J Emerg Med
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Hypertonic saline (HTS) and mannitol are frequently utilized in the emergency department (ED) to manage elevations in intracranial pressure (ICP). ⋯ There were no incidences of extravasation among patients given 3% HTS or mannitol. Clinicians should reconsider recommendations to restrict HTS or mannitol to central lines.
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Acute compartment syndrome (ACS) is a time-sensitive surgical emergency caused by increased pressure within a closed compartment. ACS can lead to significant morbidity and mortality if it is not rapidly identified and treated. ⋯ ACS is a dangerous medical condition requiring rapid diagnosis and management that can result in significant complications if not appropriately diagnosed and treated. Emergency clinician awareness and knowledge of this condition is vital to appropriate management.
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Randomized Controlled Trial
The Impact of Head of Bed Elevation on Optic Nerve Sheath Diameter in Cervical Collar Applied Healthy Volunteers.
Guidelines recommend placing a cervical collar (c-collar) until spinal injury is excluded. Previous studies have shown that c-collar placement increases intracranial pressure (ICP), which can worsen outcomes for trauma patients who are at risk of increased ICP. Head of bed elevation (HBE) has been found to decrease ICP. However, there is no consensus in the literature for the optimal degree of HBE to decrease ICP. ⋯ Our results show that c-collar increases ONSD in healthy volunteers. Elevating the head of the bed 30 and 45° for 20 min decreased ONSD to baseline values.
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Point-of-care ultrasonography (POCUS) is increasingly used for both diagnostic and guided procedures. Increasingly, POCUS has been used for identification of pneumonia and to assist in the differentiation of pleural effusions, as well as to guide thoracentesis. As such, there is a need for training with ideally high-fidelity lung ultrasound phantoms to ensure ultrasound proficiency and procedural competency. Unfortunately, most commercial ultrasound phantoms remain expensive and may have limited fidelity. ⋯ Easily prepared, homemade high-fidelity ultrasound phantom models for instructions on identification of pleural effusions and ultrasound-guided pleural tap of parapneumonic effusion were made.