Aim: Pulmonary haemorrhage (PH) is an acute catastrophic event with low incidence yet high mortality among neonates. We aimed to systematically review the management of PH. Methods:A search was carried out of the PubMed, EMBASE and Cochrane databases according to the PRISMA guidelines. Data were extracted on study design and size, patient demographics, primary and adjunctive treatment methods, and treatment outcomes.Results: Sixteen studies with 385 newborn infants were included and were significantly heterogeneous regarding treatment methods. Primary treatments included surfactant, high-frequency oscillatory ventilation (HFOV), epinephrine, coagulopathy management, intermittent positive pressure ventilation, cocaine and tolazoline.Adjunctive treatment methods included blood products, HFOV, increased positive end-expiratory pressure, vitamin K, surfactant, adrenaline, vasopressors and inotropes. All five studies using surfactant as primary treatment were effective in improving oxygenation index measures and preventing recurrence of PH, and three studies found no association between surfactant and death or long-term disability.Ventilatory support, epinephrine, management of coagulopathy and tolazoline were all found to be effective primary treatments for PH. Conclusion:There are several effective methods of managing PH in neonates. Further understanding of the aetiology of PH and ongoing research will allow future prevention and improvements in management of PH.

A 52-year-old male was discovered supine on his bed in a state of early decomposition. Commercial strychnine-treated gopher pellets were found in the home, and suicide notes were present at the scene. Biological fluids and tissues were tested for basic, acidic, and neutral drugs using gas chromatography-mass spectrometry. Concentrations of strychnine in heart and femoral blood were 0.96 and 0.31 mg/L, respectively. Vitreous fluid, bile, urine, liver, and brain specimens contained 0.36 mg/L, 1.17 mg/L, 2.92 mg/L, 4.59 mg/kg, and 0.86 mg/kg strychnine, respectively. No other drugs were detected in any of the samples. The cause of death was attributed to rodenticide poisoning, and the manner of death was suicide.

BACKGROUND AND PURPOSE: Delays to reperfusion negatively impact outcomes of patients with ischemic stroke, yet current guidelines recommend selective sequential imaging for thrombectomy candidates. We aimed to quantify and analyze time delays associated with rescanning in sequential acute stroke imaging. MATERIALS AND METHODS:This was a retrospective cohort study of consecutive patients with acute ischemic stroke who underwent imaging for treatment decision-making from January 1, 2017, to June 30, 2020. Rescan time delay was defined as $10-minute difference between initial NCCT and CTA 6 CTP. Mean rescan time delays in comprehensive and primary stroke centers were compared. Bivariate and multivariable regression analyses assessed clinical and imaging factors associated with rescanning time delays and early outcomes.RESULTS: A total of 588 patients with acute ischemic were included in statistical analyses. Rescanning occurred in 27.9% (164/588 patients), with a mean time delay of 53.7 (SD, 43.4) minutes. For patients presenting at primary compared with comprehensive stroke centers, rescan time delays were more common (59.6% versus 11.8%, P , .001), with longer delays (65.4 [SD, 45.4] minutes versus 23.6 [SD, 14.0] minutes, P , .001). Independent predictors of rescan time delays included primary stroke center presentation, intravenous thrombolysis administration, black race, admission NIHSS $10, baseline independent ambulation, and onset-tocomprehensive stroke center arrival in $6 hours. Protocols for early simultaneous comprehensive CT (NCCT 1 CTA 1 CTP) were associated with lower odds of time delays (OR = 0.34; 95% CI, 0.21-0.55). Rescanning was associated with lower odds of home discharge (OR ¼ 0.53; 95% CI, 0.30-0.95). CONCLUSIONS:A sequential approach to CT-based imaging may be significantly associated with prolonged acute stroke evaluations. Adoption of early simultaneous comprehensive CT could minimize treatment delays and improve outcomes.

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