October Research Review

Injury Patterns after IED Explosion

Nelson TJ, Clark R, Stedje-Larsen ET, et al: Ë™Close proximity blast injury patterns from improvised explosive devices in Iraq: A report of 18 cases.à“ Journal of Trauma. May 11, 2007. (ePub).

We_ve all had some introduction to blast injuries, but probably not to the type of injuries caused by an improvised explosive device (IED). Injuries from a typical blast occur primarily in the frontal plane, while IED blast injuries occur in the transverse plane, usually from the bottom up, causing extremity fractures and compression fractures of the spine, as well as disruption of the great vessels in the torso. We need to take a different approach to IED blast injuries, including the way we educate our personnel about the effects of blasts. This article would be put to good use in a basic or continuing education class.

Alcohol Pads & Blood Samples

Miller MA, Rosin A, & Levsky ME, et al: Ë™Isopropyl alcohol pad use for blood ethanol sampling does not cause false-positive results.à“ Journal of Emergency Medicine. 33(1):9à10, 2007.

Despite the push to evidence-based medicine, some Ë™traditionsà“ continue, and one of these is the methodology for collecting blood specimens for evaluating ETOH levels. Some believe there_s a legal requirement to use non-alcohol skin preps when obtaining those specimens, although the ability of the alcohol skin prep to cause false positives has never been proven. These authors wanted to find out if contamination could occur as a result of skin prep.

Five emergency physicians had baseline blood drawn, and then had it drawn again after four hours of using alcohol-based hand sanitizers. Eight of the 10 samples (80%) were drawn by prepping the skin with a standard alcohol pad; two were prepped with Betadine pads. None of the samples recorded any ETOH when analyzed.

Maybe it_s time to reconsider the way we approach this type of blood sampling. The authors acknowledge the need for more in-depth studies. Agencies that routinely draw blood for law enforcement should conduct a research project to see if this holds true with a larger sample size.


Assid PA: Ë™Emergency medical treatment and active labor act: What you need to know.à“ Journal of Emergency Nursing. 33(4):324à326, 2007.

The Emergency Medical Treatment and Active Labor Act (EMTALA) could cause your agency some headaches if personnel commit a violation. The government enacted EMTALA in 1986 in response to incidents of hospitals sending patients to other facilities due to inability to pay. This article reviews the act_s four main requirements and clarifications that have occurred in recent years.

Protecting patients_ rights is the responsibility of all health-care providers, and the more informed you are, the better advocate you_ll make. Because of this, understanding EMTALA is important. EMS organizations might find it useful to have their medical director or legal counsel lead a discussion about the aspects of EMTALA and how they might affect your area.

Management of Antifreeze Poisoning

Velez LI, Gracia R, Neerman MF: Ë™Ethylene glycol poisoning: Current diagnostic and management issues.à“ Journal of Emergency Nursing. 33(4):342à345, 2007.

Each year, hundreds of children and pets become ill following ingestion of ethylene glycol, a potent toxin with intoxicating effects and a sweet taste that can be found in solvents and antifreeze. It_s readily absorbed by the gastrointestinal tract and quickly distributed throughout the body. Once ingested it undergoes oxidative steps, culminating in the formation of oxalate crystals that deposit in most organs of the body, especially the kidneys, which can result in renal failure. This article provides an overview of the manifestations of the oxidative process and an introduction to state-of-the-art treatment that can improve patient outcome. Reading this article and having an understanding of its effects may help you recognize the presentation earlier.


Spanjersberg WR & Schipper IB: Ë™Kitesurfing: When fun turns to traumaÆ’The dangers of a new extreme sport.à“ Journal of Trauma. June 1, 2007. (ePub).

Extreme sports are becoming more popular, and these authors take a look at one of the newestÆ’kitesurfing, which incorporates aspects of windsurfing, kite flying and water skiing into one exciting water ride. The authors point out the potential injuries of kitesurfing and, after reviewing how the kite system works, present five kitesurfing patients. They found most of the injuries were extremity fractures and head injuries that occurred as a result of being blown off the water and onto land.

You might be called to respond to a patient following a kitesurfing incident. Ë™Be preparedà“ may be the motto for the Boy Scouts of America, but it also applies to EMS. So read this article, and get a head start on this extreme sport and its effects on the body.

Elizabeth Criss, RN, MEd, MS, CEN, CCRN, is a senior research associate at the University of Arizona and clinical educator for the emergency department at the University Medical Center in Tucson, Ariz. She serves as a member of the Board of Advisors of the Prehospital Care Research Forum. Criss has been involved in prehospital care and research since 1982.

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