Anesthetic management of parturients with achondroplasia: a case series.

Background: Achondroplasia is the most common form of dwarfism, and cesarean delivery is often required in parturients with achondroplasia due to cephalopelvic disproportion. Given the challenges for both regional and general anesthetic techniques, there is no consensus on the optimal anesthetic management for cesarean delivery in these patients. Method: A search of our electronic medical records for all female patients who had a diagnosis of achondroplasia and had a delivery in our health system from January 1, 2001 through June 16, 2023 was performed. Institutional review board exemption was obtained. Results: We identified seven achondroplastic patients with 12 cesarean deliveries and described their anesthetic management during labor and delivery. Conclusion: Despite the historical preference of general anesthesia in achondroplastic patients due to concerns of unpredictable spinal anatomy and unreliable local anesthetic spread, neuraxial anesthesia was successfully utilized in achondroplastic parturients and is a viable option in carefully selected patients. Reduction of intrathecal local anesthetic dose that minimizes the risk of high spinal and emergent intubation, as well as a titratable neuraxial technique, can be effective in this patient population.

Immediate Medical Care Rendered by US Law Enforcement Officers after Officer-Involved Shootings - An Open-Access Public Domain Video Analysis.

BACKGROUND: After officer-involved shootings (OIS), rapid delivery of emergency medical care is critical but may be delayed due to scene safety concerns. The purpose of this study was to describe medical care rendered by law enforcement officers (LEOs) after lethal force incidents. METHODS: Retrospective analysis of open-source video footage of OIS occurring from February 15, 2013 through December 31, 2020. Frequency and nature of care provided, time until LEO and Emergency Medical Services (EMS) care, and mortality outcomes were evaluated. The study was deemed exempt by the Mayo Clinic Institutional Review Board. RESULTS: Three hundred forty-two (342) videos were included in the final analysis; LEOs rendered care in 172 (50.3%) incidents. Average elapsed time from time-of-injury (TOI) to LEO-provided care was 155.8 (SD = 198.8) seconds. Hemorrhage control was the most common intervention performed. An average of 214.2 seconds elapsed between LEO care and EMS arrival. No mortality difference was identified between LEO versus EMS care (P = .1631). Subjects with truncal wounds were more likely to die than those with extremity wounds (P < .00001). CONCLUSIONS: It was found that LEOs rendered medical care in one-half of all OIS incidents, initiating care on average 3.5 minutes prior to EMS arrival. Although no significant mortality difference was noted for LEO versus EMS care, this finding must be interpreted cautiously, as specific interventions, such as extremity hemorrhage control, may have impacted select patients. Future studies are needed to determine optimal LEO care for these patients.

Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes.

STUDY OBJECTIVE: Stercoral colitis is inflammation of the bowel wall caused by fecal impaction. Despite reported high morbidity and risk of perforation, little research assessing outcomes is available. This study characterizes the presentation, management, and outcomes of emergency department patients with stercoral colitis. METHODS: We performed a retrospective chart review of ED patients with stercoral colitis identified on computed tomography (CT) scan. Of 814, 522 visits to multiple EDs across the US, 269 met the inclusion criteria. Variables regarding patient presentation, management, and outcomes were extracted from electronic medical records. Results were analyzed with percentages and 95% confidence intervals (CIs). RESULTS: Of 269 patients, the median age was 76 years. The most common chief concern was abdominal pain/distension (33.8%). However, abdominal pain was documented as absent in 62.1% of cases. The most common CT findings included fecal impaction (96.7%), bowel wall inflammation (72.9%), and fat stranding (48.3%). Eighty-four (31.2%) patients were discharged home from the ED, and over half of these (45/84, 53.6%) received no enema, laxatives, or disimpaction. Overall, 9 patients (3.3%, 95% CI 1.6% to 6.5%) required surgical management of a related complication within 3 months, 27 (10.0%, 95% CI 6.8% to 14.4%) returned to the ED within 72 hours, and 9 (3.3%, 95% CI 1.6% to 6.5%) died from a cause related to stercoral colitis within 3 months. CONCLUSION: Patients with stercoral colitis often present in a nonspecific manner, and short-term mortality is substantial. In this study, most discharged patients did not receive recommended treatment. This represents the largest ED study of stercoral colitis and provides further evidence linking this diagnosis with adverse outcomes.

Women Authorship Trends in the Highest-Impact Anesthesiology Journals from 2005 to 2021.

Background: Although women and men have matriculated into medical schools in similar proportions since the 1980s, recent data indicate that anesthesiology is lagging in gender equity, especially in academic leadership roles.1,2 As promotion in academic medicine is strongly influenced by publications, understanding whether a lack of women authorship is contributing to this gender gap is crucial.3,4 This article aims to assess how woman authorship trends have changed in the last 16 years, including during the COVID-19 pandemic. Materials and Methods: The five highest impact journals in anesthesia were identified as Journal of Clinical Anesthesia, British Journal of Anaesthesia, Anesthesiology, PAIN, and Regional Anesthesia & Pain Medicine. Number of total authors, including women, men, and unknown gender authors as well as incidence of woman first and/or last author, was documented from articles published in 2005, 2010, 2015, 2020, and 2021. Results: This analysis shows that women are gaining representation in anesthesia publications. Overall, there was a statistically significant increase in the total number of women authors and women first and last authorship. However, as of 2021, women still only represented ∼40% of total and first authors and ∼24% of last authors. In addition, increase in first/last woman authorship was not present in all journals when stratified. Conclusion: These journal differences may suggest the editorial evaluation process as a potential source of gender bias. There was a statistically significant relationship between women senior authors and articles with 50% or more women authors, indicating that woman mentorship is contributing to closing equity gap. These data present a starting point for further investigations into gender disparities within anesthesia to continue the forward progression for women in academic medicine.

Evaluating urgent care center referrals to the emergency department.

Background and objectives: Urgent care centers (UCCs) are increasingly popular with an estimated number of 9600 stand-alone centers in the United States compared to emergency departments (EDs). These facilities offer a potentially more convenient and affordable option for patients seeking care for a variety of low-acuity conditions. Because of the limitations of UCCs, patients occasionally are referred to EDs for further care. Prior studies have attempted to evaluate the appropriateness of these UCC referrals. Our study is the first to consider if these referrals require ED-specific care and the diagnostic concordance of these referrals. Methods: We performed a retrospective chart review to identify patients who were referred from UCCs to our ED between October 2020 and June 2021. We used a Boolean search strategy to screen charts for the terms urgent care, emergency department, referral, or transfer. Cases were manually screened until 300 met the inclusion criteria. Cases had to feature the patient being seen by a UCC provider and directly referred to the ED on the same day. Patients who presented to the ED of their own volition were excluded. Three independent abstractors reviewed the charts. All abstractors and a senior investigator piloted the use of a data collection sheet and discussed the management of any ambiguous data. A senior physician reviewed all discrepancies among abstractors. Data collected included ED final diagnosis and whether the final diagnosis was similar to the UCC diagnosis. A referral was deemed to require ED-specific care and resources if (1) the patient was admitted, (2) imaging (other than an x-ray) was performed, (3) specialist consultation was required, or (4) care was provided in the ED that is not conventionally available at UCCs. Results: From the 300 patient charts, 55% of patients referred from UCCs to the ED did not require ED-specific care or resources and 64% had discordant diagnoses between UCC diagnosis and ED diagnosis. A total of 41% of patients underwent advanced imaging studies, 26% received specialty consultations, and 15% were admitted. Subgroup analysis for lacerations, extremity/fracture care, and abnormal electrocardiograms (ECGs) showed disproportionally high levels of discordant diagnoses and referrals that did not require ED-specific care or resources. Conclusion: Our data found that 55% of patients referred to EDs from UCCs did not require ED-specific care or resources and 64% carried a discordant diagnosis between UC and ED diagnosis. We suggest quality remedies, such as educational sessions and engagement with telemedicine sub-specialists as well as a coordinated formalized system for UCC to ED referrals.

Analysis of Gender-Based Authorship Trends in Leading Pain-Medicine Journals Over 10 Years.

Authorship of peer-reviewed publications is important for academic rank, promotion, and national reputation. In pain medicine, limited information is available for authorship trends for women as compared with men. The objective of this study was to describe trends of female authorship data in the 5 pain journals with the highest impact factors over a 10-year period. We analyzed data for January, April, and October in 2009, 2014, and 2019. For each article, the following information was recorded: journal name, journal month, journal year, article title or article PMCID, total authors, total female authors, total male authors, total authors of unknown gender, presence or absence of a female first author, and presence or absence of a female last/senior author. Authorship for 924 articles was reviewed. When a man was senior author, women were first author on only 27.9% of articles (P<.001). A woman was 2 times as likely (57.2%) to be first author when a woman was the senior author (P<.001), pointing to the potential impact of female senior authors. An article with 50% or more female authors was 76.4% more likely to have a female senior author (P<.001). The results demonstrate the influence of a senior female author on the likelihood of an article's having a female first author. When men were the senior authors, women were half as likely to be first authors. The total number of female authors changed very little between 2009 and 2019.