All JTQ devices performed poorly during transport. Combined, present findings highlight the potential of JTQ products for saving lives threatened by junctional wounds, but also highlight the need for specific product improvements towards fostering JTQ performance in patient transport.

Introduction Prolonged field care for junctional wounds is challenging and involves limb movement to facilitate transport. No studies to date have explored the efficacy of gauze products to limit rebleeding in these scenarios. Materials and Methods We randomly assigned 48 swine to QuikClot Combat Gauze, ChitoGauze, NuStat Tactical, or Kerlix treatment groups (12 each) and then inflicted a severe groin injury by utilizing a modified Kheirabadi model of a 6-mm femoral artery punch followed by unrestricted bleeding for 60 seconds. We reassessed rebleed following limb movement at 30 minutes of stabilization and 4 hours after stabilization. Results Swine treated with Combat Gauze proved to have the lowest incidence of rebleeding, and conversely, NuStat Tactical had the highest incidence of rebleeding at wounds after limb movement. Importantly, rebleeds occurred at a rate of 25%-58% across all swine treatment groups at 30 minutes postinjury and 0%-42% at 270 minutes postinjury demonstrating that limb movements universally challenge hemostatic junctional wounds. Conclusions Our findings highlight the difficulty of controlling hemorrhage from junctional wounds with hemostatic gauze in the context of prolonged field care and casualty transport. Our research can guide selection of hemorrhage control gauze when patients have prolonged field extraction or difficult transport. Our data demonstrates the frequency of junctional wound rebleeding after movement and thus the importance of frequent patient reassessment.

In this data set, adolescent methamphetamine exposures were associated with increased rates of suicidal ideation and suicide attempts that are disproportionate to population-based surveys during the same period.

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of door-to-imaging. We chose door-to-imaging time because it is an objective measure of adherence to the American Heart Association Get With The Guidelines program and is primarily under the control of ED work environment and personnel.Methods: This was a retrospective analysis of prospectively collected registry data for all patients who presented to the ED of our urban, academic, regional stroke center between June 15, 2014 and June 14, 2015 for whom the stroke team was activated. Trained abstractors reviewed the medical record for each patient in the registry to validate the registry data. Our primary outcome was the binary variable of arrival-to-CT complete time (ie, images available) within 25 minutes. We considered a number of candidate predictors including age, sex, arrival hour of day, day of week, month, year, initial vital signs, initial glucose, initial Glasgow Coma Scale, mental status, National Institutes of Health Stroke Scale, time since symptom onset, prior documented stroke/TIA, diabetes, or hypertension, arrival mode, triage Emergency Severity Index (ESI) score, and whether the care was initiated in a resuscitation room. We fit a multivariate logistic regression model using stepwise backward elimination to minimize the Bayesian information criterion with maximum likelihood estimation. Odds ratios and 95% confidence intervals were calculated using exponentiation from the regression parameter estimates.Results: Of 490 registry patients, 27 were excluded due to delays in imaging due to emergent conditions other than acute stroke, most commonly airway management. Of the included patients, 207 (45%) had a final ED diagnosis of stroke or intracranial hemorrhage, 303 (65%) were admitted to neurology or neurocritical care, and 46 (9.9%) received thrombolytics or a neurointerventional procedure. Variables found to be significant in the final regression model are listed in Table 1 with multivariate odds ratios for arrival-to-CT within 25 minutes. Overall, the regression model performed well (area under the curve of 0.90).Conclusion: Of the variables considered, female sex was associated with the lowest odds ratio of timely door-to-imaging in acute stroke. It was also the only predictor not related to care process or vital signs. Prior literature is conflicting; however, these results provide evidence that sex may impact initial management of stroke patients more than currently recognized, warranting further prospective investigation.