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Prehospital Airway

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https://www.readbyqxmd.com/read/29615073/advanced-airway-management-in-hoist-and-longline-operations-in-mountain-hems-considerations-in-austere-environments-a-narrative-review-this-review-is-endorsed-by-the-international-commission-for-mountain-emergency-medicine-icar-medcom
#1
REVIEW
Urs Pietsch, Jürgen Knapp, Oliver Kreuzer, Ludwig Ney, Giacomo Strapazzon, Volker Lischke, Roland Albrecht, Patrick Phillips, Simon Rauch
BACKGROUND: Providing sufficient oxygenation and ventilation is of paramount importance for the survival of emergency patients. Therefore, advanced airway management is one of the core tasks for every rescue team. Endotracheal intubation is the gold standard to secure the airway in the prehospital setting. This review aims to highlight special considerations for advanced airway management preceding human external cargo (HEC) evacuations. METHODS: We systematically searched MEDLINE, EMBASE, and PubMed in August 2017 for articles on airway management and ventilation in patients before hoist or longline operation in HEMS...
April 3, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29558224/a-prospective-before-and-after-study-of-droperidol-for-prehospital-acute-behavioral-disturbance
#2
Colin B Page, Lachlan E Parker, Stephen J Rashford, Emma Bosley, Katherine Z Isoardi, Frances E Williamson, Geoffrey K Isbister
STUDY OBJECTIVE: Acute behavioral disturbance is a common problem for emergency medical services. We aimed to investigate the safety and effectiveness of droperidol compared to midazolam in the prehospital setting. METHODS: This was a prospective before and after study comparing droperidol to midazolam for prehospital acute behavioral disturbance, when the state ambulance service changed medications. The primary outcome was the proportion of adverse effects (airway intervention, oxygen saturation < 90%, respiratory rate < 12, systolic blood pressure < 90 mmHg, sedation assessment tool score -3 and dystonic reactions) in patients receiving sedation...
March 20, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29536862/out-of-hospital-cardiac-arrest-prehospital-management
#3
REVIEW
Marcus Eng Hock Ong, Gavin D Perkins, Alain Cariou
Sudden out-of-hospital cardiac arrest is the most time-critical medical emergency. In the second paper of this Series on out-of-hospital cardiac arrest, we considered important issues in the prehospital management of cardiac arrest. Successful resuscitation relies on a strong chain of survival with the community, dispatch centre, ambulance, and hospital working together. Early cardiopulmonary resuscitation and defibrillation has the greatest impact on survival. If the community response does not restart the heart, resuscitation is continued by emergency medical services' staff...
March 10, 2018: Lancet
https://www.readbyqxmd.com/read/29521802/prehospital-airway-procedures-performed-in-trauma-patients-by-ground-forces-in-afghanistan
#4
Megan B Blackburn, Maj Michael D April, Cpt Derek J Brown, Robert A DeLorenzo, Kathy L Ryan, August N Blackburn, Maj Steven G Schauer
BACKGROUND: Airway management is of critical importance in combat trauma patients. Airway compromise is the second leading cause of potentially survivable death on the battlefield and accounts for approximately 1 in 10 preventable deaths. Reports from the Iraq and Afghanistan wars indicate 4-7% incidence of airway interventions on casualties transported to combat hospitals. The goal of this study was to describe airway management in the prehospital combat setting and document airway devices used on the battlefield...
March 8, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29521783/a-multicenter-performance-improvement-program-uses-rural-trauma-filters-for-benchmarking-an-evaluation-of-the-findings
#5
Ray Coniglio, Constance McGraw, Mike Archuleta, Heather Bentler, Leigh Keiter, Julie Ramstetter, Elizabeth Reis, Cristi Romans, Rachael Schell, Kelli Ross, Rachel Smith, Jodi Townsend, Alessandro Orlando, Charles W Mains
Colorado requires Level III and IV trauma centers to conduct a formal performance improvement program (PI), but provides limited support for program development. Trauma program managers and coordinators in rural facilities rarely have experience in the development or management of a PI program. As a result, rural trauma centers often face challenges in evaluating trauma outcomes adequately. Through a multidisciplinary outreach program, our Trauma System worked with a group of rural trauma centers to identify and define seven specific PI filters based on key program elements of rural trauma centers...
March 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29485338/dexamethasone-related-perineal-burning-in-the-prehospital-setting-a-case-series
#6
Layne Dylla, Nicole M Acquisto, Francis Manzo, Jeremy T Cushman
Dexamethasone is frequently used in the treatment of allergic reactions and airway inflammation because of its potent anti-inflammatory effects and long duration of action. As prehospital use becomes more common, it is important for providers to be aware of unique and potentially distressing associated adverse effects. We report eight cases of intravenous dexamethasone administration associated with perineal or diffuse burning sensation in female patients.
February 27, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29465274/intubation-success-in-critical-care-transport-a-multicenter-study
#7
Ryan J Reichert, Megan Gothard, M David Gothard, Hamilton P Schwartz, Michael T Bigham
INTRODUCTION: Tracheal intubation (TI) is a lifesaving critical care skill. Failed TI attempts, however, can harm patients. Critical care transport (CCT) teams function as the first point of critical care contact for patients being transported to tertiary medical centers for specialized surgical, medical, and trauma care. The Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaborative uses a quality metric database to track CCT quality metric performance, including TI...
February 21, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29452732/efficacy-of-pre-hospital-rapid-sequence-intubation-in-paediatric-traumatic-brain-injury-a-9-year-observational-study
#8
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/29408229/trends-in-care-processes-and-survival-following-prehospital-resuscitation-improvement-initiatives-for-out-of-hospital-cardiac-arrest-in-british-columbia-2006-2016
#9
Brian Grunau, Takahisa Kawano, William Dick, Ronald Straight, Helen Connolley, Robert Schlamp, Frank Scheuermeyer, Christopher B Fordyce, David Barbic, John Tallon, Jim Christenson
BACKGROUND: British Columbia (BC) Emergency Health Services implemented a strategy to improve outcomes for out-of-hospital cardiac arrest (OHCA), focusing on paramedic-led high-quality on-scene resuscitation. We measured changes in care metrics and survival trends. METHODS: This was a post-hoc study of prospectively identified consecutive non-traumatic ambulance-treated adult OHCAs from 2006 to 2016 within BC's four metropolitan areas. The primary outcome was survival to hospital discharge; we described available favourable neurological outcomes (mRS ≤3)...
February 2, 2018: Resuscitation
https://www.readbyqxmd.com/read/29405803/prehospital-rapid-sequence-intubation-by-intensive-care-flight-paramedics
#10
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/29356286/medical-equipment-deployment-in-pediatric-emergency-prehospital-medical-units-in-japan
#11
Noriyuki Kaku, Masahiko Nitta, Takashi Muguruma, Yuichiro Hirata, Kohei Tsukahara, Emily Knaup, Nobuyuki Nosaka, Yuki Enomoto
The deployment status of pediatric emergency equipment in ambulances in Japan is unknown. To investigate the status of and issues associated with prehospital emergency medical care for pediatric patients, we conducted a descriptive epidemiological study. We carried out a Web-based survey of 767 fire defense headquarters in Japan, of which 671 responded (valid response rate, 88%). Most of the fire defense headquarters equipped all of their ambulances with oxygen masks (82%), bag-valve masks (for neonates, 83%; for children, 84%), straight laryngoscope blades (for neonates, 47%; for children 68%), blood pressure cuffs for children (91%), oximeter probes (78%), and stiff neck collars (91%); but despite the need for other equipment such as nasopharyngeal and oropharyngeal airways, and Magill forceps, they were insufficiently deployed...
January 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/29349487/lay-first-responder-training-in-eastern-uganda-leveraging-transportation-infrastructure-to-build-an-effective-prehospital-emergency-care-training-program
#12
Peter G Delaney, Richard Bamuleke, Yang Jae Lee
BACKGROUND: Though road traffic injuries (RTIs) are a major cause of mortality in East Africa, few countries have emergency medical services. The aim was to create a sustainable and efficient prehospital lay first responder program, creating a system with lay first responders spread through the 53 motorcycle taxi stages of Iganga Municipality. METHODS: One hundred and fifty-four motorcycle taxi riders were taught a first aid curriculum in partnership with a local Red Cross first aid trainer and provided with a first aid kit following WHO guidelines for basic first aid...
January 18, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29334569/assessment-of-prehospital-hemorrhage-and-airway-care-using-a-simulation-model
#13
Mariya E Skube, Seth Witthuhn, Kristine Mulier, Bonnie Boucher, Elizabeth Lusczek, Greg J Beilman
BACKGROUND: The quality of prehospital care impacts patient outcomes. Military efforts have focused on training revision and the creation of high fidelity simulation models to address potentially survivable injuries. We sought to investigate the applicability of models emphasizing hemorrhage control and airway management to a civilian population. METHODS: Prehospital healthcare providers (PHPs) undergoing their annual training were enrolled. A trauma scenario was simulated with two modules: hemorrhage control and airway management...
January 12, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29297718/evaluation-of-physiologic-alterations-during-prehospital-paramedic-performed-rapid-sequence-intubation
#14
Robert G Walker, Lynn J White, Geneva N Whitmore, Alexander Esibov, Michael K Levy, Gregory C Cover, Joel D Edminster, James M Nania
OBJECTIVE: Physiologic alterations during rapid sequence intubation (RSI) have been studied in several emergency airway management settings, but few data exist to describe physiologic alterations during prehospital RSI performed by ground-based paramedics. To address this evidence gap and provide guidance for future quality improvement initiatives in our EMS system, we collected electronic monitoring data to evaluate peri-intubation vital signs changes occurring during prehospital RSI...
January 3, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29251708/speed-is-not-everything-identifying-patients-who-may-benefit-from-helicopter-transport-despite-faster-ground-transport
#15
Xilin Chen, Mark L Gestring, Matthew R Rosengart, Timothy R Billiar, Andrew B Peitzman, Jason L Sperry, Joshua B Brown
BACKGROUND: Helicopter emergency medical services (HEMS) have demonstrated survival benefits over ground emergency medical services (GEMS) for trauma patient transport. While HEMS speed is often-cited, factors such as provider experience and level of care may also play a role. Our objective was to identify patient groups that may benefit from HEMS even when prehospital time for helicopter utilization is longer than GEMS transport. METHODS: Adult patients transported by HEMS or GEMS from the scene of injury in the Pennsylvania State Trauma Registry were included...
April 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29229538/association-of-prehospital-intubation-with-decreased-survival-among-pediatric-trauma-patients-in-iraq-and-afghanistan
#16
Steven G Schauer, Jason F Naylor, Guyon J Hill, Allyson A Arana, Jamie L Roper, Michael D April
INTRODUCTION: Airway compromise is the second leading cause of preventable death on the battlefield among US military casualties. Airway management is an important component of pediatric trauma care. Yet, intubation is a challenging skill with which many prehospital providers have limited pediatric experience. We compare mortality among pediatric trauma patients undergoing intubation in the prehospital setting versus a fixed-facility emergency department. METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric encounters in Iraq and Afghanistan from January 2007 to January 2016...
December 1, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29188917/-implementation-of-the-hartford-consensus-and-tactical-combat-casualty-care-recommendations-in-emergency-services-a-review-of-the-literature
#17
REVIEW
Carmen Usero-Pérez, Valentín González Alonso, Luis Orbañanos Peiro, José Manuel Gómez Crespo, Sheima Hossain López
Recent terrorist attacks involving active shooters or improvised explosive devices have shown that traditionally sequenced emergency management leads to delays in attending victims and suboptimal outcomes. Tactical medicine, a new concept in prehospital care, emerged from experience attending the wounded in combat zones, where the Tactical Combat Casualty Care (TCCC) recommendations are applied. TCCC targets 3 main causes of preventable death in combat: bleeding from extremities, tension pneumothorax, and airway obstruction...
2017: Emergencias: revista de la Sociedad Española de Medicina de Emergencias
https://www.readbyqxmd.com/read/29175355/an-assessment-of-ventilation-and-perfusion-markers-in-out-of-hospital-cardiac-arrest-patients-receiving-mechanical-cpr-with-endotracheal-or-supraglottic-airways
#18
Torben K Becker, Aric W Berning, Arjun Prabhu, Clifton W Callaway, Francis X Guyette, Christian Martin-Gill
AIM OF THE STUDY: Mechanical chest compression (MCPR) devices are considered equivalent to manual compressions in patient outcomes in out-of-hospital cardiac arrest (OHCA). However, recent data suggest possible harm in patients with a supraglottic airway device (SGA) during MCPR. The aim of this study was to evaluate differences in direct and indirect markers of ventilation and perfusion in patients with cardiac arrest receiving MCPR and who had their airway managed with an endotracheal tube (ETT) or SGA...
January 2018: Resuscitation
https://www.readbyqxmd.com/read/29143074/-additional-emergency-medical-measures-in-trauma-associated-cardiac-arrest
#19
B Ondruschka, C Baier, J Dreßler, A Höch, M Bernhard, C Kleber, C Buschmann
INTRODUCTION: More than half of all traumatic deaths happen in prehospital settings. Until now, there have been no long-term studies examining the actual additive treatment during trauma-associated cardiopulmonary resuscitation (tCPR), including pleural decompression, pericardiocentesis, tourniquets and external stabilization of the pelvis. The present cohort study evaluated forensic autopsy reports of trauma deaths occurring at the scene with respect to additive actions in preclinical tCPR as well as the potentially preventable nature of the individual death cases...
December 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/29109872/severe-decompression-illness-case-report-prehospital-recognition-and-regional-transport-considerations
#20
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
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