Interstitial Lung Disease: A Focused Review for the Emergency Clinician.

BACKGROUND: Interstitial lung disease (ILD) is a group of restrictive pulmonary diseases associated with diffuse interstitial and parenchymal inflammation. Patients can present to the emergency department with severe exacerbation. OBJECTIVE: This narrative review provides emergency clinicians with the most recent evidence concerning acute exacerbation of ILD (AE-ILD). DISCUSSION: AE-ILD can present as acute respiratory distress in a patient with a pre-existing ILD diagnosis or as a de novo presentation of ILD, and is associated with significant morbidity and mortality. A variety of underlying triggers may result in AE-ILD. Emergency clinicians must first assess for extraneous causes of respiratory decompensation prior to diagnosing AE-ILD. For a de novo presentation of ILD, emergency physicians should also assess for possible reversible causes. AE-ILD is managed with systemic steroids, immunosuppressants, intravenous antibiotics, supplemental oxygen, and extracorporeal membrane oxygenation in severe cases. Given the high mortality rates in the absence of lung transplantation, early referral to transplant centers is essential to increase chances of survival. CONCLUSIONS: Emergency clinician knowledge of AE-ILD can improve the evaluation and management of these patients.

Simulation-Based Assessment of the Novel, Disposable i-view Video Laryngoscope by Emergency Medicine Physicians.

INTRODUCTION: Airway obstruction is the second leading cause of potentially preventable death on the battlefield. Previous studies demonstrate the most frequent airway intervention is intubation. Currently, the US Army has advanced video laryngoscopy (VL) in its sets, kits, and outfits (SKOs) at a cost of approximately $12,000 and generally only deploys them to the forward resuscitative surgical detachments and field hospitals. The i-view is a disposable video laryngoscope that costs approximately $120. The purpose of this study was to assess operator performance with this device and survey user opinions. METHODS: We conducted a prospective, observational study with emergency medicine residents and attending physicians using a synthetic cadaver model. Placement success, time-to-cannulation, number of attempts, and number and type of complications were recorded, followed by surveys. RESULTS: We enrolled 31 participants. One was missing data and was excluded, leaving 30 for analysis. The median age was 29, most (66%) were male, most were Air Force (57%), in-training residents (77%) with few reporting previous deployment experience (13%). Almost all had real patient experience with both direct (93%) and video laryngoscopy (90%). Most (90%) were able to get a grade 1 view with all achieving airway cannulation on first-pass attempt. The median time to cannulation was 11.6 seconds. On the post-procedure survey, most strongly agreed they would use this in the deployed setting (77%). Most reported they found it easy to use (77%). CONCLUSION: Our simulation-based study demonstrates the device has strong potential use for the clinical setting with all achieving rapid first-pass success for intubation. This study lays the foundation for validation of this device in the clinical setting.

A Case Report on Rhabdomyolysis After Multiple Bee Stings.

Envenoming syndrome is an uncommon condition associated with significant morbidity and mortality following multiple Hymenoptera stings. We review the case of a 90-year-old male who presented after receiving greater than 100 bee stings and was found to have rhabdomyolysis with concomitant acute kidney injury. Physicians should consider envenoming syndrome in all patients presenting with greater than 50 bee stings, despite hemodynamically stability upon initial presentation.