Braun Industries and Pierce Manufacturing team up for all-in-one apparatus

The Patriot Model is a versatile apparatus that can serve as an ambulance, rescue vehicle and fire suppression unit

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EMT/Paramedic Program Director/Instructor - Ozarks Technical Community College

Date Position Available: September 5, 2017 Salary Scale: Salary based on experience and education. Qualifications & Experience: MANDATORY: (M1) Bachelor’s degree from a regionally accredited institution of higher learning; (M2) Current certification as an EMT/Paramedic; (M3) Two years of experience in emergency medical systems; (M4) Demonstrate current knowledge in course content and effectiveness ...

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Quick Sequential Organ Failure Assessment and Systemic Inflammatory Response Syndrome Criteria as Predictors of Critical Care Intervention Among Patients With Suspected Infection.

Objectives: The Sepsis III clinical criteria for the diagnosis of sepsis rely on scores derived to predict inhospital mortality. In this study, we introduce the novel outcome of "received critical care intervention" and investigate the related predictive performance of both the quick Sequential Organ Failure Assessment and the Systemic Inflammatory Response Syndrome criteria. Design: This was a single-center, retrospective analysis of electronic health records. Setting: Tertiary care hospital in the United States. Patients: Patients with suspected infection who presented to the emergency department and were admitted to the hospital between January 2010 and December 2014. Interventions: Systemic Inflammatory Response Syndrome and quick Sequential Organ Failure Assessment scores were calculated, and their relationships to the receipt of critical care intervention and inhospital mortality were determined. Measurement and Main Results: A total of 24,164 patients were included of whom 6,693 (27.7%) were admitted to an ICU within 48 hours; 4,453 (66.5%) patients admitted to the ICU received a critical care intervention. Among those with quick Sequential Organ Failure Assessment less than 2, 13.4% received a critical care intervention and 3.5% died compared with 48.2% and 13.4%, respectively, for quick Sequential Organ Failure Assessment greater than or equal to 2. The area under the receiver operating characteristic was similar whether quick Sequential Organ Failure Assessment was used to predict receipt of critical care intervention or inhospital mortality (0.74 [95% CI, 0.73-0.74] vs 0.71 [0.69-0.72]). The area under the receiver operating characteristic of Systemic Inflammatory Response Syndrome for critical care intervention (0.69) and mortality (0.66) was lower than that for quick Sequential Organ Failure Assessment (p

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XFIRE® Collection from TRU-SPEC® Now Available

TRU-SPEC® to release line of fire-resistant station wear MARIETTA, Ga. — TRU-SPEC®, a leading supplier of uniforms and personal equipment to the military, law enforcement, public safety and shooting sports markets, introduces the XFIRE™ collection, a line of fire resistant station wear built with the Fire, EMS and Industrial professional in mind.

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A Wee Bit More on Massive Hemoptysis

Hemoptysis redux

EMCrit by Scott Weingart.

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A Wee Bit More on Massive Hemoptysis

Hemoptysis redux

EMCrit by Scott Weingart.

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Braun Industries & Pierce Manufacturing team up for all-in-one apparatus

The Patriot Model is a a versatile apparatus that can serve as an ambulance, rescue vehicle, and fire suppression unit

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Video: Ambulance erupts in flames behind fire station

The fire department said the fire was not suspicious and was probably caused by an electrical issue

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Frequency of acute longus colli tendinitis on CT examinations

Emergency Radiology

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Risk factors and outcomes associated with a post-traumatic headache after mild traumatic brain injury

Emergency Medicine Journal

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US House panel spotlights use of FDA rules to slow generic drugs

Reuters Health News

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Research suggests new anti-inflammatory approach for treating stroke

Ottawa Hospital Research Institute News

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Merck cyber attack halted manufacturing, will hurt profits

Reuters Health News

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Operative versus non-operative management of civilian gunshot wounds to the spinal cord: Novel use of the Functional Independence Measure for validated outcomes

World Neurosurgery

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Meta-analysis comparing metoprolol and carvedilol on mortality benefits in patients with acute myocardial infarction

The American Journal of Cardiology

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Telemedicine improving efficiency in emergency medicine, reported in paper

NewYork-Presbyterian

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Sports injury and illness incidence in the Rio de Janeiro 2016 Olympic Summer Games: A prospective study of 11274 athletes from 207 countries

British Journal of Sports Medicine

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Slug slime inspires new kind of surgical glue

Reuters Health News

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Ultrasound use during cardiopulmonary resuscitation is associated with delays in chest compressions

Resuscitation

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A therapy system for post-traumatic stress disorder using a virtual agent and virtual storytelling to reconstruct traumatic memories

Journal of Medical Systems

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Predictive value of EEG in postanoxic encephalopathy: A quantitative model-based approach

Resuscitation

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The impact of antihypertensive medications on bone mineral density and fracture risk

Current Cardiology Reports

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Intubation is not a marker for coma after in-hospital cardiac arrest: A retrospective study

Resuscitation

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Abdominal-pelvic scanning parameters revisited: A case for Z-axis reduction in patients with clinical suspicion for acute appendicitis

Emergency Radiology

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Auditory discrimination improvement predicts awakening of postanoxic comatose patients treated with targeted temperature management at 36°C

Resuscitation

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Kaiser Permanente emergency department intervention for adult head trauma reduces CT use

Kaiser Permanente Health Research News

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Post-anoxic quantitative MRI changes may predict emergence from coma and functional outcomes at discharge

Resuscitation

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New report says years of sustained, coordinated efforts needed to curb opioid epidemic

Emory's Woodruff Health Sciences Center News

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Diagnostic Accuracy of Clinical Decision Rules to Exclude Fractures in Acute Ankle Injuries: Systematic Review and Meta-analysis

Publication date: Available online 29 July 2017
Source:The Journal of Emergency Medicine
Author(s): Ingrid Barelds, Wim P. Krijnen, Johannes P. van de Leur, Cees P. van der Schans, Robert J. Goddard
BackgroundAnkle decision rules are developed to expedite patient care and reduce the number of radiographs of the ankle and foot. Currently, only three systematic reviews have been conducted on the accuracy of the Ottawa Ankle and Foot Rules (OAFR) in adults and children. However, no systematic review has been performed to determine the most accurate ankle decision rule.ObjectivesThe purpose of this study is to examine which clinical decision rules are the most accurate for excluding ankle fracture after acute ankle trauma.MethodsA systematic search was conducted in the databases PubMed, CINAHL, PEDro, ScienceDirect, and EMBASE. The sensitivity, specificity, likelihood ratios, and diagnostic odds ratio of the included studies were calculated. A meta-analysis was conducted if the accuracy of a decision rule was available from at least three different experimental studies.ResultsEighteen studies satisfied the inclusion criteria. These included six ankle decision rules, specifically, the Ottawa Ankle Rules, Tuning Fork Test, Low Risk Ankle Rule, Malleolar and Midfoot Zone Algorithms, and the Bernese Ankle Rules. Meta-analysis of the Ottawa Ankle Rules (OAR), OAFR, Bernese Ankle Rules, and the Malleolar Zone Algorithm resulted in a negative likelihood ratio of 0.12, 0.14, 0.39, and 0.23, respectively.ConclusionThe OAR and OAFR are the most accurate decision rules for excluding fractures in the event of an acute ankle injury.



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The HII Score – A Novel Tool to Assess Impairment from Alcohol in Emergency Department Patients

Abstract

Background

Over 35 million alcohol impaired (AI) patients are cared for in Emergency Departments (EDs) annually. Emergency physicians are charged with ensuring AI patients’ safety by identifying resolution of alcohol induced impairment. The most common standard evaluation is an extemporized clinical examination, as ethanol levels are not reliable or predictive of clinical symptoms. There is no standard assessment of ED AI patients.

Objective

To evaluate a novel standardized emergency department assessment of alcohol impairment — Hack's Impairment Index (HII score), in a busy urban Emergency Department.

Methods

A retrospective chart review was performed for all AI patients seen in our busy urban ED over 24 months. Trained nurses evaluated AI patients with both “usual” and HII score every 2 hours. Patients were stratified by frequency of visits for AI during this time: high (≥ 6), medium (2-5), and low (1). Within each category, comparisons were made between HII scores, measured ethanol levels, and usual nursing assessment of AI. Changes in HII scores over time were also evaluated.

Results

8074 visits from 3219 unique patients were eligible for study, including 7973 (98.7%) with ethanol levels, 5061 (62.7%) with complete HII scores, and 3646 (45.2%) with HCP assessments. Correlations between HII scores and ethanol levels were poor (Pearson's R² = 0.09, 0.09, and 0.17 for high-, medium-, and low-frequency strata). HII scores were excellent at discriminating nursing assessment of AI, while ethanol levels were less effective. Omitting extrema, HII scores fell consistently an average 0.062 points per hour, throughout patients’ visits.

Conclusions

The HII score applied a quantitative, objective assessment of alcohol impairment. HII scores were superior to ethanol levels as an objective clinical measure of impairment. The HII declines in a reasonably predictable manner over time, with serial evaluations corresponding well with HCP evaluations.

This article is protected by copyright. All rights reserved.

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Patient and Surrogate Views of Community Consultation for Emergency Research

Abstract

Objective

Pre-trial community consultation (CC) is required for emergency research conducted under an exception from informed consent (EFIC) in the United States. CC remains controversial and challenging, and minimal data exist regarding the views of individuals enrolled in EFIC trials on this process. It is important to know whether participants perceive CC to be meaningful and, if so, whom they believe should be consulted.

Methods

We conducted a secondary analysis of data from two studies interviewing patients and surrogates of two recent EFIC trials (PEER-RAMPART and PEER-ProTECT). These interviews included similar open- and closed-ended questions regarding participants’ views of the importance of CC, the rationale for their responses, and their views regarding which populations should be included in consultation efforts. A template analytic strategy was used for qualitative analysis of textual data, and descriptive statistics were tabulated to characterize demographic data and instances of major themes.

Results

90% of participants perceived CC to be valuable. Participants’ reasons for finding CC valuable clustered in 2 categories: 1) as a method of informing the public about the trial to be conducted; and 2) as a way of obtaining input and feedback from the community. Participants cited the medical community (43%) and individuals with a connection to the study condition (41%) as the most important groups to involve in consultation efforts; only 5% suggested consulting the general public in the area where the research will be conducted.

Conclusion

Participants in EFIC trials and their decision-makers generally valued CC as a method of informing and seeking input from the community. Participants felt that the most appropriate groups to consult were the medical community and individuals with connections to the condition under study. Consultation efforts focused on these two groups, rather than the general public, may be more efficient and more meaningful to individuals involved in EFIC trials. These findings also reinforce the importance of the distinction between public disclosure and CC.

This article is protected by copyright. All rights reserved.

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Ambulance Operator Coordinator - City of Downey

Under general supervision, this non-sworn position plans, coordinates, monitors, and evaluates the effectiveness of the Basic Life Support (BLS) ambulance transport component of the Downey Fire Department's Emergency Medical Services Program. The following examples are intended to describe the general nature and level of work performed by persons assigned to this classification. Coordinate the medical ...

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Man arrested after stealing ambulance from hospital

Ricky Lewis Reams, 57, was charged with larceny of a motor vehicle and trying to elude law enforcement in a motor vehicle

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Postoperative Anticholinergic Poisoning: Concealed Complications of a Commonly Used Medication

Publication date: Available online 27 July 2017
Source:The Journal of Emergency Medicine
Author(s): Xiao Chi Zhang, Natalija Farrell, Thomas Haronian, Jason Hack
BackgroundScopolamine is a potent anticholinergic compound used commonly for the prevention of postoperative nausea and vomiting. Scopolamine can cause atypical anticholinergic syndromes due to its prominent central antimuscarinic effects.Case ReportA 47-year-old female presented to the emergency department (ED) 20 h after hospital discharge for a right-knee meniscectomy, with altered mental status (AMS) and dystonic extremity movements that began 12 h after her procedure. Her vital signs were normal and physical examination revealed mydriasis, visual hallucinations, hyperreflexia, and dystonic movements. Laboratory data, lumbar puncture, and computed tomography were unrevealing. The sustained AMS prompted a re-evaluation that revealed urinary overflow with 500 mL of retained urine discovered on ultrasound and a scopolamine patch hidden behind her ear. Her mental status improved shortly after patch removal and physostigmine, with complete resolution after 24 h with discharge diagnosis of scopolamine-induced anticholinergic toxicity.Why Should an Emergency Physician Be Aware of This?Although therapeutically dosed scopolamine transdermal patches rarely cause complications, incomplete toxidromes can be insidiously common in polypharmacy settings. Providers should thoroughly evaluate the skin of intoxicated patients for additional adherent medications that may result in a delay in ED diagnosis and curative therapies. Our case, as well as rare case reports of therapeutic scopolamine-induced anticholinergic toxicity, demonstrates that peripheral anticholinergic effects, such as tachycardia, dry mucous membranes, and hyperpyrexia are often not present, and incremental doses of physostigmine may be required to reverse scopolamine's long duration of action. This further complicates identification of the anticholinergic toxidrome and diagnosis.



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Pericardial Herniation of Small Bowel Post Minimally Invasive Hybrid Maze of Atrial Fibrillation

Publication date: Available online 27 July 2017
Source:The Journal of Emergency Medicine
Author(s): David A. Farcy, Angelo Lapietra, Benjamin N. Abo, Michael Dalley
BackgroundHerniation of intraabdominal contents into the pericardial cavity is exceptionally rare, and when seen, it is most often the result of trauma, postsurgical complication, or genetic defect. There have been only a few case reports describing spontaneous bowel herniation into the pericardium in minimally invasive cardiac procedures like cardiac ablation, pacemaker placement, and minimally invasive coronary artery bypass graft.Case ReportWe report the case of a 65-year-old man who presented to an urgent care center complaining of abdominal and chest pain. This patient had recently undergone a laparoscopic hybrid maze procedure and ultimately had an incarcerated loop of small bowel herniate into the pericardial sac.Why Should an Emergency Physician Be Aware of This?We present this case to increase awareness among emergency physicians of the diagnosis of a pericardial hernia in patients presenting with gastrointestinal or cardiorespiratory symptoms after surgical procedures involving the diaphragm.



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Effects of hyaluronic acid and tacrolimus on the prevention of perineural scar formation and on nerve regeneration after sciatic nerve repair in a rabbit model

Abstract

Purpose

Scar formation after injured peripheral nerve repair is a significant clinical problem because it prevents nerve regeneration. The aim of this study was to investigate and compare the effects of hyaluronic acid (HA) and tacrolimus (FK506) on peripheral nerve regeneration in rabbits after the drugs were topically applied at the site of nerve repair.

Methods

Thirty adult male European rabbits (Oryctolagus cuniculus), ranging in weight from 2.5 to 3 kg, were randomly assigned to three groups: the HA and FK506 groups comprised the experimental groups, while the saline group served as the control. At week 12, macroscopic and microscopic evaluations were performed and analyzed.

Results

In general, the macroscopic evaluations (skin and muscle fascia closure and nerve adherence), microscopic evaluations (cellular components, scar tissue formation index, and histomorphological organization), and measurements of nerve diameter and gastrocnemius muscle wet weight demonstrated the positive effects of topical application of these pharmacological agents (HA and FK506); HA and FK506 prevented scar formation and enhanced nerve regeneration. No significant differences in the parameters described above were observed between the HA and FK506 groups (P > 0.05). However, significant differences were observed between both the HA and FK506 groups and the saline group (P < 0.05).

Conclusion

Based on our findings, topical application of HA and FK506 exhibits equally positive effects, preventing perineural scar formation and enhancing nerve regeneration after peripheral nerve repair.

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Low failure rate by means of DLBP fixation of undisplaced femoral neck fractures

Abstract

Background

This study evaluated the clinical results of a new implant in the internal fixation of undisplaced femoral neck fractures.

Method

Irrespective of their age, 149 patients with undisplaced (Garden I and II) femoral neck fractures were included in a prospective multicentre clinical cohort study and were treated by internal fixation by means of the Dynamic Locking Blade Plate (DLBP). The mean age was 69 years and the follow-up at least one year.

Results

The DLBP fixation resulted in 6 out of 149 failures caused by AVN (2x), non-union (2x), loss of fixation (3x) or combination of these.

Conclusion

The fixation of undisplaced femoral neck fractures by the DLBP resulted in a low failure rate of 4 %.

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Preventable and potentially preventable deaths in severely injured patients: a retrospective analysis including patterns of errors

Abstract

Purpose

Analyzing preventable and potentially preventable deaths is a well-known procedure for improving trauma care. This study analyzes preventable and potentially preventable deaths in German trauma patients.

Methods

Patients aged between 16 and 75 years with an Injury Severity Score >15 who were primary admitted from July 2002 to December 2011 were analyzed in this study. Data from the patients’ hospital records were retrospectively analyzed, and cases were categorized as preventable, potentially preventable, and non-preventable deaths. In addition, trauma management was screened for errors.

Results

2304 patients were admitted from July 2002 to December 2011. 763 of which fulfilled the defined criteria. The mortality rate was 25.3 %. Eight cases (4.2 %) were declared as preventable deaths and 31 cases (16.1 %) as potentially preventable deaths. The most common errors in preclinical trauma care related to airway management. The main clinical error was insufficient hemorrhage control. Fluid overload from infusion was the second most common fault in both.

Conclusions

Preventable and potentially preventable errors still occur in the treatment of severely injured patients. Errors in hemorrhage control and airway management are the most common human treatment errors. The knowledge of these errors could help to improve trauma care in the future.

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Provider and practice factors associated with emergency physicians’ being named in a malpractice claim

Annals of Emergency Medicine

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US Senator expands opioid probe to distributors, drugmakers

Reuters Health News

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A 10-year review of child injury hospitalisations, health outcomes and treatment costs in Australia

Injury Prevention

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As drug prices drop, generics makers fight back with deals

Reuters Health News

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Delayed return of spontaneous circulation (the lazarus phenomenon) after cessation of out-of-hospital cardiopulmonary resuscitation

Resuscitation

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US Senate poised for healthcare showdown

Reuters Health News

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A randomized controlled trial on the effect of a double check on the detection of medication errors

Annals of Emergency Medicine

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Exposure Survey of Trends in Occupational Practice (EXPO-S.T.O.P.) 2015: A national survey of sharps injuries and mucocutaneous blood exposures among health care workers in US hospitals

American Journal of Infection Control

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The effect of medicaid expansion on utilization in maryland emergency departments

Annals of Emergency Medicine

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Does acupuncture have a role in providing analgesia in the emergency setting? A systematic review and meta-analysis

Emergency Medicine Australasia

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Emergency department visits and readmissions within 1 year of bariatric operation: A statewide analysis using hospital discharge records

Surgery

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Urinary neutrophil gelatinase-associated lipocalin and cystatin C compared to the estimated glomerular filtration rate to predict risk in patients with suspected acute myocardial infarction

International Journal of Cardiology

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Better at-home drug management needed to counter rising errors

Reuters Health News

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Elevated cardiac Troponin T in cirrhotic patients with emergency care admissions is associated with mortality

Journal of Gastroenterology and Hepatology

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Attempted suicide among adolescents in Mexico: Prevalence and associated factors at the national level

Injury Prevention

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Variation in the evaluation of testicular conditions across United States pediatric emergency departments

The American Journal of Emergency Medicine

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Effect of serum triglycerides on clinical outcomes in acute pancreatitis: Findings from a regional integrated health care system

Pancreas

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Attitude of patients, healthcare professionals, and noninjured lay persons towards online video instructions on mild traumatic brain injury: A cross-sectional study

International Journal of Emergency Medicine

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A custom-developed emergency department provider electronic documentation system reduces operational efficiency

Annals of Emergency Medicine

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Functional mitral regurgitation predicts short-term adverse events in patients with acute heart failure and reduced left ventricular ejection fraction

The American Journal of Cardiology

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Comparing Direct and Video Laryngoscopy for Prehospital Intubation: Can Meta-Analysis Provide an Exact Solution?

The recent systemic review and meta-analysis by Savino et al.¹ comparing performance of video versus direct laryngoscopy for prehospital intubation was of great interested to us. They conclude that among physician intubators with significant direct laryngoscopy (DL) experience, video laryngoscopy (VL) does not increase overall or first-pass success rate and may lead to worsening performance. However, among non-physician intubators with less experience with DL, VL may provide benefit in the prehospital setting. In a meta-analysis, the results from many studies are mathematically synthesized by complex statistical methods to evaluate the diversity among results and to estimate a common pooled effect with increased precision.

This article is protected by copyright. All rights reserved.

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In Reply: Comparing Direct and Video Laryngoscopy for Prehospital Intubation: Can Meta-Analysis Provide and Exact Solution?

We thank the authors for this letter and appreciate the opportunity to respond to the comments and clarify our position. We agree with the authors in a number of their specific comments, and will attempt to address each of them. The first comment refers to the difference in video laryngoscopy devices and how “… pooling of results from studies evaluating performance of different VLs for prehospital intubation may lead to intrinsic inconsistencies in the primary endpoints.”

This article is protected by copyright. All rights reserved.

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ESO names Tad Druart as VP of Marketing

Leading healthcare Software-As-A-Service (SaaS) and data provider taps marketing veteran to support its rapid growth AUSTIN, Texas — ESO Solutions, Inc., a leading provider of healthcare software and data interoperability solutions to emergency medical services (EMS) and hospitals, announced that Tad Druart has joined the company as Vice President of Marketing. “We’re pleased to have ...

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Risk Stratification in Pediatric Acute Respiratory Distress Syndrome: A Multicenter Observational Study.

Objectives: The Pediatric Acute Lung Injury Consensus Conference developed a pediatric specific definition for acute respiratory distress syndrome (PARDS). In this definition, severity of lung disease is stratified into mild, moderate, and severe groups. We aim to describe the epidemiology of patients with PARDS across Asia and evaluate whether the Pediatric Acute Lung Injury Consensus Conference risk stratification accurately predicts outcome in PARDS. Design: A multicenter, retrospective, descriptive cohort study. Setting: Ten multidisciplinary PICUs in Asia. Patients: All mechanically ventilated children meeting the Pediatric Acute Lung Injury Consensus Conference criteria for PARDS between 2009 and 2015. Interventions: None. Measurements and Main Results: Data on epidemiology, ventilation, adjunct therapies, and clinical outcomes were collected. Patients were followed for 100 days post diagnosis of PARDS. A total of 373 patients were included. There were 89 (23.9%), 149 (39.9%), and 135 (36.2%) patients with mild, moderate, and severe PARDS, respectively. The most common risk factor for PARDS was pneumonia/lower respiratory tract infection (309 [82.8%]). Higher category of severity of PARDS was associated with lower ventilator-free days (22 [17-25], 16 [0-23], 6 [0-19]; p

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Outcomes of Patient- and Family-Centered Care Interventions in the ICU: A Systematic Review and Meta-Analysis.

Objective: To determine whether patient- and family-centered care interventions in the ICU improve outcomes. Data Sources: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases from inception until December 1, 2016. Study Selection: We included articles involving patient- and family-centered care interventions and quantitative, patient- and family-important outcomes in adult ICUs. Data Extraction: We extracted the author, year of publication, study design, population, setting, primary domain investigated, intervention, and outcomes. Data Synthesis: There were 46 studies (35 observational pre/post, 11 randomized) included in the analysis. Seventy-eight percent of studies (n = 36) reported one or more positive outcome measures, whereas 22% of studies (n = 10) reported no significant changes in outcome measures. Random-effects meta-analysis of the highest quality randomized studies showed no significant difference in mortality (n = 5 studies; odds ratio = 1.07; 95% CI, 0.95-1.21; p = 0.27; I2 = 0%), but there was a mean decrease in ICU length of stay by 1.21 days (n = 3 studies; 95% CI, -2.25 to -0.16; p = 0.02; I2 = 26%). Improvements in ICU costs, family satisfaction, patient experience, medical goal achievement, and patient and family mental health outcomes were also observed with intervention; however, reported outcomes were heterogeneous precluding formal meta-analysis. Conclusions: Patient- and family-centered care-focused interventions resulted in decreased ICU length of stay but not mortality. A wide range of interventions were also associated with improvements in many patient- and family-important outcomes. Additional high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in the intensive care setting. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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The ICU Is Becoming a Main Battlefield for Severe Maternal Rescue in China: An 8-Year Single-Center Clinical Experience.

Objectives: To review the characteristics of and to identify the reasons for severe maternal admissions to the ICU. Design: This was an analytical, observational, open, and retrospective study. Setting: In our ICU. Patients: A total of 487 severe maternal cases were reviewed during the 8-year study period of January 2009 to December 2016. Intervention: None. Measurements and Main Results: A total of 487 severe maternal cases (12.6%) among the 3,867 patients admitted to ICU were reviewed. Of these, 361 patients were admitted for obstetric reasons, mainly pregnancy-induced hypertension (58.7%) and postpartum hemorrhage (36.8%). The remaining 126 patients were admitted for nonobstetric reasons, including cardiac-related disease (31.0%), immune-related disease (24.6%), and sepsis (20.6%). A total of 249 patients experienced combined comorbidities: the most common was a scarred uterus (100 patients; 40.2%), followed by endocrine-related disease (25.3%), immune-related disease (21.3%), and cardiac-related disease (18.1%). Central venous insertion (90.6%) was the most common intervention, followed by arterial catheter insertion (33.7%), mechanical ventilation (11.7%), blood purification (5.7%), and invasive hemodynamic monitoring (3.7%). Nine patients died during the study period, of which the death of four could have been avoided. Conclusions: The number of severe maternal cases has increased annually in our ICU. Although obstetric causes remained the most common reason for admission, the nonobstetric causes and basic complications were too complex, dangerous, and beyond the reach of the obstetrician with regard to monitoring and treatment. We call for a multidisciplinary team mainly composed of ICU staff to improve severe maternal outcomes. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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The Ties that Bind: Social Capital and the Psychology of FOAM by Mike Lauria

We come from all the divisions, ranks, and classes of society…to teach and to be taught in our turn. While we mingle together in these pursuits we shall learn to know each other more intimately; we shall remove many of the prejudices which ignorance or partial acquaintance with each other had fostered…In the parties and […]

EMCrit by Mike Lauria.

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The Ties that Bind: Social Capital and the Psychology of FOAM by Mike Lauria

We come from all the divisions, ranks, and classes of society…to teach and to be taught in our turn. While we mingle together in these pursuits we shall learn to know each other more intimately; we shall remove many of the prejudices which ignorance or partial acquaintance with each other had fostered…In the parties and […]

EMCrit by Mike Lauria.

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What first responders should seek in mental health clinicians

While responder professions can be exceptionally rewarding, they also expose men and women to traumatic scenes that can challenge their ability to cope with stress

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Community Paramedic Lead - Tri County Health Care

Summary: The primary function of this role is to provide primary care and/or advanced life support including medical evaluation, treatment and stabilization of the critically ill and injured with the goal of reducing morbidity. Supports existing health services; provided integrated health services in partnership with other health professionals; extends access to health services delivery in underserved ...

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Fierce Innovation Awards: Healthcare Edition program announces finalists, Pulsara recognized

BOZEMAN, Mont. — Pulsara announced today that the company has been selected as a finalist in this year’s Fierce Innovation Awards: Healthcare Edition 2017, an awards program from the publisher of FierceHealthcare. Pulsara was recognized as a finalist in the category of Digital/Mobile Health Solutions. Pulsara was selected as a finalist for its innovative, industry leading product, the Pulsara ...

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The effect of different torque wrenches on rotational stiffness in compressive femoral nails: a biomechanical study

Abstract

Purpose

Rotation instability and locking screws failure are common problems. We aimed to determine optimal torque wrench offering maximum rotational stiffness without locking screw failure.

Methods

We used 10 conventional compression nails, 10 novel compression nails and 10 interlocking nails with 30 composite femurs. We examined rotation stiffness and fracture site compression value by load cell with 3, 6 and 8 Nm torque wrenches using torsion apparatus with a maximum torque moment of 5 Nm in both directions. Rotational stiffness of composite femur-nail constructs was calculated.

Results

Rotational stiffness of composite femur-compression nail constructs compressed by 6 Nm torque wrench was 3.27 ± 1.81 Nm/angle (fracture site compression: 1588 N) and 60% more than that compressed with 3 Nm torque wrench (advised previously) with 2.04 ± 0.81 Nm/angle (inter fragmentary compression: 818 N) (P = 0.000). Rotational stiffness of composite-femur-compression nail constructs compressed by 3 Nm torque wrench was 2.04 ± 0.81 Nm/angle (fracture site compression: 818 N) and 277% more than that of interlocking nail with 0.54 ± 0.08 Nm/angle (fracture site compression: 0 N) (P = 0.000).

Conclusion

Rotational stiffness and fracture site compression value produced by 3 Nm torque wrench was not satisfactory. To obtain maximum rotational stiffness and fracture site compression value without locking screw failure, 6 Nm torque wrench in compression nails and 8 Nm torque wrench in novel compression nails should be used.

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Effectiveness of controlled telescoping system for lateral hip pain caused by sliding of blade following intramedullary nailing of trochanteric fracture

Injury

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Anthem may exit more individual markets over Obamacare funding

Reuters Health News

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Early computed tomography or focused assessment with sonography in abdominal trauma: What are the leading opinions?

European Journal of Trauma and Emergency Surgery

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Doctors view technology as largely problematic

Reuters Health News

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Does the type of residential housing matter for depressive symptoms in the aftermath of a disaster? Insights from the Great East Japan Earthquake and Tsunami

American Journal of Epidemiology

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Nardilysin is a promising biomarker for the early diagnosis of acute coronary syndrome

International Journal of Cardiology

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Nationwide study on peripheral venous catheter associated-bloodstream infections in internal medicine departments

Journal of Hospital Infection

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Prior beta blockers use is independently associated with increased inpatient mortality in patients presenting with acute myocardial infarction

International Journal of Cardiology

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Emergency department visits after lumbar spine surgery are associated with lower HCAHPS scores

The Spine Journal

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Temporal trends in epinephrine dispensing and allergy/immunology follow-up among emergency department anaphylaxis patients in the United States, 2005-2014

The Journal of Allergy and Clinical Immunology: In Practice

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Relationships between the frequency and severity of non-suicidal self-injury and suicide attempts in youth with borderline personality disorder

Early Intervention in Psychiatry

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Increased risk of anxiety or depression after traumatic spinal cord injury in patients with pre-existing hyperlipidemia: A population-based study

World Neurosurgery

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99% of pro football players in US autopsy study had brain damage

Reuters Health News

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Temporal pattern and prognostic significance of hypokalemia in patients undergoing targeted temperature management following cardiac arrest

The American Journal of Cardiology

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Lifetime suicidal attempts and current suicidal risk in aging survivors of the Jeju April 3 incident

Journal of Affective Disorders

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Comparison of the proportion and healthcare utilisation of adult patients with uncontrolled severe asthma versus non-severe asthma seen in a southeast Asian hospital-based respiratory specialist clinic

Annals, Academy of Medicine, Singapore

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Serum concentrations of fibrinogen in patients with spinal cord injury and its relationship with neurological function

World Neurosurgery

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Efficacy of over the scope clips in management of high-risk gastrointestinal bleeding

Clinical Gastroenterology and Hepatology

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Systematic review of mental health disorders and intimate partner violence victimisation among military populations

Social Psychiatry and Psychiatric Epidemiology

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Impact of electronic acute kidney injury (AKI) alerts with automated nephrologist consultation on detection and severity of AKI: A quality improvement study

American Journal of Kidney Diseases

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Multiple risk factor counseling to promote heart-healthy lifestyles in the chest pain observation unit: Pilot randomized controlled trial

Abstract

Objective

Admission to the chest pain observation unit (CPOU) may be an advantageous time for patients to consider heart-healthy lifestyle changes while undergoing diagnostic evaluation to rule out myocardial ischemia. The aim of this pragmatic trial was to assess the effectiveness of a multiple risk factor intervention in changing CPOU patients’ health beliefs and readiness to change health behaviors. A secondary aim was to obtain preliminary estimates of the intervention's effect on diet, physical activity, and smoking.

Method

We conducted a pilot randomized controlled trial (RCT) of a moderate intensity counseling intervention that aimed to build motivation to change and problem-solving skills in 140 adult patients with at least one modifiable cardiovascular risk factor (CRF) who were admitted to the CPOU of an academic emergency department (ED) with symptoms of possible acute coronary syndrome (ACS). Study patients were randomly assigned to full counseling (face-to-face cardiovascular risk assessment and personalized counseling on nutrition, physical activity, and smoking cessation in the ED, plus two telephone follow-up sessions) or minimal counseling (brief instruction (<5 minutes) on benefits of modifying cardiovascular risk factors) by a cardiac rehabilitation specialist. We measured Health Belief Model constructs for ischemic heart disease, stage of change, and self-reported CRF-related behaviors (diet, exercise, and smoking) during 6-month follow-up using previously validated measures. We used linear mixed models and logistic regression (with generalized estimating equations) to compare continuous and dichotomous behavioral outcomes across treatment arms, respectively.

Results

Approximately 20% more patients in the full counseling arm reported having received counseling on diet and physical activity during CPOU admission, compared to the minimal counseling arm; a similar proportion of patients in both counseling arms reported having received advice or assistance in quitting smoking. There were no significant differences between treatment arms for any cardiovascular health beliefs, readiness to change, or CRF-related behaviors during longitudinal follow-up. In Ssecondary analyses in both treatment arms combined, however,, patients showed significant differences between follow-up and baseline measurements: increases in the perceived benefits of improving CRF-related behaviors (27.7 vs. 26.6 on a scale from 7-35, p=.0001), and increased readiness to change dietary behavior and physical activity during follow-up: intake of saturated fat (83 vs. 49%), readiness to change fruit and vegetable consumption (83 vs 56%), and readiness to perform regular exercise (34 vs. 14%) at 6-months and baseline, respectively (p<.0001 for all comparisons in both treatment arms combined).

Conclusions

A multiple risk factor intervention that focused on increasing motivation to change and problem-solving skills did not significantly improve behavioral outcomes, compared to minimal counseling. Patients admitted to the CPOU demonstrated sustained changes in several cardiovascular health beliefs and risk-related behaviors during follow-up; this provides further evidence that the CPOU visit is a “teachable moment” for cardiovascular risk reduction. Future studies should evaluate the effectiveness of ED-initiated counseling interventions to engage patients in changing cardiovascular risk behaviors, in coordination with primary care.

This article is protected by copyright. All rights reserved.

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Traditional Long-Term Central Venous Catheters Versus Transhepatic Venous Catheters in Infants and Young Children.

Objectives: Children with congenital heart disease may require long-term central venous access for intensive care management; however, central venous access must also be preserved for future surgical and catheterization procedures. Transhepatic venous catheters may be an useful alternative. The objective of this study was to compare transhepatic venous catheters with traditional central venous catheters regarding complication rate and duration of catheter service. Design: Retrospective review of 12 congenital heart disease patients from September 2013 to July 2015 who underwent placement of one or more transhepatic venous catheters. Setting: Single freestanding pediatric hospital located in the central United States. Patients: Pediatric patients with congenital heart disease who underwent placement of transhepatic venous catheter. Interventions: Cohort's central venous catheter complication rates and duration of catheter service were compared with transhepatic venous catheter data. Measurements and Main Results: Twelve patients had a total of 19 transhepatic venous lines. Transhepatic venous lines had a significantly longer duration of service than central venous lines (p = 0.001). No difference between the two groups was found in the number of documented thrombi, thrombolytic burden, or catheter sites requiring wound care consultation. A higher frequency of infection in transhepatic venous lines versus central venous lines was found, isolated to four transhepatic venous lines that had a total of nine infections. All but one was successfully managed without catheter removal. The difference in the proportion of infections to catheters in transhepatic venous lines versus central venous lines was significant (p = 0.0001), but no difference in the rate of infection-related catheter removal was found. Conclusions: Without compromising future central venous access sites, transhepatic venous lines had superior duration of service without increased thrombosis, thrombolytic use, or insertion site complications relative to central venous lines. Transhepatic venous catheters had a higher infection rate, and further investigation into the etiology is warranted. (C)2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Epidemiology and location of primary retrieval missions in a Scottish aeromedical service.

Introduction: Prehospital critical care teams comprising an appropriately trained physician and paramedic or nurse have been associated with improved outcomes in selected trauma patients. These teams are a scarce and expensive resource, especially when delivered by rotary air assets. The optimal tasking of prehospital critical care teams is therefore vital and remains a subject of debate. Emergency Medical Retrieval Service (EMRS) provides a prehospital critical care response team to incidents over a large area of Scotland either by air or by road. Methods: A convenience sample of consecutive EMRS missions covering a period of 18 months from May 2013 to January 2015 was taken. These missions were matched with the ambulance service information on geographical location of the incident. In order to assess the appropriateness of tasking, interventions undertaken on each mission were analysed and divided into two subcategories: 'critical care interventions' and 'advanced medical interventions'. A tasking was deemed appropriate if it included either category of intervention or if a patient was pronounced life extinct at the scene. Results: A total of 1279 primary missions were undertaken during the study period. Of these, 493 primary missions met the inclusion criteria and generated complete location data. The median distance to scene was calculated as 5.6 miles for land responses and 34.2 miles for air responses. Overall, critical care interventions were performed on 17% (84/493) of patients. A further 21% (102/493) of patients had an advanced medical intervention. Including those patients for whom life was pronounced extinct on scene by the EMRS team, a total of 42% (206/493) taskings were appropriate. Discussion: Overall, our data show a wide geographical spread of tasking for our service, which is in keeping with other suburban/rural models of prehospital care. Tasking accuracy is also comparable to the accuracy shown by other similar services. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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EKG interpretation checklists

For cardiac rhythm strip evaluation the EKG Club expert panel recommends paramedics, EMTs and students follow a repeatable pattern or process. Although not diagnostic, in many case examining each of these characteristics can help direct appropriate prehospital patient treatment: Heart rate P wave (Normal shape" Present" Followed by QRS") PR interval (Normal" Short" Long" Irregular") QRS interval (Normal" ...

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Chief of Emergency Medical Services - Deer-Grove EMS

The Deer Grove EMS District is currently accepting resumes for Chief of EMS. Deer Grove EMS is licensed as a single Paramedic service providing Advance Life Support 911 transport services to a population of 13,000 within a 53 square mile area of East-Central Dane County, WI. The complete job posting can be found at www.deergroveems.com. A competitive compensation package is offered to the qualified ...

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Paramedic - Woodruff, WI - $2000 Sign On! - Spirit Medical Transportation

Paramedic - Spirit Medical Transportation - Northern WI / FT Rotating / $2000 Sign on Bonus Woodruff, Wisconsin Additional Job Details: Full-Time,Rotating, 36 hours,Weekly Ascension Wisconsin serves millions of people across the state with 24 hospitals and hundreds of sites of care. Approximately 23,500 associates, including nearly 1,000 medical group clinicians work collaboratively to deliver compassionate ...

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EKG interpretation checklists

Here are the EKG Club's recommended steps for interpreting cardiac rhythms and 12-lead EKGs

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Loperamide-Induced Torsades de Pointes: A Case Series

Publication date: Available online 26 July 2017
Source:The Journal of Emergency Medicine
Author(s): Kenneth D. Katz, Robert D. Cannon, Matthew D. Cook, Alexandra Amaducci, Ryan Day, Joshua Enyart, Glenn Burket, Lauren Porter, Timothy Roach, Jennifer Janssen, Karl E. Williams
BackgroundLoperamide is an over-the-counter, inexpensive, antidiarrheal opioid that can produce life-threatening toxicity at high concentrations.Case Report 1A 28-year-old man with a history of depression and substance abuse disorder (SUD) presented to the emergency department (ED) with shortness of breath and lightheadedness. He ingested large amounts of loperamide daily. The patient's initial electrocardiogram (ECG) demonstrated sinus rhythm, right axis deviation, undetectable PR interval, QRS 168 ms, and QTc 693 ms. He was administered intravenous sodium bicarbonate and magnesium sulfate and admitted to the intensive care unit, eventually developing Torsades de Pointes (TdP). He was given lidocaine and isoproterenol infusions, and an external pacemaker was placed. He was discharged in stable condition on hospital day (HD) 16.Case Report 2A 39-year-old woman with a history of hepatitis C, depression, and SUD was transported to the ED after reported seizure-like activity. The patient experienced TdP in the ED and admitted to ingesting large amount of loperamide daily. An ECG demonstrated sinus rhythm, right axis deviation, PR interval 208 ms, QRS interval 142 ms, and QTc 687 ms. She was administered intravenous magnesium, sodium bicarbonate, and isoproterenol. After intensive care unit admission, the patient experienced no further TdP and was discharged on HD 6.Why Should an Emergency Physician Be Aware of This?Emergency physicians should proceed with caution when treating patients with loperamide toxicity. Even in asymptomatic patients and drug discontinuance, obtain consultation with a medical toxicologist, promptly treat ECG abnormalities aggressively, and admit all patients for further monitoring.



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Is rural EMS on life support?

When you're living in rural America, you expect to live without a lot of services that city folk take for granted – city water, sewers and the like. Even critical services, such as law enforcement and fire protection, can be sparse. It's the price you pay for living in some of the most beautiful parts of the country. But medical emergencies, such as strokes, heart attacks and cardiac arrest ...

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Sheriff's deputy hurt in collision with ambulance responding to same scene

The deputy was checked out as a precaution; no one else was injured

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Mid-term to long-term outcome of the open Bankart repair for recurrent traumatic anterior dislocation of the shoulder

Journal of Shoulder and Elbow Surgery

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Impact of participant attrition on child injury outcome estimates: A longitudinal birth cohort study in Australia

BMJ Open

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Stopping statins for side effects could be deadly

Reuters Health News

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Surgery for cerebellar hemorrhage - A NSQIP-database analysis of patient outcomes and factors associated with 30-day mortality and prolonged ventilation

World Neurosurgery

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Dozens of US clinics sell unproven stem cell therapies for heart failure

Reuters Health News

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A video analysis of head injuries satisfying the criteria for a head injury assessment in professional Rugby Union: A prospective cohort study

British Journal of Sports Medicine

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Effect of bleeding risk on type of stent used in patients presenting with acute coronary syndrome

The American Journal of Cardiology

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Describing peripancreatic collections according to the revised Atlanta classification of acute pancreatitis: An international interobserver agreement study

Pancreas

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Incidence and risk of acute coronary syndrome in patients with acute pancreatitis: A nationwide cohort study

Pancreatology

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US jury finds AbbVie liable for misrepresentation in first AndroGel verdict

Reuters Health News

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Decannulation and functional outcome after tracheostomy in patients with severe stroke (DECAST): A prospective observational study

Neurocritical Care

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Predictors of satisfaction with life in veterans after traumatic brain injury: A VA TBI model systems study

Journal of Head Trauma Rehabilitation

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Characteristics and outcomes of patients discharged home from an emergency department with AKI

Clinical Journal of the American Society of Nephrology

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The relationship between cortical lesions and periventricular NAWM abnormalities suggests a shared mechanism of injury in primary-progressive MS

NeuroImage: Clinical

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Practice patterns of venous thromboembolism prophylaxis in underweight, critically ill patients with neurologic injury

Neurocritical Care

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Impact of surgical timing of postoperative ocular motility in orbital blowout fractures

British Journal of Ophthalmology

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Incidence and trends in hypoglycemia hospitalization in adults with type 1 and type 2 diabetes in England, 1998-2013: A retrospective cohort study

Diabetes Care

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Does age matter? A mixed methods study examining determinants of good recovery and resilience in young and middle-aged adults following moderate-to-severe traumatic brain injury

Journal of Advanced Nursing

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Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: A retrospective study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Risk factors affecting the visual outcome in patients with indirect traumatic optic neuropathy

International Ophthalmology

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Readmissions for Recurrent Sepsis: New or Relapsed Infection?.

Objectives: Sepsis hospitalizations are frequently followed by hospital readmissions, often for recurrent sepsis. However, it is unclear how often sepsis readmissions are for relapsed/recrudescent versus new infections. The aim of this study was to assess the extent to which 90-day readmissions for recurrent sepsis are due to infection of the same site and same pathogen as the initial episode. Design: Retrospective cohort study. Setting: University of Michigan Health System. Patients: All hospitalizations (May 15, 2013 to May 14, 2015) with a principal International Classification of Diseases, Ninth revision, Clinical Modification diagnosis of septicemia (038.x), severe sepsis (995.92), or septic shock (785.52), as well as all subsequent hospitalizations and sepsis readmissions within 90 days. We determined organism and site of sepsis through manual chart abstraction. Interventions: None. Measurements and Main Results: We identified 472 readmissions within 90 days of sepsis, of which 137 (29.1%) were for sepsis. In sepsis readmissions, the site and organisms were most commonly urinary (29.2%), gastrointestinal (20.4%), Gram negative (29.9%), Gram positive (16.8%), and culture negative (30.7%). Ninety-four readmissions (68.6%) were for infection at the same site as initial sepsis hospitalization. Nineteen percent of readmissions were confirmed to be same site and same organism. However, accounting for the uncertainty from culture-negative sepsis, as many as 53.2% of readmissions could plausibly due to infections with both the same organism and same site. Conclusions: Of the patients readmitted with sepsis within 90 days, two thirds had infection at the same site as their initial admission. Just 19% had infection confirmed to be from the same site and organism as the initial sepsis hospitalization. Half of readmissions were definitively for new infections, whereas an additional 34% were unclear since cultures were negative in one of the hospitalizations. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Can Concurrent Abnormalities in Free Light Chains and Immunoglobulin Concentrations Identify a Target Population for Immunoglobulin Trials in Sepsis?.

Objectives: Light chains [kappa] and [lambda] are immunoglobulin constituents but also circulate independently in blood as free light chains. We investigated whether a concomitant abnormality in free light chain and immunoglobulin levels could identify a high risk of death sepsis subpopulation to inform future IV immunoglobulin trials. We tested whether light chain allelic inclusion occurs in circulating B cells. Design: Prospective cohort study. Setting: Adult general ICUs. Patients: Adult sepsis patients without any documented immune comorbidity. Interventions: None. Measurements and Main Results: Serum total free light chain, immunoglobulin G, immunoglobulin A, and immunoglobulin M were measured on ICU days 1, 3, and 7. Population normal ranges defined normal and abnormal categories. Logistic regression models tested any independent relationship between high free light chain, immunoglobulins and hospital mortality. CD19 B-cell subsets expressing cell surface [kappa] and [lambda] were quantified by flow cytometry; their frequencies were compared against healthy subjects and correlation assessed against free light chain concentrations. On ICU day 1, high free light chain [lambda] and high free light chain [kappa] were seen in 46.5% and 75.3% of the study cohort (n = 101). Low immunoglobulin levels were commonplace (45.5%) at ICU admission. ICU admission day free light chain and immunoglobulin concentrations were significantly correlated. Septic patients had significantly more CD19 B cells expressing both [kappa] and [lambda] compared with healthy controls (median [interquartile range] 4.1% [2.4-11.0] vs 1.3% [1.2-2.9], respectively; p = 0.0001); these correlated with free light chain concentrations. Conclusions: To our knowledge, abnormalities and associations of free light chain in critically ill adults with sepsis have not been previously reported. The additional prognostic value of free light chain [lambda] and the significance of allelic inclusion in B cells in sepsis require further investigation. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Association Between Survival and Time of Day for Rapid Response Team Calls in a National Registry.

Objectives: Decreased staffing at nighttime is associated with worse outcomes in hospitalized patients. Rapid response teams were developed to decrease preventable harm by providing additional critical care resources to patients with clinical deterioration. We sought to determine whether rapid response team call frequency suffers from decreased utilization at night and how this is associated with patient outcomes. Design: Retrospective analysis of a prospectively collected registry database. Setting: National registry database of inpatient rapid response team calls. Patients: Index rapid response team calls occurring on the general wards in the American Heart Association Get With The Guidelines-Medical Emergency Team database between 2005 and 2015 were analyzed. Interventions: None. Measurements and Main Results: The primary outcome was inhospital mortality. Patient and event characteristics between the hours with the highest and lowest mortality were compared, and multivariable models adjusting for patient characteristics were fit. A total of 282,710 rapid response team calls from 274 hospitals were included. The lowest frequency of calls occurred in the consecutive 1 AM to 6:59 AM period, with 266 of 274 (97%) hospitals having lower than expected call volumes during those hours. Mortality was highest during the 7 AM hour and lowest during the noon hour (18.8% vs 13.8%; adjusted odds ratio, 1.41 [1.31-1.52]; p

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Epidemiology of Noninvasive Ventilation in Pediatric Cardiac ICUs.

Objective: To describe the epidemiology of noninvasive ventilation therapy for patients admitted to pediatric cardiac ICUs and to assess practice variation across hospitals. Design: Retrospective cohort study using prospectively collected clinical registry data. Setting: Pediatric Cardiac Critical Care Consortium clinical registry. Patients: Patients admitted to cardiac ICUs at PC4 hospitals. Interventions: None. Measurements and Main Results: We analyzed all cardiac ICU encounters that included any respiratory support from October 2013 to December 2015. Noninvasive ventilation therapy included high flow nasal cannula and positive airway pressure support. We compared patient and, when relevant, perioperative characteristics of those receiving noninvasive ventilation to all others. Subgroup analysis was performed on neonates and infants undergoing major cardiovascular surgery. To examine duration of respiratory support, we created a casemix-adjustment model and calculated adjusted mean durations of total respiratory support (mechanical ventilation + noninvasive ventilation), mechanical ventilation, and noninvasive ventilation. We compared adjusted duration of support across hospitals. The cohort included 8,940 encounters from 15 hospitals: 3,950 (44%) received noninvasive ventilation and 72% were neonates and infants. Medical encounters were more likely to include noninvasive ventilation than surgical. In surgical neonates and infants, 2,032 (55%) received postoperative noninvasive ventilation. Neonates, extracardiac anomalies, single ventricle, procedure complexity, preoperative respiratory support, mechanical ventilation duration, and postoperative disease severity were associated with noninvasive ventilation therapy (p

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Supraglottic Atomization of Surfactant in Spontaneously Breathing Lambs Receiving Continuous Positive Airway Pressure.

Objectives: To determine the short-term tolerance, efficacy, and lung deposition of supraglottic atomized surfactant in spontaneously breathing lambs receiving continuous positive airway pressure. Design: Prospective, randomized animal study. Setting: Animal research laboratory. Subjects: Twenty-two preterm lambs on continuous positive airway pressure (132 +/- 1 d gestational age). Interventions: Animals receiving continuous positive airway pressure via binasal prongs at 8 cm H2O were randomized to receive atomized surfactant at approximately 60-minute of life (atom; n = 15) or not (control; n = 7). The atom group received 200 mg/kg of poractant alfa (Curosurf; Chiesi Farmaceutici SpA, Parma, Italy) over 45 minutes via a novel atomizer located in the upper pharynx that synchronized surfactant delivery with the inspiratory phase. Measurements and Main Results: Arterial blood gas, regional distribution of tidal ventilation (electrical impedance tomography), and carotid blood flow were recorded every 15 minutes until 90 minutes after stabilizing on continuous positive airway pressure. Gas exchange, respiratory rate, and hemodynamic variables, including carotid blood flow, remained stable during surfactant treatment. There was a significant improvement in arterial alveolar ratio after surfactant delivery in the atom group (p

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Propper 4PV Armor records first save

ST. CHARLES, Mo. — Troup County (GA) Sheriff’s Deputy Michael Hockett, 24 years old and newly married, recently became the best kind of statistic – a survivor – thanks in part to his Propper 4PV concealable armor. According to the sheriff’s office, Hockett was responding just before noon on January 9 to a welfare check call in the rural community when he was allegedly shot ...

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Firefighters treat colleague for an hour after he collapses at barbecue

Firefighter-paramedics gave Steve Sawatzky CPR for nearly an hour while waiting for an ambulance at a company outing

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RN Ground Transport - $2000 Sign On - Woodruff, WI - Spirit Medical Transportation

RN / Spirit Medical Transportation / Northern Wisconsin / FT Rotating Shifts / $2000 Sign-on Bonus Woodruff, Wisconsin Ascension Wisconsin serves millions of people across the state with 24 hospitals and hundreds of sites of care. Approximately 23,500 associates, including nearly 1,000 medical group clinicians work collaboratively to deliver compassionate, personalized care every day. Ascension Wisconsin ...

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Ambulance hit by bullets on way to call

One paramedic was treated at the hospital after getting hit by shards of glass when the bullet passed through the windshield

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Canadian firefighters treat colleague after he collapses at barbecue

Firefighter paramedics gave Steve Sawatzky CPR for nearly an hour while waiting for an ambulance at a company outing

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Reamer–Irrigator–Aspirator bone graft harvesting for treatment of segmental bone loss: analysis of defect volume as independent risk factor for failure

Abstract

Introduction

The management of segmental bone loss poses a significant clinical challenge. The purpose of this study was to conduct a retrospective evaluation of our experience in treating segmental bone loss, using Reamer–Irrigator–Aspirator (RIA)-harvested autologous bone graft.

Materials and methods

Between June 2008 and March 2015, 81 patients were treated with the RIA technique for multiple purposes. Inclusion criteria for this study were skeletal mature patients with segmental bone loss, due to acute trauma or non-union, who were treated with RIA-harvested bone graft. Exclusion criteria were skeletal immaturity, pathological fractures and indications for the RIA system other than bone graft harvesting. The primary outcome parameter was clinical and radiographical bone healing.

Results

During the study period, 72 patients met the inclusion criteria. In total, 39 patients (54.2%) were classified as having clinical and radiographical bone healing. Although univariate analysis could not reveal any significant influence of specific risk factors to predict the outcome, there was a trend towards statistical significance for defect volume. Further analysis indeed revealed that smaller defect volumes (< 8 cm³) had a lower risk of non-union.

Conclusions

In approximately half of our study population, the use of the RIA technique for autologous bone graft harvesting in cases of segmental bone loss resulted in a successful outcome with bone healing. Defect size seems to be a critical issue regarding the outcome. Although our results are less promising than previously published, the RIA technique has its place in the treatment algorithm of segmental bone defects.

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Implementation of the Canadian CT Head Rule and its association with use of computed tomography among patients with head injury

Annals of Emergency Medicine

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The occurrence of aspiration pneumonia after emergency endotracheal intubation

The American Journal of Emergency Medicine

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FDA staff raise concerns about Intellipharma's opioid painkiller

Reuters Health News

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Research shows one aspect of the Affordable Care Act has no significant impact on emergency department patient visits

Johns Hopkins Medicine News

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Parents often make follow-up care mistakes after kids leave hospital

Reuters Health News

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Risk factors for developing hypoxic respiratory failure in COPD

International Journal of COPD

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Effects of exercise on fitness and health of adults with spinal cord injury: A systematic review

Neurology®

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Review: The impact of pediatric mental health care provided outpatient, primary care, community and school settings on emergency department use - A systematic review

Child and Adolescent Mental Health

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Acute hepatic porphyria and cancer risk: A nationwide cohort study

Journal of Internal Medicine

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Hopes for HIV cure revived by African child in remission

Reuters Health News

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A 6-week, multicenter, double-blind, double-dummy, chlorpromazine-controlled non-inferiorityrandomized phase iiitrial to evaluate the efficacy and safety of quetiapine fumarate (SEROQUEL) extended-release (XR) in the treatment of patients with schizophrenia and acute episodes

Psychiatry Research

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Gait and cognitive impairments in multiple sclerosis: The specific contribution of falls and fear of falling

Journal of Neural Transmission

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The effectiveness of EMLA as a primary dressing on painful chronic leg ulcers: A pilot randomized controlled trial

Advances in Skin and Wound Care

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Predictive score of haematological toxicity in patients treated with linezolid

European Journal of Clinical Microbiology & Infectious Diseases

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Differentiation between gallbladder cancer with acute cholecystitis: Considerations for surgeons during emergency cholecystectomy, a cohort study

International Journal of Surgery

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Neural correlates of heart rate variability in Posttraumatic stress disorder (PTSD) during sub- and supraliminal processing of trauma-related cues

Human Brain Mapping

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MRI evidence of acute inflammation in leukocortical lesions of patients with early multiple sclerosis

Neurology®

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Inhalation injury caused by cornstarch dust explosion in intubated patients-A single center experience

Burns

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Randomized controlled trial of brief mindfulness training and hypnotic suggestion for acute pain relief in the hospital setting

Journal of General Internal Medicine

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Research targets long-term brain deficits in cardiac arrest survivors

LSU Health Sciences Center New Orleans News

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Depression and anxiety among emergency department patients:Utilization and barriers to care

Abstract

Background

Anxiety and depression rates among ED patients are substantially higher than in the general population. Additionally, those with mental health issues often have difficulty accessing care. Unfortunately, issues of anxiety and depression are frequently not addressed in the ED due to competing care priorities. This may lead to increased burden and overcrowding in EDs.

Objective

This study related anxiety and depression with ED utilization and perceived barriers to care.

Methods

In order to limit the impact of insurance coverage on ED utilization and access to care, a convenience sample of adults 45-85 years of age in the ED were surveyed. The GAD-7 and PHQ-9 were used to measure anxiety and depression.

Results

A total of 251 subjects were enrolled. Severe anxiety was observed in 10% of patients, while moderately severe or severe depression was observed in 12%. Patients who were both severely anxious and depressed visited the ED nearly twice as often as non-anxious and non-depressed patients. The majority of patients cited at least one moderate barrier to care, and greater anxiety and depression scores were related to greater perceived barriers to care. Perceived barriers to care were > 3 times higher among patients who were both anxious and depressed compared to in patients who were neither depressed nor anxious and twice as high as in those who were either depressed or anxious (p<.001).

Conclusion

Patients identified with internalizing mental health concerns utilize the ED at elevated rates while also reporting the greatest difficulties accessing care. These findings highlight the need for ED interventions aimed at identifying patient mental health concerns, as well as perceived barriers to care, in order to design interventions to effectively improve continuity of care.

This article is protected by copyright. All rights reserved.

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Time of Admission to the PICU and Mortality.

Objectives: To evaluate for any association between time of admission to the PICU and mortality. Design: Retrospective cohort study of admissions to PICUs in the Virtual Pediatric Systems (VPS, LLC, Los Angeles, CA) database from 2009 to 2014. Setting: One hundred and twenty-nine PICUs in the United States. Patients: Patients less than 18 years old admitted to participating PICUs; excluding those post cardiac bypass. Interventions: None. Measurements and Main Results: A total of 391,779 admissions were included with an observed PICU mortality of 2.31%. Overall mortality was highest for patients admitted from 07:00 to 07:59 (3.32%) and lowest for patients admitted from 14:00 to 14:59 (1.99%). The highest mortality on weekdays occurred for admissions from 08:00 to 08:59 (3.30%) and on weekends for admissions from 09:00 to 09:59 (4.66%). In multivariable regression, admission during the morning 06:00-09:59 and midday 10:00-13:59 were independently associated with PICU death when compared with the afternoon time period 14:00-17:59 (morning odds ratio, 1.15; 95% CI, 1.04-1.26; p = 0.006 and midday odds ratio, 1.09; 95% CI; 1.01-1.18; p = 0.03). When separated into weekday versus weekend admissions, only morning admissions were associated with increased odds of death on weekdays (odds ratio, 1.13; 95% CI, 1.01-1.27; p = 0.03), whereas weekend admissions during the morning (odds ratio, 1.33; 95% CI, 1.14-1.55; p = 0.004), midday (odds ratio, 1.27; 95% CI, 1.11-1.45; p = 0.0006), and afternoon (odds ratio, 1.17; 95% CI, 1.03-1.32; p = 0.01) were associated with increased risk of death when compared with weekday afternoons. Conclusions: Admission to the PICU during the morning period from 06:00 to 09:59 on weekdays and admission throughout the day on weekends (06:00-17:59) were independently associated with PICU death as compared to admission during weekday afternoons. Potential contributing factors deserving further study include handoffs of care, rounds, delays related to resource availability, or unrecognized patient deterioration prior to transfer. (C)2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Creating a Controlled Arterio-Venous Shunt by Reversing the Extracorporeal Membrane Oxygenation Blood Flow: A Strategy for Weaning Patients Off Veno-Arterial Extracorporeal Membrane Oxygenation.

Objectives: To assess whether reversing the veno-arterial extracorporeal membrane oxygenation blood flow (thereby creating a controlled arterio-venous shunt) can be used to wean children off extracorporeal membrane oxygenation. The standard practice for weaning patients off VA extracorporeal membrane oxygenation is to gradually reduce the blood flows delivered through the extracorporeal membrane oxygenation pump to a minimum level followed by either insertion of an "arterio-venous bridge" and clamping of the blood flow to the patient or direct decannulation. "Pump controlled retrograde flow trial off" is a technique where the revolutions in the centrifugal pump are reduced to the point where the patient will drive the blood retrograde through the extracorporeal membrane oxygenation circuit, effectively turning the circuit into a controlled arterio-venous shunt. The revolutions per minute control the amount of shunt flow. This eliminates any cardiorespiratory support the extracorporeal membrane oxygenation circuit may provide to the patient. Design: Feasibility study. Setting: Pediatric intensive care. Patients: Extracorporeal membrane oxygenation-dependent pediatric patients, who were ready for weaning, and possible separation from extracorporeal membrane oxygenation entered the trial. Intervention: Pump controlled retrograde flow trial off. Measurement and Main Results: During 2016, pump controlled retrograde flow trial off was used in 17 patients, for a total of 23 episodes. One episode was unsuccessful in a patient with a body weight of 2.2 kg, where cardiac output was insufficient to provide blood flow to both body and extracorporeal membrane oxygenation circuit, though from 2.8 kg body weight upward, the technique was tolerated. The duration of pump controlled retrograde flow trial off was 15 minutes to 2.5 hours. Five cases led to a continuation of the extracorporeal membrane oxygenation run, as they were not ready to be decannulated. Fifteen patients were decannulated after the pump controlled retrograde flow trial off. No patient needed to be recommenced on extracorporeal membrane oxygenation after decannulation. Conclusions: Pump controlled retrograde flow trial off is an easy to use and easily reversible technique to assess patient readiness for separation from extracorporeal membrane oxygenation. Given pump controlled retrograde flow trial off can easily be stopped and-in our experience-is not associated with complications, it lowers the threshold to attempt coming off extracorporeal membrane oxygenation and facilitates accurate assessment of whether a patient will need further ongoing extracorporeal membrane oxygenation support. (C)2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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A Prospective Study of the Association Between Clinically Significant Bleeding in PICU Patients and Thrombocytopenia or Prolonged Coagulation Times.

Objective: There are no proven methods to predict the risk of clinically significant bleeding in the PICU. A retrospective study identified platelet count as a risk marker for clinically significant bleeding. We conducted a study to examine any association of platelet count, international normalized ratio, and activated partial thromboplastin time with bleeding risk in PICU patients. Design: Prospective observational cohort study. Setting: The PICU at the Children's Hospital of Eastern Ontario, a university-affiliated tertiary care pediatric center. Patients: Consecutive patients admitted to the PICU. Exclusion criteria were prior inclusion, admission with bleeding, inherited bleeding disorders, weight less than 3 kg, and age less than 60 days or 18 years or more. Interventions: There were no interventions in this observational study. Measurements and Main Results: Patients were monitored in real time for clinically significant bleeding, using a broadly inclusive definition of clinically significant bleeding, for up to 72 hours after admission to the PICU, or until death or discharge. All measurements of platelet count, international normalized ratio, and activated partial thromboplastin time obtained during the study period were included as time-varying covariates in Cox proportional hazard models. Two hundred thirty-four patients were eligible, and 25 (11%) had one or more episodes of clinically significant bleeding. Platelet count was associated with increased hazard of clinically significant bleeding (hazard ratio, 0.96 per 10 x 109/L increase in platelet count; 95% CI (0.93-0.997; p = 0.03). Increasing hazard for clinically significant bleeding was seen with decreasing platelet count. Neither international normalized ratio nor activated partial thromboplastin time was significantly associated with clinically significant bleeding. Conclusions: There is a statistically significant association in PICU patients between decrease in platelet count and clinically significant bleeding, and this association is stronger with lower platelet counts. Further study is required to determine whether platelet transfusion can reduce bleeding risk. International normalized ratio and activated partial thromboplastin time do not predict clinically significant bleeding, and these tests should not be used for this purpose in a general PICU patient population. (C)2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Epidemiology and Outcomes of Cardiac Arrest in Pediatric Cardiac ICUs.

Objectives: In-hospital cardiac arrest occurs in 2.6-6% of children with cardiac disease and is associated with significant morbidity and mortality. Much remains unknown about cardiac arrest in pediatric cardiac ICUs; therefore, we aimed to describe cardiac arrest epidemiology in a contemporary multicenter cardiac ICU cohort. Design: Retrospective analysis within the Pediatric Cardiac Critical Care Consortium clinical registry. Setting: Cardiac ICUs within 23 North American hospitals. Patients: All cardiac medical and surgical patients admitted from August 2014 to July 2016. Interventions: None. Measurements and Main Results: There were 15,908 cardiac ICU encounters (6,498 medical, 9,410 surgical). 3.1% had cardiac arrest; rate was 4.8 cardiac arrest per 1,000 cardiac ICU days. Medical encounters had 50% higher rate of cardiac arrest compared with surgical encounters. Observed (unadjusted) cardiac ICU cardiac arrest prevalence varied from 1% to 5.5% among the 23 centers; cardiac arrest per 1,000 cardiac ICU days varied from 1.1 to 10.4. Over half cardiac arrest occur within 48 hours of admission. On multivariable analysis, prematurity, neonatal age, any Society of Thoracic Surgeons preoperative risk factor, and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 4, 5 had strongest association with surgical encounter cardiac arrest. In medical encounters, independent cardiac arrest risk factors were acute heart failure, prematurity, lactic acidosis greater than 3 mmol/dL, and invasive ventilation 1 hour after admission. Median cardiopulmonary resuscitation duration was 10 minutes, return of spontaneous circulation occurred in 64.5%, extracorporeal cardiopulmonary resuscitation in 27.2%. Unadjusted survival was 53.2% in encounters with cardiac arrest versus 98.2% without. Medical encounters had lower survival after cardiac arrest (37.7%) versus surgical encounters (62.5%); Norwood patients had less than half the survival after cardiac arrest (35.6%) compared with all others. Unadjusted survival after cardiac arrest varied greatly among 23 centers. Conclusions: We provide contemporary epidemiologic and outcome data for cardiac arrest occurring in the cardiac ICU from a multicenter clinical registry. As detailed above, we highlight high-risk patient cohorts and periods of time that may serve as targets for research and quality improvement initiatives aimed at cardiac arrest prevention. (C)2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Interhospital Transport of Children Undergoing Cardiopulmonary Resuscitation: A Practical and Ethical Dilemma.

Objectives: To discuss risks and benefits of interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation. Design: Narrative review. Results: Not applicable. Conclusions: Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation between hospitals is potentially lifesaving if it enables access to resources such as extracorporeal support, but may risk transport personnel safety. Research is needed to optimize outcomes of patients transported with ongoing cardiopulmonary resuscitation and reduce risks to the staff caring for them. (C)2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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An Interprofessional Quality Improvement Initiative to Standardize Pediatric Extubation Readiness Assessment.

Objectives: Establishing protocols to wean mechanical ventilation and assess readiness for extubation, with the goal of minimizing morbidity associated with extubation failure and prolonged mechanical ventilation, have become increasingly important in contemporary PICUs. The aim of this quality improvement initiative is to establish a respiratory therapist-led daily spontaneous breathing trial protocol to standardize extubation readiness assessment and documentation in our PICU. Design: A quality improvement project. Setting: Single center, tertiary care Children's Hospital PICU. Patients: All intubated patients admitted to PICU requiring conventional mechanical ventilation between February 2013 and January 2016. Interventions: A working group of pediatric intensivists, respiratory therapists, nurses, and information technology specialists established the protocol, standardized documentation via the electronic medical record, and planned education. Daily spontaneous breathing trial protocol implementation began in February 2015. All patients on mechanical ventilation were screened daily at approximately 4 AM by a respiratory therapist to determine daily spontaneous breathing trial eligibility. If all screening criteria were met, patients were placed on continuous positive airway pressure of 5 cm H2O with pressure support of 8 cm H2O for up to 2 hours. If tolerated, patients would be extubated to supplemental oxygen delivered via nasal cannula in the morning, after intensivist approval. Daily audits were done to assess screening compliance and accuracy of documentation. Measurements and Main Results: We analyzed data from 398 mechanically ventilated patients during daily spontaneous breathing trial period (February 2015-January 2016), compared with 833 patients from the pre-daily spontaneous breathing trial period (February 2013-January 2015). During the daily spontaneous breathing trial period, daily screening occurred in 92% of patients. Extubation failure decreased from 7.8% in the pre-daily spontaneous breathing trial period to 4.5% in daily spontaneous breathing trial period. The use of high-flow nasal cannula slightly increased during the project, while there was no change in duration of mechanical ventilation or the use of noninvasive ventilation. Conclusions: An interprofessionally developed respiratory therapist-led extubation readiness protocol can be successfully implemented in a busy tertiary care PICU without adverse events. (C)2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Identifying Risk for Acute Kidney Injury in Infants and Children Following Cardiac Arrest.

Objectives: Our goal was to identify risk factors for acute kidney injury in children surviving cardiac arrest. Design: Retrospective analysis of a public access dataset. Setting: Fifteen children's hospitals associated with the Pediatric Emergency Care Applied Research Network. Patients: Two hundred ninety-six subjects between 1 day and 18 years old who experienced in-hospital or out-of-hospital cardiac arrest between July 1, 2003, and December 31, 2004. Interventions: None. Measurements and Main Results: Our primary outcome was development of acute kidney injury as defined by the Acute Kidney Injury Network criteria. An ordinal probit model was developed. We found six critical explanatory variables, including total number of epinephrine doses, postcardiac arrest blood pressure, arrest location, presence of a chronic lung condition, pH, and presence of an abnormal baseline creatinine. Total number of epinephrine doses received as well as rate of epinephrine dosing impacted acute kidney injury risk and severity of acute kidney injury. Conclusions: This study is the first to identify risk factors for acute kidney injury in children after cardiac arrest. Our findings regarding the impact of epinephrine dosing are of particular interest and suggest potential for epinephrine toxicity with regard to acute kidney injury. The ability to identify and potentially modify risk factors for acute kidney injury after cardiac arrest may lead to improved morbidity and mortality in this population. (C)2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Is There a Role for Enterohormones in the Gastroparesis of Critically Ill Patients?.

Objectives: Delayed gastric emptying occurs in critically ill patients and impairs the delivery, digestion, and absorption of enteral feeding. A pathophysiologic role of the enterohormones peptide YY and ghrelin is supported by preclinical data. To compare the circulating plasma levels of peptide YY and ghrelin in control subjects and in critically ill patients, during feeding and fasting, and to search for a correlation with gastric emptying. Design: A prospective observational trial. Settings: Mixed ICU of an academic hospital. Subjects: Healthy volunteers and patients expected to stay in ICU for at least 3 days in whom enteral nutrition was indicated. Interventions: None. Measurements and Main Results: Plasma peptide YY and ghrelin (enzyme-linked immunosorbent assay) were measured once in 10 fasting volunteers (controls) and daily from admission until day 5 of the ICU stay in 30 critically ill patients (median [interquartile range] age 63 [57-67] yr, median [interquartile range] Acute Physiology and Chronic Health Evaluation II score 21 [14-24]). Eight patients could not be fed (fasting group). In fed patients, 13 never had a gastric residual volume higher than 250 mL (low gastric residual volume group), in contrast to the high gastric residual volume group (n = 9). The plasma levels of peptide YY did not differ between patients (6.4 [0-18.1] pg/mL) and controls (4.8 [0.3-17.7] pg/mL). Ghrelin levels were lower in patients than in control (213 [54.4-522.7] vs 1,435 [1,321.9-1,869.3] pg/mL; p

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Diabetes Is Not Associated With Increased 90-Day Mortality Risk in Critically Ill Patients With Sepsis.

Objectives: To determine the association of pre-existing diabetes, hyperglycemia, and hypoglycemia during the first 24 hours of ICU admissions with 90-day mortality in patients with sepsis admitted to the ICU. Design: We used mixed effects logistic regression to analyze the association of diabetes, hyperglycemia, and hypoglycemia with 90-day mortality (n = 128,222). Setting: All ICUs in the Netherlands between January 2009 and 2014 that participated in the Dutch National Intensive Care Evaluation registry. Patients: All unplanned ICU admissions in patients with sepsis. Interventions: The association between 90-day mortality and pre-existing diabetes, hyperglycemia, and hypoglycemia, corrected for other factors, was analyzed using a generalized linear mixed effect model. Measurements and Main Results: In a multivariable analysis, diabetes was not associated with increased 90-day mortality. In diabetes patients, only severe hypoglycemia in the absence of hyperglycemia was associated with increased 90-day mortality (odds ratio, 2.95; 95% CI, 1.19-7.32), whereas in patients without pre-existing diabetes, several combinations of abnormal glucose levels were associated with increased 90-day mortality. Conclusions: In the current retrospective large database review, diabetes was not associated with adjusted 90-day mortality risk in critically ill patients admitted with sepsis. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Investigating the Impact of Different Suspicion of Infection Criteria on the Accuracy of Quick Sepsis-Related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores.

Objective: Studies in sepsis are limited by heterogeneity regarding what constitutes suspicion of infection. We sought to compare potential suspicion criteria using antibiotic and culture order combinations in terms of patient characteristics and outcomes. We further sought to determine the impact of differing criteria on the accuracy of sepsis screening tools and early warning scores. Design: Observational cohort study. Setting: Academic center from November 2008 to January 2016. Patients: Hospitalized patients outside the ICU. Interventions: None. Measurements and Main Results: Six criteria were investigated: 1) any culture, 2) blood culture, 3) any culture plus IV antibiotics, 4) blood culture plus IV antibiotics, 5) any culture plus IV antibiotics for at least 4 of 7 days, and 6) blood culture plus IV antibiotics for at least 4 of 7 days. Accuracy of the quick Sepsis-related Organ Failure Assessment score, Sepsis-related Organ Failure Assessment score, systemic inflammatory response syndrome criteria, the National and Modified Early Warning Score, and the electronic Cardiac Arrest Risk Triage score were calculated for predicting ICU transfer or death within 48 hours of meeting suspicion criteria. A total of 53,849 patients met at least one infection criteria. Mortality increased from 3% for group 1 to 9% for group 6 and percentage meeting Angus sepsis criteria increased from 20% to 40%. Across all criteria, score discrimination was lowest for systemic inflammatory response syndrome (median area under the receiver operating characteristic curve, 0.60) and Sepsis-related Organ Failure Assessment score (median area under the receiver operating characteristic curve, 0.62), intermediate for quick Sepsis-related Organ Failure Assessment (median area under the receiver operating characteristic curve, 0.65) and Modified Early Warning Score (median area under the receiver operating characteristic curve 0.67), and highest for National Early Warning Score (median area under the receiver operating characteristic curve 0.71) and electronic Cardiac Arrest Risk Triage (median area under the receiver operating characteristic curve 0.73). Conclusions: The choice of criteria to define a potentially infected population significantly impacts prevalence of mortality but has little impact on accuracy. Systemic inflammatory response syndrome was the least predictive and electronic Cardiac Arrest Risk Triage the most predictive regardless of how infection was defined. Copyright (C) by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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EMCrit Wee – An Amazing (Wearable) Cric Trainer from Laura Duggan and the AirwayCollaboration Folks

The new amazing cric trainer

EMCrit by Scott Weingart.

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EMCrit Wee – An Amazing (Wearable) Cric Trainer from Laura Duggan and the AirwayCollaboration Folks

The new amazing cric trainer

EMCrit by Scott Weingart.

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EMT-B or Paramedic - Seneca EMS

EMT-B, EMT-Advanced, and Paramedic positions available. Full time and part time. Contact Seneca EMS for more info. Call 412-781-8596 or visit Senecaems.org to fill out an application.

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Physician Substitute - Octapharma Plasma

We are seeking a Licensed Practical Nurse (LPN) to join our growing biopharmaceutical company and assist in opening our newest Donor Center. At Octapharma Plasma you can channel your passion for helping others into a medical career that is fast-paced and personally and professionally rewarding. Recent medically trained graduates as well as experienced healthcare professionals are welcome to apply. We ...

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Physcician Substitute - Octapharma Plasma

Want to be a part of something exciting" Help Octapharma Plasma open our next Donor Center! At Octapharma Plasma you can channel your passion for helping others into a medical career that is fast-paced and personally and professionally rewarding. We are seeking a Emergency Medical Technician (EMT) to join our growing biopharmaceutical company and assist in opening our newest Donor Center. At Octapharma ...

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Paramedic / Critical Care EMT - Finger Lakes Health

Finger Lakes Health has an opening for a Full Time and Casual status (Casual is a couple shifts/week) Paramedic at Soldiers & Sailors Memorial Hospital in Penn Yan, NY, as part of their Medic 55 Program. Requirements: NYS Certification as EMT-Paramedic or EMT- Critical Care BLS/ALS, ACLS, PALS, BTLS required within six months. NYS Driver License clear of violations in past five years. High school ...

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EMT Basic Full Time and Per Diem - Finger Lakes Health

Finger Lakes Health currently has an opening for Full Time and Casual (as needed) status EMT - Basics. This position will work out of the Penn Yan Ambulance Corp, but be employed by Finger Lakes Health. Must be willing to work all shifts, depending on department need. Requirements Education: Minimum: High School diploma or equivalent and Basic EMT training. License/Certifications: Current NYS DOH certified ...

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Woul`d you like a 50% reduction of Heroin users ..?

What realy happened when Portugal decriminalised all illegal drugs in July 2001 ..?And... How do y o u think a nation with 5% of the World`s population ( -330.000000 People ) , -hold 25% of the World`s Prison-Population In they`r Prison`s ...-A nation that ruins any chance of a normal life, a job, -a Future,,, -When they`r prisoners Come`s O u t ..? What will the F u t u r e of that nation be like ..? ExEMTNor

from EMS via xlomafota13 on Inoreader http://ift.tt/2uSpl5W

Woul`d you like a 50% reduction of Heroin users ..?

What realy happened when Portugal decriminalised all illegal drugs in July 2001 ..?And... How do y o u think a nation with 5% of the World`s population ( -330.000000 People ) , -hold 25% of the World`s Prison-Population In they`r Prison`s ...-A nation that ruins any chance of a normal life, a job, -a Future,,, -When they`r prisoners Come`s O u t ..? What will the F u t u r e of that nation be like ..? ExEMTNor

from EMS via xlomafota13 on Inoreader http://ift.tt/2uSpl5W

Woul`d you like a 50% reduction of Heroin users ..?

What realy happened when Portugal decriminalised all illegal drugs in July 2001 ..?And... How do y o u think a nation with 5% of the World`s population ( -330.000000 People ) , -hold 25% of the World`s Prison-Population In they`r Prison`s ...-A nation that ruins any chance of a normal life, a job, -a Future,,, -When they`r prisoners Come`s O u t ..? What will the F u t u r e of that nation be like ..? ExEMTNor

from EMS via xlomafota13 on Inoreader http://ift.tt/2uSpl5W

Woul`d you like a 50% reduction of Heroin users ..?

What realy happened when Portugal decriminalised all illegal drugs in July 2001 ..?And... How do y o u think a nation with 5% of the World`s population ( -330.000000 People ) , -hold 25% of the World`s Prison-Population In they`r Prison`s ...-A nation that ruins any chance of a normal life, a job, -a Future,,, -When they`r prisoners Come`s O u t ..? What will the F u t u r e of that nation be like ..? ExEMTNor

from EMS via xlomafota13 on Inoreader http://ift.tt/2uSpl5W

Advanced Tech III – Emergency - Florida Hospital

Department Profile: Our Emergency Department is located in one of the fastest-growing communities in Osceola County, close to Walt Disney World entertainment complex and local attractions. The unit consists of 35 monitored beds, two trauma rooms, dedicated pediatric rooms, and is a certified stroke center. We see over 48,000 patients each year, serving all age groups with the best in community-based ...

from EMS via xlomafota13 on Inoreader http://ift.tt/2eI8jBM

Advanced Tech II - Florida Hospital

Department Profile: Our Emergency Department is located in one of the fastest-growing communities in Osceola County, close to Walt Disney World entertainment complex and local attractions. The unit consists of 35 monitored beds, two trauma rooms, dedicated pediatric rooms, and is a certified stroke center. We see over 48,000 patients each year, serving all age groups with the best in community-based ...

from EMS via xlomafota13 on Inoreader http://ift.tt/2uZX7Ht