Medical Specialties Commons^™

Alliance For Innovation On Maternal Health: Consensus Bundle On Sepsis In Obstetric Care., Melissa E Bauer, Catherine Albright, Malavika Prabhu, R Phillips Heine, Chelsea Lennox, Christie Allen, Carol Burke, April Chavez, Brenna L Hughes, Susan Kendig, Maile Le Boeuf, Elliott Main, Tiffany Messerall, Luis D Pacheco, Laura Riley, Rachel Solnick, Andrew Youmans, Ronald Gibbs

Women’s Health Articles

Sepsis in obstetric care is one of the leading causes of maternal death in the United States, with Black, Asian/Pacific Islander, and American Indian/Alaska Native obstetric patients experiencing sepsis at disproportionately higher rates. State maternal mortality review committees have determined that deaths are preventable much of the time and are caused by delays in recognition, treatment, and escalation of care. The "Sepsis in Obstetric Care" patient safety bundle provides guidance for health care teams to develop coordinated, multidisciplinary care for pregnant and postpartum people by preventing infection and recognizing and treating infection early to prevent progression to sepsis. This is …

Monitoring, Prophylaxis, And Treatment Of Infections In Patients With Mm Receiving Bispecific Antibody Therapy: Consensus Recommendations From An Expert Panel., Noopur Raje, Kenneth Anderson, Hermann Einsele, Yvonne Efebera, Francesca Gay, Sarah P Hammond, Alexander M Lesokhin, Sagar Lonial, Heinz Ludwig, Philippe Moreau, Krina Patel, Karthik Ramasamy, Maria-Victoria Mateos

Oncology Articles

Bispecific antibodies (BsAbs) are emerging as an important novel class of immunotherapeutic agents for the treatment of multiple myeloma (MM), and are set to be more widely used in clinical practice. However, this new class of therapies is associated with a distinct adverse event (AE) profile that includes cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome, as well as AEs leading to increased infection risk such as cytopenias and hypogammaglobulinemia, and infections themselves. As preliminary data with this class of agents shows an increased risk of infections as compared with conventional MM treatment regimens, such as immunomodulatory drugs, proteasome …

Association Of Amnioinfusion Volume At The Time Of Surgery For Twin-Twin Transfusion Syndrome And Latency To Delivery., Braxton Forde, Foong-Yen Lim, David N Mckinney, Mounira Habli, Kara B Markham, Mallory Hoffman, Sammy Tabbah, Marc Oria, Jose L Peiro

Women’s Health Articles

OBJECTIVE: To evaluate the impact of amnioinfusion and other peri-operative factors on pregnancy outcomes in the setting of Twin-twin transfusion syndrome (TTTS) treated via fetoscopic laser photocoagulation (FLP).

METHODS: Retrospective study of TTTS treated via FLP from 2010 to 2019. Pregnancies were grouped by amnioinfusion volume during FLP (< 1 L vs. ≥1 L). The primary outcome was latency from surgery to delivery. An amnioinfusion statistic (AIstat) was created for each surgery based on the volume of fluid infused and removed and the preoperative deepest vertical pocket. Regression analysis was planned to assess the association of AIstat with latency.

RESULTS: Patients with amnioinfusion of ≥1 L at the time of FLP had decreased latency from surgery to delivery (61 ± 29.4 vs. 73 ± 28.8 days with amnioinfusion < 1 L, p < 0.001) and increased preterm prelabor rupture of membranes (PPROM) < 34 weeks (44.7% vs. 33.5%, p = 0.042). Amnioinfusion ≥1 L was associated with an increased risk of delivery < 32 weeks (aRR 2.6, 95% CI 1.5-4.5), 30 weeks (aRR 2.4, 95% CI 1.5-3.8), and 28 weeks (aRR 1.9, 95% CI 1.1-2.3). Cox-proportional regression revealed that AIstat was inversely associated with latency (HR 1.1, 95% CI 1.1-1.2).

CONCLUSION: Amnioinfusion ≥1 L during FLP was associated with decreased latency after surgery and increased PPROM < 34 weeks.

Assessing Patients With Altered Level Of Consciousness., Michelle Hill, Melissa Moreda, Jacqueline Navarro, Malissa Mulkey

Nursing Articles

Patients with alterations in level of consciousness are among the most difficult to assess, so knowledge of how to assess these patients is important for tracking trends and identifying changes. This article discusses methods used to assess patients admitted with an altered level of consciousness and describes the neurological assessment of and potential causes for altered level of consciousness. Identifying and understanding certain examination findings enable faster recognition and intervention for life-threatening neurological events, directly impacting outcomes for neurologically compromised individuals.

Two Thymomas Of Different Histological Subtypes Arising In A Giant Thymolipoma: Case Report And Review Of The Literature., Vincent C Daniel, Konstantin Shilo

Surgery Articles

Thymolipoma is a rare benign tumor of the anterior mediastinum. Only a few reports describing thymoma arising within a thymolipoma have been documented in the literature. We report herein a detailed description of thymolipoma giving rise to 2 thymomas of different histological subtypes. A 74-year-old male with history of metastatic papillary thyroid carcinoma gradually developed 2 soft tissue nodules within a large right hemithorax fatty mass that was present for the past 20 years. Computed tomography (CT)-guided needle biopsy revealed one of the soft tissue nodules to be a thymoma, and the entire mass was surgically resected. Final pathological examination …

A Case Report Of Acute Appendicitis Complicated By Pylephlebitis: Medical And Surgical Management., Krishna Patel, Jaya Sai Varre, Nate Williams, Oscar Ruiz

Surgery Articles

Pylephlebitis is a suppurative thrombus of the portal vein and/or its branches secondary to an intra-abdominal infection. Acute appendicitis is the most common cause of emergency operation in general surgery and is typically treated with antibiotics and timely appendectomy with minimal adverse outcomes (Ferris M, Quan S, Kaplan BS, et al. The global incidence of appendicitis: a systematic review of population-based studies.

Titratable Partial Aortic Occlusion: Extending Zone I Endovascular Occlusion Times., David Gomez, Asad Naveed, Joao Rezende, Bradley M Dennis, Rishi Kundi, Elizabeth Benjamin, Ryan Lawless, Jonathan Nguyen, Juan Duchesne, Chance Spalding, Stephanie Doris, Candice Van Skike, Ernest E Moore, Andrew Beckett

Trauma and Acute Care Articles

BACKGROUND: Extending the time to definitive hemorrhage control in noncompressible torso hemorrhage (NCTH) is of particular importance in the battlefield where transfer times are prolonged and NCTH remains the leading cause of death. While resuscitative endovascular balloon occlusion of the aorta is widely practiced as an initial adjunct for the management of NCTH, concerns for ischemic complications after 30 minutes of compete aortic occlusion deters many from zone 1 deployment. We hypothesize that extended zone 1 occlusion times will be enabled by novel purpose-built devices that allow for titratable partial aortic occlusion.

METHODS: This is a cross-sectional analysis describing pREBOA-PRO …

Recent Advances In Image-Guided Locoregional Therapies For Primary Liver Tumors., Cody R Criss, Mina S Makary

Oncology Articles

Primary liver cancer is the leading cause of cancer-related deaths worldwide. with incidences predicted to rise over the next several decades. Locoregional therapies, such as radiofrequency or microwave ablation, are described as image-guided percutaneous procedures, which offer either a curative intent for early-stage hepatocellular carcinoma or bridging/downstaging for surgical resection or transplantation. Catheter-driven locoregional therapies, such as transarterial chemoembolization and radioembolization, induce tumor hypoxia, can be palliative, and improve survival for early-to-intermediate hepatocellular carcinoma and unresectable intrahepatic cholangiocarcinoma. Herein, we provide a comprehensive overview of the antineoplastic mechanisms underpinning locoregional therapies, different treatment approaches, and the current state of the …

Dupilumab-Induced Pancreatitis., Vivek V Jasti, Sean T Mccarthy, Shail M Govani

Ambulatory and Primary Care Articles

Drug-induced pancreatitis (DIP) is a rare cause of pancreatitis with an extensive and growing list of offending medications. Drawing a causative relationship between a medication and pancreatitis can be challenging, requiring a thorough workup to exclude other potential etiologies. By using scoring systems to identify DIP, we have identified another case of suspected DIP. In this study, we present a case of pancreatitis 10 days after initiation of dupilumab. An evaluation for other causes was unrevealing. As dupilumab use increases, providers should be aware of this possible adverse effect.

Delphi Consensus On Reporting Standards In Clinical Studies For Endovascular Treatment Of Acute Iliofemoral Venous Thrombosis And Chronic Iliofemoral Venous Obstruction., Suresh Vedantham, Peter Gloviczki, Teresa L Carman, Sandra Zelman Lewis, Peter A Schneider, Saher S Sabri, Raghu Kolluri

Heart and Vascular Articles

Acute iliofemoral deep vein thrombosis and chronic iliofemoral venous obstruction cause substantial patient harm and are increasingly managed with endovascular venous interventions, including percutaneous mechanical thrombectomy and stent placement. However, studies of these treatment elements have not been designed and reported with sufficient rigor to support confident conclusions about their clinical utility. In this project, the Trustworthy consensus-based statement approach was utilized to develop, via a structured process, consensus-based statements to guide future investigators of venous interventions. Thirty statements were drafted to encompass major topics relevant to venous study description and design, safety outcome assessment, efficacy outcome assessment, and topics …

View-Vlu Observational Study Of The Effect Of Varithena On Wound Healing In The Treatment Of Venous Leg Ulcers., Michael Y Shao, Stuart Harlin, Beverly Chan, Kathylee Santangelo, Eri Fukaya, Julianne Stoughton, Raghu Kolluri

Heart and Vascular Articles

OBJECTIVE: Chronic venous hypertension, triggered by venous reflux and/or obstruction, leads to skin changes and venous leg ulcers (VLUs). Compression therapy is the standard of care, but many wounds remain unhealed. The objectives of this study were to observe the effects of endovenous chemical ablation with commercially available 1% polidocanol injectable microfoam on VLU healing and recurrence rates.

METHODS: The VIEW VLU study was a multicenter, open-label, phase IV registry of patients with active VLUs resulting from venous insufficiency of the great saphenous vein and/or anterior accessory saphenous vein systems who underwent ablation with 1% polidocanol microfoam. Primary outcomes included …

Primary Retrograde Tibiotalocalcaneal Nailing In An Elderly Osteoporotic Patient With Ankle Fracture: A Case Report., Nolan P Schmitz, Daniel R Gaines, Jignesh N Patel

Surgery Articles

INTRODUCTION: Ankle fractures are a common orthopedic injury traditionally treated with open reduction and internal fixation or conservative management. One complication introduced with open reduction and internal fixation is the requirement for non or partial weight bearing in the post-operative period. This requirement poses a unique challenge for patients who may not comply with these weight-bearing restrictions. This case is the first known article that specifically illustrates the validity and effectiveness of retrograde tibiotalocalcaneal (TTC) nailing for patients who are unlikely to follow weight-bearing restrictions.

CASE REPORT: An 83-year-old Caucasian female with idiopathic mild mental retardation and Alzheimer's presented with …

Comparative Analysis Between Operative And Non-Operative Acetabular Labral Tear Injuries In Division 1 Collegiate Athletes., Scott S Hyland, Andres D Maeso, Mark Rogers, Mike Goforth, P Gunnar Brolinson

Ambulatory and Primary Care Articles

Acetabular labral tears have shown to be difficult to diagnose and manage in an active and competitive athletic population. The goal of this study was to compare NCAA Division 1 collegiate athletes undergoing operative and non-operative management of their labral injuries by assessing ability to return to competition and secondarily evaluate days lost from sport. A retrospective cohort analysis was conducted on Division 1 collegiate athletes from 2005 to 2020, incorporating all varsity university sports. Records showing MRI confirmed diagnosis were included in the cohort, as well as all pertinent clinical data. Data revealed 10/18 (55%) of individuals managed conservatively …

Long-Term Outcomes Of Dual Vs Single Her2-Directed Neoadjuvant Therapy In Nsabp B-41., Priya Rastogi, Gong Tang, Saima Hassan, Charles E Geyer, Catherine A Azar, Gustav C Magrinat, J Marie Suga, Harry D Bear, Luis Baez-Diaz, Shakir Sarwar, Jean-Francois Boileau, Adam M Brufsky, Henry R Shibata, Hanna Bandos, Soonmyung Paik, Greg Yothers, Sandra M Swain, Eleftherios P Mamounas, Norman Wolmark

Oncology Articles

BACKGROUND: The primary aim of this randomized neoadjuvant trial in operable, HER2-positive breast cancer, was to determine the efficacy on pathologic complete response (pCR) of substituting lapatinib (L) for trastuzumab (T) or adding L to T, in combination with weekly paclitaxel (WP) following AC. Results on pCR were previously reported. Here, we report data on planned secondary endpoints, recurrence-free interval (RFI) post-surgery, and overall survival (OS).

METHODS: All patients received standard AC q3 weeks × 4 cycles followed by WP (80 mg/m

RESULTS: RFI at 4.5 years was 87.2%, 79.4% (p = 0.34; HR = 1.37; 95% CI 0.80, 2.34), …

Effects Of Atrioventricular Optimization On Left Ventricular Reverse Remodeling With Cardiac Resynchronization Therapy: Results Of The Smart-Crt Trial., Michael R Gold, Kenneth A Ellenbogen, Christophe Leclercq, Jonathan Lowy, Seth J Rials, Morio Shoda, Gery Tomassoni, Ziad Issa, Jean-Francois Sarrazin, John M Jennings, Devi G Nair, Nicholas Wold, Patrick Yong, Michelle M Harbin, Kenneth M Stein, Angelo Auricchio

Heart and Vascular Articles

BACKGROUND: The role of atrioventricular optimization (AVO) to improve cardiac resynchronization therapy outcomes remains controversial. Previous post hoc analyses of a multicenter trial showed that measures of electrical dyssynchrony (right ventricular-left ventricular [LV] or LV electrical delay durations) are associated with patients who benefit from AVO.

METHODS: This was a global, multicenter, prospective, randomized trial of de novo cardiac resynchronization therapy implant patients with an right ventricular-LV duration ≥70 ms to determine whether AVO results in greater reverse remodeling. Patients were randomized 1:1 for either an AVO algorithm (SmartDelay) that determines atrioventricular delay and pacing chamber, biventricular or LV only, …

Case Report: Large Left Ventricular Aneurysm With Contained Rupture And Haemopericardium., Aimee Willett, Zachary Glenn, Madison Rose-Malkamäki, Arash Arshi

Heart and Vascular Articles

BACKGROUND: Recent advancements in cardiology have significantly decreased the incidence of post-myocardial infarction mechanical complications. When these sequelae occur, they can have high morbidity and mortality and may require aggressive intervention.

CASE SUMMARY: We describe a case of contained rupture of a large left ventricular aneurysm (LVA) presenting with syncope in a 60-year-old male with late presentation myocardial infarction (MI) 6 weeks prior on home triple antithrombotic therapy (TAT). Urgent pericardiocentesis along with imaging techniques including ultrasound, computed tomography angiography (CTA), and cardiac magnetic resonance imaging (MRI) were used for initial diagnosis. Definitive treatment was achieved with excision and repair …

Ensuring Adequate Power: The Importance Of Statistically Significant Results In Osteopathic Research., Amanda Disabato

Medical Education Articles

No abstract provided.

Adult Female With A Painful And Pruritic Lower Extremity Skin Lesion., Chase Silvers, Christopher Lloyd

Ambulatory and Primary Care Articles

No abstract provided.

Cutaneous Graft-Versus-Host Disease Within Chronic Photodamaged Skin: A Case Series Demonstrating Role For Topical 5-Fluorouracil., Ashley N Gray, Christina Avila, Catherine G Chung, Lucia Seminario-Vidal, Alice Mims, Brittany Dulmage, Karilyn Larkin, Hannah Choe, Samantha Jaglowski, Sumithira Vasu, Benjamin H Kaffenberger

Ambulatory and Primary Care Articles

No abstract provided.

Go With The Flow: An Experimental Analysis With Tubing Alternative With Irrigation., Scott S Hyland, Daniel T Degenova, Joseph P Scheschuk, Benjamin C Taylor

Trauma and Acute Care Articles

BACKGROUND AND AIMS: Literature regarding alternative tubing for fluid delivery in irrigation and debridement procedures is lacking. The purpose of this study was to compare three different apparatuses with varying quantities of irrigation fluid to assess efficiency of administration and evaluate overall time for fluid administration.

METHODS: This model was designed to compare available methods of gravity irrigation used in practice. Fluid flow time was measured for three types of tubing: single-lumen cystoscopy tubing, Y-type double-lumen cystoscopy tubing, and nonconductive suction tubing. Irrigation times were assessed for varying volumes of 3, 6, and 9 L to investigate the relationship between …

Pacing After Tavr: Just Give Me The Beat, But Improve The Instruments., Steven J Yakubov, Anish Amin

Heart and Vascular Articles

No abstract provided.

3-Year Outcomes After Transcatheter Or Surgical Aortic Valve Replacement In Low-Risk Patients With Aortic Stenosis., John K Forrest, G Michael Deeb, Steven J Yakubov, Hemal Gada, Mubashir A Mumtaz, Basel Ramlawi, Tanvir Bajwa, Paul S Teirstein, Michael Defrain, Murali Muppala, Bruce J Rutkin, Atul Chawla, Bart Jenson, Stanley J Chetcuti, Robert C Stoler, Marie-France Poulin, Kamal Khabbaz, Melissa Levack, Kashish Goel, Didier Tchétché, Ka Yan Lam, Pim A L Tonino, Saki Ito, Jae K Oh, Jian Huang, Jeffrey J Popma, Neal Kleiman, Michael J Reardon

Heart and Vascular Articles

BACKGROUND: Randomized data comparing outcomes of transcatheter aortic valve replacement (TAVR) with surgery in low-surgical risk patients at time points beyond 2 years is limited. This presents an unknown for physicians striving to educate patients as part of a shared decision-making process.

OBJECTIVES: The authors evaluated 3-year clinical and echocardiographic outcomes from the Evolut Low Risk trial.

METHODS: Low-risk patients were randomized to TAVR with a self-expanding, supra-annular valve or surgery. The primary endpoint of all-cause mortality or disabling stroke and several secondary endpoints were assessed at 3 years.

RESULTS: There were 1,414 attempted implantations (730 TAVR; 684 surgery). Patients …

Outcomes Of The "Brca Quality Improvement Dissemination Program": An Initiative To Improve Patient Receipt Of Cancer Genetics Services At Five Health Systems., Erica M Bednar, Minxing Chen, Michael T Walsh, Amanda L Eppolito, Molly H Klein, Kelly Teed, Brittany Hodge, Jordan Hunter, Han Gill Chao, Dillon Davis, Wilshauna Serchion, Cara Yobbi, Rebekah Krukenberg, Sandra B Jenkinson, Jennifer J Moore, Cassandra Garcia, Fatimaeliza Gonzalez, Towanna Murray, Linda D Nielsen, Brenda Ho, Megan Haas, Sarah B Greenzweig, Abby Anderson, Christina Johnson, Nichole A Morman, Elizabeth Bowdish, Emaline Wise, Julia N Cooper, Pauline Kefalas Russ, Katelyn Tondo-Steele, Buonarotti F De Gracia, Brooke Levin, Kristin Mattie, Kathryn Zarnawski, Molly Kalasinski, Jennifer Stone, Caitlin O'Brien, Alexa Bream, Aidan M Kennedy, Rachel A Paul, Michelle Bilbao, Maureen Romero, Rebecca L Carr, Jennifer M Siettmann, Anna K Vercruyssen, Kaycee Leon, Banu K Arun, Andrew V Grainger, David P Warshal, Erin Bowman, Timothy A Goedde, Deepa Halaharvi, Kellie Rath, Generosa Grana, Lida Mina, Karen H Lu

Oncology Articles

OBJECTIVE: A quality improvement initiative (QII) was conducted with five community-based health systems' oncology care centers (sites A-E). The QII aimed to increase referrals, genetic counseling (GC), and germline genetic testing (GT) for patients with ovarian cancer (OC) and triple-negative breast cancer (TNBC).

METHODS: QII activities occurred at sites over several years, all concluding by December 2020. Medical records of patients with OC and TNBC were reviewed, and rates of referral, GC, and GT of patients diagnosed during the 2 years before the QII were compared to those diagnosed during the QII. Outcomes were analyzed using descriptive statistics, two-sample t-test, …

Factors Associated With No-Show To Ambulatory Tele-Video Neurology Visits., Aashrai Sai Venkat Gudlavalleti, John O Elliott, Rafah Asadi

Neuroscience Articles

Introduction Telehealth visits (TH) have become an important pillar of healthcare delivery during the COVID pandemic. No-shows (NS) may result in delays in clinical care and in lost revenue. Understanding the factors associated with NS may help providers take measures to decrease the frequency and impact of NS in their clinics. We aim to study the demographic and clinical diagnoses associated with NS to ambulatory telehealth neurology visits. Methods We conducted a retrospective chart review of all telehealth video visits (THV) in our healthcare system from 1/1/2021 to 5/1/2021 (cross-sectional study). All patients at or above 18 years of age …

Nursing Perspectives On The Use Of Continuous Glucose Monitoring In The Intensive Care Unit., Eileen R Faulds, Kathleen M Dungan, Molly Mcnett, Laureen Jones, Norma Poindexter, Matthew Exline, Jillian Pattison, Francisco J Pasquel

Nursing Articles

BACKGROUND: The COVID-19 pandemic necessitated rapid implementation of continuous glucose monitoring (CGM) in the intensive care unit (ICU). Although rarely reported, perceptions from nursing staff who used the systems are critical for successful implementation and future expanded use of CGM in the inpatient setting.

METHODS: A 22-item survey focused on CGM use was distributed to ICU nurses at two large academic medical centers in the United States in 2022. Both institutions initiated inpatient CGM in the spring of 2020 using the same CGM+point of care (POC) hybrid protocol. The survey employed a 1- to 5-point Likert scale regarding CGM sensor …

Optimized 18f-Fdg Pet-Ct Method To Improve Accuracy Of Diagnosis Of Metastatic Cancer., Richard Black, Jelle Barentsz, David Howell, David G Bostwick, Stephen B Strum

Oncology Articles

The diagnosis of cancer by FDG PET-CT is often inaccurate owing to subjectivity of interpretation. We compared the accuracy of a novel normalized (standardized) method of interpretation with conventional non-normalized SUV. Patients (

Outcomes Associated With Allogeneic Hematopoietic Stem Cell Transplantation For Relapsed And Refractory Hodgkin Lymphoma In The Era Of Novel Agents., Muhammad Salman Faisal, Walter Hanel, Timothy Voorhees, Rui Li, Ying Huang, Abdullah Khan, David Bond, Yazeed Sawalha, John Reneau, Lapo Alinari, Robert Baiocchi, Beth Christian, Kami Maddocks, Yvonne Efebera, Sam Penza, Ayman Saad, Jonathan Brammer, Marcos Delima, Samantha Jaglowski, Narendranath Epperla

Oncology Articles

BACKGROUND: Relapsed or refractory Hodgkin lymphoma (R/R HL) is a challenging disease with limited treatment options beyond brentuximab vedotin and checkpoint inhibitors. Herein we present the time-trend analysis of R/R HL patients who received allogeneic hematopoietic cell transplantation (allo-HCT) at our center from 2001-2017.

METHODS: The patients were divided into two distinct treatment cohorts: era1 (2001-2010), and era2 (2011-2017). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), non-relapse mortality (NRM), and cumulative incidence of acute and chronic graft versus host disease (GVHD).

RESULTS: Among the 51 patients included in the study, 29 were in era1, …

Educational Curriculum For Peripheral Nerve Stimulation Developed By The North American Neuromodulation Society., Hemant Kalia, Alaa Abd-Elsayed, Mark Malinowski, Adam Burkey, Rany T Abdallah, Eellan Sivanesan, Tariq Malik, Reda Tolba, Yashar Eshraghi, Kris Ferguson, Maricela Schnur, Ahmed Raslan, Maged Guirguis, Marc Russo, Konstantin V Slavin

Neuroscience Articles

BACKGROUND: Peripheral nerve stimulation (PNS) is an effective neuromodulation therapy for chronic neuropathic and nociceptive pain. Although the total number of PNS implantations has increased over the last decade, no curriculum exists to guide training and learning of this therapy. The goal of the North American Neuromodulation Society (NANS) education committee is to develop a series of competency-based curriculums for neuromodulation therapies. The PNS curriculum is the latest part of such series, following the curriculums for spinal cord stimulation and intrathecal drug delivery system.

MATERIALS AND METHODS: A multidisciplinary task force (anesthesiology, physical medicine and rehabilitation, neurosurgery, preventive medicine and …

Prehospital Shock Index Predicts Outcomes After Prolonged Transport: A Multicenter Rural Study., James M Bardes, Bradley S Price, Hannah Bailey, Alexander Quinn, Zachary D Warriner, Andrew C Bernard, Aimee Lariccia, M Chance Spalding, Melissa B Linskey Dougherty, Scott B Armen, Alison Wilson

Trauma and Acute Care Articles

BACKGROUND: Shock index (SI) predicts outcomes after trauma. Prior single-center work demonstrated that emergency medical services (EMSs) initial SI was the most accurate predictor of hospital outcomes in a rural environment. This study aimed to evaluate the predictive ability of SI in multiple rural trauma systems with prolonged transport times to a definitive care facility.

METHODS: This retrospective review was performed at four American College of Surgeons-verified level 1 trauma centers with large rural catchment basins. Adult trauma patients who were transferred and arrived >60 minutes from scene during 2018 were included. Patients who sustained blunt chest or abdominal trauma …

Recognizing Ethyl Chloride Neurotoxicity: Inhalant Abuse Hidden In Plain Sight., Robert Young, Cody Carter, Serge Cardinali, Zeryab Khan, Katelyn Bennett, Amy Jarosz, Jeffery Sobecki, Rupali Sharma, Ryan Martin

Ambulatory and Primary Care Articles

Ethyl chloride is a common topical anesthetic. However, when abused as an inhalant, effects can range from headaches and dizziness to debilitating neurotoxicity requiring intubation. While previous case reports describe the short-term reversible neurotoxicity of ethyl chloride, ours show chronic morbidity and mortality outcome. During the initial evaluation, it is essential to consider the rising trend of commercially available inhalants being used as recreational drugs. We present a case of a middle-aged man presenting with subacute neurotoxicity due to repeated abuse of ethyl chloride.