Mechanical Circulatory Support in the Cardiac Catheterization Laboratory for Cardiogenic Shock.

Despite the development of acute revascularisation, the mortality rate for cardiogenic shock remains around 50%. Mechanical circulatory support devices have long held promise in improving outcomes in shock, but high-quality evidence of benefit has not been forthcoming. In this article we review the currently available devices for treating shock, their physiological effects and the evidence base for their use in practice. We subsequently look ahead within this developing field, including new devices and novel indications for established technology.

Effect of Season, Transport Length, Deck Location, and Lairage Length on Pork Quality and Blood Cortisol Concentrations of Market Hogs.

The objective of this study was to investigate the effects of seasonal environment, transport conditions, and time in lairage on pork quality and serum cortisol concentrations. Market hogs were slaughtered during winter (n = 535), spring (n = 645), summer (n = 644), and fall (n = 488). Within season, hogs were randomly assigned to treatments in a 2 × 2 × 2 factorial arrangement, with 2 deck locations (top vs. bottom) and 2 transport and lairage durations (3 h vs. 6 h). Blood samples were collected at exsanguination for analysis of cortisol concentration. Loins were collected at 24 h postmortem for pork quality assessment. Season and deck did not have a main effect on cortisol concentrations or pork quality. Hogs transported 6 h had increased cortisol concentrations (103.0 vs. 95.5 ng/mL; P < 0.001) and decreased L* (52.49 vs. 52.69; P = 0.09), b* (6.28 vs. 6.36; P = 0.03), and hue angle (20.70 vs. 20.95; P = 0.03) compared to hogs transported 3 h. Hogs subjected to 6 h of lairage had increased 24-h pH (5.69 vs. 5.66; P = 0.005), a* (16.64 vs. 16.48; P < 0.0001), b* (6.42 vs. 6.22; P < 0.0001), saturation (17.85 vs. 17.64; P < 0.0001), and hue angle (21.01 vs. 20.65; P = 0.002) and decreased L* (52.49 vs. 52.69; P = 0.07) when compared to hogs subjected to 3 h of lairage.

"Bath salts" intoxication: a case report.

We present a case of a potentially lethal ingestion of "Bath Salts." After presentation, we briefly review the epidemiology and pathology of "bath salts" ingestion.

Use of ultrasound to facilitate accurate femoral nerve block in the emergency department.

OBJECTIVE: To compare the accuracy of ultrasound (US)-assisted femoral nerve blocks (FNB) with the fascial pop (FP) technique, examining the rates of success and complications. METHODS: This is a prospective unblinded pseudo-randomized controlled trial of US-assisted versus FP FNB techniques. The primary outcome measure was nerve block stratified to level of blockade (intact, partial or complete) with FNB assessed by skin sensation. Participants were assessed at 15 and 60 min post nerve block. RESULTS: Sixty-seven patients were enrolled. Thirty-four (50.7% [95% CI 44.7-56.8]) underwent the US-assisted technique whereas thirty-three (49.2% [95% CI 43.4-55.2]) underwent the FP technique. At 15 min, FNB using US was intact, partial or complete for 9 (26.5% [95% CI 22.5-30.4]), 15 (44.1% [95% CI 36.8-51.5]) and 10 (29.4% [95% CI 24.9-33.9]) patients, respectively, compared with 14 (42.4% [95% CI 35.3-49.6]), 17 (51.5% [95% CI 42.7-60.3]) and 2 (6.1% [95% CI 5.6-6.6]) patients, respectively (P = 0.038). There was no difference at 60 min. Complete block at 15 min was achieved in 10/34 patients (29% [95% CI 14.1-44.7]) in the US group and 2/33 patients (6% [95% CI -2.1-14.2]) in the FP group (P = 0.029); no difference was seen at 60 min. No complications were recorded in either group. CONCLUSIONS: A more complete blockade is achieved earlier using the US-assisted technique. The US-assisted technique will become the technique of choice for FNB in this department.

Injury patterns and preventability in prehospital motor vehicle crash fatalities in Victoria.

OBJECTIVE: To examine the pattern of anatomical injury in victims of motor vehicle crashes who die prior to reaching hospital. Cases were identified where death was an unexpected outcome. METHODS: A retrospective review of autopsy case records including police reports, of all persons who died in motor vehicle crashes between 1 January 1998 and 31 December 1999 and underwent full autopsy at the Victorian Institute of Forensic Medicine (VIFM). Those cases where the victim died in the prehospital phase were examined. Abbreviate Injury Scores and Injury Severity Scores were calculated in each case. Bull's probit analysis was used to identify unexpected deaths. RESULTS: There were 352 motor road crash fatalities identified that underwent autopsy at the VIFM in the study period. Two hundred and six of these were prehospital deaths involving motor vehicles, which satisfied specified criteria. 82% (95% CI: 77.7-86.3%) of cases had Abbreviated Injury Scores of 5 (critical) or 6 (incompatible with life). 80.1% (95% CI: 75.7-84.5%) had an Injury Severity Score greater than 40. 36.9% (95% CI: 34.5-39.3%) of cases had the maximum Injury Severity score of 75. 88.8% (95% CI: 85-92.7%) of cases sustained a head injury and 83.9% (95% CI: 79.8-88.2%) a chest injury. Possibly preventable fatality was identified in 30 (14.6% 95% CI: 13.9-15.3%) cases. CONCLUSION: In motor vehicle crash fatalities, most victims who die before reaching hospital do so because of major injury, with the head and chest the commonest regions involved. A large proportion of these injuries could be considered unsurvivable regardless of treatment. Earlier intervention or retrieval of such patients is unlikely to influence outcome in the majority of cases.