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Prehospital critical care

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https://www.readbyqxmd.com/read/29132578/major-trauma-outside-a-trauma-center-prehospital-emergency-department-and-retrieval-considerations
#1
REVIEW
Preston J Fedor, Brian Burns, Michael Lauria, Clare Richmond
Care of the critically injured begins well before the patient arrives at a large academic trauma center. It is important to understand the continuum of care from the point of injury in the prehospital environment, through the local hospital and retrieval, until arrival at a trauma center capable of definitive care. This article highlights the important aspects of trauma assessment and management outside of tertiary or quaternary care hospitals. Key elements of each phase of care are reviewed, including management pearls and institutional strategies to facilitate effective and efficient treatment of trauma patients from the point of injury forward...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132505/the-mobility-and-impact-of-frailty-in-the-intensive-care-unit
#2
REVIEW
Bellal Joseph, Faisal S Jehan
Prevalence of pre-existing frailty in patients admitted to the intensive care unit (ICU) is increasing. Critical illness leads to a catabolic state that further diminishes body reserves and contributes to frailty independent of age and prehospital functional status. Because early mobilization of patients in the ICU results in accelerated recovery and improvement in functional status and quality of life, frailty can severely affect the mobility of patients in ICU ultimately prolonging recovery. Understanding the concept of frailty and the association of frailty and its impact on mobility in the ICU, identifying patients, and timely resource allocation helps in optimum care and improves clinical outcomes...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29108809/response-to-symptoms-and-prehospital-delay-in-stroke-patients-is-it-time-to-reconsider-stroke-awareness-campaigns
#3
Rafael García Ruiz, Julia Silva Fernández, Rosa María García Ruiz, Marta Recio Bermejo, Ángel Arias Arias, Pablo Del Saz Saucedo, Rafael Huertas Arroyo, Ana González Manero, Ana Santos Pinto, Santiago Navarro Muñoz, Enrique Botia Paniagua, José Abellán Alemán
BACKGROUND: Despite recent advances in acute stroke care, reperfusion therapies are given to only 1%-8% of patients. Previous studies have focused on prehospital or decision delay. We aim to give a more comprehensive view by addressing different time delays and decisions. METHODS: A total of 382 patients with either acute stroke or transient ischemic attack were prospectively included. Sociodemographic and clinical parameters and data on decision delay, prehospital delay, and first medical contact were recorded...
November 3, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29088951/update-on-critical-care-for-acute-spinal-cord-injury-in-the-setting-of-polytrauma
#4
John K Yue, Ethan A Winkler, Jonathan W Rick, Hansen Deng, Carlene P Partow, Pavan S Upadhyayula, Harjus S Birk, Andrew K Chan, Sanjay S Dhall
Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29048449/emergency-medical-service-information-system-the-ares-118-experience
#5
D A Ientile, M A Cardinale, S Cataldi, M Parafati, A Pasquarella, N Trani, M P Corradi
BACKGROUND: In this paper we describe ARES 118, the prehospital Emergency Medical Service of the Region Lazio, Italy, focusing on its data system used to populate a data warehouse and to create ad hoc reports. ARES 118 is a regional public mono-specialized health company, established in 2004, that manages the emergency care throughout the Region Lazio. METHODS: Being a peculiar company in its kind, and being the first experience of this kind in Italy, ARES 118 has begun to equip itself, in an autonomous way, with a corporate information system, starting from what already existed as data collection from the individual provincial operating Centers and then by activating a unique information system at a regional and company level by deploying a data warehouse...
November 2017: Annali di Igiene: Medicina Preventiva e di Comunità
https://www.readbyqxmd.com/read/29042484/accuracy-of-oxygen-flow-delivered-by-compressed-gas-cylinders-in-hospital-and-prehospital-emergency-care
#6
Frédéric Duprez, Jean Bernard Michotte, Gregory Cuvelier, Alexandre Legrand, Sharam Mashayekhi, Gregory Reychler
BACKGROUND: Oxygen cylinders are widely used both in hospital and prehospital care. Excessive or inappropriate FIO2 may be critical for patients with hypercapnia or hypoxia. Moreover, over-oxygenation could be deleterious in ischemic disorders. Supplemental oxygen from oxygen cylinder should therefore be delivered accurately. The aim of this study was to assess the accuracy of oxygen flows for oxygen cylinder in hospital and prehospital care. METHODS: A prospective trial was conducted to evaluate accuracy of delivered oxygen flows (2, 4, 6, 9 and 12 L/min) for different oxygen cylinder ready for use in different hospital departments...
October 17, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28986740/integrated-health-care-management-of-moderate-to-severe-tbi-in-older-patients-a-narrative-review
#7
REVIEW
Rahel Schumacher, René M Müri, Bernhard Walder
PURPOSE OF REVIEW: Traumatic brain injuries are common, especially within the elderly population, which is typically defined as age 65 and older. This narrative review aims at summarizing and critically evaluating important aspects of their health care management in covering the entire pathway from prehospital care to rehabilitation and beyond. RECENT FINDINGS: The number of older patients with traumatic brain injury (TBI) is increasing, and there seem to be differences in all aspects of care along their pathway when compared to younger patients...
October 7, 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/28979529/free-open-access-med-ical-edu-cation-for-critical-care-practitioners
#8
EDITORIAL
Olusegun Olusanya, James Day, Justin Kirk-Bayley, Tamas Szakmany
Free Open Access Med(ical edu)cation refers to an online community of knowledge relating to medicine. Originating from practitioners in emergency medicine, it has since spread to critical care, internal medicine, prehospital medicine, paediatrics, and allied health professionals and continues to grow at an advanced rate. Weblogs ('blog' for short), emails, social media (in particular Twitter), recorded audio material ((podcasts), and video material are all produced on a daily basis and contribute to the continual professional development of trainees and consultants worldwide...
February 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/28965751/the-accuracy-of-acuity-scoring-tools-to-predict-24-h-mortality-in-traumatic-brain-injury-patients-a-guide-to-triage-criteria
#9
Zohre Najafi, Hossien Zakeri, Amir Mirhaghi
BACKGROUND AND AIM: Prompt identification of traumatic brain injury (TBI) is vital for patients in critical condition; however, it is not clear which acuity scoring tools are associated with short-term mortality. The aim of this study was to determine the accuracy of acuity scoring tools and 24-h mortality among TBI patients in both prehospital and hospital settings. METHODS: This study was an observational, prospective cohort, in which patients with TBI were followed from the accident scene to the hospital...
September 28, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28934985/factors-influencing-on-scene-time-in-a-rural-norwegian-helicopter-emergency-medical-service-a-retrospective-observational-study
#10
Øyvind Østerås, Jon-Kenneth Heltne, Bjørn-Christian Vikenes, Jörg Assmus, Guttorm Brattebø
BACKGROUND: Critically ill patients need to be immediately identified, properly managed, and rapidly transported to definitive care. Extensive prehospital times may increase mortality in selected patient groups. The on-scene time is a part of the prehospital interval that can be decreased, as transport times are determined mostly by the distance to the hospital. Identifying factors that affect on-scene time can improve training, protocols, and decision making. Our objectives were to assess on-scene time in the Helicopter Emergency Medical Service (HEMS) in our region and selected factors that may affect it in specific and severe conditions...
September 21, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28910212/feasibility-of-paramedic-performed-prehospital-lung-ultrasound-in-medical-patients-with-respiratory-distress
#11
Torben K Becker, Christian Martin-Gill, Clifton W Callaway, Francis X Guyette, Christopher Schott
OBJECTIVE: Prehospital ultrasound is not yet widely implemented. Most studies report on convenience samples and trauma patients, often by prehospital physicians or critical care clinicians. We assessed the feasibility of paramedic performed prehospital lung ultrasound in medical patients with respiratory distress. METHODS: Paramedics at 2 ambulance stations in the city of Pittsburgh, Pennsylvania, USA underwent a 2-hour training session in prehospital lung ultrasound using the SonoSite iViz, a handheld ultrasound device...
September 14, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28807071/single-rescuer-ventilation-using-a-bag-valve-mask-with-removable-external-handle-a-randomized-crossover-trial
#12
Paul Reed, Baruch Zobrist, Monica Casmaer, Steven G Schauer, Nurani Kester, Michael D April
Introduction Ventilation with a bag valve mask (BVM) is a challenging but critical skill for airway management in the prehospital setting. Hypothesis Tidal volumes received during single rescuer ventilation with a modified BVM with supplemental external handle will be higher than those delivered using a standard BVM among health care volunteers in a manikin model. METHODS: This study was a randomized crossover trial of adult health care providers performing ventilation on a manikin. Investigators randomized participants to perform single rescuer ventilation, first using either a BVM modified by addition of a supplemental external handle or a standard unmodified BVM (Spur II BVM device; Ambu; Ballerup, Denmark)...
August 15, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28795061/a-multi-agent-based-approach-for-prehospital-emergency-management
#13
Reza Safdari, Jaleh Shoshtarian Malak, Niloofar Mohammadzadeh, Azimeh Danesh Shahraki
OBJECTIVE: To demonstrate an architecture to automate the prehospital emergency process to categorize the specialized care according to the situation at the right time for reducing the patient mortality and morbidity. METHODS: Prehospital emergency process were analyzed using existing prehospital management systems, frameworks and the extracted process were modeled using sequence diagram in Rational Rose software. System main agents were identified and modeled via component diagram, considering the main system actors and by logically dividing business functionalities, finally the conceptual architecture for prehospital emergency management was proposed...
July 2017: Bulletin of Emergency and Trauma
https://www.readbyqxmd.com/read/28792281/pan-asian-trauma-outcomes-study-patos-rationale-and-methodology-of-an-international-and-multicenter-trauma-registry
#14
So Yeon Kong, Sang Do Shin, Hideharu Tanaka, Akio Kimura, Kyoung Jun Song, Goh E Shaun, Wen-Chu Chiang, Kentaro Kajino, Sabariah Faizah Jamaluddin, Dae Han Wi, Ju Ok Park, Sung Woo Moon, Young Sun Ro, David C Cone, James F Holmes
BACKGROUND: Trauma is a major health burden and a time-dependent critical emergency condition among developing and developed countries. In Asia, trauma has become a rapidly expanding epidemic and has spread out to many underdeveloped and developing countries through rapid urbanization and industrialization. Most casualties of severe trauma, which results in significant mortality and disability are assessed and transported by prehospital providers including physicians, professional providers, and volunteer providers...
August 9, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28766306/interpretation-of-brain-ct-scans-in-the-field-by-critical-care-physicians-in-a-mobile-stroke-unit
#15
Maren Ranhoff Hov, Erik Zakariassen, Thomas Lindner, Terje Nome, Kristi G Bache, Jo Røislien, Jostein Gleditsch, Volker Solyga, David Russell, Christian G Lund
BACKGROUND AND PURPOSE: In acute stroke, thromboembolism or spontaneous hemorrhage abruptly reduces blood flow to a part of the brain. To limit necrosis, rapid radiological identification of the pathological mechanism must be conducted to allow the initiation of targeted treatment. The aim of the Norwegian Acute Stroke Prehospital Project is to determine if anesthesiologists, trained in prehospital critical care, may accurately assess cerebral computed tomography (CT) scans in a mobile stroke unit (MSU)...
July 27, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/28748771/acute-care-referral-systems-in-liberia-transfer-and-referral-capabilities-in-a-low-income-country
#16
Jimin Kim, Maria Barreix, Christine Babcock, Corey B Bills
Introduction Following two decades of armed conflict in Liberia, over 95% of health care facilities were partially or completely destroyed. Although the Liberian health system has undergone significant rehabilitation, one particular weakness is the lack of organized systems for referral and prehospital care. Acute care referral systems are a critical component of effective health care delivery and have led to improved quality of care and patient outcomes. Problem This study aimed to characterize the referral and transfer systems in the largest county of Liberia...
July 27, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28746084/epidemiology-and-location-of-primary-retrieval-missions-in-a-scottish-aeromedical-service
#17
Gregg Neagle, Lisa Curatolo, John Ferris, Mike Donald, Stephen Hearns, Alasdair R Corfield
INTRODUCTION: Prehospital critical care teams comprising an appropriately trained physician and paramedic or nurse have been associated with improved outcomes in selected trauma patients. These teams are a scarce and expensive resource, especially when delivered by rotary air assets. The optimal tasking of prehospital critical care teams is therefore vital and remains a subject of debate. Emergency Medical Retrieval Service (EMRS) provides a prehospital critical care response team to incidents over a large area of Scotland either by air or by road...
July 25, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28717647/intracranial-hematoma-detection-by-near-infrared-spectroscopy-in-a-helicopter-emergency-medical-service-practical-experience
#18
Patrick Schober, Sebastiaan M Bossers, Lothar A Schwarte
In (helicopter) emergency medical services, (H)EMS, the prehospital detection of intracranial hematomas should improve patient care and the triage to specialized neurosurgical hospitals. Recently, noninvasive detection of intracranial hematomas became possible by applying transcranial near infrared spectroscopy (NIRS). Herein, second-generation devices are currently available, for example, the Infrascanner 2000 (Infrascan), that appear suited also for prehospital (H)EMS applications. Since (H)EMS operations are time-critical, we studied the Infrascanner 2000 as a "first-time-right" monitor in healthy volunteers (n = 17, hospital employees, no neurologic history)...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28701849/blunt-trauma-neck-with-complete-tracheal-transection-a-diagnostic-and-therapeutic-challenge-to-the-trauma-team
#19
K N J Prakash Raju, D Anandhi, R Surendar, Ashwith Shetty, Vinay R Pandit
Survival following trachea-esophageal transection is uncommon. Establishing a secure airway has the highest priority in trauma management. Airway management is a unique and a defining element to the specialty of emergency medicine. There is no doubt regarding the significance of establishing a patent airway in the critically ill patient in the emergency department. Cannot intubate and cannot ventilate situation is a nightmare to all emergency physicians. The most important take-home message from this case report is that every Emergency physician should have the ability to predict "difficult airway" and recognize "failed airway" very early and be skilled in performing rescue techniques when routine oral-tracheal intubation fails...
June 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28693524/national-consensus-on-communication-in-prehospital-trauma-care-the-denim-study
#20
Annelieke Maria Karien Harmsen, Leo Maria George Geeraedts, Georgios Fredericus Giannakopoulos, Maartje Terra, Herman M T Christiaans, Lidwine Brigitta Mokkink, Frank Willem Bloemers
BACKGROUND: In the Netherlands prehospital trauma care is provided by emergency medical services (EMS) nurses. This care is extended by Physician staffed Helicopter Emergency Medical Services (P-HEMS) for the more severely injured patient. Prehospital communication is a factor of influence on the identification of these patients and the dispatch of P-HEMS. Though prehospital communication it is often perceived to be incomplete and unstructured. To elucidated factors of influence on prehospital triage and the identification of the severely injured patient a Delphi study was performed...
July 11, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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