The Dantastic Mr Tox & Howard Episode 6 – Can’t Get Enough Fat On Thanksgiving

  https://ift.tt/2kHI6Db Spatchcocking Intralipid with Dr. Guy Weinberg Join Dan (@drusyniak) &howard (@heshiegreshie) as they talk turkey with Dr. Guy Weinberg (@lipidguy) about intralipid emulsion therapy. Learn the history of this therapy and some ideas about where it's headed, along with some holiday tips and very special treats. . . Truly Delicious Links Martha Stewart's […]

EMCrit Project by Tox & Hound.

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Electrical injury – a dual center analysis of patient characteristics, therapeutic specifics and outcome predictors

Electrical injuries represent life-threatening emergencies. Evidence on differences between high (HVI) and low voltage injuries (LVI) regarding characteristics at presentation, rhabdomyolysis markers, surgical...

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The Dantastic Mr Tox & Howard Episode 6 – Can’t Get Enough Fat On Thanksgiving

  https://ift.tt/2kHI6Db Spatchcocking Intralipid with Dr. Guy Weinberg Join Dan (@drusyniak) &howard (@heshiegreshie) as they talk turkey with Dr. Guy Weinberg (@lipidguy) about intralipid emulsion therapy. Learn the history of this therapy and some ideas about where it's headed, along with some holiday tips and very special treats. . . Truly Delicious Links Martha Stewart's […]

EMCrit Project by Tox & Hound.

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High-dose FXIII Administration Induces Effective Hemostasis for Trauma Associated Coagulopathy (TAC) both in vitro and in Rat Hemorrhagic Shock in vivo Models

Background Trauma associated coagulopathy (TAC) is an early and primary complication in severe trauma patients. FXIII is reported to stabilize a clot in the late phase of the coagulation cascade. The goal of this study was to investigate whether the administration of FXIII improves the condition of TAC both in vitro and in vivo. Methods We evaluated the effects of different doses, including a very high dose of FXIII (3.6- 32.4 IU/ml) on tissue-plasminogen activator (t-PA) induced hyperfibrinolysis and the combined condition of dilutional coagulopathy and t-PA induced hyperfibrinolysis in vitro. The coagulation status was analyzed by thromboelastometry (ROTEM) and Sonoclot. Then, we evaluated the effect of high dose FXIII (300 IU/kg) for severe coagulopathy in vivo using a rat liver trauma model in which coagulopathy similar to TAC was observed. Survival time and the amount of intra-abdominal bleeding of rats were measured and a coagulation test was also performed. Histological evaluations of rats’ lung and kidney after FXIII administration were completed. Results High-dose FXIII significantly improved clot strength as well as increased resistance to hyperfibrinolysis in vitro which was confirmed by ROTEM. Platelet function (PF) on Sonoclot was significantly increased by FXIII in a dose dependent manner. FXIII significantly decreased the total amount of bleeding and prolonged the survival time compared to control (control vs FXIII: 108.9±11.4 vs 32.6±5.5 ml/kg; p

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The Novel Oral Anticoagulants (NOACs) have Worse Outcomes Compared to Warfarin in Patients with Intracranial Hemorrhage after TBI

Introduction Novel-oral-anticoagulants(NOACs) use is increasing in trauma patients. The reversal of these agents after hemorrhage is still evolving. The aim of our study was to evaluate outcomes after traumatic brain injury in patients on NOACs. Methods 3-year (2014-2016) analysis of our prospectively maintained TBI database. We included all TBI patients with intracranial-hemorrhage (ICH) on anticoagulants. Patients were stratified into two groups; those on NOACs and on Warfarin, and were matched in a 1:2 ratio using propensity score matching for demographics, injury and vital parameters, type, and size of ICH. Outcome measures were progression of ICH, mortality, SNF disposition, and hospital and ICU length of stay (LOS). Results We analyzed 1459 TBI patients, of which 210 patients were matched (NAOCs: 70, Warfarin: 140). Matched groups were similar in age (p=0.21), mechanism of injury (p=0.61), GCS (p=0.54), ISS (p=0.62), and type and size of ICH (p=0.09). Patients on pre-injury NOACs had higher rate of progression (p=0.03), neurosurgical intervention (p=0.04), mortality (p=0.04), and longer ICU LOS (p=0.04) compared to patients on warfarin. However, there was no difference in hospital-LOS (p=0.22) and SNF disposition (p=0. 14). On sub-analysis of severe-TBI patients (GCS≤8), rate of progression (p=0.59), neurosurgical intervention (p=0.62) or mortality (p=0.81) was similar in both groups. Conclusions The use of NOACs generally carry a high risk of bleeding and can be detrimental in head injuries with ICH. NOACs use is associated with increased risk of progression of ICH, neurosurgical intervention and mortality after a mild and moderate TBI. Primary care physicians and cardiologists need to reconsider the data on the need for anticoagulation and the type of agent used and weigh it against the risk of bleeding. In addition, development of reversal agents for the NOACs and implementation of a strict protocol for the reversal of these agents may lead to improved outcomes. Level of Evidence Level III, Therapeutic studies Oral presentation for the Earl Young Resident Research Competition at the 48th Annual Meeting of Western Trauma Association, February 25th -March 2nd 2018, British Columbia, Canada. There are no identifiable conflicts of interests to report. The authors have no financial or proprietary interest in the subject matter or materials discussed in the manuscript. Address for correspondence: Bellal Joseph, MD, University of Arizona, Department of Surgery, Division of Trauma, Critical Care, and Emergency Surgery. 1501 N. Campbell Ave, Room.5411, P.O. Box 245063, Tucson, AZ 85727. E-mail: bjoseph@surgery.arizona.edu © 2018 Lippincott Williams & Wilkins, Inc.

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Acute hyperglycemia exacerbates trauma induced endothelial and glycocalyx injury: An in vitro model

Background Early hyperglycemia is associated with higher mortality in trauma and predicts multiple organ failure. Endothelial cell (EC) injury and glycocalyx (GC) degradation occur following traumatic shock and are key factors in the development of trauma-induced coagulopathy, and result in impaired microvascular perfusion and accompanying organ failure. Acute hyperglycemia has been shown to result in the loss of the GC layer, EC inflammation, and activation of coagulation in vivo. We postulated that acute hyperglycemia would exacerbate trauma induced EC injury and GC shedding and integrity. This was studied using a microfluidic device (MFD) in a bio-mimetic in vitro model. Methods Human umbilical vein endothelial cell (HUVEC) monolayers established in the microfluidic channels of a MFD well plate were perfused at constant shear overnight. HUVEC monolayers were then exposed to hypoxia/reoxygenation (H/R) and epinephrine followed by the addition of varying concentrations of glucose. Results Glycocalyx shedding and loss of dimension as well as EC injury/activation were noted after exposure to the bio-mimetic conditions of trauma/shock in our study. Similar but less dramatic findings were noted after acute hyperglycemia. Exposure to hyperglycemia exacerbated the adverse effects on the GC and EC following H/R plus epinephrine exposure and may be related to enhanced production of reactive oxygen species (ROS). Conclusion MFD study may allow the preclinical assessment and development of therapeutic strategies of the vascular barrier under stress conditions. Level of evidence not applicable Correspondence: Lawrence N. Diebel MD, Michael and Marian Ilitch Department of Surgery, 6C University Health Center, 4201 Saint Antoine, Detroit, MI 48201, Phone: 313-577-5314, Fax: 313-577-5310. Email: ldiebel@med.wayne.edu Conflicts of interest to disclose: None This study was presented at the 48th annual meeting of the Western Trauma Association, February 25-March 2, 2018, in Whistler, British Columbia. © 2018 Lippincott Williams & Wilkins, Inc.

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A US Military Role 2 Forward Surgical Team Database Study of Combat Mortality in Afghanistan

BACKGROUND Timely and optimal care can reduce mortality among critically injured combat casualties. US military Role 2 surgical teams were deployed to forward positions in Afghanistan on behalf of the battlefield trauma system. They received prehospital casualties, provided early damage control resuscitation and surgery, and rapidly transferred casualties to Role 3 hospitals for definitive care. A database was developed to capture Role 2 data. METHODS A retrospective review and descriptive analysis was conducted of battle-injured casualties transported to US Role 2 surgical facilities in Afghanistan from February 2008 to September 2014. Casualties were analyzed by mortality status and location of death (pre, intra, or post transport), military affiliation, transport time, injury type and mechanism, combat mortality index-prehospital (CMI-PH), and documented prehospital treatment. RESULTS Of 9,557 casualties (median age, 25.0; male 97.4%), most (95.1%) survived to transfer from Role 2 facility care. Military affiliation included US coalition forces (37.4%), Afghanistan National security forces (23.8%), civilian/other forces (21.3%), Afghanistan National police (13.5%), and non-US coalition forces (4.0%). Mortality differed by military affiliation (p

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As Trauma Surgeons, Let’s Call “Non-Accidental Trauma” What it is: Blunt Force or Penetrating Trauma

No abstract available

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Prevalence and Treatment of Depression and Posttraumatic Stress Disorder among Trauma Patients with Non-neurological Injuries

Background Psychological impairment among injury survivors is well documented. Little is known about the prevalence of treatment of psychological impairment, however. We aimed to determine the proportion of injury survivors treated for depression and post-traumatic stress disorder (PTSD) in the year after injury as well as to determine potential barriers to treatment. Methods Adults (18 and over) admitted to a Level I trauma center with an injury severity score (ISS) greater than 10, but without traumatic brain injury or spinal cord injury were eligible for study inclusion. The Center for Epidemiological Studies-Depression (CES-D) and PTSD CheckList – Civilian Versions (PCL-C) surveys were administered during the initial hospitalization and repeated at 1, 2, 4, and 12 months after injury. Patients were asked if they received treatment specifically for depression or PTSD at each follow-up. Factors associated with treatment were determined using multivariable logistic regression analysis. Results 500 injury survivors were enrolled in this prospective observational study. Of those, 68.4% of patients screened positive for depression at some point in the year after their injury (53.3% 1 month, 49.9% 2 month, 49.0% 4 month, and 50.2% 12 month). Only 22.2% of depressed patients reported receiving treatment for depression. 44.4% of patients screened positive for PTSD (26.6% 1 month, 27.8% 2 month, 29.8% 4 month, and 30.0% 12 month), but only 9.8% received treatment for PTSD. After adjusting for other factors, compared to commercial insurance status, self-pay insurance status was negatively associated with treatment for PTSD or depression (OR 0.44, 95% CI 0.21-0.95). Conclusion Depression and PTSD are common in non-neurotrauma patients in the year following injury. Greater collaboration between those caring for injury survivors and behavioral health experts may help improve psychological outcomes after injury. Level of Evidence Level III Prognostic Presented at the 48th Annual Meeting of the Western Trauma Association February 2018 in Whistler, BC Canada. Research reported in this publication was supported by the National Institute of General Medical Science of the National Institutes of Health under award number K23GM084427 as well as KL2TR001106, and UL1TR001108 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award; the IUPUI Research Support Funds Grant; and the IU Grand Challenge Initiative. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Corresponding Author: Ben L. Zarzaur, MD, MPH, 720 Eskenazi Avenue, H-2 Room 431, Indianapolis, Indiana 46202. bzarzaur@iupui.edu. 317-880-5034 © 2018 Lippincott Williams & Wilkins, Inc.

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The impact of inpatient palliative care on end of life care among older trauma patients who die after hospital discharge

Background Palliative care is associated with lower intensity treatment and better outcomes at the end of life. Trauma surgeons play a critical role in end-of-life (EOL) care, however the impact of PC on healthcare utilization at the end of life has yet to be characterized in older trauma patients. Methods This retrospective cohort study using 2006-2011 national Medicare claims included trauma patients ≥65 years who died within 180 days after discharge. The exposure of interest was inpatient palliative care during the trauma admission. A non-PC control group was developed by exact-matching for age, comorbidity, admission year, injury severity, length of stay, and post-discharge survival. We employed logistic regression to evaluate six EOL care outcomes: discharge to hospice, rehospitalization, skilled nursing facility (SNF) or long-term acute care hospital (LTACH) admission, death in an institutional setting, and intensive care unit (ICU) admission or receipt of life-sustaining treatments (LST) during a subsequent hospitalization. Results Of 294,665 patients who died within 180 days after discharge, 2.1% received inpatient PC. Among 5,693 matched pairs, inpatient PC was associated with increased odds of discharge to hospice (odds ratio [95% confidence interval] = 3.80 [3.54-4.09]) and reduced odds of rehospitalization (0.17[0.15-0.20]), SNF/LTACH admission (0.43[0.39-0.47]), death in an institutional setting (0.34[0.30-0.39]), subsequent ICU admission (0.51[0.36-0.72]), or receiving LST (0.56[0.39-0.80]). Conclusions Inpatient palliative care is associated with lower intensity and less burdensome EOL care in the geriatric trauma population. Nonetheless, it remains underutilized among those who die within 6 months after discharge. Level of Evidence Level III Study Type Prognostic Corresponding Author: Elizabeth J Lilley, 1 Robert Wood Johnson Place, MEB 594, New Brunswick, NJ 08901. (201) 694-8670. lilleyej@rwjms.rutgers.edu Conflicts of Interests: EJL: No conflicts of interest KCL: No conflicts of interest JWS: No conflicts of interest NJK: No conflicts of interest AHH: No conflicts of interest AS: No conflicts of interest RG: No conflicts of interest ZC: No conflicts of interest List of Meetings: 48th Annual Meeting of the Western Trauma Association, February 25 – March 2, 2018 in Whistler, British Columbia, Canada. 41st Annual Residents Trauma Papers Competition during the American College of Surgeons Committee on Trauma Annual Meeting, March 8, 2018 in San Antonio, Texas, United States Disclosures of funding: ZC is supported by the Paul B. Beeson Emerging Leaders Career Development Award in Aging (1K76AG054859-01). © 2018 Lippincott Williams & Wilkins, Inc.

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Developing a National Trauma System: Proposed Governance and Essential Elements

No abstract available

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A Different Form of Injury Prevention: Successful Screening and Referral for HIV and Hepatitis C in a Trauma Population

Background In the United States, millions of patients are living with HIV and Hepatitis C (0.44% and 1.5%) and many are currently undiagnosed. Since highly effective treatments are now available, early identification of these patients is extremely important to achieve improved clinical outcomes. Prior data and trauma-associated risk factors suggest a higher prevalence of both diseases in the trauma population. We hypothesized that a screening program could be successfully initiated amongst trauma activation patients and that a referral and linkage-to-care program could be developed. Methods Hepatitis C and HIV screening tests were added to standard trauma activation lab orders at an academic Level 1 Trauma Center. Confirmatory viral load was sent when indicated. Patients with positive results were educated about their disease and referred to disease-specific follow-up. Data was collected prospectively from January 1, 2016 until June 30, 2017. Total and new diagnosis, referral rates, and linkage-to-care rates were analyzed. Results 1898 patients arrived as trauma activations. 1217 patients (64.1%) were screened (Level A = 75.6%, Level B = 60.2%). 7% of screened patients were initially positive and 5.5% were confirmed positive. Rates of both HIV (1.1%) and Hepatitis C (4.4%) were almost triple the national average. Overall, 3.3% screened positive for a new diagnosis. For Hepatitis C, the rate of new diagnosis was twice the national average (3%). Over 85% of all cases were referred for follow-up and the combined linkage-to-care rate was 43.3%. Conclusions The majority of patients were screened and referred for follow-up indicating successful implementation of our trauma screening program. Routine screening of trauma patients should be considered to increase diagnosis rate, increase linkage-to-care rates, and decrease disease transmission. These screening efforts would help bridge the health care gap that exists in the trauma population due to lower insurance rates and limited access to primary care. Level of Evidence Level III Study Type Prospective Intervention Correspondence: Alicia Privette, MD, FACS, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 613/CSB 420, Charleston, SC 29425. Tel: (843) 792-3780; Fax: (843) 792-5906 Address for reprints: Same as correspondence Conflict of Interest: No conflict of interest exists for any of the authors Meeting Presentation: 48th Annual Meeting of the Western Trauma Association, February 25 to March 2, 2018 in Whistler, Canada Funding disclosure: The authors have no funding for this project to disclose © 2018 Lippincott Williams & Wilkins, Inc.

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In Vitro Effects of a Kaolin Coated Hemostatic Dressing on Anticoagulated Blood

Background The use of kaolin coated dressings has become common and have efficacy in normal patients, but their increased use will inevitably include use on bleeding patients taking anticoagulants. We hypothesize that kaolin coating material (KCM) will improve clotting regardless of anticoagulation medication. Methods A prospective study was performed on blood from patients who were on on a vitamin K antagonist (VKA), unfractionated heparin (UH), an anti-platelet (AP) agent, a Xa inhibitor (Xa), or a direct thrombin inhibitor (DTI). None were on more than one type of anticoagulation medication. Viscoelastic testing was performed with and without KCM. All p-values were adjusted for multiple comparisons. Results The addition of KCM significantly decreased the time for initial clot formation (CT) in all groups. The mean CT for controls was decreased from 692 to 190.8 sec(p

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Carotid and femoral Doppler do not allow the assessment of passive leg raising effects

The hemodynamic effects of the passive leg raising (PLR) test must be assessed through a direct measurement of cardiac index (CI). We tested whether changes in Doppler common carotid blood flow (CBF) and commo...

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Outcomes following trauma laparotomy for hypotensive trauma patients: a UK military and civilian perspective

Background The management of trauma patients has changed radically in the last decade and studies have shown overall improvements in survival. However, reduction in mortality for the many may obscure a lack of progress in some high-risk patients. We sought to examine the outcomes for hypotensive patients requiring laparotomy in UK military and civilian cohorts. Methods We undertook a review of two prospectively maintained trauma databases; the UK Joint Theatre Trauma Registry (JTTR) for the military cohort (4th February 2003 to 21st September 2014), and the trauma registry of the Royal London Hospital MTC (1st January 2012 to 1st January 2017) for civilian patients. Adults undergoing trauma laparotomy within 90 minutes of arrival at the Emergency Department (ED) were included. Results Hypotension was present on arrival at the ED in 155/761 (20.4%) military patients. Mortality was higher in hypotensive casualties 25.8% vs 9.7% normotensive casualties (p

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TIME TO STROKE: A WESTERN TRAUMA ASSOCIATION MULTI-CENTER STUDY OF BLUNT CEREBROVASCULAR INJURIES

Background Screening for blunt cerebrovascular injuries (BCVI) in asymptomatic high-risk patients has become routine. To date, the length of this asymptomatic period has not been defined. Determining the time to stroke could impact therapy including earlier initiation of antithrombotics in multiply injured patients. The purpose of this study is to determine the time to stroke in patients with a BCVI-related stroke. We hypothesized the majority of patients suffer stroke between 24-72 hours after injury. Methods Patients with a BCVI-related stroke from January 2007-January 2017 from 37 trauma centers were reviewed. Results During the 10-year study, 492 patients suffered a BCVI-related stroke; the majority were men (61%) with a median age of 39 and ISS of 29. Stroke was present at admission in 182 (37%) patients and occurred during an IR procedure in 6 patients. In the remaining 304 patients, stroke was identified a median of 48 hours after admission; 53 hours in the 144 patients identified by neurologic symptoms and 42 hours in the 160 patients without a neurologic exam and an incidental stroke identified on imaging. Of those patients with neurologic symptoms, 88 (61%) stroked within 72 hours while 56 stroked after 72 hours; there was a sequential decline in stroke occurrence over the first week. Of the 304 patients who suffered stroke after admission, 64 (22%) patients were being treated with antithrombotics when the stroke occurred. Conclusions The majority of patients suffer BCVI-related stroke in the first 72 hours after injury. Time to stroke can help inform clinicians about initiation of treatment in the multiply injured patient. Level of Evidence Level III, case series for therapeutic/prognostic management The authors have no conflicts of interest related to this study and no outside funding sources. Address correspondence to: Clay Cothren Burlew, MD FACS, Professor of Surgery, Director, Surgical Intensive Care Unit, Program Director, SCC and TACS Fellowships, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock Street, MC 0206, Denver, CO 80204, E-Mail: clay.cothren@dhha.org © 2018 Lippincott Williams & Wilkins, Inc.

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Biliary tract external drainage improves inflammatory mediators and pathomorphology of the intestine, liver, and lung in septic rats

Background To investigate the effect of biliary tract external drainage (BTED) on inflammatory mediators and pathomorphism of intestine, liver, and lung in septic rats. Method 48 SD rats (n=8 per group) were randomized into six groups: control, sepsis, sepsis plus BTED, normal bile (obtained from 8 healthy rats) and septic bile infusion for 6 hours respectively to test the effects of BTED bile infusion on cytokines’ expression and tissue injury in the intestine, liver, and lung of septic/normal rats. Co-cultivation of intestinal epithelial cells (IEC-6) with bile for 12 hours was performed to evaluate the potential cytotoxicity of septic bile. Survival rate for sepsis plus BTED rats was detected compared with sepsis without BTED group (n=20 per group) at 24, 48 and 72 hours respectively. Results BTED for 6 hours significantly reduced the mRNA expression levels of TNF-α and IL-1β (all P

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Lower Extremity Cooling Reduces Ischemia-Reperfusion Injury Following Zone 3 REBOA in a Porcine Hemorrhage Model

Background New strategies to mitigate ischemia during REBOA and to prolong its maximal duration are needed. We hypothesized that simple external cooling of the hind limbs would decrease ischemia-reperfusion injury following prolonged Zone 3 REBOA. Methods 12 swine were anesthetized, instrumented, splenectomized then underwent 15% total blood volume hemorrhage. Animals were randomized to hypothermia or control followed by 4 hours of Zone 3 REBOA, resuscitation with shed blood, and 3 hours of critical care. Physiologic parameters were continuously recorded, and laboratory specimens were obtained at regular intervals. Baseline and end-of-study muscle biopsies were obtained for histologic analysis. Results There were no significant differences between groups at baseline or after hemorrhage. Maximum creatine kinase was significantly lower in the hypothermia group compared to the normothermia group (median [IQR] = 3,445 U/mL [3,380-4,402] vs 22,544 U/mL [17,030-24,981]); p

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Tox & Hound – Pour Some Octreotide on Me

by Kavita Babu       In 1999, a toddler encountered glipizide during an exploratory ingestion. When he wouldn’t wake up from a nap, the family called the EMTs, who found a fingerstick blood sugar of 13 mg/dL. He received several D25 boluses – each time his sugar would respond appropriately, then fall. His care […]

EMCrit Project by Tox & Hound.

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EMCrit Podcast 225 – Tox(&Hound)idromes with Howard & Dan

The real scoop on toxidromes

EMCrit Project by Scott Weingart.

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EMCrit Podcast 225 – Tox(&Hound)idromes with Howard & Dan

The real scoop on toxidromes

EMCrit Project by Scott Weingart.

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Dallas paramedics offering free CPR training at airport

Paramedics from several EMS agencies teaching hands-only CPR to passengers at the Dallas/Fort Worth International Airport

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Payor Logic celebrates hidden superheroes during EMS Week 2018

EMS practitioners and billing administrators acknowledged for industry impact

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The Dantastic Mr. Tox & Howard Episode 12 – Isbister Bitsy Spider

https://ift.tt/2KRMfzc Join Dan (@drusyniak) &howard (@heshiegreshie) as they palaver with Dr. Geoff Isbister (@geoff_isbister) about the poison playground that is Australia. Snakes, spiders and quetiapine, oh my! Learn what color of snake to look out for (hint: all of them), learn how Australians do research (on themselves), and why generally leaving your house down under […]

EMCrit Project by Tox & Hound.

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The Dantastic Mr. Tox & Howard Episode 12 – Isbister Bitsy Spider

https://ift.tt/2KRMfzc Join Dan (@drusyniak) &howard (@heshiegreshie) as they palaver with Dr. Geoff Isbister (@geoff_isbister) about the poison playground that is Australia. Snakes, spiders and quetiapine, oh my! Learn what color of snake to look out for (hint: all of them), learn how Australians do research (on themselves), and why generally leaving your house down under […]

EMCrit Project by Tox & Hound.

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EM Nerd-The Case of the Deceptive Beacon

Let’s face it, we have an unhealthy relationship with antibiotics. We are all aware that we are currently in an antibiotic resistance crisis that is driven by overuse. And despite our enlightenment we cannot seem to stop prescribing antibiotics for complaints that have been clearly shown not to require antibiotics. And so, given our appalling […]

EMCrit Project by Rory Spiegel.

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EM Nerd-The Case of the Deceptive Beacon

Let’s face it, we have an unhealthy relationship with antibiotics. We are all aware that we are currently in an antibiotic resistance crisis that is driven by overuse. And despite our enlightenment we cannot seem to stop prescribing antibiotics for complaints that have been clearly shown not to require antibiotics. And so, given our appalling […]

EMCrit Project by Rory Spiegel.

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Effects of Helicobacter pylori eradication for metachronous gastric cancer prevention: A randomized controlled trial

Gastrointestinal Endoscopy

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Safety and effectiveness of Factor Eight Inhibitor Bypassing Activity for direct oral anticoagulant-related hemorrhage reversal

The American Journal of Emergency Medicine

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Septic acute kidney injury patients in Emergency Department: The risk factors and its correlation to serum lactate

The American Journal of Emergency Medicine

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Management of major bleeding and outcomes in patients treated with direct oral anticoagulants: Results from the START-Event registry

Internal and Emergency Medicine

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Management outcomes of diverticulitis and colitis in patients with active cancer

Surgery

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Interleukin-6 as a diagnostic marker for infection in critically ill patients: A systematic review and meta-analysis

The American Journal of Emergency Medicine

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Forecasting respiratory infectious outbreaks using ED-based syndromic surveillance for febrile ED visits in a Metropolitan City

The American Journal of Emergency Medicine

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Automated Pulmonary Embolism Risk Classification and Guideline Adherence for Computed Tomography Pulmonary Angiography Ordering

Academic Emergency Medicine, EarlyView.


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Slow Infusion of Low‐dose Ketamine Reduces Bothersome Side Effects Compared to Intravenous Push: A Double‐blind, Double‐dummy, Randomized Controlled Trial

Academic Emergency Medicine, EarlyView.


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The Banner of Hope and Solidarity After Mass Murder

Academic Emergency Medicine, EarlyView.


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In Reply:

Academic Emergency Medicine, EarlyView.


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'EMS Strong' celebrates the bonds that encourage, inspire EMS providers

EMS1 leaders reflect on the fitting theme of EMS Week 2018, and how their colleagues have furthered their own careers and contributions to the field

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Celebrating EMS Week 2018

Departments around the country are marking the occasion by enhancing their training skills, teaching lifesaving lessons to the public and reminding providers to always have their partner's back.

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Celebrating EMS Week 2018

Departments around the country are marking the occasion by enhancing their training skills, teaching lifesaving lessons to the public and reminding providers to always have their partner's back.

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Comparing population and incident data for optimal air ambulance base locations in Norway

Helicopter emergency medical services are important in many health care systems. Norway has a nationwide physician manned air ambulance service servicing a country with large geographical variations in populat...

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Celebrating EMS Week 2018

Departments around the country are marking the occasion by enhancing their training skills, teaching lifesaving lessons to the public and reminding providers to always have their partner's back.

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Positive Identification feature available in Elite for EMS

LAKEVILLE, Minn. — ImageTrend, Inc. announced the availability of a feature for Positive Identification of EMS personnel for the handling of controlled substances. This function employs a list of challenge questions that can be randomly generated at time of signature when documenting a controlled substance within a patient care report to verify the identity of the logged in medic. “A completely ...

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Paramedic, 83, hopes to return to work after hip heals

Veteran paramedic David Blackstone recently had hip surgery, but he hopes to return to the EMS industry when he is back on his feet

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EMS: So much more than lights and sirens

Celebrating those who spend their days and nights helping others when they need help the most during EMS Week 2018

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Celebrating EMS Week 2018

Departments around the country are marking the occasion by enhancing their training skills, teaching lifesaving lessons to the public and reminding providers to always have their partner's back.

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Safety and effectiveness of intranasal midazolam and fentanyl used in combination in the pediatric Emergency Department

The American Journal of Emergency Medicine

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Measuring and managing blood pressure in a primary care setting: A pragmatic implementation study

Journal of the American Board of Family Medicine

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Intravenous subdissociative-dose ketamine vs morphine for acute geriatric pain in the Emergency Department: A randomized controlled trial

The American Journal of Emergency Medicine

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Impact of extracorporeal cardiopulmonary resuscitation on outcomes of elderly patients who had out-of-hospital cardiac arrests: A single-centre retrospective analysis

BMJ Open

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Anterior vs posterior approach for thoracic corpectomy: An analysis of risk factors, outcomes, and complications

World Neurosurgery

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The high cost of critical care unit over-utilization for patients with NSTE ACS

American Heart Journal

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When will every EMT wear a body camera?

An EMT's attack of a restrained patient is a reminder for all leaders to discuss response to provocations and consider body-worn cameras to capture the EMS point-of-view

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Dear new EMT or paramedic: It's OK to ask for help

In EMS, most providers learn their most important lessons by doing; here are three lessons learned that you should never forget – no matter how long you've been in EMS

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Video: Celebrating EMS Week 2018

Departments are marking the occasion by enhancing their training skills, teaching lifesaving lessons and reminding providers to always have their partner's back

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Celebrating EMS Week 2018

Departments around the country are marking the occasion by enhancing their training skills, teaching lifesaving lessons to the public and reminding providers to always have their partner's back.

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How DahlgrenDecon is the fastest, most effective decontamination solution

DahlgrenDecon can neutralize fentanyl in about five minutes and is the most effective decontamination for other drugs, chemical and biological agents as well as toxic industrial chemicals and materials

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Celebrating EMS Week 2018

Departments around the country are marking the occasion by enhancing their training skills, teaching lifesaving lessons to the public and reminding providers to always have their partner's back.

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Early Interventions for the Prevention of Posttraumatic Stress Symptoms in Survivors of Critical Illness: A Qualitative Systematic Review

Objectives: Posttraumatic stress disorder among survivors of critical illness is of public health importance, as it is common and reduces patient quality of life. The objective of this systematic review was to collate the world’s literature on interventions aimed at preventing posttraumatic stress disorder among survivors of critical illness. Data Sources: We performed a search of CENTRAL, MEDLINE, EMBASE, CINAHL, and clinical trials registry platforms, with no restriction to language using a comprehensive strategy. Study Selection: Study inclusion criteria were as follows: 1) adult human subjects, 2) patients treated in an ICU setting, 3) intervention arm aimed at reducing posttraumatic stress disorder symptoms, 4) use of a control arm, and 5) an outcome measure assessing development of acute stress or posttraumatic stress disorder symptoms. Data Extraction: We performed a qualitative analysis to collate and summarize effects of identified interventions according to the recommended methodology from the Cochrane Handbook. Data Synthesis: Seventeen studies met all inclusion and no exclusion criteria. There was heterogeneity in interventions and outcome measures used. All studies had some concern for risk of bias as per the Cochrane tool for assessing risk of bias. In eight of 12 studies (67%) testing early interventions (i.e., initiated in the ICU course) and one of five studies (20%) testing delayed interventions following ICU discharge, posttraumatic stress disorder symptoms were decreased among the intervention group compared with controls. Conclusions: Despite a paucity of high-quality clinical investigations, the preponderance of evidence to date suggests that 1) posttraumatic stress disorder among survivors of critical illness may be preventable and 2) early interventions may be the most effective. All authors have made substantial contributions to this article; contributed to the development of the selection criteria, the risk of bias assessment strategy, and data extraction criteria; read and contributed substantially to revision of the final article; and approved the article in its final form. Drs. M. B. Roberts and B. W. Roberts developed the search strategy and drafted the article. B. W. Roberts supervised all aspects of the study design and takes responsibility for the article as a whole. 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. Jones’ institution received funding from Roche Diagnostics, AstraZeneca, Janssen, and Hologic (investigator for an ongoing study). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: roberts-brian-w@cooperhealth.edu Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Ambulance designed to transport premature newborns unveiled

Oishei Children’s Hospital, Kaleida Health and AMR teamed up to design an ambulance to transport premature newborns in honor of EMS Week

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Current practices and safety of medication use during rapid sequence intubation

Journal of Critical Care

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No radiographic safe margin found in the "Easy IJ" internal jugular vein procedure

The Journal of Emergency Medicine

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Biphasic anaphylaxis: A review of the literature and implications for emergency management

The American Journal of Emergency Medicine

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Amputation stump perfusion is predictive of post-operative necrotic eschar formation

The American Journal of Surgery

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Immediate vs overnight-delayed digital replantation: Comparative retrospective cohort study of survival outcomes

The Journal of Hand Surgery

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First presentation with psychotic symptoms to the Emergency Department

The Journal of Emergency Medicine

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Emergency Reporting training is now eligible for GoArmyEd funding

GoArmyEd is an online portal used by over 122,000 Active Duty and Army Reserve students to help them achieve educational goals in a way that allows the Army to easily monitor and fund through the Army Tuition Assistance Program.

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Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy

In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and ti...

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IAFC: Mobile technology can increase sudden cardiac arrest survival rates

The International Association of Fire Chiefs cited the PulsePoint app as a way to utilize responders and bystanders to increase sudden cardiac arrest survival

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Reduced left ventricular mechanical dispersion in heart failure patients undergoing cardiac resynchronisation therapy is associated with superior long-term outcome

Heart Rhythm

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Aldosterone antagonist therapy and mortality in patients with ST-segment elevation myocardial infarction without heart failure: A systematic review and meta-analysis

JAMA Internal Medicine

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Efficacy and safety of mechanical vs manual compression in cardiac arrest – A Bayesian network meta-analysis

Resuscitation

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Outcomes with prophylactic use of percutaneous left ventricular assist devices in high-risk patients undergoing catheter ablation of scar-related ventricular tachycardia: A propensity-matched analysis

Heart Rhythm

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Diagnostic yield of neuroimaging in syncope patients without high-risk symptoms indicating neurological syncope

The American Journal of Emergency Medicine

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The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections

Abstract

Purpose

Severe necrotizing soft-tissue infections (NSTIs) require immediate early surgical treatment to avoid adverse outcomes. This study aims to determine the impact of early surgery and comorbid conditions on the outcomes of NSTIs.

Methods

A retrospective cohort study was performed on all subjects presenting with NSTI at an academic medical center between 2005 and 2016. Patients were identified based on ICD codes. Those under the age of 18 or with intraoperative findings not consistent with NSTI diagnosis were excluded.

Results

There were 115 patients with a confirmed diagnosis of NSTI with a mean age of 55 ± 18 years; 41% were females and 55% were diabetics. Thirty percent of patients underwent early surgery (< 6 h). There were no significant differences between groups in baseline characteristics. The late group (≥ 6 h) had prolonged hospital stay (38 vs. 23 days, p < 0.008) in comparison to the early group (< 6 h). With every 1 h delay in time to surgery, there is a 0.268 day increase in length of stay, adjusted for these other variables: alcohol abuse, number of debridements, peripheral vascular disease, previous infection and clinical necrosis. Mortality was 16.5%. Multivariable analysis revealed that alcohol abuse, peripheral vascular disease, diabetes, obesity, hypothyroidism, and presence of COPD were associated with an increase in mortality.

Conclusions

Early surgical intervention in patients with severe necrotizing soft-tissue infections reduces length of hospital stay. Presence of comorbid conditions such as alcohol abuse, peripheral vascular disease, diabetes, obesity and hypothyroidism were associated with increased mortality.

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Small Poisoned Humans

by Diane Calello       A patient is brought back from triage. He is uncooperative with your exam and it is difficult to obtain vital signs. His speech is mostly incoherent, and he is drooling. You notice with disgust that he is chewing on the bedrails. He is incontinent of urine and feces, but […]

EMCrit Project by Tox & Hound.

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Small Poisoned Humans

by Diane Calello       A patient is brought back from triage. He is uncooperative with your exam and it is difficult to obtain vital signs. His speech is mostly incoherent, and he is drooling. You notice with disgust that he is chewing on the bedrails. He is incontinent of urine and feces, but […]

EMCrit Project by Tox & Hound.

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Impact of a VAP bundle in Belgian intensive care units

In order to decrease the incidence of ventilator-associated pneumonia (VAP) in Belgium, a national campaign for implementing a VAP bundle involving assessment of sedation, cuff pressure control, oral care with...

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Empire State Building to light up for EMS Week

The Empire State Building will be illuminated in yellow, white and blue with a red and white halo at sunset

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Celebrate EMS Week 2018 with EMS superlatives

You know who they are – recognize the Ferdinand Magellans, Yodas and Cliff Clavens of your agency during EMS Week

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Early results after operatively versus non-operatively treated flail chest: a retrospective study focusing on outcome and complications

Abstract

Purpose

Flail chest was traditionally treated non-operatively using mechanical ventilation and pain control. In order to reduce the occurrence of ventilation-associated complications and long-term disability, operative rib fixation is becoming a proven standard therapy for these patients. However, the consequences of the surgical complications may influence success rates negatively. The aim of this study was to compare the outcome of flail chest treatment by surgical rib fixation with non-operative treatment, with special focus on the impact of surgical complications.

Methods

A retrospective case series of operatively treated flail chest patients was compared with non-operatively treated patients. Patients’ injury and treatment characteristics and outcome parameters (e.g., duration of mechanical ventilation, length of Intensive Care stay (ICLOS) and hospital length of stay (HLOS), mortality, surgery-related complications and pneumonia) were collected from the patients’ medical files. Crude and matched-pairs analyses were performed in SPSS.

Results

Twenty-three operatively and 47 non-operatively treated patients were enrolled. Operatively treated patients required significantly shorter mechanical ventilation; median 4 days versus 12 days for the non-operative group (p = 0.011). The matched-pairs analysis also showed a lower pneumonia rate (35% versus 80%; p = 0.035) and a shorter HLOS (median 21 versus 23 days; p = 0.028) in the operative group. No significant differences in duration of ICLOS, and occurrence of other injury-related adverse events were found between both groups. 
Seven surgery-related complications occurred, of which three required invasive solutions.

Conclusions

Operative fixation of a flail chest in trauma patients results in a lower rate of pneumonia, less mechanical ventilation days and shorter hospital stay, compared with non-operative treatment, but at the cost of surgery-related complications requiring invasive solutions in some cases.

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PulmCrit- Ten dubious beliefs in neurocritical care

Recently Geert Meyfroidt published an article in Intensive Care Medicine describing ten false beliefs in neurocritical care shown here: It's a great article, but I think they could have been more aggressive about challenging neurocritical care dogmas (1).  In response, here is a list of ten dubious beliefs that goes farther to challenge the status quo.  […]

EMCrit Project by Josh Farkas.

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PulmCrit- Ten dubious beliefs in neurocritical care

Recently Geert Meyfroidt published an article in Intensive Care Medicine describing ten false beliefs in neurocritical care shown here: It's a great article, but I think they could have been more aggressive about challenging neurocritical care dogmas (1).  In response, here is a list of ten dubious beliefs that goes farther to challenge the status quo.  […]

EMCrit Project by Josh Farkas.

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Determinants of lactic acidosis in acute cyanide poisonings

Critical Care Medicine

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Findings relevant to the QRS wave in the resting electrocardiogram are associated with circulating concentrations of high-sensitivity cardiac troponin I in the general population

Journal of the American Society of Hypertension

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Differential mortality and the excess rates of hip fracture associated with type 2 diabetes: Accounting for competing risks in fracture prediction matters

Journal of Bone and Mineral Research

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Stroke severity affects timing: Time from stroke code activation to initial imaging is longer in patients with milder strokes

The Neurologist

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A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination

Abstract

Background

Circulatory collapse is a leading cause of mortality among traumatic major exsanguination and in ruptured aortic aneurysm patients. Approximately 40% of patients die before hemorrhage control is achieved. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive surgical or endovascular repair. A systematic review was conducted for the current clinical use of REBOA in patients with hemodynamic instability and to discuss its potential role in improving prehospital and in-hospital outcome.

Methods

Systematic review and meta-analysis (1900–2017) using MEDLINE, Cochrane, EMBASE, Web of Science and Central and Emcare using the keywords “aortic balloon occlusion”, “aortic balloon tamponade”, “REBOA”, and “Resuscitative Endovascular Balloon Occlusion” in combination with hemorrhage control, hemorrhage, resuscitation, shock, ruptured abdominal or thoracic aorta, endovascular repair, and open repair. Original published studies on human subjects were considered.

Results

A total of 490 studies were identified; 89 met criteria for inclusion. Of the 1436 patients, overall reported mortality was 49.2% (613/1246) with significant differences (p < 0.001) between clinical indications. Hemodynamic shock was evident in 79.3%, values between clinical indications showed significant difference (p < 0.001). REBOA was favored as treatment in trauma patients in terms of mortality. Pooled analysis demonstrated an increase in mean systolic pressure by almost 50 mmHg following REBOA use.

Conclusion

REBOA has been used in trauma patients and ruptured aortic aneurysm patients with improvement of hemodynamic parameters and outcomes for several decades. Formal, prospective study is warranted to clarify the role of this adjunct in all hemodynamic unstable patients.

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Trauma patients are safe to fly 72 hours after tube thoracostomy removal

Background Current recommendations for safe air travel following traumatic pneumothorax are 2-3 weeks after radiographic resolution. These recommendations are based on several small observational studies and expert consensus which cite a theoretical risk of recurrence and hypoxia due to decreased oxygen tension at altitude. We sought to systematically study the timing of chest drain removal after traumatic pneumothorax and risk of recurrence in relation to air travel. Methods A retrospective cohort study of consecutively admitted patients who sustained a traumatic chest injury treated with tube thoracostomy over a 5-year period was undertaken. Adult patients with a post-removal expiratory chest x-ray demonstrating absence of pneumothorax and at least a 24-hour observation period prior to flight were eligible for study. All patients were transferred to a participating medical center for continued care. In-flight medical monitoring was available for all patients. Baseline patient characteristics, interval period from drain removal to flight, in-flight medical records, and incidence of radiographic or clinical recurrence of pneumothorax at the destination facility were recorded. Results Seventy-three patients who met inclusion criteria were studied. All were male with a median age of 24 (IQR 22-26), ISS of 30 (IQR 24-38), and chest AIS of 3 (IQR 2-4). The majority of patients sustained a penetrating injury (74%). The median duration of tube thoracostomy was 4 (IQR 3-6) days. The median period between thoracostomy tube removal and flight was 2.5 (IQR 1.5-4) days. Twenty-nine (40%) patients remained mechanically ventilated during transport. There were no reported in-flight medical emergencies for the entire cohort. There were no reported post-flight radiographic or clinical recurrences during the subsequent 30 days. Conclusions Following a 72-hour period of observation, air travel after tube thoracostomy removal appears safe for both mechanically-ventilated and non-ventilated patients. Level of Evidence Care management, Level V Address for correspondence: David Zonies MD MPH, Oregon Health & Science University, Division of Trauma, Critical Care & Acute Care Surgery, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, fax 503-494-6519, phone 503-494-5300, zonies@ohsu.edu Conflicts of Interest and Source of Funding: For all authors, no conflicts were declared List of meetings at which the paper was presented: Western Trauma Association, Lake Tahoe, 2016 Disclosures of funding received for this work: None © 2018 Lippincott Williams & Wilkins, Inc.

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Suspecting Hyperferritinemic Sepsis in Iron-Deficient Population: Do We Need a Lower Plasma Ferritin Threshold?

Objectives: Hyperferritinemia is being suggested to identify patients with sepsis-induced macrophage activation syndrome for early intervention. However, data among iron-deficient children are scarce. This study was planned to explore the biological behavior of plasma ferritin in children from communities with a high frequency of iron deficiency with septic shock and its association with the outcome. Design: Prospective observational study. Setting: Tertiary care teaching hospital in a low-middle income economy of South Asia. Patients or Subjects: Patients (6 mo to 12 yr) (n = 42) with septic shock and their healthy siblings as controls (n = 36). Patients/controls with blood transfusion/iron supplement during last 6 months or with any chronic disease were excluded. Interventions: None. Measurements and Main Results: Ferritin was measured in patients at enrollment and then at 1 month of hospital discharge while they were not on iron supplementation and in controls as indicative of baseline level. Patients’ median age was 30 months (13.5–87 mo), 31% were malnourished, majority (86%) had anemia, and two thirds had microcytic hypochromic red cells. Ferritin at admission was 763 ng/mL (480–1,820 ng/mL) in nonsurvivors, whereas 415 ng/mL (262–852 ng/mL) in survivors (p = 0.11). Pediatric Logistic Organ Dysfunction score and C-reactive protein correlated positively with plasma ferritin (p = 0.03 and p = 0.01, respectively) at enrollment. Elevated ferritin of greater than 500 ng/mL (relative risk, 2.48; 95% CI, 0.95–6.43) and greater than 1,000 ng/mL (relative risk, 1.94; 95% CI, 0.94–4.02) were associated with higher mortality but not independently. Among survivors, the 1-month follow-up ferritin fell significantly to 97 ng/mL (16–118 ng/mL) (p = 0.001). However, it was still significantly higher than that in sibling controls (19 ng/mL [10–54 ng/mL]) (p = 0.003). Conclusions: Ferritin rises significantly in septic shock patients despite iron deficiency and seems to correlate with the severity of inflammation and organ dysfunction. Even a lower threshold (of 500 or 1,000 ng/mL) could predict higher mortality. It may suggest the need for redefining the plasma ferritin threshold for suspecting hyperferritinemic sepsis and sepsis-induced macrophage activation syndrome in these patients. Larger studies with frequent ferritin measurements are desirable to validate these initial observations. This study was performed at Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India. The authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: baranwal1970@gmail.com ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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Criteria to Identify a Potential Deceased Organ Donor: A Systematic Review

Objectives: To systematically review the global published literature defining a potential deceased organ donor and identifying clinical triggers for deceased organ donation identification and referral. Data Sources: Medline and Embase databases from January 2006 to September 2017. Study Selection: All published studies containing a definition of a potential deceased organ donor and/or clinical triggers for referring a potential deceased organ donor were eligible for inclusion. Dual, independent screening was conducted of 3,857 citations. Data Extraction: Data extraction was completed by one team member and verified by a second team member. Thematic content analysis was used to identify clinical criteria for potential deceased organ donation identification from the published definitions and clinical triggers. Data Synthesis: One hundred twenty-four articles were included in the review. Criteria fell into four categories: Neurological, Medical Decision, Cardiorespiratory, and Administrative. Distinct and globally consistent sets of clinical criteria by type of deceased organ donation (neurologic death determination, controlled donation after circulatory determination of death, and uncontrolled donation after circulatory determination of death) are reported. Conclusions: Use of the clinical criteria sets reported will reduce ambiguity associated with the deceased organ donor identification and the subsequent referral process, potentially reducing the number of missed donors and saving lives globally through increased transplantation. This work was performed at The Ottawa Hospital Research Institute in Ottawa, ON, Canada. 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). This study is part of the Canadian National Transplant Research Program and is supported, in part, by the Canadian Institutes of Health Research (Grant Number Transplantation Research - Full Application 127880). Drs. Squires’, Coughlin’s, Linklater’s, Grimshaw’s, and Knoll’s institutions received funding from the Canadian Institutes of Health Research. Dr. Grimshaw received funding from Abbott Diagnostics Canada, Campbell Collaboration, Biomed Central, Canadian Patient Safety Institute, and National Health Service Education in Scotland. Dr. Shemie disclosed being the Medical Advisor, Deceased Donation for Canadian Blood Services. Dr. Dhanani disclosed being the research lead for Trillium Gift of Life Network. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: janet.squires@uottawa.ca Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Inhibition of Vascular Endothelial Cell Leak Following Escherichia coli Attachment in an Experimental Model of Sepsis

Objectives: The vascular endothelium is a major target of sepsis-induced events, and endothelial activation accounts for much of the pathology of sepsis. Urinary tract infections and pneumonia caused by Escherichia coli are among of the most common infections causing sepsis in both community and hospital settings. Currently, there are no approved drugs on the market to treat the underlying pathophysiology of sepsis. The aim of this study is to elucidate the molecular mechanism by which E. coli induces endothelial injury as a result of attachment. Design: Laboratory research using a hemodynamic perfusion ex vivo model. Setting: Research Laboratories of Royal College of Surgeons in Ireland and Beaumont Hospital. Patients: Ex vivo human vascular endothelial cells. Interventions: Addition of αVβ3 antagonist, cilengitide. Measurements and Main Results: Clinical strains of E. coli isolated from patients with sepsis bound to sheared human endothelial cells under static and hemodynamic shear conditions. Binding was dependent on E. coli cell membrane protein outer membrane protein A attaching directly to endothelial cell integrin αVβ3. Attachment resulted in disturbances in endothelial barrier integrity, as determined by loss of tight junction protein staining, permeability changes, and ultimately cell death by apoptosis. Using a low concentration of the αVβ3 antagonist cilengitide or using a strain deficient in outer membrane protein A resulted in a significant reduction in endothelial dysfunction following infection. Conclusions: Inhibition of E. coli binding to endothelial cell αVβ3 by cilengitide prevents endothelial dysfunction and may, therefore, present as a novel early therapeutic for the treatment of sepsis. 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). Supported, in part, by Science Foundation Ireland Grant Number 13/CDA/2119 (to Dr. Kerrigan) and Health Research Board Grant Number HRA-POR-2010–33 (to Dr. Smith). Drs. Fagan’s and Smith’s institutions received funding from Health Research Board Ireland (a PhD studentship awarded to Dr. Smith who supported the start-up costs and PhD stipend and consumables for Dr. Fagan). Dr. Fagan received support for article research from the Health Research Board Ireland. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: skerrigan@rcsi.ie Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Acute Neurologic Complications During Extracorporeal Membrane Oxygenation—A Systematic Review

Objectives: We determine the frequency, risk factors, and mortality of neurologic complications in adults on extracorporeal membrane oxygenation and propose an algorithm for preventive strategies. Data Sources: PubMed, Embase, and Cochrane databases. Study Selection: Screening was performed using predefined search terms to identify cohort studies reporting neurologic complications in adults during extracorporeal membrane oxygenation from 1990 to 2017. Data Extraction: The final reference list was generated on the basis of relevance to the discussed topics. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation classification of evidence scheme. Data Synthesis: In 44 studies, the median frequency of acute neurologic complications is 13% (1–78%; 5% intracranial hemorrhages, 5% ischemic strokes, 2% seizures). Neurologic complications are reported more frequently with venoarterial extracorporeal membrane oxygenation compared with venovenous extracorporeal membrane oxygenation (14 vs eight studies) with a median proportion of complications of 15% (6–33%; 95% CI, 8–19) for venoarterial extracorporeal membrane oxygenation. Median in-hospital mortality is higher with neurologic complications (83%; interquartile range, 54–100% vs 42%; interquartile range, 24–55% without neurologic complications; p

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Reversible Microvascular Hyporeactivity to Acetylcholine During Diabetic Ketoacidosis

Objectives: Metabolic acidosis is commonly observed in critically ill patients. Experimental studies suggested that acidosis by itself could impair vascular function, but this has been poorly investigated in human. Design: Prospective observational study. Setting: Medical ICU in a tertiary teaching hospital. Patients: To assess the relationship between metabolic acidosis severity and microvascular reactivity, we included adult diabetic patients admitted in ICU for ketoacidosis. Microvascular response to acetylcholine iontophoresis was measured at admission (baseline) and after correction of metabolic acidosis (24 hr). Interventions: None. Measurements and Main Results: Thirty-nine patients with diabetic ketoacidosis were included (68% male), with a median age of 43 (31–57) years. At admission, microvascular reactivity negatively correlated with acidosis severity (R = –0.53; p 7.20; p

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Atlantic Safety Products, Inc. Orange Lightning® Exam Glove Certified to NFPA 1999-2018

PITTSFIELD, N.H. — Atlantic Safety Products, Inc. is pleased to announce that their Orange Lightning® Examination Glove is now certified to NFPA-1999-2018. The standard specifies the design, performance, testing and certification requirements for new single use and multi-use emergency medical protective clothing, gloves, footwear and face protection devices. The company has a reputation of ...

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Atlantic Safety Products, Inc. adds more Fentanyl Resistant Gloves to their product line

PITTSFIELD, N.H. — Atlantic Safety Products, Inc. is pleased to announce that their Orange Lightning® and InTouch® B311 Nitrile Gloves passed permeation testing for fentanyl per ASTM Standard D 6978-05. The tests were conducted for 240 minutes on each glove specimen and there was no material breach on either glove during this time. These two gloves join their Black Lightning® Glove ...

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AMR teams up with IAFC, ACEP to teach bystander CPR

The three organizations are working together to offer free training during National EMS Week

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3 things you should know about CPAP use in EMS

CPAP technology and practice in the prehospital environment has evolved for application beyond CHF and COPD

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Involvements of Parents in the Care of Preterm Infants: A Pilot Study Evaluating a Family-Centered Care Intervention in a Chinese Neonatal ICU

Objectives: To evaluate the effectiveness and safety of a family-centered care intervention in a Chinese neonatal ICU. Design: Pilot study using a randomized controlled trial design to inform a main randomized controlled trial study. Setting: Stand-alone tertiary children’s hospital in China with a 60-bed neonatal ICU serving as a regional neonatal ICU center. Patients: Premature infants (n = 61) and their parents (n = 110). Interventions: Parent education program followed by parents’ participation in care as primary caregiver until discharge for a minimum of 4 hours per day. Measurements and Main Results: Primary outcomes were infants’ weight gain at discharge, length of stay, and readmission. Parental outcomes were stress, anxiety, satisfaction, and clinical knowledge. Infants in family-centered care group (n = 31) had higher weight gain (886g vs 542g; p = 0.013), less neonatal ICU length of stay in days (43 vs 46; p = 0.937), and decreased readmission rate at 1 week (41.9 vs 70.0; p = 0.045) and at 1 month (6.5% vs 50%; p

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Dynamic Contrast-Enhanced Ultrasound Identifies Microcirculatory Alterations in Sepsis-Induced Acute Kidney Injury

Objectives: We developed quantitative methods to analyze microbubble kinetics based on renal contrast-enhanced ultrasound imaging combined with measurements of sublingual microcirculation on a fixed area to quantify early microvascular alterations in sepsis-induced acute kidney injury. Design: Prospective controlled animal experiment study. Setting: Hospital-affiliated animal research institution. Subjects: Fifteen female pigs. Interventions: The animals were instrumented with a renal artery flow probe after surgically exposing the kidney. Nine animals were given IV infusion of lipopolysaccharide to induce septic shock, and six were used as controls. Measurements and Main Results: Contrast-enhanced ultrasound imaging was performed on the kidney before, during, and after having induced shock. Sublingual microcirculation was measured continuously using the Cytocam on the same spot. Contrast-enhanced ultrasound effectively allowed us to develop new analytical methods to measure dynamic variations in renal microvascular perfusion during shock and resuscitation. Renal microvascular hypoperfusion was quantified by decreased peak enhancement and an increased ratio of the final plateau intensity to peak enhancement. Reduced intrarenal blood flow could be estimated by measuring the microbubble transit times between the interlobar arteries and capillary vessels in the renal cortex. Sublingual microcirculation measured using the Cytocam in a fixed area showed decreased functional capillary density associated with plugged sublingual capillary vessels that persisted during and after fluid resuscitation. Conclusions: In our lipopolysaccharide model, with resuscitation targeted at blood pressure, the contrast-enhanced ultrasound imaging can identify renal microvascular alterations by showing prolonged contrast enhancement in microcirculation during shock, worsened by resuscitation with fluids. Concomitant analysis of sublingual microcirculation mirrored those observed in the renal microcirculation. Drs. Lima and van Rooij contributed equally as first authors. 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). Supported, in part, by an Innovation Grant of the Dutch Kidney Foundation (14 OI 11), NanoNextNL, a micro- and nanotechnology consortium of the Government of the Netherlands and by the European Erasmus + Traineeship program. Dr. Lima’s, de Jong’s, and Ince’s institution received funding from the Dutch Kidney Foundation. Dr. van Rooij’s institution received funding from NanoNextNL, and he received support for article research from NanoNextNL and the Dutch Kidney Foundation. Dr. Ince received funding from the Dutch Kidney Foundation (Innovation Grant), and he received support for article research from the Dutch Kidney Foundation. Dr. Mik disclosed he is a founder and shareholder of Photonics Healthcare B.V. (Utrecht, The Netherlands); this company build a device for measuring mitochondrial oxygen tension, but this is not related to the subject of the article. Dr. Kooiman’s institution received funding from NanoNextNL; a Veni grant from Dutch Scientific Organization, division Toegepaste en Technische Wetenschappen; a fellowship grant from Erasmus MC Foundation; and a Grant from Phospholipid Research Center. Dr. Kooiman received funding from Erasmus MC (employer). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: a.pintolima@erasmusmc.nl Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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The Effect of IV Amino Acid Supplementation on Mortality in ICU Patients May Be Dependent on Kidney Function: Post Hoc Subgroup Analyses of a Multicenter Randomized Trial

Objectives: We investigated whether preexisting kidney function determines if ICU patients may benefit from increased (2.0 g/kg/d) protein intake. Design: Post hoc, hypothesis-generating, subgroup analysis of a multicenter, phase 2, randomized clinical trial. All analyses were conducted by intention to treat and maintained group allocation. Ninety-day mortality was the primary outcome. Setting: ICUs of 16 hospitals throughout Australia and New Zealand. Patients: Adult critically ill patients expected to remain in the study ICU for longer than 2 days. Interventions: Random allocation to receive a daily supplement of up to 100 g of IV amino acids to achieve a total protein intake of 2.0 g/kg/d or standard nutrition care. Measurements and Main Results: A total of 474 patients were randomized: 235 to standard care and 239 to IV amino acid supplementation. There was a statistically significant interaction between baseline kidney function and supplementation with study amino acids (p value for interaction = 0.026). Within the subgroup of patients with normal kidney function at randomization, patients who were allocated to receive the study amino acid supplement were less likely to die before study day 90 (covariate-adjusted risk difference, –7.9%; 95% CI, –15.1 to –0.7; p = 0.034). Furthermore, amino acid supplementation significantly increased estimated glomerular filtration rate in these patients (repeated-measures treatment × time interaction p = 0.009). Within the subgroup of patients with baseline kidney dysfunction and/or risk of progression of acute kidney injury, a significant effect of the study intervention on mortality was not found (covariate-adjusted risk difference, –0.6%; 95% CI, –16.2 to 15.2; p = 0.95). Conclusions: In this post hoc, hypothesis-generating, subgroup analysis, we observed reduced mortality and improved estimated glomerular filtration rate in ICU patients with normal kidney function who were randomly allocated to receive increased protein intake (up to 2.0 g/kg/d). We strongly recommend confirmation of these results in trials with low risk of bias before this treatment is recommended for routine care. A full list of the Nephro-Protective Trial participating sites and site investigators is provided in the online-only supplement (Supplemental Digital Content 1, https://ift.tt/2GuZpzJ). Trial Registration: anzctr.org.au Identifier: ACTRN12609001015235. 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). This work was supported, in part, by a peer-reviewed academic grant from the Australian National Health and Medical Research Council. Baxter Healthcare Pty Ltd supplied the study amino acids. Dr. Zhu reported receiving speakers’ honoraria from Nutricia Pharmaceutical (Wuxi), China, and from Fresenius Kabi SSPC, China. Dr. Allingstrup reported receiving academic research grants from Fresenius Kabi Deutschland GmbH; Medinor A/S, Denmark; and COSMED Irl, Rome, Italy, and speakers’ honoraria from Fresenius Kabi A/S, Denmark; Baxter Healthcare A/S, Denmark; and Nutricia A/S, Denmark. Dr. Perner reported receiving academic research grants from Fresenius Kabi Deutschland GmbH; Medinor A/S, Denmark; and COSMED Irl, Rome, Italy. His institution received funding from Fresenius Kabi, CSL Behring, Ferring Pharmaceuticals, and COSMED. Dr. Doig reported receiving academic research grants from Fresenius Kabi Deutschland GmbH and Baxter Healthcare, and speakers’ honoraria from Fresenius Kabi Deutschland GmbH; Baxter Healthcare Australia; Nestle Healthcare; Vevy, Switzerland; and Nutricia Pharmaceutical (Wuxi), China. His institution received funding from National Health and Medical Research Council, Baxter Healthcare, and Fresenius Kabi Deutschland GmbH. He received support for article research from Australian National Health and Medical Research Council. For information regarding this article, E-mail: gdoig@med.usyd.edu.au Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Economic analysis of diagnostic imaging in pediatric patients with suspected appendicitis

Academic Emergency Medicine

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Prospective validation and refinement of a decision rule to obtain chest X-ray in patients with nontraumatic chest pain in the Emergency Department

Academic Emergency Medicine

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Association of early myocardial workload and mortality following severe traumatic brain injury

Critical Care Medicine

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Preprocedural ultrasound for infant lumbar puncture: A randomized clinical trial

Academic Emergency Medicine

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Lightheadedness after concussion: Not all dizziness is vertigo

Clinical Journal of Sport Medicine

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Comparison of antivenom dosing strategies for rattlesnake envenomation

Critical Care Medicine

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Costal margin tenderness and the risk for intraabdominal injuries in children with blunt abdominal trauma

Academic Emergency Medicine

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Nationwide trend of sepsis: A comparison among octogenarians, elderly, and young adults

Critical Care Medicine

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Injuries among recreational football players: Results of a prospective cohort study

Clinical Journal of Sport Medicine

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Value of the delta neutrophil index for predicting 28-day mortality in patients with acute pulmonary embolism in the Emergency Department

Shock

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Comparison of outcomes in Emergency Department patients with suspected cardiac chest pain: Two-centre prospective observational study in Southern China

BMC Cardiovascular Disorders

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EM Nerd-The Peculiar Case of the Parallel Pathways

So rarely is a study published that directly and effortlessly translates into clinical practice. Very few of these studies examine the nuances of everyday practice in the fast paced milieu of the Emergency Department. Given the infrequency of such studies, I am continually amazed by the work put forth by Brian Driver and colleagues at […]

EMCrit Project by Rory Spiegel.

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EM Nerd-The Peculiar Case of the Parallel Pathways

So rarely is a study published that directly and effortlessly translates into clinical practice. Very few of these studies examine the nuances of everyday practice in the fast paced milieu of the Emergency Department. Given the infrequency of such studies, I am continually amazed by the work put forth by Brian Driver and colleagues at […]

EMCrit Project by Rory Spiegel.

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A 20‐year Review: The Use of Exception From Informed Consent and Waiver of Informed Consent in Emergency Research

Academic Emergency Medicine, EarlyView.


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The Dantastic Mr Tox & Howard Podcast 5 – Conflicts of Approval

Join Dan (@drusyniak) &howard (@heshiegreshie) as we talk with Dr. Jeanmarie Perrone (@JMPerroneMD) about the FDA and taking on “Big Pain” during her time on the FDA Drug Safety and Risk Management committee. Don’t drink the raspberries . . . Brought to you by BrownApron. Stay healthy true believers! Delicious Links: John Oliver and Supplements […]

EMCrit Project by Tox & Hound.

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5 ways to empower your EMS employees

Create a culture of recognition and invest in the proper equipment to support your EMS personnel

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The Dantastic Mr Tox & Howard Podcast 5 – Conflicts of Approval

Join Dan (@drusyniak) &howard (@heshiegreshie) as we talk with Dr. Jeanmarie Perrone (@JMPerroneMD) about the FDA and taking on “Big Pain” during her time on the FDA Drug Safety and Risk Management committee. Don’t drink the raspberries . . . Brought to you by BrownApron. Stay healthy true believers! Delicious Links: John Oliver and Supplements […]

EMCrit Project by Tox & Hound.

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EMCrit Guest Post – The good, the bad, and the ugly of the Joint Statement on REBOA by Zaffer Qasim

@emeddoc on the current state of REBOA and that bad, bad joint agreement:

EMCrit Project by Guest Author.

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EMCrit Guest Post – The good, the bad, and the ugly of the Joint Statement on REBOA by Zaffer Qasim

@emeddoc on the current state of REBOA and that bad, bad joint agreement:

EMCrit Project by Guest Author.

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Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): An international randomised, placebo-controlled, phase 3 superiority trial

The Lancet

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Systematic review and meta-analysis of outcomes of patients with subsegmental pulmonary embolism with and without anticoagulation treatment

Academic Emergency Medicine

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Comparing the effects of atorvastatin with sodium valproate (divalproex) on frequency and intensity of frequent migraine headaches: A double-blind randomized controlled study

Clinical Neuropharmacology

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Epidemiology of pedestrian–motor vehicle fatalities and injuries, 2006–2015

American Journal of Preventive Medicine

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The effectiveness of trimetazidine treatment in patients with stable angina pectoris of various durations: Results from the CHOICE-2 Study

Advances in Therapy

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Omalizumab in chronic spontaneous urticaria refractory to conventional therapy: An Italian retrospective clinical analysis with suggestions for long-term maintenance strategies

Dermatology and Therapy

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National moment of silence to be held to honor fallen EMS providers

The National EMS Memorial Service Board is requesting that agencies observe 10 to 30 seconds of radio silence on May 19

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FDNY unveils EMS Week 2018 poster

Fire Commissioner Daniel Nigro unveiled the poster, which promotes this year’s “Stronger Together” theme

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Confounding Questions in Resus – When is it safe to Perform an LP with Anti-Platelet Agents on Board

Can you tap a patient taking anti-platelet agents? CQiR:

EMCrit Project by Ashley Mogul.

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Confounding Questions in Resus – When is it safe to Perform an LP with Anti-Platelet Agents on Board

Can you tap a patient taking anti-platelet agents? CQiR:

EMCrit Project by Ashley Mogul.

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Paramedic Instructor - Garden City Community College

Garden City Community College is currently seeking a full-time dynamic Paramedic Instructor to help lead our 12-month paramedic program. The program includes a very progressive and innovative classroom setting that simulates on-the-job training. The program also utilizes the latest and most innovative equipment to promote realism through simulation in locations around campus. This position involves ...

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Boy saves grandma who collapsed thanks to 'Smart 911' system

Dispatchers were able to quickly figure out exactly where Joshua's grandmother was thanks to a new system

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Paramedic gifts AED to Lowe's after father suffers cardiac arrest

Mark Greczkowski presented an AED to Lowe's after his father, who works at the store, went into cardiac arrest while on the job

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Patient-identified needs related to seeking a diagnosis in the Emergency Department

Annals of Emergency Medicine

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TIMP-2/IGFBP7 predicts acute kidney injury in out-of-hospital cardiac arrest survivors

Critical Care

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County-level trends in suicide rates in the U.S., 2005–2015

American Journal of Preventive Medicine

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Value of the delta neutrophil index for predicting 28-day mortality in patients with acute pulmonary embolism in the Emergency Department

Shock

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Utilization of head CT during injury visits to United States Emergency Departments: 2012–2015

The American Journal of Emergency Medicine

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Comparison of outcomes in DeBakey type AI vs AII aortic dissection

The American Journal of Cardiology

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Sociodemographic determinants of non-accidental traumatic injuries in children

The American Journal of Surgery

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Usefulness of intravenous sodium nitrite during resuscitation for the treatment of out-of-hospital cardiac arrest

The American Journal of Cardiology

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Clinical effects of antiplatelet drugs and statins on D-dimer levels

European Journal of Clinical Investigation

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Cerebral tissue oximetry levels during prehospital management of cardiac arrest - A prospective observational study

Resuscitation

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Optic nerve sheath diameter measured using early unenhanced brain computed tomography shows no correlation with neurological outcomes in patients undergoing targeted temperature management after cardiac arrest

Resuscitation

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Risk factors for acute pancreatitis in patients with accidental hypothermia

The American Journal of Emergency Medicine

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A comparison of head injuries in male and female lacrosse participants seen in US Emergency Departments from 2005 to 2016

The American Journal of Emergency Medicine

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Effect of fremanezumab compared with placebo for prevention of episodic migraine: A randomized clinical trial

JAMA

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Outcomes of tibia shaft fractures caused by low energy gunshot wounds

Injury

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Practice of mechanical ventilation in cardiac arrest patients and effects of targeted temperature management: A substudy of the targeted temperature management trial

Resuscitation

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Frailty assessment to help predict patients at risk of delirium when consulting the Emergency Department

The Journal of Emergency Medicine

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Medic Mindset Podcast: The patient's perspective

Learn what it means to be "someone's someone" with Noah Galloway, author of "Living With No Excuses," and Ashley Liebig

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PulmCrit- Montreal Hospitalist & Resuscitationist Conference FOAMed

I recently got back from the inaugural Hospitalist & Resuscitationist conference, a fantastic FOAMy conference in Montreal organized by Phillipe Rola (@ThinkingCC).  It was inspiring to participate alongside fantastic folks including Rory Speigel (@EMNerd), Jon-Emile Kenny (@heart_lung), Kylie Baker (@kyliebaker88), Lawrence Lynn(@PatientStormDoc), Andre Denault, and Segun Olusanya (@iceman_ex).  Screencasts of my talks, audio clips, some videos […]

EMCrit Project by Josh Farkas.

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PulmCrit- Montreal Hospitalist & Resuscitationist Conference FOAMed

I recently got back from the inaugural Hospitalist & Resuscitationist conference, a fantastic FOAMy conference in Montreal organized by Phillipe Rola (@ThinkingCC).  It was inspiring to participate alongside fantastic folks including Rory Speigel (@EMNerd), Jon-Emile Kenny (@heart_lung), Kylie Baker (@kyliebaker88), Lawrence Lynn(@PatientStormDoc), Andre Denault, and Segun Olusanya (@iceman_ex).  Screencasts of my talks, audio clips, some videos […]

EMCrit Project by Josh Farkas.

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Early variation of quick sequential organ failure assessment score to predict in-hospital mortality in emergency department patients with suspected infection

Background The quick sequential organ failure assessment (qSOFA) score showed good prognostic performance in patients with suspicion of infection in the emergency department (ED). However, previous studies only assessed the performance of individual values of qSOFA during the ED stay. As this score may vary over short timeframes, the optimal time of measurement, and the prognostic value of its variation are unclear. The objective of the present study was to prospectively assess the prognostic value of the change in qSOFA over the first 3 h (ΔqSOFA=qSOFA at 3 h−qSOFA at inclusion). Patients and methods This is an international prospective cohort study conducted in 17 EDs in France, Belgium, and Spain. From November 2016 to March 2017, patients with a suspected infection and a qSOFA score of 2 or higher were included and followed up until death or hospital discharge. qSOFA was measured at inclusion, 1 h and 3 h. Primary end point was in-hospital mortality, truncated at 28 days. Results Of 534 recruited patients, 512 were included in the analysis. The qSOFA was improved at 3 h (ΔqSOFA

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Preprocedural Ultrasound for Infant Lumbar Puncture: A Randomized Clinical Trial

Academic Emergency Medicine, EarlyView.


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Costal Margin Tenderness and the Risk for Intraabdominal Injuries in Children With Blunt Abdominal Trauma

Academic Emergency Medicine, EarlyView.


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Webinar: How prehospital stroke management with new endovascular care is helping EMS providers

Stroke is the fifth leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. EMS providers are regularly responding to patients who show warning signs of a stroke, and every second matters when it comes to treating stroke. That’s why early detection and prompt care play a crucial role in determining outcomes for stroke patients. In honor of National Stroke Awareness Month, EMS1, Medtronic Neurovascular and the IPSA are holding this special webinar. In this webinar, Dr. Peter Taillac, an emergency physician and an associate professor of surgery, within the division of emergency medicine at the University of Utah Health, will share how new endovascular care is helping EMS providers.

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Webinar: How prehospital stroke management with new endovascular care is helping EMS providers

Stroke is the fifth leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. EMS providers are regularly responding to patients who show warning signs of a stroke, and every second matters when it comes to treating stroke. That’s why early detection and prompt care play a crucial role in determining outcomes for stroke patients. In honor of National Stroke Awareness Month, EMS1, Medtronic Neurovascular and the IPSA are holding this special webinar. In this webinar, Dr. Peter Taillac, an emergency physician and an associate professor of surgery, within the division of emergency medicine at the University of Utah Health, will share how new endovascular care is helping EMS providers.

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MicroDAIMON study: Microcirculatory DAIly MONitoring in critically ill patients: a prospective observational study

Until now, the prognostic value of microcirculatory alterations in critically ill patients has been mainly evaluated in highly selected subgroups. Aim of this study is to monitor the microcirculation daily in ...

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Webinar: How prehospital stroke management with new endovascular care is helping EMS providers

Stroke is the fifth leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. EMS providers are regularly responding to patients who show warning signs of a stroke, and every second matters when it comes to treating stroke. That’s why early detection and prompt care play a crucial role in determining outcomes for stroke patients. In honor of National Stroke Awareness Month, EMS1, Medtronic Neurovascular and the IPSA are holding this special webinar. In this webinar, Dr. Peter Taillac, an emergency physician and an associate professor of surgery, within the division of emergency medicine at the University of Utah Health, will share how new endovascular care is helping EMS providers.

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App allows air ambulance services to view patients before arriving

The GoodSAM App’s new “Instant on the Scene” feature gives flight medics the ability to see the patient’s condition with live streaming video

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Nerve trauma of the lower extremity: evaluation of 60,422 leg injured patients from the TraumaRegister DGU® between 2002 and 2015

Nerve lesions are well known reasons for reduced functional capacity and diminished quality of life. By now only a few epidemiological studies focus on lower extremity trauma related nerve injuries. This study...

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Development and implementation of a geographical area categorisation method with targeted performance indicators for nationwide EMS in Finland

In Finland, hospital districts (HD) are required by law to determine the level and availability of Emergency Medical Services (EMS) for each 1-km2 sized area (cell) within their administrative area. The cells are...

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Risk of incident atrial fibrillation in patients presenting with retinal artery or vein occlusion: A nationwide cohort study

BMC Cardiovascular Disorders

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Patient characteristics and Emergency Department factors associated with survival after sudden cardiac arrest in children and young adults: A cross-sectional analysis of a nationally representative sample, 2006–2013

Pediatric Cardiology

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Hypoglycemia as a complication of intravenous insulin to treat hyperkalemia in the Emergency Department

The American Journal of Emergency Medicine

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Clinical and laboratory features of children with community-acquired pneumonia are associated with distinct radiographic presentations

European Journal of Pediatrics

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Adjunctive use of ketamine for benzodiazepine-resistant severe alcohol withdrawal: A retrospective evaluation

Journal of Medical Toxicology

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Analysis of bystander CPR quality during out-of-hospital cardiac arrest using data derived from automated external defibrillators

Resuscitation

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Emergency Department intubation success with succinylcholine vs rocuronium: A National Emergency Airway Registry Study

Annals of Emergency Medicine

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Mortality and causes of death among people who inject amphetamine: A long-term follow-up cohort study from a needle exchange program in Sweden

Drug and Alcohol Dependence

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Short-term prognosis of myocardial injury, type 1 and type 2 myocardial infarction in the Emergency Unit

American Journal of Medicine

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The effect of different retraining intervals on the skill performance of cardiopulmonary resuscitation in laypeople--A three-armed randomized control study

Resuscitation

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How to use the FBI's Behavioral Change Stairway Model to influence like a pro

This five-step crisis communication process can improve interactions with both partners and patients

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