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https://www.readbyqxmd.com/read/29728411/prehospital-haemostatic-dressings-for-trauma-a-systematic-review
#1
Adam J Boulton, Christopher T Lewis, David N Naumann, Mark J Midwinter
BACKGROUND: Haemorrhage is a major cause of mortality and morbidity following both military and civilian trauma. Haemostatic dressings may offer effective haemorrhage control as part of prehospital treatment. AIM: To conduct a systematic review of the clinical literature to assess the prehospital use of haemostatic dressings in controlling traumatic haemorrhage, and determine whether any haemostatic dressings are clinically superior. METHODS: MEDLINE and EMBASE databases were searched using predetermined criteria...
May 4, 2018: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29618372/prehospital-triage-of-patients-diagnosed-with-perforated-peptic-ulcer-or-peptic-ulcer-bleeding-an-observational-study-of-patients-calling-1-1-2
#2
Kasper Bonnesen, Kristian D Friesgaard, Morten T Boetker, Lone Nikolajsen
BACKGROUND: Triage systems are used in emergency medical services to systematically prioritize prehospital resources according to individual patient conditions. Previous studies have shown cases of preventable deaths in emergency medical services even when triage systems are used, indicating a potential undertriage among some conditions. The aim of this study was to investigate the triage level among patients diagnosed with perforated peptic ulcer (PPU) or peptic ulcer bleeding (PUB)...
April 5, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/29573898/efficacy-of-prehospital-administration-of-tranexamic-acid-in-trauma-patients-a-meta-analysis-of-the-randomized-controlled-trials
#3
REVIEW
Ayman El-Menyar, Brijesh Sathian, Mohammed Asim, Rifat Latifi, Hassan Al-Thani
OBJECTIVE: Antifibrinolytic agent tranexamic acid (TXA) has a potential clinical benefit for in-hospital patients with severe bleeding but its effectiveness in pre-hospital settings remains unclear. We conducted a systematic review and meta-analysis to evaluate whether pre-hospital administration of TXA compared to placebo improve patients' outcomes? METHODS: PubMed, MEDLINE, Cochrane Library, WHO International Clinical Trials Registry Platform, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, clinicaltrials...
March 16, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29564473/-palliative-medicine-in-emergency-medical-services
#4
REVIEW
M Roessler, N Eulitz
The scope of emergency calls for emergency medical services staffed by an emergency physician (EMS-EP) includes calls to patients with life-limiting diseases. Symptom exacerbation as well as psychosocial overburdening of caring relatives are the most frequent reasons for activation of an EMS-EP. Pain crises, acute dyspnea, massive bleeding and/or an impending or overt cardiac arrest are the most frequent symptom exacerbations. Under the conditions of a prehospital emergency physician mission, particular challenges are the evaluation of the overall situation, the prognosis and the presumed will of the patient...
March 21, 2018: Der Anaesthesist
https://www.readbyqxmd.com/read/29487207/how-many-patients-could-benefit-from-reboa-in-prehospital-care-a-retrospective-study-of-patients-rescued-by-the-doctors-of-the-paris-fire-brigade
#5
Oscar Thabouillot, K Bertho, E Rozenberg, N-C Roche, G Boddaert, D Jost, J-P Tourtier
INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to control haemorrhage by placing a retrograde catheter in an artery and inflating a balloon at its tip. This retrospective study aimed to evaluate the proportion of injured people who could potentially have benefited from this technique prior to hospitalisation, including on the scene or during transport. METHODS: A retrospective analysis was conducted of all patients with trauma registered in the Paris Fire Brigade emergency medical system between 1 January and 31 December 2014...
February 27, 2018: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/29485427/how-hemorrhage-control-became-common-sense
#6
Alan James Hawk
BACKGROUND: Just over 200 years ago, surgeons were puzzled that the use of the tourniquet to control hemorrhage as common sense during surgery was a relatively recent development. Within the last 20 years, much progress has been made to controlling hemorrhage in the prehospital context. Then, as now, it was surprising that progress on something that appeared obvious had occurred only recently, begging the question how controlling blood loss was common sense in a surgical context, but not for emergency treatment...
February 27, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29474326/transport-time-and-preoperating-room-hemostatic-interventions-are-important-improving-outcomes-after-severe-truncal-injury
#7
John B Holcomb
OBJECTIVES: Experience in the ongoing wars in Iraq and Afghanistan confirm that faster transport combined with effective prehospital interventions improves the outcomes of patients suffering hemorrhagic shock. Outcomes of patients with hemorrhagic shock and extremity bleeding have improved with widespread use of tourniquets and early balanced transfusion therapy. Conversely, civilian patients suffering truncal bleeding and shock have the same mortality (46%) over the last 20 years. To understand how to decrease this substantial mortality, one must first critically evaluate all phases of care from point of injury to definitive hemorrhage control in the operating room...
March 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29470190/blood-transfusion-management-in-the-severely-bleeding-military-patient
#8
Jennifer M Gurney, Philip C Spinella
PURPOSE OF REVIEW: Hemorrhage remains the primary cause of preventable death on the battlefield and in civilian trauma. Hemorrhage control is multifactorial and starts with point-of-injury care. Surgical hemorrhage control and time from injury to surgery is paramount; however, interventions in the prehospital environment and perioperative period affect outcomes. The purpose of this review is to understand concepts and strategies for successful management of the bleeding military patient...
April 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29421001/thrombus-aspiration-and-prehospital-ticagrelor-administration-in-st-elevation-myocardial-infarction-findings-from-the-atlantic-trial
#9
Sinem Kilic, Enrico Fabris, Arnoud W J Van't Hof, Christian W Hamm, Frédéric Lapostolle, Jens Flensted Lassen, Anne Tsatsaris, Abdourahmane Diallo, Eric Vicaut, Gilles Montalescot
BACKGROUND: The potential interactions between prehospital (pre-H) ticagrelor administration and thrombus aspiration (TA) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) have never been studied. Therefore, we evaluated the potential benefit of TA and pre-H ticagrelor treatment in patients enrolled in the ATLANTIC trial (NCT01347580). METHODS: This analysis included 1,630 patients who underwent primary PCI...
February 2018: American Heart Journal
https://www.readbyqxmd.com/read/29415812/prediction-of-massive-bleeding-in-a-prehospital-setting-validation-of-six-scoring-systems
#10
L J Terceros-Almanza, C García-Fuentes, S Bermejo-Aznárez, I J Prieto Del Portillo, C Mudarra-Reche, H Domínguez-Aguado, R Viejo-Moreno, J Barea-Mendoza, R Gómez-Soler, I Casado-Flores, M Chico-Fernández
OBJECTIVE: To validate the diagnostic ability of six different scores to predict massive bleeding in a prehospital setting. DESIGN: Retrospective cohort. SETTING: Prehospital attention of patients with severe trauma. SUBJECTS: Subjects with more than 15 years, a history of severe trauma (defined by code 15 criteria), that were initially assisted in a prehospital setting by the emergency services between January 2010 and December 2015 and were then transferred to a level one trauma center in Madrid...
February 4, 2018: Medicina Intensiva
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
#11
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/29289392/abnormalities-of-laboratory-coagulation-tests-versus-clinically-evident-coagulopathic-bleeding-results-from-the-prehospital-resuscitation-on-helicopters-study-prohs
#12
Ronald Chang, Erin E Fox, Thomas J Greene, Michael D Swartz, Stacia M DeSantis, Deborah M Stein, Eileen M Bulger, Sherry M Melton, Michael D Goodman, Martin A Schreiber, Martin D Zielinski, Terence O'Keeffe, Kenji Inaba, Jeffrey S Tomasek, Jeanette M Podbielski, Savitri Appana, Misung Yi, Pär I Johansson, Hanne H Henriksen, Jakob Stensballe, Jacob Steinmetz, Charles E Wade, John B Holcomb
BACKGROUND: Laboratory-based evidence of coagulopathy (LC) is observed in 25-35% of trauma patients, but clinically-evident coagulopathy (CC) is not well described. METHODS: Prospective observational study of adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers in 2015. Patients meeting predefined highest-risk criteria were divided into CC+ (predefined as surgeon-confirmed bleeding from uninjured sites or injured sites not controllable by sutures) or CC-...
April 2018: Surgery
https://www.readbyqxmd.com/read/29287058/activities-of-the-thor-aabb-working-party
#13
Mark H Yazer, Philip C Spinella
The AABB (formerly the American Association of Blood Banks) is an international authority on transfusion medicine and tissue banking. The Trauma, Hemostasis and Oxygenation Research (THOR) Network is an international multidisciplinary network of civilian and military providers ranging from first responders and medics to critical care physicians, and from basic scientists to clinical trialists. The THOR Network's vision is to improve outcomes from traumatic hemorrhagic shock by optimizing the acute phase of resuscitation...
December 28, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29225903/early-clinical-outcomes-as-a-function-of-use-of-newer-oral-p2y-12-inhibitors-versus-clopidogrel-in-the-euromax-trial
#14
Kurt Huber, Gregory Ducrocq, Christian W Hamm, Arnoud van 't Hof, Frédéric Lapostolle, Pierre Coste, Giovanni Gordini, Jacob Steinmetz, Freek W A Verheugt, Jennifer Adgey, Lutz Nibbe, Vojko Kaniĉ, Peter Clemmensen, Uwe Zeymer, Debra Bernstein, Jayne Prats, Efthymios N Deliargyris, Ph Gabriel Steg
Objective: To ascertain whether different oral P2Y12 inhibitors might affect rates of acute stent thrombosis and 30-day outcomes after primary percutaneous coronary intervention (pPCI). Methods: The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) randomised trial compared prehospital bivalirudin with heparin with optional glycoprotein IIb/IIIa inhibitor treatment in patients with ST-segment elevation myocardial infarction triaged to pPCI. Choice of P2Y12 inhibitor was at the investigator's discretion...
2017: Open Heart
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
#15
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/29130951/prehospital-computed-tomography-angiography-in-acute-stroke-management
#16
Michael Kettner, Stefan Alexander Helwig, Andreas Ragoschke-Schumm, Lenka Schwindling, Safwan Roumia, Isabel Keller, Daniel Martens, Johann Kulikovski, Matthias Manitz, Martin Lesmeister, Silke Walter, Iris Quasar Grunwald, Thomas Schlechtriemen, Wolfgang Reith, Klaus Fassbender
BACKGROUND: An ambulance equipped with a computed tomography (CT) scanner, a point-of-care laboratory, and telemedicine capabilities (mobile stroke unit [MSU]) has been shown to enable the delivery of thrombolysis to stroke patients directly at the emergency site, thereby significantly decreasing time to treatment. However, work-up in an MSU that includes CT angiography (CTA) may also potentially facilitate triage of patients directly to the appropriate target hospital and specialized treatment, according to their individual vascular pathology...
2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29127102/algorithms-to-guide-ambulance-clinicians-in-the-management-of-emergencies-in-patients-with-implanted-rotary-left-ventricular-assist-devices
#17
REVIEW
Christopher T Bowles, Rachel Hards, Neil Wrightson, Paul Lincoln, Shishir Kore, Laura Marley, Jonathan R Dalzell, Binu Raj, Tracey A Baker, Diane Goodwin, Petra Carroll, Jane Pateman, John J M Black, Paul Kattenhorn, Mark Faulkner, Jayan Parameshwar, Charles Butcher, Mark Mason, Alexander Rosenberg, Ian McGovern, Alexander Weymann, Carl Gwinnutt, Nicholas R Banner, Stephan Schueler, Andre R Simon, David W Pitcher
Advances in left ventricular assist device (LVAD) therapy have resulted in increasing numbers of adult LVAD recipients in the community. However, device failure, stroke, bleeding, LVAD thrombosis and systemic infection can be life-threatening emergencies. Currently, four LVAD systems are implanted in six UK transplant centres, each of which provides device-specific information to local emergency services. This has resulted in inconsistent availability and content of information with the risks of delayed or inappropriate decision-making...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29122112/prehospital-transfusion-for-gastrointestinal-bleeding
#18
Maile E Parker, Mohammad A Khasawneh, Cornelius A Thiels, Kathleen S Berns, James R Stubbs, Donald H Jenkins, Scott P Zietlow, Martin D Zielinski
OBJECTIVE: Gastrointestinal (GI) bleeding is a common medical emergency with significant morbidity and mortality. Many patients are coagulopathic, which may perpetuate bleeding. Remote damage control resuscitation, including early correction of coagulopathy and anemia, may benefit exsanguinating patients with GI bleeding. METHODS: We conducted a retrospective review of patients with acute GI bleeding who received packed red blood cells (pRBC) and/or plasma during transportation to our institution between 2010 and 2014...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29121893/association-of-pelvic-fracture-patterns-pelvic-binder-use-and-arterial-angio-embolization-with-transfusion-requirements-and-mortality-rates-a-7-year-retrospective-cohort-study
#19
Fabio Agri, Mylène Bourgeat, Fabio Becce, Kevin Moerenhout, Mathieu Pasquier, Olivier Borens, Bertrand Yersin, Nicolas Demartines, Tobias Zingg
BACKGROUND: Pelvic fractures are severe injuries with frequently associated multi-system trauma and a high mortality rate. The value of the pelvic fracture pattern for predicting transfusion requirements and mortality is not entirely clear. To address hemorrhage from pelvic injuries, the early application of pelvic binders is now recommended and arterial angio-embolization is widely used for controlling arterial bleeding. Our aim was to assess the association of the pelvic fracture pattern according to the Tile classification system with transfusion requirements and mortality rates, and to evaluate the correlation between the use of pelvic binders and arterial angio-embolization and the mortality of patients with pelvic fractures...
November 9, 2017: BMC Surgery
https://www.readbyqxmd.com/read/29026927/diagnostics-and-early-treatment-in-prehospital-and-emergency-room-phase-in-suspicious-pelvic-ring-fractures
#20
Uwe Schweigkofler, B Wohlrath, H Trentsch, J Greipel, N Tamimi, R Hoffmann, D Wincheringer
BACKGROUND: Testing for mechanical stability in pelvic ring fractures is advocated for the initial assessment and management of pelvic ring fractures. A survey among trauma surgeons showed that 91% agree with this recommendation. The aim of the present study was to describe the actual workup of patients with a high risk for unstable pelvic fractures in daily routine. METHODS: We performed a prospective multicenter observational study on patients admitted to the emergency room with suspected pelvic ring fractures...
October 12, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
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