The American journal of emergency medicine
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We encountered a case of severe acute respiratory distress syndrome in late pregnancy due to influenza (H1N1) with refractory hypoxemia to conventional mechanical ventilation. Ventilation in prone position rescued this patient by maintaining oxygenation and sustaining improvement thereafter. ⋯ It requires frequent monitoring of possible complications due to prone position and highly dedicated supporting staffs. More data are required on safety of proning in the late pregnancy.
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Intramedullary pressure changes during intraosseous (IO) procedures have been implicated in the intravasation of bone marrow fat and with pain in conscious patients. The objective of this study was to demonstrate inter-provider variability in pressures generated during initial flush procedures. ⋯ The IO compartment pressures generated by physicians demonstrated significant interoperator variability with greater than 35-fold difference in flush forces, and an inverse relationship between intraosseous pressure and flush duration. It may be prudent practice for providers to extend the flush over several seconds, thus limiting maximal pressures.
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Nebulized particles must have diameters between 1 to 5 μm (optimal particle size range [OPSR]) to be deposited in the lower respiratory tract. The purpose of this study is to determine factors that affect the particle size distributions of nebulized albuterol. ⋯ Single-use disposable nebulizers do not degrade with use, but their performance is highly dependent on gas flow rates. At the flow rate achieved by the home pump, the semipermanent nebulizer performs better than the SUD nebulizer.
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Various emergency department (ED) HIV testing models are reported in the literature but may not all be sustainable. We sought to determine whether changing an ED rapid HIV testing program from counselor-based to ED technician-based resulted in more testing. ⋯ We present a novel approach to HIV testing using existing staff within the ED. This new ED technician-based model led to large increases in rates of testing.
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Measurement of pathogen DNA polymerase activity by enzymatic template generation and amplification (ETGA) has shown promise in detecting pathogens in bloodstream infection (BSI). We perform an in-depth analysis of patients with clinical BSI enrolled in ETGA feasibility experiments. ⋯ Patients with BSI often have diagnostic and treatment delays. Enzymatic template generation and amplification provides clinically meaningful data more rapidly than cultures. Future development should focus on real-time application of assays that detect microbes at the molecular level.