Management of the pregnant trauma patient in the emergency department.

This supplement reviews the evidence regarding important considerations in pregnant trauma patients, including the primary and secondary survey as well as the possibility for Rh exposure, placental abruption, uterine rupture, and the need for a prompt perimortem cesarean section in the moribund patient. Because ionizing radiation is a concern in pregnancy, the circumstances in which benefits of testing outweigh risks to the fetus are discussed. Emergency clinicians are encouraged to advocate for trauma prevention, including proper use of safety restraints in motor vehicles and screening for domestic violence, as these measures have been shown to be effective in reducing morbidity and mortality in this patient population.

A preprocedural checklist improves the safety of emergency department intubation of trauma patients.

Objectives: Endotracheal intubation of trauma patients is a vital and high-risk procedure in the emergency department (ED). The hypothesis was that implementation of a standardized, preprocedural checklist would improve the safety of this procedure.

Methods: A preprocedural intubation checklist was developed and then implemented in a prospective pre-/postinterventional study in an academic trauma center ED.

Trauma in the pregnant patient: an evidence-based approach to management.

The management of acute trauma in the pregnant patient relies on a thorough understanding of the underlying physiology of pregnancy. This issue reviews the evidence regarding important considerations in pregnant trauma patients, including the primary and secondary survey as well as the possibility for Rh exposure, placental abruption, uterine rupture, and the need for a prompt perimortem cesarean section in the moribund patient. Because ionizing radiation is always a concern in pregnancy, the circumstances where testing provides benefits that outweigh risks to the fetus are discussed.

To keep an incessant watch.

Medical residency is an educational enterprise directed toward producing clinicians who recognize and correctly manage disease. While formal graduate medical education provides didactics and bedside teaching to improve knowledge, individual learning efforts are essential to the educational experience. Keeping track of patient outcomes after disposition from the emergency department (ED) is a useful exercise in reviewing gaps in knowledge of the individual and deficiencies in systems-based care.

Individualized guidelines: the potential for increasing quality and reducing costs.

Background: Current guidelines focus on a particular risk factor and specify criteria for categorizing persons into a small number of treatment groups.

Objective: To compare current guidelines with individualized guidelines (that use readily available characteristics from each person to calculate the risk reduction expected from treatment and to identify persons for treatment in ranked order of decreasing expected benefit), in the context of blood pressure management.

Design: Analysis of person-specific, longitudinal data.

Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans.

Context: Millions of individuals habitually expose themselves to room light in the hours before bedtime, yet the effects of this behavior on melatonin signaling are not well recognized.

Objective: We tested the hypothesis that exposure to room light in the late evening suppresses the onset of melatonin synthesis and shortens the duration of melatonin production.

Design: In a retrospective analysis, we compared daily melatonin profiles in individuals living in room light (<200 lux) vs.

Designing synthetic vesicles that engulf nanoscopic particles.

We examine the interaction of a lipid bilayer membrane with a spherical particle in solution using dissipative particle dynamics, with the aim of controlling the passage of foreign objects into and out of vesicles. Parameters are chosen such that there is a favorable adhesive interaction between the membrane and the particle. Under these conditions, the membrane wraps the particle in a process resembling phagocytosis in biological cells.

Shear-driven release of a bud from a multicomponent vesicle.

The authors study the response of a multicomponent budded vesicle to an imposed shear flow using dissipative particle dynamics. Under certain circumstances, phase separation in the vesicle membrane leads to the formation of a minority domain which deforms into a nearly spherical bud in order to reduce its interfacial energy. The authors show that an imposed shear force has a varying effect on the vesicle, tending either to separate the bud from the vesicle or to stretch the bud open, depending on the vesicle orientation.

Designing a simple ratcheting system to sort microcapsules by mechanical properties.

Using computational modeling, we analyze the fluid-driven motion of compliant particles over a rigid, saw-toothed surface. The particles are modeled as fluid-filled elastic shells and, thus, simulate ex vivo biological cells or polymeric microcapsules. Through the model, we demonstrate how the patterned surface and an oscillatory shear flow can be combined to produce a ratcheting motion, yielding a straightforward method for sorting these capsules by their relative stiffness.

Adaptation of human pineal melatonin suppression by recent photic history.

The human circadian pacemaker controls the timing of the release of the pineal hormone melatonin, which promotes sleep, decreases body temperature, and diminishes cognitive performance. Abnormal melatonin secretion has been observed in psychiatric and circadian disorders. Although melatonin secretion is directly suppressed by exposure to light in a nonlinear intensity-dependent fashion, little research has focused on the effect of prior photic history on this response.