CDC field triage criteria accurately predicts outcomes in high impact trauma

BACKGROUND

The precision of emergency medical services (EMS) triage criteria dictates whether an injured patient receives appropriate care. The trauma triage protocol is a decision scheme that groups patients into triage categories of major, moderate and minor. We hypothesized that there is a difference between trauma triage category and injury severity score (ISS).

METHODS

This retrospective, observational study was conducted to investigate a difference between trauma triage category and ISS. Bivariate analysis was used to test for differences between the subgroup means. The differences between the group means on each measure were analyzed for direction and statistical significance using ANOVA for continuous variables and chi square tests for categorical variables. Logistic and linear regressions were performed to evaluate factors predicting mortality, ICU length of stay.

RESULTS

With respect to trauma triage category, our findings indicate that minor and moderate triage categories are similar with respect to ISS, GCS, ICU LOS, hospital LOS, and mortality. However, after excluding for low impact injuries (falls), differences between the minor and moderate categories were evident when comparing to ISS, GCS, ICU LOS, and hospital LOS. Additionally, after excluding for low impact injures, ISS, ICU LOS, and hospital stay were found to correlate well with trauma triage category.

CONCLUSIONS

In this retrospective, observational study significant differences were not seen when comparing ISS with the trauma triage categories of moderate and minor during our initial analysis. However, a difference was found after excluding for low impact injuries. These findings suggest that CDC criteria accurately predicts outcomes in high impact trauma.

High Blood flow Rates with Adjustment of Needle Diameter do not Increase Hemolysis during Hemodialysis Treatment

Background

Higher blood flow in dialysis therapy is often avoided due to concerns about shear-induced blood damage despite the lack of reliable data.

Objective

This study investigated the influence of higher blood flow rates on plasma free hemoglobin (Hb) concentration after hemodialysis (HD) treatment.

Methods

Thirty-two chronic HD patients were treated once with a blood flow rate of 250 mL/min using a 17G needle, and once with a blood flow rate of 500 mL/min using a 14G needle. Arterial and venous pressure and blood pressure (BP) were recorded before and after treatment. Blood samples were taken before and after treatment for analysis of plasma free Hb, pH, HCO3, base excess, hematocrit value, urea, sodium, potassium and calcium.

Results

HD treatment at blood flow rates of 500 mL/min did not increase plasma free Hb compared to treatments at blood flow rates of 250 mL/min. Frequency of intradialytic BP drops was not different either. By adaptation of the needle size, negative arterial pressure could be kept at a similar level. Urea reduction rates were significantly higher during treatments with higher blood flow rates.

Conclusion

Higher blood flow rates can be applied without an increased hemolysis risk provided that needle sizes are adapted accordingly.

Endoparasitosen bei Kleinsäugern aus privater Haltung und Igeln

Gegenstand der Untersuchung: Der vorliegenden Arbeit liegen labordiagnostische Befunde (2002–2004) von Kot-, Serum- und Urinproben der Kleinsäuger Kaninchen, Meerschweinchen, Frettchen, Hörnchen, Degu, Chinchilla, Ratte, Maus und Hamster aus privater Haltung sowie von Igeln zugrunde. Ziel/Problemstellung: Mithilfe einschlägiger parasitologischer Diagnoseverfahren wurden von Tierärzten eingesandte Proben auf Endoparasiten untersucht, um einen Überblick über Vorkommen und Häufigkeit der verschiedenen parasitären Erreger bei den unterschiedlichen Tierarten zu bekommen. Ergebnisse: Die wichtigsten Endoparasitosen der kleinen Heimsäuger und Igel sind Kokzidiose, Enzephalitozoonose, verschiedene Helminthosen sowie Giardiose. Die koprologische Untersuchung ergab einen negativen Befund bei 73,9% der Kaninchen-, 94,3% der Meerschweinchen-, 90,8% der Frettchen- und 29,0% der Igelproben. Andererseits waren 63% der Kaninchen serologisch positiv für Encephalitozoon cuniculi und 66,6% der Chinchillas zeigten einen positiven Giardienbefund. Schlussfolgerung: Heimtiere erfreuen sich immer größerer Beliebtheit. Dies erfordert eine intensive Beschäftigung mit deren Parasitenbefall, auch wenn die Prävalenzen oft gering sind. Die Kenntnis über die praxisrelevanten Endoparasiten beim Kleinsäuger, ihr Vorkommen und ihre Häufigkeit bei den verschiedenen Tierspezies machen eine adäquate Diagnostik und effiziente, zielführende Therapie erst möglich, wodurch parasitäre Erreger rasch und nachhaltig abgetötet werden und zum Beispiel gastrointestinale Störungen rasch abklingen.

Evaluierung von Vorratsmilben in kommerziellem Hundetrockenfutter und in der Umgebung sowie ihre Bedeutung in der Tiermedizin

Gegenstand und Ziel: Dieser Artikel gibt eine Literaturübersicht über Vorratsmilben und ihre Bedeutung in der Tiermedizin. Weiterhin präsentiert er Ergebnisse aus einer eigenen Studie, deren Ziel es war herauszufinden, ob Vorratsmilben im Trockenfutter oder in der direkten Umgebung von Hunden vorkommen. Material und Methode: Im ersten Teil der Studie wurden 23 Hundefuttersäcke über einen Zeitraum von sechs Wochen mittels mikroskopischer Untersuchung auf eine Kontamination mit Vorratsmilben überprüft. Im zweiten Teil der Studie erfolgte eine Untersuchung von Staubproben aus 20 unterschiedlichen Haushalten mit gesunden Hunden auf eine Kontamination mit Vorratsmilben. Ergebnisse: In keiner Futterprobe fanden sich Vorratsmilben. In fünf der insgesamt 40 untersuchten Staubproben waren Milben verschiedener Spezies nachweisbar: Dermatophagoides pteronyssinus (4/40), kurzschwänzige Demodex-Milbe (1/40) und Vorratsmilbe (1/40). Schlussfolgerung: Die Ergebnisse lassen vermuten, dass Vorratsmilben kommerzielles Hundetrockenfutter nicht kontaminieren, aber im Hausstaub vorkommen können. Klinische Relevanz: Bei den meisten Hunden mit positiven Serum- oder Hauttestreaktionen gegen Futtermilben wird eine Änderung der Fütterung keinen Einfluss auf die klinische Symptomatik haben.

Effect of high wavelengths low intensity light during dark period on physical exercise performance, biochemical and haematological parameters of swimming rats

Nocturnal rodents should be assessed at an appropriate time of day, which leads to a challenge in identifying an adequate environmental light which allows animal visualisation without perturbing physiological homeostasis. Thus, we analysed the influence of high wavelength and low intensity light during dark period on physical exercise and biochemical and haematological parameters of nocturnal rats. We submitted 80 animals to an exhaustive exercise at individualised intensity under two different illuminations during dark period. Red light (> 600 nm; < 15lux) was applied constantly during dark period (EI; for experimental illumination groups) or only for handling and assessments (SI; for standard illumination groups). EI led to worse haematological and biochemical conditions, demonstrating that EI alone can influence physiological parameters and jeopardise result interpretation. SI promotes normal physiological conditions and greater aerobic tolerance than EI, showing the importance of a correct illumination pattern for all researchers that employ nocturnal rats for health/disease or sports performance experiments.

[2+3] Cycloaddition Reactions of Azido Metal Complexes and Crystal Structure of the Cycloadduct of (Ρh3Ρ)2Pd(Ν3)2 with Benzonitrile

Cycloaddition reactions of (R3P) 2M(N3)2 (M = Pd, Pt) with organic nitriles, thiocyanates, isothiocyanates, dimethylacetylenedicarboxylate and carbon disulphide are described; an X-ray analysis of the crystal structure of bis (5-phenyltetrazolato) -bis (triphenylphosphine) palladium (II) is summarised and related to isomerism of the complex in solution.

14N-Kernresonanzmessungen an Isonitril- und Nitril-Metallkomplexen

14N chemical shifts are reported for nitriles, isocyanides and complexes with nitriles, isocyanides, and isohydrocyanic acid.

The correlation of the 14N coordination shifts with the metal-ligand back bonding as known from IR-investigations is discussed.

While pi bonding seems to be insignificant in isocyanide complexes with metal cations, such as Fe2⊕, 14N-NMR measurements suggest an increase of pi bond order on going from isocyanide carbonyl complexes to compounds in which isonitriles are the only ligands bound to zerovalent metals

Über Reaktionen organischer Radikale mit Palladium- und Platinkomplexen / Reactions of Organic Radicals with Palladium and Platinum Complexes

Preparation, IR- and EPR-spectra of paramagnetic dichloro-porphyrexid-palladium(II) from porphyrexid and sodium-tetrachloropalladate are reported.

The reaction of organic radicals with tetrakis (triphenylphosphine) platinum (O) provides a new type of oxydative addition. Treatment of Pt (PPh3)4 with 1,2-diphenyl-2-picrylhydrazyl yielded diphenylamido-2,4,6-trinitrophenyl-bis (triphenylphosphine) platinum (II). Dibenzoylperoxide yielded cis-dibenzoato-bis (triphenylphosphine) platinum (II), whereas with diaryl- and dialkylnitrogenoxide and tetraarylhydrazine no reaction was observed.

Notizen: Zur Kenntnis der Nitrosylhalogenide von Eisen und Kobalt

Im Sinne der bereits früher aufgestellten Systematik der Nitrosylmonohalogenide der Eisengruppe konnte durch neuere Untersuchungen festgestellt werden, daß sich den (vermutlich) tetrameren Mononitrosyl-Nikkelhalogeniden [Ni(NO)X]4 und den dimeren Dinitrosyl-Kobalthalogeniden [Co(NO)2X]2 die vollständige Reihe der monomeren Trinitrosyl-Eisenhalogenide Fe(NO)3X (X=Cl, Br, J) anschließt. Diese Verbindungen zersetzen sich leicht unter Stickoxydabgabe, jedoch nimmt wie bei den Eisentetracarbonylhalogeniden Fe(CO)4X2 die Beständigkeit in der Richtung Fe(NO)3Cl → Fe(NO)3Br → Fe(NO)3J zu. Für die untersuchten Verbindungen werden Strukturmodelle vorgeschlagen. Sie werden durch Dipolmessungen, die zugleich frühere Anschauungen über den Bindungscharakter der Metall-NO-Bindung bestätigen, gestützt

Röntgenphotoelektronenspektroskopische Untersuchungen an einigen planaren Pseudohalogeno-d8-Übergangsmetallkomplexen / X-ray Photoelectron Spectra of Some Planar Pseudohalogeno-d8-Transition Metal Complexes

X-ray photoelectron spectra, pseudohalide complexes of gold (III), linkage isomerism

Core binding energies of metals in the isomeric (Ph3As) 2Pd (NCS) 2 and (Ph3As) 2Pd (SCN) 2, and in [AsPh4] [AuX4] (X = CN-, tetrazolate, Cl-, N3 -) are reported. S- and N-Bonding mode can be distinguished in accord with semiemperical MO-calculations. XPS-results are correlated with Mößbauer spectra and the metal-cyanide and metal-tetrazolate bonds are discussed.

Effects of maximum intensity aerobic swimming exercise until exhaustion at different times of day on the hematological parameters in rats

The aims of this study were: a) to analyze the time of day effect on the aerobic capacity and time to exhaustion at aerobic capacity intensity (TE), and b) to analyze the physiological impact of handling and exercise testing during the light and dark periods, based on hematological parameters. Eighty rats were randomly divided into two control groups (C12 and C20) and two exercise groups (E12 and E20), assessed at 12:00 h (C12 and E12) or 20:00 h (C20 and E20). The lactate minimum intensity (LMi) was measured and after 48 h the exercise groups were subjected to a bout of swimming until exhaustion at LMi (TE). The TE was 1.30 ± 0.51 h for the E12 group and 1.81 ± 0.77 h for the E20 group (p = 0.03). The time of day effect was significant for all white blood cell counts (12:00 h > 20:00 h). Chronic handling and performing exercise tests at 12:00 h (light period) resulted in an increased WBC counts and decreased exercise tolerance. The favorable time of day for aerobic capacity and performance assessment and hematological parameters was at 20:00 h (dark period), which is associated with the wakefulness period of the assessed animals.

Occurrence of a house-infesting Tropical rat mite (Ornithonyssus bacoti) on murides and human beings

In Germany there is little information available about the distribution of the Tropical rat mite (Ornithonyssus bacoti) in rodents. A few case reports show that this haematophagous mite species may also cause dermatitis in man. All developmental stages are exclusively bloodfeeder. Three children (4, 11 and 15 years old) of a family and a 23-year-old medical student were attacked by the Tropical rat mite. Prior to the consultation of our institution, the patients' conditions had been diagnosed as allergic dermatitis of unclear origin and treated by several antiphlogistic agents, however without success. The conclusive diagnosis, Tropical rat mite dermatitis, was based on the identification of the arthropod Ornithonyssus bacoti in the flats of the patients (husbandry of gerbils, etc.). The diagnosis of a Rat mite dermatitis requires the detection of the parasite, which is more likely to be found in the environment of its host than on the hosts' skin itself.

High blood flow rates with adjustment of needle diameter do not increase hemolysis during hemodialysis treatment

BACKGROUND

Higher blood flow in dialysis therapy is often avoided due to concerns about shear-induced blood damage despite the lack of reliable data.

OBJECTIVE

This study investigated the influence of higher blood flow rates on plasma free hemoglobin (Hb) concentration after hemodialysis (HD) treatment.

METHODS

Thirty-two chronic HD patients were treated once with a blood flow rate of 250 mL/min using a 17G needle, and once with a blood flow rate of 500 mL/min using a 14G needle. Arterial and venous pressure and blood pressure (BP) were recorded before and after treatment. Blood samples were taken before and after treatment for analysis of plasma free Hb, pH, HCO3, base excess, hematocrit value, urea, sodium, potassium and calcium.

RESULTS

HD treatment at blood flow rates of 500 mL/min did not increase plasma free Hb compared to treatments at blood flow rates of 250 mL/min. Frequency of intradialytic BP drops was not different either. By adaptation of the needle size, negative arterial pressure could be kept at a similar level. Urea reduction rates were significantly higher during treatments with higher blood flow rates.

CONCLUSION

Higher blood flow rates can be applied without an increased hemolysis risk provided that needle sizes are adapted accordingly.

Outbreak of Tropical Rat Mite (Ornithonyssus bacoti) Dermatitis in a Home for Disabled Persons

Five mentally handicapped individuals living in a home for disabled persons in Southern Germany were seen in our outpatient department with pruritic, red papules predominantly located in groups on the upper extremities, neck, upper trunk and face. Over several weeks 40 inhabitants and 5 caretakers were affected by the same rash. Inspection of their home and the sheds nearby disclosed infestation with rat populations and mites. Finally the diagnosis of tropical rat mite dermatitis was made by the identification of the arthropod Ornithonyssus bacoti or so-called tropical rat mite. The patients were treated with topical corticosteroids and antihistamines. After elimination of the rats and disinfection of the rooms by a professional exterminator no new cases of rat mite dermatitis occurred. The tropical rat mite is an external parasite occurring on rats, mice, gerbils, hamsters and various other small mammals. When the principal animal host is not available, human beings can become the victim of mite infestation.

Evaluation of the Polyflux® 6H Dialyzer in Pediatric Patients Receiving Maintenance Hemodialysis

Hemodialysis remains the only life sustaining maintenance renal replacement therapy option for children who cannot undergo expeditious renal transplantation or who are not medical candidates for peritoneal dialysis. Provision of maintenance hemodialysis to small children entails many challenges, which arise from the limited choices for appropriately sized disposable dialysis treatment components. The dialysis extracorporeal circuit volume, comprised of the blood tubing and dialyzer, should be low enough to prevent hypotension and prevent the need for repeated blood transfusions. We performed a market acceptance evaluation of the Polyflux® 6H dialyzer (0.6 m2 membrane surface area; Gambro® Renal Products, Lakewood, Colorado) in six pediatric patients (3 male, 3 female, mean weight 24.4+6.5 kg, mean age 10.3+3.8 yrs). We found that the Polyflux® 6H Dialyzer provided a trend for improved clearance compared to Fresenius F3 and F4 dialyzers. We found that the Polyflux® 6H Dialyzer provided adequate clearance for children up to 24 kg in size and is a suitable dialyzer choice for patients 13 to 26 kg in size.

Qualitative and quantitative observations on the flea population dynamics of dogs and cats in several areas of Germany

From an ongoing country-wide study on the spectrum, the epidemiology and the population dynamics of flea infestations in dogs and cats, important preliminary results from the three areas of Karlsruhe, Nuernberg and Leipzig are presented. A total of 1922 dogs and 1838 cats from 12 different veterinary practices or clinics in three areas of Germany were systematically examined between July 2003 and June 2004. All dogs and cats appearing for a clinical veterinary consultation on one regular working day per month, per practice, were clinically examined. Dogs and cats were examined irrespective of any kind of prior therapeutic or prophylactic insecticidal treatment. The results show that a total of 99 dogs (5.13%) and 263 cats (14.33%) were infested. Cats were more often flea-infested than dogs (p < 0.05). The highest infestation rates for dogs (x = 7.87%) were detected between July and October, and for cats (x = 21.14%) between July and September, the lowest infestation rates for dogs (x = 2.88%) were observed between November and May, and for cats (x = 12.16%) between November and April (p < 0.05). Although the prevalences were generally higher during the summer months, no statistical differences were detectable when looking at the pattern between the four seasons, neither for dogs, nor for cats. Interestingly, the highest prevalences in dogs (9.9%) were detected in June 2004 and comparatively, in cats (23.86%) in August. The lowest detection rates in dogs were seen (1.28%) in April and in cats (7.26%) in January. The preliminary results did not indicate any tendency for a relationship between climatic conditions and flea infestation rates. Similarly, no differences of the infestations rates were detectable between urban and rural areas, 56% (dogs) and 46% (cats) of the infested pets originated from urban habitats. The flea species collected include Ctenocephalides felis, Ctenocephalides canis, Archaeopsylla erinacei, Pulex irritans, Ceratophyllus gallinae, etc. The overall frequencies reveal that C. felis was the most prominent species (81.5%), followed by C. canis (12.5%), A. erinacei (2.7%) and P. irritans (1.7%).