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Pre-hospital emergency care

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https://www.readbyqxmd.com/read/28627014/review-article-paediatric-status-epilepticus-in-the-pre-hospital-setting-an-update
#1
REVIEW
Jeremy Furyk, Kerriane Watt, Theophilus I Emeto, Stuart Dalziel, Daniel Bodnar, Kate Riney, Franz E Babl
Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand...
June 18, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28616160/cardiopulmonary-arrest-in-primary-care-clinics-more-holes-than-cheese-a-survey-of-the-knowledge-and-attitudes-of-primary-care-physicians-regarding-resuscitation
#2
Sharon Einav, Oren Wacht, Nechama Kaufman, Eliezer Alkalay
BACKGROUND: Patients experiencing pre-arrest symptoms may first refer to their primary care physician. The study's aim was to determine the likelihood that a patient undergoing out-of-hospital cardiac arrest will receive appropriate resuscitation efforts in a primary care clinic in a country with a directive that clinics maintain resuscitation equipment and physicians undergo periodic resuscitation training. METHODS: An anonymous, 23-question online cross-sectional survey was created and administered to primary care physicians working in community clinics (10/1/2015-5/3/2015)...
2017: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/28612689/evaluation-of-flood-preparedness-in-government-healthcare-facilities-in-eastern-province-sri-lanka
#3
Jessica M Farley, Inoka Suraweera, W L S P Perera, Jeremy Hess, Kristie L Ebi
BACKGROUND: Sri Lanka is vulnerable to floods and other hydro-meteorological disasters. Climate change is projected to increase the intensity of these events. OBJECTIVE: This study aimed to assess the flood preparedness in healthcare facilities in Eastern Province. DESIGN: This was a cross-sectional, descriptive, mixed methods study conducted in Trincomalee District. Surveys were conducted in 31 government healthcare facilities, using a pre-tested, structured questionnaire covering the last 5 years...
2017: Global Health Action
https://www.readbyqxmd.com/read/28611876/effectiveness-of-resident-physicians-as-triage-liaison-providers-in-an-academic-emergency-department
#4
Victoria Weston, Sushil K Jain, Michael Gottlieb, Amer Aldeen, Stephanie Gravenor, Michael J Schmidt, Sanjeev Malik
INTRODUCTION: Emergency department (ED) crowding is associated with detrimental effects on ED quality of care. Triage liaison providers (TLP) have been used to mitigate the effects of crowding. Prior studies have evaluated attending physicians and advanced practice providers as TLPs, with limited data evaluating resident physicians as TLPs. This study compares operational performance outcomes between resident and attending physicians as TLPs. METHODS: This retrospective cohort study compared aggregate operational performance at an urban, academic ED during pre- and post-TLP periods...
June 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28609331/evaluation-and-impact-of-the-advanced-pediatric-life-support-course-in-the-care-of-pediatric-emergencies-in-spain
#5
Javier Benito, Carlos Luaces-Cubells, Santiago Mintegi, Ignacio Manrique Martínez, Mercedes De la Torre Espí, Concepción Miguez Navarro, Paula Vazquez López, Carmen Campos Calleja, Francesc Ferres Serrat, María Teresa Alonso Salas, Javier González Del Rey
INTRODUCTION: The Advanced Pediatric Life Support (APLS) course was introduced in the training of professionals who care for pediatric emergencies in Spain in 2005. OBJECTIVE: To analyze the impact of the APLS course in the current clinical practice in Spanish PEDs. METHODS: The directors of APLS courses were asked about information regarding the courses given to date, especially on the results of the satisfaction survey completed by students at the end of the course...
June 12, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28609308/evaluation-of-a-clinical-protocol-to-assess-and-diagnose-neuropathic-pain-during-acute-hospital-admission-results-from-traumatic-spinal-cord-injury
#6
Lise M A Bélanger, Hamed S Umedaly, Vanessa K Noonan, So Eyun Park, Jennifer Prince, Nancy P Thorogood, Tian Shen, Andrea F Townson, John T Street, Marcel F Dvorak, Michael Negraeff
OBJECTIVES: A clinical protocol was developed for clinicians to routinely assess and initiate treatment for patients with neuropathic pain (NP) in an acute care setting. The objectives of this study were to: (1) determine the incidence and onset of NP in patients with traumatic SCI during acute care and (2) describe how the implementation of a clinical protocol impacts the assessment and diagnosis of NP. METHODS: The study was a cohort analysis with a pre-post-test utilizing a historical control...
June 12, 2017: Clinical Journal of Pain
https://www.readbyqxmd.com/read/28605525/infectious-diseases-team-for-the-early-management-of-severe-sepsis-and-septic-shock-in-the-emergency-department
#7
Pierluigi Viale, Sara Tedeschi, Luigia Scudeller, Luciano Attard, Lorenzo Badia, Michele Bartoletti, Alessandra Cascavilla, Francesco Cristini, Nicola Dentale, Giovanni Fasulo, Giorgio Legnani, Filippo Trapani, Fabio Tumietto, Gabriella Verucchi, Giulio Virgili, Andrea Berlingeri, Simone Ambretti, Chiara De Molo, Mara Brizi, Mario Cavazza, Maddalena Giannella
Background.: To assess the impact on all-cause 14-day survival of the implementation of an infectious disease (ID) team for the early management of severe sepsis/septic shock (SS/SS) in the Emergency Department (ED). Methods.: A quasi-experimental pre-post study was carried-out at the general ED of our 1,420-bed teaching hospital. During the pre phase (June 2013-July 2014) all consecutive adult patients with SS/SS were managed according to standard-of-care and data were prospectively collected...
June 12, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28598044/a-study-of-prehospital-delay-patterns-in-acute-myocardial-infarction-in-an-urban-tertiary-care-institute-in-mumbai
#8
Ashar Khan, Milind Phadke, Yash Y Lokhandwala, Pratap J Nathani
OBJECTIVE: There is now increasing awareness about the need for early diagnosis in patients presenting with chest pain. Pre-hospital delay remains a major hurdle in the institution of early reperfusion therapy, which is crucial in salvaging 'at-risk' myocardium and reducing adverse cardiovascular events following ST elevation myocardial infarction (STEMI). This study aims to determine the incidence and the determinants of delayed presentation STEMI and the potential impact of such delay on adverse cardiovascular outcomes...
May 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/28587264/being-in-the-chemotherapy-suite-versus-being-in-the-oncology-ward-an-analytical-view-of-two-hospital-sites-occupied-by-people-experiencing-cancer
#9
Catherine Hughes, Kate van Heugten, Sally Keeling, Francisc Szekely
How do people with cancer occupy places within the health system during their journey through palliative care? The answer to this question was explored by the authors as part of a wider ethnographic study of eight people's journeys from referral to palliative care services to the end of life. This article reports on findings that have emerged from ongoing analysis that has been completed in the years proceeding data collection. An ethnographic research design was used to collect data about the participants and their family members over a three-year period...
June 5, 2017: Cancers
https://www.readbyqxmd.com/read/28581253/severe-hypoglycemia-among-patients-with-type-2-diabetes-requiring-emergency-hospital-admission-the-hipos-er-study
#10
João Conceição, Jorge Dores, Francisco Araújo, Pedro Laires, Richard D Carr, Kimberly Brodovicz, Larry Radican, Ana Maria Nogueira
AIMS: In this study we analysed the prevalence of severe hypoglycaemia in patients with type 2 diabetes treated with antihyperglycemic agents (AHA) and requiring emergency room (ER) assistance. This analysis was also done by AHA therapy. MATERIALS AND METHODS: The HIPOS-ER study was a cross-sectional, observational, multicenter, nationwide, study with specific hypoglycemia source data collection. RESULTS: Within the study period, a total of 425,706 admissions were recorded at the ER of participating hospitals...
June 5, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28571104/a-review-of-the-burns-caseload-of-a-physician-based-helicopter-emergency-medical-service
#11
Karina Hall, Brian Burns
OBJECTIVES: The aim of this study was to describe patient demographics, injuries, physiology and interventions performed by retrieval physicians in the care of burns patients in both a pre-hospital and interhospital setting. METHODS: A retrospective review of patient records from a large Australian Helicopter Emergency Medical Service was conducted. Demographics, injury, burn type, physiology and intervention data were extracted into a database for statistical analysis...
June 1, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28569281/a-qualitative-study-of-determinants-of-patient-behaviour-leading-to-an-infection-related-hospital-admission
#12
A P Tonna, A E Weidmann, R B Laing, I Tonna, G M Macartney, V Paudyal, D Stewart
Objectives To describe and understand the determinants of patients' behaviours surrounding admission to hospital for an acute infective episode Method Patients admitted to the infection or acute medicine admission units of a major Scottish teaching hospital and commenced on antibiotic therapy after admission were included. Semi-structured face-to-face interviews were conducted using a pre-piloted interview schedule guide that focused on gathering information about patient behaviours and experiences prior to admission to hospital with an acute infection...
March 2017: Journal of the Royal College of Physicians of Edinburgh
https://www.readbyqxmd.com/read/28562308/partners-for-kids-care-coordination-lessons-from-the-field
#13
Rory Cusack Weier, William Gardner, Kimberly Conkol, Kathleen Pajer, Kelly J Kelleher
OBJECTIVE: The goal of this trial was to present a case study of care coordination for children and youth with special health care needs from an exclusively pediatric accountable care organization, and compare precare and postcare data on their use of inpatient and emergency department services. METHODS: This pre-post comparison of the health care utilization included a subset of 733 children enrolled in Partners for Kids care coordination funded through a delegation arrangement with several Medicaid managed care plans...
May 2017: Pediatrics
https://www.readbyqxmd.com/read/28560683/the-impact-of-a-multifaceted-intervention-including-sepsis-electronic-alert-system-and-sepsis-response-team-on-the-outcomes-of-patients-with-sepsis-and-septic-shock
#14
Yaseen M Arabi, Hasan M Al-Dorzi, Ahmed Alamry, Ra'ed Hijazi, Sami Alsolamy, Majid Al Salamah, Hani M Tamim, Saad Al-Qahtani, Abdulaziz Al-Dawood, Abdellatif M Marini, Fatimah H Al Ehnidi, Shihab Mundekkadan, Amal Matroud, Mohamed S Mohamed, Saadi Taher
BACKGROUND: Compliance with the clinical practice guidelines of sepsis management has been low. The objective of our study was to describe the results of implementing a multifaceted intervention including an electronic alert (e-alert) with a sepsis response team (SRT) on the outcome of patients with sepsis and septic shock presenting to the emergency department. METHODS: This was a pre-post two-phased implementation study that consisted of a pre-intervention phase (January 01, 2011-September 24, 2012), intervention phase I (multifaceted intervention including e-alert, from September 25, 2012-March 03, 2013) and intervention phase II when SRT was added (March 04, 2013-October 30, 2013) in a 900-bed tertiary-care academic hospital...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28557651/effects-of-a-new-hospital-wide-surgical-consultation-protocol-in-patients-with-clostridium-difficile-colitis
#15
Gwendolyn M van der Wilden, George C Velmahos, Yuchiao Chang, Ed Bajwa, Walter J O'Donnell, Kathleen Finn, N Stuart Harris, D Dante Yeh, David R King, Marc A de Moya, Peter J Fagenholz
BACKGROUND: Fulminant Clostridium difficile colitis (fCDC) occurs in 2%-8% of patients with CDC and carries a high death rate. Prompt operation may reduce death. Our aim was to determine whether a standardized hospital-wide protocol for surgical referral in CDC would result in earlier surgical consultation, earlier identification of patients who could benefit from surgical therapy, and reduced deaths from fCDC. METHODS: A multidisciplinary team developed consensus criteria for surgical consultation...
May 30, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28550970/thoracotomy-in-the-emergency-department-for-resuscitation-of-the-mortally-injured
#16
J Christopher DiGiacomo, L D George Angus
PURPOSE: Emergency department resuscitative thoracotomy is an intervention of last resort for the acutely dying victim of trauma. In light of improvements in pre-hospital emergency systems, improved operative strategies for survival such as damage control and improvements in critical care medicine, the most extreme of resuscitation efforts should be re-evaluated for the potential survivor, with success properly defined as the return of vital signs which allow transport of the patient to the operating room...
May 10, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28545831/pre-post-evaluation-of-effects-of-a-titanium-dioxide-coating-on-environmental-contamination-of-an-intensive-care-unit-the-titanic-study
#17
B de Jong, A M Meeder, K W A C Koekkoek, M A Schouten, P Westers, A R H van Zanten
BACKGROUND: Among patients admitted to European hospitals or intensive care units (ICUs), 5.7% and 19.5% will encounter healthcare-associated infections (HAIs), respectively, and antimicrobial resistance is emerging. As hospital surfaces are contaminated with potentially pathogenic bacteria, environmental cleanliness is an essential aspect to reduce HAIs. AIM: To address the efficacy of a titanium dioxide coating in reducing the microbial colonization of environmental surfaces in an ICU...
April 15, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28534558/-proposing-a-physiological-model-for-emergency-department-operating-principles-classification-of-overcrowding-and-guidelines-for-redesign
#18
M Herrera Carranza, F Aguado Correa, N Padilla Garrido, F López Camacho
The operation of Emergency Departments (ED) is determined by demand, their own organizational structures and the connection to other medical care levels. When these elements are not simultaneous, it hinders patient flow and decreases capacity, making it necessary to employ a systemic approach to the chain of emergency care as a single operational entity. With this theoretical orientation, we suggest a conceptual model similar to the physiological cardiac output, in which the preload is the demand, the contractile or flow pump is the organizational structure, the afterload is the hospital, the pre-ED valve is primary care and outpatient emergencies, and the post-ED valve is the diagnostic support services and the specialist consultants...
April 30, 2017: Anales del Sistema Sanitario de Navarra
https://www.readbyqxmd.com/read/28526311/dramatic-effects-of-a-new-antimicrobial-stewardship-program-in-a-rural-community-hospital
#19
Claudia R Libertin, Stephanie H Watson, William L Tillett, Joy H Peterson
BACKGROUND: New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. METHODS: An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia...
May 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28515604/development-and-psychometric-evaluation-of-the-pre-hospital-medical-emergencies-early-warning-scale
#20
Abbasali Ebrahimian, Gholamreza Masoumi, Roohangiz Jamshidi-Orak, Hesam Seyedin
INTRODUCTION: The number of requests for emergency medical services (EMSs) has increased during the past decade. However, most of the transports are not essential. Therefore, it seems crucial to develop an instrument to help EMS staff accurately identify patients who need pre-hospital care and transportation. The aim of this study was to develop and evaluate the psychometric properties of the Pre-hospital Medical Emergencies Early Warning Scale (Pre-MEWS). MATERIALS AND METHODS: This mixed-method study was conducted in two phases...
April 2017: Indian Journal of Critical Care Medicine
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