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icu transport

Alexia Chauzy, Abdelouaid Nadji, Jean-Christophe Combes, Nadine Defrance, Belaid Bouhemad, William Couet, Pascal Chavanet
Background: Owing to its antibacterial properties, ceftaroline could be attractive for prevention or treatment of bacterial post-neurosurgical meningitis/ventriculitis. However, few data are available concerning its meningeal concentrations. Objectives: To investigate ceftaroline CSF pharmacokinetics in ICU patients with an external ventricular drain (EVD). Methods: Patients received a single 600 mg dose of ceftaroline as a 1 h intravenous infusion...
December 6, 2018: Journal of Antimicrobial Chemotherapy
Cecily DuPree, Aaron Pinnola, Stefanie Gibson, Keely Muertos, John M Davis, Jason D Sciarretta
BACKGROUND: Mass casualty events are infrequent and create an abrupt surge of patients requiring emergency medical services within a brief period. We hypothesize that implementation of a controlled "traffic loop" pattern during a planned high-volume motorcycle rally could improve overall mortality and impact patient outcomes. MATERIALS AND METHODS: We performed a retrospective analysis of all motorcycle-related injuries during the city's annual motorcycle rally over a 4-y period...
February 2019: Journal of Surgical Research
Tim Rahmel, Hartmuth Nowak, Katharina Rump, Winfried Siffert, Jürgen Peters, Michael Adamzik
BACKGROUND: Aquaporin 5 (AQP5) expression impacts on cellular water transport, renal function but also on key mechanisms of inflammation and immune cell migration that prevail in sepsis and ARDS. Thus, the functionally relevant AQP5 -1364A/C promoter single nucleotide polymorphism could impact on the development and resolution of acute kidney injury (AKI). Accordingly, we tested the hypothesis that the AQP5 promoter -1364A/C polymorphism is associated with AKI in patients suffering from pneumonia evoked ARDS...
2018: PloS One
Megan J Thorvilson, Aubrey J Manahan, Brenda M Schiltz, Christopher A Collura
For most families, the preferred location of death for their child is home, yet most children still die in the hospital. Many children with life-threatening and life-limiting illness are medically dependent on technology, and palliative transport can serve as a bridge from the intensive care unit to the family's home to achieve family-centered goals of care. Palliative transport may also present an opportunity to prioritize cultural care and rituals at end of life which cannot be provided in the hospital. We describe a case series of pediatric patients from communities espousing markedly diverse cross-cultural values and limited financial resources...
December 4, 2018: Journal of Palliative Medicine
Won Gun Kwack, Miae Yun, Dong Seon Lee, Hyunju Min, Yun Young Choi, Sung Yoon Lim, Youlim Kim, Sang Hoon Lee, Yeon Joo Lee, Jong Sun Park, Young-Jae Cho
Critically ill patients could experience various risks including life-threatening events during intrahospital transportation (IHT), with a global incidence of 20% to 79.8%. Evidence on the clinical benefits of the presence of specialized intensive care members such as the rapid response team (RRT) during their transportation is limited. We aimed to elucidate the RRT's effectiveness in promoting patient's safety outcomes during transportation by comparing with those transport by general members.A single-center retrospective cohort study was conducted from January 2016 to February 2017, including critically ill patients admitted to the medical intensive care unit (ICU) due to respiratory failure under mechanical ventilation...
November 2018: Medicine (Baltimore)
Lena H Kim, Aaron B Caughey, Lynn M Yee, Yvonne W Cheng
BACKGROUND:  Twin birthweight discordance is associated with adverse outcomes. OBJECTIVE:  To determine what degree of twin birthweight discordance is associated with adverse outcomes. STUDY DESIGN:  This is a retrospective cohort study of twins with vertex twin A delivered vaginally at 36 to 40 weeks (U.S. Vital Statistics Natality birth certificate registry data 2012-2014). The primary outcome was a composite of neonatal morbidity: 5-minute Apgar < 7, neonatal intensive care unit admission, neonatal mechanical ventilation > 6 hours, neonatal seizure, and/or neonatal transport to a higher level of care...
November 26, 2018: American Journal of Perinatology
Jered Windorski, Jared Reyes, Stephen D Helmer, Jeanette G Ward, James M Haan
BACKGROUND: Critical access hospitals (CAH) serve a key role in providing medical care to rural patients. The purpose of this study was to assess effectiveness of CAHs in initial care of trauma patients. METHODS: A 5-year retrospective review was conducted of all adult trauma patients who were transported directly to a level I trauma facility or were transported to a CAH then transferred to a level I trauma facility after initial resuscitation. RESULTS: Of 1478 patients studied, 1084 were transferred from a CAH with 394 transported directly to the level I facility...
November 14, 2018: American Journal of Surgery
Benedict Griffiths, Shelley Riphagen, Jon Lillie
OBJECTIVE: To understand the impact of the National Institute for Health and Care Excellence (NICE) bronchiolitis guidelines on the management of children referred to paediatric intensive care unit (PICU) with bronchiolitis. DESIGN AND SETTING: Data were collected on all children referred to a regional PICU transport service with the clinical diagnosis of bronchiolitis during the winter prior to the NICE consultation period (2011-2012) and during the winter after publication (2015-2016)...
November 24, 2018: Archives of Disease in Childhood
Sang Hoon Lee, Hamilton P Schwartz, Michael T Bigham
Emergency medical services and critical care transport teams are relatively new parts of the American healthcare delivery system. Although most healthcare providers regularly interact with these groups and rely upon their almost ubiquitous availability, few know how these services developed or what sort of infrastructure currently exists to maintain them. This article provides a focused overview of the history and present practices of both emergency medical services and critical care transport teams, with a concentrated look at the implementation of these services in the pediatric population...
October 2018: Translational Pediatrics
Steven J Weiss, Angel Guerrero, Christian Root-Bowman, Amy Ernst, Kurt Krumperman, Jon Femling, Phil Froman
BACKGROUND: Field sepsis alerts have the ability to expedite initial ED sepsis treatment. Our hypothesis is that in patients that meet EMS sepsis alert criteria there is a strong relationship between prehospital end-tidal carbon dioxide (ETCO2) readings and the outcome of diagnosed infection. METHODS: In 2014, our EMS service initiated a protocol requiring hospitals to receive notification of a "sepsis alert" on all suspected sepsis patients. The EMS service transports 70,000 patients/year to a number of urban centers...
November 8, 2018: American Journal of Emergency Medicine
Beth C Diehl
Since the inception of organized neonatal transport in the 1940s, advances in clinical care and technology have made the neonatal intensive care unit even more mobile in terms of care delivery. There currently exists an emphasis on quality metrics and simulation-based training for transport team members to achieve high levels of individual and team competence. Emerging therapies such as active cooling for neuroprotective hypothermia and high-frequency ventilation provide evidence-based care in the transport environment to enhance clinical outcomes...
December 2018: Critical Care Nursing Clinics of North America
Baljit Cheema, Tyson Welzel, Beyra Rossouw
OBJECTIVES: Noninvasive ventilation is increasingly used in neonatal and pediatric patients, but the intensive care transport setting is lagging in terms of availability of noninvasive ventilation for children. The objective of this systematic review of the literature was to answer the question: In children 0 days to 18 years old, who are hospitalized with acute respiratory distress and require critical care transport, is noninvasive ventilation effective and safe during transport? DATA SOURCES: MEDLINE via PubMed, EMBASE (via Scopus), Cochrane Central Register of Controlled Trials, African Index Medicus, Web of Science Citation Index, and the World Health Organization Trials Registry...
November 15, 2018: Pediatric Critical Care Medicine
Philip S Nawrocki, Matthew Poremba
A 15-year-old male presented with exertional syncope and was found to be in an unstable regular wide complex tachyarrhythmia (WCT). After a trial of antiarrhythmic medication, his clinical condition declined, necessitating synchronized cardioversion. Although he noted symptomatic improvement after cardioversion, he was found to be in third-degree heart block. The patient was transported by rotor wing aircraft to a pediatric cardiac intensive care unit where he was ultimately diagnosed with Lyme disease. He was treated with a course of intravenous antibiotics, his heart block resolved, and he was discharged home with a good neurologic outcome...
November 2018: Air Medical Journal
Jason M Hardwick, Sean D Murnan, Daphne P Morrison-Ponce, John J Devlin
IntroductionEmergency physicians are using bolus-dose vasopressors to temporize hypotensive patients until more definitive blood pressure support can be established. Despite a paucity of clinical outcome data, emergency department applications are expanding into the prehospital setting. This series presents two cases of field expedient vasopressor use by emergency medicine providers for preflight stabilization during aeromedical evacuation to a hospital ship as part of the United States Navy disaster response in Puerto Rico...
November 9, 2018: Prehospital and Disaster Medicine
Jamie Ranse, Shane Lenson, Toby Keene, Matt Luther, Brandon Burke, Alison Hutton, Amy Nb Johnston, Julia Crilly
OBJECTIVE: The aim of this study was to describe the in-event, ambulance and ED impacts of patient presentations from an Australian mass gathering event (MGE) including patient demographics, provision of care, length of stay and discharge disposition. METHODS: This research was set at one MGE in Australia. The MGE had one first aid post and one in-event health team staffed by doctors, nurses and paramedics. A retrospective analysis of patient care records from providers of in-event, ambulance and ED services was undertaken...
November 8, 2018: Emergency Medicine Australasia: EMA
Matthew F Barhight, John Brinton, Timothy Stidham, Danielle E Soranno, Sarah Faubel, Benjamin R Griffin, Jens Goebel, Peter M Mourani, Katja M Gist
PURPOSE: To determine if there is an association between mortality and admission chloride levels and/or increases in the chloride level in critically ill children. METHODS: We performed a retrospective cohort study of all patients admitted to the paediatric intensive care unit (PICU) from January 2014 to December 2015. Patients were excluded for the following reasons: (1) age < 90 days or > 18 years, (2) admission to the cardiac intensive care unit, (3) no laboratory values upon admission to the PICU, (4) history of end-stage renal disease, (5) a disorder of chloride transport, and (6) admission for diabetic ketoacidosis...
October 31, 2018: Intensive Care Medicine
Aaron S Weinberg, William Chang, Grace Ih, Alan Waxman, Victor F Tapson
OBJECTIVE: Computed tomography angiography is limited in the intensive care unit (ICU) due to renal insufficiency, hemodynamic instability, and difficulty transporting unstable patients. A portable ventilation/perfusion (V/Q) scan can be used. However, it is commonly believed that an abnormal chest radiograph can result in a nondiagnostic scan. In this retrospective study, we demonstrate that portable V/Q scans can be helpful in ruling in or out clinically significant pulmonary embolism (PE) despite an abnormal chest x-ray in the ICU...
October 22, 2018: Journal of Intensive Care Medicine
Eileen Shu, Crystal Ives Tallman, William Frye, Jonathan G Boyajian, Leyla Farshidpour, Megann Young, Danielle Campagne
BACKGROUND: The quick sequential organ failure assessment score (qSOFA) has been proposed as a simple tool to identify patients with sepsis who are at risk for poor outcomes. Its utility in the pre-hospital setting has not been fully elucidated. METHODS: This is a retrospective observational study of adult patients arriving by ambulance in September 2016 to an academic emergency department in Fresno, California. The qSOFA score was calculated from pre-hospital vital signs...
September 18, 2018: American Journal of Emergency Medicine
David Hahn, Chie Emoto, Joshua C Euteneuer, Tomoyuki Mizuno, Alexander A Vinks, Tsuyoshi Fukuda
Morphine is commonly used for analgesia in the neonatal intensive care unit (NICU) despite having highly variable pharmacokinetics (PKs) between individual patients. The pharmacogenetic (PG) effect of variants at the loci of organic cation transporter 1 (OCT1) and UDP-glucuronosyltransferase 2B7 (UGT2B7) on age-dependent morphine clearance were evaluated in a cohort of critically ill neonatal patients using an opportunistic sampling design. Our primary results demonstrate the significant influence of OCT1 genotype (P < 0...
October 9, 2018: Clinical Pharmacology and Therapeutics
Joanna D Costa, Sandeep Sadashiv, Jennifer Hesler, Robert G Locke, Thomas J Blackson, Amy B Mackley
OBJECTIVE: The study aim was to identify the frequency with which tidal volumes were achieved in a target range in infants requiring positive pressure ventilation on emergency transport. STUDY DESIGN: We performed a prospective observational study of infants requiring continued positive pressure ventilation during emergency transport after resuscitation and stabilization. Blindly recorded data were analyzed for percentage of breaths that were below range, in range, and above desired range of 4-6 mL/kg...
October 5, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
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