Drug-free tracheal intubation by specialist paramedics (critical care) in a United Kingdom ambulance service: a service evaluation.

BACKGROUND: Drug-free tracheal intubation has been a common intervention in the context of out-of-hospital cardiac arrest for many years, however its use by paramedics has recently been the subject of much debate. Recent international guidance has recommended that only those achieving high tracheal intubation success should continue to use it. METHODS: We conducted a retrospective service evaluation of all drug-free tracheal intubation attempts by specialist paramedics (critical care) from South East Coast Ambulance Service NHS Foundation Trust between 1st January and 31st December 2019. Our primary outcome was first-pass success rate, and secondary outcomes were success within two attempts, overall success, Cormack-Lehane grade of view, and use of bougie. RESULTS: There were 663 drug-free tracheal intubations and following screening, 605 were reviewed. There was a first-pass success rate of 81.5%, success within two attempts of 96.7%, and an overall success rate of 98.35%. There were ten unsuccessful attempts (1.65%). Bougie use was documented in 83.4% on the first attempt, 93.5% on the second attempt and 100% on the third attempt, CONCLUSION: Specialist paramedics (critical care) are able to deliver drug-free tracheal intubation with good first-pass success and high overall success and are therefore both safe and competent at this intervention.

Pectoralis Major Tendon Rupture in an Occupational Medicine Setting: A Case Report.

Pectoralis major (PM) rupture is a rare injury, commonly misdiagnosed, that affects mostly young male athletes aged 20-40 years. This type of injury is typically associated with weight lifting, especially bench pressing. In an occupational medicine setting, it is extremely rare and not much reported in the literature. We present the case of a 30-year-old trauma technician male who presented with right shoulder and chest pain following a popping sensation while pushing in full momentum a patient on a gurney accidentally set on break mode. PM rupture was suspected clinically. Magnetic resonance imaging confirmed the diagnosis and revealed a complete rupture of the sternal head of PM. Surgical reconstruction was performed to restore the anatomy and functionality of the shoulder girdle.

Barriers and benefits to desired behaviors for single use plastic items in northeast Ohio's Lake Erie basin.

Given the growing saliency of plastic marine debris, and the impact of plastics on beaches and aquatic environments in the Laurentian Great Lakes, applied research is needed to support municipal and nongovernmental campaigns to prevent debris from reaching the water's edge. This study addresses this need by examining the barriers and benefits to positive behavior for two plastic debris items in northeast Ohio's Lake Erie basin: plastic bags and plastic water bottles. An online survey is employed to gather data on the use and disposal of these plastic items and to solicit recommendations on how to positively change behavior to reduce improper disposal. Results support a ban on plastic bags and plastic water bottles, with more enthusiasm for a bag ban. Financial incentives are also seen as an effective way to influence behavior change, as are location-specific solutions focused on education and outreach.

Plastic cigar tips debris: Exploring use and disposal issues for Lake Erie beaches.

Great Lakes states are increasingly faced with questions regarding how plastic debris is impacting marine and coastal ecosystems. This is especially evident along the southern beaches of Lake Erie, where high population and industrial development have contributed to the plastics problem. In Ohio, the most common items found are cigarettes and other smoking related materials, including plastic cigar tips. Given the growing awareness of the issue, and the impact of plastics on beaches throughout the Great Lakes, a focus group convened to investigate strategies to help address the problem. The group was comprised of individuals with practical knowledge of plastic cigar tip use and disposal issues, including representatives of government agencies, nongovernmental organizations, community groups, and local academic institutions. This report represents the exploratory results of the focus group, complete with information regarding the what, why, and how of plastic cigar tip debris in the region, guidance on the material and social barriers to sustaining desired behaviors (cessation of use by minors and/or proper disposal), strategies to overcome those barriers, and suggestions for management and policy actions moving forward. Group members suggest that a combination of education and government-supported financial incentives may be the most effective approach, with community-based positive messaging backed by local taxes on smoking items that have plastic tips and rebates or other rewards for properly disposing of debris.

Reflex sympathetic dystrophy in brain-injured patients.

One-hundred consecutive patients were prospectively evaluated on admission to our Brain Injury Unit for signs and symptoms of reflex sympathetic dystrophy (RSD) in the upper extremity. Patients averaged 4 months postinjury and had an average age of 29 years. Thirteen patients had clinical signs and symptoms of RSD and were then evaluated with standard radiographs and 3-phase radionuclide scintigraphy. Twelve of 13 patients had 3-phase bone scans (TPBS) consistent with RSD (12% overall incidence). RSD was present exclusively in the spastic upper extremity. There were 9 patients with hemiparesis and 3 with quadraparesis. There was a significantly higher (P < 0.01) incidence of associated upper extremity injury in the group with RSD (75%). All patients had a mean Rancho Cognitive Level of V and initial Glasgow Coma Scores less than 8. Patients who developed RSD had lower Glasgow Coma Scores than the non-RSD patients. Brain-injured patients often display agitation, hyperalgesia, disuse or neglect of the RSD-involved extremity. In addition, these patients are often cognitively unable to vocalize complaints of pain. Undiagnosed RSD in these patients can result in a significant delay in rehabilitation and possible loss of the use of an otherwise functional upper extremity.

Reducing nonpoint source pollution through collaboration: policies and programs across the U.S. States.

Nonpoint source (NPS) pollution has emerged as the largest threat to water quality in the United States, influencing policy makers and resource managers to direct more attention toward NPS prevention and remediation. In response, the United States Environmental Protection Agency (USEPA) spent more than $204 million in fiscal year (FY) 2006 on the Clean Water Act's Section 319 program to combat NPS pollution, much of it on the development and implementation of watershed-based plans. State governments have also increasingly allocated financial and technical resources to collaborative watershed efforts within their own borders to fight NPS pollution. With increased collaboration among the federal government, states, and citizens to combat NPS pollution, more information is needed to understand how public resources are being used, by whom, and for what, and what policy changes might improve effectiveness. Analysis from a 50-state study suggests that, in addition to the average 35% of all Section 319 funds per state that are passed on to collaborative watershed groups, 35 states have provided financial assistance beyond Section 319 funding to support collaborative watershed initiatives. State programs frequently provide technical assistance and training, in addition to financial resources, to encourage collaborative partnerships. Such assistance is typically granted in exchange for requirements to generate a watershed action plan and/or follow a mutually agreed upon work plan to address NPS pollution. Program managers indicated a need for greater fiscal resources and flexibility to achieve water quality goals.