An Adjusted Ideal Body Weight Index Formula With Fresh Frozen Plasma (FFP) Rescue Decreases Fluid Creep During Burn Resuscitation.

Severe burn injury requires significant volume resuscitation, but over-resuscitation can be deadly. Accurate resuscitation of obese patients is challenging due to the decreased vascularity of adipose tissue. This study compares an adjusted ideal body weight index formula with fresh frozen plasma rescue to historical controls resuscitated with Parkland-based resuscitation. A retrospective review was conducted of adult patients admitted to our regional burn center with ≥ 20% total body surface area (TBSA) burns from 2010 to 2017 who survived more than 48 hours. Historical controls were resuscitated with Parkland-based resuscitation with occasional albumin. The adjusted ideal body weight (AIBW) patients were resuscitated with 2-4 mL/kg/%TBSA using an adjusted ideal body weight with fresh frozen plasma (FFP) rescue. Outcomes were compared with nonparametric statistics. A total of 161 patients met inclusion criteria: 40 patients received AIBW resuscitation and 121 patients were included as controls. The AIBW group received less fluid (3.30 vs. 4.15 mL/kg/%TBSA, p<0.001). A significant reduction in acute kidney injury requiring dialysis in the AIBW group was appreciated (5% vs. 19%, p=0.03) with improved mortality in AIBW patients as well (5% vs. 20%, p=0.03). Using an adjusted ideal body weight with FFP rescue to resuscitate patients with severe burn injury leads to a significant reduction in fluid administration without increase in acute kidney injury requiring dialysis and with improved mortality.

Les brûlés graves ont besoin d'un remplissage vasculaire majeur, pouvant toutefois être mortel s'il est exagéré. Il est particulièrement difficile chez les obèses, en raison de la faible vascularisation du tissu adipeux. Cette étude compare une formule basée sur le poids idéal (PI) et utilisant du PFC à des séries historiques utilisant la formule de Parkland. Cette étude rétrospective a revu les dossiers des patients admis dans notre CTB, ayant survécu plus de 48 h, entre 2010 et 2017. Les 121 cas historiques recevaient un remplissage selon Parkland (et de l'albumine au besoin). Les 40 patients à l'étude recevaient 2 à 4 mL/kg/% de PFC, le volume étant calculé sur le poids idéal. Ce groupe recevait significativement (p < 0,001) moins (3,3 mL/kg/%) de volume que le groupe contrôle (4,15). Ils avaient aussi moins fréquemment besoin d'épuration extra- rénale (5% VS 19%, p= 0,03) et leur mortalité était moindre (5% VS 20%, p= 0,03).

Prehospital hydroxocobalamin for inhalation injury and cyanide toxicity in the United States - analysis of a database and survey of ems providers.

Prehospital use of hydroxocobalamin as an antidote for cyanide toxicity, a serious complication of smoke inhalation, has yet to be universally adopted in the United States though its efficacy and safety have been demonstrated since 2006. The purpose of this study was to characterize practices of prehospital hydroxocobalamin administration via a survey of emergency medical services (EMS) and to report a case series from an EMS database to track use of hydroxocobalamin. The Fire Smoke Coalition Newsletter emailed a voluntary survey to EMS subscribers regarding hydroxocobalamin use. Survey responses were analyzed in addition to survival data from the Smoke Inhalation Treatment Database (SITD), a publically available, self-reported, online database for EMS regarding smoke inhalation patient outcomes. Analysis was compared to current published data from PubMed. The survey had a 14% response rate (284/2000). Only 38% reported prehospital utilization of a hydrogen cyanide antidote with 46% using hydroxocobalamin. 20% of responders reported a formal ALS protocol was in place for hydroxocobalamin use. For the SITD, 12 of 13 (92%) patients who received hydroxocobalamin for suspected inhalation survived. Other studies found a survival rate of 72% and 42% after administration of hydroxocobalamin for smoke inhalation. Prehospital administration of hydroxocobalamin for cyanide toxicity is uncommon in the United States, as evidenced by this analysis, despite well-documented safety and efficacy. Although a small sample, patients who received prehospital hydroxocobalamin had improved survival. This survival rate is significantly greater than those reported previously.

L'utilisation préhospitalière de l'hydroxocobalamine (OHB12) comme antidote du cyanure, intoxication grave compliquant les inhalations de fumées (IF), n'est toujours pas réalisée partout aux États-Unis, bien que son innocuité et son efficacité aient été démontrées dès 2006. Les buts de cette étude était de caractériser l'utilisation préhospitalière d'OHB12 à travers les données des services d'urgences (SU) et de rapporter une série de cas issus de leurs dossiers. La « Fire Smoke Coalition Newsletter ¼ a proposé par courriel aux services d'urgence abonnés un étude sur l'utilisation d'OHB12, basée sur le volontariat. En plus des réponses, nous avons analysé les données de la « Smoke Inhalation Treatment Database ¼ (STID), banque de données publique abondée par les SU, colligeant le devenir des patients victimes d'une IF et les avons comparées aux données de la littérature, retrouvée dans PubMed. Le taux de réponse au questionnaire a été de 14% (284/2 000). Trente huit pour cent des répondeurs utilisent des antidotes au cyanure en préhospitalier, qui est OHB12 dans 46% des cas. Vingt pour cent des répondeurs attestent de l'existence d'un protocole formalisé quant à l'utilisation d'OHB12. Selon STID, 92% (12/13) des patients ayant reçu OHB12 ont survécu. D'autres études retrouvent des taux de survie de 72% et 42% après administration de OHB12 dans le cadre de l'IF. Cette étude confirme que l'utilisation préhospitalière d'OHB12 dans le cadre de l'intoxication au cyanure n'est pas habituelle aux États-Unis, malgré une efficacité et une innocuité reconnues. Bien que l'échantillon soit faible, les patients ayant reçu OHB12 en préhospitalier ont un taux de survie nettement amélioré par rapport à ceux précédemment rapportés.

Time-resolved soft x-ray spectra from laser-produced Cu plasma.

The volumetric heating of a thin copper target has been studied with time resolved x-ray spectroscopy. The copper target was heated by a plasma produced using the Lawrence Livermore National Laboratory's Compact Multipulse Terawatt (COMET) laser. A variable spaced grating spectrometer coupled to an x-ray streak camera measured soft x-ray emission (800-1550 eV) from the back of the copper target to characterize the bulk heating of the target. Radiation hydrodynamic simulations were modeled in two-dimensions using the HYDRA code. The target conditions calculated by HYDRA were post-processed with the atomic kinetics code CRETIN to generate synthetic emission spectra. A comparison between the experimental and simulated spectra indicates the presence of specific ionization states of copper and the corresponding electron temperatures and ion densities throughout the laser-heated copper target.

High-density baiting with ONRAB® rabies vaccine baits to control Arctic-variant rabies in striped skunks in Ontario, Canada.

The Arctic variant of rabies virus has been maintained in striped skunks in small foci in southwestern Ontario, Canada, despite the control of the disease in red foxes. To control the disease in skunks, high-density baiting with ONRAB(®) oral rabies vaccine baits was conducted by air and by hand distribution of baits in the vicinity of skunk cases. During 2009, antibody prevalences in skunks were higher in areas baited at a density of 300 baits/km(2) and flight-line spacing of 0.25 km than at 0.5-km spacing. Once an area containing Arctic-variant cases was treated with high densities of ONRAB baits, the disease did not reoccur in skunks in those areas. During 2009, only eight skunks were diagnosed with the Arctic variant of rabies virus in Ontario.

High resolution soft x-ray spectroscopy of low Z K-shell emission from laser-produced plasmas.

A large radius, R=44.3 m, high resolution grating spectrometer (HRGS) with 2400 lines/mm variable line spacing has been designed for laser-produced plasma experiments conducted at the Lawrence Livermore National Laboratory Jupiter Laser Facility. The instrument has been run with a low-noise, charge-coupled device detector to record high signal-to-noise spectra in the 10-50 A wavelength range. The instrument can be run with a 10-20 microm wide slit to achieve the best spectral resolving power, approaching 1000 and similar to crystal spectrometers at 12-20 A, or in slitless operation with a small symmetrical emission source. We describe preliminary spectra emitted from various H-like and He-like low Z ion plasmas heated by 100-500 ps (full width at half maximum), 527 nm wavelength laser pulses. This instrument can be developed as a useful spectroscopy platform relevant to laboratory-based astrophysics as well as high energy density plasma studies.

Factor structure of the McCarthy scales for males and females.

Determined the factor structure of the McCarthy Scales (1972) for a referred group of male and female children, ages 6 to 81/2, from rural eastern North Carolina and compared their factor structure to that of the standardization sample. Three hundred and one males and 177 females were separated into two groups and examined independently. The 21 individual test scores of the McCarthy were correlated and then subjected to a principal factor analysis followed by Varimax rotation. Three meaningful factors emerged for males and females: Verbal, Perceptual, and Motor factors for males and General-Cognitive, Verbal, and Memory factors for females. The factor analyses for males and females agreed with previous factor analytic studies conducted with referred samples on the absence of a Quantitative factor and inconsistencies in the emergence of General-Cognitive and Memory factors. Coefficients of congruence with Kaufman's (1975) standardization analysis suggest that the McCarthy Scales reflect a general dimension of cognitive ability rather than a measure of distinct abilities for a referred sample of males and females.

Five-year winter chemoprophylaxis for chronic bronchitis.

Seventy-nine patients with chronic bronchitis were randomly allotted to four treatment regimens-placebo throughout the winter months for five years; tetracycline for the first two winters and placebo for the next three; placebo for the first two winters and tetracycline for the next three; and tetracycline for five winters. In addition all groups recevied a five-day course of tetracycline for any acute exacerbation. There was a significant reduction in the number of exacerbations among the more susceptible patients-that is, those who suffered more than one exacerbation each winter. Though the average decline in F.E.V.(1) over the five-year period was less in the treated groups this was not statistically significant. There was no significant difference between the groups in respect of lung volumes, diffusing capacity, and blood gases.