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https://www.readbyqxmd.com/read/27918869/paramedic-initiated-cms-sepsis-core-measure-bundle-prior-to-hospital-arrival-a-stepwise-approach
#1
Jason G Walchok, Ronald G Pirrallo, Douglas Furmanek, Martin Lutz, Colt Shope, Brandi Giles, Greta Gue, Aaron Dix
BACKGROUND: To improve patient outcomes, the Center for Medicare and Medicaid Services (CMS) implemented core measures that outline the initial treatment of the septic patient. These measures include initial blood culture collection prior to antibiotics, adequate intravenous fluid resuscitation, and early administration of broad spectrum antibiotics. We sought to determine if Paramedics can initiate the CMS sepsis core measure bundle in the prehospital field reliably. METHODS: This is a retrospective, case series from a 3rd service EMS system model in Greenville, South Carolina between November 17, 2014 and February 20, 2016...
December 5, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27918639/evaluation-of-an-outpatient-protocol-in-the-treatment-of-canine-parvoviral-enteritis
#2
Emilee C Venn, Karolina Preisner, Pedro L Boscan, David C Twedt, Lauren A Sullivan
OBJECTIVE: To compare 2 treatment protocols (standard in-hospital versus modified outpatient) in affecting the duration of treatment or survival of dogs with parvoviral enteritis. DESIGN: Prospective, randomized study. SETTING: University teaching hospital. ANIMALS: Client-owned dogs with naturally acquired parvovirus were randomized to receive either an inpatient (n = 20) or outpatient (n = 20) treatment protocol. INTERVENTIONS: Both groups received intravenous (IV) fluid resuscitation and correction of hypoglycemia at hospital admission...
December 5, 2016: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/27887010/technical-note-rapid-large-volume-resuscitation-at-resuscitative-thoracotomy-by-intra-cardiac-catheterization
#3
Shamir O Cawich, Vijay Naraynsingh
An emergency thoracotomy may be life-saving by achieving four goals: (i) releasing cardiac tamponade, (ii) controlling haemorrhage, (iii) allowing access for internal cardiac massage and (iv) clamping the descending aorta to isolate circulation to the upper torso in damage control surgery. We theorize that a new goal should be achieving rapid, large-volume fluid resuscitation and we describe a technique to achieve this.
November 24, 2016: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/27857652/evaluation-of-who-oral-rehydration-solution-ors-and-salt-tablets-in-resuscitating-adult-patients-with-burns-covering-more-than-15-of-total-body-surface-area-tbsa
#4
A M Moghazy, O A Adly, M A Elbadawy, R E Hashem
Intra-venous (IV) burn resuscitation is effective; nevertheless it has its disadvantages. WHO Oral Rehydration Solution (ORS) has shown high effectiveness in treating dehydration. WHO-ORS, with salt supplement, seems to be suitable for burn resuscitation, where IV resuscitation is not available, feasible or possible. The objective of the study was to evaluate acute phase efficacy and safety, as well as limitations and complications of burn resuscitation using WHO-ORS and salt tablets. This randomized controlled clinical trial was conducted in the Burn Unit, Suez Canal University Hospital, Ismailia, Egypt...
March 31, 2016: Annals of Burns and Fire Disasters
https://www.readbyqxmd.com/read/27854071/staged-laparotomies-based-on-the-damage-control-principle-to-treat-hemodynamically-unstable-grade-iv-blunt-hepatic-injury-in-an-eight-year-old-girl
#5
Takashi Kobayashi, Masayuki Kubota, Yuhki Arai, Toshiyuki Ohyama, Naoki Yokota, Kohei Miura, Hirosuke Ishikawa, Daiki Soma, Kazuyasu Takizawa, Jun Sakata, Masayuki Nagahashi, Hitoshi Kameyama, Toshifumi Wakai
BACKGROUND: Severe blunt hepatic injury is a major cause of morbidity and mortality in pediatric patients. Damage control (DC) surgery has been reported to be useful in severely compromised children with hepatic injury. We applied such a technique in the treatment of a case of hemodynamically unstable grade IV blunt hepatic injury in an eight-year-old girl. This case is the first to use multimodal approaches including perihepatic packing, temporary closure of the abdominal wall with a plastic sheet, transarterial embolization (TAE), and planned delayed anatomical hepatic resection in a child...
December 2016: Surgical Case Reports
https://www.readbyqxmd.com/read/27849481/brief-report-systemic-vascular-access-and-resuscitation-via-corpus-cavernosum
#6
Melville Bradley
BACKGROUND: Pre-hospital systemic vascular access with early resuscitation in the hypovolemic trauma patient can be problematic and is attempted through venous cut-downs, peripheral IV lines, and/or interosseous routes. This brief report examines an alternative for males via the corpus cavernosum (CC). METHODS: A systematic literature review using certain inclusion criteria including, but not limited to, corpus cavernosum access and resuscitation was conducted and a summary table created...
November 2016: Military Medicine
https://www.readbyqxmd.com/read/27799257/defibrillators-selecting-the-right-device-for-the-right-patient
#7
Sana M Al-Khatib, Paul Friedman, Kenneth A Ellenbogen
Advances in the field of defibrillation have brought to practice different types of devices that include the transvenous implantable cardioverter-defibrillator (ICD) with or without cardiac resynchronization therapy, the subcutaneous ICD (S-ICD), and the wearable cardioverter-defibrillator. To ensure optimal use of these devices and to achieve best patient outcomes, clinicians need to understand how these devices work, learn the characteristics of patients who qualify them for one type of device versus another, and recognize the remaining gaps in knowledge surrounding these devices...
November 1, 2016: Circulation
https://www.readbyqxmd.com/read/27787442/temporary-abdominal-closure-for-trauma-and-intra-abdominal-sepsis-different-patients-different-outcomes
#8
Tyler J Loftus, Janeen R Jordan, Chasen A Croft, R Stephen Smith, Philip A Efron, Alicia M Mohr, Frederick A Moore, Scott C Brakenridge
BACKGROUND: Temporary abdominal closure (TAC) following damage control surgery (DCS) for injured patients has been generalized to septic patients. However, direct comparisons between these populations are lacking. We hypothesized that patients with intra-abdominal sepsis would have different resuscitation requirements and lower primary fascial closure rates than trauma patients. STUDY DESIGN: We performed a three year retrospective cohort analysis of patients managed with TAC for trauma (n=77) or intra-abdominal sepsis (n=147)...
October 25, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27787439/damage-control-surgery-in-weightlessness-a-comparative-study-of-simulated-torso-hemorrhage-control-comparing-terrestrical-and-weightless-conditions
#9
Andrew W Kirkpatrick, Jessica Lynn McKee, Homer Tien, Anthony J LaPorta, Kit Lavell, Tim Leslie, David R King, Paul B McBeth, Susan Brien, Derek J Roberts, Reginald Franciose, Jonathan Wong, Vivian McAlistatair, Danielle Bouchard, Chad G Ball
INTRODUCTION: Torso bleeding remains the most preventable cause of post-traumatic death worldwide. Remote Damage Control Resuscitation (RDCR) endeavours to rescue the most catastrophically injured, but has not focused on pre-hospital surgical torso haemorrhage control (HC). We examined the logistics and metrics of intra-peritoneal packing in weightlessness in Parabolic flight (0g) compared to terrestrial gravity (1g) as an extreme example of surgical RDCR. METHODS: A surgical simulator was customized with high-fidelity intra-peritoneal anatomy, a "blood" pump and flow-meter...
October 25, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27777292/temporal-trends-in-predictors-of-early-and-late-mortality-after-emergency-coronary-artery-bypass-grafting-for-cardiogenic-shock-complicating-acute-myocardial-infarction
#10
Piroze M Davierwala, Sergey Leontyev, Alexander Verevkin, Ardawan J Rastan, Matthias Mohr, Farhad Bakhtiary, Martin Misfeld, Friedrich W Mohr
BACKGROUND: Cardiogenic shock after acute myocardial infarction is an indication for emergent coronary artery bypass grafting in patients not amenable to percutaneous coronary intervention. Our study aimed to evaluate and identify risk factors for early and long-term outcomes in such patients. METHODS: A total of 508 patients who underwent coronary artery bypass grafting for cardiogenic shock complicating acute myocardial infarction between January 2000 and June 2014 were divided into 3 time cohorts: 2000 to 2004 (n=204), 2005 to 2009 (n=166), and 2010 to 2014 (n=138)...
October 25, 2016: Circulation
https://www.readbyqxmd.com/read/27768662/predicting-the-proportion-of-full-thickness-involvement-for-any-given-burn-size-based-on-burn-resuscitation-volumes
#11
Nehemiah T Liu, José Salinas, Craig A Fenrich, Maria L Serio-Melvin, George C Kramer, Ian R Driscoll, Martin A Schreiber, Leopoldo C Cancio, Kevin K Chung
INTRODUCTION: The depth of burn has been an important factor often overlooked when estimating the total resuscitation fluid needed for early burn care. The goal of this study was to determine the degree to which full-thickness (FT) involvement affected overall 24-hour burn resuscitation volumes. METHODS: We performed a retrospective review of patients admitted to our burn intensive care unit from December 2007 to April 2013, with significant burns that required resuscitation using our computerized decision support system for burn fluid resuscitation...
November 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27692663/decisions-by-default-incomplete-and-contradictory-molst-in-emergency-care
#12
Brian Clemency, Colleen Clemency Cordes, Heather A Lindstrom, Jeanne M Basior, Deborah P Waldrop
OBJECTIVES: What patients intend when they make health care choices and whether they understand the meaning of orders for life-sustaining treatment forms is not well understood. The purpose of this study was to analyze the directives from a sample of emergency department (ED) patients' MOLST forms. PROCEDURES: MOLST forms that accompanied 100 patients who were transported to an ED were collected and their contents analyzed. Data categories included age, gender, if the patient completed the form for themselves, medical orders for life-sustaining treatment including intubation, ventilation, artificial nutrition, artificial fluids or other treatment, and wishes for future hospitalization or transfer...
September 27, 2016: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/27671425/health-providers-perception-of-quality-of-care-for-neonates-in-health-facilities-in-a-municipality-in-southern-ghana
#13
Kokui Elikplim Pomevor, Augustine Adomah-Afari
Purpose The purpose of this paper is to assess available human resources for neonatal care and their skills, in order to explore health providers' perceptions of quality of neonatal care in health facilities in Ghana. Design/methodology/approach Data were gathered using qualitative interviews with health providers working in the maternity and paediatric wards and midwives; direct observation; and documentary review at a regional hospital, a municipal hospital and four health centres in a municipality in a region in Southern Ghana...
October 10, 2016: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/27648771/prehospital-point-of-care-lactate-following-trauma-a-systematic-review
#14
Christopher T Lewis, David N Naumann, Nick Crombie, Mark J Midwinter
BACKGROUND: Serum lactate serves as a surrogate marker for global tissue hypoxia following traumatic injury and has potential to guide resuscitation. Portable, handheld point-of-care monitoring devices enable lactate values to be readily available in the prehospital environment. The current review examines the utility of prehospital lactate (pLa) measurement in the management of trauma. METHODS: MEDLINE and EMBASE databases were searched using predefined criteria (pLa measurement, trauma patients) until March 10, 2016...
October 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27615346/triad-of-death-the-importance-of-temperature-monitoring-in-trauma-patients
#15
Matthew Keane
Multiple organ failure is a significant complication in traumatic injury, and can be exacerbated by a failure to adequately monitor and control trauma patients' core body temperature in emergency departments (EDs). Nearly half of trauma patients are hypothermic on arrival at emergency departments, often due to factors beyond the control of emergency service responders and during on-scene resuscitation attempts. This article examines the physiology of the 'triad of death' -hypothermia, metabolic acidosis and coagulopathy - to highlight the importance of monitoring and maintaining normothermia, or normal body temperature, which is between 36°C and 37...
September 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/27602909/cytochrome-c-limits-oxidative-stress-and-decreases-acidosis-in-a-rat-model-of-hemorrhagic-shock-and-reperfusion-injury
#16
Rebecca D Powell, Donna A Goodenow, Hannah V Mixer, Iain H Mckillop, Susan L Evans
BACKGROUND: Hemorrhagic shock and reperfusion (HSR) injury leads to a cascade of reactive oxygen species (ROS) production and mitochondrial dysfunction, which results in energy failure, cell death and multiple organ dysfunction. Cytochrome c (cyt c) is the final electron carrier in the mitochondrial electron transport chain providing the electrochemical force for ATP production. We sought to determine whether exogenous cyt c administration would improve parameters of organ dysfunction and/or mitochondrial stability in a rat model of HSR...
September 3, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27600127/burn-resuscitation-in-the-austere-environment
#17
REVIEW
Michael Peck, James Jeng, Amr Moghazy
Intravenous (IV) cannulation and sterile IV salt solutions may not be options in resource-limited settings (RLSs). This article presents recipes for fluid resuscitation in the aftermath of burns occurring in RLSs. Burns of 20% total body surface area (TBSA) can be resuscitated, and burns up to 40% TBSA can most likely be resuscitated, using oral resuscitation solutions (ORSs) with salt supplementation. Without IV therapy, fluid resuscitation for larger burns may only be possible with ORSs. Published global experience is limited, and the magnitude of burn injuries that successfully respond to World Health Organization ORSs is not well-described...
October 2016: Critical Care Clinics
https://www.readbyqxmd.com/read/27592156/effects-of-epinephrine-on-cerebral-oxygenation-during-cardiopulmonary-resuscitation-a-prospective-cohort-study
#18
Charles D Deakin, Jie Yang, Robert Nguyen, Jiawen Zhu, Stephen J Brett, Jerry P Nolan, Gavin D Perkins, David G Pogson, Sam Parnia
BACKGROUND: Epinephrine has been presumed to improve cerebral oxygen delivery during cardiopulmonary resuscitation (CPR), but animal and registry studies suggest that epinephrine-induced capillary vasoconstriction may decrease cerebral capillary blood flow and worsen neurological outcome. The effect of epinephrine on cerebral oxygenation (rSO2) during CPR has not been documented in the clinical setting. METHODS: rSO2 was measured continuously using cerebral oximetry in patients with in-hospital cardiac arrest...
December 2016: Resuscitation
https://www.readbyqxmd.com/read/27578311/successful-management-of-intraoperative-acute-bilateral-pulmonary-embolism-in-a-high-grade-astrocytoma-patient
#19
Wail N Khraise, Mohammed Z Allouh, Mohammad Y Hiasat, Raed S Said
BACKGROUND Intraoperative pulmonary embolism (PE) is a rare life-threatening complication in patients undergoing surgical intervention. Generally, cancer patients have a higher risk for developing this complication. Unfortunately, there is no standard procedure for its management. CASE REPORT We report the case of a 39-year-old woman with high-grade glioma in the right frontal lobe who was admitted to the surgical theater for craniotomy and excision of the tumor. During the general anesthesia procedure and just before inserting the central venous line, her end-tidal CO2 and O2 saturation dropped sharply...
2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27561701/analyzing-video-recorded-support-of-postnatal-transition-in-preterm-infants-following-a-c-section
#20
Dimitrios Konstantelos, Jürgen Dinger, Sascha Ifflaender, Mario Rüdiger
BACKGROUND: Over the past years, research on neonatal resuscitation has focused on single interventions. The present study was performed to analyze the process quality of delivery room management of preterm infants born by c-section in our institution. METHODS: We performed a cross-sectional study of videos of preterm infants born by c-section. Videos were analyzed according to time point, duration and number of performed medical interventions. The study period occurred between January 2012 and December 2013...
2016: BMC Pregnancy and Childbirth
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