We describe the preparation and medical care for a large outdoor mass-gathering event held in a remote and austere environment. We met the stated goals of providing needed medical care while minimizing the need to transport attendees offsite for additional care. Our experience with Burning Man 2011 may aid planners with similar events.

CPAP using a low FiO(2) (28%-30%) was highly effective in the treatment of commonly encountered prehospital respiratory emergencies.

Three independent risk factors (immature gestation, absence of antenatal glucocorticoid exposure, and presence of the rs2817399(A) allele of the gene TFAP2B) are associated with patent ductus arteriosus (PDAs) that fail to close during prostaglandin inhibition. We hypothesized that these three factors may affect a common set of genes that increase the risk of persistent PDA after birth. We studied baboon ductus from term, preterm, and glucocorticoid-treated preterm fetuses and found that both immature gestation and absence of antenatal glucocorticoid exposure decreased RNA expression of calcium-and potassium-channel genes involved in oxygen-induced constriction, and phosphodiesterase genes (that modulate cAMP/cGMP signaling). Ductus obtained from second trimester human pregnancies were genotyped for TFAP2B polymorphisms. When present, the rs2817399(A) allele also was associated with decreased expression of calcium-and potassium-channel genes. In contrast, alleles of two other TFAP2B polymorphisms, rs2817419(G) and rs2635727(T), which are not related to the incidence of PDA after birth, had no effect on RNA expression. In conclusion, three calcium-and potassium-channel genes (CACNA1G/ alpha1G, CACNB2/CaL-beta2, and KCNA2/Kv1.2) were similarly affected by each of the PDA risk factors. We speculate that these channels may play a significant role in closing the preterm ductus during prostaglandin inhibition and may be potential targets for future pharmacologic manipulations. (Pediatr Res 68: 292-297, 2010) I n contrast with the full term newborn, preterm infants frequently fail to close their ductus arteriosus after birth. Persistent ductus patency alters mesenteric blood flow, impairs pulmonary mechanics, increases the risk of pulmonary hemorrhage, and prolongs the need for mechanical ventilation (1,2).In preterm infants, persistent ductus patency appears to be the result of alterations in the balance between developmentally regulated vasoconstricting and vasodilating pathways. Alterations in prostaglandin signaling seem to account for most persistent patent ductus arteriosus (PDA); 70% of preterm infants will close their PDA when prostaglandin production is inhibited by indomethacin or ibuprofen. However, approximately 30% of PDAs are the result of factors that are independent of prostaglandin signaling. In these infants, the PDAs fail to close when prostaglandin production is inhibited (3,4). Discovering the pathways that prevent ductus closure (when prostaglandin signaling is not involved) may lead to the development of new therapeutic approaches.We recently identified three perinatal/neonatal risk factors that are independent of each other and predict the presence of PDAs that fail to close when prostaglandin signaling is inhibited (5): 1) immature gestation at birth, 2) absence of antenatal glucocorticoid exposure, and 3) racial/genetic variation (5). We hypothesized that these environmental (immature gestation and absence of antenatal glucocorticoid exposure) and genetic risk factors may be associat...

Injuries from lightning strikes are an infrequent occurrence, and are only rarely noted to involve pregnant victims. Only 13 cases of lightning strike in pregnancy have been previously described in the medical literature, along with 7 additional cases discovered within news media reports. This case report presents a novel case of lightning-associated injury in a patient in the third trimester of pregnancy, resulting in fetal ischemic brain injury and long-term morbidity, and reviews the mechanics of lightning strikes along with common injury patterns of which emergency providers should be aware.