Current Issue : July - September Volume : 2013 Issue Number : 3 Articles : 5 Articles
Background: Out-of-hospital cardiac arrest (OHCA) is a common medical emergency with significant mortality and\r\nsignificant neurological morbidity. Helicopter emergency medical services (HEMS) may be tasked to OHCA. We\r\nsought to assess the impact of tasking a HEMS service to OHCA and characterise the nature of these calls.\r\nMethod: Retrospective case review of all HEMS calls to Surrey and Sussex Air Ambulance, United Kingdom, over a\r\n1-year period (1/9/2010-1/9/2011). All missions to cases of suspected OHCA, of presumed medical origin, were\r\nreviewed systematically.\r\nResults: HEMS was activated 89 times to suspected OHCA. This represented 11% of the total HEMS missions. In 23\r\ncases HEMS was stood-down en-route and in 2 cases the patient had not suffered an OHCA on arrival of HEMS. 25\r\npatients achieved return-of-spontaneous circulation (ROSC), 13 (52%) prior to HEMS arrival. The HEMS team were never\r\nfirst on-scene. The median time from first collapse to HEMS arrival was 31 minutes (IQR 22ââ?¬â??40). The median time from\r\nHEMS activation to arrival on scene was 17 minutes (IQR 11.5-21). 19 patients underwent pre-hospital anaesthesia, 5\r\npatients had electrical or chemical cardioversion and 19 patients had therapeutic hypothermia initiated by HEMS. Only\r\n1 post-OHCA patient was transported to hospital by air. The survival to discharge rate was 6.3%.\r\nConclusion: OHCA represents a significant proportion of HEMS call outs. HEMS most commonly attend post-ROSC\r\nOHCA patients and interventions, including pre-hospital anaesthesia and therapeutic hypothermia should be targeted\r\nto this phase. HEMS are rarely first on-scene and should only be tasked as a first response to OHCA in remote locations.\r\nHEMS may be most appropriately utilised in OHCA by only attending the scene if a patient achieves ROSC....
Population estimates projects a significant increase in the geriatric population making elderly trauma patients more\r\ncommon. The geriatric trauma patients experience higher incidence of pre-existing medical conditions, impaired\r\nage-dependent physiologic reserve, use potent drugs and suffer from trauma system related shortcomings that\r\ninfluence outcomes. To improve adjustments for older age in pre-hospital assessment and care, several initiatives\r\nshould be implemented. Decision-makers should make system revisions and introduce advanced point-of-care\r\ninitiatives to improve outcome after trauma for the elderly....
Background: Still picture transmission was performed using a telemedicine system in an Emergency Medical\r\nService (EMS) during a prospective, controlled trial. In this ancillary, retrospective study the quality and content of\r\nthe transmitted pictures and the possible influences of this application on prehospital time requirements were\r\ninvestigated.\r\nMethods: A digital camera was used with a telemedicine system enabling encrypted audio and data transmission\r\nbetween an ambulance and a remotely located physician. By default, images were compressed (jpeg, 640 x 480\r\npixels). On occasion, this compression was deactivated (3648 x 2736 pixels). Two independent investigators\r\nassessed all transmitted pictures according to predefined criteria. In cases of different ratings, a third investigator\r\nhad final decision competence. Patient characteristics and time intervals were extracted from the EMS protocol\r\nsheets and dispatch centre reports.\r\nResults: Overall 314 pictures (mean 2.77 Ã?± 2.42 pictures/mission) were transmitted during 113 missions (group 1).\r\nPictures were not taken for 151 missions (group 2). Regarding picture quality, the content of 240 (76.4%) pictures\r\nwas clearly identifiable; 45 (14.3%) pictures were considered ââ?¬Å?limited qualityââ?¬Â and 29 (9.2%) pictures were deemed\r\nââ?¬Å?not usefulââ?¬Â due to not/hardly identifiable content. For pictures with file compression (n = 84 missions) and without\r\n(n = 17 missions), the content was clearly identifiable in 74% and 97% of the pictures, respectively (p = 0.003).\r\nMedical reports (n = 98, 32.8%), medication lists (n = 49, 16.4%) and 12-lead ECGs (n = 28, 9.4%) were most\r\nfrequently photographed. The patient characteristics of group 1 vs. 2 were as follows: median age ââ?¬â?? 72.5 vs.\r\n56.5 years, p = 0.001; frequency of acute coronary syndrome ââ?¬â?? 24/113 vs. 15/151, p = 0.014. The NACA scores and\r\ngender distribution were comparable. Median on-scene times were longer with picture transmission (26 vs. 22 min,\r\np = 0.011), but ambulance arrival to hospital arrival intervals did not differ significantly (35 vs. 33 min, p = 0.054).\r\nConclusions: Picture transmission was used frequently and resulted in an acceptable picture quality, even with\r\ncompressed files. In most cases, previously existing ââ?¬Å?paper dataââ?¬Â was transmitted electronically. This application may\r\noffer an alternative to other modes of ECG transmission. Due to different patient characteristics no conclusions for a\r\nprolonged on-scene time can be drawn. Mobile picture transmission holds important opportunities for clinical\r\nhandover procedures and teleconsultation....
Background: The LUCASââ??¢ device delivers mechanical chest compressions that have been shown in experimental\r\nstudies to improve perfusion pressures to the brain and heart as well as augmenting cerebral blood flow and end\r\ntidal CO2, compared with results from standard manual cardiopulmonary resuscitation (CPR). Two randomised pilot\r\nstudies in out-of-hospital cardiac arrest patients have not shown improved outcome when compared with manual\r\nCPR. There remains evidence from small case series that the device can be potentially beneficial compared with\r\nmanual chest compressions in specific situations. This multicentre study is designed to evaluate the efficacy and\r\nsafety of mechanical chest compressions with the LUCASââ??¢ device whilst allowing defibrillation during on-going\r\nCPR, and comparing the results with those of conventional resuscitation.\r\nMethods/design: This article describes the design and protocol of the LINC-study which is a randomised\r\ncontrolled multicentre study of 2500 out-of-hospital cardiac arrest patients. The study has been registered at\r\nClinicalTrials.gov (http://clinicaltrials.gov/ct2/show/NCT00609778?term=LINC&rank=1).\r\nResults: Primary endpoint is four-hour survival after successful restoration of spontaneous circulation. The safety\r\naspect is being evaluated by post mortem examinations in 300 patients that may reflect injuries from CPR.\r\nConclusion: This large multicentre study will contribute to the evaluation of mechanical chest compression in CPR\r\nand specifically to the efficacy and safety of the LUCASââ??¢ device when used in association with defibrillation during\r\non-going CPR....
Background: A selective non-operative management (SNOM) has found to be an adequate and safe strategy to assess\r\nand treat patients suffering from penetrating trauma of the extremities (PTE). With this SNOM comes a strategy in\r\nwhich adjuvant investigations or interventions are not routinely performed, but based on physical examination only.\r\nMethods: All subsequent patients presented with PTE at a Dutch level I trauma center from October 2000 to June\r\n2011 were included in this study. In-hospital and long-term outcome was analysed in the light of assessment of these\r\npatients according to the SNOM protocol.\r\nResults: A total of 668 patients (88.2% male; 33.8% gunshot wounds) with PTE presented at the Emergency\r\nDepartment of a level 1 traumacenter, of whom 156 were admitted for surgical treatment or observation. Overall, 22\r\n(14%) patients that were admitted underwent exploration of the extremity for vascular injury. After conservative\r\nobservation, two (1.5%) patients needed an intervention to treat (late onset) vascular complications. Other long-term\r\nextremity related complications were loss of function or other deformity (n = 9) due to missed nerve injury, including 2\r\npatients with peroneal nerve injury caused by delayed compartment syndrome treatment.\r\nConclusion: A SNOM protocol for initial assessment and treatment of PTE is feasible and safe. Clinical examination of the\r\ninjured extremity is a reliable diagnostic ''tool'' for excluding vascular injury. Repeated assessments for nerve injuries are\r\nimportant as these are the ones that are frequently missed and result in long-term disability. Level of evidence: II / III,\r\nretrospective prognostic observational cohort study Key words Penetrating trauma, extremity, vascular injury, complications....
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