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Prehospital emergency care

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https://www.readbyqxmd.com/read/29148174/prehospital-transfusion-of-red-cell-concentrates-in-a-paramedic-staffed-helicopter-emergency-medical-service
#1
Stefan Heschl, Emily Andrew, Anthony de Wit, Stephen Bernard, Marcus Kennedy, Karen Smith
OBJECTIVE: The optimal volume and type of intravenous fluid for the treatment of blood loss in the prehospital setting is controversial. The use of red cell concentrates (RCCs) may be associated with improved outcomes; however, the administration of blood products is limited to physicians in many jurisdictions. We sought to describe the characteristics of RCC transfusions in a paramedic-staffed helicopter emergency medical system in Victoria, Australia. METHODS: We performed a retrospective analysis of all cases where paramedics consulted the responsible physician for approval of RCC transfusion between July 2011 and December 2015 in Victoria, Australia...
November 17, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29142380/epidemiological-study-of-patients-of-road-traffic-injuries-attending-emergency-department-of-a-trauma-center-in-new-delhi
#2
Puneet Misra, Anindo Majumdar, Mahesh Chandra Misra, Shashi Kant, Sanjeev Kumar Gupta, Amit Gupta, Subodh Kumar
Background and Aims: There is paucity of data regarding some of the lesser known contextual and epidemiological factors with respect to road traffic injuries (RTIs). The objective was to study the epidemiological profile of RTI victims attending an emergency department of a tertiary care trauma center. Methods: The present study was a hospital-based cross-sectional study conducted in the emergency department of a tertiary care trauma center in New Delhi. All patients of RTI attending the emergency department during the designated data collection days were included in the study...
October 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29132578/major-trauma-outside-a-trauma-center-prehospital-emergency-department-and-retrieval-considerations
#3
REVIEW
Preston J Fedor, Brian Burns, Michael Lauria, Clare Richmond
Care of the critically injured begins well before the patient arrives at a large academic trauma center. It is important to understand the continuum of care from the point of injury in the prehospital environment, through the local hospital and retrieval, until arrival at a trauma center capable of definitive care. This article highlights the important aspects of trauma assessment and management outside of tertiary or quaternary care hospitals. Key elements of each phase of care are reviewed, including management pearls and institutional strategies to facilitate effective and efficient treatment of trauma patients from the point of injury forward...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29130951/prehospital-computed-tomography-angiography-in-acute-stroke-management
#4
Michael Kettner, Stefan Alexander Helwig, Andreas Ragoschke-Schumm, Lenka Schwindling, Safwan Roumia, Isabel Keller, Daniel Martens, Johann Kulikovski, Matthias Manitz, Martin Lesmeister, Silke Walter, Iris Quasar Grunwald, Thomas Schlechtriemen, Wolfgang Reith, Klaus Fassbender
BACKGROUND: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology...
October 31, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29109872/severe-decompression-illness-case-report-prehospital-recognition-and-regional-transport-considerations
#5
Julie Estrada, David Meurer, Kevin De Boer, Karl Huesgen
A 46-year-old male presented to our tertiary care emergency department (ED) with shortness of breath and chest pain following an uneventful four-hour SCUBA dive at 100 feet. His prehospital emergency medical services (EMS) assessment revealed transient hypotension and hypoxia. He later developed progressive skin mottling. Serology was significant for acute kidney injury, transaminitis, hemoconcentration, and hypoxia on an arterial blood gas. Computed tomography (CT) angiography demonstrated intravascular gas throughout the mesenteric and pulmonary arteries as well as the portal venous system...
2017: Case Reports in Emergency Medicine
https://www.readbyqxmd.com/read/29108809/response-to-symptoms-and-prehospital-delay-in-stroke-patients-is-it-time-to-reconsider-stroke-awareness-campaigns
#6
Rafael García Ruiz, Julia Silva Fernández, Rosa María García Ruiz, Marta Recio Bermejo, Ángel Arias Arias, Pablo Del Saz Saucedo, Rafael Huertas Arroyo, Ana González Manero, Ana Santos Pinto, Santiago Navarro Muñoz, Enrique Botia Paniagua, José Abellán Alemán
BACKGROUND: Despite recent advances in acute stroke care, reperfusion therapies are given to only 1%-8% of patients. Previous studies have focused on prehospital or decision delay. We aim to give a more comprehensive view by addressing different time delays and decisions. METHODS: A total of 382 patients with either acute stroke or transient ischemic attack were prospectively included. Sociodemographic and clinical parameters and data on decision delay, prehospital delay, and first medical contact were recorded...
November 3, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29108735/emergency-department-patient-burden-from-an-electronic-dance-music-festival
#7
Neeraj Chhabra, Renee P Gimbar, Lisa M Walla, Trevonne M Thompson
BACKGROUND: Electronic dance music (EDM) festivals are increasingly common and psychoactive substance use is prevalent. Although prehospital care can obviate the transfer of many attendees to health care facilities (HCFs), little is known regarding the emergency department (ED) burden of patients presenting from EDM festivals. OBJECTIVES: This study describes the patient volume, length of stay (LOS), and presenting complaints of patients from a 3-day EDM festival in close proximity to an area ED...
November 3, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29103830/early-reperfusion-in-myocardial-infarction-requires-widespread-access-to-prehospital-emergency-care
#8
Jorge Ferreira
No abstract text is available yet for this article.
November 2, 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/29100652/team-focused-cardiopulmonary-resuscitation-prehospital%C3%A2-principles-adapted-for-emergency-department%C3%A2-cardiac%C3%A2-arrest-resuscitation
#9
Blake Johnson, Michael Runyon, Anthony Weekes, David Pearson
BACKGROUND: Out-of-hospital cardiac arrest has high rates of morbidity and mortality, and a growing body of evidence is redefining our approach to the resuscitation of these high-risk patients. OBJECTIVES: Team-focused cardiopulmonary resuscitation (TFCPR), most commonly deployed and described by prehospital care providers, is a focused approach to cardiac arrest care that emphasizes early defibrillation and high-quality, minimally interrupted chest compressions while de-emphasizing endotracheal intubation and intravenous drug administration...
October 31, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29100549/low-sensitivity-of-qsofa-sirs-criteria-and-sepsis-definition-to-identify-infected-patients-at-risk-of-complication-in-the-prehospital-setting-and-at-the-emergency-department-triage
#10
Selin Tusgul, Pierre-Nicolas Carron, Bertrand Yersin, Thierry Calandra, Fabrice Dami
BACKGROUND: Sepsis is defined as life-threatening organ dysfunction caused by a host response to infection. The quick SOFA (qSOFA) score has been recently proposed as a new bedside clinical score to identify patients with suspected infection at risk of complication (intensive care unit (ICU) admission, in-hospital mortality). The aim of this study was to measure the sensitivity of the qSOFA score, SIRS criteria and sepsis definitions to identify the most serious sepsis cases in the prehospital setting and at the emergency department (ED) triage...
November 3, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29096666/prehospital-prognosis-is-difficult-in-patients-with-acute-exacerbation-of-chronic-obstructive-pulmonary-disease
#11
Katrine P Lindvig, Anne C Brøchner, Annmarie T Lassen, Søren Mikkelsen
BACKGROUND: Patients with acute exacerbation of chronic obstructive pulmonary disease often require prehospital emergency treatment. This enables patients who are less ill to be treated on-site and to avoid hospital admission, while severely ill patients can receive immediate ventilatory support in the form of intubation. The emergency physician faces difficult treatment decisions, however, and prognostic tools that could assist in determining which patients would benefit from intubation and ventilator support would be helpful...
November 2, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29094162/comparing-the-air-medical-prehospital-triage-score-with-current-practice-for-triage-of-injured-patients-to-helicopter-emergency-medical-services-a-cost-effectiveness-analysis
#12
Joshua B Brown, Kenneth J Smith, Mark L Gestring, Matthew R Rosengart, Timothy R Billiar, Andrew B Peitzman, Jason L Sperry, Joel S Weissman
Importance: Little evidence exists to guide helicopter emergency medical services (HEMS) triage, and current practice is inefficient. The Air Medical Prehospital Triage (AMPT) score was developed to identify patients most likely to benefit from HEMS compared with ground EMS. To our knowledge, no studies have evaluated the potential effect on costs and outcomes of a more targeted HEMS triage strategy, such as the AMPT score. Objective: To evaluate the cost-effectiveness of current practice compared with the AMPT score for HEMS scene triage of trauma patients...
November 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/29094144/accuracy-of-prehospital-triage-in-selecting-severely-injured-trauma-patients
#13
Frank J Voskens, Eveline A J van Rein, Rogier van der Sluijs, Roderick M Houwert, Robert Anton Lichtveld, Egbert J Verleisdonk, Michiel Segers, Ger van Olden, Marcel Dijkgraaf, Luke P H Leenen, Mark van Heijl
Importance: A major component of trauma care is adequate prehospital triage. To optimize the prehospital triage system, it is essential to gain insight in the quality of prehospital triage of the entire trauma system. Objective: To prospectively evaluate the quality of the field triage system to identify severely injured adult trauma patients. Design, Setting, and Participants: Prehospital and hospital data of all adult trauma patients during 2012 to 2014 transported with the highest priority by emergency medical services professionals to 10 hospitals in Central Netherlands were prospectively collected...
November 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/29088951/update-on-critical-care-for-acute-spinal-cord-injury-in-the-setting-of-polytrauma
#14
John K Yue, Ethan A Winkler, Jonathan W Rick, Hansen Deng, Carlene P Partow, Pavan S Upadhyayula, Harjus S Birk, Andrew K Chan, Sanjay S Dhall
Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29078912/mortality-rates-of-severe-traumatic-brain-injury-patients-impact-of-direct-versus-nondirect-transfers
#15
Kartik Prabhakaran, Patrizio Petrone, Gary Lombardo, Christy Stoller, Anthony Policastro, Corrado P Marini
BACKGROUND: Direct transport of patients with severe traumatic brain injury (sTBI) to trauma centers (TCs) that can provide definitive care results in lower mortality rates. This study investigated the impact of direct versus nondirect transfers on the mortality rates of patients with sTBI. METHODS: Data on patients with TBI admitted between January 1, 2012, and December 31, 2013, to our Level I TC were obtained from the trauma registry. Data included patient age, sex, mechanism, and type of injury, comorbidities, Glasgow Coma Scale, Injury Severity scores, prehospital time, time to request and to transfer, time to initiation of multimodality monitoring and goal-directed therapy protocol, dwell time in the emergency department (EDT), and mortality...
November 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29077293/-characteristics-of-emergency-poisoning-cases-in-elderly-versus-younger-patients
#16
August Supervía Caparrós, Oriol Pallàs Villaronga, Carlos Clemente Rodríguez, María Dolores Aranda Cárdenas, María Pi-Figueras Valls, Isabel Cirera Lorenzo
OBJECTIVES: To compare cases of poisoning according to age to detect differences in frequency of visits to the emergency department, patient characteristics, case management, and immediate outcome in terms of related mortality. MATERIAL AND METHODS: Descriptive study of a retrospective series of patients who visited a university hospital emergency department for treatment of poisoning between 2009 and 2014. We collected patient characteristics and data related to the event, case management, and poisoning-related death...
October 2017: Emergencias
https://www.readbyqxmd.com/read/29057682/improving-diagnosis-of-childhood-arterial-ischaemic-stroke
#17
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...
November 7, 2017: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/29048449/emergency-medical-service-information-system-the-ares-118-experience
#18
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
#19
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/29042484/accuracy-of-oxygen-flow-delivered-by-compressed-gas-cylinders-in-hospital-and-prehospital-emergency-care
#20
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
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