Leukocytosis as Prognostic Indicator of Major Injury

Objective To test the diagnostic use of the triage white blood cell (WBC) count in differentiating major from minor injuries. Methods We conducted a retrospective study of a prospectively collected database of trauma patients 13 years of age or older at a Level I trauma center from January 2005 through December 2008. We excluded all patients with obvious life-threatening injuries requiring immediate surgery, isolated head trauma, transferred from another institution or dead on arrival. We recorded age, sex, injury mechanism, vital signs, WBC, base deficit (BD), lactate (LAC) and calculated injury severity scores (ISS). Major injury was defined as either a change in hematocrit \u3e10 points or blood transfused within 24 hours, or ISS \u3e15. Results 805 patients were included in the study with an average age of 38.6 years (Range 13–95 yrs) years. 75.3% of patients were male, 45.6% had blunt and 34.4% had penetrating trauma. For vital signs, blood pressure was not significantly different between major and minor injury patients. Major compared to minor injury patients had a statistically but not clinically significant higher heart rate. Major injury patients had significantly (p \u3c 0.0001) higher WBC count (10.53 K/μl, 95% CI: 9.7–11.3) compared to patients with minor injuries (8.92 K/μl, 95% CI: 8.7–9.2), but both were in the normal range. Patients with major compared to minor injury had significantly (p \u3c 0.0001) higher BD (−3.1 versus −0.027 mmol/L) and higher LAC (3.9 versus 2.48 mmol/L). Areas under the curve for WBC count (0.60, 95% CI: 0.54–0.66) are similar to BD (0.69, 95% CI: 0.63–0.74) and LAC (0.66, 95% CI: 0.60–0.71). Conclusion WBC count is not a useful addition as a diagnostic indicator of major trauma in our study population

The role of whole blood transfusions in civilian trauma: A review of literature in military and civilian trauma

Resuscitation techniques for the management of adult trauma patients have evolved over the 20th century. Whole blood transfusions were previously used as the standard of care, whereas blood component therapy is the current method employed across most trauma centers across the United States. Prior to the transition, no studies were conducted to show improved efficacy of hemostatic potential in trauma patients. Recent conflicts in Iraq and Afghanistan have challenged the dogma that whole blood transfusions are not the standard of care and have shown potential as the superior transfusion product for adult trauma patients. The purpose of this review is to provide a comprehensive review and elucidate if whole blood transfusions have a role in civilian trauma patients based upon recent military medical literature and civilian pilot studies using whole blood transfusions

PixFEL: development of an X-ray diffraction imager for future FEL applications

A readout chip for diffraction imaging applications at new generation X-ray FELs (Free Electron Lasers) has been designed in a 65 nm CMOS technology. It consists of a 32 × 32 matrix, with square pixels and a pixel pitch of 110 µm. Each cell includes a low-noise charge sensitive amplifier (CSA) with dynamic signal compression, covering an input dynamic range from 1 to 104 photons and featuring single photon resolution at small signals at energies from 1 to 10 keV. The CSA output is processed by a time-variant shaper performing gated integration and correlated double sampling. Each pixel includes also a small area, low power 10-bit time-interleaved Successive Approximation Register (SAR) ADC for in-pixel digitization of the amplitude measurement. The channel can be operated at rates up to 4.5 MHz, to be compliant with the rates foreseen for future X-ray FEL machines. The ASIC has been designed in order to be bump bonded to a slim/active edge pixel sensor, in order to build the first demonstrator for the PixFEL (advanced X-ray PIXel cameras at FELs) imager

Belle-II VXD radiation monitoring and beam abort with sCVD diamond sensors

The Belle-II VerteX Detector (VXD) has been designed to improve the performances with respect to Belle and to cope with an unprecedented luminosity of View the MathML source8 71035cm 122s 121 achievable by the SuperKEKB. Special care is needed to monitor both the radiation dose accumulated throughout the life of the experiment and the instantaneous radiation rate, in order to be able to promptly react to sudden spikes for the purpose of protecting the detectors. A radiation monitoring and beam abort system based on single-crystal diamond sensors is now under an active development for the VXD. The sensors will be placed in several key positions in the vicinity of the interaction region. The severe space limitations require a challenging remote readout of the sensors

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Abstracts for the 36th annual emergencies in medicine conference

The 36th Annual Emergencies in Medicine Conference was held at the Hyatt Centric Hotel in Park City, Utah, from February 25 to March 1, 2018. The conference is designed by Emergency Medicine physicians to be short, engaging, and informative. Conference involved a series of fast-paced 30-min lectures from international leaders in Emergency Medicine about cutting-edge research. The following were the abstracts that were presented at the conference. There was a competition for the best abstract, determined by a vote of all the conference attendees, for which the winner received the title of “2018 Best Emergencies in Medicine Abstract,” and a cash award of $500. This year the award went to “Stethoscope Cleaning Practices: The Dirty 3rd Hand of Modern Medicine.

Leukocytosis as a Prognostic Indicator of Major Injury

Objective: To test the diagnostic use of the triage white blood cell (WBC) count in differentiating major from minor injuries.Methods: We conducted a retrospective study of a prospectively collected database of trauma patients 13 years of age or older at a Level I trauma center from January 2005 through December 2008. We excluded all patients with obvious life-threatening injuries requiring immediate surgery, isolated head trauma, transferred from another institution or dead on arrival. We recorded age, sex, injury mechanism, vital signs, WBC, base deficit (BD), lactate (LAC) and calculated injury severity scores (ISS). Major injury was defined as either a change in hematocrit >10 points or blood transfused within 24 hours, or ISS >15.Results: 805 patients were included in the study with an average age of 38.6 years (Range 13-95 yrs) years. 75.3% of patients were male, 45.6% had blunt and 34.4% had penetrating trauma. For vital signs, blood pressure was not significantly different between major and minor injury patients. Major compared to minor injury patients had a statistically but not clinically significant higher heart rate. Major injury patients had significantly (p < 0.0001) higher WBC count (10.53 K/µl, 95% CI: 9.7-11.3) compared to patients with minor injuries (8.92 K/µl, 95% CI: 8.7-9.2), but both were in the normal range. Patients with major compared to minor injury had significantly (p < 0.0001) higher BD (-3.1 versus -0.027 mmol/L) and higher LAC (3.9 versus 2.48 mmol/L). Areas under the curve for WBC count (0.60, 95% CI: 0.54-0.66) are similar to BD (0.69, 95% CI: 0.63-0.74) and LAC (0.66, 95% CI: 0.60-0.71).Conclusion: WBC count is not a useful addition as a diagnostic indicator of major trauma in our study population. [West J Emerg Med. 2010; 11(5):450-455.

Is there a correlation of sonographic measurements of true vocal cords with gender or body mass indices in normal healthy volunteers?

Background: Ultrasound is a readily available, non-invasive technique to visualize airway dimensions at the patient′s bedside and possibly predict difficult airways before invasively looking; however, it has rarely been used for emergency investigation of the larynx. There is limited literature on the sonographic measurements of true vocal cords in adults and normal parameters must be established before abnormal parameters can be accurately identified. Objectives: The primary objective of the following study is to identify the normal sonographic values of human true vocal cords in an adult population. A secondary objective is to determine if there is a difference in true vocal cord measurements in people with different body mass indices (BMIs). The third objective was to determine if there was a statistical difference in the measurements for both genders. Materials and Methods: True vocal cord measurements were obtained in healthy volunteers by ultrasound fellowship trained emergency medicine physicians using a high frequency linear transducer orientated transversely across the anterior surface of the neck at the level of the thyroid cartilage. The width of the true vocal cord was measured perpendicularly to the length of the cord at its mid-portion. This method was duplicated from a previous study to create a standard of measurement acquisition. Results: A total of 38 subjects were enrolled. The study demonstrated no correlation between vocal cord measurements and patient′s characteristics of height, weight, or BMI′s. When accounting for vocal cord measurements by gender, males had larger BMI′s and larger vocal cord measurements compared with females subjects with a statistically significant different in right vocal cord measurements for females compared with male subjects. Conclusion: No correlation was seen between vocal cord measurements and person′s BMIs. In the study group of normal volunteers, there was a difference in size between the male and female vocal cord size