* *The EMS Controller is a great opportunity for Medics looking for a change of environment with no heavy lifting or driving** Job Summary: This position is stationed in the main campus Emergency Department of Mission Hospital. Monitors and Coordinates flow of Emergency Medical Service (EMS) patients coming in and going out of the ED. Obtains and communicates pertinent information to the ED Nurse Unit ...
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Παρασκευή 31 Μαρτίου 2017
Thrombin generation profiles as predictors of symptomatic venous thromboembolism after trauma: A prospective cohort study.
Background: Reliable biomarkers predictive of venous thromboembolism (VTE) after acute trauma are uncertain. The objective of the study was to identify risk factors for symptomatic VTE after trauma, including individual plasma coagulome characteristics as reflected by thrombin generation. Methods: In a prospective, case-cohort study, trauma patients were enrolled over the 4.5 year period, 2011-2015. Blood was collected by venipuncture into 3.2% trisodium citrate at 0, 6, 12, 24 and 72 hours after injury, and at hospital discharge. Platelet poor plasma was stored at -80[degrees]C until analysis. Thrombin generation, as determined by the calibrated automated thrombogram (CAT) using 5 pM tissue factor (TF)/4 uM phospholipid (PS), was reported as peak height (nM thrombin) and time to peak height (ttPeak [minutes]). Data are presented as median [IQR] or hazard ratio (HR) with (95% CI). Results: Among 453 trauma patients (ISS=13.0 [6.0, 22.0], hospital LOS=4.0 [2.0, 10.0] days, age=49 [28, 64] years, 71% male, 96% with blunt mechanism, mortality 3.2%), 83 developed symptomatic VTE within 92 days after injury (35 [42%] after hospital discharge). In a weighted, multivariate Cox model that included clinical and CAT characteristics available within 24 hours of admission, increased patient age (1.35 [1.19,1.52] per 10 years, P= 30 kg/m2 (4.45 [2.13,9.31], p
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MATRAC SMAT Warehouse Specialist - Mission Health
MATRAC SMAT Warehouse and Logistic Specialist Mission Health System-Asheville, NC Schedule: 8:30am-5pm and varying depending on needs and deployment Status: Full-time with Benefits! Job Summary: Maintains par supply level and inventory control for MATRAC disaster cache ensuring that supplies and equipment are maintained and available for response at any given time. Ensures on-going safety and security ...
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Critical Care Paramedic - Mission Health
Critical Care Paramedic- Regional Transport Services, Mission Health- Asheville, NC NEW Budgeted Full-time and PRN positions available. About Regional Transport Services at Mission Health: Our Regional Transport Services at Mission Health complete 25,000 inter-facility ground transports and discharges per year while managing over 150 true Critical Care Transports annually. Looking to advance your career ...
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Paramedic - Mission Health
Madison County EMS (based in Marshall, NC) operates three 911 response ambulances 24/7, staffed with two Paramedics at all times. Our ambulances are built with safety of the crew and patient in mind, and include state-of-the-art equipment. Madison EMS responds to approximately 4500 calls per year. Our transport times can range from 20-90 minutes and our service area includes: A large section of the ...
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Dr. Marik Responds to a Few Tough Questions on the Metabolic Resus of Sepsis Strategy
If you don't know what all of the kerfuffle is about, read the Pulmcrit Post (including the comments) then Listen to the interview with Paul Marik I sent Paul the questions below and he was kind enough to answer them: ———————————————— Hey Paul, As I imagined, the interview and post were galvanizing. We've had thousands […]
EMCrit by Scott Weingart.
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Dr. Marik Responds to a Few Tough Questions on the Metabolic Resus of Sepsis Strategy
If you don't know what all of the kerfuffle is about, read the Pulmcrit Post (including the comments) then Listen to the interview with Paul Marik I sent Paul the questions below and he was kind enough to answer them: ———————————————— Hey Paul, As I imagined, the interview and post were galvanizing. We've had thousands […]
EMCrit by Scott Weingart.
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NYC to provide AEDs for little league teams
The Department of Parks and Recreation chose six parks in each borough to place AEDs
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Man arrested in fire truck, ambulance hit-and-run
Eric Roland put his car in reverse, accelerated and knocked a paramedic to the ground
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Termination of prehospital resuscitative efforts: a study of documentation on ethical considerations at the scene
Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when...
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Plate fixation for Letenneur Type I Hoffa fracture: A biomechanical study
Injury
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Michael J. Fox speaks out against cutting health care
AP
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Software-based system improves the ability to determine the cause of ischemic stroke
Massachusetts General Hospital News
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Physician assistant banned from providing care in Kansas
AP
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Gastrointestinal emergencies in critically ill cancer patients
Journal of Critical Care
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Endovascular therapy for acute stroke
Progress in Cardiovascular Diseases
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The effectiveness of prescribed rest depends on initial presentation after concussion
The Journal of Pediatrics
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Enteral nutrition is a risk factor for airway complications in subjects undergoing noninvasive ventilation for acute respiratory failure
Respiratory Care
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Factors affecting pain assessment scores in patients on mechanical ventilation
Intensive and Critical Care Nursing
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Corticosteroids in septic shock: A systematic review and network meta-analysis
Critical Care
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Coronary CT angiography in the emergency department utilizing second and third generation dual source CT
Journal of Cardiovascular Computed Tomography
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ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging: A meta-analysis
Neurology®
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Britain's young royals promote conversation on mental health
AP
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The effect of high-flow nasal cannula oxygen therapy on mortality and intubation rate in acute respiratory failure: A systematic review and meta-analysis
Critical Care Medicine
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The Theoretical and Psychometric Properties of the Subjective Traumatic Outlook (STO) Questionnaire
Psychiatry Research
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The atmospheric pressure and temperature seem to have no effect on the incidance of rupture of abdmonial aortic aneurysm in a mid-European region
Annals of Vascular Surgery
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Opportunity to reduce transfer of patients with mild traumatic brain injury and intracranial hemorrhage to a Level 1 trauma center
The American Journal of Emergency Medicine
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Emergency procedures in highly contagious, isolated patients: A randomized controlled manikin trial comparing airway management in different isolation strategies
Trends in Anaesthesia and Critical Care
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NOX2 deficiency alters macrophage phenotype through an IL-10/STAT3 dependent mechanism: Implications for traumatic brain injury
Journal of Neuroinflammation
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Estimation of V-POSSUM and E-PASS scores in prediction of acute kidney injury in patients after elective open abdominal aortic aneurysm surgery
Annals of Vascular Surgery
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Πέμπτη 30 Μαρτίου 2017
AT&T selected to build nationwide public safety network
The high-speed network aims to equip firefighters, EMS and police with a single network that allows real-time communication during crises
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Calif. community paramedicine project shows early success
UCSF Healthforce Center ALAMEDA, Calif. — A new independent study of California’s community paramedicine pilot projects shows encouraging results, demonstrating how specially trained paramedics can safely help improve patient outcomes, reduce unnecessary emergency department transports and lower health care costs. The study by the University of California, San Francisco Healthforce Center ...
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Inside EMS Podcast: Why confidence is vital for an EMS provider
<!--cke_bookmark_117S--><!--cke_bookmark_117E--> Download this podcast on iTunes, SoundCloud or via RSS feed Confidence is vital to your success as an EMS provider. In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson offer five tips to help grow your confidence.
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Medical simulation app aids intubation training
The free 3-D simulation app is an interactive and virtual patient airway simulator
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Drone-maker releases number of lives saved by drones
The report found that drones rescued at least 59 people from life-threatening danger
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Listen: NY hospital creates Spotify CPR playlist
The playlist features 40 songs at 100 BPM to help perform hands-only CPR
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How to improve sepsis care with better EMS education
EMS educators can improve sepsis patient outcomes by ensuring EMTs and paramedics have knowledge appropriate and impactful training
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Officers perform CPR on man in lobby at police headquarters
An officer put the man on the floor, started compressions and yelled for others to call 911 and bring a defibrillator
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Diagnostic value of urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 for acute kidney injury: A meta-analysis
Critical Care
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UN: Malaria outbreak kills over 4,000 in Burundi this year
AP
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Patterns of low acuity patient presentations to emergency departments in New South Wales, Australia
Emergency Medicine Australasia
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Alabama giving away Baby Boxes to new parents
AP
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Patients views on their decision making during inpatient rehabilitation after newly acquired spinal cord injury--A qualitative interview-based study
Health Expectations
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Association of preceding antithrombotic treatment with acute ischemic stroke severity and in-hospital outcomes among patients with atrial fibrillation
JAMA
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The HEART score with high-sensitive troponin T at presentation: Ruling out patients with chest pain in the emergency room
Internal and Emergency Medicine
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Prediction of high on-treatment platelet reactivity in clopidogrel-treated patients with acute coronary syndromes
International Journal of Cardiology
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Management of pericardial fluid in blunt trauma: Variability in practice and predictors of operative outcome in patients with computed tomography evidence of pericardial fluid
The Journal of Trauma and Acute Care Surgery
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Angioedema
Critical Care Medicine
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Advanced monitoring in traumatic brain injury: Microdialysis
Current Opinion in Critical Care
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Early Lance–Adams syndrome after cardiac arrest: Prevalence, time to return to awareness, and outcome in a large cohort
Resuscitation
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Christie, Trump to launch drug addiction task force
AP
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Moral injury in U.S. combat veterans: Results from the national health and resilience in veterans study
Depression and Anxiety
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Abdominal contamination with Candida albicans after pancreaticoduodenectomy is related to hemorrhage associated with pancreatic fistulas
Pancreatology
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Acute kidney injury after subarachnoid hemorrhage
Journal of Neurosurgical Anesthesiology
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Acute kidney injury in symptomatic primary Epstein-Barr virus infectious mononucleosis: Systematic review
Journal of Clinical Virology
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Diagnosing postpartum hemorrhage: A new way to assess blood loss in a low-resource setting
Maternal and Child Health Journal
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Treatment and outcomes of acute coronary syndromes in women: An analysis of a multicenter quality improvement Chinese study
International Journal of Cardiology
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Ketamine reduces the need for intubation in patients with acute severe mental illness and agitation requiring transport to definitive care: An observational study
Emergency Medicine Australasia
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External validation of the ROSC after cardiac arrest (RACA) score in a physician staffed emergency medical service system
The return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score may have implications as a quality indicator for the emergency medical services (EMS) system. We aimed to validate this score exte...
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Blood transfusion and coagulopathy in geriatric trauma patients
Trauma resuscitation has undergone a paradigm shift with new emphasis on the early use of blood products and increased proportions of plasma and platelets. However, it is unclear how this strategy is applied o...
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Τετάρτη 29 Μαρτίου 2017
Education Coordinator - Vitalink - New Hanover Regional Medical Center
Education Coordinator - Vitalink New Hanover Regional Medical Center Wilmington, NC New Hanover Regional Medical Center’s Emergency Transport Services (ETS) is a recognized leader at both state and national levels. Recent awards include: the 2016 American Heart Association Mission Lifeline Gold Award Recognition for EMS, AirLink, and VitaLink, the 2016 EMS National Association of Emergency Medical ...
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'Always in service' campaign celebrates, promotes EMS Week 2017
American College of Emergency Physicians DALLAS — The American College of Emergency Physicians, in partnership with the National Association of Emergency Medical Technicians, is proud to announce this year’s EMS STRONG campaign theme: Always In Service. EMS STRONG is an annual campaign designed to unite and inspire emergency medical services personnel, strengthen the profession on a national ...
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Watch: T-Rex duo does CPR in viral video from Pa. fire, EMS company
Crews took a break from traditional CPR training in this hilarious video
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Innovation Zone - MedixSafe
MedixSafe safes offer multiple layers of authentication for positive control over your narcotics and other vital equipment. Contact MedixSafe for more information.
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Innovation Zone - MedixSafe
MedixSafe safes offer multiple layers of authentication for positive control over your narcotics and other vital equipment. Contact MedixSafe for more information.
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How to not win an EMS grant proposal
Grant proposal writing isn’t any more complex than running a cardiac arrest resuscitation or leading a team of firefighters at a residential structure fire. It’s a learned skill. Like any fire or EMS skill, it takes practice, practice and more practice. You don’t improve your intubation skills without practice. The more grant proposals you write, the better you will get. Inexperienced ...
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Why EMS cares for all patients without bias, judgement
Each time a terrorism event is reported in the world, I pay attention to the efforts of the first responders who are responsible for dealing with the incident's aftermath. While the chance of me being involved personally in such an event is very small, understanding what worked and what didn't work makes me feel better prepared for such intense events. Looking at what happened in London last ...
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Innovation Zone - MedixSafe
MedixSafe safes offer multiple layers of authentication for positive control over your narcotics and other vital equipment. Contact MedixSafe for more information.
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Innovation Zone - MedixSafe
MedixSafe safes offer multiple layers of authentication for positive control over your narcotics and other vital equipment. Contact MedixSafe for more information.
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Watch: T-Rex does CPR in viral video from Pa. fire, EMS company
Crews took a break from traditional CPR training in this hilarious video
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Paramedic wants more AEDs after 2 hockey players' lives saved
The city started installing AEDs in arenas and public buildings in 2001; there are now 1,000 devices in arenas, libraries, malls and private businesses
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Cops drive man to hospital after 30-minute ambulance wait
A chief said the high call volume of heroin overdoses is taking up the majority of responders' time
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Miss. ambulance involved in 3-car crash, 6 injured
A patient, EMT and paramedic were inside the ambulance during a non-emergency transport when the crash occurred
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Predicting sport and occupational lower extremity injury risk through movement quality screening: A systematic review
British Journal of Sports Medicine
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Comparison of urinary tract infection antibiograms stratified by emergency department patient disposition
The American Journal of Emergency Medicine
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Ryan says House to revisit health care, offers no details
AP
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Retrospective comparison of the Low Risk Ankle Rules and the Ottawa Ankle Rules in a pediatric population
The American Journal of Emergency Medicine
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States push to protect birth control despite failed GOP bill
AP
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Process for developing rehabilitation practice recommendations for individuals with traumatic brain injury
BMC Neurology
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Acute stress disorder symptoms after evaluation for acute coronary syndrome predict 30-day readmission
International Journal of Cardiology
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Quality of life and prognostic factors after intra-articular tibial pilon fracture
Injury
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Impact of coronary plaque morphology assessed by optical coherence tomography on cardiac troponin elevation in patients with non-ST segment elevation acute coronary syndrome
Catheterization and Cardiovascular Interventions
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Cancer screening is proposed tax refund option in House bill
AP
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Point-of-care testing of cardiac autonomic function for risk assessment in patients with suspected acute coronary syndromes
Clinical Research in Cardiology
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Patients with ruptured abdominal aortic aneurysm have become higher risk
Annals of Vascular Surgery
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Targeted temperature management in cardiac arrest: Survival evaluated by propensity score matching
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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Does MRI of the thoracolumbar spine change management in blunt trauma patients with stable thoracolumbar spinal injuries without neurologic deficits?
World Journal of Surgery
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A nomogram for predicting prognostic value of inflammatory response biomarkers in decompensated cirrhotic patients without acute-on-chronic liver failure
Alimentary Pharmacology and Therapeutics
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Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament
Knee Surgery, Sports Traumatology, Arthroscopy
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Newer antiepileptic drugs in status epilepticus: Prescription trends and outcomes in comparison with traditional agents
CNS Drugs
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The Royal College of Emergency Medicine composite pain scale for children: Level of inter-rater agreement
Emergency Medicine Journal
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Body mass index and outcome of out-of-hospital cardiac arrest patients not treated by targeted temperature management
The American Journal of Emergency Medicine
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Major breakthrough in the manufacture of red blood cells
University of Bristol Research News
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Outcomes Related to the Use of Frozen Plasma or Pooled Solvent/Detergent-Treated Plasma in Critically Ill Children*.
Objective: To determine if the use of fresh frozen plasma/frozen plasma 24 hours compared to solvent detergent plasma is associated with international normalized ratio reduction or ICU mortality in critically ill children. Design: This is an a priori secondary analysis of a prospective, observational study. Study groups were defined as those transfused with either fresh frozen plasma/frozen plasma 24 hours or solvent detergent plasma. Outcomes were international normalized ratio reduction and ICU mortality. Multivariable logistic regression was used to determine independent associations. Setting: One hundred one PICUs in 21 countries. Patients: All critically ill children admitted to a participating unit were included if they received at least one plasma unit during six predefined 1-week (Monday to Friday) periods. All children were exclusively transfused with either fresh frozen plasma/frozen plasma 24 hours or solvent detergent plasma. Interventions: None. Measurements and Main Results: There were 443 patients enrolled in the study. Twenty-four patients (5%) were excluded because no plasma type was recorded; the remaining 419 patients were analyzed. Fresh frozen plasma/frozen plasma 24 hours group included 357 patients, and the solvent detergent plasma group included 62 patients. The median (interquartile range) age and weight were 1 year (0.2-6.4) and 9.4 kg (4.0-21.1), respectively. There was no difference in reason for admission, severity of illness score, pretransfusion international normalized ratio, or lactate values; however, there was a difference in primary indication for plasma transfusion (p
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Reducing Pediatric Sternal Wound Infections: A Quality Improvement Project.
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Τρίτη 28 Μαρτίου 2017
Minocycline Hepatotoxicity: Clinical characterization and identification of HLA-B* 35:02 as a risk factor
Journal of Hepatology
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Florida officials: Aggressive efforts to stop Zika continue
AP
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Is there a role for placental cultures in cases of clinical chorioamnionitis complicating preterm premature rupture of membranes?
American Journal of Perinatology
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Researchers to study airport responses to disease outbreaks
AP
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Universal versus targeted additional contact precautions for multidrug-resistant organism carriage for patients admitted to an intensive care unit
American Journal of Infection Control
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Clinically significant hemodynamic alterations after propacetamol injection in the emergency department: Prevalence and risk factors
Internal and Emergency Medicine
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Computed tomography for head injuries in children: Change in Australian usage rates over time
Emergency Medicine Australasia
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Left Ventricular global longitudinal strain predicts heart failure readmission in acute decompensated heart failure
Cardiovascular Ultrasound
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Depression Anxiety Stress Scales (DASS-21): Factor structure in traumatic brain injury rehabilitation
Journal of Head Trauma Rehabilitation
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Intravenous versus non-intravenous benzodiazepines for the abortion of seizures: A systematic review and meta-analysis of randomized controlled trials
Academic Emergency Medicine
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Ocular Trauma Score as prognostic value in traumatic ocular injuries due to rotating wire brushes
Graefe's Archive for Clinical and Experimental Ophthalmology
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Cohort study of oncologic emergencies in patients with head and neck cancer
Head & Neck
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High court struggles over hospital pension dispute
AP
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Risk factors for malnutrition among older adults in the emergency department: A multicenter study
Journal of the American Geriatrics Society
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Firefighter work duration influences the extent of acute kidney injury
Medicine and Science in Sports and Exercise
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Posttraumatic Stress Disorder, Antipsychotic Use and Risk of Dementia in Veterans
Journal of the American Geriatrics Society
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Primary enforcement of mandatory seat belt laws and motor vehicle crash deaths
American Journal of Preventive Medicine
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A framework for the etiology of running-related injuries
Scandinavian Journal of Medicine & Science in Sports
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Targeted complement inhibition protects vascularized composite allografts from acute graft injury and prolongs graft survival when combined with subtherapeutic cyclosporine a therapy
Transplantation
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The impact of prehospital intubation with and without sedation on outcome in trauma patients with a GCS of 8 or less
Journal of Neurosurgical Anesthesiology
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Get help managing your EMS resources: Download free AIM eBook
EMS Billing is complicated, time consuming, and essential! AIM Billing Services is here to help YOU improve your EMS billing revenue, tune staffing, get compliant, and strengthen cash flow. Some of the features and advantages or AIM Billing Services include: - Maximize Revenue with Expert EMS Billing Services that Specialize in EMS Reimbursement - Increase Profits by Reducing Costs Related to EMS Billing ...
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EMCrit Wee – Edited Version of Paul Marik on the Metabolic Resuscitation of Sepsis
Edited interview with Paul Marik
EMCrit by Scott Weingart.
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EMCrit Wee – Edited Version of Paul Marik on the Metabolic Resuscitation of Sepsis
Edited interview with Paul Marik
EMCrit by Scott Weingart.
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Injured police dogs to get ambulance rides
By EMS1 Staff CHAMPAIGN, Ill. — Police dogs hurt on the job will soon receive ambulance rides to a hospital. The News-Gazette reported that Arrow Ambulance and the University of Illinois teamed up to provide ambulance rides to the University of Illinois Veterinary Teaching Hospital. Dr. Michael Smith, medical director of Carle Regional EMS and Arrow Ambulance, said University of Illinois veterinarians ...
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Getac partners with Trivalent to provide next generation data protection for the first time in rugged computing devices
Strategic partnership delivers NSA-approved security for government and commercial markets LONDON — Getac today announces its partnership with Trivalent, a leading provider of next-generation data protection services, to deliver seamless and robust next-generation data protection for the first time on rugged computing devices. By integrating Trivalent's software security into its line of rugged ...
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NC fire department gets hybrid fire truck, ambulance
The rig looks like a fire truck on the outside, but also has an ambulance module behind the front seats
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5 reasons EMS providers should take yoga seriously
By implementing a yoga curriculum that provides a skill set that is simple, safe and effective, responders can help manage their mental health
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Δευτέρα 27 Μαρτίου 2017
Healing first responders through critical incident stress management interventions
Critical incident stress management is a short-term, psychological first-aid intervention strategy that can help mitigate long-term mental health issues
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Paul Marik on the Metabolic Resuscitation of Sepsis
Read @pulmcrit's post first then listen to this EMCrit Wee with Paul Marik on the Metabolic Resuscitation of Sepsis
EMCrit by Scott Weingart.
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Paul Marik on the Metabolic Resuscitation of Sepsis
Read @pulmcrit's post first then listen to this EMCrit Wee with Paul Marik on the Metabolic Resuscitation of Sepsis
EMCrit by Scott Weingart.
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Nurse vs. paramedic: Breaking down the rivalry
In 1982, after instructor Gene Iannuzzi had delivered the requisite lecture on pre-arrival radio reports to incoming EMTs at New York City's EMS academy, he closed the classroom door, rolled up his sleeves, faced his students and asked them the easiest question they'd get that evening: "What do you think of nurses"" "At first, the answers were like, 'They're very professional,' ...
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Why EMS agencies need a PIO
By Jim Spell Once upon a shift, there was a newly promoted captain. Hearing the tones for a bicycle accident, he moved to the rig, confident in himself and his crew. On arrival, the scene moved like ballet — firefighters on the victim dislodging legs and arms from twisted tubing with medics patching an apparent wound to the head. The patient chose to firmly fasten her helmet to the rear of the ...
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Veteran paramedic, nurse explains the rivalry
In 1982, after instructor Gene Iannuzzi had delivered the requisite lecture on pre-arrival radio reports to incoming EMTs at New York City's EMS academy, he closed the classroom door, rolled up his sleeves, faced his students and asked them the easiest question they'd get that evening: "What do you think of nurses"" "At first, the answers were like, 'They're very professional,' ...
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PulmCrit- Metabolic sepsis resuscitation: the evidence behind Vitamin C
Sepsis resuscitation generally focuses on hemodynamics. Rivers of ink have been spilled writing about oxygen delivery and fluid responsiveness. This is clearly important, but it's possible that our focus on easily observable phenomena has led us to ignore something of equal importance: metabolic resuscitation. We can deliver all the oxygen we want to the tissues, […]
EMCrit by Josh Farkas.
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PulmCrit- Metabolic sepsis resuscitation: the evidence behind Vitamin C
Sepsis resuscitation generally focuses on hemodynamics. Rivers of ink have been spilled writing about oxygen delivery and fluid responsiveness. This is clearly important, but it's possible that our focus on easily observable phenomena has led us to ignore something of equal importance: metabolic resuscitation. We can deliver all the oxygen we want to the tissues, […]
EMCrit by Josh Farkas.
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Σάββατο 25 Μαρτίου 2017
A systematic review of propensity score methods in the acute care surgery literature: avoiding the pitfalls and proposing a set of reporting guidelines
Abstract
Background
Propensity score methods are techniques commonly employed in observational research to account for confounding when estimating the effects of treatments and exposures. These methods have been increasingly employed in the acute care surgery literature in an attempt to infer causality; however, the adequacy of reporting and the appropriateness of statistical analyses when using propensity score matching remain unclear.
Objectives
The goal of this systematic review is to assess the adequacy of reporting of propensity score methods, with an emphasis on propensity score matching (to assess balance and the use of appropriate statistical tests), in acute care surgery (ACS) studies and to provide suggestions for improvement for junior investigators.
Methods
We searched three databases, and other relevant literature (from January 2005 to June 2015) to identify observational studies within the ACS literature using propensity score methods (PROSPERO No: CRD42016036432). Two reviewers extracted data and assessed the quality of the studies retrieved by reviewing the adequacy of both overall reporting and of the propensity score matching methods used.
Results
A total of 49/71 (69%) of studies adequately reported propensity score methods overall. Matching was the most common propensity score method used in 46/71 (65%) studies, with 36/46 (78%) studies reporting matching methods adequately. Only 19/46 (41%) of matching studies reported the balance of baseline characteristics between treated and untreated subjects while 6/46 (13%) used correct statistical methods to assess balance. There were 35/46 (76%) of matching studies that explicitly used statistical methods appropriate for the analysis of matched data when estimating the treatment effect and its statistical significance.
Conclusion
We have proposed reporting guidelines for the use of propensity score methods in the acute care surgery literature. This is to help investigators improve the adequacy of reporting and statistical analyses when using observational data to estimate effects of treatments and exposures.
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Intravenous versus Non-Intravenous Benzodiazepines for the Abortion of Seizures: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Abstract
Background
The acquisition of intravenous access in the actively convulsing patient is difficult. This often delays the administration of the intravenous benzodiazepine necessary for seizure abortion. Delays in seizure abortion are associated with increased pharmacoresistance, increased risk of neuronal injury, worse patient outcomes and increased morbidity.
Objective
To assess whether the delay imposed by IV access acquisition is justified by improved outcomes. We compared IV versus non-IV benzodiazepine efficacy in the real world with regards to failure rates (primary outcome), interval to seizure control and observed complications (secondary outcomes).
Methods
A systematic review using Medline, Embase and the Cochrane Library. All studies published or in press from the inception of the respective database to July 2016 were included. Only randomized and quasi-randomized controlled trials directly comparing an intra-venous to a non-intravenous (buccal, rectal, intranasal or intramuscular) benzodiazepine were included.
Results
Our search strategy retrieved 2604 citations for review. Total of 11 studies were finally included in qualitative synthesis and 10 in quantitative analysis. Only one was of high quality. For treatment failure, non-IV BDZ was superior to IV BDZ (Odd ratio [OR] = 0.72; 95% confidence interval [CI] = 0.56 to 0.92). However, no significant difference between the two treatments in pediatric subgroup (OR = 1.16; 95% CI = 0.74 to 1.81).
Non-IV BDZ was administered faster than IV BDZ and therefore controlled seizures faster (mean difference = 3.41 minutes; 95% CI = 1.69 to 5.13 minutes) despite a longer interval between drug administration and seizure cessation (mean difference = 0.74 minutes; 95% CI = 0.52-0.95 minutes. Respiratory complications requiring intervention were similar between non-IV BDZ and IV BDZ, regardless of administration route (Risk Difference [RD] =0.00; 95% CI = -0.02 to 0.01).
Conclusions
Non-IV BDZ, compared to IV BDZ, abort seizures faster and have a superior efficacy and side effect profile. Higher quality studies and further evaluation in different age groups are warranted.
This article is protected by copyright. All rights reserved.
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Sepsis patients in the emergency department: stratification using the Clinical Impression Score, Predisposition, Infection, Response and Organ dysfunction score or quick Sequential Organ Failure Assessment score?.
Objective: The aim of this study was to compare the stratification of sepsis patients in the emergency department (ED) for ICU admission and mortality using the Predisposition, Infection, Response and Organ dysfunction (PIRO) and quick Sequential Organ Failure Assessment (qSOFA) scores with clinical judgement assessed by the ED staff. Patients and methods: This was a prospective observational study in the ED of a tertiary care teaching hospital. Adult nontrauma patients with suspected infection and at least two Systemic Inflammatory Response Syndrome criteria were included. The primary outcome was direct ED to ICU admission. The secondary outcomes were in-hospital, 28-day and 6-month mortality, indirect ICU admission and length of stay. Clinical judgement was recorded using the Clinical Impression Scores (CIS), appraised by a nurse and the attending physician. The PIRO and qSOFA scores were calculated from medical records. Results: We included 193 patients: 103 presented with sepsis, 81 with severe sepsis and nine with septic shock. Fifteen patients required direct ICU admission. The CIS scores of nurse [area under the curve (AUC)=0.896] and the attending physician (AUC=0.861), in conjunction with PIRO (AUC=0.876) and qSOFA scores (AUC=0.849), predicted direct ICU admission. The CIS scores did not predict any of the mortality endpoints. The PIRO predicted in-hospital (AUC=0.764), 28-day (AUC=0.784) and 6-month mortality (AUC=0.695). The qSOFA score also predicted in-hospital (AUC=0.823), 28-day (AUC=0.848) and 6-month mortality (AUC=0.620). Conclusion: Clinical judgement is a fast and reliable method to stratify between ICU and general ward admission in ED patients with sepsis. The PIRO and qSOFA scores do not add value to this stratification, but perform better on the prediction of mortality. In sepsis patients, therefore, the principle of 'treat first what kills first' can be supplemented with 'judge first and calculate later'. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Is severe hypercalcemia immediately life-threatening?.
Objective: Severe hypercalcemia is often considered an emergency because of a potential risk of cardiac arrest or coma. However, there is little evidence to support this. The aim of our study was to assess whether severe hypercalcemia (Ca>4 mmol/l or 16 mg/dl) was associated with immediately life-threatening cardiac arrhythmias or neurological complications in patients admitted to the Emergency Department (ED). Methods: A retrospective observational study was carried out over a 5-year period (2008-2012). Eligible patients were admitted to the Adult Emergency Department of Nantes University Hospital and had a calcium concentration in excess of 4 mmol/l. There were no exclusion criteria. The primary outcome was the number of life-threatening cardiac arrhythmias and/or neurological complications during the stay in the ED. The secondary outcomes were correlation between calcium concentrations/ECG QTc intervals and mortality. Results: A total of 126 204 adult patients had calcium concentrations measured. Thirty one (0.025%) patients had severe hypercalcemia as defined in our study. The median calcium concentration was 4.3 mmol/l (Q1, 4.2; Q3, 4.7) and the median albumin-adjusted calcium concentration was 4.3 mmol/l (Q1, 4.1; Q3, 4.7). No patient presented with a life-threatening cardiac event during stay in the ED. The median ED stay was 7 h 32 min. One patient presented with a coma of multifactorial origin. There was no correlation between calcemia and QTc intervals (P=0.60). Mortality at 1 year was 55% (17 patients). Conclusion: We found no cases of immediately life-threatening cardiac arrhythmias or neurological complications associated with hypercalcemia above 4 mmol/l over a 5-year period in a large tertiary ED. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Small changes, big effects: The hemodynamics of partial and complete aortic occlusion to inform next generation resuscitation techniques and technologies.
Background: The transition from complete aortic occlusion during Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) can be associated with hemodynamic instability. Technique refinements and new technologies have been proposed to minimize this effect. In order to inform new techniques and technology, we examined the relationship between blood pressure and aortic flow during the restoration of systemic circulation following aortic occlusion at progressive levels of hemorrhage. Methods: An automated supraceliac aortic clamp, capable of continuously variable degrees of occlusion, was applied in 7 swine. The swine underwent step-wise removal of 40% of their total blood volume in four equal aliquots. After each aliquot, progressive luminal narrowing to the point of complete aortic occlusion was achieved over 5 minutes, sustained for 5 minutes, and then released over 5 minutes. Proximal and distal blood pressure, as well as distal aortic flow, were continuously recorded throughout the study. Results: Upon release of the clamp, hyperemic aortic flow was observed following 10% and 20% hemorrhage (1599mL/min+/-785, p
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The course, prediction and treatment of acute and post-traumatic stress in trauma patients: A systematic review.
Background: Trauma patients suffer from Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD). It is unknown how these disorders develop over time and when treatment is effective. Our aim was to systematically review (i) the course and predictors of ASD and PTSD after trauma and (ii) which and when psychological treatments are effective. Methods: Embase, Medline, Web of Science, Scopus, PsycInfo, Cinahl, Cochrane, Pubmed, and Google Scholar were searched up to September 14, 2015. Quality was assessed with STROBE and CONSORT checklists. Results: Overall, 49 (69%) observational studies and 22 (31%) intervention studies were included. Fifty studies (70%) were of lower (Level of Evidence (LoE) 3) or poor quality (LoE 4). ASD was present during hospitalization (range 1%-37%) and about 30% experienced PTSD one month after trauma (LoE 3). The onset of PTSD was within three months up to 12 months after trauma (LoE 3). Especially in patients with ASD, patients showed PTSD symptoms after six years (LoE 3). ASD and PTSD were associated with socio-demographic factors (e.g. being female, younger age, financial problems and low income), reduced cognitive functioning, physical (e.g. pain), social (e.g. low social support), and psychological problems (e.g. hyper-arousal) or disorders (e.g. ASD). Early treatment in the first weeks after trauma can be preventive for PTSD, but effective treatment for ASD is still unclear. Compared to other psychological treatments, the most common examined treatment for PTSD was Cognitive Behavioral Therapy (CBT), which seems to be effective (LoE 2). Conclusions: A large number of poor qualitative studies present inconsistent findings on the course of ASD and PTSD. Predictors for ASD and PTSD were identified. Early treatment can prevent PTSD. CBT is effective, but mostly examined and it has limitations (e.g. engagement). Other intervention studies are necessary. Good qualitative observational and intervention studies are lacking and needed. Level of evidence: III, study type: systematic review and meta-analyses (C) 2017 Lippincott Williams & Wilkins, Inc.
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Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: A single center 8-year experience.
Background: Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure (DPFC) and enteroatmospheric fistula rates. Methods: This was a single academic center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008-2016. Descriptive and univariate analyses were performed. Results: Forty-one patients were identified and analyzed. Median age was 59 years, preoperative septic shock was diagnosed in 54 % (n=22), and 59 % (n=24) had a postoperative peritonitis. Mortality was 29 % (n=12) and in to the ICU were admitted 76 % (n=31) of patients. The median duration of OA was seven days with a median of two dressing changes. DPFC rate among survivors was 92 % (n=33) and EAF[spacing acute]s developed in 7 % (n=3). In a subgroup analysis patients with OA in the primary laparotomy for peritonitis (n=27) were compared to patients with OA in the subsequent laparotomies (n=14). There were no significant differences between groups. Conclusions: VAWCM in patients with complicated secondary diffuse peritonitis and OA yields excellent results in terms of delayed primary fascial closure rate and a low number of enteroatmospheric fistulae. It seems to be safe to close the abdomen at the index laparotomy, if possible, even if there is a risk for a need of OA later. Level of evidence: Observational study, level III (C) 2017 Lippincott Williams & Wilkins, Inc.
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Clinical correlates to assist with CTE diagnosis: Insights from a novel rodent repeat concussion model.
Introduction: Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repetitive head injuries. CTE symptoms include changes in mood, behavior, cognition and motor function, however CTE is only currently diagnosed post-mortem. Using a rat model of recurrent traumatic brain injury (TBI) we demonstrate rodent deficits that predict the severity of CTE-like brain pathology. Methods: Bilateral, closed skull, mild TBI was administered once per week to 35 WT rats, 8 rats received 2 injuries ('2xTBI'), 27 rats received 5 injuries ('5xTBI') and 13 rats were sham controls. To determine clinical correlates for CTE diagnosis, TBI rats were separated based on the severity of rotarod deficits and classified as "mild" or "severe" and further separated into "acute", "short" and "long" based on age at euthanasia (90, 144 and 235 days, respectively). Brain atrophy, phosphorylated tau (p-tau), and inflammation were assessed. Results: All eight 2xTBI had mild rotorod deficiency, 11 5xTBI had mild deficiency and 16 had severe. In one cohort of rats, tested at ~235 days of age, balance, rearing, and grip strength were significantly worse in the severe group relative to both sham and mild groups. At the acute time period, cortical thinning, p-tau and inflammation were not observed in either TBI group, whereas corpus callosum thinning was observed in both TBI groups. At later time points, atrophy, tau pathology and inflammation were increased in mild and severe TBI groups in the cortex and corpus callosum, relative to sham controls. These injury effects were exacerbated over time in the severe TBI group in the corpus callosum. Conclusion: Our model of repeat mild TBI suggests that permanent deficits in specific motor function tests correlate with CTE-like brain pathology. Assessing balance and motor coordination over time may predict CTE diagnosis. (C) 2017 Lippincott Williams & Wilkins, Inc.
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The association of non-accidental trauma with historical factors, exam findings and diagnostic testing during the initial trauma evaluation.
Early identification of non-accidental trauma (NAT) is a critical component of pediatric trauma care. Literature searches were conducted related to the association of NAT with seven key areas: history, exam findings (burns, oral trauma, bruising) and imaging (fractures, abdominal and brain injuries). When available, odds ratios (OR) with 95% confidence intervals (CI) for associations with NAT are presented. Systematic reviews have been published in six of the seven key areas and are described. The operational definition of NAT was widely variable across studies, prohibiting meta-analysis. Select highly associated findings included bruising in a pre-mobile child, clustering of bruises (OR 4.0, CI 2.5-6.4), petechiae (OR 9.3, CI 2.9-30.2), chemical burns 24.6 (4.94-135); contact burns 5.2 (1.6-22.9); scald burns 17.4 (6.4-72), burns to hand 1.8 (1.3-2.6), feet 6.3 (4.6-8.6), buttocks 3.1 (2.2-4.5), and perineum 2.5 (1.7-3.7), subdural hematoma (OR 8.2, 6.1-11), hypoxic ischemic injury (OR 4.2, CI 0.6-2.7), and retinal hemorrhages (OR 14.7, CI 6.4 to 33.6) among others. Of note, hollow viscus injuries, particularly duodenal injuries in children
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3.0% NaCl Adenosine, Lidocaine, Mg 2+ (ALM) bolus and 4 hours 'drip' infusion reduces non-compressible hemorrhage by 60% in a rat model.
Background: Noncompressible torso hemorrhage is the leading cause of potentially survivable trauma in far-forward combat environments. Our aim was to examine the effect of small-volume 3% NaCl adenosine, lidocaine and Mg2+ (ALM) bolus and 0.9% NaCl/ALM 'drip' on survivability and cardiac/gut/kidney function in a rat model of hepatic hemorrhage and shock. Methods: Male Sprague-Dawley rats (428+/-4 g) were anesthetized and randomly assigned to one of five groups (n=16): 1) Sham, 2) No Treatment, 3) Saline controls, 4) ALM therapy and 5) Hextend(R). Animals were ventilated, instrumented with single or double laparotomy for tissue probe insertion, and hemorrhage induced by liver resection. After 15 min, a single 3% NaCl +/- ALM bolus (0.7 ml/kg) was injected IV (Phase 1) and after 60 min, 4 hours 0.9% NaCl +/- ALM stabilization 'drip' (0.5 ml/kg/hour) was administered (Phase 2), with 1 hour monitoring. Results: Mortality for Shams (no resection) was 0% (25%); No Treatment, 87.5% (100%); Saline controls, 37.5% (75%); ALM therapy, 0% (25%), and Hextend(R), 87.5% (100%) (double laparotomy in parentheses). Hextend(R)-treated animals died during the first 20 min of Phase 2. A single ALM bolus during Phase 1 led to a 2.4-fold higher cardiac output and improved hemodynamics. 3% NaCl ALM bolus increased tissue pO2 and flow in gut and kidney during Phase 1 and, during ALM 'drip' in Phase 2, tissue pO2 decreased but flow continued to rise, indicating increased tissue O2 extraction and delivery. During Phase 2, CO, ejection fraction and fractional shortening decreased and were erratic in all groups except ALM-treatment. ALM therapy led to up to 60% less bleeding over 6 hours compared to Saline controls, and 75% less bleeding than Hextend(R). Conclusions: Small-volume ALM therapy significantly reduced mortality and internal bleeding compared to Saline controls or Hextend(R)-treated rats. Hextend(R) increased mortality, severe bleeding and microvascular-organ injury. (C) 2017 Lippincott Williams & Wilkins, Inc.
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Operation versus antibiotics--The "appendicitis conundrum" continues: A meta-analysis.
Background: Acute appendicitis continues to constitute a diagnostic and therapeutic challenge. The aim of this study was to synthesize evidence from randomized controlled trials (RCTs) comparing nonoperative versus surgical management of uncomplicated acute appendicitis in adult patients. Methods: A systematic literature search of the PubMed, Cochrane and Scopus databases was performed with respect to the PRISMA statement (end-of-search date: January 29th, 2017). Data on the study design, interventions, participants, and outcomes were extracted by two independent reviewers. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when substantial heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented. Quality assessment of included RCTs was performed using the modified Jadad scale. Results: Five RCTs were included in this review. Overall, 1,430 adult patients with uncomplicated acute appendicitis underwent either nonoperative (n=727) or operative management (n=703). Treatment efficacy at 1-year follow-up was significantly lower (63.8%) for antibiotics compared to the surgery group (93%) (RR 0.68; 95% CI, 0.60-0.77, p
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Skill learning and retention.
Skills are hard to learn, and forgotten only months after a course. Initial learning is facilitated by: close individual instruction right from the start, many repetitions, short learning sessions on different days, positive calm athmosphere, learning one skill at the time, and having objective defenitions of mastery. Retention is dependant on frequent training. In the retention fase a major part of the training must be integrated in regular exercise with multiple physical and psycological stressors, to mimic real field situations. Self-training must be made possible by open training labs, video instruction, and self-training procedures. (C) 2017 Lippincott Williams & Wilkins, Inc.
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Characterization of distinct coagulopathic phenotypes in injury: Pathway-specific drivers and implications for individualized treatment.
Background: International normalized ratio (INR) and partial thromboplastin time (PTT) are used interchangeably to diagnose acute traumatic coagulopathy (ATC) but reflect disparate activation pathways. In this study we identified injury/patient characteristics and coagulation factors that drive contact pathway, tissue factor pathway (TF), and common pathway dysfunction by examining injured patients with discordant coagulopathies. We hypothesized that patients with INR/PTT discordance reflect differing phenotypes representing contact vs. tissue factor pathway perturbations, and that characterization will provide targets to guide individualized resuscitation. Methods: Plasma samples were prospectively collected from 1262 critically-injured patients at a single Level-1 trauma center. Standard coagulation measures and an extensive panel of pro- and anti-coagulant factors were assayed and analyzed with demographic and outcome data. Results: Fourteen percent of patients were coagulopathic on admission. Among these, 48% had abnormal INR and PTT (BOTH), 43% had isolated prolonged PTT (PTT-CONTACT), and 9% had isolated elevated INR (INR-TF). PTT-CONTACT and BOTH had lower GCS than INR-TF (p
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Volumetric control of whole blood collection in austere environments.
Introduction: Fresh whole blood transfusions are a powerful tool in prehospital care; however, the lack of equipment such as a scale in field situations frequently leads to collections being under- or overfilled, leading to complications for both patient and donor. This study describes two methods for simple, rapid control of collection bag volume: (1) a length of material to constrict the bag, and (2) folding/clamping the bag. Method: Whole blood collection bags were allowed to fill with saline via gravity. Paracord, zip-tie, beaded cable tie, or tourniquet was placed around the bag at circumferences of 6-8.75 inches. A hemostat was used to clamp folds of 1-1.5 inches. Several units were drawn during training exercises of the 75th Ranger Regiment with volume controlled by three methods: vision/touch estimation, constriction by paracord, and clamping with hemostat. Results: Method validation in the Terumo 450 mL bag indicated that paracord, zip-tie, and beaded cable tie lengths of 6.5 inches or clamping 1.25 inches with a hemostat provided accurate filling. The volume variance was significantly lower when using the beaded cable tie. Saline filling time was approximately two minutes. With the Fenwal 450 mL bag, the beaded cable tie gave best results; even if incorrectly placed it by one/two beads, the volume was still within limits. In training exercises, the use of the cord/clamp greatly reduced the variability; more bags were within limits. Conclusions: Both constricting and clamping allow for speed and consistency in blood collection. The use of common cord is appealing, but knot tying induces inevitable variability; a zip/cable tie is easier. Clamping was quicker but susceptible to high variance and bag rupturing. With proper methodological training, appropriate volumes can be obtained in any environment with minimal tools. Level of Evidence: Therapeutic/Care Management Study, Level II (C) 2017 Lippincott Williams & Wilkins, Inc.
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Pelvic fracture pattern predicts the need for hemorrhage control intervention -- results of a AAST multi-institutional study.
Background: Early identification of patients with pelvic fractures at risk for severe bleeding requiring intervention is critical. We performed a multi-institutional study to test our hypothesis that pelvic fracture patterns predict the need for a pelvic hemorrhage control intervention. Methods: This prospective, observational multi-center study enrolled patients with pelvic fracture due to blunt trauma. Inclusion criteria included shock on admission (SBP120 and base deficit > 5, and the ability to review pelvic imaging. Demographic data, open pelvic fracture, blood transfusion, pelvic hemorrhage control intervention (angioembolization, external fixator, pelvic packing and/or REBOA), and mortality were recorded. Pelvic fracture pattern was classified according to Young-Burgess in a blinded fashion. Predictors of pelvic hemorrhage control intervention and mortality were analyzed by univariate and multivariate regression analysis. Results: A total of 163 patients presenting in shock were enrolled from eleven Level-1 trauma centers. The most common pelvic fracture pattern was Lateral Compression (LC) I, followed by LC II, and Vertical Shear. Of the 12 patients with an Anterior-Posterior Compression (APC) III fracture, 10 (83%) required a pelvic hemorrhage control intervention. Factors associated with the need for pelvic fracture hemorrhage control intervention on univariate analysis included vertical shear pelvic fracture pattern, increasing age, and transfusion of blood products. APC III fracture patterns and open pelvic fracture predicted the need for pelvic hemorrhage control intervention on multivariate analysis. Overall in-hospital mortality for patients admitted in shock with pelvic fracture was 30% and did not differ based on pelvic fracture pattern on multivariate analysis. Conclusion: Blunt trauma patients admitted in shock with APC III fracture patterns or patients with open pelvic fracture are at greatest risk of bleeding requiring pelvic hemorrhage control intervention. Level of Evidence: Prognostic Study, Level III (C) 2017 Lippincott Williams & Wilkins, Inc.
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Managing hip fracture and lower limb surgery in the emergency setting: Potential role of non-vitamin K antagonist oral anticoagulants.
Trauma, immobilization, and subsequent surgery of the hip and lower limb are associated with a high risk of developing venous thromboembolism (VTE). Individuals undergoing hip fracture surgery (HFS) have the highest rates of VTE among orthopedic surgery and trauma patients. The risk of VTE depends on the type and location of the lower limb injury. Current international guidelines recommend routine pharmacological thromboprophylaxis based on treatment with heparins, fondaparinux, dose-adjusted vitamin K antagonists and acetylsalicylic acid for patients undergoing emergency HFS; however, not all guidelines recommend pharmacological prophylaxis for patients with lower limb injuries. Non-vitamin K antagonist oral anticoagulants (NOACs) are indicated for VTE prevention after elective hip or knee replacement surgery, but at present are not widely recommended for other orthopedic indications despite their advantages over conventional anticoagulants and promising real-world evidence. In patients undergoing HFS or lower limb surgery, decisions on whether to anticoagulate and the most appropriate anticoagulation strategy can be guided by weighing the risk of thromboprophylaxis against the benefit in relation to each patient's medical history and age. In addition, the nature and location of the fracture, operating times and times before fracture fixation should be considered. The current review discusses the need for anticoagulation in patients undergoing emergency HFS or lower limb surgery together with the current guidelines and available evidence on the use of NOACs in this setting. Appropriate thromboprophylactic strategies and practical advice on the perioperative management of patients who present to the Emergency Department on a NOAC before emergency surgery are further outlined. (C) 2017 Lippincott Williams & Wilkins, Inc.
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Career Development Awards in Emergency Medicine: Resources and Challenges
Abstract
Objectives
In the United States, emergency medicine researchers hold proportionately fewer federal career development awards than researchers in other specialties. Others hypothesize this deficit may partly be attributed to lack of mentors, departmental resources, and qualified applicants. Our objectives were to examine the association between departmental and institutional resources and career development awards and to describe the barriers to conducting research and obtaining grants in emergency medicine.
Methods
We conducted an online, cross-sectional survey study of Vice Chairs for Research and Research Directors at academic emergency departments in the United States in January-February 2016. Participants provided quantitative information regarding their department's demographics, available research resources, number of funded independent investigators, and number of career development awards. They were also asked about the perceived adequacy of departmental and institutional resources and perceived barriers to research and grant success. Data were analyzed using descriptive statistics and multivariable linear regression, as appropriate.
Results
Of 178 eligible participants, 103 (58%) completed the survey. Most departments reported some infrastructure for research and grant submission, including research coordinator(s) (n=75/99; 76%, 95%CI 66-84%), research associates (69/99; 70%, 95%CI 60-79%), and administrative/secretarial research support (79/101; 78%, 95%CI 69-86%). The majority of departments (56/103; 49%, 95%CI 44-64%) had no R01-funded researchers, and only 15 (15%, 95%CI 8-23%) had three or more R01-funded researchers. The most frequently reported challenge to junior faculty applying for grants was low motivation for applying (62/103; 60%, 95%CI 50-70%), followed closely by insufficient mentorship (50/103; 49%, 95%CI 39-59%) and discouragement from low funding rates (50/103; 49%, 95%CI 39-59%). In the multivariable model, only the number of departmental R-level funded researchers was associated with the number of departmental career development awards (coefficient 0.75 95%CI 0.39, 1.11; R2=0.57).
Conclusions
While more multiple departmental and institutional resources correlated with a greater number of funded career development awards, the single greatest predictor was the number of R-level funded researchers in the department. Low motivation and insufficient mentorship were the most frequently reported barriers to junior faculty applying for career development awards. Further studies are needed to describe junior faculty perspectives on these issues and to explore strategies for overcoming these barriers.
This article is protected by copyright. All rights reserved.
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Παρασκευή 24 Μαρτίου 2017
Treating pediatric patients with ketamine for pain
Dr. Antevy discusses the best option for ketamine administration when being used for pain.
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Treating pediatric patients with ketamine for pain
Dr. Antevy discusses the best option for ketamine administration when being used for pain.
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Treating pediatric patients with ketamine for pain
Dr. Antevy discusses the best option for ketamine administration when being used for pain.
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EMT Program Lead Instructor & Skills Instructors - Unitek Education
EMT Lead Instructors and EMT Skills Teaching Assistants needed. Per Diem, Part-time and Full-time positions available. Job Summary: Implement the Emergency Medical Technician -- Basic Program curriculum in accordance with NHTSA Emergency Medical Technician Education Standards and California Code of Regulations Title 22. Social Security Division 9. Prehospital Emergency Medical Services Chapter 2. Emergency ...
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EM Nerd-The Case of the Shadowy Spector
The shadow of the long-term sequelae of submassive pulmonary emboli has stalked the hearts and minds of Emergency Physicians. The use of thrombolytics to prevent these ramification has previously been supported primarily with surrogate data, physiological reasoning and communal anecdotal experience. Thrombolytics for submassive pulmonary emboli have failed to demonstrate an improvement in short-term mortality […]
EMCrit by Rory Spiegel.
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Treating pediatric patients with ketamine for pain
Dr. Antevy discusses the best option for ketamine administration when being used for pain.
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Video: Police explorer saves choking classmate with Heimlich maneuver
By EMS1 Staff LA CROSSE, Wis. — A teenager is being credited with saving his classmate’s life after performing the Heimlich maneuver this week. High school freshman Ian Brown, 15, was at lunch when his classmate Will Olson started choking, reported USA Today. Video posted by the high school shows Olson coughing; although some students thought Olson was joking, Brown stepped in and performed ...
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SET MEDICS FOR MOVIE SHOOT CHICAGO AREA - BLASTMEDICS
ATTENTION ALL EMTS AND PARAMEDICS BLASTMEDICS LOOKING FOR SET MEDICS FOR A MOVIE SHOOT STARTING APRIL 3RD IN THE CHICAGO AREA. YOU MUST HAVE YOUR OWN BLS BAG. IF YOU ARE INTERESTED PLEASE APPLY THROUGH OUR WEBSITE BLASTMEDICS.COM JOIN OUR TEAM,
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Inside EMS Podcast: Is EMS a career field or a stepping stone?
&lt;!--cke_bookmark_117S--&gt;&lt;!--cke_bookmark_117E--&gt; Download this podcast on iTunes, SoundCloud or via RSS feed In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson discuss the question if EMS is a career field or a stepping stone. They focus on the individuals that are using EMS as a stepping stone and some tips to ...
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5 questions to guide EMS transport decisions
Many EMS providers will remember being asked to decide in school about whether their patient required that they "load and go." The idea being that there were patients who were either so sick or required specific, time-sensitive interventions that EMS should scoop them up and immediately transport to the closest hospital. The implication was that these patients would be transported with red ...
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Abnormalities in fibrinolysis at the time of admission are associated with deep vein thrombosis, mortality and disability in pediatric trauma population
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
Author(s): Brittany Catanach
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Issue Highlights
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
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Contents
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
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Partial Contents of Volume 52, Number 5
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
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Editorial Board
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
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Pyogenic Liver Abscess: A Retrospective Study of 105 Cases in an Emergency Department from East China
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
Author(s): Li Liu, Wanjun Chen, Xiaoye Lu, Keji Zhang, Changqing Zhu
BackgroundPyogenic liver abscesses have become common in emergency departments (EDs) in recent years in Shanghai, China due to a variety of risk factors contributory to the disease.ObjectiveTo review our experience in managing pyogenic liver abscesses to aid in the current management of this complex condition.MethodsThis retrospective study was conducted to collect and analyze information from adult patients diagnosed with liver hepatic abscesses who were admitted to Ren Ji Hospital during the period from January 1, 2010 to December 31, 2015. The demographic data, etiology, underlying diseases, clinical presentation, imaging features, laboratory examinations, microbiological tests, treatment, and clinical outcomes were analyzed.ResultsThe data of a total 105 patients were retrospectively analyzed. The mean age of the patients was 62.0 ± 13.5 years. The etiology was predominantly hepatobiliary disease (43/105, 40.1%) or diabetes mellitus (42/105, 40.0%). During hospitalization, 12 patients (11.4%) with septic shock required intensive care. One patient died, yielding a 0.9% fatality rate. In addition to empiric antimicrobial therapy, 66/105 (62.9%) patients underwent ultrasound-guided percutaneous drainage of the liver abscess at diagnosis. Only 3 patients required surgical intervention. Bacterial culture of pyogenic fluids revealed 25 positive results of 66 cases (37.9%). Among them, Klebsiella pneumoniae was the primary pathogen detected in 15 cases (60.0%).ConclusionsPyogenic liver abscesses have become common in EDs in Shanghai, China. The early recognition of the disease, prompt use of empirical antimicrobial therapy, initiation of drainage in the appropriate patients, and controlling the underlying conditions were crucial for preventing severe sepsis and improving the outcome.
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American Academy of Emergency Medicine
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
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When are CT angiograms indicated for patients with lower extremity fractures? A review of 275 extremities.
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
Author(s): Nigel S. George
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Rash Decisions: An Approach to Dangerous Rashes Based on Morphology
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
Author(s): Jamie Santistevan, Brit Long, Alex Koyfman
BackgroundRash is a common complaint in the emergency department. Many causes of rash are benign; however, some patients may have a life-threatening diagnosis.ObjectiveThis review will present an algorithmic approach to rashes, focusing on life-threatening causes of rash in each category.DiscussionRash is common, with a wide range of etiologies. The differential is broad, consisting of many conditions that are self-resolving. However, several conditions associated with rash are life threatening. Several keys can be utilized to rapidly diagnose and manage these deadly rashes. Thorough history and physical examination, followed by consideration of red flags, are essential. This review focuses on four broad categories based on visual and tactile characteristic patterns of rashes: petechial/purpuric, erythematous, maculopapular, and vesiculobullous. Rashes in each morphologic group will be further categorized based on clinical features such as the presence or absence of fever and distribution of skin lesions.ConclusionsRashes can be divided into petechial/purpuric, erythematous, maculopapular, and vesiculobullous. After this differentiation, the presence of fever and systemic signs of illness should be assessed. Through the breakdown of rashes into these classes, emergency providers can ensure deadly conditions are considered.
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Allergic Reaction to Ketamine as Monotherapy for Procedural Sedation
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
Author(s): Tammy T. Nguyen, Bethany Baker, Jeffrey D. Ferguson
BackgroundKetamine is a cyclohexamine derivative that acts as a noncompetitive N-methyl D-aspartate receptor antagonist. Its use for procedural sedation is recommended by national clinical policy. However, its immunogenic potential is not well documented.Case ReportWe report a case of allergic reaction associated with the administration of intravenous ketamine for procedural sedation in a 16-year-old male. Minutes after administration, the patient developed a morbilliform, erythematous rash that extended to the upper and lower torso and resolved with intravenous diphenhydramine. It is most likely that this allergic reaction was caused by a ketamine-induced histamine release that has been described in vitro.Why Should an Emergency Physician be Aware of This?This is the first case report in which ketamine was used as monotherapy in the emergency department for the facilitation of procedural sedation that resulted in an allergic reaction. Supportive measures, including advanced airway procedures and hemodynamic support, may be necessary in more severe anaphylactic cases. Providers should be aware of this potential adverse effect when using ketamine for procedural sedation.
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Synthetic Cannabinoid Abuse Resulting in ST-Segment Elevation Myocardial Infarction Requiring Percutaneous Coronary Intervention
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
Author(s): Richard J. Hamilton, Vadim Keyfes, Sahil S. Banka
BackgroundSynthetic cannabinoids (SC) are recreational designer drugs intended to mimic delta-9-tetrahydrocannabinol while surreptitiously circumventing classification by the Drug Enforcement Administration.Case ReportA 50-year-old black male arrived in the Emergency Department transported by Emergency Medical Services (EMS) for altered mental status after complaining of chest pain associated with smoking SCs. EMS found the patient with an empty foil pack labeled “Scooby Snax Limited Edition Blueberry Potpourri.” The patient was somnolent, but became agitated when stimulated and complained of chest pain. Vital signs were blood pressure 87/52 mm Hg and pulse 52 beats/min. The electrocardiogram demonstrated an inferior wall myocardial infarction. Coronary angiography identified an occluded obtuse marginal second branch that was successfully opened with a drug-eluting stent. The patient recovered uneventfully. Urine drug screen was negative for cocaine, and gas chromatography/mass spectrometry testing of the smoked material identified PB-22 and AMB-FUBINACA as the active ingredients.Why Should an Emergency Physician Be Aware of This?Emergency physicians and cardiologists need to be aware that the mechanism of action of synthetic cannabinoids on the endocannabinoid system may result in acute ST-segment elevation myocardial infarction requiring percutaneous coronary intervention.
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Alcohol Abuse and Cardiac Disease
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
Author(s): Brittany Catanach
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Peritoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
Author(s): Brittany Catanach
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Should grade of solid organ injury determine need for hospitalization in children?
Source:The Journal of Emergency Medicine, Volume 52, Issue 4
Author(s): Nigel S. George
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Vertebral artery injury in patients with isolated transverse process fractures
Journal of Clinical Neuroscience
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UN aims to immunize more than 115 million kids against polio
AP
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The Latest: House Freedom Caucus says no deal on health care
AP
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Effect of paracetamol (acetaminophen) on body temperature in acute stroke: A meta-analysis
The American Journal of Emergency Medicine
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A study on the etiology, severity, and mortality of 3260 patients with acute pancreatitis according to the revised Atlanta classification in Jiangxi, China over an 8-year period
Pancreas
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Computer tablet distraction reduces pain and anxiety in pediatric burn patients undergoing hydrotherapy: A randomized trial
Burns
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Lipid and lipoprotein abnormalities in acute lymphoblastic leukemia survivors
Journal of Lipid Research
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Leisure time physical activity among older adults with long-term spinal cord injury
Spinal Cord
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Factors driving customers to seek health care from pharmacies for acute respiratory illness and treatment recommendations from drug sellers in Dhaka city, Bangladesh
Patient Preference and Adherence
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Posterior versus lateral approach for hemiarthroplasty after femoral neck fracture: Early complications in a prospective cohort of 583 patients
Injury
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Coffee shops, ATMs may be ideal locations for lifesaving AEDs
American Heart Association News
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Apigenin attenuates oxidative stress and neuronal apoptosis in early brain injury following subarachnoid hemorrhage
Journal of Clinical Neuroscience
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Clinical outcome of primary medial collateral ligament-posteromedial corner repair with or without staged anterior cruciate ligament reconstruction
Injury
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Acute circulatory failure chronic liver failure sequential organ failure assessment score: A novel scoring model for mortality risk prediction in critically ill cirrhotic patients with acute circulatory failure
European Journal of Gastroenterology & Hepatology
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Outcome of low profile mesh plate in management of comminuted displaced fracture patella
Injury
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Can C-reactive protein levels increase the accuracy of the Ranson score in predicting the severity and prognosis of acute pancreatitis? A prospective cohort study
The Turkish Journal of Gastroenterology
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Presentations for hypoglycemia associated with diabetes mellitus to emergency departments in a Canadian province: A database and epidemiological analysis
Diabetes Research and Clinical Practice
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Diagnostic and therapeutic role of endoscopic retrograde pancreatography in the management of traumatic pancreatic duct injury patients: Single center experience for 34 years
International Journal of Surgery
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Work related injury among Saudi Star Agro Industry workers in Gambella region, Ethiopia; a cross-sectional study
Journal of Occupational Medicine and Toxicology
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Infection after fracture fixation of the tibia: Analysis of healthcare utilization and related costs
Injury
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We need to include bystander first aid in trauma research
The chain of trauma survival is a concept that originated in the area of out-of-hospital cardiac arrest (OHCA) and was adapted to the treatment of trauma. In out-of-hospital cardiac arrest research into bystan...
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Acute traumatic coagulopathy: The elephant in a room of blind scientists.
Acute traumatic coagulopathy (ATC) is the failure of coagulation homeostasis that can rapidly arise following traumatic injury, hemorrhage, and shock; it is associated with higher injury severity, coagulation abnormalities, and increased blood transfusions. ATC has historically been defined by a prolonged prothrombin time (PT), although newer, more informative measurements of hemostatic function have been employed to improve diagnosis and support clinical decision making. The underlying biochemical mechanisms of and best practice therapeutics for ATC remain under active investigation because of its significant correlation to poor outcomes. The wide range of hypothesized mechanisms for ATC results from the large number of symptoms, phenotypes, and altered states in these patients as observed by multiple research groups. Much like the ancient fable of blind men describing an elephant from their limited perspectives, the limited nature of clinical and laboratory tools used to diagnose coagulopathy or evaluate hemostatic function have made finding causation difficult. The prolonged PT, degree of fibrinolysis, depletion of coagulation factors and inhibitors, and general failure of the blood have all been identified as being primary indicators for ATC. Therapeutic interventions including recombinant coagulation factors, anti-fibrinolytics, and blood products have been used with varying degrees of success as they are employed to address specific symptoms. To truly understand the causes of ATC, research efforts must recognize the complexity of the hemostatic system and get to the heart of the matter by answering the question, "Is ATC a pathological condition that develops from the observed deficiencies in coagulation, fibrinolysis, and autoregulation, or is ATC an adaptive response generated as the body attempts to restore perfusion and avoid massive organ failure?" Since patient management must proceed without definitive answers regarding the entire causative chain, the current therapeutic focus should be on using what knowledge has been gained to the patient's advantage: control hemorrhage, maintain appropriate homeostatic balances of coagulation proteins, and restore oxygen perfusion. (C) 2017 Lippincott Williams & Wilkins, Inc.
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Minimal variation in anti-A and -B titers among healthy volunteers over time: implications for the use of out -of- group blood components.
Background: Using potentially out-of-group blood components, like low titer A plasma and O whole blood, in the resuscitation of trauma patients is becoming increasingly popular. However, very little is known whether the donors' anti-A and/or -B titers change over time and whether repeated titer measurements on the same donor are required to ensure that each donation produces a low titer product. Methods: The anti-A and/or -B titers were measured on 56 healthy adult volunteers (47 blood donors; 9 blood center personnel) every three months for 12 consecutive months using an automated solid phase analyzer. The results were expressed as log2 titer steps (e.g., titer 32 = 5 titer steps). Results: Minor variations in the average anti-A and/or -B titers were seen over time; the maximum individual SD in each group was 1.50 (IgG anti-A) or 1.00 (IgM anti-A, IgM and IgG anti-B). When the SDs for the 4 titer measurements from all 56 volunteers were combined as appropriate, the highest overall combined SD was 0.47 titer steps for IgG anti-A. This value corresponds to a 95% confidence interval for intra-individual variation in this antibody's titer over 12 months of 0.96 titer steps. Thus, based on one measurement, an IgG anti-A with a titer step of, for example, 6 would be expected to be in the range of titer step 5 to titer step 7 over the course of one year with 95% probability. Conclusion: The titers of anti-A and/or -B among healthy adults are stable over at least one year. This suggests that repeated titer measurements within a year on the same donor are not necessary if donations are made at >=3 month intervals. Level of evidence: 5 Study type: Diagnostic test (C) 2017 Lippincott Williams & Wilkins, Inc.
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Deployed skills training for whole blood collection by a special operations expeditionary surgical team.
Background: Non-compressible hemorrhage is the leading cause of potentially preventable battlefield death. Combining casualty retrieval from the battlefield and damage control resuscitation (DCR) within the "golden hour" increases survival. However, transfusion requirements may exceed the current blood component stocks held by forward surgical teams. Warm fresh whole blood (WFWB) is an alternative. We report WFWB transfusion training developed by and delivered to a US Golden Hour Offset Surgical Treatment Team (GHOST-T) and the resulting improvement in confidence with WFWB transfusion. Methods: A bespoke instructional package was derived from existing operational clinical guidelines. All GHOST-T personnel completed initial training, reinforced through ongoing casualty simulations. A record of blood types and donor eligibility was established to facilitate rapid identification of potential WFWB donors. Self-reported confidence in seven aspects of the WFWB transfusion process was assessed before and after training using a five-point Likert scale. Personnel were analyzed by groups consisting of those whose operational role includes WFWB transfusion ("transfusers"), clinical personnel without such responsibilities ("non-transfusers") and non-clinical personnel (other). Comparisons within and between groups were made using appropriate non-parametric tests. Results: Data were collected from 39/44 (89%) training participants: 24 (62%) transfusers, 12 (31%) non-transfusing clinicians and 3 (8%) other personnel. Transfusers and non-transfusers reported increased comfort with all practical elements of WFWB transfusion. The confidence of other personnel also increased, but (likely due to small numbers) was not statistically significant. Conclusion: WFWB transfusion is an integral part of modern deployed military remote DCR. Our in-theatre training program rapidly and reproducibly enhanced the comfort in WFWB transfusion in providers from a range of backgrounds and skill-mixes. This model has the potential to improve both safety and effectiveness of WFWB remote DCR in the far-forward deployed setting. Level of Evidence: Care management study, level IV. (C) 2017 Lippincott Williams & Wilkins, Inc.
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Immunologic effects of trauma and transfusion.
The immunologic response to severe traumatic injury is complex - such that individual patients may face exceptionally different immunologic challenges at different points in time. It is in this context that one must consider potentially additive immunomodulatory effects of blood product transfusion. This review will consider first the immunologic response to traumatic injury, followed by the epidemiology and outcomes related to blood product transfusion in trauma patients, and lastly immunologic effects of transfusion in the context of trauma. (C) 2017 Lippincott Williams & Wilkins, Inc.
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Leadership and a casualty response system for eliminating preventable death.
Combat casualties who die from their injuries do so primarily in the prehospital setting. Although most of these deaths result from injuries that are non-survivable, some are potentially survivable. Of injuries that are potentially survivable, most are from hemorrhage. Thus, military organizations should direct efforts toward prehospital care, particularly through early hemorrhage control and remote damage control resuscitation, in order to eliminate preventable death on the battlefield. A systems-based approach and priority of effort for institutionalizing such care was developed and maintained by medical personnel and command-directed by non-medical combatant leaders within the 75th Ranger Regiment, U.S. Army Special Operations Command. The objective of this manuscript is to describe the key components of this prehospital casualty response system; emphasize the importance of leadership; underscore the synergy achieved through collaboration between medical and non-medical leaders; and provide an example to other organizations and communities striving to achieve success in trauma as measured through improved casualty survival. (C) 2017 Lippincott Williams & Wilkins, Inc.
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Measuring the compensatory reserve to identify shock.
Successful management of shock heavily relies on the ability to identify early stages of hemorrhage. During blood loss and reduced blood volume, multiple physiological mechanisms are able to compensate in order to preserve tissue oxygenation and blood flow. Unfortunately, this compensation makes the crucial early stage identification of hemorrhage complicated as traditionally monitored vital signs reflect this compensation, and do not change until significant amounts of blood have been lost. New insights and a recent body of literature utilizing a human model of hemorrhage provide evidence that it is possible to measure the body's reserve to continue to compensate for a reduced circulating blood volume. The function of 'compensatory reserve' can be accurately assessed from real-time measurements of changes in arterial waveform features. In this review, the compensatory mechanisms and physiology underlying the development and evaluation of a new non-invasive technology that allows for real-time measurement of the compensatory reserve will be discussed, along with clinical implications for earlier and more accurate prediction of shock utilizing the body's compensatory reserve. (C) 2017 Lippincott Williams & Wilkins, Inc.
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Zero preventable deaths after traumatic injury: An achievable goal.
Preventable deaths after injury must be reduced to improve outcomes for trauma patients. The elimination of preventable deaths after injury has been documented by the 75th US Army Ranger Regiment. Therefore, zero preventable deaths after injury is an achievable goal. Trauma is the most common cause of death between the ages of 1-46 and is the most common cause of life-years lost, before 75 years of age, compared to all other etiologies. Traumatic Hemorrhagic Shock (THS) is the leading cause of death that is preventable after injury, accounting for potentially 17,000 preventable deaths per year in the US. Civilian and US Military data estimate that upwards of 20-27.5% of trauma related deaths are preventable, respectively, and that 64-90% of these preventable deaths are due to THS. To achieve the goal of zero preventable deaths after injury a systematic approach is needed that can be modeled as a learning health care system (LHCS). Successful LHCS's are characterized by; leadership with authority and accountability that fosters a culture of learning; a highly coordinated performance improvement process that captures all aspects of patient care; that is transparent, and allows for rapid real time assessment of performance; a system for ensuring the maintenance of an expert trauma care workforce; and patient-centered care. In addition, the use of implementation science principles, and cost-effectiveness analyses are tools that can be used effectively to improve trauma systems. Lack of funding for trauma research is a major barrier for improving outcomes after traumatic injury. Trauma research is and has remained the lowest funded illness for the burden of disease it creates in our society when compared to all other diseases. Increased resources and an integrated military and civilian trauma system are required to achieve zero preventable deaths after injury in the United States. (C) 2017 Lippincott Williams & Wilkins, Inc.
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Leadership lessons learned in tactical combat casualty care.
The US Military has achieved remarkable success in improving survival for our nation's combat wounded throughout the 14 years of conflict in Iraq and Afghanistan. For the prehospital phase of care, where most combat fatalities occur, these advances have been embodied in Tactical Combat Casualty Care (TCCC.) TCCC is a set of evidence-based, best-practice, prehospital trauma care guidelines that are customized for use on the battlefield. The TCCC Guidelines have been updated on an ongoing basis over the last 15 years through the work of the Committee on TCCC and the TCCC Working Group. The process of developing improvements in battlefield trauma care and advocating for them to be implemented throughout the US Military was lengthy, challenging, and evolutionary. This paper describes the major leadership lessons learned in the TCCC effort during the 20 years from its inception to the present. (C) 2017 Lippincott Williams & Wilkins, Inc.
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Prehospital blood transfusion programs: Capabilities and lessons learned.
The Trauma and Hemostasis Oxygenation Research (THOR) network has met in Bergen, Norway every summer over the past six years in an effort to have experts in transfusion, blood banking, military medicine, and trauma surgery exchange ideas, share their experiences, and set an agenda to move the science of remote damage control resuscitation forward. In this manuscript, we supply the lessons shared from the authors/speakers to the reader. These lessons include the experiences of the Norwegian Military with freeze dried plasma and whole blood resuscitation, lessons from extreme remote damage control resuscitation situations on oceanic cruises, and remote blood product resuscitation techniques at Mayo Clinic and the University of Pittsburgh. (C) 2017 Lippincott Williams & Wilkins, Inc.
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Πέμπτη 23 Μαρτίου 2017
Masimo announces CE Marking of Rad-97™ Pulse CO-Oximeter®
NEUCHATEL, Switzerland Masimo (NASDAQ: MASI) announced today the CE marking of the Rad-97™ Pulse CO-Oximeter®. Rad-97 offers the same Measure-through Motion and Low Perfusion™ SET® pulse oximetry and upgradeable rainbow SET™ technology as the Radical-7® Pulse CO-Oximeter – in a versatile standalone monitor configuration. Rad-97 features a high-resolution 1080p HD color display with user-friendly ...
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Masimo announces CE Marking of Rad-97™Pulse CO-Oximeter® and connectivity hub with noninvasive blood pressure
NEUCHATEL, Switzerland Masimo (NASDAQ: MASI) announced today the CE marking of noninvasive blood pressure (NIBP) measurements for the Rad-97™ Pulse CO-Oximeter® and connectivity hub. Rad-97 offers Measure-through Motion and Low Perfusion™ SET® pulse oximetry and upgradeable rainbow® noninvasive blood constituent monitoring technology in a compact standalone monitor configuration which can also ...
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SAM Medical launches new Sam XT Extremity Tourniquet
WILSONVILLE, Ore. — SAM Medical Products, an industry leader in the pre-hospital, trauma care market, today announced the launch of its latest product, the SAM XT Extremity Tourniquet. Extremity tourniquets have been on the market for several years. Unfortunately, as noted by numerous papers on extremity tourniquet failure, lives have been lost due to inappropriately applied tourniquets. Slack ...
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EMT saves cop, lifelong friend from carbon monoxide poisoning
By EMS1 Staff PRINCE GEORGE’S COUNTY, Md. — An EMT is being credited with saving his best friend and colleague from carbon monoxide poisoning earlier this month. Seat Pleasant volunteer EMT Phil Martin was talking on the phone to his best friend and police officer Ricardo Biddy, who is also an EMT, March 3. Martin and Biddy have known each other since they were 7 years old. After his shift ...
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Quantum EMS Solutions is pleased to announce the Ambulance Child Restraint System (ACR-4) meets and exceeds the weight recommendations for the new National Association of State EMS official guidelines March 2017
The Ambulance Child Restraint system safely restrains all children from 4-99 pounds
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Belluscura Ltd. launches Slyde in EU
Belluscura’s first product launch outside the USA OXFORD, England — Belluscura Limited (“Belluscura”) today launched Slyde™, its first product launch outside the USA. The Belluscura Evacuation Slyde™ is a light and compact sled for moving its occupant safely down stairs or over rough ground in the event of an emergency evacuation. It provides a safe, efficient way ...
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GCSS-Army deploying 9,783 Getac F110 G3 rugged tablets
Tablets replace aging management information systems, will be used to capture UID data using built-in bar code reader IRVINE, Calif. — The Global Combat Support System branch of the U.S. Army (GCSS-Army) has ordered 9,783 Getac F110 G3 rugged tablets with docking stations. After a thorough vetting process, GCSS-Army determined the Getac F110 G3 would be the best new rugged tablet to replace several ...
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Excellance, Inc. equips mobile stroke treatment units with CT scanners to diagnose, treat on the scene
Excellance, Inc. finishes new Mobile Stroke Treatment Unit for Rush University Medical Center in Chicago.
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Stroke ambulances dramatically cut treatment time
Cleveland Clinic reports how studies from their Mobile Stroke Treatment Unit (MSTU) are dramatically cutting treatment time. Excellance, Inc. manufactured the MSTU and there are currently only 11 units in the world like this one that are active.
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Excellance, Inc. equips mobile stroke treatment units with CT scanners to diagnose, treat on the scene
Excellance, Inc. finishes new Mobile Stroke Treatment Unit for Rush University Medical Center in Chicago.
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Stroke ambulances dramatically cut treatment time
Cleveland Clinic reports how studies from their Mobile Stroke Treatment Unit (MSTU) are dramatically cutting treatment time. Excellance, Inc. manufactured the MSTU and there are currently only 11 units in the world like this one that are active.
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Excellance, Inc. equips mobile stroke treatment units with CT scanners to diagnose, treat on the scene
Excellance, Inc. finishes new Mobile Stroke Treatment Unit for Rush University Medical Center in Chicago.
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Stroke ambulances dramatically cut treatment time
Cleveland Clinic reports how studies from their Mobile Stroke Treatment Unit (MSTU) are dramatically cutting treatment time. Excellance, Inc. manufactured the MSTU and there are currently only 11 units in the world like this one that are active.
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Excellance, Inc. equips mobile stroke treatment units with CT scanners to diagnose, treat on the scene
Excellance, Inc. finishes new Mobile Stroke Treatment Unit for Rush University Medical Center in Chicago.
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Stroke ambulances dramatically cut treatment time
Cleveland Clinic reports how studies from their Mobile Stroke Treatment Unit (MSTU) are dramatically cutting treatment time. Excellance, Inc. manufactured the MSTU and there are currently only 11 units in the world like this one that are active.
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Abstract In this work, novel thin-film composite forward osmosis (TFC-FO) hollow fiber membranes were fabricated by modifying polyamide ac...
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Objectives: Opioids and benzodiazepines are commonly used to provide analgesia and sedation for critically ill children with cardiac disease...
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Abstract Purpose Lithium (Li), the first-line treatment of bipolar disorder, was first developed as an immediate-release form with a rou...
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Objective: Inotropic and vasopressor drugs are routinely used in critically ill patients to maintain adequate blood pressure and cardiac ou...
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Abstract The dispersion properties of Love waves are utilized for the fabrication of sensor devices in the different material environments...
