WorldWideScience

Sample records for basic prehospital trauma

  1. Trauma in elderly people: access to the health system through pre-hospital care1

    Science.gov (United States)

    da Silva, Hilderjane Carla; Pessoa, Renata de Lima; de Menezes, Rejane Maria Paiva

    2016-01-01

    Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25%) and in the age range between 60 and 69 years (38.25%), average age 74.19 years (standard deviation±10.25). Among the mechanisms, falls (56.75%) and traffic accidents (31.25%) stood out, showing a significant relation with the pre-hospital care services (p<0.001). Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8%) were the most used, with trauma referral hospitals as the main destination (56.7%). Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims. PMID:27143543

  2. Prehospital Volume Therapy as an Independent Risk Factor after Trauma

    OpenAIRE

    2015-01-01

    Background. Prehospital volume therapy remains widely used after trauma, while evidence regarding its disadvantages is growing. The primary objective of this study was to investigate the volume administered in a prehospital setting as an independent risk factor for mortality. Material and Methods. Patients who met the following criteria were analyzed retrospectively: Injury Severity Score = 16, primary admission (between 2002 and 2010), and age = 16 years. The following data had to be availab...

  3. Prehospital pediatric trauma classification (PHPTC) as a tool for optimizing trauma care resources in the city of São Paulo, Brazil

    OpenAIRE

    Abib Simone de Campos Vieira; Schettini Sergio Tomaz; Figueiredo Luiz Francisco Poli de

    2006-01-01

    PURPOSE: To evaluate the pediatric prehospital care in São Paulo, the databases from basic life support units (BLSU) and ALSU, and to propose a simple and effective method for evaluating trauma severity in children at the prehospital phase. METHODS: A single firemen headquarter coordinates all prehospital trauma care in São Paulo city. Two databases were analyzed for children from 0 to 18 years old between 1998 and 2001: one from the Basic Life Support Units (BLSU - firemen) and one from the ...

  4. Prehospital care for multiple trauma patients in Germany

    Institute of Scientific and Technical Information of China (English)

    Marc Maegele

    2015-01-01

    For the German speaking countries,Tscherne's definition of "polytrauma" which represents an injury of at least two body regions with one or a combination being life-threatening is still valid.The timely and adequate management including quick referral of the trauma patient into a designated trauma center may limit secondary injury and may thus improve outcomes already during the prehospital phase of care.The professional treatment of multiple injured trauma patients begins at the scene in the context of a well structured prehospital emergency medical system.The "Primary Survey" is performed by the emergency physician at the scene according to the Prehospital Trauma Life Support (PHTLS)-concept.The overall aim is to rapidly assess and treat life-threatening conditions even in the absence of patient history and diagnosis ("treat-first-what-kills-first").If no immediate treatment is necessary,a "Secondary Survey" follows with careful and structured body examination and detailed assessment of the trauma mechanism.Massive and life-threatening states of hemorrhage should be addressed immediately even disregarding the ABCDE-scheme.Critical trauma patients should be referred without any delay ("work and go") to TR-DGU(R) certified trauma centers of the local trauma networks.Due to the difficult prehospital environment the number of quality studies in the field is low and,as consequence,the level of evidence for most recommendations is also low.Much information has been obtained from different care systems and the interchangeability of results is limited.The present article provides a synopsis of recommendations for early prehospital care for the severely injured based upon the 2011 updated multidisciplinary S3-Guideline "Polytrauma/Schwerstverletzten Behandlung",the most recently updated European Trauma guideline and the current PHTLS-algorithms including grades of recommendation whenever possible.

  5. Prehospital Volume Therapy as an Independent Risk Factor after Trauma

    Directory of Open Access Journals (Sweden)

    Bjoern Hussmann

    2015-01-01

    Full Text Available Background. Prehospital volume therapy remains widely used after trauma, while evidence regarding its disadvantages is growing. The primary objective of this study was to investigate the volume administered in a prehospital setting as an independent risk factor for mortality. Material and Methods. Patients who met the following criteria were analyzed retrospectively: Injury Severity Score = 16, primary admission (between 2002 and 2010, and age = 16 years. The following data had to be available: volume administered (including packed red cells, blood pressure, Glasgow Coma Scale, therapeutic measures, and laboratory results. Following a univariate analysis, independent risk factors for mortality after trauma were investigated using a multivariate regression analysis. Results. A collective of 7,641 patients met the inclusion criteria, showing that increasing volumes administered in a prehospital setting were an independent risk factor for mortality (odds ratio: 1.34. This tendency was even more pronounced in patients without severe traumatic brain injury (TBI (odds ratio: 2.71, while the opposite tendency was observed in patients with TBI. Conclusions. Prehospital volume therapy in patients without severe TBI represents an independent risk factor for mortality. In such cases, respiratory and circulatory conditions should be stabilized during permissive hypotension, and patient transfer should not be delayed.

  6. Gravidade do trauma avaliada na fase pré-hospitalar Trauma severity assessment in prehospital setting

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    I.Y. Whitaker

    1998-06-01

    Full Text Available A avaliação da gravidade do trauma e a instituição de manobras para manutenção básica da vida, no local do evento, podem representar a oportunidade de sobrevida para as vítimas de trauma até a sua chegada ao hospital. OBJETIVO: Estudar vítimas de causas externas avaliadas por um índice fisiológico denominado Trauma Score modificado (TSm aplicado durante o atendimento pré-hospitalar. MATERIAL E MÉTODO: Analisaram-se, retrospectivamente, 1.414 vítimas de causas externas atendidas pelo Sistema de Atendimento Móvel às Urgências (SAMU-RESGATE-SP no município de São Paulo, no ano de 1991. Os dados foram obtidos da ficha de atendimento pré-hospitalar e laudo de necropsia. RESULTADOS: O atendimento pré-hospitalar em 81,31% ocorreu até 40 minutos, dos quais 83,96% das vítimas não-fatais obtiveram escores TSm 12 e 11, e 53,96% das vítimas fatais obtiveram escores 0, 1 e 2. Superfície externa (30,25% e região da cabeça/pescoço (20,98% foram as mais acometidas. Das vítimas fatais, 63,63% com Injury Severity Score (ISS > ou = 16 morreram nas primeiras 24 horas. No cotejamento dos escores TSm e ISS, verificou-se que vítimas fatais com escore TSm entre 0 e 11 foram confirmadas como com ISS crítico (ISS > ou = 16. CONCLUSÃO: Constataram-se fortes indícios de que vítimas fatais com escores TSm baixos relacionaram-se com escores ISS altos.The trauma severity assessment and basic life support maneuvers in prehospital setting can represent to the trauma victim the opportunity of survival until his/her can get assistance in the hospital. PURPOSE: To study external cause victims assessed in the prehospital phase by the physiologic index named Trauma Score modificado (TSm. METHODS: Retrospective analyses were made of 1414 victims attended by Sistema de Atendimento Móvel às Urgências (SAMU-RESGATE-SP in the Municipality of São Paulo during 1991. Data were gathered from prehospital data recording sheets and necropsy records

  7. The Quality of Pre-Hospital Oxygen Therapy in Patients With Multiple Trauma: A Cross-Sectional Study

    OpenAIRE

    Adib-Hajbaghery, Mohsen; Maghaminejad, Farzaneh; Paravar, Mohammad

    2014-01-01

    Background: Trauma is a major healthcare challenge worldwide. In developing countries, most road deaths happen during the pre-hospital phase; consequently, pre-hospital trauma care has received considerable attention during the past decades. Objectives: The aim of this study was to investigate the quality of pre-hospital oxygen therapy in patients with multiple trauma. Patients and Methods: This cross-sectional study was conducted in the year 2013. The study population consisted of all patien...

  8. Risk assessment of pre-hospital trauma airway management by anaesthesiologists using the predictive Bayesian approach

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    Nakstad Anders R

    2010-04-01

    Full Text Available Abstract Introduction Endotracheal intubation (ETI has been considered an essential part of pre-hospital advanced life support. Pre-hospital ETI, however, is a complex intervention also for airway specialist like anaesthesiologists working as pre-hospital emergency physicians. We therefore wanted to investigate the quality of pre-hospital airway management by anaesthesiologists in severely traumatised patients and identify possible areas for improvement. Method We performed a risk assessment according to the predictive Bayesian approach, in a typical anaesthesiologist-manned Norwegian helicopter emergency medical service (HEMS. The main focus of the risk assessment was the event where a patient arrives in the emergency department without ETI despite a pre-hospital indication for it. Results In the risk assessment, we assigned a high probability (29% for the event assessed, that a patient arrives without ETI despite a pre-hospital indication. However, several uncertainty factors in the risk assessment were identified related to data quality, indications for use of ETI, patient outcome and need for special training of ETI providers. Conclusion Our risk assessment indicated a high probability for trauma patients with an indication for pre-hospital ETI not receiving it in the studied HEMS. The uncertainty factors identified in the assessment should be further investigated to better understand the problem assessed and consequences for the patients. Better quality of pre-hospital airway management data could contribute to a reduction of these uncertainties.

  9. Effect of prehospital ultrasound on clinical outcomes of non-trauma patients

    DEFF Research Database (Denmark)

    Rudolph, Søren Steemann; Sørensen, Martin Kryspin; Svane, Christian;

    2014-01-01

    outcomes for non-trauma patients. METHOD: We conducted a systematic review on non-trauma patients who had an US examination performed in the prehospital setting. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the ISI Web of Science and the references of the included...... studies for additional relevant studies. We then performed a risk of bias analysis and descriptive data analysis. RESULTS: We identified 1707 unique citations and included ten studies with a total of 1068 patients undergoing prehospital US examination. Included publications ranged from case series to non...

  10. Comparison between two mobile pre-hospital care services for trauma patients

    OpenAIRE

    Gonsaga Ricardo; Brugugnolli Izabela; Fraga Gustavo

    2012-01-01

    Abstract Objectives Pre-hospital care (PH) in Brazil is currently in the phase of implementation and expansion, and there are few studies on the impacts of this public health service. The purpose of this study is to assess the quality of care and severity of trauma among the population served, using trauma scores, attendance response times, and mortality rates. This work compares two pre-hospital systems: the Mobile Emergency Care Service, or SAMU 192, and the Fire Brigade Group, or CB. Metho...

  11. Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma

    Directory of Open Access Journals (Sweden)

    Mamta Swaroop

    2013-01-01

    Full Text Available Background: Achieving definitive care within the "Golden Hour" by minimizing response times is a consistent goal of regional trauma systems . This study hypothesizes that in urban Level I Trauma Centers, shorter pre-hospital times would predict outcomes in penetrating thoracic injuries. Materials and Methods: A retrospective cohort study was performed using a statewide trauma registry for the years 1999-2003 . Total pre-hospital times were measured for urban victims of penetrating thoracic trauma. Crude and adjusted mortality rates were compared by pre-hospital time using STATA statistical software. Results: During the study period, 908 patients presented to the hospital after penetrating thoracic trauma, with 79% surviving . Patients with higher injury severity scores (ISS were transported more quickly. Injury severity scores (ISS ≥16 and emergency department (ED hypotension (systolic blood pressure, SBP <90 strongly predicted mortality (P < 0.05 for each . In a logistic regression model including age, race, and ISS, longer transport times for hypotensive patients were associated with higher mortality rates (all P values <0.05. This was seen most significantly when comparing patient transport times 0-15 min and 46-60 min (P < 0.001. Conclusion: In victims of penetrating thoracic trauma, more severely injured patients arrive at urban trauma centers sooner . Mortality is strongly predicted by injury severity, although shorter pre-hospital times are associated with improved survival . These results suggest that careful planning to optimize transport time-encompassing hospital capacity and existing resources, traffic patterns, and trauma incident densities may be beneficial in areas with a high burden of penetrating trauma.

  12. Does prehospital ultrasound improve treatment of the trauma patient? A systematic review

    DEFF Research Database (Denmark)

    Jørgensen, Henrik; Jensen, Carsten H; Dirks, Jesper

    2010-01-01

    Ultrasound (US) has been used for in-hospital evaluation of the trauma victim for many years. The outcome in severely injured patients remains heavily influenced by initial life support and early care, as time plays a major role. Development of handheld, battery-powered, low-weight US machines has...... regarding the use of US in the prehospital setting is sparse, often of low quality and describing a broad variety of patients and clinical challenges. Therefore, from an evidence point of view it is not possible to answer the objectives in this review. In the prehospital setting, rapid assessment plays an...... important role, as initial life support and early surgical care influences the outcome of the severely injured patient. Time is especially crucial in blunt abdominal trauma and penetrating truncal injuries. Several studies in this review showed that prehospital US is feasible and that the procedure is...

  13. Epidemiology of Patients With Multiple Trauma and the Quality of Their Prehospital Respiration Management in Kashan, Iran: Six Months Assessment

    OpenAIRE

    Adib-Hajbaghery, Mohsen; Maghaminejad, Farzaneh

    2014-01-01

    Background: Respiration management is an important and critical issue in prehospital transportation phase of multiple trauma patients. However, the quality of this important care has not been assessed in Iran Emergency Medical Services’ (EMS). Objectives: This study was conducted to investigate the quality of prehospital respiration management in patients with multiple trauma, referred to the Shahid Beheshti Trauma Center, Kashan, Iran. Patients and Methods: This cross-sectional study was con...

  14. Efficacy of a sedo-analgesia protocol in pre-hospital trauma treatment

    Directory of Open Access Journals (Sweden)

    Savino Occhionorelli

    2013-06-01

    Full Text Available Pre-hospital trauma treatment is an important situation in which pain should be appropriately assessed and treated, but there is a great lack of studies about it. Literature has widely pointed out that the underanalgesia problem is spread to all groups of patients. The objective of the study is to verify the efficacy of a sedation-analgesia protocol based on the use of NSAIDs, Fentanyl and Midazolam, for prehospital treatment of trauma patients. The protocol was tested in three Emergency Medical Services for a four month period, in which 30 patients were included in the study. Results evidenced a good management of both pain and anxiety in the majority of patients treated, with the achievement of analgesia target in 80% of the patients and sedation target in 100% of the patients.

  15. Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model

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    Grier Gareth

    2010-03-01

    Full Text Available Abstract Introduction We describe a system of scenario-based training using simple mannequins under realistic circumstances for the training of pre-hospital care providers. Methods A simple intubatable mannequin or student volunteers are used together with a training version of the equipment used on a routine basis by the pre-hospital care team (doctor + paramedic. Training is conducted outdoors at the base location all year round. The scenarios are led by scenario facilitators who are predominantly senior physicians. Their role is to brief the training team and guide the scenario, results of patient assessment and the simulated responses to interventions and treatment. Pilots, fire-fighters and medical students are utilised in scenarios to enhance realism by taking up roles as bystanders, additional ambulance staff and police. These scenario participants are briefed and introduced to the scene in a realistic manner. After completion of the scenario, the training team would usually be invited to prepare and deliver a hospital handover as they would in a real mission. A formal structured debrief then takes place. Results This training method technique has been used for the training of all London Helicopter Emergency Medical Service (London HEMS doctors and paramedics over the last 24 months. Informal participant feedback suggests that this is a very useful teaching method, both for improving motor skills, critical decision-making, scene management and team interaction. Although formal assessment of this technique has not yet taken place we describe how this type of training is conducted in a busy operational pre-hospital trauma service. Discussion The teaching and maintenance of pre-hospital care skills is essential to an effective pre-hospital trauma care system. Simple mannequin based scenario training is feasible on a day-to-day basis and has the advantages of low cost, rapid set up and turn around. The scope of scenarios is limited only by

  16. Comparison between two mobile pre-hospital care services for trauma patients

    Directory of Open Access Journals (Sweden)

    Gonsaga Ricardo

    2012-08-01

    Full Text Available Abstract Objectives Pre-hospital care (PH in Brazil is currently in the phase of implementation and expansion, and there are few studies on the impacts of this public health service. The purpose of this study is to assess the quality of care and severity of trauma among the population served, using trauma scores, attendance response times, and mortality rates. This work compares two pre-hospital systems: the Mobile Emergency Care Service, or SAMU 192, and the Fire Brigade Group, or CB. Method Descriptive study evaluating all patients transported by both systems in Catanduva, SP, admitted to a single hospital. Results 850 patients were included, most of whom were men (67.5%; the mean age was 38.5 ± 18.5 years. Regarding the use of PH systems, most patients were transported by SAMU (62.1%. The trauma mechanisms involved motorcycle accidents in 32.7% of cases, transferred predominantly by SAMU, followed by falls (25.8%. Regarding the response time, CB showed the lowest rates. In relation to patient outcome, only 15.5% required hospitalization. The average score on the Glasgow Coma Scale was 14.7 ± 1.3; average RTS was 7.7 ± 0.7; ISS 3.8 ± 5.9; and average TRISS 97.6 ± 9.3. The data analysis showed no statistical differences in mortality between the groups studied (SAMU - 1.5%; CB - 2.5%. The trauma scores showed a higher severity of trauma among the fatal victims. Conclusion Trauma victims are predominantly young and male; the trauma mechanism that accounted for the majority of PH cases was motorcycle accidents; CB responded more quickly than SAMU; and there was no statistical difference between the services of SAMU and CB in terms of severity of the trauma and mortality rates.

  17. An Intelligent Ecosystem for Providing Support in Prehospital Trauma Care in Cuenca, Ecuador.

    Science.gov (United States)

    Timbi-Sisalima, Cristian; Rodas, Edgar B; Salamea, Juan C; Sacoto, Hernán; Monje-Ortega, Diana; Robles-Bykbaev, Vladimir

    2015-01-01

    According to facts given by the World Health Organization, one in ten deaths worldwide is due to an external cause of injury. In the field of pre-hospital trauma care, adequate and timely treatment in the golden period can impact the survival of a patient. The aim of this paper is to show the design of a complete ecosystem proposed to support the evaluation and treatment of trauma victims, using standard tools and vocabulary such as OpenEHR, as well as mobile systems and expert systems to support decision-making. Preliminary results of the developed applications are presented, as well as trauma-related data from the city of Cuenca, Ecuador. PMID:26262065

  18. An Intelligent Ecosystem for Providing Support in Prehospital Trauma Care in Cuenca, Ecuador.

    Science.gov (United States)

    Timbi-Sisalima, Cristian; Rodas, Edgar B; Salamea, Juan C; Sacoto, Hernán; Monje-Ortega, Diana; Robles-Bykbaev, Vladimir

    2015-01-01

    According to facts given by the World Health Organization, one in ten deaths worldwide is due to an external cause of injury. In the field of pre-hospital trauma care, adequate and timely treatment in the golden period can impact the survival of a patient. The aim of this paper is to show the design of a complete ecosystem proposed to support the evaluation and treatment of trauma victims, using standard tools and vocabulary such as OpenEHR, as well as mobile systems and expert systems to support decision-making. Preliminary results of the developed applications are presented, as well as trauma-related data from the city of Cuenca, Ecuador.

  19. [Analgesia and anesthesia in the prehospital stage of mechanical trauma].

    Science.gov (United States)

    Beliakov, V A; Sinitsyn, L N; Maksimov, G A; Akulov, M S; Kalachev, S A; Medvedskiĭ

    1993-01-01

    The work reviews the results of the use of various analgesics and anesthetics in 965 outpatients with mechanical traumas, including 340 ones with shock and blood loss. Central hemodynamics has been studied in 60 patients during anesthesia with lexir, ketamine, sodium hydroxybutyrate, respiratory function has been assessed in 20 patients. The results have been confirmed experimentally on 160 rats, 50 cats, and 40 dogs. It is recommended to apply narcotic and nonnarcotic analgesics, lexir, ketamine intramuscularly not only to patients with shock and pronounced blood loss in whom infusion therapy and intravenous anesthesia with sodium hydroxybutyrate are necessary but in all other cases as well. PMID:8116897

  20. Performance of a prehospital trauma diversion system in Hong Kong, China

    Institute of Scientific and Technical Information of China (English)

    Tak-Wai Lui; Kit-Ling Fan; Ling-Pong Leung

    2015-01-01

    Purpose:To evaluate the performance of a prehospital trauma diversion system in Hong Kong,China.Methods:A retrospective analysis of prospectively collected data in the trauma registry of Queen Mary Hospital,Hong Kong from 1 January 2009 to 31 December 2013 was done.All adult patients aged 18 years or above,either primarily or secondarily diverted to Queen Mary Hospital according to the trauma patient diversion protocol,were recruited.Need for trauma center level of care was based on a consensus-based criterion standard published in 2014.Performance of the protocol in terms of overdiversion and under-diversion was determined.Results:A total of 209 patients were included for analysis.About 30% of the patients required trauma center level of care.The most common reason was the need for vascular,neurologic,abdominal,thoracic,pelvic,spine or limb-conserving surgery within 24 h of presentation.The over-diversion rate and underdiversion rate were 69.6% and 19.7% respectively.Conclusion:The trauma patient diversion protocol currently in use in Hong Kong is not accurate enough.Further revision and refinement is needed.

  1. Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach

    Directory of Open Access Journals (Sweden)

    Hasselberg Marie

    2010-11-01

    Full Text Available Abstract Background Road traffic injuries are a major global public health problem. Improvements in pre-hospital trauma care can help minimize mortality and morbidity from road traffic injuries (RTIs worldwide, particularly in low- and middle-income countries (LMICs with a high rate of RTIs such as Iran. The current study aimed to explore pre-hospital trauma care process for RTI victims in Iran and to identify potential areas for improvements based on the experience and perception of pre-hospital trauma care professionals. Methods A qualitative study design using a grounded theory approach was selected. The data, collected via in-depth interviews with 15 pre-hospital trauma care professionals, were analyzed using the constant comparative method. Results Seven categories emerged to describe the factors that hinder or facilitate an effective pre-hospital trauma care process: (1 administration and organization, (2 staff qualifications and competences, (3 availability and distribution of resources, (4 communication and transportation, (5 involved organizations, (6 laypeople and (7 infrastructure. The core category that emerged from the other categories was defined as "interaction and common understanding". Moreover, a conceptual model was developed based on the categories. Conclusions Improving the interaction within the current pre-hospital trauma care system and building a common understanding of the role of the Emergency Medical Services (EMS emerged as key issues in the development of an effective pre-hospital trauma care process.

  2. Review on pharmacological pain management in trauma patients in (pre-hospital) emergency medicine in the Netherlands

    NARCIS (Netherlands)

    Dijkstra, B.M.; Berben, S.A.A.; Dongen, R.T.M. van; Schoonhoven, L.

    2014-01-01

    Pain is one of the main complaints of trauma patients in (pre-hospital) emergency medicine. Significant deficiencies in pain management in emergency medicine have been identified. No evidence-based protocols or guidelines have been developed so far, addressing effectiveness and safety issues, taking

  3. Review on pharmacological pain management in trauma patients in (pre-hospital) emergency medicine in the Netherlands.

    Science.gov (United States)

    Dijkstra, B M; Berben, S A A; van Dongen, R T M; Schoonhoven, L

    2014-01-01

    Pain is one of the main complaints of trauma patients in (pre-hospital) emergency medicine. Significant deficiencies in pain management in emergency medicine have been identified. No evidence-based protocols or guidelines have been developed so far, addressing effectiveness and safety issues, taking the specific circumstances of pain management of trauma patients in the chain of emergency care into account. The aim of this systematic review was to identify effective and safe initial pharmacological pain interventions, available in the Netherlands, for trauma patients with acute pain in the chain of emergency care. Up to December 2011, a systematic search strategy was performed with MeSH terms and free text words, using the bibliographic databases CINAHL, PubMed and Embase. Methodological quality of the articles was assessed using standardized evaluation forms. Of a total of 2328 studies, 25 relevant studies were identified. Paracetamol (both orally and intravenously) and intravenous opioids (morphine and fentanyl) proved to be effective. Non-steroidal anti-inflammatory drugs (NSAIDs) showed mixed results and are not recommended for use in pre-hospital ambulance or (helicopter) emergency medical services [(H)EMS]. These results could be used for the development of recommendations on evidence-based pharmacological pain management and an algorithm to support the provision of adequate (pre-hospital) pain management. Future studies should address analgesic effectiveness and safety of various drugs in (pre-hospital) emergency care. Furthermore, potential innovative routes of administration (e.g., intranasal opioids in adults) need further exploration. PMID:23737462

  4. Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service

    Directory of Open Access Journals (Sweden)

    Lossius Hans

    2010-06-01

    Full Text Available Abstract Background Anaesthesiologists are airway management experts, which is one of the reasons why they serve as pre-hospital emergency physicians in many countries. However, limited data are available on the actual quality and safety of anaesthesiologist-managed pre-hospital endotracheal intubation (ETI. To explore whether the general indications for ETI are followed and what complications are recorded, we analysed the use of pre-hospital ETI in severely traumatised patients treated by anaesthesiologists in a Norwegian helicopter emergency medical service (HEMS. Methods A retrospective audit of prospectively registered data concerning patients with trauma as the primary diagnosis and a National Committee on Aeronautics score of 4 - 7 during the period of 1994-2005 from a mixed rural/urban Norwegian HEMS was performed. Results Among the 1255 cases identified, 238 successful pre-hospital ETIs out of 240 attempts were recorded (99.2% success rate. Furthermore, we identified 47 patients for whom ETI was performed immediately upon arrival to the emergency department (ED. This group represented 16% of all intubated patients. Of the ETIs performed in the ED, 43 patients had an initial Glasgow Coma Score (GCS Conclusions We found a very high success rate of pre-hospital ETI and few recorded complications in the studied anaesthesiologist-manned HEMS. However, a substantial number of trauma patients were intubated first on arrival in the ED. This delay may represent a quality problem. Therefore, we believe that more studies are needed to clarify the reasons for and possible clinical consequences of the delayed ETIs.

  5. Prehospital pediatric trauma classification (PHPTC as a tool for optimizing trauma care resources in the city of São Paulo, Brazil Classificação do atendimento pré-hospitalar pediátrico como instrumento para otimizar a alocação de recursos no atendimento do trauma na cidade de São Paulo, Brasil

    Directory of Open Access Journals (Sweden)

    Simone de Campos Vieira Abib

    2006-02-01

    Full Text Available PURPOSE: To evaluate the pediatric prehospital care in São Paulo, the databases from basic life support units (BLSU and ALSU, and to propose a simple and effective method for evaluating trauma severity in children at the prehospital phase. METHODS: A single firemen headquarter coordinates all prehospital trauma care in São Paulo city. Two databases were analyzed for children from 0 to 18 years old between 1998 and 2001: one from the Basic Life Support Units (BLSU - firemen and one from the Advanced Life Support Units (ALSU - doctor and firemen. During this period, advanced life support units provided medical reports from 604 victims, while firemen provided 12.761 reports (BLSU+ALSU. Pre-Hospital Pediatric Trauma Classification is based on physiological status, trauma mechanism and anatomic injuries suggesting high energy transfer. In order to evaluate the proposed classification, it was compared to the Glasgow Coma Score and to the Revised Trauma Score. RESULTS: There was a male predominance in both databases and the most common trauma mechanism was transport related, followed by falls. Mortality was 1.6% in basic life support units and 9.6% in ALSU. There was association among the proposed score, the Glasgow Coma Score and to the Revised Trauma Score (pOBJETIVO: Avaliar o atendimento pré-hospitalar de crianças e adolescentes em São Paulo, avaliar o banco de dados das Unidades de Suporte Básico (UR e Avançado (USA e propor um método simples e eficaz para a avaliação da gravidade do trauma pediátrico na fase pré-hospitalar. MÉTODOS: Uma única central do Corpo de Bombeiros (COBOM coordena todo o atendimento pré-hospitalar em São Paulo. Dois bancos de dados foram analisados para crianças de 0 a 18 anos de idade, entre 1998 e 2001: um das Unidades de Suporte Básico de Vida (UR- bombeiros e outra de Unidades de Suporte Avançado (USA - médico e bombeiros. Neste período, o Serviço de Atendimento Médico de Urgência do Estado de

  6. Discussion on pre-hospital emergency care for severe trauma patients%严重创伤院前急救中值得探讨的几个问题

    Institute of Scientific and Technical Information of China (English)

    姚元章

    2012-01-01

    Prehospital emergency care is an important part of severe trauma treatment chains , also is a basic link of trauma treatment system. And it also is an important part of acute medical service system in our country , which is essential to increase the success rate of rescuing severe trauma and decrease the death rate . However, there is no unified pre-hospital emergency care model in our country ,but the same aim of all the pre-hospital emergency care models is to obey the principle of " quick, accurate and steady ". With reviewing the literatures and clinical work experience ,we discuss the problems in the pre-hospital emergency care model.%院前急救是严重创伤救治链中非常重要的一环,也是创伤救治体系"三环理论"中的一个基本环节,是我国急救医疗服务体系中的重要组成部分,是提高严重创伤救治成功率、降低死亡率的根本保证.目前国内院前急救的模式还不统一,存在较多争议,但创伤院前急救的"快、准、稳"是院前急救工作者永远追求的目标.通过回顾文献、结合临床工作经历,就创伤院前急救中涉及的几个问题做一初步探讨,供同仁参考.

  7. Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital.

    Science.gov (United States)

    Jones, Courtney Marie Cora; Cushman, Jeremy T; Lerner, E Brooke; Fisher, Susan G; Seplaki, Christopher L; Veazie, Peter J; Wasserman, Erin B; Dozier, Ann; Shah, Manish N

    2016-01-01

    We describe the decision-making process used by emergency medical services (EMS) providers in order to understand how 1) injured patients are evaluated in the prehospital setting; 2) field triage criteria are applied in-practice; and 3) selection of a destination hospital is determined. We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions. Four exploratory focus groups were conducted to identify overarching themes and five additional confirmatory focus groups were conducted to verify initial focus group findings and provide additional detail regarding trauma triage decision-making and application of field triage criteria. All focus groups were conducted by a public health researcher with formal training in qualitative research. A standardized question guide was used to facilitate discussion at all focus groups. All focus groups were audio-recorded and transcribed. Responses were coded and categorized into larger domains to describe how EMS providers approach trauma triage and apply the Field Triage Decision Scheme. We conducted 9 focus groups with 50 EMS providers. Participants highlighted that trauma triage is complex and there is often limited time to make destination decisions. Four overarching domains were identified within the context of trauma triage decision-making: 1) initial assessment; 2) importance of speed versus accuracy; 3) usability of current field triage criteria; and 4) consideration of patient and emergency care system-level factors. Field triage is a complex decision-making process which involves consideration of many patient and system-level factors. The decision model presented in this study suggests that EMS providers place significant emphasis on speed of decisions, relying on initial impressions and immediately observable information, rather than precise measurement of vital signs or systematic application of field triage criteria. PMID:26017368

  8. Prehospital Trauma Triage Decision-making: A Model of What Happens between the 9-1-1 Call and the Hospital.

    Science.gov (United States)

    Jones, Courtney Marie Cora; Cushman, Jeremy T; Lerner, E Brooke; Fisher, Susan G; Seplaki, Christopher L; Veazie, Peter J; Wasserman, Erin B; Dozier, Ann; Shah, Manish N

    2016-01-01

    We describe the decision-making process used by emergency medical services (EMS) providers in order to understand how 1) injured patients are evaluated in the prehospital setting; 2) field triage criteria are applied in-practice; and 3) selection of a destination hospital is determined. We conducted separate focus groups with advanced and basic life support providers from rural and urban/suburban regions. Four exploratory focus groups were conducted to identify overarching themes and five additional confirmatory focus groups were conducted to verify initial focus group findings and provide additional detail regarding trauma triage decision-making and application of field triage criteria. All focus groups were conducted by a public health researcher with formal training in qualitative research. A standardized question guide was used to facilitate discussion at all focus groups. All focus groups were audio-recorded and transcribed. Responses were coded and categorized into larger domains to describe how EMS providers approach trauma triage and apply the Field Triage Decision Scheme. We conducted 9 focus groups with 50 EMS providers. Participants highlighted that trauma triage is complex and there is often limited time to make destination decisions. Four overarching domains were identified within the context of trauma triage decision-making: 1) initial assessment; 2) importance of speed versus accuracy; 3) usability of current field triage criteria; and 4) consideration of patient and emergency care system-level factors. Field triage is a complex decision-making process which involves consideration of many patient and system-level factors. The decision model presented in this study suggests that EMS providers place significant emphasis on speed of decisions, relying on initial impressions and immediately observable information, rather than precise measurement of vital signs or systematic application of field triage criteria.

  9. The use of the spinal board after the pre-hospital phase of trauma management

    OpenAIRE

    Vickery, D

    2001-01-01

    Objectives—For pre-hospital spinal immobilisation the spinal board is the established gold standard. There are concerns that its subsequent use in hospital may adversely affect patient outcome. This review examines the effect of prolonged patient immobilisation on the spinal board.

  10. The Quality of Pre-hospital Circulatory Management in Patients With Multiple Trauma Referred to the Trauma Center of Shahid Beheshti Hospital in Kashan, Iran, in the First Six Months of 2013

    Directory of Open Access Journals (Sweden)

    Maghaminejad

    2016-05-01

    Full Text Available Background Circulatory management is a critical issue in pre-hospital transportation phase of multiple trauma patients. However, the quality of this important care did not receive enough attention. Objectives The aim of this study was to investigate the quality of pre-hospital circulatory management in patients with multiple trauma. Patients and Methods This was a cross-sectional study conducted in 2013. The study population consisted of all patients with multiple trauma who had been transferred by emergency medical services (EMS to the central trauma department in Kashan Shahid Beheshti medical center, Kashan, Iran. We recruited a convenience sample of 400 patients with multiple trauma. Data were collected using the circulatory assessment questionnaire and controlling hemorrhage (CAQCH that were designed by the researchers and were described by using frequency tabulations, central tendency measures, and variability indices. The chi-square test was used to analyze the data. Results The study sample consisted of 263 males (75.2%; 57.75% had lower levels of education and 28.75% were workers. The most common mechanism of trauma was traffic accident (85.4%. We found that the quality of circulatory management was unfavorable in 61% of the cases. A significant relationship was observed between the quality of circulatory management and type of trauma and staff’s employment status. Conclusions The quality of pre-hospital circulatory management provided to patients with multiple trauma was unfavorable. Therefore, establishment of in-service training programs on circulatory management is recommended.

  11. 创伤院前急救的气道管理%Airway management in pre-hospital first aid in trauma patients

    Institute of Scientific and Technical Information of China (English)

    陈志; 张雁; 张进军

    2012-01-01

    This paper summarized the respiratory problems and first-aid techniques during the period of trauma pre-hospital first aid. And the authors pointed that proper respiratory management was the key to treat severe trauma patients. In order to ensure patients with timely and efficient respiratory support ,the respiratory management was suggested to be conducted with sequences of evaluation ,prevention ,and intervention.%本文将有关创伤院前急救时遇到的呼吸问题和急救技术进行总结、分类,其核心是对所有严重创伤患者进行阶梯化的呼吸管理--评估、预防和干预,使伤病员获得及时、有效的呼吸支持.

  12. Evaluation of the status of the pre-hospital trauma care in road trafifc accidents in Kancheepuram district of Tamil Nadu

    Institute of Scientific and Technical Information of China (English)

    Prateek Saurabh Shrivastava; Jegadeesh Ramasamy

    2015-01-01

    Objective:To evaluate the status of the pre-hospital trauma care in a road traffic accidents in a rural area of Kancheepuram district. Methods: A cross-sectional study of two months duration (June and July 2014) was conducted in the tertiary care hospital of a medical college, and its affiliated urban/rural health centers. Universal sampling was used and all road accident victims were enrolled as study participants. The required information was obtained with the help of a semi-structured questionnaire. Ethical clearance was obtained before the start of the study.SPSS version 18 was used for data entry and statistical analysis. Descriptive statistics were calculated for all the variables. Results:A total of 80 (77.7%) study subjects were from the productive age group (15–45 years). Most of the accidents were reported at night time [43 (41.7%)], on weekends [59 (56.5%)], and involved two-wheelers [81 (78.6%)]. In addition, 69 cases (67%) of the victims were not aware of the existence of emergency ambulance services, while only 6 (5.8%) of the victims were brought to the hospital in an emergency ambulance. Conclusions: The study findings clearly suggest that the quality of the pre-hospital trauma care for road traffic accidentvictims in a rural area of Kancheepuram district lacks on multiple dimensions and there is an immense need to improve and strengthen the range of services to save the lives of the victims.

  13. Evaluation of the status of the pre-hospital trauma care in road traffic accidents in Kancheepuram district of Tamil Nadu

    Directory of Open Access Journals (Sweden)

    Saurabh RamBihariLal Shrivastava

    2015-12-01

    Full Text Available Objective: To evaluate the status of the pre-hospital trauma care in a road traffic accidents in a rural area of Kancheepuram district. Methods: A cross-sectional study of two months duration (June and July 2014 was conducted in the tertiary care hospital of a medical college, and its affiliated urban/rural health centers. Universal sampling was used and all road accident victims were enrolled as study participants. The required information was obtained with the help of a semi-structured questionnaire. Ethical clearance was obtained before the start of the study. SPSS version 18 was used for data entry and statistical analysis. Descriptive statistics were calculated for all the variables. Results: A total of 80 (77.7% study subjects were from the productive age group (15–45 years. Most of the accidents were reported at night time [43 (41.7%], on weekends [59 (56.5%], and involved two-wheelers [81 (78.6%]. In addition, 69 cases (67% of the victims were not aware of the existence of emergency ambulance services, while only 6 (5.8% of the victims were brought to the hospital in an emergency ambulance. Conclusions: The study findings clearly suggest that the quality of the pre-hospital trauma care for road traffic accident victims in a rural area of Kancheepuram district lacks on multiple dimensions and there is an immense need to improve and strengthen the range of services to save the lives of the victims.

  14. Prehospital response model and time to CT scan in blunt trauma patients; an exploratory analysis of data from the head injury retrieval trial

    OpenAIRE

    Garner, Alan A; Mann, Kristy P.; Poynter, Elwyn; Weatherall, Andrew; Dashey, Susan; Puntis, Michael; Gebski, Val

    2015-01-01

    Background It has been suggested that prehospital care teams that can provide advanced prehospital interventions may decrease the transit time through the ED to CT scan and subsequent surgery. This study is an exploratory analysis of data from the Head Injury Retrieval Trial (HIRT) examining the relationship between prehospital team type and time intervals during the prehospital and ED phases of management. Methods Three prehospital care models were compared; road paramedics, and two physicia...

  15. The nursing of pre-hospital care of patients with trauma%外伤患者院前急救的护理

    Institute of Scientific and Technical Information of China (English)

    吕茂英; 李静

    2014-01-01

    For trauma patients,pre-hospital emergency rescue is the golden period.Strict management of the visiting staff, improving the level of first aid,enhancing nurses' consciousness of emergency and first aid ability are the key of pre-hospital care. In our hospital,through a strict management of staff, good treatment and nursing on the patients, no 1 case disputes occur for pre-hospital emergency medical, and it has obtained certain high praise in the society.%外伤患者的院前急救为抢救生命的黄金时期。对出诊人员进行严格管理,提高院前急救水平,增强护士急救意识和急救能力,是做好院前急救的关键。我院通过对出诊人员实行严格管理、对患者实施良好的治疗和护理,无一例因院前急救发生医疗纠纷,在社会上取得了一定好评。

  16. Pre-hospital Emergency Care in 107 Cases of Severe Trauma Patients in Emergency Department%严重创伤患者107例的院前急救护理

    Institute of Scientific and Technical Information of China (English)

    谭雯; 黄严

    2012-01-01

    Objective To explore and improve the measures of pre-hospital emergency care of patients with severe trauma. Methods We retrospectively analyzed the situation and measures of pre-hospital emergency care of 107 patients with severe trauma in our hospital from January 2008 to December 2011. Results Through the rapid and effective pre-hospital emergency care concerning bandaging,hemostasis,fixation and respiration maintenance,our pre-hospital rescue rate reached 98. 13%. Conclusion Professional emergency care team,right measures for emergency care and rational allocation of pre-hospital care resources can effectively improve the survival rate of pre-hospital emergency care.%目的 探讨和完善严重创伤患者的院前急救护理措施.方法 回顾性分析解放军第202医院急诊科2008年1月至2011年12月间107例严重创伤患者的院前急救状况和护理措施.结果 经过及时有效的包扎、止血、固定、维持呼吸等院前急救处理,本组患者院前抢救成功率达到98.13%.结论 强化的急救护理专业队伍建设、采取正确的急救护理措施、合理配置院前急救资源,能有效提高严重创伤患者院前急救的成功率.

  17. An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma.

    Science.gov (United States)

    Bulger, Eileen M; Snyder, David; Schoelles, Karen; Gotschall, Cathy; Dawson, Drew; Lang, Eddy; Sanddal, Nels D; Butler, Frank K; Fallat, Mary; Taillac, Peter; White, Lynn; Salomone, Jeffrey P; Seifarth, William; Betzner, Michael J; Johannigman, Jay; McSwain, Norman

    2014-01-01

    This report describes the development of an evidence-based guideline for external hemorrhage control in the prehospital setting. This project included a systematic review of the literature regarding the use of tourniquets and hemostatic agents for management of life-threatening extremity and junctional hemorrhage. Using the GRADE methodology to define the key clinical questions, an expert panel then reviewed the results of the literature review, established the quality of the evidence and made recommendations for EMS care. A clinical care guideline is proposed for adoption by EMS systems. Key words: tourniquet; hemostatic agents; external hemorrhage. PMID:24641269

  18. Pre-hospital emergency medicine.

    Science.gov (United States)

    Wilson, Mark H; Habig, Karel; Wright, Christopher; Hughes, Amy; Davies, Gareth; Imray, Chirstopher H E

    2015-12-19

    Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care. PMID:26738719

  19. Nursing experiences of trauma patients with prehospital care and transport in Mount Huangshan%黄山山岳型景区外伤患者院前急救与转运的护理体会

    Institute of Scientific and Technical Information of China (English)

    程利萍; 王莉; 汪秀桃; 方婷婷; 潘海波

    2012-01-01

    目的 分析黄山景区院前急救中外伤患者的院前急救与转运特点,探讨山岳型景区外伤患者院前急救护理经验,提高山岳型景区医疗急救人员院前急救和转运外伤患者的能力.方法 对2005年1月1日~2010年12月31日黄山风景区院前急救中的483例外伤患者的病情、急救应急反应、急诊诊断、转运情况、院前护理、死亡等情况进行统计、分析.结果 院前急救外伤患者483例患者,其中头面部外伤216例,死亡5例;四肢伤155例;全身多处伤112例,死亡4例.按病情:一般362例,较重85例,危重27例,死亡9例;转运途中(共转运259例):平稳234例,加重23例,死亡2例.结论 山岳型景区发生的外伤患者需要得到现场及时的急救和规范的院前急救护理,以及转运途中的良好护理,从而提高院前急救的整体水平和急救效果.%Objective To analyse the characteristics in trauma patients with pre-hospital emergency and transport in Mount Huangshan, and discuss the flrst-aid nursing experiences in trauma patients of pre-hospital emergency, to improve the emergency medical technicians ' ability of pre-hospital care and transport of trauma patients in mountain type scenic spot. Methods Statistics and analysis were made of the emergency response, emergency diagnosis, transfer case, pre-hospital care, death on 483 cases of trauma patients with pre-hospital care in the Mount Huangshan scenic area from January 1, 2005 to December 31, 2010. Results The 483 cases of pre-hospital trauma patients, included 216 cases of head and face injuries, S deaths; limb injuries 155 cases; systemic multiple injuries 112 cases, 4 deaths. As for the disease; general 362 cases, severe 85 cases, 27 cases critical, 9 dead; In the course of transport;smooth 234 cases, worsen 23 cases, 2 deaths. Conclusion Trauma patients need to receive timely and standard pre-hospital emergency care, and good transit care, to improve the overall level of first aid

  20. Pain management in trauma patients in (pre)hospital based emergency care: Current practice versus new guideline

    NARCIS (Netherlands)

    A.C. Scholten (Annemieke); S.A.A. Berben (Sivera); A.H. Westmaas (Alvin H); P.M. van Grunsven (Pierre); E.T. de Vaal; P.P.M. Rood (Pleunie); N. Hoogerwerf (N.); C.J.M. Doggen (Carine); R. van Schoonhoven (Renee)

    2015-01-01

    textabstractIntroduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideli

  1. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M.; Vaal, de E.T.; Rood, Pleunie P.M.; Hoogerwerf, N.; Doggen, C.J.M.; Schoonhoven, L.

    2015-01-01

    Introduction Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was devel

  2. Pain management in trauma patients in (pre)hospital based emergency care: current practice versus new guideline

    NARCIS (Netherlands)

    Scholten, A.C.; Berben, S.A.A.; Westmaas, A.H.; Grunsven, P.M. van; Vaal, E.T. de; Hoogerwerf, N.; Doggen, C.J.; Schoonhoven, L.

    2015-01-01

    INTRODUCTION: Acute pain in trauma patients in emergency care is still undertreated. Early pain treatment is assumed to effectively reduce pain in patients and improve long-term outcomes. In order to improve pain management in the chain of emergency care, a national evidence-based guideline was deve

  3. Principles of prehospital care of musculoskeletal injuries.

    Science.gov (United States)

    Worsing, R A

    1984-05-01

    Prehospital management of musculoskeletal injuries in the traumatized patient is based on the application of a few basic principles in an orderly but expeditious manner. The patient must be assessed for immediate life-threatening conditions involving airway, respiratory, and circulatory functions while the cervical spine is protected. Resuscitative efforts to reestablish and preserve an adequate circulating volume of oxygenated blood must follow, using airways, oxygen therapy, and fluid replacement through MAST trousers and intravenous fluids. Cardiac function must be maintained as well. Respiratory function must be monitored and assisted as required. Finally, neurologic status must be assessed and monitored. Secondary assessment of all pertinent history and physical findings is made to delineate all other injuries that do not pose an immediate threat to the life or limb of the patient. Definitive care follows but is limited to basic resuscitation, stabilization, and immobilization techniques under medical control through telemetry and radio communication. Immediate definitive care of the traumatized patient requires the expeditious intervention of the trauma team in a hospital setting with surgical, blood banking, radiographic, laboratory, and other hospital-based capabilities available. Field management of the traumatized patient is directed at the expeditious delivery of the viable patient to the trauma team. In the multiply traumatized patient with severe injuries to several organ systems, prehospital care may need to be expedited to provide this patient the in-hospital care required to save his or her life. Appropriate treatment in such life-threatening trauma situations will consist of a rapid primary assessment, airway and cervical spine control, appropriate respiratory and cardiovascular assistance, gross whole body fracture immobilization using a backboard, and immediate transport. For less severely injured patients, primary assessment, resuscitation

  4. Indicadores clínicos e pré-hospitalares de sobrevivência no trauma fechado: uma análise multivariada Indicadores clínicos y prehospitalarios de supervivencia al trauma cerrado: un análisis multivariado Clinical and prehospital survival indicators in blunt trauma: a multivariate analysis

    Directory of Open Access Journals (Sweden)

    Marisa Aparecida Amaro Malvestio

    2010-06-01

    protector en todos los períodos. Los resultados sugieren que la magnitud de la hipoxemia y la inestabilidad hemodinámica debida a la hemorragia influyeron de manera significativa en la muerte temprana y tardía en este grupo de víctimas.The aim of the study was to identify the clinical and prehospital indicators associated to the survival of blunt trauma victims. The Kaplan Meier survival analysis and the Cox proportional hazards model were used to analyze the association of 33 variables to early and late death, proposing multivariate models. The final models until 48 hours post-trauma showed high rates of risk promoted by abdominal injuries, Injury Severity Score > 25, advanced respiratory procedures and prehospital chest compressions. In the model up to 7 days, a systolic blood pressure in accident site lower than 75mmHg was associated with increased risk of death, and if absent it was associated with higher risk of death after 7 days. The prehospital volume replacement showed a protective effect in all periods. Results suggest that the magnitude of hypoxemia and hemodynamic instability due to bleeding had a significant influence on early and late death in this group of victims.

  5. 1480例院前急救创伤患者流行病学调查%Epidemiology features of 1480 trauma patients with pre-hospital first-aid

    Institute of Scientific and Technical Information of China (English)

    亚力坤·赛来; 阿合买提江·帕哈丁; 帕尔哈提·拜合提

    2014-01-01

    目的 分析新疆医科大学第一附属医院院前急救创伤患者流行病学特点,为创伤急救提供客观依据.方法 收集2006年1月至2010年12月本院“120”接诊的1480例创伤患者院前急救病历,对其致伤原因、受伤时间、AIS-ISS评分等进行回顾性研究.结果 5年期间,本院接诊的院前急救创伤患者,人数逐年增加;院前急救创伤患者占院前急救患者总数的比例也在逐年增加;本院接诊的1480例创伤患者的致伤原因中,位居前3位的分别为交通伤、摔伤以及暴力伤;根据对院前创伤患者的AIS-ISS评分的分析,16~25分之间的创伤患者数量最多,而在这一分值之间的患者,经过合理的治疗,多能治愈,病死率不高;创伤发生的高发年龄段分别为21 ~ 30岁、31~40岁和41~50岁;致伤原因在不同年龄段的分布也有所不同;每天好发创伤的时间段分别为10:00-12:00和16:00-18:00;每年好发创伤的月份分别为5月、6月、7月和8月.结论 院前创伤患者的急救工作应该以创伤患者的疾病分类、年龄、创伤好发的时间为依据,科学合理地安排院前急救工作,组织培训专业人员,使患者得到最快、最好的院前救护.%Objective To analyze the epidemiology features of casualties with pre-hospital first-aid in order to provide an objective basis for the trauma care.Methods Data of 1480 trauma patients with pre hospital first-aid were collected from January 2006 to December 2010.The causes of injury,injury time,and AIS-ISS score were retrospectively analyzed.Results During this five-year period,the number of trauma patients with pre-hospita first-aid admitted into our hospital increased.The ratio of trauma patients treated with first-aid to the total number of rescued patients increased year by year.In these 1480 trauma patients,the three leading causes of trauma were traffic injuries,accidental falls and violence injury.Analysis of the results showed trauma

  6. An investigative study on prehospital trauma care in the downtown area of Chongqing%重庆市主城区120院前创伤急救情况调查

    Institute of Scientific and Technical Information of China (English)

    蔡平军; 周月琴; 都定元

    2012-01-01

    Objective To investigate prehospital trauma care in the downtown area of Chongqing munici -pality. Methods The data of prehospital trauma care of Chongqing municipality from Jan . 2004 to Dec. 2011 were collected from the computer database of Chongqing Emergency Medical Center . Results The total number of prehospital trauma care from Jan. 2004 to Dec. 2011 was 101496 times,road traffic trauma accounted for 68. 23% ,falling injuries 2. 52% , and knife cut injuries 2.21%. The total number of prehospital trauma care from 2007 to 2011 had a significant increase in comparison to the period from 2004 to 2006. The highest trauma incidences by months were ranked in Sep. ,May and Jul.. The lowest incidences by months were ranked in Feb . ,Jan. and Dec.. More injuries occurred in summer than in winter (P <0. 05). Traffic injuries of the highest incidence occurred in the pe -riod of 8-22 o'clock,the lowest incidence in the period of 0-6 o'clock(P <0.05) ; falling injuries of the highest incidence occurred in the period of 8-12 o'clock, 14-16 o'clock,the lowest incidence in the period of 0-6 o'clock(P < 0. 05) ;knife cut injuries of the highest incidence occurred in the period of 20-2 o'clock,the lowest incidence in the period of 4-8 o'clock(P<0.05) ;suicide of the highest incidence occurred in the period of 1046 o'clock,the lowest incidence in the period of 2-8 o'clock( P <0.05) ;burn and scald injury of the highest incidence occurred in the pe -riod of 840 o'clock,648 o'clock,the lowest incidence in the period of 2-6 o'clock(P <0.05). Conclusion Trauma occurrence is related to factors involving the geographical conditions ,road traffic, construction and development in urban and rural areas , industrial and agricultural production , transportation, local public security , weather, and culture. The incidence of trauma also has significantly increased year by year . Different mechanisms of injury have different characteristics in the occurrence frequency and time interval . It

  7. [Prehospital thrombolytic therapy in acute myocardial infarction].

    Science.gov (United States)

    Carlsson, J; Schuster, H P; Tebbe, U

    1997-10-01

    thrombolytic agents in the prehospital setting with the same rate of complications as expected for in-hospital thrombolysis, provided basic resuscitation equipment including a defibrillator is available. The results of randomized studies comparing the results of prehospital and in-hospital thrombolysis seem to justify the prehospital institution of thrombolytic therapy, especially in rural areas where transport times to the hospital are long and the expected time gain is largest. The choice of the thrombolytic agent seems to be of minor importance and should follow prehospital practicability (bolus injection) and costs. Aspirin should be given to all prehospital patients with suspected myocardial infarction regardless of thrombolytic therapy. PMID:9424965

  8. Introduction of the French pre-hospital trauma care system%法国院前创伤急救体系介绍

    Institute of Scientific and Technical Information of China (English)

    顾旭东; 聂时南

    2013-01-01

    The French emergency system is one of the most high -speed and effective emergency systems in the world. Its unique mode of the pre-hospital traumatic care is different from the American mode which is generally used in the world. It greatly improves the success rate of the French pre -hospital traumatic care. Learning the advanced experience of the French pre -hospital traumatic care system will promote our country ' s pre-hospital traumatic care development.%法国的急救体系是目前国际上最高速、最有效的急救体系之一,其独特的急救模式不同于美国和大多数国家的模式,大大提高了法国创伤急救的成功率,学习法国急救经验将有助于我国院前创伤急救体系的发展.

  9. 损伤控制骨科理论指导一体化救治模式在骨科严重多发伤中的应用%Application of damage control orthopaedics guiding the integrated emergency mode of prehospital and inhospital in the severe multiple trauma patients with orthopaedic trauma

    Institute of Scientific and Technical Information of China (English)

    郑世成; 高宗强; 樊立宏; 时志斌; 王坤正; 陈君长; 王小燕

    2013-01-01

    Objective To explore the feasibility and efficacy of damage control orthopaedics (DCO) in treating severe polytrauma patients combined with orthopedic trauma. Methods A retrospective analysis was performed in 82 eligible polytrauma patients with injury severity score >25. From January 2009 to December 2011, the DCO was used to guide the integrated emergency mode of prehospital and inhospital in the severe polytrauma patients with orthopaedic trauma. The time from the admission to definitive surgery, ICU length of stay, total hospital stay, complications and mortality were compared. Results The DCO guiding the integrated emergency mode of prehospital and inhospital could shorten ICU length of stay and the time from the admission to definitive surgery, and lower complications and mortality. Conclusion It is a feasible and effective method in treating severe polytrauma patients combined with orthopaedic trauma by the DCO guiding the integrated emergency mode of prehospital and inhospital.%目的 探讨损伤控制骨科(damage control orthopaedics,DCO)理论在骨科严重多发伤中的可行性和有效性.方法 回顾性分析采用DCO理论指导一体化救治模式后骨科严重多发伤的救治疗效.自2009-01~2011-12在院前、院内一体化救治模式下,骨科严重多发伤采用DCO理论进行救治,比较连续三年的疗效变化,包括来院至接受确定性手术的时间、ICU住院时间、总住院时间、并发症和死亡率等.结果 DCO理论指导一体化救治模式具有可行性,临床效果明显,缩短了ICU的住院时间,显著缩短了严重多发伤患者入院至接受确定手术的时间,明显降低了多发伤患者的并发症和死亡率.结论 运用DCO理论指导骨科多发创伤的一体化治疗,可以降低患者的死亡率,提高救治成功率.

  10. Equipment to prevent, diagnose, and treat hypothermia: a survey of Norwegian pre-hospital services

    OpenAIRE

    Karlsen, Anders M; Thomassen, Øyvind; Vikenes, Bjarne H.; Brattebø, Guttorm

    2013-01-01

    Introduction Hypothermia is associated with increased morbidity and mortality in trauma patients and poses a challenge in pre-hospital treatment. The aim of this study was to identify equipment to prevent, diagnose, and treat hypothermia in Norwegian pre-hospital services. Method In the period of April-August 2011, we conducted a survey of 42 respondents representing a total of 543 pre-hospital units, which included all the national ground ambulance services, the fixed wing and helicopter air...

  11. Acidentes de trânsito: caracterização das vitimas segundo o "Revised Trauma Score" medido no período pré-hospitalar Accidentes de transito: caracterización de las víctimas según el "Revised Trauma Score" medido en el periodo pre-hospitalario Motor vehicle crash: victims' characterization throughout prehospital "Revised Trauma Score"

    Directory of Open Access Journals (Sweden)

    Marisa Amaro Malvestio

    2002-12-01

    Full Text Available O estudo descreve idade, sexo, aspectos do mecanismo e procedimentos realizados em. 643 acidentados de trânsito atendidos nas Marginais Tietê e Pinheiros, considerando os valores do Revised Trauma Score (RTS do período pré-hospitalar. As vítimas com RTS=12 somaram 90,8%, com RTS=11, 4,0% e RTSEste estudio tiene como obje tivo describer, considerando el Revised Trauma Score (RTS obtenido en el periodo pré hospitalario, edad, sexo, aspectos del mecanismo e procedimientos realizados en 643 víctimas de accidente de tránsito. Las víctimas con RTS=12 sumaron 90,8%, con RTS=11, 4,0% y RTSThis report describes age, gender, trauma mechanics aspects and procedures from 643 motor vehicle crashes, MVC, victims in Tietê and Pinheiros expressways, by considering the prehospital Revised Trauma Score (RTS. The RTS=12 victims' were 90,8%, with RTS=11 added 4,0% and in group with RTS<10, 5,2%. Among the RTS<10 victims, the pedestrians stand out (36,4%, the frontal impacts (24,2% and the projected (36,4% or trapped victims (15,1%, and those that received advanced life support procedures.The motorcyclists and the male victims with 21 with 30 years of age were predominant. This study is expected to contribute to a better assistance to MVC victims.

  12. A rubber-covered ceramic weapon reduces the incidence of dental trauma in recruits during combat basic training.

    Science.gov (United States)

    Becker, Talia; Ashkenazi, Malka

    2011-10-01

    The effect of a rubber-covered ceramic weapon was assessed on the incidence of dental trauma during basic training, since soldiers are more at risk of impact from a personal weapon. Dental files of soldiers (n = 4,542), who completed 8 months of training during 2008, were analyzed for incidence and type of dental trauma from a personal weapon. A rubber-covered ceramic weapon (n = 2,972) or a conventional one (n = 1,570, control) was used. Dental trauma was 0.4% per 8 months (0.6% per year) from the ceramic weapon and 1.5% per 8 months (2.3% per year) from the conventional one (pcontrol group). The ceramic weapon significantly reduced dental trauma by diminishing the impact while in direct contact with the teeth or by absorbing and/or distributing the impact force. In conclusion, when possible a rubber-covered ceramic weapon should be preferred for basic combat training.

  13. 院前院内无缝衔接一体化创伤救治%Integrated First Aid for Trauma Patients by Combining Pre-hospital Care with In-hospital Treatment

    Institute of Scientific and Technical Information of China (English)

    班宇侠; 舒艳; 刘利民; 万立东; 王玮; 胡怀建

    2012-01-01

    Objective To explore the possibility and necessity of a new first aid model for trauma which integrates pre—hospital medial care with in—hospital treatment. Methods A comparison was made at the times of pre—operation preparation and hospitalization between two different trauma rescue models. From October in 2010 to October in 2011,116 patients were managed with the new integrated first aid model (pre-hospital care, emergency and multi-department consultations in the hospital) and 86 patients with traditional model (triage in emergency room, preliminary diagnosis by orthopedic doctors, multi-department consultations and medical care). Results There was no significant difference between the two groups in pre—hospital index score (PHI). The total times needed for the preparation before emergency operation and for hospitalization of the new model group were (58±29)min and (28±15)d respectively while those for the traditional model group were (125±60)min and (40±19)d. The differences between the two groups were statistical significant (P < 0.01). Conclusion Both the time of pre-emergency operation and that of hospitalization for trauma patients are shortened through the application of the new trauma rescue model. Patients get better medical care and the efficiency of treatments is improved.%目的 探讨院前院内一体化创伤急救新模式的可行性和必要性.方法 对比研究院前院内联动、院内多学科创伤急救一体化救治的新模式治疗的116例创伤患者和到院后再行院内分诊、多科会诊、分科诊治的传统模式治疗的86例创伤患者,比较两种不同模式的急诊手术前时间和住院时间.结果 新模式的急诊手术前时间和住院时间为(58±29)min及(28±15)d,传统模式为(125±60)min及(40±19)d,2组比较差异均有统计学意义(P均<0.01).结论 院前院内无缝衔接的一体化急救新模式比到院后院内分诊的传统模式大大缩短了急诊反应

  14. Trauma

    Science.gov (United States)

    ... a society whose purpose is to facilitate the integration of basic and clinical disciplines in the study of ... of Health and Human Services National Institutes of Health: NIH...Turning Discovery Into ...

  15. Prehospital Care of Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    TVSP Murthy

    2008-01-01

    Full Text Available Traumatic brain injury (TBI occurs when a sudden trauma causes brain damage. Depending on the severity, outcome can be anything from complete recovery to permanent disability or death. Emergency medical services play a dominant role in provision of primary care at the site of injury. Since little can be done to reverse the initial brain damage due to trauma, attempts to prevent further brain damage and stabilize the patient before he can be brought to a specialized trauma care centre play a pivotal role in the final outcome. Recognition and early treatment of hypoten-sion, hypoxemia, and hypoglycemia, objective neurological assessment based on GCS and pupils, and safe transport to an optimal care centre are the key elements of prehospital care of a TBI patient.

  16. [Case Report: prehospital treatment on a major injured motorcycle driver].

    Science.gov (United States)

    Gräsner, Jan-Thorsten; Knacke, Peer G; Heller, Gilbert; Naguschewski, Jörg; Scholz, Jens

    2008-09-01

    This case report describes the prehospital care of a 42-year-old person damaged by a severe motorcycle accident in a rural scene. The injured person was unconscious, one pupil was dilated and rib fractures were palpable. Purposeful therapy without delay was necessary. The prehospital therapy took 35 minutes in total. The time benefit by using a rescue helicopter is illustrated: time to initial treatment is minimized and duration of transport as well - direct transport to a trauma center is possible. PMID:18792860

  17. London Trauma Conference 2015

    OpenAIRE

    Avery, Pascale; Salm, Leopold; Bird, Flora; Hutchinson, Anja; Jarman, Heather; Nilsson, Maria Bergman; Konig, Tom; Tai, Nigel; Fevang, Espen; Hognestad, Børge; Abrahamsen, Håkon B.; Cheetham, Olivia V.; Thomas, Matthew J C; Rooney, Kieron D.; Murray, Josephine

    2016-01-01

    Table of contents I1: Trauma, Pre-hospital and Cardiac Arrest Care 2015 Pascale Avery, Leopold Salm, Flora Bird A1: Retrospective evaluation of HEMS ‘Direct to CT’ protocol Anja Hutchinson, Ashley Matthies, Anthony Hudson, Heather Jarman A2 Rush hour – Crush hour: temporal relationship of cyclist vs. HGV trauma admissions. A single site observational study Maria Bergman Nilsson, Tom Konig, Nigel Tai A3 Semiprone position endotracheal intubation during continuous cardiopulmonary resuscitation ...

  18. Prehospital care in Indonesia

    OpenAIRE

    Pitt, E.; Pusponegoro, A

    2005-01-01

    Current system: Hospitals of varying standards are widespread but have no system of emergency ambulance or patient retrieval. Indonesia's only public emergency ambulance service, 118, is based in five of the biggest cities and is leading the way in paramedic training and prehospital care.

  19. Management of pain in pre-hospital settings.

    Science.gov (United States)

    Parker, Michael; Rodgers, Antony

    2015-06-01

    Assessment and management of pain in pre-hospital care settings are important aspects of paramedic and clinical team roles. As emergency department waiting times and delays in paramedic-to-nurse handover increase, it becomes more and more vital that patients receive adequate pre-hospital pain relief. However, administration of analgesia can be inadequate and can result in patients experiencing oligoanalgesia, or under-treated pain. This article examines these issues along with the aetiology of trauma and the related socioeconomic background of traumatic injury. It reviews validated pain-assessment tools, outlines physiological responses to traumatic pain and discusses some of the misconceptions about the provision of effective analgesia in pre-hospital settings. PMID:26050779

  20. Improving adjustments for older age in pre-hospital assessment and care

    OpenAIRE

    Rehn Marius

    2013-01-01

    Abstract Population estimates projects a significant increase in the geriatric population making elderly trauma patients more common. The geriatric trauma patients experience higher incidence of pre-existing medical conditions, impaired age-dependent physiologic reserve, use potent drugs and suffer from trauma system related shortcomings that influence outcomes. To improve adjustments for older age in pre-hospital assessment and care, several initiatives should be implemented. Decision-makers...

  1. A method to reduce response times in prehospital care: the motorcycle experience.

    Science.gov (United States)

    Lin, C S; Chang, H; Shyu, K G; Liu, C Y; Lin, C C; Hung, C R; Chen, P H

    1998-11-01

    This study compared the response times of a motorcycle and a standard ambulance in a congested urban emergency medical services (EMS) setting. The study was performed in Taipei, Taiwan, a densely populated urban area. A basic life support (BLS) motorcycle (without defibrillation capability) and an advanced life support (ALS) ambulance were based at three study hospitals and simultaneously dispatched when there was a perceived need for ALS ambulance transport. Over a 3-month period, prehospital personnel evaluated 307 medical and trauma emergencies. Time data were insufficient for analysis in 33 cases, leaving a study population of 274. Response times of the motorcycle and the ambulance were prospectively assessed and compared. During rush hours, the response times of the motorcycle and ambulance were 4.9+/-3.0 minutes and 6.3+/-3.4 minutes (P motorcycles to transport EMTs to the emergency scene significantly reduced response time compared with a standard ambulance in a congested urban setting. Large prospective studies are required to determine the impact on patient outcome of shorter EMS response times using motorcycles. EMS motorcycles appear feasible and deserve consideration to help expedite prehospital care in other systems in densely populated cities. PMID:9827757

  2. Paediatric trauma and trauma care in Flanders (Belgium). Methodology and first descriptive results of the PENTA registry.

    Science.gov (United States)

    Van de Voorde, Patrick; Sabbe, Marc; Calle, Paul; Lesaffre, Emmanuel; Rizopoulos, Dimitris; Tsonaka, Roula; Christiaens, Daphne; Vantomme, Anneleen; De Jaeger, Annick; Matthys, Dirk

    2008-11-01

    Paediatric injury surveillance and prevention are definite priorities for the European, Belgian, and Flemish authorities. Current available data for Flanders (Belgium) are fragmentary and out-of-date. The PENTA registry (PaEdiatric Network around TraumA) was therefore set up to obtain recent population-based data on trauma and trauma care in children and youngsters in Flanders. Data were collected prospectively in a representative sample (n = 18) of Flemish emergency departments (ED). All children (age 0-17 years) who presented at the ED in 2005 or died prehospital due to trauma were included. The registry was split into two levels. The basic A registry ('all' trauma) consisted of 30 variables, and the more exhaustive B registry ('severe trauma', defined as length of hospitalisation >48 hours, including all nonsurvivors) collected data on 291 variables. The incidence for paediatric trauma presenting at Flemish ED was approximately 119/1000/year. Further data were collected in a random sample of 7,879 cases (21.9% of 35,900 eligible patients). Of all cases, 0.8% were considered 'severe' and included in the B registry. In conclusion, the 'burden' of injury in Flanders is still enormous. PENTA provides the first population-based data about the circumstances and the extent of injury in children and youngsters for the Flemish region. In this article we present in detail the surplus value of the methods used, the difficulties encountered, and the most relevant epidemiological findings from the registry. PMID:18202851

  3. Prehospital transported patients

    DEFF Research Database (Denmark)

    Bech, Camilla Louise Nørgaard; Brabrand, M.; Lassen, Annmarie Touborg

    2015-01-01

    in the period of inclusion. Overall 7-day mortality was 4.3% (95% CI = 4.0 to 4.6). Univariate analysis showed increasing age, Charlson Comorbidity Index >2, vital parameters outside the normal reference range and summoned physician-assisted mobile emergency care units to be associated with 7-day mortality...... for assessing potential risk factors associated with adverse outcomes and mortality. Our aim was to describe ambulance transports to the ED and identify prognostic factors accessible in the prehospital phase and associated with 7-day mortality. Methods We included all adult patients (>18 years) with a first......-based healthcare registers in order to identify comorbid conditions and information on mortality. Demographic factors and first registered vital sign were analysed by univariate logistic regression analysis, with 7-day mortality as outcome. Results In total, 18,572 first-time ambulance contacts were identified...

  4. The development and features of the Spanish prehospital advanced triage method (META) for mass casualty incidents.

    Science.gov (United States)

    Arcos González, Pedro; Castro Delgado, Rafael; Cuartas Alvarez, Tatiana; Garijo Gonzalo, Gracia; Martinez Monzon, Carlos; Pelaez Corres, Nieves; Rodriguez Soler, Alberto; Turegano Fuentes, Fernando

    2016-01-01

    This text describes the process of development of the new Spanish Prehospital Advanced Triage Method (META) and explain its main features and contribution to prehospital triage systems in mass casualty incidents. The triage META is based in the Advanced Trauma Life Support (ATLS) protocols, patient's anatomical injuries and mechanism of injury. It is a triage method with four stages including early identification of patients with severe trauma that would benefit from a rapid evacuation to a surgical facility and introduces a new patient flow by-passing the advanced medical post to improve evacuation. The stages of triage META are: I) Stabilization triage that classifies patients according to severity to set priorities for initial emergency treatment; II) Identifying patients requiring urgent surgical treatment, this is done at the same time than stage I and creates a new flow of patients with high priority for evacuation; III) Implementation of Advanced Trauma Life Support protocols to patients previously classified according to stablished priority; and IV) Evacuation triage, stablishing evacuation priorities in case of lacks of appropriate transport resources. The triage META is to be applied only by prehospital providers with advanced knowledge and training in advanced trauma life support care and has been designed to be implemented as prehospital procedure in mass casualty incidents (MCI). PMID:27130042

  5. Shock trauma.

    Science.gov (United States)

    Trunkey, D D

    1984-09-01

    Trauma - accidental or intentional injury - is a major health and social problem. It is still the chief cause of death in people between the ages of 1 and 38 years. In the United States, the mortality due to trauma between the ages of 15 and 24 years increased by 13% from 1960 to 1978. During the same period, the mortality for people aged 25 to 64 years declined by 16%. Murders have increased from 8464 in 1960, to 26 000 in 1982. The overall death rate of American teenagers and young adults is 50% higher than that of their counterparts in Britain, Sweden and Japan. Trauma affects young, productive citizens, and the estimated costs for death, disability and loss of productivity exceed $230 million a day. The most tragic statistic is that at least 40% of the deaths are needless and preventable if better treatment and prevention programs were available. Trauma deaths that might be prevented are those due to motor vehicle accidents, homicide, burns, and alcohol and drug abuse. In this paper suggestions for prevention are made. They include improved crash worthiness of motor vehicles, revocation of drunk drivers' licences, use of devices that limit drunk drivers, increased tax on alcohol and random breathalyser tests, and the use of seat belts and motorcycle helmets. Control of hand-guns and burn characteristics of cigarettes could also reduce deaths. The problems and issues in trauma care can be divided into two broad categories: system and professional. System problems include prehospital care, in-hospital care, rehabilitation and prevention. Professional problems include education, research, economics, and quality.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6478325

  6. Improving adjustments for older age in pre-hospital assessment and care

    Directory of Open Access Journals (Sweden)

    Rehn Marius

    2013-01-01

    Full Text Available Abstract Population estimates projects a significant increase in the geriatric population making elderly trauma patients more common. The geriatric trauma patients experience higher incidence of pre-existing medical conditions, impaired age-dependent physiologic reserve, use potent drugs and suffer from trauma system related shortcomings that influence outcomes. To improve adjustments for older age in pre-hospital assessment and care, several initiatives should be implemented. Decision-makers should make system revisions and introduce advanced point-of-care initiatives to improve outcome after trauma for the elderly.

  7. The effects of different pre-hospital intervention of treatment modes on the prognosis of patients with severe multiple trauma%不同院前干预救治模式对重症多发创伤患者预后的影响

    Institute of Scientific and Technical Information of China (English)

    周开国; 李建忠; 贾慧林; 马炳辰; 曹秋梅

    2016-01-01

    Objective To investigate the effects of different treatment modes on the prognosis of patients with severe trauma.Methods The general data of 396 patients with severe trauma [injurey severity scores (ISS) ≥25] in our hospital emergency for treatment from January 1,2008 to January 1,2012 was collected.The trauma patients were divided into study group and control group.In the study group,the trauma patients were cared by emergency physician of our hospital for pre-hospital treatment during transportation by ambulance since January 1,2010.In the control group,the trauma patients were served with traditional pre-hospital emergency care by the 120 and 999 before January 1,2010.The injury severity score,medical care and outcomes were recorded in trauma database and the efficiency and quality of medical care were compared between two groups.Results The emergency treatment time,length of hospital stays,ICU admission rate,prehospital mortality rate,long-term (6 months) disability rate,and complication rate in the study group were lower than those in the control group,presenting (78.23 ± 21.57) min vs.(96.45 ± 35.14) min,(23.55±12.46) dvs.(28.67±20.72) d,8.1% (18/222)vs.65.5% (114/174),13.3% (34/256) vs.21.6% (48/222),4.1% (9/222)vs.9.2% (16/174),8.1% (18/222)vs.18.4% (32/174),in which the differences were statistically significant (P < 0.05).Hospital mortality in the study group was also lower than that in the control group,showing 8.1% (18/222) vs.12.6% (22/174),but there was no statistically significant difference (P < 0.05).There was no significant difference in time from occurrence of injury to receiving treatment between the two groups.Conclusion Emergency physicians-cared mode had advantages to improve treatment success rates and reduce mortality in patients with multiple trauma compared with the current conventional emergency mode.It is a good alternative emergency mode.%目的 探讨不同院前救治模式对重症创

  8. Taking the Blood Bank to the Field: The Design and Rationale of the Prehospital Air Medical Plasma (PAMPer) Trial.

    Science.gov (United States)

    Brown, Joshua B; Guyette, Francis X; Neal, Matthew D; Claridge, Jeffrey A; Daley, Brian J; Harbrecht, Brian G; Miller, Richard S; Phelan, Herb A; Adams, Peter W; Early, Barbara J; Peitzman, Andrew B; Billiar, Timothy R; Sperry, Jason L

    2015-01-01

    Hemorrhage and trauma induced coagulopathy remain major drivers of early preventable mortality in military and civilian trauma. Interest in the use of prehospital plasma in hemorrhaging patients as a primary resuscitation agent has grown recently. Trauma center-based damage control resuscitation using early and aggressive plasma transfusion has consistently demonstrated improved outcomes in hemorrhaging patients. Additionally, plasma has been shown to have several favorable immunomodulatory effects. Preliminary evidence with prehospital plasma transfusion has demonstrated feasibility and improved short-term outcomes. Applying state-of-the-art resuscitation strategies to the civilian prehospital arena is compelling. We describe here the rationale, design, and challenges of the Prehospital Air Medical Plasma (PAMPer) trial. The primary objective is to determine the effect of prehospital plasma transfusion during air medical transport on 30-day mortality in patients at risk for traumatic hemorrhage. This study is a multicenter cluster randomized clinical trial. The trial will enroll trauma patients with profound hypotension (SBP ≤ 70 mmHg) or hypotension (SBP 71-90 mmHg) and tachycardia (HR ≥ 108 bpm) from six level I trauma center air medical transport programs. The trial will also explore the effects of prehospital plasma transfusion on the coagulation and inflammatory response following injury. The trial will be conducted under exception for informed consent for emergency research with an investigational new drug approval from the U.S. Food and Drug Administration utilizing a multipronged community consultation process. It is one of three ongoing Department of Defense-funded trials aimed at expanding our understanding of the optimal therapeutic approaches to coagulopathy in the hemorrhaging trauma patient.

  9. Organizational network in trauma management in Italy

    OpenAIRE

    Osvaldo Chiara; Stefania Cimbanassi; Alba Fava; Sergio Vesconi

    2005-01-01

    In Italy, as in other western countries, trauma is a leading cause of death during the first four decades of life, with almost 18.000 of deaths per year. Since 80s organized systems for trauma care, including a pre-hospital emergency medical system and a network of hospitals designated as Trauma Centres, have been developed in north American countries. Effectiveness of trauma systems has been investigated comparing the post-system to the pre-system trauma care with the method of panel evaluat...

  10. Trauma care system in Iran

    Institute of Scientific and Technical Information of China (English)

    Moussa Zargar; Sarah Ganji; Mahmoud Khodabandeh; Shahab Abdollahi Far; Morteza Abdollahi; Mohammad Reza Zarei; Seyed Mohammad Reza Kalantar Motamedi; Mojgan Karbakhsh; Seyed Mohammad Ghodsi; Vafa Rahimi-Movaghar; Farzad Panahi; Soheil Saadat; Ali Khaji; Seyed Mahdi Davachi

    2011-01-01

    Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries,but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement,hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance,financial resources), it is not yet established in our system of trauma care.Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.

  11. [Scandinavian guidelines for prehospital management of severe traumatic brain injury

    DEFF Research Database (Denmark)

    Sollid, S.; Sundstrom, T.; Kock-Jensen, C.;

    2008-01-01

    Head trauma is the cause the death for many young persons. The number of fatalities can be reduced through systematic management. Prevention of secondary brain injury combined with the fastest possible transport to a neurosurgical unit, have been shown to effectively reduce mortality and morbidity....... Evidence-based guidelines already exist that focus on all steps in the process. In the present article members of the Scandinavian Neurotrauma Committee present recommendations on prehospital management of traumatic brain injury adapted to the infrastructure of the Nordic region Udgivelsesdato: 2008/6/26...

  12. Migrants' and professionals' views on culturally sensitive pre-hospital emergency care.

    Science.gov (United States)

    Kietzmann, Diana; Hannig, Christian; Schmidt, Silke

    2015-08-01

    This study was designed to explore the views of migrants and professionals on culturally sensitive pre-hospital emergency care in order to adapt such care to migrants' needs. Interviews were conducted with 41 migrants who had received direct (as a patient) or indirect (as a significant other) pre-hospital emergency care. Furthermore, 20 professionals in the field of pre-hospital emergency care were interviewed. The content analysis showed five distinguishable categories based on the statements by the migrants and six categories based on the statements by the professionals. While migrants gave priority to basic proficiencies of first responders such as 'social/emotional competencies' and 'communication skills', the professionals considered '(basic) cultural knowledge', 'awareness' and 'attitude' the most important. Furthermore, migrants provided practical indications, e.g. regarding areas of cultural knowledge, whereas professionals seemed to view the issue of culturally pre-hospital emergency care from a more theoretical perspective. The issues of the culturally sensitive pre-hospital emergency care itself, as well as the varying points of view of the two groups interviewed, resulted in eight recommendations for culturally sensitive pre-hospital emergency care. PMID:26123882

  13. Triage in the Tower of Babel: interpreter services for children in the prehospital setting.

    Science.gov (United States)

    Tate, Ramsey C; Kelley, Maureen C

    2013-12-01

    Minority pediatric populations have higher rates of emergency medical services use than the general pediatric population, and prior studies have documented that limited-English proficiency patients are more likely to undergo invasive procedures, require more resources, and be admitted once they arrive in the emergency department. Furthermore, limited-English proficiency patients may be particularly vulnerable because of immigration or political concerns. In this case report, we describe an infant with breath-holding spells for whom a language barrier in the prehospital setting resulted in an escalation of care to the highest level of trauma team activation. This infant underwent unnecessary, costly, and harmful interventions because of a lack of interpreter services. In a discussion of the legal, ethical, and medical implications of this case, we conclude that further investigation into prehospital strategies for overcoming language barriers is required to provide optimal prehospital care for pediatric patients. PMID:24300472

  14. 衢州地区急性颅脑创伤患者院前及急诊救治现状分析%Analysis on pre-hospital care and emergency treatment of craniocerebral trauma patients in Quzhou district

    Institute of Scientific and Technical Information of China (English)

    黄强; 戴伟民; 揭园庆; 聂俊; 王小芳; 胡永亮; 余小明; 宋光太; 金涛

    2013-01-01

    Objective To study an epidemiological research and analysis on current status of craniocerebral trauma patients'pre-hospital care and emergency treatment.Methods In order to achieve the objective,factors,including age,sex,cause of injury,injury date and time,on-site emergency treatment,transport mode,time period from injury to specialist treatment,time period from injury to first-time head examine,emergency room treatment status,treatment outcomes,etc.,are analyzed based on statistics of craniocerebral trauma in-patients of Quzhou district in 2009.Results Young men are the high risk population of acute craniocerebral trauma.Traffic accident is the main cause of trauma,mines and factories are closely related places.The relative percentages of on-site professional emergency treatment and ambulance transportation are quite low.Township hospitals have the shortest time period from injury to hospital treatment,but also have the longest time period from injury to specialist treatment or first-time head CT examine.raniocerebral trauma are mainly closed injuries,while the most common emergency room treatments are debridement and suturing.Conclusion Craniocerebral trauma is a dangerous kind of traumatic diseases with high risk and incidence rate.The incidence rate of the trauma can be reduced by strengthening the enforcement of related laws and regulations as well as the popularization and education of related knowledge.The mortality rate and disability rate can be reduced by training the doctors and nurses as well as improving the medical equipment of hospitals,especially the primary hospitals.%目的 对颅脑创伤患者的院前急救和急诊室救治现状进行流行病学调查和研究.方法 以2009年衢州地区颅脑创伤住院病人为研究对象,对年龄、性别、致伤原因、致伤日期和时间、现场急救、伤员转运方式、受伤-急诊专科救治时间、受伤-首次头颅检查时间、急诊室急救现状和治疗结

  15. Organization of prehospital medical care for patients with cerebral stroke

    Directory of Open Access Journals (Sweden)

    Nikolai Anatolyevich Shamalov

    2013-01-01

    Full Text Available The main tasks of prehospital medical care are to make a correct diagnosis of stroke and to minimize patient transportation delays. Stroke is a medical emergency so all patients with suspected stroke must be admitted by a first arrived ambulance team to a specialized neurology unit for stroke patients. Most rapidly transporting the patient to hospital, as well as reducing the time of examination to verify the pattern of stroke are a guarantee of successful thrombolytic therapy that is the most effective treatment for ischemic stroke. Substantially reducing the time of in-hospital transfers (the so-called door-to-needle time allows stroke patients to be directly admitted to the around the clock computed tomography room, without being sent to the admission unit. Prehospital stroke treatment policy (basic therapy is to correct the body’s vital functions and to maintain respiration, hemodynamics, and water-electrolyte balance and it can be performed without neuroimaging verification of the pattern of stroke. The application of current organizational, methodical, and educational approaches is useful in improving the quality of medical care for stroke patients, in enhancing the continuity between prehospital and hospital cares, and in promoting new effective technologies in stroke therapy.

  16. Anaesthesiologist-provided prehospital airway management in patients with traumatic brain injury: an observational study

    Science.gov (United States)

    Hansen, Troels M.; Kirkegaard, Hans; Tønnesen, Else

    2014-01-01

    Background Guidelines recommend that patients with brain trauma with a Glasgow Coma Scale (GCS) score of less than 9 should have an airway established. Hypoxia, hypotension and hypertension as well as hypoventilation and hyperventilation may worsen outcome in these patients. Objectives The objectives were to investigate guideline adherence, reasons for nonadherence and the incidences of complications related to prehospital advanced airway management in patients with traumatic brain injury. Materials and methods We prospectively collected data from eight anaesthesiologist-staffed prehospital critical care teams in the Central Denmark Region according to the Utstein-style template. Results Among 1081 consecutive prehospital advanced airway management patients, we identified 54 with a traumatic brain injury and an initial GCS score of less than 9. Guideline adherence in terms of airway management was 92.6%. The reasons for nonadherence were the patient’s condition, anticipated difficult airway management and short distance to the emergency department. Following rapid sequence intubation (RSI), 11.4% developed oxygen saturation below 90%, 9.1% had a first post-RSI systolic blood pressure below 90 mmHg and 48.9% had a first post-RSI systolic blood pressure below 120 mmHg. The incidence of hypertension following prehospital RSI was 4.5%. The incidence of postendotracheal intubation hyperventilation was as high as 71.1%. Conclusion The guideline adherence was high. The incidences of post-RSI hypoxia and systolic blood pressure below 90 compare with the results reported from other physician-staffed prehospital services. The incidence of systolic blood pressure below 120 as well as that of hyperventilation following prehospital endotracheal intubation in patients with traumatic brain injury call for a change in our current practice. PMID:24368407

  17. Trauma care system in Iran

    Directory of Open Access Journals (Sweden)

    Zargar Moussa

    2011-06-01

    Full Text Available 【Abstract】Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to de- scribe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through ex- pert panels and semi-structured interviews with trauma spe- cialists and policy makers. Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of pub- lic education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training stan- dards of the front line medical team and continuing educa- tion and evaluation are yet to be addressed. Trauma regis- try has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources, it is not yet established in our system of trauma care. Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system. Key words: Emergency medical services; Trauma centers; Wounds and injuries

  18. Airway management in trauma

    Directory of Open Access Journals (Sweden)

    Rashid M Khan

    2011-01-01

    Full Text Available Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level.

  19. Is paediatric trauma severity overestimated at triage?

    DEFF Research Database (Denmark)

    DO, H Q; Hesselfeldt, R; Steinmetz, J;

    2014-01-01

    BACKGROUND: Severe paediatric trauma is rare, and pre-hospital and local hospital personnel experience with injured children is often limited. We hypothesised that a higher proportion of paediatric trauma victims were taken to the regional trauma centre (TC). METHODS: This is an observational...... follow-up study that involves one level I TC and seven local hospitals. We included paediatric (trauma patients with a driving distance to the TC > 30 minutes. The primary end-point was the proportion of trauma patients arriving in the TC. RESULTS: We included 1934...... trauma patients, 238 children and 1696 adults. A total of 33/238 children (13.9%) vs. 304/1696 adults (17.9%) were transported to the TC post-injury (P = 0.14). Among these, children were significantly less injured than adults [median Injury Severity Score (ISS) 9 vs. 14, P 

  20. Outcome following physician supervised prehospital resuscitation

    DEFF Research Database (Denmark)

    Mikkelsen, Søren; Krüger, Andreas J; Zwisler, Stine T;

    2015-01-01

    to treat the patient. RESULTS: Of 25 647 patients treated by the MECU, 701 (2.7%) received prehospital 'life saving treatment'. In 596 (2.3%) patients this treatment exceeded the competences of the attending emergency medical technician or paramedic. Of these patients, 225 (0.9%) were ultimately discharged...... to their own home. CONCLUSIONS: The present study demonstrates that anaesthesiologist administrated prehospital therapy increases the level of treatment modalities leading to an increased survival in relation to a prehospital system consisting of emergency medical technicians and paramedics alone and thus......BACKGROUND: Prehospital care provided by specially trained, physician-based emergency services (P-EMS) is an integrated part of the emergency medical systems in many developed countries. To what extent P-EMS increases survival and favourable outcomes is still unclear. The aim of the study was thus...

  1. Pre-hospital and initial management of head injury patients: An update

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2014-01-01

    Full Text Available Background: Most of the bad outcomes in patients with severe traumatic brain injury (TBI are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on "Prehospital Management" published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006. Methods: A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013, which specifically discussed about the topic, was conducted. Results: Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficult airway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided. Conclusion: Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.

  2. Poly Trauma in Rural India-Changing Trends

    Directory of Open Access Journals (Sweden)

    Goyal S

    2006-01-01

    Full Text Available Background : Poly trauma is a major killer. Team work is essential for better management. Method : Survey was undertaken to collect baseline data in polytrauma patient. Result : Two thousand patients were studied. Cause was fall in 904, vehicular accident in 776 and assault in 320 patients. Conclusion : There should be good prehospital emergency service and quick transport to equipped hospital.

  3. Trauma Kimia

    OpenAIRE

    Lubis, Rodiah Rahmawaty

    2015-01-01

    Mata merupakan organ yang keberadaannya berhubungan langsung dengan lingkungan luar sehingga sering menyebabkan mata terkena dampak dari posisi anatominya tersebut. Mata sering terpapar dengan keadaan lingkungan sekitar seperti udara, debu, benda asing dan suatu trauma yang dapat langsung mengenai mata. Trauma pada mata meliputi trauma tumpul, trauma tajam, trauma kimia, dan trauma radiasi. Rodiah Rahmawaty Lubis

  4. Development of the trauma emergency care system based on the three links theory

    Institute of Scientific and Technical Information of China (English)

    JIANG Guan-yu; SHEN Wei-feng; GAN Jian-xin

    2005-01-01

    The three links theory applied in trauma emergency care system refers to an integrated system with the three important components of trauma emergency care system, viz. prehospital trauma services, hospital trauma services and critical care services. The development of the trauma emergency care system should be guided by the three links theory so as to set up a practical and highly efficient system: a prompt operating and monitoring transportation system, a smooth and real-time information system, a rational and sustainable system of regulations and contingency plans, and a system for cultivating all-round trauma physicians.

  5. Prehospital care in Hong Kong.

    Science.gov (United States)

    Lo, C B; Lai, K K; Mak, K P

    2000-09-01

    A quick and efficient prehospital emergency response depends on immediate ambulance dispatch, patient assessment, triage, and transport to hospital. During 1999, the Ambulance Command of the Hong Kong Fire Services Department responded to 484,923 calls, which corresponds to 1329 calls each day. Cooperation between the Fire Services Department and the Hospital Authority exists at the levels of professional training of emergency medical personnel, quality assurance, and a coordinated disaster response. In response to the incident at the Hong Kong International Airport in the summer of 1999, when an aircraft overturned during landing, the pre-set quota system was implemented to send patients to designated accident and emergency departments. Furthermore, the 'first crew at the scene' model has been adopted, whereby the command is established and triage process started by the first ambulance crew members to reach the scene. The development of emergency protocols should be accompanied by good field-to-hospital and interhospital communication, the upgrading of decision-making skills, a good monitoring and auditing structure, and commitment to training and skills maintenance. PMID:11025847

  6. Organizational network in trauma management in Italy

    Directory of Open Access Journals (Sweden)

    Osvaldo Chiara

    2005-10-01

    Full Text Available In Italy, as in other western countries, trauma is a leading cause of death during the first four decades of life, with almost 18.000 of deaths per year. Since 80s organized systems for trauma care, including a pre-hospital emergency medical system and a network of hospitals designated as Trauma Centres, have been developed in north American countries. Effectiveness of trauma systems has been investigated comparing the post-system to the pre-system trauma care with the method of panel evaluation of preventable death rates and comparison of observed survival with expected probability of survival. In Italy, a pre-hospital emergency medical system has been implemented on a national scale, while a trauma network has not been developed. Nowadays, trauma patients are often admitted to the closest hospital, independently from local resources. The Superior Council of Ministry of Health has presented in 2004 a new trauma system model (SIAT based on the recognition in the field of patients with more serious injuries and the transportation to general hospitals with resources and multidisciplinary teams specialized in trauma care (trauma team. The designation of few trauma team hospitals, one highly specialized Centre (CTS and two area Centres (CTZ every two millions of inhabitants allows each Centre to treat at least 250 severe trauma patients per year to increase experience. Less severe injured patients may be treated in non-trauma team acute care facilities, according to the inclusive system model. The development of trauma team services in some Italian hospitals has demonstrated an increase in survival and a decrease in preventable death rate from 42% to 7,6%. Economic studies of Ministry of Health have established that the implementation of a trauma system model on a national scale with a 25% decrease of preventable trauma deaths and disabilities would save 7500 million of euros of public money. Therefore, in our country the concentration of severely

  7. [Scandinavian guidelines on the pre-hospital management of traumatic brain injury

    DEFF Research Database (Denmark)

    Juul, N.; Sollid, S.; Sundstrom, T.;

    2008-01-01

    Head trauma causes the death of many young persons. The number of fatalities can be reduced through systematic management. Preventing secondary brain injury together with the fastest possible transport to a neurosurgical unit has been shown to be effective in reducing mortality and morbidity....... Evidence-based guidelines already exist that focus on all steps in the management. This article, which was written by members of the Scandinavian Neurotrauma Committee, presents recommendations on the pre-hospital management of traumatic brain injury adapted to the infrastructure of Scandinavia...

  8. Hypotensive Resuscitation among Trauma Patients

    Science.gov (United States)

    Carrick, Matthew M.; Leonard, Jan; Slone, Denetta S.; Mains, Charles W.

    2016-01-01

    Hemorrhagic shock is a principal cause of death among trauma patients within the first 24 hours after injury. Optimal fluid resuscitation strategies have been examined for nearly a century, more recently with several randomized controlled trials. Hypotensive resuscitation, also called permissive hypotension, is a resuscitation strategy that uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock. A lower-than-normal blood pressure is maintained until operative control of the bleeding can occur. The randomized controlled trials examining restricted fluid resuscitation have demonstrated that aggressive fluid resuscitation in the prehospital and hospital setting leads to more complications than hypotensive resuscitation, with disparate findings on the survival benefit. Since the populations studied in each randomized controlled trial are slightly different, as is the timing of intervention and targeted vitals, there is still a need for a large, multicenter trial that can examine the benefit of hypotensive resuscitation in both blunt and penetrating trauma patients. PMID:27595109

  9. Prehospital identification of stroke - room for improvement

    DEFF Research Database (Denmark)

    Fischer, C.E.; Barnung, S.; Nielsen, S.L.;

    2008-01-01

    INTRODUCTION: Rapid recognition of stroke is important because it allows early brain imaging and management such as thrombolytic therapy. We evaluated the identification of the diagnosis acute cerebrovascular incident in a physician-based prehospital emergency medical system. METHODS: From the...

  10. Sobrevivência após acidentes de trânsito: impacto das variáveis clínicas e pré-hospitalares Sobrevida después de accidentes de tránsito: impacto de las variables clínicas y pre hospitalarias Survival after motor vehicle crash: impact of clinical and prehospital variables

    Directory of Open Access Journals (Sweden)

    Marisa Aparecida Amaro Malvestio

    2008-08-01

    Full Text Available OBJETIVO: Analisar as variáveis clínicas e pré-hospitalares associadas à sobrevivência de vítimas de acidente de trânsito. MÉTODOS: Estudo realizado no município de São Paulo, SP, de 1999 a 2003. Foram analisados dados de 175 pacientes, entre 12 e 65 anos, vitimados por acidente de trânsito. A Análise de Sobrevivência de Kaplan-Meier foi utilizada na abordagem dos resultados na cena do acidente com as vítimas de escore OBJETIVO: Analizar las variables clínicas y pre hospitalarias asociadas a la sobrevida de víctimas de accidentes del tránsito. MÉTODOS: Estudio realizado en el municipio de São Paulo (Sudeste de Brasil, de 1999 a 2003. Fueron analizados datos de 175 pacientes, entre 12 y 65 años, victimas de accidentes de tránsito. El análisis de Sobrevida de Kaplan-Meier fue utilizado en el abordaje de los resultados en la escena del accidente con las víctimas de score OBJECTIVE: To assess clinical and prehospital variables associated with survival of motor vehicle crash victims. METHODS: Study carried out in the city of São Paulo (Southeastern Brazil, from 1999 to 2003. Data from 175 patients, who were aged between 12 and 65 years and had been motor vehicle crash victims, were analyzed. Kaplan-Meier Survival Analysis was used to approach the results at the accident scene with victims scoring <11, according to the Revised Trauma Score. Variables analyzed were: sex, age, injury mechanisms, basic and advanced support procedures, Revised Trauma Score parameters and fluctuations, time elapsed in the prehospital phase and trauma severity according to the Injury Severity Score and Maximum Abbreviated Injury Scale. RESULTS: Analysis revealed that victims who were less likely to survive during the hospitalization period showed serious lesions in the abdomen, thorax, or lower limbs, with negative fluctuation of respiratory frequency and Revised Trauma Score in the prehospital phase. In addition, they needed specialized

  11. Trauma renal Renal trauma

    Directory of Open Access Journals (Sweden)

    Gerson Alves Pereira Júnior

    1999-02-01

    Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration

  12. Prehospital airway management: A prospective case study.

    Science.gov (United States)

    Wilbers, N E R; Hamaekers, A E W; Jansen, J; Wijering, S C; Thomas, O; Wilbers-van Rens, R; van Zundert, A A J

    2011-01-01

    We conducted a one-year prospective study involving a prehospital Emergency Medical Service in the Netherlands to investigate the incidence of failed or difficult prehospital endotracheal intubation. During the study period the paramedics were asked to fill in a registration questionnaire after every endotracheal intubation. Of the 26,271 patient contacts, 256 endotracheal intubations were performed by paramedics in one year. Endotracheal intubation failed in 12 patients (4.8%). In 12.0% of 249 patients, a Cormack and Lehane grade III laryngoscopy was reported and a grade IV laryngoscopy was reported in 10.4%. The average number of endotracheal intubations per paramedic in one year was 4.2 and varied from zero to a maximum of 12. The median time between arrival on the scene and a positive capnograph was 7 min.38 s in the case of a Cormack and Lehane grade I laryngoscopy and 14 min.58 s in the case of a Cormack and Lehane grade 4 laryngoscopy. The incidence of endotracheal intubations performed by Dutch paramedics in one year was low, but endotracheal intubation was successful in 95.2%, which is comparable with findings in international literature. Early capnography should be used consistently in prehospital airway management. PMID:21612142

  13. CERN’s firefighters hone their trauma response skills

    CERN Multimedia

    Anaïs Schaeffer

    2016-01-01

    Seven CERN firefighters have been trained in how to treat trauma victims. This training forms part of the Fire Brigade’s efforts to acquire specialist knowledge.   The fifteen trainees who took the PHTLS course at CERN, with the instructor team. On 23 and 24 May, the CERN Fire Brigade welcomed five instructors from Life Support France, an association that offers training in pre-hospital emergency treatment, to provide a course on Pre-Hospital Trauma Life Support (PHTLS). Fifteen “trainees” – seven CERN firefighters and eight rescue and healthcare professionals from outside the Organization (nurses, paramedics and firefighters) – took part in the course, at the end of which they were awarded an official PHTLS certificate, valid for four years. Of course, the whole PHTLS programme cannot be covered in just two days, so several months of additional work were required in advance of the course, particularly to acquire the necessary theoretical knowledg...

  14. Trauma-related dispatch criteria for Helicopter Emergency Medical Services in Europe

    NARCIS (Netherlands)

    L.D. Wigman (Laura); E.M.M. van Lieshout (Esther); G. de Ronde (Gijs); P. Patka (Peter); I.B. Schipper (Inger)

    2011-01-01

    textabstractIntroduction: Helicopter Emergency Medical Services (HEMS) are used worldwide in order to provide potentially life-saving pre-hospital medical support to trauma patients at the accident scene. It is currently unclear how much overlap exists regarding the number and type of dispatch crite

  15. Facial trauma

    Science.gov (United States)

    Maxillofacial injury; Midface trauma; Facial injury; LeFort injuries ... Kellman RM. Maxillofacial trauma. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. Philadelphia, PA: ...

  16. Systemic trauma.

    Science.gov (United States)

    Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

    2014-01-01

    Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

  17. Systemic trauma.

    Science.gov (United States)

    Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

    2014-01-01

    Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering. PMID:24617751

  18. Safety and Efficacy of Prehospital Diltiazem

    Directory of Open Access Journals (Sweden)

    Jeffrey H Luk

    2013-05-01

    Full Text Available Introduction: Very few studies exist on the use of diltiazem in the prehospital setting. Some practitioners believe this medication is prone to causing hypotension in this setting. Our goals were to determine whether the prehospital administration of diltiazem induced hypotension and to evaluate the efficacy of the drug.Methods: Our two-tiered system is located in a suburban region of New Jersey with advanced life support (ALS care provided by fly-car units. The ALS units do not transport patients, and all of them are hospital based. The ALS providers are employed by the hospital system. In New Jersey, all ALS care requires online medical control, including the administration of diltiazem. We retrospectively reviewed patient care records for those who were believed to be in rapid atrial fibrillation and were given diltiazem in a suburban emergeny medical services system over a 22-month period. We examined the differences between heart rate (HR and blood pressure (BP on the initial evaluation and on arrival to the emergency department (ED. A hypotensive response was defined as a final systolic BP (SBP less than 90 mmHg and a drop in SBP of at least 10 mmHg. Diltiazem was considered effective if the ED HR was ,100 beats per minute (bpm or if it decreased [1]20%.Results: During the study period, 26,979 patients were transported. Of these patients, 2,488 had a documented rhythm of atrial fibrillation or atrial flutter. Of the 320 patients who received diltiazem, 42 patient encounters were excluded for incomplete data, yielding 278 patients for analysis. The average initial SBP was 139 mmHg and the average diastolic BP was 84 mmHg. The average diltiazem dosage was 16.7 mg. Two patients became hypotensive. The average initial HR was 154 bpm. On arrival to the ED, 33% of the patients had an HR , 100 bpm and 69% had a drop in HR [1] 20%. The overall efficacy of prehospital diltiazem was 73%.Conclusion: In the prehospital setting, diltiazem is associated

  19. The spectrum of agricultural trauma.

    Science.gov (United States)

    Cogbill, T H; Busch, H M

    1985-01-01

    During the past 6 years, 375 patients were hospitalized with injuries resulting from farm accidents. The mechanism of injury was farm animal in 135 patients (36%), tractor in 89 (24%), corn picker or auger in 57 (15%), power take-off in 29 (8%), other farm machinery in 50 (13%), and miscellaneous in 15 (4%). Injury severity score (ISS) of 25 or greater was calculated for 29 individuals (8%). Eleven groups of surgical subspecialists performed 539 procedures. Eight patients (2.1%) died as a result of their injuries. All eight deaths occurred after tractor accidents secondary to pelvic fractures, head and spinal cord injury, or blunt chest trauma. Thirty-nine patients (10%) were left with serious permanent disability. Unnecessary morbidity and mortality in many cases were attributed to excessive prehospital care times within a largely rural area. Better prevention by farmer education and the initiation of mandatory safety devices on agricultural equipment may lower the incidence of farm accidents. Major agricultural trauma is frequent and diverse and is optimally managed in a regional trauma center. PMID:4093573

  20. Geriatric Trauma.

    Science.gov (United States)

    Reske-Nielsen, Casper; Medzon, Ron

    2016-08-01

    Within the next 15 years, 1 in 5 Americans will be over age 65. $34 billion will be spent yearly on trauma care of this age group. This section covers situations in trauma unique to the geriatric population, who are often under-triaged and have significant injuries underestimated. Topics covered include age-related pathophysiological changes, underlying existing medical conditions and certain daily medications that increase the risk of serious injury in elderly trauma patients. Diagnostic evaluation of this group requires liberal testing, imaging, and a multidisciplinary team approach. Topics germane to geriatric trauma including hypothermia, elder abuse, and depression and suicide are also covered. PMID:27475011

  1. Communicative Management in Ambulatory Services: Prehospital Management Communication--Limits and Possibilities.

    Science.gov (United States)

    Nordby, Halvor

    2015-01-01

    Poor management communication in healthcare services affects employees' motivation, commitment, and, in the final instance, organizational performance and the quality of patient care. In any area of health management, good communication is, therefore, key to successful management. This article discusses how managers of ambulance stations should secure communication with their paramedic crews. The first part uses ethical concepts to analyze communicative disagreement in interactive dialogue between managers and paramedics. The second part outlines basic communication principles that can serve as conceptual tools for avoiding misinterpretation in prehospital manager-employee interaction.

  2. NATO Blood Panel perspectives on changes to military prehospital resuscitation policies: current and future practice.

    Science.gov (United States)

    Woolley, Tom; Badloe, John; Bohonek, Milos; Taylor, Audra L; Erik Heier, Hans; Doughty, Heidi

    2016-04-01

    The North Atlantic Treaty Organization (NATO) Blood Panel exists to promote interoperability of transfusion practice between NATO partners. However, it has served as an important forum for the development of prehospital transfusion and transfusion in the austere environment. There are synergies with the trauma hemostasis and oxygen research community especially in the areas of innovation and research. Four presentations are summarized together with a review of some scientific principles. The past decade has already seen significant changes in early transfusion support. Sometimes practice has preceded the evidence and has stretched regulatory and logistic constraints. Ethical and philosophical issues are also important and require us to question "should we" and not just "could we." The challenge for the combined communities is to continue to optimize transfusion support underpinned by evidence-based excellence. PMID:27100759

  3. Prehospital rapid sequence induction by emergency physicians: Is it safe?

    OpenAIRE

    Mackay, C; Terris, J; Coats, T

    2001-01-01

    Objectives—To determine if there were differences in practice or intubation mishap rate between anaesthetists and accident and emergency physicians performing rapid sequence induction of anaesthesia (RSI) in the prehospital setting.

  4. "DETERMINANTS OF PREHOSPITAL DELAY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION"

    OpenAIRE

    Alidoosti, M

    2004-01-01

    Determination of pre-hospital delay time of patients with acute myocardial infarction and seeking ways of speeding up the time for reperfusion is an important factor to lower mortality in these patients. This is a cross-sectional study to determine pre-hospital delay time, its components, and related causes and conditions, obtained in 375 patients with prolonged chest pain referred to four hospitals of Tehran University of Medical Sciences. Means of transport to hospital, reasons of ambulance...

  5. Analysis of 10 126 Cases of Pre-hosPital Emergency Care%10126例院前急救病例分析

    Institute of Scientific and Technical Information of China (English)

    付丽琼; 胡远扬; 林建功; 朱龙华

    2013-01-01

    目的:了解泉州市区院前急救疾病的病种及其特点。方法回顾性分析泉州市急救指挥中心2009年1月至2009年12月救治转送的10126例患者及180例死亡病例。结果院前急救病种排序前五位依次为各种创伤6035(59.58%)、脑血管病907(8.95%)、中毒与损伤621(6.13%)、心血管病446(4.6%)、消化系统423(4.2%)此前五位占全部患者的83.46%,创伤中交通伤占一半以上。结论院前急救在医务人员与设备配置方面应与急救疾病谱的变化相适应,要加强针对医务人员及社会公众进行急救创伤知识、心脑血管疾病等培训,提高急救抢救能力。%Objective To explore the disease entity and its clinical characteristics in the pre-hospital emergency cases. Method A retrospective study of 10 126 patients transferred by Quanzhou Emergency Center and 180 deaths among them between January 2009 and December 2009 was performed. Result The five common disease entities in pre-hospital emergency patients which account for 83.46%of the total amount are:6035 cases of trauma(59.58%),half of which are auto accidents,907 cases of cerebrovascular disease(8.95%),621 cases of poisoning (6.13%),446 cases of cardiovascular disease(4.6%),423 cases of gastrointestinal disease(4.2%). Conclusion It is recommended that the emergency resource such as pre-hospital rescuers and devices should be allocated in accordance with the disease spectrum for pre-hospital emergency care. It is essential to improve the quality of the training about the pre-hospital rescue of trauma and cardiac-cerebral vascular disease to ensure the high performance of pre-hospital emergency care.

  6. Trauma Africa

    Directory of Open Access Journals (Sweden)

    Victor Y. Kong

    2013-11-01

    Full Text Available “Major Trauma. Dr. Kong, please come to the Trauma Unit immediately. Dr. Kong, please come to the Trauma Unit immediately.” Even though I have been working at Edendale Hospital as a trauma registrar for over a year, whenever I hear this announcement over the hospital intercom system, my heart beats just a little faster than normal. When I first arrived at Edendale my colleagues told me that the adrenaline rush I would experience after being called out to attend a new emergency would decrease over time, and indeed they were right. However, it is also true to say that on some occasions more than others, it is still felt more strongly than ever.

  7. Video laryngoscopy in pre-hospital critical care – a quality improvement study

    OpenAIRE

    Rhode, Marianne Grønnebæk; Vandborg, Mads Partridge; Bladt, Vibeke; Rognås, Leif

    2016-01-01

    Background Pre-hospital endotracheal intubation is challenging and repeated endotracheal intubation is associated with increased morbidity and mortality. We investigated whether the introduction of the McGrath MAC video laryngoscope as the primary device for pre-hospital endotracheal intubation could improve first-pass success rate in our anaesthesiologist-staffed pre-hospital critical care services. We also investigated the incidence of failed pre-hospital endotracheal intubation, the use of...

  8. Trauma care systems in Spain.

    Science.gov (United States)

    Queipo de Llano, E; Mantero Ruiz, A; Sanchez Vicioso, P; Bosca Crespo, A; Carpintero Avellaneda, J L; de la Torre Prado, M V

    2003-09-01

    Trauma care systems in Spain are provided by the Nacional Health Service in a decentralized way by the seventeen autonomous communities whose process of decentralization was completed in January 2002. Its organisation is similar in all of them. Public sector companies of sanitary emergencies look after the health of citizens in relation to medical and trauma emergencies with a wide range of up to date resources both technical and human. In the following piece there is a description of the emergency response teams divided into ground and air that are responsible for the on site care of the patients in coordination with other public services. They also elaborate the prehospital clinical history that is going to be a valuable piece of information for the teams that receive the patient in the Emergency Hospital Unit (EHU). From 1980 to 1996 the mortality rate per 10.000 vehicles and the deaths per 1.000 accidents dropped significantly: in 1980 6.4 and 96.19% and in 1996, 2.8 and 64.06% respectively. In the intrahospital organisation there are two differentiated areas to receive trauma patients the casualty department and the EHU. In the EHU the severe and multiple injured patients are treated by the emergency hospital doctors; first in the triage or resuscitation areas and after when stabilised they are passed too the observation area or to the Intensive Care Unit (ICU) and from there the EHU or ICU doctors call the appropriate specialists. There is a close collaboration and coordination between the orthopaedic surgeon the EHU doctors and the other specialists surgeons in order to comply with treatment prioritization protocols. Once the patient has been transferred an entire process of assistance continuity is developed based on interdisciplinary teams formed in the hospital from the services areas involved in trauma assistance and usually coordinated by the ICU doctors. There is also mentioned the assistance registry of trauma patients, the ICU professional training

  9. Architecture of a prehospital emergency patient care report system (PEPRS).

    Science.gov (United States)

    Majeed, Raphael W; Stöhr, Mark R; Röhrig, Rainer

    2013-01-01

    In recent years, prehospital emergency care adapted to the technology shift towards tablet computers and mobile computing. In particular, electronic patient care report (e-PCR) systems gained considerable attention and adoption in prehospital emergency medicine [1]. On the other hand, hospital information systems are already widely adopted. Yet, there is no universal solution for integrating prehospital emergency reports into electronic medical records of hospital information systems. Previous projects either relied on proprietary viewing workstations or examined and transferred only data for specific diseases (e.g. stroke patients[2]). Using requirements engineering and a three step software engineering approach, this project presents a generic architecture for integrating prehospital emergency care reports into hospital information systems. Aim of this project is to describe a generic architecture which can be used to implement data transfer and integration of pre hospital emergency care reports to hospital information systems. In summary, the prototype was able to integrate data in a standardized manner. The devised methods can be used design generic software for prehospital to hospital data integration. PMID:23920925

  10. Clinical management of abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    FANG Guo-en; LUO Tian-hang; DU Cheng-hui; BI Jian-wei; XUE Xu-chao; WEI Guo; WENG Zhao-zhang; MA Li-ye; HUA Ji-de

    2008-01-01

    Objective: To improve the prognosis of patients with abdominal trauma. Methods: Between January 1993 and December 2005, 415 patients were enrolled in this research. The patients consisted of 347 males and 68 females with mean age of 36 years ranging from 3-82 years. All abdominal traumas consisted of closed traumas 360 cases, 86.7% and open traumas 55 cases, 13.3%. Results: Atotal of 407 cases 98.1% were fully recovered from trauma and the other 8 cases 1.9% died of multiple injuries. The mean injury severity score ISS of all patients was 22 while the mean ISS of the patients who died in hospital was 42. Postoperative complications were seen in 9 patients such as infection of incisional wounds 6 cases, pancreatic fistula 2 cases and intestinal fistula 1 case. All these postoperative complications were cured by the conservative treatment. Conclusion: Careful case history inquisition and physical examination are the basic methods to diagnose abdomi- nal trauma. Focused abdominal ultrasonography is always the initial imaging examination because it is non-invasive and can be performed repeatedly with high accuracy. The doctors should consider the severity of local injuries and the general status of patients during the assessment of abdominal trauma. The principle of treatment is to save lives at first, then to cure the injuries. Unnecessary laparotomy should be avoided to reduce additional surgical trauma.

  11. Comparison of Three Prehospital Cervical Spine Protocols for Missed Injuries

    Directory of Open Access Journals (Sweden)

    Rick Hong

    2014-07-01

    Full Text Available Introduction: We wanted to compare 3 existing emergency medical services (EMS immobilization protocols: the Prehospital Trauma Life Support (PHTLS, mechanism-based; the Domeier protocol (parallels the National Emergency X-Radiography Utilization Study [NEXUS] criteria; and the Hankins’ criteria (immobilization for patients 65 years, those with altered consciousness, focal neurologic deficit, distracting injury, or midline or paraspinal tenderness.To determine the proportion of patients who would require cervical immobilization per protocol and the number of missed cervical spine injuries, had each protocol been followed with 100% compliance. Methods: This was a cross-sectional study of patients ≥18 years transported by EMS post-traumatic mechanism to an inner city emergency department. Demographic and clinical/historical data obtained by physicians were recorded prior to radiologic imaging. Medical record review ascertained cervical spine injuries. Both physicians and EMS were blinded to the objective of the study. Results: Of 498 participants, 58% were male and mean age was 48 years. The following participants would have required cervical spine immobilization based on the respective protocol: PHTLS, 95.4% (95% CI: 93.1-96.9%; Domeier, 68.7% (95% CI: 64.5-72.6%; Hankins, 81.5% (95% CI: 77.9-84.7%. There were 18 cervical spine injuries: 12 vertebral fractures, 2 subluxations/dislocations and 4 spinal cord injuries. Compliance with each of the 3 protocols would have led to appropriate cervical spine immobilization of all injured patients. In practice, 2 injuries were missed when the PHTLS criteria were mis-applied. Conclusion: Although physician-determined presence of cervical spine immobilization criteria cannot be generalized to the findings obtained by EMS personnel, our findings suggest that the mechanism-based PHTLS criteria may result in unnecessary cervical spine immobilization without apparent benefit to injured patients. PHTLS

  12. Abdominal trauma

    International Nuclear Information System (INIS)

    Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery

  13. Visitation by physicians did not improve triage in trauma patients

    DEFF Research Database (Denmark)

    Holm Burén, Lars Andreas; Daugaard, Morten; Larsen, Jens Rolighed;

    2013-01-01

    Introduction: A formalized trauma response team is designed to optimize the quality and progress of patient care for severely injured patients in order to reduce mortality and morbidity. The goal of this study was to determine over- and undertriage and to evaluate if a physicianmanned pre......-hospital response (MD-EMS) would reduce overtriage. Overtriage was defined as the process of overestimating the level of injury sustained by an individual. Material and methods: This was a retrospective study. All patients admitted with trauma team activation (TTA) (n = 1,468) during a four-year period (2007......-2011) were included. Undertriage was estimated by assessing the fraction of major trauma patients (New Injury Severity Score (NISS) > 15) admitted to Viborg Regional Hospital in the project period without TTA. RESULTS : For each year, overtriage was 88.3% (2007), 89.9% (2008), 92.8% (2009) and 88.2% (2010...

  14. Theater Blood Support in the Prehospital Setting.

    Science.gov (United States)

    Taylor, Audra L; Corley, Jason B

    2016-01-01

    The Army Blood Program (ABP) is charged with the responsibility of supporting the Warfighter on the battlefield, in addition to meeting garrison hospital blood requirements on a daily basis. Blood support concepts developed in response to Operation Iraqi Freedom/Operation Enduring Freedom combat operations are the cornerstone to maintaining current capabilities and shaping future endeavors.. The ABP is actively engaged with research, advanced development of blood products and medical technology to improve blood safety and efficacy for both our conventional and operational forces. The feasibility of frozen/deglycerolized red blood cell use in theater has been demonstrated. The use of Blood Group A plasma in the place of Blood Group AB plasma has been successful. Placement of cryoprecipitate at Role 2 medical facilities and the placement of blood products on MEDEVAC (Vampire Program missions) have proven invaluable in moving transfusion therapy closer to the point of Injury. The improved patient outcomes from earlier transfusion of blood products has driven the requirement for far-forward blood support. Now (more than ever), there are products and processes in place to meet the requirements for blood use in the prehospital setting. PMID:27215865

  15. Acute chest pain emergencies - spouses' prehospital experiences.

    Science.gov (United States)

    Forslund, Kerstin; Quell, Robin; Sørlie, Venke

    2008-10-01

    The call to the Emergency Medical Dispatch Centre is often a person's first contact with the health-care system in cases of acute illness or injury and acute chest pain is a common reason for calling. The aim was to illuminate how spouses to persons with acute chest pain experienced the alarm situation, the emergency call and the prehospital emergency care. Interviews were conducted with nineteen spouses. A phenomenological-hermeneutic approach was used for the analyses. The themes responsibility and uneasiness emerged as well as an overall theme of aloneness. Being a spouse to a person in need of acute medical and nursing assistance was interpreted as "Being responsible and trying to preserve life" and "Being able to manage the uneasiness and having trust in an uncertain situation." When their partners' life was at risk the spouses were in an escalating spiral of worry, uncertainty, stress, fear of loss, feeling of loneliness and desperation. They had to manage emotional distress and felt compelled to act to preserve life, a challenging situation. PMID:18929341

  16. Factors influencing prehospital delay for patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Shujuan CHENG; Lufen GUO; Juyuan LIU; Xiaoling ZHU; Hongbing YAN

    2007-01-01

    Objective To investigate the influencing factors for prehospital delay in patients with acute myocardial infarction (AMI).Methods A total of 807 consecutive patients with AMI who presented to the emergency department of Beijing Anzhen Hospital were analyzed. The influence of several potential risk factors on the prehospital delay time (PDT) was evaluated by comparing patients admitted more than 2 hours after onset of chese pain with those admitted within 2 hours after onset. Results Among 807 patients, 402 came to the hospital within 2 hours while the others arrived at the hospital after 2 hours. The median PDT was 130 min. Among the potential variables, advanced age, history of diabetes mellitus, occurrence of symptom at night and use of emergency medical service significantly affected PDT by multivariate analysis. Conclusion Interventions aimed at reducing the prehospital delay in AMI should primarily focus on the awareness of the risk and help-seeking behavior of patients.

  17. Communication technology in trauma centers: a national survey.

    Science.gov (United States)

    Xiao, Yan; Kim, Young-Ju; Gardner, Sharyn D; Faraj, Samer; MacKenzie, Colin F

    2006-01-01

    The relationship between information and communication technology (ICT) and trauma work coordination has long been recognized. The purpose of the study was to investigate the type and frequency of use of various ICTs to activate and organize trauma teams in level I/II trauma centers. In a cross-sectional survey, questionnaires were mailed to trauma directors and clinicians in 457 trauma centers in the United States. Responses were received from 254 directors and 767 clinicians. Communication with pre-hospital care providers was conducted predominantly via shortwave radio (67.3%). The primary communication methods used to reach trauma surgeons were manual (56.7%) and computerized group page (36.6%). Computerized group page (53.7%) and regular telephone (49.8%) were cited as the most advantageous devices; e-mail (52.3%) and dry erase whiteboard (52.1%) were selected as the least advantageous. Attending surgeons preferred less overhead paging and more cellular phone communication than did emergency medicine physicians and nurses. Cellular phones have become an important part of hospital-field communication. In high-volume trauma centers, there is a need for more accurate methods of communicating with field personnel and among hospital care providers. PMID:16434331

  18. "DETERMINANTS OF PREHOSPITAL DELAY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION"

    Directory of Open Access Journals (Sweden)

    M. Alidoosti

    2004-05-01

    Full Text Available Determination of pre-hospital delay time of patients with acute myocardial infarction and seeking ways of speeding up the time for reperfusion is an important factor to lower mortality in these patients. This is a cross-sectional study to determine pre-hospital delay time, its components, and related causes and conditions, obtained in 375 patients with prolonged chest pain referred to four hospitals of Tehran University of Medical Sciences. Means of transport to hospital, reasons of ambulance disuse, decision time by the patient and finally the entire time of pre-hospital delay were specified. Suspected factors related to delays of more than 2 and 6 h were scrutinized with chi-square test. Rate of ambulance utility (18.9% directly correlated with age of patients (P<0.05. Principal motives to disuse ambulance insuccession were unrememberance (33.7%, access to private vehicle (32.8% and supposition of sufficient speed of personal reference (18.9%. Pre-hospital delay time was 8.1 ± 9.1 h (mean ± SD in whole patients and 7.6 ± 9.1 h in those with acute myocardial infarction. Delays of more than 2 and 6 hoccurred in 67.5% and 33.6% of patients, respectively. Decision time constitute three fourth of whole pre-hospital delay and was correlated with female gender, older age, history of diabetes, lower level of literacy and nocturnal onset of symptoms. In conclusion, a significant number of patients with acute myocardial infarction have pre-hospital delay of more than 2 and even 6 h, when golden time for thrombolytic therapy has already been elapsed.

  19. Prehospital emergency care and injury prevention in Sudan

    Directory of Open Access Journals (Sweden)

    Khalid Elbashir

    2014-12-01

    Conclusion: Due to an absence of published literature in Sudan, much of the data have been recorded from paper records and empirical observations. Prehospital care and injury prevention in the Sudan is a recent initiative, but it is developing into a promising model with many opportunities for improvement. This momentum should be nurtured and requires a purposive, collective collaboration to draw a blueprint for a locally relevant, effective and efficient prehospital system in Sudan. It is hoped that this article will highlight and encourage further progress.

  20. Convergence of Health Level Seven Version 2 Messages to Semantic Web Technologies for Software-Intensive Systems in Telemedicine Trauma Care

    OpenAIRE

    Menezes, Pedro Monteiro; Cook, Timothy Wayne; Cavalini, Luciana Tricai

    2016-01-01

    Objectives To present the technical background and the development of a procedure that enriches the semantics of Health Level Seven version 2 (HL7v2) messages for software-intensive systems in telemedicine trauma care. Methods This study followed a multilevel model-driven approach for the development of semantically interoperable health information systems. The Pre-Hospital Trauma Life Support (PHTLS) ABCDE protocol was adopted as the use case. A prototype application embedded the semantics i...

  1. Trauma Theory

    DEFF Research Database (Denmark)

    Pedersen, Bodil Maria

    There are two main trends in psychological approaches to human suffering related to what we term trauma. Although they have their respective limitations both approaches may help us explore and alleviate human suffering. One trend, primarily using concepts like traumatic events and traumatisation...

  2. Trauma Ultrasound.

    Science.gov (United States)

    Wongwaisayawan, Sirote; Suwannanon, Ruedeekorn; Prachanukool, Thidathit; Sricharoen, Pungkava; Saksobhavivat, Nitima; Kaewlai, Rathachai

    2015-10-01

    Ultrasound plays a pivotal role in the evaluation of acute trauma patients through the use of multi-site scanning encompassing abdominal, cardiothoracic, vascular and skeletal scans. In a high-speed polytrauma setting, because exsanguinations are the primary cause of trauma morbidity and mortality, ultrasound is used for quick and accurate detection of hemorrhages in the pericardial, pleural, and peritoneal cavities during the primary Advanced Trauma Life Support (ATLS) survey. Volume status can be assessed non-invasively with ultrasound of the inferior vena cava (IVC), which is a useful tool in the initial phase and follow-up evaluations. Pneumothorax can also be quickly detected with ultrasound. During the secondary survey and in patients sustaining low-speed or localized trauma, ultrasound can be used to help detect abdominal organ injuries. This is particularly helpful in patients in whom hemoperitoneum is not identified on an initial scan because findings of organ injuries will expedite the next test, often computed tomography (CT). Moreover, ultrasound can assist in detection of fractures easily obscured on radiography, such as rib and sternal fractures.

  3. Prehospital care of the acute stroke patient.

    Science.gov (United States)

    Rajajee, Venkatakrishna; Saver, Jeffrey

    2005-06-01

    Emergency medical services (EMS) is the first medical contact for most acute stroke patients, thereby playing a pivotal role in the identification and treatment of acute cerebrovascular brain injury. The benefit of thrombolysis and interventional therapies for acute ischemic stroke is highly time dependent, making rapid and effective EMS response of critical importance. In addition, the general public has suboptimal knowledge about stroke warning signs and the importance of activating the EMS system. In the past, the ability of EMS dispatchers to recognize stroke calls has been documented to be poor. Reliable stroke identification in the field enables appropriate treatment to be initiated in the field and potentially inappropriate treatment avoided; the receiving hospital to be prenotified of a stroke patient's imminent arrival, rapid transport to be initiated; and stroke patients to be diverted to stroke-capable receiving hospitals. In this article we discuss research studies and educational programs aimed at improving stroke recognition by EMS dispatchers, prehospital personnel, and emergency department (ED) physicians and how this has impacted stroke treatment. In addition public educational programs and importance of community awareness of stroke symptoms will be discussed. For example, general public's utilization of 911 system for stroke victims has been limited in the past. However, it has been repeatedly shown that utilization of the 911 system is associated with accelerated arrival times to the ED, crucial to timely treatment of stroke patients. Finally, improved stroke recognition in the field has led investigators to study in the field treatment of stroke patients with neuroprotective agents. The potential impact of this on future of stroke treatment will be discussed. PMID:16194754

  4. Prehospital endotracheal intubation; need for routine cuff pressure measurement?

    NARCIS (Netherlands)

    Peters, J.H.; Hoogerwerf, N.

    2013-01-01

    In endotracheal intubation, a secured airway includes an insufflated cuff distal to the vocal cords. High cuff pressures may lead to major complications occurring after a short period of time. Cuff pressures are not routinely checked after intubation in the prehospital setting, dealing with a vulner

  5. Treatment of opioid overdose in a physician-based prehospital EMS: frequency and long-term prognosis

    DEFF Research Database (Denmark)

    Nielsen, Karina Skafte; Nielsen, Søren Louman; Siersma, Volkert Dirk;

    2011-01-01

    Prehospital treatment of opioid overdose accounts for a significant proportion of the workload of the emergency system in most major cities. Treatment consists of basic life support and administering naloxone. In our physician-manned mobile emergency care unit (MECU), most patients are released...... and not admitted to hospital. In this study, we aimed to assess the pattern in the number of episodes with opioid overdose treated by MECU in Copenhagen during a 10-year period and to investigate risk factors for mortality of these patients beyond the initial contact....

  6. Prehospital and in-hospital delays in acute stroke care.

    Science.gov (United States)

    Evenson, K R; Rosamond, W D; Morris, D L

    2001-05-01

    Current guidelines emphasize the need for early stroke care. However, significant delays occur during both the prehospital and in-hospital phases of care, making many patients ineligible for stroke therapies. The purpose of this study was to systematically review and summarize the existing scientific literature reporting prehospital and in-hospital stroke delay times in order to assist future delivery of effective interventions to reduce delay time and to raise several key issues which future studies should consider. A comprehensive search was performed to find all published journal articles which reported on the prehospital or in-hospital delay time for stroke, including intervention studies. Since 1981, at least 48 unique reports of prehospital delay time for patients with stroke, transient ischemic attack, or stroke-like symptoms were published from 17 different countries. In the majority of studies which reported median delay times, the median time from symptom onset to arrival in the emergency department was between 3 and 6 h. The in-hospital times from emergency department arrival to being seen by an emergency department physician, initiation and interpretation of a computed tomography (CT) scan, and being seen by a neurologist were consistently longer than recommended. However, prehospital delay comprised the majority of time from symptom onset to potential treatment. Definitions and methodologies differed across studies, making direct comparisons difficult. This review suggests that the majority of stroke patients are unlikely to arrive at the emergency department and receive a diagnostic evaluation in under 3 h. Further studies of stroke delay and corresponding interventions are needed, with careful attention to definitions and methodologies. PMID:11359072

  7. Early, Prehospital Activation of the Walking Blood Bank Based on Mechanism of Injury Improves Time to Fresh Whole Blood Transfusion.

    Science.gov (United States)

    Bassett, Aaron K; Auten, Jonathan D; Zieber, Tara J; Lunceford, Nicole L

    2016-01-01

    Balanced component therapy (BCT) remains the mainstay in trauma resuscitation of the critically battle injured. In austere medical environments, access to packed red blood cells, apheresis platelets, and fresh frozen plasma is often limited. Transfusion of warm, fresh whole blood (FWB) has been used to augment limited access to full BCT in these settings. The main limitation of FWB is that it is not readily available for transfusion on casualty arrival. This small case series evaluates the impact early, mechanism-of-injury (MOI)-based, preactivation of the walking blood bank has on time to transfusion. We report an average time of 18 minutes to FWB transfusion from patient arrival. Early activation of the walking blood bank based on prehospital MOI may further reduce the time to FWB transfusion.

  8. Telemedicine and telepresence for trauma and emergency care management.

    Science.gov (United States)

    Latifi, R; Weinstein, R S; Porter, J M; Ziemba, M; Judkins, D; Ridings, D; Nassi, R; Valenzuela, T; Holcomb, M; Leyva, F

    2007-01-01

    The use of telemedicine is long-standing, but only in recent years has it been applied to the specialities of trauma, emergency care, and surgery. Despite being relatively new, the concept of teletrauma, telepresence, and telesurgery is evolving and is being integrated into modern care of trauma and surgical patients. This paper will address the current applications of telemedicine and telepresence to trauma and emergency care as the new frontiers of telemedicine application. The University Medical Center and the Arizona Telemedicine Program (ATP) in Tucson, Arizona have two functional teletrauma and emergency telemedicine programs and one ad-hoc program, the mobile telemedicine program. The Southern Arizona Telemedicine and Telepresence (SATT) program is an inter-hospital telemedicine program, while the Tucson ER-link is a link between prehospital and emergency room system, and both are built upon a successful existing award winning ATP and the technical infrastructure of the city of Tucson. These two programs represent examples of integrated and collaborative community approaches to solving the lack of trauma and emergency care issue in the region. These networks will not only be used by trauma, but also by all other medical disciplines, and as such have become an example of innovation and dedication to trauma care. The first case of trauma managed over the telemedicine trauma program or "teletrauma" was that of an 18-month-old girl who was the only survival of a car crash with three fatalities. The success of this case and the pilot project of SATT that ensued led to the development of a regional teletrauma program serving close to 1.5 million people. The telepresence of the trauma surgeon, through teletrauma, has infused confidence among local doctors and communities and is being used to identify knowledge gaps of rural health care providers and the needs for instituting new outreach educational programs.

  9. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study

    OpenAIRE

    Rognås, Leif; Hansen, Troels Martin; Kirkegaard, Hans; Tønnesen, Else

    2013-01-01

    Introduction We report data from the first Utstein-style study of physician-provided pre-hospital advanced airway management. Materials and methods Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a mixed rural and urban region with 1.27 million inhabitants) prospectively registered data according to the template for reporting data from pre-hospital advanced airway management. Data collection took place from February 1st 2011 to October 31st 2012. ...

  10. Pre-hospital treatment of acute poisonings in Oslo

    Directory of Open Access Journals (Sweden)

    Nore Anne K

    2008-11-01

    Full Text Available Abstract Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40% were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84% were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%, were frequently comatose (35%, had respiratory depression (37%, and many received naloxone (49%. The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%, fewer were comatose (10%, and they rarely had respiratory depression (4%. Among the hospitalized, pharmaceutical poisonings were most common (58%, 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often

  11. 以色列院前急救服务现状及启示%The present status and revelation of pre-hospital emergency service in Israel

    Institute of Scientific and Technical Information of China (English)

    谢碧香

    2015-01-01

    This article aims to Introduce the present situation of Israel's pre-hospital first aid service.The ability of Israel's pre-hospital first aid service is the first level in the world, especially in the field of dealing with trauma treatment.By contrast, we may learn success experience from Israel, but it is difficult to copy their experience completely because of the native situations.In order to improve emergency medical ability and level of emergency medical rescue, we should seek way from facts, particularly in improving the pre-hospital emergency service system suitable for our national conditions, establishing and improving the pre -hospital first aid network information technology, popularizing of pre-hospital first aid volunteers training, improving the contingency plans with exercise, optimizing and configuration of the pre-hospital transportation equipment etc.%本文介绍了以色列的院前急救服务现状。以色列的院前急救服务能力具有世界一流水准,尤其是创伤救治卓有成效。相比之下,以色列所取得的成功经验我们可以借鉴,但难以完全复制。应根据我国国情,扬长避短。实事求是地完善适合于我们国情的院前急救服务体系,建立健全院前急救网络信息化,普及院前急救志愿者的培训,完善与演练应急预案,优化和配置院前运输设备。以此,全面提升急救医疗能力和紧急医疗救护水平。

  12. Trauma Adapted Family Connections: Reducing Developmental and Complex Trauma Symptomatology to Prevent Child Abuse and Neglect

    Science.gov (United States)

    Collins, Kathryn S.; Strieder, Frederick H.; DePanfilis, Diane; Tabor, Maureen; Clarkson Freeman, Pamela A.; Linde, Linnea; Greenberg, Patty

    2011-01-01

    Families living in urban poverty, enduring chronic and complex traumatic stress, and having difficulty meeting their children's basic needs have significant child maltreatment risk factors. There is a paucity of family focused, trauma-informed evidence-based interventions aimed to alleviate trauma symptomatology, strengthen family functioning, and…

  13. 3494例院前死亡患者流行病学分析%Epidemiological Analysis of 3494 Cases of Pre-hospital Death in Patients

    Institute of Scientific and Technical Information of China (English)

    张琴; 李汉才

    2013-01-01

    Objective:To investigate the cause of death and characteristics of patients with pre-hospital emergency, draw experience and lessons learned to improve the level of pre-hospital emergency care, to minimize the pre-hospital mortality.Methods:Export all deaths from January 1, 2010 to 31 December 2011 from the emergency center of Shenzhen City in the scheduling system database for statistical analysis. Results:Results of pre-hospital death in patients with monthly distribution of the highest in December, January, followed by 2,9 month at least;hospital died before the peak period is from 06:00 to 10:00; mortality in the highest age group> 70 years; male pre-hospital death was significantly higher than female, male to female ratio was 2.49︰1; lead to the hospital died before the top three diseases is trauma, diseases of the circulatory system (can not determine the type of disease).Conclusion:Based on the cause of death and characteristics of the region's pre-hospital emergency patients to make management decisions, can improve the efficiency and quality of pre-hospital emergency care, reduce pre-hospital mortality.%  目的:探讨院前急救患者死亡原因和特点,从中吸取经验和教训,提高院前急救水平,最大限度降低院前死亡率.方法:从深圳市急救中心调度系统数据库中导出2010年1月1日至2011年12月31日期间所有死亡病例进行统计分析.结果:院前死亡患者的月份分布以12月份最高,1月份次之,2、9月份最少;院前死亡的高峰期是06:00~10:00;死亡率最高年龄组为>70岁;男性院前死亡明显高于女性,男女比例为2.49︰1;导致院前死亡前3位的疾病是创伤、循环系统疾病、其他(不能确定疾病类型).结论:根据本地区的院前急救患者死亡原因和特点做出管理决策,以提高院前急救的效率和质量,降低院前死亡率.

  14. Advanced communication infrastructure for pre-hospital EMS care.

    Science.gov (United States)

    Orthner, Helmuth; Mazza, Giovanni; Mazza, Giovanni Giorgio; Shenvi, Rohit; Battles, Marcie

    2008-11-06

    The traditional communication infrastructure of the pre-hospital Emergency Medical System (EMS) is limited to voice communication using radio or cell phone technologies. With the emergence of 3rd Generation wireless networks (3G) and enhanced mobile devices capable of data communication (e.g., mobile tablets, PDAs with cell phones, or cell phones with PDA capabilities), the voice communication can be enhanced with interactive data messaging and perhaps even with interactive video communication. However, video requires substantially more bandwidth which 4th Generation (4G) systems are promising. However, their availability is limited. We present an infrastructure that allows dynamic selection of the best data transport mode in the pre-hospital EMS environment.

  15. ANALYSIS OF PRE-HOSPITAL TREATMENT OF ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    O. V. Reshetko

    2015-12-01

    Full Text Available Aim. To evaluate the pre-hospital treatment of patients with acute coronary syndromes (acute myocardial infarction and unstable angina in 2001 and 2006.Material and methods. Retrospective pre-hospital treatment survey was performed in 1114 patients with acute coronary syndrome (acute myocardial infarction (AMI or unstable angina (UA in 2001 and 2006.Results. For acute myocardial infarction use of aspirin, β-blockers, heparin was 0%, 0%, 81,5% in 2001 and 23,9%, 8%, 13,4% in 2006, respectively. Use of aspirin, β-blockers, heparin in unstable angina were 0%, 16,2%, 12,3% in 2001 and 3,4%, 1,6%, 0,5% in 2006, respectively. Fibrinolytic therapy was not provided. Polypragmasia reduced in 2006 in comparison with 2001.Conclusions. This survey demonstrates the discordance between existing current practice and guidelines for acute coronary syndrome.

  16. ANALYSIS OF PRE-HOSPITAL TREATMENT OF ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    O. V. Reshetko

    2007-01-01

    Full Text Available Aim. To evaluate the pre-hospital treatment of patients with acute coronary syndromes (acute myocardial infarction and unstable angina in 2001 and 2006.Material and methods. Retrospective pre-hospital treatment survey was performed in 1114 patients with acute coronary syndrome (acute myocardial infarction (AMI or unstable angina (UA in 2001 and 2006.Results. For acute myocardial infarction use of aspirin, β-blockers, heparin was 0%, 0%, 81,5% in 2001 and 23,9%, 8%, 13,4% in 2006, respectively. Use of aspirin, β-blockers, heparin in unstable angina were 0%, 16,2%, 12,3% in 2001 and 3,4%, 1,6%, 0,5% in 2006, respectively. Fibrinolytic therapy was not provided. Polypragmasia reduced in 2006 in comparison with 2001.Conclusions. This survey demonstrates the discordance between existing current practice and guidelines for acute coronary syndrome.

  17. A dramatic drop in blood pressure following prehospital GTN administration.

    Science.gov (United States)

    Boyle, Malcolm J

    2007-03-01

    A male in his sixties with no history of cardiac chest pain awoke with chest pain following an afternoon sleep. The patient did not self medicate. The patient's observations were within normal limits, he was administered oxygen via a face mask and glyceryl trinitrate (GTN). Several minutes after the GTN the patient experienced a sudden drop in blood pressure and heart rate, this was rectified by atropine sulphate and a fluid challenge. There was no further deterioration in the patient's condition during transport to hospital. There are very few documented case like this in the prehospital scientific literature. The cause appears to be the Bezold-Jarish reflex, stimulation of the ventricular walls which in turn decreases sympathetic outflow from the vasomotor centre. Prehospital care providers who are managing any patient with a syncopal episode that fails to recover within a reasonable time frame should consider the Bezold-Jarisch reflex as the cause and manage the patient accordingly.

  18. [Pre-hospital medicine and medical control system in Japan].

    Science.gov (United States)

    Tanabe, Seizan

    2016-02-01

    It is necessary to treat the patient from the site of the emergency to raise a lifesaving rate of the patient. As a prime example would be out-of-hospital cardiac arrest. Once you start the treatment after hospital arrival, cardiac arrest patient can't be life-saving. It is necessary to start the chest compression, etc. from the site of the emergency. Medical care to be carried out on the scene of emergency is the pre-hospital care. In recent years, improvement of the pre-hospital care is remarkable in Japan. It is because of that the quantity and quality of the emergency life-saving technician are being enhanced. And also doctor-helicopter system have been enhanced. Medical control is a critical component of the improvement. PMID:26915258

  19. Job Burnout Status among Pre-Hospital Emergency Technicians

    Directory of Open Access Journals (Sweden)

    Zohre Moradi

    2015-02-01

    Full Text Available Introduction: Since pre-hospital emergency staff, who play a vital role in saving peoples’ lives, work under a lot of pressure, determining the rate and dangers of their job burnout is very important. Therefore, this study was carried out to determine the job burnout rate of the pre-hospital emergency staff in Isfahan, Iran. Methods: In this cross-sectional study, all of the pre-hospital emergency staff in all emergency operation centers in Isfahan were included. Using the standard Maslach burnout inventory questionnaire, the job burnout rate of emergency technicians was measured. The studied aspects were frequency and intensity of emotional exhaustion, depersonalization and personal accomplishment feeling, which were then divided into 3 levels (low, average and high according to the intensity and frequency of these feelings. Results: In the end, 68 technicians were involved in this study (Mean age 26.97±7.7; 42.6% single. Regarding intensity, their mean emotional exhaustion score was 25.59±20.39, depersonalization score was 10.57±7.83 and personal accomplishment feeling was 34.6±8.46. Moreover, the mean emotional exhaustion frequency was 21.21±11.95 (low level, depersonalization frequency was 8.94±5.43 (low level and personal accomplishment feeling frequency was 26.82±5.72 (high level. Conclusion: The data obtained in this study shows that the pre-hospital emergency technicians in Isfahan show average levels of emotional exhaustion and depersonalization intensity and frequency and feel highly unaccomplished.

  20. Understanding prehospital delay behavior in acute myocardial infarction in women.

    Science.gov (United States)

    Waller, Cynthia G

    2006-12-01

    Studies demonstrate that acute myocardial infarction (AMI) mortality can be reduced if reperfusion therapy is initiated within 1 hour of AMI symptom onset. However, a considerable number of men and women arrive at the emergency department outside of the time frame for thrombolytic and angioplasty effectiveness. This is especially true for women who have been shown to delay longer than men due to their prehospital decision-making process utilized. With a mean total delay time greater than 4 hours, the time interval from symptom onset to transport activation to the hospital consumes the majority of the prehospital phase of emergency cardiac care. The health belief model, self-regulation model, theory of reasoned action, and theory of planned behavior have all been used to describe the prehospital decision-making process of both men and women with an AMI and the variables that impact that process. These models have identified the importance of symptom attribution to cardiac-related causes as a target variable for research and interventions related to care-seeking behavior. PMID:18340239

  1. [A historical retrospect of Pre-hospital emergency treatment].

    Science.gov (United States)

    Li, Yan; Li, Peng; Cui, Yong-Ying; Wang, Zhen-E

    2013-07-01

    In 1240, the first organization of first aid medical service for rescuing and transferring the wounded in the world was established at Florence, Italy. The stations of Air Ambulances were set up in most of the developed countries at the end of the 1960s. In the middle of the 1970s, the International Red Cross put forward the principles of internationalization, international cooperation and its standardization, thus, promoting the development of pre-hospital emergency treatment. In 1972, the first Emergency Medical Service Center was established and in 1973, Congress of the United States passed the Emergency Medical Services Act (EMSS). In 1976, the legislative procedure was finished and the National Emergency Network was formed, afterwards, pre-hospital emergency treatment, on-site rescue and transfer care, patient monitoring system of ICU-CCU were set up successively. Since the first rescue group of "three failure" (heart failure, lung failure and renal failure) was first formed at Tianjin First Center Hospital in August 1974, the pre-hospital emergency of China had been developing gradually. PMID:24345547

  2. Effect of ultrasound training of physicians working in the prehospital setting

    DEFF Research Database (Denmark)

    Krogh, Charlotte Loumann; Steinmetz, Jacob; Rudolph, Søren Steemann;

    2016-01-01

    BACKGROUND: Advances in technology have made ultrasound (US) devices smaller and portable, hence accessible for prehospital care providers. This study aims to evaluate the effect of a four-hour, hands-on US training course for physicians working in the prehospital setting. The primary outcome...

  3. Prehospital diagnosis of massive ethylene glycol poisoning and use of an early antidote.

    Science.gov (United States)

    Amathieu, Roland; Merouani, Medhi; Borron, Stephen W; Lapostolle, Frédéric; Smail, Nadia; Adnet, Frédéric

    2006-08-01

    We report the case of a patient suspected of voluntary massive poisoning by ethylene glycol. Prehospital diagnosis was established by portable blood analyser and an early antidote with 4 MP treatment initiated in out-of-hospital setting. Use of portable blood analyser in prehospital care should be considered in case of suspected massive poisoning by ethylene glycol. PMID:16808995

  4. Use of Morphine Sulphate by South African Paramedics for Prehospital Pain Management

    Directory of Open Access Journals (Sweden)

    Craig Vincent-Lambert

    2015-01-01

    Full Text Available BACKGROUND: Evidence in the literature highlights the fact that acute pain in the prehospital setting remains poorly managed. Morphine remains the most commonly used analgesic agent in the South African prehospital emergency care setting. Although guidelines and protocols relating to the dosage and administration of morphine exist, little data are available describing its use by South African paramedics.

  5. Preventable trauma deaths: from panel review to population based-studies

    Directory of Open Access Journals (Sweden)

    Vesconi Sergio

    2006-04-01

    Full Text Available Abstract Preventable trauma deaths are defined as deaths which could be avoided if optimal care has been delivered. Studies on preventable trauma deaths have been accomplished initially with panel reviews of pre-hospital and hospital charts. However, several investigators questioned the reliability and validity of this method because of low reproducibility of implicit judgments when they are made by different experts. Nevertheless, number of studies were published all around the world and ultimately gained some credibility, particularly in regions where comparisons were made before and after trauma system implementation with a resultant fall in mortality. During the last decade of century the method of comparing observed survival with probability of survival calculated from large trauma registries has obtained popularity. Preventable trauma deaths were identified as deaths occurred notwithstanding a high calculated probability of survival. In recent years, preventable trauma deaths studies have been replaced by population-based studies, which use databases representative of overall population, therefore with high epidemiologic value. These databases contain readily available information which carry out the advantage of objectivity and large numbers. Nowadays, population-based researches provide the strongest evidence regarding the effectiveness of trauma systems and trauma centers on patient outcomes.

  6. [Time costs cardiac muscle tissue--prehospital therapy of acute myocardial infarct--a case report].

    Science.gov (United States)

    Eschenburg, G; Pappert, D; Ohlmeier, H

    2003-01-01

    Symptoms of an acute myocardial infarction are a common reason for calling the emergency physician. Pre-hospital mortality caused by cardiac infarction is constantly high. The main potential for decreasing infarction mortality lies in the pre-hospital period. The problems and prospects of treatment in the early period are described in the case of a 73-year-old patient with an acute anterior infarction. The diagnostic and therapeutic approach is shown and discussed in this concrete case, taking into consideration the guidelines for diagnostics and therapy of acute myocardial infarction in the pre-hospital period of the German Society for Cardiology. A particular focus is the management of pre-hospital thrombolysis, the preconditions, realization and risks of which are described. In this context, the experience and competence of the emergency physician is prerequisite for the exact diagnosis and therapy. Furthermore, the importance of a smooth transition from pre-hospital therapy to intensive care is emphasized. PMID:12666508

  7. Accuracy of Perceived Estimated Travel Time by EMS to a Trauma Center in San Bernardino County, California

    Directory of Open Access Journals (Sweden)

    Michael M. Neeki

    2016-06-01

    Full Text Available Introduction: Mobilization of trauma resources has the potential to cause ripple effects throughout hospital operations. One major factor affecting efficient utilization of trauma resources is a discrepancy between the prehospital estimated time of arrival (ETA as communicated by emergency medical services (EMS personnel and their actual time of arrival (TOA. The current study aimed to assess the accuracy of the perceived prehospital estimated arrival time by EMS personnel in comparison to their actual arrival time at a Level II trauma center in San Bernardino County, California. Methods: This retrospective study included traumas classified as alerts or activations that were transported to Arrowhead Regional Medical Center in 2013. We obtained estimated arrival time and actual arrival time for each transport from the Surgery Department Trauma Registry. The difference between the median of ETA and actual TOA by EMS crews to the trauma center was calculated for these transports. Additional variables assessed included time of day and month during which the transport took place. Results: A total of 2,454 patients classified as traumas were identified in the Surgery Department Trauma Registry. After exclusion of trauma consults, walk-ins, handoffs between agencies, downgraded traumas, traumas missing information, and traumas transported by agencies other than American Medical Response, Ontario Fire, Rialto Fire or San Bernardino County Fire, we included a final sample size of 555 alert and activation classified traumas in the final analysis. When combining all transports by the included EMS agencies, the median of the ETA was 10 minutes and the median of the actual TOA was 22 minutes (median of difference=9 minutes, p<0.0001. Furthermore, when comparing the difference between trauma alerts and activations, trauma activations demonstrated an equal or larger difference in the median of the estimated and actual time of arrival (p<0.0001. We also found

  8. Regionalized trauma care: a methodological proposal from the system dynamics

    Directory of Open Access Journals (Sweden)

    Piedad Roldán J

    2009-08-01

    Full Text Available Studies relating to trauma are mainly multicausal, but when we observe the impact of interventions on their causes, there is no clarity about the best way for prevention and control. Objective: To approach the problem of trauma from an integral point of view that facilitates understanding the phenomenon from its complex interrelationships. Methodology: using the system dynamics raised by Forrester to propose a dynamic model capable of predicting situations related to prevention and care, to raise public policies towards reducing the incidence and mortality. The process included six steps of the dynamics of systems to deliver a model for the analysis of existing and potential scenarios in their care, based on simulations of the behavior of the trauma, including the incidence and prevention of variables in interaction with prehospital care and hospitable. Results: the proposal was ideal in the care of trauma described in the dynamic scenario put “appropriate care of the patient described in the appropriate institution, is guaranteed to reduce the mortality for trauma”.

  9. Emergency Physician Awareness of Prehospital Procedures and Medications

    Directory of Open Access Journals (Sweden)

    Rachel Waldron

    2014-07-01

    Full Text Available Introduction: Maintaining patient safety during transition from prehospital to emergency department (ED care depends on effective handoff communication between providers. We sought to determine emergency physicians’ (EP knowledge of the care provided by paramedics in terms of both procedures and medications, and whether the use of a verbal report improved physician accuracy. Methods: We conducted a 2-phase observational survey of a convenience sample of EPs in an urban, academic ED. In this large ED paramedics have no direct contact with physicians for non-critical patients, giving their report instead to the triage nurse. In Phase 1, paramedics gave verbal report to the triage nurse only. In Phase 2, a research assistant (RA stationed in triage listened to this report and then repeated it back verbatim to the EPs caring for the patient. The RA then queried the EPs 90 minutes later regarding their patients’ prehospital procedures and medications. We compared the accuracy of these 2 reporting methods. Results: There were 163 surveys completed in Phase 1 and 116 in Phase 2. The oral report had no effect on EP awareness that the patient had been brought in by ambulance (86% in Phase 1 and 85% in Phase 2. The oral report did improve EP awareness of prehospital procedures, from 16% in Phase 1 to 45% in Phase 2, OR=4.28 (2.5-7.5. EPs were able to correctly identify all oral medications in 18% of Phase 1 cases and 47% of Phase 2 cases, and all IV medications in 42% of Phase 1 cases and 50% of Phase 2 cases. The verbal report led to a mild improvement in physician awareness of oral medications given, OR=4.0 (1.09-14.5, and no improvement in physician awareness of IV medications given, OR=1.33 (0.15-11.35. Using a composite score of procedures plus oral plus IV medications, physicians had all three categories correct in 15% of Phase 1 and 39% of Phase 2 cases (p<0.0001. Conclusion: EPs in our ED were unaware of many prehospital procedures and

  10. [Pre-hospital management of acute coronary syndrome].

    Science.gov (United States)

    Lefort, Hugues; Fradin, Jordan; Blgnand, Michel; Tourtier, Jean-Pierre

    2015-03-01

    The medical management of acute coronary syndrome (ACS) follows the recommendations of international medical societies. The call to the emergency services by the patient triggers a race against the clock in pre-hospital care. It is essential to reduce the duration of the inadequate perfusion of the heart in order to limit its consequences. An effective reperfusion strategy must be planned in advance taking into account the logistical constraints. It is crucial that the general public is educated to recognise the signs of ACS and to call the emergency services immediately (such as 15, 112 or 991). PMID:26040140

  11. Relationship between trauma narratives and trauma pathology.

    Science.gov (United States)

    Amir, N; Stafford, J; Freshman, M S; Foa, E B

    1998-04-01

    In this study we examined the relationship between posttrauma pathology and the level of articulation (complexity) in rape narratives recounted by victims shortly after the assault. Degree of articulation was operationalized as the reading level of the narrative as determined by a computer program. Shortly after the trauma, reading level was correlated with severity of anxiety but not with posttraumatic stress disorder (PTSD) symptoms. Degree of the narrative articulation shortly after the trauma, however, was related to severity of later PTSD. These results are consistent with the hypothesis that the less developed trauma narratives hinder recovery from trauma. PMID:9565923

  12. On-scene time and outcome after penetrating trauma: an observational study

    DEFF Research Database (Denmark)

    Funder, Kamillia S.; Petersen, John Asger; Steinmetz, Jacob

    2011-01-01

    prehospital setting. Follow-up data were obtained from a national administrative database. The primary end point was 30-day survival. Results Of the 467 patients registered, 442 (94.6%) were identified at the 30-day follow-up, of whom 40 (9%) were dead. A higher mortality was found among patients treated on...... observational cohort study of penetrating trauma patients treated by the Mobile Emergency Care Unit in Copenhagen with a 30-day follow-up. Between January 2002 and September 2009, data were prospectively registered regarding the anatomical location of the trauma, time intervals and procedures performed in the...... On-scene time might be important in penetrating trauma, and ALS procedures should not delay transport to definite care at the hospital....

  13. The trauma film paradigm as an experimental psychopathology model of psychological trauma: intrusive memories and beyond.

    Science.gov (United States)

    James, Ella L; Lau-Zhu, Alex; Clark, Ian A; Visser, Renée M; Hagenaars, Muriel A; Holmes, Emily A

    2016-07-01

    A better understanding of psychological trauma is fundamental to clinical psychology. Following traumatic event(s), a clinically significant number of people develop symptoms, including those of Acute Stress Disorder and/or Post Traumatic Stress Disorder. The trauma film paradigm offers an experimental psychopathology model to study both exposure and reactions to psychological trauma, including the hallmark symptom of intrusive memories. We reviewed 74 articles that have used this paradigm since the earliest review (Holmes & Bourne, 2008) until July 2014. Highlighting the different stages of trauma processing, i.e. pre-, peri- and post-trauma, the studies are divided according to manipulations before, during and after film viewing, for experimental as well as correlational designs. While the majority of studies focussed on the frequency of intrusive memories, other reactions to trauma were also modelled. We discuss the strengths and weaknesses of the trauma film paradigm as an experimental psychopathology model of trauma, consider ethical issues, and suggest future directions. By understanding the basic mechanisms underlying trauma symptom development, we can begin to translate findings from the laboratory to the clinic, test innovative science-driven interventions, and in the future reduce the debilitating effects of psychopathology following stressful and/or traumatic events.

  14. Head Trauma, First Aid

    Science.gov (United States)

    ... rashes clinical tools newsletter | contact Share | Head Trauma, First Aid A A A Head trauma signs and symptoms ... to take care for potential neck/spinal injury. First Aid Guide If you suspect either a serious head ...

  15. Common Reactions After Trauma

    Science.gov (United States)

    ... here Enter ZIP code here Common Reactions After Trauma Public This section is for Veterans, General Public, Family, & Friends Common Reactions After Trauma Available in Spanish: Reacciones Comunes Después de un ...

  16. Wireless local area network in a prehospital environment

    Directory of Open Access Journals (Sweden)

    Grimes Gary J

    2004-08-01

    Full Text Available Abstract Background Wireless local area networks (WLANs are considered the next generation of clinical data network. They open the possibility for capturing clinical data in a prehospital setting (e.g., a patient's home using various devices, such as personal digital assistants, laptops, digital electrocardiogram (EKG machines, and even cellular phones, and transmitting the captured data to a physician or hospital. The transmission rate is crucial to the applicability of the technology in the prehospital setting. Methods We created two separate WLANs to simulate a virtual local are network environment such as in a patient's home or an emergency room (ER. The effects of different methods of data transmission, number of clients, and roaming among different access points on the file transfer rate were determined. Results The present results suggest that it is feasible to transfer small files such as patient demographics and EKG data from the patient's home to the ER at a reasonable speed. Encryption, user control, and access control were implemented and results discussed. Conclusions Implementing a WLAN in a centrally managed and multiple-layer-controlled access control server is the key to ensuring its security and accessibility. Future studies should focus on product capacity, speed, compatibility, interoperability, and security management.

  17. Acute Alcohol Use and Injury Patterns in Young Adult Prehospital Patients.

    Science.gov (United States)

    Barton, David J; Tift, Frank W; Cournoyer, Lauren E; Vieth, Julie T; Hudson, Korin B

    2016-01-01

    The objective was to determine if acute alcohol consumption is associated with differences in injury pattern among young adult patients with traumatic injuries presenting to emergency medical services (EMS). A cross-sectional, retrospective review of prehospital patient care reports (PCRs) was conducted evaluating injured patients who presented to a collegiate EMS agency from January 1, 2011 to December 31, 2012. Included patients were age 18-24 y and sustained an injury within the previous 24 h. PCRs were reviewed independently by two abstractors to determine if the patient was documented to have acutely consumed alcohol proximate to his/her injury. Primary and secondary sites of regional body injury were recorded. Injury severity was recorded using the Revised Trauma Score (RTS). The association between primary injury site and acute alcohol use was assessed using a chi-square test. Multiple logistic regression was used to control for sex in predicting injury type. Of 440 injured patients, 135 (30.6%) had documented alcohol use prior to injury. Acute alcohol consumption altered the overall pattern of regional injury (p Alcohol users were more likely to present with injury secondary to assault, fall/trip, and unknown mechanism of injury (p alcohol group (p alcohol consumption predicted increased risk of head/neck injury 5.59-fold (p alcohol use in collegiate EMS patients appears to alter injury patterns in young adults and increases risk of head/neck injury. EMS providers in similar agencies should consider these trends when assessing and treating injured college-aged patients. PMID:27002348

  18. Prehospital delay in acute coronary syndrome--an analysis of the components of delay

    DEFF Research Database (Denmark)

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian;

    2004-01-01

    more frequently atypical symptoms and increased prehospital delay caused by prolonged physician and transportation delay. Physician delay among women and men were 69 and 16 min, respectively. Patients with prior myocardial infarction had reduced prehospital delay, which was caused by shorter decision...... admitted with acute coronary syndrome is warranted. METHODS: A structured interview was conducted on 250 consecutive patients admitted alive with acute coronary syndrome. RESULTS: Median prehospital, decision, physician and transportation delays were 107, 74, 25 and 22 min, respectively. Women (n=77) had...... of acute coronary syndrome among women, and thereby contributes to unnecessary long delay to treatment. The patient's prior experience and interpretation has a significant influence on behaviour....

  19. Prehospital therapeutic hypothermia after cardiac arrest--from current concepts to a future standard.

    Science.gov (United States)

    Kämäräinen, Antti; Hoppu, Sanna; Silfvast, Tom; Virkkunen, Ilkka

    2009-01-01

    Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies on prehospital induction of mild hypothermia after cardiac arrest. Most reported studies present data on cooling rates, safety and feasibility of different methods, but are inconclusive as regarding to outcome effects. PMID:19821967

  20. Prehospital therapeutic hypothermia after cardiac arrest - from current concepts to a future standard

    Directory of Open Access Journals (Sweden)

    Hoppu Sanna

    2009-10-01

    Full Text Available Abstract Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies on prehospital induction of mild hypothermia after cardiac arrest. Most reported studies present data on cooling rates, safety and feasibility of different methods, but are inconclusive as regarding to outcome effects.

  1. Prehospital therapeutic hypothermia after cardiac arrest - from current concepts to a future standard

    Science.gov (United States)

    Kämäräinen, Antti; Hoppu, Sanna; Silfvast, Tom; Virkkunen, Ilkka

    2009-01-01

    Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies on prehospital induction of mild hypothermia after cardiac arrest. Most reported studies present data on cooling rates, safety and feasibility of different methods, but are inconclusive as regarding to outcome effects. PMID:19821967

  2. Prehospital thrombolysis perfomed by a ship's nurse with on-line physician consultation.

    Science.gov (United States)

    Väisänen, Olli; Mäkijärvi, Markku; Silfvast, Tom

    2005-02-01

    Prehospital thrombolysis for acute ST-elevation myocardial infarction (STEMI) has been shown to improve recovery from myocardial function. We describe prehospital thrombolytic treatment in two patients suffering from STEMI complicated by ventricular fibrillation (VF) on a passenger ship. The importance of a functioning Emergency Medical Service (EMS) system providing guidance for paramedical personnel is discussed briefly. Both our patients survived and returned back to normal life. It is concluded that EMS physician guided prehospital thrombolytic treatment may offer an important therapeutic option for nurses or paramedics in locations out of reach of ordinary EMS services. PMID:15680535

  3. MANAGEMENT OF LIVER TRAUMA

    OpenAIRE

    Dova Subba; Mallapraggada Rama Chandra; Erabatti

    2016-01-01

    AIM To estimate the incidence of Liver Trauma injuries and grade their severity of injury. To assess the factors responsible for morbidity and mortality after Liver Trauma. To study the postoperative complications and the management of Liver Trauma. MATERIALS AND METHODS The present prospective study was conducted on 100 patients who were admitted to Department of General Surgery for treatment who were managed operatively or non-operatively for abdominal trauma and h...

  4. Helping Youth Overcome Trauma

    Science.gov (United States)

    Chambers, Jamie C.

    2005-01-01

    The effects of trauma can roll on unchecked like a spirit of death. In its path are strewn its once vibrant victims. Human bonds are rent asunder by the disgrace of trauma. These are the youngsters who have been verbally bashed, physically battered, sexually assaulted, and spiritually exploited. Other traumas of childhood neglect include: (1)…

  5. Factors Associated with the Use of Helicopter Inter-facility Transport of Trauma Patients to Tertiary Trauma Centers within an Organized Rural Trauma System

    Science.gov (United States)

    Stewart, Kenneth; Garwe, Tabitha; Bhandari, Naresh; Danford, Brandon; Albrecht, Roxie

    2016-01-01

    Objective A review of the literature yielded little information regarding factors associated with the decision to use ground (GEMS) or helicopter (HEMS) emergency medical services for trauma patients transferred inter-facility. Furthermore, studies evaluating the impact of inter-facility transport mode on mortality have reported mixed findings. Since HEMS transport is generally reserved for more severely injured patients, this introduces indication bias, which may explain the mixed findings. Our objective was to identify factors at referring non-tertiary trauma centers (NTC) influencing transport mode decision. Methods This was a case-control study of trauma patients transferred from a Level III or IV NTC to a tertiary trauma center (TTC) within 24-hours reported to the Oklahoma State Trauma Registry between 2005 and 2012. Multivariable logistic regression was used to determine clinical and non-clinical factors associated with the decision to use HEMS. Results A total of 7380 patients met the study eligibility. Of these, 2803(38%) were transported inter-facility by HEMS. Penetrating injury, prehospital EMS transport, severe torso injury, hypovolemic shock, and TBI were significant predictors (p<0.05) of HEMS use regardless of distance to a TTC. Association between HEMS use and male gender, Level IV NTC, and local ground EMS resources varied by distance from the TTC. Many HEMS transported patients had minor injuries and normal vital signs. Conclusions Our results suggest that while distance remains the most influential factor associated with HEMS use, significant differences exist in clinical and non-clinical factors between patients transported by HEMS versus GEMS. To ensure comparability of study groups, studies evaluating outcome differences between HEMS and GEMS should take factors determining transport mode into account. The findings will be used to develop propensity scores to balance baseline risk between GEMS and HEMS patients for use in subsequent studies

  6. Treatment of opioid overdose in a physician-based prehospital EMS: Frequency and long-term prognosis

    DEFF Research Database (Denmark)

    Nielsen, K.; Nielsen, S.L.; Siersma, Volkert Dirk;

    2011-01-01

    BACKGROUND: Prehospital treatment of opioid overdose accounts for a significant proportion of the workload of the emergency system in most major cities. Treatment consists of basic life support and administering naloxone. In our physician-manned mobile emergency care unit (MECU), most patients...... are released and not admitted to hospital. In this study, we aimed to assess the pattern in the number of episodes with opioid overdose treated by MECU in Copenhagen during a 10-year period and to investigate risk factors for mortality of these patients beyond the initial contact. METHODS: Data were collected...... prospectively in the MECU database covering all cases of opioid overdose in a 10-year period between 1994 and 2003. The pattern in the number of opioid overdose was analysed in Poisson regression models, and mortality was analysed in Kaplan-Meier plots and in Cox regression models. RESULTS: A total of 4762...

  7. The Trauma of Goodness in Patricia Grace's Fiction

    NARCIS (Netherlands)

    Visser, Irene

    2012-01-01

    Postcolonial literary critics today increasingly draw on cultural trauma theory to illuminate processes concerning the traumatic aftermath of colonization. There is also, however, a growing resistance to some of cultural trauma theory's central concepts and its basic orientation, which are often dee

  8. The role of the nurse in voluntary pre-hospital emergency care schemes

    OpenAIRE

    Trueman, Ian

    2010-01-01

    This presentation will explore the variety of evolving roles for the registered nurse in the prehospital emergency care arena and the relevant qualifications and skills required to advance the profession in this area.

  9. Exploration of key stakeholders' preferences for pre-hospital physiologic monitoring by emergency rescue services.

    Science.gov (United States)

    Mort, Alasdair J; Rushworth, Gordon F

    2013-12-01

    To gather preferences for novel pre-hospital physiologic monitoring technologies from emergency rescue services. Qualitative semi-structured interviews and focus groups were conducted with three groups from UK Search and Rescue (SAR); (1) Extractors (e.g. SAR teams), (2) Transporters (personnel primarily responsible for casualty transport), and (3) Treaters (e.g. Emergency Department doctors). Three themes were defined; SAR casualty management, novel physiologic monitor potential, and physiologic monitor physical properties. Some SAR groups already employed physiologic monitoring but there was no consensus on which monitor(s) to carry or what to monitor and how frequently. Existing monitors also tended to be bulky and heavy and could be unreliable in an unstable environment or if the casualty was cold. Those performing monitoring tended to have only basic first-aid training, and their workload was often high particularly if there was more than one casualty. The potential benefits of employing a novel monitor were strategic and clinical; an opportunity for transmitting data off-scene in order to facilitate monitoring or generate advice (i.e. telemedicine) was also voiced. A range of more intuitive, physical properties was also raised (e.g. small/compact, lightweight). SAR-specific technology should be simple to operate by those with less medical training, which means that clinical data interpretation and presentation should be carefully considered. It would be beneficial if novel monitors carried out a majority of the interpretation, allowing rescuers to proceed with their priority task of removing the casualty to safety.

  10. Prehospital therapeutic hypothermia after cardiac arrest - from current concepts to a future standard

    OpenAIRE

    Hoppu Sanna; Kämäräinen Antti; Silfvast Tom; Virkkunen Ilkka

    2009-01-01

    Abstract Therapeutic hypothermia has been shown to improve survival and neurological outcome after prehospital cardiac arrest. Existing experimental and clinical evidence supports the notion that delayed cooling results in lesser benefit compared to early induction of mild hypothermia soon after return of spontaneous circulation. Therefore a practical approach would be to initiate cooling already in the prehospital setting. The purpose of this review was to evaluate current clinical studies o...

  11. Witnessed arrest, but not delayed bystander cardiopulmonary resuscitation improves prehospital cardiac arrest survivial

    OpenAIRE

    Vukmir, R

    2004-01-01

    Methods: This prospective, randomised, double blinded clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered in a prehospital urban, suburban, and rural regional emergency medical service (EMS) area. This group underwent conventional advanced cardiac life support intervention followed by empiric early administration of sodium bicarbonate (1 mEq/l), monitoring conventional resuscitation parameters. Survival was measured as presence of vital signs on em...

  12. The prehospital phase of acute myocardial infarction in the era of thrombolysis.

    Science.gov (United States)

    Schmidt, S B; Borsch, M A

    1990-06-15

    To evaluate the factors affecting the time between symptom onset and hospital arrival in patients with acute myocardial infarction (AMI), we gave a detailed questionnaire to all who were admitted or transferred with AMI from January 1988 to February 1989. In these 126 patients (94 men, 32 women) the mean prehospital time was 5.9 +/- 11.0 hours (median 2.0, range 0.4 to 69.0). The time between symptom onset and reaching a decision that medical care should be sought was 62% of the mean prehospital time. In 100 (79%) patients, the prehospital time was less than or equal to 6 hours; of these, 61 (61%) were retrospectively judged to have been optimal candidates for lytic therapy. Stepwise multiple regression selected the following 4 variables as independent predictors of prehospital time: slow symptom progression; low income; female gender; and advanced age. All of these variables are predictive (p less than 0.03) of increased prehospital time; absence of prior AMI was of borderline additional significance (p = 0.053). Similarly, logistic regression analysis selected slow symptom progression, female gender and low income as significant (p less than or equal to 0.02) independent predictors of prehospital time greater than 6 hours. The logistic regression model incorporating these 3 variables had a sensitivity of 54%, a specificity of 95% and a positive predictive value of 72% in identifying patients with prehospital time greater than 6 hours. Thus, these data indicate it is possible to characterize patients likely to experience undue prehospital delay during AMI, which may be of importance to future public education efforts. PMID:2353644

  13. Hot Air Balloon: An Unusual Cause of Multicasualty Trauma Incident.

    Science.gov (United States)

    Persoz, Marc-Olivier; Dami, Fabrice; Ciavatta, Ettore; Vallotton, Laurent; Albrecht, Roland; Carron, Pierre-Nicolas

    2016-01-01

    Hot air balloon incidents are few and far between compared with the total number of flights. Nevertheless, hot air balloon incidents may produce severe trauma involving several patients and are linked to significant mortality. The prehospital management of injured patients starts after having secured potential surrounding dangers, such as fire or explosion. In the context of a rescue by helicopter, close attention must be paid to potential obstacles, like trees or electrical wires, and the risk of aspiration of the balloon envelope into the rotor. Patients involved in such incidents are often split up in a closed perimeter around the crash point. The severity of the trauma depends essentially on the height of the fall. The most frequent traumatic lesions involve fractures of the lower limbs, the spine, and the pelvis as well as severe burns caused by the balloon fire. Because of the number of patients present, an initial triage is usually required at the site. The use of rescue helicopters can be helpful. They can perform aerial reconnaissance, provide on-site high-level resources, enable access to the patients even in hostile environments, and quickly transport them to trauma center hospitals. PMID:27255882

  14. Identification of adults with sepsis in the prehospital environment: a systematic review

    Science.gov (United States)

    Smyth, Michael A; Brace-McDonnell, Samantha J; Perkins, Gavin D

    2016-01-01

    Objective Early identification of sepsis could enable prompt delivery of key interventions such as fluid resuscitation and antibiotic administration which, in turn, may lead to improved patient outcomes. Limited data indicate that recognition of sepsis by paramedics is often poor. We systematically reviewed the literature on prehospital sepsis screening tools to determine whether they improved sepsis recognition. Design Systematic review. The electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed were systematically searched up to June 2015. In addition, subject experts were contacted. Setting Prehospital/emergency medical services (EMS). Study selection All studies addressing identification of sepsis (including severe sepsis and septic shock) among adult patients managed by EMS. Outcome measures Recognition of sepsis by EMS clinicians. Results Owing to considerable variation in the methodological approach adopted and outcome measures reported, a narrative approach to data synthesis was adopted. Three studies addressed development of prehospital sepsis screening tools. Six studies addressed paramedic diagnosis of sepsis with or without use of a prehospital sepsis screening tool. Conclusions Recognition of sepsis by ambulance clinicians is poor. The use of screening tools, based on the Surviving Sepsis Campaign diagnostic criteria, improves prehospital sepsis recognition. Screening tools derived from EMS data have been developed, but they have not yet been validated in clinical practice. There is a need to undertake validation studies to determine whether prehospital sepsis screening tools confer any clinical benefit. PMID:27496231

  15. Evaluation of the Effects of Standard Rescue Procedure on Severe Trauma Treatment in China

    Institute of Scientific and Technical Information of China (English)

    Xiao-Feng Yin; Tian-Bing Wang; Pei-Xun Zhang; Yu-Hui Kou; Dian-Ying Zhang; Kai Yu; De-Cheng Lyu

    2015-01-01

    Background:This study aimed to evaluate the effects of standard rescue procedure (SRP) in improving severe trauma treatments in China.Methods:This study was conducted in 12 hospitals located in geographically and industrially different cities in China.A standard procedure on severe trauma rescue was established as a general rule for staff training and patient treatment.A regional network (system) efficiently integrating prehospital rescue,emergency room treatments,and hospital specialist treatments was built under the rule for information sharing and improving severe trauma treatments.Treatment outcomes were compared between before and I year after the implementation of the SRP.Results:The outcomes of a total of 74,615 and 12,051 trauma cases were collected from 12 hospitals before and after the implementation of the SRP.Implementation of the SRP led to efficient cooperation and information sharing of different treatment services.The emergency response time,prehospital transit time,emergency rescue time,consultation call time,and mortality rate of patients were 24.24 ± 4.32 min,45.69 ± 3.89 min,6.38 ± 1.05 min,17.53 ± 0.72 min,and 33.82% ± 3.87% (n =441),respectively,before the implementation of the standardization and significantly reduced to 10.11 ± 3.21 min,22.39 ± 4.32 min,3.26 ± 0.89 min,3.45 ± 0.45 min,and 20.49% ± 3.11%,separately (n =495,P < 0.05) after that.Conclusions:Staff training and SRP can significantly improve the efficiency of severe trauma treatments in China.

  16. Influence of The Education and Training of Prehospital Medical Crews on Measures of Performance and Patient Outcomes

    OpenAIRE

    Blomberg, Hans

    2013-01-01

    Prehospital care has developed dramatically the last decades with the implementation of new devices and educational concepts. Clinical decisions and treatments have moved out from the hospitals to the prehospital setting. In Sweden this has been accompanied by an increase in the level of competence, i.e. by introducing nurses in the ambulances. With some exceptions the scientific support for these changes is poor. This thesis deals with such changes in three different subsets of prehospital c...

  17. Diagnostic Accuracy of Cincinnati Pre-Hospital Stroke Scale

    Directory of Open Access Journals (Sweden)

    Behzad Zohrevandi

    2015-07-01

    Full Text Available Introduction: Stroke is recognized as the third cause of mortality after cardiovascular and cancer diseases, so that lead to death of about 5 million people, annually. There are several scales to early prediction of at risk patients and decreasing the rate of mortality by transferring them to the stroke center. In the present study, the accuracy of Cincinnati pre-hospital stroke scale was assessed. Methods: This was a retrospective cross-sectional study done to assess accuracy of Cincinnati scale in prediction of stroke probability in patients referred to the emergency department of Poursina Hospital, Rasht, Iran, 2013 with neurologic symptoms. Three criteria of Cincinnati scale including facial droop, dysarthria, and upper extremity weakness as well as the final diagnosis of patients were gathered. Sensitivity, specificity, predictive values, and likelihood ratios of Cincinnati scale were calculated using SPSS version 20. Results: 448 patients were assessed. The agreement rate of Cincinnati scale and final diagnosis was 0.483 ± 0.055 (p<0.0001. The sensitivity of 93.19% (95% Cl: 90.11-95.54, specificity of 51.85% (95% Cl: 40.47-63.10, positive predictive value of 89.76% (95% Cl: 86.27-92.62, negative predictive value of 62.69% (95% Cl: 55.52-72.45, positive likelihood ratio of 1.94% (95% Cl: 1.54-2.43, and negative likelihood ratio of 0.13% (95% Cl: 0.09-0.20 were calculated. Conclusion: It seems that pre-hospital Cincinnati scale can be an appropriate screening tool in prediction of stroke in patients with acute neurologic syndromes.

  18. The Impact of Childhood Trauma on Brain Development: A Literature Review and Supporting Handouts

    Science.gov (United States)

    Kirouac, Samantha; McBride, Dawn Lorraine

    2009-01-01

    This project provides a comprehensive overview of the research literature on the brain and how trauma impacts brain development, structures, and functioning. A basic exploration of childhood trauma is outlined in this project, as it is essential in making associations and connections to brain development. Childhood trauma is processed in the…

  19. 初级创伤救治模式在多发伤急救中的应用%Application of primary trauma care model in severe multiple trauma emergency

    Institute of Scientific and Technical Information of China (English)

    崔守永

    2014-01-01

    Objective To investigate the application of the primary trauma care model in res-cued patients with severe multiple trauma in pre-hospital and hospital emergency. Methods The clini-cal data of 109 patients with severe multiple trauma admitted to pre-hospital first aid and hospital e-mergency in our hospital from september 2012 to september 2013 were retrospectively analyzed. All patients treated according to primary trauma care( primary trauma care,PTC)model. Results One hundred nine cases with severe multiple trauma received rescue,6 cases died in pre-hospital treat-ment,with the rescue success rate of 94. 5%. One hundred and three patients received treatment in hospital continually,7 patients were died in the process,with the rescue success rate of 88. 1%. Conclusions Adopting primary trauma care model is effective guarantee for the successful rescue of patients with severe multiple trauma.%目的:探讨初级创伤救治模式在院前和院内多发伤急救中的应用。方法2012年9月至2013年9月滨州医学院附属医院院前急救和院内急救接诊处理的严重多发伤患者109例,按照初级创伤救治( PTC)的模式进行救治。结果109例严重多发伤患者中院前死亡6例,院前急救成功率为94.5%,继续接受院内救治的103例患者中死亡7例,院内抢救成功率为88.1%。结论初级创伤救治的模式严重多发伤患者抢救成功的有效保障。

  20. Prehospital Ketamine is a Safe and Effective Treatment for Excited Delirium in a Community Hospital Based EMS System.

    Science.gov (United States)

    Scaggs, Thomas R; Glass, David M; Hutchcraft, Megan Gleason; Weir, William B

    2016-10-01

    Excited delirium syndrome (ExDS) is defined by marked agitation and confusion with sympathomimetic surge and incessant physical struggle, despite futility, which may lead to profound pathophysiologic changes and sudden death. Severe metabolic derangements, including lactic acidosis, rhabdomyolysis, and hyperthermia, occur. The pathophysiology of excited delirium is a subject of ongoing basic science and clinical research. Positive associations with ExDS include male gender, mental health disorders, and substance abuse (especially sympathomimetics). Excited delirium syndrome patients often exhibit violent, psychotic behavior and have "superhuman" strength which can result in the patient fighting with police and first responders. Continued struggle can cause a patient with ExDS to experience elevated temperature (T) and acidosis which causes enzymes to fail, leading to sudden death from cardiovascular collapse and multi-system organ failure. Therefore, effective early sedation is optimal to stop this fulminant process. Treatment of ExDS must be focused on rapidly, safely, and effectively sedating the patient and providing intensive, supportive care. Benzodiazepines, like midazolam, may not be ideal to sedate ExDS patients since their onset takes several minutes, and their side effects include loss of airway control and respiratory depression. Injectable antipsychotic medications have a relatively slow onset and may cause prolongation of the QTc interval. Ketamine is the ideal medication to sedate patients with ExDS. Ketamine has a rapid, predictable onset within three to four minutes when given by intramuscular (IM) injection. It does not adversely affect airway control, breathing, heart rate, or blood pressure (BP). In this retrospective case series, prehospital scenarios in which ExDS patients received ketamine by paramedics for sedation, and their subsequent treatment in the emergency department (ED) and hospital, are described. It is demonstrated that ketamine

  1. Management of duodenal trauma

    Institute of Scientific and Technical Information of China (English)

    CHEN Guo-qing; YANG Hua

    2011-01-01

    Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature in PubMed by the keywords of duodenal trauma, therapy, diagnosis and abdomen. It shows that because the diagnosis and management are complicated and the mortality is high,duodenal trauma should be treated in time and tactfully.And application of new technology can help improve the management. In this review, we discussed the incidence,diagnosis, management, and complications as well as mortality of duodenal trauma.

  2. Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva; Gerds, Thomas Alexander;

    2012-01-01

    Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often...... combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTrauma...

  3. Management of duodenal trauma

    OpenAIRE

    Chen, Guo-Qing; Hua YANG

    2011-01-01

    【Abstract】Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature...

  4. Trauma is danger

    OpenAIRE

    Porterfield Nancy; Hwang Paul F; Pannell Dylan; Davis Thomas A; Elster Eric A

    2011-01-01

    Abstract Background Trauma is one of the leading causes of death in young adult patients. Many pre-clinical and clinical studies attempt to investigate the immunological pathways involved, however the true mediators remain to be elucidated. Herein, we attempt to describe the immunologic response to systemic trauma in the context of the Danger model. Data Sources A literature search using PubMed was used to identify pertinent articles describing the Danger model in relation to trauma. Conclusi...

  5. Trauma--the disease that was neglected. Progress: past and that to be.

    Science.gov (United States)

    Howard, J M

    1994-12-01

    Sir Harold Stiles has a historic spot in the annals of trauma care to which he and his military colleagues so richly contributed. For this we honour him today. Tremendous progress has been achieved during our lifetime in the field of trauma. Injury prevention has been the most important facet with progress underway in the fields of gun control, seatbelts, motorcycle and bicycle helmets, child restraint seats, airbags and particularly alcohol restraint. Overall, traffic fatalities are being reduced. Of great importance is the need for de-emphasis and deglamorization of violence by television, movie, and news media. Improved prehospital care has taken the form of professionalism of emergency medical services comparable to that in law enforcement and fire services. Improved hospital care is resulting, in part, from the widespread development of trauma and burn centres. Continued progress is needed in each field, particularly in gun control, alcohol control, overall traffic accident prevention, and in the understanding of cerebral oedema after head injury. The teaching of the principles of trauma prevention and community organization for better emergency medical response should be introduced into the Health or Civics curriculum perhaps at the 5th or 6th grade level in elementary schools. Perhaps the greatest potential for progress in the field of trauma which we have witnessed in our lifetime may prove to have been the actions of the United Nations in Korea in 1950 and Kuwait in 1991, proclaiming that 'war will no longer be tolerated as an instrument of national aggression'. PMID:7869286

  6. Trauma in pregnancy.

    Science.gov (United States)

    Oxford, Corrina M; Ludmir, Jonathan

    2009-12-01

    In the United States, trauma is the leading nonobstetric cause of maternal death. The principal causes of trauma in pregnancy include motor vehicle accidents, falls, assaults, homicides, domestic violence, and penetrating wounds. The managing team evaluating and coordinating the care of the pregnant trauma patient should be multidisciplinary so that it is able to understand the physiologic changes in pregnancy. Blunt trauma to the abdomen increases the risk of placental abruption. Evaluation of the pregnant trauma patient requires a primary and secondary survey with emphasis on airway, breathing, circulation, and disability. The use of imaging studies, invasive hemodynamics, critical care medications, and surgery, if necessary, should be individualized and guided by a coordinating team effort to improve maternal and fetal conditions. A clear understanding of gestational age and fetal viability should be documented in the record. PMID:20393413

  7. Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva Fejerskov; Christensen, Søren Steno Ahrensburg;

    2012-01-01

    Diagnose and treatment of traumatic dental injuries is very complex due to the multiple trauma entities represented by 6 lunation types and 9 fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and lunation injuries are often combined......, the result is, that more than 100 trauma scenario exist when the two dentitions are combined. Each of these trauma scenarios have a specific treatment demand and prospect for healing. With such a complexity in diagnose and treatment it is obvious that even experienced practitioners may have problems may have...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an internet based knowledge base consisting of 4000 dental trauma cases with long term follow up is now available to the public and professionals, on the internet using the address www...

  8. Comparison of current injury scales for survival chance estimation: an evaluation comparing the predictive performance of the ISS, NISS, and AP scores in a Dutch local trauma registration.

    NARCIS (Netherlands)

    Frankema, S.P.; Steyerberg, E.W.; Edwards, M.J.R.; Vugt, A.B. van

    2005-01-01

    BACKGROUND: Prediction of survival chances for trauma patients is a basic requirement for evaluation of trauma care. The current methods are the Trauma and Injury Severity Score (TRISS) and A Severity Characterization of Trauma (ASCOT). Scales for scoring injury severity are part of these methods. T

  9. Fast assessment and management of chest pain without ST-elevation in the pre-hospital gateway : rationale and design

    NARCIS (Netherlands)

    Ishak, Maycel; Ali, Danish; Fokkert, Marion J; Slingerland, Robbert J; Dikkeschei, Bert; Tolsma, Rudolf T; Lichtveld, Rob A; Bruins, Wendy; Boomars, René; Bruheim, Kim; van Eenennaam, Fred; Timmers, Leo; Voskuil, Michiel; Doevendans, Pieter A; Mosterd, Arend; Hoes, Arno W; ten Berg, Jurriën M; van 't Hof, Arnoud W J

    2015-01-01

    BACKGROUND: For chest pain patients without ST-segment elevation in the pre-hospital setting, current clinical guidelines merely offer in-hospital risk stratification and management, as opposed to chest pain patients with ST-segment elevation for whom there is a straightforward pre-hospital strategy

  10. Effects of physician-based emergency medical service dispatch in severe traumatic brain injury on prehospital run time

    NARCIS (Netherlands)

    Franschman, G.; Verburg, N.; Brens-Heldens, V.; Andriessen, T.M.J.C.; Naalt, J. van der; Peerdeman, S.M.; Valk, J.P.M. van der; Hoogerwerf, N.; Greuters, S.; Schober, P.; Vos, P.E.; Christiaans, H.M.; Boer, C.

    2012-01-01

    INTRODUCTION: Prehospital care by physician-based helicopter emergency medical services (P-HEMS) may prolong total prehospital run time. This has raised an issue of debate about the benefits of these services in traumatic brain injury (TBI). We therefore investigated the effects of P-HEMS dispatch o

  11. Effects of physician-based emergency medical service dispatch in severe traumatic brain injury on prehospital run time

    NARCIS (Netherlands)

    Franschman, G.; Verburg, N.; Brens-Heldens, V.; Andriessen, T. M. J. C.; Van der Naalt, J.; Peerdeman, S. M.; Hoogerwerf, N.; Greuters, S.; Schober, P.; Vos, P. E.; Christiaans, H. M. T.; Boer, C.; Valk, J.P.

    2012-01-01

    Introduction: Prehospital care by physician-based helicopter emergency medical services (P-HEMS) may prolong total prehospital run time. This has raised an issue of debate about the benefits of these services in traumatic brain injury (TBI). We therefore investigated the effects of P-HEMS dispatch o

  12. The World Health Organization's action plan on the road traffic injury pandemic: is there any action for orthopaedic trauma surgeons?

    Science.gov (United States)

    Moroz, Paul J; Spiegel, David A

    2014-01-01

    Road traffic crash-related death, injury, and chronic disability continue to be a major worldwide burden to drivers, pedestrians, and users of mass transit, especially in low- and middle-income countries (LMIC). Projections predict worsening of this burden, and while motorization of LMIC increases exponentially, a corresponding improvement in prehospital and acute in-hospital trauma care has not been seen. The WHO now has 2 programs that address different elements of this challenge, namely, the Violence and Injury Prevention department (prevention) and the Emergency and Essential Surgical Care project (treatment). Activities of Violence and Injury Prevention have included developing guidelines for prehospital and essential trauma care, whereas activities of the Emergency and Essential Surgical Care have included developing the Integrated Management of Emergency and Essential Surgical Care toolkit and a textbook, "Surgical Care at the District Hospital." Organized surgical institutions in high-income countries-trauma associations, university departments, surgical nongovernmental organizations, etc.-can benefit from the infrastructure and tools the WHO has developed to better address the deficits in surgical services to improve the equitable distribution of surgical care services and resources to LMIC.

  13. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services

    DEFF Research Database (Denmark)

    Kruger, Andreas J; Lockey, David; Kurola, Jouni;

    2011-01-01

    have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care.......ABSTRACT: BACKGROUND: Physician-staffed pre-hospital units are employed in many Western emergency medical systems (EMS). Although these services usually integrate well within their EMS, little is known about the quality of care delivered, the precision of dispatch, and whether the services deliver...... a higher quality of care to pre-hospital patients. There is no current data set collected to document the activity of physician pre-hospital activity which makes shared research efforts difficult. The aim of this study was to develop a core data set for routine documentation and reporting in physician...

  14. Trauma radiology in infancy and childhood

    International Nuclear Information System (INIS)

    The aim of this review article is to familiarise the reader with the specific paediatric conditions in trauma radiology. The article briefly describes the major pathophysiologic differences in childhood and the consecutive altered injury pattern. The standard radiological imaging protocol for various involved body regions and different trauma settings/varying queries is described, with suggestion for standardised diagnostic flowcharts in some typical settings. Special regard is given to radiation protection and the potential of newer imaging modalities such as ultrasound, multi-detector- and spiral CT as well as MRI in paediatric trauma patients. As such the paper hopefully provides some basic guidelines for general radiologists in peripheral hospitals who less often have to deal with paediatric queries. (orig.)

  15. The internationalisation of prehospital education: a merging of ideologies between Australia and the USA.

    Science.gov (United States)

    Williams, B; Upchurch, J

    2006-07-01

    The aim of this project was to promote internationalisation of prehospital education collaboratively between students and teachers from EMS Education and Training, Montana, USA, and Monash University Centre for Ambulance and Paramedic Studies (MUCAPS), Victoria, Australia. The project required students and teachers to engage in a series of face to face lectures, which was reinforced through distance education strategies, such as online learning. The overall project aim was to establish an objective and descriptive view of the internationalisation of prehospital and community based emergency health education using e-learning as the educational approach. A cross sectional survey design using paper based evaluation was adopted in this project. Results revealed a positive student reaction, with flexible pedagogical processes broadening student learning and facilitating an international dimension otherwise not achievable. Given the current state of globalisation, internationalisation has the capacity to improve educational standards, quality, student interactions and specific learning outcomes in prehospital education.

  16. Continuous positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure

    DEFF Research Database (Denmark)

    Bakke, Skule A; Bøtker, Morten Thingemann; Riddervold, Ingunn S;

    2014-01-01

    Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are frequently used inhospital for treating respiratory failure, especially in treatment of acute cardiogenic pulmonary edema and exacerbation of chronic obstructive pulmonary disease. Early initiation of treatment...... is important for success and introduction already in the prehospital setting may be beneficial. Our goal was to assess the evidence for an effect of prehospital CPAP or NIV as a supplement to standard medical treatment alone on the following outcome measures; mortality, hospital length of stay, intensive care...... examine prehospital CPAP. Of these, only one small, randomized controlled trial shows a reduced mortality rate and a reduced intubation rate with supplemental CPAP. The other three studies have neutral findings, but in two of these a trend toward lower intubation rate is found. The effect of supplemental...

  17. Trauma Induced Coagulopathy

    DEFF Research Database (Denmark)

    Genét, Gustav Folmer; Johansson, Per; Meyer, Martin Abild Stengaard;

    2013-01-01

    It remains debated whether traumatic brain injury (TBI) induces a different coagulopathy compared to non-TBI. This study investigated traditional coagulation tests, biomarkers of coagulopathy and endothelial damage in trauma patients with and without TBI. Blood from 80 adult trauma patients were...... sampled (median of 68 min (IQR 48-88) post-injury) upon admission to our trauma centre. Plasma/serum were retrospectively analysed for biomarkers reflecting sympathoadrenal activation (adrenaline, noradrenaline), coagulation activation/inhibition and fibrinolysis (protein C, activated protein C, tissue...

  18. Chest Pain of Suspected Cardiac Origin: Current Evidence-based Recommendations for Prehospital Care

    Directory of Open Access Journals (Sweden)

    P. Brian Savino

    2015-12-01

    Full Text Available Introduction: In the United States, emergency medical services (EMS protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of chest pain of suspected cardiac origin and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California. Methods: We performed a literature review of the current evidence in the prehospital treatment of chest pain and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the chest pain protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were use of supplemental oxygen, aspirin, nitrates, opiates, 12-lead electrocardiogram (ECG, ST segment elevation myocardial infarction (STEMI regionalization systems, prehospital fibrinolysis and β-blockers. Results: The protocols varied widely in terms of medication and dosing choices, as well as listed contraindications to treatments. Every agency uses oxygen with 54% recommending titrated dosing. All agencies use aspirin (64% recommending 325mg, 24% recommending 162mg and 15% recommending either, as well as nitroglycerin and opiates (58% choosing morphine. Prehospital 12- Lead ECGs are used in 97% of agencies, and all but one agency has some form of regionalized care for their STEMI patients. No agency is currently employing prehospital fibrinolysis or β-blocker use. Conclusion: Protocols for chest pain of suspected cardiac origin vary widely across California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

  19. EMS Adherence to a Pre-hospital Cervical Spine Clearance Protocol

    Directory of Open Access Journals (Sweden)

    Johnson, David

    2001-10-01

    Full Text Available Purpose: To determine the degree of adherence to a cervical spine (c-spine clearance protocol by pre-hospital Emergency Medical Services (EMS personnel by both self-assessment and receiving hospital assessment, to describe deviations from the protocol, and to determine if the rate of compliance by paramedic self-assessment differed from receiving hospital assessment. Methods: A retrospective sample of pre-hospital (consecutive series and receiving hospital (convenience sample assessments of the compliance with and appropriateness of c-spine immobilization. The c-spine clearance protocol was implemented for Orange County EMS just prior to the April-November 1999 data collection period. Results: We collected 396 pre-hospital and 162 receiving hospital data forms. From the pre-hospital data sheet. the percentage deviation from the protocol was 4.096 (16/396. Only one out of 16 cases that did not comply with the protocol was due to over immobilization (0.2%. The remaining 15 cases were under immobilized, according to protocol. Nine of the under immobilized cases (66% that should have been placed in c-spine precautions met physical assessment criteria in the protocol, while the other five cases met mechanism of injury criteria. The rate of deviations from protocol did not differ over time. The receiving hospital identified 8.0% (13/162; 6/16 over immobilized, 7/16 under immobilized of patients with deviations from the protocol; none was determined to have actual c-spine injury. Conclusion: The implementation of a pre-hospital c-spine clearance protocol in Orange County was associated with a moderate overall adherence rate (96% from the pre-hospital perspective, and 92% from the hospital perspective, p=.08 for the two evaluation methods. Most patients who deviated from protocol were under immobilized, but no c-spine injuries were missed. The rate of over immobilization was better than previously reported, implying a saving of resources.

  20. Feasibility of prehospital teleconsultation in acute stroke--a pilot study in clinical routine.

    Directory of Open Access Journals (Sweden)

    Sebastian Bergrath

    Full Text Available BACKGROUND: Inter-hospital teleconsultation improves stroke care. To transfer this concept into the emergency medical service (EMS, the feasibility and effects of prehospital teleconsultation were investigated. METHODOLOGY/PRINCIPAL FINDINGS: Teleconsultation enabling audio communication, real-time video streaming, vital data and still picture transmission was conducted between an ambulance and a teleconsultation center. Pre-notification of the hospital was carried out with a 14-item stroke history checklist via e-mail-to-fax. Beside technical assessments possible influences on prehospital and initial in-hospital time intervals, prehospital diagnostic accuracy and the transfer of stroke specific data were investigated by comparing telemedically assisted prehospital care (telemedicine group with local regular EMS care (control group. All prehospital stroke patients over a 5-month period were included during weekdays (7.30 a.m.-4.00 p.m.. In 3 of 18 missions partial dropouts of the system occurred; neurological co-evaluation via video transmission was conducted in 12 cases. The stroke checklist was transmitted in 14 cases (78%. Telemedicine group (n = 18 vs. control group (n = 47: Prehospital time intervals were comparable, but in both groups the door to brain imaging times were longer than recommended (median 59.5 vs. 57.5 min, p = 0.6447. The prehospital stroke diagnosis was confirmed in 61% vs. 67%, p = 0.8451. Medians of 14 (IQR 9 vs. 5 (IQR 2 stroke specific items were transferred in written form to the in-hospital setting, p<0.0001. In 3 of 10 vs. 5 of 27 patients with cerebral ischemia thrombolytics were administered, p = 0.655. CONCLUSIONS: Teleconsultation was feasible but technical performance and reliability have to be improved. The approach led to better stroke specific information; however, a superiority over regular EMS care was not found and in-hospital time intervals were unacceptably long in both groups. The

  1. Prehospital Emergency Ultrasound: A Review of Current Clinical Applications, Challenges, and Future Implications

    Directory of Open Access Journals (Sweden)

    Mazen J. El Sayed

    2013-01-01

    Full Text Available Imaging modalities in the prehospital setting are helpful in the evaluation and management of time-sensitive emergency conditions. Ultrasound is the main modality that has been applied by emergency medical services (EMS providers in the field. This paper examines the clinical applications of ultrasound in the prehospital setting. Specific focus is on applications that provide essential information to guide triage and management of critical patients. Challenges of this modality are also described in terms of cost impact on EMS agencies, provider training, and skill maintenance in addition to challenges related to the technical aspect of ultrasound.

  2. Trauma no idoso Trauma in the elderly

    Directory of Open Access Journals (Sweden)

    JOSÉ ANTONIO GOMES DE SOUZA

    2002-03-01

    Full Text Available O crescimento populacional de idosos, associado a uma forma de vida mais saudável e mais ativa, deixa este grupo de pessoas mais exposto ao risco de acidentes. Em alguns países, o trauma do idoso responde por uma elevada taxa de mortalidade, a qual se apresenta de forma desproporcionalmente maior do que a observada entre a população de adultos jovens. Tal fato acarreta um grande consumo de recursos financeiros destinados à assistência da saúde e um elevado custo social. As características fisiológicas próprias do idoso, assim como a presença freqüente de doenças associadas, faz com que estes pacientes se comportem diferentemente e de forma mais complexa do que os demais grupos etários. Estas particularidades fazem com que o atendimento ao idoso vítima de trauma se faça de forma diferenciada. A presente revisão aborda aspectos da epidemiologia, da prevenção, da fisiologia, do atendimento e da reabilitação do idoso vítima de trauma.The populational growth of the elderly, associated to a healthier and more active life, make this group of people more exposed to accidents. In some countries, trauma in the elderly is responsible for a high mortality rate, desproportionately higher than in the adults. This fact consumes a great portion of health care resources and implies in a high social cost. The distinct physiologic characteristics of the elderly and the frequent presence of associated diseases make that these patients behave diferently and in a more complex way than patients of other ages. These particularities make that health care to the elderly victims of trauma have to be different. The present revision is about aspects of epidemiology, prevention, physiology, health care and reabilitation of the elderly victims of trauma.

  3. Trauma and Coagulation

    Directory of Open Access Journals (Sweden)

    Murat Yılmaz

    2011-08-01

    Full Text Available Bleeding and coagulation disorders related to trauma are pathological processes which are frequently seen and increase mortality. For the purpose, trauma patients should be protected from hypoperfusion, hypothermia, acidosis and hemodilution which may aggravate the increase in physiological responses to trauma as anticoagulation and fibrinolysis. Performing damage control surgery and resuscitation and transfusion of adequate blood and blood products in terms of amount and content as stated in protocols may increase the rate of survival. Medical treatments augmenting fibrin formation (fibrinogen, desmopressin, factor VIIa or preventing fibrin degradation (tranexamic acid have been proposed in selected cases but the efficacy of these agents in trauma patients are not proven. (Journal of the Turkish Society Intensive Care 2011; 9:71-6

  4. Suspension Trauma / Orthostatic Intolerance

    Science.gov (United States)

    ... such fatalities often are referred to as "harnessinduced pathology" or "suspension trauma." Signs & symptoms that may be ... move legs Hypothermia Pain Shock Injuries during fall Cardiovascular disease Fatigue Respiratory disease Dehydration Blood loss References: ...

  5. Platelet aggregation following trauma

    DEFF Research Database (Denmark)

    Windeløv, Nis A; Sørensen, Anne M; Perner, Anders;

    2014-01-01

    We aimed to elucidate platelet function in trauma patients, as it is pivotal for hemostasis yet remains scarcely investigated in this population. We conducted a prospective observational study of platelet aggregation capacity in 213 adult trauma patients on admission to an emergency department (ED......). Inclusion criteria were trauma team activation and arterial cannula insertion on arrival. Blood samples were analyzed by multiple electrode aggregometry initiated by thrombin receptor agonist peptide 6 (TRAP) or collagen using a Multiplate device. Blood was sampled median 65 min after injury; median injury...... severity score (ISS) was 17; 14 (7%) patients received 10 or more units of red blood cells in the ED (massive transfusion); 24 (11%) patients died within 28 days of trauma: 17 due to cerebral injuries, four due to exsanguination, and three from other causes. No significant association was found between...

  6. Acute coagulopathy of trauma

    DEFF Research Database (Denmark)

    Johansson, P I; Ostrowski, S R

    2010-01-01

    Acute coagulopathy of trauma predicts a poor clinical outcome. Tissue trauma activates the sympathoadrenal system resulting in high circulating levels of catecholamines that influence hemostasis dose-dependently through immediate effects on the two major compartments of hemostasis, i.......e., the circulating blood and the vascular endothelium. There appears to be a dose-dependency with regards to injury severity and the hemostatic response to trauma evaluated in whole blood by viscoelastic assays like thrombelastography (TEG), changing from normal to hypercoagulable, to hypocoagulable and finally......, is an evolutionary developed response that counterbalances the injury and catecholamine induced endothelial activation and damage. Given this, the rise in circulating catecholamines in trauma patients may favor a switch from hyper- to hypocoagulability in the blood to keep the progressively more procoagulant...

  7. Noninvasive ventilation in trauma

    OpenAIRE

    Karcz, Marcin K; Peter J. Papadakos

    2015-01-01

    Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia. It is well-known that these patients are at increased risk to develop ...

  8. Trauma registry reengineered.

    Science.gov (United States)

    Wargo, Christina; Bolig, Nicole; Hixson, Heather; McWilliams, Nate; Rummerfield, Heather; Stratton, Elaine; Woodruff, Tracy

    2014-01-01

    A successful trauma registry balances accuracy of abstraction and timeliness of case submissions to achieve quality performance. Staffing to achieve quality performance is a challenge at times based on competitive institutional need. The aim of this performance improvement timing study was to identify trauma registry job responsibilities and redesign the responsibilities to create increased abstraction time and maintain accuracy of data abstraction. The outcome is measured by case submission rates with existing staffing and interrater reliability outcomes. PMID:25397337

  9. Childhood trauma in bipolar disorder

    OpenAIRE

    Watson, S; Gallagher, P.; Dougall, D.; R Porter; Moncrieff, J.; Ferrier, I. N.; Young, A. H.

    2014-01-01

    Objective: There has been little investigation of early trauma in bipolar disorder despite evidence that stress impacts on the course of this illness. We aimed to compare the rates of childhood trauma in adults with bipolar disorder to a healthy control group, and to investigate the impact of childhood trauma on the clinical course of bipolar disorder. Methods: Retrospective assessment of childhood trauma was conducted using the Childhood Trauma Questionnaire (CTQ) in 60 outpatients with bipo...

  10. Noninvasive ventilation in trauma.

    Science.gov (United States)

    Karcz, Marcin K; Papadakos, Peter J

    2015-02-01

    Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with trauma-related hypoxemia. It is well-known that these patients are at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma. PMID:25685722

  11. Education On Prehospital Pain Management: A Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Scott C. French

    2013-03-01

    Full Text Available Introduction: The most common reason patients seek medical attention is pain. However,there may be significant delays in initiating prehospital pain therapy. In a 2001 qualityimprovement (QI study, we demonstrated improvement in paramedic knowledge,perceptions, and management of pain. This follow-up study examines the impact of thisQI program, repeated educational intervention (EI, and effectiveness of a new painmanagement standard operating procedure.Methods: 176 paramedics from 10 urban and suburban fire departments and two privateambulance services participated in a 3-hour EI. A survey was performed prior to the EI andrepeated one month after the EI. We reviewed emergency medical services (EMS runs withpain complaints prior to the EI and one month after the EI. Follow-up results were comparedto our prior study. We performed data analysis using descriptive statistics and chi-square tests.Results: The authors reviewed 352 surveys and 438 EMS runs with pain complaints. Usingthe same survey questions, even before the EI, 2007 paramedics demonstrated significantimprovement in the knowledge (18.2%; 95% CI 8.9%, 27.9%, perceptions (9.2%; 95% CI6.5%, 11.9%, and management of pain (13.8%; 95% CI 11.3%, 16.2% compared to 2001.Following EI in 2007, there were no significant improvements in the baseline knowledge (0%;95% CI 5.3%, 5.3% but significant improvements in the perceptions of pain principles (6.4%;95% CI 3.9%, 9.0% and the management of pain (14.7%; 95% CI 11.4%, 18.0%.Conclusion: In this follow up study, paramedics’ baseline knowledge, perceptions, andmanagement of pain have all improved from 6 years ago. Following a repeat educationalintervention, paramedics further improved their field management of pain suggestingparamedics will still benefit from both initial and also ongoing continuing education on thetopic of pain management.

  12. Prehospital Identification of Stroke Subtypes in Chinese Rural Areas

    Institute of Scientific and Technical Information of China (English)

    Hai-Qiang Jin; Jin-Chao Wang; Yong-An Sun; Pu Lyu; Wei Cui; Yuan-Yuan Liu; Zhi-Gang Zhen

    2016-01-01

    Background:Differentiating intracerebral hemorrhage (ICH) from cerebral infarction as early as possible is vital for the timely initiation of different treatments.This study developed an applicable model for the ambulance system to differentiate stroke subtypes.Methods:From 26,163 patients initially screened over 4 years,this study comprised 1989 consecutive patients with potential first-ever acute stroke with sudden onset of the focal neurological deficit,conscious or not,and given ambulance transport for admission to two county hospitals in Yutian County of Hebei Province.All the patients underwent cranial computed tomography (CT) or magnetic resonance imaging to confirm the final diagnosis based on stroke criteria.Correlation with stroke subtype clinical features was calculated and Bayes' discriminant model was applied to discriminate stroke subtypes.Results:Among the 1989 patients,797,689,109,and 394 received diagnoses of cerebral infarction,ICH,subarachnoid hemorrhage,and other forms of nonstroke,respectively.A history of atrial fibrillation,vomiting,and diabetes mellitus were associated with cerebral infarction,while vomiting,systolic blood pressure ≥180 mmHg,and age <65 years were more typical of ICH.For noncomatose stroke patients,Bayes' discriminant model for stroke subtype yielded a combination of multiple items that provided 72.3% agreement in the test model and 79.3% in the validation model; for comatose patients,corresponding agreement rates were 75.4% and 73.5%.Conclusions:The model herein presented,with multiple parameters,can predict stroke subtypes with acceptable sensitivity and specificity before CT scanning,either in alert or comatose patients.This may facilitate prehospital management for patients with stroke.

  13. Evaluation of the Relationship Between Mechanism of Injury and Outcome in Pediatric Trauma

    Science.gov (United States)

    Burd, Randall S.; Jang, Tai S.; Nair, Satish S.

    2016-01-01

    Background Most prehospital triage strategies are based on physiologic, anatomic, and mechanism-related variables. Although previous studies have suggested the value of physiologic and anatomic triage criteria, the predictive capacity of mechanism of injury has been questioned. The purpose of the current study was to evaluate the relationship between mechanism of injury and resource utilization and outcome among injured children treated at trauma centers. Methods The relationship between mechanism of injury and mortality and resource utilization (need for operative care, total and ICU length of stay) was analyzed using the records of pediatric patients (age Significant variability in the outcome, resources requirements, and need for inpatient rehabilitation after discharge were observed among the mechanisms analyzed. Mechanisms such as firearm injuries were more likely to be severe and require significant trauma center resources, whereas other mechanisms such as falls related to stairs were more likely to result in injuries that were less severe and require relatively few resources. A proposed framework is presented into which mechanisms are stratified according to severity of injury (high vs. low severity) and need for trauma center resources (high vs. low requirement). Conclusions Mechanism of injury is associated with the need for trauma center care but this association is highly dependent on the measure used to determine appropriateness of triage. PMID:17426560

  14. Patterns of ocular trauma

    International Nuclear Information System (INIS)

    To describe the patterns of ocular trauma, cause of injury and its effects on eye. A retrospective case series. Medical records of 1105 patients admitted with ocular trauma were reviewed. The details of patients regarding age, gender, literacy, cause of injury and its effects on eye were entered into specially-designed performa. Sample selection consisted of all patients with history of ocular trauma and who were admitted to hospital. Population details consisted patients who were referred to the hospital from all parts of N.W.F.P. Thus, the frequency of trauma in the hospital admissions was analysed. Ophthalmic trauma comprised 6.78% of the hospital admission. One thousand one hundred and five patients presented with eye injuries. Out of them, 21 patients suffered from trauma to both eyes. Almost 80% patients were male and 69% patients were below 30 years of age. Delayed presentation was more common and 63.61% patients presented after one week. Open globe injuries were more common (520 eyes (46.18%)) than closed globe injuries (484 eyes (42.98%)). 23.26% of open globe injuries were associated with intraocular and intra-orbital foreign bodies. Superficial non-perforating, eyelid and adnexal and burns were seen in 122 eyes (10.83%). Among the complications, lens damage and hyphema was seen in more than 50% of the patients, 16.60% eyes were infected at the time of admission and 4.88% of eyes needed enucleation or evisceration. The common causes of injury were violence in 37.37%, occupational in 24.43% and domestic accidents in 19.18%. Ophthalmic trauma is a major public health problem. Majority of the involved are male and under 30 years of age. Delayed presentation is more common. Open globe injuries are more frequent. Violence and occupational injuries are the major causes. (author)

  15. Systemic inflammation after trauma.

    Science.gov (United States)

    Lenz, Andreas; Franklin, Glen A; Cheadle, William G

    2007-12-01

    Trauma is still one of the main reasons for death among the population worldwide. Mortality occurring early after injury is due to "first hits", including severe organ injury, hypoxia, hypovolaemia or head trauma. Massive injury leads to activation of the immune system and the early inflammatory immune response after trauma has been defined as systemic inflammatory response syndrome (SIRS). "Second hits" such as infections, ischaemia/reperfusion or operations can further augment the pro-inflammatory immune response and have been correlated with the high morbidity and mortality in the latter times after trauma. SIRS can lead to tissue destruction in organs not originally affected by the initial trauma with subsequent development of multi-organ dysfunction (MOD). The initial pro-inflammatory response is followed by an anti-inflammatory response and can result in immune suppression with high risk of infection and sepsis. Trauma causes activation of nearly all components of the immune system. It activates the neuroendocrine system and local tissue destruction and accumulation of toxic byproducts of metabolic respiration leads to release of mediators. Extensive tissue injury may result in spillover of these mediators into the peripheral bloodstream to further maintain and augment the pro-inflammatory response. Hormones like ACTH, corticosteroids and catecholamines as well as cytokines, chemokines and alarmins play important roles in the initiation and persistence of the pro-inflammatory response after severe injury. The purpose of this review is therefore to describe the immunological events after trauma and to introduce important mediators and pathways of the inflammatory immune response.

  16. A retrospective quality assessment of pre-hospital emergency medical documentation in motor vehicle accidents in south-eastern Norway

    Directory of Open Access Journals (Sweden)

    Staff Trine

    2011-03-01

    Full Text Available Abstract Background Few studies have evaluated pre-hospital documentation quality. We retrospectively assessed emergency medical service (EMS documentation of key logistic, physiologic, and mechanistic variables in motor vehicle accidents (MVAs. Methods Records from police, Emergency Medical Communication Centers (EMCC, ground and air ambulances were retrospectively collected for 189 MVAs involving 392 patients. Documentation of Glasgow Coma Scale (GCS, respiratory rate (RR, and systolic blood pressure (SBP was classified as exact values, RTS categories, clinical descriptions enabling post-hoc inference of RTS categories, or missing. The distribution of values of exact versus inferred RTS categories were compared (Chi-square test for trend. Results 25% of ground and 11% of air ambulance records were unretrieveable. Patient name, birth date, and transport destination was documented in >96% of ambulance records and 81% of EMCC reports. Only 54% of patient encounter times were transmitted to the EMCC, but 77% were documented in ground and 96% in air ambulance records. Ground ambulance records documented exact values of GCS in 48% and SBP in 53% of cases, exact RR in 10%, and RR RTS categories in 54%. Clinical descriptions made post-hoc inference of RTS categories possible in another 49% of cases for GCS, 26% for RR, and 20% for SBP. Air ambulance records documented exact values of GCS in 89% and SBP in 84% of cases, exact RR in 7% and RR RTS categories in 80%. Overall, for lower RTS categories of GCS, RR and SBP the proportion of actual documented values to inferred values increased (All: p Conclusion EMS documentation of logistic and mechanistic variables was adequate. Patient physiology was frequently documented only as descriptive text. Our finding indicates a need for improved procedures, training, and tools for EMS documentation. Documentation is in itself a quality criterion for appropriate care and is crucial to trauma research.

  17. Dyspnea is a dangerous symptom in the pre-hospital setting

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann; Kirkegaard, Hans; Christensen, Erika Frischknecht;

    ABSTRACT: Background Electrocardiogram (ECG) based telemedicine is a cornerstone in pre-hospital triage of patients with suspected ST-elevation myocardial infarction (STEMI). An ECG transmitted from the ambulance is reviewed by a cardiologist on-call in case of ongoing or recent chest pain, resus...

  18. An application of the MEMbrain training module: Pre-hospital rescue operation

    DEFF Research Database (Denmark)

    Andersen, V.

    1998-01-01

    A system for training in pre-hospital emergency management is being developed and the first version of a prototype has been completed. The training system fulfils the demands from the domain of hospital emergency planning centres and medical attendants concerning increased efficiency of rescue...

  19. Design of a game-based pre-hospital resuscitation training for first responders

    NARCIS (Netherlands)

    Kalz, Marco; Schmitz, Birgit; Biermann, Henning; Klemke, Roland; Ternier, Stefaan; Specht, Marcus

    2013-01-01

    Kalz, M., Schmitz, B., Biermann, H., Klemke, R., Ternier, S., & Specht, M. (2013). Design of a game-based pre-hospital resuscitation training for first responders. In A. Holzinger, M. Ziefle, & V. Glavinić (Eds.), SouthCHI 2013, LNCS 7946 (pp. 363-372). Germany: Springer, Heidelberg.

  20. Prehospital diagnosis in STEMI patients treated by primary PCI : the key to rapid reperfusion

    NARCIS (Netherlands)

    Vermeulen, R. P.; Jaarsma, T.; Hanenburg, F. G. A.; Nannenberg, J. W.; Jessurun, G. A. J.; Zijlstra, F.

    2008-01-01

    Background. Primary coronary intervention (PCI) for acute myocardial infarction should be performed as quickly as possible, with a door-to-balloon time of less then 90 minutes. However, in daily practice this cannot always be achieved. Prehospital diagnosis of ST-elevation myocardial infarction (STE

  1. Nontraumatic Hypotension and Shock in the Emergency Department and the Prehospital setting, Prevalence, Etiology, and Mortality

    DEFF Research Database (Denmark)

    Holler, Jon Gitz; Bech, Camilla Nørgaard; Henriksen, Daniel Pilsgaard;

    2015-01-01

    studies in Epidemiology (STROBE-statement) to assess the quality. RESULTS: Six observational studies were considered eligible for analysis based on the evaluation of 11,880 identified papers. Prehospital prevalence of hypotension was 19.5/1000 emergency medicine service (EMS) contacts, and the prevalence...

  2. Response interval is important for survival until admission after prehospital cardiac arrest

    DEFF Research Database (Denmark)

    Do, Hien Quoc; Nielsen, Søren Loumann; Rasmussen, Lars Simon

    2010-01-01

    An increasing distance to the nearest hospital must be expected as a result of centralization of acute care at a small number of hospitals. This may have important consequences in emergency situations, such as prehospital or out-of-hospital cardiac arrest (OHCA) where the aim is to obtain return...

  3. Prehospital administration of P2Y12 inhibitors and early coronary reperfusion in primary PCI

    DEFF Research Database (Denmark)

    De Backer, Ole; Ratcovich, Hanna; Biasco, Luigi;

    2015-01-01

    to prehospital loading with clopidogrel in a real-world ST-elevation myocardial infarction (STEMI) setting. Over a 70-month period, 3497 patients with on-going STEMI of less than 6 hours and without cardiac arrest or cardiogenic shock underwent primary percutaneous coronary intervention (PPCI) at our centre...... in a PPCI cohort excluding cardiac arrest and cardiogenic shock....

  4. Prehospital Unassisted Assessment of Stroke Severity Using Telemedicine A Feasibility Study

    NARCIS (Netherlands)

    Van Hooff, Robbert-Jan; Cambron, Melissa; Van Dyck, Rita; De Smedt, Ann; Moens, Maarten; Espinoza, Alexis Valenzuela; Van de Casseye, Rohny; Convents, Andre; Hubloue, Ives; De Keyser, Jacques; Brouns, Raf

    2013-01-01

    Background and Purpose We evaluated the feasibility and the reliability of remote stroke severity quantification in the prehospital setting using the Unassisted TeleStroke Scale (UTSS) via a telestroke ambulance system and a fourth-generation mobile network. Methods The technical feasibility and the

  5. Prehospital Lactate Measurement by Emergency Medical Services in Patients Meeting Sepsis Criteria

    Directory of Open Access Journals (Sweden)

    Lori L. Boland

    2016-09-01

    Full Text Available Introduction: We aimed to pilot test the delivery of sepsis education to emergency medical services (EMS providers and the feasibility of equipping them with temporal artery thermometers (TATs and handheld lactate meters to aid in the prehospital recognition of sepsis. Methods: This study used a convenience sample of prehospital patients meeting established criteria for sepsis. Paramedics received education on systemic inflammatory response syndrome (SIRS criteria, were trained in the use of TATs and hand-held lactate meters, and enrolled patients who had a recent history of infection, met ≥ 2 SIRS criteria, and were being transported to a participating hospital. Blood lactate was measured by paramedics in the prehospital setting and again in the emergency department (ED via usual care. Paramedics entered data using an online database accessible at the point of care. Results: Prehospital lactate values obtained by paramedics ranged from 0.8 to 9.8 mmol/L, and an elevated lactate (i.e. ≥ 4.0 was documented in 13 of 112 enrolled patients (12%. The unadjusted correlation of prehospital and ED lactate values was 0.57 (p< 0.001. The median interval between paramedic assessment of blood lactate and the electronic posting of the ED-measured lactate value in the hospital record was 111 minutes. Overall, 91 patients (81% were hospitalized after ED evaluation, 27 (24% were ultimately diagnosed with sepsis, and 3 (3% died during hospitalization. Subjects with elevated prehospital lactate were somewhat more likely to have been admitted to the intensive care unit (23% vs 15% and to have been diagnosed with sepsis (38% vs 22% than those with normal lactate levels, but these differences were not statistically significant. Conclusion: In this pilot, EMS use of a combination of objective SIRS criteria, subjective assessment of infection, and blood lactate measurements did not achieve a level of diagnostic accuracy for sepsis that would warrant hospital

  6. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

    Directory of Open Access Journals (Sweden)

    Lockey David

    2011-10-01

    Full Text Available Abstract Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-hospital critical care. Methods A European expert panel participated in a consensus process based upon a four-stage modified nominal group technique that included a consensus meeting. Results The expert panel concluded that the five most important areas for further research in the field of physician-based pre-hospital critical care were the following: Appropriate staffing and training in pre-hospital critical care and the effect on outcomes, advanced airway management in pre-hospital care, definition of time windows for key critical interventions which are indicated in the pre-hospital phase of care, the role of pre-hospital ultrasound and dispatch criteria for pre-hospital critical care services. Conclusion A modified nominal group technique was successfully used by a European expert group to reach consensus on the most important research priorities in physician-provided pre-hospital critical care.

  7. Trauma in pregnancy

    Directory of Open Access Journals (Sweden)

    A Rudra

    2007-01-01

    Full Text Available Trauma is the most common non-obstetrical cause of death in pregnant women. Pregnancy must always be suspected in any female trauma patient of childbearing age until proved otherwise. Unique changes in anatomy and physiology that takes place during pregnancy alter the pathophysiology and location of maternal injuries in pregnancy, which may be significantly different from the non-pregnant state. Trauma from road traffic accidents, falls and domestic violence are the most common causes of abdominal blunt trauma. As pregnancy progresses, the change of accidental injury increases. Head and neck injuries, respiratory failure, and hypovolemic shock constitute the most frequent causes of trauma related maternal death in pregnancy. Even the pregnant woman with minor injuries should be carefully observed. Initial management is directed at resuscitation and stabilization of the mother that takes precedence over that of the fetus, unless vital signs cannot be maintained and perimortem cesarean section decided upon. Fetal monitoring should be maintained after satisfactory resuscitation and stabilization of the mother. Preventive measures include proper seat belt use and identifying and counseling victims of suspected domestic violence.

  8. Epidemiology of severe trauma.

    Science.gov (United States)

    Alberdi, F; García, I; Atutxa, L; Zabarte, M

    2014-12-01

    Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions.

  9. Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest.

    Science.gov (United States)

    Hammer, Laure; Vitrat, François; Savary, Dominique; Debaty, Guillaume; Santre, Charles; Durand, Michel; Dessertaine, Geraldine; Timsit, Jean-François

    2009-06-01

    Therapeutic hypothermia (TH) improves the outcomes of cardiac arrest (CA) survivors. The aim of this study was to evaluate retrospectively the efficacy and safety of an immediate prehospital cooling procedure implemented just after the return of spontaneous circulation with a prehospital setting. During 30 months, the case records of comatose survivors of out-of-hospital CA presumably due to a cardiac disease were studied. A routine protocol of immediate postresuscitation cooling had been tested by an emergency team, which consisted of an infusion of large-volume, ice-cold intravenous saline. We decided to assess the efficacy and tolerance of this procedure. A total of 99 patients were studied; 22 were treated with prehospital TH, and 77 consecutive patients treated with prehospital standard resuscitation served as controls. For all patients, TH was maintained for 12 to 24 hours. The demographic, clinical, and biological characteristics of the patients were similar in the 2 groups. The rate of patients with a body temperature of less than 35 degrees C upon admission was 41% in the cooling group and 18% in the control group. Rapid infusion of fluid was not associated with pulmonary edema. After 1 year of follow-up, 6 (27%) of 22 patients in the cooling group and 30 (39%) of 77 patients in the control group had a good outcome. Our preliminary observation suggests that in comatose survivors of CA, prehospital TH with infusion of large-volume, ice-cold intravenous saline is feasible and can be used safely by mobile emergency and intensive care units. PMID:19497463

  10. Epidemiological characteristics and related analysis in 5117 cases of pre-hospital emergency patients%5117例院前急救患者流行病学特征及相关分析

    Institute of Scientific and Technical Information of China (English)

    葛文汉; 阮海林; 杨春旭; 杨家有

    2012-01-01

    patients dead before visting hospital,in whichthe ratio of male to female was 2. 14 ∶ 1; age: 61. 34±18. 49. There were significantly positive linear correlations between the number of pre-hospital emergency and the number of pre-hospital deaths within the phases (r=0. 689, P = 0. 013); the first causes of pre-hospital emergency disease were trauma (34. 38% ), nervous system diseases (26. 81 % ), circulatory system diseases (11. 47%) , digestive system diseases (7.78%), others (7.60%), poisoning (6.59%). The first causes of pre-hospital deathwere circulatory system diseases (30. 37%), nervous system diseases (21. 78%), trauma (18. 34%) , digestive system diseases (12. 32%), respiratory system diseases (7. 45%), others(2. 87%). Compared with other groups. Male patients between 30 and 59 were more likely to suffer from trauma and cardiovascular disease (P value were 0. 000 and 0. 008 respectively). Conclusion:①The characteristics of the epidemiology of Pre-hospital patients provide the basis for disease monitoring and prevention, which were important to guide the pre-hospital emergency work. ②Strengthen the public education on trauma, cardiovascular and cerebro-vascular disease, and poisoning, popularize the nationwide first-aid knowledge, carry out a range of critical care first-aid drill, in order to improve the treatment success rate. ③Strengthen health and safety prevention education in young and middle-aged male, reduce the occurrence of trauma and circulatory system disease, which made the health care inyoung and middle-aged male more effective.

  11. Customer care. Patient satisfaction in the prehospital setting.

    Science.gov (United States)

    Doering, G T

    1998-09-01

    The focus of the study was to prioritize six emergency medical service treatment factors in terms of their impact upon patient satisfaction in the prehospital setting. The six treatment areas analyzed were: EMS response time; medical care provided on scene; explanation of care by the provider; the provider's ability to reduce patient anxiety; the provider's ability to meet the patient's non-medical needs; and the level of courtesy/politeness shown by the EMS provider toward the patient. Telephone interviews were conducted with both patients and bystanders to obtain their perception of how well the system met their needs. The study analyzed how the six issues were rated and then evaluated the impact an individual's low score in a category had on that person's overall rating of the service provided. The overall satisfaction rating is not a calculated score, but an overall score specified by the respondent. The effect each issue had on the respondent's overall rating was determined by averaging the overall ratings for a category's low scorers, averaging the overall ratings for high scorers and then measuring the difference. Results of the study indicate that the factor with the greatest negative impact on patient satisfaction came from a perceived lack of crew courtesy and politeness. Respondents who indicated a fair to poor score in this category decreased their overall score by 60.2%. Ratings in other categories yielded the following results: When respondents rated the response time as fair to poor, their average overall rating showed an 18.4% decrease. When respondents rated the quality of medical care as fair to poor, their average overall rating showed a decrease of 22.6%. When the crew's ability to explain what was happening to the patient was rated as fair to poor, the average overall score dropped 33.6%. When the EMT's and medic's ability to reduce the patient's anxiety was rated fair to poor, average overall score declined by 32.6%. Finally, when the crew

  12. Customer care. Patient satisfaction in the prehospital setting.

    Science.gov (United States)

    Doering, G T

    1998-09-01

    The focus of the study was to prioritize six emergency medical service treatment factors in terms of their impact upon patient satisfaction in the prehospital setting. The six treatment areas analyzed were: EMS response time; medical care provided on scene; explanation of care by the provider; the provider's ability to reduce patient anxiety; the provider's ability to meet the patient's non-medical needs; and the level of courtesy/politeness shown by the EMS provider toward the patient. Telephone interviews were conducted with both patients and bystanders to obtain their perception of how well the system met their needs. The study analyzed how the six issues were rated and then evaluated the impact an individual's low score in a category had on that person's overall rating of the service provided. The overall satisfaction rating is not a calculated score, but an overall score specified by the respondent. The effect each issue had on the respondent's overall rating was determined by averaging the overall ratings for a category's low scorers, averaging the overall ratings for high scorers and then measuring the difference. Results of the study indicate that the factor with the greatest negative impact on patient satisfaction came from a perceived lack of crew courtesy and politeness. Respondents who indicated a fair to poor score in this category decreased their overall score by 60.2%. Ratings in other categories yielded the following results: When respondents rated the response time as fair to poor, their average overall rating showed an 18.4% decrease. When respondents rated the quality of medical care as fair to poor, their average overall rating showed a decrease of 22.6%. When the crew's ability to explain what was happening to the patient was rated as fair to poor, the average overall score dropped 33.6%. When the EMT's and medic's ability to reduce the patient's anxiety was rated fair to poor, average overall score declined by 32.6%. Finally, when the crew

  13. Trauma-Focused CBT for Youth who Experience Ongoing Traumas

    OpenAIRE

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura A.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will this in some way impair their responding to current or ongoing trauma? The paper addresses practical strategies for implementing one evidence-based ...

  14. Transfusion practices in trauma

    Directory of Open Access Journals (Sweden)

    V Trichur Ramakrishnan

    2014-01-01

    Full Text Available Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.

  15. An evaluation of a Shockroom located CT scanner: a randomized study of early assessment by CT scanning in trauma patients in the bi-located trauma center North-West Netherlands (REACT trial

    Directory of Open Access Journals (Sweden)

    Reitsma Hans B

    2008-08-01

    Full Text Available Abstract Background Trauma is a major source of morbidity and mortality, especially in people below the age of 50 years. For the evaluation of trauma patients CT scanning has gained wide acceptance in and provides detailed information on location and severity of injuries. However, CT scanning is frequently time consuming due to logistical (location of CT scanner elsewhere in the hospital and technical issues. An innovative and unique infrastructural change has been made in the AMC in which the CT scanner is transported to the patient instead of the patient to the CT scanner. As a consequence, early shockroom CT scanning provides an all-inclusive multifocal diagnostic modality that can detect (potentially life-threatening injuries in an earlier stage, so that therapy can be directed based on these findings. Methods/design The REACT-trial is a prospective, randomized trial, comparing two Dutch level-1 trauma centers, respectively the VUmc and AMC, with the only difference being the location of the CT scanner (respectively in the Radiology Department and in the shockroom. All trauma patients that are transported to the AMC or VUmc shockroom according to the current prehospital triage system are included. Patients younger than 16 years of age and patients who die during transport are excluded. Randomization will be performed prehospitally. Study parameters are the number of days outside the hospital during the first year following the trauma (primary outcome, general health at 6 and 12 months post trauma, mortality and morbidity, and various time intervals during initial evaluation. In addition a cost-effectiveness analysis of this shockroom concept will be performed. Regarding primary outcome it is estimated that the common standard deviation of days spent outside of the hospital during the first year following trauma is a total of 12 days. To detect an overall difference of 2 days within the first year between the two strategies, 562 patients per

  16. Brain Basics

    Medline Plus

    Full Text Available ... as depression. The Growing Brain Inside the Brain: Neurons & Neural Circuits Neurons are the basic working unit of the brain ... specialized for the function of conducting messages. A neuron has three basic parts: Cell body which includes ...

  17. Asthma Basics

    Science.gov (United States)

    ... Tropical Delight: Melon Smoothie Pregnant? Your Baby's Growth Asthma Basics KidsHealth > For Parents > Asthma Basics Print A ... Asthma Categories en español Asma: aspectos fundamentales About Asthma Asthma is a common lung condition in kids ...

  18. Brain Basics

    Medline Plus

    Full Text Available ... Basics will introduce you to some of this science, such as: How the brain develops How genes and the environment affect the brain The basic structure of the brain How different parts of ...

  19. Backpack Basics

    Science.gov (United States)

    ... How Can I Help a Friend Who Cuts? Backpack Basics KidsHealth > For Teens > Backpack Basics Print A ... it can cause back problems or even injury. Backpacks Are Best Backpacks can't be beat for ...

  20. Transfusion protocol in trauma

    Directory of Open Access Journals (Sweden)

    Kaur Paramjit

    2011-01-01

    Full Text Available Blood and blood components are considered drugs because they are used in the treatment of diseases. As with any drug, adverse effects may occur, necessitating careful consideration of therapy. Like any other therapeutic decision, the need for transfusion should be considered on the basis of risks and benefits and alternative treatments available to avoid over- and under-transfusion. This review is focused on the blood transfusion protocol in trauma patients with hemorrhagic shock. Besides, issues related to emergency and massive transfusion have also been elaborated. We conducted a comprehensive MEDLINE search and reviewed the relevant literature, with particular reference to emergency medical care in trauma.

  1. Onycholysis due to trauma

    Directory of Open Access Journals (Sweden)

    Patricia Chang

    2014-04-01

    Full Text Available Female patient, 35 years old who came to the private office due to discoloration of her left thumbnail and little pain since 1 month ago. Clinical examination shows nail disease on her left thumbnail with onycholysis and dyschromia, dermatoscopy showed white-yellowish discoloration (Fig. 1A, B. The rest of the clinical examination was normal. Patient use to using acrylic nails since 2 years ago and denied some trauma at the nail. The diagnosis of onycholysis due to trauma was done and recommended her not to use acrylic nail, maintain the nail short and avoid wetness.

  2. Sonography of scrotal trauma

    Directory of Open Access Journals (Sweden)

    Meka Srinivasa Rao

    2012-01-01

    Full Text Available The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance.

  3. Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

    Science.gov (United States)

    Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

    2011-01-01

    Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

  4. 探讨本地区社区人群院前急救的综合防治策略%To Approach the Strategy of Pre-hospital Care of the Community Groups in this Area

    Institute of Scientific and Technical Information of China (English)

    杨海侠

    2014-01-01

    Objective A retrospective survey of the pre-hospital care of the community groups in this area in 2013 to improve the pre-hospital emergency strategy. Methods Age, sex, disease, response time and other data of the patients who received the pre-hospital emergency will be a retrospective study. Results Number of pre-hospital emergency cases in this area is 9 751, trauma patients is 2 061, about 21.14%, no significant seasonal distribution, cerebrovascular disease is 1 855, about 19.02%, more common in winter and spring, cardiovascular disease is 1 826, about 18.73%, more common in winter and spring. The CPR is not implemented in the patients who sudden died. Conclusion (1) Improve community health awareness and reduce the incidence of acute and critically ill patients. (2) Enhance the training of pre-hospital emergency medical personnel knowledge. (3) To optimize the process of the"120"pre-hospital emergency calls and the Ambulance visits.%目的:回顾性调查本地区社区人群2013年1~12月的院前急救相关资料,探讨合理的院前急救的综合防治策略。方法对本地区社区人群的院前急救患者的疾病类型、年龄、呼叫反应时间等数据资料进行回顾性分析。结果本地区院前急救例数总计约9751例,创伤所占比例最多,共约2061人,约占21.14%,无明显季节分布。其次是脑血管疾病,共约1855人,约占19.02%,冬春季节多见。心血管疾病,共约1826人,约占18.73%,冬春季节多见。院前死亡无一例行心肺复苏。院前急救呼叫反应时间约为20分钟。结论(1)加强社区人员培训,同时做好宣传、制定个性化方案,有效预防院前急症发生。(2)对医务人员规范化培训,并率先垂范,具备普及心肺复苏的认知观念。(3)优化120呼叫及出诊流程,避免资源浪费。

  5. A national research agenda for pre-hospital emergency medical services in the Netherlands: a Delphi-study

    OpenAIRE

    van de Glind, Irene; Berben, Sivera; Zeegers, Fon; Poppen, Henk; Hoogeveen, Margreet; Bolt, Ina; van Grunsven, Pierre; Vloet, Lilian

    2016-01-01

    Background In pre-hospital Emergency Medical Services (EMS) more research is needed to direct and underpin care delivery and inform policy. To target future research efforts, this study aimed to determine future research priorities with representatives of the EMS field. Methods A four-round online Delphi survey was used to discuss different viewpoints and reach consensus on research priorities. A multidisciplinary panel of experts was recruited in the field of pre-hospital EMS and adjoining (...

  6. Prehospital noninvasive ventilation for acute respiratory failure: systematic review, network meta-analysis, and individual patient data meta-analysis.

    OpenAIRE

    Goodacre, Steve; Stevens, John W; Pandor, Abdullah; Poku, Edith; Ren, Shijie; Cantrell, Anna; Bounes, Vincent; Mas, Arantxa; Payen, Didier; Petrie, David; Roessler, Markus Soeren; Weitz, Gunther; Ducros, Laurent; Plaisance, Patrick

    2014-01-01

    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...

  7. Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation.

    OpenAIRE

    Pandor, A; Thokala, P.; Goodacre, S; Poku, E.; Stevens, J.W.; Ren, S.; Cantrell, A.; Perkins, G.D.; Ward, M.; Penn-Ashman, J.

    2015-01-01

    BACKGROUND: Non-invasive ventilation (NIV), in the form of continuous positive airway pressure (CPAP) or bilevel inspiratory positive airway pressure (BiPAP), is used in hospital to treat patients with acute respiratory failure. Pre-hospital NIV may be more effective than in-hospital NIV but requires additional ambulance service resources. OBJECTIVES: We aimed to determine the clinical effectiveness and cost-effectiveness of pre-hospital NIV compared with usual care for adults presenting to t...

  8. Risk factors of delayed pre-hospital treatment seeking in patients with acute coronary syndrome: A prospective study

    OpenAIRE

    Fathi, Marzieh; Rahiminiya, Aysan; Zare, Mohammad Amin; Tavakoli, Nader

    2016-01-01

    Objectives Despite enormous efforts in public education, treatment seeking time still remains more than optimal in patients with acute coronary syndrome. This prospective study tries to determine the risk factors of pre-hospital delay in patients with acute coronary syndrome. Methods Descriptive data of 190 patients with diagnosis of acute coronary syndrome attending in 2 tertiary level teaching hospital emergency departments were analyzed to determine risk factors of delayed pre-hospital tre...

  9. Implementation of a pre-hospital decision rule in general practice. Triage of patients with suspected myocardial infarction

    OpenAIRE

    Grijseels, Els; Deckers, Jaap; Hoes, Arno; Boersma, Eric; Hartman, J.A.M.; van der Does, Emiel; Simoons, Maarten

    1996-01-01

    textabstractOBJECTIVE: To improve pre-hospital triage of patients with suspected acute cardiac disease. DESIGN: Prospective study. SUBJECTS. Patients with symptoms suggestive of acute cardiac pathology, who were seen by a general practitioner, for whom acute admission into hospital was requested, and in whom a pre-hospital electrocardiogram was recorded by the ambulance service. METHODS: The study consisted of two phases. In the first phase, a decision rule was developed based on clinical cha...

  10. Limited evidence for intranasal fentanyl in the emergency department and the prehospital setting--a systematic review

    DEFF Research Database (Denmark)

    Hansen, Morten Sejer; Dahl, Jørgen Berg

    2013-01-01

    The intranasal (IN) mode of application may be a valuable asset in non-invasive pain management. Fentanyl demonstrates pharmacokinetic and pharmacodynamic properties that are desirable in the management of acute pain, and IN fentanyl may be of value in the prehospital setting. The aim...... of this systematic review was to evaluate the current evidence for the use of IN fentanyl in the emergency department (ED) and prehospital setting....

  11. PRE-HOSPITAL MANAGEMENT OF FEBRILE SEIZURES IN CHILDREN SEEN AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA

    OpenAIRE

    Jarrett, O.O.; Fatunde, O.J.; OSINUSI, K; Lagunju, I.A.

    2012-01-01

    Background: Febrile seizures are commonly encountered in emergency paediatric practice. Initial pre-hospital intervention given by caregivers has been shown to impact outcome. Objectives:: To describe the spectrum of pre-hospital interventions given for the treatment of childhood febrile seizures in Ibadan, Nigeria. Methods: All consecutive cases of febrile seizures seen at the emergency room of University College Hospital, Ibadan over a period of 13 months were the subjects of the study. Det...

  12. Ecopsychology: A Perspective on Trauma

    OpenAIRE

    Milton, MJ; Corbett, L

    2011-01-01

    Literature has suggested that the cyclical nature of psychological trauma can cause enduring long-term effects on individuals and those around them. This review examines the effects of psychological trauma and its relationship to ecopsychology to provoke questions about integration and stimulate debate pertinent to trauma therapy. While being relatively unexplored with regards to psychological trauma, empirical evidence is beginning to amass to suggest that ecopsychology could be incorporated...

  13. Emergency Department Management of Trauma

    DEFF Research Database (Denmark)

    MacKenzie, Colin; Lippert, Freddy

    1999-01-01

    Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... injured patients after these patients reach a hospital emergency department or a trauma center....

  14. Trauma and the endocrine system.

    Science.gov (United States)

    Mesquita, Joana; Varela, Ana; Medina, José Luís

    2010-12-01

    The endocrine system may be the target of different types of trauma with varied consequences. The present article discusses trauma of the hypothalamic-pituitary axes, adrenal glands, gonads, and pancreas. In addition to changes in circulating hormone levels due to direct injury to these structures, there may be an endocrine response in the context of the stress caused by the trauma.

  15. Early Childhood Trauma

    Science.gov (United States)

    National Child Traumatic Stress Network, 2010

    2010-01-01

    Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may be different from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the…

  16. Trauma and Symbolic Violence

    DEFF Research Database (Denmark)

    Pedersen, Bodil Maria

    2011-01-01

    Our understanding of 'reactions to trauma' is dominated by concepts like Post-Traumatic Stress Disorder. The use of such concepts has been criticised but simultaneously integrated in folk-psychology. Connecting emotional and cognitive processes as well as acts - such as in gendered practices...

  17. Skeleton scintigraphy in trauma

    International Nuclear Information System (INIS)

    Skeletal trauma is common and presents both an opportunity and a problem in skeletal scintigraphy. The opportunity arises in the ability of skeletal scintigraphy to demonstrate abnormalities early after direct trauma. It is well recognized that the early detection of fractures in some sites cannot be reliably achieved by standard radiography, especially in the femoral neck and scaphoid bone. The problem comes in recognizing the effects of skeletal trauma when using skeletal scintigraphy for another purpose, such as the detection of metastatic disease. iatrogenic trauma to either the skeleton or soft tissues may be manifest scintigraphic ally. For example Craniotomy typically leaves a rim pattern at the surgical margin. Rib Retraction during thoracotomy can elicit periosteal reaction. Areas of the skeletal receiving curative levels of ionizing radiation (typically 4000 rads or greater) characteristically demonstrate decreased uptake within 6 months to 1 year after therapy. The generally high sensitivity of the skeletal scintigraphy seems to make it an ideal survey test in cases of suspected child abuse especially in which radiographs are unrevealing. Because of difficulties in obtaining a history of trauma from a preschool child or even eliciting a satisfactory description of the location and nature of the pain, skeletal scintigraphy provides a simple and reliable investigation in these children. Subtle trauma, such as that from stress fractures is often difficult to visualize on a plain radiograph. Skeletal scintigraphy is frequently positive at the time of clinical presentation. Skeletal scintigraphy is exquisitely sensitive to the remodeling process and typically shows abnormalities 1 to 2 weeks or more before the appearance of radiographic changes in stress fractures. The periosteal reaction can be visualized within hours of the injury. Insufficiency and fatigue fractures such as vertebral compression fracture, which is probably the most common consequence of

  18. The prehospital management of chest injuries: a consensus statement. Faculty of Pre‐hospital Care, Royal College of Surgeons of Edinburgh

    OpenAIRE

    Lee, Caroline; Revell, Matthew; Porter, Keith; Steyn, Richard

    2007-01-01

    This paper provides a guideline for the management of prehospital chest injuries after a consensus meeting held by the Faculty of Prehospital Care, Royal College of Surgeons of Edinburgh, Edinburgh, UK, in January 2005. An overview of the prehospital assessment, diagnosis and interventions for life threatening chest injury are discussed, with the application of skills depending on the training, experience and competence of the individual practitioner.

  19. Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care

    Directory of Open Access Journals (Sweden)

    Herlitz Johan

    2012-06-01

    Full Text Available Abstract Background Sepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis. Aim To describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis. Methods A literature search was performed on the PubMed, Embase (Ovid SP and Cochrane Library databases. Results In overall terms, we found a small number of articles (n = 12 of 1,162 unique hits which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis. Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT. Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT. There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers. Conclusion Severe sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.

  20. A validation of ground ambulance pre-hospital times modeled using geographic information systems

    Directory of Open Access Journals (Sweden)

    Patel Alka B

    2012-10-01

    Full Text Available Abstract Background Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS using geographic information systems (GIS. The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. Methods The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval. The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. Results There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7–8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. Conclusions The widespread use of generalized EMS pre-hospital

  1. Paediatric trauma care

    Directory of Open Access Journals (Sweden)

    Sebastian van As A

    2010-01-01

    Full Text Available Background: Childhood trauma has become a major cause of mortality and morbidity, disability and socio-economic burden and it is expected by the World Health Organization (WHO that by 2020 it will be the number 1 disease globally. The WHO and UNICEF have published their third World Report on Child Injury Prevention in December 2008. Materials and Methods: A systematic review was performed on the history and magnitude of paediatric trauma worldwide. Additionally exciting developments and new trends were assessed and summarized. Results: Paediatric trauma is a growing field of clinical expertise. New developments include total body digital imaging of children presenting with polytrauma; targeted management of head injuries; conservative management of abdominal injuries in children and diagnostic laparoscopy, including the laparoscopic management of complications following the conservative management of solid organ injuries. Conclusion: Paediatric trauma has long been neglected by the medical profession. In order to deal with it appropriately, it makes sense to adopt the public health approach, requiring that we view child injuries similarly to any other disease or health problem. The greatest gain in our clinical practice with dealing with child injuries will result from a strong focus on primary (preventing the injury, secondary (dealing with the injury in the most efficient manner as well as tertiary prevention (making sure that children treated for trauma will be appropriately reintegrated within our society. By actively promoting child safety we will not only achieve a most welcome reduction in medical cost and disability, but also the ever-so-much desired decline of avoidable childhood misery and suffering.

  2. Imaging in spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium); Algemeen Ziekenhuis Maria Middelares, Department of Radiology, Sint-Niklaas (Belgium); Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium)

    2005-03-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  3. MANAGEMENT OF LIVER TRAUMA

    Directory of Open Access Journals (Sweden)

    Dova Subba

    2016-03-01

    Full Text Available AIM To estimate the incidence of Liver Trauma injuries and grade their severity of injury. To assess the factors responsible for morbidity and mortality after Liver Trauma. To study the postoperative complications and the management of Liver Trauma. MATERIALS AND METHODS The present prospective study was conducted on 100 patients who were admitted to Department of General Surgery for treatment who were managed operatively or non-operatively for abdominal trauma and having liver injury forms the material of the study. This study was conducted over a span of 24 months from June 2013 to November 2015. RESULTS Maximum number of patients are in the age group of 21-30 years (46%. 85% patients (85/100 are males and 15% of patients (15/100 are females. Lapse time of injury and admission varied from 25 minutes to 66 hours and 30 minutes. 75 % of the patients (75/100 presented within 24 hours after injury. Death rate of patients who reached hospital after 24 hours of injury was higher than the patients who reached hospital within 24 hours of injury. 28% of patients (28/100 had associated bony injuries, out of which 5% of patients (5/100 expired due to primary haemorrhage of fractured femur. More than one segment was injured in many patients. Segment V is involved commonly making 55% (55/100 of patients. Next common segment involved is segment VII, making 39% (39/100. CONCLUSION Mechanism of injury is the important factor which is responsible for morbidity in liver injury. Nonoperative management proved to be safe and effective and often has been used to treat patients with liver trauma.

  4. Imaging in spinal trauma

    International Nuclear Information System (INIS)

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  5. Gênero e trauma Gender and trauma

    OpenAIRE

    Gláucio Ary Dillon Soares; Dayse Miranda

    2005-01-01

    As conseqüências sociais e psicológicas da violência urbana sobre os parentes e amigos de pessoas vitimadas por mortes violentas (homicídio, suicídio ou acidentes) são analisadas à luz das diferenças de gênero. A literatura especializada nesta área propõe que mulheres e homens vivenciam experiências traumáticas de forma peculiar. Porém, os traumas típicos são diferentes em cada gênero, deixando em aberto a questão sobre quanto das diferenças entre as respostas se devem a gênero e quanto se de...

  6. A DIALECTICAL PERSPECTIVE OF TRAUMA PROCESSING

    Directory of Open Access Journals (Sweden)

    Brurit Laub

    2014-03-01

    Full Text Available This article presents a dialectical perspective, which attempts to elucidate the integrative components of trauma processing in therapy. It is proposed that the inherent movement toward greater integration is an expanding dialectical movement. It is conceived as a spiral resulting from the synergy of two dialectical movements. The horizontal line moves between the opposite aspects of the individual (thesis vs. antithesis toward a synthesis. The vertical line moves upward via whole/part shifts toward greater integration, or downward toward disintegration and fragmentation. It is proposed that the complementary processes of differentiation and linking are the building blocks of the integrative/dialectical movement. Differentiation relates to the separation of parts and linking relates to their connection. The role of differentiation and linking in three basic interacting systems of trauma work is discussed. It is proposed that the dialectical principles are applicable to various therapeutic approaches and clinical vignettes are included to illustrate.

  7. Interdisciplinary trauma room management: staff-related apparative and logistic concepts in three level trauma centers in Europe

    International Nuclear Information System (INIS)

    Objective. To analyse common and divergent features of staff-related, equipmental and spatial/logistical concepts of three large trauma centers of highest health care level.Methods. The health care mandate as well as the staff management, the organisational and the constructional-spacial structure of trauma room diagnostics and therapy of the trauma centers of the Universities of Leiden and Munich (Innenstadt) and the Zentralklinikum Augsburg are described. In particular the technical equipment and the process of the radiological diagnostic procedures in the trauma room are outlined.Results. Staff availability and basic technical equipment of the trauma rooms are comparable between the three hospitals. Divergent concepts exist concerning the complexity of the initial radiologic examination protocols. Spacial connection and importance of computed tomography are also discussed controversially. Urgent interventional procedures are increasingly performed within the trauma room. Magnetic-resonance-tomography does not play a role in early care from multiple injured patients.Conclusion. Trauma centers have to meet certain personnel and technical prerequisites to guarantee a temporally optimised care for multiple injured patients. Differences between the three centers concerning the logistic sequence and the radiologic examination techniques used are mainly due to variable emphasis put on CT in the initial phase of patient care. (orig.)

  8. Cyclosporin A affects the level of anti-myelin basic protein in serum and myelinoclasis after rat brain trauma%环孢素A对大鼠脑损伤后髓鞘碱性蛋白抗体及继发性脱髓鞘病变的影响

    Institute of Scientific and Technical Information of China (English)

    褚建成; 李卫; 刘灵慧; 李虹; 陈善成

    2010-01-01

    Objective To investigate the effect of cyclosporin A(CsA)on the level of anti-myelin basic protein(anti-MBP)in the serum and myelinoclasis in rat models after brain trauma.Methods Seventy-seven SD rats were randomized into blank control group(n=7),model group(n=35)and CsA-treated group(n=35).The 0.9% normal saline(5 mg/kg/d)was intraperitoneally injected into the model group and 5 mg/mL CsA(5 mg/kg/d)was injected into the CsA-treated group.Different time points(1,4,10,20 and 30 d)after the brain trauma,the MBP content and anti-MBP titer in the serum were measured using enzyme-linked immunosorbent assay(ELISA)and the degree of myelinoclasis in the brain stem slices was assessed with Marchi's method.Results As compared with that in the blank control group,the MBP and Anti-MBP contents in the model group were significantly increased(P0.05).However,lower level of anti-MBP in the serum 1 d after the injury and degree of myelinoclasis in the brain stem 4 daRer the injury in the CsA-treated group were observed as compared with those in the model group(P0.05),而伤后1d开始Anti-MBP含量降低、伤后4 d开始变性髓鞘数量降低.差异有统计学意义(P<0.05);Pearson相关分析显示CsA组与模型组大鼠血清Anti-MBP含量与脑干变性髓鞘的数量呈正相关关系(r=0.959,P=0.000).结论 CsA可以干预脑组织损伤后大鼠的免疫系统,在一定程度上可以减少Anti-MBP的产生、减轻大鼠继发性脑干脱髓鞘病变的程度.

  9. Basic electrotechnology

    CERN Document Server

    Ashen, R A

    2013-01-01

    BASIC Electrotechnology discusses the applications of Beginner's All-purpose Symbolic Instruction Code (BASIC) in engineering, particularly in solving electrotechnology-related problems. The book is comprised of six chapters that cover several topics relevant to BASIC and electrotechnology. Chapter 1 provides an introduction to BASIC, and Chapter 2 talks about the use of complex numbers in a.c. circuit analysis. Chapter 3 covers linear circuit analysis with d.c. and sinusoidal a.c. supplies. The book also discusses the elementary magnetic circuit theory. The theory and performance of two windi

  10. Helicopter Evacuation Following a Rural Trauma: An Emergency Medicine Simulation Scenario Using Innovative Simulation Technology.

    Science.gov (United States)

    Whalen, Desmond; Harty, Chris; Ravalia, Mohamed; Renouf, Tia; Alani, Sabrina; Brown, Robert; Dubrowski, Adam

    2016-01-01

    The relevance of simulation as a teaching tool for medical professionals working in rural and remote contexts is apparent when low-frequency, high-risk situations are considered. Simulation training has been shown to enhance learning and improve patient outcomes in urban settings. However, there are few simulation scenarios designed to teach rural trauma management during complex medical transportation. In this technical report, we present a scenario using a medevac helicopter (Replica of Sikorsky S-92 designed by Virtual Marine Technology, St. John's, NL) at a rural community. This case can be used for training primary care physicians who are working in a rural or remote setting, or as an innovative addition to emergency medicine and pre-hospital care training programs. PMID:27081585

  11. 120急救中心院前急救患者的疾病谱探析%The Analysis of Disease Spectrum of Patients Under Pre-hospital Emergency Care in 120 Emergency Center

    Institute of Scientific and Technical Information of China (English)

    梁鹤峰

    2015-01-01

    目的:分析鹤岗市人民医院120急救中心院前急救患者的疾病谱特点。方法随机选取本院120急救中心院前急救患者1000例,分析患者在性别、年龄、疾病分布、死亡情况等方面的特点及其内在联系。结果各个年龄段的男女比例差异显著,P<0.05,具有统计学意义。根据院前急救疾病谱,因受创伤而急救的患者比重最大,其次为脑血管疾病、心血管疾病、消化系统疾病等,创伤、脑血管疾病、心血管疾病等男女患者所占比重具有显著差异,P<0.05,具有统计学意义。结论鉴于创伤、脑血管疾病、心血管疾病、呼吸系统疾病等是急救中心院前急救常见病症,医院在医疗设备的配置、人员的配备和培训上应给予重视,提高急救处理水平。%Objective To analyze disease spectrum of patients under pre-hospital emergency care in 120 emergency center affiliated to Hegang People’s hospital. Methods 1,000 cases of patients received pre-hospital emergency were randomly selected from 120 emergency center in our hospital, the patients’ distribution characteristics and inner relations of gender, age, disease and death were analyzed. Results Proportion of men and women of all ages had signiifcant difference(P<0.05). All of the patients received pre-hospital emergency care,trauma occupies the largest proportion, followed by cerebrovascular diseases, cardiovascular disease, and digestive system disease. In addition, the proportion between men and women who suffered trauma, cerebrovascular disease, and cardiovascular disease differed signiifcantly(P<0.05). Conclusion Given the trauma, cerebrovascular disease, cardiovascular disease, respiratory disease are the common diseases in pre-hospital emergency care center, it is fair to say that due attention should be paid by hospitals regarding the distribution of medical equipments, stuff number and training in order to improve the emergency care

  12. Feasibility and safety of prehospital administration of bivalirudin in patients with ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Sejersten, Maria; Nielsen, Søren Loumann; Engstrøm, Thomas;

    2009-01-01

    of this preliminary study was to describe the feasibility and safety of a switch from prehospital administration of unfractionated heparin to bivalirudin in ST-elevation acute myocardial infarction (STEMI) patients referred for primary percutaneous coronary intervention. Patients with STEMI treated...... GPI. A total of 102 patients (59%) receiving bivalirudin and 72 receiving heparin were followed during hospitalization. The baseline characteristics and prehospital treatment times were comparable between the 2 groups. The thrombolysis in myocardial infarction flow before and after primary......The selective thrombin inhibitor bivalirudin with a provisional glycoprotein IIb/IIIa inhibitor (GPI) has been shown to be comparable to heparin plus GPI in the rates of ischemic events but to significantly reduce the risk of bleeding complications in patients with acute coronary syndromes. The aim...

  13. Spontaneous subarachnoid hemorrhage as a differential diagnosis of pre-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Sohil Pothiawala

    2012-01-01

    Full Text Available Spontaneous subarachnoid hemorrhage is the most common neurological disorder leading to pre-hospital cardiac arrest. ECG changes in SAH may mimic myocardial infarction or ischemia, and thus lead to delayed treatment of the primary problem. Early identification of SAH-induced cardiac arrest with the use of computed tomography scan of the brain obtained immediately after resuscitation will aid emergency physicians make further decisions. The overall prognosis of patients who are resuscitated is extremely poor. But, prompt neurosurgical referral and multidisciplinary intensive care management can improve the survival rate and the functional outcome. Thus, physicians should consider SAH as a differential diagnosis in patients presenting with pre-hospital cardiac arrest.

  14. Risk factors for 48-hours mortality after prehospital treatment of opioid overdose

    DEFF Research Database (Denmark)

    Wichmann, Sine; Nielsen, Søren Loumann; Siersma, Volkert Dirk;

    2013-01-01

    INTRODUCTION: Opioid overdose is commonly treated by prehospital emergency services and the majority of the patients are discharged immediately after treatment and a short observation period. There is a minor risk for rebound opioid toxicity and other life-threatening conditions might occur after...... such episodes. The authors describe the short-term outcome and identify risk factors for death within 48 h after prehospital treatment of opioid overdose in Copenhagen, the capital of Denmark. METHODS: Data on all cases of opioid overdose treated by the medical emergency care unit between 1994 and 2003 were...... recorded prospectively. Risk factors for death within 48 h after initial medical emergency care unit contact were analysed in a multivariable logistic regression analysis. RESULTS: The authors recorded 4762 episodes of opioid overdose, covering 1967 unique identified patients. A total of 78 patients (8...

  15. Factors Influencing Pre-hospital Patient Delay in Patients with Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    La Xie; Su-Fang Huang∗; You-Zhen Hu

    2015-01-01

    Acute myocardial infarction ( AMI) is a dangerous disease with a high mortality rate. For AMI patients, the outcome of the patients depends on time to beginning of effective treatment in addition to other factors such as severity of disease and involved vessels etc. The key is whether reperfusion therapy is started early enough after the onset of symptoms, and the benefit of reperfu-sion therapy depends on the time, too. The delay of AMI treatment is divided into pre-hospital de-lay and in-hospital delay. In-hospital delay, Door-to-Balloon Time, has been well controlled. Pre-hospital delay, accounting for 75% of the total delay time, is the most important factor affect-ing AMI treatment. Patient delay ( PD) time for AMI patients is summarised in this study.

  16. Hospital care in severe trauma: Initial strategies and life-saving surgical procedures.

    Science.gov (United States)

    Monchal, T; Hornez, E; Prunet, B; Beaume, S; Marsaa, H; Bourgouin, S; Baudoin, Y; Bonnet, S; Morvan, J-B; Avaro, J-P; Dagain, A; Platel, J-P; Balandraud, P

    2016-08-01

    Severe trauma patients should be received at the hospital by a multidisciplinary team directed by a "trauma leader" and all institutions capable of receiving such patients should be well organized. As soon as the patient is accepted for care, the entire team should be prepared so that there is no interruption in the pre-hospital chain of care. All caregivers should thoroughly understand the pre-established protocols of diagnostic and therapeutic strategies to allow optimal management of unstable trauma victims in whom hemostasis must be obtained as soon as possible to decrease the morbid consequences of post-hemorrhagic shock. In patients with acute respiratory, circulatory or neurologic distress, several surgical procedures must be performed without delay by whichever surgeon is on call. Our goal is to describe these salvage procedures including invasive approaches to the upper respiratory tract, decompressive thoracostomy, hemostatic or resuscitative thoracotomy, hemostatic laparotomy, preperitoneal pelvic packing, external pelvic fixation by a pelvi-clamp, decompressive craniotomy. All of these procedures can be performed by all practitioners but they require polyvalent skills and training beforehand. PMID:27260640

  17. Prehospital Use of the Intubating Laryngeal Mask Airway in Patients with Severe Polytrauma: A Case Series

    Directory of Open Access Journals (Sweden)

    Andrew M. Mason

    2009-01-01

    Full Text Available A case series of five patients is described demonstrating the utility of the intubating laryngeal mask airway in the prehospital setting, both as a primary airway rescue device and as a bridge to tracheal intubation. All patients were hypoxaemic, had sustained severe polytrauma and were trapped in their vehicles following road traffic collisions. A probability of survival study showed better-than-predicted outcomes for the group as a whole.

  18. Prehospital treatment of opioid overdose in Copenhagen--is it safe to discharge on-scene?

    DEFF Research Database (Denmark)

    Rudolph, Søren; Jehu, G; Nielsen, Søren Loumann;

    2011-01-01

    In the prehospital setting opioid overdose is often treated with naloxone. In our physician-based medical emergency care unit (MECU) we have adopted a discharge-on-scene policy, where patients are released on scene if no residual signs of opioid intoxication are found after treatment. The aim...... of this study was to describe our experience with the discharge-on-scene policy used during a 10-year-period with focus on the frequency of rebound opioid toxicity....

  19. Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review.

    Science.gov (United States)

    Ebben, Remco H A; Vloet, Lilian C M; Verhofstad, Michael H J; Meijer, Sanne; Mintjes-de Groot, Joke A J; van Achterberg, Theo

    2013-01-01

    A gap between guidelines or protocols and clinical practice often exists, which may result in patients not receiving appropriate care. Therefore, the objectives of this systematic review were (1) to give an overview of professionals' adherence to (inter)national guidelines and protocols in the emergency medical dispatch, prehospital and emergency department (ED) settings, and (2) to explore which factors influencing adherence were described in studies reporting on adherence. PubMed (including MEDLINE), CINAHL, EMBASE and the Cochrane database for systematic reviews were systematically searched. Reference lists of included studies were also searched for eligible studies. Identified articles were screened on title, abstract and year of publication (≥1990) and were included when reporting on adherence in the eligible settings. Following the initial selection, articles were screened full text and included if they concerned adherence to a (inter)national guideline or protocol, and if the time interval between data collection and publication date was articles were assessed on reporting quality. Each step was undertaken by two independent researchers. Thirty-five articles met the criteria, none of these addressed the emergency medical dispatch setting or protocols. Median adherence ranged from 7.8-95% in the prehospital setting, and from 0-98% in the ED setting. In the prehospital setting, recommendations on monitoring came with higher median adherence percentages than treatment recommendations. For both settings, cardiology treatment recommendations came with relatively low median adherence percentages. Eight studies identified patient and organisational factors influencing adherence. The results showed that professionals' adherence to (inter)national prehospital and emergency department guidelines shows a wide variation, while adherence in the emergency medical dispatch setting is not reported. As insight in influencing factors for adherence in the emergency care

  20. Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review

    OpenAIRE

    Ebben, R.H.A.; Vloet, L.C.M.; Verhofstad, M.H.J.; Meijer, S.; de Groot, J.; van Achterberg, T

    2013-01-01

    A gap between guidelines or protocols and clinical practice often exists, which may result in patients not receiving appropriate care. Therefore, the objectives of this systematic review were (1) to give an overview of professionals' adherence to (inter)national guidelines and protocols in the emergency medical dispatch, prehospital and emergency department (ED) settings, and (2) to explore which factors influencing adherence were described in studies reporting on adherence. PubMed (including...

  1. Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients

    Directory of Open Access Journals (Sweden)

    Kenneth A. Scheppke

    2014-11-01

    Full Text Available 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. Methods: We reviewed paramedic run sheets from five different catchment areas in suburban Florida communities. We identified 52 patients as having been given intramuscular ketamine 4mg/kg IM, following a specific protocol devised by the EMS medical director of these jurisdictions, to treat agitated and violent patients, including a subset of which would be expected to suffer from ExDS. Twenty-six of 52 patients were also given parenteral midazolam after medical control was obtained to prevent emergence reactions associated with ketamine. Results: Review of records demonstrated that almost all patients (50/52 were rapidly sedated and in all but three patients no negative side effects were noted during the prehospital care. All patients were subsequently transported to the hospital before ketamine effects wore off. Conclusion: Ketamine may be safely and effectively used by trained paramedics following a specific protocol. The drug provides excellent efficacy and few clinically significant side effects in the prehospital phase of care, making it an attractive choice in those situations requiring rapid and safe sedation especially without intravenous access. [West J Emerg Med. 2014;15(7:–0.

  2. Factors influencing pre-hospital delay among patients with acute myocardial infarction in Iran

    Institute of Scientific and Technical Information of China (English)

    Maryam Momeni; Arsalan Salari; Shora Shafighnia; Atefeh Ghanbari; Fardin Mirbolouk

    2012-01-01

    Background Acute myocardial infarction (AMI) is the leading cause of morbidity and disability among Iranian population.Pre-hospital delay is an important cause of increasing early and also late mortality in AMI.Thus the aim of the present study was to identify the factors influencing pre-hospital delay among patients with AMI in Iran.Methods Between August 2010 and May 2011,a cross-sectional and single-center survey was conducted on 162 consecutive patients with ST-elevation myocardial infarction (STEMI) admitted to Cardiac Care Unit (CCU) of Dr.Heshmat Hospital,Rasht.All patients were interviewed by the third author within 7 days after admission by using a four-part questionnaire including socio-demographic,clinical,situational and cognitive factors.Data were analyzed by descriptive and Logistic regression model at P < 0.05 using SPSS 16.Results Mean age was (60.11±12.29) years in all patients.Majority of patients (65.4%) were male.The median of pre-hospital delay was 2 hours,with a mean delay of 7.4 hours (±16.25 hours).Regression analysis showed that admission in weekend (P <0.04,OR=1.033,95% Cl=1.187-2.006) and misinterpretation of symptoms as cardiac origin (P <0.002,OR=1.986,95% Cl=1.254-3.155) and perceiving symptoms to not be so serious (P <0.003,OR=3.264,95%Cl=1.492-7.142) were factors influencing pre-hospital delay > 2 hours.Conclusions Our findings highlight the importance of cognitive factors on decision-making process and pre-hospital delays.Health care providers can educate the public on AMI to enable them recognize the signs and symptoms of AMI correctly and realize the benefits of early treatment.

  3. Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study

    Directory of Open Access Journals (Sweden)

    Castrén Maaret

    2011-05-01

    Full Text Available Abstract Background Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days. Methods The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation. Results The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators. Conclusions The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.

  4. Brain Basics

    Medline Plus

    Full Text Available ... pituitary-adrenal (HPA) axis. Brain Basics in Real Life Brain Basics in Real Life—How Depression affects the Brain Meet Sarah Sarah ... having trouble coping with the stresses in her life. She began to think of suicide because she ...

  5. Brain Basics

    Medline Plus

    Full Text Available ... Basics in Real Life Brain Basics in Real Life—How Depression affects the Brain Meet Sarah Sarah is a middle-aged woman who seemed to have it all. She was happily married and successful in business. Then, after a serious setback at work, she lost interest ...

  6. Substance Abuse and Trauma.

    Science.gov (United States)

    Simmons, Shannon; Suárez, Liza

    2016-10-01

    There is a strong, bidirectional link between substance abuse and traumatic experiences. Teens with cooccurring substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) have significant functional and psychosocial impairment. Common neurobiological foundations point to the reinforcing cycle of trauma symptoms, substance withdrawal, and substance use. Treatment of teens with these issues should include a systemic and integrated approach to both the SUD and the PTSD. PMID:27613348

  7. CRANIOROFACIAL TRAUMA - RADIODIAGNOSIS

    Directory of Open Access Journals (Sweden)

    Zambrano JCR

    2013-09-01

    Full Text Available Clinical examination of Craniorofacial injuries are often limited in patients with trauma to the head and neck region due to obscuration by overlying edema, hematoma, hemorrhage, and soft-tissue injury. Craniorofacial injuries require accurate and prompt diagnosis for management. For Proper clinical examination and treatment plan, high resolution radiographs are always essential which will indirectly contribute to render a good medical care to the patients.

  8. Pre-hospital advanced airway management by anaesthesiologists: Is there still room for improvement?

    Directory of Open Access Journals (Sweden)

    Søreide Eldar

    2008-07-01

    Full Text Available Abstract Background Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Method Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Results Of the 17 available respondents, most (88% felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. Conclusion The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted.

  9. Impact of Prehospital Care on Outcomes in Sepsis: A Systematic Review

    Science.gov (United States)

    Smyth, Michael A; Brace-McDonnell, Samantha J; Perkins, Gavin D

    2016-01-01

    Introduction Sepsis is a common and potentially life-threatening response to an infection. International treatment guidelines for sepsis advocate that treatment be initiated at the earliest possible opportunity. It is not yet clear if very early intervention by ambulance clinicians prior to arrival at hospital leads to improved clinical outcomes among sepsis patients. Methoda We systematically searched the electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed up to June 2015. In addition, subject experts were contacted. We adopted the GRADE (grading recommendations assessment, development and evaluation) methodology to conduct the review and follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations to report findings. Results Nine studies met the eligibility criteria – one study was a randomized controlled trial while the remaining studies were observational in nature. There was considerable variation in the methodological approaches adopted and outcome measures reported across the studies. Because of these differences, the studies did not answer a unique research question and meta-analysis was not appropriate. A narrative approach to data synthesis was adopted. Conclusion There is little robust evidence addressing the impact of prehospital interventions on outcomes in sepsis. That which is available is of low quality and indicates that prehospital interventions have limited impact on outcomes in sepsis beyond improving process outcomes and expediting the patient’s passage through the emergency care pathway. Evidence indicating that prehospital antibiotic therapy and fluid resuscitation improve patient outcomes is currently lacking. PMID:27429693

  10. Imaging of laryngeal trauma.

    Science.gov (United States)

    Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D; Dulguerov, Pavel; Varoquaux, Arthur

    2014-01-01

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed. PMID:24238937

  11. Fluid resuscitation in trauma

    Directory of Open Access Journals (Sweden)

    Rudra A

    2006-01-01

    Full Text Available Appropriate fluid replacement is an essential component of trauma fluid resuscitation. Once hemorrhage is controlled, restoration of normovolemia is a priority. In the presence of uncontrolled haemorrhage, aggressive fluid management may be harmful. The crystalloid-colloid debate continues but existing clinical practice is more likely to reflect local biases rather than evidence based medicine. Colloids vary substantially in their pharmacology and pharmacokinetics,and the experimental finding based on one colloid cannot be extrapolated reliably to another. In the initial stages of trauma resuscitation the precise fluid used is probably not important as long as an appropriate volume is given. Later, when the microcirculation is ′leaky′, there may be some advantages to high or medium weight colloids such as hydroxyethyl starch. Hypertonic saline solutions may have some benefit in patients with head injuries. A number of hemoglobin solutions are under development, but one of the most promising of these has been withdrawn recently. It is highly likely that at least one of these solutions will eventually become routine therapy for trauma patient resuscitation. In the meantime, contrary to traditional teaching, recent data suggest that restrictive strategy of red cell transfusion may improve outcome in some critically ill patients.

  12. Imaging of laryngeal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Minerva, E-mail: Minerva.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Leuchter, Igor, E-mail: Igor.Leuchter@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Platon, Alexandra, E-mail: Alexandra.Platon@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Becker, Christoph D., E-mail: Christoph.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Dulguerov, Pavel, E-mail: Pavel.Dulguerov@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Varoquaux, Arthur, E-mail: Arthur.Varoquaux@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland)

    2014-01-15

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.

  13. Trauma is danger

    Directory of Open Access Journals (Sweden)

    Porterfield Nancy

    2011-06-01

    Full Text Available Abstract Background Trauma is one of the leading causes of death in young adult patients. Many pre-clinical and clinical studies attempt to investigate the immunological pathways involved, however the true mediators remain to be elucidated. Herein, we attempt to describe the immunologic response to systemic trauma in the context of the Danger model. Data Sources A literature search using PubMed was used to identify pertinent articles describing the Danger model in relation to trauma. Conclusions Our knowledge of Danger signals in relation to traumatic injury is still limited. Danger/alarmin signals are the most proximal molecules in the immune response that have many possibilities for effector function in the innate and acquired immune systems. Having a full understanding of these molecules and their pathways would give us the ability to intervene at such an early stage and may prove to be more effective in blunting the post-injury inflammatory response unlike previously failed cytokine experiments.

  14. Imaging of laryngeal trauma

    International Nuclear Information System (INIS)

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed

  15. Basic hydraulics

    CERN Document Server

    Smith, P D

    1982-01-01

    BASIC Hydraulics aims to help students both to become proficient in the BASIC programming language by actually using the language in an important field of engineering and to use computing as a means of mastering the subject of hydraulics. The book begins with a summary of the technique of computing in BASIC together with comments and listing of the main commands and statements. Subsequent chapters introduce the fundamental concepts and appropriate governing equations. Topics covered include principles of fluid mechanics; flow in pipes, pipe networks and open channels; hydraulic machinery;

  16. Validation of the use of the ROSIER scale in prehospital assessment of stroke

    Directory of Open Access Journals (Sweden)

    He Mingfeng

    2012-01-01

    Full Text Available Aim: To determine the utility of the Recognition of Stroke in the Emergency Room (ROSIER scale as a stroke recognition tool among Chinese patients in the prehospital setting. Materials and Methods: Compared with the Cincinnati Prehospital Stroke Scale (CPSS, emergency physicians prospectively used the ROSIER as a stroke recognition tool on suspected patients in the prehospital setting. And, the final discharge diagnosis of stroke or transient ischemic attack made by neurologists, after assessment and review of clinical symptomatology and brain imaging findings, was used as the reference standard for diagnosis in the study. Then, the ROSIER and the CPSS like sensitivity (Se, specificity (Sp, positive predictive value (PPV, negative predictive value (NPV, related coefficient (r and Kappa value were calculated. Results: In this study, 540 of 582 suspected stroke patients met the study criteria. The CPSS showed a diagnostic Se of 88.77% (95% confidence intervals [CI] 86.11-91.43%, Sp of 68.79% (95% CI 64.88-72.70%, PPV of 87.40% (95% CI 85.97-88.83%, NPV of 71.52% (95% CI 67.71-75.33% and r of 0.503. Relatively, the ROSIER showed a diagnostic Se of 89.97% (95% CI 87.44-92.64%, Sp of 83.23% (95% CI 80.08-86.38%, PPV of 92.66% (95% CI 90.46-94.86%, NPV of 77.91% (95% CI 74.41-81.41% and r of 0.584. According to the final discharge diagnosis, both the ROSIER and the CPSS were associated with the final discharge diagnosis (P 0.05. Conclusions: The ROSIER is a sensitive and specific stroke recognition tool for health providers′ use among Chinese patients in the prehospital setting. However, it cannot be used to confidently rule out or identify stroke as a diagnosis. Comprehensive clinical assessment and further examination on potential stroke patients are still important and cannot be replaced. When it is difficult to objectively complete the ROSIER for patients, the CPSS could replace it in the prehospital setting.

  17. Evaluation of emergency tourniquets for prehospital use in China

    Institute of Scientific and Technical Information of China (English)

    GUO Jun-yan; LIU Yu; MA Yan-lan; PI Hong-ying; WANG Jian-rong

    2011-01-01

    Objective: Massive hemorrhage is lifethreatening during armed conflicts. Tourniquets are important medical devices used to reduce severe bleeding in trauma. The aim of this study was to empirically evaluate the current tourniquets used in China and provide information to emergency nurses in selecting the appropriate tourniquet.Methods: Five tourniquets were self-applied by 20healthy participants. The blood flow distal to the tourniquet site was assessed using vascular Doppler ultrasound.Application time, pain, numbness, and other parameters were evaluated.Results: The bladder tourniquet and windlass tourniquet effectively occluded arterial blood flow with success rates higher than 75% in both the upper and lower extremities. The Cargo-strap was the fastest to apply, taking (7.22±2.30) s for the upper extremity and (6.48±2.40) s for the lower extremity. The rubber tube was the most painful, and the improvised tourniquet was the least efficient. The success rates were higher in the lower extremity than in the upper extremity (P<0.05, X2=5.714).Conclusions: The bladder tourniquet and the windlass tourniquet are efficient tourniquets, although the windlass is superior with respect to portability and pain. The Cargo-strap and rubber tourniquets have several disadvantages that reduce their suitability for field use. The improvised tourniquet is not recommended because of low efficiency and severe pain during implementation.

  18. 院前急救2021例患者疾病谱分析%Analysis of Disease Spectrum of 2021 Pre-hospital Emergency Care

    Institute of Scientific and Technical Information of China (English)

    杨叶; 周瑞卿

    2014-01-01

    Objective:To provide the scientific basis of pre -hospital emergency measures by Analyzing the disease spectrum for pre -hospital emergency in local area .Methods:The data of 2021 cases of pre-hospital emergency treatment in our hospital from January 2013 to December 2013 were retrospectively analyzed .Results:Pre-hospital emergency patients was dominated by men , The six leading disease among the spectrum for pre -hospital emergency care included trauma , cardiovascular disease , cerebrovascular disease , acute poisoning , digestive disease , respiratory disease ,accounting for 81.25% of the total.Conclusiongs:The training emphasis should be performed the real-time adjustment and the emergency medications and equipment should be rationally adjusted according to the disease spectrum for pre-hospital emergency .It has great significance for the pre -hospital emergency work .%目的:分析本地区院前急救患者疾病谱,为改善院前急救措施提供科学依据。方法:回顾性分析本院2013年1月~2013年12月2021例院前急救病例进行统计分析。结果:院前急救患者中以男性居多,院前急救疾病谱前6位分别是创伤、心血管疾病、脑血管疾病、急性中毒、消化系统疾病、呼吸系统疾病,占总有效病例81.25%。结论:以院前急救患者的疾病谱为依据,对院前急救医护人员进行针对性培训,同时调整出诊药物、器械,对院前急救工作具有重大意义。

  19. Brain Basics

    Medline Plus

    Full Text Available ... the anatomy, physiology, and chemistry of the nervous system. When the brain cannot effectively coordinate the billions ... basic working unit of the brain and nervous system. These cells are highly specialized for the function ...

  20. Brain Basics

    Medline Plus

    Full Text Available ... News About Us Home > Health & Education > Educational Resources Brain Basics Introduction The Growing Brain The Working Brain ... to mental disorders, such as depression. The Growing Brain Inside the Brain: Neurons & Neural Circuits Neurons are ...

  1. Brain Basics

    Medline Plus

    Full Text Available ... Trials — Participants Statistics Help for Mental Illnesses Outreach Research Priorities Funding Labs at NIMH News About Us Home > Health & Education > Educational Resources Brain Basics Introduction The Growing Brain The ...

  2. Brain Basics

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    Full Text Available ... Brain Basics will introduce you to some of this science, such as: How the brain develops How ... cell, and responds to signals from the environment; this all helps the cell maintain its balance with ...

  3. Brain Basics

    Medline Plus

    Full Text Available ... How the brain develops How genes and the environment affect the brain The basic structure of the ... inside contents of the cell from its surrounding environment and controls what enters and leaves the cell, ...

  4. Brain Basics

    Science.gov (United States)

    ... News About Us Home > Health & Education > Educational Resources Brain Basics Introduction The Growing Brain The Working Brain ... to mental disorders, such as depression. The Growing Brain Inside the Brain: Neurons & Neural Circuits Neurons are ...

  5. Cancer Basics

    Science.gov (United States)

    ... Cancer? Breast Cancer Colon/Rectum Cancer Lung Cancer Prostate Cancer Skin Cancer Show All Cancer Types News and Features Cancer Glossary ACS Bookstore Cancer Information Cancer Basics Cancer Prevention & Detection Signs & Symptoms of Cancer Treatments & Side Effects ...

  6. Brain Basics

    Medline Plus

    Full Text Available ... Brain Basics provides information on how the brain works, how mental illnesses are disorders of the brain, ... learning more about how the brain grows and works in healthy people, and how normal brain development ...

  7. Basic Finance

    Science.gov (United States)

    Vittek, J. F.

    1972-01-01

    A discussion of the basic measures of corporate financial strength, and the sources of the information is reported. Considered are: balance sheet, income statement, funds and cash flow, and financial ratios.

  8. Brain Basics

    Medline Plus

    Full Text Available ... Brain Basics provides information on how the brain works, how mental illnesses are disorders of the brain, ... others live with symptoms of mental illness every day. They can be moderate, or serious and cause ...

  9. Brain Basics

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    Full Text Available ... the function of conducting messages. A neuron has three basic parts: Cell body which includes the nucleus, ... Plan in 2016 August 31, 2016, 2:00-3:00 PM ET Recovery Month September 2016 National ...

  10. Blood Basics

    Science.gov (United States)

    ... Patient Group Links Advocacy Toolkit Home For Patients Blood Basics Blood is a specialized body fluid. It ... about 9 pints. Jump To: The Components of Blood and Their Importance Many people have undergone blood ...

  11. Brain Basics

    Medline Plus

    Full Text Available ... for the function of conducting messages. A neuron has three basic parts: Cell body which includes the ... disorder (ADHD) . Glutamate —the most common neurotransmitter, glutamate has many roles throughout the brain and nervous system. ...

  12. Brain Basics

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    Full Text Available ... interconnections. neuron —A nerve cell that is the basic, working unit of the brain and nervous system, which processes and transmits information. neurotransmitter —A chemical produced by ...

  13. Brain Basics

    Medline Plus

    Full Text Available ... The Growing Brain Inside the Brain: Neurons & Neural Circuits Neurons are the basic working unit of the ... distant nerve cells (via axons) to form brain circuits. These circuits control specific body functions such as ...

  14. Brain Basics

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    Full Text Available ... science, such as: How the brain develops How genes and the environment affect the brain The basic ... that with brain development in people mental disorders. Genes and environmental cues both help to direct this ...

  15. Body Basics

    Science.gov (United States)

    ... about how the body works, what basic human anatomy is, and what happens when parts of the body don't function properly. Blood Bones, Muscles, and Joints Brain and Nervous System Digestive System Endocrine System Eyes Female Reproductive System ...

  16. Brain Basics

    Medline Plus

    Full Text Available ... Real Life Brain Basics in Real Life—How Depression affects the Brain Meet Sarah Sarah is a ... blues" from time to time. In contrast, major depression is a serious disorder that lasts for weeks. ...

  17. Global trauma: the great divide

    OpenAIRE

    Paniker Jayanth; Graham Simon Matthew; Harrison James William

    2015-01-01

    Road trauma is an emergent global issue. There is huge disparity between the population affected by road trauma and the resource allocation. If the current trend continues, a predicted extra 5 million lives will be lost in this decade. This article aims to create an awareness of the scale of the problem of road trauma and the inequality in the resources available to address this problem. It also describes the responses from the international organisations and the orthopaedic community in deal...

  18. Trauma Studies: prospettive e problemi

    Directory of Open Access Journals (Sweden)

    Rachele Branchini

    2013-12-01

    Full Text Available The trauma paradigm pervades contemporary life. In newspapers, on television, on the web, even in ordinary conversation, experiences of every kind (both figurative and positive ones are described as “traumatic”. Thus the very meaning of the term is often overturned. This article seeks to reshape the limits of the concept of trauma by tracing its evolution from the psychological debate of the early nineteenth century to the recent setting up of the specific discipline of Trauma Studies.

  19. The epidemiology of renal trauma

    OpenAIRE

    Voelzke, Bryan B.; Leddy, Laura

    2014-01-01

    Introduction Nonoperative and minimally invasive management techniques for both blunt and penetrating renal trauma have become standard of care over the past decades. We sought to examine the modern epidemiology of renal trauma over the past decade. Methods A systematic review of PubMed from the past decade was conducted to examine adult and pediatric renal trauma. A total of 605 articles were identified. Of these, 15 adult and 5 pediatric articles met our a priori search criteria. Results Th...

  20. Translating orthopaedic basic science into clinical relevance

    OpenAIRE

    Madry, Henning

    2014-01-01

    In orthopaedic and trauma surgery, the rapid evolution of biomedical research has fundamentally changed the perception of the musculoskeletal system. Here, the rigor of basic science and the art of musculoskeletal surgery have come together to create a new discipline -experimental orthopaedics- that holds great promise for the causative cure of many orthopaedic conditions. The Journal of Experimental Orthopaedics intends to bridge the gap between orthopaedic basic science and clinical relevan...

  1. Global trauma: the great divide.

    Science.gov (United States)

    Paniker, Jayanth; Graham, Simon Matthew; Harrison, James William

    2015-01-01

    Road trauma is an emergent global issue. There is huge disparity between the population affected by road trauma and the resource allocation. If the current trend continues, a predicted extra 5 million lives will be lost in this decade. This article aims to create an awareness of the scale of the problem of road trauma and the inequality in the resources available to address this problem. It also describes the responses from the international organisations and the orthopaedic community in dealing with this issue. The International Orthopaedic community has a unique opportunity and moral obligation to play a part in changing this trend of global trauma.

  2. Global trauma: the great divide

    Directory of Open Access Journals (Sweden)

    Paniker Jayanth

    2015-01-01

    Full Text Available Road trauma is an emergent global issue. There is huge disparity between the population affected by road trauma and the resource allocation. If the current trend continues, a predicted extra 5 million lives will be lost in this decade. This article aims to create an awareness of the scale of the problem of road trauma and the inequality in the resources available to address this problem. It also describes the responses from the international organisations and the orthopaedic community in dealing with this issue. The International Orthopaedic community has a unique opportunity and moral obligation to play a part in changing this trend of global trauma.

  3. Trauma and Symbolic Violence

    DEFF Research Database (Denmark)

    Pedersen, Bodil Maria

    2011-01-01

    Our understanding of 'reactions to trauma' is dominated by concepts like Post-Traumatic Stress Disorder. The use of such concepts has been criticised but simultaneously integrated in folk-psychology. Connecting emotional and cognitive processes as well as acts - such as in gendered practices...... seeks to undertake a discussion of personal meanings attributed to 'traumatisation'. It raises questions as to whether concepts of this kind and related practices may constitute symbolic violence and contribute to victimisation through looping-processes. Furthermore it aims at unfolding an understanding...

  4. Reno Orthopaedic Trauma Fellowship business curriculum.

    Science.gov (United States)

    Althausen, Peter L; Bray, Timothy J; Hill, Austin D

    2014-07-01

    The Reno Orthopaedic Center (ROC) Trauma Fellowship business curriculum is designed to provide the fellow with a graduate level business practicum and research experience. The time commitments in a typical 12-month trauma fellowship are significant, rendering a traditional didactic master's in business administration difficult to complete during this short time. An organized, structured, practical business education can provide the trauma leaders of tomorrow with the knowledge and experience required to effectively navigate the convoluted and constantly changing healthcare system. The underlying principle throughout the curriculum is to provide the fellow with the practical knowledge to participate in cost-efficient improvements in healthcare delivery. Through the ROC Trauma Fellowship business curriculum, the fellow will learn that delivering healthcare in a manner that provides better outcomes for equal or lower costs is not only possible but a professional and ethical responsibility. However, instilling these values without providing actionable knowledge and programs would be insufficient and ineffective. For this reason, the core of the curriculum is based on individual teaching sessions with a wide array of hospital and private practice administrators. In addition, each section is equipped with a suggested reading list to maximize the learning experience. Upon completion of the curriculum, the fellow should be able to: (1) Participate in strategic planning at both the hospital and practice level based on analysis of financial and clinical data, (2) Understand the function of healthcare systems at both a macro and micro level, (3) Possess the knowledge and skills to be strong leaders and effective communicators in the business lexicon of healthcare, (4) Be a partner and innovator in the improvement of the delivery of orthopaedic services, (5) Combine scientific and strategic viewpoints to provide an evidence-based strategy for improving quality of care in a

  5. Trauma-Focused CBT for Youth with Complex Trauma

    Science.gov (United States)

    Cohen, Judith A.; Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

    2012-01-01

    Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive…

  6. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management

    DEFF Research Database (Denmark)

    Sollid, Stephen J M; Lockey, David; Lossius, Hans Morten;

    2009-01-01

    process with international experts to establish a set of core data points to be documented and reported in cases of advanced pre-hospital airway management. METHODS: A four-step modified nominal group technique process was employed. RESULTS: The inclusion criterion for the template was defined as any...... with airway management have recently propagated the need for guidelines and standards in pre-hospital airway management. Following the path of other initiatives to establish templates for uniform data reporting, like the many Utstein-style templates, we initiated and carried out a structured consensus...... points. Additionally, the group defined 19 optional variables for which a consensus could not be achieved or the data were considered as valuable but not essential. CONCLUSION: We successfully developed an Utstein-style template for documenting and reporting pre-hospital airway management. The core...

  7. Management of liver trauma.

    LENUS (Irish Health Repository)

    Badger, S A

    2012-02-01

    BACKGROUND: Blunt and penetrating liver trauma is common and often presents major diagnostic and management problems. METHODS: A literature review was undertaken to determine the current consensus on investigation and management strategies. RESULTS: The liver is the most frequently injured organ following abdominal trauma. Immediate assessment with ultrasound has replaced diagnostic peritoneal lavage in the resuscitation room, but computerised tomography remains the gold standard investigation. Nonoperative management is preferred in stable patients but laparotomy is indicated in unstable patients. Damage control techniques such as perihepatic packing, hepatotomy plus direct suture, and resectional debridement are recommended. Major complex surgical procedures such as anatomical resection or atriocaval shunting are now thought to be redundant in the emergency setting. Packing is also recommended for the inexperienced surgeon to allow control and stabilisation prior to transfer to a tertiary centre. Interventional radiological techniques are becoming more widely used, particularly in patients who are being managed nonoperatively or have been stabilised by perihepatic packing. CONCLUSIONS: Management of liver injuries has evolved significantly throughout the last two decades. In the absence of other abdominal injuries, operative management can usually be avoided. Patients with more complex injuries or subsequent complications should be transferred to a specialist centre to optimise final outcome.

  8. Basic electronics

    CERN Document Server

    Holbrook, Harold D

    1971-01-01

    Basic Electronics is an elementary text designed for basic instruction in electricity and electronics. It gives emphasis on electronic emission and the vacuum tube and shows transistor circuits in parallel with electron tube circuits. This book also demonstrates how the transistor merely replaces the tube, with proper change of circuit constants as required. Many problems are presented at the end of each chapter. This book is comprised of 17 chapters and opens with an overview of electron theory, followed by a discussion on resistance, inductance, and capacitance, along with their effects on t

  9. Bone scintigraphy in children: trauma

    International Nuclear Information System (INIS)

    The sensitivity of radionuclide imaging in identifying skeletal trauma in children has been established. Growth plates present a set of problems unique to pediatric studies and diagnotic accuracy is very technique dependent. Imaging for sports injuries and suspected child abuse has been productive. An expanding role for bone scintigraphy in the management of orthopedic problems post-trauma is developing

  10. Spinal trauma. An imaging approach

    International Nuclear Information System (INIS)

    The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

  11. The epidemiology of pre-hospital emergency medical care in Nanxing District of Shanghai%上海嘉定南翔地区839例院前急救患者的流行病学分析

    Institute of Scientific and Technical Information of China (English)

    周海龙; 于海文; 曹利杰; 钟沛霖

    2008-01-01

    Objective The pre-hospital data of 839 emergency patients who were admitted to Naxiang Emergency Center of Shanghai from Dec 11 2006 to Jun 11 2007 were analyzed.The first five causes of emergency call were trauma,diseases of newborns,neuron-system diseases.eardio-vascuIar diseases and digestive diseases.The epidemiological data including gender,age of patients,distance to emergency site,duration of ambulance dispatch,results of first aid.etc were also presented in the paper.These data would be helpful for improving pre-hospital medical care of emergency patients.%对2006年12月11日至2007年6月11日院前急救患者的性别、年龄、现场地址、出诊时间、病情分类、急救半径等项目调查分析.院前急救前5大类疾病依次足创伤、新生儿疾病、神经系统疾病、心血管系统疾病、消化系统疾病.了解和掌握院前急救患者的临床情况及就诊时间分布特点和规律,对及时、有效、准确做好院前急救工作,提高危重症患者的抢救成功率有重要意义.

  12. Basic Backwardness.

    Science.gov (United States)

    Weingartner, Charles

    This paper argues that the "back to basics" movement is regressive and that regression is the characteristic mode of fear-ridden personalities. It is argued that many people in American society today have lost their ability to laugh and do not have the sense of humor which is crucial to a healthy mental state. Such topics as necrophilia, mental…

  13. Brain Basics

    Medline Plus

    Full Text Available ... Life Brain Basics in Real Life—How Depression affects the Brain Meet Sarah Sarah is a middle-aged woman ... new memories. hypothalmic-pituitary-adrenal (HPA) axis —A brain-body ... stress. impulse —An electrical communication signal sent between neurons ...

  14. Brain Basics

    Medline Plus

    Full Text Available ... Welcome. Brain Basics provides information on how the brain works, how mental illnesses are disorders of the brain, ... highly developed area at the front of the brain that, in humans, plays a role in executive functions such as ...

  15. Ethanol Basics

    Energy Technology Data Exchange (ETDEWEB)

    None

    2015-01-30

    Ethanol is a widely-used, domestically-produced renewable fuel made from corn and other plant materials. More than 96% of gasoline sold in the United States contains ethanol. Learn more about this alternative fuel in the Ethanol Basics Fact Sheet, produced by the U.S. Department of Energy's Clean Cities program.

  16. Basic Skills.

    Science.gov (United States)

    Luparelli, Augustus N.; And Others

    1981-01-01

    These four articles focus on developing basic reading, science, and job search skills: "Reading Program for Vocational Classes" by Augustus Luparelli; "Why Teach Employability Skills?" by Larry Siefferman; "Improving Vocabulary and Reading Skills" by Edythe Conway; and "Science in Everyday Life" by Virginia Eleazer and George Carney. (SK)

  17. Maternal mortality due to trauma.

    Science.gov (United States)

    Romero, Vivian Carolina; Pearlman, Mark

    2012-02-01

    Maternal mortality is an important indicator of adequacy of health care in our society. Improvements in the obstetric care system as well as advances in technology have contributed to reduction in maternal mortality rates. Trauma complicates up to 7% of all pregnancies and has emerged as the leading cause of maternal mortality, becoming a significant concern for the public health system. Maternal mortality secondary to trauma can often be prevented by coordinated medical care, but it is essential that caregivers recognize the unique situation of providing simultaneous care to 2 patients who have a complex physiologic relationship. Optimal management of the pregnant trauma victim requires a multidisciplinary team, where the obstetrician plays a central role. This review focuses on the incidence of maternal mortality due to trauma, the mechanisms involved in traumatic injury, the important anatomic and physiologic changes that may predispose to mortality due to trauma, and finally, preventive strategies that may decrease the incidence of traumatic maternal death.

  18. Operative treatment of hepatic trauma in Vachira Phuket Hospital.

    Science.gov (United States)

    Vatanaprasan, Thanong

    2005-03-01

    Descriptive study of an 8-year period, 211 patients with hepatic trauma were studied retrospectively. Most of the patients were male (81.5%). Patients mainly affected were in the third decade of life (46.9%) with an age range of 2 to 65 years old (Mean 26.1 +/- 9.8). Fifty four percent resulted from blunt and 46.4% from penetrating injuries. The most common cause of injuries was motorcycle accidents (41.2%). The injuries were graded by the hepatic injury scale (grades I to VI). There were 22 (10.4%), 62 (29.4%), 70 (33.2%), 27 (12.8%), 28 (13.3%) and 2 (0.9%) patients with grade I, II, III, IV, V and VI hepatic injuries, respectively. Forty seven percent of patients were in shock when they first arrived at the emergency room. One hundred and sixty five patients (78.2%) had 375 associated injuries. Seventy three percent of patients had low grade hepatic injuries (grades I to III), the remainder (27%) had high grade hepatic injuries (grades IV to VI). Operative treatment of hepatic injuries varied according to degree of injury. Low grade hepatic injuries amenable to relatively simple operative treatment. Nineteen deaths (12.3%) occurring in this group were attributed to the commonly encountered associated injuries inside and outside the abdomen, which were more frequently seen after blunt trauma (89.5%). High-grade hepatic injuries required major techniques. Thirty four of these patients died (59.6%), death was related to the injury itself (91.2%), which were more frequently seen after blunt trauma (85%). During operation, suture ligature of the bleeding point, or hepatorrhaphy stopped the bleeding in most circumstances. Perihepatic packing was a useful procedure when termination of the operation was considered necessary in order to prevent the development of hypothermia, acidosis and coagulopathy. Perihepatic packing was used for treatment of 73% of high grade hepatic injuries and yielded 65.5% survival rate. The results were 59 patients had complication (morbidity

  19. [Prehospital management of febrile convulsions by the Mobile Emergency Care Unit in the Capital Region of Denmark

    DEFF Research Database (Denmark)

    Lindekaer, A.L.; Nielsen, S.L.; Pedersen, Ulf Gøttrup

    2008-01-01

    INTRODUCTION: We conducted a quality assurance project of The Mobile Emergency Care Unit (MECU) in the Capital Region of Denmark when dispatched to febrile convulsions. The study focuses on prehospital treatment, comparison between prehospital and in-hospital diagnoses and parents' perceptions of...... their child's febrile convulsions and their satisfaction with the MECU. MATERIAL AND METHODS: The period of investigation was from March 1st 2004 to March 31st 2005. Children with a diagnosis of febrile convulsions or relevant differential diagnoses were eligible for inclusion. Children were excluded if...... the MECU should still be dispatched primarily to febrile convulsions Udgivelsesdato: 2008/11/24...

  20. Lightweight physiologic sensor performance during pre-hospital care delivered by ambulance clinicians.

    Science.gov (United States)

    Mort, Alasdair J; Fitzpatrick, David; Wilson, Philip M J; Mellish, Chris; Schneider, Anne

    2016-02-01

    The aim of this study was to explore the impact of motion generated by ambulance patient management on the performance of two lightweight physiologic sensors. Two physiologic sensors were applied to pre-hospital patients. The first was the Contec Medical Systems CMS50FW finger pulse oximeter, monitoring heart rate (HR) and blood oxygen saturation (SpO2). The second was the RESpeck respiratory rate (RR) sensor, which was wireless-enabled with a Bluetooth(®) Low Energy protocol. Sensor data were recorded from 16 pre-hospital patients, who were monitored for 21.2 ± 9.8 min, on average. Some form of error was identified on almost every HR and SpO2 trace. However, the mean proportion of each trace exhibiting error was <10 % (range <1-50 % for individual patients). There appeared to be no overt impact of the gross motion associated with road ambulance transit on the incidence of HR or SpO2 error. The RESpeck RR sensor delivered an average of 4.2 (±2.2) validated breaths per minute, but did not produce any validated breaths during the gross motion of ambulance transit as its pre-defined motion threshold was exceeded. However, this was many more data points than could be achieved using traditional manual assessment of RR. Error was identified on a majority of pre-hospital physiologic signals, which emphasised the need to ensure consistent sensor attachment in this unstable and unpredictable environment, and in developing intelligent methods of screening out such error. PMID:25804608

  1. Importance of transport in prehospital treatment of children with craniocerebral injuries

    Directory of Open Access Journals (Sweden)

    Stanić-Čanji Danica

    2007-01-01

    Full Text Available Introduction. In initial, prehospital, phase of treatment of the injured pediatric patient, transport plays an important role. Objective. The aim of this study was to determine the influence of an adequate transport on the survival rate and final outcome of patients with craniocerebral injuries. Method. This study is a clinical, partly prospective, partly retrospective study that includes 60 patients with isolated craniocerebral injuries, aged up to 17 years, and with Glasgow Coma Scale under 8, that did not require surgical treatment. The patients were divided in two groups each with 30 patients. The first group included patients that had adequate prehospital treatment. The second group included patients that had improper prehospital treatment. In both groups the emphasis was on the transport as an important step in initial treatment. Results. There was a statistically significant difference in respect to the mode of transport. In group I there was a greater number of patients transported by specialized emergency vehicles (93.3% compared to the group II. There was also a difference regarding the time that had elapsed from the moment of injury to the moment of arrival to the hospital - a significantly shorter time in group I. In a group of patients that survived, a greater percentage of patients had been transported by specialized emergency vehicles compared to the group of patients that did not survive. Conclusion. Adequate transport improves the survival rate of the patients with craniocerebral injuries. Also the time that has elapsed from the moment of injury to the moment of arrival to the hospital also influences the survival rate, but the final outcome, too. Transport of pediatric patients is globally neglected. Transport of unstable, critically ill and injured patients accompanied by inexperienced and unspecialized staff is followed an increased mortality rate. .

  2. Penetrating abdominal trauma.

    Science.gov (United States)

    Henneman, P L

    1989-08-01

    The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. Blood should be obtained for initial hematocrit, type and cross-matching, electrolytes, and an alcohol level or drug screen as needed. Initial resuscitation should utilize crystalloid fluid replacement. If more than 2 liters of crystalloid are needed to stabilize an adult (less in a child), blood should be given. Group O Rh-negative packed red blood cells should be immediately available for a patient in impending arrest or massive hemorrhage. Type-specific blood should be available within 15 minutes. A patient with penetrating thoracic and high abdominal trauma should receive a portable chest x-ray, and a hemo- or pneumothorax should be treated with tube thoracostomy. An unstable patient with clinical signs consistent with a pneumothorax, however, should receive a tube thoracostomy prior to obtaining roentgenographic confirmation. If time permits, a nasogastric tube and Foley catheter should be placed, and the urine evaluated for blood (these procedures can be performed in the operating room). If kidney involvement is suspected because of hematuria or penetrating trauma in the area of a kidney or ureter in a patient requiring surgery, a single-shot IVP should be performed either in the ED or the operating room. An ECG is important in patients with possible cardiac involvement and in patients over the age of 40 going to the operating room. Tetanus status should be updated, and appropriate antibiotics covering bowel flora should be given. Operative management should rarely be delayed

  3. 349例院前死亡患者流行病学特征分析%Analysis of epidemiological features from 349 cases of pre-hospital death

    Institute of Scientific and Technical Information of China (English)

    葛文汉; 阮海林; 杨春旭; 杨家有

    2012-01-01

    目的 分析我院院前死亡患者流行病学特征,提高院前急救水平,最大限度降低院前死亡率.方法 采用前瞻性资料收集的方法,对我院2010年度所有院前死亡患者的年龄、性别、就诊时间、急诊诊断等要素进行调查统计分析.结果 本组院前死亡病例349例,男女比为2.14:1,年龄(61.34±18.49)岁;院前死亡1、2月份较高,5、7月份较低;日时间段高峰为8:00~10:00;死因前3位依次为猝死(37.25%)、神经系统疾病(17.77%)、创伤(10.60%);出诊反应时间为(1.46±0.78)min,到达现场时间(10.20±6.79)min,现场抢救时间(20.94±12.87)min,急救半径(8.56±6.33)km.结论 ①15~79岁,随着年龄的增长院前死亡逐渐增加,注意改变亚健康状态,正确治疗基础疾病;②创伤死亡主要为青中年,加强急诊外科建设,提高创伤救治成功率;③猝死是首要死因,心脑血管疾病年轻化,普及大众急救知识,尤其提高常见心脑血管疾病急危重症的早期识别及院前急救水平,对提高院前急救成功率有重要意义.%Objective Try to analyze the epidemiological fealures of the prehospilal death in order Lo improve the technical merit of prehospital emergency. As a result, the rate of prehospital death will be decreased at an utmost extent. Methods Investigation and statistical analysis for the related factor such as age, gender, visiting time and emergency diagnosis of the prehospital death in 2010 are made by using prospective data collection method. Results There are 349 cases of death in this group. The ratio stood 2. 14:1 by male -female, age 61. 34 ±18.49; the prehospital death is higher in January and February, but it is a little lower in May and July. The rush hour in the day is around 8:00 ~ 10:00. The top 3 causes of the death are respectively sudden death ( 37. 25% ) , nervous system desease ( 17. 77% ) and trauma ( 10. 60% ) . The visiting response time was 1. 46 min ( SD 0. 78 ) , and the arrival time was 10

  4. 德阳市院前急救现况调查与分析%Epidemiology Analysis of Pre-Hospital First Aid Patients of Deyang City

    Institute of Scientific and Technical Information of China (English)

    鄢涛; 王森; 谭鸿; 姜伟; 刘辉; 李远建; 胡壮俐

    2011-01-01

    (45.23 ± 17.46) years. The scheduling time, running time,rescue time,returning time were(1.89 ±0. 82)min, (14. 22 ±5. 23)min, (14. 33 ±4. 34)min, (13. 12 ±4. 35) min,respectively. The period with highest frequency of emergency call occurred in winter and summer( 62. 99% ,10 245/16 265 ) of the year and in 8:00 -24:00(86. 74% ,14 108/16 265)of the day. The top five causes of emergency call were trauma(38. 80% , 6311/16 265) .cerebrovascular diseases(18. 73% ,3047/1265) .cardiovascular diseases(17. 54% ,2852/16 265), respiratory diseases(9.67% , 1573/16 265) and poisonings(6.00% ,975/16 265). The radius of emergency care within five kilometer was 52.36% (8517/16 265). ②The scheduling time,running time,returning time had no significant difference between the death group and the non-death group( P >0.05),but rescue time in the death group were longer than those in the non-death group(P < 0.05) ,and the top three causes of the death cases were cerebrovascular diseases(28. 34% ,333/1175) .cardiovascular diseases (24.94% ,293/1175) and trauma(22.38% ,263/1175) .whose age grades was by far above 60. Conclusion It was significant to promote the pre-hospital first aid for human health and emergency medicines building. These results of epidemiology analysis of pre-hospital first aid patients could provide relative data for building emergency treatment system and promoting emergency management.

  5. Evolving prehospital, emergency department, and "inpatient" management models for geriatric emergencies.

    Science.gov (United States)

    Carpenter, Christopher R; Platts-Mills, Timothy F

    2013-02-01

    Alternative management methods are essential to ensure high-quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols to support early condition-specific treatment of older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to address the influence of other factors on the patient's health. This article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care.

  6. Association between prehospital physician involvement and survival after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Hamilton, Annika; Steinmetz, Jacob; Wissenberg, Mads;

    2016-01-01

    involvement and 30-day survival. METHODS: Observational study including persons registered with first-time OHCA of any cause in the Danish Cardiac Arrest Registry during 2005-2012. We used logistic regression analysis to assess the association between 30-day survival and involvement of a physician at any time......AIM: Sudden out-of-hospital cardiac arrest (OHCA) is an important public health problem. While several interventions are known to improve survival, the impact of physician-delivered advanced cardiac life support for OHCA is unclear. We aimed to assess the association between prehospital physician...

  7. Prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest

    DEFF Research Database (Denmark)

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian;

    2003-01-01

    OBJECTIVE: To study prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest. DESIGN: Structured interview of 250 consecutive patients with acute coronary syndrome and relatives of 48 patients with witnessed cardiac arrest. The following courses of action......-four per cent of the patients admitted with cardiac arrest expressed no prior symptoms. Two-thirds of patients with typical symptoms interpreted it as cardiac-still only half took action within 20 min. Fifty per cent of patients who called a physician were delayed by wrong advice or misinterpretation. One...

  8. An application of the MEMbrain training module: Pre-hospital rescue operation

    DEFF Research Database (Denmark)

    Andersen, V.

    1998-01-01

    A system for training in pre-hospital emergency management is being developed and the first version of a prototype has been completed. The training system fulfils the demands from the domain of hospital emergency planning centres and medical attendants concerning increased efficiency of rescue...... efforts. This includes enhanced first aid on site and improved overall co-ordination amongst the organisations involved in coping with emergency situations. The training system is based on the Multi-User System for Training Emergency Response (MUSTER) concept which is used for the training module in the...

  9. Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment

    DEFF Research Database (Denmark)

    Simonsen, Sofie; Andresen, Morten; Michelsen, Lene;

    2014-01-01

    BackgroundEffective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during a...... five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009.MethodsWe performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011. We noted response time from dispatch...

  10. Lightweight Trauma Module - LTM

    Science.gov (United States)

    Hatfield, Thomas

    2008-01-01

    Current patient movement items (PMI) supporting the military's Critical Care Air Transport Team (CCATT) mission as well as the Crew Health Care System for space (CHeCS) have significant limitations: size, weight, battery duration, and dated clinical technology. The LTM is a small, 20 lb., system integrating diagnostic and therapeutic clinical capabilities along with onboard data management, communication services and automated care algorithms to meet new Aeromedical Evacuation requirements. The Lightweight Trauma Module is an Impact Instrumentation, Inc. project with strong Industry, DoD, NASA, and Academia partnerships aimed at developing the next generation of smart and rugged critical care tools for hazardous environments ranging from the battlefield to space exploration. The LTM is a combination ventilator/critical care monitor/therapeutic system with integrated automatic control systems. Additional capabilities are provided with small external modules.

  11. Radiology of trauma to kidney and lower urinary tract

    International Nuclear Information System (INIS)

    The contents are trauma to kidney, imaging of kidney trauma, management of renal trauma, delayed complications, trauma to the lower urinary tract, trauma to urinary bladder, radiologic diagnosis, ethiology of blunt bladder injury, urethal injury (6 refs.)

  12. Wavelet basics

    CERN Document Server

    Chan, Y T

    1995-01-01

    Since the study of wavelets is a relatively new area, much of the research coming from mathematicians, most of the literature uses terminology, concepts and proofs that may, at times, be difficult and intimidating for the engineer. Wavelet Basics has therefore been written as an introductory book for scientists and engineers. The mathematical presentation has been kept simple, the concepts being presented in elaborate detail in a terminology that engineers will find familiar. Difficult ideas are illustrated with examples which will also aid in the development of an intuitive insight. Chapter 1 reviews the basics of signal transformation and discusses the concepts of duals and frames. Chapter 2 introduces the wavelet transform, contrasts it with the short-time Fourier transform and clarifies the names of the different types of wavelet transforms. Chapter 3 links multiresolution analysis, orthonormal wavelets and the design of digital filters. Chapter 4 gives a tour d'horizon of topics of current interest: wave...

  13. Variations in pre-hospital fibrinolysis process of care: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic 3 Plus international acute myocardial infarction pre-hospital care survey.

    NARCIS (Netherlands)

    Welsh, R.C.; Goldstein, P.; Adgey, J.; Verheugt, F.W.A.; Bestilny, S.A.; Wallentin, L.; Werf, F. van de; Armstrong, P.W.

    2004-01-01

    The Assessment of the Safety and Efficacy of a New Thrombolytic 3 (ASSENT 3 PLUS) Plus trial (n=1639) was an international trial of pre-hospital fibrinolysis with tenecteplase randomly assigned to enoxaparin or unfractionated heparin, involving 106 sites in 12 countries. Given the potential impact o

  14. An ecological view of psychological trauma and trauma recovery.

    Science.gov (United States)

    Harvey, M R

    1996-01-01

    This paper presents an ecological view of psychological trauma and trauma recovery. Individual differences in posttraumatic response and recovery are the result of complex interactions among person, event, and environmental factors. These interactions define the interrelationship of individual and community and together may foster or impede individual recovery. The ecological model proposes a multidimensional definition of trauma recovery and suggests that the efficacy of trauma-focused interventions depends on the degree to which they enhance the person-community relationship and achieve "ecological fit" within individually varied recovery contexts. In attending to the social, cultural and political context of victimization and acknowledging that survivors of traumatic experiences may recover without benefit of clinical intervention, the model highlights the phenomenon of resiliency, and the relevance of community intervention efforts. PMID:8750448

  15. Dental Trauma. A Case Report

    Directory of Open Access Journals (Sweden)

    Alain Soto Ugalde

    2015-06-01

    Full Text Available Dental traumas in children are common; therefore the dentist should be trained to solve them. This paper presents the diagnosis, treatment and outcome of a child with a 12 mm overjet, mouth breathing habit and bilabial incompetence who suffered a severe trauma to tooth number 11, causing its mobility. A splint was applied to the affected tooth and subsequently, a root canal filling was performed, all with a satisfactory outcome. Although these traumas are common, the presentation of this case is important due to its use in the teaching context.

  16. Structured diagnostic imaging in patients with multiple trauma

    International Nuclear Information System (INIS)

    Purpose. Development of a concept for structured diagnostic imaging in patients with multiple trauma.Material and methods. Evaluation of data from a prospective trial with over 2400 documented patients with multiple trauma. All diagnostic and therapeutic steps, primary and secondary death and the 90 days lethality were documented.Structured diagnostic imaging of multiple injured patients requires the integration of an experienced radiologist in an interdisciplinary trauma team consisting of anesthesia, radiology and trauma surgery. Radiology itself deserves standardized concepts for equipment, personnel and logistics to perform diagnostic imaging for a 24-h-coverage with constant quality.Results. This paper describes criteria for initiation of a shock room or emergency room treatment, strategies for documentation and interdisciplinary algorithms for the early clinical care coordinating diagnostic imaging and therapeutic procedures following standardized guidelines. Diagnostic imaging consists of basic diagnosis, radiological ABC-rule, radiological follow-up and structured organ diagnosis using CT. Radiological trauma scoring allows improved quality control of diagnosis and therapy of multiple injured patients.Conclusion. Structured diagnostic imaging of multiple injured patients leads to a standardization of diagnosis and therapy and ensures constant process quality. (orig.)

  17. Secondary Trauma in Children and School Personnel

    Science.gov (United States)

    Motta, Robert W.

    2012-01-01

    A review of childhood secondary trauma is presented. Secondary trauma involves the transfer and acquisition of negative affective and dysfunctional cognitive states due to prolonged and extended contact with others, such as family members, who have been traumatized. As such, secondary trauma refers to a spread of trauma reactions from the victim…

  18. Regression Basics

    CERN Document Server

    Kahane, Leo H

    2007-01-01

    Using a friendly, nontechnical approach, the Second Edition of Regression Basics introduces readers to the fundamentals of regression. Accessible to anyone with an introductory statistics background, this book builds from a simple two-variable model to a model of greater complexity. Author Leo H. Kahane weaves four engaging examples throughout the text to illustrate not only the techniques of regression but also how this empirical tool can be applied in creative ways to consider a broad array of topics. New to the Second Edition Offers greater coverage of simple panel-data estimation:

  19. Basic electronics

    CERN Document Server

    Tayal, DC

    2010-01-01

    The second edition of this book incorporates the comments and suggestions of my friends and students who have critically studied the first edition. In this edition the changes and additions have been made and subject matter has been rearranged at some places. The purpose of this text is to provide a comprehensive and up-to-date study of the principles of operation of solid state devices, their basic circuits and application of these circuits to various electronic systems, so that it can serve as a standard text not only for universities and colleges but also for technical institutes. This book

  20. Instrument for assessing the quality of mobile emergency pre-hospital care: content validation

    Directory of Open Access Journals (Sweden)

    Rodrigo Assis Neves Dantas

    2015-06-01

    Full Text Available OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K and Content Validity Index (CVI, considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.

  1. Physiological-Social Scores in Predicting Outcomes of Prehospital Internal Patients

    Directory of Open Access Journals (Sweden)

    Abbasali Ebrahimian

    2014-01-01

    Full Text Available The physiological-social modified early warning score system is a newly developed instrument for the identification of patients at risk. The aim of this study was to investigate the feasibility of using the physiological-social modified early warning score system for the identification of patients that needed prehospital emergency care. This prospective cohort study was conducted with 2157 patients. This instrument was used as a measure to detect critical illness in patients hospitalised in internal wards. Judgment by an emergency medicine specialist was used as a measure of standard. Data were analyzed by using receiver operating characteristics curves and the area under the curve with 95% confidence interval. The mean score of the physiological-social modified early warning score system was 2.71 ± 3.55. Moreover, 97.6% patients with the score ≥ 4 needed prehospital emergency services. The area under receiver operating characteristic curve was 0.738 (95% CI = 0.708–0.767. Emergency medical staffs can use PMEWS ≥ 4 to identify those patients hospitalised in the internal ward as at risk patients. The physiological-social modified early warning score system is suggested to be used for decision-making of emergency staff about internal patients’ wards in EMS situations.

  2. Analysis of 78 cases of prehospital death due to traffic accident injury

    Institute of Scientific and Technical Information of China (English)

    胡孝菽; 洪勇; 等

    1999-01-01

    Objective The cause and time of prehospital death for the injured patients caused by traffic accidents were studied in order to improve traffic management and clinical treatment,and reduce mortality.Methods The characteristics of the injury,the rescue procedure,the status of the injury leading to death were analyzed based on the retrospective data of 78 cases died before admission.Results The main causes of prehospital death in the traffic accidents included:1.head injury,2.bleeding,3.chest and heart wound,4.spinal cord injury at upper cervix.Death happened immediately after injury was in 17 cases.Death happened from the accident site to our hospital was in 47 cases.Death happened within half an hour after reaching emergency room was in 14 cases.In all of the cases,the death on the transfer took up 62.5%.Conclusions Findings from analysis of the data will be presented on a wide range of traffic safety issues.These include enhancing education of traffic safety and administration of drivers and motor vehicles,establishing a perfect emergency medical service system and a well-trained team of first aid,and popularizing first aid knowledge to all people.

  3. The emerging trend in the epidemiology of gunshot injuries in the emergency department of a Nigerian tertiary hospital in a State without formal prehospital emergency medical services

    Directory of Open Access Journals (Sweden)

    Gabriel Uche Pascal Iloh

    2013-01-01

    Full Text Available Background : Gunshot injuries (GSIs though a rarity in Nigeria before the Nigerian civil war have now become rampant with variable epidemiology. It is emerging as a common cause of trauma-related emergency hospitalizations. Aim: The study was aimed at reviewing the epidemiology of gunshot injuries in the emergency department (ED of a Nigerian tertiary hospital over a 5-year period. Materials and Methods: This was a retrospective study of GSIs seen at the ED of Federal Medical Centre, Umuahia, Nigeria using data from medical records, patients′ case notes, ED admission registers, and nurses′ report books. The data collected included age, sex, place of the incidence, time of the incidence, time of presentation to the hospital, anatomic sites, and etiology of the injury. Results : The age ranged from 14 years to 80 years with mean age of 47 ± 8.1 years. There were 95 males and 22 females with a male to female ratio of 4.3:1. The three most common causes were armed robbery (31.6%, kidnapping (21.3%, and police brutality (17.9%. The incident predominantly affected the middle age group (57.3%, occurred mostly during the day time (72.6%, affecting mainly the lower limbs (65.8% and majority (84.6% of the victims presented 1 hour after the injury. None of the victims received prehospital care. Conclusion: There was variability in the epidemiology of GSIs with kidnapping and police brutality emerging among preeminent contributors and downward trend of armed robbery-related GSIs. The incident occurred predominantly during the day time and most victims presented late to the ED. Interventional strategies including the responsible security apparatus system are advocated.

  4. Barriers of Pre-Hospital Services in Road Traffic Injuries in Tehran: The Viewpoint of Service Providers

    Directory of Open Access Journals (Sweden)

    Shahrokh Alinia

    2015-10-01

    Full Text Available Abstract Background: Iran is one of the countries with considerable road traffic injuries. Pre-hospital interventions have an important role in preventing mortalities and disabilities caused by traffic accidents.The present study aimed to explore the barriers of pre-hospital care in traffic injuries in Tehran, Iran. Methods: A qualitative content analysis approach was conducted based on 21 semi-structured interviews with 18 participants. A purposeful sampling method was applied until reaching data saturation. Interviews were transcribed verbatim, and then data condensing, labeling, coding and defining categories were performed by qualitative content analysis. Results: Four main barriers including 4 main categories and 13 subcategories emerged; they included Barriers related to people, Barriers related to metropolitan infrastructure,Barriers related to the profession and Barriers related to managerial issues. Conclusion: Based on the findings of this study, pre-hospital service barriers in traffic accidents have many dimensions including cultural, structural and managerial domains. Policy makers in health system can use these findings to promote the quality of pre-hospital services, especially in the field of traffic injuries.

  5. An Introduction to Emergency Medical Services (EMS). Pre-Hospital Phase. Emergency Medical Services Orientation, Lesson Plan No. 9.

    Science.gov (United States)

    Young, Derrick P.

    Designed for use with interested students at high schools, community colleges, and four-year colleges, this lesson plan was developed to provide an introduction to the pre-hospital phase of Emergency Medical Services (EMS) and to serve as a recruitment tool for the EMS Program at Kapiolani Community College (KCC) in Hawaii. The objectives of the…

  6. Implementation of a pre-hospital decision rule in general practice. Triage of patients with suspected myocardial infarction

    NARCIS (Netherlands)

    E.W.M. Grijseels (Els); J.W. Deckers (Jaap); A.W. Hoes (Arno); H. Boersma (Eric); J.A.M. Hartman; E. van der Does (Emiel); M.L. Simoons (Maarten)

    1996-01-01

    textabstractOBJECTIVE: To improve pre-hospital triage of patients with suspected acute cardiac disease. DESIGN: Prospective study. SUBJECTS. Patients with symptoms suggestive of acute cardiac pathology, who were seen by a general practitioner, for whom acute admission into hospital was requested, an

  7. 院前急救的护理体会%Care experience of pre-hospital emergency

    Institute of Scientific and Technical Information of China (English)

    经璐瑶

    2014-01-01

    院前急救当中应积极运用护理的急救思维,使用高效的护理方法,于院前急症、危、重症病人的急救当中起着非常重要的作用,熟练的了解院前急救现场及转运途中的监护且及时有效的予以心理护理,明显的提高了院前抢救的成功率,为患者转入医院内进行下一步的治疗奠定了很好的基础。%Among pre-hospital emergency care, first aid should actively use thinking.The using of efficient methods of care.In pre-hospital emergency,crisis, emergency among critically ill patients plays a very important role.Proficient knowledge of the field of pre-hospital emergency care and transport on the way and give timely and effective psychological care.Significantly improved the success rate of pre-hospital rescue.For patients transferred to the hospital for the next treatment laid a good foundation.

  8. Explore the Pre-hospital Emergency Management style%探讨院前急救的管理方式

    Institute of Scientific and Technical Information of China (English)

    白素慧

    2014-01-01

    急诊医疗服务体系(EMS)有三个环节组成,有危重病救治、院内急诊和院前急救,院前急救是极其重要的缓解。医院应该把院前急救的地位提升起来,进而对一个地域的急救能力和工作水平评价。本文首先阐述了院前急救的意义,其次,分析了院前急救任务,同时,就院前急救的管理方法进行了深入的探讨,具有一定的参考价值。%Emergency medical services system (EMS) has three aspects of the composition,there are critical y il treatment,pre-hospital emergency and hospital care,pre-hospital care is extremely important relief. We should enhance the status of pre-hospital emergency together,and then work on the level of a first-aid skil s and geographical evaluation. This paper first describes the significance of pre-hospital first aid,fol owed by analysis of the pre-hospital emergency tasks,while,on the pre-hospital emergency management methods conducted in-depth discussion,with some reference value.

  9. Clinical study on renal trauma

    International Nuclear Information System (INIS)

    We analyzed 26 cases of renal trauma, which occurred during the last 7 years and 6 months. Computed tomography was performed in all cases. Four cases were of type Ib, 13 cases of type II, 3 cases of type IIIa, 5 cases of type IIIb and 1 case of type IVa, according to the classification of renal injury by the Japanese association for the surgery of trauma. Conservative treatment was done in 21 cases, selective transcatheter arterial embolization (TAE) in 4 cases, and surgical treatment in 1 case. Conservative treatment was effective for type I and II renal trauma. In the cases of type IIIa and IIIb renal trauma, open surgery could be avoided and the affected kidney preserved by early TAE. (author)

  10. Development and evaluation of a novel, real time mobile telesonography system in management of patients with abdominal trauma: study protocol

    Directory of Open Access Journals (Sweden)

    Ogedegbe Chinwe

    2012-12-01

    Full Text Available Abstract Background Despite the use of e-FAST in management of patients with abdominal trauma, its utility in prehospital setting is not widely adopted. The goal of this study is to develop a novel portable telesonography (TS system and evaluate the comparability of the quality of images obtained via this system among healthy volunteers who undergo e-FAST abdominal examination in a moving ambulance and at the ED. We hypothesize that: (1 real-time ultrasound images of acute trauma patients in the pre-hospital setting can be obtained and transmitted to the ED via the novel TS system; and (2 Ultrasound images transmitted to the hospital from the real-time TS system will be comparable in quality to those obtained in the ED. Methods Study participants are three healthy volunteers (one each with normal, overweight and obese BMI category. The ultrasound images will be obtained by two ultrasound-trained physicians The TS is a portable sonogram (by Sonosite interfaced with a portable broadcast unit (by Live-U. Two UTPs will conduct e-FAST examinations on healthy volunteers in moving ambulances and transmit the images via cellular network to the hospital server, where they are stored. Upon arrival in the ED, the same UTPs will obtain another set of images from the volunteers, which are then compared to those obtained in the moving ambulances by another set of blinded UTPs (evaluators using a validated image quality scale, the Questionnaire for User Interaction Satisfaction (QUIS. Discussion Findings from this study will provide needed data on the validity of the novel TS in transmitting live images from moving ambulances to images obtained in the ED thus providing opportunity to facilitate medical care of a patient located in a remote or austere setting.

  11. Processing Trauma: A Case Study

    OpenAIRE

    Hamilton, Jenny

    2013-01-01

    This dissertation is informed by a bio psychosocial model of trauma, synthesising elements of emotional processing, information processing, social cognitive, biochemical, evolutionary and psychosocial perspectives. It is an adaptive model of individuals striving to make sense of, narrate and come to terms with difficult events, as part of the organisms’ tendency towards growth. However, Person Centred theory has so far accounted for trauma through a defence model (Joseph, 2004). Warner (2005,...

  12. Imaging of cervicothoracic junction trauma

    OpenAIRE

    Kaewlai, Rathachai

    2013-01-01

    Sirote Wongwaisayawan,1 Ruedeekorn Suwannanon,2 Rathachai Kaewlai11Department of Radiology, Ramathibodi Hospital and Mahidol University, Bangkok, Thailand; 2Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, ThailandAbstract: Cervicothoracic junction trauma is an important cause of morbidity and mortality in trauma patients. Imaging has played an important role in identifying injuries and guiding appropriate, timely therapy. Computed tomography is currently a...

  13. Regional anesthesia for trauma patients

    OpenAIRE

    TONKOVIĆ, DINKO; NESEK ADAM, VIŠNJA; BARONICA, ROBERT; BANDIĆ PAVLOVIĆ, DANIJELA; DRVAR, ŽELJKO; Zah Bogović, Tajana

    2013-01-01

    Trauma patients demands special medical care. Pain is frequently undertreated in the early phase of trauma. Pain is a major symptom of surgical conditions and minimizing pain could lead to misdiagnoses and technical facilities are not appropriate for adequate pain treatment. Consequences of inappropriate pain treatment could aggravate stress response, increases oxygen demand and led to myocardial ischemia Analgesia with parenteral opioids is effective but carries a risk of respiratory depr...

  14. Radiographic evaluation of hepatic trauma

    International Nuclear Information System (INIS)

    The incidence of significant abdominal trauma continues to rise and accounts currently for approximately 10 percent of the annual 130,000 trauma-related deaths in the United States. Over 60 percent of patients are from 10 to 40 years of age, with a striking predominance of males. Children are mostly victims of blunt trauma, while some large reviews of liver trauma in adults show a prevalence of penetrating injuries. Injury to the liver is second only to the spleen in incidence of intraperitoneal injuries. Morbidity and mortality from hepatic trauma are related to the mechanism and extent of injury. Penetrating injuries generally have a lower mortality, about 5 percent, especially if they are due to stab wounds or low velocity gunshot wounds. Shotgun and high velocity gunshot wounds may cause massive fragmentation of the liver and are associated with proportionately greater mortality. The mortality from blunt trauma is from 15 to 45 percent in many large series. Death from isolated liver injury is uncommon, but is usually due to uncontrolled hemorrhage. Injury to other abdominal organs is associated in many cases, as are injuries to the head, chest, and limbs. The extraabdominal injuries are frequently more apparent clinically, but may mask potentially life-threatening abdominal visceral injuries

  15. Imaging of blunt chest trauma

    Energy Technology Data Exchange (ETDEWEB)

    Wicky, S.; Wintermark, M.; Schnyder, P.; Capasso, P.; Denys, A. [Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland). Dept. of Radiology

    2000-10-01

    In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. (orig.)

  16. Trauma of the midface

    Directory of Open Access Journals (Sweden)

    Kühnel, Thomas S.

    2015-12-01

    Full Text Available Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.

  17. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review.

    Directory of Open Access Journals (Sweden)

    Jon Gitz Holler

    Full Text Available Acute patients presenting with hypotension in the prehospital or emergency department (ED setting are in need of focused management and knowledge of the epidemiology characteristics might help the clinician. The aim of this review was to address prevalence, etiology and mortality of nontraumatic hypotension (SBP ≤ 90 mmHg with or without the presence of shock in the prehospital and ED setting.We performed a systematic literature search up to August 2013, using Medline, Embase, Cinahl, Dare and The Cochrane Library. The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines and The Cochrane Collaboration. No restrictions on language, publication date, or status were imposed. We used the Newcastle-Ottawa quality assessment scale (NOS-scale and the Strengthening the Reporting of Observational studies in Epidemiology (STROBE-statement to assess the quality.Six observational studies were considered eligible for analysis based on the evaluation of 11,880 identified papers. Prehospital prevalence of hypotension was 19.5/1000 emergency medicine service (EMS contacts, and the prevalence of hypotensive shock was 9.5-19/1000 EMS contacts with an inhospital mortality of shock between 33 to 52%. ED prevalence of hypotension was 4-13/1000 contacts with a mortality of 12%. Information on mortality, prevalence and etiology of shock in the ED was limited. A meta-analysis was not feasible due to substantial heterogeneity between studies.There is inadequate evidence to establish concise estimates of the characteristics of nontraumatic hypotension and shock in the ED or in the prehospital setting. The available studies suggest that 2% of EMS contacts present with nontraumatic hypotension while 1-2% present with shock. The inhospital mortality of prehospital shock is 33-52%. Prevalence of hypotension in the ED is 1% with an inhospital mortality of 12%. Prevalence

  18. Reprodaetion of an animal model of multiple intestinal injuries mimicking "lethal triad" caused by severe penetrating abdominal trauma

    Directory of Open Access Journals (Sweden)

    Peng-fei WANG

    2011-03-01

    Full Text Available Objective To reproduce an animal model of multi-intestinal injuries with "lethal triad" characterized by low body temperature,acidosis and coagulopathy.Methods Six female domestic outbred pigs were anesthetized,and the carotid artery and jugular vein were cannulated for monitoring the blood pressure and heart rate and for infusion of fluid.The animals were shot with a gun to create a severe penetrating abdominal trauma.Immediately after the shooting,50% of total blood volume(35ml/kg hemorrhage was drawn from the carotid artery in 20min.After a 40min shock period,4h of pre-hospital phase was mimicked by normal saline(NS resuscitation to maintain systolic blood pressure(SBP > 80mmHg or mean arterial pressure(MAP > 60mmHg.When SBP > 80mmHg or MAP > 60mmHg,no fluid infusion or additional bleeding was given.Hemodynamic parameters were recorded,and pathology of myocardium,lung,small intestine and liver was observed.Results There were multiple intestinal perforations(8-10 site injuries/pig leading to intra-abdominal contamination,mesenteric injury(1-2 site injuries/pig resulted in partial intestinal ischemia and intra-abdominal hemorrhage,and no large colon and mesenteric vascular injury.One pig died before the completion of the model establishment(at the end of pre-hospital resuscitation.The typical symptoms of trauma-induced hemorrhagic shock were observed in survival animals.Low temperature(33.3±0.5℃,acidosis(pH=7.242±0.064,and coagulopathy(protrombin time and activated partial thromboplasting time prolonged were observed after pre-hospital resuscitation.Pathology showed that myocardium,lung,small intestine and liver were severely injured.Conclusions A new model,simulating three stages of "traumatic hemorrhagic shock,pre-hospital recovery and hospital treatment" and inducing the "lethal triad" accompanied with abdominal pollution,has been successfully established.This model has good stability and high reproducibility.The survival animals can be

  19. Exploring trauma associated appraisals in trauma survivors from collectivistic cultures.

    Science.gov (United States)

    Engelbrecht, Alberta; Jobson, Laura

    2016-01-01

    Appraisals are a key feature in understanding an individual's experience; this is especially important when the experience is a traumatic one. However, research is diminutive when looking at the interaction between trauma appraisals and culture in relation to posttraumatic stress disorder using qualitative methodologies. This study explored cultural differences in perceptions and appraisals of trauma using three qualitative focus groups with community members (n = 11) from collectivistic cultures who had experienced a traumatic event and three qualitative individual key informant interviews with mental health practitioners (n = 3) routinely working with trauma survivors. Using template analysis, eight emergent themes were highlighted from the data sets [(1) trauma and adjustment; (2) cultural and social roles; (3) traumatised self; (4) relationships; (5) external attribution; (6) future; (7) education; (8) language] that potentially have significant consequences for posttrauma psychological adjustment and recovery. Cumulatively, while a number of themes are similar to that which is emphasised in current literature (e.g. damaged self, negative appraisals of the world, others, future) a number of themes were also resonant and warrant further scrutiny. For instance, the importance and interconnectedness of the group to the individual and the impact trauma has on this; the importance of social roles, cultural appropriateness and violations of cultural values and norms; findings and implications are discussed. PMID:27652138

  20. Trauma-Informed Care in the Massachusetts Child Trauma Project.

    Science.gov (United States)

    Bartlett, Jessica Dym; Barto, Beth; Griffin, Jessica L; Fraser, Jenifer Goldman; Hodgdon, Hilary; Bodian, Ruth

    2016-05-01

    Child maltreatment is a serious public health concern, and its detrimental effects can be compounded by traumatic experiences associated with the child welfare (CW) system. Trauma-informed care (TIC) is a promising strategy for addressing traumatized children's needs, but research on the impact of TIC in CW is limited. This study examines initial findings of the Massachusetts Child Trauma Project, a statewide TIC initiative in the CW system and mental health network. After 1 year of implementation, Trauma-Informed Leadership Teams in CW offices emerged as key structures for TIC systems integration, and mental health providers' participation in evidence-based treatment (EBT) learning collaboratives was linked to improvements in trauma-informed individual and agency practices. After approximately 6 months of EBT treatment, children had fewer posttraumatic symptoms and behavior problems compared to baseline. Barriers to TIC that emerged included scarce resources for trauma-related work in the CW agency and few mental providers providing EBTs to young children. Future research might explore variations in TIC across service system components as well as the potential for differential effects across EBT models disseminated through TIC. PMID:26564909

  1. Thanatos and massive psychic trauma: the impact of the death instinct on knowing, remembering, and forgetting.

    Science.gov (United States)

    Laub, Dori; Lee, Susanna

    2003-01-01

    The connection between massive psychic trauma and the concept of the death instinct is explored using the basic assumptions that the death instinct is unleashed through and is in a sense characteristic of traumatic experience, and that the concept of the death instinct is indispensable to the understanding and treatment of trauma. Characteristics of traumatic experience, such as dissolution of the empathic bond, failure to assimilate experience into psychic representation and structure, a tendency to repeat traumatic experience, and a resistance to remembering and knowing, are considered as trauma-induced death instinct derivatives. An initial focus is on the individual, on how death instinct manifestations can be discerned in the survivors of trauma. Next the intergenerational force of trauma is examined; a clinical vignette illustrates how the death instinct acts on and is passed on to the children of survivors. Finally, the cultural or societal aspects of trauma are considered, with an eye to how death instinct derivatives permeate cultural responses (or failures to respond) to trauma. Because trauma causes a profound destructuring and decathexis, it is concluded that the concept of the death instinct is a clinical and theoretical necessity. PMID:12866753

  2. Inflation Basics

    Energy Technology Data Exchange (ETDEWEB)

    Green, Dan [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States)

    2014-03-01

    inflation since metrical fluctuations, both scalar and tensor, are also produced in inflationary models. Thus, the time appears to be appropriate for a very basic and simple exposition of the inflationary model written from a particle physics perspective. Only the simplest scalar model will be explored because it is easy to understand and contains all the basic elements of the inflationary model.

  3. Prehospital and hospital delays after stroke onset--United States, 2005-2006.

    Science.gov (United States)

    2007-05-18

    Each year approximately 700,000 persons in the United States have a new or recurrent stroke; of these persons, 15%-30% become permanently disabled, and 20% require institutionalization during the first 3 months after the stroke. The severity of stroke-related disability can be reduced if timely and appropriate treatment is received. Patients with ischemic stroke may be eligible for treatment with intravenous thrombolytic (i.e., tissue plasminogen activator [t-PA]) therapy within 3 hours of symptom onset. Receipt of this treatment usually requires patients to recognize stroke symptoms and receive prompt transport to a hospital emergency department (ED), where timely evaluation and brain imaging (i.e., computed tomography or magnetic resonance imaging) can take place. For patients eligible for t-PA, evidence suggests that the earlier patients are treated after the onset of symptoms the greater the likelihood of a more favorable outcome. In 2001, Congress established the Paul Coverdell National Acute Stroke Registry to measure and track the quality of care provided to acute stroke patients. To assess prehospital delays from onset of stroke symptoms to ED arrival and hospital delays from ED arrival to receipt of brain imaging, CDC analyzed data from the four states participating in the national stroke registry. The results of that analysis indicated that fewer than half (48.0%) of stroke patients for whom onset data were available arrived at the ED within 2 hours of symptom onset, and prehospital delays were shorter for persons transported to the ED by ambulance (i.e., emergency medical services) than for persons who did not receive ambulance transport. The interval between ED arrival and brain imaging also was significantly reduced for those arriving by ambulance. More extensive public education is needed regarding early recognition of stroke and the urgency of telephoning 9-1-1 to receive ambulance transport. Shortening prehospital and hospital delays will increase

  4. Clinical Study on Ocular Trauma in Children

    Institute of Scientific and Technical Information of China (English)

    Zicai Huang; Hongni Li; Yixia Huang; Zhongxia Zhou

    2002-01-01

    Purpose: To investigate the clinical characteristics of ocular trauma in children and put forward the major treatment and prevention of ocular trauma in children.Methods: To analyze the clinical data by 77 eyes in 77 cases of ocular trauma in children from April 1999 to February 2002. Results: The male and female were in the ratio of 2.21: 1. Right eye ocular traumas were more than left ones. Ocular penetrating trauma was 83.12% and blunt trauma 12.99%. 41 cases (53.25%) were injured by themselves while 33 cases by others. 90.91% patients came from the countryside.Conclusion: The rate of blindness of children with ocular trauma could be reduced by prompt treatment. The study indicated that ocular trauma preventive publicity should be faced in the countryside in order to improve the understanding of the severity of ocular trauma and treat it as a social problem.

  5. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration

    OpenAIRE

    Lockey David; Fevang Espen; Thompson Julian; Lossius Hans

    2011-01-01

    Abstract Background Physician-manned emergency medical teams supplement other emergency medical services in some countries. These teams are often selectively deployed to patients who are considered likely to require critical care treatment in the pre-hospital phase. The evidence base for guidelines for pre-hospital triage and immediate medical care is often poor. We used a recognised consensus methodology to define key priority areas for research within the subfield of physician-provided pre-...

  6. Delta Alerts: Changing Outcomes in Geriatric Trauma.

    Science.gov (United States)

    Wiles, Lynn L; Day, Mark D; Harris, LeAnna

    2016-01-01

    Geriatric trauma patients (GTPs) suffering minor injuries have suboptimal outcomes compared with younger populations. Patients 65 years or older account for 10% of all traumas but 28% of all trauma deaths. This trauma center established a third tier trauma alert specifically targeting GTPs at risk for poor outcomes. A Delta Alert is activated when GTPs suffer injuries that fall outside traditional trauma alert guidelines. Early identification and treatment of injuries and expedited referral to specialty groups have improved our GTPs' outcomes including decreased mortality and length of stay and increased percentage of GTPs who are discharged home. PMID:27414140

  7. Analysis and strategies of pre-hospital emergency care for a community-based population in urban areas of Fuzhou city in 2010%福州市2010年中心城区社区人群的院前急救分析及策略

    Institute of Scientific and Technical Information of China (English)

    陈锋; 柯俊; 钱欣; 王晓萍; 陈敏; 陈兵; 何武兵; 林才经

    2013-01-01

    Objective To retrospectively analyze the epidemiological characteristics of pre-hospital emergency care for a community-based population in the urban areas of Fuzhou city and to propose strategies for improving pre-hospital emergency care and the prevention and treatment of common emergency conditions.Methods Data of different sorts of diseases,age,gender,monthly variation in number of cases,time required to response the emergency call and outcome of care were retrospectively analyzed in patients who received pre-hospital emergency care in the urban areas of Fuzhou city in 2010.Results A total of 2130 subjects had pre-hospital emergency care in the urban areas of Fuzhou city.Among them,trauma was the major cause,and was found mainly in youths and adults aged 31-40 years.Cardiovascular and cerebrovascular diseases were the second most common causes and were found mainly in patients aged >50 years (especially in those > 70) accounting for 50.57% in patients of that age cohort.More males than females received pre-hospital emergency care (1.57∶1).A total of 190 patients died during pre-hospital emergency care with trauma (n =69,36.32%),the leading cause of death.Cardiovascular and cerebrovascular diseases were the second leading cause of death and found mainly in patients aged > 50 (n =53) accounting for 81.54% of deaths in patients of this age cohort.Among patients with sudden death before admission,there was no one had cardiopulmonary resuscitation performed by witness before the emergency care given.Pre-hospital emergency care and pre-hospital deaths were more often occurred in the winter and spring seasons.The time required to response emergency call and the time elapsed to on-site emergency care were (10.0 ± 6.1) min and (11.8 ± 5.9) min,respectively,for patients receiving prehospital emergency care; and the time required to response the emergency call and the time elapsed to onsite emergency care were (11.2 ± 6.2) min and (29.0 ± 21.1) min

  8. Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and teatment of STEMI

    DEFF Research Database (Denmark)

    Rasmussen, Martin Bøhme; Frost, Lars; Stengaard, Carsten;

    2014-01-01

    diagnoses established by telemedicine confirmed on hospital arrival, and we determined system delay in patients diagnosed before hospital arrival and triaged directly to the catheterisation laboratory. Methods: Design: Population-based follow-up study. Setting: Central Denmark Region. Participants: 15 992...... patients diagnosed using telemedicine. Results: During the study period, a tentative diagnosis of STEMI was established in 1061 patients, of whom 919 were triaged directly to the PCI centre. In 771 (84%) patients, a diagnosis of STEMI was confirmed. Patients transported <10 km had a mean system delay of 82...... living <10 km from the PCI centre, only 16 (14%) had a system delay of 60 min or less. Conclusions: The use of telemedicine for prehospital diagnosis and triage of patients directly to the catheter laboratory is feasible and allows 89% of patients living up to 95 km from the invasive centre to be treated...

  9. Anaesthesiologists in prehospital care make a difference to certain groups of patients

    DEFF Research Database (Denmark)

    Christensen, Erika Frischknecht; Melchiorsen, Hanne; Kilsmark, J.;

    2003-01-01

    and (2) to evaluate the impact of one mobile emergency care unit (MECU) staffed by an anesthesiologist. DESIGN AND METHODS: A descriptive and quasi-experimental study of consecutive emergency ambulance users during two 3-month periods: before the MECU (Period 1) and after (Period 2). Hospitalization......, diagnostic and 0-180-day mortality data were requested from national registers. Diagnoses were according to the International Classification of Diseases (ICD). RESULTS: Periods 1 and 2 included 2950 and 2869 users, respectively. The MECU attended 27.7% in Period 2. Fewer users were brought to hospital......ACKGROUND: Knowledge of the population using prehospital emergency services is scarce except for selected subgroups. Interventions are often made without evaluation. The aim of this study was (1) to describe mortality, hospitalization and the diagnostic pattern among emergency ambulance users...

  10. Prehospital treatment of opioid overdose in Copenhagen--is it safe to discharge on-scene?

    DEFF Research Database (Denmark)

    Rudolph, S.S.; Jehu, G.; Nielsen, S.L.;

    2011-01-01

    INTRODUCTION: In the prehospital setting opioid overdose is often treated with naloxone. In our physician-based medical emergency care unit (MECU) we have adopted a discharge-on-scene policy, where patients are released on scene if no residual signs of opioid intoxication are found after treatment....... The aim of this study was to describe our experience with the discharge-on-scene policy used during a 10-year-period with focus on the frequency of rebound opioid toxicity. METHODS: Data were prospectively recorded in our MECU database and we reviewed all cases of opioid overdose between 1994 and 2003....... The MECU database was cross-referenced with the Central Personal Registry. For patients who died within 48 h of MECU contact we reviewed the forensic autopsy reports to establish whether rebound opioid toxicity was likely. RESULTS: We found 4762 cases of acute opioid overdose. In 3245 cases positive...

  11. Evaluation of intensified prehospital treatment in out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Frandsen, F; Nielsen, J R; Gram, L;

    1991-01-01

    with doctors collaborating (advanced EMS) were used, and 11 (13%) patients were discharged. The intermediate EMS system was used in another area with 45,000 inhabitants/population density of 340/km2, and in this area 20 (18%) patients were discharged. Among the survivors a psychological assessment in form...... of a test for dementia was assessed in long-term survivors (n = 30) together with 28 patients surviving acute myocardial infarction and 11 control persons. The results of the investigation demonstrate that the more intensive the prehospital treatment of out-of-hospital cardiac arrest, the more patients...... survive and the more patients survive with good cerebral function. However, the ambulances with specially trained paramedics were only effective in the area with 340 inhabitants/km2....

  12. Hospital and Pre-Hospital Triage Systems in Disaster and Normal Conditions; a Review Article

    Directory of Open Access Journals (Sweden)

    Saeed Safari

    2015-02-01

    Full Text Available Triage is a priority classification system based on the severity of problem to do the best therapeutic proceedings for patients in the less time. A triage system should be performed in a way which can make a decision with high accuracy and in the least time for each patient. Simplicity and reliability of the performance are the most important features of a standard triage system. An appropriate triage causes to increase the quality of health care services and patients’ satisfaction rate, decrease the waiting time as well as mortality rate, and increase the yield and efficiency of emergency wards along with reducing the related expenses. Considering to the above statements, in the present study the history of triage formation was evaluated and categorizing of all triage systems regarding prehospital and hospital as well as triage in normal and critical conditions were assessed, too.

  13. Outcomes of acute exacerbations in COPD in relation to pre-hospital oxygen therapy

    DEFF Research Database (Denmark)

    Ringbaek, Thomas J; Terkelsen, Jakob; Lange, Peter

    2015-01-01

    BACKGROUND: Pre-hospital, high-concentration oxygen therapy during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been associated with increased mortality. Recent COPD guidelines have encouraged titrated oxygen therapy with a target saturation range of 88-92%. Oxygen...... therapy leading to saturation above 92% is defined as 'inappropriate oxygen therapy'. OBJECTIVES: To examine the frequency of inappropriate oxygen therapy and whether inappropriate oxygen therapy in the ambulance in an urban area with short transit time to hospital was associated with poor outcome......, and in-hospital mortality. RESULTS: Only 15 patients were not treated with oxygen and information on oxygen flow was missing in seven patients and on saturation on one patient. Altogether, 352 (88.7%) of 397 patients received inappropriate oxygen therapy. Patients on 'inappropriate oxygen therapy...

  14. Pre-Hospital Fast Positive Cases Identified by DFB Ambulance Paramedics – Final Clinical Diagnosis

    LENUS (Irish Health Repository)

    Feeney, A

    2016-04-01

    Ischaemic stroke clinical outcomes are improved by earlier treatment with intravenous thrombolysis. An existing pathway at the Mater University Hospital for assessment of suspected acute stroke in the Emergency Department was updated, aiming to shorten ‘door to needle time’. This study examines the final clinical diagnosis of Dublin Fire Brigade Ambulance Paramedic identified Face Arm Speech Test (FAST) positive patients presenting to the Emergency Department over a 7 month period. A retrospective analysis was carried out of 177 consecutive FAST positive patients presenting between March and November 2014. The final clinical diagnosis was acute stroke in 57.1% (n=101) of patients. Of these, 76 were ischaemic strokes of whom 56.5% (n=43) were thrombolysed. In the pre-hospital setting Ambulance Paramedics can identify, with reasonable accuracy, acute stroke using the FAST test. Over half of the ischaemic stroke patients presenting via this pathway can be treated with intravenous thrombolysis

  15. Systolic blood pressure and short-term mortality in the emergency department and prehospital setting

    DEFF Research Database (Denmark)

    Kristensen, Anders Kasper Bruun; Holler, Jon Gitz; Mikkelsen, Søren;

    2015-01-01

    staffed mobile emergency care unit in Odense between 2007 and 2013. We used the first recorded systolic blood pressure and the main outcome was 7-day mortality. Best performing thresholds were identified with methods based on receiver operating characteristics (ROC) and multivariate regression......INTRODUCTION: Systolic blood pressure is a widely used tool to assess circulatory function in acutely ill patients. The systolic blood pressure limit where a given patient should be considered hypotensive is the subject of debate and recent studies have advocated higher systolic blood pressure...... thresholds than the traditional 90 mmHg. The aim of this study was to identify the best performing systolic blood pressure thresholds with regards to predicting 7-day mortality and to evaluate the applicability of these in the emergency department as well as in the prehospital setting. METHODS...

  16. Advance Directives and Communication Skills of Prehospital Physicians Involved in the Care of Cardiovascular Patients.

    Science.gov (United States)

    Gigon, Fabienne; Merlani, Paolo; Ricou, Bara

    2015-12-01

    Advance directives (AD) were developed to respect patient autonomy. However, very few patients have AD, even in cases when major cardiovascular surgery is to follow. To understand the reasons behind the low prevalence of AD and to help decision making when patients are incompetent, it is necessary to focus on the impact of prehospital practitioners, who may contribute to an increase in AD by discussing them with patients. The purpose of this study was to investigate self-rated communication skills and the attitudes of physicians potentially involved in the care of cardiovascular patients toward AD.Self-administered questionnaires were sent to general practitioners, cardiologists, internists, and intensivists, including the Quality of Communication Score, divided into a General Communication score (QOCgen 6 items) and an End-of-life Communication score (QOCeol 7 items), as well as questions regarding opinions and practices in terms of AD.One hundred sixty-four responses were received. QOCgen (mean (±SD)): 9.0/10 (1.0); QOCeol: 7.2/10 (1.7). General practitioners most frequently start discussions about AD (74/149 [47%]) and are more prone to designate their own specialty (30/49 [61%], P communication skills as good, whereas end-of-life communication was rated much lower. Only half of those surveyed speak about AD with cardiovascular patients. The majority would prefer that physicians of another specialty, most frequently general practitioners, initiate conversation about AD. In order to increase prehospital AD incidence, efforts must be centered on improving practitioners' communication skills regarding death, by providing trainings to allow physicians to feel more at ease when speaking about end-of-life issues.

  17. Prehospitalization Risk Factors for Acute Kidney Injury during Hospitalization for Serious Infections in the REGARDS Cohort

    Directory of Open Access Journals (Sweden)

    Henry E. Wang

    2015-11-01

    Full Text Available Background/Aims: Acute kidney injury (AKI frequently occurs in hospitalized patients. In this study, we determined prehospitalization characteristics associated with AKI in community-dwelling adults hospitalized for a serious infection. Methods: We used prospective data from 30,239 participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS study, a national cohort of community-dwelling adults ≥45 years old. We identified serious infection hospitalizations between 2003 and 2012. Using the Kidney Disease Improving Global Outcomes (KDIGO criteria, we defined AKI as an increase in serum creatinine (sCr ≥0.3 mg/dl from the first inpatient sCr measurement during the first 7 hospitalization days. We excluded individuals with a history of renal transplant or preexisting end-stage renal disease as well as individuals with Results: Over a median follow-up of 4.5 years (interquartile range 2.4-6.3, we included 2,074 serious infection hospitalizations among 1,543 individuals. AKI occurred in 296 of 2,074 hospitalizations (16.5%. On multivariable analysis, prehospitalization characteristics independently associated with AKI among individuals hospitalized for a serious infection included a history of diabetes [odds ratio (OR 1.38; 95% CI 1.02-1.89], increased cystatin C (OR 1.73 per SD; 95% CI 1.20-2.50, and increased albumin-to-creatinine ratio (OR 1.19 per SD; 95% CI 1.007-1.40. Sex, race, hypertension, myocardial infarction, estimated glomerular filtration rate, high-sensitivity C-reactive protein, and the use of nonsteroidal anti-inflammatory, statin, or antihypertensive medications were not associated with AKI. Conclusions: Community-dwelling adults with a history of diabetes or increased cystatin C or albumin-to-creatinine ratio are at increased risk for AKI after hospitalization for a serious infection. These findings may be used to identify individuals at high risk for AKI.

  18. Faculty of Prehospital Care, Royal College of Surgeons Edinburgh guidance for medical provision for wilderness medicine.

    Science.gov (United States)

    Mellor, Adrian; Dodds, Naomi; Joshi, Raj; Hall, John; Dhillon, Sundeep; Hollis, Sarah; Davis, Pete; Hillebrandt, David; Howard, Eva; Wilkes, Matthew; Langdana, Burjor; Lee, David; Hinson, Nigel; Williams, Thomas Harcourt; Rowles, Joe; Pynn, Harvey

    2015-01-01

    To support leaders and those involved in providing medical care on expeditions in wilderness environments, the Faculty of Pre-Hospital Care (FPHC) of The Royal College of Surgeons of Edinburgh convened an expert panel of leading healthcare professionals and expedition providers. The aims of this panel were to: (1) provide guidance to ensure the best possible medical care for patients within the geographical, logistical and human factor constraints of an expedition environment. (2) Give aspiring and established expedition medics a 'benchmark' of skills they should meet. (3) Facilitate expedition organisers in selecting the most appropriate medical cover and provider for their planned activity. A system of medical planning is suggested to enable expedition leaders to identify the potential medical risks and their mitigation. It was recognised that the scope of practice for wilderness medicine covers elements of primary healthcare, pre-hospital emergency medicine and preventative medicine. Some unique competencies were also identified. Further to this, the panel recommends the use of a matrix and advisory expedition medic competencies relating to the remoteness and medical threat of the expedition. This advice is aimed at all levels of expedition medic, leader and organiser who may be responsible for delivering or managing the delivery of remote medical care for participants. The expedition medic should be someone equipped with the appropriate medical competencies, scope of practice and capabilities in the expedition environment and need not necessarily be a qualified doctor. In addition to providing guidance regarding the clinical competencies required of the expedition medic, the document provides generic guidance and signposting to the more pertinent aspects of the role of expedition medic. PMID:26629337

  19. Profile of chest trauma in Zaria Nigeria: A prelminary report

    Directory of Open Access Journals (Sweden)

    S A Edaigbini

    2011-01-01

    Materials and Methods A prospective study of trauma patients admitted to Ahmadu Bello University Teaching Hospital through the Accident and Emergency units was commenced in January 2008.This preliminary report is for the period of 27months.The clinical history, physical examination and outcome of management recorded in a predesigned proforma, were analysed with SPSS 15 and the patients were followed up in the surgical outpatient department. Results A total of 4784 patients (3143 men and 1641 women were admitted during this period for trauma. There were a total of 628(13.13% deaths. Of the 42 consecutive patients identified with chest trauma35 (83.3% were males and 7(16.7% were females. The age range was from 5-75years and the mean age was 35.4years, while the most affected ages were in the range of 20 to 49years. Blunt injury constituted 71.4% and penetrating injury constituted 28.6%. Road traffic accident was responsible for 61.9%, stab injury 21.4%, falls 7.1%, gunshot injury 4.8%, impalement 2.4% and animal attack also 2.4%. The average time taken between accident and admission was 31hours,40minutes and 12seconds while the average duration of hospital stay was 16.10 days. The injury pattern included rib fracture(s (23.8%, hemopneumothorax (14.3%, hemothorax (7.1%, pneumothorax (4.8%, combinations of chest injuries (7.1%, chest laceration 7.1%, bruises 11.9%, lung contusion 4.8%, subcutaneous empyema 2.4%, flail chest 4.8% and no specific injury (11.9%. Associated injuries included head injury (63.6%, orthopaedic injury (27.3% and combinations (abdominal, head, orthopaedic (9.1%. The fatality of road traffic accident was 36.8%. No patient was attended to by paramedics at the scene of accident while 21.9% of the patients had pre-hospital resuscitation in peripheral clinics before admission. The transfusion requirement was 14.3%. One patient (2.4% required a median sternotomy and cardiopulmonary bypass, 54.8% required tube thoracostomy while 42.9% had general

  20. Treatment strategy for hepatic trauma

    Institute of Scientific and Technical Information of China (English)

    Wu-Yong Yu; Qu-Jin Li; Jian-Ping Gong

    2016-01-01

    Liver is one of the organs with the highest injury rate,and in recent decades,the guidelines for the treatment of liver trauma have changed considerably.Now,there is a growing consensus that the most important step is diagnosis and depending upon the degree of severity,non-operative therapy is the main treatment method for hepatic trauma if conditions permit.For serious hepatic trauma patients such as those with hemodynamic instability,they should be operated upon as soon as possible.Regardless of the surgical options,doctors should control damage to patients and try to prevent complications.New therapies such as hepatic artery embolization and liver transplantation have been more and more used for the treatment of serious hepatic damage in clinics.

  1. Ventilatory strategies in trauma patients.

    Science.gov (United States)

    Arora, Shubhangi; Singh, Preet Mohinder; Trikha, Anjan

    2014-01-01

    Lung injury in trauma patients can occur because of direct injury to lung or due to secondary effects of injury elsewhere for example fat embolism from a long bone fracture, or due to response to a systemic insult such as; acute respiratory distress syndrome (ARDS) secondary to sepsis or transfusion related lung injury. There are certain special situations like head injury where the primary culprit is not the lung, but the brain and the ventilator strategy is aimed at preserving the brain tissue and the respiratory system takes a second place. The present article aims to delineate the strategies addressing practical problems and challenges faced by intensivists dealing with trauma patients with or without healthy lungs. The lung protective strategies along with newer trends in ventilation are discussed. Ventilatory management for specific organ system trauma are highlighted and their physiological base is presented. PMID:24550626

  2. Management of Acute Skin Trauma

    Institute of Scientific and Technical Information of China (English)

    Joel W. Beam

    2010-01-01

    @@ Acute skin trauma (ie, abrasions, avulsions, blisters, incisions, lacerations, and punctures) is common among individuals involved in work, recreational, and athletic activities. Appropriate management of these wounds is important to promote healing and lessen the risk of cross-contamination and infection. Wound management techniques have undergone significant changes in the past 40 years but many clinicians continue to manage acute skin trauma with long-established, traditional techniques (ie, use of hydrogen peroxide, adhesive strips/patches, sterile gauze, or no dressing) that can delay healing and increase the risk of infection. The purpose of this review is to discuss evidence-based cleansing, debridement, and dressing techniques for the management of acute skin trauma.

  3. Ventilatory strategies in trauma patients

    Directory of Open Access Journals (Sweden)

    Shubhangi Arora

    2014-01-01

    Full Text Available Lung injury in trauma patients can occur because of direct injury to lung or due to secondary effects of injury elsewhere for example fat embolism from a long bone fracture, or due to response to a systemic insult such as; acute respiratory distress syndrome (ARDS secondary to sepsis or transfusion related lung injury. There are certain special situations like head injury where the primary culprit is not the lung, but the brain and the ventilator strategy is aimed at preserving the brain tissue and the respiratory system takes a second place. The present article aims to delineate the strategies addressing practical problems and challenges faced by intensivists dealing with trauma patients with or without healthy lungs. The lung protective strategies along with newer trends in ventilation are discussed. Ventilatory management for specific organ system trauma are highlighted and their physiological base is presented.

  4. Vascular Injury in Orthopedic Trauma.

    Science.gov (United States)

    Mavrogenis, Andreas F; Panagopoulos, George N; Kokkalis, Zinon T; Koulouvaris, Panayiotis; Megaloikonomos, Panayiotis D; Igoumenou, Vasilios; Mantas, George; Moulakakis, Konstantinos G; Sfyroeras, George S; Lazaris, Andreas; Soucacos, Panayotis N

    2016-07-01

    Vascular injury in orthopedic trauma is challenging. The risk to life and limb can be high, and clinical signs initially can be subtle. Recognition and management should be a critical skill for every orthopedic surgeon. There are 5 types of vascular injury: intimal injury (flaps, disruptions, or subintimal/intramural hematomas), complete wall defects with pseudoaneurysms or hemorrhage, complete transections with hemorrhage or occlusion, arteriovenous fistulas, and spasm. Intimal defects and subintimal hematomas with possible secondary occlusion are most commonly associated with blunt trauma, whereas wall defects, complete transections, and arteriovenous fistulas usually occur with penetrating trauma. Spasm can occur after either blunt or penetrating trauma to an extremity and is more common in young patients. Clinical presentation of vascular injury may not be straightforward. Physical examination can be misleading or initially unimpressive; a normal pulse examination may be present in 5% to 15% of patients with vascular injury. Detection and treatment of vascular injuries should take place within the context of the overall resuscitation of the patient according to the established principles of the Advanced Trauma Life Support (ATLS) protocols. Advances in the field, made mostly during times of war, have made limb salvage the rule rather than the exception. Teamwork, familiarity with the often subtle signs of vascular injuries, a high index of suspicion, effective communication, appropriate use of imaging modalities, sound knowledge of relevant technique, and sequence of surgical repairs are among the essential factors that will lead to a successful outcome. This article provides a comprehensive literature review on a subject that generates significant controversy and confusion among clinicians involved in the care of trauma patients. [Orthopedics. 2016; 39(4):249-259.]. PMID:27322172

  5. A prehospital use of ITClamp for haemostatic control and fixation of a chest tube

    DEFF Research Database (Denmark)

    Barnung, S; Steinmetz, J

    2014-01-01

    We here present three cases in which a new device, the ITClamp Hemorrhage Control System (Innovative Trauma Care, Inc., Edmonton, Canada), was used for bleeding control and for securing a chest tube....

  6. Complicaciones en el trauma raquimedular

    OpenAIRE

    López, M

    2013-01-01

    El trauma raquimedular es un enfermedad que afecta principalmente a adultos jóvenes y suele resultar en muerte o discapacidad con sus complicaciones implícitas. Las personas con trauma raquimedular presentan complicaciones multisistemicas según el tipo y nivel de lesión, además, su aparición depende del manejo médico y terapéutico temprano. Entre las complicaciones más comunes se encuentran las respiratorias, cardiovasculares (hipotensión ortostatica, disrreflexia autonómica y trombosis venos...

  7. [Polyvagal theory and emotional trauma].

    Science.gov (United States)

    Leikola, Anssi; Mäkelä, Jukka; Punkanen, Marko

    2016-01-01

    According to the polyvagal theory, the autonomic nervous system can, in deviation from the conventional theory, be divided in three distinct parts that are in hierarchical relationship with each other. The most-primitive autonomic control results in depression of vital functions, the more evolved one in fighting or escape and the most evolved one in social involvement. Practical application of the polyvagal theory has resulted in positive results above all in the treatment of emotional trauma. in Finland, therapy of complex trauma is founded on the theory of structural dissociation of the personality, which together with the polyvagal theory forms a practical frame of reference for psychotherapeutic work. PMID:27044181

  8. Component separation in abdominal trauma.

    Science.gov (United States)

    Rawstorne, Edward; Smart, Christopher J; Fallis, Simon A; Suggett, Nigel

    2014-01-01

    Component separation is established for complex hernia repairs. This case presents early component separation and release of the anterior and posterior sheath to facilitate closure of the abdominal wall following emergency laparotomy, reinforcing the repair with a biological mesh. On Day 11 following an emergency laparotomy for penetrating trauma, this patient underwent component separation and release of the anterior and posterior sheath. An intra-abdominal biological mesh was secured, and the fascia and skin closed successfully. Primary abdominal closure can be achieved in patients with penetrating abdominal trauma with the use of component separation and insertion of intra-abdominal biological mesh, where standard closure is not possible. PMID:24876334

  9. Accuracy of continuous noninvasive hemoglobin monitoring for the prediction of blood transfusions in trauma patients.

    Science.gov (United States)

    Galvagno, Samuel M; Hu, Peter; Yang, Shiming; Gao, Cheng; Hanna, David; Shackelford, Stacy; Mackenzie, Colin

    2015-12-01

    Early detection of hemorrhagic shock is required to facilitate prompt coordination of blood component therapy delivery to the bedside and to expedite performance of lifesaving interventions. Standard physical findings and vital signs are difficult to measure during the acute resuscitation stage, and these measures are often inaccurate until patients deteriorate to a state of decompensated shock. The aim of this study is to examine a severely injured trauma patient population to determine whether a noninvasive SpHb monitor can predict the need for urgent blood transfusion (universal donor or additional urgent blood transfusion) during the first 12 h of trauma patient resuscitation. We hypothesize that trends in continuous SpHb, combined with easily derived patient-specific factors, can identify the immediate need for transfusion in trauma patients. Subjects were enrolled if directly admitted to the trauma center, >17 years of age, and with a shock index (heart rate/systolic blood pressure) >0.62. Upon admission, a Masimo Radical-7 co-oximeter sensor (Masimo Corporation, Irvine, CA) was applied, providing measurement of continuous non-invasive hemoglobin (SpHb) levels. Blood was drawn and hemoglobin concentration analyzed and conventional pulse oximetry photopletysmograph signals were continuously recorded. Demographic information and both prehospital and admission vital signs were collected. The primary outcome was transfusion of at least one unit of packed red blood cells within 24 h of admission. Eight regression models (C1-C8) were evaluated for the prediction of blood use by comparing area under receiver operating curve (AUROC) at different time intervals after admission. 711 subjects had continuous vital signs waveforms available, to include heart rate (HR), SpHb and SpO2 trends. When SpHb was monitored for 15 min, SpHb did not increase AUROC for prediction of transfusion. The highest ROC was recorded for model C8 (age, sex, prehospital shock index, admission

  10. Rural Emergency Medical Services (EMS) and Trauma

    Science.gov (United States)

    ... View more Rural Emergency Medical Services (EMS) and Trauma Emergency medical services (EMS) providers care for individuals ... hospital be part of the regional and statewide trauma system? Yes. According to Safety in Numbers: Are ...

  11. Abusive Head Trauma (Shaken Baby Syndrome)

    Science.gov (United States)

    ... Things to Know About Zika & Pregnancy Abusive Head Trauma (Shaken Baby Syndrome) KidsHealth > For Parents > Abusive Head ... babies tend to cry the most. How These Injuries Happen Abusive head trauma results from injuries caused ...

  12. Cultural Trauma and Life Stories / Ene Kõresaar

    Index Scriptorium Estoniae

    Kõresaar, Ene

    2007-01-01

    Aili Aarelaid-Tarti 15-aastase uuringu tulemused raamatus "Cultural Trauma and Life Stories", Hesinki, Kikimora Publications, 2006. Uuritud on kolme suurt rahvusgruppi 1940-test tingitud trauma kontekstis: eestlased kodumaal, eestlased eksiilis ja venekeelne rahvusgrupp Eestis postsovetlikus diskursuses

  13. Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

    NARCIS (Netherlands)

    Mauritz, M.W.; Goossens, P.J.J.; Draijer, N.; Achterberg, T. van

    2013-01-01

    BACKGROUND: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. OBJECTIVE: To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. METHODS: We con

  14. Witnessing Trauma:A Reading of A Pale of Hills Based on Trauma Theory

    Institute of Scientific and Technical Information of China (English)

    王肖

    2016-01-01

    This thesis tries to interpret A Pale View of Hills based on trauma theory, and to have a detailed analysis from the aspects of trauma experience and memory and recovery from trauma in order to illustrate the connotations behind trauma and how to get healed and regain new hope for the future.

  15. External Validation of the Emergency Trauma Score for Early Prediction of Mortality in Trauma Patients

    NARCIS (Netherlands)

    Joosse, Pieter; de Jong, Willem-Jan J.; Wendt, Klaus W.; Schep, Niels W.; Goslings, J. Carel; Reitsma, J.

    2014-01-01

    Objectives: The Emergency Trauma Score has been developed for early estimation of mortality risk in adult trauma patients with an Injury Severity Score of 16 or higher. Emergency Trauma Score combines four early predictors available at the trauma resuscitation room: age, Glasgow Coma Scale, base exc

  16. Negotiated knowledge positions : communication in trauma teams

    OpenAIRE

    Härgestam, Maria

    2015-01-01

    Background Within trauma teams, effective communication is necessary to ensure safe and secure care of the patient. Deficiencies in communication are one of the most important factors leading to patient harm. Time is an essential factor for rapid and efficient disposal of trauma teams to increase patients’ survival and prevent morbidity. Trauma team training plays an important role in improving the team’s performance, while the leader of the trauma team faces the challenge of coordinating and...

  17. The role of interventional radiology in trauma

    Institute of Scientific and Technical Information of China (English)

    Douglas M. Coldwell

    2007-01-01

    @@ Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient. In all hospitals, regardless of size, the Interventional Radiologist must consider their relationships with the trauma service in order to quickly and efficiently render aid to the trauma victim. Such consideration should take place in the light of day as it seems that most trauma occurs in the middle of the night or another inconvenient time. The watchwords of trauma IR are speed and efficiency.

  18. Hypoadrenalism Following Trauma: Is Sepsis Always Necessary?

    OpenAIRE

    Paquette, Ian M; Burchard, Kenneth W.

    2008-01-01

    Purpose of the Study: Trauma patients can exhibit the systemic inflammatory response syndrome (SIRS) without evidence of infection. SIRS from infection has been associated with hypoadrenalism. We hypothesized that hypoadrenalism can accompany SIRS from trauma without infection. To investigate this further, we performed a retrospective study of trauma patients admitted to the ICU at our rural academic level 1 trauma center from October 2003- June 2005, with measurement of blood cortisol in the...

  19. Establishing a successful pre-hospital emergency service in a developing country: experience from Rescue 1122 service in Pakistan.

    Science.gov (United States)

    Waseem, Hunniya; Naseer, Rizwan; Razzak, Junaid Abdul

    2011-06-01

    As in many other developing countries, emergency medical services, especially pre-hospital emergency care, has long been neglected in Pakistan. Consequently, patients are brought to the emergency departments by relatives or bystanders in private cars, taxis or any other readily available mode of transportation. Ambulances, where they exist, have barely a stretcher and arrangements for oxygen supply. Modern emergency services are considered too costly for many countries. A model of pre-hospital emergency services, called Rescue 1122 and established in Punjab province of Pakistan, is presented. The system is supported by government funding and provides a quality service. The article describes the process of establishment of the service, the organisational structure, the scope of services and the role it is currently playing in the healthcare of the region it serves.

  20. Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using ice-cold Ringer's solution: a pilot study.

    Science.gov (United States)

    Virkkunen, Ilkka; Yli-Hankala, Arvi; Silfvast, Tom

    2004-09-01

    The cooling and haemodynamic effects of prehospital infusion of ice-cold Ringer's solution were studied in 13 adult patients after successful resuscitation from non-traumatic cardiac arrest. After haemodynamics stabilisation, 30 ml/kg of Ringer's solution was infused at a rate of 100ml/min into the antecubital vein. Arterial blood pressure and blood gases, pulse rate, end-tidal CO(2) and oesophageal temperature were monitored closely. The mean core temperature decreased from 35.8 +/- 0.9 degrees C at the start of infusion to 34.0 +/- 1.2 degrees C on arrival at hospital (P < 0.0001). No serious adverse haemodynamic effects occurred. It is concluded that the induction of therapeutic hypothermia using this technique in the prehospital setting is feasible. PMID:15325449

  1. Discussion on Prehospital Care Fees Regime%院前急救收费机制的探讨

    Institute of Scientific and Technical Information of China (English)

    郑小坚; 田建广; 张燕

    2016-01-01

    院前急救作为重要的公共服务的组成部分,其发展的程度和质量直接影响着广大公民的身心健康,需要全社会资源的有效注入。合理的收费机制,可以为院前急救的发展提供有效的资金保障,促进院前急救质量的不断改善。但在目前的条件下,院前急救的收费标准偏低,收费机制不健全,极大地制约着院前急救事业的健康发展,亟需通过收费机制的调整来予以改变。面对上海市院前急救体系的收费机制不健全的现状,应该在大方向上,坚持体现资源投入和劳务付出的对等性,在具体的计算方式上,体现多元化收费标准、动态的成本核算,以有效的核算模型进行精准的设计。只有坚持在收费机制上的现代化科学改革,才能更好地提升院前急救运营的效能,从而为社会提供更优质的院前急救服务。%Prehospital care as an important part of public service, and quality of their development directly affects the health of the majority of citizens, the whole society resource efficient injection. Reasonable charging mechanism that can provide effective financial security for the development of pre-hospital care, and promote the continuous improvement of the quality of pre-hospital care. But in the current conditions, pre-hospital care fees low, charging mechanism is not perfect, greatly restricting the healthy development of the cause of pre-hospital care, need to be changed by adjusting the fees regime. Faced with the charging mechanism in Shanghai pre-hospital emergency system is not perfect situation, should be in the general direction, adhere to reflect the investment of resources and services to pay reciprocity, in particular on the manner of calculating the fees reflect the diverse, dynamic and cost accounting, an effective accounting model for accurate design. Only insist on charging mechanism modern science reform, in order to better enhance the

  2. Ambulanssjuksköterskors upplevelser av smärtlindring av barn i en prehospital kontext - en kvalitativ intervjustudie

    OpenAIRE

    Ekstrand, Magnus; Hed, Kristina

    2014-01-01

    Syftet med denna studie är att studera ambulanssjuksköterskors upplevelser av att bedöma och vårda barn under tio års ålder med akut smärta i en prehospital kontext.   Metod: Studien utfördes som en kvalitativ empirisk intervjustudie baserad på fem öppna frågor. Tio ambulanssjuksköterskor intervjuades och fick beskriva positiva och negativa upplevelser av att omhänderta barn 0-10 år med akut smärta i prehospital kontext. Materialet analyserades genom en kvalitativ innehållsanalys med en manif...

  3. Decolonizing Trauma Theory : Retrospect and Prospects

    NARCIS (Netherlands)

    Visser, Irene

    2015-01-01

    Decolonizing trauma theory has been a major project in postcolonial literary scholarship ever since its first sustained engagements with trauma theory. Since then, trauma theory and postcolonial literary studies have been uneasy bedfellows, and the time has now come to take stock of what remains in

  4. Helpers in Distress: Preventing Secondary Trauma

    Science.gov (United States)

    Whitfield, Natasha; Kanter, Deborah

    2014-01-01

    Those in close contact with trauma survivors are themselves at risk for trauma (e.g., Bride, 2007; Figley, 1995). Family, friends, and professionals who bear witness to the emotional retelling and re-enacting of traumatic events can experience what is called "secondary trauma" (Elwood, Mott, Lohr, & Galovski, 2011). The literature…

  5. Addressing Trauma in Substance Abuse Treatment

    Science.gov (United States)

    Giordano, Amanda L.; Prosek, Elizabeth A.; Stamman, Julia; Callahan, Molly M.; Loseu, Sahar; Bevly, Cynthia M.; Cross, Kaitlin; Woehler, Elliott S.; Calzada, Richard-Michael R.; Chadwell, Katie

    2016-01-01

    Trauma is prevalent among clients with substance abuse issues, yet addictions counselors' training in trauma approaches is limited. The purpose of the current article is to provide pertinent information regarding trauma treatment including the use of assessments, empirically supported clinical approaches, self-help groups and the risk of vicarious…

  6. A consensus-based template for uniform reporting of data from pre-hospital advanced airway management

    Directory of Open Access Journals (Sweden)

    Lockey David

    2009-11-01

    Full Text Available Abstract Background Advanced airway management is a critical intervention that can harm the patient if performed poorly. The available literature on this subject is rich, but it is difficult to interpret due to a huge variability and poor definitions. Several initiatives from large organisations concerned with airway management have recently propagated the need for guidelines and standards in pre-hospital airway management. Following the path of other initiatives to establish templates for uniform data reporting, like the many Utstein-style templates, we initiated and carried out a structured consensus process with international experts to establish a set of core data points to be documented and reported in cases of advanced pre-hospital airway management. Methods A four-step modified nominal group technique process was employed. Results The inclusion criterion for the template was defined as any patient for whom the insertion of an advanced airway device or ventilation was attempted. The data points were divided into three groups based on their relationship to the intervention, including system-, patient-, and post-intervention variables, and the expert group agreed on a total of 23 core data points. Additionally, the group defined 19 optional variables for which a consensus could not be achieved or the data were considered as valuable but not essential. Conclusion We successfully developed an Utstein-style template for documenting and reporting pre-hospital airway management. The core dataset for this template should be included in future studies on pre-hospital airway management to produce comparable data across systems and patient populations and will be implemented in systems that are influenced by the expert panel.

  7. Trends of pre-hospital emergency medical services activity over 10 years: a population-based registry analysis

    OpenAIRE

    Pittet V.; Burnand B.; Yersin B.; Carron P.N.

    2014-01-01

    BACKGROUND: The number of requests to pre-hospital emergency medical services (PEMS) has increased in Europe over the last 20 years, but epidemiology of PEMS interventions has little be investigated. The aim of this analysis was to describe time trends of PEMS activity in a region of western Switzerland. METHODS: Use of data routinely and prospectively collected for PEMS intervention in the Canton of Vaud, Switzerland, from 2001 to 2010. This Swiss Canton comprises approximately 10% of the wh...

  8. Triage and mortality in 2875 consecutive trauma patients

    DEFF Research Database (Denmark)

    Meisler, Rikke; Thomsen, A B; Abildstrøm, H;

    2010-01-01

    Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage.......Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage....

  9. MDCT in blunt intestinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Romano, Stefania [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy)]. E-mail: stefromano@libero.it; Scaglione, Mariano [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Tortora, Giovanni [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Martino, Antonio [Trauma Center, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Di Pietto, Francesco [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Romano, Luigia [Department of Diagnostic Imaging, ' A.Cardarelli' Hospital, 80131 Naples (Italy); Grassi, Roberto [Department ' Magrassi-Lanzara' , Section of Radiology, Second University of Naples, 80138 Naples (Italy)

    2006-09-15

    Injuries to the small and large intestine from blunt trauma represent a defined clinical entity, often not easy to correctly diagnose in emergency but extremely important for the therapeutic assessment of patients. This article summarizes the MDCT spectrum of findings in intestinal blunt lesions, from functional disorders to hemorrhage and perforation.

  10. Medicating Relational Trauma in Youth

    Science.gov (United States)

    Foltz, Robert

    2008-01-01

    Children who have experienced relational trauma present a host of problems and are often diagnosed with psychiatric disorders and then medicated. But there is evidence that commonly used drugs interfere with oxytocin or vasopressin, the human trust and bonding hormones. Thus, psychotropic drugs may impair interpersonal relationships and impede…

  11. Liver trauma: WSES position paper

    OpenAIRE

    Coccolini, Federico; Montori, Giulia; Catena, Fausto; Di Saverio, Salomone; Biffl, Walter; Moore, Ernest E; Peitzman, Andrew B; Rizoli, Sandro; Tugnoli, Gregorio; Sartelli, Massimo; Manfredi, Roberto; Ansaloni, Luca

    2015-01-01

    The liver is the most injured organ in abdominal trauma. Road traffic crashes and antisocial, violent behavior account for the majority of liver injuries. The present position paper represents the position of the World Society of Emergency Surgery (WSES) about the management of liver injuries.

  12. Transforming Cultural Trauma into Resilience

    Science.gov (United States)

    Brokenleg, Martin

    2012-01-01

    One of the biggest challenges facing Aboriginal populations increasingly is being called "intergenerational trauma." Restoring the cultural heritage is a central theme in the book, "Reclaiming Youth at Risk." That work describes the Circle of Courage model for positive development which blends Native child and youth care philosophy with research…

  13. The Trauma-Sensitive Teacher

    Science.gov (United States)

    Craig, Susan E.

    2016-01-01

    According to the National Center for Mental Health Promotion and Youth Violence Prevention, about one quarter of children in the United States will witness or experience a traumatic event before the age of four. In this article, Susan E. Craig explains how these early trauma histories prime a child's brain to expect certain experiences,…

  14. Epidemiology of acute wrist trauma

    DEFF Research Database (Denmark)

    Larsen, C F; Lauritsen, Jens

    1993-01-01

    Epidemiological data on wrist injuries in a population can be used for planning by applying them to criteria for care and thus deriving estimates of provisions for care according to currently desirable standards. In a 1-year study all patients > or = 15 years with acute wrist trauma and treated i...

  15. Blunt Head Trauma and Headache

    Directory of Open Access Journals (Sweden)

    Ana B Chelse

    2015-04-01

    Full Text Available Investigators from New York Presbyterian Morgan Stanley Children’s Hospital examined whether having an isolated headache following minor blunt head trauma was suggestive of traumatic brain injury (TBI among a large cohort of children 2-18 years of age.

  16. Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need

    Directory of Open Access Journals (Sweden)

    Faul, Mark

    2014-11-01

    Full Text Available Introduction: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care.   Methods: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443. The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need” as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need.     Results: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need.  Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the

  17. Science In Trauma

    CERN Document Server

    Chauhan, B C

    2002-01-01

    Quantum theory has been proved as an outstanding {\\it mystery} in modern science. The predictions of science have turned out to be {\\it probabilistic}. The principle of determinism has {\\it failed}. For systems like weather, earthquakes, rolling dices etc... and of course human behaviour it has proved {\\it impossible}, for science, to describe a state of the system accurately for a long time into the future. Moreover, modern cosmology has to rely on {\\it philosophical} assumptions. In the present work, it is argued --by taking into account of the views of learned scientists and philosophers-- that modern science can never explain everything and it is totally impossible to discover the {\\it ``Theory Of Everything''}. All these facts and results put a big question-mark (?) on the grass-root level working of science. All scientific researches are based upon ordinary sense perception, which keeps the outer physical universe as a separate entity, that is something quite independent of the observer. Basically, it i...

  18. The National Trauma Research Repository: Ushering in a New ERA of trauma research (Commentary).

    Science.gov (United States)

    Smith, Sharon L; Price, Michelle A; Fabian, Timothy C; Jurkovich, Gregory J; Pruitt, Basil A; Stewart, Ronald M; Jenkins, Donald H

    2016-09-01

    Despite being the leading cause of death in the United States for individuals 46 years and younger and the primary cause of death among military service members, trauma care research has been underfunded for the last 50 years. Sustained federal funding for a coordinated national trauma clinical research program is required to advance the science of caring for the injured. The Department of Defense is committed to funding studies with military relevance; therefore, it cannot fund pediatric or geriatric trauma clinical trials. Currently, trauma clinical trials are often performed within a single site or a small group of trauma hospitals, and research data are not available for secondary analysis or sharing across studies. Data-sharing platforms encourage transfer of research data and knowledge between civilian and military researchers, reduce redundancy, and maximize limited research funding. In collaboration with the Department of Defense, trauma researchers formed the Coalition for National Trauma Research (CNTR) in 2014 to advance trauma research in a coordinated effort. CNTR's member organizations are the American Association for the Surgery of Trauma (AAST), the American College of Surgeons Committee on Trauma (ACS COT), the Eastern Association for the Surgery of Trauma (EAST), the Western Trauma Association (WTA), and the National Trauma Institute (NTI). CNTR advocates for sustained federal funding for a multidisciplinary national trauma research program to be conducted through a large clinical trials network and a national trauma research repository. The initial advocacy and research activities underway to accomplish these goals are presented. PMID:27496599

  19. Nonpathologizing trauma interventions in abnormal psychology courses.

    Science.gov (United States)

    Hoover, Stephanie M; Luchner, Andrew F; Pickett, Rachel F

    2016-01-01

    Because abnormal psychology courses presuppose a focus on pathological human functioning, nonpathologizing interventions within these classes are particularly powerful and can reach survivors, bystanders, and perpetrators. Interventions are needed to improve the social response to trauma on college campuses. By applying psychodynamic and feminist multicultural theory, instructors can deliver nonpathologizing interventions about trauma and trauma response within these classes. We recommend class-based interventions with the following aims: (a) intentionally using nonpathologizing language, (b) normalizing trauma responses, (c) subjectively defining trauma, (d) challenging secondary victimization, and (e) questioning the delineation of abnormal and normal. The recommendations promote implications for instructor self-reflection, therapy interventions, and future research.

  20. Effects of a recombinant FVIIa analogue, NN1731, on blood loss and survival after liver trauma in the pig

    DEFF Research Database (Denmark)

    Zaar, M; Secher, N H; Johansson, P I;

    2009-01-01

    BACKGROUND: We considered whether haemorrhage after a liver trauma would be reduced by early administration of a pro-haemostatic agent and evaluated the effect of i.v. vs i.m. administration of the coagulation factor VIIa analogue NN1731 on haemorrhage after a liver trauma in the pig. METHODS......: The pharmacokinetics of i.v. and i.m. NN1731 was evaluated in eight minipigs, and the effects of dose and administration route of NN1731 (i.v. 180 microg kg(-1), n=6; i.m. 540 microg kg(-1), n=4, or 2000 microg kg(-1), n=6) vs vehicle (n=16) were studied on a liver laceration injury in pigs. To simulate a pre......-hospital setting, the administration of NN1731 was delayed by 1 min for i.m. administration and 7 min for i.v. administration, at which time fluid resuscitation also began. RESULTS: In the minipigs, NN1731 exposure was similar after i.v. 180 microg kg(-1) and i.m. 540 microg kg(-1), with a bioavailability...

  1. History of the Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg

    2012-01-01

    The history of the Dental Trauma Guide dates back to 1965, where guidelines were developed for trauma records and treatment of various trauma entities at the Department of Oral and Maxillofacial Surgery at the University Hospital in Copenhagen. In 1972, a unique possibility came up at the Serum...... Institute in Copenhagen to test various dental trauma procedures in monkeys, which served as kidney donors in the polio vaccine production. Over the years, 40 000 dental trauma patients were treated at the Trauma Centre according to established guidelines, and 4000 of these have been enrolled in long......-term follow-up of various trauma entities. This has resulted in 79 clinical studies, and 64 studies in monkeys have examined the effect of various treatment procedures and the aetiology of most healing complications....

  2. Hemostasis and thrombosis in trauma patients.

    Science.gov (United States)

    Gando, Satoshi

    2015-02-01

    Hemostasis and thrombosis in trauma patients consist of physiological hemostasis for wound healing and the pathological reaction of disseminated intravascular coagulation (DIC). Whole body trauma, isolated brain injury, and fat embolism syndrome, if extremely severe, can cause DIC and affect a patient's prognosis. Shock-induced hyperfibrinolysis causes DIC with the fibrinolytic phenotype, contributing to oozing-type severe bleeding. If uncontrolled, this phenotype progresses to thrombotic phenotype at the late stage of trauma, followed by microvascular thrombosis, leading to organ dysfunction. Another type of pathological hemostatic change is acute coagulopathy of trauma shock (ACOTS), which gives rise to activated protein C-mediated systemic hypocoagulation, resulting in bleeding. ACOTS occurs only in trauma associated with shock-induced hypoperfusion and there is nothing to suggest DIC in this phenomenon. This review will provide information about the recent advances in hemostasis and thrombosis in trauma and will clarify the pathogeneses of the pathological processes observed in trauma patients. PMID:25602698

  3. The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature.

    Science.gov (United States)

    Goodwin, Nicholas S; Spinks, Anneliese; Wasiak, Jason

    2016-08-01

    The aim of this systematic review was to determine the supporting evidence for the clinical use of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting. Two authors searched three databases (Ovid Medline, Ovid Embase and The Cochrane Library) for relevant English language articles published through September 2014. Reference lists, conference proceedings and non-indexed academic journals were manually searched. A separate search was conducted using the Internet search engine Google to source additional studies from burns advisory agencies, first aid bodies, military institutions, manufacturer and paramedic websites. Two authors independently assessed study eligibility and relevance of non-traditional data forms for inclusion. Studies were independently assessed and included if Hydrogel-based burn dressings (HBD) were examined in first aid practices in the pre-hospital setting. A total of 129 studies were considered for inclusion, of which no pre-hospital studies were identified. The review highlights that current use of HBD in the pre-hospital setting appears to be driven by sources of information that do not reflect the paramedic environment. We recommend researchers in the pre-hospital settings undertake clinical trials in this field. More so, the review supports the need for expert consensus to identify key demographic, clinical and injury outcomes for clinicians and researchers undertaking further research into the use of dressings as a first aid measure.

  4. The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature.

    Science.gov (United States)

    Goodwin, Nicholas S; Spinks, Anneliese; Wasiak, Jason

    2016-08-01

    The aim of this systematic review was to determine the supporting evidence for the clinical use of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting. Two authors searched three databases (Ovid Medline, Ovid Embase and The Cochrane Library) for relevant English language articles published through September 2014. Reference lists, conference proceedings and non-indexed academic journals were manually searched. A separate search was conducted using the Internet search engine Google to source additional studies from burns advisory agencies, first aid bodies, military institutions, manufacturer and paramedic websites. Two authors independently assessed study eligibility and relevance of non-traditional data forms for inclusion. Studies were independently assessed and included if Hydrogel-based burn dressings (HBD) were examined in first aid practices in the pre-hospital setting. A total of 129 studies were considered for inclusion, of which no pre-hospital studies were identified. The review highlights that current use of HBD in the pre-hospital setting appears to be driven by sources of information that do not reflect the paramedic environment. We recommend researchers in the pre-hospital settings undertake clinical trials in this field. More so, the review supports the need for expert consensus to identify key demographic, clinical and injury outcomes for clinicians and researchers undertaking further research into the use of dressings as a first aid measure. PMID:26177570

  5. Bipolar Disorder and Childhood Trauma

    Directory of Open Access Journals (Sweden)

    Evrim Erten

    2015-06-01

    Full Text Available Bipolar disorder is a chronic disorder in which irregular course of depressive, mania or mixed episodes or a complete recovery between episodes can be observed. The studies about the effects of traumatic events on bipolar disorder showed that they had significant and long-term effects on the symptoms of the disorder. Psychosocial stress might change the neurobiology of bipolar disorder over time. The studies revealed that the traumatic events could influence not only the onset of the disorder but also the course of the disorder and in these patients the rate of suicide attempt and comorbid substance abuse might increase. Bipolar patients who had childhood trauma had an earlier onset, higher number of episodes and comorbid disorders. In this review, the relationship between childhood trauma and bipolar disorder is reviewed. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2015; 7(2: 157-165

  6. : FMRI in acoustic trauma sequelae

    OpenAIRE

    Job, Agnès; Pons, Yoann; Lamalle, Laurent; Jaillard, Assia; Buck, Karl; Segebarth, Christoph; Delon-Martin, Chantal

    2012-01-01

    International audience The most common consequences of acute acoustic trauma (AAT) are hearing loss at frequencies above 3 kHz and tinnitus. In this study, we have used functional Magnetic Resonance Imaging (fMRI) to visualize neuronal activation patterns in military adults with AAT and various tinnitus sequelae during an auditory "oddball" attention task. AAT subjects displayed overactivities principally during reflex of target sound detection, in sensorimotor areas and in emotion-related...

  7. Ventilatory strategies in trauma patients

    OpenAIRE

    Shubhangi Arora; Preet Mohinder Singh; Anjan Trikha

    2014-01-01

    Lung injury in trauma patients can occur because of direct injury to lung or due to secondary effects of injury elsewhere for example fat embolism from a long bone fracture, or due to response to a systemic insult such as; acute respiratory distress syndrome (ARDS) secondary to sepsis or transfusion related lung injury. There are certain special situations like head injury where the primary culprit is not the lung, but the brain and the ventilator strategy is aimed at preserving the brain tis...

  8. Contemporary Management of Renal Trauma

    Science.gov (United States)

    Shoobridge, Jennifer J; Corcoran, Niall M; Martin, Katherine A; Koukounaras, Jim; Royce, Peter L; Bultitude, Matthew F

    2011-01-01

    In the management of renal trauma, surgical exploration inevitably leads to nephrectomy in all but a few specialized centers. With current management options, the majority of hemodynamically stable patients with renal injuries can be successfully managed nonoperatively. Improved radiographic techniques and the development of a validated renal injury scoring system have led to improved staging of injury severity that is relatively easy to monitor. This article reviews a multidisciplinary approach to facilitate the care of patients with renal injury. PMID:21941463

  9. Management of Temporal Bone Trauma

    OpenAIRE

    Patel, Alpen; Groppo, Eli

    2010-01-01

    The temporal bones are paired structures located on the lateral aspects of the skull and contribute to the skull base. Trauma is usually the result of blunt head injury and can result in damage to the brain and meninges, the middle and internal ear, and the facial nerve. Complications can include intracranial hemorrhage, cerebral contusion, CSF leak and meningitis, hearing loss, vertigo, and facial paralysis. To prevent these complications, diagnosis followed by appropriate medical and surgic...

  10. Component separation in abdominal trauma

    OpenAIRE

    Rawstorne, Edward; Smart, Christopher J.; Fallis, Simon A.; Suggett, Nigel

    2014-01-01

    Component separation is established for complex hernia repairs. This case presents early component separation and release of the anterior and posterior sheath to facilitate closure of the abdominal wall following emergency laparotomy, reinforcing the repair with a biological mesh. On Day 11 following an emergency laparotomy for penetrating trauma, this patient underwent component separation and release of the anterior and posterior sheath. An intra-abdominal biological mesh was secured, and t...

  11. Radionuclide evaluation of lung trauma.

    Science.gov (United States)

    Lull, R J; Tatum, J L; Sugerman, H J; Hartshorne, M F; Boll, D A; Kaplan, K A

    1983-07-01

    Nuclear medicine imaging procedures can play a significant role in evaluating the pulmonary complications that are seen in trauma patients. A quantitative method for measuring increased pulmonary capillary permeability that uses Tc-99m HSA allows early diagnosis of acute respiratory distress syndrome (ARDS) and accurately differentiates this condition from pneumonia or cardiogenic pulmonary edema. This technique may be of great value in following the response to therapy. The use of 133Xe to diagnose inhalation injury remains an important diagnostic tool, particularly at hospitals with specialized burn units. Regional decreases in ventilation-perfusion images reliably localize aspirated foreign bodies. Radionuclide techniques that are used to demonstrate gastropulmonary aspiration remain controversial and require further clinical evaluation. Pulmonary perfusion imaging, although nonspecific, may provide the earliest clue for correct diagnosis of fat embolism, air embolism, contusion, or laceration. Furthermore, the possibility of perfusion abnormality due to these uncommon conditions must be remembered whenever trauma patients are evaluated for pulmonary thromboembolism with scintigraphy. Occasionally, liver or spleen scintigraphy may be the most appropriate procedure when penetrating chest trauma also involves these subdiaphragmatic organs. PMID:6226097

  12. Radionuclide evaluation of lung trauma

    Energy Technology Data Exchange (ETDEWEB)

    Lull, R.J.; Tatum, J.L.; Sugerman, H.J.; Hartshorne, M.F.; Boll, D.A.; Kaplan, K.A.

    1983-07-01

    Nuclear medicine imaging procedures can play a significant role in evaluating the pulmonary complications that are seen in trauma patients. A quantitative method for measuring increased pulmonary capillary permeability that uses Tc-99m HSA allows early diagnosis of acute respiratory distress syndrome (ARDS) and accurately differentiates this condition from pneumonia or cardiogenic pulmonary edema. This technique may be of great value in following the response to therapy. The use of 133Xe to diagnose inhalation injury remains an important diagnostic tool, particularly at hospitals with specialized burn units. Regional decreases in ventilation-perfusion images reliably localize aspirated foreign bodies. Radionuclide techniques that are used to demonstrate gastropulmonary aspiration remain controversial and require further clinical evaluation. Pulmonary perfusion imaging, although nonspecific, may provide the earliest clue for correct diagnosis of fat embolism, air embolism, contusion, or laceration. Furthermore, the possibility of perfusion abnormality due to these uncommon conditions must be remembered whenever trauma patients are evaluated for pulmonary thromboembolism with scintigraphy. Occasionally, liver or spleen scintigraphy may be the most appropriate procedure when penetrating chest trauma also involves these subdiaphragmatic organs.

  13. Radionuclide evaluation of lung trauma

    International Nuclear Information System (INIS)

    Nuclear medicine imaging procedures can play a significant role in evaluating the pulmonary complications that are seen in trauma patients. A quantitative method for measuring increased pulmonary capillary permeability that uses Tc-99m HSA allows early diagnosis of acute respiratory distress syndrome (ARDS) and accurately differentiates this condition from pneumonia or cardiogenic pulmonary edema. This technique may be of great value in following the response to therapy. The use of 133Xe to diagnose inhalation injury remains an important diagnostic tool, particularly at hospitals with specialized burn units. Regional decreases in ventilation-perfusion images reliably localize aspirated foreign bodies. Radionuclide techniques that are used to demonstrate gastropulmonary aspiration remain controversial and require further clinical evaluation. Pulmonary perfusion imaging, although nonspecific, may provide the earliest clue for correct diagnosis of fat embolism, air embolism, contusion, or laceration. Furthermore, the possibility of perfusion abnormality due to these uncommon conditions must be remembered whenever trauma patients are evaluated for pulmonary thromboembolism with scintigraphy. Occasionally, liver or spleen scintigraphy may be the most appropriate procedure when penetrating chest trauma also involves these subdiaphragmatic organs

  14. Orofacial injuries associated with prehospital management of febrile convulsion in Nigerian children.

    Science.gov (United States)

    Ndukwe, Kizito C; Folayan, Morenike O; Ugboko, Vincent I; Elusiyan, Jerome B E; Laja, Olajumoke O

    2007-04-01

    The aim of this prospective study was to determine in a population of pediatric patients with febrile convulsions the prevalence and pattern of orofacial and dental injuries caused by traditional remedies used in a suburban Nigerian community. Over the study period of 28 months, 75 cases of febrile convulsion presented to the Children's Emergency unit of our hospital. Of these, 27 children (36%) sustained orofacial injuries caused by forceful insertion of a spoon into the mouth (96.3%) or a bite (3.7%) during convulsive episodes. The ages of the patients ranged from 12 to 84 months with a mean 39.8 +/- 18.3 months. There were 15 males and 11 females with a male to female ratio of 1.4:1. The orofacial and dental injuries sustained from prehospital treatment at home were lacerations and bruising of soft tissues including lips, tongue, mucosa and commissures and tooth subluxation, displacement or avulsion. Other injuries sustained outside the mouth include second-degree burns to the feet, a chin laceration and facial bruises resulting from a fall. Many oral injuries were overlooked by pediatricians. Prompt recognition and appropriate management of febrile convulsion would be of great benefit to the pediatric patients. PMID:17367452

  15. Methicillin-resistant Staphylococcus aureus:An occupational health hazard in the prehospital setting

    Institute of Scientific and Technical Information of China (English)

    Alaa Al Amiry

    2015-01-01

    Methicillin-resistantStaphylococcus aureus (MRSA) is a serious nosocomial infection within healthcare settings, and with its community version worldwide (i.e. community-acquired-MRSA), it is safe now to classify it as an epidemic. The aim of this paper is to build the logic for the reader to understand why this drug-resistant infection can impose an occupational hazard towards emergency health services personnel in the prehospital settings. This logic started with a model, the author conceptualizes as a cross-transmission continuum, in which the author explains the role of emergency medical service personnel in possibly contributing to the transmission of MRSA back and forth the community. A solution to interrupt this continuum, particularly surveillance systems within the emergency medical service field, is suggested and discussed. This is especially important in the light of bioterrorism as surveillance can become a necessity in preparation for biological disasters whether they are intentional (i.e. bioterrorism) or natural (i.e. outbreaks).

  16. Being first on the scene of an accident--experiences of 'doing' prehospital emergency care.

    Science.gov (United States)

    Elmqvist, Carina; Brunt, David; Fridlund, Bengt; Ekebergh, Margaretha

    2010-06-01

    Prehospital emergency care includes the care and treatment of patients prior to them reaching hospital. This is generally a field for the ambulance services, but in many cases firemen or police can be the ones to provide the first responses. The aim of this study was to describe and understand experiences of being the first responder on the scene of an accident, as described by policemen, firemen and ambulance staff. A lifeworld perspective was used in four different traumatic situations from southern Sweden. The data consisted of 13 unstructured interviews with first responders. The phenomenological analysis showed that experiences of being the first responder on the scene of an accident is expectations of doing a systematic course of action, dressed in the role of a hero, and at the same time being genuine in an interpersonal encounter. This entails a continuous movement between 'being' and 'doing'. It is not a question of either - or, instead everything is to be understood in relation to each other at the same time. Five constituents further described the variations of the phenomenon; a feeling of security in the uncertainty, a distanced closeness to the injured person, one moment in an eternity, cross-border cooperation within distinct borders and a need to make the implicit explicit. This finding highlights the importance of using policemen and firemen in doing life support measures while waiting for the ambulance staff, and would in turn increase the importance of the relationship between the different professionals on the scene of an accident. PMID:19732398

  17. Prehospital Medication Administration: A Randomised Study Comparing Intranasal and Intravenous Routes

    Directory of Open Access Journals (Sweden)

    Cian McDermott

    2012-01-01

    Full Text Available Introduction. Opioid overdose is an ever-increasing problem globally. Recent studies have demonstrated that intranasal (IN naloxone is a safe and effective alternative to traditional routes of naloxone administration for reversal of opioid overdose. Aims. This randomised controlled trial aimed to compare the time taken to deliver intranasal medication with that of intravenous (IV medication by advanced paramedic trainees. Methods. 18 advanced paramedic trainees administered either an IN or IV medication to a mannequin model in a classroom-based setting. The time taken for medication delivery was compared. End-user satisfaction was assessed using a 5-point questionnaire regarding ease of use and safety for both routes. Results. The mean time taken for the IN and IV group was 87.1 seconds and 178.2 seconds respectively. The difference in mean time taken was 91.1 seconds (95% confidence interval 55.2 seconds to 126.9 seconds, P≤0.0001. 89% of advanced paramedic trainees reported that the IN route was easier and safer to use than the IV route. Conclusion. This study demonstrates that, amongst advanced paramedic trainees, the IN route of medication administration is significantly faster, better accepted and perceived to be safer than using the IV route. Thus, IN medication administration could be considered more frequently when administering emergency medications in a pre-hospital setting.

  18. AToMS: A Ubiquitous Teleconsultation System for Supporting AMI Patients with Prehospital Thrombolysis

    Directory of Open Access Journals (Sweden)

    Bruno S. P. M. Correa

    2011-01-01

    Full Text Available The latest population-based studies in the medical literature worldwide indicate that acute myocardial infarction (AMI patients still experience prolonged delay to be rescued, which often results in morbidity and mortality. This paper reports from a technological standpoint a teleconsultation and monitoring system named AToMS. This system addresses the problem of prehospital delivery of thrombolysis to AMI patients by enabling the remote interaction of the paramedics and a cardiologist available at a Coronary Care Unit (CCU. Such interaction allows the diagnosis of the patient eligibility to the immediate application of thrombolysis, which is meant to reduce the delay between the onset of symptoms and the eventual application of proper treatment. Such delay reduction is meant to increase the AMI patient's chances of survival and decrease the risks of postinfarction sequels. The teleconsultation is held with the support of wireless and mobile technologies, which also allows the cardiologist to monitor the patient while he/she is being taken to the nearest CCU. All exchanged messages among paramedics and cardiologists are recorded to render an auditable system. AToMS has been deployed in a first stage in the city of Rio de Janeiro, where the medical team involved in the project has conducted commissioned tests.

  19. The imaging of maxillofacial trauma and its pertinence to surgical intervention.

    Science.gov (United States)

    Mehta, Nisha; Butala, Parag; Bernstein, Mark P

    2012-01-01

    Maxillofacial skeletal injuries account for a large proportion of emergency department visits and often result in surgical consultation. Although many of the principles of detection and repair are basic, the evolution of technology and therapeutic strategies has led to improved patient outcomes. This article aims to provide a review of the imaging aspects involved in maxillofacial trauma and to delineate its relevance to management.

  20. A drenagem pleural pré-hospitalar: apresentação de mecanismo de válvula unidirecional Pre-hospital chest drainage: presention one-way valve mechanism

    Directory of Open Access Journals (Sweden)

    Alexandre Garcia de Lima

    2006-04-01

    Full Text Available OBJETIVO: O objetivo do presente estudo é apresentar um mecanismo de válvula unidirecional para substituição do selo de água na drenagem pleural tubular fechada, em ambiente pré-hospitalar, bem como registrar os resultados de seu uso inicial no SAMU-Campinas/SP/Brasil. MÉTODO: Foram realizadas 22 (vinte e duas drenagens pleurais com válvula em doentes vítimas de traumatismo ou pneumotórax espontâneo, todos em ambiente pré-hospitalar, de forma prospectiva, não randomizada. RESULTADOS: O débito total de líquidos através da válvula variou de zero a 1500 ml, com média de 700 ± 87,4 ml, para um tempo de percurso em média de 18 ± 1,1 minutos, variando de 8 a 26 minutos. A frequência cardíaca inicial foi 120 ± 2,7 bpm e final de 100 ± 2 bpm (p 0,00 e a frequência respiratória inicial foi 24 ± 0,8 ipm e o valor final foi de 15 ± 0,3 ipm (p 0,03. Houve apenas duas falhas mecânicas do sistema e uma foi corrigida pela substituição da mesma, trazudindo num índice de sucesso de 95,4% neste trabalho. CONCLUSÃO: Levando em conta exame físico inicial com o exame físico final, bem como pela quantificação de débitos, concluímos que a válvula mostrou-se eficiente e funcionante, e que é segura para o uso em urgências pré-hospitalares.BACKGROUND: The purpose of this study is to present an one-way valve mechanism to replace the underwater seal for pleural drainage, currently used in the prehospital attendance, as well as document preliminary results of its initial use at SAMUCampinas/ SP/Brasil. METHODS: Twenty two pleural drains with the valve were carried out, all of these in prehospital environment, in patients who suffered thoracic trauma or spontaneous pneumothorax, in a prospective not randomized trial. RESULTS: The total volume output drained through the valve ranged from 0 to 1500 ml, mean 700 ± 87,4 ml, in an average time lag of 18 minutes (± 1,1 minutes - ranging from 8 to 26 minutes. The initial and final

  1. 德阳市19288例院外急救流行病学调查与分析%Epidemiology analysis on the pre-hospital patients in Deyang

    Institute of Scientific and Technical Information of China (English)

    鄢涛; 王森; 谭鸿; 姜伟; 刘辉; 李远建; 胡壮俐

    2012-01-01

    目的 调查了解德阳市院外急救患者流行病学特点,以提高院外急救质量和管理水平.方法 选用德阳市紧急救援指挥中心救护记录单为调查表,调查对象为2010年l月1日~12月31日德阳市急救中心所有院外急救患者,共19 288例,采用现况研究.结果 德阳市院外急救调度时间、到达时间、现场时间、返回时间分别为(1.88±0.91)min、(14.45±6.41)min、(14.17±5.26)min、(13.84±5.89)min.院外急救病种前5 位是创伤(37.59%,7 250/19 288)、脑血管病(19.09%,3 682/19 288)、心血管病(17.81%,3 436/19288)、呼吸系统疾病(10.47%,2 019/19 288)、中毒(5.93%,1 144/19 288).结论 德阳市院外急救有其自身的流行病学特点,本调查为德阳市院外急救的管理和建设提供了一定的参考依据.%Objective To investigate the epidemiological characteristics of the pre-hospital patients and distribution of disease, for provide reference to improve the Emergency medical treatment system in Deyang city. Method 19288 patients who called for pre-hospital first aid from 2009-01-01 to 2009-12-31 in Deyang city were analyzed. Results The dispatching time, ambulance running time, treatment time, returning time were (1.88±0.9l)min,(l4.45±6.4l)min,(l4.17±5.26)min,(l3.84±5.89)min respectively. The top five causes of emergency call were trauma(37.59% , 7 250/19 288), cerebrovascular diseases (19.09% , 3 682/19 288), cardiovascular diseases (17.81%, 3436/19288), respiratory diseases(10.47% , 2 019/19 288) and poisonings (5.93% , 1 144/19 288) respectively.Conclusion These results of epidemiology analysis on the pre-hospital patients could provide relative data for building emergency treatment system in Deyang city

  2. Basics of SCI Rehabilitation

    Medline Plus

    Full Text Available Experts \\ The Basics of Spinal Cord Injury Rehabilitation Topics Adult Injuries Spinal Cord Injury 101 Spinal Cord Injury 101 The Basics of Spinal Cord Injury Rehabilitation The Basics ...

  3. Basics of SCI Rehabilitation

    Medline Plus

    Full Text Available Experts \\ The Basics of Spinal Cord Injury Rehabilitation Topics Adult Injuries Spinal Cord Injury 101 Spinal Cord Injury 101 The Basics of Spinal Cord Injury Rehabilitation The Basics of Spinal Cord ...

  4. Basics of SCI Rehabilitation

    Medline Plus

    Full Text Available Experts \\ The Basics of Spinal Cord Injury Rehabilitation Topics Adult Injuries Spinal Cord Injury 101 Spinal Cord Injury 101 The Basics of Spinal Cord Injury Rehabilitation The Basics of ...

  5. Stem Cell Basics

    Science.gov (United States)

    ... Information Stem Cell Basics Stem Cell Basics: Introduction Stem Cell Information General Information Clinical Trials Funding Information Current Research Policy Glossary Site Map Stem Cell Basics Introduction: What are stem cells, and why ...

  6. Common tasks and problems in paediatric trauma radiology

    International Nuclear Information System (INIS)

    Scope of this article is to give practical hints for the most common, typical and important topics of trauma radiology in children to those radiologists who are not exclusively occupied with paediatric imaging. Due to the increased radiation sensitivity of children compared with adults balancing radiation protection and necessary image quality is of utmost importance. Outlines for this optimisation process are given. Especially in imaging of the extremities perhaps the greatest difficulties are posed by the dynamically changing face of the immature, growing, only partially ossified skeleton. Lack of experience must be compensated by meticulous comparison with the normal skeletal development as shown in standard textbooks, and by knowledge of the radiological image of the developmental variants. Besides general remarks about paediatric trauma radiology, some important topics are discussed into more detail. Especially the elbow joint poses a challenge for those less experienced with its radiological appearance in children. More than in adults, ultrasound should remain the primary imaging modality of choice especially in the assessment of abdominal trauma, and CT be tailored to radiological and clinical findings. Imaging and diagnosis of non-accidental injury (NAI) may be a less common task for the general radiologist, however, the severe social implications of physical child abuse mandate a basic knowledge about the radiological symptoms and the imaging management of this problem for all physicians occupied with paediatric radiology

  7. COMMUNISM AND THE TRAUMA OF ITS COLLAPSE REVISITED.

    Science.gov (United States)

    Schmidt-Löw-Beer, Catherine; Atria, Moira; Davar, Elisha

    2015-12-01

    This paper focuses on the intertwinement of society and the psyche as a consequence of 70 years of Communist rule and the trauma of its collapse in the 90's. The trauma had profound effects on the psyche. An empirical study that was carried out in 1996/1997, which compared the personality structure of adolescents from Russia and Austria, and a research dialogue in 1999, has been re-evaluated in the light of current political events. One aim that we had was to find out whether we could discover characteristic personality features, resulting from the Communist totalitarian society in Russia, as well as from the trauma of its collapse. This led to the development of the concepts of the "impersonal self" and the "denial mode". The Russians seemed to be frozen in a protective shell with "flat" affects. They were anxious, conflict avoidant, and somewhat lost. Ideas about missing adolescence and the importance of privacy are discussed. Society was shown to not only have intruded into the individual psyche, but also into the members of the intercultural research team in the form of projective identification. The importance of the interaction between society and the individual as a basic psychoanalytic concept dating back to Freud is elaborated. Finally, considerations pertaining to mental health and democracy are presented. PMID:26611131

  8. COMMUNISM AND THE TRAUMA OF ITS COLLAPSE REVISITED.

    Science.gov (United States)

    Schmidt-Löw-Beer, Catherine; Atria, Moira; Davar, Elisha

    2015-12-01

    This paper focuses on the intertwinement of society and the psyche as a consequence of 70 years of Communist rule and the trauma of its collapse in the 90's. The trauma had profound effects on the psyche. An empirical study that was carried out in 1996/1997, which compared the personality structure of adolescents from Russia and Austria, and a research dialogue in 1999, has been re-evaluated in the light of current political events. One aim that we had was to find out whether we could discover characteristic personality features, resulting from the Communist totalitarian society in Russia, as well as from the trauma of its collapse. This led to the development of the concepts of the "impersonal self" and the "denial mode". The Russians seemed to be frozen in a protective shell with "flat" affects. They were anxious, conflict avoidant, and somewhat lost. Ideas about missing adolescence and the importance of privacy are discussed. Society was shown to not only have intruded into the individual psyche, but also into the members of the intercultural research team in the form of projective identification. The importance of the interaction between society and the individual as a basic psychoanalytic concept dating back to Freud is elaborated. Finally, considerations pertaining to mental health and democracy are presented.

  9. Imaging of accidental paediatric head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Tang, Phua Hwee [KK Women' s and Children' s Hospital, Department of Diagnostic Imaging, Singapore (Singapore); Lim, Choie Cheio Tchoyoson [National Neuroscience Institute, Department of Neuroradiology, Singapore (Singapore)

    2009-05-15

    Head trauma is the most common form of injury sustained in serious childhood trauma and remains one of the top three causes of death despite improved road planning and safety laws. CT remains the first-line investigation for paediatric head trauma, although MRI may be more sensitive at picking up the full extent of injuries and may be useful for prognosis. Follow-up imaging should be tailored to answer the specific clinical question and to look for possible complications. (orig.)

  10. Imaging of accidental paediatric head trauma

    International Nuclear Information System (INIS)

    Head trauma is the most common form of injury sustained in serious childhood trauma and remains one of the top three causes of death despite improved road planning and safety laws. CT remains the first-line investigation for paediatric head trauma, although MRI may be more sensitive at picking up the full extent of injuries and may be useful for prognosis. Follow-up imaging should be tailored to answer the specific clinical question and to look for possible complications. (orig.)

  11. Disability evaluation in acoustic blast trauma

    OpenAIRE

    Ganesan Raju

    2015-01-01

    Introduction: Acoustic blast trauma is different from Noise induced hearing loss. Blast trauma can damage the tympanic membrane, ossicles and cochlea singly or in combination. It produces immediate severe hearing loss and may be associated with tinnitus and vestibular symptoms. Hearing loss recovers spontaneously in many cases but may be permanent in 30-55% cases. Thirteen patients working in an explosive manufacturing unit in Andhra Pradesh were exposed to blast trauma at work place. All the...

  12. Existential Therapy: A Useful Approach to Trauma?

    OpenAIRE

    Corbett, L; Milton, M

    2011-01-01

    Background: Literature has suggested that the cyclical nature of psychological trauma can lead to enduring long-term effects on individuals and those around them. Content and Focus: This review examines the effects of psychological trauma and its relationship with existential therapy, not to endorse a particular approach in isolation, but to explore a variety of understandings of psychological trauma pertinent to counselling psychology. Despite being relatively unexplored with regards to psyc...

  13. Renal Trauma: Case Reports and Overview

    OpenAIRE

    Tait, Campbell D.; Somani, B. K.

    2012-01-01

    Introduction. Renal trauma patients are largely managed conservatively but on occasion have to be embolised or taken to theatre for definitive surgical management, usually in the form of emergency nephrectomy. Review. We present an overview of renal trauma as illustrated by three interesting cases of blunt renal trauma who presented in quick succession of each other to the Emergency Department. The first case—a 48-year-old-female passenger in a road traffic accident—was treated with life-savi...

  14. Development of an interactive dental trauma guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva Fejerskov; Christensen, Søren Steno Ahrensburg

    2009-01-01

    resulting in 54 trauma scenarios of which many have specific requirements for treatment The situation is further complicated by the fact that the two dentitions have very different treatment demands. As a result it's impossible even for experienced practitioners to provide evidence-based treatment on the...... available on the internet at: "www.DentalTraumaGuide.org". We hope that the Dental Trauma Guide can help improve the knowledge about dental traumatology worldwide and hereby improve the quality of treatment....

  15. CraniOrofacial Trauma: The first law

    Directory of Open Access Journals (Sweden)

    Shikha Bharadwaj

    2013-09-01

    Full Text Available Trauma has been given the utmost importance in the field of medicine since ages and is still being the most common cause of mortality and disability worldwide. Every hospital must have a fully equipped trauma care unit, operation theaters and intensive care units to render a better care to trauma patients and also emergency medical services and specialist from all the medical specialties.

  16. Development of an interactive dental trauma guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva; Christensen, Søren Steno Ahrensburg

    2009-01-01

    resulting in 54 trauma scenarios of which many have specific requirements for treatment The situation is further complicated by the fact that the two dentitions have very different treatment demands. As a result it's impossible even for experienced practitioners to provide evidence-based treatment...... be available on the internet at: "www.DentalTraumaGuide.org". We hope that the Dental Trauma Guide can help improve the knowledge about dental traumatology worldwide and hereby improve the quality of treatment....

  17. Serum electrolyte changes in major surgical trauma

    OpenAIRE

    Ram Ranjan Singh; Sudhanshu Shekhar; Md. Jawed Akhtar; Vijay Shankar

    2016-01-01

    Background: Operative trauma is followed by a series of changes collectively referred to as metabolic response to injury, the magnitude and duration of the response being directly proportional to the severity of the trauma. Operative trauma imposes a great impact in the physiology of fluid and electrolytes within the body. Fluid and electrolyte management has thus been an integral part of care of each and every surgical patient. In the present study, an attempt has been made to study the elec...

  18. Pattern of ocular trauma among primary school pupils in Ilorin, Nigeria.

    Science.gov (United States)

    Ayanniyi, A A; Mahmoud, O A; Olatunji, F O; Ayanniyi, R O

    2009-06-01

    To report the pattern of ocular trauma among school pupils in Ilorin, Nigeria, a cross sectional survey of primary school children in 10 randomly selected primary schools within Ilorin, Nigeria was carried out between July 2005 and January 2006. Relevant ocular history and basic ocular examinations were carried out on the children that were selected from a multi-stage sampling process. Diagnosis of ocular trauma was based on historical recollection together with corroborating ocular signs among affected pupils. Ocular trauma was found among 11 (8 boys and 3 girls) out of 1393 (0.8%) pupils and their ages ranged from 5 to 13 years. The trauma related ocular pathology found among the 11 pupils included unilateral phthisis bulbi (2, 0.14%), couching (1, 0.07%) and retinal detachment (1, 0.07%) all leading to blindness in the affected eyes. There was also a unilateral visual impairment caused by traumatic optic atrophy. Others included eyelid bruises (2, 0.14%) and one pupil (0.07%) each with hyphema, eyelid ecchymosis, eyelid laceration, and subconjunctival haemorrhage. The ocular trauma occurred following unsupervised play (4, 36.40%), corporal punishment at school and at home (3, 27.30%), fight (2, 18.20%), home accident (1, 9.10%) and couching (1, 9.10%). School pupils can lose vision to preventable traumatic eye injuries both at school and at home. Measures to minimize ocular trauma both in the home and at school are advocated. PMID:20175424

  19. The association between childhood trauma and facial emotion recognition in adults with bipolar disorder.

    Science.gov (United States)

    Russo, Manuela; Mahon, Katie; Shanahan, Megan; Solon, Carly; Ramjas, Elizabeth; Turpin, Justin; E Burdick, Katherine

    2015-10-30

    Many patients with bipolar disorder (BD) have difficulties in facial emotion recognition, which may also be impaired in maltreated children and in subjects who have a positive history of childhood traumatic experiences. Childhood trauma is reported with a high prevalence in BD and it is considered a risk factor for the disorder. As the relationship between facial emotion recognition and childhood trauma in BD has not yet been directly investigated, in this study we examined whether the presence of a childhood trauma in affectively stable BD patients was associated with poorer performance in emotion recognition. Seventy-five BD I and II participants completed the Childhood Trauma Questionnaire retrospectively assessing five types of childhood trauma (emotional, physical and sexual abuse, and emotional and physical neglect) and the Emotion Recognition Task evaluating the ability to correctly identify six basic facial emotions (happiness, sadness, anger, disgust, fear and surprise). Our results suggest that the presence of childhood trauma in participants with BD is associated with a more severe clinical presentation (earlier onset, longer duration of illness, and higher depressive symptom ratings) and that BD patients with a positive childhood history of emotional neglect perform worse than those without such a history in recognizing anger. PMID:26272021

  20. Pattern of ocular trauma among primary school pupils in Ilorin, Nigeria.

    Science.gov (United States)

    Ayanniyi, A A; Mahmoud, O A; Olatunji, F O; Ayanniyi, R O

    2009-06-01

    To report the pattern of ocular trauma among school pupils in Ilorin, Nigeria, a cross sectional survey of primary school children in 10 randomly selected primary schools within Ilorin, Nigeria was carried out between July 2005 and January 2006. Relevant ocular history and basic ocular examinations were carried out on the children that were selected from a multi-stage sampling process. Diagnosis of ocular trauma was based on historical recollection together with corroborating ocular signs among affected pupils. Ocular trauma was found among 11 (8 boys and 3 girls) out of 1393 (0.8%) pupils and their ages ranged from 5 to 13 years. The trauma related ocular pathology found among the 11 pupils included unilateral phthisis bulbi (2, 0.14%), couching (1, 0.07%) and retinal detachment (1, 0.07%) all leading to blindness in the affected eyes. There was also a unilateral visual impairment caused by traumatic optic atrophy. Others included eyelid bruises (2, 0.14%) and one pupil (0.07%) each with hyphema, eyelid ecchymosis, eyelid laceration, and subconjunctival haemorrhage. The ocular trauma occurred following unsupervised play (4, 36.40%), corporal punishment at school and at home (3, 27.30%), fight (2, 18.20%), home accident (1, 9.10%) and couching (1, 9.10%). School pupils can lose vision to preventable traumatic eye injuries both at school and at home. Measures to minimize ocular trauma both in the home and at school are advocated.

  1. Trauma pattern in a level I east-European trauma center

    Directory of Open Access Journals (Sweden)

    Bogdan Stoica

    2015-10-01

    Conclusions: Our trauma pattern profile is similar to the one found in west-European countries, with a predominance of traffic-related injuries and falls. The severity and anatomical puzzle for trauma lesions were more complex secondary to motorcycle or bicycle-to-auto vehicles collisions. A trauma registry, with prospective enrollment of patients, is a very effective tool for constant improvements in trauma care.

  2. Nursing Risk Analysis and Countermeasures of Pre-hospital Emergency%院前急救中的护理风险分析与对策

    Institute of Scientific and Technical Information of China (English)

    周涛

    2014-01-01

    目的:分析院前急救存在的护理风险,并提出相应的对策。方法通过回顾性总结我院2013年1月~6月院前出诊1502例次患者急救时护理风险存在原因。结果存在护理风险表现在院前急救特殊的工作性质,人员因素,护患沟通与知情同意告知,护理记录,患者因素,仪器设备物品不完善,车辆及车载因素,社会因素。结论针对院前急救存在的护理风险,提出了加强院前急救特殊的工作性质的宣传,强化风险管理意识,培养院前护士急救技能、沟通能力,重视规范护理记录、加强仪器设备的管理,普及民众的急救知识与技能,是提高院前急救患者抢救成功率,减少护理纠纷,确保院前急救护理安全的保证。%Objective To analyze risk of pre-hospital emergency care, and put forward corresponding countermeasures. Methods Through a retrospective summary of pre-hospital visits in January 2013~June 1502 cases patients with emergency nursing risks exist. Results In pre-hospital emergency nursing risks in the special nature of work and personnel factors, communication and informed consent inform nurse and nursing records, patient factors, imperfect instruments and equipment items, vehicle and vehicle factors, social factors. Conclusion Aiming at the existence of pre-hospital first aid nursing risk, put forward to strengthen pre-hospital emergency special nature of the work of propaganda, strengthen risk management consciousness, cultivate nurse pre-hospital first aid skil s, communication skills, at ention to standardize the nursing records, to strengthen the management of instruments and equipment, popularize first-aid knowledge and skil s of the people, is to improve the pre-hospital emergency patients rescue success rate, reduce nursing disputes and ensure the safety of pre-hospital emergency care.

  3. Decolonizing Trauma Theory: Retrospect and Prospects

    Directory of Open Access Journals (Sweden)

    Irene Visser

    2015-06-01

    Full Text Available Decolonizing trauma theory has been a major project in postcolonial literary scholarship ever since its first sustained engagements with trauma theory. Since then, trauma theory and postcolonial literary studies have been uneasy bedfellows, and the time has now come to take stock of what remains in postcolonial trauma studies from the original formulations of trauma theory, and see which further steps must be envisaged in order to reach the ideal of a truly decolonized trauma theory today. To this end, this article presents a detailed overview of the short history and the present situation of the trajectory of decolonizing trauma theory for postcolonial studies, clarifying the various re-routings that have so far taken place, and delineating the present state of the project, as well as the need for further developments towards an increased expansion and inclusiveness of the theory. I argue that openness to non-Western belief systems and their rituals and ceremonies in the engagement with trauma is needed in order to achieve the remaining major objectives of the long-standing project of decolonizing trauma theory.

  4. Diagnosis and outcome in a prehospital cohort of patients with bundle branch block and suspected acute myocardial infarction

    Science.gov (United States)

    Stengaard, Carsten; Sørensen, Christina Ankjær; Thygesen, Kristian; Bøtker, Hans Erik; Thuesen, Leif; Terkelsen, Christian Juhl

    2013-01-01

    Background: Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly. Methods: ECG, final diagnosis, and mortality were assessed in a prehospital cohort of 4905 consecutive patients with suspected acute myocardial infarction (AMI). Bundle branch block (BBB) was defined as QRS duration ≥120 ms caused by delayed intraventricular conduction. Mortality and angiography data were obtained from the Central Office of Civil Registration and the Western Denmark Heart Registry. Definite diagnosis of AMI and the onset of BBB were determined by expert consensus. Patients were divided into four groups: with or without AMI and with or without BBB. Mortality was evaluated by Kaplan–Meier plots and compared using log-rank statistics. Results: AMI was diagnosed in 954 patients, of whom 118 had BBB. In 3951 patients without AMI, 436 had BBB. Patients with BBBMI were less often revascularized than patients with AMI without BBB (24 vs. 54%, p<0.001). BBBMI was categorized as new onset in 43 patients of whom two were triaged for acute angioplasty. One-year mortality was 47.2, 17.5, 20.8, and 8.6% (log-rank <0.001) in patients with BBBMI, patients with AMI without BBB, patients with BBB without AMI, and patients without AMI or BBB, respectively. Conclusions: Patients with BBBMI have a high mortality. Less than 25% undergo revascularization and only very few patients with new-onset BBBMI are transferred for urgent revascularization. Focus on improving triage and prehospital identification of high-risk patients with BBB and chest pain could improve outcome. PMID:24222828

  5. Expanding Trauma through Space and Time: Mapping the Rhetorical Strategies of Trauma Carrier Groups

    Science.gov (United States)

    Degloma, Thomas

    2009-01-01

    In this article, I detail two rhetorical strategies that trauma carrier groups--including social movement organizations, professional mental health associations, and patient advocacy groups--use to expand the relevance of trauma and Post-Traumatic Stress Disorder (PTSD) through space and time: the social transmission of trauma and the social…

  6. Isolated hip fracture care in an inclusive trauma system : A trauma system wide evaluation

    NARCIS (Netherlands)

    van Laarhoven, J. J E M; van Lammeren, G. W.; Houwert, R. M.; van Laarhoven, C. J H C M; Hietbrink, F.; Leenen, L. P H; Verleisdonk, E. J M M

    2015-01-01

    Introduction: Elderly patients with a hip fracture represent a large proportion of the trauma population; however, little is known about outcome differences between different levels of trauma care for these patients. The aim of this study is to analyse the outcome of trauma care in patients with a h

  7. An evolution of trauma care evaluation: A thesis on trauma registry and outcome prediction models

    NARCIS (Netherlands)

    P. Joosse

    2013-01-01

    Outcome prediction models play an invaluable role in the evaluation and improvement of modern trauma care. Trauma registries underlying these outcome prediction models need to be accurate, complete and consistent. This thesis focused on the opportunities and limitations of trauma registries and outc

  8. Demographic patterns and outcomes of patients in level I trauma centers in three international trauma systems

    NARCIS (Netherlands)

    Gunning, Amy C.; Lansink, K. W. W.; van Wessem, Karlijn J. P.; Balogh, Zsolt J.; Rivara, Frederick P.; Maier, Ronald V.; Leenen, Luke P. H.

    2015-01-01

    Introduction Trauma systems were developed to improve the care for the injured. The designation and elements comprising these systems vary across countries. In this study, we have compared the demographic patterns and patient outcomes of Level I trauma centers in three international trauma systems.

  9. The trauma of a recession.

    LENUS (Irish Health Repository)

    Murphy, S M

    2011-09-01

    Employment in construction in Ireland fell by 10% from nearly 282,000 in the second quarter of 2007 to 255,000 in the same period of 2008. Our study looks at the differences in soft tissue upper limb trauma dynamics of a pre- and post-recession Ireland. Construction accounted for 330 patients (27%) of all hand injuries in 2006, but only 18 (3%) in 2009. Our data shows a significant drop in hand injuries related to the construction industry, and more home\\/DIY cases and deliberate self-harm presenting in their stead.

  10. The trauma of a recession.

    Science.gov (United States)

    Murphy, S M; Kieran, I; Shaughnessy, M O

    2011-09-01

    Employment in construction in Ireland fell by 10% from nearly 282,000 in the second quarter of 2007 to 255,000 in the same period of 2008. Our study looks at the differences in soft tissue upper limb trauma dynamics of a pre- and post-recession Ireland. Construction accounted for 330 patients (27%) of all hand injuries in 2006, but only 18 (3%) in 2009. Our data shows a significant drop in hand injuries related to the construction industry, and more home/DIY cases and deliberate self-harm presenting in their stead. PMID:21431394

  11. Taser-Related Testicular Trauma.

    Science.gov (United States)

    Theisen, Katherine; Slater, Rick; Hale, Nathan

    2016-02-01

    The Thomas A. Swift's Electric Rifle (Taser) is an electrical weapon designed as a nonlethal means to subdue violent or fleeing subjects. Several reports have been published on the safety and efficacy of, as well as injury profile from, police Tasers. Documented urologic involvement is rare. The sequela of an electrical current from a Taser gun to the testis in regard to both short- and long-term functions is unknown. Herein we present a case of penetrating trauma to the scrotum from a Taser dart. PMID:26592466

  12. Pneumothorax in severe thoracic traumas

    International Nuclear Information System (INIS)

    The authors reviewed CT scans and supine chest X-ray of 47 patients affected by severe thoracic trauma, examined in 1985-86. The sensibility of the two methodologies in the assessment of pneumothorax was compared. CT detected 25 pneumothorax, whereas supine chest X-ray allowed a diagnosis in 18 cases only. In 8 of the latter (44.4%) the diagnosis was made possible by the presence of indirect signs of pneumothorax only - the most frequent being the deep sulcus sign. The characterization of pneumothorax is important especially in the patients who need to be treated with mechanical ventilation therapy, or who are to undergo surgery in total anaesthesia

  13. Interactive work place trauma (IWPT).

    Science.gov (United States)

    Shewchuk, Muriel

    2005-06-01

    Tragically, horizontal violence and bullying behaviour being master minded by nursing colleagues is firmly entrenched in many perioperative environments--just like a serious pathological bacteria. Interactive Workplace Trauma (IWPT) is ugly, mean, destructive, demoralizing and counterproductive to efficient, effective patient care and positive staff performance. Get educated and use astute observations to ensure you clearly understand what is occurring. Make sure the staff feel safe and have the appropriate, necessary protection to deal with unacceptable conduct. Deal effectively with the bullies. Remember if it is not documented, it didn't happen! PMID:16092572

  14. Trauma social y memoria colectiva

    Directory of Open Access Journals (Sweden)

    Margarita Iglesias Saldaña

    2009-04-01

    Full Text Available El trauma social y la memoria colectiva, o memorias colectivas están de la mano en la América latina post-dictatorial. Desde fines de los años ochenta, se fueron destituyendo las dictaduras latinoamericanas, la mayoría sobre bases de consensos entre las fuerzas dictatoriales y los negociadores políticos de corrientes democráticas. La fuerza de los movimientos sociales sirvió de puente para las negociaciones, pero no logró estar del todo en las transacciones hacia los procesos de transición. Si así hubiera sido, la justicia y la verdad hubieran tenido un lugar privilegiado en los procesos denominados de "transición a las democracias" en distintos países del cono sur latinoamericano. La memoria colectiva ligada al trauma social tendrá varios componentes que abarcan también la memoria individual, incluyendo los espacios de la experiencia, propia y ajena. Este artículo pretende bucear en las interacciones entre ambos ámbitos de la memoria y sus conexiones con el tiempo presente.__________ABSTRACT:Social trauma and collective memory or collective memories are linked to the post-dictatorial Latin America. Since the late eighties, Latin American dictatorships were progressively dismissing, the majority on the basis of consensus between the dictatorial forces and the political mediators of the democratic part. The strength of social movements formed the bridge to negotiations, but could not entirely participate in the transactions to the transition process. If it would have been so, justice and truth would have had a special place in the process called "transition to democracy" in several Latin American Southern Cone countries. The collective memory linked to social trauma will have several components that also include individual memory, including personal and collective spaces of experience. This article aims to analyze the interactions between the two areas of memory and its connections to the present time.

  15. An analysis on 5828 cases of pre-hospital care of a traditional Chinese medicine hospital%中医院5828例院前急救病例分析

    Institute of Scientific and Technical Information of China (English)

    蒋文钧

    2011-01-01

    Objective To analyze various types of pre-hospital emergency disease spectrum and the amount of visits and their visit correlations to various months and different day times to provide a theoretical basis for specifying the construction of reasonable salvage and treatments in an emergency department. Methods A retrospective analysis of 5 828 cases undergoing pre-hospital emergency treatment in Emergency Department in Guilin Traditional Chinese Medicine Hospital from 0 h on January 1st 2008 to 24 h on December 31st 2010 was made. The patient's age and sex distribution, the amount of visits, their visit correlations to various months and different daytimes, and the situation of the common disease spectrum were analyzed. Results The number of patient visits for pre-hospital emergency treatment had a tendency of increase year by year;the ratio of men to women was 1. 37 :1,and the number of cases with 19-49 years of age was the greatest; the peak of the first-aid consultation was in November, December, January and February; the daily visits in 0 - 6 h period were accounted for 17. 48% , in the morning session 7 - 12 h, 27. 30% , in the afternoon session 13 - 18 h, 34. 63%, and in the evening or night time 19 - 24 h, 20. 59%. The diseases occupied the first 3 positions were trauma, intoxication, etc. Various external causes, being accounted for 48. 20% , and the diseases of nervous system and cardiovascular diseases were respectively 13. 74% and 11. 05%. Conclusion According to the pre-hospital emergency disease spectrum, the technology emphasized and the direction of personnel cultivation in emergency medicine can be established. In this department, the knowledge and training of emergency treatment and salvage of cases with trauma, intoxication and cardiocerebrovascular diseases should be particularly enhanced. The salvage scheme and service process for green channel of critical patients should be formulated, and the plans for responding to sudden occurrences of various

  16. A prediction model for prehospital triage of patients with suspected cardiac ischemia.

    Science.gov (United States)

    Grzybowski, M; Zalenski, R J; Ross, M A; Bock, B

    2000-01-01

    The American College of Cardiology recommends that patients with high risk acute myocardial infarction (AMI) be triaged to hospitals with percutaneous transluminal coronary angioplasty capability. However, there are no prehospital triage criteria to select candidates for bypassing community hospitals and being taken directly to "cardiac centers." This article assesses which independent variables predict death within 7 days in patients with suspected AMI transported by EMS. This is a retrospective study of 291 AMI patients transported by ambulance to 3 hospitals during 1996-1997. Included were patients who were (n = 244) > or =18 years of age, had a ED chief complaint of chest pain or dyspnea for whom we had mortality data. Mortality at 7 days, our primary outcome measure, was obtained by using a metropolitan Detroit tricounty death index records. Differences between the survivors and nonsurvivors were assessed using the Student's t-test and chi-square tests. Multiple triage criteria were assessed for optimal identification of high risk patients by constructing a logistic multivariate model. Among the study population, 15% died within 7 days (95% confidence interval (CI) 10.3-19.2), and this group represented 63.2% of all deaths over a 2 year surveillance period. Survivors, compared to nonsurvivors, were 14.1 years younger (P or =65 (OR = 5.9; P or = 20 (OR = 4.6; P < or = .001), SBP < 120 (OR = 2.4; P < or = .05). The overall model was 86% sensitive and 53% specific with an area under the receiving operating characteristic curve of 0.8 (P < or = .001). A triage rule based on a multivariate model can identify the group at high risk of early cardiac death. This decision rule needs to be prospectively validated. PMID:11265730

  17. PRE-HOSPITAL EMERGENCY MEDICAL SERVICES FOR ELDERLY POPULATION IN TBILISI.

    Science.gov (United States)

    Dalakishvili, S; Bakuradze, N; Gugunishvili, M; Jojua, R; Eremashvili, M

    2016-04-01

    The importance of the issue is determined by the current demographic situation in Georgia and the world in general. The trend of growing the number of older people and the increase of the life span is obvious. At the same time in the number of countries, particularly in the developed western countries and Japan, the decrease of birth rate is noticed. Similar processes are taking place in Georgia; this logically increases the number of sick and weakened people, which means that taking care of them becomes more acute problem. Therefore, the purpose of this paper was the study of the situation of the pre-hospital emergency medical services in the Georgian capital Tbilisi during the period of 2012-2014. For this reason, the data provided by the Tbilisi Emergency Medical Service were used. Besides, we have also looked for the statistics of the different countries, including the US, Japan and South-East Asian countries. Attention was paid to the recommendations proposed because of the Monitoring of the European Union Mission in Georgia, which focuses on the social and economic protection of elderly. The tables and diagrams, describing the current conditions are provided. Since 2012, there has been launched the state health care program for the elderly in Georgia, but based on research conducted, it does not cover home care services while, the majority of the elderly are chronically sick people and suffer from the number of diseases. Results of the study can be used for improving quality of the Emergency Medical Service model in Georgia and finding the possible ways for its reforms. PMID:27249441

  18. Prehospital electronic patient care report systems: early experiences from emergency medical services agency leaders.

    Directory of Open Access Journals (Sweden)

    Adam B Landman

    Full Text Available BACKGROUND: As the United States embraces electronic health records (EHRs, improved emergency medical services (EMS information systems are also a priority; however, little is known about the experiences of EMS agencies as they adopt and implement electronic patient care report (e-PCR systems. We sought to characterize motivations for adoption of e-PCR systems, challenges associated with adoption and implementation, and emerging implementation strategies. METHODS: We conducted a qualitative study using semi-structured in-depth interviews with EMS agency leaders. Participants were recruited through a web-based survey of National Association of EMS Physicians (NAEMSP members, a didactic session at the 2010 NAEMSP Annual Meeting, and snowball sampling. Interviews lasted approximately 30 minutes, were recorded and professionally transcribed. Analysis was conducted by a five-person team, employing the constant comparative method to identify recurrent themes. RESULTS: Twenty-three interviewees represented 20 EMS agencies from the United States and Canada; 14 EMS agencies were currently using e-PCR systems. The primary reason for adoption was the potential for e-PCR systems to support quality assurance efforts. Challenges to e-PCR system adoption included those common to any health information technology project, as well as challenges unique to the prehospital setting, including: fear of increased ambulance run times leading to decreased ambulance availability, difficulty integrating with existing hospital information systems, and unfunded mandates requiring adoption of e-PCR systems. Three recurring strategies emerged to improve e-PCR system adoption and implementation: 1 identify creative funding sources; 2 leverage regional health information organizations; and 3 build internal information technology capacity. CONCLUSION: EMS agencies are highly motivated to adopt e-PCR systems to support quality assurance efforts; however, adoption and

  19. Patients with pelvic fractures due to falls: A paradigm that contributed to autopsy-based audit of trauma in Greece

    Directory of Open Access Journals (Sweden)

    Kotsilianou Olympia

    2011-01-01

    Full Text Available Abstract Background Evaluation of the pelvic fractures (PFx population in auditing effective components of trauma care is the subject of this study. Methods A retrospective, case-control, autopsy-based study compared a population with PFx to a control-group using a template with trauma outcome variables, which included demographics, ICD-9, intention, mechanisms, toxicology, Abbreviated Injury Scale (AIS-90, Injury Severity Score (ISS, causes of haemorrhage, comorbidity, survival time, pre-hospital response, in hospital data, location of death, and preventable deaths. Results Of 970 consecutive patients with fatal falls, 209 (21.5% had PFx and constituted the PFx-group while 761 (78.5% formed the control-group. Multivariate analysis showed that gender, age, intention, and height of fall were risk factors for PFx. A 300% higher odds of a psychiatric history was found in the PFx-group compared to the control-group (p The median ISS was 50 (17-75 for the PFx-group and 26 (1-75 for the control-group (p Associated injuries were significantly more common in the PFx-group than in the control-group. Potentially preventable deaths (ISS A subset of 126 (60.3% potentially preventable deaths in the PFx-group had at least one AIS-90 code other than the PFx, denoting major haemorrhage. Deaths directly attributed to PFx were limited to 6 (2.9%. The median survival time was 30 minutes for the PFx-group and 20 hours for the control-group (p Pre-hospital mortality was significantly higher in the PFx-group i.e. 70.3% of the PFx-group versus 42.7% of the control-group (p Conclusions The PFx-group shared common causative risk factors, high severity and multiplicity of injuries that define the PFx-group as a paradigm of injury for audit. This reduced sample of autopsies substantially contributed to the audit of functional, infrastructural, management and prevention issues requiring transformation to reduce mortality.

  20. Imaging following acute knee trauma.

    Science.gov (United States)

    Kijowski, R; Roemer, F; Englund, M; Tiderius, C J; Swärd, P; Frobell, R B

    2014-10-01

    Joint injury has been recognized as a potent risk factor for the onset of osteoarthritis. The vast majority of studies using imaging technology for longitudinal assessment of patients following joint injury have focused on the injured knee joint, specifically in patients with anterior cruciate ligament injury and meniscus tears where a high risk for rapid onset of post-traumatic osteoarthritis is well known. Although there are many imaging modalities under constant development, magnetic resonance (MR) imaging is the most important instrument for longitudinal monitoring after joint injury. MR imaging is sensitive for detecting early cartilage degeneration and can evaluate other joint structures including the menisci, bone marrow, tendons, and ligaments which can be sources of pain following acute injury. In this review, focusing on imaging following acute knee trauma, several studies were identified with promising short-term results of osseous and soft tissue changes after joint injury. However, studies connecting these promising short-term results to the development of osteoarthritis were limited which is likely due to the long follow-up periods needed to document the radiographic and clinical onset of the disease. Thus, it is recommended that additional high quality longitudinal studies with extended follow-up periods be performed to further investigate the long-term consequences of the early osseous and soft tissue changes identified on MR imaging after acute knee trauma. PMID:25278054