Hantavirus infection in North America: a clinical review.

The recent outbreak of hantavirus in Yosemite National Park has attracted national attention, with 10 confirmed cases of hantavirus cardiopulmonary syndrome and thousands of more people exposed. This article will review the epidemiology, presentation, workup, and treatment for this rare but potentially lethal illness. The possibility of infection with hantavirus deserves consideration in patients with severe respiratory symptoms with rodent exposure or rural/wilderness travel. Accurate diagnosis requires a high index of suspicion. Hantavirus cardiopulmonary syndrome presents as a vague prodrome of fever, cough, myalgias, chills, and nausea followed by a rapidly worsening respiratory phase. Presumptive diagnosis can be made based on pulmonary interstitial edema on chest radiographs in association with leukocytosis, thrombocytopenia, and hemoconcentration. Suspected cases should be confirmed with a reference laboratory and reported to the appropriate public health authorities. Although treatment is primarily supportive, aggressive fluid administration should be avoided due to the risk of pulmonary edema. The cardiopulmonary phase of the disease can progress rapidly with catastrophic decompensation in as little as a few hours. Patients require rapid intensive care unit admission for monitoring, mechanical ventilation, vasoactive agents, and possibly extracorporeal mechanical ventilation. Emergency physicians should be aware of outbreaks and vigilant for hantavirus exposures, especially during the summer and early fall months.

Bilateral obstructing renal stones: an uncommon cause of acute renal failure.

Bilateral renal calculi are an uncommon cause of acute renal failure (ARF). The causes of ARF include prerenal, obstructive (or postrenal), and intrinsic [1,2]. Postrenal causes account for 5% to 15% of cases of ARF [3]. This case report will present a case of acute renal failure secondary to bilateral obstructing ureteral calculi.

Versatility With Far Forward Damage Control Surgery: Successful Resuscitative Thoracotomy in an HH-60 Black Hawk.

The military conflicts of the past 17 years have taught us many lessons, including the evolution of the tiered trauma system with en route resuscitation. The evolution of the conflict has begun to limit the reach of this standard trauma system. Recent evidence suggests that 95% of early deaths resulting from traumatic injuries may be prevented if the patient can undergo damage control surgery within 23 minutes of injury. US Military Surgical Resuscitation Teams have been developed to shorten this time from injury to surgical care, as illustrated by this case report.

Comparison of Intubation Using Personal Protective Equipment and Standard Uniform in Simulated Cadaveric Models.

Introduction: The use of personal protection equipment (PPE) for patient care can have an impact on the delivery of effective patient care. The purpose of this study is to examine the effects of basic PPE on intubation times and corresponding success rates in cadaver models. Methods: A prospective crossover design using a single cohort of emergency medicine residents was used for this study. The primary objective is to compare time with intubation in standard uniform (e.g., scrubs without PPE) and using PPE. The secondary objectives are measuring success rates of intubation and the perceived difficulty of intubation when using PPE. Results: The mean time to intubation in the standard uniform group was 18.85 s, whereas the mean time to intubation in the PPE group was 19.29. The overall success rate in the standard uniform group was 83% compared with the PPE group, which was 72%. The perceived difficulty was higher in the PPE group (3.38) when compared with the standard uniform. Conclusion: Although the mean intubation times between the groups were not significantly different, the overall success rate was significantly higher in the standard uniform group when compared with PPE group. The perceived difficulty rating was also noted to be significantly higher in the PPE group when compared with the standard uniform group.

Evaluation and management of traumatic knee injuries in the emergency department.

Posttraumatic knee pain is a common presentation in the emergency department (ED). The use of clinical decision rules can rule out reliably fractures of the knee and reduce the unnecessary cost and radiation exposure associated with plain radiographs. If ligamentous or meniscal injury to the knee is suspected, the ED physician should arrange for expedited follow- up with the patient's primary care physician or an orthopedic specialist for consideration of an MRI and further management. Patients presenting after high-energy mechanisms are at risk for occult fracture and vascular injuries. ED providers must consider these injuries in the proper clinical setting.

Evaluation of a new nonnvasive device in determining hemoglobin levels in emergency department patients.

INTRODUCTION: The Masimo Radical-7 Pulse CO-Oximeter is a medical device recently approved by the US Food and Drug Administration that performs noninvasive oximetry and estimated venous or arterial hemoglobin measurements. A portable, noninvasive device that rapidly measures hemoglobin concentration could be useful in both austere and modern hospital settings. The objective of this study is to determine the degree of variation between the device's estimated hemoglobin measurement and the actual venous hemoglobin concentration in undifferentiated emergency department (ED) patients. METHODS: We conducted a prospective, observational, cross-sectional study of adult patients presenting to the ED. The subjects consisted of a convenience sample of adult ED patients who required a complete blood count as part of their care in the ED. A simultaneous probe hemoglobin was obtained and recorded. RESULTS: Bias between probe and laboratory hemoglobin measurements was -0.5 (95% confidence interval, - 0.8 to -0.1) but this was not statistically significant from 0 (t 0.05,124 = 0.20, P > 0.5). The limits of agreement were -4.7 and 3.8, beyond the clinically relevant standard of equivalency of ± 1 g/dL. CONCLUSION: These data suggest that noninvasive hemoglobin determination is not sufficiently accurate for emergency department use.