Christina Zompola, Lina Palaiodimou, Konstantinos Voumvourakis, Leonidas Stefanis, Aristeidis H Katsanos, Else C Sandset, Estathios Boviatsis, Georgios Tsivgoulis
The management of blood pressure variability (BPV) in acute stroke presents a complex challenge with profound implications for patient outcomes. This narrative review examines the role of BPV across various stages of acute stroke care, highlighting its impact on treatment strategies and prognostic considerations. In the prehospital setting, while guidelines lack specific recommendations for BP management, emerging evidence suggests a potential link between BPV and outcomes. Among ischaemic stroke patients who are ineligible for reperfusion therapies, BPV independently influences functional outcomes, emphasising the need for individualised approaches to BP control...
March 29, 2024: Journal of Clinical Medicine
Sami Gendler, Shaul Gelikas, Tomer Talmy, Roy Nadler, Avishai M Tsur, Irina Radomislensky, Moran Bodas, Elon Glassberg, Ofer Almog, Avi Benov, Jacob Chen
Background : Trauma laparotomy (TL) remains a cornerstone of trauma care. We aimed to investigate prehospital measures associated with in-hospital mortality among casualties subsequently undergoing TLs in civilian hospitals. Methods : This retrospective cohort study cross-referenced the prehospital and hospitalization data of casualties treated by Israel Defense Forces-Medical Corps teams who later underwent TLs in civilian hospitals between 1997 and 2020. Results : Overall, we identified 217 casualties treated by IDF-MC teams that subsequently underwent a TL, with a mortality rate of 15...
March 22, 2024: Journal of Clinical Medicine
Shadman Aziz, Kate Lachowycz, Rob Major, Paul Rees, Jon Barratt
Outcomes after out-of-hospital cardiac arrest (OHCA) remain poor in the UK. In order to increase the chances of successful resuscitation, international society guidelines on cardiopulmonary resuscitation quality have recommended titration of chest compression parameters and vasopressor administration to arterial diastolic blood pressure if invasive catheters are in situ at the time of cardiac arrest. However, prehospital initiation of arterial and central venous catheterisation is seldom undertaken due to the risks and significant technical challenges in the context of ongoing resuscitation in this environment...
April 12, 2024: Journal of Vascular Access
Léo Charrin, Nicolas Romain-Scelle, Christian Di-Filippo, Eric Mercier, Frederic Balen, Karim Tazarourte, Axel Benhamed
BACKGROUND: Shortness of breath is a common complaint among individuals contacting emergency communication center (EMCCs). In some prehospital system, emergency medical services include an advanced life support (ALS)-capable team. Whether such team should be dispatched during the phone call or delayed until the BLS-capable paramedic team reports from the scene is unclear. We aimed to evaluate the impact of delayed MMT dispatch until receiving the paramedic review compared to immediate dispatch at the time of the call on patient outcomes...
April 12, 2024: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Emil Jensen, Helena Rentzhog, Johan Herlitz, Christer Axelsson, Peter Lundgren
BACKGROUND: Accidental hypothermia is common in all trauma patients and contributes to the lethal diamond, increasing both morbidity and mortality. In hypotensive shock, fluid resuscitation is recommended using fluids with a temperature of 37-42°, as fluid temperature can decrease the patient's body temperature. In Sweden, virtually all prehospital services use preheated fluids. The aim of the present study was to investigate how the temperature of preheated infusion fluids is affected by the ambient temperatures and flow rates relevant for prehospital emergency care...
April 12, 2024: BMC Emergency Medicine
Jason Friesen, Ramu Kharel, Peter G Delaney
A majority of emergency response in low and middle-income countries (LMICs) without formal emergency medical services (EMS) rely on uncoordinated layperson first responders (LFRs) to respond to emergencies using readily available mobile phones and private transport. Although formally trained LFRs are an important foundation for nascent emergency medical services (EMS) development, without coordination by standardized emergency medical dispatch (EMD) systems, LFR response is limited to witnessed emergencies, which provides significant but incomplete coverage...
April 11, 2024: Surgery
Zachary J Eisner, Ken Diango, Jared H Sun
Prehospital emergency medical services play a vital role in providing essential emergency medical and trauma care. However, in many low- and middle-income countries, there is a significant lack of adequate emergency medical services coverage, a problem compounded by a profound deficit of first responder training programs. The African Federation of Emergency Medicine classifies prehospital emergency care into 2 categories: tier-1, which includes laypersons, and tier-2, consisting of professionals equipped with dispatch capabilities...
April 11, 2024: Surgery
Sriram Ramgopal, Robert J Sepanski, Jillian K Gorski, Pradip P Chaudhari, Ryan G Spurrier, Christopher M Horvat, Michelle L Macy, Rebecca Cash, Christian Martin-Gill
OBJECTIVE: The shock index (SI), the ratio of heart rate to systolic blood pressure, is a clinical tool for assessing injury severity. Age-adjusted SI models may improve predictive value for injured children in the out-of-hospital setting. We sought to characterize the proportion of children in the prehospital setting with an abnormal SI using established criteria, describe the age-based distribution of SI among injured children, and determine prehospital interventions by SI. METHODS: We performed a multi-agency retrospective cross-sectional study of children (<18 years) in the prehospital setting with a scene encounter for suspected trauma and transported to the hospital between 2018 and 2022 using the National Emergency Medical Services (EMS) Information System datasets...
April 3, 2024: American Journal of Emergency Medicine
Laura Melero Guijarro, Francisco Martín-Rodríguez, Jesús Álvarez Manzanares, Carlos Del Pozo Vegas, Ancor Sanz García, Miguel Ángel Castro Villamor, Raúl López-Izquierdo
OBJECTIVES: To develop and validate a risk model for 1-year mortality based on variables available from early prehospital emergency attendance of patients with infection. MATERIAL AND METHODS: Prospective, observational, noninterventional multicenter study in adults with suspected infection transferred to 4 Spanish hospitals by advanced life-support ambulances from June 1, 2020, through June 30, 2022. We collected demographic, physiological, clinical, and analytical data...
April 2024: Emergencias: Revista de la Sociedad Española de Medicina de Emergencias
Upendra Hansda, Tushar S Mishra, Nitish Topno, Sangeeta Sahoo, Sreshtaa Mohan, Sebastian Chakola
BACKGROUND: Management of trauma patients includes prevention, prehospital care, appropriate resuscitation at a hospital, definitive treatment, and rehabilitation. Timely and adequate care for a trauma patient is paramount, which can dramatically impact survival. This study was planned to assess the proportion of patients who failed to receive adequate prehospital care before reaching our institute. MATERIALS AND METHODS: A retrospective study was conducted in the trauma and emergency department of a level-1 trauma center in eastern India from February to April 2022...
February 2024: Journal of Family Medicine and Primary Care
Sean van Diepen, Michel R Le May, Patricia Alfaro, Michael J Goldfarb, Adriana Luk, Rebecca Mathew, Maude Peretz-Larochelle, Erin Rayner-Hartley, Juan J Russo, Janek M Senaratne, Craig Ainsworth, Emilie Belley-Côté, Christopher B Fordyce, Julie Kromm, Christopher B Overgaard, Gregory Schnell, Graham C Wong
Survival to hospital discharge among patients with out-of-hospital cardiac arrest (OHCA) is low and important regional differences in treatment practices and survival have been described. Since the 2017 publication of the Canadian Cardiovascular Society's position statement on OHCA care, multiple randomized controlled trials have helped to better define optimal post cardiac arrest care. This working group provides updated guidance on the timing of cardiac catheterization in patients with ST-elevation and without ST-segment elevation, on a revised temperature control strategy targeting normothermia instead of hypothermia, blood pressure, oxygenation, and ventilation parameters, and on the treatment of rhythmic and periodic electroencephalography patterns in patients with a resuscitated OHCA...
April 2024: Canadian Journal of Cardiology
Jens Neudecker, Marco Nicolas Andreas, Aina Lask, Julia Strauchmann, Aron Elsner, Jens-Carsten Rückert, Tomasz Dziodzio
This manuscript provides an overview of the principles and requirements for implementing the ERAS program in thoracic surgery.The ERAS program optimises perioperative management of elective lung resection procedures and is based on the ERAS Guidelines for Thoracic Surgery of the ERAS Society. The clinical measures are described as in the current literature, with a focus on postoperative outcome. There are currently 45 enhanced recovery items covering four perioperative phases: from the prehospital admission phase (patient education, screening and treatment of potential risk factors such as anaemia, malnutrition, cessation of nicotine or alcohol abuse, prehabilitation, carbohydrate loading) to the immediate preoperative phase (shortened fasting period, non-sedating premedication, prophylaxis of PONV and thromboembolic complications), the intraoperative measures (antibiotic prophylaxis, standardised anaesthesia, normothermia, targeted fluid therapy, minimally invasive surgery, avoidance of catheters and probes) through to the postoperative measures (early mobilisation, early nutrition, removal of a urinary catheter, hyperglycaemia control)...
April 11, 2024: Zentralblatt Für Chirurgie
Benjamin Powell, Susanna Cramb
OBJECTIVE: To define the utility of the Triage Revised Trauma Score (TRTS), GCS/Age/arterial Pressure (GAP) score, and shock index (SI) in predicting the need for in-flight blood product administration in civilian trauma patients transported by an aeromedical platform. METHODS: A retrospective chart review of 3582 aeromedical trauma cases was conducted. An initial TRTS, GAP score and SI were calculated for each patient, and the administration of in-flight blood products was also recorded...
April 11, 2024: Emergency Medicine Australasia: EMA
Sine Mette Øgendahl Buus, Anne Brink Behrndtz, Marie Louise Schmitz, Jakob Nebeling Hedegaard, Pia Cordsen, Søren Paaske Johnsen, Thanh Phan, Grethe Andersen, Claus Ziegler Simonsen
INTRODUCTION: Rural residency has been associated with lower reperfusion treatment rates for acute ischemic stroke in many countries. We aimed to explore urban-rural differences in IV thrombolysis rates in a small country with universal health care, and short transport times to stroke units. PATIENTS AND METHODS: In this nationwide cohort study, adult ischemic stroke patients registered in the Danish Stroke Registry (DSR) between 2015 and 2020 were included. The exposure was defined by residence rurality...
April 10, 2024: European Stroke Journal
Peter G Delaney, Jon Moussally, Benjamin W Wachira
The lack of prehospital care access in low- and middle-income countries is one of the greatest unmet needs and, therefore, one of the most urgent priorities in global health. Establishing emergency medical services in low- and middle-income countries poses significant challenges and complexities, requiring solutions tailored to prevailing conditions, informed by needs assessments, and adapted to meet local demands in a culturally appropriate and sustainable manner. In areas without existing emergency medical services, patients must rely on informal networks of untrained bystanders and community members to provide first aid and transport to definitive care...
April 9, 2024: Surgery
Jared H Sun, Shaheem de Vries, Nee-Kofi Mould-Millman
The World Health Organization recognized timely healthcare as a human right and called for the expansion of two-tiered prehospital and out-of-hospital emergency care systems in low- and middle-income countries. Tier-1 systems involve community-based first responder care, and Tier-2 systems involve more formalized emergency medical services designed as a sustainable system of services, including dedicated ambulances, personnel, and equipment. Tier-2 systems can play a crucial role in reducing mortality and disability due to emergency medical and surgical conditions worldwide...
April 10, 2024: Surgery
(no author information available yet)
INTRODUCTION: Though the disease burden addressable by prehospital and out-of-hospital emergency care(OHEC) spans communicable diseases, maternal conditions, chronic conditions and injury, the single largest disability-adjusted life year burden contributor is injury, primarily driven by road traffic injuries(RTIs). Establishing OHEC for RTIs and other common emergencies in low- and middle-income countries(LMICs) where the injury burden is disproportionately greatest is a logical first step toward more comprehensive emergency medical services(EMS)...
April 2, 2024: Injury
Julie Holst Gudichsen, Emil Aggerholm Bækdal, Frederik Bloch Jessen, Annmarie Touborg Lassen, Carsten Bindslev-Jensen, Charlotte G Mortz, Søren Mikkelsen
Anaphylaxis is an allergic manifestation characterised by rapid onset and progression. Rapid treatment may be challenging in patients with atypical symptoms or no previous history of anaphylaxis. This study aimed to describe the clinical prehospital presentation of first-time anaphylactic patients. To help target educational initiatives, we sought to identify which groups of medical professionals are most likely to encounter first-time anaphylactic patients and investigated the referral pattern for suspected anaphylactic patients for specialised treatment...
April 10, 2024: Internal and Emergency Medicine
David T Lubkin, Krislynn M Mueck, Gabrielle E Hatton, Jason B Brill, Mariela Sandoval, Jessica C Cardenas, Charles E Wade, Bryan A Cotton
OBJECTIVES: Some centers have recommended including concentrated fibrinogen replacement in massive transfusion protocols (MTPs). Given our center's policy of aggressive early balanced resuscitation (1:1:1), beginning prehospital, we hypothesized that our rates of hypofibrinogenemia may be lower than those previously reported. METHODS: In this retrospective cohort study, patients presenting to our trauma center November 2017 to April 2021 were reviewed. Patients were defined as hypofibrinogenemic (HYPOFIB) if admission fibrinogen <150 or rapid thrombelastography angle <60...
2024: Trauma Surgery & Acute Care Open
Nichole Starr, Lucy Kornblith
No abstract text is available yet for this article.
2024: Trauma Surgery & Acute Care Open
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