Man Tries To Shoot His Way Out Of Wreck

From JEMS:

A man is recovering at Pitt County Memorial Hospital after he wrecked his car on Grimesland Bridge Road.

Pitt County Sheriff’s Deputies, along with EMS and the Grimesland Fire Department were called to the Grimesland Bridge around 10 o’clock Monday night. That’s where officials at the scene say a man lost control of his vehicle and collided with the bridge’s railing.

The accident flipped his vehicle on it’s side and caused the driver to be pinned inside. In an attempt to free himself, the driver shot multiple rounds into his car and airbag.

Survival Prediction of Initial Blood pH for Nontraumatic Out-of-hospital Cardiac Arrest Patients in the Emergency Department

From the International Journal of Geronotology:

Background: Most nontraumatic out-of-hospital cardiac arrest (NTOHCA) patients who fail in prehospital resuscitation receive continued cardiopulmonary resuscitation in the emergency department (ED). Initial blood pH, which can be assessed rapidly in the ED, was examined to see whether it is a strong survival predictor for these patients.

Methods: A 1-year retrospective study included consecutive 225 NTOHCA patients at a medical center in northern Taiwan who presented through the emergency medical services system. On arrival at the ED, these patients received continued cardiopulmonary resuscitation, and their initial blood pH data were assessed.

Results: The pH value was positively correlated with variables such as return of spontaneous circulation, witnessed arrest, short prehospital time (≤20 minutes), and survival. The best cut-off value of initial blood pH, revealed by the receiver operating characteristic curve, was 7.068. The lowest pH value of the survivors was 6.856. The results of logistic regression model analysis shows that the odds ratios of survival was 10.0 (95% confidence interval [CI], 2.1–47.7) for patients with initial blood pH ≥ 7.068, 5.3 (95% CI, 1.48–18.9) for those with nonasystole rhythm, 4.0 (95% CI, 1.1–14.8) for those with prehospital time ≤20 minutes, and 9.1 (95% CI, 2.3–35.2) for those without NaHCO3 administration during resuscitation, respectively.

Conclusion: A cut-off value of an initial blood pH of 7.068 can serve as a predictor for survival among NTOHCA patients. In addition, patients whose initial blood pH is lower than 6.85 in the ED may not survive until hospital discharge.

Delayed Sequence Intubation (DSI)

From The Central Line:

Your first impulse may be to perform RSI, maybe with some bagging during the paralysis period. This is essentially a gamble. If you have first pass success, you (and your patient) may just luck out, allowing you to get the tube in and start ventilation before critical desaturation and the resultant hemodynamic instability.

Charity at Home: Donation Only Clinic in Atlantic, Iowa

From Neatorama:

Dr. Keith Swanson of Atlantic, Iowa was going to retire and work for free over seas. Instead his wife talked him into opening a “donations only” clinic. This way he could do his charity work right in his home town. To cover his expenses his wife made a donation box. It’s a simple shoe box covered in red tape. There is slit on the top where people can place donations. The average donation is about $10.

Swanson said he has no plans to quit what he’s doing any time soon.

“I always tell people, the last day — if I walk down the hall and die, you’ll know I’m not going to be here tomorrow.”