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Prehospital fluid management

D Brilej, D Stropnik, R Lefering, R Komadina
BACKGROUND: Early recognition and management of trauma related coagulopathy improves the outcome. Trauma facilities should implement an algorithm to identify the bleeding trauma patient with coagulopathy. OBJECTIVE: The scope of the paper is to identify the indicators of early coagulopathy and to optimize the indications for thromboelastometry and coagulation support. DESIGN: Cohort study based on data from trauma registry. SETTING: Data of 493 major trauma patients treated in GH Celje from 2006 to 2014 were included into The TraumaRegister DGU(®) (TR-DGU)...
September 22, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Michael A Smyth, Samantha J Brace-McDonnell, Gavin D Perkins
OBJECTIVE: Early identification of sepsis could enable prompt delivery of key interventions such as fluid resuscitation and antibiotic administration which, in turn, may lead to improved patient outcomes. Limited data indicate that recognition of sepsis by paramedics is often poor. We systematically reviewed the literature on prehospital sepsis screening tools to determine whether they improved sepsis recognition. DESIGN: Systematic review. The electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed were systematically searched up to June 2015...
2016: BMJ Open
Emma Lucy Joynes, Jodie Martin, Mark Ross
This study aims to assess the management of septic shock by air medical retrieval teams in the remote setting. A retrospective observational study was performed over 36 months. Sixty-seven adult patients who met the criteria for septic shock were included. Respiratory sepsis was the working diagnosis for 53% of patients; this was confirmed on intensive care unit (ICU) discharge in 39% of patients. Intravenous antibiotics and oxygen were delivered in over 90% of patients. Central and arterial line insertions were performed in 48% and 40% of patients, respectively, and 79% of patients were catheterized...
July 2016: Air Medical Journal
Helmut Trimmel, Janett Kreutziger, Robert Fitzka, Stephan Szüts, Christoph Derdak, Elisabeth Koch, Boris Erwied, Wolfgang G Voelckel
OBJECTIVES: We sought to assess whether the GlideScope Ranger video laryngoscope may be a reliable alternative to direct laryngoscopy in the prehospital setting. DESIGN: Multicenter, prospective, randomized, control trial with patient recruitment over 18 months. SETTING: Four study centers operating physician-staffed rescue helicopters or ground units in Austria and Norway. PATIENTS: Adult emergency patients requiring endotracheal intubation...
July 2016: Critical Care Medicine
Daniel Lane, Robbie I Ichelson, Ian R Drennan, Damon C Scales
OBJECTIVE: To identify studies describing the accuracy of prehospital sepsis identification and to summarise results of studies of prehospital management of patients with sepsis, severe sepsis or septic shock. METHODS: We conducted a systematic review to retrieve studies that evaluated the prehospital identification or treatment of patients with sepsis by emergency medical services (EMS). Two authors extracted data describing the study characteristics, incidence of sepsis among EMS-transported patients, criteria used to identify sepsis and specific treatments provided to patients with sepsis...
June 2016: Emergency Medicine Journal: EMJ
Tabitha Garwe, Jeremy J Johnson, Robert W Letton
OBJECTIVES: Traditionally, in both pediatric and adult trauma patients, management of hemorrhage and shock has included early rapid intravenous fluid (IVF) replacement at the scene or during transport to a definitive care facility. Because prehospital resuscitation can be considered as a lifesaving intervention, severely injured patients are more likely to receive IVF. Observational studies not adequately adjusting for this confounding by indication (indication bias) while evaluating the impact of prehospital IVF on mortality in clinically heterogeneous patient populations are likely to find an increased mortality associated with the use of prehospital IVF, an association that may be spurious even after traditional multivariable risk adjustment...
January 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Kyle K Sokol, George E Black, Kenneth S Azarow, William Long, Matthew J Martin, Matthew J Eckert
BACKGROUND: The current conflict in Afghanistan has resulted in a high volume of significantly injured pediatric patients. The austere environment has demanded emphasis on prehospital interventions (PHIs) to sustain casualties during transport. METHODS: The Department of Defense Trauma Registry was queried for all pediatric patients (≤18 years) treated at Camp Bastion from 2004 to 2012. PHIs were grouped by Advanced Trauma Life Support categories into (1) airway (A)--intubation or surgical airway; 2) breathing (B)--chest tube or needle thoracostomy; and 3) circulation (C)--tourniquet or hemostatic dressing...
December 2015: Journal of Trauma and Acute Care Surgery
Hu Hang, Wang Jianan, Han Chunmao
BACKGROUND: On 5 July 2014, a suicide terrorist set a crowded bus on fire in Hangzhou, injuring 33 passengers. Among these, 19 adult victims with the most severe burns were triaged to our center. This is a single-center, descriptive study recording the prehospital response and in-hospital treatment of these patients. METHODS: Information on the attack, on-scene rescue, and patient triage was collected from public media, governmental, and hospital reports. Information on patient injury and our in-hospital procedures was collected from the emergency registry and patient records...
February 2016: Burns: Journal of the International Society for Burn Injuries
Michael W Donnino, Lars W Andersen, Katherine M Berg, Joshua C Reynolds, Jerry P Nolan, Peter T Morley, Eddy Lang, Michael N Cocchi, Theodoros Xanthos, Clifton W Callaway, Jasmeet Soar
For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C...
January 2016: Resuscitation
Przemysław Kluj, Dawid Aleksandrowicz, Waldemar Machała, Tomasz Gaszyński
Hemostatic agents are currently used in the form of special granules or soaked gauze. Their use is particularly advantageous in difficult body location (e.g. on neck, armpit or groin), where other methods of bleeding control are impossible to use or fail. In a tactical environment tranexamic acid received first class recommendation for use in case of severe bleeding in the US Army. Its application should be considered in case of traumatic amputation, penetrating chest and abdominal trauma or hemorrhagic shock...
September 2015: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Megan Corrigan, Suprat Saely Wilson, Jeremy Hampton
PURPOSE: The safety and efficacy of medications that may be administered via the intranasal route in adult patients in the prehospital and emergency department (ED) settings are reviewed. SUMMARY: When medications of appropriate molecular character and concentration are delivered intranasally, they are quickly transported across this capillary network and delivered to the systemic circulation, thereby avoiding the absorption-limiting effects of first-pass metabolism...
September 15, 2015: American Journal of Health-system Pharmacy: AJHP
Dhuleep S Wijayatilake, Suyogi V Jigajinni, Peter B Sherren
PURPOSE OF REVIEW: Over many years, understanding of the pathophysiology in traumatic brain injury (TBI) has resulted in the development of core physiological targets and therapies to preserve cerebral oxygenation, and in doing so prevent secondary insult. The present review revisits the evidence for these targets and therapies. RECENT FINDINGS: Achieving oxygen, carbon dioxide, blood pressure, temperature and glucose targets remain a key goal of therapy in TBI, as does the role of effective prehospital care...
October 2015: Current Opinion in Anaesthesiology
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
Alexandra Brazinova, Marek Majdan, Johannes Leitgeb, Helmut Trimmel, Walter Mauritz
BACKGROUND: Existing evidence concerning the management of traumatic brain injury (TBI) patients underlines the importance of appropriate treatment strategies in both prehospital and early in-hospital care. The objectives of this study were to analyze the current state of early TBI care in Austria with its physician-based emergency medical service. Subsequently, identified areas for improvement were transformed into treatment recommendations. The proposed changes were implemented in participating emergency medical services and hospitals and evaluated for their effect...
2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Tara Irani, Jonathan Meizoso, George Garcia, Carl Schulman, Edward Lineen, Nicholas Namias, Patricia Byers
STATEMENT OF PURPOSE: In July 2000, Florida's universal helmet law was lessened to a partial helmet law despite unhelmeted riders being more likely to suffer serious and fatal head injuries. In response to these legislative changes and the increasing use of motorcycles among Floridians, we created an education program to teach early recognition of injuries with optimisation of care to prehospital personnel. This tertiary prevention program aims to mitigate the effect of motorcycle crash injuries by providing education focused on paramedic judgement for triage decisions, motorcycle injury patterns, and medical techniques, including fluid resuscitation, tourniquet use, helmet removal, cricothyroidotomy, and needle decompression...
April 2015: Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention
Nizama Salihefendic, Muharem Zildzic, Sead Ahmetagic
Acute respiratory distress syndrome (ARDS) is a form of acute life threatening respiratory failure. In daily practice there is difficulty in diagnostic and therapeutic management of Acute respiratory distress syndrome (ARDS). We observed delay in diagnostic and therapeutic procedures in patients with clinical signs for the presence of severe respiratory disorders. Finding timely evidence of the presence the clinical signs of threatening ARDS and underlying diseases like influenza A/H1N1 during prehospital period in early stage of disease it is possible introduce early adequate treatment: high flow oxygen, fluid replacement and pharmacological and antiviral therapy...
February 2015: Medical Archives
Guangming Yang, Yi Hu, Xiaoyong Peng, Yu Zhu, Jiatao Zang, Tao Li, Liangming Liu
BACKGROUND: The optimal resuscitation strategy for traumatic hemorrhagic shock is not completely determined. The objective of the present study was to investigate whether hypotensive resuscitation in combination with arginine vasopressin (AVP) can prolong the hypotensive resuscitation time by minimizing blood loss and stabilizing hemodynamics for uncontrolled hemorrhagic shock. METHODS: With an established rat model of uncontrolled hemorrhagic shock, we compared the beneficial effects of hypotensive resuscitation in combination with AVP to maintain blood pressure at 50 mm Hg for 3 hours to hypotensive resuscitation alone on animal survival, blood loss, and vital organ functions...
April 2015: Journal of Trauma and Acute Care Surgery
Scott A Goldberg, Dhanadol Rojanasarntikul, Andrew Jagoda
Traumatic brain injury (TBI) is an important cause of death and disability, particularly in younger populations. The prehospital evaluation and management of TBI is a vital link between insult and definitive care and can have dramatic implications for subsequent morbidity. Following a TBI the brain is at high risk for further ischemic injury, with prehospital interventions targeted at reducing this secondary injury while optimizing cerebral physiology. In the following chapter we discuss the prehospital assessment and management of the brain-injured patient...
2015: Handbook of Clinical Neurology
Ann-Charlotte Falk, Annika Alm, Veronica Lindström
BACKGROUND: Studies show that there are differences between men and women when it comes to several aspects of health care. But the research on equal care in a prehospital setting for patients with severe traumatic brain injury (TBI) has been sparsely investigated. The aim of this study is to describe prehospital care from a gender perspective. METHOD: This is a retrospective study of (n = 651) patients (>15 years) with severe TBI requiring intensive care at a University Hospital in Sweden during the years 2000-2010...
July 2015: International Emergency Nursing
Jon Femling, Steven Weiss, Eric Hauswald, David Tarby
OBJECTIVES: Sepsis is a significant problem. The differences between patients with sepsis who walk into the emergency department (ED) and those who are transported via emergency medical services (EMS) have not been clarified. The aim of the study was to determine whether there was a difference in outcome between patients arriving by EMS and those presenting directly to the ED. METHODS: We prospectively collected and reviewed a cohort of all cases of severe sepsis and septic shock admitted to the medical intensive care unit from the ED from November 2009 to March 2012...
December 2014: Southern Medical Journal
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