Succinate (SI) is a citric acid cycle metabolite that accumulates in tissues during hemorrhagic shock (HS) due to electron transport chain uncoupling. Dimethyl malonate (DMM) is a competitive inhibitor of SI dehydrogenase, which has been shown to reduce SI accumulation and protect against reperfusion injury. Whether DMM can be therapeutic after severe HS is unknown. We hypothesized that DMM would prevent SI buildup during resuscitation (RES) in a swine model of HS, leading to better physiological recovery after RES. The carotid arteries of Yorkshire pigs were cannulated with a 5-Fr catheter. After placement of a Swan-Ganz catheter and femoral arterial line, the carotid catheters were opened and the animals were exsanguinated to a mean arterial pressure (MAP) of 45 mm. After 30 minutes in the shock state, the animals were resuscitated to a MAP of 60 mm using lactated ringers. A MAP above 60 mm was maintained throughout RES. One group received 10 mg/kg of DMM (n = 6), while the control received sham injections (n = 6). The primary end-point was SI levels. Secondary end-points included cardiac function and lactate. Succinate levels increased from baseline to the 20-minute RES point in control, while the DMM cohort remained unchanged. The DMM group required less intravenous fluid to maintain a MAP above 60 (450.0 vs. 229.0 mL; p = 0.01). The DMM group had higher pulmonary capillary wedge pressure at the 20-minute and 40-minute RES points. The DMM group had better recovery of cardiac output and index during RES, while the control had no improvement. While lactate levels were similar, DMM may lead to increased ionized calcium levels. Dimethyl malonate slows SI accumulation during HS and helps preserve cardiac filling pressures and function during RES. In addition, DMM may protect against depletion of ionized calcium. Dimethyl malonate may have therapeutic potential during HS.

Цель работы — оценка эффективности симуляционных технологий в процессе формирования и поддержания у клинических ординаторов и аспирантов практических навыков сердечно-легочной реанимации и компетенций оказания неотложной помощи. Был проведен проспективный анализ обучения и усвоения теоретических знаний и практических навыков по проведению сердечно-легочной реанимации клиническими ординаторами и аспирантами. Установлено, что симуляционные формы обучения с использованием современных манекенов способствуют быстрому, эффективному и безопасному формированию у слушателей курса как технических, так и нетехнических навыков оказания неотложной помощи.

Whether and when to perform coronary angiography in patients successfully resuscitated from out-of-hospital cardiac arrest remain controversial. The

Nurses felt powerless to challenge resuscitation notices

Chest compression efficiency for three methods of single-person rescuer infant cardiopulmonary resuscitation

Objective: To establish a predictive model for acute respiratory distress syndrome (ARDS) in critical burn patients with the screened independent risk factors, and to validate its predictive value. Methods: Totally 131 critical burn patients (101 males and 30 females, aged 18-84 years) who met the inclusion criteria were admitted to the Department of Burns of the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2018 to December 2019. A retrospective case-control study was conducted. The patients were divided into ARDS group (54 cases) and non-ARDS group (77 cases) according to whether ARDS occurred or not. The statistics of patients in the two groups were recorded including the gender, age, burn index, combination of inhalation injury, smoking history, delayed resuscitation, indwelling nasogastric tube, and complication of sepsis, and the data were statistically analyzed with independent sample t test, chi-square test, and Fisher's exact probability test. The multivariate logistic regression analysis was performed on the indicators with statistically significant differences between the two groups to screen the independent risk factors for developing ARDS in critical burn patients, and the corresponding nomograph prediction model for the risk of ARDS in critical burn patients was established. The risk scores for patients developing ARDS were therefore obtained based on the above-mentioned nomograph, and the corresponding receiver operating characteristic (ROC) curve was drawn to calculate the area under the curve. The internal validation of the above-mentioned ARDS prediction model was performed using the Bootstrap method, and the area under the ROC curve was calculated for modeling group (79 cases) and validation group (52 cases), respectively. A calibration curve was drawn to assess the predictive conformity of the above-mentioned ARDS prediction model for the occurrence of ARDS in critical burn patients. Results: The burn index, proportion of combination of inhalation injury, and proportion of complication of sepsis of patients were significantly higher in ARDS group than in non-ARDS group (t=0.36, χ2=33.78, 49.92, P<0.01). The gender, age, smoking history, delayed resuscitation, and indwelling nasogastric tube of patients in ARDS group were close to those in non-ARDS group (P>0.05). The multivariate logistic regression analysis showed that the burn index, combination of inhalation injury, and complication of sepsis were the independent risk factors for developing ARDS in critical burn patients (odds ratio=1.05, 15.33, 5.02, 95% confidence interval=1.01-1.10, 2.65-88.42, 1.28-19.71, P<0.05 or P<0.01). The overall area under the ROC curve of the above-mentioned ARDS prediction model was 0.92 (95% confidence interval=0.88-0.97), and the area under the ROC curve was 0.95 and 0.91 (95% confidence interval=0.90-1.00, 0.86-0.97) for validation group and modeling group, respectively. When applying the above-mentioned ARDS prediction model for ARDS incidence prediction, there might be some risk of overestimating ARDS incidence when the prediction probability was <35.0% or >85.0%, and some risk of underestimating ARDS incidence when the prediction probability was 35.0%-85.0%. Conclusions: The burn index, inhalation injury, and sepsis are the independent risk factors for the occurrence of ARDS in critical burn patients. The risk prediction model for ARDS based on these three indicators has good predictive ability for ARDS in critical burn patients.

Influences of hands-only cardiopulmonary resuscitation on lumbar muscle tone, stiffness, and fatigue in emergency medical technicians

Trauma is still one of the main causes of morbidity and mortality worldwide. Traumatic cardiac arrest (TCA) stands out among the causes of death of these patients. Multiple authors claim that, despite medical advances, resuscitation efforts in these patients may lead to poor outcomes, since those suffering from TCA have high mortality rates and poor neurological prognosis. This article compiles the available evidence, which despite being limited, points to recent advances in the management and approach of these patients. The aim of this review is to reach a consensus on the approach to patients in cardiac arrest in the context of trauma, based on the most recent literature and evidence.

A healthy full-term female neonate, aged 3 days and born by vaginal delivery (with a 1-minute Apgar score of 10 and a 5-minute Apgar score of 10), had unexpected cardiac and respiratory arrests in the early morning on day 3 after birth and recovered to spontaneous breathing and heartbeat after a 10-minute resuscitation. The child had poor response and convulsion after resuscitation. Blood gas analysis showed metabolic acidosis, and amplitude-integrated EEG showed a burst-suppression pattern. She was diagnosed with sudden unexpected postnatal collapse but improved after hypothermia and symptomatic/supportive treatment. This article reports the first case of sudden unexpected postnatal collapse in China and summarizes related risk factors, pathophysiological mechanisms, and preventive and treatment measures of this disorder.

Intra-abdominal infections(IAIs) are common surgical emergencies and complications, which usually need multidisciplinary management including surgeons, intensivists, infectious disease experts, microbiologists, and clinical pharmacists. Based on international and domestic guidelines and recent advances, a number of experts' statements of consensus, with a problem-oriented approach, were made on the cornerstones of effective treatment of IAIs such as early recognition, etiology identification, adequate source control, and appropriate antimicrobial therapy. Main recommendations include concepts of intra-abdominal infection, pathoqen diagnosis precautions; surgical intervention principles and strategies of specific causes including acute appendicitis, upper gastrointestinal perforation, lower gastrointestinal perforation, acute biliary infection, liver abscess, severe acute pancreatitis, pancreatic fistula, biliary fistula, anastomotic leakage, gastrointestinal perforation, as well as perforation due to endoscopic procedure etc.; principles of antimicrobial therapy, dosage of antibiotics in specific population and pathophysiological state; and systematic support of severe infection such as early resuscitation and nutrition support.

Early in the COVID-19 pandemic, experts debated about whether cardiopulmonary resuscitation (CPR) should be offered to critically ill patients with

Thirty-six puerperas who underwent emergency cesarean section at Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 24, 2020 to February 9, 2020, who all wore medical surgical masks, were retrospectively included in this study Anesthesia management was performed under tertiary medical protection measures A dedicated anesthesia equipment was separately sterilized Narcotic drugs were used for one patient only, and disposable medical supplies were used for anesthetic supplies Contact transmission should be avoided when a neonate required resuscitation, and early isolation and nucleic acid testing were provided for the neonates The rate of suspected cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 11% , and the rate of clinically diagnosed cases was 17% before surgery The rate of clinically diagnosed cases of SARS-CoV-2 was 22%, the rate of confirmed cases was 8%, and the total positive rate of diagnosis was 31% after surgery The rate of neuraxial anesthesia was 86%, the rate of general anesthesia was 14%, the time of spinal puncture was (15±7) min, the time of tracheal intubation under general anesthesia was (2 1±1 3) min, the operation time was (95±36) min, and blood loss was (276±166) ml The Apgar score of newborns was 8 8±0 5 There was 1 neonate whose mother was diagnosed as having coronavirus disease 2019 after operation, an oropharyngeal swab specimen was obtained at 36 h of birth, and the swab was tested positive for SARS-CoV-2 by nucleic acid testing As of February 10, 2020, an anesthesiologist involved in the operation was diagnosed to have infection by SARS-CoV-2 In conclusion, diagnosis of coronavirus disease 2019 during pregnancy is more difficult, it is necessary to perform anesthesia management for cesarean section under tertiary medical protection Although the difficulty in anesthesia operation is increased under tertiary medical protection, anesthesiologists can carry out standardized anesthesia management and guarantee the safety of maternal and infants and anesthesiologists themselves as long as they are rigorously trained and adhere to protective protocols © 2020 Chinese Medical Association

Current literature suggests that surgical complications from oocyte retrievals (ORs) are uncommon. Here, we present a rare case of bladder injury during OR and its subsequent management. A 37-year-old nulliparous woman underwent assisted reproductive therapy (ART) for primary infertility secondary to anovulatory cycle. During OR, there was an inadvertent puncture of the bladder, with active intra-bladder bleeding seen on transvaginal ultrasound. Bladder washout followed by continuous drainage was instituted with antibiotic coverage over several days. Bladder integrity ascertained through computer tomography urogram and cystoscopy were unremarkable. She was discharged well and continued with her fertility treatment. Transvaginal OR is associated with few complications. Bladder injury, albeit rare, can present with massive hematuria and hemodynamic instability. Early identification of the injury is key to management with insertion of the indwelling urinary catheter, hemodynamic resuscitation and bladder irrigation. With a urological multi-disciplinary approach, most bladder injuries can be resolved non-invasively. J Med Cases. 2021;12(3):102-106 doi: https://doi.org/10.14740/jmc3632

Drowning is a leading cause of accidental injury in children and has a great impact on family and society. The prevention and treatment of drowning is of great importance for reducing mortality rate. This consensus reviews the literature on the epidemiology, rescue, resuscitation, and acute clinical management and prevention of drowning. The panel determines the score of available evidence according to the criteria of Oxford Centre for Evidence-Based Medicine and then makes recommendations on evidence based on such criteria, so as to provide a basis for further reducing the mortality and disability rates caused by drowning.

Background Perforated duodenal ulcer (DU) is a dangerous and life-threatening condition, with associated high mortality, especially when there is releakage after initial repair with omental patch. There are multiple methods recommended by different studies for its management. These methods include cholecystoduodenoplasty, a jejunal serosal patch, triple-tube drainage, T-tube duodenostomy, and conservative methods. The aim of the study is to compare between triple-tube drainage and jejunal serosal patch as methods of management of releaked DU regarding the efficacy, failure, and mortality. Patients and methods This study included 20 patients presented with releaked perforated DU treated initially with pedicled omental patch technique. They were divided randomly into two groups: group A included 10 patients who were treated by triple-tube drainage and group B included 10 patients who were treated by jejuna serosal patch. Results The mean age of group A patients was 54 years, whereas for group B patients, it was 51 years. Most of the group A patients were males (80%) and also 90% of the group B patients were males. All patients (100%) of both groups were presented with manifestations of shock like hypotension and palpitation. The average length of hospital stay was 11 days (range, 8–15 days) for the group A patients and 13 days (range, 7–19 days) for group B patients. Conclusion Releaked perforated DU after initial omental patch repair is a life-threatening entity and needs urgent resuscitation and interference. There are several methods of its management, among them are triple-tube drainage and jejunal serosal patch. Both methods have nearly the same success, complications, and mortality rates.

Background: This study investigated the knowledge of and willingness to learn cardiopulmonary resuscitation among the Saudi Arabian general population.Methods: The authors randomly distributed 1,000 questionnaires to residents from Jeddah, Saudi Arabia which surveyed their knowledge, experiences, and attitudes toward cardiopulmonary resuscitation. The authors then performed descriptive statistics on the results of the questionnaire. The study was conducted from September 2019 to January 2020.Results: A total of 798 invitees responded. Of the respondents, 511 (64.0%) had previous knowledge about CPR, 283 (35.5%) were completely unaware of CPR, and 11 (1.3%) provided incomplete data. There were 118 (14.8%) participants who encountered a situation that required CPR, and 673 (84.2%) who never experienced a situation that required CPR. There were 684 (85.7%) respondents who were willing and had the desire to learn more about CPR, 42 (5.3%) were unwilling, and 2 (0.3%) considered CPR useless. Factors that influenced their opinion of CPR included: just for professionals 25 (3.1%), and limited time to learn CPR during everyday life 17 (2.1%). There were 489 (61.3%) who supported mandatory CPR training for all students, and 117 (14.7%) responded that CPR training should be reserved for specific professions, and 7 (1.1%) were not interested in training.Conclusions: Cardiopulmonary resuscitation training in Saudi Arabia is not publicized, and the general public knowledge of the life-saving attributes of CPR should be increased. Most respondents were aware of CPR and expressed a desire and willingness to learn CPR. Overall, there is a need for a CPR training campaign in our region.

INTRODUCTION: In early March 2020, COVID-19 spread in New York City This paper shows trends of rising cases of DKA associated with a worsening COVID-19 pandemic in New York City With the potential for such a large number of DKA patients, our institution found a need for revised glycemic management protocol We discuss how a multidisciplinary team designed a protocol to care for patients with COVID-19 infection and DKA METHODS: Five of The Mount Sinai Health System's EDs are on a shared electronic health record system (Epic Systems, Verona, WI) Deidentified visit data extracted for routine quality review was made available for analysis We looked at total visits and select visit diagnoses related to DKA through March, April and May 2019 and compared those counts to the same period in 2020 Our protocol was developed by stakeholders in a multidisciplinary hospital team We focused on the basic tenets of DKA management: insulin therapy, fluid resuscitation, and electrolyte repletion RESULTS: A total of 93,218 visits were recorded across the five EDs from March 1-May 31, 2019 During that period there were 106 diagnoses of DKA made in the EDs (0 114% of visits) Across the same period in 2020 there were 59,009 visits, and 214 diagnoses of DKA (0 363% of visits) This coincides with the height of the Sars-CoV-2 pandemic in New York City To address this surge, our protocol decreased the frequency of fingerstick monitoring, with changes to insulin dosing allowing admission to non-ICU beds We transitioned from a provider-driven protocol to a nurse-driven protocol to avoid treatment delays due to order placement Insulin infusion rate charts were created to provide nurses guidance on dosing modifications To minimize ARDS risk, our protocol's fluid replacement recommendations lowered resuscitation and replacement rate volumes, adjusting based on provider reassessment Lab values were monitored every 3-4 hours CONCLUSIONS: There is a correlation between the rise of the Sars-CoV-2 pandemic in New York City and a net rise in patients diagnosed with diabetic ketoacidosis We believe our DKA protocol will facilitate safe and effective management of patients with COVID-19 and DKA, reducing the healthcare burden associated with protocols that necessitate frequent treatment modifications and ICU-level care

INTRODUCTION: Lemierre syndrome is septic thrombophlebitis of internal jugular vein caused by oropharyngeal or head and neck infections The main causative organism is Fusobacterium necrophorum but rarely other organisms such as Staphylococcus aureus, E coli, streptococci, staphylococci, Klebsiella etc can cause the syndrome as well Members of the Streptococcus Anginosus group are rare causes of Lemierre syndrome with very few pediatric case reports in the literature METHODS: A previously healthy 15-year-old female presented with four days of fever, throat pain, abdominal pain and persistent vomiting and was admitted with septic shock requiring extensive fluid resuscitation and vasopressor support Initial labs included WBC 15 2 x 10 9/ L, CRP 34 9 mg/dL, ESR 78 mm/Hr Review of systems was negative for tampon use Rapid streptococcus probe test, respiratory viral panel, and SARS CoV-2 tests were all negative Clindamycin was added to empiric coverage with concern for toxic shock syndrome Within 24 hours of hospitalization, she developed ARDS requiring non-invasive positive pressure ventilation She continued to complain of worsening throat pain and headache CT scan of the neck revealed extensive thrombosis of the left internal jugular and initial blood culture grew Streptococcus constellatus, a member of the S Anginosus group Antibiotic coverage was switched to piperacillin-tazobactam to cover anaerobic organisms such as Fusobacterium as well as Streptococcus Anginosis Enoxaparin was started Lupus antibodies were transiently positive secondary to infection Following discharge, she received intravenous ceftriaxone via PICC line and oral metronidazole for 3 weeks and then oral levofloxacin and metronidazole for 2 weeks She was followed up regularly to assure clearance of septic thrombi from internal jugular vein after 6 weeks of antithrombotic therapy RESULTS: Lemierre syndrome should be considered a diagnosis for an adolescent with throat pain presenting with shock

Cesar, Regina Grigolli; de Souza, Nelio; Laporte, Roberta Machado Rissoni; AndreÍ£o, Marjorie Dias; de Mendonͧa Neto, Pedro Teles; Amorim, Fernanda; Migliori, Leilane; de Oliveira, Rafael Garcia; Alves, Ariane Emy Rodrigues; Homem, Matheus Fischer Severo Cruz; Badia, Marcelo Matheus; Palissari, TaÍ s Fernanda; Somaili, Ibrahim Yahia El; Coutinho, Bianca; Fonseca, Thais Suelotto Machado; de Abreu Neto, Manoel Jacinto; Gazolli, Jorgiani Andrade; de Carvalho, Cid Eduardo; Adda, Adriana Della Author Information

Byline Backstory No. 11: Something Old, Something New—Antiques and Resuscitations Bond a Future Curator’s Family with the Muse of Anaesthesia