Cardiac Arrest in Special Populations.

Best practices in cardiac arrest depend on continuous high-quality chest compressions, appropriate ventilatory management, early defibrillation of shockable rhythms, and identification and treatment of reversible causes. Although most patients can be treated according to highly vetted treatment guidelines, some special situations in cardiac arrest arise where additional skills and preparation can improve outcomes. Situations covered in this section involve cardiac arrest in context of electrical injuries, asthma, allergic reactions, pregnancy, trauma, electrolyte imbalances, toxic exposures, hypothermia, drowning, pulmonary embolism, and left ventricular assist devices.

Evidence of a genetic background predisposing to complex regional pain syndrome type 1.

Background: Complex regional pain syndrome type 1 (CRPS-1) is a rare, disabling and sometimes chronic disorder usually arising after a trauma. This exploratory study examined whether patients with chronic CRPS-1 have a different genetic profile compared with those who do not have the condition.

Methods: Exome sequencing was performed to seek altered non-synonymous SNP allele frequencies in a discovery cohort of well-characterised patients with chronic CRPS-1 (n34) compared with population databases.

Under-representation of low and middle income countries (LMIC) in the research literature: Ethical issues arising from a survey of five leading medical journals: have the trends changed?

Despite many initiatives taken by funding bodies and health care organisations, the 10/90 gap in health care and health system research between low and middle-income countries (LIMC) and high income countries is still widely recognised. We aimed to quantify the contribution of LMIC in high impact medical journals and compare the results with the previous survey conducted in 2000. Research articles were anaylsed to determine the origin of data and authorship affiliated countries in a calendar year (2017) for five journals: British Medical Journal, The Lancet, New England Journal of Medicine (NEJM), Annals of Internal Medicine and the Journal of the American Medical Association.

Cardiac Arrest in Special Populations.

Best practices in cardiac arrest depend on continuous high-quality chest compressions, appropriate ventilatory management, early defibrillation of shockable rhythms, and identification and treatment of reversible causes. Although most patients can be treated according to highly vetted treatment guidelines, some special situations in cardiac arrest arise where additional skills and preparation can improve outcomes. Situations covered in this section involve cardiac arrest in context of electrical injuries, asthma, allergic reactions, pregnancy, trauma, electrolyte imbalances, toxic exposures, hypothermia, drowning, pulmonary embolism, and left ventricular assist devices.

Emergency department care of patients with Duchenne muscular dystrophy.

Patients with Duchenne muscular dystrophy are living longer and are increasingly seen in Emergency Departments. Though the most common cause of death remains progressive respiratory failure, increased life expectancies have unmasked the significance of progressive myocardial dysfunction, now associated with nearly 40% of mortalities in the DMD population. Cardiac complications such as arrhythmias and cardiomyopathy are becoming ever more widely recognized.

Provider Fatigue During Direct Manual Compression for Life-Threatening Bleeding.

Introduction Trauma is a leading cause of death throughout the world, with hemorrhage being responsible for more than 35% of pre-hospital trauma deaths and more than 40% of deaths within the first 24 hours after injury. Despite first aid having a demonstrable effect on mortality from trauma, relatively little research has compared the best methods for bleeding control in the prehospital first aid setting. The most common first-line therapy for external bleeding control in the pre-hospital first aid setting is direct manual compression (DMC).

Understanding the genetic basis of congenital insensitivity to pain.

Introduction Or Background: Congenital insensitivity to pain (CIP) is caused by extremely rare Mendelian genetic disorders. CIP individuals demonstrate the unexpectedly severe consequences of painlessness. Although only a small number of causative conditions and genes are known, most have led to profound insights into human nociception.

Opioid Prescribing: Where Should Academic Emergency Departments Focus Their Efforts?

Background: Opioid prescriptions from the emergency department (ED) are being heavily scrutinized. This has resulted in prescribing guidelines and laws.

Objective: We analyzed the "current state" of opioid prescribing practices by emergency medicine (EM) trainees to gain understanding where operational, educational, or supervisory efforts should be directed to comply with current guidelines and future legislation.

Comparison of viral load in individuals with and without asthma during infections with rhinovirus.

Rationale: Most virus-induced attacks of asthma are caused by rhinoviruses (RVs).

Objectives: To determine whether people with asthma are susceptible to an increased viral load during RV infection.

Methods: Seventy-four children (4-18 yr old) were enrolled; 28 with wheezing, 32 with acute rhinitis, and 14 without respiratory tract symptoms.

The wire is really easy to see (WIRES): sonographic visualization of the guidewire by novices.

Objective: To determine whether novices can distinguish between properly and improperly placed guidewires in a vascular access model after only minimal training.

Methods: This was a prospective study involving trainees with no previous training in sonographic guidewire visualization. A vascular access model was created with guidewires positioned inside or adjacent to simulated veins.

Brain injury risk from primary blast.

Background: Military service members are often exposed to at least one explosive event, and many blast-exposed veterans present with symptoms of traumatic brain injury. However, there is little information on the intensity and duration of blast necessary to cause brain injury.

Methods: Varying intensity shock tube blasts were focused on the head of anesthetized ferrets, whose thorax and abdomen were protected.

Pediatric resuscitation and cardiac arrest.

Cardiac arrest in children is, fortunately, a relatively infrequent event. Mortality rate after cardiac arrest is greater than 50%. This article discusses strategies to increase the chance of survival to discharge.

Metabolic rate variation over adult lifetime in the butterfly Vanessa cardui (Nymphalidae: Nymphalinae): aging, feeding, and repeatability.

Questions about the adaptive importance of metabolic rate can be approached only when measurements of differences between individuals are repeatable. We made daily measurements of CO(2) production, body mass, and food uptake over the adult life span of unmated Vanessa cardui kept under constant environmental conditions in both fed and unfed treatments. Mass and CO(2) production generally declined with age in both treatments, though with much day-to-day variability in the fed treatment.

Visceral-locomotory pistoning in crawling caterpillars.

Animals with an open coelom do not fully constrain internal tissues, and changes in tissue or organ position during body movements cannot be readily discerned from outside of the body. This complicates modeling of soft-bodied locomotion, because it obscures potentially important changes in the center of mass as a result of internal tissue movements. We used phase-contrast synchrotron X-ray imaging and transmission light microscopy to directly visualize internal soft-tissue movements in freely crawling caterpillars.

The transient relationship between pressure and volume in the pediatric pulmonary system.

An accurate understanding of the relationship between pulmonary pressure and volume is required for modeling pulmonary mechanics in a variety of clinical applications. In this study the experimental techniques and mathematical formulations used to characterize viscoelastic materials are applied to characterize transient pulmonary compliance in juvenile swine. Fixed volumes of air were insufflated into 5 swine and held constant for 45 s while the transient decay in tracheal pressure was measured.

The energetic costs of stereotyped behavior in the paper wasp, Polistes dominulus.

Polistes wasps engage in many behavioral interactions. Although there has been debate over the meaning of these interactions, these stereotypical behaviors can be used to determine a colony's linear dominance hierarchy. Due to the implicit relationship between behavioral and reproductive dominance, behavioral interactions are commonly used to distinguish the reproductively dominant alpha foundress from the beta foundress.

Dynamic properties of a locomotory muscle of the tobacco hornworm Manduca sexta during strain cycling and simulated natural crawling.

Caterpillars are soft-bodied terrestrial climbers that perform a wide variety of complex movements with several hundred muscles and a relatively small number of neurons. Control of movements is therefore expected to place unusual demands on the mechanical properties of the muscles. The muscles develop force slowly (1-6 s to peak) yet over a strain range extending from under 60% to more than 160% of resting length, with a length-tension relationship resembling that of supercontracting or cross-striated muscle.

Care of the acutely ill pediatric heart transplant recipient.

Young children may present to the emergency department after undergoing orthotopic heart transplantation. Emergency department care of pediatric heart transplant recipients with an acute illness is not clearly defined. To assist the emergency physician with treating these children, 2 cases are detailed to demonstrate the variation in outcome of young children presenting to the emergency department with acute illness months after their transplant.

Energy and predation costs of firefly courtship signals.

Animal courtship signals include many highly conspicuous traits and behaviors, and it is generally assumed that such signals must balance the benefits of attracting mates against some fitness costs. However, few studies have assessed the multiple costs potentially incurred by any one courtship signal, so we have limited understanding of the relative importance of different costs. This study provides the first comprehensive assessment of signal costs for Photinus fireflies (Coleoptera: Lampyridae), using controlled experiments to measure both the energy and predation costs associated with their bioluminescent courtship signals.

Muscle performance in a soft-bodied terrestrial crawler: constitutive modelling of strain-rate dependency.

Experimental data on the passive mechanical properties of the ventral interior lateral muscle of the tobacco hornworm caterpillar, Manduca sexta, are reported. The stress-deformation response of the Manduca muscle is shown to be nonlinear pseudo-elastic, capable of large deformations and subject to stress softening during initial loading cycles. The muscle passive mechanical properties also depend on multiple time-dependent processes.

Condition indices for conservation: new uses for evolving tools.

Biologists have developed a wide range of morphological, biochemical and physiological metrics to assess the health and, in particular, the energetic status of individual animals. These metrics originated to quantify aspects of human health, but have also proven useful to address questions in life history, ecology and resource management of game and commercial animals. We review the application of condition indices (CI) for conservation studies and focus on measures that quantify fat reserves, known to be critical for energetically challenging activities such as migration, reproduction and survival during periods of scarcity.

Cardiovascular emergencies in the pediatric patient.

Children who have heart disease may present to the emergency department (ED) in many stages of life with a range of cardiovascular manifestions, from minimally irritating palpitations to the life-threatening derangements of shock or lethal dysrhythmia. They can present with congenital heart disease, after a temporizing procedure has been performed or after their definitive repair. Children can also present with fever, weakness, dyspnea, syncope, or chest pain; alternatively, children may present to the ED with active dysrhythmia, pulmonary edema, or cardiogenic shock .