Evaluation of a Simplified Index of Initial Prognosis in Polytrauma

1987 ◽  
Vol 3 (1) ◽  
pp. 7-9
Author(s):  
Philippe Scherpereel ◽  
Jean-Pierre Vandenameele ◽  
Daniel Hochart ◽  
Jean-Claude Marson ◽  
Patrick Goldstein
Keyword(s):  
Emergency Care ◽  
Injury Severity ◽  
Severity Index ◽  
Spinal Trauma ◽  
Initial Assessment ◽  
Emergency Unit ◽  
Severity Scale ◽  
Injury Score ◽  
Reliable Tool ◽  
Life Threatening

Three hundred cases of polytrauma were investigated to evaluate the reliability of the Lindsey severity index. This simplified injury score can be used by paramedics or low-skilled emergency practioners to obtain a correct screening of patients and an initial prognosis on the basis of a simple injury severity scale. An evaluation by the Lindsey index was done in the field and at the emergency care unit. Results compare the final status of the patient which was obtained using the Patel score, derived from the patient's chart after his discharge. The Lindsey index demonstrated a correct assessment of the patient's status in 60% of the cases at the scene of the accident and 77% in the emergency unit. Most of the errors were due to underevaluations of the skull and spinal trauma. Patel's scale emphasizes locomotor sequellae, while skeletal injuries seldom provide life-threatening events, widely considered in the Lindsey index. Lindsey's index is a simple and reliable tool for initial assessment and a useful method of teaching.

Diving Accident Evacuations by Helicopter and Immersion Pulmonary Edema

2020 ◽  
Vol 91 (10) ◽  
pp. 806-811
Author(s):  
Laëtitia Corgie ◽  
Nicolas Huiban ◽  
Jean-Michel Pontier ◽  
François-Xavier Brocq ◽  
Jean-François Boulard ◽  
...  
Keyword(s):  
Pulmonary Edema ◽  
Decompression Sickness ◽  
Mediterranean Coast ◽  
Military Hospital ◽  
Emergency Unit ◽  
Diving Accident ◽  
Landing Zone ◽  
Diving Accidents ◽  
Non Invasive Ventilation ◽  
Life Threatening

BACKGROUND: Scuba diving activities expose divers to serious accidents, which can require early hospitalization. Helicopters are used for early evacuation. On the French Mediterranean coast, rescue is made offshore mainly by a French Navy Dauphin or at a landing zone by an emergency unit EC 135 helicopter.METHODS: We retrospectively analyzed diving accidents evacuated by helicopter on the French Mediterranean coast from 1 September 2014 to 31 August 2016. We gathered data at the Center for Hyperbaric Medicine and Diving Expertise (SMHEP) of the Sainte-Anne Military Hospital (Toulon, France), the 35 F squadron at Hyres (France) Naval Air Station, and the SAMU 83 emergency unit (Toulon, France).RESULTS: A total of 23 diving accidents were evacuated offshore by Dauphin helicopter and 23 at a landing zone on the coast by EC 135 helicopter without hoist. Immersion pulmonary edema (IPE) accounted for one-third of the total diving accidents evacuated by helicopter with identified causes. It was responsible for at least half of the deaths at the dive place. A quarter of the rescued IPE victims died because of early cardiac arrest.DISCUSSION: Helicopter evacuation is indicated when vital prognosis (IPE and pulmonary overpressure in particular) or neurological functional prognosis (decompression sickness) is of concern. IPE is the primary etiology in patients with serious dive injuries that are life-threatening and who will benefit from helicopter evacuation. A non-invasive ventilation device with inspiratory support and positive expiratory pressure must be used, in particular for IPE.Corgie L, Huiban N, Pontier J-M, Brocq F-X, Boulard J-F, Monteil M. Diving accident evacuations by helicopter and immersion pulmonary edema. Aerosp Med Hum Perform. 2020; 91(10):806811.

scholarly journals Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

2021 ◽  
Author(s):  
Silke Piedmont ◽  
Anna Katharina Reinhold ◽  
Jens-Oliver Bock ◽  
Enno Swart ◽  
Bernt-Peter Robra
Keyword(s):  
Health Insurance ◽  
Emergency Care ◽  
Third Party ◽  
Insurance Companies ◽  
Prehospital Emergency Care ◽  
Health Related ◽  
Life Threatening ◽  
Prehospital Emergency ◽  
Health Insurance Companies ◽  
Reported Data

Abstract Objectives/Background In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients’ perspectives is helpful. Methods We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called “objective” characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016. Results According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients’ subjective urgency and different items for objective care. Conclusion Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients’ perceived urgency may affect the disposition, rapidness of the service and transport targets.

scholarly journals Bedside examination of the vestibular and ocular motor system in patients with acute vertigo or dizziness

2019 ◽  
Vol 3 (2) ◽  
pp. 2514183X1988615
Author(s):  
Alexander A Tarnutzer ◽  
Marianne Dieterich
Keyword(s):  
Diagnostic Testing ◽  
Initial Assessment ◽  
Head Impulse Test ◽  
Motor Deficits ◽  
Ocular Motor ◽  
Bedside Examination ◽  
Life Threatening ◽  
Ocular Motor System ◽  
Bedside Tests ◽  
The Brain

In the initial assessment of the patient with acute vertigo or dizziness, both structured history-taking and a targeted bedside neuro-otological examination are essential for distinguishing potentially life-threatening central vestibular causes from those of benign, self-limited peripheral labyrinthine origin and thus for deciding on further diagnostic testing. In this article, the key elements of the vestibular and ocular motor examination, which should be obtained at the bedside in these acutely dizzy patients, will be discussed. Specifically, this will include the following five domains: ocular stability for (I) nystagmus and for (II) eye position (skew deviation), (III) the head-impulse test (HIT), (IV) postural stability, and (V) ocular motor deficits of saccades, smooth pursuit eye movements, and optokinetic nystagmus. We will also discuss the diagnostic accuracy of specific combinations of these bedside tests (i.e. HIT, testing for nystagmus and vertical divergence, referred to as the H.I.N.T.S. three-step examination), emphasizing that the targeted neuro-otological bedside examination is more sensitive for identifying central causes in acute prolonged vertigo and dizziness than early MRI of the brain.

School Nurses on the Front Lines of Medicine: Take a BREATH: The Approach to a Student With Respiratory Distress

2017 ◽  
Vol 33 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Morgann Loaec ◽  
Robert P. Olympia
Keyword(s):  
Emergency Department ◽  
Respiratory Distress ◽  
Respiratory Symptoms ◽  
School Setting ◽  
School Nurses ◽  
Initial Assessment ◽  
Level Of Care ◽  
Primary Health ◽  
Life Threatening

Students presenting with varying degrees of respiratory symptoms and distress occur commonly in the school setting. It is important to develop a differential diagnosis for respiratory distress, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary health care provider’s office, or directly to the closest emergency department via Emergency Medical Services). This article describes the initial assessment and management of a student presenting with respiratory distress.

Acute Asthma in Adults: Controversies and Best Practice

2009 ◽  
Vol 8 (1) ◽  
pp. 10-16
Author(s):  
Maren Schuhmann ◽  
◽  
Fraser Brims ◽  
Anoop J Chauhan ◽  
◽  
...  
Keyword(s):  
Emergency Care ◽  
Best Practice ◽  
Care Setting ◽  
Acute Asthma ◽  
British Thoracic Society ◽  
International Guidelines ◽  
Life Threatening

Asthma in the emergency care setting is common and may be life-threatening. Last year the British Thoracic Society updated their guidelines for the management of asthma, however some treatments remain controversial and there is variation in adherence to these and other national and international guidelines.

New treatment strategy and assessment questionnaire for external auditory canal pruritis: topical pimecrolimus therapy and Modified Itch Severity Scale

2009 ◽  
Vol 124 (2) ◽  
pp. 147-151 ◽  
Author(s):  
B Acar ◽  
H Karabulut ◽  
Y Sahin ◽  
M A Babademez ◽  
A S Karadag ◽  
...  
Keyword(s):  
External Auditory Canal ◽  
Scoring System ◽  
Assessment Tool ◽  
Initial Assessment ◽  
Severity Scale ◽  
The Third ◽  
Systemic Treatments ◽  
New Treatment ◽  
Assess Treatment Response ◽  
Self Reporting Questionnaire

AbstractObjective:We aimed to compare the efficacy of topical pimecrolimus versus hydrocortisone in treating external auditory canal pruritis, using the Modified Itch Severity Scale as an assessment tool.Methods:We included in the study 40 patients with isolated itching of the external auditory canal who had not received any benefit from previous topical and systemic treatments. Topical 1 per cent pimecrolimus or topical hydrocortisone was applied to each patient's external auditory canal for three months. A Modified Itch Severity Scale was developed and used to assess treatment response.Results:Compared with itching scores on initial assessment, the scores of patients receiving topical pimecrolimus had decreased by 52.3 per cent by the third week of treatment and by 77.6 per cent by the third month, whereas the scores of patients receiving topical hydrocortisone had decreased by 34.4 per cent by the third week and by 64.2 per cent by the third month.Conclusions:Topical pimecrolimus appears to be as effective as topical hydrocortisone in relieving external auditory canal pruritis. We used a novel scoring system, the Modified Itch Severity Scale, to evaluate external auditory canal pruritus; this is the first self-reporting questionnaire for the quantification of external auditory canal pruritus severity. Further studies are needed to validate this scoring system.

scholarly journals Informed consent di Instalasi Gawat Darurat RSUP Prof. Dr. R. D. Kandou Manado

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Christilia G. Wagiu ◽  
Erwin G. Kristanto ◽  
Theo Lumunon
Keyword(s):  
Informed Consent ◽  
Emergency Care ◽  
Field Observation ◽  
Qualitative Method ◽  
Secondary Data ◽  
Medical Intervention ◽  
Referral Hospital ◽  
Medical Doctors ◽  
Emergency Unit ◽  
Physical Handicap

Abstract: According to the Minister of Health regulation No. 290 Year 2008 article 1 which is relevant to medical intervention issues, informed consent has to be signed by the patient prior to any medical intervention after the patient has been informed completely about the purpose and the risk of certain intervention. In general, medical doctors already admits that informed consent is an important part of the ethical code of their profession. Albeit, in certain circumstances such as in emergency cases with life or physical handicap threatening, the medical doctors are demanded to do medical intervention ‘ignoring’ the informed consent. This study was aimed to obtain the implementation of informed consent in Emergency Care Unit at Prof. Dr. R. D. Kandou Hospital Manado, the central referral hospital in East Indonesia. In this study, we used qualitative method through interview, direct field observation, and document observation as secondary data. The results showed that informed consent was implemented at the Emergencey Care Unit, however, in emergency cases, informed consent was given orally, followed by signing it as soon as the intervention had been completely performed. Conclusion: Informed consent was implemented in every medical intervention at Prof. Dr. R. D. Kandou Hospital including the Emergency Care Unit.Keywords: informed consent, emergency care unitAbstrak: Menurut ketentuan Permenkes No. 290 tahun 2008 pasal 1 yang mengatur tentang tindakan medik disebutkan bahwa ijin melakukan tindakan medik diberi oleh pasien setelah terlebih dahulu pasien mendapat penjelasan tentang tujuan dan manfaat maupun risiko dari tindakan medik tersebut. Umumnya dokter telah mengetahui dan mengakui bahwa persetujuan tindakan medik atau informed consent ialah bagian kode etik profesi sebelum diatur dalam ketentuan undang-undang tentang rumah sakit, praktik kedokteran, maupun peraturan menteri kesehatan. Dalam keadaan tertentu dokter juga dituntut untuk dapat segera melaksanakan tindakan medis dan mengesampingkan informed consent antara lain dalam keadaan gawat darurat dimana terdapat ancaman kematian atau kecacatan. Penelitian ini bertujuan untuk mengetahui penyelenggaran persetujuan tindakan medik di Instalasi Gawat Darurat RSUP Prof. Dr. R. D. Kandou yang merupakan rumah sakit pusat rujukan di Indonesia Timur. Pada penelitian ini digunakan metode kualitatif melalui wawancara, pengamatan langsung di lapangan, dan observasi dokumen sebagai data sekunder. Hasil penelitian mendapatkan bahwa informed consent di Instalasi Gawat Darurat masih tetap dipakai, walaupun pada keadaan gawat darurat persetujuan diberikan secara lisan baru setelah selesai tindakan baru dimintakan tanda tangan pada lembar informed consent. Simpulan: Informed consent tetap diperlukan untuk setiap tindakan kedokteran yang dilakukan di RSUP Prof. Dr. R. D. Kandou termasuk pada Instalasi Gawat Darurat.Kata kunci: informed consent, emergency unit care

Outcomes following non-life-threatening orthopaedic trauma: Why are they considered to be so poor?

Trauma ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 133-138
Author(s):  
Rachele Quested ◽  
Scott Sommerville ◽  
Michael Lutz
Keyword(s):  
Risk Factors ◽  
Injury Severity ◽  
Relevant Literature ◽  
Educational Status ◽  
External Source ◽  
Initial Assessment ◽  
Future Research ◽  
Orthopaedic Trauma ◽  
Passive Coping ◽  
Physical Consequences

The purpose of this review article is to assess the current literature on the outcomes of simple orthopaedic trauma. Simple trauma is defined as the fracture or injury of one limb due to an acute event. Fractures are the most common cause of hospitalized trauma in Australia and associated with multiple social, psychological and physical consequences for patients. The literature to date suggests that there are multiple factors leading to relatively poor outcomes following simple trauma, modifiable and non-modifiable. The most oft cited are older age, lower educational status, being injured at work, injury severity score, pre-existing disease, workers compensation, litigation and pain at initial assessment. Additional psychological risk factors quoted attribute to the injury to an external source and the use of passive coping strategies. This review aims to summarise the relevant literature relating to these risk factors and give direction to improving outcomes and future research into this important area.

A Detailed Injury Severity Scale for Lower Limbs Based on Analysis of Injuries Sustained by Pedestrians

1983 ◽  
Author(s):  
J. Farisse ◽  
J. Bonnoit ◽  
B. Seriat-Gautier ◽  
C. Brunet ◽  
N. Daon ◽  
...  
Keyword(s):  
Injury Severity ◽  
Lower Limbs ◽  
Severity Scale

Acute kidney injury

2020 ◽  
pp. 4807-4829
Author(s):  
John D. Firth
Keyword(s):  
Acute Kidney Injury ◽  
Specific Treatment ◽  
Kidney Injury ◽  
Initial Assessment ◽  
Volume Depletion ◽  
Excretory Function ◽  
Tubular Necrosis ◽  
Life Threatening ◽  
Common Precipitant ◽  
General Aspects

Definition—for practical clinical purposes, acute kidney injury (AKI) is defined as a significant decline in renal excretory function occurring over hours or days, detected by either a fall in urinary output or a rise in the serum concentration of creatinine. Oliguria—defined (arbitrarily) as a urinary volume of less than 400 ml/day—is usually present, but not always. Clinical approach: diagnosis—all patients admitted to hospital with acute illness, but particularly older people and those with pre-existing chronic kidney disease, should be considered at risk of developing AKI. The most common precipitant is volume depletion. Serum creatinine and electrolytes should be measured on admission in all acutely ill patients, and repeated daily or on alternate days in those who remain so. Assessment—after treatment of life-threatening complications, the initial assessment of a patient who appears to have AKI must answer three questions: (1) is the kidney injury really acute? (2) Is urinary obstruction a possibility? And (3) is there a renal inflammatory cause? General aspects of management—the immediate management of a patient with renal impairment is directed towards three goals: (1) recognition and treatment of any life-threatening complications of AKI, (2) prompt diagnosis and treatment of hypovolaemia, and (3) specific treatment of the underlying condition—if this persists untreated then renal function will not improve. Specific causes of acute kidney injury—there are many possible causes of AKI, but in any given clinical context few of these are likely to require consideration. By far the most frequent are prerenal failure and acute tubular necrosis, which together account for 80 to 90% of cases of AKI seen by physicians.

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