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Prehospital Trauma

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https://www.readbyqxmd.com/read/29452732/efficacy-of-pre-hospital-rapid-sequence-intubation-in-paediatric-traumatic-brain-injury-a-9-year-observational-study
#1
Stefan Heschl, Ben Meadley, Emily Andrew, Warwick Butt, Stephen Bernard, Karen Smith
INTRODUCTION: Prehospital airway management of the paediatric patient with traumatic brain injury (TBI) is controversial. Endotracheal intubation of children in the field requires specific skills and has potential benefits but also carries potentially serious complications. We aimed to compare mortality and functional outcomes after six months between children with TBI who either underwent prehospital rapid sequence intubation (RSI) by trained Intensive Care paramedics (ICP) or received no intubation...
February 12, 2018: Injury
https://www.readbyqxmd.com/read/29450470/incidence-of-delayed-intracranial-hemorrhage-in-older-patients-after-blunt-head-trauma
#2
James A Chenoweth, Samuel D Gaona, Mark Faul, James F Holmes, Daniel K Nishijima
Importance: Current guidelines conflict on the management of older adults who have blunt head trauma taking anticoagulant and antiplatelet medications. This is partially due to the limited data comparing patients who are taking these medications with those who are not. Objective: To investigate the incidence of delayed traumatic intracranial hemorrhage in older adults with head trauma, including those taking anticoagulant and antiplatelet medications. Design, Setting, and Participants: This prospective observational cohort study included patients 55 years and older who had blunt head trauma and were transported via emergency medical services between August 1, 2015, and September 30, 2016...
February 14, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29438134/better-compliance-with-triage-criteria-in-trauma-would-reduced-costs-with-maintained-patient-safety
#3
Fredrik Linder, Lina Holmberg, Hampus Eklöf, Martin Björck, Claes Juhlin, Kevin Mani
OBJECTIVE: To evaluate trauma triage criteria in terms of compliance, undertriage, and overtriage and identify risk factors for mistriage. METHODS: In a retrospective cohort study, all consecutive trauma patients at a University Hospital in Sweden in 2012 were included. Patients were stratified into three groups on the basis of trauma team activation (full trauma team, limited trauma team, and no trauma team). Case records were reviewed for mechanism of injury, vital signs, and injuries...
February 12, 2018: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/29433888/trauma-registry-implementation-in-low-and-middle-income-countries-challenges-and-opportunities
#4
REVIEW
Krishna Bommakanti, Isabelle Feldhaus, Girish Motwani, Rochelle A Dicker, Catherine Juillard
BACKGROUND: Trauma registries are an essential part of trauma quality improvement programs aimed at decreasing morbidity and mortality in high-income countries. In low- and middle-income countries (LMICs), where the burden of injury is disproportionately high, hospitals have faced challenges in adapting trauma registry models implemented in high-income countries. We analyze the barriers to trauma registry implementation in LMICs to inform development of sustainable models in resource-constrained settings...
March 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29432381/systematic-review-of-prehospital-tourniquet-use-in-civilian-limb-trauma
#5
David S Kauvar, Michael A Dubick, Thomas J Walters, John F Kragh
BACKGROUND: Military enthusiasm for limb tourniquet use in combat casualty care has resulted in acceptance by the trauma community for use in the prehospital care of civilian limb injuries. To date there has been no report synthesizing the published data on civilian tourniquet use. The objective of this systematic review was to compile and analyze the content and quality of published data on the civilian use of tourniquets in limb trauma. METHODS: The MEDLINE database was searched for studies on civilian limb tourniquet use in adults published between 2001 and 2017...
February 9, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29432043/prehospital-application-of-hemostatic-agents-in-iraq-and-afghanistan
#6
Steven G Schauer, Michael D April, Jason F Naylor, Joseph K Maddry, Allyson A Arana, Michael A Dubick, Andrew D Fisher, Cord W Cunningham, Anthony E Pusateri
INTRODUCTION: Hemorrhage is the leading cause of death on the battlefield. Development of chitosan- and kaolin-based hemostatic agents has improved hemorrhage control options. Sparse data exists on the use of these agents in the prehospital, combat setting. We describe recent use of these agents and compare patients receiving hemostatic to the baseline population. METHODS: We used a series of emergency department (ED) procedure codes to identify patients within the Department of Defense Trauma Registry (DODTR) from January 2007 to August 2016...
February 12, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29429772/reliability-of-glasgow-coma-score-in-pediatric-trauma-patients
#7
Sandra R DiBrito, Marcelo Cerullo, Seth D Goldstein, Susan Ziegfeld, Dylan Stewart, Isam W Nasr
BACKGROUND: Discordant assessments of Glasgow Coma Score (GCS) following trauma can result in inappropriate triage. This study sought to determine the reliability of prehospital GCS compared to emergency department (ED) GCS. METHODS: We conducted a retrospective review of traumas from 01/2000 to 12/2015 at a Level-1 pediatric trauma center. We evaluated reliability between field and ED GCS using Pearson's correlation. We ascertained the difference between prehospital and ED GCS (delta-GCS)...
January 31, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29415812/prediction-of-massive-bleeding-in-a-prehospital-setting-validation-of-six-scoring-systems
#8
L J Terceros-Almanza, C García-Fuentes, S Bermejo-Aznárez, I J Prieto Del Portillo, C Mudarra-Reche, H Domínguez-Aguado, R Viejo-Moreno, J Barea-Mendoza, R Gómez-Soler, I Casado-Flores, M Chico-Fernández
OBJECTIVE: To validate the diagnostic ability of six different scores to predict massive bleeding in a prehospital setting. DESIGN: Retrospective cohort. SETTING: Prehospital attention of patients with severe trauma. SUBJECTS: Subjects with more than 15 years, a history of severe trauma (defined by code 15 criteria), that were initially assisted in a prehospital setting by the emergency services between January 2010 and December 2015 and were then transferred to a level one trauma center in Madrid...
February 4, 2018: Medicina Intensiva
https://www.readbyqxmd.com/read/29412051/prehospital-analgesia-for-pediatric-trauma-patients-in-iraq-and-afghanistan
#9
Steven G Schauer, Allyson A Arana, Jason F Naylor, Guyon J Hill, Michael D April
BACKGROUND: Previous studies have evaluated prehospital analgesia during combat operations in Iraq and Afghanistan, but were limited to the adult population. However, a significant portion of the casualties of those conflicts were children. We describe the prehospital analgesia administered to wartime pediatric trauma patients. METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric patients (<18 years of age) admitted to United States and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016...
February 7, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29409595/the-pediatric-resuscitative-thoracotomy-during-combat-operations-in-iraq-and-afghanistan-a-retrospective-cohort-study
#10
Steven G Schauer, Guyon J Hill, Richard E Connor, John S Oh, Michael D April
BACKGROUND: Combat zone trauma poses a unique set of challenges and injury patterns not seen in the civilian setting. The role of the pediatric resuscitative thoracotomy in combat zones remains unclear given a paucity of data regarding procedure outcomes in this setting. We compare outcomes among children in traumatic arrest undergoing resuscitative thoracotomy versus cardiopulmonary (CPR) resuscitation only. METHODS: We queried the Department of Defense Trauma Registry (DODTR) from 2007 to 2016 for all pediatric subjects that underwent a resuscitative thoracotomy or CPR in the prehospital or emergency department setting during operations in Iraq or Afghanistan...
January 31, 2018: Injury
https://www.readbyqxmd.com/read/29406555/brister-i-systematiskt-omh%C3%A3-ndertagande-p%C3%A3-olycksplatser-en-studie-av-traumasimuleringar-inom-ambulanssjukv%C3%A3-rden
#11
Jonas Aléx, Lina Gyllencreutz
Trauma care at an accident site is of great importance for patient survival. The purpose of the study was to observe the compliance of ambulance nurses with the Prehospital Trauma Life Support (PHTLS) concept of trauma care in a simulation situation. The material consisted of video recordings in trauma simulation and an observation protocol was designed to analyze the video material. The result showed weaknesses in systematic exam and an ineffective use of time at the scene of injury. Development of observation protocols in trauma simulation can ensure the quality of ambulance nurses' compliance with established concepts...
February 5, 2018: Läkartidningen
https://www.readbyqxmd.com/read/29405803/prehospital-rapid-sequence-intubation-by-intensive-care-flight-paramedics
#12
Ashleigh Delorenzo, Toby St Clair, Emily Andrew, Stephen Bernard, Karen Smith
OBJECTIVE: Rapid sequence intubation (RSI) is an advanced airway procedure for critically ill or injured patients. Paramedic-performed RSI in the prehospital setting remains controversial, as unsuccessful or poorly conducted RSI is known to result in significant complications. In Victoria, intensive care flight paramedics (ICFPs) have a broad scope of practice including RSI in both the adult and pediatric population. We sought to describe the success rates and characteristics of patients undergoing RSI by ICFPs in Victoria, Australia...
February 6, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29395772/effectiveness-of-prehospital-trauma-triage-systems-in-selecting-severely-injured-patients-is-comparative-analysis-possible
#13
REVIEW
Eveline A J van Rein, Rogier van der Sluijs, R Marijn Houwert, Amy C Gunning, Rob A Lichtveld, Luke P H Leenen, Mark van Heijl
INTRODUCTION: In an optimal trauma system, prehospital trauma triage ensures transport of the right patient to the right hospital. Incorrect triage results in undertriage and overtriage. The aim of this systematic review is to evaluate and compare prehospital trauma triage system quality worldwide and determine effectiveness in terms of undertriage and overtriage for trauma patients. METHODS: A systematic search of Pubmed/MEDLINE, Embase, and Cochrane Library databases was performed, using "trauma", "trauma center," or "trauma system", combined with "triage", "undertriage," or "overtriage", as search terms...
January 27, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29391099/high-risk-prehospital-mechanisms-in-tier-ii-trauma-codes-an-analysis-of-under-triage-at-a-level-ii-trauma-center
#14
Sergey Kozyr, Santa Ponce, Hope Feramisco, Andrea Pakula, Ruby Skinner
Under-triage is used as a surrogate for trauma quality. We sought to analyze factors that may impact under-triage at our institution by a detailed analysis of prehospital mechanisms and patient factors that were associated with the need for invasive intervention, intensive care unit monitoring, or death. Patients admitted to our Level II trauma center who met the criteria for under-triage using the Cribari method were studied, n = 160, and prominent mechanisms were motor vehicle collisions (MVCs). Patient demographics, detailed mechanism characteristics, ED vital signs, operative intervention, and outcomes were studied...
October 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29391095/delta-shock-index-in-the-emergency-department-predicts-mortality-and-need-for-blood-transfusion-in-trauma-patients
#15
Morgan Schellenberg, Aaron Strumwasser, Daniel Grabo, Damon Clark, Kazuhide Matsushima, Kenji Inaba, Demetrios Demetriades
Shock Index (SI = heart rate/systolic blood pressure) predicts outcomes among trauma patients. Studies have also shown that the change in SI between the field and Emergency Department (ED) arrival (Delta SI) predicts mortality in trauma. Given the lack of reliable prehospital data, Delta SI may more accurately prognosticate if used within the ED. All trauma patients arriving to our Level I trauma center in 2014 were reviewed. Patients were matched for age, gender, mechanism of injury, and injury severity score...
October 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/29389838/too-little-too-late-hypotension-and-blood-transfusion-in-the-trauma-bay-are-independent-predictors-of-death-in-injured-children
#16
Christine M Leeper, Christine McKenna, Barbara A Gaines
BACKGROUND: Hypotension is a late finding in pediatric shock despite significant blood loss; consequently, recognition of hemodynamic compromise can be delayed. We sought to describe the impact of late stage shock in children, indicated by hypotension or trauma bay blood transfusion, and quantify the association with poor outcome. METHODS: Children age<18 from the Pennsylvania Trauma Outcome Study registry (2000-2013) were included. Primary outcome was mortality...
January 31, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29387959/trauma-care-in-mongolia-intact-evaluation-and-recommendations-for-improvement
#17
S Lombardo, B Unurbileg, J Gerelmaa, L Bayarbaatar, E Sarnai, R Price
INTRODUCTION: Injury is the third leading cause of death in Mongolia, with a 29% increase in motor vehicle fatalities over the past decade. Half of the population lives outside the urbanized capital of Ulaanbaatar, where access to care is limited. This study evaluates and describes the Mongolian trauma system and makes recommendations for improvements. METHODS: Hospital-level data were collected, and an International Assessment of Capacity for Trauma (INTACT) score (0-10) was calculated...
January 31, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29384419/procedural-sedation-and-analgesia-in-trauma-patients-in-an-out-of-hospital-emergency-setting-a-prospective-multicenter-observational-study
#18
Michel Galinski, Laure Hoffman, Delphine Bregeaud, Mounir Kamboua, François-Xavier Ageron, Catherine Rouanet, Jean-Christophe Hubert, Jacques Istria, Mirko Ruscev, Karim Tazarourte, Florence Pevirieri, Frédéric Lapostolle, Frédéric Adnet
BACKGROUND: The quality of procedural analgesia and sedation among trauma patients has not been studied much in the prehospital setting. The main objective of this study was to characterize the quality of procedural analgesia sedation practices in prehospital settings in trauma patients. METHODS: This was an open-label observational prospective multicenter study (January 01, 2012-December 31, 2013). We included all consecutive trauma victims undergoing a potentially painful procedure on the accident scene...
January 31, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29366336/end-of-life-decision-making-for-patients-with-geriatric-trauma-cared-for-in-a-trauma-intensive-care-unit
#19
Meghan Wooster, Alyssa Stassi, Joshua Hill, James Kurtz, Marco Bonta, M Chance Spalding
BACKGROUND: The geriatric trauma population is growing and fraught with poor physiological response to injury and high mortality rates. Our primary hypothesis analyzed how prehospital and in-hospital characteristics affect decision-making regarding continued life support (CLS) versus withdrawal of care (WOC). Our secondary hypothesis analyzed adherence to end-of-life decisions regarding code status, living wills, and advanced directives. MATERIALS AND METHODS: We performed a retrospective review of patients with geriatric trauma at a level I and level II trauma center from January 1, 2007, to December 31, 2014...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29362272/what-fluids-are-given-during-air-ambulance-treatment-of-patients-with-trauma-in-the-uk-and-what-might-this-mean-for-the-future-results-from-the-rescuer-observational-cohort-study
#20
David N Naumann, James M Hancox, James Raitt, Iain M Smith, Nicholas Crombie, Heidi Doughty, Gavin D Perkins, Mark J Midwinter
OBJECTIVES: We investigated how often intravenous fluids have been delivered during physician-led prehospital treatment of patients with hypotensive trauma in the UK and which fluids were given. These data were used to estimate the potential national requirement for prehospital blood products (PHBP) if evidence from ongoing trials were to report clinical superiority. SETTING: The Regional Exploration of Standard Care during Evacuation Resuscitation (RESCUER) retrospective observational study was a collaboration between 11 UK air ambulance services...
January 23, 2018: BMJ Open
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