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Prehospital Trauma

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https://www.readbyqxmd.com/read/29050889/nine-point-plan-to-improve-care-of-the-injured-patient-a-case-study-from-kenya
#1
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/29040202/re-examination-of-a-battlefield-trauma-golden-hour-policy
#2
Jeffrey T Howard, Russ S Kotwal, Alexis R Santos, Matthew J Martin, Zsolt T Stockinger
BACKGROUND: Most combat casualties who die, do so in the prehospital setting. Efforts directed toward alleviating prehospital combat trauma death, known as killed in action (KIA) mortality, have the greatest opportunity for eliminating preventable death. METHODS: 4,542 military casualties injured in Afghanistan from September 11, 2001 to March 31, 2014 were included in this retrospective analysis to evaluate proposed explanations for observed KIA reduction following a mandate by Secretary of Defense Robert M...
October 16, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29026927/diagnostics-and-early-treatment-in-prehospital-and-emergency-room-phase-in-suspicious-pelvic-ring-fractures
#3
Uwe Schweigkofler, B Wohlrath, H Trentsch, J Greipel, N Tamimi, R Hoffmann, D Wincheringer
BACKGROUND: Testing for mechanical stability in pelvic ring fractures is advocated for the initial assessment and management of pelvic ring fractures. A survey among trauma surgeons showed that 91% agree with this recommendation. The aim of the present study was to describe the actual workup of patients with a high risk for unstable pelvic fractures in daily routine. METHODS: We performed a prospective multicenter observational study on patients admitted to the emergency room with suspected pelvic ring fractures...
October 12, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28975883/prehospital-interventions-before-and-after-implementation-of-a-physician-staffed-helicopter
#4
Asger Sonne, Sandra Wulffeld, Jacob Steinmetz, Lars S Rasmussen, Rasmus Hesselfeldt
INTRODUCTION: Implementation of a physician-staffed helicopter emergency medical service (HEMS) in eastern Denmark was associated with increased survival for severely injured patients. This study aimed to assess the potential impact of advanced prehospital interventions by comparing the proportion of patients who received those interventions before and after the HEMS implementation. METHODS: A post-hoc analysis of a prospective before-after study. We included trauma patients with Injury Severity Scores above three who had been admitted to seven emergency departments or one level 1 trauma centre in the course of a five-month period before and a 12-month period after the HEMS implementation...
October 2017: Danish Medical Journal
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
#5
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
#6
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/28965751/the-accuracy-of-acuity-scoring-tools-to-predict-24-h-mortality-in-traumatic-brain-injury-patients-a-guide-to-triage-criteria
#7
Zohre Najafi, Hossien Zakeri, Amir Mirhaghi
BACKGROUND AND AIM: Prompt identification of traumatic brain injury (TBI) is vital for patients in critical condition; however, it is not clear which acuity scoring tools are associated with short-term mortality. The aim of this study was to determine the accuracy of acuity scoring tools and 24-h mortality among TBI patients in both prehospital and hospital settings. METHODS: This study was an observational, prospective cohort, in which patients with TBI were followed from the accident scene to the hospital...
September 28, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28962953/arachnoid-cyst-associated-chronic-subdural-hematoma-report-of-14-cases-and-a-systematic-literature-review
#8
Xuanxuan Wu, Guichen Li, Jinchuan Zhao, Xiaobo Zhu, Yang Zhang, Kun Hou
BACKGROUND: Arachnoid cyst (AC) associated chronic subdural hematoma (CSDH) differs a lot from its counterparts without AC in epidemiological, demographic, and clinical characteristics, management, and prognosis. To further illustrate the epidemiological, demographic, and clinical characteristics, diagnosis, treatment, and prognosis of AC associated CSDH. METHODS: A retrospective study of the medical records at the neurosurgical departments of two institutions was performed combined with a systematic PubMed search of the published studies written in English and Chinese...
September 26, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28958367/prehospital-assessment-of-trauma
#9
REVIEW
Joshua Brown, Nitin Sajankila, Jeffrey A Claridge
The organization of prehospital care for trauma patients began in the military arena. At the urging of multiple stakeholders and providers, these lessons were applied to the civilian setting and emergency medical services were created across the nation. Advances have taken place in the triage, transport, and management of severely injured patients. Many issues remain in the care of trauma patients in the prehospital environment. Collaboration between stakeholders and providers, regionalization of trauma care, and protocol-driven care may be solutions to some of these issues...
October 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/28955433/trauma-care-in-malawi-a-call-to-action
#10
Wakisa Mulwafu, Linda Chokotho, Nyengo Mkandawire, Hemant Pandit, Dan L Deckelbaum, Chris Lavy, Kathryn H Jacobsen
Injuries are a global public health concern because most are preventable yet they continue to be a major cause of death and disability, especially among children, adolescents, and young adults. This enormous loss of human potential has numerous negative social and economic consequences. Malawi has no formal system of prehospital trauma care, and there is limited access to hospital-based trauma care, orthopaedic surgery, and rehabilitation. While some hospitals and research teams have established local trauma registries and quantified the burden of injuries in parts of Malawi, there is no national injury surveillance database compiling the data needed in order to develop and implement evidence-based prevention initiatives and guidelines to improve the quality of clinical care...
June 2017: Malawi Medical Journal: the Journal of Medical Association of Malawi
https://www.readbyqxmd.com/read/28945676/endotheliopathy-of-trauma-is-an-on-scene-phenomenon-and-is-associated-with-multiple-organ-dysfunction-syndrome-a-prospective-observational-study
#11
David N Naumann, Jon Hazeldine, David J Davies, Jon Bishop, Mark J Midwinter, Antonio Belli, Paul Harrison, Janet M Lord
BACKGROUND: Trauma patients are vulnerable to coagulopathy and inflammatory dysfunction associated with endotheliopathy of trauma (EoT). In vitro evidence has suggested that tranexamic acid (TXA) may ameliorate endotheliopathy. We aimed to investigate how soon after injury EoT occurs, its association with multiple organ dysfunction syndrome (MODS), and whether TXA ameliorates it. METHODS: A prospective observational study included 91 trauma patients enrolled within 60 minutes of injury and 19 healthy controls...
September 22, 2017: Shock
https://www.readbyqxmd.com/read/28934985/factors-influencing-on-scene-time-in-a-rural-norwegian-helicopter-emergency-medical-service-a-retrospective-observational-study
#12
Øyvind Østerås, Jon-Kenneth Heltne, Bjørn-Christian Vikenes, Jörg Assmus, Guttorm Brattebø
BACKGROUND: Critically ill patients need to be immediately identified, properly managed, and rapidly transported to definitive care. Extensive prehospital times may increase mortality in selected patient groups. The on-scene time is a part of the prehospital interval that can be decreased, as transport times are determined mostly by the distance to the hospital. Identifying factors that affect on-scene time can improve training, protocols, and decision making. Our objectives were to assess on-scene time in the Helicopter Emergency Medical Service (HEMS) in our region and selected factors that may affect it in specific and severe conditions...
September 21, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28930960/prehospital-administration-of-freeze-dried-plasma-is-it-the-solution-for-trauma-casualties
#13
Amir Shlaifer, Maya Siman-Tov, Irina Radomislensky, Kobi Peleg, Avi Shina, Erez Nachum Baruch, Elon Glassberg, Avraham Yitzhak
BACKGROUND: Hemorrhage is the leading cause of possible preventable death in the battlefield. There is an increasing evidence for the effectiveness of blood component therapy in general, and plasma infusion in particular but their use is less applicable in the prehospital setting due to logistic difficulties. Israeli Defense Force has implemented the use of freeze-dried plasma (FDP) at the point of injury (POI), this adoption of FDP use entailed doubts regarding the feasibility and effectiveness of this practice...
October 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28930937/administration-of-hypertonic-solutions-for-hemorrhagic-shock-a-systematic-review-and-meta-analysis-of-clinical-trials
#14
Meng-Che Wu, Tin-Yun Liao, Erica M Lee, Yueh-Sheng Chen, Wan-Ting Hsu, Meng-Tse Gabriel Lee, Po-Yang Tsou, Shyr-Chyr Chen, Chien-Chang Lee
BACKGROUND: Several clinical trials on hypertonic fluid administration have been completed, but the results have been inconclusive. The objective of this study is to summarize current evidence for treating hypovolemic patients with hypertonic solutions by performing a systematic review and meta-analysis. METHODS: Major electronic databases were searched from inception through June 2014. We included only randomized controlled trials involving hemorrhagic shock patients treated with hypertonic solutions...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28930098/bioimpedance-technology-for-detection-of-thoracic-injury
#15
Ruben Buendia, Stefan Candefjord, Benjamin Sanchez, Hans Granhed, Bengt-Arne Sjöqvist, Per Örtenwall, Eva-Corina Caragounis
Thoracic trauma is one of the most common and lethal types of injury, causing over a quarter of traumatic deaths. Severe thoracic injuries are often occult and difficult to diagnose in the field. There is a need for a point-of-care diagnostic device for severe thoracic injuries in the prehospital setting. Electrical bioimpedance (EBI) is non-invasive, portable, rapid and easy to use technology that can provide objective and quantitative diagnostic information for the prehospital environment. Here, we evaluated the performance of EBI to detect thoracic injuries...
September 20, 2017: Physiological Measurement
https://www.readbyqxmd.com/read/28927951/definitive-airway-management-after-pre-hospital-supraglottic-airway-insertion-outcomes-and-a-management-algorithm-for-trauma-patients
#16
Matthew C Hernandez, Johnathon M Aho, Martin D Zielinski, Scott P Zietlow, Brian D Kim, David S Morris
BACKGROUND: Prehospital airway management increasingly involves supraglottic airway insertion and a paucity of data evaluates outcomes in trauma populations. We aim to describe definitive airway management in traumatically injured patients who necessitated prehospital supraglottic airway insertion. METHODS: We performed a single institution retrospective review of multisystem injured patients (≥15years) that received prehospital supraglottic airway insertion during 2009 to 2016...
September 16, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28921731/inter-observer-agreement-in-pediatric-cervical-spine-injury-assessment-between-prehospital-and-emergency-department-providers
#17
Lorin R Browne, Hamilton Schwartz, Fahd A Ahmad, Michael Wallendorf, Nathan Kuppermann, E Brooke Lerner, Julie C Leonard
BACKGROUND: Investigators have derived cervical spine injury (CSI) decision support tools from physician observations. There is a need to demonstrate that prehospital emergency medical services (EMS) providers can use these tools to appropriately determine the need for spinal motion restrictions and make field disposition decisions. OBJECTIVE: To determine the inter-observer agreement between EMS and emergency department (ED) providers for CSI risk assessment variables and overall gestalt for CSI in children after blunt trauma...
September 18, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28920524/remotely-supported-prehospital-ultrasound-a-feasibility-study-of-real-time-image-transmission-and-expert-guidance-to-aid-diagnosis-in-remote-and-rural-communities
#18
Leila Eadie, John Mulhern, Luke Regan, Alasdair Mort, Helen Shannon, Ashish Macaden, Philip Wilson
Introduction Our aim is to expedite prehospital assessment of remote and rural patients using remotely-supported ultrasound and satellite/cellular communications. In this paradigm, paramedics are remotely-supported ultrasound operators, guided by hospital-based specialists, to record images before receiving diagnostic advice. Technology can support users in areas with little access to medical imaging and suboptimal communications coverage by connecting to multiple cellular networks and/or satellites to stream live ultrasound and audio-video...
January 1, 2017: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/28910475/chest-seal-placement-for-penetrating-chest-wounds-by-prehospital-ground-forces-in-afghanistan
#19
Steven G Schauer, Michael D April, Jason F Naylor, Erica M Simon, Andrew D Fisher, Cord W Cunningham, Daniel M Morissette, Jessie Renee D Fernandez, Kathy L Ryan
BACKGROUND: Thoracic trauma represents 5% of all battlefield injuries. Communicating pneumothoraces resulting in tension physiology remain an important etiology of prehospital mortality. In addressing penetrating chest trauma, current Tactical Combat Casualty Care (TCCC) guidelines advocate the immediate placement of a vented chest seal device. Although the Committee on TCCC (CoTCCC) has approved numerous chest seal devices for battlefield use, few data exist regarding their use in a combat zone setting...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28910470/a-comparison-of-ventilation-rates-between-a-standard-bag-valve-mask-and-a-new-design-in-a-prehospital-setting-during-training-simulations
#20
Joseph T Costello, Paul B Allen, Robert Levesque
BACKGROUND: Excessive ventilation of sick and injured patients is associated with increased morbidity and mortality. Combat Medical Systems® (CMS) is developing a new bag-valve-mask (BVM) designed to limit ventilation rates. The purpose of this study was to compare ventilation rates between a standard BVM device and the CMS device. METHODS: This was a prospective, observational, semirandomized, crossover study using Army Medics. Data were collected during Brigade Combat Team Trauma Training classes at Camp Bullis, Texas...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
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