See one, see one, teach one - Decisions on allocating intubation opportunities in pediatric emergency medicine.

Background: Decisions about who should perform tracheal intubation in academic settings must balance the needs of trainees to develop competency in pediatric intubation with patient safety. Airway protocols during the COVID-19 pandemic may have reduced opportunities for trainees, representing an opportunity to examine the impact of shifting laryngoscopy responsibilities away from trainees.

Methods: This observational study combined data from 11 pediatric emergency departments in North America participating in either the National Emergency Airway Registry for Children (NEAR4KIDS) or a national pediatric emergency medicine airway education collaborative.

Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS).

Background: Tracheal intubation (TI) practice across pediatric emergency departments (EDs) has not been comprehensively reported. We aim to describe TI practice and outcomes in pediatric EDs in contrast to those in intensive are units (ICUs) and use the data to identify quality improvement targets.

Methods: Consecutive TI encounters from pediatric EDs and ICUs in the National Emergency Airway Registry for Children (NEAR4KIDS) database from 2015 to 2018 were analyzed for patient, provider, and practice characteristics and outcomes: adverse TI-associated events (TIAEs), oxygen desaturation (SpO < 80%), and procedural success.

The treatment and management of atopic dermatitis in the pediatric emergency department: Highlighting physician practices and the desire for patient-centered resources.

Atopic dermatitis is a common, complex skin disorder with significant morbidity. The management of atopic dermatitis is multifactorial and often varies by physician experience and comfort level. We conducted a single-institution survey of pediatric emergency medicine physicians regarding their perceived confidence in managing atopic dermatitis, knowledge of treatment options, and interest in patient-centered clinical resources.

Mitral valve repair complicated by left circumflex coronary artery occlusion: The vital role of the anesthesiologist.

The anatomical relationship between the mitral valve and the left circumflex coronary artery places this vessel at risk for occlusion during mitral valve repair or replacement. In view of the potential high morbidity and mortality of this complication, the anesthesiologist has a vital role in its prompt diagnosis. We present the case of a 47-year-old man who underwent a minimally invasive mitral valve repair, which was complicated by left circumflex coronary artery occlusion.

Unicuspid aortic valve: Case series and review.

A unicuspid aortic valve is a very rare valvular lesion. Its physical manifestations vary and are associated with other cardiovascular abnormalities such as aortic stenosis/insufficiency and aortopathy. Echocardiography remains the modality of choice, with computerized tomography or cardiac magnetic resonance used as adjunctive imaging.

Decreasing hospital length of stay and enhancing recovery in Total Knee Arthroplasty.

Background: Patients undergoing Total Knee Arthroplasty (TKA) typically have early postoperative pain and decreased mobility, especially so in the first 24 h. Achieving a pain free knee in the immediate postoperative period and reducing complications using multimodal pain and blood management protocols forms a keystone in early mobilization and functional recovery. Enhanced Recovery after Surgery pathways (ERASp) since their inception, have significantly improved perioperative care and functional outcomes, thereby reducing the average length of stay (ALOS), complications and overall healthcare costs.

Persistent left superior vena cava identified by transesophageal echocardiography.

A 70-year-old female with severe aortic stenosis presented for aortic valve replacement and underwent routine preoperative Swan-Ganz catheter placement. Transesophageal echocardiography demonstrated a dilated coronary sinus with a catheter present. A high suspicion of venous anomaly prompted an agitated saline study.

Acute Adrenal Insufficiency After an Antiemetic Dose of Dexamethasone: A Case Report.

Dexamethasone is widely used in current practice for the prevention of postoperative nausea and vomiting. Although its use in the perioperative setting has been associated with several side effects (eg, hyperglycemia and suppression of adrenal cortisol production), their clinical significance remains questionable. We present the case of a healthy 27-year-old woman who developed acute adrenal insufficiency after receiving intraoperative dexamethasone for postoperative nausea and vomiting prophylaxis during a laparoscopic left oophorectomy.

Papillary Fibroelastoma Found With Transesophageal Echocardiography After a Normal Transthoracic Echocardiography.

We present the case of a patient with transient ischemic attacks who was being investigated for multiple embolic strokes. Initial workup, including brain computed tomography, computed tomography angiography, and transthoracic echocardiography (TTE) were negative for a source until transesophageal echocardiography (TEE) found a mass in the left atrium. The TEE differentiated the mass as a rare cardiac papillary fibroelastoma on the left atrial free wall confirmed by postsurgical pathology.

Glycopyrrolate: It's time to review.

Medication shortages have become an all-too-common inconvenience that has forced anesthesia providers to examine our administering practices. Because of these shortages, commonly used medications are at the greatest risk. Glycopyrrolate (Robinul), which has been in short supply in recent years, is one of the most widely used anticholinergic agents, especially in conjunction with the anticholinesterase neostigmine, for reversal of neuromuscular blockade (NMB) drugs.

Audiological findings in cleft palate patients attending speech camp.

Background & Objective: Hearing impairment is one of the associated problems seen particularly in children with cleft palate rather than cleft lip alone. This has received very little attention in the area of cleft care although research shows that hearing impairment affects language development The present study was carried not to find out the type and pattern of audiogram in cases attending a speech camp, average degree of hearing loss and its relation to the side of cleft, and the acoustic immittance findings and its relation to the otological evaluation. The parental awareness about the hearing problem was also assessed.

Conditions for insertion of the laryngeal mask airway: comparisons between sevoflurane and propofol using fentanyl as a co-induction agent. A pilot study.

Background And Objective: To compare the conditions for insertion of the laryngeal mask airway using sevoflurane or propofol plus fentanyl. We evaluated the haemodynamic changes and cost of induction of anaesthesia in both groups.

Methods: Sixty patients were equally and randomly divided into two groups.

Use of the intubating laryngeal mask airway in a case of ankylosing spondylitis for coronary artery bypass grafting.

The intubating laryngeal mask airway is a modification of the conventional laryngeal mask and is used as a tool for difficult intubation. It can be inserted without placing the head and neck in the Magill position and has been used successfully in cervical spine injuries. Reported is a case of successful insertion of the intubating laryngeal mask and subsequent intubation through it in a patient with ankylosing spondylitis with cervical involvement resulting in a fixed flexion deformity who underwent coronary artery bypass grafting.

Interactions of aphid herbivory and nitrogen availability on the total foliar glycoalkaloid content of potato plants.

In plant growth room (PGR) and open-air pot (OAP) experiments, potato cvs King Edward and Maris Piper were grown under two nitrogen levels or two different nitrogen release patterns. Plants were subjected to infestation by peach potato aphids Myzus persicae (Homoptera: Aphididae). Total glycoalkaloid (GA) levels were measured in the foliage of both infested and non-infested plants, before, during and after aphid infestation.

Mycotoxin production in a carbendazim-resistant strain of fusarium sporotrichioides.

Mycelial yield and production of three trichothecenes, namely T-2 toxin, diacetoxyscirpenol (DAS) and neosolaniol (NEO) were compared in control (CS) and carbendazim-resistant strains (RS) ofFusarium sporotrichioides. Each strain was exposed to graded concentrations of carbendazim (0, 1, 2, and 4 μg/ml media) for 2, 5 and 7 days under shake-culture conditions at an incubation temperature of 25°C. Mycelial yield was significantly (P<0.

3-Acetyl deoxynivalenol and esterase production in a fungicideinsensitive strain ofFusarium culmorum.

3-Acetyl deoxynivalenol (3-ADON) and esterase production were determined in a strain ofFusarium culmorum insensitive to the fungicide, difenoconazole. Following further exposure to this fungicide for different periods of time, the initiation of 3-ADON production was observed to be accelerated in the insensitive strain compared to a control (sensitive) strain of the phytopathogen. In particular, 3-ADON appeared in insensitive cultures within 21 days of incubation with fungicide levels of 1 to 4 µg/ml media and at 43 days with difenoconazole levels of 6 and 10 µg/ml.

3-Acetyl deoxynivalenol production in a strain ofFusarium culmorum insensitive to the fungicide difenoconazole.

The production of the mycotoxin, 3-acetyl deoxynivalenol (3-ADON), was investigated in a strain ofFusarium culmorum insensitive to the systemic fungicide, difenoconazole. On exposure to graded concentrations of the fungicide, the insensitive strain continued to synthesise 3-ADON when difenoconazole levels of 100 and 200μg/ ml media were used. In contrast, a control (sensitive) strain ceased production of 3-ADON at difenoconazole levels of 100 μg/ml.

High risk register--an economical tool for early identification of hearing loss.

Deafness needs to be dignified nearly as its adverse effects increase with the degree and age of onset. The high risk register helps to alert the professional to suspect the presence of this hidden handicap. Histories of 281 hearing impaired children and 158 normal children was collected and analysed.

Determination of mimosine and 3-hydroxy-4(1h)-pyridone in Leucaena, avian excreta and serum using reversed-phase ion-pair high-performance liquid chromatography.

The estimation of mimosine and 3-hydroxy-4(1H)-pyridone in Leucaena leucocephala, Leucaena seeds, chick excreta and chick serum using reversed-phase ion-pair high-performance liquid chromatography was investigated. Isocratic elution of both compounds was achieved in 11 min using sodium octyl sulphate as the pairing agent in a pH 2.25 buffer.

Blood pyruvate carboxylase activity as a criterion of biotin status in young pigs.

A basal diet containing isolated soybean protein was supplemented with 100 and 500 microgram biotin/kg and another basal diet containing hen-egg albumen was supplemented with 1300 microgram biotin/kg. The five diets were fed to groups of young pigs from four to 12 weeks old. Growth depression or skin or foot lesions characteristic of biotin deficiency were not seen but the undersurfaces of the hooves of pigs given the basal albumen diet were unusually soft.