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Pre-Hospital Emergency Medicine

Nils Kunze-Szikszay, Lennart A Krack, Pauline Wildenauer, Saskia Wand, Tim Heyne, Karoline Walliser, Christopher Spering, Martin Bauer, Michael Quintel, Markus Roessler
BACKGROUND: Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. METHODS: From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED)...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Maru Aregawi, Samuel J Smith, Musa Sillah-Kanu, John Seppeh, Anitta R Y Kamara, Ryan O Williams, John J Aponte, Andrea Bosman, Pedro Alonso
BACKGROUND: As emergency response to the Ebola epidemic, the Government of Sierra Leone and its partners implemented a large-scale Mass Drug Administration (MDA) with artesunate-amodiaquine (ASAQ) covering >2.7 million people in the districts hardest hit by Ebola during December 2014-January 2015. The World Health Organization (WHO) and the National Malaria Control Programme (NMCP) evaluated the impact of the MDA on malaria morbidity at health facilities and the number of Ebola alerts received at District Ebola Command Centres...
2016: Malaria Journal
Peter Paal, Les Gordon, Giacomo Strapazzon, Monika Brodmann Maeder, Gabriel Putzer, Beat Walpoth, Michael Wanscher, Doug Brown, Michael Holzer, Gregor Broessner, Hermann Brugger
BACKGROUND: This paper provides an up-to-date review of the management and outcome of accidental hypothermia patients with and without cardiac arrest. METHODS: The authors reviewed the relevant literature in their specialist field. Summaries were merged, discussed and approved to produce this narrative review. RESULTS: The hospital use of minimally-invasive rewarming for non-arrested, otherwise healthy, patients with primary hypothermia and stable vital signs has the potential to substantially decrease morbidity and mortality for these patients...
September 15, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Simon G A Brown, Emma L Ball, Kyle Perrin, Catherine A Read, Stephen E Asha, Richard Beasley, Diana Egerton-Warburton, Peter G Jones, Gerben Keijzers, Frances B Kinnear, Ben C H Kwan, Y C Gary Lee, Julian A Smith, Quentin A Summers, Graham Simpson
INTRODUCTION: Current management of primary spontaneous pneumothorax (PSP) is variable, with little evidence from randomised controlled trials to guide treatment. Guidelines emphasise intervention in many patients, which involves chest drain insertion, hospital admission and occasionally surgery. However, there is evidence that conservative management may be effective and safe, and it may also reduce the risk of recurrence. Significant questions remain regarding the optimal initial approach to the management of PSP...
September 13, 2016: BMJ Open
Yoshito Zamami, Toru Imai, Masaki Imanishi, Kenshi Takechi, Naoko Shiraishi, Toshihiro Koyama, Hidenori Sagara, Yasukazu Shiino, Toshiaki Sendo, Keisuke Ishizawa
BACKGROUND: Many pharmacists are participating in team-based medical care in emergency hospitals. Therefore, there is a desperate need to improve the education system. In the present study, we provided a "pharmaceutical lifesaving skills training" to the students in their fifth and sixth year of the pharmaceutical school and evaluated the program's impact on the students' learning and confidence in their ability to perform pharmaceutical interventions for emergency patients. METHODS: We conducted a pharmaceutical lifesaving skills training program with 12 participants who were in their fifth and six year of pharmaceutical school...
2016: Journal of Pharmaceutical Health Care and Sciences
Joshua J Wiegel, Ali J Olyaei
Pharmacists may play a key role on the multidisciplinary transplant team. This article describes the development and current status of pharmacists in the management of transplant recipients in the United States. Traditionally, pharmacists played an important support role in transplant medicine. This role has been expanded to include direct patient care for the avoidance, detection, and/or treatment of side effects from the polypharmacy necessary in the management of these complex patients. Pharmacists provide pre- and post-transplant education to transplant recipients to enhance adherence to complicated medical regimens and thereby reduce readmission to hospital and unscheduled, costly visits to urgent care centers and/or hospital emergency departments...
July 2016: Indian Journal of Urology: IJU: Journal of the Urological Society of India
Ilana Bank, Elene Khalil
OBJECTIVES: Pediatric hospital disaster responders must be well-trained and prepared to manage children in a mass-casualty incident. Simulations of various types have been the traditional way of testing hospital disaster plans and training hospital staff in skills that are used in rare circumstances. The objective of this longitudinal, survey-based, observational study was to assess the effect of disaster response and management-based experiential learning on the knowledge and confidence of advanced learners...
October 2016: Prehospital and Disaster Medicine
C Buschmann, C Kleber, M Tsokos, T Kerner, K Püschel, U Schmidt, H Fischer, M Stuhr
There are considerable similarities and intersections between forensic medicine and emergency medicine. This applies especially to frustraneously resuscitated patients or other lethal clinical courses of traumatized patients who are subject to latter forensic autopsy. Cooperation between departments of emergency and forensic medicine not only has emergency medical training potential, but also the possibility of retrospective evaluation of medical emergency measures - both in individual cases and with regard to epidemiological aspects...
August 2016: Der Anaesthesist
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No abstract text is available yet for this article.
June 2016: Annals of Intensive Care
Biljana Lakić, Maja Račić, Duško Vulić
OBJECTIVE: The aim of this study was to investigate the differences in pre-hospital care of patients with acute myocardial infarction between emergency medical services and family medicine. PATIENTS AND METHODS: This retrospective descriptive study included patients treated for acute myocardial infarction at the University Clinical Centre of Banja Luka, in the period from 1st January to 31st December 2011. The patients were divided into two groups: patients who received a hospital referral from the family medicine service and those who received one from the emergency medical service...
May 2016: Acta Medica Academica
M Rehn, P K Hyldmo, V Magnusson, J Kurola, P Kongstad, L Rognås, L K Juvet, M Sandberg
BACKGROUND: The Scandinavian society of anaesthesiology and intensive care medicine task force on pre-hospital airway management was asked to formulate recommendations following standards for trustworthy clinical practice guidelines. METHODS: The literature was systematically reviewed and the grading of recommendations assessment, development and evaluation (GRADE) system was applied to move from evidence to recommendations. RESULTS: We recommend that all emergency medical service (EMS) providers consider to: apply basic airway manoeuvres and airway adjuncts (good practice recommendation); turn unconscious non-trauma patients into the recovery position when advanced airway management is unavailable (good practice recommendation); turn unconscious trauma patients to the lateral trauma position while maintaining spinal alignment when advanced airway management is unavailable [strong recommendation, low quality of evidence (QoE)]...
August 2016: Acta Anaesthesiologica Scandinavica
Yuwares Sittichanbuncha, Sorrawit Savatmongkorngul, Puchong Jawroongrit, Kittisak Sawanyawisuth
BACKGROUND: Pre-hospital emergency medical services are an important network for Emergency Medicine. It has been shown to reduce morbidity and mortality of patients by medical procedures. The Thai government established pre-hospital emergency medical services in 2008 to improve emergency medical care. Since then, there are limited data at the national level on mortality rates with pre-hospital care and the risk factors associated with mortality in non-traumatic patients. AIMS: To study the pre-hospital mortality rate and factors associated with mortality in non-traumatic patients using the emergency medical service in Thailand...
September 2015: Turkish Journal of Emergency Medicine
Jennifer K Spinler, Caná L Ross, Tor C Savidge
: With the end of the golden era of antibiotic discovery, the emergence of a new post-antibiotic age threatens to thrust global health and modern medicine back to the pre-antibiotic era. Antibiotic overuse has resulted in the natural evolution and selection of multi-drug resistant bacteria. One major public health threat, Clostridium difficile, is now the single leading cause of hospital-acquired bacterial infections and is by far the most deadly enteric pathogen for the U.S. POPULATION: Due to the high morbidity and mortality and increasing incidence that coincides with antibiotic use, non-traditional therapeutics are ideal alternatives to current treatment methods and also provide an avenue towards prevention...
May 12, 2016: Anaerobe
Mohammad U Khubaib, Farooq A Rathore, Ahmed Waqas, Mohsin M Jan, Sana Sohail
INTRODUCTION: Stroke is the leading cause of neurological disability in the world. In Pakistan, house officers (HOs) are usually the first contact for a stroke patient in the emergency department. Sometimes they need to make quick decisions regarding diagnosis and management without specialist supervision. Thousands of current final year MBBS (Bachelor of Medicine, Bachelor of Surgery) students will be performing the duties of HOs soon. This study documents the knowledge and confidence levels of final year students and HOs in Pakistan regarding basic facts related to initial diagnosis and management of stroke...
2016: Curēus
Krisda H Chaiyachati, Andre N Sofair, Jeremy I Schwartz, David Chia
OBJECTIVES: Patient throughput and early discharges are important for decreasing emergency department wait times and creating available beds for new hospital admissions. The educational schedule of internal medicine trainees can interfere with timely discharges, but targeted interventions can help residents meet the hospital's patient flow needs. Our training program instituted daily morning discharge rounds on the inpatient service, requiring each team to prepare potential discharges 1 day ahead and prioritizing these discharges the next day...
May 2016: Southern Medical Journal
Sergio Javier Villaseñor Bayardo
Mexican psychiatry initiated since pre-Hispanic times. Historically, treatments were a mixture of magic, science and religion. Ancient Nahuas had their own medical concepts with a holistic view of medicine, considering men and cosmos as a whole. The first psychiatric hospital appeared in 1566 and a more modern psychiatric asylum emerged until 1910. International exchanges of theoretical approaches started in the National University with the visit of Pierre Janet. There were other important figures that influenced Mexican psychiatry, such as Erich Fromm, Henri Ey, Jean Garrabé and Yves Thoret...
April 2016: International Review of Psychiatry
Zhuoyuan Liang, Lijie Ren, Ting Wang, Huoyou Hu, Weiping Li, Yaping Wang, Dehong Liu, Yi Lie
The efficacy of thrombolytic therapy for acute ischemic stroke (AIS) decreases when the administration of tissue plasminogen activator (tPA) is delayed. Derived from Toyota Production System, lean production aims to create top-quality products with high-efficiency procedures, a concept that easily applies to emergency medicine. In this study, we aimed to determine whether applying lean principles to flow optimization could hasten the initiation of thrombolysis. A multidisciplinary team (Stroke Team) was organized to implement an ongoing, continuous loop of lean production that contained the following steps: decomposition, recognition, intervention, reengineering and assessment...
April 19, 2016: Australasian Physical & Engineering Sciences in Medicine
Desmond Whalen, Chris Harty, Mohamed Ravalia, Tia Renouf, Sabrina Alani, Robert Brown, Adam Dubrowski
The relevance of simulation as a teaching tool for medical professionals working in rural and remote contexts is apparent when low-frequency, high-risk situations are considered. Simulation training has been shown to enhance learning and improve patient outcomes in urban settings. However, there are few simulation scenarios designed to teach rural trauma management during complex medical transportation. In this technical report, we present a scenario using a medevac helicopter (Replica of Sikorsky S-92 designed by Virtual Marine Technology, St...
2016: Curēus
P Daniel, R Gist, A Grock, S Kohlhoff, P Roblin, B Arquilla
OBJECTIVES: The aim of this study was to describe an educational method teaching Disaster Medicine to American Emergency Medicine (EM) physicians and to evaluate knowledge attainment using this method. METHODS: This was an observational study using a pre-test and a post-test. A full-scale disaster exercise (FSE) was conducted at a large academic center with two hospitals in Brooklyn, New York (USA). Eighty-two EM residents (physicians in training, post medical school) participated in the study...
June 2016: Prehospital and Disaster Medicine
Martin Kimmel, Jing Shi, Joerg Latus, Christoph Wasser, Daniel Kitterer, Niko Braun, Mark Dominik Alscher
BACKGROUND AND OBJECTIVES: Emergency departments (EDs) have a growing role in hospital admissions, but few studies address AKI biomarkers in the ED. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients admitted to the internal medicine service were enrolled during initial workup in the ED at Robert-Bosch-Hospital, Stuttgart, Germany. Daily serum creatinine (sCr) and urine output (UO) were recorded for AKI classification by Kidney Disease Improving Global Outcomes (KDIGO) criteria...
June 6, 2016: Clinical Journal of the American Society of Nephrology: CJASN
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