Torney General Hospital was a US Army Hospital in Palm Springs, California, in Riverside County used during World War II. Parts of Torney General Hospital are now the Desert Regional Medical Center.In November 1945 Torney General Hospital was closed and the Federal Works Administration sold the site. The Torney General Hospital became the Palm Springs Desert Hospital and the Palm Springs Desert Medical Plaza. The hospital is now called the Desert Regional Medical Center. The El Mirador Tower is still a landmark at the entrance to the hospital.
Introduction Patients with acute stroke may occasionally present as trauma activations, particularly after being found down or sustaining falls. This atypical presentation can delay diagnosis and treatment. We compared the evaluation and outcomes of patients with acute stroke presenting as trauma activations versus code stroke activations. Methods We conducted a retrospective review of all trauma activations at our level 1 trauma center from January 2018-December 2024. Patients diagnosed with acute stroke on initial trauma imaging formed the code trauma (CT) group. These patients were compared to all patients treated as a code stroke (CS) activation in 2024. The primary outcome was door-to-imaging time; secondary outcomes included door-to-intervention time, discharge disposition and mortality. Results There were 208 CS patients and 198 CT patients. CT patients were older (75.3 vs 70.3 years, p<0.001) and had a higher percentage of hemorrhagic stroke (43.9% vs 14.4%, p<0.001). CT patients had a higher NIHSS score (14.44 vs 9.67, p<0.001). Despite minimal injuries (mean ISS 3.3), CT patients experienced longer times to initial brain imaging (47.4 vs 24.8 minutes, p<0.001), lower rates of discharge home (23.2% vs 42.8%) and higher mortality (24.2% vs 12%, p<0.001). Conclusions Stroke patients presenting as trauma activations face significant delays in imaging and worse outcomes, despite having few injuries. This may be related to additional testing performed in the trauma bay resulting in imaging delays. Improved protocols are needed to identify possible stroke in low-impact trauma activations and expedite care.
Background Uterine rupture is a rare but life-threatening obstetric emergency, usually associated with labor in patients with a prior cesarean delivery. Spontaneous rupture remote from a uterine scar, particularly at the cornua in the second trimester, is exceedingly uncommon. Case We report a 30-year-old gravida 2 para 1 at 25 3/7 weeks' gestation with a dichorionic-diamniotic twin pregnancy who presented with abrupt abdominal pain and hemoperitoneum of unclear etiology. Despite reassuring imaging, progressive maternal deterioration and non-reassuring fetal status prompted emergent laparotomy and cesarean delivery. A 3 cm × 3 cm full-thickness left cornual rupture was identified. Conclusion In pregnant patients with unexplained hemoperitoneum, clinical status must override reassuring imaging, and prompt surgical intervention is essential.
Background and Objective: Inhaled corticosteroids (ICS) are central to pediatric asthma treatment, but systemic exposure may suppress the hypothalamic-pituitary-adrenal (HPA) axis. This systematic review evaluated whether different ICS delivery technologies are associated with different systemic bioavailability or adrenal suppression in children with asthma. Methods: A PROSPERO-registered review identified pediatric asthma studies comparing defined delivery technologies and reporting cortisol, adrenal, or pharmacokinetic outcomes. The supplied records documented 121 screened records, 14 full-text reports assessed, an eight-record source pool, and five studies carried into completed outcome analysis. Results: The five analyzed studies had a nominal combined sample of 751 participants. Three core studies addressed hydrofluoroalkane (HFA) versus chlorofluorocarbon (CFC) pressurized metered-dose inhalers and budesonide dry-powder inhaler versus pressurized metered-dose inhaler with spacer. Two secondary studies addressed ciclesonide HFA delivery versus budesonide dry-powder inhaler and nebulized budesonide systems. Meta-analysis was not performed because drug molecule, dose, formulation, device, spacer or nebulizer use, duration, and outcome timing differed substantially. Conclusions: Available pediatric evidence is limited and does not support a broad assumption that one delivery-device class is consistently safer for adrenal suppression. Interpretation should separate pharmacokinetic exposure from biochemical adrenal outcomes and should account for drug, dose, formulation, delivered dose, and measurement method. PROSPERO: CRD420261460607.
Background Snakebite envenoming causes an estimated 81,000–138,000 deaths and more than 400,000 cases of permanent disability each year, disproportionately affecting low-resource regions. Antivenom is the only approved treatment but requires intravenous administration. We evaluated intravenous followed by oral varespladib as adjunctive therapy to antivenom in hospitalized patients with snakebite envenoming. Methods and findings In this multicenter, randomized, double-blind, placebo-controlled phase II trial in India (CTRI/2023/10/058782) and the USA (NCT05717062), patients with snakebite envenoming were randomly assigned (1:1) to receive varespladib or placebo, both in addition to standard of care including antivenom. For elapid envenoming, the primary endpoint was time to recovery of 5-second head-lift. For viper envenoming, the primary endpoint was area under the curve (AUC) from baseline to Day 14 of a 3-item Snakebite Severity Score (SSS). Between June 3 rd , 2023, and October 19 th , 2024, 140 patients were randomized and 139 were analyzed (73 varespladib; 66 placebo). Study drug was initiated a mean of 7.3 hours after the bite and 3.3 hours after antivenom. Among elapid-bite patients, mean time to head-lift recovery was 27.6 hours with varespladib vs. 36.2 hours with placebo (p = 0.6). Among viper-bite patients, SSS AUC to Day 14 was 660 with varespladib vs. 629 with placebo (p = 0.7). No serious adverse event occurred with varespladib. Conclusions In this trial in which varespladib was initiated on average 7 hours after snakebite and several hours after antivenom, late adjunctive varespladib did not meet the primary endpoint. Interpretation of these results is limited by heterogeneity in the snake species responsible for envenoming and the associated differences in venom composition, clinical manifestations, and antivenom treatments.
BackgroundUnintentional falls are the leading cause of injury among adults 65 years and older. It's believed that adverse benzodiazepine side effects increase the risk and frequency of falls. We hypothesize that geriatric patients taking benzodiazepines prior to admission experience worse clinical outcomes compared to those without preadmission use.MethodsUsing our level 1 trauma database, patients 65 years or older admitted following a ground level fall were divided into 2 groups, benzodiazepines positive on admission urine drug screen (+Benzo) and negative (-Benzo). Primary outcomes included in-hospital complications with additional outcomes including ICU admission rates, ICU LOS, overall hospital LOS, injury pattern data, and Injury Severity Score (ISS).Results11 133 patients were included with 764 in the +Benzo group. There was no difference in Injury Severity Score between the two groups (6.1 vs 5.7, P = .140). The + Benzo group had a higher percentage of TBI (39.7% vs 29.8%, P < .001), rib fractures (12.7% vs 9.1%, P = .001), and extremity fractures (49.9% vs 43.2%, <.001) with no difference in ISS (6.1 vs 5.7, P = .140). The + Benzo group had higher ICU admission rates (25.8% vs 17.7%, P < .001) and experienced more cardiac arrests (2.2% vs 1.0%, P = .004), pulmonary embolus (4.6% vs 3.1%, P = .032), and pneumonia/VAP (0.65% vs 0.15%, P = .008). On multivariable analysis, benzodiazepines prior to admission were an independent predictor of in-hospital complications (OR: 1.60, CI: 1.18-2.17, P = .003).DiscussionOur study identifies pre-hospital benzodiazepine use and its association with worse in-hospital outcomes. Our findings can be used to identify high-risk fall patients on admission to mobilize additional resources to reduce the risk of adverse in-hospital outcomes.
