Cardiac resynchronisation therapy in a pace-dependent infant with tetralogy of Fallot

We present the case of a 5-month-old infant with tetralogy of Fallot and congenital atrio-ventricular block that developed severe left ventricular dysfunction during apical left ventricular pacing, in which cardiac resynchronisation therapy was used as an emergency procedure due to persistent low cardiac output syndrome.

In-House Filtration Efficiency Assessment of Vapor Hydrogen Peroxide Decontaminated Filtering Facepiece Respirators (FFRs)

To cope with the shortage of filtering facepiece respirators (FFRs) caused by the coronavirus disease (COVID-19), healthcare institutions have been forced to reuse FFRs using different decontamination methods, including vapor hydrogen peroxide (VHP). However, most healthcare institutions still struggle with evaluating the effect of VHP on filtration efficiency (FE) of the decontaminated FFRs. We developed a low-cost in-house FE assessment using a novel 3D-printed air duct. Furthermore, we assessed the FE of seven types of FFRs. Following 10 VHP cycles, we evaluated the FE of KN95 and 3M-N95 masks. The 3M-N95 and Benehal-N95 masks showed significant lower FE (80.4–91.8%) at fine particle sizes (0.3–1 µm) compared to other FFRs (FE ≥ 98.1%, p < 0.05). Following 10 VHP cycles, the FE of KN95 masks was almost stable (FE stability > 99.1%) for all particle sizes, while 3M-N95 masks were stable only at 2 and 5 µm (FE stability > 98.0%). Statistically, FE stability of 3M-N95 masks at 0.3, 0.5, and 0.7 µm was significantly lower (p ≤ 0.006) than 2 and 5 µm. The in-house FE assessment may be used as an emergency procedure to validate the decontaminated FFRs, as well as a screening option for production control of FFRs. Following VHP cycles, both masks showed high stability at 5 µm, the size of the most suspected droplets implicated in COVID-19 transmission.

An infusion of history: transfusion medicine from the 17th century to current emergency practices

Blood transfusions represent a key life-saving practice for the management of hemorrhage in emergency medicine and a commonly performed procedure in hospital settings. The ability to store and utilize the various components of blood, while avoiding adverse reactions and ensuring public health, is due to many historical research advances and refinements in our understanding of the circulatory and immune systems. This article will review the historical development of blood transfusion practices including the initial descriptions of animal-human transfusion, the first implementations in patient care and the translation into a widely used emergency procedure.

Experimental Investigation of a Cable Robot Recovery Strategy

Developing an emergency procedure for cable-driven parallel robots is not a trivial process, since it is not possible to halt the end-effector by quickly braking the actuators as in rigid-link manipulators. For this reason, the cable robot recovery strategy is an important topic of research, and the literature provides several approaches. However, the computational efficiency of the recovery algorithm is fundamental for real-time applications. Thus, this paper presents a recovery strategy adopted in an experimental setup consisting of a three degrees-of-freedom (3-DOF) suspended cable robot controlled by an industrial PC. The presentation of the used control system lists the industrial-grade components installed, further highlighting the industrial implication of the work. Lastly, the experimental validation of the recovery strategy proves the effectiveness of the work.

Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time-Critical, Low-Volume Emergency Procedure Over Three Time Periods

Background Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome. Methods An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as ‘early’, ‘developing’ and ‘mature’ time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time. Results Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The “early” phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in ‘elderly’ (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time. Conclusion The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care.

Death, a Rare Complication of Cranioplasty in Emergency: A Case Report

Cranioplasty is a reconstructive procedure which is performed to restore the calvarial integrity with either a stored autologous bone flap or a custom synthetic prosthesis. It is performed to protect the brain and as a cosmetic procedure. It has been shown to improve patient’s functional outcome. This procedure has been performed as early as <14 days postdecompressive craniectomy. Cranioplasty in emergency which is a variant of secondary cranioplasty is rarely indicated after decompressive craniectomy. Complication rate associated with cranioplasty is relatively high. Infection, convulsions, and epidural haematoma are frequent complications of cranioplasty which are not life threatening. Fatal complications associated with this procedure are not well documented and that could be among one of the reason that death, as a complication following cranioplasty is substantially low. Here, a case of unexpected death of a 37-year-old female postcranioplasty which was performed as an emergency procedure is reported. She was a previous case of right mid one-third parasagittal meningioma who developed severe sinking skin flap syndrome after three months of parasagittal craniectomy. The patient was operated under general anaesthesia for reconstruction of the residual calvarial defect. However, the patient developed bacterial meningitis and on the 16th day postcranioplasty procedure, she died of cardiac arrest. The procedure had otherwise been uneventful and it was speculated that infection and cerebral oedema postcranioplasty might have been the cause of death.