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Emergency physicians are using bolus-dose vasopressors to temporize hypotensive patients until more definitive blood pressure support can be established. Despite a paucity of clinical outcome data, emergency department applications are expanding into the prehospital setting. This series presents two cases of field expedient vasopressor use by emergency medicine providers for preflight stabilization during aeromedical evacuation to a hospital ship as part of the United States Navy disaster response in Puerto Rico. A critical approach and review of the literature are discussed.
Two critically ill patients were managed in an austere environment as a result of the devastation from Hurricane Maria (Yabucoa, Puerto Rico; 2017). They both exhibited signs of respiratory distress, hemodynamic instability, and distributive shock requiring definitive airway management and hemodynamic support prior to aeromedical evacuation.
The novel use of field expedient vasopressors prior to induction for rapid sequence intubation was successfully and safely employed in both cases. Both patients had multiple risk factors for peri-induction cardiac arrest given their presenting hemodynamics. Despite their illness severity, both patients were induced, transported, and ultimately admitted to the intensive care unit (ICU) in stable condition following administration of the field expedient vasopressors.
Field expedient vasopressors were safely and effectively employed in an austere field environment during a disaster response. This case series contributes to the growing body of literature of safe bolus-dose vasopressor use by emergency physicians to temporize hypotensive patients in resource-constrained situations.
HardwickJM, MurnanSD, Morrison-PonceDP, DevlinJJ. Field Expedient Vasopressors During Aeromedical Evacuation: A Case Series from the Puerto Rico Disaster Response. Prehosp Disaster Med. 2018;33(6):668–672.
Field experiments were conducted in Louisiana and Mississippi from 2011 through 2013 to evaluate crop injury, weed control, and yield in field corn following pyroxasulfone applied PRE and POST. Pyroxasulfone PRE or POST did not injure corn at any evaluation. Barnyardgrass control was not improved with the addition of any POST treatment to pyroxasulfone alone or atrazine plus pyroxasulfone PRE; however, all POST treatments increased barnyardgrass control to at least 95% at all evaluations following atrazine PRE. All treatments that contained a PRE followed by POST application controlled browntop millet ≥90% at all evaluations. All POST treatments increased ivyleaf morningglory control to ≥92% following atrazine or pyroxasulfone alone PRE. However, control with atrazine plus pyroxasulfone PRE was similar or greater 28 d after POST than all treatments that received a POST application. In the absence of a POST treatment, pyroxasulfone or atrazine plus pyroxasulfone PRE controlled Palmer amaranth 93 to 96% at all evaluations, but atrazine alone PRE provided 84, 82, and 66% control 7, 14, and 28 d after POST, respectively. All programs that contained a PRE followed by POST herbicide treatment controlled Palmer amaranth >90% at all evaluations. Corn yield following all treatments except atrazine alone PRE and the nontreated were similar and ranged from 10990 to 12330 kg ha−1. This research demonstrated that pyroxasulfone can be a valuable tool for weed management in a corn weed management program.
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