Consensus statement on abusive head trauma in infants and young children

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature

N-Terminal Pro-Brain Natriuretic Peptide in combination with the 80-lead Body Surface Map Improves Detection of Acute Inferior Myocardial Infarction with Right Ventricular Involvement

Abstract Right ventricular myocardial infarction with an acute inferior infarction remains a diagnostic challenge and is associated with increased rates of morbidity and mortality necessitating rapid myocardial reperfusion for their reduction. In this study, we have shown that in patients with acute inferior-territory myocardial infarction, the early combination of Body Surface Potential Mapping and serum N-terminal pro-Brain Natriuretic peptide identifies those with right ventricular involvement -a group where early reperfusion is paramount. Introduction Acute myocardial infarction (AMI) involving only the right ventricle (RV) is a rare event [1], however its involvement in the context of inferior AMI is much more common Regarding clinical diagnosis, the triad of hypotension, clear lung fields and elevated jugular venous pressure in a patient with inferior AMI is virtually pathognomonic of RVMI We hypothesize that the combination of BSPM and plasma NT-proBNP will improve the diagnosis of RVMI complicating inferior-wall AMI. Methods Study population Between January 2003 and January 2006 we retrospectively studied all patients admitted to our coronary care unit using either the emergency department or mobile coronary care unit (MCCU). Patients were excluded from analysis if they were unable to provide informed consent or had any of the following: conditions precluding STE on ECG, i.e. left bundle branch block defined as QRS duration ≥ 120ms, QS or rS wave in lead V 1 and slurred R waves in leads I and V 5 or V 6 [11], right bundle branch block defined as QRS duration ≥ 120ms, rSR' complex in leads V 1 and V 2 and S waves in leads I and V 5 or V 6 [11], left ventricular hypertrophy defined as a sum of the R wave in leads V 5 or V 6 and S wave in V 1 ≥ 3.8mV [12], digitalis therapy or ventricular pacing (247 patients); had received fibrinolytic therapy, nitrates or glycoprotein IIb/IIIa inhibitors prior to initial ECG or BSPM; prior history of coronary artery bypass grafting (CABG) surgery; BSPM recorded >15mins after initial 12-lead ECG; left ventricular ejection fraction <55%; severe valvular disease; or renal impairment (eGFR<30ml/hr). Those who fulfilled the following criteria were studied