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Prehospital emergency care

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https://www.readbyqxmd.com/read/28622155/triad-ix-can-a-patient-testimonial-safely-help-ensure-prehospital-appropriate-critical-versus-end-of-life-care
#1
Ferdinando Mirarchi, Christopher Cammarata, Timothy E Cooney, Kristin Juhasz, Stanley A Terman
OBJECTIVE: The present study sought to assess the clarity of Physician Orders for Life-Sustaining Treatment (POLST) or Living Will (LW) documents alone or in combination with a video message/testimonial (VM). METHODS: Emergency medical services (EMS) personnel responded to survey questions about the meaning of stand-alone POLST and LW documents and those used in conjunction with emergent care scenarios. Personnel were randomized to receive documents only or documents with VM...
June 16, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/28622074/disparities-in-feedback-provision-to-emergency-medical-services-professionals
#2
Rebecca E Cash, Remle P Crowe, Severo A Rodriguez, Ashish R Panchal
INTRODUCTION: Feedback to EMS professionals is a critical component for optimizing patient care and outcomes in the prehospital setting. There is a paucity of data concerning the feedback received by prehospital providers. OBJECTIVES: The objective of this study was to describe the prevalence of feedback received by EMS professionals in the past 30 days including the types, sources, modes, and utility of feedback. The secondary objective was to identify factors associated with receiving any feedback and, specifically, feedback regarding medical care provided...
June 16, 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/28615900/predictors-of-outcome-in-children-with-status-epilepticus-during-resuscitation-in-pediatric-emergency-department-a-retrospective-observational-study
#3
Indumathy Santhanam, Sangeetha Yoganathan, V Akila Sivakumar, Rubini Ramakrishnamurugan, Sharada Sathish, Murali Thandavarayan
OBJECTIVES: To study the clinical profile and predictors of outcome in children with status epilepticus (SE) during resuscitation in pediatric emergency department. MATERIALS AND METHODS: This retrospective study was carried out in a tertiary care teaching hospital. Admission and resuscitation data of children, aged between 1 month and 12 years, treated for SE, between September 2013 and August 2014, were extracted using a standard data collection form. Our SE management protocol had employed a modified pediatric assessment triangle to recognize and treat acute respiratory failure, cardiovascular dysfunction (CD), and subtle SE until all parameters resolved...
April 2017: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/28615177/direct-transport-to-a-percutaneous-cardiac-intervention-center-and-outcomes-in-patients-with-out-of-hospital-cardiac-arrest
#4
Kristian Kragholm, Carolina Malta Hansen, Matthew E Dupre, Ying Xian, Benjamin Strauss, Clark Tyson, Lisa Monk, Claire Corbett, Christopher B Fordyce, David A Pearson, Emil L Fosbøl, James G Jollis, Benjamin S Abella, Bryan McNally, Christopher B Granger
BACKGROUND: Practice guidelines recommend regional systems of care for out-of-hospital cardiac arrest. However, whether emergency medical services should bypass nonpercutaneous cardiac intervention (non-PCI) facilities and transport out-of-hospital cardiac arrest patients directly to PCI centers despite longer transport time remains unknown. METHODS AND RESULTS: Using the Cardiac Arrest Registry to Enhance Survival with geocoding of arrest location, we identified out-of-hospital cardiac arrest patients with prehospital return of spontaneous circulation and evaluated the association between direct transport to a PCI center and outcomes in North Carolina during 2012 to 2014...
June 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28602381/variability-of-care-in-infants-with-severe-bronchiolitis-less-invasive-respiratory-management-leads-to-similar-outcomes
#5
Sandrine Essouri, Florent Baudin, Laurent Chevret, Mélanie Vincent, Guillaume Emeriaud, Philippe Jouvet
OBJECTIVE: To compare the management of children with severe bronchiolitis requiring intensive care (based on duration of ventilatory support and duration of pediatric intensive care unit [PICU] stay) in 2 countries with differing pediatric transport and PICU organizations. STUDY DESIGN: This was a prospective observational care study in 2 PICUs of tertiary care university hospitals, 1 in France and 1 in Canada. All children with bronchiolitis who required admission to the PICU between November 1, 2013, and March 31, 2014, were included...
June 8, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28601212/awake-cricothyrotomy-a-novel-approach-to-the-surgical-airway-in-the-tactical-setting
#6
REVIEW
Robert L Mabry, Chetan U Kharod, Brad L Bennett
Airway obstruction on the battlefield is most often due to maxillofacial trauma, which may include bleeding and disrupted airway anatomy. In many of these cases, surgical cricothyrotomy (SC) is the preferred airway management procedure. SC is an emergency airway procedure performed when attempts to open an airway using nasal devices, oral devices, or tracheal intubation have failed, or when the risks from intubation are unacceptably high. The aim of this overview is to describe a novel approach to the inevitably surgical airway in which SC is the first and best procedure to manage the difficult or failed airway...
June 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28601206/prolonged-field-care-beyond-the-golden-hour
#7
REVIEW
Sean Keenan, Jamie C Riesberg
Prolonged field care (PFC) has emerged as a recent area of focus for US military Special Operations Forces (SOF) medical experts. Focused on the current reality of providing medical care to military forces often deployed in remote and austere locations far from medical support or a robust casualty evacuation chain, PFC encompasses evolving operational situations not unlike many wilderness medicine practice environments. SOF currently operates in all areas of the world and on a variety of different missions, which finds these small teams far from the accustomed practice environment of robust deployed medical infrastructure commonly seen during the last 15 years of military conflicts...
June 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28599052/tccc-updates-two-decades-of-saving-lives-on-the-battlefield-tactical-combat-casualty-care-turns-20
#8
Frank K Butler
BACKGROUND: Twenty years ago, the original Tactical Combat Casualty Care (TCCC) article was published in this journal. Since TCCC is essentially a set of bestpractice prehospital trauma care guidelines customized for use on the battlefield, the presence of a journal with a specific focus on military medicine was a profound benefit to the initial presentation of TCCC to the US Military. METHODS: In the two ensuing decades, which included the longest continuous period of armed conflict in our nation's history, TCCC steadily evolved as the prehospital trauma care evidence base was augmented and as feedback from user medics, corpsmen, and pararescuemen was obtained...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28598044/a-study-of-prehospital-delay-patterns-in-acute-myocardial-infarction-in-an-urban-tertiary-care-institute-in-mumbai
#9
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/28573388/medical-management-of-the-severe-traumatic-brain-injury-patient
#10
Jonathan Marehbian, Susanne Muehlschlegel, Brian L Edlow, Holly E Hinson, David Y Hwang
Severe traumatic brain injury (sTBI) is a major contributor to long-term disability and a leading cause of death worldwide. Medical management of the sTBI patient, beginning with prehospital triage, is aimed at preventing secondary brain injury. This review discusses prehospital and emergency department management of sTBI, as well as aspects of TBI management in the intensive care unit where advances have been made in the past decade. Areas of emphasis include intracranial pressure management, neuromonitoring, management of paroxysmal sympathetic hyperactivity, neuroprotective strategies, prognostication, and communication with families about goals of care...
June 1, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28560799/blood-pressure-management-and-guideline-adherence-in-hypertensive-emergencies-and-urgencies-a-comparison-between-telemedically-supported-and-conventional-out-of-hospital-care
#11
Jörg C Brokmann, Rolf Rossaint, Michael Müller, Christina Fitzner, Luigi Villa, Stefan K Beckers, Sebastian Bergrath
Prehospital hypertensive emergencies and urgencies are common, but evidence is lacking. Telemedically supported hypertensive emergencies and urgencies were prospectively collected (April 2014-March 2015) and compared retrospectively with a historical control group of on-scene physician care in the emergency medical service of Aachen, Germany. Blood pressure management and guideline adherence were evaluated. Telemedical (n=159) vs conventional (n=172) cases: blood pressure reductions of 35±24 mm Hg vs 44±23 mm Hg revealed a group effect adjusted for baseline differences (P=...
May 30, 2017: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/28557070/color-and-power-doppler-sonography-for-pneumothorax-detection
#12
John R Richards, Julianne M Awrey, Sarah E Medeiros, John P McGahan
The use of B- and M-mode sonography for detection of pneumothorax has been well described and studied. It is now widely incorporated by sonographers, emergency physicians, trauma surgeons, radiologists, and critical care specialists worldwide. Lung sonography can be performed rapidly at the bedside or in the prehospital setting. It is more sensitive, specific, and accurate than plain chest radiography. The use of color and power Doppler sonography as an adjunct to B- and M-mode imaging for detection of pneumothorax has been described in a small number of studies and case reports but is much less widely known or used...
May 30, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28545931/validating-a-questionnaire-prehospital-preparedness-for-pediatric-trauma-patients
#13
Karin Bölenius, Christin Vestin, Britt-Inger Saveman, Lina Gyllencreutz
In recent decades, prehospital emergency care has undergone extensive development. Today, prehospital emergency nurses (PENs) are well trained and provide advanced care to patients of all ages. Caring for pediatric trauma patients is considered to be particularly demanding. However, in Sweden and internationally, there is a lack of research regarding PENs' preparedness for caring for pediatric trauma patients. OBJECTIVE: The development and testing of a questionnaire on self-reported preparedness among PENs caring for pediatric trauma patients in a prehospital emergency setting...
May 22, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28535961/emergency-intubation-in-prehospital-care
#14
Tomasz Klosiewicz, Radoslaw Zalewski, Agata Dabrowska, Adrian Maciejewski
No abstract text is available yet for this article.
May 15, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28508800/electronic-health-records-in-prehospital-care
#15
Katharina Rohrer
Documentation is an essential part and duty in all clinical settings. "ELGA" (short for "Elektronische Gesundheitsakte") is the Austrian Electronic Health Record and aims to support the process of clinical decision-making. However the use case of integrating ELGA to an out-of-hospital setting is not defined yet. This work explores the special requirements in prehospital care. The aim of research is to identify needed information and processes at the emergency scene to establish appropriate decisions about diagnosis, treatments and transport...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28501121/validation-of-a-field-spinal-motion-restriction-protocol-in-a-level-i-trauma-center
#16
James M Tatum, Nicolas Melo, Ara Ko, Navpreet K Dhillon, Eric J T Smith, Dorothy A Yim, Galinos Barmparas, Eric J Ley
BACKGROUND: Spinal motion restriction (SMR) after traumatic injury has been a mainstay of prehospital trauma care for more than 3 decades. Recent guidelines recommend a selective approach with cervical spine clearance in the field when criteria are met. MATERIALS AND METHODS: In January 2014, the Department of Health Services of the City of Los Angeles, California, implemented revised guidelines for cervical SMR after blunt mechanism trauma. Adult patients (aged ≥18 y) with an initial Glasgow Coma Scale (GCS) score of ≥13 presented to a single level I trauma center after blunt mechanism trauma over the following 1-y period were retrospectively reviewed...
May 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28499459/dispatch-and-prehospital-transport-for-acute-septic-patients-an-observational-study
#17
Peter Bank Pedersen, Daniel Pilsgaard Henriksen, Søren Mikkelsen, Annmarie Touborg Lassen
BACKGROUND: In order to dispatch ambulances with the correct level of urgency, the dispatch center has to balance the perceived urgency and traffic safety considerations with the available resources. As urgency is not clear in all clinical situations, some high urgency patients may end up with a suboptimal mode of transport. Patients with severe sepsis or septic shock suffer from highly time dependent conditions but they present with a wide range of symptoms, which might be difficult to identify in the dispatch system...
May 12, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28495830/establishing-recommendations-for-stroke-systems-in-the-thrombectomy-era-the-upstate-new-york-stakeholder-proceedings
#18
Zainab Magdon-Ismail, Curtis Benesch, Jeremy T Cushman, Ian Brissette, Andrew M Southerland, Ethan S Brandler, Cemal B Sozener, Sue Flor, Roseanne Hemmitt, Kathleen Wales, Krystal Parrigan, Steven R Levine
BACKGROUND AND PURPOSE: The American Heart Association/American Stroke Association and Department of Health Stroke Coverdell Program convened a stakeholder meeting in upstate NY to develop recommendations to enhance stroke systems for acute large vessel occlusion. METHODS: Prehospital, hospital, and Department of Health leadership were invited (n=157). Participants provided goals/concerns and developed recommendations for prehospital triage and interfacility transport, rating each using a 3-level impact (A [high], B, and C [low]) and implementation feasibility (1 [high], 2, and 3 [low]) scale...
May 11, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28492918/association-of-a-primary-stroke-center-protocol-for-suspected-stroke-by-large-vessel-occlusion-with-efficiency-of-care-and-patient-outcomes
#19
Ryan A McTaggart, Shadi Yaghi, Shawna M Cutting, Morgan Hemendinger, Grayson L Baird, Richard A Haas, Karen L Furie, Mahesh V Jayaraman
Importance: While prehospital triage to the closest comprehensive stroke center (CSC) may improve the delivery of care for patients with suspected emergent large-vessel occlusion (ELVO), efficient systems of care must also exist for patients with ELVO who first present to a primary stroke center (PSC). Objective: To describe the association of a PSC protocol focused on 3 key steps (early CSC notification based on clinical severity, vessel imaging at the PSC, and cloud-based image sharing) with the efficiency of care and the outcomes of patients with suspected ELVO who first present to a PSC...
May 8, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28492412/patients-in-prehospital-transport-to-the-emergency-department-a-cohort-study-of-risk-factors-for-7-day-mortality
#20
Camilla L Noergaard Bech, Mikkel Brabrand, Søren Mikkelsen, Annmarie Lassen
BACKGROUND: Ambulance transfer is the first contact with the healthcare system for many patients in emergency conditions.We aimed to identify prognostic risk factors accessible in the prehospital phase that indicate an increased risk of 7-day mortality. PATIENTS AND METHODS: We included patients aged 18 years or older, transferred by ambulance to the emergency department at Odense University Hospital, from 1 April 2012 to 30 September 2014. We carried out multivariate logistic regressions, adjusted for age and sex, to describe the relationship between vital sign values recorded in the prehospital setting and 7-day mortality...
May 10, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
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