Romain Jouffroy, Teddy Léguillier, Basile Gilbert, Jean Pierre Tourtier, Emmanuel Bloch-Laine, Patrick Ecollan, Vincent Bounes, Josiane Boularan, Papa Gueye-Ngalgou, Valérie Nivet-Antoine, Jean-Louis Beaudeux, Benoit Vivien
BACKGROUND: Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, blood lactate measurement is broadly used in combination with the clinical evaluation of patients as the clinical picture alone is not sufficient for assessing disease severity and outcomes. METHODS: From 15th April 2017 to 15th April 2019, patients with SS requiring prehospital mobile Intensive Care Unit intervention (mICU) were prospectively included in this observational study...
October 17, 2020: American Journal of Emergency Medicine
Isabelle Mullen, Benjamin S Abella
Out-of-hospital cardiac arrest remains a major challenge worldwide, with survival to discharge rates of <20% in the great majority of countries. Advancements in prehospital care, including increasing deployment of automated external defibrillators and improvements in bystander cardiopulmonary resuscitation, have led to more victims achieving return of spontaneous circulation (ROSC), yet the majority of patients with ROSC suffer in-hospital mortality or significant neurologic injuries that persist after discharge...
October 2020: Turkish Journal of Emergency Medicine
Carl Eriksson, Amanda Schoonover, Tabria Harrod, Garth Meckler, Matt Hansen, David Yanez, Mo Daya, Jonathan Jui, Jeanne-Marie Guise
INTRODUCTION: Efforts to improve the quality of emergency medical services (EMS) care for adults with out-of-hospital cardiac arrest (OHCA) have led to improved survival over time. Similar improvements have not been observed for children with OHCA, who may be at increased risk for preventable adverse safety events during prehospital care. The purpose of this study is to identify patient and organisational factors that are associated with adverse safety events during the EMS care of paediatric OHCA...
October 21, 2020: BMJ Open
Bradley Waterman, Kristine Van Aarsen, Michael Lewell, Homer Tien, Frank Myslik, Michael Peddle, Sean Doran
BACKGROUND: The Focused Assessment with Sonography in Trauma (FAST) exam is a rapid ultrasound test to identify evidence of hemorrhage within the abdomen. Few studies examine the accuracy of paramedic performed FAST examinations. The duration of an ultrasound training program remains controversial. This study's purpose was to assess the accuracy of paramedic FAST exam interpretation following a one hour didactic training session. METHODS: The interpretation of paramedic performed FAST exams was compared to the interpretation of physician performed FAST examinations on a mannequin model containing 300ml of free fluid following a one hour didactic training course...
September 2020: CJEM
Bradley Waterman, Kristine Van Aarsen, Michael Lewell, Frank Myslik, Michael Peddle, Sean Doran
BACKGROUND: Point of care ultrasound (POCUS) is an essential tool for physicians to guide treatment decisions in both hospital and prehospital settings. Despite the potential patient care and system utilization benefits of prehospital ultrasound, the financial burden of a "hands-on" training program for large numbers of paramedics remains a barrier to implementation. In this study, we conducted a prospective, observational, double-blinded study comparing paramedics to emergency physicians in their ability to generate usable abdominal ultrasound images after a 1-hour didactic training session...
September 2020: CJEM
Mu Huang, Joseph C Watso, Gilbert Moralez, Matthew N Cramer, Joseph M Hendrix, Jeung-Ki Yoo, Mark B Badrov, Qi Fu, Carmen Hinojosa-Laborde, Craig G Crandall
KEY POINTS: Haemorrhage is the leading cause of battlefield and civilian trauma deaths. Given that a haemorrhagic injury on the battlefield is almost always associated with pain, it is paramount that the administered pain medication does not disrupt the physiological mechanisms that are beneficial in defending against the haemorrhagic insult. Current guidelines from the US Army's Committee on Tactical Combat Casualty Care (CoTCCC) for the selection of pain medications administered to a haemorrhaging soldier are based upon limited scientific evidence, with the clear majority of supporting studies being conducted on anaesthetized animals...
October 20, 2020: Journal of Physiology
Gilbert Koome, Martin Atela, Faith Thuita, Thaddaeus Egondi
Background: Africa accounts forabout 90% of the global trauma burden. Mapping evidence on health systemfactors associated with post-trauma mortality is essential in definingpre-hospital care research priorities and mitigation of the burden. The studyaimed to map and synthesize existing evidence and research gaps on healthsystem factors associated with post-trauma mortality at the pre-hospital carelevel in Africa. Methods: A scoping review of published studies and grey literature was conducted...
2020: Trauma Surgery & Acute Care Open
Susan Yeargin, Rebecca Hirschhorn, Andrew Grundstein
Background and objectives: Heat-related illness (HRI) can have significant morbidity and mortality consequences. Research has predominately focused on HRI in the emergency department, yet health care leading up to hospital arrival can impact patient outcomes. Therefore, the purpose of this study was to describe HRI in the prehospital setting. Materials and Methods: A descriptive epidemiological design was utilized using data from the National Emergency Medical Services (EMS) Information System for the 2017-2018 calendar years...
October 17, 2020: Medicina
Marcela Usberti Gutierre, João Paulo Mota Telles, Leonardo Christiaan Welling, Nícollas Nunes Rabelo, Manoel Jacobsen Teixeira, Eberval Gadelha Figueiredo
Cellular response to TBI is a mixture of excitotoxicity, neuroinflammation, and cell death. Biomarkers that can track these lesions and inflammatory processes are being explored for their potential to provide objective measures in the evaluation of TBI, from prehospital care to rehabilitation. By understanding the pathways involved, we could be able to improve diagnostic accuracy, guide management, and prevent long-term disability. We listed some of the recent advances in this translational, intriguing, fast-growing field...
October 19, 2020: Neurosurgical Review
Qin Xiang Ng, Ebenezer Zhong Han Lee, Joey Ai Meng Tay, Shalini Arulanandam
OBJECTIVE: To understand the impact of COVID-19 restrictions on emergency medical services (EMS) utilisation and out-of-hospital cardiac arrest (OHCA) outcomes in Singapore. METHODS: This was a retrospective observational study comparing data collected by the Singapore Civil Defence Force (SCDF) on EMS utilisation in Singapore from April 1 to May 31, 2020 to previous figures. RESULTS: Overall, EMS call volume and total OHCAs remained comparable to past years, however, there was a considerable decrease in prehospital return of spontaneous circulation (ROSC) rates, albeit not statistically significant (p=0...
October 19, 2020: Emergency Medicine Australasia: EMA
Kiyonori Ito, Susumu Ookawara, Takayuki Uchida, Hideyuki Hayasaka, Masaya Kofuji, Haruhisa Miyazawa, Akinori Aomatsu, Yuichiro Ueda, Keiji Hirai, Yoshiyuki Morishita
Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in clinical settings including cardiovascular and brain surgery, neonatal monitoring and prehospital medicine. The NIRS monitoring devices are real-time and noninvasive, and have mainly been used for evaluating cerebral oxygenation in critically ill patients during an operation or intensive care. Thus far, the use of NIRS monitoring in patients with chronic kidney disease (CKD) including hemodialysis (HD) has been limited; therefore, we investigated rSO2 values in some organs during HD...
October 2, 2020: Journal of Visualized Experiments: JoVE
Matthew R Neth, Jennifer S Love, B Zane Horowitz, Michael D Shertz, Ritu Sahni, Mohamud R Daya
Sodium nitrite is a powerful oxidizing agent that causes hypotension and limits oxygen transport and delivery in the body through the formation of methemoglobin. Clinical manifestations can include cyanosis, hypoxia, altered consciousness, dysrhythmias, and death. The majority of reports on sodium nitrite poisonings have been the result of unintentional exposures. We report a case of an intentional fatal overdose of sodium nitrite. A 17-year-old female reportedly drank approximately one tablespoon of sodium nitrite in a self-harm attempt...
October 19, 2020: Prehospital Emergency Care
Kameron Bechler, Kristina Shkirkova, Jeffrey L Saver, Sidney Starkman, Scott Hamilton, David S Liebeskind, Marc Eckstein, Samuel Stratton, Frank Pratt, Robin Conwit, Nerses Sanossian
Background: Cardiac adverse events are common among patients presenting with acute stroke and contribute to overall morbidity and mortality. Prophylactic measures for the reduction of cardiac adverse events in hospitalized stroke patients have not been well understood. We sought to investigate the effect of early initiation of high-dose intravenous magnesium sulfate on cardiac adverse events in stroke patients. Methods: This is a secondary analysis of the prehospital Field Administration of Stroke Therapy-Magnesium (FAST-MAG) randomized phase-3 clinical trial, conducted from 2005-2013...
2020: Cardiovascular Therapeutics
Tyler P Rasmussen, T C Bullis, S Girotra
Purpose of review: Cardiac arrest is a common condition associated with high mortality and a substantial risk of neurological injury among survivors. Targeted temperature management (TTM) is the only strategy shown to reduce the risk of neurologic disability cardiac arrest patients. In this article, we provide a comprehensive review of TTM with an emphasis on recent trials. Recent findings: After early studies demonstrating the benefit of TTM in out-of-hospital cardiac arrest due to a shockable rhythm, newer studies have extended the benefit of TTM to patients with a nonshockable rhythm and in-hospital cardiac arrest...
2020: Current Treatment Options in Cardiovascular Medicine
Willemijn J Maas, Maarten M H Lahr, Erik Buskens, Durk-Jouke van der Zee, Maarten Uyttenboogaart
The efficacy of intravenous thrombolysis and endovascular thrombectomy (EVT) for acute ischemic stroke is highly time dependent. Optimal organization of acute stroke care is therefore important to reduce treatment delays but has become more complex after the introduction of EVT as regular treatment for large vessel occlusions. There is no singular optimal organizational model that can be generalized to different geographic regions worldwide. Current dominant organizational models for EVT include the drip-and-ship- and mothership model...
October 19, 2020: Stroke; a Journal of Cerebral Circulation
Layne Dylla, Jeremy T Cushman, Beau Abar, Curtis Benesch, Courtney M C Jones, M Kerry O'Banion, David H Adler
OBJECTIVE: Hyperoxia, the delivery of high levels of supplemental oxygen (sO2 ) despite normoxia, may increase cerebral oxygenation to penumbral tissue and improve stroke outcomes. However, it may also alter peripheral hemodynamic profiles with potential negative effects on cerebral blood flow (CBF). This study examines the hemodynamic consequences of prehospital sO2 in stroke. METHODS: A retrospective analysis of adult acute stroke patients (aged ≥18 years) presenting via EMS to an academic Comprehensive Stroke Center between January 1, 2013 and December 31, 2017 was conducted using demographic and clinical characteristics obtained from Get with the Guidelines-Stroke registry and subjects' medical records...
July 11, 2020: American Journal of Emergency Medicine
Francisco Martín-Rodríguez, Raúl López-Izquierdo, Miguel A Castro-Villamor, José L Martín-Conty, Rosa M Herrero-Antón, Carlos Del Pozo-Vegas, David Guillén-Gil, Antonio Dueñas-Laita
OBJECTIVE: The objective of this study was to design a risk model with variables determined before hospital arrival to predict the risk of serious adverse events in patients with acute poisoning. METHODS: A preliminary prospective, multicentre cohort study of adults with prehospital diagnosis of acute intoxication was conducted. The study was carried out in the Public Health System of the Community of Castilla-Leon (Spain), including seven advanced life support units and five hospitals, between April 1, 2018, and June 30, 2019...
October 13, 2020: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Phoebe Johnson-Black, Gregory Wong, Sidney Starkman, Nerses Sanossian, Latisha Sharma, May Kim-Tenser, David Liebeskind, Lucas Restrepo-Jimenez, Miguel Valdes-Sueiras, Samuel Stratton, Marc Eckstein, Frank Pratt, Robin Conwit, Scott Hamilton, Judy Guzy, Ileana Grunberg, Kristina Shkirkova, Claude Hemphill, Jeffrey Saver
BACKGROUND: Because "time is brain," acute stroke trials are migrating to the prehospital setting. The impact upon enrollment in post-arrival trials of earlier recruitment in a prehospital trial requires delineation. METHODS: We analyzed all patients recruited into acute and prevention stroke trials during an 8-year period when an academic medical center (AMC) was participating in a prehospital treatment trial - the NIH Field Administration of Stroke Treatment - Magnesium (FAST-MAG) study...
November 2020: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Yoichiro Nagao, Makoto Nakajima, Yuichiro Inatomi, Yasuyuki Ito, Yanosuke Kouzaki, Kuniyasu Wada, Toshiro Yonehara, Tadashi Terasaki, Yoichiro Hashimoto, Yukio Ando
PURPOSE: There is scant data related to prehospital delay in cases of acute ischemic stroke from multicenter studies conducted after change of the therapeutic window of intravenous tissue plasminogen activator (iv-tPA) administration to within 4.5 h of onset. We investigated factors causing prehospital delay and their associations with clinical outcomes using data from a regional multicenter stroke registry. METHODS: Data from the multicenter regional stroke registry were analyzed...
November 2020: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Helen Rynor, Jake Levine, Joseph Souchak, Ned Shashoua, Maygret Ramirez, Ivis C Gonzalez, Virginia Ramos, Anshul Saxena, Emir Veledar, Amy K Starosciak, Felipe De Los Rios La Rosa
BACKGROUND: Acute stroke outcomes depend on timely reperfusion. In 3/2017, local EMS agencies implemented a prehospital triage algorithm with hospital bypass and field activation of the neurointerventional team using the Field Assessment Stroke Triage for Emergency Destination (FAST-ED). A score ≥4 bypasses to a comprehensive stroke center (CSC) and a score ≥6 also has the interventional team field activated off-hours. AIM: We analyzed effects of this initiative on volume, acute stroke transfers, treatment times, and outcomes and determined the tool's ability to predict large vessel occlusion...
November 2020: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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