Emergency intraosseous access in a helicopter emergency medical service: a retrospective study

<p>Abstract</p> <p>Background</p> <p>Intraosseous access (IO) is a method for providing vascular access in out-of-hospital resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseous techniques have been used by our Helicopter Emergency Medical Services (HEMS) since 2003. Few articles document IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS.</p> <p>Methods</p> <p>We reviewed all medical records from the period May 2003 to April 2010, and compared three different techniques: Bone Injection Gun (B.I.G^®- Waismed), manual bone marrow aspiration needle (Inter V - Medical Device Technologies) and EZ-IO^®(Vidacare), used on both adults and paediatric patients.</p> <p>Results</p> <p>During this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were 50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO^®. Rates of success on first attempt were significantly higher using the EZ-IO^®compared to the manual needle/Bone Injection Gun (p < 0.01/p < 0.001). Fifteen failures were due to insertion-related problems (19.2%), with four technical problems (5.1%) and three extravasations (3.8%) being the most frequent causes. Intraosseous access was primarily used in connection with 53 patients in cardiac arrest (75.7%), including traumatic arrest, drowning and SIDS. Other diagnoses were seven patients with multi-trauma (10.0%), five with seizures/epilepsy (7.1%), three with respiratory failure (4.3%) and two others (2.9%). Nearly one third of all insertions (n = 22) were made in patients younger than two years. No cases of osteomyelitis or other serious complications were documented on the follow-up.</p> <p>Conclusions</p> <p>Newer intraosseous techniques may enable faster and more reliable vascular access, and this can lower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believe that all emergency services that handle critically ill or injured paediatric and adult patients should be familiar with intraosseous techniques.</p

The evolution of precipitate crystal structures in an Al-Mg-Si(-Cu) alloy studied by a combined HAADF-STEM and SPED approach

This work presents a detailed investigation into the effect of a low Cu addition (0.01 at.%) on precipitation in an Al-0.80Mg-0.85Si alloy during ageing. The precipitate crystal structures were assessed by scanning transmission electron microscopy combined with a novel scanning precession electron diffraction approach, which includes machine learning. The combination of techniques enabled evaluation of the atomic arrangement within individual precipitates, as well as an improved estimate of precipitate phase fractions at each ageing condition, through analysis of a statistically significant number of precipitates. Based on the obtained results, the total amount of solute atoms locked inside precipitates could be approximated. It was shown that even with a Cu content close to impurity levels, the Al-Mg-Si system precipitation was significantly affected with overageing. The principal change was due to a gradually increasing phase fraction of the Cu-containing Q'-phase, which eventually was seen to dominate the precipitate structures. The structural overtake could be explained based on a continuous formation of the thermally stable Q'-phase, with Cu atomic columns incorporating less Cu than what could potentially be accommodated.Comment: 13 pages, 10 figures, 2 table

Access to side-chain carbon information in deuterated solids under fast MAS through non-rotor-synchronized mixing.

We demonstrate the accessibility of aliphatic 13C side chain chemical shift sets for solid-state NMR despite perdeuteration and fast MAS using isotropic, non-rotor-synchronized 13C-13C mixing. Combined with amide proton detection, we unambiguously and sensitively detect whole side chain to backbone correlations for two proteins using around 1 mg of sample

Ambient Images

The digitization of the image has intensified the transformation of the relationship between humans and images. The proliferation of tools for the production of images and acceleration in their distribution has meant that a blasé attitude toward visual saturation, already prominent in the 20th century, has become more widespread. Writing in 1927, Siegfried Kracauer presciently spoke of a “blizzard of photographs.” In the first decades of the 21st century this grew into an environmental flood and the multiple streams along which people circulated images, challenged many of the traditional assumptions about the status and function of the image. Then came the pandemic. Suddenly, the relationship between the personal image and the public image was reconfigured. People hung out on platforms such as Instagram and Tik Tok with increased intensity and hunger. The platforms for virtual communication absorbed and at times aimed to compensate for the loss of events, meetings, face-to-face encounters and relationships. Confinement to the domestic sphere produced ever more mundane practices of co-present intimacy across platforms. For instance, while cross-generational practices of food photo sharing have long been a significant genre, photographs of home baking became an Instagram cliché, with “sourdough” becoming Google’s top food-related search phrase in 2020. The zoom boom soon became a new malaise—zoom fatigue. This adoption of virtual platforms was a profound incursion. It altered our sense of time and space as sense-making and social performance were increasingly aimed at and organised via camera and screen. Linear biographical narratives were cross-cut and spliced in novel ways. The image was less and less a document of an external reality, but more and more part of the new forms of mediated sociality. The diminution of physical engagements had an impact on how impressions were formed, what constituted the sensory triggers for memory, as well as shifting the markers for processes of understanding and decision-making. In this environment, images do not just multiply. Their increasing number also accentuates how they are stitched together to form new atmospheres, assemblages, iterations—or what we call the production of ambient images

Digestibility in selected rainbow trout families and modelling of growth from the specific intake of digestible protein

The experiments aimed to clarify variations in digestibility of dietary nutrients in rainbow trout. Furthermore, the objective was to study how differences in digestibility might be related to growth and feed utilisation at various growth rates. When comparing the results from the experiments it appeared that particularly protein digestibility was closely related to specific growth rate and feed conversion ratio at high growth rates. As a tool to visualise the relationship between protein digestibility and growth of rainbow trout a growth model was developed based on the specific intake of digestible protein, and general assumptions on protein content and protein retention efficiency in rainbow trout. The model indicated that increased protein digestibility only partly explained growth increase and that additional factors were important for growth increment

Introduction to Nordic Mediation Research

Non peer reviewe

Selenium toxicity but not deficient or super-nutritional selenium status vastly alters the transcriptome in rodents

<p>Abstract</p> <p>Background</p> <p>Protein and mRNA levels for several selenoproteins, such as glutathione peroxidase-1 (Gpx1), are down-regulated dramatically by selenium (Se) deficiency. These levels in rats increase sigmoidally with increasing dietary Se and reach defined plateaus at the Se requirement, making them sensitive biomarkers for Se deficiency. These levels, however, do not further increase with super-nutritional or toxic Se status, making them ineffective for detection of high Se status. Biomarkers for high Se status are needed as super-nutritional Se intakes are associated with beneficial as well as adverse health outcomes. To characterize Se regulation of the transcriptome, we conducted 3 microarray experiments in weanling mice and rats fed Se-deficient diets supplemented with up to 5 μg Se/g diet.</p> <p>Results</p> <p>There was no effect of Se status on growth of mice fed 0 to 0.2 μg Se/g diet or rats fed 0 to 2 μg Se/g diet, but rats fed 5 μg Se/g diet showed a 23% decrease in growth and elevated plasma alanine aminotransferase activity, indicating Se toxicity. Rats fed 5 μg Se/g diet had significantly altered expression of 1193 liver transcripts, whereas mice or rats fed ≤ 2 μg Se/g diet had < 10 transcripts significantly altered relative to Se-adequate animals within an experiment. Functional analysis of genes altered by Se toxicity showed enrichment in cell movement/morphogenesis, extracellular matrix, and development/angiogenesis processes. Genes up-regulated by Se deficiency were targets of the stress response transcription factor, Nrf2. Multiple regression analysis of transcripts significantly altered by 2 μg Se/g and Se-deficient diets identified an 11-transcript biomarker panel that accounted for 99% of the variation in liver Se concentration over the full range from 0 to 5 μg Se/g diet.</p> <p>Conclusion</p> <p>This study shows that Se toxicity (5 μg Se/g diet) in rats vastly alters the liver transcriptome whereas Se-deficiency or high but non-toxic Se intake elicits relatively few changes. This is the first evidence that a vastly expanded number of transcriptional changes itself can be a biomarker of Se toxicity, and that identified transcripts can be used to develop molecular biomarker panels that accurately predict super-nutritional and toxic Se status.</p

Adult advanced life support: Section 3 of the European Resuscitation Council Guidelines for Resuscitation 2015

Erweiterte lebensrettende Maßnahmen für Erwachsene („advanced life support“, ALS) kommen zum Einsatz, nachdem Basismaßnahmen zur Wiederbelebung („basic life support“, BLS) begonnen und, wenn sinnvoll, ein automatisierter externer Defibrillator (AED) verwendet wurde. Die Basismaßnahmen zur Wiederbelebung eines Erwachsenen und der Einsatz von AEDs wird in Kap. 2 ausgeführt. Basis- und erweiterte Maßnahmen sollen nahtlos ineinander übergehen, da erstere fortgeführt werden und sich mit den erweiterten überschneiden. Dieses Kapitel über die erweiterten Maßnahmen beinhaltet die Vermeidung des Kreislaufstillstands, spezielle Aspekte des außerklinischen ALS, den Start der innerklinischen Reanimation, den ALS-Algorithmus, die manuelle Defibrillation, das Atemwegsmanagement während der Reanimaton, Medikamente und ihre Anwendung während der Reanimation sowie die Behandlung von Periarrest-Arrhythmien. Es gibt zwei Änderungen in der äußeren Form dieser Leitlinien des Europäischen Rats für Wiederbelebung seit den Leitlinien von 2010: [1] Das Kapitel „Elektrotherapie“ [2] ist nicht mehr eigenständig, sondern Teil dieses Kapitels; und die Leitlinien zur Behandlung nach Reanimation sind in ein neues Kapitel ausgegliedert, welches die Bedeutung dieses letzten Glieds der Überlebenskette unterstreicht [3]. Diese Leitlinien basieren auf den International Liaison Committee on Resuscitation (ILCOR) Consensus on Science and Treatment Recommendations (CoSTR) für ALS von 2015 [4]. Die Überprüfung der ILCOR-Empfehlungen von 2015 konzentrierte sich auf 42 Themen, entsprechend der zeitlichen Abfolge der erweiterten Maßnahmen: Defibrillation, Atemwege, Oxygenierung und Ventilation, Kreislaufunterstützung und Überwachung und Einsatz von Medikamenten während der Reanimation. Für diese Leitlinien wurden die ILCOR-Empfehlungen durch ein gezieltes Literatur-Review ergänzt, welches von der ERC-ALS-Leitlinien Autorengruppe zu den Themen die nicht in den ILCOR-CoSTR-Empfehlungen von 2015 überarbeitet wurden erstellt wurde. Die Leitlinien wurden ausgearbeitet, von den ALS-Verfassern geprüft und abschließend von der ERC-Vollversammlung und dem ERC-Vorstand abgesegnet