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Prehospital never events

Richard Lammers, Maria Willoughby-Byrwa, William Fales
BACKGROUND: Systematic evaluation of the performances of prehospital providers during actual pediatric anaphylaxis cases has never been reported. Epinephrine medication errors in pediatric resuscitation are common, but the root causes of these errors are not fully understood. OBJECTIVE: The primary objective of this study was to identify underlying causes of prehospital medication errors that were observed during a simulated pediatric anaphylaxis reaction. METHODS: Two- and 4-person emergency medical services crews from eight geographically diverse agencies participated in a 20-minute simulation of a 5-year old child with progressive respiratory distress and hypotension from an anaphylactic reaction...
April 2014: Prehospital Emergency Care
C Hohenstein, K Schultheis, J Winning, P Rupp, T Fleischmann
BACKGROUND: Many patients are victims of disastrous incidents during medical interventions. One of the obligations of physicians is to identify these incidents and to subsequently develop preventive strategies in order to prevent future events. Airway management and prehospital emergency medicine are of particular interest as both categories frequently show very dynamic developments. Incidents in this particular area can lead to serious injury but at the same time it has never been analyzed what kind of incidents might harm patients during prehospital airway management...
September 2013: Der Anaesthesist
Jean-Louis Ducassé, Georges Siksik, Manon Durand-Béchu, Sébastien Couarraze, Baptiste Vallé, Nathalie Lecoules, Patrice Marco, Thierry Lacombe, Vincent Bounes
OBJECTIVES: Although 50% nitrous oxide (N(2) O) and oxygen is a widely used treatment, its efficacy had never been evaluated in the prehospital setting. The objective of this study was to demonstrate the efficacy of premixed N(2) O and oxygen in patients with out-of-hospital moderate traumatic acute pain. METHODS: This prospective, randomized, multicenter, double-blind trial enrolled patients with acute moderate pain (numeric rating scale [NRS] score between 4 and 6 out of 10) caused by trauma...
February 2013: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Aino Lammintausta, Juhani K E Airaksinen, Pirjo Immonen-Räihä, Jorma Torppa, Antero Y Kesäniemi, Matti Ketonen, Heli Koukkunen, Päivi Kärjä-Koskenkari, Seppo Lehto, Veikko Salomaa
BACKGROUND: Single living has been associated with a worse prognosis of acute coronary syndrome (ACS). We aimed to study the relation of sociodemographic characteristics to the morbidity, mortality, and case fatality (CF) of ACS in a large population-based ACS register. METHODS: The population-based FINAMI myocardial infarction register recorded 15,330 cases of ACS among persons aged 35-99 years in Finland in 1993-2002. Record linkage with the files of Statistics Finland provided information on sociodemographic characteristics (marital status, household size)...
August 2014: European Journal of Preventive Cardiology
Daniel Kollek, Michelle Welsford, Karen Wanger
Providing prehospital care poses unique risks. Paramedics are essentially the only medical personnel who are routinely at the scene of violent episodes, and they are more likely to be assaulted than are other prehospital personnel. In addition to individual acts of violence, emergency medical services (EMS) providers now need to cope with tactical violence, defined as the deployment of extreme violence in a non-random fashion to achieve tactical or strategic goals. This study reviewed two topics; the readiness of EMS crews for violence in their environment and the impact of violence on the EMS crew member...
March 2010: Prehospital and Disaster Medicine
Christine J Chaput, Matthew R Deluhery, Christine E Stake, Katherine A Martens, Mark E Cichon
OBJECTIVE: To survey prehospital providers to determine 1) the quantity and format of training recalled over the past year in chemical, biological, radiological/nuclear (CBRN), and other mass casualty events (MCEs); 2) preferred educational formats; 3) self-assessed preparedness for various CBRN/MCEs; and 4) perceived likelihood of occurrence for CBRN/MCEs. METHODS: A survey, consisting of 11 questions, was distributed to 1,010 prehospital providers in a system where no formal CBRN/mass casualty training was given...
October 2007: Prehospital Emergency Care
Patricia Jabre, Xavier Combes, Bertrand Leroux, Emanuelle Aaron, Harold Auger, Alain Margenet, Gilles Dhonneur
The objective of this study was to assess effectiveness of gum elastic bougie (GEB) in case of difficult intubation occurring in the prehospital settings. After manikin training to GEB handling, physicians were recommended to use GEB as first alternative technique in case of difficult intubation. Intubating conditions and details of patients requiring GEB-assisted laryngoscopy were recorded over 30 months. Among the 1442 extrahospital intubations performed, 41 patients (3%) required GEB. Gum elastic bougie allowed successful intubation in 33 cases (78%) and 8 patients sustained a second alternative technique...
July 2005: American Journal of Emergency Medicine
Giuseppe De Luca, Harry Suryapranata, Menko-Jan de Boer
Timely restoration of antegrade blood flow in the infarct-related artery of patients with ST-segment elevation myocardial infarction (STEMI) results in myocardial salvage and improved survival. We describe the Zwolle approach with regard to prehospital phase, the first 15 min in hospital, initial pharmacological therapy, angiography, angioplasty, risk stratification, rehabilitation and secondary prevention. Confirmation of the diagnosis by 12-lead electrocardiography by either general practitioners or ambulance paramedics allows substantial reduction in the time-delay to first balloon inflation, as the hospital and the catheterization laboratory can be prepared in advance, and the emergency room and the coronary care unit with their unavoidable delays can be skipped on the way to acute angiography...
June 2005: Italian Heart Journal: Official Journal of the Italian Federation of Cardiology
K N Garratt, D R Holmes, V Molina-Viamonte, G S Reeder, D O Hodge, K R Bailey, J K Lobl, D A Laudon, R J Gibbons
OBJECTIVES: A pilot study was designed to assess the safety of combined intravenous adenosine and lidocaine in patients with acute myocardial infarction and to estimate the likelihood of a beneficial effect on final infarct size. BACKGROUND: Adenosine plus lidocaine reduces infarct size in animals, but the safety and efficacy in human beings is unknown. METHODS AND RESULTS: Adenosine (70 microg/kg per minute intravenous infusion) plus lidocaine (1 mg/kg intravenous bolus injection and 2 mg/kg per minute infusion) was given to 45 patients with acute myocardial infarction...
August 1998: American Heart Journal
A D Slonim, K M Patel, U E Ruttimann, M M Pollack
OBJECTIVE: To determine the effectiveness of cardiopulmonary resuscitation (CPR) in the pediatric intensive care unit (ICU). DESIGN: A nonconcurrent cohort study of consecutive admissions. SETTING: Thirty-two pediatric ICUs. PATIENTS: Consecutive admissions to 32 pediatric ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Pediatric ICU patients were followed for the occurrence of a cardiopulmonary arrest (external cardiac massage for at least 2 mins)...
December 1997: Critical Care Medicine
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