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Morten Langfeldt Friberg, Leif Rognås
OBJECTIVES: The primary objective was to estimate the incidence of patients in the Central Denmark Region triaged to bypass the local emergency department without being part of a predefined fast-track protocol. The secondary objective was to describe these triage decisions in more detail with regard to the most common diagnoses, incidence of direct referral sorted by the prehospital critical care team (PHCCT) and the destination hospital. DESIGN: Retrospective descriptive study...
July 18, 2018: BMJ Open
J M Boulanger, M P Lindsay, G Gubitz, E E Smith, G Stotts, N Foley, S Bhogal, K Boyle, L Braun, T Goddard, Mks Heran, N Kanya-Forster, E Lang, P Lavoie, M McClelland, C O'Kelly, P Pageau, J Pettersen, H Purvis, M Shamy, D Tampieri, B vanAdel, R Verbeek, D Blacquiere, L Casaubon, D Ferguson, Y Hegedus, G J Jacquin, M Kelly, N Kamal, B Linkewich, C Lum, B Mann, G Milot, N Newcommon, P Poirier, W Simpkin, E Snieder, A Trivedi, R Whelan, M Eustace, E Smitko, K Butcher
The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Matthew D Neal, Benjamin R Reynolds, David Bertoty, Keith J Murray, Andrew B Peitzman, Raquel M Forsythe
BACKGROUND: Hemorrhage is the leading cause of preventable death in trauma, and nearly 40% of prehospital deaths can be attributable to blood loss. The Stop The Bleed program provides a structured curriculum for teaching hemorrhage control and the use of bleeding control kits. In order to overcome implementation barriers and to achieve the goal of making education on bleeding control as common as cardiopulmonary resuscitation, widespread implementation with outreach to the public and law enforcement is necessary...
July 17, 2018: Journal of Trauma and Acute Care Surgery
Byron C Drumheller, Deborah M Stein, Thomas M Scalea
BACKGROUND: Correction of hypothermia is a key component of the resuscitation of critically injured patients with hemorrhagic shock who require damage control surgery. External rewarming methods may not be sufficient in this population, while extracorporeal techniques lack widespread feasibility. Intravascular catheter-based temperature modulation is increasingly being employed in different critically ill patient populations but has not been described as part of a damage control resuscitation strategy in trauma patients...
July 8, 2018: Injury
Kazuteru Niinomi, Minae Fukui
The psychological well-being of the siblings of hospitalized children is at risk. This study examined the variables related to siblings' internalizing problems and personal growth during hospitalization from the perspectives of mothers and other main caregivers who temporarily assumed the main caregiver role to the siblings of hospitalized children in place of mothers in the period of children's hospitalization. A cross-sectional, exploratory survey conducted in Japan examined 113 mothers' and 90 other main caregivers' perspectives regarding the psychological state of 2- to 18-year-old siblings of hospitalized children...
January 2018: Inquiry: a Journal of Medical Care Organization, Provision and Financing
Henry Zhao, Skye Coote, Lauren Pesavento, Brett Jones, Edrich Rodrigues, Jo Lyn Ng, Felix Ng, Bernard Yan, Mark Parsons, Bruce Cv Campbell, Damien Easton, Geoffrey A Donnan, Stephen M Davis
Background Administration of intravenous idarucizumab to reverse dabigatran anticoagulation prior to thrombolysis for patients with acute ischemic stroke has been previously described, but not in the prehospital setting. The speed and predictability of idarucizumab reversal is well suited to prehospital treatment in a mobile stroke unit and allows patients with recent dabigatran intake to access reperfusion therapy. Aims To describe feasibility of prehospital idarucizumab administration prior to thrombolysis on the Melbourne mobile stroke unit...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
C Kill, S Betz, E Bösl
Loss of consciousness is a frequent cause for an emergency call to the emergency medical services (EMS). It can be associated with life-threatening conditions. A distinction must be made between transient loss of consciousness (TLOC) and syncope, which is of cardiovascular origin by definition. Initial assessment in prehospital emergency care should follow the ABCDE algorithm including a 12-lead ECG. The presence of important risk factors such as occurrence in supine position, physical stress, palpitations, history of heart diseases, and any abnormalities in the ECG warrants hospital admission...
July 16, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Joanna M Le Parc, Jason J Bischof, Andrew M King, Sarah Greenberger, David P Way, Ashish R Panchal, Geoffrey I Finnegan, Thomas E Terndrup
Introduction: Emergency endotracheal intubation (ETI) is a common and critical procedure performed in both prehospital and in-hospital settings. Studies of prehospital providers have demonstrated that rescuer position influences ETI outcomes. However, studies of in-hospital rescuer position for ETI are limited. While we adhere to strict standards for the administration of ETI, we posited that perhaps requiring in-hospital rescuers to stand for ETI is an obstacle to effectiveness. Our objective was to compare in-hospital emergency medicine (EM) trainees' performance on ETI delivered from both the seated and standing positions...
July 2018: Western Journal of Emergency Medicine
Jenna E Tuttle, Michael W Hubble
Introduction: Many factors contribute to the survival of out-of-hospital cardiac arrest (OHCA). One such factor is the quality of resuscitation efforts, which in turn may be a function of OHCA case volume. However, few studies have investigated the OHCA case volume-survival relationship. Consequently, we sought to develop a model describing the likelihood of return of spontaneous circulation (ROSC) as a function of paramedic cumulative OHCA experience. Methods: We conducted a statewide retrospective study of cardiac arrest using the North Carolina Prehospital Care Reporting System...
July 2018: Western Journal of Emergency Medicine
Christopher E Gainey, Heather A Brown, William C Gerard
As health care systems in the United States have become pressured to provide greater value, they have embraced the adoption of innovative population health solutions. One of these initiatives utilizes prehospital personnel in the community as an extension of the traditional health care system. These programs have been labeled as Community Paramedicine (CP) and Mobile Integrated Health (MIH). While variation exists amongst these programs, generally efforts are targeted at individuals with high rates of health care utilization...
July 17, 2018: Prehospital and Disaster Medicine
Joseph Cuthbertson, Frank Archer, Andy Robertson
The World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) is a multi-disciplinary professional association whose mission is the global improvement of prehospital and emergency health care, public health, and disaster health and preparedness. In April 2017, the biennial general meeting of the World Congress for Disaster and Emergency Medicine (WCDEM) endorsed the WADEM Climate Change Position Statement, which was subsequently published in Prehospital and Disaster Medicine in July 2017...
July 17, 2018: Prehospital and Disaster Medicine
Mohamad Sorani, Sogand Tourani, Hamid Reza Khankeh, Sirous Panahi
Introduction: Prehospital Emergency Medical Care (EMC) is a critical service in disaster management. The aim of this study was to explore the challenges of prehospital Emergency Medical Services (EMS) during disaster response in Iran. Methods: A qualitative study was conducted from April 2015 to March 2017. Data were collected through in-depth, semi-structured interviews with 23 experienced individuals in the field of disaster that were selected using purposeful sampling...
2018: Emergency (Tehran, Iran)
Yuko Ono, Koichi Tanigawa, Takeyasu Kakamu, Kazuaki Shinohara, Ken Iseki
OBJECTIVE: Clinical procedural experience and confidence are both important when performing complex medical procedures. Since out-of-hospital endotracheal intubation (ETI) is a complex intervention, we sought to clarify clinical ETI experience among prehospital rescuers as well as their confidence in performing ETI and confidence-associated factors. DESIGN: Population-based cross-sectional study conducted from January to September 2017. SETTING: Northern Japan, including eight prefectures...
July 13, 2018: BMJ Open
Dhuleep S Wijayatilake, Dominic P D Nielsen, Elinor Baker, Vinod Patil
PURPOSE OF REVIEW: Traumatic brain injury (TBI) remains an unfortunately common disease with potentially devastating consequences for patients and their families. However, it is important to remember that it is a spectrum of disease and thus, a one 'treatment fits all' approach is not appropriate to achieve optimal outcomes. This review aims to inform readers about recent updates in prehospital and neurocritical care management of patients with TBI. RECENT FINDINGS: Prehospital care teams which include a physician may reduce mortality...
July 12, 2018: Current Opinion in Anaesthesiology
Kazutaka Uchida, Shinichi Yoshimura, Nagayasu Hiyama, Yoshiharu Oki, Tsuyoshi Matsumoto, Ryo Tokuda, Ikuya Yamaura, Shin Saito, Masataka Takeuchi, Keigo Shigeta, Hayato Araki, Takeshi Morimoto
BACKGROUND AND PURPOSE: Endovascular therapy is effective against acute cerebral large vessel occlusion (LVO). However, many patients do not receive such interventions because of the lack of timely identification of the type of stroke. If the types of stroke (any stroke, LVO, intracranial hemorrhage [ICH], and subarachnoid hemorrhage [SAH]) were to be predicted at the prehospital stage, better access to appropriate interventions would be possible. Japan Urgent Stroke Triage (JUST) score was clinical prediction rule to classify suspected patients of acute stroke into different types at the prehospital stage...
July 12, 2018: Stroke; a Journal of Cerebral Circulation
Alexander G Chartrain, Hazem Shoirah, Edward C Jauch, J Mocco
Endovascular thrombectomy (EVT) is now the standard of care for eligible patients with acute ischemic stroke (AIS) secondary to emergent large vessel occlusion (ELVO). However, there remains uncertainty in how hospital systems can most efficiently route patients with suspected ELVO for EVT treatment. Given the relative geographic distribution of centers with and without endovascular capabilities, the value of prehospital triage directly to centers with the ability to provide EVT remains debated. While there are no randomized trial data available to date, there is substantial evidence in the literature that may offer guidance on the subject...
July 12, 2018: Journal of Neurointerventional Surgery
Changsun Kim, Hyuk Joong Choi, Hyungjun Moon, Giwoon Kim, Choungah Lee, Jin Sung Cho, Seongjung Kim, Kyoungmi Lee, Hanjoo Choi, Wonjung Jeong
OBJECTIVE: To compare the survival to discharge between nursing home (NH) cardiac arrest patients receiving smartphone-based advanced cardiac life support (SALS) and basic life support (BLS). METHODS: The SALS registry includes data on cardiac arrest from 7 urban and suburban areas in Korea between July 2015 and December 2016. We include adult patients (>18) with out-of-hospital cardiac arrest (OHCA) of medical causes and EMS attended and dispatched in. SALS is an advanced field resuscitation including drug administration by paramedics with video communication-based direct medical direction...
July 9, 2018: American Journal of Emergency Medicine
Romain Jouffroy, Anastasia Saade, Jean Pierre Tourtier, Papa Gueye, Emmanuel Bloch-Laine, Patrick Ecollan, Pierre Carli, Benoît Vivien
OBJECTIVES: The early identification of septic shock patients at high risk of poor outcome is essential to early initiate optimal treatments and to decide on hospital admission. Biomarkers are often used to evaluate the severity. In prehospital settings, the availability of biomarkers, such as lactate, is restricted. In this context, clinical tools such as skin mottling score (SMS) and capillary refill time (CRT) are more suitable. In this study, we describe prehospital SMS and CRT's ability to predict mortality of patients with septic shock initially cared in the prehospital setting by a mobile intensive care unit...
July 6, 2018: American Journal of Emergency Medicine
Zhicai Chen, Ruiting Zhang, Feizhou Xu, Xiaoxian Gong, Feina Shi, Meixia Zhang, Min Lou
Background : Identifying large vessel occlusion (LVO) patients in the prehospital triage stage to avoid unnecessary and costly delays is important but still challenging. We aim to develop an artificial neural network (ANN) algorithm to predict LVO using prehospital accessible data including demographics, National Institutes of Health Stroke Scale (NIHSS) items and vascular risk factors. Methods : Consecutive acute ischemic stroke patients who underwent CT angiography (CTA) or time of flight MR angiography (TOF-MRA) and received reperfusion therapy within 8 h from symptom onset were included...
2018: Frontiers in Aging Neuroscience
Nicolas Clementy, Ambroise Fourquet, Clémentine Andre, Arnaud Bisson, Bertrand Pierre, Laurent Fauchier, Dominique Babuty, Denis Angoulvant
Palpitations are a frequent symptom in the general population, and if cardiac arrhythmias are the most frequent etiology, their diagnosis may be uncertain. We sought to see whether a specialized management of palpitations is associated with a high diagnostic accuracy in patients presenting with palpitations.Consecutive patients addressed for isolated palpitations in our outpatient cardiac unit were prospectively included in this observational cohort study. The initial management was standardized: 12-lead electrocardiogram (ECG) as early as possible, ECG monitoring, potentially followed by an individualized management...
July 2018: Medicine (Baltimore)
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