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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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https://www.readbyqxmd.com/read/28927439/barriers-and-facilitators-towards-implementing-the-sepsis-six-care-bundle-bliss-1-a-mixed-methods-investigation-using-the-theoretical-domains-framework
#1
Neil Roberts, Guy Hooper, Fabiana Lorencatto, Wendell Storr, Michael Spivey
BACKGROUND: The 'Sepsis 6', a care bundle of basic, but vital, measures (e.g. intravenous fluid, antibiotics) has been implemented to improve sepsis treatment. However, uptake has been variable. Tools from behavioral sciences, such as the Theoretical Domains Framework (TDF) may be used to understand and address such implementation issues. This study used a behavioral science approach to identify barriers and facilitators towards Sepsis Six implementation at a case study hospital. METHODS: Semi-structured interviews based on the TDF were conducted with a sample group of consultants, junior doctors and nurses from Emergency Department, Medical and Surgical Admissions, to explore barriers/facilitators to Sepsis Six performance...
September 19, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28915913/neurological-outcomes-and-duration-from-cardiac-arrest-to-the-initiation-of-extracorporeal-membrane-oxygenation-in-patients-with-out-of-hospital-cardiac-arrest-a-retrospective-study
#2
Takahiro Yukawa, Masahiro Kashiura, Kazuhiro Sugiyama, Takahiro Tanabe, Yuichi Hamabe
BACKGROUND: We investigated the relationship between neurological outcomes and duration from cardiac arrest (CA) to the initiation of extracorporeal membrane oxygenation (ECMO) (CA-to-ECMO) in patients with out-of-hospital cardiac arrest (OHCA) treated with extracorporeal cardiopulmonary resuscitation (ECPR) and determined the ideal time at which ECPR should be performed. METHODS: During the time period in which this study was conducted, 3451 patients experienced OHCA...
September 16, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28915898/physician-staffed-helicopter-emergency-medical-service-has-a-beneficial-impact-on-the-incidence-of-prehospital-hypoxia-and-secured-airways-on-patients-with-severe-traumatic-brain-injury
#3
Toni Pakkanen, Antti Kämäräinen, Heini Huhtala, Tom Silfvast, Jouni Nurmi, Ilkka Virkkunen, Arvi Yli-Hankala
BACKGROUND: After traumatic brain injury (TBI), hypotension, hypoxia and hypercapnia have been shown to result in secondary brain injury that can lead to increased mortality and disability. Effective prehospital assessment and treatment by emergency medical service (EMS) is considered essential for favourable outcome. The aim of this study was to evaluate the effect of a physician-staffed helicopter emergency medical service (HEMS) in the treatment of TBI patients. METHODS: This was a retrospective cohort study...
September 15, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28899418/the-effect-of-a-national-web-course-help-brain-heart-as-a-supplemental-learning-tool-before-cpr-training-a-cluster-randomised-trial
#4
Anette Nord, Leif Svensson, Andreas Claesson, Johan Herlitz, Håkan Hult, Susanne Kreitz-Sandberg, Lennart Nilsson
BACKGROUND: The effectiveness of cardiopulmonary resuscitation (CPR) learning methods is unclear. Our aim was to evaluate whether a web course before CPR training, teaching the importance of recognition of symptoms of stroke and acute myocardial infarction (AMI) and a healthy lifestyle, could influence not only theoretical knowledge but also practical CPR skills or willingness to act in a cardiac arrest situation. METHODS: Classes with 13-year-old students were randomised to CPR training only (control) or a web course plus CPR training (intervention)...
September 12, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28893325/the-most-commonly-used-disease-severity-scores-are-inappropriate-for-risk-stratification-of-older-emergency-department-sepsis-patients-an-observational-multi-centre-study
#5
Bas de Groot, Frank Stolwijk, Mats Warmerdam, Jacinta A Lucke, Gurpreet K Singh, Mo Abbas, Simon P Mooijaart, Annemieke Ansems, Laura Esteve Cuevas, Douwe Rijpsma
BACKGROUND: Sepsis recognition in older emergency department (ED) patients is difficult due to atypical symptom presentation. We therefore investigated whether the prognostic and discriminative performance of the five most commonly used disease severity scores were appropriate for risk stratification of older ED sepsis patients (≥70 years) compared to a younger control group (<70 years). METHODS: This was an observational multi-centre study using an existing database in which ED patients who were hospitalized with a suspected infection were prospectively included...
September 11, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28893316/intraosseous-blood-samples-for-point-of-care-analysis-agreement-between-intraosseous-and-arterial-analyses
#6
Milla Jousi, Simo Saikko, Jouni Nurmi
BACKGROUND: Point-of-care (POC) testing is highly useful when treating critically ill patients. In case of difficult vascular access, the intraosseous (IO) route is commonly used, and blood is aspirated to confirm the correct position of the IO-needle. Thus, IO blood samples could be easily accessed for POC analyses in emergency situations. The aim of this study was to determine whether IO values agree sufficiently with arterial values to be used for clinical decision making. METHODS: Two samples of IO blood were drawn from 31 healthy volunteers and compared with arterial samples...
September 11, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28886743/fatal-poisonings-in-northern-finland-causes-incidence-and-rural-urban-differences
#7
Lauri Koskela, Lasse Raatiniemi, Håkon Kvåle Bakke, Tero Ala-Kokko, Janne Liisanantti
BACKGROUND: In this study we evaluate differences between rural and urban areas in the causes and incidence of fatal poisonings. METHODS: Data from all fatal poisonings that occurred in Northern Finland from 2007 to 2011 were retrieved from Cause of Death Registry death certificates provided by Statistics Finland. The demographics and causes of fatalities were compared between rural and urban areas. Incidences were calculated based on the population data. RESULTS: There were a total of 684 fatal poisonings during the study period and 57...
September 8, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28877728/we-need-support-a-delphi-study-about-desirable-support-during-the-first-year-in-the-emergency-medical-service
#8
Anna Hörberg, Maria Jirwe, Susanne Kalén, Veronica Vicente, Veronica Lindström
BACKGROUND: New and inexperienced emergency medical service (EMS) professionals lack important experience. To prevent medical errors and improve retention there is an urgent need to identify ways to support new professionals during their first year in the EMS. METHODS: A purposeful sample and snowball technique was used and generated a panel of 32 registered nurses with 12-48 months of EMS experience. A Delphi technique in four rounds was used. Telephone interviews were undertaken in round one to identify what desirable support professionals new to the EMS desire during their first year...
September 6, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28877702/psychosocial-risk-and-protective-factors-for-the-health-and-well-being-of-professionals-working-in-emergency-and-non-emergency-medical-transport-services-identified-via-questionnaires
#9
P Navarro Moya, M González Carrasco, E Villar Hoz
BACKGROUND: Medical transport (MT) professionals are subject to considerable emotional demands due to their involvement in life-or-death situations and their exposure to the serious health problems of their clients. An increase in the demand for MT services has, in turn, increased interest in the study of the psychosocial risk factors affecting the health of workers in this sector. However, research thus far has not distinguished between emergency (EMT) and non-emergency (non-EMT) services, nor between the sexes...
September 6, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28859678/does-the-applied-polytrauma-definition-notably-influence-outcome-and-patient-population-a-retrospective-analysis
#10
Stephan Frenzel, Philipp Krenn, Thomas Heinz, Lukas Leopold Negrin
BACKGROUND: Although the term "polytrauma" has been in use for decades, no generally accepted definition exists. The aim of this study was to demonstrate that different polytrauma definitions applied to a specific patient population result in diverse subgroups of individuals, who in turn present a varying outcome. METHODS: All patients (≥18 years) treated at our level I trauma center within a time period of three years were classified according to 11 selected polytrauma definitions and included in our study, if they were rated "polytraumatized" by at least one of these definitions...
August 31, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28851446/daily-volume-of-cases-in-emergency-call-centers-construction-and-validation-of-a-predictive-model
#11
Damien Viglino, Aurelien Vesin, Stephane Ruckly, Xavier Morelli, Rémi Slama, Guillaume Debaty, Vincent Danel, Maxime Maignan, Jean-François Timsit
BACKGROUND: Variations in the activity of emergency dispatch centers are an obstacle to the rationalization of resource allocation. Many explanatory factors are well known, available in advance and could predict the volume of emergency cases. Our objective was to develop and evaluate the performance of a predictive model of daily call center activity. METHODS: A retrospective survey was conducted on all cases from 2005 to 2011 in a large medical emergency call center (1,296,153 cases)...
August 29, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28841884/early-post-traumatic-seizures-are-associated-with-valproic-acid-plasma-concentrations-and-ugt1a6-cyp2c9-genetic-polymorphisms-in-patients-with-severe-traumatic-brain-injury
#12
Yirui Sun, Jian Yu, Qiang Yuan, Xing Wu, Xuehai Wu, Jin Hu
BACKGROUND: Seizure is a common complication for severe traumatic brain injury (TBI). Valproic acid (VPA) is a first-line antiepileptic drug, though its metabolism is affected by genetic polymorphisms and varies between individuals. The aim of this study was to investigate such association and to explore its influence on the occurrence of early post-traumatic seizure. METHODS: A prospective case control study was conducted from 2012 to 2016 recruiting adult patients with severe TBI...
August 25, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28835284/maintaining-immobilisation-devices-on-trauma-patients-during-ct-a-feasibility-study
#13
Pål Johan Stokkeland, Erlend Andersen, Maria Myhre Bjørndal, Arne Morten Mikalsen, Sindre Aslaksen, Per Kristian Hyldmo
BACKGROUND: To reduce the possibility of secondary deterioration of spinal injuries, it is desirable to maintain the spinal immobilisation that is applied in the prehospital setting throughout computed tomography (CT) scanning. A previous study found that metallic components within the inflation valve of the vacuum mattresses caused CT artefacts. The aim of our study was to investigate the effect of vacuum mattresses with plastic valves on CT artefacts, the radiation dose, and noise compared to a trauma transfer board and the spine boards currently used in our trauma system...
August 23, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28835283/identifying-pre-hospital-factors-associated-with-outcome-for-major-trauma-patients-in-a-regional-trauma-network-an-exploratory-study
#14
Lee Thompson, Michael Hill, Caroline Davies, Gary Shaw, Matthew D Kiernan
BACKGROUND: Major trauma is often life threatening and the leading cause of death in the United Kingdom (UK) for adults aged less than 45 years old. This study aimed to identify pre-hospital factors associated with patient outcomes for major trauma within one Regional Trauma Network. METHOD: Secondary analysis of pre-hospital audit data and patient outcome data from the Trauma Audit Research Network (TARN) was undertaken. The primary outcome used in analysis was 'Status at Discharge' (alive/deceased)...
August 23, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28810921/the-role-of-whole-body-computed-tomography-in-the-diagnosis-of-thoracic-injuries-in-severely-injured-patients-a-retrospective-multi-centre-study-based-on-the-trauma-registry-of-the-german-trauma-society-traumaregister-dgu-%C3%A2
#15
Patricia Lang, Martin Kulla, Fabian Kerwagen, Rolf Lefering, Benedikt Friemert, Hans-Georg Palm
BACKGROUND: Thoracic injuries are a leading cause of death in polytrauma patients. Early diagnosis and treatment are of paramount importance. Whole-body computed tomography (WBCT) has largely replaced traditional imaging techniques such as conventional radiographs and focused computed tomography (CT) as diagnostic tools in severely injured patients. It is still unclear whether WBCT has led to higher rates of diagnosis of thoracic injuries and thus to a change in outcomes. METHODS: In a retrospective study based on the trauma registry of the German Trauma Society (TraumaRegister DGU(®)), we analysed data from 16,545 patients who underwent treatment in 59 hospitals between 2002 and 2012 (ISS ≥ 9)...
August 15, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28810904/antiarrhythmic-drug-therapy-among-patients-presenting-to-emergency-department-with-symptomatic-atrial-fibrillation-a-prospective-nationwide-cohort
#16
Tero Penttilä, Heikki Mäkynen, Juha Hartikainen, Harri Hyppölä, Timo Lauri, Mika Lehto, Juha Lund, M J Pekka Raatikainen
BACKGROUND: Atrial fibrillation (AF) is a common arrhythmia that causes numerous visits to emergency departments (ED). The aim of the FinFib2 study was to evaluate whether treatment of patients with AF in ED is consistent with the contemporary European Society of Cardiology (ESC) management guidelines. Here we report the results of antiarrhythmic drug therapy (AAD) in ED. METHODS: All patients within the two-week study period whose primary reason for the ED visit was symptomatic AF were included into this prospective multicentre study...
August 15, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28810888/hospitalisation-in-an-emergency-department-short-stay-unit-compared-to-an-internal-medicine-department-is-associated-with-fewer-complications-in-older-patients-an-observational-study
#17
Camilla Strøm, Talie Khadem Mollerup, Laurits Schou Kromberg, Lars Simon Rasmussen, Thomas Andersen Schmidt
BACKGROUND: Older patients are at particular risk of experiencing adverse events during hospitalisation. OBJECTIVE: To compare the frequencies and types of adverse events during hospitalisation in older persons acutely admitted to either an Emergency Department Short-stay Unit (SSU) or an Internal Medicine Department (IMD). METHODS: Observational study evaluating adverse events during hospitalisation in non-emergent, age-matched, internal medicine patients ≥75 years, acutely admitted to either the SSU or the IMD at Holbaek Hospital, Denmark, from January to August, 2014...
August 15, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28807040/management-of-upper-gastrointestinal-bleeding-in-emergency-departments-from-bleeding-symptoms-to-diagnosis-a-prospective-multicenter-observational-study
#18
Pierre-Clément Thiebaud, Youri Yordanov, Jacques-Emmanuel Galimard, Pierre-Alexis Raynal, Sébastien Beaune, Laurent Jacquin, François-Xavier Ageron, Dominique Pateron
BACKGROUND: Upper gastrointestinal bleeding (UGB) is common in emergency departments (EDs) and can be caused by many eso-gastro-duodenal lesions. Most available epidemiological data and data on the management of UGB comes from specialized departments (intensive care units or gastroenterology departments), but little is known from the ED perspective. We aimed to determine the distribution of symptoms revealing UGB in EDs and the hemorrhagic lesions identified by endoscopy. We also describe the characteristics of patients consulting for UGB, UGB management in the ED and patients outcomes...
August 14, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28806988/subjective-safety-and-self-confidence-in-prehospital-trauma-care-and-learning-progress-after-trauma-courses-part-of-the-prospective-longitudinal-mixed-methods-epptc-trial
#19
David Häske, Stefan K Beckers, Marzellus Hofmann, Rolf Lefering, Paul A Grützner, Ulrich Stöckle, Vassilios Papathanassiou, Matthias Münzberg
BACKGROUND: Prehospital trauma care is stressful and requires multi-professional teamwork. A decrease in the number of accident victims ultimately affects the routine and skills and underlines the importance of effective training. Standardized courses, like PHTLS, are established for health care professionals to improve the prehospital care of trauma patients. The aim of the study was to investigate the subjective safety in prehospital trauma care and learning progress by paramedics in a longitudinal analysis...
August 14, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28778172/characteristics-and-outcome-of-rapid-response-team-patients-%C3%A2-75%C3%A2-years-old-a-prospective-observational-cohort-study
#20
Joonas Tirkkonen, Piritta Setälä, Sanna Hoppu
BACKGROUND: Rapid response teams (RRTs) attend severely ill general ward patients whose average 30-day mortality is near 30%. A major part of RRT patients are over 75 years old, but there are no studies on the characteristics and outcome of this geriatric RRT population. We compared the characteristics and outcome of geriatric RRT sub-population with the RRT patients <75 years old. We further investigated, whether the accumulation of risk factors (RFs) for mortality among the general RRT population predicts a tenuous outcome among the geriatric sub-population...
August 4, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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