Continuous In-woods Production of Biochar Using a Trailer-mounted Air Curtain Burner.

Fuel treatments and other forest restoration thinning practices aim to reduce wildfire risk while building forest resilience to drought, insects, and diseases and increasing aboveground carbon (C) sequestration. However, fuel treatments generate large amounts of unmerchantable woody biomass residues that are often burned in open piles, releasing significant quantities of greenhouse gases and particulates, and potentially damaging the soil beneath the pile. Air curtain burners offer a solution to mitigate these issues, helping to reduce smoke and particulates from burning operations, more fully burn biomass residues compared to pile burning, and eliminate the direct and intense fire contact that can harm soil beneath the slash pile. In an air curtain burner, burning takes place in a controlled environment. Smoke is contained and recirculated by the air curtain, and therefore burning can be conducted under a variety of climatic conditions (e.g., wind, rain, snow), lengthening the burning season for disposal of slash material. The mobile pyrolysis unit that continuously creates biochar was specifically designed to dispose of residual woody biomass at log landings, green wood at landfills, or salvaged logged materials and create biochar in the process. This high-carbon biochar output can be used to enhance soil resilience by improving its chemical, physical, and biological properties and has potential applications in remediating contaminated soils, including those at abandoned mine sites. Here, we describe the general use of this equipment, appropriate siting, loading methods, quenching requirements, and lessons learned about operating this new technology.

The Role of Tourniquet Placement in Management of a Patient With Status Epilepticus.

BACKGROUND: The global burden of seizure disorders is apparent and necessitates the effective management of patients with status epilepticus (SE). The goal of management is universally accepted as the prompt mitigation of seizure activity with appropriate supportive care. During management, patients may require intubation. In the process of endotracheal tube placement, patients are administered neuromuscular blockers and general anesthesia. Paralytic activity on the neuromuscular junction hinders the emergency physician's ability to effectively observe seizure activity. Moreover, little can be discerned about patient sedation levels for titration. Effective tourniquet placement may be used to separate a region of the body from general circulation, rendering distal tissues unaffected by neuromuscular blockade. CASE REPORT: A 73-year-old white woman presented to the emergency department with a stroke, and her condition generalized into diffuse tonic-clonic seizures. Concern for airway integrity warranted intubation with appropriate induction of paralysis and sedation. A tourniquet was placed proximal to the right knee and tightened until a dorsalis pedis pulse was no longer palpable. Computed tomography and computed tomography angiography of the head revealed no cerebrovascular event. After imaging, purposeful movements were noted in the right lower extremity distal to the tourniquet despite the initiation of standard dose post-intubation sedation with fentanyl (0.5 µg/kg/h) and propofol (20 µg/kg/min). No tonic-clonic activity was observed. With necessary up-titration, movements ceased. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The observations made support the use of temporally limited tourniquet placement during paralytic administration to assess patient seizure status and sedation levels. Mindful tourniquet use in this manner permits a more effective sedation and management protocol for SE patients coming into the ED and may outweigh the minor risks associated with short-term hypoperfusion.

E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) in an Active Duty Service Member.

E-cigarette or vaping product use-associated lung injury (EVALI) is a developing serious pulmonary disease associated with the increasing use of vaping products in both civilian and active duty populations. This case study describes an active duty trainee using unbranded vaping products who developed acute respiratory distress syndrome necessitating intubation and multiday intensive care unit hospitalization. Diffuse ground glass opacities in imaging, lipid-laden macrophages found on bronchoalveolar lavage, negative infectious disease workup, and recent vaping indicate EVALI. This case demonstrates more work needs to be done within the Armed Forces to reduce use of vaping products given the danger of EVALI.

"Doctors' Lounge" podcast to teach clinical reasoning to first-year medical students.

This article was migrated. The article was marked as recommended. In the first year of medical school, our students have a comprehensive course in history taking, physical examination skills, clinical reasoning, and patient-centered care. We have observed that first year students struggle to conduct a focused history and perform a focused physical examination on a given chief complaint. We developed an innovative program to address this concern in our Essentials of Medicine- Physical Diagnosis course. We created an online outline and audio podcast for students to review illustrating the key elements of the history of presenting illness, review of systems, other historical patient information, and focused physical examination for 3 specific chief complaints to assist them in their approach to these patients. This resource also included the discussion of the work up and treatment plans and was created in collaboration of Internal, Family, and Emergency Medicine to account for the various approaches to the same chief complaint within the various specialites of medicine. Students completed a brief pre- and post-session survey to assess their utilization of the resource, quality of the content, and delivery of the session materials. The preceptor's were also surveyed regarding the students' ability to conduct a patient encounter and discuss their assessment and plan comparing current students to those in previous years who did not use this resource. We also asked for feedback on how these resources might be improved for future use. The resource was highly effective for first-year medical students in preparation for focused history taking and physical examination of a patient with a specific chief complaint. Students were more engaged in the critical reasoning discussion of the case assessment and plan after using this resource and preceptors were in agreement. We believe this model we called the "Doctors' Lounge" developed for the chief complaints of sore throat, chest pain, and abdominal pain can be replicated at any medical school desiring to introduce or enhance teaching of clinical reasoning skills to their preclinical students.