Using Esophageal Temperature Management to Treat Severe Heat Stroke: A Case Report.

BACKGROUND: Exertional heat stroke (EHS) is defined by a core body temperature that exceeds 40°C with associated central nervous system dysfunction, skeletal muscle injury, and multiple organ damage. The most important initial focus of treatment involves reduction of patient temperature. First approaches to achieve temperature reduction often include ice packs, water blankets, and cold intravenous fluid administration. When these measures fail, more advanced temperature management methods may be deployed but often require surgical expertise. Esophageal temperature management (ETM) has recently emerged as a new temperature management modality in which an esophageal heat transfer device replaces the standard orogastric tube routinely placed after endotracheal intubation and adds a temperature modulation capability. The objective of this case study is to report the first known use of ETM driven by bedside nursing staff in the treatment of EHS. METHOD: An ETM device was placed after endotracheal intubation in a 28-year-old man experiencing EHS over a 5-day course of treatment. RESULTS: Because the ETM device was left in place, when the patient experienced episodes of increasing temperature as high as 39.1°C, which required active cooling, nursing staff were able to immediately adjust the external heat exchange unit settings to achieve aggressive cooling at bedside. CONCLUSION: This nurse-driven technology offers a new means to rapidly deploy cooling to critically ill patients without needing to implement advanced surgical approaches or obstruct access to the patient, freeing the provider to continue optimal care in high-morbidity conditions.

Esophageal Temperature Management in Patients Suffering from Traumatic Brain Injury.

Traumatic brain injury (TBI) is a leading cause of death in the United States, and represents 2.5 million Emergency Department attendances, admissions into hospital, and deaths. A range of temperature modulating devices have been used to proactively cool TBI patients; however, there are currently no uniform targeted temperature management (TTM) guidelines in this patient population. Esophageal temperature management (ETM) is a relatively new TTM modality and the purpose of this study is to determine whether ETM is effective in controlling core temperature in TBI cases. This prospective interventional trial was a single-site study that enrolled 12 patients who received a TTM protocol using ETM. Eleven out of 12 patients reached target temperature during the first 10 hours of treatment. A total of 480 temperature measurements were recorded; 85% of the total measurements were within ±1°C of target temperature (408 measurements) and 75% were within ±0.5°C of target temperature (360 measurements). The average time to target was 5.83 ± 5.01 hours (range 1-20), with an average cooling rate of 0.58°C/h (range 0.15-1.5°C/h). This prospective interventional trial supports that ETM is a feasible TTM modality for severe TBI cases. The esophageal heat transfer device used in this study demonstrated comparable or superior performance to other commercially available TTM modalities, and the low adverse event rate may offer advantages over more invasive methods with reported higher complication rates.

Retrospective Analysis of Esophageal Heat Transfer for Active Temperature Management in Post-cardiac Arrest, Refractory Fever, and Burn Patients.

Core temperature management is an important aspect of critical care; preventing unintentional hypothermia, reducing fever, and inducing therapeutic hypothermia when appropriate are each tied to positive health outcomes. The purpose of this study is to evaluate the performance of a new temperature management device that uses the esophageal environment to conduct heat transfer. De-identified patient data were aggregated from three clinical sites where an esophageal heat transfer device (EHTD) was used to provide temperature management. The device was evaluated against temperature management guidelines and best practice recommendations, including performance during induction, maintenance, and cessation of therapy. Across all active cooling protocols, the average time-to-target was 2.37 h and the average maintenance phase was 22.4 h. Patients spent 94.9% of the maintenance phase within ±1.0°C and 67.2% within ±0.5°C (574 and 407 measurements, respectively, out of 605 total). For warming protocols, all of the patient temperature readings remained above 36°C throughout the surgical procedure (average 4.66 h). The esophageal heat transfer device met performance expectations across a range of temperature management applications in intensive care and burn units. Patients met and maintained temperature goals without any reported adverse events.

Non-invasive Detection of Unique Molecular Signatures in Laser-Induced Retinal Injuries.

Unintentional laser exposure is an increasing concern in many operational environments. Determining whether a laser exposure event caused a retinal injury currently requires medical expertise and specialized equipment that are not always readily available. The purpose of this study is to test the feasibility of using dynamic light scattering (DLS) to non-invasively detect laser retinal injuries through interrogation of the vitreous humor (VH). Three grades of retinal laser lesions were studied: mild (minimally visible lesions), moderate (Grade II), and severe (Grade III). A pre-post-treatment design was used to collect DLS measurements in vivo at various time points, using a customized instrument. VH samples were analyzed by liquid chromatography/tandem mass spectrometry (LC-MS/MS) and relative protein abundances were determined by spectral counting. DLS signal analysis revealed significant changes in particle diameter and intensity in laser-treated groups as compared with control. Differences in protein profile in the VH of the laser-treated eyes were noted when compared with control. These results suggest that laser injury to the retina induces upregulation of proteins that diffuse into the VH from the damaged tissue, which can be detected non-invasively using DLS.

Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management.

Controlling patient temperature is important for a wide variety of clinical conditions. Cooling to normal or below normal body temperature is often performed for neuroprotection after ischemic insult (e.g. hemorrhagic stroke, subarachnoid hemorrhage, cardiac arrest, or other hypoxic injury). Cooling from febrile states treats fever and reduces the negative effects of hyperthermia on injured neurons. Patients are warmed in the operating room to prevent inadvertent perioperative hypothermia, which is known to cause increased blood loss, wound infections, and myocardial injury, while also prolonging recovery time. There are many reported approaches for temperature management, including improvised methods that repurpose standard supplies (e.g., ice, chilled saline, fans, blankets) but more sophisticated technologies designed for temperature management are typically more successful in delivering an optimized protocol. Over the last decade, advanced technologies have developed around two heat transfer methods: surface devices (water blankets, forced-air warmers) or intravascular devices (sterile catheters requiring vascular placement). Recently, a novel device became available that is placed in the esophagus, analogous to a standard orogastric tube, that provides efficient heat transfer through the patient's core. The device connects to existing heat exchange units to allow automatic patient temperature management via a servo mechanism, using patient temperature from standard temperature sensors (rectal, Foley, or other core temperature sensors) as the input variable. This approach eliminates vascular placement complications (deep venous thrombosis, central line associated bloodstream infection), reduces obstruction to patient access, and causes less shivering when compared to surface approaches. Published data have also shown a high degree of accuracy and maintenance of target temperature using the esophageal approach to temperature management. Therefore, the purpose of this method is to provide a low-risk alternative method for controlling patient temperature in critical care settings.

Evaluation of advanced cooling therapy's esophageal cooling device for core temperature control.

Managing core temperature is critical to patient outcomes in a wide range of clinical scenarios. Previous devices designed to perform temperature management required a trade-off between invasiveness and temperature modulation efficiency. The Esophageal Cooling Device, made by Advanced Cooling Therapy (Chicago, IL), was developed to optimize warming and cooling efficiency through an easy and low risk procedure that leverages heat transfer through convection and conduction. Clinical data from cardiac arrest, fever, and critical burn patients indicate that the Esophageal Cooling Device performs very well both in terms of temperature modulation (cooling rates of approximately 1.3°C/hour, warming of up to 0.5°C/hour) and maintaining temperature stability (variation around goal temperature ± 0.3°C). Physicians have reported that device performance is comparable to the performance of intravascular temperature management techniques and superior to the performance of surface devices, while avoiding the downsides associated with both.

Temperature modulation with an esophageal heat transfer device - a pediatric swine model study.

BACKGROUND: An increasing number of conditions appear to benefit from control and modulation of temperature, but available techniques to control temperature often have limitations, particularly in smaller patients with high surface to mass ratios. We aimed to evaluate a new method of temperature modulation with an esophageal heat transfer device in a pediatric swine model, hypothesizing that clinically significant modulation in temperature (both increases and decreases of more than 1°C) would be possible. METHODS: Three female Yorkshire swine averaging 23 kg were anesthetized with inhalational isoflurane prior to placement of the esophageal device, which was powered by a commercially available heat exchanger. Swine temperature was measured rectally and cooling and warming were performed by selecting the appropriate external heat exchanger mode. Temperature was recorded over time in order to calculate rates of temperature change. Histopathology of esophageal tissue was performed after study completion. RESULTS: Average swine baseline temperature was 38.3°C. Swine #1 exhibited a cooling rate of 3.5°C/hr; however, passive cooling may have contributed to this rate. External warming blankets maintained thermal equilibrium in swine #2 and #3, demonstrating maximum temperature decrease of 1.7°C/hr. Warming rates averaged 0.29°C/hr. Histopathologic analysis of esophageal tissue showed no adverse effects. CONCLUSIONS: An esophageal heat transfer device successfully modulated the temperature in a pediatric swine model. This approach to temperature modulation may offer a useful new modality to control temperature in conditions warranting temperature management (such as maintenance of normothermia, induction of hypothermia, fever control, or malignant hyperthermia).

Technical and operational users' opinions of a handheld device to detect directed energy.

INTRODUCTION: Lasers, a form of directed energy (DE), are a threat to pilots and Air Force personnel. In light of this threat, a handheld medical device called the "Tricorder" is under development to improve situational awareness of DE. Current operational procedures do not include methods for recording or handling new information regarding DE. The purpose of this study was to understand Air Force personnel opinions and beliefs about desired features and operational use to enhance user acceptance of the Tricorder. METHOD: Q-methodology was implemented to study opinions and beliefs related to DE. Two groups were approached, medical personnel in the Illinois Air National Guard and four active duty members of an Air Force Rescue Squadron. Both groups completed the same Q-sort of both operational and equipment concerns. RESULTS: Six opinion sets regarding operational concerns described 61% of the total variation in perceptions among participants. The factors were: concern over health effects, implications to individuals, combat/tactical concerns, force health protection, and theater/tactical concerns. Five opinion sets described 68% of the variation in the equipment functions perceived as most important. The participants indicated that ideally the device should measure exposure, enhance laser detection/response, support night vision and ease of use, detect threats, and enhance combat medicine. CONCLUSION: This survey revealed the complexity of equipment and the operational implications of detecting DE. Q-methodology is a unique strategy to both evaluate technology and explore users' concerns.

Handheld directed energy sensor for environmental monitoring and clinician safety.

INTRODUCTION: Directed energy (DE) research and development is generating more powerful portable devices designed to support operational, environmental, clinical, point detection, and remote-sensing applications. These same DE devices present potential for injury, thereby impacting medical operations. The environmental surveillance and clinical communities require handheld sensor platforms that afford preemptive detection and monitoring of potentially hazardous exposures to DE and other electromagnetic (EM) frequencies. METHODS: A personal digital assistant (PDA) was interfaced with a wavelength sensor board via a multifunction data acquisition card to passively detect wavelengths in the 480-950 nm range. A 9V DC battery coupled to a voltage up-converter with a manual ON/OFF switch powered the sensor board. The sensor board was integrated with a standard operating system-based PDA. Graphical programming software integrated the data acquisition card with the PDA. RESULTS: The DE wavelength sensor/PDA platform detected and relayed laser radiation information from 480 to 950 nm ranges, with graphical data output to the PDA screen. DISCUSSION: This project demonstrated the technical ability to detect anthropogenic DE frequency signatures using a handheld, battery-driven DE sensor platform. Laboratory and field assessment studies are underway to validate operational applications. This DE-sensing prototype is designed explicitly for DE medical measurement and signatures intelligence (MED MASINT) to meet the protection needs of environmental and clinical operators.

The role of the dentist at crime scenes.

The medical response to a mass casualty further complicates the hectic environment that follows a terrorist event. In addition to providing treatment, medical professionals may discover items or persons of interest to the pending investigation and should be aware of how to handle these situations appropriately. Examples of case law are provided to illustrate how practitioners' actions could help or hinder prosecution. The traditional forensic role of dental professionals is identifying victims through dental records. In this article, the dental professional is considered a member of a disaster response team, and the differences in responsibilities are highlighted.

Disaster medicine training survey results for dental health care providers in Illinois.

BACKGROUND: Ongoing vigilance by governments, public health agencies and health care professionals monitoring potential epidemic and pandemic outbreaks, terrorist threats and ever-present natural disasters requires the continuous evolution of comprehensive disaster response plans and teams, which include the integration of oral health care professionals. METHODS: The authors conducted a study in which oral health care professionals assessed their training in the American Medical Association's (AMA's) National Disaster Life Support (NDLS) courses. At the conclusion of each instructional session, the authors asked participants to complete an anonymous course evaluation form to report their impressions of the training activity. The authors included in the analysis those evaluations associated with sessions attended almost exclusively by dentists and hygienists. RESULTS: The authors derived descriptive statistics from the selected course evaluations. Overall, oral health care professionals believed that the Core Disaster Life Support (CDLS) and Basic Disaster Life Support (BDLS) courses were of great educational value, rating course impact at 9.50 and 9.29, respectively, on a scale from 1 to 10. CONCLUSIONS: Statistical evaluation instruments reveal satisfaction with the all-hazards awareness training received through the AMA's NDLS disaster medicine training curriculum. Licensed oral health care professionals in Illinois accepted the utility and merits of, and benefited from, the four-hour CDLS and eight-hour BDLS certification programs. Practice Implications. Dental professionals in Illinois require minimal additional training for dental emergency responder duties. The AMA's NDLS curriculum provides effective preparation for dental professionals.