Breast Implant Stopped a Bullet?

From the LA Times:

When a gunman stormed a Simi Valley dental office last summer and shot Lydia Carranza in the chest, salvation may have come in the shape of her size-D breast implant.

That’s the theory at least of a Beverly Hills cosmetic surgeon who hopes to drum up support to defray the costs of Carranza’s reconstructive surgery.

Volunteer ED Physicians Staff Central Park Ambulance

From the NY Post:

Central Park might be the safest place in the world to have a heart attack on a Saturday night.

That’s because some of the city’s top emergency doctors can be found cruising the park on weekends in a volunteer ambulance.

The real life “Doctor McDreamys” — mostly experienced emergency-room physicians from local hospitals — double as unpaid EMTs during their time off for the Central Park Medical Unit, patrolling the leafy byways and treating citizens for free as a way to give back to the city they love.

Small hospital rises to a big challenge

From the News-Sun:

The call came in Monday at 2:20 p.m.

A tour bus had overturned on U.S. 27, just north of Lake Placid.

The word went out — despite being the smallest hospital in Highlands County, the bulk of the injured passengers were going to be sent to Florida Hospital’s Lake Placid campus because it was so close to the site of the accident.

Over the scanner that sits in the emergency room, the staff listened with horror as one paramedic, just arrived at the scene and not yet out of his ambulance, described seeing 10 to 15 bodies laying on the highway and the roadside.

The 50-bed hospital faced a harrowing test.

Airway Scope in Trauma Patients with Suspected C-Spine Derangement

From the Journal of Trauma, Injury, Infection and Critical Care:

Tracheal intubation in patients with suspected neck injuries should achieve two contradicting goals-sufficient laryngeal exposure and the least cervical spine movement. Because the former involves displacements of the cervical vertebrae, intubation under immobilization is widely performed today to prevent exacerbation of spinal code injuries. The unique curving blade of the Airway Scope (AWS) is designed to fit the oropharyngeal anatomy. A camera at the tip of the blade displays the view of the larynx, but unlike the direct laryngoscope, it needs no line-of-sight of the oral, pharyngeal, and tracheal axis. Our purpose is to determine whether AWS could be a suitable airway device for the intubation of patients with potential neck injury.

Conclusions: In neck-immobilized patients using semi-rigid cervical collars, AWS improves laryngeal exposure and facilitates tracheal intubation. AWS may be a suitable intubation device for trauma patients

The Blade That Would Make Helicopters Almost Silent

From Gizmodo:

Helicopters make a lot of noise because of a physical phenomenon called blade-vortex interaction. Eurocopter engineers have developed a new kind of rotor blade that attenuates this problem. It’s called Blue Edge.

The new blade shape is combined with another technology called Blue Pulse, which adds three flaps to the edge of the rotor blades. These flaps move up and down at 15 to 40 times per second, using piezoelectric motors that also help to reduce the blade-vortex interaction.

CHI agrees to turn hospital over to community group

From Modern Healthcare:

After months of wrangling, Denver-based Catholic Health Initiatives said it has agreed to turn over a Kansas critical-access hospital to a community group instead of closing the hospital. As part of the agreement, the Kansas attorney general would dismiss a lawsuit filed against CHI.

CHI has agreed in principal to transfer St. Joseph Memorial Hospital, Larned, Kan., to the Pawnee County Community Health Organization by March 1, said Sharon Lind, president and CEO of CHI’s Central Kansas Medical Center, Great Bend, Kan. Kansas Attorney General Steve Six will drop the lawsuit in Pawnee County District Court once the transfer is made, Lind said. Lawyers are drafting the final agreement and should finish in time for transferring the hospital by March 1, she said.

Ala. man attacked with Worcestershire sauce bottle

From the Washington Post:

Police said a 38-year-old man was charged with beating another man at a motel with a sauce bottle and a fire extinguisher. Police said the suspect was being held at the Lauderdale County Jail on $6,000 bond on charges he attacked a 43-year-old man who was returning to his motel room.

Officers said that as the man opened the door to his room Wednesday night, the suspect hit him on the head with a bottle of Worcestershire sauce, then grabbed a fire extinguisher and hit him on the head and face.

Rapid Sequence Airway Instead of Rapid Sequence Intubation

From Resuscitation:

Rapid sequence airway (RSA) utilizes rapid sequence intubation (RSI) pharmacology followed by the placement of an extraglottic airway without direct laryngoscopy.

Study objective

To evaluate the difference in time to airway placement and lowest oxygen saturations in a simulated trauma patient using RSI or RSA with a Laryngeal Mask Airway—Supreme (LMAS).

Methods

This randomized, prospective, non-blinded, IRB-approved observational study used a SimMan® human simulator in an ambulance. FC were randomly assigned to initially manage the patient with RSI or RSA. They then completed the same scenario with the other modality to serve as their own control. Trained assistants performed directed tasks. SimMan® had an initial grade III view and desaturated along a standardized curve until intubation, LMAS, or bag-valve-mask ventilation (BVMV) was initiated. When BVMV was used, oxygen saturation increased along a standardized curve. The simulator’s airway converted to a grade II view after the first attempt if difficult airway maneuvers were applied. Time, oxygen saturation, number of attempts and back-up airway placement were recorded.

Results

Nineteen FC completed both paired modalities. Paired T-test was used for statistical analysis. Average time to secure the airway was 145s shorter in the RSA group (95% CI: 100.4–189.7). Lowest oxygen saturation was 4.8% higher (95% CI: 2.8–6.8) in the RSA group. During RSI, FC placed a back-up airway 47% of the time.

Conclusion

In a simulated moderately difficult trauma airway managed by FC, RSA results in a significantly shorter time to secure the airway and less hypoxemia compared to RSI.

Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP)

From Critical Care Medicine:

Objectives: Prehospital triage of trauma patients is of paramount importance because adequate trauma center referral improves survival. We developed a simple score that is easy to calculate in the prehospital phase.

Design: Multicenter prospective observational study.

Setting: Prehospital physician-staffed emergency system in university and nonuniversity hospitals.

Interventions: We evaluated 1360 trauma patients receiving care from a prehospital mobile intensive care unit in 22 centers in France during 2002. The association of prehospital variables with in-hospital death was tested using logistic regression, and a simple score (the Mechanism, Glasgow coma scale, Age, and Arterial Pressure [MGAP] score) was created and compared with the triage Revised Trauma Score, Revised Trauma Score, and Trauma Related Injury Severity Score. The model was validated in 1003 patients from 2003 through 2005.

Measurements and Main Results: Four independent variables were identified, and each was assigned a number of points proportional to its regression coefficient to provide the MGAP score: Glasgow Coma Scale (from 3–15 points), blunt trauma (4 points), systolic arterial blood pressure (>120 mm Hg: 5 points, 60 to 120 mm Hg: 3 points), and age <60 yrs (5 points). The area under the receiver operating characteristic curve of MGAP was not significantly different from that of the triage Revised Trauma Score or Revised Trauma Score, but when sensitivity was fixed >0.95 (undertriage of 0.05), the MGAP score was more specific and accurate than triage Revised Trauma Score and Revised Trauma Score, approaching those of Trauma Related Injury Severity Score. We defined three risk groups: low (23–29 points), intermediate (18–22 points), and high risk (<18 points). In the derivation cohort, the mortality was 2.8%, 15%, and 48%, respectively. Comparable characteristics of the MGAP score were observed in the validation cohort.

Conclusion: The MGAP score can accurately predict in-hospital death in trauma patients.

The Benefit of Prehospital Ischemic Preconditioning in STEMI

From MedPage Today:

Heart attack patients who had an ordinary blood-pressure cuff applied to their arms by paramedics suffered significantly less damage to their heart muscles in a randomized trial than heart attack victims who received standard care.

The finding, reported in the Feb. 27 issue of The Lancet, could represent a payoff from 25 years of research into a phenomenon called ischemic preconditioning.

Some of this research has shown that brief ischemia in one part of the body can provide protection elsewhere, dubbed remote ischemic preconditioning.

Clinically, squeezing patients’ arms enough to create distal ischemia has been found to help reduce cardiac damage resulting from surgery and angioplasty, during which blood flow to the heart may be stopped for long periods.