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https://www.readbyqxmd.com/read/29057682/improving-diagnosis-of-childhood-stroke-arterial-ischemic-stroke
#1
Mark T Mackay, Paul Monagle, Franz E Babl
At least half of childhood stroke survivors suffer long-term impairments. Rapid identification of stroke is essential to minimize the extent of injury by restoring perfusion to viable brain. Improving diagnosis of childhood stroke requires correct identification of stroke by prehospital and emergency physicians, rapid performance of appropriate neuroimaging to confirm infarction, and targeted investigations to determine underlying causes, which guide treatment decisions to reduce recurrence risk. Areas covered: This review will summarize the barriers to rapid stroke diagnosis in pre-hospital and emergency department settings, describe recent progress in understanding of the spectrum, presenting clinical features and differential diagnosis of childhood stroke, discuss clinical stroke recognition tools which improve diagnostic accuracy, and their application to children...
October 23, 2017: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/29056391/prehospital-triage-of-septic-patients-at-the-samu-regulation-comparison-of-qsofa-mrst-mews-and-presep-scores
#2
R Jouffroy, A Saade, S Ellouze, A Carpentier, M Michaloux, P Carli, B Vivien
PURPOSE: A couple of scoring systems have been developed for risk stratification of septic patients. Their performance in the management of out-of-hospital initial care delivery is not documented. This study try to evaluate the predictive ability of Quick Sequential Organ Failure Assessment (qSOFA), Robson Screening Tool (RST), Modified Early Warning Score (MEWS) and Prehospital Early Sepsis Detection (PRESEP) scores on out of-hospital triage of septic patients, to predict intensive care unit (ICU) admission...
October 12, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29050889/nine-point-plan-to-improve-care-of-the-injured-patient-a-case-study-from-kenya
#3
Abdulgafoor M Bachani, Isaac Botchey, Fatima Paruk, Daniel Wako, Hassan Saidi, Bethuel Aliwa, Simon Kibias, Adnan A Hyder
BACKGROUND: Injury rates in low- and middle-income countries are among the greatest in the world, with >90% of unintentional injury occurring in low- or middle-income countries. The risk of death from injuries is 6 times more in low- and middle-income countries than in high-income countries. This increased rate of injury is partly due to the lack of availability and access to timely and appropriate medical care for injured individuals. Kenya, like most low- and middle-income countries, has seen a 5-fold increase in injury fatalities throughout the past 4 decades, in large part related to the absence of a coordinated, integrated system of trauma care...
October 16, 2017: Surgery
https://www.readbyqxmd.com/read/29048449/emergency-medical-service-information-system-the-ares-118-experience
#4
D A Ientile, M A Cardinale, S Cataldi, M Parafati, A Pasquarella, N Trani, M P Corradi
BACKGROUND: In this paper we describe ARES 118, the prehospital Emergency Medical Service of the Region Lazio, Italy, focusing on its data system used to populate a data warehouse and to create ad hoc reports. ARES 118 is a regional public mono-specialized health company, established in 2004, that manages the emergency care throughout the Region Lazio. METHODS: Being a peculiar company in its kind, and being the first experience of this kind in Italy, ARES 118 has begun to equip itself, in an autonomous way, with a corporate information system, starting from what already existed as data collection from the individual provincial operating Centers and then by activating a unique information system at a regional and company level by deploying a data warehouse...
November 2017: Annali di Igiene: Medicina Preventiva e di Comunità
https://www.readbyqxmd.com/read/29044938/hot-off-the-press-prehospital-advanced-cardiac-life-support-for-out-of-hospital-cardiac-arrest
#5
Corey Heitz, Justin Morgenstern, William K Milne
This retrospective cohort study examined the rate of survival to hospital discharge among adult patients with out of hospital cardiac arrest (OHCA), comparing patients who received care only from basic cardiac life support (BCLS) trained emergency medical service (EMS) crews to patients who had an advanced cardiac life support (ACLS) trained EMS crew on scene at some point during the resuscitation. There was no difference in the primary outcome of rate of survival to hospital discharge (10.9% with ACLS care and 10...
October 16, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29044463/prehospital-delay-in-older-adults-with-acute-myocardial-infarction-the-comprehensive-evaluation-of-risk-factors-in-older-patients-with-acute-myocardial-infarction-study
#6
Gregory M Ouellet, Mary Geda, Terrence E Murphy, Sui Tsang, Mary E Tinetti, Sarwat I Chaudhry
BACKGROUND/OBJECTIVES: Timely administration of antiischemic therapies improves outcomes in individuals with acute myocardial infarction (AMI). Prior literature on delays in AMI care has largely focused on in-hospital delay ("door to balloon" time). Our objective was to identify factors associated with prehospital delay in a contemporary national cohort of older adults with AMI. DESIGN: Cross-sectional analysis of data from the ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study, an observational study of older adults hospitalized for AMI...
October 18, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29042484/accuracy-of-oxygen-flow-delivered-by-compressed-gas-cylinders-in-hospital-and-prehospital-emergency-care
#7
Frédéric Duprez, Jean Bernard Michotte, Gregory Cuvelier, Alexandre Legrand, Sharam Mashayekhi, Gregory Reychler
BACKGROUND: Oxygen cylinders are widely used both in hospital and prehospital care. Excessive or inappropriate FIO2 may be critical for patients with hypercapnia or hypoxia. Moreover, over-oxygenation could be deleterious in ischemic disorders. Supplemental oxygen from oxygen cylinder should therefore be delivered accurately. The aim of this study was to assess the accuracy of oxygen flows for oxygen cylinder in hospital and prehospital care. METHODS: A prospective trial was conducted to evaluate accuracy of delivered oxygen flows (2, 4, 6, 9 and 12 L/min) for different oxygen cylinder ready for use in different hospital departments...
October 17, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29032875/ventilator-use-by-emergency-medical-services-during-911-calls-in-the-united-states
#8
Mazen El Sayed, Hani Tamim, Aurelie Mailhac, Mann N Clay
BACKGROUND: Emergency and transport ventilators use in the prehospital field is not well described. This study examines trends of ventilator use by EMS agencies during 911 calls in the United States and identifies factors associated with this use. METHODS: This retrospective study used four consecutive releases of the US National Emergency Medical Services Information System (NEMSIS) public research dataset (2011-2014) to describe scene EMS activations (911 calls) with and without reported ventilator use...
October 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29031508/specialist-nurses-experiences-when-caring-for-preverbal-children-in-pain-in-the-prehospital-context-in-sweden
#9
Karin Gunnvall, David Augustsson, Veronica Lindström, Veronica Vicente
No abstract text is available yet for this article.
October 11, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/29023167/state-regulation-of-community-paramedicine-programs-a-national-analysis
#10
Melody Glenn, Olivia Zoph, Kim Weidenaar, Leila Barraza, Warren Greco, Kylie Jenkins, Pooja Paode, Jonathan Fisher
BACKGROUND: Community Paramedicine (CP) is a rapidly evolving field within prehospital care where paramedics step outside of their traditional roles of treating acute conditions to provide elements of primary and preventive care. It is unclear if current state oversight regarding the scope of practice (SOP) for paramedics provides clear guidance on the novel functions provided and skills performed by CP programs. OBJECTIVE: To determine the process and authority, as currently defined by state laws and regulations in the United States, to expand paramedic SOP in order to perform CP roles and to assess state EMS agencies' interpretation of paramedic SOP as it applies to CP...
October 12, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29021273/improvement-in-care-and-outcomes-for-emergency-medical-service-transported-patients-with-st-elevation-myocardial-infarction-stemi-with-and-without-prehospital-cardiac-arrest-a-mission-lifeline-stemi-accelerator-study
#11
Kristian Kragholm, Di Lu, Karen Chiswell, Hussein R Al-Khalidi, Mayme L Roettig, Matthew Roe, James Jollis, Christopher B Granger
BACKGROUND: Patients with ST-elevation myocardial infarction (STEMI) with out-of-hospital cardiac arrest (OHCA) may benefit from direct transport to a percutaneous cardiac intervention (PCI) hospital but have previously been less likely to bypass local non-PCI hospitals to go to a PCI center. METHODS AND RESULTS: We reported time trends in emergency medical service transport and care of patients with STEMI with and without OHCA included from 171 PCI-capable hospitals in 16 US regions with participation in the Mission: Lifeline STEMI Accelerator program between July 1, 2012, and March 31, 2014...
October 11, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29016418/improving-posthospital-discharge-telephone-reach-rates-through-prehospital-discharge-face-to-face-meetings
#12
Franz H Vergara, Daniel J Sheridan, Nancy J Sullivan, Chakra Budhathoki
PURPOSE OF THE STUDY: The purpose of this study was to determine whether a face-to-face meeting with patients by a telephonic case manager prehospital discharge would result in increased telephone follow-up (TFU) reach rates posthospital discharge. PRIMARY PRACTICE SETTING: Acute care adult medicine inpatient units. METHODOLOGY AND SAMPLE: A quasiexperimental design was utilized. Two adult inpatient medicine units were selected as the intervention and comparison groups...
November 2017: Professional Case Management
https://www.readbyqxmd.com/read/28991676/sulfonylurea-drug-pretreatment-and-functional-outcome-in-diabetic-patients-with-acute-intracerebral-hemorrhage
#13
Jason J Chang, Yasser Khorchid, Ali Kerro, L Goodwin Burgess, Nitin Goyal, Anne W Alexandrov, Andrei V Alexandrov, Georgios Tsivgoulis
PURPOSE: Intracerebral hemorrhage (ICH) is associated with poor clinical outcome and high mortality. Sulfonylurea (SFU) use may be a viable therapy for inhibiting sulfonylurea receptor-1 and NCCa-ATP channels and reducing perihematomal edema and blood-brain barrier disruption. We sought to evaluate the effects of prehospital SFU use with outcomes in diabetic patients with acute ICH. METHODS: We retrospectively analyzed a cohort of diabetic patients presenting with acute ICH at a tertiary care center...
October 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28989879/root-cause-analysis-of-diabetic-ketoacidosis-admissions-at-a-tertiary-referral-pediatric-emergency-department-in-north-india
#14
Muralidharan Jayashree, Rohit Sasidharan, Sunit Singhi, Karthi Nallasamy, Mullai Baalaaji
OBJECTIVES: To identify system-based factors contributing to Emergency Department (ED) admissions of children with diabetic ketoacidosis (DKA) and related complications with emphasis on parental and physician awareness and prereferral management. MATERIALS AND METHODS: A prospective observational root cause analysis study of all consecutive admissions of children with DKA to pediatric ED of a tertiary care referral hospital in northern India over a period of 1 year (July 2010-June 2011)...
September 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28988962/prehospital-cooling-to-improve-successful-targeted-temperature-management-after-cardiac-arrest-a-randomized-controlled-trial
#15
D C Scales, S Cheskes, P R Verbeek, R Pinto, D Austin, S C Brooks, K N Dainty, K Goncharenko, M Mamdani, K E Thorpe, L J Morrison
RATIONALE: Targeted temperature management (TTM) improves survival with good neurological outcome after out-of-hospital cardiac arrest (OHCA), but is delivered inconsistently and often with delay. OBJECTIVE: To determine if prehospital cooling by paramedics leads to higher rates of 'successful TTM', defined as achieving a target temperature of 32-34°C within 6h of hospital arrival. METHODS: Pragmatic RCT comparing prehospital cooling (surface ice packs, cold saline infusion, wristband reminders) initiated 5min after return of spontaneous circulation (ROSC) versus usual resuscitation and transport...
October 5, 2017: Resuscitation
https://www.readbyqxmd.com/read/28986740/integrated-health-care-management-of-moderate-to-severe-tbi-in-older-patients-a-narrative-review
#16
REVIEW
Rahel Schumacher, René M Müri, Bernhard Walder
PURPOSE OF REVIEW: Traumatic brain injuries are common, especially within the elderly population, which is typically defined as age 65 and older. This narrative review aims at summarizing and critically evaluating important aspects of their health care management in covering the entire pathway from prehospital care to rehabilitation and beyond. RECENT FINDINGS: The number of older patients with traumatic brain injury (TBI) is increasing, and there seem to be differences in all aspects of care along their pathway when compared to younger patients...
October 7, 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/28979529/free-open-access-med-ical-edu-cation-for-critical-care-practitioners
#17
EDITORIAL
Olusegun Olusanya, James Day, Justin Kirk-Bayley, Tamas Szakmany
Free Open Access Med(ical edu)cation refers to an online community of knowledge relating to medicine. Originating from practitioners in emergency medicine, it has since spread to critical care, internal medicine, prehospital medicine, paediatrics, and allied health professionals and continues to grow at an advanced rate. Weblogs ('blog' for short), emails, social media (in particular Twitter), recorded audio material ((podcasts), and video material are all produced on a daily basis and contribute to the continual professional development of trainees and consultants worldwide...
February 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/28975247/association-of-prehospital-mode-of-transport-with-mortality-in-penetrating-trauma-a-trauma-system-level-assessment-of-private-vehicle-transportation-vs-ground-emergency-medical-services
#18
Michael W Wandling, Avery B Nathens, Michael B Shapiro, Elliott R Haut
Importance: Time to definitive care following injury is important to the outcomes of trauma patients. Prehospital trauma care is provided based on policies developed by individual trauma systems and is an important component of the care of injured patients. Given a paucity of systems-level trauma research, considerable variability exists in prehospital care policies across trauma systems, potentially affecting patient outcomes. Objective: To evaluate whether private vehicle prehospital transport confers a survival advantage vs ground emergency medical services (EMS) transport following penetrating injuries in urban trauma systems...
September 20, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28974202/weaknesses-and-capacities-affecting-the-prehospital-emergency-care-for-victims-of-road-traffic-incidents-in-the-greater-kampala-metropolitan-area-a-cross-sectional-study
#19
Joseph Kimuli Balikuddembe, Ali Ardalan, Davoud Khorasani-Zavareh, Amir Nejati, Owais Raza
BACKGROUND: Pre-hospital emergency care is a vital and integral component of health systems particularly in the resource constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities and trauma caused by the road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA). METHODS: A cross-sectional study was conducted in the GKMA using a three-part structured questionnaire...
October 3, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28966826/the-impact-of-presurgical-comorbidities-on-discharge-disposition-and-length-of-hospitalization-following-craniotomy-for-brain-tumor
#20
Whitney E Muhlestein, Dallin S Akagi, Silky Chotai, Lola B Chambless
BACKGROUND: Identifying risk factors for negative postoperative outcomes is an important part of providing quality care. Here, we build machine learning (ML) ensembles to model the independent impact of presurgical comorbidities on discharge disposition and length of stay (LOS) following brain tumor resection from the HCUP National Inpatient Sample (NIS). METHODS: We performed a retrospective cohort study of 41,222 patients who underwent craniotomy for brain tumors during 2002-2011 and were registered in the NIS...
2017: Surgical Neurology International
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