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Prehospital Trauma

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https://www.readbyqxmd.com/read/29914554/prehospital-point-of-care-emergency-ultrasound-a-cohort-study
#1
Maximilian Scharonow, Christian Weilbach
BACKGROUND: In the prehospital situation, the diagnostic armamentarium available to the rescue physician is limited. Emergency ultrasound has proven to be a useful diagnostic tool, providing crucial information for the management of critically ill and injured patients. The proportion of performed ultrasound scans in all patients attended to by the rescue service team, the quality of the findings and the ultrasound-related changes in management approach and patient transport were evaluated...
June 18, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29913751/parenteral-opioids-in-emergency-medicine-a-systematic-review-of-efficacy-and-safety
#2
Leila Niemi-Murola, Jani Unkuri, Katri Hamunen
Introduction and aim Pain is a frequent symptom in emergency patients and opioids are commonly used to treat it at emergency departments and at pre-hospital settings. The aim of this systematic review is to examine the efficacy and safety of parenteral opioids used for acute pain in emergency medicine. Method Qualitative review of randomized controlled trials (RCTs) on parenteral opioids for acute pain in adult emergency patients. Main outcome measures were: type and dose of the opioid, analgesic efficacy as compared to either placebo or another opioid and adverse effects...
December 29, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/29889964/methods-for-early-control-of-abdominal-hemorrhage-an-assessment-of-potential-benefit
#3
Paul M Cantle, Matthew J Hurley, Michael D Swartz, John B Holcomb
BACKGROUND: Noncompressible truncal hemorrhage (NCTH) after injury is associated with a mortality increase that is unchanged during the past 20 years. Current treatment consists of rapid transport and emergent intervention. Three early hemorrhage control interventions that may improve survival are placement of a resuscitative endovascular balloon occlusion of the aorta (REBOA), injection of intracavitary self-expanding foam, and application of the Abdominal Aortic Junctional Tourniquet (AAJT™)...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/29889961/survey-of-casualty-evacuation-missions-conducted-by-the-160th-special-operations-aviation-regiment-during-the-afghanistan-conflict
#4
Theodore T Redman, Kevin E Mayberry, Alejandra G Mora, Brock A Benedict, Elliot M Ross, Julian G Mapp, Russ S Kotwal
BACKGROUND: Historically, documentation of prehospital combat casualty care has been relatively nonexistent. Without documentation, performance improvement of prehospital care and evacuation through data collection, consolidation, and scientific analyses cannot be adequately accomplished. During recent conflicts, prehospital documentation has received increased attention for point-of-injury care as well as for care provided en route on medical evacuation platforms. However, documentation on casualty evacuation (CASEVAC) platforms is still lacking...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/29889959/junctional-tourniquet-use-during-combat-operations-in-afghanistan-the-prehospital-trauma-registry-experience
#5
Steven G Schauer, Michael D April, Andrew D Fisher, Cord W Cunningham, Jennifer Gurney
BACKGROUND: Hemorrhage is the leading cause of potentially preventable death on the battlefield. Although the resurgence of limb tourniquets revolutionized hemorrhage control in combat casualties in the recent conflicts, the mortality rate for patients with junctional hemorrhage is still high. Junctional tourniquets (JTQs) offer a mechanism to address the high mortality rate. The success of these devices in the combat setting is unclear given a dearth of existing data. METHODS: From the Prehospital Trauma Registry (PHTR) and the Department of Defense Trauma Registry, we extracted cases of JTQ use in Afghanistan...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/29889956/prehospital-administration-of-antibiotic-prophylaxis-for-open-combat-wounds-in-afghanistan-2013-2014
#6
Steven G Schauer, Andrew D Fisher, Michael D April, Katherine A Stolper, Cord W Cunningham, Robert Carter, Jessie Renee D Fernandez, James A Pfaff
BACKGROUND: Military operations place injured Servicemembers at high risk for open wounds. Austere environments and initial wound contamination increase the risk for infection. Wound infections continue to cause significant morbidity among injured Servicemembers. Limited evidence suggests that early antibiotic therapy for open wounds reduces infection rates. METHODS: We obtained data from the Prehospital Trauma Registry (PHTR) from January 2013 through September 2014...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/29889952/management-of-suspected-tension-pneumothorax-in-tactical-combat-casualty-care-tccc-guidelines-change-17-02
#7
Frank K Butler, John B Holcomb, Stacy Shackelford, Harold R Montgomery, Shawn Anderson, Jeffrey S Cain, Howard R Champion, Cord W Cunningham, Warren C Dorlac, Brendon Drew, Kurt Edwards, John V Gandy, Elon Glassberg, Jennifer Gurney, Theodore Harcke, Donald A Jenkins, Jay Johannigman, Bijan S Kheirabadi, Russ S Kotwal, Lanny F Littlejohn, Matthew Martin, Edward L Mazuchowski, Edward J Otten, Travis Polk, Peter Rhee, Jason M Seery, Zsolt Stockinger, Jeremy Torrisi, Avi Yitzak, Ken Zafren, Scott P Zietlow
This change to the Tactical Combat Casualty Care (TCCC) Guidelines that updates the recommendations for management of suspected tension pneumothorax for combat casualties in the prehospital setting does the following things: (1) Continues the aggressive approach to suspecting and treating tension pneumothorax based on mechanism of injury and respiratory distress that TCCC has advocated for in the past, as opposed to waiting until shock develops as a result of the tension pneumothorax before treating. The new wording does, however, emphasize that shock and cardiac arrest may ensue if the tension pneumothorax is not treated promptly...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/29880720/comparison-of-the-performance-of-battery-operated-fluid-warmers
#8
Amit Lehavi, Avraham Yitzhak, Refael Jarassy, Rami Heizler, Yeshayahu Shai Katz, Aeyal Raz
OBJECTIVES: Warming intravenous fluids is essential to prevent hypothermia in patients with trauma, especially when large volumes are administered. Prehospital and transport settings require fluid warmers to be small, energy efficient and independent of external power supply. We compared the warming properties and resistance to flow of currently available battery-operated fluid warmers. METHODS: Fluid warming was evaluated at 50, 100 and 200 mL/min at a constant input temperature of 20°C and 10°C using a cardiopulmonary bypass roller pump and cooler...
June 7, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29880018/does-the-prehospital-national-early-warning-score-predict-the-short-term-mortality-of-unselected-emergency-patients
#9
Marko Hoikka, Tom Silfvast, Tero I Ala-Kokko
OBJECTIVES: The prehospital research field has focused on studying patient survival in cardiac arrest, as well as acute coronary syndrome, stroke, and trauma. There is little known about the overall short-term mortality and its predictability in unselected prehospital patients. This study examines whether a prehospital National Early Warning Score (NEWS) predicts 1-day and 30-day mortalities. METHODS: Data from all emergency medical service (EMS) situations were coupled to the mortality data obtained from the Causes of Death Registry during a six-month period in Northern Finland...
June 7, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29872865/-successful-prehospital-emergency-thoracotomy-after-blunt-thoracic-trauma-case-report-and-lessons-learned
#10
Janosch Dahmen, Marko Brade, Christian Gerach, Martin Glombitza, Jan Schmitz, Simon Zeitter, Eva Steinhausen
BACKGROUND: The European Resuscitation Council guidelines for resuscitation in patients with traumatic cardiac arrest recommend the immediate treatment of all reversible causes, if necessary even prior to continuous chest compression. In the case of cardiac tamponade immediate emergency thoracotomy should also be considered. OBJECTIVE: The authors report the case of a 23-year-old male patient with multiple injuries including blunt thoracic trauma, which caused a witnessed cardiac arrest...
June 5, 2018: Der Unfallchirurg
https://www.readbyqxmd.com/read/29861368/the-utility-of-point-of-care-ultrasound-in-targeted-automobile-ramming-mass-casualty-tarmac-attacks
#11
Hamid Shokoohi, Ali Pourmand, Keith Boniface, Rebecca Allen, Bruno Petinaux, Babak Sarani, James P Phillips
As terrorist actors revise their tactics to outmaneuver increasing counter-terrorism security measures, a recent trend toward less-sophisticated attack methods has emerged. Most notable of these "low tech" trends are the Targeted Automobile Ramming MAss Casualty (TARMAC) attacks. Between 2014 and November 2017, 18 TARMAC attacks were reported worldwide, resulting in 181 deaths and 679 injuries. TARMAC attack-related injuries are unique compared to accidental pedestrian trauma and other causes of mass casualty incidents (MCI), and therefore they require special consideration...
May 29, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29851919/epidemiology-of-pediatric-traumatic-brain-injury-in-a-dense-urban-area-served-by-a-helicopter-trauma-service
#12
Ciaran S Hill, Aaron L McLean, Mark H Wilson
OBJECTIVE: Pediatric traumatic brain injury is the most common cause of death and a major cause of morbidity in children and young adults worldwide. Despite this, our understanding of epidemiological factors relating to this type of injury is incomplete. The objective of this study was to explore a variety of factors relating to these injuries including mechanism, timing of emergency response, prehospital management, radiological diagnosis, neurosurgical care, and final outcomes. METHODS: A retrospective review of all pediatric traumas attending a single large, densely populated urban area within a 2-year period was undertaken, and all cases with significant pediatric traumatic brain injury, as defined by a computed tomography scan showing an intracranial injury, were included for further analysis...
June 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29851907/a-us-military-role-2-forward-surgical-team-database-study-of-combat-mortality-in-afghanistan
#13
Russ S Kotwal, Amanda M Staudt, Edward L Mazuchowski, Jennifer M Gurney, Stacy A Shackelford, Frank K Butler, Zsolt T Stockinger, John B Holcomb, Shawn C Nessen, Elizabeth A Mann-Salinas
BACKGROUND: Timely and optimal care can reduce mortality among critically injured combat casualties. US military Role 2 surgical teams were deployed to forward positions in Afghanistan on behalf of the battlefield trauma system. They received prehospital casualties, provided early damage control resuscitation and surgery, and rapidly transferred casualties to Role 3 hospitals for definitive care. A database was developed to capture Role 2 data. METHODS: A retrospective review and descriptive analysis was conducted of battle-injured casualties transported to US Role 2 surgical facilities in Afghanistan from February 2008 to September 2014...
May 30, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29850251/ambulance-nurses-competence-and-perception-of-competence-in-prehospital-trauma-care
#14
Anna Abelsson, Lillemor Lindwall, Björn-Ove Suserud, Ingrid Rystedt
Introduction: We focus on trauma care conducted in the context of a simulated traumatic event. This is in this study defined as a four-meter fall onto a hard surface, resulting in severe injuries to extremities in the form of bilateral open femur fractures, an open tibia fracture, and a closed pelvic fracture, all fractures bleeding extensively. Methods: The simulated trauma care competence of 63 ambulance nurses in prehospital emergency care was quantitatively evaluated along with their perception of their sufficiency...
2018: Emergency Medicine International
https://www.readbyqxmd.com/read/29847536/outcomes-following-trauma-laparotomy-for-hypotensive-trauma-patients-a-uk-military-and-civilian-perspective
#15
Max Marsden, Rich Carden, Lalin Navaratne, Iain M Smith, Jowan G Penn-Barwell, Luke M Kraven, Karim Brohi, Nigel R M Tai, Douglas M Bowley
BACKGROUND: The management of trauma patients has changed radically in the last decade and studies have shown overall improvements in survival. However, reduction in mortality for the many may obscure a lack of progress in some high-risk patients. We sought to examine the outcomes for hypotensive patients requiring laparotomy in UK military and civilian cohorts. METHODS: We undertook a review of two prospectively maintained trauma databases; the UK Joint Theatre Trauma Registry (JTTR) for the military cohort (4th February 2003 to 21st September 2014), and the trauma registry of the Royal London Hospital MTC (1st January 2012 to 1st January 2017) for civilian patients...
May 25, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29807729/preventable-deaths-in-a-french-regional-trauma-system-a-six-year-analysis-of-severe-trauma-mortality
#16
E Girard, Q Jegousso, B Boussat, P François, F-X Ageron, C Letoublon, P Bouzat
BACKGROUND: Analyzing mortality in a mature trauma system is useful to improve quality of care of severe trauma patients. Standardization of error reporting can be done using the classification of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). The aim of our study was to describe preventable deaths in our trauma system and to classify errors according to the JCAHO taxonomy. METHODS: We performed a six-year retrospective study using the registry of the Northern French Alps trauma network (TRENAU)...
May 25, 2018: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/29799916/accuracy-of-pediatric-trauma-field-triage-a-systematic-review
#17
Rogier van der Sluijs, Eveline A J van Rein, Joep G J Wijnand, Luke P H Leenen, Mark van Heijl
Importance: Field triage of pediatric patients with trauma is critical for transporting the right patient to the right hospital. Mortality and lifelong disabilities are potentially attributable to erroneously transporting a patient in need of specialized care to a lower-level trauma center. Objective: To quantify the accuracy of field triage and associated diagnostic protocols used to identify children in need of specialized trauma care. Evidence Review: MEDLINE, Embase, PsycINFO, and Cochrane Register of Controlled Trials were searched from database inception to November 6, 2017, for studies describing the accuracy of diagnostic tests to identify children in need of specialized trauma care in a prehospital setting...
May 16, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29799823/trauma-hemostasis-and-oxygenation-research-network-position-paper-on-the-role-of-hypotensive-resuscitation-as-part-of-remote-damage-control-resuscitation
#18
Thomas Woolley, Patrick Thompson, Emrys Kirkman, Richard Reed, Sylvain Ausset, Andrew Beckett, Christopher Bjerkvig, Andrew P Cap, Tim Coats, Mitchell Cohen, Marc Despasquale, Warren Dorlac, Heidi Doughty, Richard Dutton, Brian Eastridge, Elon Glassberg, Anthony Hudson, Donald Jenkins, Sean Keenan, Christophe Martinaud, Ethan Miles, Ernest Moore, Giles Nordmann, Nicolas Prat, Joseph Rappold, Michael C Reade, Paul Rees, Rory Rickard, Martin Schreiber, Stacy Shackelford, Håkon Skogran Eliassen, Jason Smith, Mike Smith, Philip Spinella, Geir Strandenes, Kevin Ward, Sarah Watts, Nathan White, Steve Williams
The Trauma Hemostasis and Oxygenation Research (THOR) Network has developed a consensus statement on the role of permissive hypotension in remote damage control resuscitation (RDCR). A summary of the evidence on permissive hypotension follows the THOR Network position on the topic. In RDCR, the burden of time in the care of the patients suffering from noncompressible hemorrhage affects outcomes. Despite the lack of published evidence, and based on clinical experience and expertise, it is the THOR Network's opinion that the increase in prehospital time leads to an increased burden of shock, which poses a greater risk to the patient than the risk of rebleeding due to slightly increased blood pressure, especially when blood products are available as part of prehospital resuscitation...
June 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29799611/tourniquet-use-in-the-prehospital-setting-are-they-being-used-appropriately
#19
Kevin M Duignan, Laura C Lamb, Monica M DiFiori, John Quinlavin, James M Feeney
OBJECTIVE: The objective of this study was to evaluate tourniquet use in the Hartford prehospital setting during a 34-month period after the Hartford Consensus was published, which encouraged increasing tourniquet use in light of military research. DESIGN: This was a retrospective review of patients with bleeding from a serious extremity injury to determine appropriateness of tourniquet use or omission. SETTING: Level II trauma center between April 2014 and January 2017...
January 2018: American Journal of Disaster Medicine
https://www.readbyqxmd.com/read/29797031/-prehospital-application-of-tourniquets-for-life-threatening-extremity-hemorrhage-systematic-review-of-literature
#20
REVIEW
B Hossfeld, R Lechner, F Josse, M Bernhard, F Walcher, M Helm, M Kulla
INTRODUCTION: The effectiveness of a tourniquet in the case of life-threatening hemorrhages of the extremities is well recognized and led to the recommendations on "Tourniquet" of the German Society of Anaesthesiology and Intensive Care (DGAI) in 2016. The aim of this systematic review was to re-evaluate the current medical literature in relation to the published DGAI recommendations. MATERIAL AND METHODS: Based on the analysis of all studies published from January 2015 until January 2018 in the PubMed databases, the publicized recommendations for action on "Tourniquet" of the DGAI were critically re-evaluated...
May 24, 2018: Der Unfallchirurg
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