Prehospital Treatment with Dobutamine

1993 ◽  
Vol 8 (3) ◽  
pp. 247-249
Author(s):  
Bjarne Oberg ◽  
Mogens Bredgaard Sorensen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infusion Pump ◽  
Mean Value ◽  
Prehospital Treatment ◽  
Emergency Situations ◽  
Life Saving ◽  
Circulatory Insufficiency ◽  
Mobile Intensive Care Unit ◽  
Blood Pressures

AbstractPurpose:To assess the effectiveness of the use of dobutamine hydrochloride in out-of hospital emergency situations.Population:Patients with severe circulatory insufficiency caused by acute illness or injury encountered by the Mobile Intensive Care Unit of Copenhagen (population 467,000) during a 15-month study period.Methods:A newly developed dobutamine solution was administered by infusion pump to patients in whom normal emergency treatment failed to restore an acceptable circulatory state.Results:A total of 40 patients were treated with 4–48 μg dobutamine/kg/minute. The treatment was judged to be primary life-saving in 15 patients, the condition was improved in 16 patients, and nine patients died. Systolic blood pressures (in those who survived) rose from a mean value of 45 mmHg (range 0–80 mmHg) to 105 mmHg (range 65–180 mmHg). No tachycardia or arrhythmias were noted.Conclusion:This newly developed dobutamine solution is very useful in prehospital treatment of patients with circulatory failure and is recommend for use by mobile intensive care unit teams.

The Development and Evaluation of a Paramedic-Staffed Mobile Intensive Care Unit for Interfacility Patient Transport

1996 ◽  
Vol 11 (1) ◽  
pp. 37-43 ◽  
Author(s):  
Robert M. Domeier ◽  
James D. Hill ◽  
Roger D. Simpson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Staff ◽  
Mean Value ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Patient Transport ◽  
Cooperative Program ◽  
Mobile Intensive Care Unit ◽  
Control Authority

AbstractObjective:As the role of paramedics evolves, evaluation of their ability to accomplish an expanded scope of practice is necessary. The objective of this study was to determine whether specially trained paramedics can monitor and treat patients appropriately during interfacility transports that traditionally have required the use of supplemental, hospital-based personnel.Methods:A paramedic-staffed mobile intensive care unit was developed as a cooperative program between Huron Valley Ambulance and the Washtenaw/Livingston County Medical Control Authority. This prospective observational study involved 111 patients requiring interfacility transport, conveyed by a paramedic-staffed mobile intensive care unit. A change in the Acute Physiologic and Chronic Health Evaluation (APACHE II) score components of mean arterial pressure, heart rate, and respiratory rate at the beginning and end of the transport was used to evaluate the ability of the paramedics to accomplish the transfer appropriately.Results:APACHE II scares increased in 20 patients, decreased in 16, and were unchanged in 75. The mean value for the change in APACHE score was 0.11 (95% confidence interval: −0.11−0.33).Conclusion:Specially trained paramedics can monitor and treat patients appropriately during interfacility transfers that traditionally would have required supplementation with additional hospital staff.

A bed-mounted mobile intensive-care unit

1988 ◽  
Vol 12 (3) ◽  
pp. 121-123
Author(s):  
R. Railton ◽  
S. R. P. Docker ◽  
A. J. Munley ◽  
W. Richardson ◽  
G. M. Harvey
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mobile Intensive Care Unit

scholarly journals Quality of interhospital transport of the critically ill: impact of a Mobile Intensive Care Unit with a specialized retrieval team

Critical Care ◽  
2011 ◽  
Vol 15 (1) ◽  
pp. R75 ◽  
Author(s):  
Janke S Wiegersma ◽  
Joep M Droogh ◽  
Jan G Zijlstra ◽  
Janneke Fokkema ◽  
Jack JM Ligtenberg
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Interhospital Transport ◽  
Mobile Intensive Care Unit ◽  
Retrieval Team

scholarly journals Reducing errors in the administration of medication with infusion pumps in the intensive care department: A lean approach

2019 ◽  
Vol 7 ◽  
pp. 205031211882262
Author(s):  
Alexander F van der Sluijs ◽  
Eline R van Slobbe-Bijlsma ◽  
Astrid Goossens ◽  
Alexander PJ Vlaar ◽  
Dave A Dongelmans
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Confidence Interval ◽  
Medication Errors ◽  
Infusion Pump ◽  
Baseline Measurement ◽  
Infusion Pumps ◽  
Improvement Measures ◽  
The Impact

Background: Medication errors occur frequently and may potentially harm patients. Administering medication with infusion pumps carries specific risks, which lead to incidents that affect patient safety. Objective: Since previous attempts to reduce medication errors with infusion pumps failed in our intensive care unit, we chose the Lean approach to accomplish a 50% reduction of administration errors in 6 months. Besides improving quality of care and patient safety, we wanted to determine the effectiveness of Lean in healthcare. Methods: We conducted a before-and-after observational study. After baseline measurement, a value stream map (a detailed process description, used in Lean) was made to identify important underlying causes of medication errors. These causes were discussed with intensive care unit staff during frequent stand-up sessions, resulting in small improvement cycles and bottom-up defined improvement measures. Pre-intervention and post-intervention measurements were performed to determine the impact of the improvement measures. Infusion pump syringes and related administration errors were measured during unannounced sequential audits. Results: Including the baseline measurement, 1748 syringes were examined. The percentage of errors concerning the administration of medication by infusion pumps decreased from 17.7% (95% confidence interval, 13.7–22.4; 55 errors in 310 syringes) to 2.3% (95% confidence interval, 1–4.6; 7 errors in 307 syringes) in 18 months (p < 0.0001). Conclusion and Relevance: The Lean approach proved to be helpful in reducing errors in the administration of medication with infusion pumps in a high complex intensive care environment.

scholarly journals Using Catecholamines in Prehospital Settings by French Mobile Intensive Care Unit

2001 ◽  
Vol 16 (S1) ◽  
pp. S75-S75
Author(s):  
K. Tazarourte ◽  
L. Goix ◽  
N. Bertozzi ◽  
J. M. Felden ◽  
P.I. Rouge
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mobile Intensive Care Unit

scholarly journals Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients – real-world data from the Acute Coronary Syndrome Israeli Survey

2017 ◽  
Vol 7 (6) ◽  
pp. 497-503 ◽  
Author(s):  
Edward Koifman ◽  
Roy Beigel ◽  
Zaza Iakobishvili ◽  
Nir Shlomo ◽  
Yitschak Biton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Odds Ratio ◽  
St Elevation Myocardial Infarction ◽  
Ischemic Time ◽  
Mobile Intensive Care Unit ◽  
St Elevation ◽  
Mobile Intensive Care Units ◽  
One Year

Background: Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients. Methods: Data from the Acute Coronary Survey in Israel registry 2000–2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes. Results: The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( p<0.001). Independent predictors of mobile intensive care unit use were Killip>1 (odds ratio=1.32, p<0.001), the presence of cardiac arrest (odds ratio=1.44, p=0.02), and a systolic blood pressure <100 mm Hg (odds ratio=2.01, p<0.001) at presentation. Patients arriving via mobile intensive care units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, p<0.001). Among ST-elevation myocardial infarction patients undergoing primary reperfusion, those arriving by mobile intensive care unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120–262) vs 195 (interquartile range 130–333) min, respectively ( p<0.001)). Upon a multivariate analysis, mobile intensive care unit use was the most important predictor in achieving door-to-balloon time <90 min (odds ratio=2.56, p<0.001) and door-to-needle time <30 min (odds ratio=2.96, p<0.001). One-year mortality rates were 10.7% in both groups (log-rank p-value=0.98), however inverse propensity weight model, adjusted for significant differences between both groups, revealed a significant reduction in one-year mortality in favor of the mobile intensive care unit group (odds ratio=0.79, 95% confidence interval (0.66–0.94), p=0.01). Conclusions: Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.

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