Optimal Landmark for Chest Compressions during Cardiopulmonary Resuscitation Derived from a Chest Computed Tomography in Arms-Down Position

Compressions at the left ventricle increase rate of return of spontaneous circulation. This study aimed to identify the landmark of the point of maximal left ventricular diameter on the sternum (LVmax) by using chest computed tomography (CCT) in the arms-down position, which was similar to an actual cardiac arrest patient. A retrospective study was conducted between September 2014 and November 2020. We included adult patients who underwent CCT in an arms-down position and measured the rescuer’s hand. We measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand, which placed the lowest palmar margin of the rescuer’s reference hand at the xiphisternal junction. Thirty-nine patients were included. The LVmax was located below the lower half of the sternum; DLVmax and DLH were 12.6 and 10.0 cm, respectively (p < 0.001). Distance from the sternal notch to the point of maximal force of the left hand, with the ulnar border located at the xiphisternal junction, was close to DLVmax; 11.3 and 12.6 cm, respectively (p = 0.076). In conclusion, LVmax was located below the lower half of the sternum, which is recommended by current guidelines

Developing a Simple Score for Diagnosis of Acute Cholecystitis at the Emergency Department

We aim to develop a diagnostic score for acute cholecystitis that integrates symptoms, physical examinations, and laboratory data to help clinicians for timely detection and early treatment of this disease. We retrospectively collected data from our database from 2010 to 2020. Patients with acute abdominal pain who underwent an ultrasound or computed tomography (CT) scan at the emergency department (ED) were included. Cases were identified by pathological, CT, or ultrasound reports. Non-cases were those who did not fulfill any of these criteria. Multivariable regression analysis was conducted to identify predictors of acute cholecystitis. The model included 244 patients suspected of acute cholecystitis. Eighty-six patients (35.2%) were acute cholecystitis confirmed cases. Five final predictors remained within the reduced logistic model: age < 60, nausea and/or vomiting, right upper quadrant pain, positive Murphy’s sign, and AST ≥ two times upper limit of normal. A practical score diagnostic performance was AuROC 0.74 (95% CI, 0.67–0.81). Patients were categorized with a high probability of acute cholecystitis at score points of 9–12 with a positive likelihood ratio of 3.79 (95% CI, 1.68–8.94). ED Chole Score from these five predictors may aid in diagnosing acute cholecystitis at ED. Patients with an ED Chole Score >8 should be further investigated

Oekologisch orientierte Raumplanung

TIB: RN 5044 (98) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Optimal Landmark for Chest Compressions during Cardiopulmonary Resuscitation Derived from a Chest Computed Tomography in Arms-Down Position

Compressions at the left ventricle increase rate of return of spontaneous circulation. This study aimed to identify the landmark of the point of maximal left ventricular diameter on the sternum (LVmax) by using chest computed tomography (CCT) in the arms-down position, which was similar to an actual cardiac arrest patient. A retrospective study was conducted between September 2014 and November 2020. We included adult patients who underwent CCT in an arms-down position and measured the rescuer’s hand. We measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand, which placed the lowest palmar margin of the rescuer’s reference hand at the xiphisternal junction. Thirty-nine patients were included. The LVmax was located below the lower half of the sternum; DLVmax and DLH were 12.6 and 10.0 cm, respectively (p p = 0.076). In conclusion, LVmax was located below the lower half of the sternum, which is recommended by current guidelines

Association (log odds ratio) between living in an urban environment and obesity by GNI per capita.

<p>Size of circles reflects sample size. Higher log odds ratio (logor) reflect larger effect size for living in an urban environment and obesity; gross national income (GNI) per capita in US dollar corresponding to year and country of fieldwork; Reference group is living in a rural environment.</p

Adjusted odds ratios (OR) for living in an urban environment and obesity using stratification by country/countries, per capita GNI, year of fieldwork, sex, age of study population and criteria for obesity.

<p>Twenty eight studies contributed to 37 independent age and sex adjusted estimates (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0113547#pone-0113547-g001" target="_blank">Figure 1</a>); Reference group is living in a rural environment; GNI gross national income; WC waist circumference;</p><p>* p-value for heterogeneity chi-square;</p><p>** Likelihood ratio test for heterogeneity between subgroup by meta-regression, providing F-ratio and p-values.</p><p>Adjusted odds ratios (OR) for living in an urban environment and obesity using stratification by country/countries, per capita GNI, year of fieldwork, sex, age of study population and criteria for obesity.</p

Flow chart of articles included in the review.

<p>Flow chart of articles included in the review.</p

chain drug

drug n....over rough country,see, you had to have drugs. I never used two, though,for all I seed people with two - one on each runner. We always had a chain drug - a chain wrapped around the nose o' the sled,see, to drop.... An' that was a great help sometimes when the dogs 'd want to go where you didn't want 'em to go. You drop that drug an' get 'em buckled down to it, an' they'd understand you wanted them to stop.YesDNE-cit J.D.A. WIDDOWSONAUG 1973Used I and SupUsed IUsed