Category Archives: Emergency Medicine

Emergency Medicine

ENRICH study leads to first positive surgical trial in the deadliest … – Emory News Center

The results of a promising surgical treatment for hemorrhagic strokes, led by researchers at Emory University School of Medicine since 2017, were announced Saturday in a late-breaking clinical trial presentation at the American Association of Neurological Surgeons (AANS) meeting in Los Angeles.

The ENRICH (Early MiNimally-invasive Removal of ICH) trial demonstrated a positive surgical outcome in the treatment of intracerebral hemorrhage (ICH). A randomized, multi-center clinical trial, ENRICH compared standard medical management to early minimally invasive parafascicular surgery (MIPS), using the NICO Corporations BrainPath and Myriad technology.

Each year, two million people suffer hemorrhagic strokes, which are considered the deadliest, most costly and debilitating form of stroke. Hemorrhagic stroke occurs when a weakened vessel ruptures and bleeds into the surrounding brain, leading to the accumulation of toxic blood within the brain. Unfortunately, up to 50% of people who suffer from hemorrhagic strokes will die within 30 days.

Research suggests that removal of blood from the brain within 24 hours after bleeding starts could help reduce brain damage and death. Right now, the standard of care for patients is to give them medicine or monitor and see what happens, often called the watch and see" approach. This can mean blood stays in the brain for longer, increasing the risk for complications.

ENRICH is the first, randomized clinical trial to meet its primary endpoint, while improving outcomes for these deadly strokes, says Gustavo Pradilla, MD, co-lead investigator for ENRICH, associate professor of neurosurgery at Emory University School of Medicine and chief of neurosurgery for Grady Memorial Hospital.

This trial will help to change how we treat hemorrhagic stroke moving forward, says Pradilla, who presented the findings at the AANS meeting.

The BrainPath device is a tool used to help surgeons get to the site of bleeding in the brain by carefully moving through its delicate folds and fibers. It gently moves aside brain tissue to create a path to the bleeding site. Once it gets there, the Myriad device, an automated suction and resection tool, can remove the clot.

The 37 participating sites did a great job with the trial and carefully randomized and expertly managed the enrolled patients, says co-prinicipal investigator Dan Barrow, the Pamela R. Rollins Chairman and Professor of Neurosurgery at Emory University.We want to thank our brave patients and their families for entrusting us with their care and agreeing to participate in a trial to advance scientific knowledge for the benefit of others.Their selfless behavior is necessary to advance the scientific basis of medical care.

Other participating trial sites included: Mayo Clinic, Johns Hopkins University, Washington University, Cleveland Clinic Foundation, University of Southern California, Brigham and Women's Hospital, Vanderbilt University, University of North Carolina and Penn State University.

At Emory, the ENRICH research team was comprised of a cross-disciplinary team from the neurosciences and emergency medicine. In addition to Barrow and Pradilla, supporting Emory faculty members on this research include: co-principal investigator Jonathan Ratcliff, MD; Michael Frankel, MD; Jason W. Allen, MD, PhD; David Wright, MD; and Alex Hall, MS, RN.

For more information on the ENRICH trial, please visit: https://clinicaltrials.gov/ct2/show/NCT02880878

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ENRICH study leads to first positive surgical trial in the deadliest ... - Emory News Center

Emergency Medicine

‘Do something!’ We Need an Emmett Till Moment – New York … – Amsterdam News

Do something was the plea from Dr. Jason Smith, whose medical team treated eight people injured in the first of two mass shootings in Louisville, Kentucky, in one week. The surgeons remarks about an April 10 incident that left five dead were directed at policymakers on the local, state. and national levels.

In a news conference with the Louisville acting chief of police, Smith said they barely had [time] to adjust their operating table schedule. There has been so much violenceat least 42 homicides.

For evidence, look no farther than Louisvillenext mass shooting. Just days later at Chickasaw Park, gun violence left two dead and four injured; many physicians from across the nation could have made Smiths remarks. As an emergency medicine doctor for more than 30 years in urban, suburban, and rural hospitals, I would have added that the situation is worse today than three decades ago.

In 1991, when I was a resident, the shooting deaths of four people at Michigans Royal Oak Post Office was nationwide news for days. Going postal had already become an expression based on a rash of murders at U.S. post offices. Although I am on the frontline of this violence, including the shootings at the Royal Oak Post Office, I never thought that firearms would become the leading cause of deaths among children and teens.

Now incidents with four or more dead are too common. in a Kaiser Family Foundation poll, roughly half of U.S. adults (54%) reported that they or a family member have had first-hand experience with gun violence. On the same day as the Chickasaw Park shooting, a birthday party in Alabama ended with four dead and more than 28 shot.

For years, gun violence looked like something that happened in somebody elses neighborhood. Today, mass shootings happen anywhere and anytime in a bank, a private elementary school, a park, and most recently during a 16th birthday party, a wrong turn into a driveway, or a knock on a door.

We can do something. America must see what Smith and I routinely see. They need to see what gun violence really looks like. We need an Emmett Till moment.

In 1955, the open-casket funeral of Emmett Till drew international attention to the savagery of Jim Crow segregation, spurring a national Civil Rights Movement. A 14-year-old Black boy had been kidnapped, beaten, mutilated, shot, lynched, and thrown in the Tallahatchie River in Drew, Mississippi. Jet magazine published a photo of Tills brutalized body.

Now almost 68 years later, we must do something to stop the gun violence. Opening the casket of someone who was shot by an assault rifle in a mass shooting may be the shock the nation needs. It may be the photograph that launches a bigger, broader movement to overwhelm the clout of gun manufacturers and other entrenched influences.

This shocking picture requires planning. Conversations among loved ones is a good starting point. Quick approvals with doctors and journalists based on these conversations is another key ingredient. It literally will require the blood, sweat, and tears of the entire village.

But is it worth the collective trauma?

History books are filled with images that inspired our nation to change. In addition to Emmett Tills body, photographs of fighting in Vietnam helped to end the 20-year war. Who can forget seeing a Buddhist monk set on fire? What about the front-page image of a South Vietnamese general firing a pistol into the head of a Viet Cong officer? And how about the picture of a naked child fleeing a napalm attack?

Ten years ago, a journalist asked to take a photo of the operating room table right after a shooting victim was taken to the morgue. He wanted to show the blood and bits left on the ceiling, table, walls, floor, and medical team. His editors and my hospital declined the idea. We had not even discussed the idea with the parents whose hopes and dreams for their child were dashed.

Now, given the increased frequency and brutality of mass shootings, I would answer yes to a journalist who wants my help in requesting a photographing of a loved one killed by gun violence. Ask yourself, your family, and friends: What can each of us do?

Will you help to stop gun violence? If readers are interesting in doing something contact Dr. Valda Crowder, Director, Health Committee for Black Women for Positive Change; email: drvaldac@gmail.com.

Valda Crowder, MD, MBA, is a board-certified emergency medicine physician who serves as medical director of emergency medicine at UPMC Community Hospital in Harrisburg, Pennsylvania, and is director of the Health Committee for Black Women for Positive Change.

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'Do something!' We Need an Emmett Till Moment - New York ... - Amsterdam News

Emergency Medicine

Spotlight on Dartmouth Ski Patrol: Winters at the ‘Way – The Dartmouth

One writer investigates the culture and commitment of the student patrollers keeping the Dartmouth Skiway safe.

by Marius DeMartino | 4/26/23 2:15am

Formed more than sixty years ago by the College, the Dartmouth Ski Patrol is a community organization for students interested in ensuring the safety of those on the Dartmouth Skiway. Every winter, these students, who are trained in various forms of emergency medicine, each patrol the mountain for about 10 hours a week, according to patroller Kiki Levy 24. For many Dartmouth students, joining Ski Patrol (SkiPa) is the natural next step of years spent skiing at home.

Sam Frohlich 25, who grew up skiing on the West Coast, saw Ski Patrol as the perfect opportunity to integrate skiing into his life at Dartmouth and to explore new interests.

I had been considering going into medicine, and I thought [Ski Patrol] could be a cool way to see if emergency medicine would pique my interest, Frohlich said. It started out as interest, but I very quickly got invested in joining patrol.

In fact, Renesa Khanna 24, Ski Patrols training officer for the upcoming year, said she came to Dartmouth specifically for SkiPa after she patrolled at Winter Park Resort in her home of Colorado. Khanna expressed that while the exclusive nature of skiing makes it hard to get more diversity in a ski patrol club, the overall atmosphere of the group is very welcoming.

People love to be outside doing things, and its easy to get a group to rally and organize, Khanna added.

However, not all of the Dartmouth ski patrollers spent their childhoods on the mountain. Meghan OKeefe 24, the incoming student director of SkiPa, was initially nervous about joining because she thought she lacked the proper experience.

I skied growing up but never raced. We didnt go that often it was very expensive, so I was definitely apprehensive about being good enough. I really took a leap by trying out, she said.

Jacob Schnell 26, one of Ski Patrols newest members, echoed this sentiment.

Growing up [in Atlanta], I couldnt ski very much. Being able to do it for at least two shifts a week has forced me to go to the Skiway more, Schnell said.

Even with years of skiing experience, the process of becoming a patroller is no bunny hill. According to OKeefe, the recruitment process begins the first week of fall term, freshman year.

[Candidates] show up for interviews based on skiing equipment knowledge, skiing ability and a general interview. Thirty people from these initial applications will take a medical class to get their [Outdoor Emergency Care] certification, OKeefe said.

During their freshman fall, candidates take the OEC class, which allows them to become certified to patrol on any mountain in the U.S. Taking 120 hours to complete, the course prepares patrollers to care for patients out in the wilderness, with a mix of self-study and hands-on practical work.

It was one of the more intense terms Ive had at Dartmouth, Frohlich said. The medical training is pretty much like another class, with four hours a week and homework for each class. The defining part of my freshman fall was grinding so that I could make patrol.

After the arduous OEC class, potential patrollers take a final exam, after which only about fifteen are selected for a ski test at the start of winter term. Even then, those that make it through all of these obstacles still arent full patrollers they only earn the title of apprenti. On their first year on patrol, apprenti do not respond directly to calls themselves, rather they learn by helping out on the mountain. Before their sophomore winter, they return early to the Skiway to get vested and become full patrollers.

After the vest test a final demonstration of skills learned during their apprentice year the fledgling patrollers get to don Ski Patrols signature red jackets.

Its a very long process, so everyone that goes through it is an absolute trooper, OKeefe said.

Levy commented on how different the process was for the patrollers in the Class of 2024, adding that it was no less difficult.

There was no way for there to be a fair process because so many people were off-campus, so it had to be remote, Levy said. We had a more extensive interview process, and they actually admitted students first and had us complete OEC afterwards.

During the winter season, the patrollers spend plenty of time together according to Levy, each patroller is on duty at least ten hours a week and they find ways to make it fun.

We have a lot of silly day-to-day things to pass the time, like the Sunday morning shift makes a charcuterie board every time, OKeefe said. Starting new traditions has been really fun too we use our feed money from the DOC to [organize] a formal where we all wear something nice to eat pizza.

Despite its size of roughly sixty people, it does feel tight-knit and cohesive according to Frohlich, the incoming administrative officer of SkiPa.

It feels like one big group when we have social gatherings, theres a lot of turnout and people really buy into it, Frohlich added.

Schnell said that as a freshman, its exciting to have access to a community of outgoing people.

I feel welcome in most spaces, just because I likely know someone from patrol there, he said. Even in the fall, walking around and knowing some older people was a nice feeling, being a newer person on campus.

It also doesnt hurt to have a community of outdoorsy people eager for other adventures. Several of the patrollers recounted a recent excursion to Tuckermans Ravine one persons idea that snowballed into a thirty-person trip, according to Levy.

According to OKeefe, the patrollers are also in tune with the Upper Valley, working with local patrollers that volunteer at the Skiway.

Its a really good way for everyone to connect with the community where we live and get out of the Dartmouth bubble, OKeefe said. An annual banquet, held last weekend, even gave the senior patrollers a chance to thank and say goodbye to the community volunteers.

I love the community banquet, Levy said. At Dartmouth, you can get caught up in everything centering around students, so one of my favorite things about patrol is getting experience outside of that and putting energy into friendships with people outside of Dartmouths campus.

Whether on the slopes or on the Green, Ski Patrol provides a tight-knit community for its members many expressed how glad they were to have been exposed to such a fun group of people with similar interests.

I just like being around other people that like to ski, Schnell said. Its a community of people who like doing that in their spare time and are down to go to other mountains too.

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Spotlight on Dartmouth Ski Patrol: Winters at the 'Way - The Dartmouth

Emergency Medicine

A California physician training program adds diversity, but where do … – Valley Public Radio

Marcus Cummins grew up dreaming of becoming a doctor, but the Central Valley, California, native didnt have Black physicians to look up to. At times he doubted himself, but he credits the determination he developed as a receiver on the University of California-Davis football team to get him through his studies.

Being a collegiate athlete gave me confidence to apply myself and handle the rigorous schoolwork of medical school, said the 25-year-old husband and father of three. It was harder because I didnt have any physician role models.

This spring, Cummins will complete his fourth year of medical school at the University of California-San Francisco School of Medicines regional campus in Fresno. In March, he matched with UCSF Fresnos internal medicine residency program, where he will complete his training.

The campus is home to one of the University of Californias Programs in Medical Education, or UC PRIME, which encourages students of color to pursue medical degrees to help diversify the field and ease the physician shortage, particularly in underserved communities. The public university system launched the first training program in 2004, at its Irvine campus, and has since expanded it to all six medical schools, many with an emphasis on medically underserved communities.

Researchers have found that the program has succeeded at diversifying enrollment, but there is not enough long-term tracking to know whether these medical school graduates return to practice in regions where theyre most needed. Little is known about the long-term outcomes of UC PRIME, such as practice location or specialty, in the absence of a longitudinal, summative program evaluation across all UC PRIME programs, researchers with Mathematica wrote last fall after assessing the program through a grant from the California Health Care Foundation. (KFF Health News publishes California Healthline, an editorially independent service of the California Health Care Foundation.)

UC administrators say their data shows promising results. In its March report to the state legislature, the university system found over half of those who have completed their training are serving underserved communities, although the Los Angeles and San Francisco schools were unable to provide complete information. Participating students are trained in specialized coursework and clinical experiences to deliver culturally competent care. Depending on their individual circumstances, they may receive financial aid and scholarships as well as leadership development and mentoring.

These outcomes demonstrate that UC PRIME programs have a substantial impact on increasing the number of UC medical school graduates who pursue careers devoted to improving the health of the underserved through leadership roles as community-engaged clinicians, educators, researchers, and social policy advocates, the university system wrote.

Deena McRae, interim associate vice president of academic health sciences for the UC Office of the President, said the university will continue to enhance its tracking.

Several years ago, the California Future Health Workforce Commission recommended expanding the program, noting that graduates are likely to be from underrepresented racial and ethnic groups, likely to practice in California, and more likely to care for underserved populations than physicians who do not participate in similar programs during medical school. The medical training program also seeks to recruit students at an early age. For example, UCSF Fresnos Office of Health Career Pathways runs programs that encourage middle and high school students to pursue careers in medicine.

The state has followed through by increasing support. In 2021, the state allocated almost $13 million in new funding for UC PRIME. That amount will allow the program to grow from 396 students this year to nearly 500 by the 2026-27 academic year, UC predicted.

Sidra Suess, a Pakistani who grew up in Modesto, now practices internal medicine at Kaiser Permanente in Stockton. She completed her undergraduate work and two years of medical school at UC Davis before doing her final two years of medical school at UCSF Fresno through its San Joaquin Valley program.

Stockton is such a diverse mix and beautiful blend of cultures and languages, Suess said. I know I made the right choice to be here, and PRIME opened doors for me to do this. The tuition help, scholarships, and other support that PRIME offers can be fundamental to getting students involved and active who can do well.

Last fall, Mathematica found underrepresented medical students at UC schools more than doubled, from 16% in 2000 to 40% in 2021, an increase largely attributed to UC PRIME. Researchers credited the program for focusing recruitment efforts on individuals committed to serving underrepresented communities.

However, the report cited a lack of long-term data as an obstacle to knowing where these graduates end up practicing. One study of the programs graduates and those from several other community-focused special education tracks from the UC Davis School of Medicine found as many as 62% practiced in an underserved location, but that research relied on secondary sources.

It takes at least 11 years or more to produce a practicing physician after high school, depending on the specialty, said Kenny Banh, assistant dean of undergraduate medical education at UCSF Fresno. More time is needed to track outcomes for our graduates.

Craig Kohlruss

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KFF Health News

Banh, an emergency medicine physician, stressed the importance of doctors who speak the same languages and come from the same cultures as their patients. He said rural areas in need often import foreign physicians, sponsoring their visas, but that those doctors arent necessarily committed to the region. They may accept sign-on bonuses and work for a time then leave.

Meanwhile, more than 80% of his students come from disadvantaged and underrepresented backgrounds, he said. I went into medicine to open doors for students like myself, said Banh. Students dont just walk through those alone.

In underserved regions, there tend to be fewer doctors serving patients; hospitals and health facilities likely have a harder time recruiting and retaining clinicians; and patients may have to drive long distances to access care. A 2021 report from the Healthforce Center at UCSF found that the Inland Empire had the lowest ratio of primary care physicians per 100,000 people in California while the San Joaquin Valley had the lowest ratio of specialists per 100,000 people.

Diversifying the field could also be good for patients health. For example, new research has found that Black people live longer in areas with more Black doctors.

From Selma, then Kingsburg, Inderpreet Inder Bals parents worked as immigrant farmers. She chose to pursue medicine during her third year at Fresno State, she applied to UCSF, and she is now in UCSF San Joaquin Valley PRIMEs class of 2024. It definitely lived up to everything I imagined, said Bal, who is Punjabi Sikh.

Through her mothers journey with terminal cancer, Bal realized that being a doctor didnt mean she could cure everyone, but she strives to give every patient her best. Bal said shes committed to practicing in the Central Valley one day.

This article was produced byKFF Health News, which publishesCalifornia Healthline, an editorially independent service of theCalifornia Health Care Foundation.

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A California physician training program adds diversity, but where do ... - Valley Public Radio

Emergency Medicine

NASA is about to lock these 4 researchers in a simulated Mars … – Space.com

When we think about sending astronauts to Mars, many of us first think of the hardware the rocket, for instance, or the habitat.

But NASA must also consider the human factors involved with Mars missions, which is why the agency is running a series of long-duration analogs here on Earth, called the Crew Health and Performance Exploration Analog (CHAPEA).

The first mission is set to commence in June, when four crewmembers will enter a 1,700-square-foot (158 square meters) habitat and live there for an entire year to simulate a Mars surface mission. And NASA has just announced who those crewmembers are.

Related: A month on 'Mars': Preparing to visit the Red Planet ... on Earth

Leading the mission is commander Kelly Haston, a research scientist studying human disease. Joining her is flight engineer Ross Brockwell, a structural engineer; medical officer Nathan Jones, an emergency medicine physician; and science officer Alyssa Shannon, an advanced practice nurse. Serving as backup crewmembers are aerospace and defense engineer Trevor Clark and U.S. Navy microbiologist Anca Selariu.

NASA first put out the call for CHAPEA participants (opens in new tab) in 2021, with requirements including a degree in a STEM (science, technology, engineering and math) field, as well as professional experience in that field, piloting experience or military training. Ultimately, the CHAPEA candidates had to pass the same physical and psychological testing as astronaut candidates to ensure they were fit for the program.

During the upcoming CHAPEA mission, the four crewmembers will live in a 3D-printed habitat called Mars Dune Alpha, which is located at NASA's Johnson Space Center in Houston. The habitat, designed by 3D-printing architecture studio ICON, includes private crew quarters, a kitchen, living areas, work areas and two bathrooms. There's also a 1,200-square-foot (111 square meters) "external" environment complete with Mars murals and red sand. There, the crew will conduct simulated spacewalks accompanied by virtual reality.

While living in Mars Dune Alpha, the CHAPEA crew will participate in the same kinds of activities that astronauts on Mars would do, from cooking to exercise to cleaning, as well as maintenance work on the habitat, crop growth and scientific research. They'll also encounter environmental stressors that astronauts might experience on Mars, such as equipment failures and communications delays with mission control due to the distance between Mars and Earth.

"The simulation will allow us to collect cognitive and physical performance data to give us more insight into the potential impacts of long-duration missions to Mars on crew health and performance," Grace Douglas, the CHAPEA principal investigator, said in a NASA statement (opens in new tab). "Ultimately, this information will help NASA make informed decisions to design and plan for a successful human mission to Mars."

While 12 months might seem like a long time to spend in Mars Dune Alpha, astronauts who travel to Mars will likely have to endure being away from home for much longer. A round-trip journey from Earth to Mars will take an estimated 21 months, given the time it takes to travel between the two planets, plus waiting for their alignment to be just right for the return. And, of course, the portion of the mission on the surface of Mars could run for weeks or even months.

Realistically, we're still a decade or two away from a human Mars mission, but preparations are well underway. And two more CHAPEA missions are scheduled for 2025 and 2026, respectively.

Follow Stefanie Waldek on Twitter @StefanieWaldek (opens in new tab). Follow us @Spacedotcom (opens in new tab), or on Facebook (opens in new tab) and Instagram (opens in new tab).

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Emergency Medicine

Sustaining emergency and critical care services through an equine … – Virginia Tech Daily

It has been widely known in the equine community in recent years that students in veterinary colleges throughout the country are choosing to steer away from equine veterinary medicine.

In 2021, the American Association of Equine Practitioners highlighted this plight, sharing that only a small percentage of veterinary graduates were entering the equine profession. Even more disturbing is the fact that 50 percent of these graduates will leave the equine profession within five years.

This issue has caused some serious outside-the-box thinking at the Virginia-Maryland College of Veterinary Medicine as well as other veterinary colleges and private equine practices throughout the country that wish to sustain emergency and elective services that they currently offer to clients.

Michael Erskine '84, DVM '88, the Jean Ellen Shehan Professor and director of theMarion duPont Scott Equine Medical Center (EMC), is acting co-chair on a subcommittee of the American Association of Equine Practitioners' Commission on Equine Veterinary Sustainability, which focuses on the demands of emergency coverage. At the recent 2022 association convention in San Antonio, Texas, Erskine moderated a roundtable and presented a lecture on this topic.

Since the equine medical center opened its doors in 1984, its clinicians have been expected to offer outpatient and elective treatments and cover 24/7 emergency and critical care services. This expectation causes clinicians and clinical support staff enormous stress and fatigue, affecting not only their work-life balance, but also their ability to cover daytime scheduled appointments in a timely, efficient way. Due to the continuing increase in the emergency and critical care caseload, this is not a sustainable situation.

Theequine medical center has seen a substantial increase in emergency and critical care cases in recent years. In fiscal year 2022, emergency cases increased by 21.5 percent over the previous year, amounting to 739 emergency cases treated during the 12 months. There has been much discussion as to how to continue offering the current high level of emergency while being supportive of the expectations levied on clinical staff.

To sustain emergency services at the EMC, we are planning to create a dedicated emergency and critical care team, Erskine said. This team will be focused around specially trained equine clinicians who have completed advanced training in both emergency medicine and surgery."

Clinician Emily Schaefer, clinical assistant professor of internal medicine, will complete a fellowship in equine emergency and critical care this summer. EMC Advisory Council Vice Chair Shelley Duke and her husband, Phil, made this fellowship possible through their generous sponsorship.

The fellowship, a collaboration with the Ohio State University College of Veterinary Medicine, spanned three years and will culminate in Schaefer being board-certified by the American College of Veterinary Emergency and Critical Care. Schaefer will fill one of two new faculty positions generated by the program alongside Sarah Dukti, clinical assistant professor of emergency and critical care, who joined the equine medical center in March.

Philanthropic support was sought to cover three-year bridge funding to launch the emergency and critical care team. Schaefer and Dukti, both emergency-focused and highly trained clinicians, will be on-call day and night to cover emergency and critical care services and will be supported by the centers clinical staff. This dedicated team will allow clinicians to focus on outpatient appointments and elective surgeries, mitigating sometimes lengthy wait times for these services.

A generous and committed supporter of equine medical center shared her desire for all equine-focused veterinarians to have a sustainable work-life balance. Her passion encouraged her and her husband to commit support for the initial three-year bridge funding of $1.5 million to stand up the service, which is expected to be self-sustaining by the end of the three-year term.

The donor explained her reasons behind her decision to support the field of equine emergency and critical care Emergency equine medical care is at the epicenter of the crisis in veterinary medicine. I have watched with increasing dismay, then alarm, as our horses finest care providers have left equine medicine for saner, more predictable, better-paid small animal practices or positions in government.

Constant on-call demands with no let up on daily duties leave new (and not so new) veterinarians emotionally drained and physically exhausted, too often questioning their choices. Equine veterinary medicine is a calling for the practitioners I know, and they are leaving the field with regret. As a client, as the mother of a veterinarian, I can see that we need radical new thinking about the structural context that sets up emergency medicine not only for successful outcomes but for successful and sustainable careers.

I am so proud of the work EMC has done to reimagine this context, and of the courage Mike Erskine and his team have shown in their willingness to lead the way to make emergency medicine the exciting career choice it should be.

As part of the Virginia Maryland College of Veterinary Medicine, the equine medical centers mission is to offer excellent and compassionate clinical services to horses and their owners while still focusing on the education of veterinary students, clients, and equine veterinary professionals. Introducing the emergency and critical care team will allow the center to continue to fulfill this challenging mission.

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Emergency Medicine

The burden of incidental SARS-CoV-2 infections in hospitalized … – Nature.com

The Division of General Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134C Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB, T6G 2G3, Canada

Finlay A. McAlister

The Alberta Strategy for Patient Oriented Research Support Unit, Edmonton, Canada

Finlay A. McAlister

Department of Emergency Medicine, University of British Columbia, Vancouver, Canada

Jeffrey P. Hau&Corinne M. Hohl

Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

Clare Atzema,Laurie J. Morrison&Ivy Cheng

Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada

Clare Atzema,Laurie J. Morrison&Ivy Cheng

ICES, Toronto, ON, Canada

Clare Atzema

Department of Emergency Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada

Andrew D. McRae

Department of Emergency Medicine, McGill University, Montreal, QC, Canada

Lars Grant

Lady Davis Institute for Medical Research, Montreal, QC, Canada

Lars Grant

Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

Rhonda J. Rosychuk

Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada

Corinne M. Hohl

Dartmouth General Hospital, Dartmouth, NS, Canada

Hana Wiemer

Halifax Infirmary, Halifax, NS, Canada

Patrick Fok

Hants Community Hospital, Windsor, NS, Canada

Samuel Campbell

Cobequid Community Health Centre, Lower Sackville, NS, Canada

Kory Arsenault

Secondary Assessment Centers of Dartmouth General and Halifax Infirmary, Dartmouth, NS, Canada

Tara Dahn

Dalhousie University, Halifax, NS, Canada

Corinne DeMone

Saint John Regional Hospital and Dalhousie University, Saint John, NS, Canada

Kavish Chandra&Jacqueline Fraser

Hotel-Dieu de Lvis, Lvis, QC, Canada

Patrick Archambault

Jewish General Hospital, Montreal, QC, Canada

Joel Turner

Centre Hospitalier de LUniversit Laval (CHU de Qubec), Quebec, QC, Canada

ric Mercier

Lhpital Royal Victoria-Royal Victoria Hospital, Montreal, QC, Canada

Greg Clark

Hpital de LEnfant-Jsus, Quebec, QC, Canada

ric Mercier

Hpital du Saint-Sacrement, Quebec, QC, Canada

ric Mercier

Hpital Saint-Franois dAssise, Quebec, QC, Canada

ric Mercier

Htel-Dieu de Qubec, CHU de Qubec, Quebec, QC, Canada

ric Mercier

IUCPQ: Institut Universitaire de Cardiologie et de Pneumologie de Qubec, Quebec, QC, Canada

Sbastien Robert

Hpital du Sacr-Coeur de Montreal, Montreal, QC, Canada

Sbastien Robert

Centre Intgr de Sant et de Services Sociaux de Chaudire-Appalaches (Htel-Dieu de Lvis Site), Lvis, QC, Canada

Martyne Audet

CHU de Qubec Universit Laval, Quebec City, QC, Canada

Alexandra Nadeau

Centre Intgr de Sant et de Services Sociaux de Chaudire-Appalaches (Htel-Dieu de Lvis Site, Quebec, QC, Canada

Audrey Nolet

Jewish General Hospital, Montral, QC, Canada

Xiaoqing Xue

McGill University Health Center, Montral, QC, Canada

David Iannuzzi

Hpital du Sacr-Cur de Montral, Montral, QC, Canada

Chantal Lanthier

Sunnybrook, Toronto, ON, Canada

Laurie Morrison&Ivy Cheng

Queens University, Kingston, ON, Canada

Steven Brooks&Connie Taylor

The Ottawa Hospital, Ottawa, ON, Canada

Jeffrey Perry

Hamilton General Hospital, Hamilton, ON, Canada

Michelle Welsford

Health Science North, Sudbury Ontario, ON, Canada

Rob Ohle

University Hospital and Victoria Hospital-London Health Sciences Centre, London, ON, Canada

Justin Yan

North York General Hospital, Toronto, ON, Canada

Rohit Mohindra

Toronto Western Hospital, Toronto, ON, Canada

Megan Landes

University Health Network, Toronto, ON, Canada

Konika Nirmalanathan

Kingston General Hospital, Hotel Dieu Hospital, Kingston, ON, Canada

Vlad Latiu

Sunnybrook Health Sciences Center, Toronto, ON, Canada

Joanna Yeung

Hamilton General Hospital, Juravinski Hospital, Hamilton, ON, Canada

Natasha Clayton

London Health Sciences Centre, London, ON, Canada

Tom Chen

Health Sciences North, Sudbury, ON, Canada

Jenna Nichols

Health Sciences Centre, Winnipeg, MB, Canada

Tomislav Jelic&Kate Mackenzie

St Pauls Hospital, Royal University Hospital, Saskatoon City Hospital, Saskatoon, SK, Canada

Phil Davis

Originally posted here:

The burden of incidental SARS-CoV-2 infections in hospitalized ... - Nature.com

Emergency Medicine

With little FDA oversight, melatonin supplements vary widely in … – STAT

WASHINGTON Consumers turning to melatonin gummies to get some help falling asleep might be getting a lot more help than they bargained for, according to a new study published Tuesday in the Journal of the American Medical Association.

Researchers tested the melatonin concentration in more than two dozen gummy dietary supplements that recently launched and that were available at mainstream retailers like Amazon and Walmart. Nearly all of the products had more than 10% more melatonin than advertised. One product was even three times more powerful than the label suggested.

The study underscores the Food and Drug Administrations lax regulation of melatonin supplements, and natural products more generally. The agency does not review supplements before they hit the market like it does for prescription drugs.

The study is the perfect example of why the FDA needs to do a better job overseeing dietary supplements, according to Stephen Ostroff, a former FDA official who served as both acting commissioner and deputy commissioner of the agencys food program.

Ostroff was reluctant to criticize the FDA for the current situation, and instead argued that the agency needs more money and legal authority to police the growing supplement market.

The new studys lead author, Pieter Cohen, an associate professor of medicine at Harvard Medical School, was less forgiving. While he acknowledged the FDAs current legal authority to regulate supplements is weak, he argued the agency shares some of the blame for not enforcing its existing supplement rules.

We have an inactive FDA, he said. The industry knows that if they put whatever they want to in these melatonin products theres going to be no consequences.

In a statement, the FDA promised to review the findings of the paper, and said it takes product quality concerns, including under- or over-potent products, seriously. However, the agency underscored that it does not have the authority to approve dietary supplements before they are marketed, and firms have the primary responsibility to make sure their products are not adulterated or misbranded before they are distributed.

Large amounts of the substance have also been shown to have adverse effects in children, prompting an exponential increase in poison control calls in recent years, adding to the researchers alarm.

However, one dietary supplement lobbying group argued that variability in strength of the gummies studied is to be expected, and is often purposefully done by manufacturers to ensure they do not degrade overtime and thereby run afoul of the FDAs rules. Dietary supplements are required to demonstrate they contain 100% of the listed ingredient until their expiration date, and thus manufacturers will put an overage in to start to be sure that six months from now that when that consumer buys the product, theyre still getting 100% of whats on the label, according to Steve Mister, the CEO of the Council for Responsible Nutrition.

The new study is not the first to find quality issues with melatonin supplements. A 2017 study found that the strength of melatonin supplements sold in Canada was also unreliable. That study also found several products containing undeclared amounts of the drug serotonin, which the newly published study did not find.

Mister conceded that he did share concerns about two of the products studied one which included no melatonin and another that included more than 300% of the advertised amount. He maintained, however, that there is absolutely nothing in this study that should alarm consumers.

However, the report is likely to prompt debate about the potential risks associated with the increasingly popular sleep aid.

A 2022 study found that melatonin use among U.S. adults more than quintupled from 1999 and 2018, and the number of adults taking high doses more than tripled from 2005 to to 2018.

Theres scant information available about the highest melatonin dose consumers can safely take. One of the only recommendations comes from Health Canada, which recommends no more than 10 milligrams per day.

Two of the products studied would provide users more than that daily maximum in just one recommended serving, according to the study.

This is something that we should be concerned about, said Jocelyn Cheng, a senior director at the drugmaker Eisai and a spokesperson for the American Academy of Sleep Medicine. In general [melatonin] is construed as being safe, but in high quantities we just dont have enough data to say with certainty that it would be safe.

Theres also increasing evidence that melatonin supplements are landing children in the hospital.

A report published last June found that pediatric melatonin-related calls to poison control centers spiked by 530% from 8,337 in 2012 to 52,563 in 2021, and that 4,097 children were hospitalized as a result.

Cohen argued in an interview that the extra-high potency of the products may help explain the recent spike in poison control calls.

Having something that [contains] 50% more melatonin could be the difference between whether [a child needs] to go to the emergency room or you just rest it off at home, he said.

The dietary supplement lobby, however, argued that the new studys focus on children raises a false alarm, because manufacturers typically warn that their products are not meant for children, and most calls to the poison control center were the result of accidental ingestion.

Its a misleading comparison to look at scenarios where kids, for example, got their hands on an entire bottle of adult gummies and became ill after eating multiple servings, versus having slightly more of an ingredient in a single serving that, if taken as directed, would pose no harm, Mister said.

The JAMA study did not name each product individually, but STATs review of the database used to identify the products did reveal that many products included a disclaimer they were not meant for kids. It did appear, however, that certain products bearing that disclaimer also appeared marketed to parents.

One product, for example, included a warning on the back of the bottle indicating it was not meant for people under 18, but the Amazon listing for the product also included a photo advertisement of a mother kissing a young boy good night.

Sarah Ash Combs, an emergency medicine physician at Childrens National Hospital, said the study raises the question of why melatonin and other supplements are sold as gummies in the first place.

What worries me about things being put into gummy form is if you get a hold of that and youre a little kid, youre going to chow down on it, Combs said. It continues to be problematic to me that we put dietary supplements [that are] unregulated by the FDA, such as melatonin in a form that is attractive to kids.

Combs added that she was surprised by the variability in strength of products, and it should be a signal to parents considering using melatonin to help their kids sleep that they should try other remedies like limiting screen time and maintaining a bedtime routine before reaching for melatonin. She added that if a parent still thinks their child needs melatonin that they should talk to their doctor first.

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With little FDA oversight, melatonin supplements vary widely in ... - STAT

Emergency Medicine

Burns, how bad is the patient? About Wallace’s Rule of Nine – Emergency Live International

Dealing with an emergency scenario involving the possibility of severe burns results in a certain speed of assessment.

It is therefore important for the rescuer to be equipped with some basic knowledge that will enable him/her to correctly frame the burn victim.

Measuring the initial surface area of the burn is important for estimating fluid resuscitation requirements since patients with severe burns will experience massive fluid loss due to the removal of the skin barrier.

This tool is only used for second- and third-degree burns (also referred to as partial-thickness and full-thickness burns) and assists the provider in the rapid assessment to determine severity and fluid requirements.

The Rule of Nine has proven to be the algorithm most frequently recited by physicians and nurses to estimate burn surface area in numerous studies.[1][2][3]

The Rule of Nines estimation of burnt body surface area is based on assigning percentages to different areas of the body.

The entire head is estimated at 9% (4.5% for front and back).

The entire torso is estimated at 36% and can be further divided into 18% for the front and 18% for the back.

The front part of the trunk can be further subdivided into thorax (9%) and abdomen (9%).

The upper extremities total 18% and then 9% for each upper extremity. Each upper extremity can be further subdivided into anterior (4.5%) and posterior (4.5%).

The lower limbs are estimated at 36%, 18% for each lower limb.

Again this can be further subdivided into 9% for the anterior aspect and 9% for the posterior aspect.

The groin is estimated at 1%.[4][5]

The Rule of Nine functions as a tool for assessing the second- and third-degree total body surface area (TBSA) in burn patients.

Once the TBSA is determined and the patient is stabilised, fluid resuscitation can often begin with the use of a formula.

The Parkland formula is often used.

It is calculated as 4 ml intravenous (IV) fluid per kilogram of ideal body weight per TBSA percentage (expressed as a decimal) over 24 hours.

Due to reports of excessive resuscitation, other formulas have been proposed such as the modified Brooke formula, which reduces IV fluid to 2 ml instead of 4 ml.

After establishing the total volume of resuscitation with intravenous fluids for the first 24 hours, the first half of the volume is administered in the first 8 hours and the other half is administered in the next 16 hours (this is converted to an hourly rate by dividing half of the total volume of 8 and 16).

The 24-hour volume time starts at the time of the burn.

If the patient presents 2 hours after the burn and fluid resuscitation has not been started, the first half of the volume should be administered in 6 hours with the remaining half of the fluids being administered as per protocol.

Fluid resuscitation is very important in the initial management of second- and third-degree burns comprising more than 20 per cent of TBSA as complications of renal failure, myoglobinuria, haemoglobinuria and multi-organ failure may occur if not treated aggressively early.

Mortality has been shown to be higher in patients with TBSA burns greater than 20% who do not receive appropriate fluid resuscitation immediately after injury.[6][7][8]

The Rule of Nine can best be used in patients weighing more than 10 kilograms and less than 80 kilograms if defined by BMI as less than obese.

For infants and obese patients, special attention should be paid to the following:

Patients defined as obese by BMI have disproportionately large trunks compared to their non-obese counterparts.

Obese patients have closer to 50% TBSA of the trunk, 15% TBSA for each leg, 7% TBSA for each arm and 6% TBSA for the head.

Android-shaped patients, defined as a preferential distribution of trunk and upper body adipose tissue (abdomen, chest, shoulders and neck), have a trunk that is closer to 53% TBSA.

Patients with gynoid shape, defined as preferential distribution of adipose tissue in the lower body (lower abdomen, pelvis and thighs), have a trunk that is closer to 48% TBSA.

As the degree of obesity increases, the degree of underestimation of TBSA involvement of the trunk and legs increases when adhering to the Rule of Nine.

Infants have proportionally larger heads that alter the surface contribution of other major body segments.

A Rule of Eight is best for infants weighing less than 10 kg.

This rule imposes approximately 32% TBSA for the patients trunk, 20% TBSA for the head, 16% TBSA for each leg and 8% TBSA for each arm.

Despite the efficiency of the Rule of Nine and its penetration into surgical and emergency medicine specialities, studies show that at 25% TBSA, 30% TBSA and 35% TBSA, the percentage of TBSA is overestimated by 20% compared to computer-based applications.

An overestimation of the TBSA burned can lead to excessive resuscitation with intravenous fluids, giving the possibility of volume overload and pulmonary oedema with increased cardiac demand.

Patients with pre-existing comorbidities are at risk of acute cardiac and respiratory decompensation and should be monitored in the intensive care unit (ICU) during the aggressive phase of fluid resuscitation, preferably in a burn centre.[9][10]

Studies have found that after examining the fully undressed patient, the percentage of TBSA can be determined by the Rule of Nine within minutes.

Several studies found in a review of the literature stated that the patients palm, excluding the fingers, accounted for approximately 0.5 per cent TBSA and that verification was detected with computer-based applications.

The inclusion of the fingers in the palm accounted for approximately 0.8% TBSA.

The use of the palm, which is the basis on which the Rule of Nine was established, is considered more appropriate for smaller second- and third-degree burns.

It has been noted that the more training a specialist has, the lower the overestimation, especially on minor burns.

Due to the inherent nature of error in human burn assessment even in rule setting, computer-based applications available for smartphones are produced to minimise over- and underestimation of TBSA rates.

The applications use standardised sizes of small, medium and obese male and female models.

Applications are also moving towards measurements of newborns.

These computer applications are experiencing variability in the reporting of TBSA rates of up to 60 per cent overestimation of the burned surface up to 70 per cent underestimation.

Intravenous fluid resuscitation guided by the Rule of Nine is only valid for patients with a TBSA percentage above 20% and these patients should be transported to the nearest trauma centre.

With the exception of special areas, such as the face, genitals and hands, which must be seen by a specialist, transfer to major trauma centres is only necessary for more than 20% TBSA burns.

The American Burn Association (ABA) has also defined criteria for which patients should be transferred to a burn centre.

Once fluid resuscitation has begun, it is important to identify whether appropriate perfusion, hydration and renal function are present.

Resuscitation derived from the Rule of Nine and intravenous fluid formula (Parkland, Brooke modified, among others) should be carefully monitored and adjusted as these initial values are guidelines.

The management of severe burns is a fluid process that requires constant monitoring and adjustments.

Lack of attention to detail can lead to increased morbidity and mortality as these patients are critically ill.

The Rule of Nine, also known as Wallaces Rule of Nine, is a tool used by healthcare professionals to assess the total body surface area (TBSA) involved in burn patients.

The measurement of the initial burn surface area by the healthcare team is important for estimating fluid resuscitation requirements because patients with severe burns have massive fluid losses due to the removal of the skin barrier.

The activity updates healthcare teams on the use of the Rule of Nine in burn victims that will produce better outcomes for patients. [Level V].

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Burns, how bad is the patient? About Wallace's Rule of Nine - Emergency Live International

Emergency Medicine

Class of 2023 President’s Engagement and Innovation Prize Winners – University of Pennsylvania

Class of 2023 Presidents Engagement and Innovation Prize Winners

On April 21, Penn President Liz Magill announced the recipients of the 2023 Presidents Engagement and Innovation Prizes. Awarded annually, the prizes empower Penn students to design and undertake post-graduation projects that make a positive, lasting difference in the world. Each prize-winning project will receive $100,000, as well as a $50,000 living stipend per team member. The prizes are the largest of their kind in higher education. All prize recipients collaborate with a Penn faculty mentor.

Two seniors and one December 2022 graduate were named recipients of the 2023 Presidents Engagement Prize. They are Seungwon (Lucy) Lee for Communities for Childbirth, and Kenneth Pham and Catherine Chang for Act First. Gabriella Daltoso, Sophie Ishiwari, Gabriela Cano, Caroline Amanda Magro, and Tifara Eliana Boyce have received the Presidents Innovation Prize for their project, Sonura.

This years Presidents Engagement and Innovation Prize recipients are fueled by a desire to make a differencein their community, across the country, and around the world, said PresidentMagill. Communities for Childbirth, Act First, and Sonura embody an inspiring blend of passion and purpose. They are addressing consequential challenges with compelling solutions, and their dedication and smarts areexemplary. I congratulate them and wish them success as they launch and grow their ventures.

The 2023 prize recipientsselected from an applicant pool of 76will spend the next year implementing the following projects:

Seungwon (Lucy) Lee for Communities for Childbirth:Ms. Lee, a neuroscience major in the College of Arts and Sciences, is CEO and co-founder of Communities for Childbirth, an international organization that empowers maternal and child health in Jinja, Uganda. With the support of the Presidents Engagement Prize, Ms. Lee will create a community-based referral system that provides efficient transportation to health facilities and patient-hospital communication during obstetric emergencies. Ms. Lee is mentored by Lisa D. Levine, the Michael T. Mennuti Associate Professor in Reproductive Health in the Perelman School of Medicine.

Kenneth Pham and Catherine Chang for Act First:Mr. Pham, a chemistry major in the College of Arts and Sciences, and Ms. Chang, a December 2022 CAS graduate, willexpand on an idea started through Penns Medical Emergency Response Team (MERT) to provide critical first-aid training to high school students in Philadelphia, including opioid reversal, CPR, and bleeding prevention. Mr. Pham is a former MERT administrative director and Ms. Chang is a former MERT general board member. They are mentored by Joshua Glick, an assistant professor of emergency medicine in the Perelman School of Medicine.

Gabriella Daltoso, Sophie Ishiwari, Gabriela Cano, Caroline Amanda Magro, and Tifara Eliana Boyce for Sonura:Ms. Daltoso, Ms. Ishiwari, Ms. Cano, Ms. Magro, and Ms. Boyce are bioengineering majors in the School of Engineering and Applied Science. Their startup, Sonura, is developing a beanie that promotes the cognitive and socioemotional development of newborns in the NICU by protecting them from the auditory hazards of their environments while fostering parental connection. The Sonura beanie is composed of a frequency-dependent filter and a mobile application. The Sonura team is mentored by Brian Halak, a lecturer in the engineering entrepreneurship program.

We are very proud of the wide-ranging curiosity and passionate commitment to improving the world that characterize our great Penn students said Interim Provost Beth A. Winkelstein. These three exciting projects provide creative, innovative solutions that will shape the future of areas from cognitive development of newborns to childbirth in Africa to first-aid training here in Philadelphia. We are deeply grateful to the committees that worked tirelessly to review this years exceptional applicants, as well as to the Center for Undergraduate Research and Fellowships and the outstanding faculty advisors who worked closely with these students to develop their visionary ideas.

The prizes are supported by Trustee Emerita Judith Bollinger and William G. Bollinger, in honor of Ed Resovsky; Trustee Emerita Lee Spelman Doty and George E. Doty, Jr.; Trustee Emeritus James S. Riepe and Gail Petty Riepe; Trustee David Ertel and Beth Seidenberg Ertel; Trustee Ramanan Raghavendran; Wallis Annenberg and the Annenberg Foundation; and an anonymous donor.

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Class of 2023 President's Engagement and Innovation Prize Winners - University of Pennsylvania