BACKGROUND: Safe anesthesia care is challenging in developing countries where there are shortages of personnel, drugs, equipment, and training. Anesthetists' Non-technical Skills (ANTS)-task management, team working, situation awareness, and decision making-are difficult to practice well in this context. Cesarean delivery is the most common surgical procedure in sub-Saharan Africa. This pilot study investigates whether a low-cost simulation model, with good psychological fidelity, can be used effectively to teach ANTS during cesarean delivery in Rwanda. METHODS: Study participants were anesthesia providers working in a tertiary referral hospital in Rwanda. Baseline observations were conducted for 20 anesthesia providers during cesarean delivery using the established ANTS framework. After the first observation set was complete, participants were randomly assigned to either simulation intervention or control groups. The simulation intervention group underwent ANTS training using low-cost high psychological fidelity simulation with debriefing. No training was offered to the control group. Postintervention observations were then conducted in the same manner as the baseline observations. RESULTS: The primary outcome was the overall ANTS score (maximum, 16). The median (range) ANTS score of the simulation group was 13.5 (11-16). The ANTS score of the control group was 8 (8-9), with a statistically significant difference (P = .002). Simulation participants showed statistically significant improvement in subcategories and in the overall ANTS score compared with ANTS score before simulation exposure. CONCLUSIONS: Rwandan anesthesia providers show improvement in ANTS practice during cesarean delivery after 1 teaching session using a low-cost high psychological fidelity simulation model with debriefing. (C) 2016 International Anesthesia Research Society
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Τετάρτη 22 Ιουνίου 2016
Impact of On-Bypass Red Blood Cell Transfusion on Severe Postoperative Morbidity or Mortality in Children.
BACKGROUND: Children undergoing cardiac surgery are frequently exposed to red blood cell (RBC) transfusions mainly in the case of hemorrhage or low oxygen transport. However, in this population, RBCs are sometimes added to the cardiopulmonary bypass (CPB) priming solution to maintain a predefined hematocrit on bypass. In this study, we investigated the impact of RBCs added to the CPB on severe postoperative morbidity or mortality. METHODS: This retrospective cohort study was conducted between 2006 and 2012 in a tertiary care level, children's hospital. Children receiving red cells only to prime the CPB (CPB transfusion) were compared with those receiving no RBCs during their entire hospital stay. The primary outcome was severe postoperative morbidity or mortality. Studied secondary outcomes were neurologic deficit, infection, length of mechanical ventilation, pediatric intensive care unit and hospital length of stay, and mortality. Both groups were compared with propensity score analysis where patients were matched via a genetic matching algorithm. In all analyses, applying a Bonferroni correction, a P value <.05 .00625 was considered statistically significant. results: among the patients retained for this study received no rbc transfusion during their entire hospital stay and a cpb transfusion. thirty-five in no-transfusion group developed severe postoperative morbidity or died. difference significant using univariate analysis .001 propensity score showed that died compared with .043 relative risk its bonferroni-corrected confidence interval all secondary outcomes were not significantly different between both groups except number of who infections conclusions: condition our adding rbcs to priming maintain predefined hematocrit does seem impact markedly mortality children undergoing cardiac surgery. only infection increased group. further studies are warranted better understand complex interaction severity illness anemia outcome international anesthesia research society>
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GRINSPAN’S SYNDROME – a case report
2016-06-22T22-25-00Z
Source: Case Study and Case Report
Sadije Halimi, Mybera Ferizi, Antigona Gerqari, Nita Krasniqi, Mergita Ferizi.
Some internal disease can have impact in the skin. Grinspan syndrome is a syndrome characterized by presence of the triad: hypertension, diabetes mellitus and oral lichen planus . Grinspan in 1963 raported 23 patient having oral erosive lichen planus, associated with diabetes mellitus . In 1965 this triad was subsequently referred to as Grinspan syndrome by Grupper and Avul. Oral lichen planus is thought to be a result of the drugs used for treatment of hypertension and diabetes mellitus because drug therapy for diabetes mellitus and hypertension is capable of producing lichenoid reactions of the oral mucosa but this is not confirmed. This paper presents a case of mucocutaneous lichen planus associated with diabetes mellitus, and vascular hypertension. Our case is a 63 years old female. During intraoral examination, we can see white and ulcerated lesions all over the oral mucosa and pain during mastication, upon for the past one year ,associated with diabetes mellitus and arterial hypertension. Some internal disease can have impact in the skin. Grinspan syndrome is characterized by presence of the triad : hypertension, diabetes mellitus and oral lichen planus. The patients with oral lichen planus, should have a healthy lifestyle, well-balanced diet and stress reduction because this disease can be controlled but not eliminated.
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Paramedic Upstate SC - Upstate Carolina EMS
Upstate Carolina EMS located in Cherokee County, South Carolina is seeking part time EMTs and full time Paramedics. Sign-on bonuses are available for both full and part time. Successful candidates will possess a National Registry of Emergency Medical Technicians certification and a valid S.C. certification. Out of state applicants are welcome to submit their interest however NREMT certification must ...
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RhBMP-2-induced radiculitis in transforaminal lumbar interbody patients: relationship to dose
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Determination of the oswestry disability index score equivalent to a “satisfactory symptom state” in patients undergoing surgery for degenerative disorders of the lumbar spine – A spine tango registry-based study
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Operative management of complex lumbosacral dissociations in combat injuries
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Emerging S-shaped curves in congenital scoliosis after hemivertebra resection and short segmental fusion
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Professional Sports Drug Testing Collector (Part-Time) - Comprehensive Drug Testing (CDT)
CDT is seeking qualified candidates with a background in law enforcement, emergency medical response, or laboratory science/toxicology for a unique part-time opportunity as a Professional Sports Drug Testing Collector. ABOUT US CDT, Inc. (Comprehensive Drug Testing, Inc.) manages drug-testing programs for several major professional sports organizations. Administering a nationwide drug-testing program ...
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Real-time estimation of FES-induced joint torque with evoked EMG
Functional electrical stimulation (FES) is a neuroprosthetic technique for restoring lost motor function of spinal cord injured (SCI) patients and motor-impaired subjects by delivering short electrical pulses ...
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Part-time Firefighter/EMT - Washington Township Fire Department
WASHINGTON TOWNSHIP FIRE DEPARTMENT 8320 MCEWEN RD. DAYTON, OHIO 45458 Updated: June 13, 2016 Job Classification: Part-Time Firefighter/EMT Washington Township (Montgomery County) is currently hiring for part-time Firefighter/EMT positions to perform all functions associated with fire suppression, EMS, technical rescue, hazardous materials, fire prevention, and station and equipment maintenance activities ...
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Intravenous loading of nitroglycerin during rewarming of cardiopulmonary bypass improves metabolic homeostasis in cardiac surgery: a retrospective analysis
Abstract
Purpose
The aim of the study was to evaluate the effects of high-dose nitroglycerine (NTG) on glucose metabolism, tissue oxygenation and postoperative recovery in cardiac surgical patients.
Methods
Cardiac surgical patients in the retrospective survey were classified into two groups based on the NTG regimen. NTG group had intravenous loading of NTG (infusion rate 10–20 mg/h with total dose of ≥0.5 mg/kg) starting at rewarming of cardiopulmonary bypass (CPB) (n = 101), and control group had no intravenous loading of NTG (n = 151). Data for intraoperative plasma glucose and lactate levels, and regular insulin consumption were collected. Propensity score methodology was utilized to adjust for potential confounders.
Results
After adjustment for propensity score, the plasma glucose was significantly lower in the NTG group during (161 ± 39 versus 179 ± 45 mg/dl, p = 0.005) and after CPB (167 ± 41 versus 184 ± 48 mg/dl, p = 0.012). Total consumption of regular insulin was significantly lower in the NTG group, median 8 (range 0–50) versus 13 (0–90) international units, p = 0.005. There was a trend towards statistical significance in a lower incidence of hyperlactatemia (>2.2 mmol/l) in the NTG group during CPB, 21/100 (21 %) versus 40/132 (30.3 %), p = 0.065. The mixed venous oxygen saturation in the intensive care unit was higher in the NTG group, 65 ± 9 versus 62 ± 11 %, p = 0.056.
Conclusions
Intravenous loading of NTG during and after CPB is safe and effective for attenuating the hyperglycemic response and reduce the incidence of hyperlactatemia during cardiac surgery with CPB.
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Flight RN / Paramedic - Life Link III
Provides clinical care to patients being transported or being prepared for transportation and assists other medical facilities personnel with procedures as requested. Assesses, plans, implements and evaluates care to patients transported by air ambulance. Provides care as directed by the Life Link III Medical Directors, medical control physicians and patient physician. Renders patient care based on ...
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How to make a differential diagnosis
Watch this explanation of how to make and organize a differential diagnosis for an ill or injured patient. And yes, EMTs and paramedics diagnose patients.
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How to make a differential diagnosis
Watch this explanation of how to make and organize a differential diagnosis for an ill or injured patient. And yes, EMTs and paramedics diagnose patients.
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Top Gear ambulance challenge
A clip from the BBC hit show "Top Gear" features a custom-made ambulance and one of the show's stars attempting to complete some tasks on a manikin.
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The effectiveness of integrated teaching over traditional teaching in third MBBS students
2016-06-22T09-15-43Z
Source: International Journal of Medical Science and Public Health
Varsha Shah, Uresh J Jain.
Background: Integration in education means co-ordination in teaching learning activities to ensure harmonious functioning of the educational processes. Well-designed curriculum and good teaching methods will help students gain a body of knowledge, habit of study, and capacity of independent thinking. Objectives: To assess the effectiveness of the integrated teaching method over the traditional teaching method among third year MBBS students. Materials and Methods: Study was conducted on 80 students of third year MBBS, Part I. Two study groups, each of 40 students were formed. They were exposed to integrated teaching and traditional lecture method. Integrated teaching was implemented by the active involvement of medicine, pharmacology, and physiology departments. Traditional teaching was implemented by faculty of medicine department. Evaluation was done by pre-test, post-test, and feedback questionnaire of students with Likert scale. Results: Statistically significant difference in marks was obtained in the test provided after integrated teaching when compared to traditional teaching method (significant P-value). 95% students felt that integrated teaching provides better understanding of subject and learning skills. Conclusion: Results of this study suggest that integrated teaching was found more effective than traditional teaching. Integrated teaching should be introduced in undergraduate medical curriculum.
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Knowledge and attitude of pre-university adolescent girls regarding STDs/HIV and sexual health in Mysore city
2016-06-22T09-15-43Z
Source: International Journal of Medical Science and Public Health
MANSOOR AHMED, KUSUMA M L.
Background: Adolescent girls are less likely than older women to access sexual and reproductive health care. Information about knowledge and attitude is essential to better understand the dynamics of the STI epidemic and to plan preventive measures. Objective: To assess the knowledge and attitude of pre-university adolescent girls regarding STDs/HIV. Materials and Methods: A cross-sectional study was conducted among pre-university adolescent girls in Mysore city between June 2013 and November 2013. The sample size of 1500 was selected from the total population of 4155 using Proportional Stratified Sampling technique. Direct interview method was used to collect the information using a pretested, semi-structured questionnaire after taking consent from the students. Result: Of all, 1425 (95%) of the study subjects had never discussed any sexual health-related matter with their fathers and similarly 1279 (85.32%) had not discussed with their mothers. A total of 1012 (67.46%) believed that girls should remain virgin until marriage and 1411 (94.06%) students had heard of HIV/AIDS but only 613 (40.86%) knew the abbreviation of AIDS. Among all, 931 (62.06%) students knew that HIV is incurable, and only 623 (41.53%) knew that there was a simple test to diagnose HIV. Although 646 (43.06%) students knew that there are other STIs apart from HIV, very few knew about its signs and symptoms. 102 (6.80%) study subjects had a misconception that hugging and kissing an infected person transmits HIV. 10% girls had a misconception that using oral pills and avoiding social interaction with HIV-infected people would prevent the transmission. For many 1129 (75.26%) study subjects, the source of information regarding HIV was from mass media. 1171 (78.71%) subjects felt that there should be classes on reproductive and sexual health in schools and colleges. Conclusion: There is a substantial lacuna in the knowledge and perception of the girls regarding sexual health. A lot of myths and misconceptions are prevailing among the girls in the core areas such as condom use, HIV transmission, and prevention.
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A cross-sectional study to observe the effects of dose of anti-snake venom on outcomes and adverse effects in snake bite cases
2016-06-22T09-15-43Z
Source: International Journal of Medical Science and Public Health
Swapnil P Chube, Anand S Kale, Vinod S Deshmukh, Harshal N Pise.
Background: Snake bite is a major problem in rural India. The lack of universal consensus toward the dose of ASV to be used and dose-related adverse effects have been long-standing issues in the snake bite management protocols. Objective: To observe the effects of dose of anti-snake venom (ASV) on outcomes and adverse effects in snake bite cases, in a rural tertiary care hospital in Maharashtra, India. Materials and Methods: A cross-sectional observational study was carried out in the medicine intensive care unit (ICU) of SRTR GMC, Ambajogai by scrutinizing the prescriptions of 70 snake bite patients admitted to the ICU during the study period of 3 months. Data were analyzed using descriptive statistics and Microsoft Excel 2007. Statistical analysis was carried out using the Fishers Exact test. Result: Acute kidney injury developed in 6 (20%) and 9 (22.5%) patients, neuroparalysis requiring ventilator support developed in 4 (13.3%) and 6 (15%) patients, hospital stay duration was 1.36 and 2.92 days and the mortality rate was 3.3% versus 5%, in patients given low and high dose of ASV, respectively. But, the occurrence of adverse effects to ASV was significantly less with low dose of ASV. Conclusion: Results were found to be comparable in terms of treatment outcomes. So, low doses of ASV can be utilized to optimize usage and minimize its adverse effects.
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How to make a differential diagnosis
Watch this explanation of how to make and organize a differential diagnosis for an ill or injured patient. And yes, EMTs and paramedics diagnose patients.
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Top Gear ambulance challenge
A clip from the BBC hit show "Top Gear" features a custom-made ambulance and one of the show's stars attempting to complete some tasks on a manikin.
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Remember 2 Things: Sedation for violent, restrained patients
In this episode on patient restraint Steve Whitehead discusses the need for and importance of sedation for restrained, violent patients. Follow your local protocols to select and administer a sedative. Whitehead also describes the importance of continuing restraints after administering a sedative.
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Remember 2 Things: How to monitor violent, restrained patients
In this episode on patient restraint Steve Whitehead describes the importance of capnography to monitor violent patients who have been restrained. Whitehead also discusses the importance of temperature assessment and monitoring.
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Remember 2 Things: Supplemental oxygen and fluids for violent, restrained patients
After successfully applying restraints to a violent patient remember two important things for continuing to assess and care for the patient. In this episode on patient restraint Steve Whitehead discusses the importance of supplemental oxygen and fluid resuscitation.
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Remember 2 Things: How to prevent medication administration errors
A large percentage of errors are due to medication administration errors. In this episode of Remember 2 Things Steve Whitehead reminds paramedics of the importance of drawing up a medication dose into a syringe and what to do with the medication remaining in a vial. After watching share your medication administration tips in the comments and read this excerpt from "Med Math Simplified."
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Methods for Incorporating Patient Preferences for Treatments of Depression in Community Mental Health Settings
Abstract
We developed three methods (rating, ranking, and discrete choice) for identifying patients' preferred depression treatments based on their prioritization of specific treatment attributes (e.g., medication side effects, psychotherapy characteristics) at treatment intake. Community mental health patients with depressive symptoms participated in separate studies of predictive validity (N = 193) and short-term (1-week) stability (N = 40). Patients who received non-preferred initial treatments (based on the choice method) switched treatments significantly more often than those who received preferred initial treatments. Receiving a non-preferred treatment at any point (based on rating and choice methods) was a significant predictor of longer treatment duration. All three methods demonstrated good short-term stability.
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How to make a differential diagnosis
Watch this explanation of how to make and organize a differential diagnosis for an ill or injured patient. And yes, EMTs and paramedics diagnose patients.
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Top Gear ambulance challenge
A clip from the BBC hit show "Top Gear" features a custom-made ambulance and one of the show's stars attempting to complete some tasks on a manikin.
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Remember 2 Things: Sedation for violent, restrained patients
In this episode on patient restraint Steve Whitehead discusses the need for and importance of sedation for restrained, violent patients. Follow your local protocols to select and administer a sedative. Whitehead also describes the importance of continuing restraints after administering a sedative.
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Remember 2 Things: How to monitor violent, restrained patients
In this episode on patient restraint Steve Whitehead describes the importance of capnography to monitor violent patients who have been restrained. Whitehead also discusses the importance of temperature assessment and monitoring.
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Remember 2 Things: Supplemental oxygen and fluids for violent, restrained patients
After successfully applying restraints to a violent patient remember two important things for continuing to assess and care for the patient. In this episode on patient restraint Steve Whitehead discusses the importance of supplemental oxygen and fluid resuscitation.
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Remember 2 Things: How to prevent medication administration errors
A large percentage of errors are due to medication administration errors. In this episode of Remember 2 Things Steve Whitehead reminds paramedics of the importance of drawing up a medication dose into a syringe and what to do with the medication remaining in a vial. After watching share your medication administration tips in the comments and read this excerpt from "Med Math Simplified."
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Top Gear ambulance challenge
A clip from the BBC hit show "Top Gear" features a custom-made ambulance and one of the show's stars attempting to complete some tasks on a manikin.
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Remember 2 Things: Sedation for violent, restrained patients
In this episode on patient restraint Steve Whitehead discusses the need for and importance of sedation for restrained, violent patients. Follow your local protocols to select and administer a sedative. Whitehead also describes the importance of continuing restraints after administering a sedative.
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Remember 2 Things: How to monitor violent, restrained patients
In this episode on patient restraint Steve Whitehead describes the importance of capnography to monitor violent patients who have been restrained. Whitehead also discusses the importance of temperature assessment and monitoring.
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Remember 2 Things: Supplemental oxygen and fluids for violent, restrained patients
After successfully applying restraints to a violent patient remember two important things for continuing to assess and care for the patient. In this episode on patient restraint Steve Whitehead discusses the importance of supplemental oxygen and fluid resuscitation.
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Remember 2 Things: How to prevent medication administration errors
A large percentage of errors are due to medication administration errors. In this episode of Remember 2 Things Steve Whitehead reminds paramedics of the importance of drawing up a medication dose into a syringe and what to do with the medication remaining in a vial. After watching share your medication administration tips in the comments and read this excerpt from "Med Math Simplified."
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Intramuscular MAPK signaling following high volume and high intensity resistance exercise protocols in trained men
Abstract
Purpose
To examine the mitogen-activated protein kinase (MAPK) family of signaling proteins following typical high volume (HV) and high intensity (HI) lower body resistance exercise protocols in resistance-trained men.
Methods
Ten resistance-trained men (24.7 ± 3.4 year; 90.1 ± 11.3 kg; 176.0 ± 4.9 cm) performed each resistance exercise protocol in a random, counterbalanced order. The HV protocol utilized a load of 70 % 1-RM for sets of 10–12 repetitions with a 1-min rest period length between sets and exercises. The HI protocol utilized a load of 90 % 1-RM for sets of 3–5 repetitions with a 3-min rest period length between sets and exercises. Both protocols included six sets of barbell back squats and four sets of bilateral leg press, bilateral hamstring curls, bilateral leg extensions, and seated calf raises. Fine needle muscle biopsies of the vastus lateralis were completed at baseline (BL) and 1-h post exercise (1H).
Results
No significant differences over time were noted for phosphorylation of MEK1, ERK1/2, p38, MSK1, ATF2, p53, or c-Jun (p > 0.05). No significance between trial interactions was noted for phosphorylation of MAPK signaling proteins, including MEK1, ERK1/2, p38, JNK, MSK1, ATF2, STAT1, p53, c-Jun, or HSP27 (p > 0.05). However, significant time effects were observed for phosphorylation of JNK (p < 0.01), HSP27 (p < 0.01), and STAT1 (p = 0.03). Phosphorylation of JNK, HSP27, and STAT1 was significantly elevated from BL at 1H for both HV and HI.
Conclusions
HV and HI lower body resistance exercise protocols appear to elicit similar MAPK activation in resistance-trained men.
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Oral nitrate and citrulline decrease blood pressure and increase vascular conductance in young adults: a potential therapy for heart failure
Abstract
Purpose
Both inorganic nitrate and citrulline are known to alter the arginine–nitric oxide–nitrate system to increase the bioavailability of nitric oxide with potential benefits in the treatment of heart failure. However, their effects on cardiac electrical activity, vascular compliance and peripheral conductance are less well understood. This study examined the effect of nitrate and citrulline on cardiac electrical activity and blood flow.
Methods
Young adult subjects (n = 12) were recruited to investigate the effects of acute oral nitrate consumption (8 mg/kg) and chronic citrulline consumption (3 g/day) on cardiac electrical activity measured by ECG recording and blood pressure. Blood flow and vascular compliance were measured by IR-plethysmography at the thumb and the hallux.
Results
Nitrate (p < 0.05) and citrulline (p < 0.01) consumption both decreased diastolic blood pressure but had no effect on either pulse pressure or rate-pressure product (NS for both). Citrulline also decreased systolic pressure (p < 0.01). Nitrate and citrulline both decreased vascular compliance (p < 0.05 for both) prior to isometric grip exercise, but this was increased for nitrate following exercise (NS). Citrulline decreased R–R interval 9 % (p < 0.05) at rest and increased heart rate (p < 0.05) in addition to significantly decreasing pulse transit duration (6 %; p < 0.05). QRS duration was also decreased by 5 % for citrulline (p < 0.05) with the reduction in R–R interval.
Conclusion
Both nitrate and citrulline supplementation decreased vascular tone at rest but citrulline also altered sympathovagal balance to increase sympathetic tone. We suggest that both oral nitrate and citrulline may be suitable adjuvants for patients with heart failure to improve peripheral tissue oxygenation.
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Remember 2 Things: Sedation for violent, restrained patients
In this episode on patient restraint Steve Whitehead discusses the need for and importance of sedation for restrained, violent patients. Follow your local protocols to select and administer a sedative. Whitehead also describes the importance of continuing restraints after administering a sedative.
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Remember 2 Things: How to monitor violent, restrained patients
In this episode on patient restraint Steve Whitehead describes the importance of capnography to monitor violent patients who have been restrained. Whitehead also discusses the importance of temperature assessment and monitoring.
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Remember 2 Things: Supplemental oxygen and fluids for violent, restrained patients
After successfully applying restraints to a violent patient remember two important things for continuing to assess and care for the patient. In this episode on patient restraint Steve Whitehead discusses the importance of supplemental oxygen and fluid resuscitation.
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Remember 2 Things: How to prevent medication administration errors
A large percentage of errors are due to medication administration errors. In this episode of Remember 2 Things Steve Whitehead reminds paramedics of the importance of drawing up a medication dose into a syringe and what to do with the medication remaining in a vial. After watching share your medication administration tips in the comments and read this excerpt from "Med Math Simplified."
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Sober legal advice for LAFD's new EMS program
The Los Angeles Fire Department is proposing a new program to address the problem of frequent users on and near the famed Skid Row. As an attorney committed to the protection and defense of EMS providers and advocating for the best in patient care, I have mixed feelings about the SOBER unit.
The issues are real. Like most large metropolitan departments, LAFD EMS resources can respond to the same person multiple times in a single day for generally non-emergent reasons. Those calls for emergency care are often related to the use or abuse of drugs and alcohol — problems better suited to a social worker and a substance abuse counselor than a paramedic, ambulance, and an emergency room.
The proposed solution is a unit staffed with an EMS provider and a community outreach worker who will follow a checklist and triage the individual either to a hospital or to a new sobering center. The idea — as an idea — is brilliant. I love it!
I admire and respect the LAFD for its very creative forward-thinking and willingness to solve problems. I am impressed that they are willing to break free of the chains of tradition to reach for a better, broader and more appropriate approach to patient care and people care.
In practice, however, I have grave concerns.
I am fearful for the EMS provider on the street who, when something goes wrong, will be left out in the bitter cold with nothing more than a good idea to protect him or her from the wolves.
Problem: Rigid regulatory climate
Local and state polices, protocols and procedures in California are not very flexible and are vigorously and, at times, viciously enforced.
The very first time an individual is transported to the sobering center only to go into cardiac arrest — at any point during or after transport — it is the paramedic who will be investigated, disciplined and likely face an administrative law judge who will determine whether the paramedic's license should be revoked at the behest of the State EMS Authority.
The paramedic will find little refuge in an LAFD pilot program when California's EMS Authority comes banging on the door.
Problem 2: Liability for assessment
According to the story, the paramedic would check the patient's mental status and for "evidence of head injury or seizure activity." What does that mean and how does a paramedic adequately check for such things"
We all know that in the field evidence of a head injury or seizure activity is not the same as proof of a head injury or seizure activity. Nevertheless, the way I read the news, it is the paramedic who will be held liable for making the mistake; and why not" They are now held liable for mistakes.
How to make this work
For what it's worth — and legally speaking — I think this can work and I believe it can be a great success for everyone.
First, policies, protocols and procedures that protect the paramedic from liability, while ensuring only the highest in compliance to established standards would have to be codified and accepted by the State EMS Authority before the SOBER unit's first call.
This is not something that needs to happen just in the city, but at the state level because it is the state who will come after the paramedic's license.
Next, paramedics will have to undergo extensive training and continuing education on the new policies, protocols and procedures as well as comprehensive training on patient care documentation. The proposed checklist will have to be extensive and very clearly documented on every call.
Then, there will have to be a comprehensive and closely monitored quality-control element to aggressively prevent and eliminate policy fallouts and detect and manage negative trends. This is not necessarily because the paramedics will make mistakes, but because patients will complain.
I guarantee an intoxicated person who wants to go to the hospital will be taken to a sobering center and a complaint — or lawsuit — will be filed for which the paramedic will be left holding the bag when EMSA gets involved.
Lastly, LAFD needs to be prepared for the unintended consequences. The residents of Skid Row have a better communication network than Facebook will ever imagined.
It will not be long before the word spreads about free rides to the sobering center. On hot days and cold nights the demand for the SOBER units will grow faster than the department's ability to keep up and that means more rescues out of service and on Skid Row.
If LAFD truly wants this to work and puts its best people on it and if they don't rush into as a public relations opportunity, the SOBER program is bound to succeed and be a model for agencies nationwide. I hope it works.
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Validity of ultrasonographic measurement of gastric volume in fasted pediatric patients without sedation
Abstract
Recently, gastric ultrasonography has been used as a noninvasive portable tool for evaluating gastric content and volume in adults and children. Pediatric patients are not always cooperative, especially younger ones, and it may be difficult to keep them in the appropriate scanning position without sedation. Hence, we modified the scanning method and position, and evaluated the efficacy of this alternative scanning technique in pediatric cases. We evaluated the gastric contents of 44 pediatric patients aged 4–14 years who were about to undergo elective surgery. Solid food and fluids were prohibited 8 and 2 h before anesthesia, respectively. Before anesthetic induction, we used gastric ultrasonography to measure the antral cross-sectional area in the supine position (supine CSA), irrespective of peristaltic contractions. The gastric volume was then aspirated using a multi-orifice catheter under general anesthesia. Supine CSA measured via this gastric ultrasonography method was positively correlated with gastric volume (r = 0.56, p < 0.0001). We concluded that our alternative method of measuring antral CSA may be applicable for children minimal gastric contents.
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Anesthetic management of a patient with polycythemia vera for neurosurgery
Abstract
Polycythemia vera (PV) is a myeloproliferative disorder characterized by excess red cell clonality. The increased number of red blood cells can lead to increased viscosity of the blood and ultimately compromise the blood supply to the end organs. Thromboembolic and hemorrhagic complications can also develop. Patients with PV presenting with neurological diseases that require surgical intervention are at an increased risk due to various factors, such as immobility, prolonged surgical time, hypothermia and dehydration. We report anesthetic management of a patient with PV who underwent neurosurgical intervention for vestibular schwannoma excision.
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Factors that Influence the Performance of Elite Sprint Cross-Country Skiers
Abstract
Background
Sprint events in cross-country skiing are unique not only with respect to their length (0.8–1.8 km), but also in involving four high-intensity heats of ~3 min in duration, separated by a relatively short recovery period (15–60 min).
Objective
Our aim was to systematically review the scientific literature to identify factors related to the performance of elite sprint cross-country skiers.
Methods
Four electronic databases were searched using relevant medical subject headings and keywords, as were reference lists, relevant journals, and key authors in the field. Only original research articles addressing physiology, biomechanics, anthropometry, or neuromuscular characteristics and elite sprint cross-country skiers and performance outcomes were included. All articles meeting inclusion criteria were quality assessed. Data were extracted from each article using a standardized form and subsequently summarized.
Results
Thirty-one articles met the criteria for inclusion, were reviewed, and scored an average of 66 ± 7 % (range 56–78 %) upon quality assessment. All articles except for two were quasi-experimental, and only one had a fully-experimental research design. In total, articles comprised 567 subjects (74 % male), with only nine articles explicitly reporting their skiers' sprint International Skiing Federation points (weighted mean 116 ± 78). A similar number of articles addressed skating and classical techniques, with more than half of the investigations involving roller-skiing assessments under laboratory conditions. A range of physiological, biomechanical, anthropometric, and neuromuscular characteristics was reported to relate to sprint skiing performance. Both aerobic and anaerobic capacities are important qualities, with the anaerobic system suggested to contribute more to the performance during the first of repeated heats; and the aerobic system during subsequent heats. A capacity for high speed in all the following instances is important for the performance of sprint cross-country skiers: at the start of the race, at any given point when required (e.g., when being challenged by a competitor), and in the final section of each heat. Although high skiing speed is suggested to rely primarily on high cycle rates, longer cycle lengths are commonly observed in faster skiers. In addition, faster skiers rely on different technical strategies when approaching peak speeds, employ more effective techniques, and use better coordinated movements to optimize generation of propulsive force from the resultant ski and pole forces. Strong uphill technique is critical to race performance since uphill segments are the most influential on race outcomes. A certain strength level is required, although more does not necessarily translate to superior sprint skiing performance, and sufficient strength-endurance capacities are also of importance to minimize the impact and accumulation of fatigue during repeated heats. Lastly, higher lean mass does appear to benefit sprint skiers' performance, with no clear advantage conferred via body height and mass.
Limitations
Generalization of findings from one study to the next is challenging considering the array of experimental tasks, variables defining performance, fundamental differences between skiing techniques, and evolution of sprint skiing competitions. Although laboratory-based measures can effectively assess on-snow skiing performance, conclusions drawn from roller-skiing investigations might not fully apply to on-snow skiing performance. A low number of subjects were females (only 17 %), warranting further studies to better understand this population. Lastly, more training studies involving high-level elite sprint skiers and investigations pertaining to the ability of skiers to maintain high-sprint speeds at the end of races are recommended to assist in understanding and improving high-level sprint skiing performance, and resilience to fatigue.
Conclusions
Successful sprint cross-country skiing involves well-developed aerobic and anaerobic capacities, high speed abilities, effective biomechanical techniques, and the ability to develop high forces rapidly. A certain level of strength is required, particularly ski-specific strength, as well as the ability to withstand fatigue across the repeated heats of sprint races. Cross-country sprint skiing is demonstrably a demanding and complex sport, where high-performance skiers need to simultaneously address physiological, biomechanical, anthropometric, and neuromuscular aspects to ensure success.
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Sober legal advice for LAFD's new EMS program
The LAFD SOBER unit for Skid Row's frequent users is a good idea, but potential dangers to paramedics cannot be ignored
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75 paramedic students complete all-day field ops training
400 instructors, volunteers and patient actors, along with 26 ambulances and two helicopters, helped paramedic students complete 70 different scenarios
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Could acupuncture be an adequate alternative to dexamethasone in pediatric tonsillectomy?
Summary
Background
Usage of nonpharmacological treatment contributes to an overall patient well-being, assisting in physical and emotional healing. Acupuncture has been reported to be useful in reducing early postoperative vomiting and attenuating postoperative pain.
Aim
The aim of this study was to compare the effect of dexamethasone vs acupuncture at P6 bilaterally and CV13 on the incidence and severity of POV in children undergoing tonsillectomy with or without adenoidectomy.
Method
One hundred and twenty children, ASA I–III aged 2–8 years undergoing elective tonsillectomy were included in this prospective randomized double-blind study. Children were randomly divided into two equal groups (60 each). At induction of anesthesia, the dexamethasone group received 0.15 mg·kg−1 dexamethasone IV plus sham acupuncture, and the acupuncture group received acupuncture at P6 bilaterally and CV13 plus 2 ml of normal saline IV. Vomiting was recorded at 0–6, 6–24, and 0–24 h postoperatively.
Results
There was no difference in the incidence of vomiting between the acupuncture and dexamethasone groups. The mean difference in time to first oral intake (95% CI) was 4.3 (0.5–8.6) min between dexamethasone group and acupuncture group; P = 0.426. The mean difference in time until first vomit (95% CI) was 12 (9.5–13.8) min between both groups. No significant differences between Kaplan–Meier curves for time until first vomit (log-rank test) were obtained (P < 0.697).
Conclusion
Acupuncture at P6 bilaterally and CV13 provided similar antiemetic effect to dexamethasone in children undergoing tonsillectomy.
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