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https://www.readbyqxmd.com/read/28432194/diagnostic-value-of-prehospital-ecg-in-acute-stroke-patients
#1
Tobias Bobinger, Bernd Kallmünzer, Markus Kopp, Natalia Kurka, Martin Arnold, Stefan Heider, Stefan Schwab, Martin Köhrmann
OBJECTIVE: To investigate the diagnostic yield of prehospital ECG monitoring provided by emergency medical services in the case of suspected stroke. METHODS: Consecutive patients with acute stroke admitted to our tertiary stroke center via emergency medical services and with available prehospital ECG were prospectively included during a 12-month study period. We assessed prehospital ECG recordings and compared the results to regular 12-lead ECG on admission and after continuous ECG monitoring at the stroke unit...
April 21, 2017: Neurology
https://www.readbyqxmd.com/read/28413705/acute-stroke-alert-activation-emergency-service-use-and-reperfusion-therapy-in-sweden
#2
Marie Eriksson, Eva-Lotta Glader, Bo Norrving, Birgitta Stegmayr, Kjell Asplund
OBJECTIVES: Ambulance services and stroke alerts reduce the time from stroke onset to acute stroke diagnosis. We describe the use of stroke alerts and ambulance services in different hospitals and patient groups and their relationship with reperfusion therapy. METHODS: This nationwide study included 49,907 patients admitted with acute stroke who were registered in The Swedish Stroke Register (Riksstroke) in 2011-2012. RESULTS: The proportions of patients admitted as stroke alerts out of all acute stroke admissions varied from 12...
April 2017: Brain and Behavior
https://www.readbyqxmd.com/read/28395982/cardiopulmonary-resuscitation-of-out-of-hospital-traumatic-cardiac-arrest-in-qatar-a-nationwide-population-based-study
#3
Furqan B Irfan, Rafael Consunji, Ayman El-Menyar, Pooja George, Ruben Peralta, Hassan Al-Thani, Stephen Hodges Thomas, Guillaume Alinier, Ashfaq Shuaib, Jassim Al-Suwaidi, Rajvir Singh, Maaret Castren, Peter A Cameron, Therese Djarv
BACKGROUND: Traumatic cardiac arrest studies have reported improved survival rates recently, ranging from 1.7-7.5%. This population-based nationwide study aims to describe the epidemiology, interventions and outcomes, and determine predictors of survival from out-of-hospital traumatic cardiac arrest (OHTCA) in Qatar. METHODS: An observational retrospective population-based study was conducted on OHTCA patients in Qatar, from January 2010 to December 2015. Traumatic cardiac arrest was redefined to include out-of-hospital traumatic cardiac arrest (OHTCA) and in-hospital traumatic cardiac arrest (IHTCA)...
March 30, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28389617/a-dedicated-spanish-language-line-increases-enrollment-of-hispanics-into-prehospital-clinical-research
#4
Nerses Sanossian, Lauren Rosenberg, David S Liebeskind, Sidney Starkman, Marc Eckstein, Samuel Stratton, Franklin D Pratt, Scott Hamilton, May Kim-Tenser, Latisha K Sharma, Lucas Restrepo, Miguel Valdes-Suieras, Robin Conwit, Jeffrey L Saver
BACKGROUND AND PURPOSE: Novel methods are needed to reduce the disparity of Hispanic enrollment in stroke clinical trials. Prehospital enrollment using a dedicated Spanish language line may help overcome this bias. METHODS: Subjects or legally authorized representatives provided information on race and ethnicity for all cases enrolled in the FAST-MAG clinical trial (Field Administration of Stroke Therapy-Magnesium), a prehospital phase 3 randomized study of intravenous magnesium for neuroprotection...
April 7, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28383476/multicenter-observational-prehospital-resuscitation-on-helicopter-study-prohs
#5
John B Holcomb, Michael D Swartz, Stacia M DeSantis, Thomas J Greene, Erin E Fox, Deborah M Stein, Eileen M Bulger, Jeffrey D Kerby, Michael Goodman, Martin A Schreiber, Martin D Zielinski, Terence O'Keeffe, Kenji Inaba, Jeffrey S Tomasek, Jeanette M Podbielski, Savitri Appana, Misung Yi, Charles E Wade
BACKGROUND: Earlier use of in-hospital plasma, platelets and red blood cells (RBCs) has improved survival in trauma patients with severe hemorrhage. Retrospective studies have associated improved early survival with prehospital blood product transfusion (PHT). We hypothesized that PHT of plasma and/or RBCs would result in improved survival after injury in patients transported by helicopter. METHODS: Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers were prospectively observed from Jan-Nov 2015...
April 5, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333833/leadership-and-a-casualty-response-system-for-eliminating-preventable-death
#6
Russ S Kotwal, Harold R Montgomery, Ethan A Miles, Curtis C Conklin, Michael T Hall, Stanley A McChrystal
Combat casualties who die from their injuries do so primarily in the prehospital setting. Although most of these deaths result from injuries that are non-survivable, some are potentially survivable. Of injuries that are potentially survivable, most are from hemorrhage. Thus, military organizations should direct efforts toward prehospital care, particularly through early hemorrhage control and remote damage control resuscitation, in order to eliminate preventable death on the battlefield. A systems-based approach and priority of effort for institutionalizing such care was developed and maintained by medical personnel and command-directed by non-medical combatant leaders within the 75th Ranger Regiment, U...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28318991/bleeding-control-using-hemostatic-dressings-lessons-learned
#7
REVIEW
Brad L Bennett
Based on lessons learned, many military battlefield trauma advances ultimately transition to enhance civilian trauma care. However, even with major strides to enhance battlefield hemorrhage control, it is unclear how effectively these techniques and products are being translated to civilian trauma. The purpose of this brief review is to present the evidence of current hemostatic product effectiveness, determine the evidence for transitioning of this technology to prehospital civilian application, and provide recommendations about potential use in the wilderness/austere setting...
March 16, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28318990/junctional-hemorrhage-control-for-tactical-combat-casualty-care
#8
REVIEW
Russ S Kotwal, Frank K Butler
During historic, as well as more recent, conflicts, most combat casualties who die from their injuries do so in the prehospital setting. Although many of the injuries incurred by these casualties are nonsurvivable, a number of injuries are still potentially survivable. Of those injuries that are potentially survivable, the majority are truncal, junctional, and extremity hemorrhage. Novel and effective approaches directed toward prehospital hemorrhage control have emerged in recent years, some of which can prove useful in the management of junctional hemorrhage whether in a military or civilian setting...
March 16, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28290925/two-decades-of-saving-lives-on-the-battlefield-tactical-combat-casualty-care-turns-20
#9
Frank K Butler
BACKGROUND: Twenty years ago, the original Tactical Combat Casualty Care (TCCC) article was published in this journal. Since TCCC is essentially a set of best-practice prehospital trauma care guidelines customized for use on the battlefield, the presence of a journal with a specific focus on military medicine was a profound benefit to the initial presentation of TCCC to the U.S. Military. METHODS: In the two ensuing decades, which included the longest continuous period of armed conflict in our nation's history, TCCC steadily evolved as the prehospital trauma care evidence base was augmented and as feedback from user medics, corpsmen, and pararescuemen was obtained...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28285483/a-perspective-on-the-potential-for-battlefield-resuscitative-endovascular-balloon-occlusion-of-the-aorta
#10
Ryan M Knight
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has a place in civilian trauma centers in the United States, and British physicians performed the first prehospital REBOA, proving the concept viable for civilian emergency medical service. Can this translate into battlefield REBOA to stop junctional hemorrhage and extend "golden hour" rings in combat? If yes, at what level is this procedure best suited and what does it entail? This author's perspective, after treating patients on the battlefield and during rotary wing evacuation, is that REBOA may have a place in prehospital resuscitation but patient and provider selection are paramount...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28285482/clinical-image-visual-estimation-of-blood-loss
#11
Benjamin Donham, Robby Frondozo, Michael Petro, Andrew Reynolds, Jonathan Swisher, Ryan M Knight
Military prehospital providers frequently have to make important clinical decisions with only limited objective information and vital signs. Because of this, accurate estimation of blood loss, at the point of injury, can augment any available objective information. Prior studies have shown that individuals significantly overestimate the amount of blood loss when the amount of hemorrhage is small, and they tend to underestimate the amount of blood loss with larger amounts of hemorrhage. Furthermore, the type of surface on which the blood is deposited can impact the visual estimation of the amount of hemorrhage...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28284483/tactical-combat-casualty-care-beginnings
#12
REVIEW
Frank K Butler
Tactical Combat Casualty Care (TCCC) is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield. The origins of TCCC were nontraditional. The TCCC program began as a Naval Special Warfare biomedical research effort launched after the realization that extremity hemorrhage, a leading cause of preventable death on the battlefield, was not being treated with a readily available and highly effective intervention: the tourniquet. This insight prompted a systematic reevaluation of all aspects of battlefield trauma care that was conducted from 1993 to 1996 as a joint effort by special operations medical personnel and the Uniformed Services University of the Health Sciences...
March 8, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28280651/prehospital-systolic-hypertension-and-outcomes-in-patients-with-spontaneous-intracerebral-hemorrhage
#13
Stacy Hatcher, Connie Chen, Prasanthi Govindarajan
BACKGROUND: It is well known that hematoma volume and expansion is associated with poor outcomes in patients with spontaneous intracerebral hemorrhage (sICH). The factors associated with hematoma volume and possible expansion include the use of anticoagulant medications, autoimmune or bacterial diseases that reduce platelet production, and genetic defects of Von Willebrand factor causing inhibition or reduction of platelet aggregation. However, little is known about the role of elevated systolic blood pressure (SBP) on hematoma volume and its ultimate role on sICH when identified in the prehospital setting...
January 26, 2017: Curēus
https://www.readbyqxmd.com/read/28257392/prehospital-hypertonic-fluid-resuscitation-for-trauma-patients-a-systematic-review-and-meta-analysis
#14
Claire de Crescenzo, Farzam Gorouhi, Edgardo S Salcedo, Joseph M Galante
BACKGROUND: Prehospital assessment of a patient's circulation status and appropriate resuscitation with intravenous fluids plays a critical role in patients with obvious hemorrhage or systolic blood pressure below 90 mm Hg. OBJECTIVES: We assessed the efficacy and safety of prehospital administration of crystalloids or colloids to improve the survival rate of trauma patients with acceptable safety profile. DATA SOURCES: We searched SCOPUS, Embase, TRIP database, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and PubMed as per search protocol from January 1, 1900 to February 12, 2015...
May 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28255632/population-based-autopsy-study-of-traumatic-fatalities
#15
S Saar, A Lomp, J Laos, V Mihnovitš, R Šalkauskas, T Lustenberger, M Väli, U Lepner, P Talving
BACKGROUND: Injuries result in 5.8 million global fatalities annually and are the leading cause of death in younger individuals. Nevertheless, population-based autopsy investigations on traumatic deaths are scarce. We set out to study all consecutive autopsies on traumatic fatalities performed in a 5-year time segment in Estonia. METHODS: After the ethics review board approval, all consecutive autopsies after blunt or penetrating deaths occurring in prehospital or in-hospital settings between January 1, 2009, and December 31, 2013, were retrospectively reviewed using the National Forensic Medicine Database...
March 2, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28245880/pre-hospital-ct-diagnosis-of-subarachnoid-hemorrhage
#16
Maren Ranhoff Hov, Annette Ryen, Katrine Finsnes, Janne Storflor, Thomas Lindner, Jostein Gleditsch, Christian Georg Lund
BACKGROUND: Subarachnoid hemorrhage (SAH) is associated with higher mortality in the acute phase than other stroke types. There is a particular risk of early and devastating re-bleeding. Patients therefore need urgent assessment in a neurosurgical department, and the shorter the time from symptom onset to diagnosis the better. CASE PRESENTATION: The Norwegian Acute Stroke Pre-hospital Project (NASPP) has developed a Mobile Stroke Unit (MSU) model, which is staffed with anesthesiologists also trained in pre-hospital clinical assessment of acute stroke patients and interpretation of computerized tomography (CT)...
February 28, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28238499/out-of-hospital-triage-of-older-adults-with-head-injury-a-retrospective-study-of-the-effect-of-adding-anticoagulation-or-antiplatelet-medication-use-as-a-criterion
#17
Daniel K Nishijima, Samuel D Gaona, Trent Waechter, Ric Maloney, Troy Bair, Adam Blitz, Andrew R Elms, Roel D Farrales, Calvin Howard, James Montoya, Jeneita M Bell, Mark Faul, David R Vinson, Hernando Garzon, James F Holmes, Dustin W Ballard
STUDY OBJECTIVE: Field triage guidelines recommend that emergency medical services (EMS) providers consider transport of head-injured older adults with anticoagulation use to trauma centers. However, the triage patterns and the incidence of intracranial hemorrhage or neurosurgery in these patients are unknown. Our objective is to describe the characteristics and outcomes of older adults with head trauma who are transported by EMS, particularly for patients who do not meet physiologic, anatomic, or mechanism-of-injury (steps 1 to 3) field triage criteria but are receiving anticoagulant or antiplatelet medications...
February 23, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28159434/-and-if-it-happened-to-children-adapting-medical-care-during-terrorist-attacks-with-multiple-pediatric-victims
#18
L Alix-Séguin, N Lodé, G Orliaguet, E Chamorro, F Kerroué, C Lorge, A Moreira
In light of the recent terrorist attacks in Europe, we need to reconsider the organization of rescue and medical management and plan for an attack involving multiple pediatric victims. To ensure quick surgical management, but also to minimize risk for on-site teams (direct threats from secondary terrorist attacks targeting deployed emergency services), it is crucial to evacuate patients in a swift but orderly fashion. Children are vulnerable targets in terrorist attacks. Their anatomical and physiological characteristics make it likely that pediatric victims will suffer more brain injuries and require more, often advanced, airway management...
March 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28087807/field-validation-of-the-los-angeles-motor-scale-as-a-tool-for-paramedic-assessment-of-stroke-severity
#19
Joon-Tae Kim, Pil-Wook Chung, Sidney Starkman, Nerses Sanossian, Samuel J Stratton, Marc Eckstein, Frank D Pratt, Robin Conwit, David S Liebeskind, Latisha Sharma, Lucas Restrepo, May-Kim Tenser, Miguel Valdes-Sueiras, Jeffrey Gornbein, Scott Hamilton, Jeffrey L Saver
BACKGROUND AND PURPOSE: The Los Angeles Motor Scale (LAMS) is a 3-item, 0- to 10-point motor stroke-deficit scale developed for prehospital use. We assessed the convergent, divergent, and predictive validity of the LAMS when performed by paramedics in the field at multiple sites in a large and diverse geographic region. METHODS: We analyzed early assessment and outcome data prospectively gathered in the FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium phase 3) among patients with acute cerebrovascular disease (cerebral ischemia and intracranial hemorrhage) within 2 hours of onset, transported by 315 ambulances to 60 receiving hospitals...
February 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27973670/fixed-distance-model-for-balloon-placement-during-fluoroscopy-free-resuscitative-endovascular-balloon-occlusion-of-the-aorta-in-a-civilian-population
#20
Pierre Pezy, Alexandros N Flaris, Nicolas J Prat, François Cotton, Peter W Lundberg, Jean-Louis Caillot, Jean-Stéphane David, Eric J Voiglio
Importance: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an innovative procedure in the treatment of noncompressible truncal hemorrhage. However, readily available fluoroscopy remains a limiting factor in its widespread implementation. Several methods have been proposed to perform REBOA without fluoroscopic guidance, and these methods were adapted predominantly from the military theater. Objective: To develop a method for performing REBOA in a civilian population using a standardized distance from a set point of entry...
April 1, 2017: JAMA Surgery
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