Higher Prehospital Blood Glucose Levels Associated With Return of Spontaneous Circulation in Out-of-Hospital Non-traumatic Cardiac Arrests.

Objective: Cardiac arrest leads to an array of metabolic disturbances. We aimed to investigate the association between prehospital blood glucose levels (BGLs) and rates of return of spontaneous circulation (ROSC) in non-traumatic out-of-hospital cardiac arrests (OHCAs).

Methods: A retrospective analysis of adult non-traumatic OHCAs within Kalamazoo County, MI, from January 2018 to May 2020 using the Michigan Emergency Medical Services Information System database was performed.

Teaching Cardiopulmonary Resuscitation to Later Elementary School Students.

Study Objective: Bystander cardiopulmonary resuscitation (CPR) rates remain low in the United States. Training children is a proposed method to increase this rate, but data on the compression efficacy of US elementary school-aged children are scarce. We hypothesized that fourth and fifth graders could learn how to respond to cardiac arrests and provide effective chest compressions.

Emergency medical services Milestones 2.0: What has changed?

Background: Since 2015, development of competencies by emergency medical services (EMS) fellows have been evaluated using the EMS Milestones 1.0 developed by a working group consisting of relevant stakeholders convened by the Accreditation Council for Graduate Medical Education (ACGME). Feedback from users and data collected from the milestones assessments in the interim indicated a need for revision of the original milestones.

Retrospective Comparison of Prehospital Sustained Return of Spontaneous Circulation (ROSC) Rates Within a Single Basic Life Support Jurisdiction Using Manual vs Lund University Cardiac Assist System (LUCAS-2) Mechanical Cardiopulmonary Resuscitation.

Objective Several studies have examined the impact of mechanical cardiopulmonary resuscitation (CPR) devices among multi-jurisdictional emergency medical services (EMS) systems; however, the variability across such systems can inject bias and confounding variables. We focused our investigation on the effect of introducing the Lund University Cardiac Assist System 2 (LUCAS-2) into a single basic life support (BLS) fire department first response jurisdiction served by a single private advanced life support (ALS) agency, hypothesizing that the implementation of the device would increase prehospital return of spontaneous circulation (ROSC) rates as compared with manual CPR.  Methods A retrospective observational analysis of adult non-traumatic prehospital cardiac arrest ALS agency records was conducted.

Quality Evaluation of a Checklist for Intubation Preparation in Graduate Medical Education.

Background Rapid sequence intubation (RSI) is a multistep process that emergency physicians commonly perform. Unfortunately, there is little published in the graduate medical education literature regarding the use of checklists for RSI education. Methods We developed a pre-intubation checklist for RSI preparation and evaluated emergency medicine residents' use of it.

Evaluation of Basic Life Support First Responder Naloxone Administration Protocol Adherence.

Objectives: Opioid overdoses have become a significant problem across the United States resulting in respiratory depression and risk of death. Basic Life Support (BLS) first responders have had the option to treat respiratory depression using a bag-valve-mask device, however naloxone, an opioid antagonist, has been shown to quickly restore normal respiration. Since the introduction of naloxone and recent mandates across many states for BLS personnel to carry and administer naloxone, investigation into the adherence of naloxone use standing protocols is warranted.

Intraosseous administration of hydroxocobalamin after enclosed structure fire cardiac arrest.

Smoke inhalation is the most common cause of acute cyanide poisoning in the developed world. Hydroxocobalamin is an antidote for cyanide poisoning. There is little published about human intraosseous antidote administration.

Going vertical: triage flags improve extraction times for priority patients.

Objective: The number of mass casualty incidents (MCIs) has been steadily increasing. High-priority MCI patient outcomes are highly dependent on rapid identification, treatment, and transport. Although there are several methods used to mark patients for rapid extraction, most current methods utilize low-profile tags, with no gold standard.

A Focal Pontine Infarct Presenting as Unilateral Facial Nerve Paralysis.

Brainstem infarction typically presents with vague symptoms, including headache, nausea, vomiting, and vertigo. Rarely do patients present with complete unilateral facial paralysis, mimicking Bell's palsy. Here we report the case of a 40-year-old woman who presented to the emergency department with intractable nausea, vomiting, and vertigo upon waking along with left-sided upper and lower extremity numbness and right-sided facial paralysis.

Varicella Zoster Virus Meningoencephalitis With an Atypical Presentation of Chest Pain, Impaired Memory, and Seizure.

Background: Neurologic complications of varicella zoster virus (VZV) reactivation can be associated with considerable mortality and morbidity. Aseptic meningitis associated with VZV infection is rare, occurring in 0.5% of immunocompetent individuals.

Differentiating Pseudohyperkalemia From True Hyperkalemia in a Patient With Chronic Lymphocytic Leukemia and Diverticulitis.

Acute changes in electrolyte levels can result in severe physiologic complications. Rapid treatment of abnormally elevated potassium levels is essential due to the increased risk of potentially fatal cardiac arrhythmias. However, there are a number of circumstances that can lead to falsely elevated serum potassium levels, including fist clenching during phlebotomy and hemolysis of hematocytes during laboratory processing.

An Innovative Inexpensive Portable Pulmonary Edema Intubation Simulator.

Audience: This pulmonary edema intubation simulator is designed to instruct paramedics, medical students, emergency medicine residents, emergency medical services fellows, and attending physicians.

Introduction: Acute pulmonary edema results in respiratory distress and may require endotracheal intubation. On occasion, pulmonary edema can result in copious amounts of pink, frothy sputum in the airway, complicating intubation by hindering the intubator's view.

Tension Hemopneumothorax in the Setting of Mechanical CPR during Prehospital Cardiac Arrest.

There are several complications associated with automated mechanical CPR (AM-CPR), including tension pneumothoraces. The incidence of these complications and the risk factors for their development remain poorly characterized. Tension hemopneumothorax is a previously unreported complication of AM-CPR.

Undifferentiated Embryonal Sarcoma of the Liver Presents as a Molecular Mimic of Parasitic Infection.

Medical laboratory tests are becoming more reliable with increased specificity and sensitivity, leading to their use as definitive diagnostic tests for many medical conditions. Enzyme-linked immunosorbent assay (ELISA) tests are convenient, sensitive, and standardly used for rapid detection and quantification of antigens or patient antibodies against specific antigens. However, based upon the specificity and sensitivity of an ELISA test, the results may not be definitive for a specific disease but merely suggestive, due to potential cross-reactivity of antigens and antibodies.

Morel-Lavallée lesion of the anterior leg: a rare anatomical presentation.

A Morel-Lavallée lesion (MLL) is a rare injury caused by blunt force trauma causing separation of subcutaneous tissue from the deep fascia. It is frequently seen in orthopaedic cases involving fractures of the hip or pelvis but is rare in the lower leg. The rarity of this condition often leads to misdiagnosis.

Pain in the hip: Spontaneous retroperitoneal hemorrhage in an elderly patient on apixaban.

As many as 5% of patients using oral anticoagulants suffer from a major bleeding event annually. Spontaneous retroperitoneal hemorrhage is a rare but serious complication, with a mortality rate as high as 20%. Oral anticoagulants were responsible for 2.

Successful Intubation of a Difficult Airway Using a Yankauer Suction Catheter.

Background: Endotracheal intubation (ETI) is used to effectively manage a patient's airway. Failure of ETI may lead to ineffective ventilation or oxygenation, potentially causing organ damage and eventually death. Approximately 8% of ETIs are difficult and 1% are unsuccessful.

Neurologic Acyclovir Toxicity in the Absence of Kidney Injury.

Background: Herpes zoster (zoster) also commonly known as "shingles," occurs following re-activation of the varicella zoster virus. It contributes a large cost burden to the U.S.

Air Medical Curricula in Emergency Medicine Residencies: A National Survey.

Objective: The aim of this study was to determine if a common air medical curriculum exists among Accreditation Council for Graduate Medical Education (ACGME) emergency medicine (EM) residencies.

Methods: Institutional review board exemption was obtained. A cross-sectional survey study design was used.