will join her to make sure their police, deputies and firefighters aren’t forgotten until there’s a tragedy they must attend to — or that has involved their own fellow responders.

Tuesday evening she would be busy repackaging cookies into assortments that would offer something for everyone in each station, and the variety was going to make it a challenge.

Brooks picked up a little sugar cookie in the shape of a hand, dusted with rosy sugar and dots of cinnamon imperial “nail polish.” “Isn’t that clever?” she said. “Some of the women actually used recipes from the cookbook of Vineyards community favorites.”

One had carefully specified “chocolate chip, no nuts,” for those with allergies. Green coconut wreaths and white frosted pumpkin cookies added to the fragrance. Against the backsplash stood a fresh glazed Bundt cake from a woman who didn’t bake cookies but wanted to help.

Chocolate chip were by far the favored offering.

“They’re the firemen’s favorite,” she said, adding with a chuckle. “Well, at least they are this time.”

Part of the challenge of dividing up the cookies was knowing how many first responders and support staff were at each station. At Station No. 46, for example, there were five or six employees, Brooks explained. At the county Sheriff’s Office in the government complex, however, there are 180 employees.

Brooks and three volunteer drivers would sort out routes and start driving Wednesday morning, Thanksgiving morning — and even Friday morning, if necessary.

“We’ll drive until we get to everybody,” Brooks declared. “Or until we run out of cookies.”

More information about Brooks’ cookie organization can be obtained by submitting the contact form on the collier100club.org website.

Copyright 2016 the Naples Daily News

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American Academy of Emergency Medicine

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6





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Issue Highlights

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6





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Rates of Firearm Homicide by Chicago Region, Age, Sex, and Race/Ethnicity, 2005-2010

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): Mario Andres Camacho




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Contents

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6





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Partial Contents of Volume 52, Number 1

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6





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Asymptomatic Subjects with Airway Obstruction have Significant Impairment at Exercise

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): John Michael Rague




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Rural Trauma Team Development Course Decreases Time to Transfer for Trauma Patients

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): Stephanie Diebold




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Editorial Board

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6





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Computed Tomography Utilization for the Diagnosis of Acute Appendicitis in Children Decreases with a Diagnostic Algorithm

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): Mario Andres Camacho




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Overcoming Spatial and Temporal Barriers to Public Access Defibrillators Via Optimization

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): Benjamin Li




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Effect of Time to Operation on Mortality for Hypotensive Patients with Gunshot Wounds to the Torso: The Golden 10 minutes

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): Stephanie Diebold




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Too Good to Treat? Ischemic Stroke Patients with Small Computed Tomography Perfusion Lesions May Not Benefit from Thrombolysis

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): John Michael Rague




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An Effective Way to Utilize Daycare Organizations to Distribute Home Safety Equipment

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): John Michael Rague




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The Impact of Patient Protection and Affordable Care Act on Trauma Care: A Step in the Right Direction

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): Mario Andres Camacho




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A Clustering Approach to Identify Severe Bronchiolitis Profiles in Children

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): Benjamin Li




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Trauma Patients on New Oral Anticoagulation Agents Have Lower Mortality Than Those on Warfarin

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): Benjamin Li




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Imaging Before Transfer to Designated Pediatric Trauma Centers Exposes Children to Excess Radiation

Publication date: December 2016
Source:The Journal of Emergency Medicine, Volume 51, Issue 6
Author(s): Stephanie Diebold




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Replica weapons: A collective effort to stop mistake of fact shootings

By Dave Blake, Force Certified Analyst, Certified Criminal Investigator

In September, police officers in Columbus, Ohio, were called to an armed robbery. They spotted people who fit the description of the robbers and pursued them on foot. When one suspect pulled a handgun from his waistband, he was immediately shot and killed by police. The handgun was discovered to be a replica BB gun with a laser sight and the suspect a 13-year-old boy.

There have been several cases around the country where children have been mistaken for armed suspects and lost their lives. In two similar incidents, one in October 2013 and another in November 2014, a 13- and a 12-year-old boy were also killed by police. Both boys were handling replica guns with the orange safety tips removed. These tragedies have devastated families and communities, as well as the officers who pulled the triggers.

The public is understandably quick to blame law enforcement for these “mistake of fact” shootings, incidents where an officer reasonably – but inaccurately – believed the suspect was armed and posed an imminent threat. In order to stop such incidents that involve replica weapons, we should consider if there is also a larger social problem at play.

Read the full story: Replica weapons: A collective effort to stop mistake of fact shootings

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Mich. EMT, college student saves father’s life after heart attack

Mario Calabria was biking with his family when his father fell off his bike, hit a tree and was knocked unconscious.

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A comparison of two insulin infusion protocols in the medical intensive care unit by continuous glucose monitoring

Achieving good glycemic control in intensive care units (ICU) requires a safe and efficient insulin infusion protocol (IIP). We aimed to compare the clinical performance of two IIPs (Leuven versus modified Yal...

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Mich. EMT, college student saves father’s life after heart attack

By EMS1 Staff

TECH, Mich. — During a family mountain biking trip, an EMT had one of the most difficult calls unfold right in front of him.

Mario Calabria was biking with his family when his father fell off his bike, hit a tree and was knocked unconscious, reported Up Matters. 

Calabria began to perform CPR after he was unable to find a pulse. He told his brother’s girlfriend to call 911 and gave her a map so she could show their location to first responders. 

Although Calabria managed to get a pulse, his father stopped breathing a second time. Soon after, EMTs and police officers arrived on scene and used an AED. Calabria’s father was also intubated to avoid swelling in his airway. After five shocks, first responders were able to get a pulse. 

“At first, it was just me versus a massive heart attack,” Calabria said. “Then I was surrounded with people who knew what they were doing … it was a team effort.”

Calabria’s father was loaded into an ambulance and later airlifted to a medical center. He was put into an induced coma; he was released from the hospital six days later.

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30-Day, 90-day and 1-year mortality after emergency colonic surgery

Abstract

Purpose

Emergency surgery is an independent risk factor in colonic surgery resulting in high 30-day mortality. The primary aim of this study was to report 30-day, 90-day and 1-year mortality rates after emergency colonic surgery, and to report factors associated with 30-day, 90-day and 1-year mortality. Second, the aim was to report 30-day postoperative complications and their relation to in-hospital mortality.

Methods

All patients undergoing acute colonic surgery in the period from May 2009 to April 2013 at Copenhagen University Hospital Herlev, Denmark, were identified. Perioperative data was collected from medical journals.

Results

30-day, 90-day and 1-year mortality was 21, 30 and 41%, respectively. Age >70 years, Performance status ≥3 and resection with stoma were independent factors associated with 30-day mortality. Age >70 years, Performance status ≥3, resection with stoma and malignant disease were independent risk factors associated with 90-day mortality. Age >70 years, Performance status ≥3, resection with stoma and malignant disease were independent factors associated with 1-year mortality. Overall, 30-day complication rate was 63%, with cardiopulmonary complications leading to most postoperative deaths.

Conclusion

Mortality and complication rates after emergency colonic surgery are high and associated with patient related risk factors that cannot be modified, but also treatment related outcomes that are modifiable. An increased focus on medical and other preventive measures should be explored in the future.

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