Practice makes perfect: The impact of Stop the Bleed training on hemorrhage control knowledge, wound packing, and tourniquet application in the workplace.

INTRODUCTION: The national Stop the Bleed (STB) campaign was implemented in 2015 to provide hemorrhage control education to non-medical providers to reduce the number of deaths due to uncontrolled hemorrhage. Hands on training limits the availability of this program, and its importance is not known amongst lay providers. This study aimed to evaluate the efficacy of STB training for laypersons on knowledge and skill-based abilities in the workplace setting. We hypothesized such hands on and in-person training would improve performance. METHODS: Non-medical potential first responders (PFR; N = 298) participated in STB training comprised of a lecture and hands-on component. PFRs completed a bleeding control knowledge-based pre-and post-assessment. Following the lecture, participants were divided into experimental and control groups during which hands-on practice was manipulated to determine the impact of guided practice on wound packing and tourniquet application. Wound packing and tourniquet application assessments were performed and scores compared between the experimental and control groups. RESULTS: PFRs scored higher on the bleeding control bleeding control knowledge-based post-test (M = 4.63, SD = 1.32) than on the pre-test (M = 3.21, SD = 1.14). Employees in the experimental group (M = 2.93, SD = .26) also scored significantly higher than the control group (M = 1.97, SD = .77) that attempted wound packing without any hands-on training. PFRs in the experimental group scored significantly higher (M = 7.41, SD = .91) than PFRs in the control group (M = 5.99, SD = 1.81) for tourniquet application. CONCLUSION: Knowledge related to hemorrhage control increased following the STB course. Participants who engaged in hands-on practice for tourniquet and wound packing were more proficient than those who only saw the lecture. We confirm that in person, hands on training is key to the success of lay STB training.

Pneumoscrotum: Value as an early diagnostic sign of tension pneumothorax in blunt thoracic trauma.

Pneumoscrotum is a rare complication that can result from various etiologies and can be essential in the diagnosis of those causative factors, especially life-threatening ones such as infection or trauma. We present here a case of a patient who presented in posttraumatic cardiac arrest and an extensive, grossly obvious, and rapidly expanding pneumoscrotum. Based on our patient's clinical presentation and a history of a high-speed mechanism with obvious torso trauma, a diagnosis of tension pneumothorax was quickly made resulting in immediate treatment. We review the existing literature and highlight the importance of pneumoscrotum in aiding with differential diagnosis. The presence of pneumoscrotum is often benign; however, in the right clinical setting, it can be an extremely important and useful clinical tool for the early identification and timely treatment of life-threatening diagnoses, such as tension pneumothorax.

Nitric oxide donor properties of hydroxyurea in patients with sickle cell disease.

Hydroxyurea therapy reduces the rates of vaso-occlusive crisis in patients with sickle cell anaemia and recent data suggest that hydroxyurea treatment can generate nitric oxide (NO). Nitric oxide has been proposed as a novel therapy for sickle cell disease via a number of pathways. We therefore sought to determine whether hydroxyurea has NO donor properties in patients with sickle cell anaemia and explore potential mechanisms by which NO production could be therapeutic. Venous blood was collected from 19 fasting sickle cell anaemia patients, on chronic hydroxyurea therapy, at baseline and 2 and 4 h after a single morning dose of hydroxyurea, as well as 10 patients not taking hydroxyurea. The plasma and red cell NO reaction products nitrate, nitrite and nitrosylated- haemoglobin were measured using ozone-based chemiluminescent assays (using vanadium, KI and I3- reductants respectively). Consistent with NO release from hydroxyurea, baseline levels of total nitrosylated haemoglobin increased from 300 nmol/l to 500 nmol/l (P = 0.01). Plasma nitrate and nitrite levels also significantly increased with peak levels observed at 2 h. Glutathionyl-haemoglobin levels were unchanged, while plasma secretory vascular cellular adhesion molecule-1 levels were reduced in patients taking hydroxyurea (419 +/- 40 ng/ml) compared with control patients with sickle cell anaemia (653 +/- 55 ng/ml; P = 0.003), and were inversely correlated with fetal haemoglobin levels (r = -0.72; P = 0.002). These results demonstrate that hydroxyurea therapy is associated with the intravascular and intraerythrocytic generation of NO. The role of NO in the induction of fetal haemoglobin and possible synergy between NO donor therapy and classic cytostatic and differentiating medications should be explored.