Is it time to pull epinephrine from the EMS formulary?

Our co-hosts discuss a recent study out of the UK that puts the use of epinephrine in prehospital cardiac arrest patients into question

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The development of a digital gamma-gamma coincidence/anticoincidence spectrometer and its applications to monitor low-level atmospheric 22Na/7Be activity ratios in Resolute Bay, Canada

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 192

Author(s): Weihua Zhang, Kenneth Lam, Kurt Ungar

Abstract

Using a previously developed digital gamma-gamma coincidence/anticoincidence spectrometer, daily aerosol samples collected at Resolute Bay, Canada (74.71°N, 94.97°W) from May 2016 to April 2017 were analysed for activity concentrations of ²²Na and ⁷Be. The spectrometer design allows a more selective measurement of ²²Na with a significant background reduction by gamma-gamma coincidence events processing. It has been demonstrated that the improved spectrometer provides a more sensitive and effective way to quantify trace amounts of ²²Na and ⁷Be with a critical limit of 3 mBq and 5 Bq respectively for a 20 h counting. The ⁷Be/²²Na ratio data set obtained in this study showed significant annual variation, which has a distinct spring (typically from February to May) maximum and winter (from September to February of next calendar year) minimum, which suggest that it could be used as a radiochronometer for studying the atmospheric processes. The ⁷Be/²²Na ratios are most likely connected to deep stratosphere-to-troposphere transport (STT) exchange events where air with a higher ⁷Be/²²Na ratio originates from downward flow from stratosphere to the troposphere. The aerosols with lower ⁷Be/²²Na ratios located between two oscillation peaks may have longer residence time. The correlations between ⁷Be and ²²Na activity concentration were the high during these time periods. Compared with other studies based on weekly collected aerosol samples, the techniques greatly improve the temporal resolution of ⁷Be/²²Na data set that will be able to provide more detailed information to study various atmospheric phenomena.

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Provider Counseling About Secondhand Smoke Exposure for Urban Children With Persistent or Poorly Controlled Asthma

Urban children continue to be exposed to secondhand smoke (SHS), and this is particularly concerning for children with asthma. The objective of this study is to describe SHS exposure among urban children with asthma and assess SHS counseling delivered at primary care visits. We interviewed caregivers of 318 children (2–12 years) with persistent asthma at the time of a health care visit and reviewed medical records. We found that one third (32%) of children lived with a caregiver who smoked and that 15% lived with other smokers.

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The Relationship Between Neighborhood Safety and Children's Asthma: An Integrative Review

There is a growing body of research analyzing the relationships between neighborhood safety and children's asthma prevalence and control. There are several inconsistencies in concepts and methods that have led to mixed results. The purpose of this review is to critically evaluate the current evidence analyzing neighborhood safety and childhood asthma and identify nursing research and policy implications.

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Collaborative Care of Attention Deficit Hyperactivity Disorder: An Innovative Partnership to Serve Rural Pediatric Patients

Attention deficit hyperactivity disorder (ADHD) is a common behavioral health disorder in childhood that causes significant impairments in quality of life, home relationships, and school success. Despite a substantial evidence base and corresponding practice guidelines established by the American Academy of Pediatrics that support use of behavioral therapy to treat ADHD, affected patients infrequently receive therapy. This article will review the causes of underuse of behavioral therapy and methods to overcome these barriers such as integrating behavioral health care, thereby creating a pediatric patient–centered medical home.

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P30. A novel application of the Phase-lag-Index in functional connectivity research

The phase-lag-index (PLI) (Stam et al., 2007) is a commonly used method to quantify functional connectivity (FC) in EEG/MEG data. When calculated for short epochs in the order of several seconds, PLI varies considerably from epoch to epoch. Using resting-state EEG data from 105 healthy subjects, we demonstrate that the pattern of correlations between PLI time-series is characteristic for an individual's brain. In addition to acting as an identifying fingerprint, this pattern is also highly gender-specific and bears characteristics that are shared among people and also between hemispheres.

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Massive hemobilia following plastic stent removal in common bile duct cancer associated with primary sclerosing cholangitis (with video)

Abstract

Hemobilia is defined as bleeding into the biliary tract. Herein, we report a very rare case of massive hemobilia following plastic stent (PS) removal in common bile duct (CBD) cancer. A 72-year-old man with primary sclerosing cholangitis had undergone repeated insertion of a PS into the CBD. Biliary tract biopsy was performed based on suspicion of combined CBD cancer. Biopsy revealed poorly differentiated adenocarcinoma of the CBD. One month after the biliary tract biopsy, he was admitted for acute cholangitis, and endoscopic retrograde cholangiography was performed for the exchange of the PS. When one of the two biliary PSs was removed, spurting bleeding from the major papilla began abruptly. The massive bleeding caused the patient to be in a pre-shock state. A retrieval balloon catheter was compressed against the papilla for hemostasis. Although he was treated conservatively, the patient developed a bloody discharge. Upper gastrointestinal endoscopy revealed that the pulsatile bleeding beside the PSs started immediately after the removal of the coagula. Emergent contrast-enhanced computed tomography showed right hepatic artery aneurysm across the CBD. Therefore, transarterial embolization was performed. The patient's post-therapeutic course was uneventful. He received chemotherapy, but died about a half year after hemobilia occurred.

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