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Prehospital AND anaesthesia

Arthur Bailly, Jean Baptiste Lascarrou, Aurelie Le Thuaut, Julie Boisrame-Helms, Toufik Kamel, Emmanuelle Mercier, Jean Damien Ricard, Virginie Lemiale, Benoit Champigneulle, Jean Reignier
INTRODUCTION: Critically ill patients with acute respiratory, neurological or cardiovascular failure requiring invasive mechanical ventilation are at high risk of difficult intubation and have organ dysfunctions associated with complications of intubation and anaesthesia such as hypotension and hypoxaemia. The complication rate increases with the number of intubation attempts. Videolaryngoscopy improves elective endotracheal intubation. McGRATH MAC is the lightest videolaryngoscope and the most similar to the Macintosh laryngoscope...
December 23, 2015: BMJ Open
Alan A Garner, Claire L Barker, Andrew D Weatherall
BACKGROUND: Drowning patients may benefit from the advanced airway management capabilities that can be provided by physician staffed helicopter emergency medical services. The aim of this study is to describe paediatric drowning patients treated by such a service examining tasking systems, initial physiology at the incident scene, survival and neurological outcome. METHODS: Retrospective analysis of paediatric drowning victims over a 5- year period. Case identification system, patient age, site of drowning, presence or absence of cardiac output, first Glasgow Coma Scale (GCS) score and interventions were collected from prehospital notes, and survival and neurological outcomes from hospital and rehabilitation notes...
2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Johannes Prottengeier, Matthias Albermann, Sebastian Heinrich, Torsten Birkholz, Christine Gall, Joachim Schmidt
OBJECTIVES: Intravenous access in prehospital emergency care allows for early administration of medication and extended measures such as anaesthesia. Cannulation may, however, be difficult, and failure and resulting delay in treatment and transport may have negative effects on the patient. Therefore, our study aims to perform a concise assessment of the difficulties of prehospital venous cannulation. METHODS: We analysed 23 candidate predictor variables on peripheral venous cannulations in terms of cannulation failure and exceedance of a 2 min time threshold...
June 23, 2015: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Emma L Hartley, Roger Alcock
INTRODUCTION: Prehospital anaesthesia in the United Kingdom (UK) is provided by Helicopter Emergency Medical Service (HEMS) and British Association for Immediate Care (BASICS), a road-based service. Muscle relaxation in rapid sequence induction (RSI) has been traditionally undertaken with the use of suxamethonium; however, rocuronium at higher doses has comparable intubating conditions with fewer side effects. HYPOTHESIS/PROBLEM: The aim of this survey was to establish how many prehospital services in the UK are now using rocuronium as first line in RSI...
April 2015: Prehospital and Disaster Medicine
Pavel Michálek, Donald M Miller
Extraglottic airway devices (EADs) are commonly used equipment for airway maintenance during elective procedures under general anaesthesia. They may be used also in other indications such as conduit for tracheal intubation or rescue airway device in prehospital medicine. Current classifications of the EADs lack systematic approach and therefore classification according to the sealing sites and sealing mechanisms is suggested in this review article. Modern EADs are disposable, latex-free devices made of plastic materials most commonly from polyvinylchloride (PVC)...
2014: Prague Medical Report
D J Lockey, B Healey, K Crewdson, G Chalk, A E Weaver, G E Davies
BACKGROUND: Treatment of airway compromise in trauma patients is a priority. Basic airway management is provided by all emergency personnel, but the requirement for on-scene advanced airway management is controversial. We attempted to establish the demand for on-scene advanced airway interventions. Trauma patients managed with standard UK paramedic airway interventions were assessed to determine whether airway compromise had been effectively treated or whether more advanced airway management was required...
April 2015: British Journal of Anaesthesia
Yashvi H Wimalasena, Alasdair R Corfield, Stephen Hearns
OBJECTIVE: To investigate the incidence and factors associated with desaturation related to emergency intubations within an aeromedical retrieval service pertaining to both primary prehospital and secondary interhospital missions. METHODS: A retrospective analysis of all rapid sequence intubations (RSI) was performed by the Emergency Medical Retrieval Service over a 4.5-year period (June 2008-November 2012). For each RSI, clinical indication for RSI, age, sex, traumatic or medical diagnosis, team leader specialty, Cormack and Lehane (C-L) grade of laryngoscope view, attempts at intubation, desaturation and hypotension was analysed...
August 2015: Emergency Medicine Journal: EMJ
R Leberle, A Ernstberger, M Loibl, J Merkl, M Bunz, M Creutzenberg, B Trabold
INTRODUCTION: Initial fluid resuscitation in trauma is still controversial. Hydroxyethyl starch (HES), a commonly used fluid for resuscitation in trauma patients, has potential nephrotoxic effects. Advancing age is a known risk factor for acute kidney injury (AKI) in trauma patients. Therefore, the objective of this study was to evaluate the impact of large volumes of HES 130/0.4 on renal function in trauma patients, with a particular focus on the significance of age. METHODS: A retrospective review of all patients admitted to the Trauma Centre of the University Hospital Regensburg from September 1, 2007 to December 31, 2012 was performed...
January 2015: Injury
Peter Brendon Sherren, Stephen Tricklebank, Guy Glover
INTRODUCTION: Rapid sequence induction (RSI) of critically ill patients outside of theatres is associated with a higher risk of hypoxia, cardiovascular collapse and death. In the prehospital and military environments, there is an increasing awareness of the benefits of standardised practice and checklists. METHODS: We conducted a non-systematic review of literature pertaining to key components of RSI preparation and management. A standard operating procedure (SOP) for in-hospital RSI was developed based on this and experience from large teaching hospital anaesthesia and critical care departments...
2014: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
E B G Barnard, R J Moy, A D Kehoe, V S Bebarta, J E Smith
BACKGROUND: Intraosseous (IO) drug infusion has been reported to have similar pharmacokinetics to intravenous (IV) infusion. In military and civilian trauma, the IO route is often used to obtain rapid and reliable parenteral access for drug administration. Only a few case reports have described the use of IO infusion to administer drugs for rapid sequence induction of anaesthesia (RSI). OBJECTIVE: We aimed to assess the feasibility of the administration of RSI drugs via an IO catheter in a prospective observational study...
June 2015: Emergency Medicine Journal: EMJ
Joost Peters, Bas van Wageningen, Ilze Hendriks, Ruud Eijk, Michael Edwards, Nico Hoogerwerf, Jan Biert
INTRODUCTION: Endotracheal intubation is a frequently performed procedure for securing the airway in critically injured or ill patients. Performing prehospital intubation may be challenging and intubation skills vary. We reviewed the first-attempt tracheal intubation success rate in a Dutch prehospital setting. PATIENTS AND METHODS: We studied our database for all intubations performed by helicopter emergency medical services (HEMS) physicians, HEMS nurse and ambulance paramedics under HEMS supervision between January 2007 and July 2012...
December 2015: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Richard M Lyon, Ben Macauley, Sarah Richardson, Richard de Coverly, Malcolm Russell
BACKGROUND: Horse riding is a common leisure activity associated with a significant rate of injury. Helicopter emergency medical services (HEMS) may be called to equestrian accidents. Accurate HEMS tasking is important to ensure appropriate use of this valuable medical resource. We sought to review HEMS response to equestrian accidents and identify factors associated with the need for HEMS intervention or transport of the patient to a major trauma centre. METHODS: Retrospective case review of all missions flown by Kent, Surrey & Sussex Air Ambulance Trust over a 1-year period (1 July 2011 to 1 July 2012)...
April 2015: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Carl McQueen, Nicholas Crombie, Jonathan Hulme, Stef Cormack, Nageena Hussain, Frank Ludwig, Steve Wheaton
INTRODUCTION: In the West Midlands region of the UK, delivery of pre-hospital care has been remodelled through introduction of a 24 h Medical Emergency Response Incident Team (MERIT). Teams including physicians and critical care paramedics (CCP) are deployed to incidents on land-based and helicopter-based platforms. Clinical practice, including delivery of rapid sequence induction of anaesthesia (RSI), is underpinned by standard operating procedures (SOP). This study describes the first 12 months experience of prehospital RSI in the MERIT scheme in the West Midlands...
January 2015: Emergency Medicine Journal: EMJ
Alan A Garner, Michael Fearnside, Val Gebski
BACKGROUND: The utility of advanced prehospital interventions for severe blunt traumatic brain injury (BTI) remains controversial. Of all trauma patient subgroups it has been anticipated that this patient group would most benefit from advanced prehospital interventions as hypoxia and hypotension have been demonstrated to be associated with poor outcomes and these factors may be amenable to prehospital intervention. Supporting evidence is largely lacking however. In particular the efficacy of early anaesthesia/muscle relaxant assisted intubation has proved difficult to substantiate...
2013: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Carl McQueen, Richard Apps, Fay Mason, Nicholas Crombie, Jon Hulme
The deployment of specialist teams to incident scenes by helicopter and the delivery of critical care interventions such as Rapid Sequence Induction of anaesthesia to patients are becoming well-established components of trauma care in the UK. Traditionally in the UK, Helicopter Emergency Medical Services (HEMS) are limited to daylight operations only. The safety and feasibility of operating HEMS services at night is a topic of debate currently in the UK HEMS community. Within the West Midlands Major Trauma Network, the Medical Emergency Response Incident Team (MERIT) provides a physician-led prehospital care service that responds to incidents by air during daylight hours and by Rapid Response Vehicle during the hours of darkness...
November 2013: Emergency Medicine Journal: EMJ
Johannes von Vopelius-Feldt, Jonathan Benger
INTRODUCTION: Emergency medical services in the UK are facing the challenge of responding to an increasing number of calls, often for non-emergency care, while also providing critical care to the few severely ill or injured patients. In response, paramedic training in the UK has been extended and there are regional strategies to improve prehospital critical care (PHCC). We describe the clinical competencies of three groups of prehospital providers in the UK with the aim of informing future planning of the delivery of PHCC...
December 2014: Emergency Medicine Journal: EMJ
Carl McQueen, Matthew Wyse
INTRODUCTION: Pre-hospital Emergency Medicine is a subspecialty of Emergency Medicine and Anaesthesia in the UK, overseen by the Inter-collegiate Board for Training in Pre-hospital Emergency Medicine (IBTPHEM). Organisations delivering General Medical Council (GMC) approved programmes require clear educational governance frameworks to ensure high standards of training. This study outlines the experiences of an Emergency Medicine trainee during an Out of Programme Year with a regional Air Ambulance service in the UK...
March 2014: Emergency Medicine Journal: EMJ
Adam Chesters, Nadine Keefe, Jeremy Mauger, David Lockey
INTRODUCTION: This paper describes the first 16-months experience of prehospital rapid sequence intubation (RSI) in a rural and suburban helicopter-based doctor-paramedic service after the introduction of a standard operating procedure (SOP) already proven in an urban trauma environment. METHOD: A retrospective database review of all missions between October 2010 and January 2012 was carried out. Any RSI or intubation carried out was included, regardless of age or indication...
January 2014: Emergency Medicine Journal: EMJ
Johannes von Vopelius-Feldt, Jonathan R Benger
OBJECTIVES: Prehospital anaesthesia using rapid sequence induction (RSI) is carried out internationally and in the UK despite equivocal evidence of clinical benefit. It is a core skill of the prehospital critical care service established by the Great Western Ambulance Service NHS Trust (GWAS) in 2008. This retrospective analysis of the service's first 150 prehospital RSIs describes intubation success rates and complications, thereby contributing towards the ongoing debate on its role and safety...
December 2013: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Tim J Leeuwenburg
INTRODUCTION: In rural Australia, general practitioners (GPs) form the frontline for provision of medical services. Besides responsibilities for primary care via private practice, rural doctors often provide emergency and inpatient services for rural hospitals. The aim of this study was to determine access to difficult airway equipment and training among the GP-anaesthetist cadre in rural Australia. METHODS: HASH(0x3fbf710) DESIGN: an online survey regarding availability of difficult airway equipment, access to ongoing training and inviting comments on rural anaesthesia in general...
2012: Rural and Remote Health
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