Salvage intraosseous thrombolysis and extracorporeal membrane oxygenation for massive pulmonary embolism.

Intraosseous access is an alternative route of pharmacotherapy during cardiopulmonary resuscitation. Extracorporeal membrane oxygenation (ECMO) provides cardiac and respiratory support when conventional therapies fail. This case reports the use of intraosseous thrombolysis and ECMO in a patient with acute massive pulmonary embolism (PE). A 34-year-old female presented to the emergency department with sudden onset severe shortness of breath. Due to difficulty establishing intravenous access, an intraosseous needle was inserted into the left tibia. Echocardiography identified severe right ventricular dilatation with global systolic impairment and failure, indicative of PE. Due to the patient's hemodynamic compromise a recombinant tissue plasminogen activator (Alteplase) bolus was administered through the intraosseous route. After transfer to the intensive care unit, venous-arterial ECMO was initiated as further therapy. The patient recovered and was discharged 36 days after admission. This is the first report of combination intraosseous thrombolysis and ECMO as salvage therapy for massive PE.

Eye trauma epidemiology in regional Australia.

PURPOSE: To describe the epidemiology of eye trauma presenting to a regional referral health service in New South Wales, Australia. METHODS: A two-stage retrospective and prospective case series study was conducted. Patients who presented with eye trauma to Wagga Wagga Base Hospital (WWBH) emergency department (ED) during a one-year review period formed the retrospective case series (RCS). Patient inclusion was determined using Systematized Nomenclature of Medicine Clinical Terms and International Classification of Diseases 10th revision codes applied to medical records. Patients presenting with eye trauma to the WWBH ED or its ophthalmology service over a prospective 80-day study period formed the prospective case series (PCS). The main outcome measures were patient demographics, eye trauma incidence for Wagga Wagga and the Murrumbidgee region and injury details. RESULTS: A total of 411 and 117 eye injuries were identified for the RCS and PCS, respectively. Mean age was 35.5 ± 18.6 years (RCS) and 34.1 ± 17.1 years (PCS), with male predominance (77.9%, RCS; 89.7%, PCS). The incidence of eye trauma in Wagga Wagga and Murrumbidgee was estimated from the PCS at 537.1 and 334.4, respectively, per 100,000 person-years. A large proportion of injuries were work-related (40.2% RCS, 45.8% PCS). Protective eyewear use in work-related injuries was low (27.6% RCS, 39.0% PCS). CONCLUSIONS: Eye trauma remains a significant public health concern with a high incidence in Wagga Wagga and the Murrumbidgee region. Protective eyewear compliance is low in work-related eye injuries. Patient demographic and occupational factors may be targeted to reduce the burden of disease.

Comparison of topcon optical coherence tomography and ultrasound pachymetry.

PURPOSE: To establish within-rater repeatability and minimum measurements required for reliable assessment of central corneal thickness (CCT) using Topcon three-dimensional OCT-2000 (Topcon Medical Systems, Oakland, NJ) Fourier-domain optical coherence tomography (FD-OCT) and to test agreement against ultrasound pachymetry (USP). METHODS: Twenty participants underwent five scans using FD-OCT followed by five CCT measurements using USP. Each FD-OCT scan produced 12 meridional optical sections, giving 60 sections in total. The FD-OCT CCT was calculated from each section using Topcon FastMap software. Within-rater repeatability was assessed using intraclass correlation coefficient (ICC), within-subject variance (Sw), and within-subject coefficients of repeatability (COR) and variation (COV). Agreement was assessed using analysis of variance, simple linear regression, Bland-Altman analysis, and ICC. The minimum number of FD-OCT scans required to achieve a mean CCT within the 99% confidence intervals of all 60 measurements was calculated. RESULTS: Mean CCTs were 528 ± 27 µm (FD-OCT) and 544 ± 29 µm (USP). The FD-OCT within-rater repeatability values assessed using ICC, Sw, COR, and COV were 0.99, 5.07 µm, 14.07 µm, and 0.01%, respectively. The USP within-rater repeatability values assessed using ICC, Sw, COR, and COV were 0.96, 5.49 µm, 15.22 µm, and 0.01%, respectively. Both instruments were similarly correlated (p < 0.05), with FD-OCT underestimating CCT by 16.08 µm relative to USP. Four FD-OCT scans were required to achieve a mean within the 99% confidence interval of all measurements for each participant. CONCLUSIONS: Both instruments displayed high repeatability, with strong agreement between devices, although FD-OCT significantly underestimated CCT compared with USP. The FD-OCT agreement with USP remained strong when only four scans were analyzed.