Purpose Ferumoxytol, an ultrasmall superparamagnetic particle of iron oxide, was suggested as a potential alternative MRI contrast agent in patients with renal failure. We compared ferumoxytol to gadoteridol enhancement on T1- and T2-weighted MRI in CNS pathology to explore its diagnostic utility. Materials & Methods Data were collected from 3 IRB-approved HIPAA-compliant protocols in 70 adults who underwent alternate day post-gadoteridol and post-ferumoxytol MRI using identical parameters. Two neuroradiologists measured lesion enhancing size and intensity on post-contrast T1-weighted acquisitions in consensus. T2-weighted images were evaluated for the presence of post-contrast hypointensity. Mixed model repeated measures analysis of variance determined differences between T1 – weighted enhancement size and intensity for individual protocols and group. Results Following exclusions, 49 MRI studies in 29 males and 20 females (mean age 51 years) were assessed. T1-weighted estimated enhancing sizes were different between agents (p = 0.0456) as a group, however no differences were observed with untreated gliomas (n=17) on two protocols (p = 1.0, 0.99 respectively). Differences in T1-weighted enhancement intensity between agents were significant for the group (p = 0.0006) until interactions of protocol and agent were considered (non-significant). T2-weighted images were assessed for post-contrast hypointensity, observed in 26/51 (51%) of ferumoxytol and 0/51 (0%) of gadoteridol scans. Conclusion Ferumoxytol may be a useful MRI contrast agent in patients unable to receive gadolinium-based contrast agents (GBCA). Greater experience with a wider variety of pathology is necessary in order to understand differences in enhancement with ferumoxytol compared to GBCA given different mechanisms of action.

While BP decreased significantly in patients undergoing GA for acute stroke intervention, it did not correlate with patient outcome. Decreases in ETCO2 at 30 and 60 min, however, were associated with 90-day mRS.

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Introduction: A majority of residents provide care for critically ill patients, yet only a minority of medical schools require ICU rotations. Therefore, many medical students enter residency without prior ICU experience. The third-year internal medicine (IM) clerkship at our institution's Veterans Affairs Medical Center (VAMC) provided an opportunity for medical students to rotate through an open ICU as part of their inpatient ward rotation. Prior to March 2019, no structured critical care curriculum existed within the IM clerkship to prepare students for this experience. Methods: We created a seven-session ICU curriculum integrated within the VAMC IM clerkship addressing core critical care topics and skills including bedside presentations, shock, and respiratory failure. IM residents facilitated the curriculum's case-based, small-group discussions. We assessed curricular efficacy and impact with a pre-and posttest and end-of-curriculum survey. Results: Forty-one students participated in the curriculum from March to November 2019. As a result, students agreed that their overall clerkship experience improved (73% strongly agree, 24% agree). Students also reported increased comfort in their ability to participate in the management of critically ill patients (44% strongly agree, 51% agree). Objectively, student performance on a 15-question pre-and posttest improved from a precurricular average of 7.5 (50%) questions correct to a postcurricular average of 10.7 (71%) questions correct (p <.0001; CI 2.2-4.4). Discussion: Following implementation of our ICU curriculum, medical student attitudes regarding overall IM clerkship experience, self-perceived confidence in critically ill patient management, and medical knowledge all improved.

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