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Caitlin Wilson, Clare Harley, Stephanie Steels
INTRODUCTION: Paramedics are involved in examining, treating and diagnosing patients. The accuracy of these diagnoses is evaluated using diagnostic accuracy studies. We undertook a systematic review of published literature to provide an overview of how accurately paramedics diagnose patients compared with hospital doctors. A bivariate meta-analysis was incorporated to examine the range of diagnostic sensitivity and specificity. METHODS: We searched MEDLINE, CINAHL, Embase, AMED and the Cochrane Database from 1946 to 7 May 2016 for studies where patients had been given a diagnosis by paramedics and hospital doctors...
September 14, 2018: Emergency Medicine Journal: EMJ
Pei-Yang Hu, Xin-Yi Chen, Xiong-Huan Chen, Yi-Min Chen
Severe trauma has the characteristics of complicated condition, multiple organs involved, limited auxiliary examinations, and difficulty in treatment. Most of the trauma patients were sent to primary hospitals to receive treatments. But the traditional mode of separate discipline management can easily lead to delayed treatment, missed or wrong diagnosis and high disability, which causes a high mortality in severe trauma patients. Therefore, if the primary hospitals, especially county-level hospitals (usually the top general hospital within the administrative region of a county), can establish a scientific and comprehensive trauma care system, the success rate of trauma rescue in this region can be greatly improved...
April 25, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
Philippe Lemmel
Any out-of-hospital neurological deficit of less than 24 hours should prompt a call for emergency medical help Urgent Medical Aid Service. Early identification of signs of stroke or transient ischaemic attack allows to guide the therapeutic approach towards intravenous thrombolysis or other alternatives. Telemedicine centres complement the network of neurovascular units.
September 2018: Soins; la Revue de Référence Infirmière
Elaine De Gruyter, Clare Saunders, Bill Stavreski, Garry Jennings
BACKGROUND: This research estimates the broader socioeconomic impacts of reducing pre-hospital delay times across Australia in patients with heart attack symptoms. METHODS: A cost benefit analysis (CBA) was undertaken to demonstrate the costs and benefits of a public awareness/education campaign to reduce pre-hospital delay time from 5.2hours (Base Case) to 4.1hours (Scenario 1) and 2.0hours (Scenario 2). All assumptions underlying the CBA are supported by academic literature...
August 31, 2018: Heart, Lung & Circulation
Mirko Zanatta, Piero Benato, Sigilfredo De Battisti, Concetta Pirozzi, Renato Ippolito, Vito Cianci
BACKGROUND: Pre-hospital ultrasound is a new challenge and lung ultrasound could be an interesting opportunity in the pre-hospital medical service. The aim of our study was to evaluate the efficacy of lung ultrasound in out-of-hospital non-traumatic respiratory insufficiency. METHODS: We planned a case-controlled study in the ULSS 5 ovest vicentino area (Vicenza-Italy) enrolling subjects with severe dyspnea caused by cardiac heart failure or acute exacerbation of chronic obstructive pulmonary disease...
September 10, 2018: Critical Ultrasound Journal
Xinyu Wang, Yuanfa Tao, Xiandong Tao, Jianglong Chen, Yifeng Jin, Zhengxiang Shan, Jiyang Tan, Qixin Cao, Tiewen Pan
The success rate of pre-hospital endotracheal intubation (ETI) by paramedics is lower than physicians. We aimed to establish a remote robot-assisted intubation system (RRAIS) and expected it to improve success rate of pre-hospital ETI. To test the robot's feasibility, 20 pigs were intubated by direct laryngoscope or the robot system. Intubation time, success rate, airway complications were recorded during the experiment. The animal experiment showed that participants achieved a higher success rate in absolute numbers by the robot system...
September 7, 2018: Scientific Reports
Anna-Carin Persson, Åsa Engström, Oskar Burström, Päivi Juuso
BACKGROUND: Working as an ambulance nurse means interacting with and caring for acutely ill and injured patients. It can even involve births before arrival to the hospital (BBA), which are rare but increasing due to the centralization of maternity wards. AIM: This study describes the experiences of specialist ambulance nurses with BBA. METHOD: A qualitative study was conducted, and nine specialist ambulance nurses who had assisted with one or more prehospital births were interviewed...
September 3, 2018: International Emergency Nursing
Meng-Yu Wu, Yu-Long Chen, Giou-Teng Yiang, Chia-Jung Li, Amy Shu-Chuan Lin
Geriatric traumatic injuries in emergency departments are frequent and associated with higher mortality rates and catastrophic functional outcomes. Several prediction scores have been established to manage traumatic patients, including the shock index (SI), revised trauma score (RTS), injury severity score (ISS), trauma injury severity score (TRISS), and new injury severity score (NISS). However, it was necessary to investigate the effectiveness and efficiency of care for the geriatric traumatic population...
September 4, 2018: Journal of Clinical Medicine
D E Bragin, D A Lara, O A Bragina, M V Kameneva, E M Nemoto
Traumatic brain injury (TBI) is frequently accompanied by hemorrhagic shock (HS) which significantly worsens morbidity and mortality. Existing resuscitation fluids (RF) for volume expansion inadequately mitigate impaired microvascular cerebral blood flow (mvCBF) and hypoxia after TBI/HS. We hypothesized that nanomolar quantities of drag reducing polymers in resuscitation fluid (DRP-RF), would improve mvCBF by rheological modulation of hemodynamics. METHODS: TBI was induced in rats by fluid percussion (1...
2018: Advances in Experimental Medicine and Biology
Anna Jarosz, Paweł Podsiadło, Tomasz Darocha, Tomasz Sanak, Sylweriusz Kosiński, Robert Gałązkowski, Rafał Drwiła
OBJECTIVE: Introduction: The paper covers the problem of pre-hospital hypothermia recognition and management among lifeguards, board guards and policemen, who took part in e-learning course Academy of Hypothermia. PATIENTS AND METHODS: Materials and methods: The subject of analysis were the results of pre-test, post-test and lesson revision tests of Academy of Hypothermia e-learning course, taken by lifeguards (WOPR), board guards (SG) and policemen (POL). RESULTS: Results: 221 participants were enrolled in a study...
2018: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Dae-Hyun Kim, Byungjun Kim, Cheolkyu Jung, Hyo Suk Nam, Jin Soo Lee, Jin Woo Kim, Woong Jae Lee, Woo-Keun Seo, Ji-Hoe Heo, Seung Kug Baik, Byung Moon Kim, Joung-Ho Rha
Recent clinical trials demonstrated the clinical benefit of endovascular treatment (EVT) in patients with acute ischemic stroke due to large vessel occlusion. These trials confirmed that good outcome after EVT depends on the time interval from symptom onset to reperfusion and that in-hospital delay leads to poor clinical outcome. However, there has been no universally accepted in-hospital workflow and performance benchmark for rapid reperfusion. Additionally, wide variety in workflow for EVT is present between each stroke centers...
September 2018: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Rita Patel, Manjula D Nugawela, Hannah B Edwards, Alison Richards, Hein Le Roux, Anne Pullyblank, Penny Whiting
OBJECTIVE: To evaluate the effectiveness and predictive accuracy of early warning scores (EWS) to predict deteriorating patients in pre-hospital settings. METHODS: Systematic review. Seven databases searched to August 2017. Study quality was assessed using QUADAS-2. A narrative synthesis is presented. ELIGIBILITY: Studies that evaluated EWS predictive accuracy or that compared outcomes in populations that did or did not use EWS, in any pre-hospital setting were eligible for inclusion...
August 29, 2018: Resuscitation
Silke Walter, Iris Q Grunwald, Stefan A Helwig, Andreas Ragoschke-Schumm, Michael Kettner, Mathias Fousse, Martin Lesmeister, Klaus Fassbender
PURPOSE OF REVIEW: Acute stroke is a treatable disease. Nevertheless, only a minority of patients obtain guideline-adjusted therapy. One major reason is the small time window in which therapies have to be administered in order to reverse or mitigate brain injury and prevent disability. The Mobile Stroke Unit (MSU) concept, available for a decade now, is spreading worldwide, comprising ambulances, fully equipped with computed tomography, laboratory unit and telemedicine connection to the stroke centre and staffed with a specialised stroke team...
August 29, 2018: Current Atherosclerosis Reports
Eleanor Rye, Andrea Lee, Arun Narayan, A Robert Denniss, Clara Chow, Pramesh Kovoor, Gopal Sivagangabalan
BACKGROUND: Internationally a growing number of studies have identified race related disparities in the presentation, treatment and outcomes of patients with ST-Elevation Myocardial Infarction (STEMI). With a large migrant population Australia presents a unique microcosm in which to study the impact of migrant status and ethnicity in STEMI patients. AIM & METHODS: We conducted a retrospective observational study utilising data from a clinician-initiated registry to investigate if first-generation migrants differed in presentation, treatment or outcomes following STEMI compared with the Australian-born population...
August 27, 2018: Internal Medicine Journal
David Häske, Stefan K Beckers, Marzellus Hofmann, Rolf Lefering, Christine Preiser, Bernhard Gliwitzky, Paul Alfred Grützner, Ulrich Stöckle, Matthias Münzberg
BACKGROUND: Trainings in emergency medicine are well structured, but examinations are rarely validated. We are evaluating the impact of pre-hospital emergency trainings on participants and patient care and developed and validated a checklist to assess emergency trainings. METHODS: We used videos recorded at the time points directly before (t0), directly after (t1), and one year after (t2) training to develop the PERFECT checklist (Performance Assessment of Emergency Teams and Communication in Trauma Care)...
2018: PloS One
William Lack, Rachel Seymour, Anna Bickers, Jonathan Studnek, Madhav Karunakar
OBJECTIVE: Early antibiotic administration has been associated with a significant decrease in infection following open fractures. However, antibiotics are most effective at a time when many patients are still being transported for care. There is limited evidence that antibiotics may be safely administered for open fractures when being transported by life-flight personnel. No such data exists for ground ambulance transport of patients with open fractures. The purpose of the study was to assess the safety and feasibility of prophylactic antibiotic delivery in the prehospital setting...
September 14, 2018: Prehospital Emergency Care
Sophie Jefferys, A J Martin-Bates, A Harold, R Withnall
OBJECTIVES: To record the activation and use of the Eastern Sovereign Base Area (ESBA) emergency ambulance service of British Forces Cyprus between 1 September 2013 and 31 August 2016. To reflect on these findings in light of data from 1995 to 1998 to identify current treads and areas of development. METHOD: Retrospective epidemiological study of all activations of the ESBA emergency ambulance service within the study period. RESULTS: 812 patients were treated over 3 years, an 80% increase in workload, of which 41% were entitled personnel...
August 23, 2018: Journal of the Royal Army Medical Corps
Michael S Clemens, Mamie C Stull, Jason M Rall, Ian J Stewart, Jonathan A Sosnov, Kevin K Chung, James D Ross
Introduction: Options for the treatment of hyperkalemia in the pre-hospital setting are limited, particularly in the context of natural disaster or during combat operations. Contemporary interventions require extensive resources and technical expertise. Here we examined the potential for a simple, field deployable bridge-dialysis as a countermeasure for acute hyperkalemia induced by prolonged ischemia-reperfusion. Methods: Twenty female swine were randomized into two experimental groups undergoing a 2-hour bilateral hindlimb ischemia-reperfusion injury...
August 20, 2018: Military Medicine
Lars Nepper-Christensen, Jacob Lønborg, Kiril A Ahtarovski, Dan E Høfsten, Kasper Kyhl, Mikkel M Schoos, Christoffer Göransson, Peter N Laursen, Golnaz Sadjadieh, Adam Ali Ghotbi, Litten Bertelsen, Lars Køber, Steffen Helqvist, Frants Pedersen, Erik Jørgensen, Henning Kelbæk, Niels Vejlstrup, Lene Holmvang, Thomas Engstrøm
BACKGROUND: Elevated heart rate is associated with poor clinical outcome in patients with acute myocardial infarction. However, in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention the importance of elevated heart rate in the very early phase remains unknown. We evaluated the impact of elevated heart rate in the very early pre-hospital phase of ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention on cardiovascular magnetic resonance markers of reperfusion success and clinical outcome...
August 23, 2018: European Heart Journal. Acute Cardiovascular Care
Kathleen A Puntillo, Adeline Max, Jean-Francois Timsit, Stephane Ruckly, Gerald Chanques, Gemma Robleda, Ferran Roche-Campo, Jordi Mancebo, Jigeeshu V Divatia, Marcio Soares, Daniela C Ionescu, Ioana M Grintescu, Salvatore Maurizio Maggiore, Katerina Rusinova, Radoslaw Owczuk, Ingrid Egerod, Elizabeth D E Papathanassoglou, Maria Kyranou, Gavin M Joynt, Gaston Burghi, Ross C Freebairn, Kwok M Ho, Anne Kaarlola, Rik T Gerritsen, Jozef Kesecioglu, Miroslav M S Sulaj, Michelle Norrenberg, Dominique D Benoit, Myriam S G Seha, Akram Hennein, Fernando J Pereira, Julie S Benbenishty, Fekri Abroug, Andrew Aquilina, Julia R C Monte, Youzhong An, Elie Azoulay
PURPOSE: The intensity of procedural pain in intensive care unit (ICU) patients is well documented. However, little is known about procedural pain distress, the psychological response to pain. METHODS: Post hoc analysis of a multicenter, multinational study of procedural pain. Pain distress was measured before and during procedures (0-10 numeric rating scale). Factors that influenced procedural pain distress were identified by multivariable analyses using a hierarchical model with ICU and country as random effects...
September 2018: Intensive Care Medicine
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