Simulated rescue airway use by laypersons with scripted telephonic instruction.

BACKGROUND: The King LT-D is a supraglottic airway with the potential for use by trained first responders in settings where access to advanced life support interventions by a physician or Emergency Medical Services may be delayed. OBJECTIVES: To determine the success rate of novice users in the telephone-directed placement of the King LT-D airway during a simulated respiratory arrest in order to establish the feasibility of conducting further study into use of the device by first responders after minimal training. METHODS: We conducted a prospective study using 30 undergraduate students without medical training and a high-fidelity simulator. Subjects were instructed using a telephone-directed protocol to assess the airway, place the King LT-D and ventilate the simulator. Subjects were assessed on the successful placement of the King LT-D, time to placement, and perceived ease of use of the device. A Likert scale was used to identify the participant\u27s perceptions. Subjects with CPR/AED certification were compared to those without such training. Data were analyzed using descriptive statistics and a t-test. RESULTS: The King airway was successfully placed in 80% (95% CI: 65; 95) of attempts. Success rate did not differ with prior CPR training. The median time to successful placement was 1min 50s (95% CI: 1min 6s; 2min 39s). The participants perceived the King LT-D to be easy to place in 90% (27/30) of cases. CONCLUSION: The King LT-D is simple enough to use, that it can be successfully placed by novice users with minimal telephonic instruction. This suggests that further studies could be conducted to determine the effect of King LT-D use on quality of airway management in scenarios depicting management of cardiac arrest by first responders in areas with delayed access to ALS interventions

Variation in suicide occurrence by day and during major American holidays.

BACKGROUND: Due to temporal variations in completed suicides, it has been suggested that impulsivity and environmental factors may influence suicide. STUDY OBJECTIVE: Our intent was to determine if particular days of the week, seasons, or holidays were associated with increased attempted and completed suicides by poisoning. METHODS: All calls recorded in the National Poison Database System coded as suspected suicide from 2006 through 2010 were included. Exposures were evaluated by day, season, and holidays, and compared to control dates. RESULTS: There were 1,065,067 exposures (63% female) related to suicide attempts, with completions in 0.4% of cases. Sundays and Mondays for adults, and Mondays and Tuesdays for age \u3c 19 years were the most common. Spring and fall had higher numbers of exposures than summer and winter. New Year\u27s Day had a higher number of exposures, whereas Independence Day, Thanksgiving, and Christmas had fewer exposures. CONCLUSIONS: The beginning of the week, spring and fall, and New Year\u27s Day were associated with higher numbers of ingestions with suicidal intent. This has implications for clinicians advising potential victims and providing emergency care for these patients

Neurogenic stunned myocardium associated with acute spinal cord infarction: a case report.

Introduction. Neurogenic stunned myocardium (NSM) is a reversible cardiomyopathy resulting in transient left ventricular apical ballooning presumed to result from catecholamine surge occurring under physiologic stress. Acute spinal cord ischemia is a rare ischemic vascular lesion. We report a case of neurogenic stunned myocardium occurring in the setting of acute spinal cord infarction. Methods. Singe case report was used. Results. We present the case of a 63-year-old female with a history of prior lacunar stroke, hypertension, chronic back pain, and hypothyroidism who presented with a brief episode of diffuse abdominal and bilateral lower extremity pain which progressed within minutes to bilateral lower extremity flaccid paralysis. MRI of the spinal cord revealed central signal hyperintensity of T2-weighted imaging from conus to T8 region, concerning for acute spinal cord ischemia. Transthoracic echocardiogram was performed to determine if a cardiac embolic phenomenon may have precipitated this ischemic event and showed left ventricular apical hypokinesis and ballooning concerning for NSM. Conclusion. Neurogenic stunned myocardium is a reversible cardiomyopathy which has been described in patients with physiologic stress resulting in ventricular apical ballooning. Our case suggests that it is possible for neurogenic stunned myocardium to occur in the setting of acute spinal cord ischemia

Effect of fatigue and hypohydration on gait characteristics during treadmill exercise in the heat while wearing firefighter thermal protective clothing.

This study compared the gait characteristics of individuals walking in heat while wearing firefighting equipment in fatigued and non-fatigued states. Nineteen subjects performed a 50-min treadmill protocol in a heated room while gait patterns were recorded using a digital video camcorder. Forty gait cycles were analyzed near the beginning (9 min) and at the end (39-49 min) of exercise. Spatio-temporal gait variables including step frequency, step length, swing time, stance time, cycle time and double-support time were determined. Gait variability was quantified by the standard deviation (SD) and coefficient of variation (CV) of each variable. Left-right symmetry was calculated using the symmetry index (SI) and symmetry angle (SA). Paired t-tests (alpha = 0.05) were performed to identify difference between the beginning and the end of the protocol for each measured variable. Spatio-temporal gait characteristics did not differ between the beginning and the end of exercise. Gait variability of the double-support time increased at the end as measured by both SD (P = 0.037) and CV (P = 0.030) but no change was observed for other variables. Left-right symmetry measured using either SI or SA did not differ between sessions. In summary, spatio-temporal gait characteristics and symmetry while wearing firefighting equipment are insensitive to physiological fatigue. Prolonged walking in heat while wearing firefighting equipment may increase gait variability and therefore the likelihood of a fall. Future studies are needed to confirm the potential relationship between fatigue and gait variability and to investigate the possible influence of individual variation

Moving beyond misuse and diversion: the urgent need to consider the role of iatrogenic addiction in the current opioid epidemic.

An epidemic of drug overdose deaths has led to calls for programs and policies to limit misuse and diversion of opioid medications. Any parallel call to consider the risk of iatrogenic addiction when treating pain has been muted in comparison. We have moved beyond questions of nonmedical use, abuse, and diversion to highlight the role of prescription opioids in causing addiction even when prescribed and used appropriately. Unfortunately, current evidence is insufficient, and a rapid expansion of longitudinal research is urgently needed to guide clinicians in balancing the need for opioids with the risk of adverse consequences. Meanwhile, medical education should place greater emphasis on the abuse liability of prescription opioids, and providers should endeavor to attenuate risk when possible

Syndrome of Inappropriate Antidiuretic Hormone Secretion and Lead Toxicity in a Child With Sickle Cell Disease and Pica.

We describe the presentation and management of a three-year-old child with a history of pica, vitamin D deficiency, and sickle cell disease, who was admitted for pyelonephritis, and found to have elevated blood lead level (BLL) of 103.7 µg/dL, and who subsequently developed altered mental status and syndrome of inappropriate antidiuretic hormone secretion (SIADH). In consultation with Medical Toxicology, the patient was chelated with calcium disodium edetate (EDTA) and British Anti Lewisite (BAL). The patient\u27s hyponatremia was managed with hypertonic saline infusion. The patient\u27s encephalopathy improved throughout her hospital course, and she was discharged on hospital day 8. Following five days of EDTA and three days of BAL injections, her repeat BLL was 15.3 µg/dL. SIADH has been associated with severe lead poisoning and may be more likely to occur in high risk patients such as individuals with sickle cell anemia, particularly where medications are used that may cause iatrogenic hyponatremia