Impact of an Electronic App on Resident Responses to Simulated In-Flight Medical Emergencies: Randomized Controlled Trial.

BACKGROUND: Health care providers are often called to respond to in-flight medical emergencies, but lack familiarity with expected supplies, interventions, and ground medical control support. OBJECTIVE: The objective of this study was to determine whether a mobile phone app (airRx) improves responses to simulated in-flight medical emergencies. METHODS: This was a randomized study of volunteer, nonemergency resident physician participants who managed simulated in-flight medical emergencies with or without the app. Simulations took place in a mock-up cabin in the simulation center. Standardized participants played the patient, family member, and flight attendant roles. Live, nonblinded rating was used with occasional video review for data clarification. Participants participated in two simulated in-flight medical emergencies (shortness of breath and syncope) and were evaluated with checklists and global rating scales (GRS). Checklist item success rates, key critical action times, GRS, and pre-post simulation confidence in managing in-flight medical emergencies were compared. RESULTS: There were 29 participants in each arm (app vs control; N=58) of the study. Mean percentages of completed checklist items for the app versus control groups were mean 56.1 (SD 10.3) versus mean 49.4 (SD 7.4) for shortness of breath (P=.001) and mean 58 (SD 8.1) versus mean 49.8 (SD 7.0) for syncope (P<.001). The GRS improved with the app for the syncope case (mean 3.14, SD 0.89 versus control mean 2.6, SD 0.97; P=.003), but not the shortness of breath case (mean 2.90, SD 0.97 versus control mean 2.81, SD 0.80; P=.43). For timed checklist items, the app group contacted ground support faster for both cases, but the control group was faster to complete vitals and basic exam. Both groups indicated higher confidence in their postsimulation surveys, but the app group demonstrated a greater increase in this measure. CONCLUSIONS: Use of the airRx app prompted some actions, but delayed others. Simulated performance and feedback suggest the app is a useful adjunct for managing in-flight medical emergencies.

Cervical artery dissection related to chiropractic manipulation: One institution's experience.

PURPOSE: The purpose of this study was to determine the frequency of patients seen at a single institution who were diagnosed with a cervical vessel dissection related to chiropractic neck manipulation. METHODS: We identified cases through a retrospective chart review of patients seen between April 2008 and March 2012 who had a diagnosis of cervical artery dissection following a recent chiropractic manipulation. Relevant imaging studies were reviewed by a board-certified neuroradiologist to confirm the findings of a cervical artery dissection and stroke. We conducted telephone interviews to ascertain the presence of residual symptoms in the affected patients. RESULTS: Of the 141 patients with cervical artery dissection, 12 had documented chiropractic neck manipulation prior to the onset of the symptoms that led to medical presentation. The 12 patients had a total of 16 cervical artery dissections. All 12 patients developed symptoms of acute stroke. All strokes were confirmed with magnetic resonance imaging or computerized tomography. We obtained follow-up information on 9 patients, 8 of whom had residual symptoms and one of whom died as a result of his injury. CONCLUSION: In this case series, 12 patients with newly diagnosed cervical artery dissection(s) had recent chiropractic neck manipulation. Patients who are considering chiropractic cervical manipulation should be informed of the potential risk and be advised to seek immediate medical attention should they develop symptoms.

Cross-Sectional Survey of Physicians on Providing Volunteer Care for In-Flight Medical Events.

BACKGROUND: Airline carriers have equipment, procedures, and protocols in place to handle in-flight medical events (IFMEs). Community physicians may be asked for aid during IFMEs. Cross-Sectional Survey of Physicians on Providing Volunteer Care for In-Flight Medical Events surveyed self-assessed awareness and knowledge, perceived barriers, and suggestions for improving responses to IFMEs. METHODS: We composed a survey regarding clinicians' self-assessed understanding of in-flight resources, procedures, flight environmental issues, and Good Samaritan protections. The survey was distributed primarily via electronic mail to medical staff list serves to a total of approximately 1300 physicians representing 2 health networks that serve urban, suburban, and rural areas in both inpatient and outpatient settings. RESULTS: Total number of responses was 418. Physician response rate was 29.2% (379/1300). In 3% (39/1300), the responder either failed to indicate their background or was another type of health care professional (e.g., dentist, medical student, physician assistant). Of the physicians, 37.5% (142/379) were primary care and 42% (177/418) of responders reported at least one experience of being asked to volunteer. When asked how well they understand the protocols with which medical events are handled, 64% (262/412) responded "not at all" and 23% (94/412) reported "a little" knowledge. Only 56% (223/397) answered that 75% or more of U.S. flights have ground medical support available. There were 73% (298/411) who believed airlines were required to have medical supplies, but 54% (222/410) reported no knowledge of supplies available. A total of 69% (279/403) believed or were sure that the U.S. has a Good Samaritan law that applies to IFMEs. DISCUSSION: Many physicians lack basic knowledge about IFMEs. Responders may assist more effectively if better informed about protocols and the availability of ground medical support. Education and timely information support are recommended.Chatfield E, Bond WF, McCay B, Thibeault C, Alves PM, Squillante M, Timpe J, Cook CJ, Bertino RE. Cross-Sectional Survey of Physicians on Providing Volunteer Care for In-Flight Medical Events. Aerosp Med Hum Perform. 2017; 88(9):876-879.

Effect of intraparenchymal blood patch on rates of pneumothorax and pneumothorax requiring chest tube placement after percutaneous lung biopsy.

OBJECTIVE: The purpose of this study was to determine whether an autologous intraparenchymal blood patch reduces the rate of pneumothorax and the rate of pneumothorax requiring chest tube placement after percutaneous lung biopsy. SUBJECTS AND METHODS: A prospective randomized controlled trial enrolling 242 patients was conducted. Adult patients undergoing percutaneous biopsy of lung or mediastinal lesions of undetermined cause were candidates. Patients were excluded if aerated lung tissue was not crossed during the biopsy. A standard biopsy procedure was followed for all patients until an adequate tissue sample was obtained. Patients were then randomized. For patients randomized to the treatment group, an intraparenchymal blood patch was administered through the guiding needle on removal. The same postbiopsy procedures were followed for both the treatment and control groups. Data collected included development of pneumothorax and placement of a chest tube. RESULTS: The rate of pneumothorax was reduced from 35% to 26% (p = 0.12) with the use of the blood patch, but the reduction was not significant. The rate of pneumothorax requiring chest tube placement was significantly reduced from 18% to 9% (p = 0.048). There was a greater benefit in the blood patch group when a 19-gauge guiding needle was used: Pneumothorax requiring chest tube placement was reduced from 19% to 3% whereas an increase from 16% to 20% was seen with a 17-gauge needle (p = 0.029). CONCLUSION: The use of an autologous intraparenchymal blood patch significantly reduces the rate of pneumothorax requiring chest tube placement. It seems to be more beneficial when a 19-gauge guiding needle is used.

Ultrasound imaging of carotid artery stenosis: application of the Society of Radiologists in Ultrasound Consensus Criteria to a Single Institution Clinical Practice.

Carotid duplex Doppler ultrasound (CDDU) is increasingly used for the evaluation of internal carotid artery (ICA) stenosis. In CDDU, velocity measurements are used to estimate the degree of ICA stenosis. Traditionally, radiologists have relied on institutional experience and published research when interpreting CDDU. In 2003, a consensus committee of experts convened as the Society of Radiologists in Ultrasound Consensus Committee and proposed standard criteria for grading ICA stenosis including the use of peak systolic velocity (PSV) of greater than 230 cm/s for assigning ICA stenosis of greater than 70%. The purpose of this study was to evaluate the accuracy of the Society of Radiologists in Ultrasound Consensus Criteria in classifying carotid stenoses. This study shows the following: (1) that the criterion of PSV of greater than 230 cm/s for angiographic stenosis of greater than 70% performs as predicted by the consensus committee, with sensitivity of 95.3% (95% confidence interval [CI], 0.89-0.99) and specificity of 84.4% (95% CI, 0.80-0.88); (2) using Pearson correlations, there is no statistical difference found between the correlation of PSV with angiography (0.825 [95% CI, 0.792-0.853]), end diastolic velocity with angiography (0.762 [95% CI, 0.718-0.799]), and the ICA/common carotid artery (CCA) systolic ratio with angiography (0.766 [95% CI, 0.723-0.802]). The correlation of the ICA/CCA diastolic ratio with angiography (0.643 [95% CI, 0.584-0.696]) is less predictive at a 95% confidence interval than the other 3 velocity-based variables, and (3) when the 4 velocity-based variables are taken in pairs (eg, PSV and end diastolic velocity), there is no pair that shows statistically significant improvement in performance. Peak systolic velocity in combination with other variables does show a slight trend toward superior performance.