Last year I had the opportunity to return to practicing as a paramedic for a local ambulance service. I had spent the last several years working in a few different non-clinical positions, including EMS coordinator for a county system and online EMS education contributor. But, I had a little more time available now and thought it would be a good opportunity to return to the streets. I immediately began ...
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Δευτέρα 30 Απριλίου 2018
Back on the streets: An old paramedic's return to patient care
It's important to brush up on protocols, equipment and other areas of EMS after taking some time away from the field
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from EMS via xlomafota13 on Inoreader https://ift.tt/2r9zms8
EMCrit Podcast 223 – TTP & DIC with Tom DeLoughery – Part I
Low platelets in the Critically Ill Patient--TTP, DIC, MAHA
EMCrit Project by Scott Weingart.
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IS THIS ANYTHING?
by Andrew Stolbach Naloxone-resistant opioids I just read another paper about someone not waking up with naloxone after taking a synthetic opioid. The prospect of “narcan-resistant” opioids makes me think of David Letterman. When I was in elementary school I used to watch David Letterman’s show with my mother after school. This […]
EMCrit Project by Tox & Hound.
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ResQPOD ITD Overview
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ResQPOD ITD Overview
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EMCrit Podcast 223 – TTP & DIC with Tom DeLoughery – Part I
Low platelets in the Critically Ill Patient--TTP, DIC, MAHA
EMCrit Project by Scott Weingart.
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IS THIS ANYTHING?
by Andrew Stolbach Naloxone-resistant opioids I just read another paper about someone not waking up with naloxone after taking a synthetic opioid. The prospect of “narcan-resistant” opioids makes me think of David Letterman. When I was in elementary school I used to watch David Letterman’s show with my mother after school. This […]
EMCrit Project by Tox & Hound.
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ResQPOD ITD Overview
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ResQPOD ITD Overview
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Κυριακή 29 Απριλίου 2018
W.Va. fire chief makes TIME’s top 100 influential people list
Huntington Fire Chief Jan Rader, who was recently featured in the Netflix documentary “Heroin(e),” was recognized for raising awareness about the opioid crisis
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from EMS via xlomafota13 on Inoreader https://ift.tt/2r8Lz0e
Platelet-rich plasma as an additional therapeutic option for infected wounds with multi-drug resistant bacteria: in vitro antibacterial activity study
Abstract
Purpose
Infected wounds, such as diabetic foot infections, are mostly polymicrobial and microorganisms have high resistance rates to antimicrobials. Infected wounds in diabetic patients have high cost, morbidity, and mortality rates. Based on these facts, there is a need for supportive localized treatment options such as platelet-rich plasma (PRP) implementations. Demonstrating the in vitro antimicrobial effect, our aim was to lead up to clinical trials of localized PRP implementations in infected wounds such as diabetic foot infections. In this study, we aimed to demonstrate the in vitro antibacterial activity of PRP against methicilin-resistant Staphylococcus aureus (MRSA) and three more multi-drug resistant bacteria species that are important and hard-to-treat in wound infections.
Materials and methods
In vitro antimicrobial activity of autologous PRP, platelet-poor plasma (PPP), and phosphate-buffered saline (PBS) on methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp., extended spectrum beta lactamase producing Klebsiella pneumoniae, and carbapenem-resistant Pseudomonas aeruginosa was compared by assessment of bacterial growth on agar plates and antimicrobial susceptibility test results.
Results
When compared to control group, PRP and PPP significantly suppressed bacterial growth of MRSA, K. pneumoniae, and P. aeruginosa at 1st, 2nd, 5th, and 10th hours of incubation (p < 0.05). VRE was the only bacteria that PRP and PPP showed limited activity against. When compared to PPP, PRP showed higher activity against MRSA, K. pneumoniae, and P. aeruginosa. However, the differences between PRP and PPP were statistically significant only against MRSA and P. aeruginosa at the first hour of incubation.
Conclusions
Emerging PRP and other platelet-derived products seem to be promising alternative tools besides antibiotic treatment, debridement, negative pressure wound therapy, hyperbaric oxygen therapy, and other treatment options for treating diabetic foot infections.
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Σάββατο 28 Απριλίου 2018
EMCrit – Wanted Dead or Alive, Your FONA Experiences
Airway App Data
EMCrit Project by Laura Duggan.
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EMCrit – Wanted Dead or Alive, Your FONA Experiences
Airway App Data
EMCrit Project by Laura Duggan.
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Implementation of a mechanical CPR device in a physician staffed HEMS – a prospective observational study
In this prospective, observational study we describe the incidence and characteristics of out of hospital cardiac arrest (OHCA) cases who received mechanical CPR, after the implementation of a mechanical CPR d...
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from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2HCuFhm
Παρασκευή 27 Απριλίου 2018
Annual NAVIGATOR conference highlights achievements of two outstanding emergency telecommunicators
Brought to you by Priority Dispatch LAS VEGAS — The International Academies of Emergency Dispatch® (IAED™) has recognized the outstanding accomplishments of emergency dispatchers and the contributions of dedicated professionals at its annual NAVIGATOR conference, held April 24–26 at the Aria Resort and Casino in Las Vegas, Nevada. At the event, IAED officials presented awards to ...
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from EMS via xlomafota13 on Inoreader https://ift.tt/2Jz9I7I
Pulsara named one of Montana High Tech Business Alliance’s 12 High Growth companies to watch in 2018
BOZEMAN, Mont. — The spotlight is being shone once again on Pulsara, recently named one of Montana High Tech Business Alliance’s 12 High Growth companies to watch in 2018. Pulsara is excited to be recognized as one of Montana’s rising stars among over 500 high-tech companies in the state. Pulsara is a healthcare product that securely enables all members of a patient care team — ...
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There is more to septic shock than arterial hypotension and elevated lactate levels: another appeal to rethink current resuscitation strategies!
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Πέμπτη 26 Απριλίου 2018
Congressional baseball practice gunshot victim reunites with paramedics
By EMS1 Staff ALEXANDRIA, Va. — A lobbyist who was shot at the GOP congressional baseball team practice last June reunited with the paramedics who saved him. WTOP reported that paramedic Chad Shade and now-retired paramedic Fiona Apple reunited with Tyson Foods lobbyist Matt Mika at the first practice since the incident at Eugene Simpson Field, where James Hodgkinson opened fire near the third ...
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NYPD officers help save elderly tourist in cardiac arrest
The police officers were driving by when they noticed a commotion around Ron Gargalowitz, who had gone into cardiac arrest while walking with his family
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from EMS via xlomafota13 on Inoreader https://ift.tt/2Kg4b72
‘Single-checked’ Patient Group Directions during initial nurse assessment within paediatric emergency departments of the UK and Ireland
Objective Double checking medications at initial assessment within paediatric emergency departments (EDs) has the potential to delay patient flow, and doubt has been cast on the efficacy of double checking in all but high-risk medications. We aimed to benchmark current practice for the use of Patient Group Direction (PGD) medications at initial assessment in EDs within the Paediatric Emergency Research UK and Ireland (PERUKI) network, with a focus on the use of ‘single-checker’ PGDs. Methods Online survey was distributed to the research representative at each PERUKI site. The survey was open for 5 weeks (from March 2015 to April 2015) and was completed by any appropriate clinician within the site. Results The response rate was 84% (36/43 EDs). From these, 22 out of 36 (61%) EDs were using single-checker PGDs. The commonest single-checked medications in use were paracetamol and ibuprofen for pain. Among PERUKI sites, 21.9% of EDs reported drug errors related to standard (double-checked) PGDs, whereas 13.6% of those with single-checked PGDs reported drug errors (Fisher’s exact test with significance level of 0.05, P=0.501). The commonest errors reported were duplicated dose, incorrect weight, incorrect volume drawn up, contraindication missed. Conclusion Single-checker PGDs are currently in use in nearly two-thirds of PERUKI sites. No evidence of increased medication errors was reported with this practice; however, more detailed studies are required to support this finding and to inform best practice.from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2HudfUa
Reliability and validity of emergency department triage tools in low- and middle-income countries: a systematic review
Objective Despite the universal acknowledgment that triage is necessary to prioritize emergency care, there is no review that provides an overview of triage tools evaluated and utilized in resource-poor settings, such as low- and middle-income countries (LMICs). We seek to quantify and evaluate studies evaluating triage tools in LMICs. Methods We performed a systematic review of the literature between 2000 and 2015 to identify studies that evaluated the reliability and validity of triage tools for adult emergency care in LMICs. Studies were then evaluated for the overall quality of evidence using the GRADE criteria. Results Eighteen studies were included in the review, evaluating six triage tools. Three of the 18 studies were in low-income countries and none were in rural hospitals. Two of the six tools had evaluations of reliability. Each tool positively predicted clinical outcomes, although the variety in resource environments limited ability to compare the predictive nature of any one tool. The South African Triage Scale had the highest quality of evidence. In comparison with high-income countries, the review showed fewer studies evaluating reliability and presented a higher number of studies with small sample sizes that decreased the overall quality of evidence. Conclusion The quality of evidence supporting any single triage tool’s validity and reliability in LMICs is moderate at best. Research on triage tool applicability in low-resource environments must be targeted to the actual clinical environment where the tool will be utilized, and must include low-income countries and rural, primary care settings.from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2HRr1DY
Prognostic value of infrared thermography in an emergency department
Objective In this study, we aimed to investigate the prognostic potential of infrared thermography in a population of medical patients admitted to the emergency department. Central-to-peripheral temperature gradients were analyzed for association with 30-day mortality. Methods This prospective observational study included 198 medical patients admitted to the Emergency Department, at Odense University Hospital. A standardized thermal picture was taken and temperatures of the inner canthus, the earlobe, the nose tip, and the tip of the third finger were reported. The inner canthus was chosen as a marker for central temperature and the three others as markers for peripheral temperatures, resulting in three gradients per patient. Thirty-day follow-up was performed and 30-day mortality was reported. Results One hundred and ninety-eight patients were included and the number of events was nine. The gradient between the inner canthus and the nose tip (ΔN) and the gradient between the inner canthus and the fingertip (ΔF) showed a significant association with 30-day mortality (ΔN: odds ratio: 1.31; 95% confidence interval: 1.05–1.64 and ΔF: odds ratio: 1.27; 95% confidence interval: 1.02–1.57). Conclusion ΔN and ΔF showed a significant association with 30-day mortality, suggesting a prognostic value. However, this was a small pilot study with few events. Larger studies are warranted for confirmation of these findings.from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2JsJaEZ
Review of existing measurement tools to assess spinal motion during prehospital immobilization
The quantification of spinal movement to investigate the efficacy of prehospital immobilization devices and techniques remains difficult. Therefore, we aim to systematically review the literature on reported measurement tools applicable within this research field. A keyword literature search of relevant articles was performed using the database of PubMed including international literature published in English between January 2010 and December 2015. Only studies describing methods applicable to estimate spinal movement during prehospital immobilization were included. Six measurement tools were found that have either been used (goniometer/inclinometer, imaging modalities, electromagnetic systems, and optoelectronic systems) or have the potential to be used (inertial measurement units and a combination of strain gauge technology and accelerometers) in this research field. Novel devices can assess spinal motion during prehospital care including extrication, application of immobilization devices, and transportation from the site of the accident to the final destination, and therefore can be considered for usage.from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2r2FdQE
Improved response time following a change in the transport system of newborns
No abstract availablefrom Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2JwjCXx
Emergency Heart Failure Mortality Risk Grade score performance for 7-day mortality prediction in patients with heart failure attended at the emergency department: validation in a Spanish cohort
Objective The Emergency Heart Failure Mortality Risk Grade (EHMRG) scale, derived in 86 Canadian emergency departments (EDs), stratifies patients with acute-decompensated heart failure (ADHF) according to their 7-day mortality risk. We evaluated its external validity in a Spanish cohort. Patients and methods We applied the EHMRG scale to ADHF patients consecutively included in the Epidemiology of Acute Heart Failure in Emergency departments (EAHFE) registry (29 Spanish EDs) and measured its performance. Patients were distributed into quintiles according to the original and their self-defined score cutoffs. The 7-day mortality rates were compared internally among different categories and with categories of Canadian cohorts. Results The EAHFE group [n: 1553 patients; 80 (10) years; 55.6% women] had a 5.5% 7-day mortality rate and the EHMRG scale c-statistic was 0.741 (95% confidence interval: 0.688–0.793) compared with 0.807 (0.761–0.842) and 0.804 (0.763–0.840) obtained in the Canadian derivation and validation cohorts. The mortality rate of the EAHFE group mortality increased progressively as the quintile categories increased using intervals defined by either the Canadian or the Spanish EHMRG score cutoffs, although with more regular increments with the EAHFE-defined intervals; using the latter, patients at quintiles 2, 3, 4, 5a and 5b had (compared with quintile 1) odds ratios of 1.77, 3.36, 4.44, 9.39 and 16.19, respectively. Conclusion The EHMRG scale stratified risk in an ADHF cohort that included both palliative and nonpalliative patients in Spanish EDs, showing an extrapolation to a higher mortality risk cohort than the original derivation sample. Stratification improved when the score was recalibrated in the Spanish cohort.from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2HObbK6
Impact of a general practitioners’ strike and of terrorist attacks on a call centre
Objective We aimed to evaluate the impact of the same-day GPs’ strike and terrorist attacks on a call centre’s activity. Methods We compared the number of calls received, the number of patient’s medical files (PMFs) created and the number of mobile ICU (MICU) dispatched per hour on Friday, 13 November, to the repository established on the five previous Fridays. As previously published, the variation criterion was set to an activity variation above 20% for more than 2 h. Results On Friday, 13 November, 1745 calls were received compared with 1455 calls, on average, for the five previous Fridays. The number of calls received increased after the terrorist attacks (≤90%) and remained above the threshold for 3 h. The number of PMFs exceeded the threshold from 10:00 a.m. to 05:00 p.m., but was not affected by the attacks. The number of MICUs dispatched exceeded the threshold (>500%) in the first hour after the attacks. Conclusion The GPs’ strike and the terrorist attacks did not impact our call centre’s activity in the same manner. The strike increased the number of PMFs without increasing the number of calls received. The attacks increased the number of calls received and MICU dispatched without increasing the number of PMFs. Many markers are at the disposal of call centres to evaluate the impact of healthcare events.from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2JtvutC
Value of the coronary artery disease consortium rule in patients with acute chest pain and negative troponins referred for exercise stress testing
Objective To assess the value of the pretest probability (PTP) of coronary artery disease (CAD) for predicting stress testing results and coronary events in patients with acute chest pain and negative troponins. Patients and methods A total of 3527 patients without a history of CAD referred to our chest pain unit with suspected acute coronary syndromes, nondiagnostic ECGs, and negative troponin levels underwent exercise stress testing. PTP was estimated with the CAD consortium prediction rule, and was categorized as low (85%). The endpoints were the presence of signs of inducible myocardial ischemia on stress testing and the occurrence of coronary events within 6 months. Results The probability of exercise-induced myocardial ischemia was 2.6, 12.6, 42.9, and 82.1% in patients with low, low–intermediate, intermediate–high, and high PTP, respectively (Ptrendfrom Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2HSdHyR
Adverse events and risk factors during emergency intubation in a tertiary paediatric emergency department
Background Rapid sequence intubation and emergency intubation in the emergency department (ED) can be life-saving procedures, but require the appropriate skills, experience and preparation to avoid complications ranging from simple trauma to life-threatening desaturation. Only scarce data exist in the published literature on complications following emergency intubation in children and most guidelines are extrapolated from the adult population. Patients and methods We reviewed all emergency intubations of patients in our tertiary paediatric ED within a 2-year period to estimate the incidence of complications and to analyse the risk factors associated with this procedure. Results Seventy-two children were intubated; complications occurred in one in four and repeated attempts at intubation in 17/23 children. The median age of the children was 2 years (range: 0 days–6 years). The most common reason for intubation was altered level of consciousness and the most frequent diagnosis at the time of intubation was seizure/status epilepticus. Complications were related to desaturation (n=7), equipment failure (n=3), intravenous access (n=2) and hypotension (n=2), erroneous or insufficient drug preparation (n=1) and other reasons (n=3). There was no significant association of complications with the child’s age or weight, time of arrival to ED, preintubation hypotension or combination of drugs used. Conclusion Complications of rapid sequence intubation, a relatively low-frequency procedure in the paediatric ED, occurred in one of four children and repeat attempts at intubation were made in another 24%. We suggest that the use of an intubation checklist including the preparation of equipment and recommendations for drug use would minimize the occurrence of adverse events of intubation in children.from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2JuvjOq
Retrospective validation of the pulmonary embolism rule-out criteria rule in ‘PE unlikely’ patients with suspected pulmonary embolism
Introduction Patients presenting to emergency departments (EDs) with suspected pulmonary embolism (PE) can be risk stratified and those who are deemed to be at low risk for PE usually undergo D-dimer testing. A negative D-dimer in this low-risk group rules out PE with a high degree of certainty because of its high sensitivity. The D-dimer is, however, a poorly specific test and positive results often lead to unnecessary radiological imaging (notably computed tomography pulmonary angiography). The Pulmonary Embolism Rule-Out Criteria (PERC) rule has been suggested as an alternative to D-dimer testing in these patients. This study looked at whether the PERC rule could safely replace the use of D-dimer in patients suspected of PE, but deemed ‘PE unlikely’ by the dichotomized Wells score in a UK ED setting. Patients and methods This was a retrospective review of 986 patients with suspected PE who had a blood sample for D-dimer level taken. In patients deemed ‘PE unlikely’ (using the dichotomized Wells score), the diagnostic performance of the PERC rule was compared with a standard D-dimer level in the detection of PE at index presentation and up to 3 months afterwards. Results Of the 986 patients, 940 patients were deemed ‘PE unlikely’ using the dichotomized Wells score. Three patients with confirmed PE would have been missed by the PERC rule compared with only one missed by the D-dimer test. In these patients, the sensitivity of the PERC rule for detecting PE was 91.4% [95% confidence interval (CI): 76.9–98.2%], with a negative likelihood ratio of 0.25 (95% CI: 0.08–0.73). However, the negative predictive value of the PERC rule was 99.1% (95% CI: 97.3–99.8%). In comparison, the sensitivity for the standard D-dimer test was 97.1% (95% CI: 85.1–99.9%), with a negative likelihood ratio of 0.04 (95% CI: 0.01–0.27). The negative predictive value for the standard D-dimer test was 99.8% (95% CI: 99.2–100%). Conclusion The PERC rule has a high negative predictive value for excluding PE in patients presenting with suspected PE to the ED. However, the PERC rule may still miss around 8% of confirmed PE in patients who are deemed ‘PE unlikely’ by a dichotomized Wells score. Caution is advised in using the PERC rule as a substitute for the standard D-dimer test in all these patients.from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2HSdATX
Consensus-derived clinical decision rules to guide advanced imaging decisions for pulmonary embolism in pregnancy and the postpartum period
No abstract availablefrom Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2HuuSDq
Mental health promotion for junior physicians working in emergency medicine: evaluation of a pilot study
Objectives Work-related stress is highly prevalent among physicians working in emergency medicine. Mental health promotion interventions offer the chance to strengthen physicians’ health, work ability, and performance. The aim of this study was to implement and evaluate a mental health promotion program for junior physicians working in emergency medicine. Methods In total, 70 junior physicians working in emergency medicine were randomized to either the mental health promotion program (n=35) or a waitlist control arm (n=35). The training involved 90-min sessions over a time period of 3 months. The primary outcome was perceived stress. The secondary outcomes included emotional exhaustion, emotion regulation, work engagement, and job satisfaction. Self-report assessments for both groups were scheduled at baseline, after the training, after 12 weeks, and 6 months. Results The intervention group showed a highly significant reduction in perceived stress and emotional exhaustion from baseline to all follow-up time points, with no similar effects found in the comparison group. The benefit of the mental health promotion program was also evident in terms of improved emotion regulation skills, job satisfaction, and work engagement. Participating physicians evaluated the training with high scores for design, content, received outcome, and overall satisfaction. Conclusion The results suggest that this health promotion program is a promising intervention to strengthen mental health and reduce perceived work stress. It is suitable for implementation as a group training program for junior physicians working in emergency medicine. Comparable interventions should be pursued further as a valuable supportive offer by hospital management.from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2HVufpR
An evaluation of patient ownership and use and acceptability of smartphone technology within the emergency department
No abstract availablefrom Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2JsAr5L
Τετάρτη 25 Απριλίου 2018
Outcomes of Patients With Syncope and Suspected Dementia
Academic Emergency Medicine, EarlyView.
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NREMT launches EMS certification app
The iPhone app allows EMS personnel to manage their continuing education and recertification components
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RapidDeploy becomes first Computer-Aided Dispatch (CAD) System to receive ProQA Titanium Certification
Priority Dispatch recognizes RapidDeploy for its dynamic, customizable interface and commitment to the public safety community.
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3 towns team up to keep ambulance services alive
The towns of Remsen, Steuben and Trenton are streamlining their ambulance services in an effort to keep them up and running
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Haemodynamic outcomes during piston-based mechanical CPR with or without active decompression in a porcine model of cardiac arrest
Experimental active compression-decompression (ACD) CPR is associated with increased haemodynamic outcomes compared to standard mechanical chest compressions. Since no clinically available mechanical chest com...
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from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2qY1IXb
Simple modification of trauma mechanism alarm criteria published for the TraumaNetwork DGU® may significantly improve overtriage – a cross sectional study
No consensus exists in the literature on the use of uniform emergency room trauma team activation criteria (ERTTAC). Today excessive over- or undertriage rates continue to be a challenge for most trauma centre...
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from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2vTyvSb
3 harms of EMS miscommunication and how to fix them
Communication is critical to ensure that emergency department resources are available and ready for your patient
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Τρίτη 24 Απριλίου 2018
Why EMS agencies should change their definition of intubation success
Dr. Jeffrey Jarvis, medical director for Williamson County (Texas) EMS, will discuss why delayed sequence intubation is a cure for Rapid Sequenced Death at EMS PRO conference
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Learn how to combat sleep deprivation and fatigue in EMS
Amy Eisenhauer to discuss health risks and performance impact of disrupted sleep, as well as strategies for overcoming these challenges, as part of EMS PRO conference
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from EMS via xlomafota13 on Inoreader https://ift.tt/2HLs1t7
3 ways to overcome your fear of pediatric patients
Providing effective pediatric care starts with confronting your challenges with children
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from EMS via xlomafota13 on Inoreader https://ift.tt/2vHXl7o
W.Va. fire chief makes TIME’s top 100 influential people list
By EMS1 Staff HUNTINGTON, W.Va. — A fire chief who has gained national attention for being a leader in the fight against the opioid crisis was named one of TIME’s Top 100 Influential People of 2018. WSAZ reported that Huntington Fire Department Chief Jan Rader, who was recently featured in the Netflix documentary “Heroin(e),” said she is “honored” to be recognized ...
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My patient has received fluid. How to assess its efficacy and side effects?
Many efforts have been made to predict, before giving fluid, whether it will increase cardiac output. Nevertheless, after fluid administration, it is also essential to assess the therapeutic efficacy and to lo...
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from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2HnbNHj
Traumatic cardiac arrest in Sweden 1990-2016 - a population-based national cohort study
Trauma is a main cause of death among young adults worldwide. Patients experiencing a traumatic cardiac arrest (TCA) certainly have a poor prognosis but population-based studies are sparse. Primarily to descri...
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from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2qXsWMr
Reply to the letter to the editor “Minimized approaches to the posterolateral chest wall in the fixation of rib fracture” by Yih-Wen Tarng, Yi-Pin Chou, Tung-Ho Wu, Hsing-Lin Lin
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Emergency Reflex Action Drills
By Mike Lauria, Cliff Reid, and Scott Weingart It is even better to act quickly and err than to hesitate until the time of action is past. –Carl von Clausewitz, Vom Kriege “Contact Right!” In the special operations community we accepted that certain dangerous situations develop at a speed that exceeds our analytical capability. This […]
EMCrit Project by Mike Lauria.
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Emergency Reflex Action Drills
By Mike Lauria, Cliff Reid, and Scott Weingart It is even better to act quickly and err than to hesitate until the time of action is past. –Carl von Clausewitz, Vom Kriege “Contact Right!” In the special operations community we accepted that certain dangerous situations develop at a speed that exceeds our analytical capability. This […]
EMCrit Project by Mike Lauria.
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Δευτέρα 23 Απριλίου 2018
Webinar: How data is being used to improve patient care
NHTSA’s Office of EMS will discuss how two EMS agencies are using data to not only improve performance, but demonstrate value
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The Purge
by Howard Greller An absurdists’ take on whole bowel irrigation Throw out your conceited opinions, for it is impossible for a person to begin to learn what he thinks he already knows. – Epictetus, Discourses, 2.17.1 A consensus means that everyone agrees to say collectively what no one believes individually. – Abba […]
EMCrit Project by Tox & Hound.
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Mom wins AED for school after son’s death at hockey practice
In addition to creating the 4AlecFoundation to raise awareness for undetected heart disease, Stephanie Kornet also won a national contest by sharing her son’s story
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Webinar to be hosted on improving patient care with data
NHTSA’s Office of EMS will discuss how two EMS agencies are using data to not only improve performance, but demonstrate value
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The Purge
by Howard Greller An absurdists’ take on whole bowel irrigation Throw out your conceited opinions, for it is impossible for a person to begin to learn what he thinks he already knows. – Epictetus, Discourses, 2.17.1 A consensus means that everyone agrees to say collectively what no one believes individually. – Abba […]
EMCrit Project by Tox & Hound.
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Diaphragm function and weaning from mechanical ventilation: an ultrasound and phrenic nerve stimulation clinical study
Diaphragm dysfunction is defined by a value of twitch tracheal pressure in response to magnetic phrenic stimulation (twitch pressure) amounting to less than 11 cmH2O. This study assessed whether this threshold or...
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Early goal-directed therapy using a physiological holistic view: the ANDROMEDA-SHOCK—a randomized controlled trial
Septic shock is a highly lethal condition. Early recognition of tissue hypoperfusion and its reversion are key factors for limiting progression to multiple organ dysfunction and death. Lactate-targeted resusci...
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PulmCrit- Shrug Technique for US-guided subclavian lines
The CDC guidelines recommend placing subclavian lines to reduce the risk of catheter-related bloodstream infections. Meanwhile, mounting evidence suggests that we should probably be placing lines with ultrasound guidance. Unfortunately, the ultrasound-guided subclavian can be tricky. This post describes a slight modification that could make the technique easier and safer.
EMCrit Project by Josh Farkas.
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PulmCrit- Shrug Technique for US-guided subclavian lines
The CDC guidelines recommend placing subclavian lines to reduce the risk of catheter-related bloodstream infections. Meanwhile, mounting evidence suggests that we should probably be placing lines with ultrasound guidance. Unfortunately, the ultrasound-guided subclavian can be tricky. This post describes a slight modification that could make the technique easier and safer.
EMCrit Project by Josh Farkas.
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Pneumomediastinum and pneumopericardium following blunt thoracic trauma: much ado about nothing?
Abstract
Purpose
Pneumomediastinum is the hallmark of intrathoracic aerodigestive trauma, but rare following blunt injury. Aim: review of blunt thoracic trauma (BTC) for the incidence and outcome of patients with pneumomediastinum or pneumopericardium (PM/PC) on Computerised Tomographic scanning.
Methods
Admissions to the level I trauma ICU at IALCH, Durban, ZA following BTC from April 2007 to March 2014. Patients with Chest-CT-scan were analysed. Variables included age, sex, mechanism of injury, and Injury Severity Score (ISS). Specific injury patterns: isolated thoracic trauma, flail chest, bilateral injury and presence of haemothorax or pneumothorax were analysed.
Results
Three hundred and eighty-nine patients were included. Males (70.9%) accounted for the majority of patients. The median Injury Severity Score was 32 (IQR 24-41). Motor vehicle collisions accounted for 94% of injury mechanisms. Twenty-three (5.9%) were identified with pneumomediastinum, 6 (1.5%) with both pneumomediastinum and pneumopericardium, and 1 (0.2%) with isolated pneumopericardium. No patient required surgery for thoracic trauma. Increasing age (p < 0.001) and a flail chest (p = 0.005) were significant associations. The mortality rate was almost identical in those with or without air within the mediastinum. No patient died from a missed mediastinal aero-digestive injury.
Conclusion
The presence of PM/PC following BTC is incidental and benign. Increased injury severity with a flail chest is associated with a significant increase in the presence of free gas within the mediastinum. In the absence of complications, no obvious injury to the intrathoracic aero-digestive tract on CT scanning, and no difference in mortality, a conservative management policy is warranted.
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Κυριακή 22 Απριλίου 2018
Going Beyond Zip Code: Can a Person's Address Help Us Improve Their Acute Care?
Academic Emergency Medicine, EarlyView.
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Issue Information
Academic Emergency Medicine, Volume 25, Issue 4, Page 373-377, April 2018.
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Σάββατο 21 Απριλίου 2018
Risk factors associated with short term mortality changes over time, after arrival to the emergency department
Preventing death is the most important outcome pursued in the Emergency Department. Prompt accurate assessment, followed by competent and efficient investigation and treatment is the recipe sought. Abnormal ph...
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Neb. county equips public places with AEDs
Platte County voted to purchase seven automated defibrillators that can save lives of members of the public and employees who suddenly suffer cardiac arrest
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Παρασκευή 20 Απριλίου 2018
EAST Multicenter Trial on Targeted Temperature Management for Hanging-Induced Cardiac Arrest
BACKGROUND We sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study. METHODS We analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category (CPC) score of 1 or 2 was considered good neurologic outcome, while CPC of 3 or 4 was considered poor outcome. Classification and Regression Trees (CART) recursive partitioning was used to develop multivariate predictive models for survival and neurological outcome. RESULTS Total of 692 hanging patients from 17 centers were analyzed for this study. Their overall survival rate was 77%, and the CA survival rate was 28.6%. The CA patients had significantly higher severity of illness and worse outcome than the non-CA patients. Of the 175 CA patients who survived to hospital admission, 81 patients (46.3%) received post-cardiac arrest TTM. The unadjusted survival of TTM CA patients (24.7% vs 39.4%, p
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Artificial Intelligence Can Predict Daily Trauma Volume and Average Acuity
Introduction The goal of this study was to integrate temporal and weather data in order to create an artificial neural network (ANN) to predict trauma volume, the number of emergent operative cases, and average daily acuity at a level 1 trauma center. Methods Trauma admission data from TRACS and weather data from the National Oceanic and Atmospheric Administration (NOAA) was collected for all adult trauma patients from July 2013-June 2016. The ANN was constructed using temporal (time, day of week), and weather factors (daily high, active precipitation) to predict four points of daily trauma activity: number of traumas, number of penetrating traumas, average ISS, and number of immediate OR cases per day. We trained a two-layer feed-forward network with 10 sigmoid hidden neurons via the Levenberg-Marquardt backpropagation algorithm, and performed k-fold cross validation and accuracy calculations on 100 randomly generated partitions. Results 10,612 patients over 1,096 days were identified. The ANN accurately predicted the daily trauma distribution in terms of number of traumas, number of penetrating traumas, number of OR cases, and average daily ISS (combined training correlation coefficient r = 0.9018+/-0.002; validation r = 0.8899+/- 0.005; testing r = 0.8940+/-0.006). Conclusion We were able to successfully predict trauma and emergent operative volume, and acuity using an ANN by integrating local weather and trauma admission data from a level 1 center. As an example, for June 30, 2016, it predicted 9.93 traumas (actual: 10), and a mean ISS score of 15.99 (actual: 13.12); see figure 3. This may prove useful for predicting trauma needs across the system and hospital administration when allocating limited resources. Evidence Level Level III Study Type Prognostic/Epidemiological 48th Annual Western Trauma Association Meeting, February 26, 2018 in Whistler, BC, Canada Correspondence to: Oscar.Guillamondegui@Vanderbilt.edu, 1211 21st Ave S #404, Nashville, TN 37212Conflict of Interest: There was no support from pharmaceutical or other industry, or from grants or other sources of funding. © 2018 Lippincott Williams & Wilkins, Inc.
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The Dantastic Mr. Tox & Howard Episode 11 – In the Weeds with the Full Monte
https://ift.tt/2vwkF7V Legalization, edible issues and airport amnesty dumpster diving with Dr. Andrew Monte Join Dan (@drusyniak) &howard (@heshiegreshie) as they discuss all things marijuana with Dr. Andrew Monte (@PreciseMDMonte) on this very special day. Learn about the interaction between marijuana and ERs in Colorado before and after legalization, the influence of Big Green, and why […]
EMCrit Project by Tox & Hound.
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The Dantastic Mr. Tox & Howard Episode 11 – In the Weeds with the Full Monte
https://ift.tt/2vwkF7V Legalization, edible issues and airport amnesty dumpster diving with Dr. Andrew Monte Join Dan (@drusyniak) &howard (@heshiegreshie) as they discuss all things marijuana with Dr. Andrew Monte (@PreciseMDMonte) on this very special day. Learn about the interaction between marijuana and ERs in Colorado before and after legalization, the influence of Big Green, and why […]
EMCrit Project by Tox & Hound.
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Evolution of Acute Kidney Injury and Its Association With Systemic Hemodynamics in Children With Fluid-Refractory Septic Shock
Objectives: There are no studies in pediatrics evaluating the progression of acute kidney injury in septic shock. We investigated the evolution of sepsis-associated acute kidney injury and its association with systemic hemodynamics in children with fluid-refractory septic shock. Design: Prospective cohort study. Setting: PICU of a tertiary care hospital. Patients: All patients with fluid-refractory septic shock (n = 61) between September 2010 and February 2014. Interventions: Hemodynamic variables using noninvasive ultrasound cardiac output monitor were measured at admission and 6 hourly thereafter till 48 hours. We used the Kidney Disease: Improving Global Outcomes criteria to define and stage acute kidney injury. Associations between various hemodynamic variables and development of acute kidney injury were evaluated. Severe acute kidney injury was defined as stage 2 or 3 acute kidney injury and was compared with no acute kidney injury or stage 1 acute kidney injury. Measurements and Main Results: Severe acute kidney injury developed in 29.5% (n = 18) of the 61 children with fluid-refractory septic shock, whereas 43 patients (70.49%) had either no or stage 1 acute kidney injury. Most patients who developed acute kidney injury did so within the first 48 hours of PICU admission. Severe acute kidney injury conferred a three-fold increased risk of death by day 28 (hazard ratio, 3.23; 95% CI, 1.52–6.67; p = 0.002), longer ICU stay, and increased duration of mechanical ventilation. Central venous pressure at presentation was higher in severe acute kidney injury by 5 cm H2O. Highest lactate in the first 24 hours of PICU admission, low diastolic blood pressure, low systemic vascular resistance index at admission were associated with severe acute kidney injury. This model reliably predicted stage 2/3 acute kidney injury by day 3 with area under the curve equals to 94%; 95% CI, 88.3–99.99. None of the other hemodynamic variables showed any association with severe acute kidney injury. Conclusions: Manifestations of sepsis-associated acute kidney injury often occur early after PICU admission and is associated with increased morbidity and mortality. There is a need to develop a predictive model in septic shock which could facilitate early detection of acute kidney injury. This work was performed at King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom. Ethical Statement: This was an observational study of routinely monitored hemodynamic and biochemical variables in the clinical management of children in septic shock in PICU and their outcomes. All children received standard therapies. Therefore, according to local guidelines, Ethics Committee review was not required. However, this study was registered as a service evaluation project at King’s College Hospital (Clinical Audit Support System project no. 2902). Dr. Deep is the supervisor who conceptualized the project and supervised data collection, interpretation and has reviewed and edited the article. He is the corresponding author. Drs. Sagar and Karthikeyan collected the data and contributed to the initial article. Drs. Goonasekera and Brierley helped edit the article. Dr. Douiri is senior lecturer of Biostatistics and Epidemiology in the department of primary care and public health sciences at King’s College London who advised the statistical design and analysis of the data. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/29S62lw). Dr. Douiri acknowledges financial support from the National Institute for Health Research (NIHR) Biomedical Research and from the NIHR Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust. The remaining authors have disclosed that they do not have any potential conflicts of interest. Address requests for reprints to: Akash Deep, MD, FRCPCH, PICU, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom. E-mail: akash.deep@nhs.net Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
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Near-Continuous Glucose Monitoring Makes Glycemic Control Safer in ICU Patients
Objectives: Tight glycemic control using intermittent blood glucose measurements is associated with a risk of hypoglycemia. Glucose concentrations can now be measured near continuously (every 5–15 min). We assessed the quality and safety of glycemic control guided by a near-continuous glucose monitoring system in ICU patients. Design: Prospective, cluster-randomized, crossover study. Setting: Thirty-five–bed medico-surgical department of intensive care with four separate ICUs. Patients: Adult patients admitted to the department and expected to stay for at least 3 days were considered for inclusion if they had persistent hyperglycemia (blood glucose > 150 mg/dL) up to 6 hours after admission and/or were receiving insulin therapy. Interventions: A peripheral venous catheter was inserted in all patients and connected to a continuous glucose monitoring sensor (GlucoClear; Edwards Lifesciences, Irvine, CA). The four ICUs were randomized in pairs in a crossover design to glycemic control using unblinded or blinded continuous glucose monitoring monitors. The insulin infusion rate was adjusted to keep blood glucose between 90 and 150 mg/dL using the blood glucose values displayed on the continuous glucose monitor (continuous glucose monitoring group—unblinded units) or according to intermittent blood glucose readings (intermittent glucose monitoring group—blinded units). Measurements and Main Results: The quality and safety of glycemic control were assessed using the proportion of time in range, the frequency of blood glucose less than 70 mg/dL, and the time spent with blood glucose less than 70 mg/dL (TB70), using blood glucose values measured by the continuous glucose monitoring device. Seventy-seven patients were enrolled: 39 in the continuous glucose monitoring group and 38 in the intermittent glucose monitoring group. A total of 43,107 blood glucose values were recorded. The time in range was similar in the two groups. The incidence of hypoglycemia (8/39 [20.5%] vs 15/38 [39.5%]) and the TB70 (0.4% ± 0.9% vs 1.6% ± 3.4%; p
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Ky. fire dept. seeking grant for firefighter, EMS body armor
The department is asking for a $44,600 Homeland Security grant to purchase body armor responders can wear during incidents where responders might be in danger
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Characterization of the Glucocorticoid Receptor in Children Undergoing Cardiac Surgery
Objectives: Postoperative administration of corticosteroids is common practice for managing catecholamine refractory low cardiac output syndrome. Since corticosteroid activity is dependent on the glucocorticoid receptor, we sought to characterize glucocorticoid receptor levels in children undergoing cardiac surgery and examined the association between glucocorticoid receptor levels and cardiovascular dysfunction. Design: Prospective observational cohort study. Setting: Large, tertiary pediatric cardiac center. Subjects: Children undergoing corrective or palliative cardiac surgery. Interventions: None. Measurements and Main Results: A prospective observational cohort study was conducted in 83 children with congenital heart disease. Total glucocorticoid receptor levels were measured in the peripheral WBCs using flow cytometry. In addition, blood samples were collected for total cortisol levels. The primary outcome studied was the time to being inotrope free. An increase in glucocorticoid receptor level from postoperative day 1 to postoperative day 3 was associated with a longer time to being inotrope free (hazard ratio, 0.49 [0.29–0.81]; p = 0.01) in the univariate analysis. This association remained significant after adjusting for age, weight, cardiopulmonary bypass time, cross clamp time, Risk Adjustment for Congenital Heart Surgery-1 score, and postoperative steroid use (hazard ratio, 0.53 [0.29–0.99]; p = 0.05). Postoperative day 3 glucocorticoid receptor level showed a trend to have longer time to being inotrope free (hazard ratio, 0.66 [0.42–1.02]; p = 0.0.06). The cortisol levels minimally increased during the study duration and did not correlate with glucocorticoid receptor levels. Conclusions: Increasing glucocorticoid receptor levels in peripheral WBCs of children undergoing cardiac surgery are associated with a longer time to being inotrope free. Cortisol levels minimally increased during the study duration. These results suggest that exposure to high-dose perioperative corticosteroids may suppress the hypothalamic-pituitary-adrenal axis leading to increase in glucocorticoid receptor levels in response to a low cortisol environment. Further studies are required to better delineate the interplay between glucocorticoid receptor levels, cortisol levels, corticosteroid exposure, and postoperative inotropic requirements. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). Drs. Alder’s and Wong’s institutions received funding from the National Institutes of Health (NIH), and they received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: saul.flores2@bcm.edu ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
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Landiolol Hydrochloride Rapidly Controls Junctional Ectopic Tachycardia After Pediatric Heart Surgery
Objectives: Junctional ectopic tachycardia is a supraventricular tachyarrhythmia with atrioventricular dissociation that causes life-threatening postsurgical conditions in pediatric heart patients. This study evaluates the efficacy of landiolol hydrochloride for managing junctional ectopic tachycardia. Design: A single-center retrospective study. Setting: PICU at the university hospital. Patients: Of 561 pediatric patients who underwent open-heart surgery between 2006 and 2017, 10 patients developed sustained junctional ectopic tachycardia and were selected for landiolol treatment. Interventions: None. Measurements and Main Results: Landiolol decreased mean heart rate significantly from 206.1 ± 14.5 to 158.0 ± 8.6 beats/min within 2 hours after administration (p
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Ky. fire department requests grant for body armor
The department is asking for a $44,600 Homeland Security grant to purchase body armor firefighters can wear during incidents where responders might be in danger
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3 reasons to attend the EMS PRO conference
Keep up with the latest best practices and learn from EMS experts, vendors and peers at the annual conference and trade show
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The prognostic impact of abdominal surgery in cancer patients with neutropenic enterocolitis: a systematic review and meta-analysis, on behalf the Groupe de Recherche en Réanimation Respiratoire du patient d’Onco-Hématologie (GRRR-OH)
Neutropenic enterocolitis (NE) is a diagnostic and therapeutic challenge associated with high mortality rates, with controversial opinions on its optimal management. Physicians are usually reluctant to select ...
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Acid–base status and its clinical implications in critically ill patients with cirrhosis, acute-on-chronic liver failure and without liver disease
Acid–base disturbances are frequently observed in critically ill patients at the intensive care unit. To our knowledge, the acid–base profile of patients with acute-on-chronic liver failure (ACLF) has not been...
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De-escalation of antifungal treatment in critically ill patients with suspected invasive Candida infection: incidence, associated factors, and safety
Antifungal treatment is common in critically ill patients, but only a small proportion of patients receiving antifungals have a proven fungal infection. However, antifungal treatment has side effects such as t...
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Six-month Follow Up of the Injured Trauma Survivor Screen (ITSS): Clinical Implications and Future Directions
Background The Injured Trauma Survivor Screen (ITSS) has been shown to predict PTSD and depression risk at one-month after traumatic injury. This study explored the ability of the ITSS to predict chronic distress after injury, as well as the impact of combining the ITSS with an additional screening measure. Method Patients were enrolled following admission to a Level 1 trauma center. Baseline measurements were collected during initial hospitalization, and follow-up measures were collected an average of 6.5 months after injury. Receiver Operating Characteristic (ROC) curve analyses were run to determine predictive accuracy, controlling for participants who had mental health intervention and for those who experienced additional potentially psychologically traumatic events since their injury event. Results Utilizing a cut score of 2, the ITSS PTSD scale had a sensitivity of 85.42%, specificity 67.35%, NPV 91.9% and PPV 51.4%. The Combined PTSD risk group (risk positive on the baseline ITSS and the PTSD Checklist for the DSM-5) had a sensitivity of 72.92%, specificity 81.63%, NPV 88.2% and PPV 61.6%. Also utilizing a cut score of 2, the ITSS Depression scale had a sensitivity of 72.50%, specificity 70.29%, NPV 91.1% and PPV 37.9%. Conclusions The 9-item ITSS, which takes approximately five minutes to administer, is a stable screening tool for predicting those most at risk for PTSD and/or depression six-months after admission to a Level 1 trauma center following traumatic injury. The Combined PTSD risk group data provide evidence that symptom evaluation by a psychologist can improve specificity. These results further inform the recommendation of the American College of Surgeons Committee on Trauma regarding PTSD and depression screening in trauma centers. Level of Evidence Prognostic study, Level III. Corresponding Author: Joshua C. Hunt, Ph.D., Medical College of Wisconsin, 9200 West Wisconsin Ave., Milwaukee, WI 53226. 414-805-8641. Fax: 414-805-8641. jhunt@mcw.edu The authors have no conflicts of interest to report. Funded in part byNIH grant, 1 R21 MH 102838-01 A1 76th Annual Meeting of AAST and Clinical Congress of Acute Care Surgery, September 13-16, 2017, in Baltimore, MD © 2018 Lippincott Williams & Wilkins, Inc.
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Mobile Forward Looking Infrared Technology Allows Rapid Assessment of Resuscitative Endovascular Balloon Occlusion of the Aorta in Hemorrhage and Blackout Conditions
INTRODUCTION Objective assessment of final REBOA position and adequate distal aortic occlusion is critical in patients with hemorrhagic shock, especially as feasibility is being increasingly investigated in the pre-hospital setting. We propose that mobile forward looking infrared (FLIR) thermal imaging is a fast, reliable, and non-invasive method to assess REBOA position and efficacy in scenarios applicable to battlefield and pre-hospital care. METHODS Ten swine were randomized to a 40% hemorrhage group (H, n=5) or non-hemorrhage group (NH, n=5). Three experiments were completed after zone one placement of a REBOA catheter. REBOA was deployed for 30 minutes in all animals followed by randomized continued deployment vs sham in both light and blackout conditions. FLIR images and hemodynamic data were obtained. Images were presented to 62 blinded observers for assessment of REBOA inflation status. RESULTS There was no difference in hemodynamic or laboratory values at baseline. The H group was significantly more hypotensive (MAP 44 vs 60, p
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Plasma Co-Administration Improves Resuscitation with Tranexamic Acid or Prothrombin Complex in a Porcine Hemorrhagic Shock Model
BACKGROUND Traumatic coagulopathy has now been well characterized and carries high rates of mortality due to bleeding. A "factor-based" resuscitation strategy using pro-coagulant drugs and factor concentrates in lieu of plasma is being used by some, but with little evidentiary support. We sought to evaluate and compare resuscitation strategies using combinations of tranexamic acid (TXA), prothrombin complex concentrate (PCC), and fresh frozen plasma (FFP). METHODS 60 adult swine underwent 35% blood volume hemorrhage combined with a truncal ischemia-reperfusion injury to produce uniform shock and coagulopathy. Animals were randomized to control (N=12), a single agent group (TXA, N=10, PCC, N=8, or FFP, N=6) or combination groups (TXA-FFP, N=10, PCC-FFP, N=8, TXA-PCC, N=6). Resuscitation was continued to 6 hours. Key outcomes included hemodynamics, lab values, and rotational thromboelastometry (ROTEM). Results were compared between all groups, with additional comparisons between FFP and non-FFP groups. RESULTS All 60 animals survived to 6 hours. Shock was seen in all animals, with hypotension (MAP 44mmHg), tachycardia (HR 145), acidosis (pH 7.18, lactate 11), anemia (HCT 17), and coagulopathy (Fibrinogen 107). There were clear differences between groups for mean pH (p=0.02), INR (p
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Deconstructing Dogma: Non-Operative Management of Small Bowel Obstruction in the Virgin Abdomen
Background Management of small bowel obstruction (SBO) has become more conservative, especially in those patients with previous abdominal surgery (PAS). However, surgical dogma continues to recommend operative exploration for SBO with no PAS. With the increased use of CT imaging resulting in more SBO diagnoses, it is important to reevaluate the role of mandatory operative exploration. Gastrografin administration decreases the need for operative exploration and may be an option for SBO without PAS. We hypothesized that the use of GG for SBO without PAS will be equally effective in reducing the operative exploration rate compared to that for SBO with PAS. Methods A post-hoc analysis of prospectively collected data was conducted for patients with SBO from February 2015 through December 2016. Patients
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A DUAL METHOD APPROACH TO IDENTIFYING INTIMATE PARTNER VIOLENCE WITHIN A LEVEL 1 TRAUMA CENTER
Background Intimate partner violence (IPV) is a serious public health problem leading many health care organizations to recommend universal screening as part of standard health care practice. Prior work shows that most IPV victims and perpetrators are unidentified by health care staff. We sought to enhance the capacity of an urban trauma center to identify IPV using a dual-method screening tool, and to establish prevalence of IPV victimization and perpetration among this population. Methods Patients aged 18 and over were recruited from a Level 1 Trauma Center from May 2015 to July 2017. Participants were assessed for IPV using a touch-screen tablet and then via face-to-face assessment. The data were used to determine feasibility of this dual-method and to establish prevalence of IPV in this sample. Results Of 586 eligible patients, 250 were successfully recruited for the study (43% response rate). Using the subscales of physical abuse, severe psychological abuse, and sexual coercion from the tablet-based CTS-2, 40% of women and 34% of men met criteria for IPV exposure in the past year and 35.6% of men and 50.6% of women met criteria using the face-to-face screen. In total, 102 patients (40.8%) screened positive using the dual method. Conclusion This study reports on a dual method to improve screening and identification of IPV in a Level 1 Trauma Center. Ultimately, the dual screening method identified more victims than either method on its own. Our findings provide evidence to standardize universal screening in our trauma center. Moving forward, we will link screening results to medical record data to identify predictors of patients’ current experiences of psychological and physical IPV. Our ultimate goal is to use these predictors to build a model for identifying patients who are at high risk for IPV victimization or perpetration. Level of Evidence Level III, Epidemiological; intimate partner violence; screening; trauma center Address correspondence to: Susan DiVietro, Connecticut Children’s Medical Center, Injury Prevention Center, 282 Washington Street, Hartford, CT 06106, sdivietro@connecticutchildrens.org, 860-837-5311. Funding Source: No external funding for this manuscript. Presentations: This paper will be presented as a Quickshot Presentation at the 76th Annual Meeting of AAST and Clinical Congress of Acute Care Surgery in Baltimore, MD. Financial Disclosure: The authors have no financial relationships relevant to this article to disclose. Conflict of Interest: The authors have indicated they have no potential conflicts of interest to disclose. © 2018 Lippincott Williams & Wilkins, Inc.
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The use of ABC score in activation of massive transfusion: The Yin and the Yang
BACKGROUND Hemorrhage is the most common cause of early death in trauma patients. Massive Transfusion Protocols (MTP) have been designed to accelerate the release of blood products but can result in waste if activated inappropriately. The Assessment of Blood Consumption (ABC) score has become a widely accepted score for MTP activation. In this study we compare the use of ABC criteria to physician judgment in MTP activation. METHODS Adult trauma patients treated at University of Louisville Trauma Center from January 2016 to December 2016 were studied. Activation via ABC score was assessed retrospectively from ED data. Location, timing of activation, percent of patients using more than five units of pRBC, amount of product waste, factors associated with early activation by physicians and mortality were analyzed. RESULTS 3,421 patients were included in this study. Only 33% of the patients who would have had MTP activation based on the ABC criteria used more than 5 units of blood products within 24 hours of admission compared to 65% of the patients in whom clinical judgment was used. 76% of all MTP activations from clinical judgment would have been activated by the ABC criteria in the ED. 55% of all MTP activations via clinical judgment were activated in the OR and 41% in the ED. 81% of activations that occurred in the OR by physician judgment could have been activated earlier in the ED if the ABC criteria had been used. However, ABC score can lead to higher potential FFP waste (588u vs 84u) compared to physician judgement. CONCLUSION ABC criteria overestimates need for MT and can lead to increased product waste compared to physician judgement, but its use leads to earlier MTP activation. Criteria to trigger MT activation should rely on both clinical acumen and validated prediction tools. Study type Diagnostic test Level of Evidence Level 3 Correspondence: Amirreza Motameni MD, Department of Surgery, University of Louisville, Email: amirm1231@gmail.com, 550 South Jackson Street, Louisville, KY 40202 There are no conflicts of interest for any of the above-mentioned authors, this incudes pharmaceutical and/or industry support. No funding was received for this work. This work was presented at 31st Annual Meeting of the Eastern Association for the Surgery of Trauma, January 9-13, 2018 in Lake Buena Vista, Florida. Electronically Signed: Amirreza Motameni MD © 2018 Lippincott Williams & Wilkins, Inc.
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Anti-oxidant treatment after injury suppresses second hit immune priming
Background Pulmonary contusion is a common injury that often results in priming for exaggerated inflammatory responses to a second hit. Previous studies used a mouse model of pulmonary contusion and showed an early and sustained reduction of SIRT1 protein and activity in the lung and BAL cells of injured mice. Sustained decrease in SIRT1 was associated with a primed phenotype in injured mice challenged with an inflammatory stimulus. This study tests the hypothesis that pulmonary contusion induces oxidant production that modifies and decreases SIRT1 and primes the lung for the second hit response. Methods A mouse model of pulmonary contusion was used to investigate injury induced oxidant changes in SIRT1. Second hit responses were evaluated by infection (S. pneumoniae) and inflammatory challenge using bacterial lipopolysaccharide. BAL, lung tissue and blood were collected and used to evaluate inflammatory responses and SIRT1 levels, oxidant modification, and activity. Levels of NO in the BAL from mice and patients with PC were also assessed. Results We found that oxidants produced as a result of pulmonary contusion resulted in modification of SIRT1. S-Nitrosylation was observed and correlated with increased inducible nitric oxide synthase expression after injury. Anti-oxidant treatment of injured mice preserved SIRT1 activity, decreased second hit responses and improved lung function. Elevated NO levels in the BAL of PC patients was associated with ARDS or diagnosis of pneumonia. Conclusions We conclude that oxidative stress in the lung after injury induces redox modification of SIRT1 and contributes to priming of the lung for a second hit response. Anti-oxidant treatment suggests that SIRT1 activity after injury may be beneficial in suppressing second hit responses. This work was supported, in part, by the Clowes/ACS/AAST Award and GM083154 (JH), R33CA1777461 and R21ES025645 (CMF), and AI065791 and AI079144 (CM, BY). All authors declare no conflicts of interest. Corresponding author: J. Jason Hoth, MD., PhD., Department of General Surgery, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157. e-mail: jhoth@wakehealth.edu © 2018 Lippincott Williams & Wilkins, Inc.
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Independent Predictors of Survival After Traumatic Atlanto-Occipital Dissociation
Background Atlanto-occipital dissociation (AOD) occurs when the skull base is forcibly separated from the vertebral column. Existing literature on AOD is sparse and risk factors for mortality are unknown. This study determined independent predictors of survival after AOD. Methods Patients who sustained AOD were identified from the NTDB (2007-2014). Those arriving without signs of life or with missing mortality data were excluded. Study groups were defined as patients who survived to hospital discharge vs patients who died in hospital. Demographics, injury data, interventions, and outcomes were compared between groups using univariate analysis. Multivariate logistic regression was used to determine independent predictors of survival. Results After applying exclusion criteria, 1489 patients (0.05). Patients who survived had a median hospital LOS of 5 days [IQR 1-14] and ICU LOS of 1 day [IQR 0-7]. The most common discharge destination was home (n=395, 26%). Conclusions Traumatic AOD is not uniformly fatal, with 78% of patients who arrive alive to hospital surviving to discharge. When death occurs, it is typically within the first 23 hours. Lower ISS and higher GCS on admission independently predict survival, while time to neurosurgical intervention does not. Survivors have a short hospital stay and are commonly discharged home. This study suggests that AOD among patients who arrive alive to hospital may not be as devastating as previously considered. Level of Evidence III Study Type Prognostic and Epidemiological Address for Correspondence and Reprints: Kenji Inaba, MD, FRCSC, FACS, Division of Trauma and Surgical Critical Care, LAC + USC Medical Center, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA 90033, E-mail: kinaba@surgery.usc.edu Conflict of Interest The authors have no conflicts of interest or disclosures of funding to declare. Presentations The results of this study were presented at the Trauma Association of Canada (TAC) Annual Meeting in Toronto, Canada on February 22-23, 2018. © 2018 Lippincott Williams & Wilkins, Inc.
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THE EPIDEMIOLOGY OF EMERGENCY DEPARTMENT THORACOTOMY IN A STATEWIDE TRAUMA SYSTEM: DOES CENTER VOLUME MATTER?
Introduction The relationship between high volume and improved outcomes has been described for a host of elective high-impact, low-frequency procedures, but there are little data to support such a relationship in high-impact low-frequency procedures in trauma. Using emergency department thoracotomy (EDT) as a model, we hypothesized that patients presenting to centers with higher institutional volumes of EDT would have improved survival referent to those presenting to lower volume institutions. Materials and Methods We queried the Pennsylvania Trauma Outcomes Study (PTOS) registry from 2007-2015 for all EDTs performed at level I and II centers identified by ICD-9 procedure codes and a location stamp indicating the emergency department. We examined patient-level risk factors for survival in univariate regression and multivariable regression models. Centers were divided into tertiles of mean annual EDT volume and the association between mean annual EDT volume and patient survival was examined using logistic regression after controlling for patient factors. Results 1,399 emergency department thoracotomies were performed at 28 centers. Overall survival was 6.8%. After controlling for patient age, mechanism of injury, signs of life, and injury severity, patients presenting to centers in the highest tertile of volume had significantly higher odds of survival compared to patients presenting to centers in the lowest tertile of volume (OR 4.56, 95% CI 1.43-14.50). Conclusions Patients presenting to centers with higher mean annual volume of EDTs have improved survival compared to those presenting to institutions with lower mean annual EDT volume. Efforts to understand the etiology of this finding may lead to interventions to improve outcomes at lower volume centers. Study type Level 3: Retrospective cohort study Corresponding author and requests for reprint requests: Ryan P. Dumas, MD, Department of Surgery, University of Pennsylvania School of Medicine, 51 N 39th St, MOB building 1st floor, Philadelphia PA 19104. ryan.dumas@uphs.upenn.edu Conflicts of Interest and Source of Funding: No authors have conflicts to declare. DNH is currently supported by a training grant through the National Heart, Lung, and Blood Institute. (K08HL131995) Meetings at which this was presented: 47th World Surgical Congress, August 13-17, 2017, Basel Switzerland. © 2018 Lippincott Williams & Wilkins, Inc.
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Πέμπτη 19 Απριλίου 2018
Coming to the rescue of first responders
Addressing behavioral health needs must be a priority
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One-year and three-year mortality prediction in adult major blunt trauma survivors: a National Retrospective Cohort Analysis
Survivors of trauma are at increased risk of dying after discharge. Studies have found that age, head injury, injury severity, falls and co-morbidities predict long-term mortality. The objective of our study w...
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Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score
Bowel ischemia is a life-threatening emergency defined as an inadequate vascular perfusion leading to bowel inflammation resulting from impaired colonic/small bowel blood supply. Main issue for physicians rega...
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Τετάρτη 18 Απριλίου 2018
ESO continues integration of FIREHOUSE Software®
Key milestones include tighter product integration with ESO EHR; infrastructure improvements, investment in customer service and support; high volume of sales opportunities.
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ESO launches surveillance form for overdose
Specialty Patient Form to help standardize definitions and data collection, highlight responder safety.
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Fla. county considers waiving ambulance fees for locals
Bay County commissioners are considering a policy that would still bill insurance companies, but not require locals to pay out-of-pocket fees
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EMS in the warm zone: Tactical medicine inter-agency training
Considerations for planning interdisciplinary training and staging include properly equipping EMS providers and developing a common lexicon
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Traumatic Brain Injury and Infectious Encephalopathy in Children From Four Resource-Limited Settings in Africa
Objectives: To assess the frequency, interventions, and outcomes of children presenting with traumatic brain injury or infectious encephalopathy in low-resource settings. Design: Prospective study. Setting: Four hospitals in Sub-Saharan Africa. Patients: Children age 1 day to 17 years old evaluated at the hospital with traumatic brain injury or infectious encephalopathy. Interventions: None. Measurements and Main Results: We evaluated the frequency and outcomes of children presenting consecutively over 4 weeks to any hospital department with traumatic brain injury or infectious encephalopathy. Pediatric Cerebral Performance Category score was assessed pre morbidity and at hospital discharge. Overall, 130 children were studied (58 [45%] had traumatic brain injury) from hospitals in Ethiopia (n = 51), Kenya (n = 50), Rwanda (n = 20), and Ghana (n = 7). Forty-six percent had no prehospital care, and 64% required interhospital transport over 18 km (1–521 km). On comparing traumatic brain injury with infectious encephalopathy, there was no difference in presentation with altered mental state (80% vs 82%), but a greater proportion of traumatic brain injury cases had loss of consciousness (80% vs 53%; p = 0.004). Traumatic brain injury patients were older (median [range], 120 mo [6–204 mo] vs 13 mo [0.3–204 mo]), p value of less than 0.001, and more likely male (73% vs 51%), p value of less than 0.01. In 78% of infectious encephalopathy cases, cause was unknown. More infectious encephalopathy cases had a seizure (69% vs 12%; p
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Effects of a PICU Status Asthmaticus De-Escalation Pathway on Length of Stay and Albuterol Use
Objectives: Evaluate the effects of an asthma de-escalation clinical pathway on selected outcomes for patients admitted to a PICU with status asthmaticus. Design: Time series quality improvement trial. Setting: PICU in a tertiary care children’s hospital. Patients: Children age 2–18 years old with a known diagnosis of asthma presenting with status asthmaticus. Intervention: One-hundred five admissions to a PICU for status asthmaticus were treated according to a new de-escalation pathway between August 15, 2015, and August 30, 2016. This group was compared with a prepathway group of 141. Measurements and Main Results: Primary outcome was variability in PICU length of stay. Secondary outcomes were median PICU length of stay, median hospital length of stay, and median duration a patient received continuous nebulized albuterol. The effectiveness of the intervention was tracked using control charts. The postpathway group demonstrated decreased variability of PICU length of stay and time receiving continuous albuterol. Statistically significant decreases were seen in median PICU length of stay (16 vs 13 hr; p = 0.0009), median duration a child spent receiving continuous nebulized albuterol (10.8 vs 7.3 hr; p = 0.0008), and median hospital length of stay (37 vs 31 hr; p = 0.02). Total number of asthma assessments completed by respiratory therapists increased from 741 to 1,087. Conclusions: Implementation of a PICU asthma de-escalation pathway demonstrated statistical decrease in the reported measures for children with status asthmaticus. Although the clinical significance of these changes may be debatable, the results demonstrate that efforts to standardize asthma care in the PICU setting is an area in need of further study. Dr. Brennan was involved in the conception, design, and implementation of this project. He drafted the initial article, performed a portion of the statistical analysis, and created the control charts. Dr. Lowrie was involved in the conception, design, and implementation of this project. She reviewed the analysis and approved the final article for submission. Dr. Wooldridge was involved in the conception, design, and implementation of this project. She reviewed the analysis and approved the final article for submission. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: skbrennan@wustl.edu ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
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Do-Not-Resuscitate Orders in the Neonatal ICU: Experiences and Beliefs Among Staff
Objectives: Studies in adult patients have shown that do-not-resuscitate orders are often associated with decreased medical intervention. In neonatology, this phenomenon has not been investigated, and how do-not-resuscitate orders potentially affect clinical care is unknown. Design: Retrospective medical record data review and staff survey responses about neonatal ICU do-not-resuscitate orders. Setting: Four academic neonatal ICUs. Subjects: Clinical staff members working in each neonatal ICU. Interventions: Survey response collection and analysis. Measurements and Main Results: Participating neonatal ICUs had 14–48 beds and 120–870 admissions/yr. Frequency range of do-not-resuscitate orders was 3–11 per year. Two-hundred fifty-seven surveys were completed (46% response). Fifty-nine percent of respondents were nurses; 20% were physicians. Over the 5-year period, 44% and 17% had discussed a do-not-resuscitate order one to five times and greater than or equal to 6 times, respectively. Fifty-seven percent and 22% had cared for one to five and greater than or equal to 6 patients with do-not-resuscitate orders, respectively. Neonatologists, trainees, and nurse practitioners were more likely to report receiving training in discussing do-not-resuscitate orders or caring for such patients compared with registered nurses and respiratory therapists (p
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Τρίτη 17 Απριλίου 2018
CrewCare Introduction
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CrewCare Introduction
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Learn about stress and mental health with CrewCare
You Are Invited Join us April 19th to learn how the CrewCare project is a vital resource in understanding how stress plays a role in the lives of crew members, organizations and the first responder industry. CrewCare was created in response to growing concerns about mental health. ImageTrend and the collaborative minds behind the project are committed to making a positive impact on the daily struggles ...
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CrewCare Introduction
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CrewCare Introduction
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Should you outsource your ambulance billing or keep it in house?
Weigh the pros and cons of partnering with a billing partner to maximize your revenue
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A novel sampling method to detect airborne influenza and other respiratory viruses in mechanically ventilated patients: a feasibility study
Respiratory viruses circulate constantly in the ambient air. The risk of opportunistic infection from these viruses can be increased in mechanically ventilated patients. The present study evaluates the feasibi...
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Macrophages play an essential role in trauma-induced sterile inflammation and tissue repair
Abstract
Severe trauma is accompanied by a profound activation of the immune system. Patients with polytrauma develop systemic inflammatory response syndrome (SIRS) and often sepsis, which contributes substantially to high mortality of this condition. On a cellular level, necrosis and loss of plasma membrane integrity lead to the release of endogenous “damage-associated molecular patterns” (DAMPs) as danger signals, which in turn activate innate immune cells. Inflammation that occurs in the absence of invading pathogens has been termed sterile inflammation and trauma with tissue damage represents an acute form of sterile inflammation. Macrophages are a heterogeneous group of phagocytes of the innate immune system and serve as sentinels to detect loss of tissue integrity. Macrophages show a remarkable plasticity and undergo phenotypical changes in response to injury and repair. Under basal conditions, tissue-resident macrophages are distributed in various organ systems and have critical functions in tissue development and the maintenance of homeostasis. Inflammatory conditions, such as major trauma, lead to the rapid recruitment of blood-derived monocytes that mature into macrophages as well as direct recruitment of macrophages from the cavity that surrounds the injured organ. This leads to augmentation of the pool of tissue-resident macrophages. Besides their essential role in sensing tissue damage and initiating inflammation, macrophages contribution critically to tissue repair and wound healing, ultimately allowing full restoration. Dysregulated sterile inflammation and defective healing result in chronic inflammatory disease with persistent tissue damage. In this review, we summarize the cellular and molecular mechanisms that lead to activation of sterile inflammation, recruitment of immune cells and initiation of wound healing. We focus on the pivotal role of macrophages played in this context.
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Δευτέρα 16 Απριλίου 2018
EMT remains friends with mom and child she saved 20 years ago
By Molly Crane-Newman New York Daily News NEW YORK — EMT Vivian Lomacang was in the final minutes of her shift when her two-way radio crackled to life with what seemed like an unremarkable job. It was a mild March evening, and the emergency dispatcher reported “a heavy bleeder” inside an apartment at Monroe St. and Marcus Garvey Blvd. in Bedford-Stuyvesant, Brooklyn. Lomacang and her ...
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Couple honors fallen responders with cross-country 'Move Over' campaign
By Bill Hand Sun Journal HAVELOCK, N.C. — It's the law: slow down and move over. The message, American Towman Magazine believes, should go a long way toward protecting first responders, and it has made the slogan its mission, sending a husband and wife team across the country in a special RV, carrying a symbolic coffin, to remind drivers of what happens when they don't give emergency personnel ...
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Illbutrin
by Dan Rusyniak Let me just get this out of the way, I hate bupropion (Wellbutrin™ ) with the “white-hot intensity of a thousand suns” (Hulu). There is nothing “Well” about this drug. It was first synthesized by Burroughs-Wellcome (no, you are not Wellcome) in 1966, and was first approved by the […]
EMCrit Project by Tox & Hound.
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Illbutrin
by Dan Rusyniak Let me just get this out of the way, I hate bupropion (Wellbutrin™ ) with the “white-hot intensity of a thousand suns” (Hulu). There is nothing “Well” about this drug. It was first synthesized by Burroughs-Wellcome (no, you are not Wellcome) in 1966, and was first approved by the […]
EMCrit Project by Tox & Hound.
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Drone standards for public safety boosted by joint effort
The National Fire Protection Association and ASTM International signed a Memorandum of Understanding to support a joint working group of public safety experts
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Uber adds direct 911 button to its app
The button will dial 911 in the case of an emergency as part of the company’s initiative to increase safety for riders
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Couple honors fallen responders with cross-county 'Move Over' campaign
By Bill Hand Sun Journal HAVELOCK, N.C. — It's the law: slow down and move over. The message, American Towman Magazine believes, should go a long way toward protecting first responders, and it has made the slogan its mission, sending a husband and wife team across the country in a special RV, carrying a symbolic coffin, to remind drivers of what happens when they don't give emergency personnel ...
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EMCrit RACC – Analyzing Difficult Resuscitation Cases #1 from ResusMe
STEPUP for case analysis
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EMCrit RACC – Analyzing Difficult Resuscitation Cases #1 from ResusMe
STEPUP for case analysis
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Κυριακή 15 Απριλίου 2018
Couple honor fallen responders with cross-county 'Move Over' campaign
By Bill Hand Sun Journal HAVELOCK, N.C. — It's the law: slow down and move over. The message, American Towman Magazine believes, should go a long way toward protecting first responders, and it has made the slogan its mission, sending a husband and wife team across the country in a special RV, carrying a symbolic coffin, to remind drivers of what happens when they don't give emergency personnel ...
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Nurse saves cardiac arrest victim in spin class
Heather Fleming, a 34-year-old intensive care nurse, was in a morning spin class when a fellow spinner collapsed and appeared to go into cardiac arrest
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A Pilot Randomized Controlled Trial of an Intervention to Promote Psychological Well-Being in Critically Ill Children: Soothing Through Touch, Reading, and Music
Objectives: To examine the feasibility and acceptability of a PICU Soothing intervention using touch, reading, and music. Design: Nonblinded, pilot randomized controlled trial. Setting: The PICU and medical-surgical wards of one Canadian pediatric hospital. Patients: Twenty PICU patients age 2–14 years old and their parents, randomized to an intervention group (n = 10) or control group (n = 10). Intervention: PICU Soothing consisted of: 1) parental comforting (touch and reading), followed by 2) a quiet period with music via soft headbands, administered once daily throughout hospitalization. Measurements and Main Results: Acceptability and feasibility of the intervention and methods were assessed via participation rates, observation, measurement completion rates, semistructured interviews, and telephone calls. Psychological well-being was assessed using measures of distress, sleep, and child and parent anxiety in the PICU, on the wards and 3 months post discharge. Forty-four percent of parents agreed to participate. Seventy percent and 100% of intervention group parents responded positively to comforting and music, respectively. Most intervention group parents (70%) and all nurses felt children responded positively. All nurses found the intervention acceptable and feasible. Measurement completion rates ranged from 70% to 100%. Pilot data suggested lower intervention group child and parent anxiety after transfer to hospital wards. Conclusions: PICU Soothing is acceptable and feasible to conduct. Results support the implementation of a full-scale randomized controlled trial to evaluate intervention effectiveness. ClinicalTrials.gov Identifier: NCT01176188; Unique Protocol identifier: 09-069-PED. This research was funded by the Quebec Interuniversity Nursing Intervention Research Group (GRIISIQ; now the Quebec Nursing Intervention Research Network [RRISIQ]), and the Canadian Nurses Foundation. Dr. Rennick holds a Fonds de recherche du Québec – Santé (FRQ-S) Clinical Research Scholar Award. During the study, Dr. Stremler held a Canadian Institutes of Health Research (CIHR) New Investigator Award and an Ontario Ministry of Research and Innovation Early Researcher Award. Dr. Aita held a CIHR RCT Mentoring Program Award; and Dr. Constantin held an FRQ-S Clinical Scholar Award. Drs. Rennick, Constantin, and Majnemer are members of the Research Institute of the McGill University Health Centre, which is funded by the FRQ-S. The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: janet.rennick@muhc.mcgill.ca ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
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Oral Candida colonization in xerostomic post‐radiotherapy head and neck cancer patients 16h ... Oral Candida colonization in xerostomic post...
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Journal of Medical Case Reports from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2cbjvRY
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Publication date: Available online 6 December 2018 Source: The Journal of Emergency Medicine Author(s): Brit Long, Jennifer Robertson, Al...
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Astronomical constraints on deposition of the Middle Triassic Chang 7 lacustrine shales in the Ordos Basin, Central China Publication date: ...
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The Cardiopulmonary Resuscitation Support Pillow is designed to aid with performing proper CPR for single or dual first responders from EM...
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http://www.bldeujournalhs.in/currentissue.asp?sabs=n Moving toward competency-based medical education Tejaswini Vallabha BLDE University Jou...
