A Review of Current Management of Knee Hemarthrosis in the Non-Hemophilic Population.

The knee joint is one of the most frequently injured joints in the body, and the resulting injury may often lead to the presence of a bloody effusion, or hemarthrosis. The acute management of this condition can have long-lasting implications, and may ultimately result in the early onset of osteoarthritis in this population. Heme, a breakdown product of erythrocytes, and associated pro-inflammatory mediators, are known to have deleterious interactions with cartilage and synovium. The presence of blood in a joint following injury can precipitate these effects and accelerate the degenerative changes in the joint. Currently, there is no consensus on the optimal management of a traumatic knee joint injury with a hemarthrosis. Nontraumatic hemarthosis, seen most commonly in hemophilia patients, has a set of established guidelines that does not routinely recommend drainage of the joint. This article presents a rationale for joint aspiration to minimize the harmful effects of blood following traumatic hemarthrosis.

An introductory educational session improves medical student knowledge and comfort levels in caring for patients with physical disabilities.

BACKGROUND: Despite a growing number of people living with disabilities (PWD), many experience health disparities related to access to high quality medical care. Lack of knowledge and low comfort level of medical providers in caring for PWD is a significant barrier and can lead to poor health outcomes. Education of future physicians is an important factor in addressing these health disparities. OBJECTIVE/HYPOTHESIS: The objective of this study is to assess the knowledge and comfort level of first-year medical students towards PWD before and after a mandatory educational session focused on the health disparities and appropriate care of PWD. We hypothesized that this introductory session would lead to a greater awareness and improved comfort level around caring for PWD. METHODS: For the two academic years 2016-2018, we created a mandatory educational session for first-year students consisting of a 30-min lecture followed by discussion of video vignettes and a PWD patient panel. Students completed pre- and post-session surveys that evaluated changes in knowledge and comfort levels around working with PWD, and elicited their feedback. RESULTS: 355 students participated in the educational session and among 278 matched pre- and post-survey responses, we found a significant improvement in knowledge and comfort levels towards encountering PWD. Student feedback was overwhelmingly positive with the PWD panel receiving the highest effectiveness rating. CONCLUSION: A mandatory educational session for medical students including didactics, videos, and testimonials on caring for PWD improved students' knowledge and comfort levels. Additional research on the long-term effects of early training is needed.

A Mechanical Intermittent Abdominal Pressure Ventilator.

Pneumatically driven intermittent abdominal pressure ventilators were a popular means of daytime ventilatory support until the late 1960s paradigm shift to invasive (tracheostomy) mechanical ventilation. However, although many patients still use intermittent abdominal pressure ventilators, currently available turbine-driven portable home care ventilators are not powerful enough to always successfully operate them. We describe a new mechanically driven intermittent abdominal pressure ventilator operated by a 1-pound motor that provided a depth of abdominal compression of almost 2 in in 1.05 to 1.13 secs to normalize alveolar ventilation for a 72-yr-old postpolio survivor. It increased her autonomous 200- to 320-ml tidal volumes by greater than 300 ml to normalize her respiratory rate, relieve her dyspnea, and maintain normal oxyhemoglobin saturation levels throughout daytime hours for a 9-mo period of continuous ventilatory support.