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Prehospital Emergency

Daniel Kolinsky, Samuel M Keim, Brian G Cohn, Evan S Schwarz, Donald M Yealy
BACKGROUND: The current standards for domestic emergency medical services suggest that all patients suspected of opioid overdose be transported to the emergency department for evaluation and treatment. This includes patients who improve after naloxone administration in the field because of concerns for rebound toxicity. However, various emergency medical services systems release such patients at the scene after a 15- to 20-min observation period as long as they return to their baseline...
October 18, 2016: Journal of Emergency Medicine
Camilla Hardeland, Kjetil Sunde, Helge Ramsdal, Susan R Hebbert, Linda Soilammi, Fredrik Westmark, Fredrik Nordum, Andreas E Hansen, Jon E Steen-Hansen, Theresa M Olasveengen
AIM: Explore, understand and address issues that impact upon timely and adequate allocation of prehospital medical assistance and resources to out-of-hospital cardiac arrest (OHCA) patients. METHODS: Mixed-methods: design obtaining data for one year in three emergency medical communication centres (EMCC); Oslo-Akershus (OA), Vestfold-Telemark (VT) and Østfold (Ø). Data collection included quantitative data from analysis of dispatch logs, ambulance records and audio files...
October 18, 2016: Resuscitation
Youcef Azeli, Eneko Barbería, María Jiménez-Herrera, Gil Bonet, Eva Valero-Mora, Alfonso Lopez-Gomariz, Isaac Lucas-Guarque, Alex Guillen-Lopez, Carlos Alonso-Villaverde, Inés Landín, Pilar Torralba, Ali Jammoul, Jordi Bladé-Creixenti, Christer Axelsson, Alfredo Bardají
BACKGROUND: Cardiovascular diseases are one of the leading causes of death in the industrialized world. Sudden cardiac death is very often the first manifestation of the disease and it occurs in the prehospital setting. The determination of the sudden cardiac death phenotype is challenging. It requires prospective studies in the community including multiple sources of case ascertainment that help to identify the cause and circumstances of death. The aim of the Clinical and Pathological Registry of Tarragona (ReCaPTa) is to study incidence and etiology of Sudden Cardiac Death in the Tarragona region (Catalonia, Spain)...
October 19, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Fu Shan Xue, Gui Zhen Yang, Chao Sun
No abstract text is available yet for this article.
November 2016: Critical Care Medicine
Leslie L Davis, Thomas P McCoy, Barbara Riegel, Sharon McKinley, Lynn V Doering, Kathleen Dracup, Debra K Moser
BACKGROUND: Past research has shown discrepancies between the time of symptom onset for patients with acute coronary syndrome (ACS) as documented in the medical record (MR) and patients' recall of the time assessed through subject interviews done later by researchers. PURPOSE: The aim of this study is to determine if there were differences between the time of symptom onset documented in the MR and subject interview taking into consideration sex, age group, and recall period for patients admitted to the emergency department for symptoms suggestive of ACS...
November 2016: Dimensions of Critical Care Nursing: DCCN
Mark Xavier Cicero, Travis Whitfill, Frank Overly, Janette Baird, Barbara Walsh, Jorge Yarzebski, Antonio Riera, Kathleen Adelgais, Garth D Meckler, Carl Baum, David Christopher Cone, Marc Auerbach
OBJECTIVE: Paramedics and emergency medical technicians (EMTs) triage pediatric disaster victims infrequently. The objective of this study was to measure the effect of a multiple-patient, multiple-simulation curriculum on accuracy of pediatric disaster triage (PDT). METHODS: Paramedics, paramedic students, and EMTs from three sites were enrolled. Triage accuracy was measured three times (Time 0, Time 1 [two weeks later], and Time 2 [6 months later]) during a disaster simulation, in which high and low fidelity manikins and actors portrayed 10 victims...
October 17, 2016: Prehospital Emergency Care
Ala'a O Oteir, Karen Smith, Johannes U Stoelwinder, Shelley Cox, James W Middleton, Paul A Jennings
BACKGROUND: Traumatic Spinal Cord Injury (TSCI) is relatively uncommon, yet a devastating and costly condition. Despite the human and social impacts, studies describing patients with potential TSCI in the pre-hospital setting are scarce. This paper aims to describe the epidemiology of patients potentially at risk of or suspected to have a TSCI by paramedics, with a view to providing a better understanding of factors associated with potential TSCI. METHODS: This is a retrospective cohort study of all adult patients managed and transported by Ambulance Victoria (AV) between 01 January 2007 and 31 December 2012 who, based on meeting pre-hospital triage protocols and criteria for spinal clearance, paramedic suspicion or spinal immobilisation, were classified to be at risk of or suspected to have a TSCI...
December 2016: Injury Epidemiology
Andrew O'Keefe, Ann Clarke, Yvan St Pierre, Jennifer Mill, Yuka Asai, Harley Eisman, Sebastien La Vieille, Reza Alizadehfar, Lawrence Joseph, Judy Morris, Jocelyn Graveli, Moshe Ben-Shoshan
OBJECTIVES: To determine the recurrence rate of anaphylaxis in children medically attended in an emergency department (ED), we performed a prospective cohort study to evaluate prehospital and ED management of children with recurrent anaphylaxis and to assess factors associated with recurrent anaphylaxis. STUDY DESIGN: As part of the Cross-Canada Anaphylaxis Registry, parents of children with anaphylaxis identified prospectively in 3 EDs and through an emergency medical response service were contacted annually after presentation and queried on subsequent reactions...
October 12, 2016: Journal of Pediatrics
Chulin Chen, Ting Kan, Shuang Li, Chen Qiu, Li Gui
OBJECTIVES: This review aimed to analyze published literature to introduce the use and implementation of standard operating procedures (SOPs) and checklists in prehospital emergency medicine and their impact on guideline adherence and patient outcome. METHODS: An English literature search was carried out using the Cochrane Library, MEDLINE, EMBASE, Springer, Elsevier, and ProQuest databases. Original articles describing the use and implementation of SOPs or checklists in prehospital emergency medicine were included...
September 28, 2016: American Journal of Emergency Medicine
Matthew S Siket
Although stroke declined from the third to fifth most common cause of death in the United States, the annual incidence and overall prevalence continue to increase. Since the available US Food and Drug Administration-approved treatment options are time dependent, improving early stroke care may have more of a public health impact than any other phase of care. Timely and efficient stroke treatment should be a priority for emergency department and prehospital providers. This article discusses currently available and emerging treatment options in acute ischemic stroke focusing on the preservation of salvageable brain tissue, minimizing complications, and secondary prevention...
November 2016: Emergency Medicine Clinics of North America
A R Alpysova, Yu V Subbota, A K Adambekova, N T Telembetov, M Maratkyzy
AIM: To analyze the management of patients with associated complications from hypertension to improve prehospital therapeutic and diagnostic care. MATERIAL AND METHODS: The accounts and records (125,905 calling cards over 2012-2014) of the Statistics Division, Karaganda Regional First Aid Station, were used. The methods of clinical and mathematical analysis were applied. RESULTS: There was an annual increase in the number of calls for all cases of hypertension complications in relation to the higher rate of hospitalization by 2014...
2016: Terapevticheskiĭ Arkhiv
Akira Funada, Yoshikazu Goto, Tetsuo Maeda, Hayato Tada, Ryota Teramoto, Yoshihiro Tanaka, Kenshi Hayashi, Masakazu Yamagishi
BACKGROUND: Population aging has rapidly progressed in Japan. However, few data exist regarding the characteristics of extremely elderly patients with out-of-hospital cardiac arrest (OHCA). We aimed to determine the prehospital predictors of one-month survival with favorable neurological outcomes (Cerebral Performance Category scale, category 1 or 2; CPC 1-2) in this population. METHODS: We investigated 23,520 OHCA patients aged ≥95 years from a prospectively recorded, nationwide, Utstein-style Japanese database between 2008 and 2012...
October 7, 2016: Journal of Cardiology
Vibe Maria Laden Nielsen, Jacob Madsen, Anette Aasen, Anne Pernille Toft-Petersen, Kenneth Lübcke, Bodil Steen Rasmussen, Erika Frischknecht Christensen
BACKGROUND: Patients with acute respiratory failure are at risk of deterioration during prehospital transport. Ventilatory support with continuous positive airway pressure (CPAP) can be initiated in the prehospital setting. The objective of the study is to evaluate adherence to treatment and effectiveness of CPAP as an addition to standard care. METHODS: In North Denmark Region, patients with acute respiratory failure, whom paramedics assessed as suffering from acute cardiopulmonary oedema, acute exacerbation of chronic obstructive pulmonary disease or asthma were treated with CPAP using 100 % O2 from 1 March 2014 to 3 May 2015...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
G Lee Pride, Justin F Fraser, Rishi Gupta, Mark J Alberts, J Neal Rutledge, Ray Fowler, Sameer A Ansari, Todd Abruzzo, Barb Albani, Adam Arthur, Blaise Baxter, Ketan R Bulsara, Michael Chen, Josser E Delgado Almandoz, Chirag D Gandhi, Don Heck, Steven W Hetts, Joshua A Hirsch, M Shazam Hussain, Richard Klucznik, Seon-Kyu Lee, William J Mack, Thabele Leslie-Mazwi, Ryan A McTaggart, Philip M Meyers, J Mocco, Charles Prestigiacomo, Athos Patsalides, Peter Rasmussen, Robert M Starke, Peter Sunenshine, Donald Frei, Mahesh V Jayaraman
No abstract text is available yet for this article.
October 5, 2016: Journal of Neurointerventional Surgery
Linda L Coventry, Johanna W van Schalkwyk, Peter Thompson, Scott Hawkins, Desley Hegney
AIMS AND OBJECTIVES: To explore patient decision delay, the symptom experience, and factors that motivated the patient experiencing myocardial infarction (MI) to go to the emergency department (ED). BACKGROUND: Reperfusion for MI is more effective if performed as soon as possible after the onset of symptoms. Multiple studies show that prehospital delay is long and can average several hours. DESIGN: A qualitative descriptive design using semi-structured interviews...
October 5, 2016: Journal of Clinical Nursing
Aimee Alphonso, Marc Auerbach, Kirsten Bechtel, Kyle Bilodeau, Marcie Gawel, Jeannette Koziel, Travis Whitfill, Gunjan Kamdar Tiyyagura
OBJECTIVES: To develop and provide validity evidence for a performance checklist to evaluate the child abuse screening behaviors of prehospital providers. METHODS: Checklist Development: We developed the first iteration of the checklist after review of the relevant literature and on the basis of the authors' clinical experience. Next, a panel of six content experts participated in three rounds of Delphi review to reach consensus on the final checklist items. Checklist Validation: Twenty-eight emergency medical services (EMS) providers (16 EMT-Basics, 12 EMT-Paramedics) participated in a standardized simulated case of physical child abuse to an infant followed by one-on-one semi-structured qualitative interviews...
October 4, 2016: Prehospital Emergency Care
Matthew Pritam Taylor, Paul Wrenn, Andrew David O'Donnell
BACKGROUND: Injury to the spinal cord can result in loss of sympathetic innervation causing a drop in BP and HR, this condition is known as neurogenic shock. There is debate among the literature on how and when neurogenic shock presents and what values of HR and BP should be used to define it. Previous studies do not take into account multiple prehospital and emergency department recordings. OBJECTIVE: To improve understanding of how neurogenic shock presents in humans, allowing better identification and treatment...
October 3, 2016: Emergency Medicine Journal: EMJ
Laura Cluzol, Jennifer Cautela, Pierre Michelet, Antoine Roch, François Kerbaul, Julien Mancini, Marc Laine, Michael Peyrol, Floriane Robin, Franck Paganelli, Laurent Bonello, Franck Thuny
BACKGROUND: Acute heart failure (AHF) is a life-threatening medical emergency for which no new effective therapies have emerged in recent decades. No previous study has exhaustively described the entire course of care of AHF patients from first medical contact to hospital discharge or assessed its impact on prognosis. AIM: To fully describe the course of care and analyze its influence on outcomes in patients hospitalized with an AHF syndrome in an academic university center...
September 29, 2016: Archives of Cardiovascular Diseases
Daniel W Spaite, Chengcheng Hu, Bentley J Bobrow, Vatsal Chikani, Bruce Barnhart, Joshua B Gaither, Kurt R Denninghoff, P David Adelson, Samuel M Keim, Chad Viscusi, Terry Mullins, Duane Sherrill
STUDY OBJECTIVE: Survival is significantly reduced by either hypotension or hypoxia during the out-of-hospital management of major traumatic brain injury. However, only a handful of small studies have investigated the influence of the combination of both hypotension and hypoxia occurring together. In patients with major traumatic brain injury, we evaluate the associations between mortality and out-of-hospital hypotension and hypoxia separately and in combination. METHODS: All moderate or severe traumatic brain injury cases in the preimplementation cohort of the Excellence in Prehospital Injury Care study (a statewide, before/after, controlled study of the effect of implementing the out-of-hospital traumatic brain injury treatment guidelines) from January 1, 2007, to March 31, 2014, were evaluated (exclusions: <10 years, out-of-hospital oxygen saturation ≤10%, and out-of-hospital systolic blood pressure <40 or >200 mm Hg)...
September 27, 2016: Annals of Emergency Medicine
Jeffrey Siegler, Melissa Kroll, Susan Wojcik, Hawnwan Philip Moy
INTRODUCTION: In the prehospital setting, Emergency Medical Services (EMS) professionals rely on providing positive pressure ventilation with a bag-valve-mask (BVM). Multiple emergency medicine and critical care studies have shown that lung-protective ventilation protocols reduce morbidity and mortality. Our primary objective was to determine if a group of EMS professionals could provide ventilations with a smaller BVM that would be sufficient to ventilate patients. Secondary objectives included 1) if the pediatric bag provided volumes similar to lung-protective ventilation in the hospital setting and 2) compare volumes provided to the patient depending on the type of airway (mask, King tube, and intubation)...
October 3, 2016: Prehospital Emergency Care
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