Simulation-Based Assessment of the Novel, Disposable i-view Video Laryngoscope by Emergency Medicine Physicians.

INTRODUCTION: Airway obstruction is the second leading cause of potentially preventable death on the battlefield. Previous studies demonstrate the most frequent airway intervention is intubation. Currently, the US Army has advanced video laryngoscopy (VL) in its sets, kits, and outfits (SKOs) at a cost of approximately $12,000 and generally only deploys them to the forward resuscitative surgical detachments and field hospitals. The i-view is a disposable video laryngoscope that costs approximately $120. The purpose of this study was to assess operator performance with this device and survey user opinions. METHODS: We conducted a prospective, observational study with emergency medicine residents and attending physicians using a synthetic cadaver model. Placement success, time-to-cannulation, number of attempts, and number and type of complications were recorded, followed by surveys. RESULTS: We enrolled 31 participants. One was missing data and was excluded, leaving 30 for analysis. The median age was 29, most (66%) were male, most were Air Force (57%), in-training residents (77%) with few reporting previous deployment experience (13%). Almost all had real patient experience with both direct (93%) and video laryngoscopy (90%). Most (90%) were able to get a grade 1 view with all achieving airway cannulation on first-pass attempt. The median time to cannulation was 11.6 seconds. On the post-procedure survey, most strongly agreed they would use this in the deployed setting (77%). Most reported they found it easy to use (77%). CONCLUSION: Our simulation-based study demonstrates the device has strong potential use for the clinical setting with all achieving rapid first-pass success for intubation. This study lays the foundation for validation of this device in the clinical setting.

Drug reaction with eosinophilia and systemic symptoms: An emergency medicine focused review.

INTRODUCTION: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug reaction associated with potentially severe morbidity and mortality. OBJECTIVE: This narrative review evaluates the pathogenesis, diagnosis, and management of DRESS for emergency clinicians. DISCUSSION: DRESS is a severe hypersensitivity reaction which can involve multiple organ systems, including the skin, lymphatic system, lungs, kidneys, and heart. Treatment is primarily supportive care combined with removal of the offending agent and initiation of corticosteroids. Additional options include cyclophosphamide, cyclosporine, intravenous immunoglobulin, and N-acetylcysteine. CONCLUSION: It is important for the emergency clinician to be aware of the diagnosis and management of DRESS in order to best optimize care for these patients.

Pediatric volvulus induced thyroid storm.

Thyroid storm is an unusually rare but life-threatening pediatric occurrence, carrying significant mortality. Skewed towards the adolescent population, thyroid decompensation occurs due to inciting factors ranging from infection, trauma, surgery, burns, medications, direct thyroid trauma, and rarely volvulus. Emergent care focuses on both reversing the inciting event as well as quelling the metabolic hyperactivity associated with thyroid storm. In review of the available literature, this case is the first to date of thyroid storm secondary to malrotation with midgut volvulus in a previously euthyroid adolescent patient.

Cardiomegaly Masquerading as a Pediatric Thymoma: A Case Report.

Thymoma is a very rare pediatric tumor, accounting for less than 1% of all childhood mediastinal tumors with scant literature, and only 23 pediatric cases were identified by a pediatric tumor surveillance registry between 1973 and 2008. In contrast to adult thymomas, pediatric thymomas have an aggressive tendency, though the majority is discovered as incidental findings. Patient presentations to the emergency department (ED) are often subtle and non-specific such as dyspnea, cough, and chest pain, requiring a broad differential on the part of the emergency clinician. Because of this presentation, diagnosis often occurs later in the disease process when compared with adults. Chest radiograph may demonstrate an enlarged thymic shadow or cardiomegaly, necessitating further cardiac workup, commonly routed through cardiology. Computed tomography and biopsy are required for definitive diagnosis, requiring a multidisciplinary approach to management. We present a case of a 16-year-old female complaining of progressive dyspnea and chest pain over the course of one to two months with radiographic cardiomegaly. She was found to have a Masaoka stage III World Health Organization (WHO) type B3 thymic endothelial neoplasm and underwent surgical resection.

Acute Mesenteric Ischemia With Secondary Thromboembolism: A Rare Complication.

Acute mesenteric ischemia presents a clinical challenge due to its subtle presentation and high mortality rate, which can mimic a variety of other conditions. Acute mesenteric ischemia requires a high index of suspicion, especially in those with comorbidities and risk factors such as hypertension, diabetes, atrial fibrillation, and peripheral arterial disease. The inciting thrombus commonly originates in the left atrial appendage or left atrium, embolizing to occlude mesenteric vessels, with resulting gut ischemia. Patients commonly present with post-prandial abdominal pain as mesenteric vascular demands increase, though diarrhea and gastrointestinal bleeding may be the presenting symptom. CT angiography of the abdomen and pelvis provides rapid confirmation of the diagnosis and visualization of the thrombus, aiding vascular surgical management. The authors present a novel case of a 69-year-old female with an acute mesenteric ischemia of her superior mesenteric artery and a second acute arterial thromboembolism to the right axillary artery visualized from her left atrial appendage.