Intravenous Ketamine to Facilitate Transport of Agitated Patients to the ECT Clinic.

Objectives: Electroconvulsive therapy (ECT) can be effective for a variety of psychiatric conditions, including for some patients who are very psychotic or agitated. Transferring such patients from the psychiatric ward to the ECT clinic can pose significant challenges for treating teams, as they try to minimize the use of restraint.

Methods: We developed a protocol for safe transfer of such patients using sedation with ketamine.

Arterial waveform morphomics during hemorrhagic shock.

Purpose: The arterial pressure waveform is a composite of multiple interactions, and there may be more sensitive and specific features associated with hemorrhagic shock and intravascular volume depletion than systolic and/or diastolic blood pressure (BP) alone. The aim of this study was to characterize the arterial pressure waveform in differing grades of hemorrhage.

Methods: Ten anesthetized swine (70-90 kg) underwent a 40% controlled exponential hemorrhage.

Extended resuscitative endovascular balloon occlusion of the aorta (REBOA)-induced type 2 myocardial ischemia: a time-dependent penalty.

Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) increases cardiac-afterload and is used for patients in hemorrhagic shock. The cardiac tolerance of prolonged afterload augmentation in this context is unknown. The aim of this study is to quantify cardiac injury, if any, following 2, 3 and 4 hours of REBOA.

Aortic branch vessel flow during resuscitative endovascular balloon occlusion of the aorta.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a torso hemorrhage control adjunct. Aortic branch vessel flow (BVF) during REBOA is poorly characterized and has implications for ischemia-reperfusion injury. The aim of this study is to quantify BVF in hypovolemic shock with and without REBOA.

No wire? No problem: Resuscitative endovascular balloon occlusion of the aorta can be performed effectively and more rapidly with a wire-free device.

Background: A wire-free device is available for resuscitative endovascular balloon occlusion of the aorta (REBOA) providing aortic occlusion (AO) without lengthy platform guide-wires and large sheaths.

Methods: This was a retrospective, single-institution review of patients who received REBOA from May 2014 to September 2017. Timing of procedural steps was measured in seconds using time-stamped videography.

Bringing Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Closer to the Point of Injury.

Background: The management of noncompressible torso hemorrhage remains a significant issue at the point of injury. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used in the hospital to control bleeding and bridge patients to definitive surgery. Smaller delivery systems and wirefree devices may be used more easily at the point of injury by nonphysician providers.

Assessment of Blood Flow Patterns Distal to Aortic Occlusion Using CT in Patients with Resuscitative Endovascular Balloon Occlusion of the Aorta.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to decrease hemorrhage below the level of aortic occlusion (AO); however, the amount of collateral blood flow below the level of occlusion is unknown. Our aim was to investigate blood flow patterns during complete AO in patients who underwent CT scan after REBOA.

Study Design: Between February 2013 and January 2017, patients who received REBOA and underwent CT scan with intravenous contrast during full AO were included.

Comparison of in vivo clinical performance and shaft temperature and in vitro tissue temperature and transection times between new and reprocessed harmonic scalpels.

The ultrasonic harmonic scalpel (HS) uses ultrasound energy to achieve surgical dissection. To test the feasibility of limited HS reuse and to insure that reprocessed HS function in a substantially equivalent manner to their new counterparts, this study compared in vivo mesenteric vessel and liver cutting characteristics, scalpel shaft temperatures during in vivo usage and in vitro tissue temperature dissipation characteristics between new and reprocessed ACE™36 series HS. The study found that new and reprocessed ACE™-36 HS exhibit identical performance with respect to in vivo dissection characteristics and postcut shaft temperatures.

Structural assignment of poecillastrins B and C, macrolide lactams from the deep-water Caribbean sponge Poecillastra species.

Two new chondropsin-type macrolide lactams, poecillastrins B (1) and C (2), were isolated from aqueous extracts of the marine sponge Poecillastra sp. These trace metabolites were isolated in low yield (400-600 microg), and their structures were determined primarily by analysis of NMR data acquired using a cyrogenically cooled probe. High-quality 1D and 2D NMR data sets allowed complete assignment of the spectroscopic data and defined the new structures as 35-membered ring analogues of poecillastrin A (3).