Current Issue : July - September Volume : 2017 Issue Number : 3 Articles : 8 Articles
Background: Ambulance paramedics play a critical role expediting patient access to emergency treatments.\nStandardised handover communication frameworks have led to improvements in accuracy and speed of\ninformation transfer but their impact upon time-critical scenarios is unclear. Patient outcomes might be improved\nby paramedics staying for a limited time after handover to assist with shared patient care. We aimed to categorize\nand synthesise data from studies describing development/extension of the ambulance-based paramedic role\nduring and after handover for time-critical conditions (trauma, stroke and myocardial infarction).\nMethods: We conducted an electronic search of published literature (Jan 1990 to Sep 2016) by applying a structured\nstrategy to eight bibliographic databases. Two reviewers independently assessed eligible studies of paramedics,\nemergency medical (or ambulance) technicians that reported on the development, evaluation or implementation of (i)\ngeneric or specific structured handovers applied to trauma, stroke or myocardial infarction (MI) patients; or (ii)\nparamedic-initiated care processes at handover or post-handover clinical activity directly related to patient care in\nsecondary care for trauma, stroke and MI. Eligible studies had to report changes in health outcomes.\nResults: We did not identify any studies that evaluated the health impact of an emergency ambulance paramedic\nintervention following arrival at hospital. A narrative review was undertaken of 36 studies shortlisted at the full text stage\nwhich reported data relevant to time-critical clinical scenarios on structured handover tools/protocols; protocols/enhanced\nparamedic skills to improve handover; or protocols/enhanced paramedic skills leading to a change in in-hospital transfer\nlocation. These studies reported that (i) enhanced paramedic skills (diagnosis, clinical decision making and administration\nof treatment) might supplement handover information; (ii) structured handover tools and feedback on handover\nperformance can impact positively on paramedic behaviour during clinical communication; and (iii) additional roles of\nparamedics after arrival at hospital was limited to ââ?¬Ë?direct transportationââ?¬â?¢ of patients to imaging/specialist care facilities.\nConclusions: There is insufficient published evidence to make a recommendation regarding condition-specific handovers\nor extending the ambulance paramedic role across the secondary/tertiary care threshold to improve health outcomes.\nHowever, previous studies have reported non-clinical outcomes which suggest that structured handovers and enhanced\nparamedic actions after hospital arrival might be beneficial for time-critical conditions and further investigation is required...
We describe herein a patient who presented with painful ophthalmoplegia and\nwas ultimately diagnosed via magnetic imaging resonance studies and successfully\ntreated for Tolosa-Hunt syndrome. Tolosa-Hunt syndrome is a rare,\nreversible and painful ophthalmoplegia characterized by recurrent unilateral\norbital pain, ipsilateral oculomotor paralysis and prompt response to steroids.\nSpecific criteria for its diagnosis exist and are discussed herein. Individuals affected\nmay display signs of select cranial nerve palsies, ptosis, facial numbness,\ndiplopia, midrosis, and proptosis. Appropriate recognition of the disease can\nallow for immediate intervention and thus decrease the length and severity of\nsymptoms especially as symptoms may not spontaneously resolve without\ntreatment which leads to unnecessary suffering through pain, anxiety, and decreased\nvision. We describe the case presentation and keys for diagnosis\nemergency medicine that physicians should know for this potentially devastating\ncondition....
Full medical evaluation is paramount for all trauma patients. Minor traumas are often overlooked, as they are thought to bear low\ninjury potential. In this case report, we describe the case of a 48-year-old man presenting to our Emergency Department with\nmild to moderate right-sided shoulder and scapular pain following a fall from his own height ten days previously. Clinical and\nparaclinical investigations (CT) revealed diffuse right shoulder pain, with crepitations on palpation of the neck, right shoulder,\nand right lateral chest wall. Computed tomography (CT) demonstrated right-sided costal fractures (ribs 7 to 9), with diffuse\nsubcutaneous emphysema and pneumomediastinum due to laceration of the visceral and parietal pleura and the adjacent lung\nparenchyma. In addition, a small ipsilateral pneumothorax was found. Surprisingly, the clinical status was only minimally affected\nby mild to moderate pain and minor functional impairment....
We assessed the effect of focused point of care ultrasound (POCUS) used for critical nontraumatic hypotensive patients presenting\nto the emergency department of our hospital on the clinical decisions of the physicians and whether it led to the modification\nof the treatment modality. This prospective clinical study was conducted at the Emergency Department of Antalya Training and\nResearchHospital. Nontraumatic patients aged 18 and older who presented to our emergency department and whose systolic blood\npressure was <100mmHg or shock index (heart rate/systolic blood pressure) was >1 were included in the study. While the most\nprobable preliminary diagnosis established by the physician before POCUS was consistent with the definitive diagnosis in 60.6%\n(...
Profunda femoris artery (PFA) pseudoaneurysm after blunt trauma without associated femur fracture is a rare occurrence.Most of\nthe reported cases of PFA pseudoaneurysm in the English literature developed after penetrating trauma, surgical procedures, and\nfemur fractures.We present two such cases following blunt trauma andwithout any associated long bone injury.After initial imaging\nfailed to show any long bone fracture, CT angiography confirmed pseudoaneurysm of the branch of the PFA. Both patients were\nthen treated with emergent coil embolization of the bleeding vessel. Pseudoaneurysms typically present late and signs of persistent\nhip pain, thigh swelling, presence of a pulsatile mass, and even unexplained anemia all may suggest the diagnosis. Recognition of\nPFA pseudoaneurysm requires high index of suspicion and is often difficult to diagnose clinically because of its location....
Background and Purpose. Trauma is the leading cause of death for youth in developing countries. Given the prevalence of head\ntrauma (HT) in society and its complication and burden, the epidemiologic study of head trauma is necessary and is the main aim\nof this study. Materials and Methods. This retrospective population-based survey describes the epidemiology of head injury in a\ndefined population in Ardabil city. It includes all 204 patients with head injury referred to the University Hospital of Ardabil, Iran,\nduring 2013-2014. Data were collected by a checklist and analyzed by statistical methods in SPSS.19. Significance level ...
Objective. Tranexamic Acid (TXA) is currently the only drug with prospective clinical evidence supporting its use in bleeding\ntrauma patients. We sought to better understand the barriers preventing its use and elicit suggestions to further its use in trauma\npatients in the state of Maryland. Methods. This is a cross-sectional study. Results. The overall response rate was 38%. Half of all\nparticipants reported being familiar with the CRASH-2 trial and MATTERs study. Half reported being aware of TXA as part of\ntheir institution�s massive transfusion protocol. The majority of participants felt that TXA would have a significant positive impact\non the survival of trauma patients.Amajority also felt that the use of TXAwould increase if its administration was the responsibility\nof both trauma surgeons and emergency physicians. Conclusion. Only half of responders reported being aware of TXA as being\npart of their institution�s massive transfusion protocol. Lack of awareness of the clinical data supporting its use is a major barrier.\nHowever, most trauma providers and emergency physicians do have a favorable view of TXA and support its incorporation into\nmassive transfusion protocols.We believe that more studies of this kind on both state and national level are needed....
A 27-year-old female with a history of Crohn�s disease and familial adenomatous\npolyposis (FAP) presented to the emergency department (ED) with\nsevere abdominal pain after an endoscopic exam. Chest and abdominal radiographs\nrevealed massive pneumoperitoneum and the patient underwent\nemergent exploratory surgery. Herein, we discuss the management and outcomes\nof this case. The importance of a thorough history and physical exam\nwhen evaluating for an acute abdomen and thus the development of a successful\nmanagement plan is also underscored...
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