Non –communicable diseases (NCDs), primarily cardiovascular diseases, cancer, respiratory diseases and diabetes, are significantly increasing globally. According to the WHO, cardiovascular diseases alone account for 17.5 million deaths annually- the most of any NCD.
If someone has return of spontaneous circulation after cardiac arrest, but does not have ST-elevations on their post-arrest ECG, should you emergently activate the cath lab?
In a just released systematic review and meta-analysis in Resuscitation, Dr. Millin and colleagues found that almost one third of patients successfully resuscitated without ST elevation on their ECG had a culprit lesion that would benefit from emergent intervention.
Bottom Line: While this is not definitive proof to emergently activate the cath lab for a NSTEMI, it is another strong indication that post cardiac arrest patients without ST elevation may benefit from emergent percutaneous coronary intervention.
Bottom Line:
July 2016 was the hottest month ever recorded. As the temperature of the planet continues to rise, changes in infectious disease patterns of transmission are likely to occur. Many formerly exotic diseases, such as Zika, West Nile, malaria and cholera are spreading to new areas. Some of these are now found in the United States. Below is a table (from M. L. Wilson) that exemplifies how environmental changes can impact infectious diseases.
Bottom Line: Remain vigilant for unusual infectious diseases, especially among travelers. However recognize that many diseases have the potential to spread to the U.S., especially considering ongoing environmental changes.
An Arbovirus is a virus transmitted primarily by an arthropod
There are a number of major arbovirus families:
The main viral family that causes substantial human disease is the Flaviviridae family.
Just the Facts:
112.5-million blood donations globally and half of these come from High-income countries
High-income countries more often use blood for supportive care during surgery, in traumas or therapy for malignancies
Low and middle-income countries more often use blood to manage pregnancy-related complications or in severe childhood anemia
General availability of blood is based on the donation rate
High-income countries have 33.1 donations/1000 people
Middle-income countries have 11.7 donations/1000 people
Low-income countries have 4.6 donations/1000 people
70 countries reported collecting fewer than 10 donations per 1000 people and half of these countries were in the African region
Disease prevalence in the region is reflected in the transmission rate of transfusion-transmissible infections (TTI)
Table 1. Prevalence of TTIs in blood donations (Median, Interquartile range (IQR)), by income groups
|
| HIV | HBV | HCV |
|
|---|---|---|---|---|
| High-income countries | 0.003% (0.001% – 0.040%) | 0.030% (0.008% – 0.180%) | 0.020% (0.003% – 0.160%) | |
| Middle-income countries | 0.120% (0.020% – 0.340%) | 0.910% (0.280% – 2.460%) | 0.320% (0.090% – 0.690%) | |
| Low-income countries | 1.080% (0.560% – 2.690%) | 3.700% (3.340% – 8.470%) | 1.030% (0.670% – 1.800%) |
Submitted by: Dr. Laura Diegelmann
There are many definitions for a disaster. Per the International Federation of Red Cross and Red Crescent Societies (IFRC), they define a disaster as:“…a sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources. Though often caused by nature, disasters can have human origins.”
However, in the heat of the moment, a shorter definition is easier to remember. The IFRC also define a disaster as:
A shorter, more practical definition is:
In consideration of the recent shootings in Orlando, Florida, how common are intentional homicides globally?
Please keep the families and friends of the victims of the Orlando events, as well as the many emergency workers who helped them, in your thoughts and prayers.
As we head into the summer travel season, it is important to know what potential dangers lurk out there for the unwary traveler. While injuries are usually the primary cause for death and disability for Americans abroad, what about other diseases?
The Centers for Disease Control and Prevention (CDC) has a webpage with travel health notices.
They are three types of notices:
Currently, there are a number of Level 1 watches and Level 2 alerts for different countries, but no Level 3 warnings. Many of the Level 2 alerts relate to Zika virus, but there are others for MERS, Yellow Fever and Polio.
To see more, go to: http://wwwnc.cdc.gov/travel/notices
The classification of blast injuries was first described by Zuckerman in 1941 and is still widely used today. This system organizes injuries by the mechanism through which they are sustained and classifies them as primary, secondary, tertiary and quaternary. These injuries may occur in isolation or in combination with each other.
| Category | Mechanism | Typical Injuries |
| Primary | Caused by blast wave of overpressure | Tympanic membrane rupture, blast lung, intestinal hemorrhage and rupture |
| Secondary | Caused by flying debris and shrapnel | Blunt and penetrating traumatic injuries
|
| Tertiary | Due to individual being thrown by blast | Blunt and penetrating traumatic injuries
|
| Quaternary | Thermal, toxic, and asphyxiant effects | Thermal burns, chemical burns, exposure to toxins, asphyxiation
|
The term quinary blast injury has also been used to describe delayed effects of explosions, such as infections, radiation exposure, and other toxic exposures.
Author: R. Gentry Wilkerson
Why are selfie deaths on the rise?
People travel everywhere now with their camera equipped smart phones. Capturing a selfie while travelling is very common. This leads to more distracted people and lack of situational-awareness.
Where and how do these deaths occur?
Selfies taken from a height, on a bridge, near motorized traffic, during thunderstorms, at sporting events and near wild animals
Other information:
Submitted by Dr. Laura Diegelmann
The terms and concepts of “waiver of informed consent’ versus “exception from informed consent” are often confused. Within the U.S., these concepts are not the same.
Bottom line:
Waiver of Informed Consent ≠ EFIC
These are the rules and regulations for the U.S. The regulations for emergency research in other countries may or may not be similar to these.
As noted previously, injuries cause substantial morbidity and mortality globally. How does it vary by age group?
The following table shows that unintentional injuries are the leading cause of death for individuals 1-44 years of age. Even when they are not the leading cause of death, injuries cause substantial mortality in all age groups.
Emergency medicine remains a relatively young and developing specialty in most parts of the world. However, it is growing in popularity, especially in the U.S. How competitive is it currently?
For the recent 2016 Match, there were 2476 applicants for 1895 categorical emergency medicine positions from 174 programs.
Bottom Line: Emergency medicine remains a highly desired and competitive specialty in the U.S.
Congratulations to all the incoming interns for the 2016-2017 year!
While the flu season this year has been mild, it is still important to recognize which patients are at high risk for flu-related complications:
During the influenza season, when admitting a patient who 1) has respiratory symptoms and 2) is at high risk for influenza complications, consider testing them for influenza.
What are the criteria for dengue hemorrhagic fever?
On February 1st, the World Health Organization declared that Zika was an international public health emergency. As noted in the Pearl from January 20th, 2016, Zika is a mosquito-borne RNA flavivirus that is usually asymptomatic. However, congenital malformations have been seen in pregnant women infected with Zika.
While it is clear that the decision to declare an international public health is a judgement call, what are the criteria for considering this declaration?
Per the WHO, the term Public Health Emergency of International Concern is defined in the IHR (2005) as “an extraordinary event which is determined, as provided in these Regulations:
· to constitute a public health risk to other States through the international spread of disease; and
· to potentially require a coordinated international response”. This definition implies a situation that: is serious, unusual or unexpected; carries implications for public health beyond the affected State’s national border; and may require immediate international action.
The responsibility of determining whether an event is within this category lies with the WHO Director-General and requires the convening of a committee of experts – the IHR Emergency Committee.
For Zika, the sequalae of concern are the clusters of microcephaly and Guillain-Barré syndrome suspected to have resulted from Zika infection.
Zika virus is a mosquito-borne flavivirus.
While outbreaks have been previously reported in Africa, Asia and the islands of the Pacific, it was first reported in the Western Hemisphere in May 2015.
Clinical Disease:
Diagnosis and Treatment
Prevention
Every year approximately 265,000 people die from burns
· The vast majority occur in low- and middle-income countries
o The rate of child death from burns is 7 times worse in low- and middle-income countries compared to high income countries
· Almost half of all fatal burns occur in the WHO South-East Asia Region
Non-fatal burns are a leading cause of global morbidity
· In 2004, almost 11 million individuals worldwide were burned badly enough to require medical attention
Unlike many other unintentional injuries, burns occur:
· Mainly in the home and workplace
o Women are at greater risk secondary to open fire cooking
· Approximately equally among men and women
o Most other injuries occur more frequently in men
Most burns are preventable. Developing an effective burn prevention plan involving multiple sectors is important. Per the WHO, the plan should be broad with efforts to:
· improve awareness
· develop and enforce effective policy
· describe burden and identify risk factors
· set research priorities with promotion of promising interventions
· provide burn prevention programmes
· strengthen burn care
· strengthen capacities to carry out all of the above.
In many countries, alcohol is commonly drunk for special occasions, such as New Year’s. What can be the consequences of drinking too much?
As noted in an article on the validation of the Dutch version of the brief young adult alcohol consequences questionnaire, the most common consequences were:
According to the Alcohol Hangover Research Group Consensus Statement on Best Practice in Alcohol Hangover Research, items 1, 2, 4, 6 and 9 are or may be related to hangovers.
Have an enjoyable, but safe New Year.
Synthetic cathinones, known as bath salts, are a frequently used street drug in the United States. They have been discussed in a number of previous pearls. But from where did cathinone originate?
Khat (Catha edulis) is flowing plant native to the Arabian Peninsula and the Horn of Africa. It contains the monoamine alkaloid cathinone, which is an amphetamine-like stimulant that also causes euphoria. Historically, khat has been chewed for thousands of years and predates the use of coffee. Khat chewing is particularly popular in Yemen.
Khat contains many different compounds, which cause a number of different effects. Many of these effects are considered harmful to health. Khat chewing primarily impacts the central nervous system and the gastrointestinal system. However, it also has effects on cardiovascular, respiratory, endocrine, and genitourinary systems. In addition to the amphetamine like central nervous effects, other toxic effects include elevated blood pressure, tachycardia, insomnia, anorexia, constipation and general malaise.
Next time you see a patient with confusion and hallucinations from Yemen, Ethiopia, Somalia and other countries around the Horn of Africa, consider Khat in your differential.
