Kinneri Mehta

Objectives: To perform a needs‐based assessment for tracheostomy care education for nonsurgical first responders in the hospital setting and to implement and assess the efficacy of a targeted tracheostomy educational program.Methods: A prospective observational study conducted between October 2017 and May 2018 including emergency medicine (EM) residents, internal medicine (IM) residents, and intensive care unit (ICU) advanced practice providers at 2 tertiary hospitals. Needs‐based assessments were conducted, leading to specialty specific curricula. One‐hour educational sessions included didactics and case‐based simulation. A pre‐ and posttest objective knowledge quiz and self‐assessment were administered, and a posttest was repeated at 6 months.Results: There were 85 participants (13 ICU, 40 EM, 32 IM). Significant improvement (P <. 05) in mean objective knowledge score was seen across all groups between pre‐ and postintervention assessments with relative but not significant improvement at 6 months. There were significant increases in comfort level from pre‐ to postintervention. At 6‐month follow‐up, comfort level remained significantly increased for the majority of questions for the EM group and for select questions for IM and ICU advanced practice provider groups.Discussion: Nonsurgeons are often first responders to critical airway situations yet receive limited formal education regarding tracheostomy. We demonstrated improvement in knowledge and comfort after a targeted educational module for tracheostomy care and management.Implications for Practice: Although tracheostomy care is multidisciplinary, specialty‐specific education may provide a more relevant foundation on which to build skills. Prompt and effective management of tracheostomy emergencies by first responders may improve patient safety and reduce mortality.

A man in his 60s presented to the otolaryngology clinic with a 1-month history of clear drainage from his left naris during activity. Approximately 1 month prior he had been admitted to the hospital and treated for meningitis. During his hospital course, a computed tomographic (CT) scan of his head revealed a lytic lesion of the left occipital bone. After treatment with intravenous antibiotics and steroids, his neurologic examination results returned to baseline, and he was discharged home. Magnetic resonance imaging (MRI) was deferred to the outpatient setting. At the otolaryngologist’s office, the patient stated that he had not experienced otalgia, otorrhea, tinnitus, or vertigo. His examination revealed clear nasal discharge and a normal otoscopic finding. His audiogram demonstrated normal sloping to moderate sensorineural hearing loss with type A tympanometry result on the right and type A on the left. His word recognition score was 100% bilaterally. The collection of nasal discharge for β-2 transferrin analysis was attempted, but insufficient quantity was obtained. To evaluate for a skull base defect and cerebrospinal fluid (CSF) leak, a noncontrast CT scan of the temporal bones was obtained (Figure, A and B). This demonstrated a large area of bony destruction and osteolysis involving the left occipital bone. A T2-weighted MRI sequence showed a lesion, isointense to CSF, with thinning of the bony cortex (Figure, C and D). Based on the imaging, the differential diagnosis included metabolic, infectious, or metastatic lesions to the bone.

Rationale:: Compartmentation of ion channels on the cardiomyocyte surface is important for electric propagation and electromechanical coupling. The specialized T-tubule and costameric structures facilitate spatial coupling of various ion channels and receptors. Existing methods such as immunofluorescence and patch clamp techniques are limited in their ability to localize functional ion channels. As such, a correlation between channel protein location and channel function remains incomplete. Objective:: To validate a method that permits routine imaging of the topography of a live cardiomyocyte and study clustering of functional ion channels from a specific microdomain. Methods and Results:: We used scanning ion conductance microscopy and conventional cell-attached patch clamp with a software modification that allows controlled increase of pipette tip diameter. The sharp nanopipette used for topography scan was modified into a larger patch pipette that could be positioned with nanoscale precision to a specific site of interest (crest, groove, or T-tubules of cardiomyocytes) and sealed to the membrane for cell-attached recording of ion channels. Using this method, we significantly increased the probability of detecting activity of L-type calcium channels in the T-tubules of ventricular cardiomyocytes. We also demonstrated that active sodium channels do not distribute homogenously on the sarcolemma instead, they segregate into clusters of various densities, most crowded in the crest region, that are surrounded by areas virtually free of functional sodium channels. Conclusions:: Our new method substantially increases the throughput of recording location-specific functional ion channels on the cardiomyocyte sarcolemma, thereby allowing characterization of ion channels in relation to the microdomain where they reside.