The effectiveness of the manual pressure points technique for hemorrhage control-The 2022 THOR pre-conference meeting experience.

INTRODUCTION: Limb and junctional hemorrhage are leading causes of potentially preventable death among trauma casualties. Hemorrhage control for these regions could be achieved by direct or indirect pressure. The manual pressure points (MPP) involves applying manual pressure on the arterial supply to occlude distal blood flow without the need for specialized equipment. STUDY DESIGN AND METHODS: Prospective, non-randomized, human volunteer, controlled environment study involving 38 healthy military caregivers, with 26 participants attending a short instructional session. During a medical exercise, participants were requested to apply pressure on the supraclavicular and femoral points aiming to stop regional blood flow, measured by distal pulse palpation. The measures recorded included achievement of distal pulse cessation, success in achieving cessation for a full minute, and subjects' pain scores reported after each attempt. RESULTS: All participants succeeded in achieving distal pulse cessation for both the supraclavicular and femoral points for a full minute. The median time to initial success was 3.0 (interquartile range 2.0-5.0) seconds in the supraclavicular point and 4.5 (interquartile range 3.0-6.0) seconds in the femoral point. Pain scores ranging between 0 and 3 were reported by most subjects during supraclavicular (68.4%) and femoral occlusion (84.2%). CONCLUSION: The MPP technique was highly effective in occluding distal palpable pulses in healthy volunteers when applied to the supraclavicular and femoral arteries. Brief instruction on the technique can potentially improve the chances of achieving hemorrhage control within 5 s. Further research is required to determine efficacy among different populations and providers with varying experience levels.

Family history of diabetes mellitus and long-term endocrine morbidity of the offspring.

Background: Little is known regarding the long-term outcomes of offsprings to non-diabetic mothers with family history of diabetes mellitus (FHDM).Objective: The aim of the study was to determine whether being born to a non-diabetic mother with FHDM increases the risk for long-term endocrine morbidity.Methods: This is a population-based cohort study, comparing long-term endocrine morbidity between offspring born to non-diabetic mothers with and without FHDM. The Kaplan-Meier survival curve was used to compare cumulative morbidity incidence. Cox proportional hazards model was performed to control for confounders.Results: During the study period, 208,728 children met the inclusion criteria. Using a Kaplan-Meier survival curve, offspring born to non-diabetic mothers with a FHDM had higher cumulative incidence of endocrine morbidity compared to their counterparts without FHDM (Log rank test p = .014). Using a Cox model, controlling for confounders, being born to a non-diabetic mother with FHDM was an independent risk factor for long-term endocrine morbidity of the offspring (adjusted HR = 1.24, 95%CI 1.001-1.54; p = .043).Conclusion: Being born to a non-diabetic mother with a FHDM is independently associated with higher risk for long-term endocrine morbidity of the offspring.