Kilichobbs2187

Introduction Competency in and understanding of the factors impacting cardiopulmonary resuscitation (CPR) are key to emergency medicine. The purpose of this study was to assess the impact of the automated LUCAS-2 device on survival to emergency department (ED) compared to manual CPR as part of the EMS response using a large data set collected in a mostly rural U.S. state. Methods We conducted a retrospective analysis of South Dakota's electronic Patient Care Reports (ePCR) collected from Jan. 1, 2013 through Dec. 31, 2015. The primary outcome measure was survival to ED. Results A mechanical piston device (LUCAS-2), was utilized in 260 (15 percent) of 1,781 total cases during this period. The odds for survival to ED were calculated and compared between manual and LUCAS-2-assisted CPR. The odds ratio for survival to ED using compressions alone was 3.94 compared to LUCAS-2 and those results persisted after adjusting for significant covariates. Cediranib Discussion Despite hemodynamic benefits associated with the LUCAS-2 device in the laboratory and in other settings, this and other studies indicate that compression-only CPR outperforms automation-assisted CPR during OHCA. However, the data also suggest that enhanced training of emergency providers to improve response times and levels of expertise with the equipment may improve the outcomes associated with the LUCAS-2 and it is recommended that further training should be pursued.Birt-Hogg-Dube (BHD) syndrome is a rare condition that typically presents with a triad of benign cutaneous papules including fibrofolliculomas, pulmonary cysts and pneumothoraxes, and renal tumors. Though a rare disease, it is an important diagnosis so that monitoring for a renal neoplasm can begin. In this case report we discuss an asymptomatic patient diagnosed with BHD after undergoing a routine skin exam and highlight the importance of diagnosis so that routine screening can be implemented.Right heart thrombus (RHT) occurs secondary to deep venous thrombus in transit to pulmonary veins, intra cardiac devices and prosthetic valves. When RHT is present in a patient with pulmonary embolism (PE) it is generally shown to be associated with worse outcomes. Even though multiple trials have studied treatment of PE, the optimal treatment of PE associated with RHT is still largely based on clinical judgment. We present a 73-year- old female patient with submassive PE and right ventricular thrombus in transit, who was successfully treated with ultrasound guided catheter based thrombolysis.Introduction The purpose of this report was to determine the prevalence of safe sleep practices among South Dakota mothers, and the impact that education from their healthcare provider had on infant safe sleep practices as defined by the American Academy of Pediatrics (AAP). Method A population-based survey was administered to a random sample of mothers delivering in 2017. Data were weighted to obtain statewide and race-specific (white, non-Hispanic; American Indian; other races) prevalence rates. Results Weighted response rate was 67 percent, with 9.9 percent of mothers giving birth in 2017 completing a survey. Greater than 85 percent of mothers met recommendations regarding placing their infant on their back, breastfeeding, not consuming alcohol or illicit drugs during pregnancy, and attending 80 percent or more of prenatal visits. Less than 85 percent met recommendations regarding infant always sleeping alone on an approved sleep surface (30.8 percent), room-sharing without bed-sharing (44.3 percent), keeping soft objects and loose bed- ding out of crib (47.7 percent), and avoiding smoke exposure during and after pregnancy (82.1 percent). Only 7.7 percent of mothers met all eight recommendations. Healthcare providers talking to the mother about placing the infant to sleep in a crib and placing the crib in the mother's room were associated with a higher percent of mothers meeting these recommendations. Although the health care provider asking the mother if she was going to breastfeed was not associated with ever breastfeeding (p=0.95), if the mother received information from the doctor about breastfeeding she was slightly more likely to breastfeed than if she did not receive information (90.3 vs. 85 percent, p=0.06). Conclusions A low percentage of South Dakota mothers met all eight AAP safe sleep recommendations that could be assessed using these data. Health care providers can influence a mother's compliance with some of the safe sleeping recommendations.Introduction Schwannomas are benign neurogenic tumors that make up less than 1 percent of all gastrointestinal tumors. Schwannoma can occur along peripheral nerves anywhere throughout the body. Gastrointestinal schwannoma is relatively rare and most commonly occurs in the stomach, small intestine, and colon, respectively. There have only been a handful of case reports describing appendiceal schwannomas. Approximately 30-50 percent of appendicular tumors show clinical symptoms and signs similar to those of appendicitis. Case report A 36-year-old male presented initially for right lower quadrant pain of one day duration. He denied any other associated symptoms. CT imaging of abdomen and pelvis showed a fluid-filled and dilated appendix with fat stranding consistent with appendicitis. He underwent laparoscopic appendectomy without complication. The pathology report showed a well-defined proliferation of bland uniform cells that contained small smooth nuclei and abundant foamy cytoplasm at the tip of the appendix. Scattered eosinophils were noted. These neoplastic cells were positive for S100 and negative for CD68, CD34, and CD117, most consistent with a schwannoma. Discussion Diagnosing appendiceal schwannoma pre-operatively is a challenging task due to the rare nature of the tumors and the lack of clinical features to separate it from other appendiceal pathology. Appendiceal schwannomas are benign but it is unclear if malignant transformation is possible if left untreated. While there are currently no agreed upon treatment guidelines for appendiceal schwannoma, it is currently thought that complete surgical resection is the best treatment while chemotherapy and radiotherapy are not effective.