The Critical Intervention Screen: A Novel Tool to Determine the Use of Lights and Sirens during the Transport of Trauma Patients.

Objective: EMS use of lights and sirens has long been employed in EMS systems, despite an increased risk of motor vehicle collisions associated with their use. The specific aims of this study were to assess the current use of lights and sirens during the transport of trauma patients in a busy metropolitan area and to subsequently develop a novel tool, the Critical Intervention Screen, to aid EMS professionals tasked with making transport decisions in the presence of acute injury.Methods: This single-center, retrospective study included all patients transported to an academic Level One trauma center by ground ambulance from the scene of presumed or known injury. A subset of patients was identified as being most likely to benefit from shorter transport times if they received one of the following critical interventions within 20 minutes of emergency department arrival: intubation, thoracotomy, chest tube, blood products, central line, arterial line, REBOA, disposition to an operating room, or death. Stepwise logistic regression was employed for the development of the Critical Intervention Screen, with a subset of data retained for internal validation.Results: 1296 patients were available for analysis. Overall, 217 patients (16.7%) received a critical intervention, and 112 patients (8.6%) of those patients received a critical intervention within 20 minutes of emergency department arrival. At baseline, EMS use of lights and sirens was 91.1% sensitive and 80.3% specific for receiving a critical intervention. Stepwise logistic regression demonstrated that the need for assisted ventilation, GCS Motor < 6, and penetrating trauma to the trunk were the most predictive prehospital data for receiving at least one critical intervention. The Critical Intervention Screen, defined as having at least one of these risk factors in the prehospital setting, modestly increased sensitivity and specificity (96.4% and 87.9%, respectively) predicting the need for a critical intervention.Conclusion: These findings indicate that EMS are able to correctly identify high-acuity trauma patients, but at times employ L&S during the transport of patients with a low likelihood of receiving a time-sensitive intervention upon emergency department arrival. Therefore, the Critical Intervention Screen has the potential to reduce the use of lights and sirens and improve EMS safety.

Rhabdomyolysis; is it an overlooked DKA complication.

BACKGROUND: Rhabdomyolysis is considered by some studies as a rare complication of a common disorder of diabetic ketoacidosis, while others consider it as not so uncommon. The mechanism is still not clear but can be attributed to a number of factors like acidosis, hyperglycemia and electrolyte disturbances especially hypophosphatemia and hypokalaemia. Missing it may lead to more serious complications and may prolong and/or complicate full recovery of diabetic ketoacidosis. AIM: The aim of this study was to measure the incidence of rhabdomyolysis among patients presented with diabetic ketoacidosis in the emergency department of Baghdad Teaching hospital, its relation to the severity of diabetic ketoacidosis and the associated electrolytes disturbances. PATIENTS AND METHODS: This is a cross sectional study carried out in the emergency department of Baghdad teaching hospital/Iraq; where 43 patients with type1 diabetes presenting with diabetic ketoacidosis were included. Diabetic ketoacidosis was classified into mild, moderate and severe, and the incidence of rhabdomyolysis was calculated accordingly. Full blood investigations, urinary ketones and arterial blood gasses were done. RESULTS: Rhabdomyolysis was found in 3 (6.98%) patients with more severe acidosis and urinary ketones in the setting of moderate and severe diabetic ketoacidosis. Statistically significant finding was observed with the duration of diabetes, higher serum creatinine, higher serum potassium, higher serum chloride, severe acidosis and urinary ketones. CONCLUSIONS: Rhabdomyolysis incidence in this study was 6.98% of patients with more severe acidosis, urinary ketones in the setting of moderate to severe diabetic ketoacidosis and with longer duration of diabetes.

Nephrotic range proteinuria; does it predict lung involvement in patients with type 2 diabetes.

BACKGROUND: Diabetes mellitus is a chronic metabolic disorder that is well known for its long term serious complications. Proteinuria whether micro or macroproteinuria is one of these complications. Many studies has related proteinuria to other complications of diabetes as retinopathy and cardiovascular disease of diabetes, while the lungs of diabetic patients which is the largest organ in the body with a large macro and microvascular bed, has not been related to this complication. AIM: The aim of the study was to find out whether proteinuria in diabetic patients can predict lung involvement. PATIENTS AND METHODS: A comparative cross sectional study in which we compared the lung function of 100 type 2 diabetic patients with proteinuria with that of 100 type 2 diabetic patients without proteinuria. Proteinuria is measured in a random sample by "urine protein/urine creatinine ratio". FEV1 and FVC were measured by spirometer. RESULTS: The results showed that patients with proteinuria had a high frequency of abnormal PFT (86%), while patients without proteinuria had a low frequency of abnormal PFT (11%).Also diabetic patients with proteinuria had lower FVC (72.9 ±â€¯6.5 vs. 88.2 ±â€¯8.2), than diabetic patients without proteinuria. CONCLUSIONS: We concluded that diabetes mellitus causes a significant impairment in pulmonary function test. This impairment is significantly related with proteinuria.

Comparison of the Coagulation Effect Achieved by OctaplasLG Versus Fresh Frozen Plasma in Pediatric Cardiac Surgical Patients.

OctaplasLG is indicated for use in patients undergoing cardiac surgery who require replacement of multiple clotting factors. The use of OctaplasLG over single-donor fresh frozen plasma (FFP) may have beneficial effects when considering the transmission of enveloped viruses. Additionally, it has the potential for fewer adverse reactions, reduced disease transmission, and a more homogenous coagulation factor composition. However, its efficacy and safety have not yet been evaluated in the pediatric population. Pediatric patients aged less than 2 years old and less than 10 kg, who underwent complete tetralogy of Fallot repair and received either OctaplasLG or FFP intraoperatively were identified over a 10-year period for this retrospective analysis. A review of case notes, intra-operative, and laboratory data were used to assess intraoperative blood product usage, blood loss, and postoperative coagulopathy. Data were analyzed to assess the efficacy of OctaplasLG in achieving hemostasis when compared to FFP. Results showed clinically better hemostasis postoperatively in OctaplasLG group compared with FFP group and better coagulation results. OctaplasLG was as effective as FFP when used in pediatric patients undergoing cardiac surgery.

Nanosilica-supported polyethoxyamines as low-cost, reversible carbon dioxide sorbents.

Novel hybrid quasi-solid-state sorbents pairing inexpensive CO(2)-reactive polyethoxyamine (Jeffamine®) fluids with an abundantly available silica support have been investigated for carbon capture. The highest performance sorbent was capable of reversibly capturing close to 70 mg of CO(2) per gram of sorbent at 45°C, could be almost fully (~90%) regenerated by simple vacuum swing, and was stable over many sequential capture-release cycles. The new supports can be handled as solventless, free-flowing powders even post-CO(2) capture, obviating the mass flow problems arising from viscous liquid (or solid, gel, or wax) formation frequently attending carbamate formation. Our results have important ramifications for reducing the high costs of thermal regeneration in conventional carbon capture schemes, particularly in comparison with the aqueous monoethanolamine-based system currently favoured industrially. The strategy of uniformly dispersing a functional fluid onto a solid nanosupport in a manner that allows intimate contact with and diffusion of external gaseous species is additionally projected to find value in a range of gas separation and sensing endeavours.