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Prehospital and CCT

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120 papers 1000+ followers Articles relevant to prehospital care and critical care transport.
By Brian Gacioch EM intern starting 2014; 12 years 911, CCT, and flight paramedic; interest areas critical care medicine, airway, point of care ultrasound, medical education.
https://www.readbyqxmd.com/read/25733113/preoxygenation-reduces-desaturation-events-and-improves-intubation-success
#1
Daniel P Davis, Justin Lemieux, John Serra, William Koenig, Steve A Aguilar
OBJECTIVE: Oxygen desaturation occurs frequently in the course of prehospital rapid sequence intubation (RSI) and is associated with increased morbidity and mortality. Preoxygenation with positive pressure ventilation by bag valve mask may delay the onset of desaturation. The purpose of this study was to evaluate implementation of a targeted preoxygenation protocol including the use of positive pressure ventilation on desaturation events and intubation success during air medical RSI. METHODS: The RSI air medical program airway training model was modified to target an oxygen saturation as measured by pulse oximetry value of ≥ 93% before initial laryngoscopy...
March 2015: Air Medical Journal
https://www.readbyqxmd.com/read/25269576/prehospital-noninvasive-ventilation-for-acute-respiratory-failure-systematic-review-network-meta-analysis-and-individual-patient-data-meta-analysis
#2
REVIEW
Steve Goodacre, John W Stevens, Abdullah Pandor, Edith Poku, Shijie Ren, Anna Cantrell, Vincent Bounes, Arantxa Mas, Didier Payen, David Petrie, Markus Soeren Roessler, Gunther Weitz, Laurent Ducros, Patrick Plaisance
OBJECTIVES: This meta-analysis aimed to determine the effectiveness of prehospital continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP) in acute respiratory failure. METHODS: Fourteen electronic databases and research registers were searched from inception to August 2013. Randomized or quasi-randomized controlled trials that reported mortality or intubation rate for prehospital CPAP or BiPAP were selected and compared to a relevant comparator in patients with acute respiratory failure...
September 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25281177/prospective-evaluation-of-prehospital-trauma-ultrasound-during-aeromedical-transport
#3
Gregory M Press, Sara K Miller, Iman A Hassan, Kiyetta H Alade, Elizabeth Camp, Deborah Del Junco, John B Holcomb
BACKGROUND: Ultrasound is widely considered the initial diagnostic imaging modality for trauma. Preliminary studies have explored the use of trauma ultrasound in the prehospital setting, but the accuracy and potential utility is not well understood. OBJECTIVE: We sought to determine the accuracy of trauma ultrasound performed by helicopter emergency medical service (HEMS) providers. METHODS: Trauma ultrasound was performed in flight on adult patients during a 7-month period...
December 2014: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/21107105/prehospital-rapid-sequence-intubation-improves-functional-outcome-for-patients-with-severe-traumatic-brain-injury-a-randomized-controlled-trial
#4
RANDOMIZED CONTROLLED TRIAL
Stephen A Bernard, Vina Nguyen, Peter Cameron, Kevin Masci, Mark Fitzgerald, David J Cooper, Tony Walker, B Paramed Std, Paul Myles, Lynne Murray, David, Taylor, Karen Smith, Ian Patrick, John Edington, Andrew Bacon, Jeffrey V Rosenfeld, Rodney Judson
OBJECTIVE: To determine whether paramedic rapid sequence intubation in patients with severe traumatic brain injury (TBI) improves neurologic outcomes at 6 months compared with intubation in the hospital. BACKGROUND: Severe TBI is associated with a high rate of mortality and long-term morbidity. Comatose patients with TBI routinely undergo endo-tracheal intubation to protect the airway, prevent hypoxia, and control ventilation. In many places, paramedics perform intubation prior to hospital arrival...
December 2010: Annals of Surgery
https://www.readbyqxmd.com/read/25447434/risk-factors-for-unsuccessful-prehospital-laryngeal-tube-placement
#5
Christian Martin-Gill, Heather A Prunty, Seth C Ritter, Jestin N Carlson, Francis X Guyette
INTRODUCTION: Laryngeal tube (LT) airways are commonly used in the prehospital setting, but there are limited data on clinical success rates across emergency medical services (EMS) agencies. We aimed to determine factors associated with unsuccessful LT placement in the prehospital setting. METHODS: We retrospectively reviewed all King LT placement attempts by prehospital providers in 35 ground advanced life support EMS agencies and one air medical critical care service with 17 rotorwing bases, between January 1, 2006 and August 31, 2011...
January 2015: Resuscitation
https://www.readbyqxmd.com/read/25542192/when-to-stop-cpr-and-when-to-perform-rhythm-analysis-potential-confusion-among-acls-providers
#6
Brandon Giberson, Amy Uber, David F Gaieski, Joseph B Miller, Charles Wira, Katherine Berg, Tyler Giberson, Michael N Cocchi, Benjamin S Abella, Michael W Donnino
BACKGROUND: Health care providers nationwide are routinely trained in Advanced Cardiac Life Support (ACLS), an American Heart Association program that teaches cardiac arrest management. Recent changes in the ACLS approach have de-emphasized routine pulse checks in an effort to promote uninterrupted chest compressions. We hypothesized that this new ACLS algorithm may lead to uncertainty regarding the appropriate action following detection of a pulse during a cardiac arrest. METHODS: We conducted an observational study in which a Web-based survey was sent to ACLS-trained medical providers at 4 major urban tertiary care centers in the United States...
September 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/25493111/prehospital-use-of-i-m-ketamine-for-sedation-of-violent-and-agitated-patients
#7
MULTICENTER STUDY
Kenneth A Scheppke, Joao Braghiroli, Mostafa Shalaby, Robert Chait
INTRODUCTION: Violent and agitated patients pose a serious challenge for emergency medical services (EMS) personnel. Rapid control of these patients is paramount to successful prehospital evaluation and also for the safety of both the patient and crew. Sedation is often required for these patients, but the ideal choice of medication is not clear. The objective is to demonstrate that ketamine, given as a single intramuscular injection for violent and agitated patients, including those with suspected excited delirium syndrome (ExDS), is both safe and effective during the prehospital phase of care, and allows for the rapid sedation and control of this difficult patient population...
November 2014: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/25493114/does-pre-hospital-endotracheal-intubation-improve-survival-in-adults-with-non-traumatic-out-of-hospital-cardiac-arrest-a-systematic-review
#8
REVIEW
Ling Tiah, Kentaro Kajino, Omer Alsakaf, Dianne Carrol Tan Bautista, Marcus Eng Hock Ong, Desiree Lie, Ghulam Yasin Naroo, Nausheen Edwin Doctor, Michael Y C Chia, Han Nee Gan
INTRODUCTION: Endotracheal intubation (ETI) is currently considered superior to supraglottic airway devices (SGA) for survival and other outcomes among adults with non-traumatic out-of-hospital cardiac arrest (OHCA). We aimed to determine if the research supports this conclusion by conducting a systematic review. METHODS: We searched the MEDLINE, Scopus and CINAHL databases for studies published between January 1, 1980, and 30 April 30, 2013, which compared pre-hospital use of ETI with SGA for outcomes of return of spontaneous circulation (ROSC); survival to hospital admission; survival to hospital discharge; and favorable neurological or functional status...
November 2014: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/25291522/parenteral-midazolam-is-superior-to-diazepam-for-treatment-of-prehospital-seizures
#9
Brian M Clemency, Jamie A Ott, Christopher T Tanski, Joseph A Bart, Heather A Lindstrom
INTRODUCTION: Diazepam and midazolam are commonly used by paramedics to treat seizures. A period of drug scarcity was used as an opportunity to compare their effectiveness in treating prehospital seizures. METHODS: A retrospective chart review of a single, large, commercial agency during a 29-month period was performed. The period included alternating shortages of both medications. Ambulances were stocked with either diazepam or midazolam based on availability of the drugs...
April 2015: Prehospital Emergency Care
https://www.readbyqxmd.com/read/25350689/risk-factors-for-failed-tracheal-intubation-in-pediatric-and-neonatal-critical-care-specialty-transport
#10
Kristen A Smith, M David Gothard, Hamilton P Schwartz, John S Giuliano, Michael Forbes, Michael T Bigham
Abstract Objective. Nearly 200,000 pediatric and neonatal transports occur in the United States each year with some patients requiring tracheal intubation. First-pass intubation rates in both pediatric and adult transport literature are variable as are the factors that influence intubation success. This study sought to determine risk factors for failed tracheal intubation in neonatal and pediatric transport. Methods. A retrospective chart review was performed over a 2.5-year period. Data were collected from a hospital-based neonatal/pediatric critical care transport team that transports 2,500 patients annually, serving 12,000 square miles...
January 2015: Prehospital Emergency Care
https://www.readbyqxmd.com/read/25420089/u-s-military-use-of-tourniquets-from-2001-to-2010
#11
John F Kragh, Michael A Dubick, James K Aden, Anne L McKeague, Todd E Rasmussen, David G Baer, Lorne H Blackbourne
OBJECTIVE: This study was conducted to associate tourniquet use and survival in casualty care over a decade of war in order to provide evidence to emergency medical personnel for the implementation and efficacy of tourniquet use in a large trauma system. METHODS: This survey is a retrospective review of data extracted from a trauma registry. The decade (2001-2010) outcome trend analysis of tourniquet use in the current wars was made in order to associate tourniquet use and survival in an observational cohort design...
April 2015: Prehospital Emergency Care
https://www.readbyqxmd.com/read/25495011/fat-intravasation-from-intraosseous-flush-and-infusion-procedures
#12
Bernard J Rubal, Belinda L Meyers, Sarah A Kramer, Margaret A Hanson, Jared M Andrews, Robert A DeLorenzo
STUDY HYPOTHESIS: The primary study objective was to delineate the procedural aspects of intraosseous (IO) infusions responsible for fat intravasation by testing the hypothesis that the fat content of effluent blood increases during IO infusions. METHODS: IO cannulas were inserted into the proximal tibiae of 35 anesthetized swine (Sus scrofa, 50.1 ± 3.5 kg) and intravasated fat was assessed using a lipophilic fluoroprobe (Nile red) and by vascular ultrasound imaging...
July 2015: Prehospital Emergency Care
https://www.readbyqxmd.com/read/25540067/advanced-airway-management-is-necessary-in-prehospital-trauma-patients
#13
D J Lockey, B Healey, K Crewdson, G Chalk, A E Weaver, G E Davies
BACKGROUND: Treatment of airway compromise in trauma patients is a priority. Basic airway management is provided by all emergency personnel, but the requirement for on-scene advanced airway management is controversial. We attempted to establish the demand for on-scene advanced airway interventions. Trauma patients managed with standard UK paramedic airway interventions were assessed to determine whether airway compromise had been effectively treated or whether more advanced airway management was required...
April 2015: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/25544733/factors-associated-with-successful-resuscitation-after-out-of-hospital-cardiac-arrest-and-temporal-trends-in-survival-and-comorbidity
#14
Helle Søholm, Christian Hassager, Freddy Lippert, Matilde Winther-Jensen, Jakob Hartvig Thomsen, Hans Friberg, John Bro-Jeppesen, Lars Køber, Jesper Kjaergaard
STUDY OBJECTIVE: Out-of-hospital cardiac arrest has an overall poor prognosis. We sought to identify what temporal trends and influencing factors existed for this condition in one region. METHODS: We studied consecutive out-of-hospital cardiac arrest patients from 2007 to 2011 with attempted resuscitation in Copenhagen. From an Utstein database, we assessed survival to admission and comorbidity with the Charlson comorbidity index from the National Patient Registry and employment status from the Danish Rational Economic Agents Model database...
May 2015: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/25441518/paramedic-specialization-a-strategy-for-better-out-of-hospital-care
#15
Sean M Caffrey, John R Clark, Scott Bourn, Jim Cole, John S Cole, Maria Mandt, Jimm Murray, Harry Sibold, David Stuhlmiller, Eric R Swanson
Demographic, economic, and political forces are driving significant change in the US health care system. Paramedics are a health profession currently providing advanced emergency care and medical transportation throughout the United States. As the health care system demands more team-based care in nonacute, community, interfacility, and tactical response settings, specialized paramedic practitioners could be a valuable and well-positioned resource to meet these needs. Currently, there is limited support for specialty certifications that demand appropriate education, training, or experience standards before specialized practice by paramedics...
November 2014: Air Medical Journal
https://www.readbyqxmd.com/read/25441531/use-of-arterial-catheters-in-the-management-of-acute-aortic-dissection
#16
Michael W Ruszala, Andrew P Reimer, Ronald L Hickman, John M Clochesy, Fredric M Hustey
PURPOSE: The aim of this study was to investigate the relationship between the use of invasive arterial blood pressure (IBP) monitoring and reaching established aggressive medical management goals in acute aortic dissection. METHODS: Data were collected through a retrospective chart review of patients diagnosed with acute aortic syndromes of the thoracic cavity who required transport to tertiary care over a 28-month period. The 2010 American Heart Association medical management goals of thoracic aortic disease were used as hemodynamic end points...
November 2014: Air Medical Journal
https://www.readbyqxmd.com/read/25542726/rural-trauma-patients-cannot-wait-tranexamic-acid-administration-by-helicopter-emergency-medical-services
#17
May Mrochuk, Domhnall ÓDochartaigh, Eddie Chang
OBJECTIVE: Tranexamic acid (TXA) administration has been shown to reduce mortality in bleeding trauma patients if given in the hospital within 3 hours of injury. Its use has been theorized to be of benefit in the prehospital environment. This study evaluates the timing of TXA administration in a critical care helicopter emergency medical service (HEMS) versus that of the destination trauma hospital. METHODS: We performed a retrospective chart review of consecutive trauma patients who were given TXA during HEMS transfer...
January 2015: Air Medical Journal
https://www.readbyqxmd.com/read/25186802/right-people-right-time-prehospital-and-retrieval-medicine
#18
Stefan Mazur, Daniel Ellis
No abstract text is available yet for this article.
October 2014: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/25153713/the-use-of-prehospital-ketamine-for-control-of-agitation-in-a-metropolitan-firefighter-based-ems-system
#19
David Keseg, Eric Cortez, Douglas Rund, Jeffrey Caterino
Abstract Introduction. Prehospital personnel frequently encounter agitated, combative, and intoxicated patients in the field. In recent years, ketamine has been described as an effective sedative agent to treat such patients; however, a paucity of research exists describing the use of prehospital ketamine. The objective of this study was to provide a descriptive analysis of the Columbus Division of Fire's experience with utilizing ketamine in the prehospital setting. We hypothesized that ketamine administration improves patient condition, is effective at sedating patients, and does not result in endotracheal intubation in the prehospital setting or in the emergency department (ED)...
January 2015: Prehospital Emergency Care
https://www.readbyqxmd.com/read/25155289/use-of-prehospital-12-lead-electrocardiography-and-treatment-times-among-st-elevation-myocardial-infarction-patients-with-atypical-symptoms
#20
Austin R Cannon, Li Lin, Barbara Lytle, Eric D Peterson, Charles B Cairns, Seth W Glickman
OBJECTIVES: Guidelines advise that a prehospital electrocardiogram (ECG) should be obtained in any patients with chest pain, yet up to 20% of patients with ST-elevation myocardial infarction (STEMI) do not present with chest pain. The objective was to determine the association of atypical presentations in the prehospital setting on the likelihood of receiving a prehospital ECG and subsequent time to reperfusion therapy. METHODS: This study used a data set that linked prehospital medical information from a statewide EMS data system with a clinical registry of treatment and outcomes data for patients with STEMI...
August 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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