Effects of Position on Intracranial Pressure Management in Porcine Traumatic Brain Injury with Hemorrhagic Shock

The head elevation position increased mortality, decreased MAP, and showed no significant change in CePP.

Reanimate the Dead to Life by Practicing Cryo Techniques

The pigs were immediately connected to a ventilator device for assisted respiration. After about a day or so these pigs returned to normalcy with regards to heart & breathing rhythms. By following the above procedure dead humans may also be brought back to life immediately after demise. This procedure will be more effective in dead youths who unfortunately got killed. Pigs were used for this experiment as they share a number of surprising comparable traits with humans which is a well-known fact.

Single-Shot Sub-Dissociative Dose Ketofol versus Ketamine Alone for Emergency Department Procedural Sedation and Analgesia in Adult

When compared with Ketamine alone for PSA in ED settings, the Ketofol with rapid onset of action, faster recovery time, cardio respiratory stability, less adverse events, and high patient satisfaction level make it a better option.

Implementation of a Simplified Pediatric Peri-Appendectomy Antibiotic Regimen

A simplified peri-appendectomy antibiotic regimen was as effective with fewer nursing resources and treatment costs

Indicators of Non-accidental Trauma in Patients Under 24 Months of Age

Emergency department medical staff should be cautious of trauma patients who present with any of thesevariables found to be associated with NAT. Identification of NAT on the first presentation by medical staff may prevent victims of NAT from facing subsequent abuse, fatality, or lifelong complications

Associating Insulin Instillation with Negative Pressure Wound Therapy Reduces Insulin Resistance in Diabetic Patients with Infected Foot Wounds

In this work we investigated whether a joint treatment with insulin instillation and negative pressure wound therapy (NPWT) would reduce insulin resistance (IR) in diabetic patients with infected diabetic foot ulcers (DFUs) and improve their healing. We also studied the effects of insulin+NPWT treatment on the inflammatory response coupled with wound healing. Seventy-five diabetic patients with infected DFUs were recruited and randomly divided into equal (n=25) groups treated respectively with NPWT alone, NPWT+insulin, and conventional dressings (controls). Thereafter, the ulcers’ healing progress was assessed. The serum levels of Tumor Necrosis Factor-α (TNF-α), Interleukin-2 (IL-2), and Interleukin-6 (IL-6) were measured at 1 day before and at 7, 14, and 21 days after each treatment using specific double-antibody sandwich enzyme-linked immunosorbent assays (ELISA). Serum glucose was measured via a glucose-oxidase method, and serum insulin via radioimmunoassay. In each patient, IR was appraised via the Homeostasis Model Assessment (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI). Our results showed that at 7, 14 and 21 days post-treatment, with respect to the control group the two NPWT-treated groups had (i) significantly (p < 0.05) lower serum levels of TNF-α, IL-2 and IL-6; (ii) a significantly (p < 0.01) greater reduction in IR; and (iii) significantly (p < 0.05) higher wound healing rates. Moreover, at 14- and 21-days post-treatment, the NPWT+insulin-treated group had a significantly (p < 0.05) higher wound healing rate than the NPWT alone-treated group. In conclusion, the combined NPWT+insulin instillation treatment gave superior results by improving wound healing, decreasing inflammation at the wounds surface, and reducing IR in diabetic patients with infected DFUs.

Clinical Features of Children with Abusive Head Injury and Apparent Life-Threatening Events Upon Presentation to a Children’s Hospital

Background: The symptoms of child abuse and ALTE are similar. Diagnosing child abuse in those who present with an ALTE may be difficult since the symptoms are similar, and bruising is not always seen in those abused. Approximately only 50% of infants who have bruising are found to be abused. There is limited literature showing bruises to the face or blood in the nose or mouth are distinguishing features of those abused infants who initially present to the Emergency Department (ED) for ALTE. Objective: To determine if bruises or contusions to the face or body in infants occur more often in those who present to the ED as an ALTE but found to have Abusive Head Injury (AHI) versus those who present as ALTE and not found to have AHI. A secondary aim was to determine if blood in the mouth and/or nose was present in those with ALTE but found to have AHI. Methods: Retrospective case-control study of infants Results: There were 49 patients in the study: 20 AHI and 29 non-AHI. All infants in both groups had apnea as a presenting symptom. There were no differences in race or gender between groups. No patients in the non-AHI group had retinal hemorrhages. There was not a significant difference in CPR performed prior to arriving to the ED between groups. Intubation was performed with higher frequency in the AHI patients than non-AHI patients (62% vs 0%, p=0.002 by Fisher’s Exact Test). All nine patients requiring intubation were in the AHI group and had intracranial bleeds. Bruises were present with higher frequency in the abused than non-abused group (31% vs 0%, P=0.017 by Fisher’s Exact Test). All bruises were found on patients’ bodies and none on their faces. There were 2 patients with blood from the nose but those were in the non-AHI group and had received CPR. Conclusions: Infants with ALTE who have AHI are more likely to present with bruising to the body, retinal hemorrhages, and intracranial bleeds than infants who have AHI. Blood in the nose does not identify those with AHI. The performance of CPR does not differentiate between groups but the need for intubation was associated with AHI.

Combining Negative Pressure Wound Therapy with Insulin Instillation Reduces Insulin Resistance and Accelerates Healing in Patients with Chronically Infected Wounds

Aim: This study aimed at evaluating the effects of negative pressure wound therapy (NPWT) combined with insulin instillation on wound healing and insulin resistance (IR) in patients with chronically infected wounds. Methods: Sixty-three patients were recruited and randomly divided into three groups (21 cases each) according to treatments: NPWT only; NPWT+insulin; and controls (conventional dressings). Both NPWT treatments lasted for three weeks. Thereafter, wounds’ healing conditions were assessed. At 1 day before and 7, 14, and 21 days posttreatment Interleukin- 6 (IL-6), Interleukin- 2 (IL-2), and Tumor Necrosis Factor-α (TNF-α) serum levels were assessed via specific double-antibody sandwich enzyme-linked immunosorbent assays; and plasma glucose and insulin were quantified via glucose-oxidase and radioimmunoassay, respectively. IR was appraised via homeostasis model assessment (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI). Results: At 7, 14, and 21 days after treatments onset the two NPWT groups had significantly (P = 0.0001) lower IL-6, IL-2, and TNF-α serum levels and HOMA-IR values than controls while wound healing rates were higher (P < 0.001) than controls. Notably, the NPWT+insulin treatment results were better (P < 0.01) than those of NPWT alone. Conclusion: NPWT+insulin instillation improved wound healing, mitigated inflammation, and reduced IR in patients with chronically infected wounds.

Groin Abscess: Assessing The Diagnostic Accuracy Of Emergency Department Clinicians And Imaging Modalities

Objective: To determine the clinical and imaging diagnostic accuracy in adult patients presenting to the Emergency Department with groin abscess. Method: Retrospective chart review of all adult patients presenting to a district general hospital with a provisional diagnosis of groin abscess was undertaken from January 2019 to December 2019. A proforma was used to capture data such as the age, sex, co-morbidities, grade of assessing clinician and imaging profile. Results: 39 patients with a provisional diagnosis of groin abscess were identified; representing approximately 1% of all ED attendances. There were 21 males and 18 females. The age range was from 23 to 73 years (mean age 42). The abscess was located on the left side in 19 patients (49%), 18 (46%) on the right and 2 (5%) were bilateral. The overall rate of correct diagnosis of the ED clinicians compared to CT diagnosis is indicated by a sensitivity of 82%, positive predictive value of 90% and an accuracy of 75%. 22 patients had CT scan which confirmed an abscess in 18 (83%). Conclusion: Groin abscess is a rare presentation to the Emergency department. Most patients were seen by clinicians below the consultant grade. Diagnostic accuracy was highest amongst physicians.