The A to E (ABCDE) Pit Crew Model: A Novel Approach to Team Based Care of Critical Patients in the Prehospital Setting.

Background: This study aimed to evaluate the effectiveness of a Pit Crew intervention to improve team dynamics and time to performance of critical actions in a prehospital critical care scenario. The primary outcome was successful completion of critical actions and time to completion of these critical actions. Secondary outcomes included effectiveness of communication and overall team functioning. Methods: The study was conducted with a fire-based Emergency Medical Services (EMS) system with 233 paramedics and 115 Emergency Medical Technicians (EMT). Eight EMS crews comprised of five members each were randomly selected and assigned to either the intervention or the control group. The intervention group (n=20) watched a thirty-minute video prior to the training describing the "Pit Crew Approach;" the control group (n=20) did not watch the video. Each crew was given the same simulation scenario of a pediatric patient that had overdosed on a beta-blocker. Completion of predetermined critical tasks were noted and timestamped. A survey was administered to the participants following the training to assess team dynamics and level of confidence. Results: Three outcomes were statistically significant between the two arms: The interventional group felt they themselves had a more defined role in the resuscitation in comparison to the non-interventional group (p= 0.021). The interventional group also felt that their team members had a clearer and more defined role than the nonintervention group (p= 0.018). The interventional group also felt more confident managing a beta blocker overdose than the nonintervention group (p.007). The only statistically significant secondary outcome finding was in scene departure decision: the interventional arm spent more time on-scene (p=0.031). Of note, the non-intervention group missed performing tasks more often than the interventional group and team leaders of these groups often performed task(s) while also directing the patient care. Conclusion: The Pit Crew model was developed to optimize communication and team function. Our data identified that a formal instruction of the pit crew approach to a critical care scenario improved comfort in patient care. Future studies are needed evaluate other methods of training and the effects of continued formal pit-crew training over time.

Bilateral Maxillary and Mandibular Periapical Abscesses.

Odontogenic infections commonly arise from poor dental hygiene that forms dental caries, which can eventually progress to gingivitis and periodontitis. The authors present a case of facial swelling diagnosed as a periapical abscess with soft tissue swelling that extended into both the maxilla and mandible.

Tissue plasminogen activator and patients with acute ischemic stroke: The litigation landscape.

OBJECTIVE: Tissue plasminogen activator (tPA) is considered standard of care for acute ischemic stroke treatment, but some physicians withhold or delay this highly time-dependent therapy from stroke patients because they do not think it works well or they are worried about the adverse effects or fear medico-legal consequences. The authors sought to investigate whether litigation arises from physicians treating versus not treating acute ischemic stroke patients with tPA. METHODS: The authors examined closed cases from 1996 to 2020 in an online legal database, Westlaw, regarding alleged complaints for whether or not thrombolytic treatment was given for acute stroke. RESULTS: Sixty-six relevant cases were identified. In all 66 cases, the plaintiffs sued for issues stemming from either failure to give tPA or a delay in giving tPA. In 77% of cases the verdict was in favor of the defendant. Only 1 lawsuit included intracerebral hemorrhage after tPA, but it was brought forth owing to delay in giving tPA; the verdict was in favor of the defendant. CONCLUSION: It is more common for patients to sue physicians for not administering tPA in a timely fashion or at any point. Medicolegal risks of withholding or delaying tPA are clear, whereas we found no clear medicolegal risk to providing tPA when indicated.

Testicular compartment syndrome: An unexpected diagnosis in a case of testicular pain.

This case discusses the presentation of a surprising diagnosis of testicular compartment syndrome in a patient with severe testicular pain and swelling in the Emergency Department.

A Rapid Diagnosis and Treatment of a Traumatic Aortic Transection: A Case of Survival to the ICU.

We present the case of a young man with traumatic aortic dissection secondary to a motor vehicle collision. While the differential diagnosis for traumatic injury after a motor vehicle collision can include commonly studied and trained for cases, such as pneumo/hemothorax, pulmonary contusion, splenic laceration, and pelvic fractures, for example, one of the more deadly and hence rare presentations of motor vehicle trauma is aortic transection. The fact that the diagnostic studies included as part of the initial Advanced Trauma Life Support® (ATLS®) trauma survey are not well equipped to diagnose such an injury is also a deadly factor. In this case review, we explore factors affecting the timely diagnosis, management, and outcomes of traumatic aortic injury. Prompt diagnosis is imperative in order to save a patient's life.

Pulmonary Embolism Presenting as an Anterior ST-elevation Myocardial Infarction: A Case Report.

INTRODUCTION: While the electrocardiogram (ECG) for pulmonary embolism typically shows tachycardia or evidence of right heart strain, it can demonstrate ischemic changes similar to acute coronary syndrome. CASE REPORT: The patient in this case presented with syncope, chest pain, and an ECG showing an anterior acute myocardial infarction (AMI) without evidence of right heart strain. His cardiac catheterization showed no coronary artery occlusions, but some signs of pulmonary embolism (PE), which was confirmed on computed tomography angiography of the chest. CONCLUSION: This case demonstrates that PE should be high on the differential for AMI and describes an uncommonly encountered mimic for classic ST-elevation myocardial infarction ECG changes. Further diagnostics to confirm the diagnosis should be obtained when indicated.

Childhood Pityriasis Rosea With Multiple Herald Patches.

Pityriasis rosea is a common skin condition that mainly affects people in their mid to late 20s. The disease commonly begins with the presentation of a herald patch, followed by the spreading of smaller lesions. The authors of this case look at a school-age male child with pityriasis rosea that originated on his back and spread to his chest, legs, arms, and buttocks. The age of this child falls below the expected range of pityriasis rosea patients. On his back, there are multiple herald patches at which the rash originated, which is significantly less common than a single herald patch.

A Case Report of Basilar Artery Occlusion in a Healthy 36-Year-Old Female.

Basilar artery occlusion is rare, accounting for approximately 1% of strokes. Symptoms range from paresthesia and oculomotor symptoms to locked-in syndrome. Intervention can lead to complete neurological recovery despite the severity of initial deficits. We report a case of basilar artery occlusion in a healthy 36-year-old female with minimal risk factors. The patient underwent interventional thrombectomy within eight hours of onset of symptoms and made a significant recovery. Due to the variation in severity and character of symptoms, the diagnosis of basilar artery occlusion is often a barrier to care.