Diabetics at higher risk of COVID-19
COVID-19 is a novel pathogen that can cause severe pneumonia and acute respiratory distress syndrome which can lead to multi-organ failure/death. This retrospective Chinese study looked at the relationship between COVID-19 and diabetes. Patients with diabetes are often more susceptible than the average population to contracting infections, probably from disruption in immune system regulation.
There were 174 patients confirmed to have COVID-19 enrolled into the study at one Wuhan hospital in February 2020. Data collected included patient history, test results and treatment plans. Patients were separated into two groups: those with diabetes and those without. Anyone with comorbidities other than diabetes was excluded. Computed tomography (CT) imaging scores were decided by two physicians who were blinded to the participants.
Results showed that patients with diabetes were at higher risk of severe pneumonia, release of tissue injury-related enzymes, excessive uncontrolled inflammation responses and hypercoagulable state associated with dysregulation of glucose metabolism. CT scanning demonstrated worse pathological changes on imaging, and laboratory tests indicated more damage to the myocardium, liver and kidneys than in patients without diabetes. Diabetes was not as effectively controlled during COVID-19 and diabetic complications increased mortality. Diabetes should be considered as a risk factor for a rapid progression and bad prognosis of COVID~19; prognosis from COVID-19 worsens as diabetes severity increases.
Prehospital critical care: results from Scotland
In 2007, the Trauma: Who Cares? report highlighted that a significant number of seriously injured patients died in the UK owing to limitations in their prehospital care. Most commonly, these deaths were attributed to airway obstruction, chest injuries and hypovolaemic shock, suggesting that ambulance clinicians' capabilities at that time did not always meet the needs of severely injured adult patients. Notably, in Scotland, serious trauma accounted for only 0.3% of the annual ambulance incident volume.
This retrospective study examined data from the Scottish Trauma Audit Group from 2011–2016 to ascertain whether the support offered by Scotland's three prehospital critical care teams (PHCCT) was effective in reducing deaths from serious trauma. There were 3076 patients (21.5%) who met the International Severity Score of >15 criterion for major trauma. Patients in the PHCCT cohort were statistically significantly more likely to be male; to be transported to a Major Trauma Centre; to have suffered major trauma; to have suffered a severe head injury; to be transported by air and to be intubated prior to arrival in hospital. The Odds Ratio for 30-day mortality for patients seen by a PHCCT was 0.56 (95% CI 0.36–0.86, p=0.01). The results show a reduction in mortality when trauma patients receive physician-led prehospital critical care.
Fingers or thumbs?
Current guidelines recommend that single-person cardiopulmonary resuscitation (CPR) on an infant should be performed with two-fingers with the hand clenched, while two-person CPR should be performed with two thumbs and with the hands encircling the chest. The literature suggests higher-quality chest compressions with the two-thumb technique, but concerns exist that this technique may compromise ventilation parameters when performed by the single rescuer. This systematic review and meta-analysis sought to compare the two techniques and ventilation parameters.
The authors identified 20 manuscripts examining single-person infant CPR that met study criteria, with 16 that included suitable data for meta-analysis. All of the studies were performed on a standardised manikin. The results demonstrated that the quality of chest compressions for infant CPR was significantly greater when performed using the two-thumb encircling technique as compared with the two-finger technique. Interestingly, the quality of ventilation did not differ between the two techniques.
The review and meta-analysis had a number of limitations, not least that all included studies were performed on manikins. This means that we are unsure as to whether these findings would be replicated in practice; however, better-quality compressions with no fall-off in ventilations makes for interesting reading.