Sonographic Detection of Cutaneous Myiasis

Cutaneous maggots are occasionally encountered in the emergency department. We present a case in which maggots were visually identified and ultrasound was used to detect additional maggots below the skin crevices in a patient with elephantiasis nostras verrucosa

Performance of emergency physicians utilizing a video-assisted semi-rigid fiberoptic stylet for intubation of a difficult airway in a high-fidelity simulated patient: a pilot study

BACKGROUND: This study was designed to evaluate emergency physician success and satisfaction using a video-assisted semi-rigid fiberoptic stylet, the Clarus Video System (CVS), during a simulated difficult airway scenario. FINDINGS: Emergency physicians (EPs) of all levels were first shown a brief slide show and three example videos, and then given 20 min to practice intubating a mannequin using both the CVS and standard direct laryngoscopy (DL). The mannequin was then placed in a c-collar and set to simulate an apneic patient with an edematous tongue and trismus. Each EP was given up to three timed attempts with each technique. They rated their satisfaction with the CVS, usefulness for their practice, and the effectiveness of the tutorial. Direct laryngoscopy had a 65% success rate on the first attempt, 20% on the second, and 15% required three or more. The CVS had a 100% success rate with a single attempt. Average time for independent DL attempts was 43.41 s (SD = ±26.82) and 38.71 s (SD = ±34.14) with CVS. Cumulative attempt times were analyzed and compared (DL = 74.55 ± 68.40 s and CVS = 38.71 ± 34.14 s; p = 0.028). EPs rated their satisfaction with, and usefulness of, the CVS as ≥6 out of 10. CONCLUSION: Emergency physicians were able to successfully intubate a simulated difficult airway model on the first attempt 100% of the time. Emergency physicians were satisfied with the CVS and felt that it would be useful in their practice

Incidental Findings on CT Scans in the Emergency Department

Objectives. Incidental findings on computed tomography (CT) scans are common. We sought to examine rates of findings and disclosure among discharged patients who received a CT scan in the ED. Methods. Retrospective chart review (Aug-Oct 2009) of 600 patients age 18 and older discharged home from an urban Level 1 trauma center. CT reports were used to identify incidental findings and discharge paperwork was used to determine whether the patient was informed of these findings. Results. There were 682 CT scans among 600 patients: 199 Abdomen & Pelvis, 405 Head, and 78 Thorax. A total of 348 incidental findings were documented in 228/682 (33.4%) of the scans, of which 34 (9.8%) were reported to patients in discharge paperwork. Patients with 1 incidental finding were less likely to receive disclosure than patients with 2 or more (P = .010). Patients age <60 were less likely to have incidental findings (P < .001). There was no significant disclosure or incidental finding difference by gender. Conclusions. While previous research suggests that CT incidental findings are often benign, reporting to patients is recommended but this is rarely happening

Chesapeake Bay Bibliography - Volume II Virginia Waters

The Chesapeake Bay Bibliography was initiated by the Virginia Institute of Marine Science in response to growing resource management problems of the Chesapeake Bay and its tributaries. With these problems carne the realization that planning and management of such a great natural resource is an overwhelming task requiring the best available information. This bibliography, therefore, was undertaken to document existing sources of information, to help identify research and data gathering needs, and to develop a comprehensive research and information services programs for individuals interested in research on, and management of the natural resources of the Chesapeake Bay region. This, the second volume of the multi-volume bibliography, is devoted largely to materials focused on the lower half of the Bay, though articles of bay-wide interest are included. Books, periodicals, government, institutional, and academic reports, theses, and dissertations have been consulted to compile the citations contained in the bibliography See also: Volume I (1971) which summarized information sources dealing with the James River Link Volumes III Maryland (1975) focused the respective segments of the Chesapeake Bay and its tributaries.Link Volume IV Virginia Waters (1976) includes and updates the water resource-oriented citations contained in Volumes I and II, and it also identifies information sources dealing with the land resources of Virginia\u27s nine coastal planning regions.Link Volume V Virginia and Maryland Waters (1981) covers the entire Bay and its tributaries, from the fall line of the Susquehanna River, south through Maryland and Virginia to the Hampton Roads area and extends three miles into the territorial offshore waters of Virginia. The Virginia segment of the Eastern Shore on the Delmarva Peninsula is also included.Lin

Dietary electrolytes are related to mood

Dietary therapies are routinely recommended to reduce disease risk; however, there is concern they may adversely affect mood. We compared the effect on mood of a low-sodium, high-potassium diet (LNAHK) and a high-calcium diet (HC) with a moderate-sodium, high-potassium, high-calcium Dietary Approaches to Stop Hypertension (DASH)-type diet (OD). We also assessed the relationship between dietary electrolytes and cortisol, a stress hormone and marker of hypothalamic&ndash;pituitary&ndash;adrenal (HPA) axis activity. In a crossover design, subjects were randomized to two diets for 4 weeks, the OD and either LNAHK or HC, each preceded by a 2-week control diet (CD). Dietary compliance was assessed by 24 h urine collections. Mood was measured weekly by the Profile of Mood States (POMS). Saliva samples were collected to measure cortisol. The change in mood between the preceding CD and the test diet (LNAHK or HC) was compared with the change between the CD and OD. Of the thirty-eight women and fifty-six men (mean age 56&middot;3 (sem 9&middot;8) years) that completed the OD, forty-three completed the LNAHK and forty-eight the HC. There was a greater improvement in depression, tension, vigour and the POMS global score for the LNAHK diet compared to OD (P &lt; 0&middot;05). Higher cortisol levels were weakly associated with greater vigour, lower fatigue, and higher levels of urinary potassium and magnesium (r 0&middot;1&ndash;0&middot;2, P &lt; 0&middot;05 for all). In conclusion, a LNAHK diet appeared to have a positive effect on overall mood.<br /

Chesapeake Bay Bibliography - Volume I The James River

The Chesapeake Bay Bibliography was initiated by the Virginia Institute of Marine Science in response to growing resource management problems of the Chesapeake Bay and its tributaries. With these problems came the realization that planning and management of such a great natural resource is an overwhelming task requiring the best available information. This bibliography, therefore, was undertaken to document existing sources of information, to help identify research and data gathering needs, and to develop a comprehensive research and information services programs for individuals interested in research on, and management of the natural resources of the Chesapeake Bay region. The James River Bibliography is a subject index of literature concerning the James Basin. See also: Volumes II - Virginia (1972) focused the respective segments of the Chesapeake Bay and its tributaries.Link Volume III - Maryland (1975) focused the respective segments of the Chesapeake Bay and its tributaries. Link Volume IV - Virginia Waters (1976) includes and updates the water resource-oriented citations contained in Volumes I and II, and it also identifies information sources dealing with the land resources of Virginia\u27s nine coastal planning regions. Link Volume V - Virginia and Maryland Waters (1981) covers the entire Bay and its tributaries, from the fall line of the Susquehanna River, south through Maryland and Virginia to the Hampton Roads area and extends three miles into the territorial offshore waters of Virginia. The Virginia segment of the Eastern Shore on the Delmarva Peninsula is also included. Lin

Delay in Hospital Presentation Is the Main Reason Large Vessel Occlusion Stroke Patients Do Not Receive Intravenous Thrombolysis

OBJECTIVES: Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are the mainstays of treatment for large vessel occlusion stroke (LVOS). Prior studies have examined why patients have not received IVT, the most cited reasons being last-known-well (LKW) to hospital arrival of \u3e4.5 hours and minor/resolving stroke symptoms. Given that LVOS patients typically present moderate-to-severe neurologic deficits, these patients should be easier to identify and treat than patients with minor strokes. This investigation explores why IVT was not administered to a cohort of LVOS patients who underwent EVT. METHODS: This is an analysis of the Optimizing the Use of Prehospital Stroke Systems of Care (OPUS-REACH) registry, which contains patients from 9 endovascular centers who underwent EVT between 2015 and 2020. The exposure of interest was the receipt of intravenous thrombolysis. Descriptive summary statistics are presented as means and SDs for continuous variables and as frequencies with percentages for categorical variables. Two-sample RESULTS: Two thousand forty-three patients were included and 60% did not receive IVT. The most common reason for withholding IVT was LKW to arrival of \u3e4.5 (57.2%). The second most common contraindication was oral anticoagulation (15.5%). On multivariable analysis, 2 factors were associated with not receiving IVT: increasing age (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.78-0.93) and increasing time from LKW-to hospital arrival (OR 0.45 95% CI 0.46-0.49). CONCLUSION: Like prior studies, the most frequent reason for exclusion from IVT was a LKW to hospital presentation of \u3e4.5 hours; the second reason was anticoagulation. Efforts must be made to increase awareness of the time-sensitive nature of IVT and evaluate the safety of IVT in patients on oral anticoagulants