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Objective We aim to evaluate if point-of-care ultrasound use in cardiac arrest is associated with CPR pause duration. Methods This is a prospective cohort study of patients with cardiac arrest (CA) presenting to an urban emergency department from July 2016 to January 2017. We collected video recordings of patients with CA in designated code rooms with video recording equipment. The CAs recordings were reviewed and coded by two abstractors. The primary outcome was the difference CPR pause duration when POCUS was and was not performed. Results A total of 110 CPR pauses were evaluated during this study. The median CPR pause with POCUS performed lasted 17 s (IQR 13 − 22.5) versus 11 s (IQR 7 − 16) without POCUS. In addition, multiple regression analysis demonstrated that POCUS was associated with longer pauses (6.4 s, 95%CI 2.1- 10.8); ultrasound fellowship trained faculty trended towards shorter CPR pauses (-4.1 s, 95%CI −8.8–0.6) compared to non-ultrasound fellowship trained faculty; and when the same provider led the resuscitation and performed the POCUS, pause durations were 6.1 s (95%CI 0.4 −11.8) longer than when another provider performed the POCUS. Conclusion In this prospective cohort trial of 24 patients with CA, POCUS during CPR pauses was associated with longer interruptions in CPR.

Objectives Patients commonly come to the emergency department (ED) with social needs. To address this, we created the Highland Health Advocates (HHA), an ED-based help desk and medical-legal partnership using undergraduate volunteers to help patients navigate public resources and provide onsite legal and social work referrals. We were able to provide these services in English and Spanish. We aimed to determine the social needs of the patients who presented to our ED and the potential impact of the programme in resolving those needs and connecting them to a ‘medical home’ (defined as a consistent, primary source of medical care such as a primary care doctor or clinic). Methods ED patients at a US safety net hospital were enrolled in a 1:2 ratio in a quasi-experiment comparing those who received intervention from the HHA during a limited access rollout with controls who received usual care on days with no help desk. We collected a baseline social needs evaluation, with follow-up assessments at 1 and 6 months. Primary outcomes were linkages for the primary identified need and to a medical home within 1 month. Other outcomes at 6 months included whether a patient (1) felt helped; 2) had a decreased number of ED visits; (3) had the primary identified need met; (4) had a primary doctor; and (5) had a change in self-reported health status. Results We enrolled 459 subjects (intervention=154, control=305). Housing (41%), employment (23%) and inability to pay bills (22%) were participants’ top identified needs. At baseline, 32% reported the ED as their medical home, with the intervention cohort having higher ED utilisation (>1 ED visit in the prior month: 49% vs 24%). At 1 month, 185 (40%) subjects were reached for follow-up, with more HHA subjects linked to a resource (59% vs 37%) and a medical home (92% vs 76%). At 6 months, 75% of subjects felt HHA was helpful and more subjects in the HHA group had a doctor (93% v 69%). No difference was found in ED utilisation, primary need resolution or self-reported health status. Conclusions Health-related social needs are common in this US safety net ED. Our help desk is one possible model for addressing social needs.

Background Five billion people, primarily in low-income and middle-income countries, cannot access safe, affordable surgical and anesthesia care, particularly for orthopaedic trauma. The rate-limiting step for many orthopaedic surgical procedures performed in the developing world is the absence of safe anesthesia. Even surgical mission teams providing surgical care are limited by the availability of anesthesiologists. Emergency physicians, who are already knowledgeable in airway management and procedural sedation, may be able to help to fulfill the need for anesthetists in disaster relief and surgical missions. Methods Following the 2010 earthquake in Haiti, an emergency physician was trained using the Emergency Physician's General Anesthesia Syllabus (EP GAS) to perform duties similar to those of certified registered nurse anesthetists. The emergency physician then provided anesthesia during surgical mission trips with an orthopaedic team from February 2011 to March 2017, in Milot, Haiti. This is a descriptive overview of this training program and prospectively collected data on the cohort of patients whom the surgical mission teams treated in Haiti during that time frame. Results A single emergency physician anesthetist provided anesthesia for 71 of the 172 orthopaedic surgical cases, nearly doubling the number of cases that could be performed. This also allowed the anesthesiologists to focus on pediatric and more difficult cases. Both immediately after the surgical procedure and at 1 year, there were no serious adverse events for cases in which the emergency physician provided anesthesia. Conclusions Given emergency physicians' baseline training in airway management and sedation, well-supervised and focused extra training under the vigilant supervision of a board-certified anesthesiologist may allow emergency physicians to be able to safely administer anesthesia. Using emergency physicians as anesthetists in this closely supervised setting could increase the number of surgical cases that can be performed in a disaster setting.

Neurogenic stunned myocardium is a rare disease entity that has been typically described as a consequence of subarachnoid hemorrhage and, less commonly, seizures. Here we describe a case of a healthy young woman who drank excessive free water causing acute hyponatremia complicated by cerebral edema and seizure, leading to cardiogenic shock from neurogenic stunned myocardium. Two days later, she had complete return of her normal cardiac function.