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https://www.readbyqxmd.com/read/29796145/risk-factors-for-ventilator-associated-pneumonia-in-trauma-patients-a-descriptive-analysis
#1
Suresh Kumar Arumugam, Insolvisagan Mudali, Gustav Strandvik, Ayman El-Menyar, Ammar Al-Hassani, Hassan Al-Thani
BACKGROUND: We sought to evaluate the risk factors for developing ventilator-associated pneumonia (VAP) and whether the location of intubation posed a risk in trauma patients. METHODS: Data were retrospectively reviewed for adult trauma patients requiring intubation for > 48 hours, admitted between 2010 and 2013. Patients' demographics, clinical presentations and outcomes were compared according to intubation location (prehospital intubation [PHI] vs. trauma room [TRI]) and presence vs...
2018: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29787544/a-clinical-prediction-model-for-raised-intracranial-pressure-in-patients-with-traumatic-brain-injuries
#2
J Pace, N Parry, K Vogt, R Hilsden, R Leeper, Z Markova, F Priestap, J Younan, I M Ball
BACKGROUND: Intracranial hypertension is believed to contribute to secondary brain insult in traumatically brain injured patients. Currently the diagnosis of intracranial hypertension requires intracranial monitoring or advanced imaging. Unfortunately, prehospital transport times can be prolonged, delaying time to the initial radiographic assessment. The aim of this study was to identify clinical variables associated with raised intracranial pressure (ICP) prior to the completion of neuroimaging...
April 30, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29693490/fatal-wounding-pattern-and-causes-of-potentially-preventable-death-following-the-pulse-night-club-shooting-event
#3
E Reed Smith, Geoff Shapiro, Babak Sarani
BACKGROUND: Mortality following shooting is related to time to provision of initial and definitive care. An understanding of the wounding pattern, opportunities for rescue, and incidence of possibly preventable death is needed to achieve the goal of zero preventable deaths following trauma. METHODS: A retrospective study of autopsy reports for all victims involved in the Pulse Nightclub Shooting was performed. The site of injury, probable site of fatal injury, and presence of potentially survivable injury (defined as survival if prehospital care is provided within 10 minutes and trauma center care within 60 minutes of injury) was determined independently by each author...
April 25, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29692881/quantitative-approach-based-on-wearable-inertial-sensors-to-assess-and-identify-motion-and-errors-in-techniques-used-during-training-of-transfers-of-simulated-c-spine-injured-patients
#4
Karina Lebel, Vanessa Chenel, John Boulay, Patrick Boissy
Patients with suspected spinal cord injuries undergo numerous transfers throughout treatment and care. Effective c-spine stabilization is crucial to minimize the impacts of the suspected injury. Healthcare professionals are trained to perform those transfers using simulation; however, the feedback on the manoeuvre is subjective. This paper proposes a quantitative approach to measure the efficacy of the c-spine stabilization and provide objective feedback during training. Methods . 3D wearable motion sensors are positioned on a simulated patient to capture the motion of the head and trunk during a training scenario...
2018: Journal of Healthcare Engineering
https://www.readbyqxmd.com/read/29596006/accuracy-of-prehospital-identification-of-stroke-in-a-large-stroke-belt-municipality
#5
Nee-Kofi Mould-Millman, Halea Meese, Ibthial Alattas, Moges Ido, Iasson Yi, Tolulope Oyewumi, Michael Colman, Michael Frankel, Arthur Yancey
OBJECTIVE: Strokes are a leading cause of morbidity and mortality in the United States, especially in the "stroke belt" of the southeast. Up to 65% of stroke patients access care by calling 9-1-1. The primary objective of this study is to measure the accuracy of emergency medical dispatchers (EMD) and paramedics, in the prehospital identification of stroke. METHODS: The study was based at Grady Emergency Medical Services, which is Atlanta, Georgia's public emergency medical services (EMS) provider...
March 29, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29573111/a-tale-of-two-cities-prehospital-intubation-with-or-without-paralysing-agents-for-traumatic-brain-injury
#6
Cino Bendinelli, Dominic Ku, Shane Nebauer, Kate L King, Teresa Howard, Russel Gruen, Tiffany Evans, Mark Fitzgerald, Zsolt J Balogh
BACKGROUND: The role of prehospital endotracheal intubation (PETI) for traumatic brain injury is unclear. In Victoria, paramedics use rapid sequence induction (RSI) drugs to facilitate PETI, while in New South Wales (NSW) they do not have access to paralysing agents. We hypothesized that RSI would both increase PETI rates and improve mortality. METHODS: Retrospective comparison of adult primary admissions (Glasgow Coma Scale <9 and abbreviated injury scale head and neck >2) to either Victorian or NSW trauma centre, which were compared with univariate and logistic regression analysis to estimate odds ratio for mortality and intensive care unit (ICU) length of stay...
May 2018: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29541826/anatomic-location-and-mechanism-of-injury-correlating-with-prehospital-deaths-in-sub-saharan-africa
#7
T D Reid, P D Strassle, J Gallaher, J Grudziak, C Mabedi, A G Charles
INTRODUCTION: Trauma is a large contributor to morbidity and mortality in developing countries. We sought to determine which anatomic injury locations and mechanisms of injury predispose to prehospital mortality in Malawi to help target preventive and therapeutic interventions. We hypothesized that head injury would result in the highest prehospital mortality. METHODS: This was a retrospective analysis of all trauma patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, from 2008 to 2015...
March 14, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29476943/evolution-and-organisation-of-trauma-systems
#8
Jean Stéphane David, Pierre Bouzat, Mathieu Raux
Over the last 20 years, numerous studies have fairly consistently reported an improvement in the prognosis of patients with severe trauma after the establishment of a trauma network. These systems can be either exclusive, in which all patients are referred only to a small number of specifically designated centres that meet strict criteria, or inclusive, in which patients may be referred to any hospital of a particular area according to capacity, which is observed in France. Hospitals are classified (level 1 to level 3) according to their technical facilities and the number of patients admitted for severe trauma, knowing that studies have also shown an improvement of the outcome for the most severely injured patients (haemorrhagic shock, severe head trauma), in hospitals with the greatest technical facilities and the most important activity...
February 21, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29476389/age-and-mortality-in-pediatric-severe-traumatic-brain-injury-results-from-an-international-study
#9
Ajit Sarnaik, Nikki Miller Ferguson, A M Iqbal O'Meara, Shruti Agrawal, Akash Deep, Sandra Buttram, Michael J Bell, Stephen R Wisniewski, James F Luther, Adam L Hartman, Monica S Vavilala
BACKGROUND: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study. METHODS: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score ≤ 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy)...
February 23, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29450470/incidence-of-delayed-intracranial-hemorrhage-in-older-patients-after-blunt-head-trauma
#10
James A Chenoweth, Samuel D Gaona, Mark Faul, James F Holmes, Daniel K Nishijima
Importance: Current guidelines conflict on the management of older adults who have blunt head trauma taking anticoagulant and antiplatelet medications. This is partially due to the limited data comparing patients who are taking these medications with those who are not. Objective: To investigate the incidence of delayed traumatic intracranial hemorrhage in older adults with head trauma, including those taking anticoagulant and antiplatelet medications. Design, Setting, and Participants: This prospective observational cohort study included patients 55 years and older who had blunt head trauma and were transported via emergency medical services between August 1, 2015, and September 30, 2016...
February 14, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29313512/mortality-during-road-traffic-accidents-in-bangui-central-african-republic
#11
B J D Tékpa, H C Diemer, P A Issa Mapouka, V Ndoma Ngatchokpo, B Gassima, M N Nali
The authors examined mortality during road traffic accidents (RTAs) to propose solutions for their prevention. This descriptive prospective study took place over a 12-month period (June 1, 2011, to May 30, 2012) and included all fatalities from RTAs brought to selected hospitals. These RTA fatalities were studied in the morgues and selected sites. An autopsy was conducted for each victim to clarify the cause of death. An injury severity score (ISS) was also calculated for each victim. The data were analyzed with Epi-Info 2008...
November 1, 2017: Médecine et Santé Tropicales
https://www.readbyqxmd.com/read/29303442/blossoming-contusions-identifying-factors-contributing-to-the-expansion-of-traumatic-intracerebral-hemorrhage
#12
Joseph A Carnevale, David J Segar, Andrew Y Powers, Meghal Shah, Cody Doberstein, Benjamin Drapcho, John F Morrison, John R Williams, Scott Collins, Kristina Monteiro, Wael F Asaad
OBJECTIVE Traumatic brain injury (TBI) remains a significant cause of neurological morbidity and mortality. Each year, more than 1.7 million patients present to the emergency department with TBI. The goal of this study was to evaluate the prognosis of traumatic cerebral intraparenchymal hemorrhage (tIPH), to develop subclassifications of these injuries that relate to prognosis, and to provide a more comprehensive assessment of hemorrhagic progression contusion (HPC) by analyzing the rate at which tIPH "blossom" (i...
January 5, 2018: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29297717/cincinnati-prehospital-stroke-scale-can-identify-large-vessel-occlusion-stroke
#13
Christopher T Richards, Ryan Huebinger, Katie L Tataris, Joseph M Weber, Laura Eggers, Eddie Markul, Leslee Stein-Spencer, Kenneth S Pearlman, Jane L Holl, Shyam Prabhakaran
OBJECTIVE: Accurate prehospital identification of patients with acute ischemic stroke (AIS) from large vessel occlusion (LVO) facilitates direct transport to hospitals that perform endovascular thrombectomy. We hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), a simple assessment tool currently used by emergency medical services (EMS) providers, can be used to identify LVO. METHODS: Consecutively enrolled, confirmed AIS patients arriving via EMS between August 2012 and April 2014 at a high-volume stroke center in a large city with a single municipal EMS provider agency were identified in a prospective, single-center registry...
January 3, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29258783/air-versus-ground-transportation-in-isolated-severe-head-trauma-a-national-trauma-data-bank-study
#14
Alberto Aiolfi, Elizabeth Benjamin, Gustavo Recinos, Alejandro De Leon Castro, Kenji Inaba, Demetrios Demetriades
BACKGROUND: The effect of prehospital helicopter emergency medical services (HEMS) on mortality has been analyzed previously in polytrauma patients with discordant results. OBJECTIVE: Our aim was to compare outcomes in patients with isolated severe blunt traumatic brain injuries (TBIs) transported by HEMS or ground emergency medical services (GEMS). METHODS: We conducted a National Trauma Data Bank study (2007-2014). All adult patients (≥16 years old) who sustained an isolated severe blunt TBI and were transported by HEMS or GEMS were included in the study...
March 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29191378/patients-with-head-trauma-a-study-on-initial-prehospital-assessment-and-care
#15
Rebecka Rubenson Wahlin, Veronica Lindström, Sari Ponzer, Veronica Vicente
BACKGROUND: Best evidence guidelines are intended to standardise assessment and treatment of patients with head trauma and improve outcomes for TBI patients. The primary aim was to explore pre-hospital emergency care nurses' (PECNs') documented assessment and care of patients with head trauma and the secondary aim to study gender differences in the documented care and interventions given by the PECNs. METHODS: A retrospective observational study was conducted by evaluating 2750 prehospital medical records...
January 2018: International Emergency Nursing
https://www.readbyqxmd.com/read/29180189/impact-of-triage-guidelines-on-prehospital-triage-comparison-of-guidelines-with-a-statistical-model
#16
COMPARATIVE STUDY
Priti P Parikh, Pratik Parikh, Bradley Guthrie, Logan Mamer, Melissa Whitmill, Timothy Erskine, Randy Woods, Jonathan Saxe
BACKGROUND: The American College of Surgeons developed the National Field Triage Decision Scheme (NFTDS) that has been adapted by many trauma centers in the nation, but quantitative evidence of its efficacy is unclear. We compare the NFTDS and state of Ohio guidelines to the "observed" rates and with rates derived using a statistical model. METHODS: We used 4757 trauma records from 2008-2012 available from the state and calculated undertriage (UT) and overtriage (OT) rates...
December 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29117058/the-effect-of-time-to-international-normalized-ratio-reversal-on-intracranial-hemorrhage-evolution-in-patients-with-traumatic-brain-injury
#17
Hans Andrews, Katelyn Rittenhouse, Brian Gross, Frederick B Rogers
The incidence of geriatric traumatic brain injury (TBI) is increasing throughout the United States, with many of these patients taking anticoagulation (AC) medication. The purpose of this investigation was to determine the effect of time to international normalized ratio (INR) reversal on intracranial hemorrhage evolution in TBI patients taking prehospital AC medication. We hypothesized that rapid reversal of INR improves outcomes of head-injured patients taking AC medication. Admissions to a Level II trauma center between February 2011 and December 2013 were reviewed...
November 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/29109872/severe-decompression-illness-case-report-prehospital-recognition-and-regional-transport-considerations
#18
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
https://www.readbyqxmd.com/read/29096887/definitive-airway-management-after-prehospital-supraglottic-rescue-airway-in-pediatric-trauma
#19
Matthew C Hernandez, Ryan M Antiel, Karthik Balakrishnan, Martin D Zielinski, Denise B Klinkner
INTRODUCTION: Supraglottic airway (SGA) use and outcomes in pediatric trauma are poorly understood. We compared outcomes between patients receiving prehospital SGA versus bag mask ventilation (BVM). METHODS: We reviewed pediatric multisystem trauma patients (2005-2016), comparing SGA and BVM. Primary outcome was adequacy of oxygenation and ventilation. Additional measures included tracheostomy, mortality and abbreviated injury scores (AIS). RESULTS: Ninety patients were included (SGA, n=17 and BVM, n=73)...
February 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29067429/association-of-prehospital-blood-product-transfusion-during-medical-evacuation-of-combat-casualties-in-afghanistan-with-acute-and-30-day-survival
#20
Stacy A Shackelford, Deborah J Del Junco, Nicole Powell-Dunford, Edward L Mazuchowski, Jeffrey T Howard, Russ S Kotwal, Jennifer Gurney, Frank K Butler, Kirby Gross, Zsolt T Stockinger
Importance: Prehospital blood product transfusion in trauma care remains controversial due to poor-quality evidence and cost. Sequential expansion of blood transfusion capability after 2012 to deployed military medical evacuation (MEDEVAC) units enabled a concurrent cohort study to focus on the timing as well as the location of the initial transfusion. Objective: To examine the association of prehospital transfusion and time to initial transfusion with injury survival...
October 24, 2017: JAMA: the Journal of the American Medical Association
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