ABSTRACT
Objectives. Ultrasound (US) guidance is a safe and effective method for peripheral intravenous (IV) catheter placement. However, no studies have directly compared the success rate of emergency medicine (EM) residents and nurses at using this technique especially in community hospital settings. This prospective "noninferiority" study sought to demonstrate that nursing staff are at least as successful as EM residents at placing US guided IVs. Methods. A group of 5 EM residents and 11 nurse volunteers with at least two years' experience underwent training sessions in hands-on practice and didactic instruction with prospective follow-up. Two failed attempts on a patient using standard approach by an emergency department (ED) nurse were deemed to be "difficult sticks" and randomly assigned to either a nurse or resident, based on the day they presented. Results. A total of 90 attempts, consisting of trials on 90 patients, were recorded with a success rate of 85% and 86% for residents and nurses, respectively. With a p value of .305, there was no statistically significant difference in the success rate between the residents and nurses. Conclusion. Properly trained nursing staff can be as equally successful as EM residents in placing US guided intravenous lines.
ABSTRACT
Both instrumental data analyses and coupled ocean-atmosphere models indicate that Atlantic meridional overturning circulation (AMOC) variability is tightly linked to abrupt tropical North Atlantic (TNA) climate change through both atmospheric and oceanic processes. Although a slowdown of AMOC results in an atmospheric-induced surface cooling in the entire TNA, the subsurface experiences an even larger warming because of rapid reorganizations of ocean circulation patterns at intermediate water depths. Here, we reconstruct high-resolution temperature records using oxygen isotope values and Mg/Ca ratios in both surface- and subthermocline-dwelling planktonic foraminifera from a sediment core located in the TNA over the last 22 ky. Our results show significant changes in the vertical thermal gradient of the upper water column, with the warmest subsurface temperatures of the last deglacial transition corresponding to the onset of the Younger Dryas. Furthermore, we present new analyses of a climate model simulation forced with freshwater discharge into the North Atlantic under Last Glacial Maximum forcings and boundary conditions that reveal a maximum subsurface warming in the vicinity of the core site and a vertical thermal gradient change at the onset of AMOC weakening, consistent with the reconstructed record. Together, our proxy reconstructions and modeling results provide convincing evidence for a subsurface oceanic teleconnection linking high-latitude North Atlantic climate to the tropical Atlantic during periods of reduced AMOC across the last deglacial transition.
