Novel approach to the diagnosis of fractures in an austere environment using a stethoscope and a cellular phone

Prehospital Trauma Compendium: Management of Suspected Femoral Shaft Fractures - A position statement and resource document of NAEMSP

Emergency medical services (EMS) clinicians encounter patients with suspected femoral shaft fractures due to both blunt and penetrating trauma. Traction splinting is commonly used by many EMS systems on the premise that it might reduce the perceived risk for hemorrhage and can help reduce pain. It has been called into question whether femoral shaft fractures are truly causative of hemorrhagic shock. Additionally, traction splinting has been associated with iatrogenic injuries, especially if applied to patients with co-morbid lower extremity and pelvic injuries. The application of a traction splint is also an infrequent EMS intervention, raising concerns about skill decay and maintenance of competency. Non-traction splinting, or static splinting, is also a therapeutic option in the field management of suspected femur fractures. Because the benefits of traction splinting versus static splinting of suspected femur fractures in the EMS setting are uncertain, the National Association of EMS Physicians (NAEMSP) performed a review of the evidence regarding EMS management of femoral shaft fractures and developed the following recommendations and summarization of the evidence.

Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health

Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for use in these settings. These challenges can be mitigated by taking advantage of affordable consumer electronics mobile devices such as webcams, mobile phones, charge-coupled device (CCD) cameras, lasers, and LEDs. Low-cost, portable multi-wavelength fluorescence plate readers have been developed for many applications including detection of microbial toxins such as C. Botulinum A neurotoxin, Shiga toxin, and S. aureus enterotoxin B (SEB), and flow cytometry has been used to detect very low cell concentrations. However, the relatively low sensitivities of these devices limit their clinical utility. We have developed several approaches to improve their sensitivity presented here for webcam based fluorescence detectors, including (1) image stacking to improve signal-to-noise ratios; (2) lasers to enable fluorescence excitation for flow cytometry; and (3) streak imaging to capture the trajectory of a single cell, enabling imaging sensors with high noise levels to detect rare cell events. These approaches can also help to overcome some of the limitations of other low-cost optical detection technologies such as CCD or phone-based detectors (like high noise levels or low sensitivities), and provide for their use in low-cost medical diagnostics in resource-poor settings.