Southern medical journal
-
Southern medical journal · Aug 2018
THAM Administration to Pediatric Trauma Patients in a Combat Zone.
Pediatric casualties made up a significant proportion of patients during the recent military conflicts in Iraq and Afghanistan. Damage control resuscitation strategies used by military physicians included rapid reversal of metabolic acidosis to mitigate its pathophysiologic consequences, primarily through hemorrhage control and volume restoration. Alkalizing agents, including tris(hydroxymethyl)aminomethane (THAM), are potential therapeutic adjuncts to treat significant acidosis. There is, however, limited published data on THAM administration in the pediatric trauma population. We compared demographics and outcomes among pediatric trauma patients in Afghanistan and Iraq receiving THAM versus those not receiving THAM. ⋯ THAM was administered rarely to pediatric trauma casualties during the conflicts in Afghanistan and Iraq. Subjects receiving THAM were more critically injured than the baseline population.
-
Southern medical journal · Aug 2018
Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Use for Subclassification and Genotyping of Lung Non-Small-Cell Carcinoma.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the primary method for the diagnosis and staging of lung cancer. The purpose of this study was to assess the yield of EBUS-TBNA in the subtyping and genotyping of lung adenocarcinoma. ⋯ EBUS-TBNA with a 21-gauge needle is appropriate for the analysis of multiple mutations and the genotyping of lung adenocarcinoma.
-
Dog bite injuries are encountered frequently in emergency departments and can cause significant morbidity. The objective of this study was to explore the associations between the multiple variables at play during these occurrences (eg, the patient's age, the bite location, the bite severity, the dog's relationship with the patient, the breed of dog). ⋯ The results of this retrospective review are aligned mostly with the general trends found in previous national and global studies, supporting the notion that family dogs represent a more significant threat than often is realized and that, among the breeds identified, pit bulls are proportionally linked with more severe bite injuries. Our data further validate previous studies that note an increased risk of bites and bite severity in children younger than 5 years. In addition, our data show that bites to the head and neck occurred more frequently among children younger than 5 years than among older children, and that boys younger than 5 years were bitten more frequently than girls.
-
Southern medical journal · Jul 2018
Review Case ReportsPoint-of-Care Ultrasound in Resource-Limited Settings: Common Applications.
Point-of-care ultrasound (POCUS) is used increasingly in resource-limited settings (RLSs), particularly as inexpensive ultrasound machines and evidence-based protocols become more available. POCUS often is the only imaging modality available in such settings, and it has the potential to significantly affect patient care. ⋯ It concludes with a discussion of the logistical considerations specific to implementing POCUS in RLSs, particularly equipment and training. The literature reviewed suggests that POCUS has the potential to improve the diagnosis and management of multiple conditions in RLSs, although further research is needed.
-
The original and most widely accepted applications for point-of-care ultrasound (POCUS) are in the settings of trauma, shock, and bedside procedures. Trauma was the original setting for the introduction of POCUS and has been standardized under the four-plus view examination called the Focused Assessment with Sonography in Trauma (FAST). This examination was found to be especially practice changing for achieving rapid diagnoses in critically ill patients who are too unstable for the delays and transportation inherent in more advanced imaging with computed tomography. ⋯ US guidance of procedures has improved the safety of central line insertion, thoracentesis, and paracentesis, and has an emerging role in lumbar puncture. Experience in bedside US is becoming a vital tool in the clinician's bedside assessment and management, filling a void between the stethoscope and the more advanced studies and interventions available through radiology. Understanding the strengths and limitations of US enables clinicians to identify the appropriate situations in which they can apply this tool confidently.