Ascension Via Christi

This study examines the trend in gun-related trauma in Kansas before and after the enactment of a law nullifying the need for a concealed carry license. A retrospective chart review was conducted of all patients admitted to a level 1 trauma center with a traumatic injury secondary to a gunshot wound. Comparisons were between three time periods: baseline (T1), after concealed carry with limited exceptions (T2), and after the exceptions expired (T3). The average number of patients per year increased from T1 (54 patients/year) to T2 (83 patients/year) and T3 (87 patients/year). The proportion of injuries caused by handguns went from 24.6 ​% in T1 to 72.5 ​% in T2 and 63.4 ​% in T3 (p ​< ​.001). There was no difference between the time periods for injury severity, mortality, or discharge disposition. These findings could suggest a correlation in concealed carry law and availability of handguns in Kansas.

Abstract Introduction: Actinomycosis is a rare, chronic infection caused by Actinomyces species, anaerobic Gram-positive bacteria that can invade deeper tissues when mucosal barriers are disrupted. These infections typically follow trauma, surgery, or dental procedures. Although cervicofacial involvement is most common, thoracic actinomycosis can develop if oropharyngeal secretions are aspirated into the lungs or mediastinum. We present a unique case of mediastinal lymphadenitis due to actinomycosis in a patient with prior resection of a submandibular gland carcinoma. Case: A 55-year-old male with no smoking, cardiac, or pulmonary history was evaluated for mediastinal lymphadenopathy in the pulmonary clinic. He had recently undergone surgical resection of a high-grade secretory carcinoma in the right submandibular gland. A PET scan post-surgery showed an FDG-avid submandibular mass with mediastinal lymphadenopathy, raising concerns of metastasis or a second primary malignancy. The scan highlighted a 2.0 cm FDG-avid right paratracheal lymph node and a mildly FDG-avid 10 mm antero-posterior window lymph node. The patient reported persistent trismus and pain around his right ear since the initial surgery but denied respiratory symptoms or fever. Physical examination showed no respiratory distress. Given the concerning PET findings, he underwent bronchoscopy with endobronchial ultrasound (EBUS) and transbronchial needle aspiration biopsy (TBNA) of the enlarged lymph nodes, specifically at stations 2R and 7. No endobronchial lesions were seen. Cytology from TBNA showed non-necrotizing granulomatous inflammation, with GMS staining revealing filamentous organisms. AFB-Fite staining was negative for acid-fast bacteria, and no malignant cells were found. Further microbiological testing confirmed Actinomyces species, diagnosing the patient with mediastinal lymphadenitis secondary to actinomycosis. He was started on a prolonged course of amoxicillin and doxycycline, with close follow-ups planned for 6 to 12 months. Discussion: Actinomycosis lymphadenitis presents diagnostic challenges due to its resemblance to malignancy, and mediastinal lymph node involvement is exceptionally rare. In this case, the patient's prior submandibular gland surgery likely created a route for bacterial invasion, facilitating infection in adjacent tissues and mediastinal lymph nodes. Initially, the FDG-avid lymphadenopathy on PET imaging suggested metastatic spread of his carcinoma, necessitating EBUS-TBNA biopsy to differentiate infection from malignancy. This case highlights the need for tissue sampling to distinguish between actinomycosis and malignancy on imaging, ensuring an accurate diagnosis and preventing unnecessary treatments. Treatment typically requires long-term antibiotics, with penicillin as the first-line choice; alternatives include amoxicillin, amoxicillin-clavulanate, or doxycycline. Multidisciplinary evaluation remains critical to avoid misdiagnosis and ensure optimal patient care.

Objectives While epinephrine is widely used for medical cardiac arrests, there is a knowledge gap regarding its utility for traumatic arrests. Traumatic arrests result from hypovolemia, hypoxia, or anatomic impairment of cardiac function such that the inotropic and vasoconstrictive effects of epinephrine may be ineffective or harmful. We hypothesized that epinephrine does not improve survival among patients with traumatic cardiac arrest. Methods This was a multicenter retrospective cohort study of trauma patients sustaining prehospital cardiac arrest who were treated at seven level I and II trauma centers over 6 years (2011–2017), ascertained via trauma registry data and chart abstraction. The primary outcome was survival to hospital discharge; patients treated with or without epinephrine were compared. Multivariable analyses were performed using Poisson regression. Time to event analyses were conducted using Cox proportional hazard models. Results We included 1631 adult and pediatric trauma patients with prehospital cardiac arrest. Prehospital epinephrine was administered to 844 (52%). The median age was 35 years, 335 (21%) were female, 712 (44%) sustained blunt trauma, and 58 (4%) had a shockable initial rhythm. Survival to hospital discharge was significantly lower in the prehospital epinephrine cohort compared to the no epinephrine cohort in univariable analysis [43/844 (5%) vs. 125/787 (16%), p < 0.001]. Among patients with blunt mechanism, survival was significantly lower in the prehospital epinephrine cohort [12/382 (3%) vs. 54/330 (16%), p < 0.001]. Among patients with penetrating mechanism, survival was not statistically different [10/276 (4%) with epinephrine vs. 22/374 (6%) without, p = 0.19]. In multivariable analyses adjusting for age, sex, mechanism, and initial rhythm, epinephrine was associated with lower likelihood of survival in the overall and blunt cohorts; there was no significant difference in the penetrating cohort (overall aRR 0.33, 95% CI 0.23–0.46; blunt aRR 0.20, 95% CI 0.11–0.37; penetrating aRR 0.62, 95% CI 0.30–1.28). Adjusted and unadjusted time to event analyses across each of these cohorts showed that epinephrine was associated with either statistically inferior or indistinct hazard ratios. Conclusions Epinephrine was not associated with improved survival following traumatic cardiac arrest, and in multiple subanalyses, it was associated with inferior outcomes. These results may inform prehospital traumatic arrest protocols.