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Prehospital haemorrhage management

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https://www.readbyqxmd.com/read/27503306/-preclinical-fibrinolysis-in-patients-with-st-segment-elevation-myocardial-infarction-in-a-rural-region
#1
T Viergutz, J Grüttner, T Walter, C Weiss, B Haaff, G Pollach, C Madler, T Luiz
BACKGROUND: In the current guidelines for the treatment of patients with ST-segment elevation myocardial infarction (STEMI), the European Society of Cardiology (ESC) recommends preclinical fibrinolysis as a reperfusion therapy if, due to long transportation times, no cardiac catheterisation is available within 90-120 min. However, there is little remaining in-depth expertise in this method because fibrinolysis is presently only rarely indicated. METHODS: In a rural area in southwestern Germany, where an emergency primary percutaneous coronary intervention was not routinely available within 90-120 min, 156 STEMI patients underwent fibrinolysis with the plasminogen activator reteplase, performed by trained emergency physicians...
September 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/26772450/the-itclamp-in-the-management-of-prehospital-haemorrhage
#2
Edward C T H Tan, Joost H Peters, Jessica L Mckee, Michael J R Edwards
INTRODUCTION: Bleeding remains a leading cause of death in trauma patients. The iTClamp is a temporary wound closure device designed to control external bleeding within seconds of injury. We describe our experience using this device on 10 patients in the prehospital environment. METHODS: We have implemented the iTClamp for prehospital use through our physician-staffed helicopter emergency medical service (HEMS). Indications were massive bleeding that could not be controlled with an ordinary compressive bandage or a haemostatic bandage...
May 2016: Injury
https://www.readbyqxmd.com/read/26355932/-combined-treatment-of-complicated-forms-of-angiodysplasias-in-conditions-of-a-multimodality-hospital
#3
V V Soroka, I E Borovsky, I A Khomchuk, D V Ovcharenko, I D Magamedov
Presented herein is a case report dealing with successive combined treatment for arteriovenous malformation of the left part of the chest, macrofistular form complicated by necroses of the left thoracic portion with arrosive haemorrhage from the area of necrosis. The authors describe diagnosis of this disease, technical peculiarities of performing transcatheter endovascular occlusion and topical treatment of wounds, underlining difficulties of verifying the pathology concerned at the prehospital stage and prevention of complications...
2015: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/26220293/prehospital-use-of-plasma-in-traumatic-hemorrhage-the-pupth-trial-study-protocol-for-a-randomised-controlled-trial
#4
RANDOMIZED CONTROLLED TRIAL
Penny S Reynolds, Mary Jane Michael, Emily D Cochran, Jacob A Wegelin, Bruce D Spiess
BACKGROUND: Severe traumatic injury and haemorrhagic shock are frequently associated with disruptions of coagulation function (such as trauma-induced coagulopathy TIC) and activation of inflammatory cascades. These pathologies may be exacerbated by current standard of care resuscitation protocols. Observational studies suggest early administration of plasma to severely-injured haemorrhaging patients may correct TIC, minimise inflammation, and improve survival. The proposed randomised clinical trial will evaluate the clinical effectiveness of pre-hospital plasma administration compared with standard- of-care crystalloid resuscitation in severely-injured patients with major traumatic haemorrhage...
2015: Trials
https://www.readbyqxmd.com/read/25398509/-gunshot-and-stab-wounds-in-germany-epidemiology-and-outcome-analysis-from-the-traumaregister-dgu%C3%A2
#5
D Bieler, A F Franke, S Hentsch, T Paffrath, A Willms, R Lefering, E W Kollig
BACKGROUND: The management of gunshot wounds is a rare challenge for trauma surgeons in Germany and Central Europe as a result of the low incidence of this type of trauma. Penetrating injuries occur with an incidence of 5% in Germany. They are caused by gunshots or more commonly by knives or other objects, for example during accidents. Since even the number of patients who are treated at level 1 trauma centres is limited by the low incidence, the objective of this study was to assess the epidemiology and outcome of gunshot and stab wounds in Germany...
November 2014: Der Unfallchirurg
https://www.readbyqxmd.com/read/24360668/fractures-of-the-pelvic-ring
#6
James Min-Leong Wong, Andrew Bucknill
Traumatic disruptions of the pelvic ring are high energy life threatening injuries. Management represents a significant challenge, particularly in the acute setting in the presence of severe haemorrhage. Initial management is focused on preserving life by controlling haemorrhage and associated injuries. Advances in prehospital care, surgery, interventional radiology and the introduction of treatment algorithms to streamline decision making have improved patient survival. As more patients with unstable pelvic injuries survive, the poor results associated with nonoperative management and increasing patient expectations of outcome are making surgical management of these fractures increasingly common...
December 2, 2013: Injury
https://www.readbyqxmd.com/read/23896213/haemorrhagic-shock-therapeutic-management
#7
REVIEW
J-S David, C Spann, G Marcotte, B Reynaud, O Fontaine, M Lefèvre, V Piriou
The management of a patient in post-traumatic haemorrhagic shock will meet different logics that will apply from the prehospital setting. This implies that the patient has beneficiated from a "Play and Run" prehospital strategy and was sent to a centre adapted to his clinical condition capable of treating all haemorrhagic lesions. The therapeutic goals will be to control the bleeding by early use of tourniquet, pelvic girdle, haemostatic dressing, and after admission to the hospital, the implementation of surgical and/or radiological techniques, but also to address all the factors that will exacerbate bleeding...
July 2013: Annales Françaises D'anesthèsie et de Rèanimation
https://www.readbyqxmd.com/read/23352673/iv-access-in-bleeding-trauma-patients-a-performance-review
#8
Paul T Engels, Edward Passos, Andrew N Beckett, Jeffrey D Doyle, Homer C Tien
BACKGROUND: Exsanguinating haemorrhage is a leading cause of death in severely injured trauma patients. Management includes achieving haemostasis, replacing lost intravascular volume with fluids and blood, and treating coagulopathy. The provision of fluids and blood products is contingent on obtaining adequate vascular access to the patient's venous system. We sought to examine the nature and timing of achieving adequate intravenous (IV) access in trauma patients requiring uncrossmatched blood in the trauma bay...
January 2014: Injury
https://www.readbyqxmd.com/read/22886891/prehospital-delay-in-acute-stroke-and-tia
#9
Kashif Waqar Faiz, Antje Sundseth, Bente Thommessen, Ole Morten Rønning
BACKGROUND: Early management improves outcome in acute stroke. This study was designed to assess the prehospital path from symptom onset to arrival in hospital and to identify factors associated with prehospital delay. METHODS: A prospective study was conducted including patients with acute ischaemic stroke, intracerebral haemorrhage and transient ischaemic attack admitted to hospital. Time intervals for prehospital delay, background data, severity, type of first medical contact and mode of transport were recorded...
August 2013: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/22362649/major-trauma-and-urban-cyclists-physiological-status-and-injury-profile
#10
Joanna Manson, Sian Cooper, Anita West, Elizabeth Foster, Elaine Cole, Nigel R M Tai
INTRODUCTION: Pedal cycling in cities has the potential to deliver significant health and economic benefits for individuals and society. Safety is the main concern for potential cyclists although the statistical risk of death is low. Little is known about the severity of injuries sustained by city cyclists and their outcome. AIM: The aim of this study was to characterise the physiological status and injury profile of cyclists admitted to our urban major trauma centre (MTC)...
January 2013: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/22026077/-pelvic-ring-injuries-current-concepts-of-management
#11
REVIEW
Salásek Martin, Pavelka Tomás
Pelvic ring injuries occur at any age. Most injuries to the pelvis are due to high-energy trauma, these injuries are therefore associated with abdominal, thoracic and head injuries. Unstable disruption of the pelvic ring has been often coupled with massive or life-threatening haemorrhage. The goal of the prehospital management is to keep airway open, start oxygen therapy, fluid replacement therapy and apply appropriate immobilization device. On admission of hemodynamically stable patients CT is preferred, for hemodynamically unstable the plain antero-posterior pelvis radiograph and ultrasound...
2011: Casopís Lékar̆ů C̆eských
https://www.readbyqxmd.com/read/20515913/drivers-of-acute-coagulopathy-after-severe-trauma-a-multivariate-analysis-of-1987-patients
#12
Arasch Wafaisade, Sebastian Wutzler, Rolf Lefering, Thorsten Tjardes, Marc Banerjee, Thomas Paffrath, Bertil Bouillon, Marc Maegele
OBJECTIVE: The role of acute coagulopathy after severe trauma as a major contributor to exsanguination and death has recently gained increasing appreciation, but the causes and mechanisms are not fully understood. This study was conducted to assess the risk factors associated with acute traumatic coagulopathy together with quantitative estimates of their importance. METHODS: Using the multicentre Trauma Registry of the German Society for Trauma Surgery, adult trauma patients with an Injury Severity Score ≥16 were retrospectively analysed for independent risk factors of acute traumatic coagulopathy on arrival at the emergency department (ED) by multivariate stepwise logistic regression analysis...
December 2010: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/19018136/characterisation-of-the-diagnostic-window-of-serum-glial-fibrillary-acidic-protein-for-the-differentiation-of-intracerebral-haemorrhage-and-ischaemic-stroke
#13
Florian Dvorak, Isabel Haberer, Matthias Sitzer, Christian Foerch
BACKGROUND: The rapid differentiation between intracerebral haemorrhage (ICH) and ischaemic stroke (IS) using biomarker testing would allow the prehospital, cause-specific management of stroke patients. Based on single measurements made during the acute phase of stroke, the value of serum glial fibrillary acidic protein (GFAP) was reported to be higher in ICH patients than in IS patients. The aim of the present study was to characterise the diagnostic window of serum GFAP for differentiating between ICH and IS...
2009: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/18467882/developing-alternative-strategies-for-the-treatment-of-traumatic-haemorrhagic-shock
#14
REVIEW
Hannes G Lienhart, Karl H Lindner, Volker Wenzel
PURPOSE OF REVIEW: The optimal strategy of stabilizing haemodynamic function in uncontrolled traumatic haemorrhagic shock states is unclear. Although fluid replacement is established in controlled haemorrhagic shock, its use in uncontrolled haemorrhagic shock is controversial, because it may worsen bleeding. RECENT FINDINGS: In the refractory phase of severe haemorrhagic shock, arginine vasopressin has been shown to be beneficial in selected cases due to an increase in arterial blood pressure, shift of blood away from a subdiaphragmatic bleeding site towards the heart and brain, and decrease in fluid resuscitation requirements...
June 2008: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/18446066/emergency-department-at-the-cutting-edge
#15
John D Ferris, Innes Smith, Colin E Robertson
OBJECTIVE: This paper reviews the experience of penetrating chest trauma over a 3-year period in one UK emergency department. METHODS: A retrospective review was performed of patients assessed in the emergency department resuscitation room between 1 January 2002 and 31 December 2005. Patients with penetrating chest trauma, either isolated or in combination with other injuries, were included. A Medline search was performed using the terms 'chest', 'trauma' and 'penetrating'...
April 2008: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/16113195/prehospital-management-of-lower-limb-fractures
#16
REVIEW
C Lee, K M Porter
Lower limb fractures are common injuries in prehospital care. Untreated fractures can lead to hypovolaemic shock especially if open, and should be treated with effective haemorrhage control and splintage. A brief assessment for open fractures, deformity, and neurovascular compromise should be followed by effective analgesia, wound management, reduction (if needed), splintage, and packaging of the patient. Early appropriate management reduces the morbidity and mortality of lower limb fractures.
September 2005: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/15193210/clinical-effectiveness-and-cost-effectiveness-of-prehospital-intravenous-fluids-in-trauma-patients
#17
REVIEW
J Dretzke, J Sandercock, S Bayliss, A Burls
OBJECTIVES: To systematically review the evidence on the effectiveness (in terms of mortality and morbidity) of prehospital intravenous (i.v.) fluid replacement, compared with no i.v. fluid replacement or delayed fluid replacement, in trauma patients with no head injury who have haemorrhage-induced hypotension due to trauma. DATA SOURCES: Electronic databases, relevant websites, handsearching, expert contacts. REVIEW METHODS: Search strategies were defined to identify randomised controlled trials (RCTs) and previous systematic reviews relating to the use of i...
June 2004: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/14653053/-changes-in-reperfusion-strategies-in-the-acute-phase-of-myocardial-infarction-from-1988-to-2001
#18
COMPARATIVE STUDY
J M Juliard, P Aubry, J L Golmard, D Himbert, H Benamer, L J Feldman, O Boudvillain, T Haghighat, A Ricard-Hibon, P G Steg
The objective of this study was to evaluate the evolution of therapeutic strategies in the course of myocardial infarction. Two successive periods were studied: 1988/96 (700 patients) and 1996/2001 (700 patients). The following parameters were compared: patient characteristics, management methods, and results on the hospital morbidity and mortality. The patient characteristics were little changed, in terms of age and sex, with a drop in the frequency of anterior infarcts during the second period (46 vs 51%, p = 0...
October 2003: Archives des Maladies du Coeur et des Vaisseaux
https://www.readbyqxmd.com/read/11558833/management-of-acute-ischaemic-stroke-in-the-elderly-tolerability-of-thrombolytics
#19
REVIEW
D Tanne, D Turgeman, Y Adler
Stroke and its consequences are of global concern. Although stroke can affect individuals of any age, it primarily affects the elderly. It is among the leading causes of severe disability and mortality. In recent years, acute stroke has become a medical emergency requiring urgent evaluation and treatment. Effective management of patients with acute stroke starts with organisation of the entire stroke care chain, from the community and prehospital scene, through the emergency department, to a dedicated stroke unit and then to comprehensive rehabilitation...
2001: Drugs
https://www.readbyqxmd.com/read/10572515/-supply-of-emergency-physicians-for-patients-with-stroke-in-the-m%C3%A3-nster-area-a-cross-sectional-study-of-the-quality-of-regional-health-care
#20
COMPARATIVE STUDY
B Weltermann, D vom Eyser, R Kleine-Zander, T Riedel, J Dieckmann, E B Ringelstein
BACKGROUND AND OBJECTIVE: Advances in understanding the pathophysiology and treatment of stroke have led to changed requirements, including the prehospital phase, for the care of patients with acute stroke. Rapid transport to a regional stroke centre is nowadays considered to be the standard for optimal quality of care. A retrospective cross-sectional analysis was undertaken in 1996 in the region of the town of Münster to test the quality of medical care provided by physicians on emergency call...
October 15, 1999: Deutsche Medizinische Wochenschrift
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