scholarly journals Care transition of trauma patients: Processes with articulation work before and after handoff

2022 ◽  
Vol 98 ◽  
pp. 103606
Author(s):  
Abigail R. Wooldridge ◽  
Pascale Carayon ◽  
Peter Hoonakker ◽  
Bat-Zion Hose ◽  
Katherine Schroeer ◽  
...  
Keyword(s):  
Care Transition ◽  
Trauma Patients ◽  
Articulation Work ◽  
Before And After

scholarly journals Introduction of a standardised protocol, including systematic use of tranexamic acid, for management of severe adult trauma patients in a low-resource setting: the MSF experience from Port-au-Prince, Haiti

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Alessandro Jachetti ◽  
Rose Berly Massénat ◽  
Nathalie Edema ◽  
Sophia C. Woolley ◽  
Guido Benedetti ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Traumatic Event ◽  
Penetrating Trauma ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Early Administration ◽  
Massive Haemorrhage ◽  
Low Resource ◽  
Resource Setting ◽  
Before And After

Abstract Background Bleeding is an important cause of death in trauma victims. In 2010, the CRASH-2 study, a multicentre randomized control trial on the effect of tranexamic acid (TXA) administration to trauma patients with suspected significant bleeding, reported a decreased mortality in randomized patients compared to placebo. Currently, no evidence on the use of TXA in humanitarian, low-resource settings is available. We aimed to measure the hospital outcomes of adult patients with severe traumatic bleeding in the Médecins Sans Frontières Tabarre Trauma Centre in Port-au-Prince, Haiti, before and after the implementation of a Massive Haemorrhage protocol including systematic early administration of TXA. Methods Patients admitted over comparable periods of four months (December2015- March2016 and December2016 - March2017) before and after the implementation of the Massive Haemorrhage protocol were investigated. Included patients had blunt or penetrating trauma, a South Africa Triage Score ≥ 7, were aged 18–65 years and were admitted within 3 h from the traumatic event. Measured outcomes were hospital mortality and early mortality rates, in-hospital time to discharge and time to discharge from intensive care unit. Results One-hundred and sixteen patients met inclusion criteria. Patients treated after the introduction of the Massive Haemorrhage protocol had about 70% less chance of death during hospitalization compared to the group “before” (adjusted odds ratio 0.3, 95%confidence interval 0.1–0.8). They also had a significantly shorter hospital length of stay (p = 0.02). Conclusions Implementing a Massive Haemorrhage protocol including early administration of TXA was associated with the reduced mortality and hospital stay of severe adult blunt and penetrating trauma patients in a context with poor resources and limited availability of blood products.

The effect of training and experience on mass casualty incident triage performance: Evidence from emergency personnel in a high complexity university hospital

2019 ◽  
Vol 14 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Juan P. Vargas, MD, MSc ◽  
Ives Hubloue, MD, PhD ◽  
Jazmín J. Pinzón, MD ◽  
Alejandra Caycedo Duque, MD
Keyword(s):  
Emergency Department ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
University Hospital ◽  
Trauma Patients ◽  
Post Intervention ◽  
Cross Sectional ◽  
Emergency Department Staff ◽  
Department Staff ◽  
Before And After

Mass casualty incident (MCI) can occur at any time and place and health care institutions must be prepared to deal with these incidents. Emergency department staff rarely learn how to triage MCI patients during their medical or nurse degrees, or through on-the-job training. This study aims to evaluate the effect of training and experience on the MCI triage performance of emergency personnel.Methodology: This was a cross-sectional prospective study that analyzed the performance of 94 emergency department staff on the triage classifications of 50 trauma patients, before and after a short training in MCI triage, while taking into account their academic background and work experience.Results: The participants were assigned initially to one of two groups: low experience if they had less than 5 years of practice, and high experience if they had more than 5 years of practice. In the low experience group, the initial accuracy was 45.76 percent, over triage 45.84 percent, and subtriage 8.38 percent. In the high experience group, the initial accuracy was 53.80 percent, over triage 37.66 percent, and sub triage 8.57 percent.Postintervention Results: In the low experience group, the post intervention accuracy was 63.57 percent, over triage 21.15 percent, and subtriage 15.30 percentage. In the high experience group, the post-intervention accuracy was 67.66 percentage, over triage 15.19 percentage, and subtriage 17.14 percentage.  Conclusion: Upon completion of this study, it can be concluded that MCI triage training significantly improved the performance of all those involved in the workshop and that experience plays an important role in MCI triage performance.

scholarly journals A Prospective Evaluation of Missed Injuries in Trauma Patients, Before and After Formalising the Trauma Tertiary Survey

2013 ◽  
Vol 38 (1) ◽  
pp. 222-232 ◽  
Author(s):  
Gerben B. Keijzers ◽  
Don Campbell ◽  
Jeffrey Hooper ◽  
Nerolie Bost ◽  
Julia Crilly ◽  
...  
Keyword(s):  
Trauma Patients ◽  
Prospective Evaluation ◽  
Missed Injuries ◽  
Before And After ◽  
Tertiary Survey

“A-OK”: Chest Radiograph during Primary Survey Facilitates Faster, More Accurate Endotracheal Tube Position in Injured Children

2019 ◽  
Vol 85 (5) ◽  
pp. 479-487
Author(s):  
Andrea N. Doud ◽  
Michaela Gaffley ◽  
Olivia Hostetter ◽  
Jennifer W. Talton ◽  
John K. Petty
Keyword(s):  
Endotracheal Tube ◽  
Life Support ◽  
Pediatric Trauma ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Primary Survey ◽  
Breath Sounds ◽  
Before And After ◽  
Chest X Ray ◽  
Baseline Characteristics

The Advanced Trauma Life Support algorithm recommends bedside confirmatory techniques to confirm correct endotracheal tube (ETT) depth, a critical component in the care of pediatric trauma patients. We hypothesized that bedside confirmatory techniques are inaccurate and that early chest X-ray (CXR) would overcome such inaccuracies, allowing for faster intervention of malpositioned ETTs. An “A-OK” algorithm of immediate CXR following intubation in injured children aged <16 years was implemented. Eligible patients the years before and after implementation were identified. The accuracy of bedside confirmatory techniques (use of length-based depths and auscultation of breath sounds) was assessed. Post-“A-OK” patients were compared with pre-“A-OK” controls regarding the speed of malpositioned ETTrepositioning. Twenty-eight post-“A-OK” cases and 23 pre-“A-OK” controls were identified. The groups did not differ in baseline characteristics. Bedside confirmatory techniques were accurate in only 61 per cent (length-based depth) and 58 per cent (auscultation of breath sounds) of patients. Time to ETT repositioning was significantly longer in pre-“A-OK” controls than in post-“A-OK” cases (35.2 ± 15.9 minutes vs 21.1 ± 11.8 minutes, P = 0.03). Bedside confirmatory techniques to determine ETT positioning are inaccurate in children. Inclusion of CXR in the primary survey is safe and allows for more rapid repositioning of malpositioned ETTs.

Time to Resuscitate a Sacred Cow… with Normal Saline

2014 ◽  
Vol 80 (3) ◽  
pp. 301-306 ◽  
Author(s):  
James S. Davis ◽  
Salman Alsafran ◽  
Cheryl D. Richie ◽  
Joshuaw Moore ◽  
Nicholas Namias ◽  
...  
Keyword(s):  
Normal Saline ◽  
Injury Severity ◽  
National Level ◽  
Cost Savings ◽  
Blood Gases ◽  
Trauma Patients ◽  
Trauma Population ◽  
Before And After ◽  
Resuscitation Fluid ◽  
Level I

Normal saline (NS) is not used for trauma resuscitation because of its potential for acidosis. Lactated Ringer's (LR) is preferred instead. However, the two crystalloids have never been compared in trauma patients. We hypothesized that NS would be an acceptable fluid for resuscitation in the trauma patient. In 2011, a Level I trauma center switched resuscitation fluid from LR to NS. Admissions before and after the change were retrospectively reviewed. Demographics, vitals, blood work, and fluid intake were recorded over 24 hours. Acidosis level, stratified by Injury Severity Score (ISS), was compared. Four hundred ten patients were included, 207 in the LR cohort and 203 in the NS. Chloride (LR 105.26 ± 4.75 vs NS 106.48 ± 4.19), base excess (-2.53 ± 3.77 vs -3.28 ± 4.15), pH (7.37 ± 0.08 vs 7.36 ± 0.07), and bicarbonate (22.83 ± 3.45 vs 21.65 ± 5.06) were statistically different but not clinically significant. This was also true when results were stratified by ISS. In addition, there was no difference in the number of blood gases drawn between the groups (584 vs 544, P = nonsignificant). NS resuscitation is a safe, viable alternative to LR in the trauma population studied. Its use carries a potentially substantial cost savings on a national level.

Lidocaine Patches Reduce Pain in Trauma Patients with Rib Fractures

2011 ◽  
Vol 77 (4) ◽  
pp. 438-442 ◽  
Author(s):  
Karen A. Zink ◽  
John C. Mayberry ◽  
Ellen G. Peck ◽  
Martin A. Schreiber
Keyword(s):  
Rib Fracture ◽  
Mcgill Pain Questionnaire ◽  
Trauma Patients ◽  
Control Subjects ◽  
Pain Scores ◽  
Baseline Activity ◽  
Before And After ◽  
Long Term Follow Up ◽  
C 32 ◽  
Patch Placement

Rib fracture pain is notoriously difficult to manage. The lidocaine patch is effective in other pain scenarios with an excellent safety profile. This study assesses the efficacy of lidocaine patches for treating rib fracture pain. A prospectively gathered cohort of patients with rib fracture was retrospectively analyzed for use of lidocaine patches. Patients treated with lidocaine patches were matched to control subjects treated without patches. Subjective pain reports and narcotic use before and after patch placement, or equivalent time points for control subjects, were gathered from the chart. All patients underwent long-term follow-up, including a McGill Pain Questionnaire (MPQ). Twenty-nine patients with lidocaine patches (LP) and 29 matched control subjects (C) were analyzed. During the 24 hours before patch placement, pain scores and narcotic use were similar (LP 5.3, C 4.6, P = 0.19 and LP 51, C 32 mg morphine, P = 0.17). In the 24 hours after patch placement, LP patients had a greater decrease in pain scores (LP 1.2, C 0.0, P = 0.01) with no change in narcotic use (LP -8.4, C 0.5-mg change in morphine, P = 0.25). At 60 days, LP patients had a lower MPQ pain score (LP 7.7, C 12.2, P < 0.01), although only one patient was still using a patch. There was no difference in time to return to baseline activity (LP 73, C 105 days, P = 0.16) and no adverse events. Lidocaine patches are a safe, effective adjunct for rib fracture pain. Lidocaine patches resulted in a sustained reduction in pain, outlasting the duration of therapy.

Needle Thoracostomy: Does Changing Needle Length and Location Change Patient Outcome?

2018 ◽  
Vol 33 (3) ◽  
pp. 237-244 ◽  
Author(s):  
Lori A. Weichenthal ◽  
Scott Owen ◽  
Geoffory Stroh ◽  
John Ramos
Keyword(s):  
Patient Outcome ◽  
Injury Severity ◽  
Trauma Patients ◽  
Needle Length ◽  
Publication Type ◽  
Clinical Change ◽  
Needle Size ◽  
Severity Scores ◽  
Before And After ◽  
Location Change

AbstractBackgroundNeedle thoracostomy (NT) is a common prehospital intervention for patients in extremis or cardiac arrest due to trauma. The purpose of this study is to compare outcomes, efficacy, and complications after a change in policy related to NT in a four-county Emergency Medical Services (EMS) system with a catchment area of greater than 1.6 million people.MethodsThis is a before and after observational study of all patients who had NT performed in the Central California (USA) EMS system. The before, anterior midclavicular line (MCL) group consisted of all patients who underwent NT from May 7, 2007 through February 28, 2013. The after, midaxillary line (MAL) axillary group consisted of all patients who underwent NT from March 1, 2013 through January 30, 2016, after policy revisions changed the timing, needle size, and placement location for NT. All prehospital and hospital records where NT was performed were queried for demographics, mechanism of injury, initial status and post-NT clinical change, reported complications, and final outcome. The trauma registry was accessed to obtain Injury Severity Scores (ISS). Information was manually abstracted by study investigators and examined utilizing univariate and multivariate analyses.ResultsThree-hundred and five trauma patients treated with NT were included in this study, of which, 169 patients (the MCL group) were treated with a 14-guage intravenous (IV) catheter at least 5.0-cm long at the second intercostal space (ICS), MCL after being placed in the ambulance; and 136 patients (the MAL group) were treated with a 10-guage IV catheter at least 9.5-cm long at the fifth ICS, MAL on scene. The mean ISS was lower in the MAL cohort (64.5 versus 69.2; P=.007). The mortality rate was 79% in both groups. The multivariate model with regard to survival supported that a lower ISS (P<.001) and reported clinical change after NT (P=.003) were significant indicators of survival. No complications from NT were reported.ConclusionsChanging the timing, length of needle, and location of placement did not change mortality in patients requiring NT. Needle thoracostomy was used more frequently after the change in policy, and the MAL cohort was less injured. No increase in reported complications was noted.WeichenthalLA, OwenS, StrohG, RamosJ. Needle thoracostomy: does changing needle length and location change patient outcome?Prehosp Disaster Med. 2018;33(3):237–244.

scholarly journals Functional electrical stimulation improves brain perfusion in cranial trauma patients

2011 ◽  
Vol 69 (4) ◽  
pp. 682-686 ◽  
Author(s):  
Bárbara Juarez Amorim ◽  
Allan de Oliveira Santos ◽  
Telma Dagmar Oberg ◽  
Juliana Romanato ◽  
Dalton A. Anjos ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Functional Electrical Stimulation ◽  
Brain Perfusion ◽  
Trauma Patients ◽  
Cranial Trauma ◽  
Significant Statistical Difference ◽  
Infarct Area ◽  
Before And After ◽  
Perfusion Spect ◽  
Large Infarct

OBJECTIVE: Demonstrate brain perfusion changes due to neuronal activation after functional electrical stimulation (FES). METHOD: It was studied 14 patients with hemiplegia who were submitted to a program with FES during fourteen weeks. Brain perfusion SPECT was performed before and after FES therapy. These patients were further separated into 2 groups according to the hemiplegia cause: cranial trauma and major vascular insults. All SPECT images were analyzed using SPM. RESULTS: There was a significant statistical difference between the two groups related to patient's ages and extent of hypoperfusion in the SPECT. Patients with cranial trauma had a reduction in the hypoperfused area and patients with major vascular insult had an increase in the hypoperfused area after FES therapy. CONCLUSION: FES therapy can result in brain perfusion improvement in patients with brain lesions due to cranial trauma but probably not in patients with major vascular insults with large infarct area.

Medication errors in the care transition of trauma patients

2019 ◽  
Vol 75 (12) ◽  
pp. 1739-1746
Author(s):  
Mª Ángeles Parro Martín ◽  
M. Muñoz García ◽  
E. Delgado Silveira ◽  
S. Martin-Aragón ◽  
T. Bermejo Vicedo
Keyword(s):  
Medication Errors ◽  
Care Transition ◽  
Trauma Patients
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