scholarly journals Tension Pneumothorax in Prehospital Setting

2021 ◽  
pp. 1-1
Author(s):  
Yagmur Ay ◽  
Mustafa Emin Canakci
Keyword(s):  
Tension Pneumothorax ◽  
Prehospital Setting

scholarly journals MP42: Evaluating clinical and situational factors related to the likelihood of physician authorization for time-sensitive procedures during mandatory paramedic patches

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S57-S58
Author(s):  
D. Kelton ◽  
S. Doran ◽  
M. Davis ◽  
K. Van Aarsen ◽  
J. Momic
Keyword(s):  
Prehospital Care ◽  
Tension Pneumothorax ◽  
Situational Factors ◽  
Prehospital Setting ◽  
Audio Recordings ◽  
Close Proximity ◽  
Transcutaneous Pacing ◽  
Symptomatic Bradycardia ◽  
Efficient Care ◽  
The Impact

Introduction: Delegation of controlled medical acts by physicians to paramedics is an important component of the prehospital care framework. Where directives indicate that physician input is needed before proceeding with certain interventions, online medical control (a “patch”) exists to facilitate communication between a paramedic and a Base Hospital Physician (BHP) to request an order to proceed with that intervention. The clinical and logistical setting will contribute to the decision to proceed with or withhold an intervention in the prehospital setting. The aim of this study was to examine the impact of various clinical and situational factors on the likelihood of a patch request being granted. Methods: Prehospital paramedic calls that included a mandatory patch point (excluding requests exclusively for termination of resuscitation and those records which were unavailable) were identified through review of all patch records from January 1, 2014 to December 31, 2017 for Paramedic Services in our region. Written Ambulance Call Reports (ACRs) and audio recordings of paramedic patches were obtained and reviewed. Results: 214 patch records were identified and screened for inclusion. 91 ACRs and audio patch records were included in the analysis. 51 of 91 (56%) patch requests were granted by the BHP. Of the 40 paramedic requests that were not granted, the most commonly cited reason was close proximity to hospital (22/40; 55%) followed by low likelihood of the intervention making a clinical impact in the prehospital setting (11/40; 27.5%). Requests for certain interventions were more likely to be granted than other requests. All requests to perform needle thoracostomy for possible tension pneumothorax, administer atropine for symptomatic bradycardia and treat hemodynamically unstable hyperkalemia were granted (2/2, 3/3 and 7/7, respectively), while requests for synchronized cardioversion (7/19; 37%) and transcutaneous pacing (2/6; 33%) were approved less than half of the time. Conclusion: This retrospective review suggests that requests to perform certain critical and potentially time sensitive interventions are more likely to be granted which calls into question the requirement for a mandatory patch point for these procedures. Furthermore, the interplay between proximity to hospital and the decision to proceed with an intervention potentially informs future modifications to directives to facilitate timely, safe and efficient care.

Survival case of acute and severe respiratory distress due to spontaneous tension gastrothorax

2020 ◽  
Vol 13 (9) ◽  
pp. e235281
Author(s):  
Sanjan Asanaru Kunju ◽  
Prithvishree Ravindra ◽  
Ramya Kumar Madabushi Vijay ◽  
Priya Pattath Sankaran
Keyword(s):  
Tension Pneumothorax ◽  
Emergency Laparotomy ◽  
Severe Respiratory Distress ◽  
Mediastinal Shift ◽  
Breath Sounds ◽  
Chest X Ray ◽  
The Right ◽  
Tension Gastrothorax ◽  
Obstructive Shock ◽  
Survival Case

A 20-year-old woman presented with abdominal pain and shortness of breath. She was in obstructive shock with absent breath sounds on the left haemithorax. Chest X-ray showed a large radiolucent shadow with absent lung markings and mediastinal shift to the right side with concerns for tension pneumothorax. Though tube thoracostomy was done on the left side of the chest, column movement was absent. To confirm the diagnosis CT with contrast was done that revealed a huge left side diaphragmatic defect with abdominal contents in the thorax and mediastinal structures are shifted to left. She underwent emergency laparotomy and postoperative period was uneventful.

scholarly journals Two cases of intraoperative hemodynamic instability during combined thoracoscopic-laparoscopic surgery for esophagogastric junction carcinoma

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Makiko Tani ◽  
Yoshikazu Matsuoka ◽  
Mayu Sugihara ◽  
Ayaka Fujii ◽  
Tomoyuki Kanazawa ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Esophagogastric Junction ◽  
Intraoperative Complications ◽  
Proximal Gastrectomy ◽  
Tension Pneumothorax ◽  
Hemodynamic Instability ◽  
Laparoscopic Proximal Gastrectomy ◽  
Surgical Field ◽  
Coronary Ischemia ◽  
Thoracic And Abdominal

Abstract Background Intraoperative complications during combined thoracoscopic-laparoscopic surgery for esophagogastric junction (EGJ) carcinoma have not been reported as compared to those during surgery for esophageal carcinoma. We present two cases which had surgery-related hemodynamic instability during laparoscopic proximal gastrectomy and intra-mediastinal valvuloplastic esophagogastrostomy (vEG) with thoracoscopic mediastinal lymphadenectomy for EGJ carcinoma. Case presentation In case 1, the patient fell into hypotension with hypoxemia during laparoscopic vEG due to pneumothorax caused by entry of intraabdominal carbon dioxide. In case 2, ventricular arrythmia and ST elevation occurred during laparoscopic vEG. Pericardium retraction to secure surgical field during reconstruction compressed the coronary artery, which caused coronary malperfusion. These two events were induced by the surgical procedure, characterized by the following: (1) connection of the thoracic and abdominal cavities and (2) cardiac displacement during vEG. Conclusion These cases indicated tension pneumothorax and coronary ischemia are possible intraoperative complications specific to combined thoracoscopic-laparoscopic surgery for EGJ carcinoma.

scholarly journals Prehospital characteristics of COVID-19 patients in Helsinki – experience of the first wave of the pandemic

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Markku Kuisma ◽  
Heini Harve-Rytsälä ◽  
Jussi Pirneskoski ◽  
James Boyd ◽  
Mitja Lääperi ◽  
...  
Keyword(s):  
Foreign Language ◽  
World Health Organisation ◽  
Prehospital Setting ◽  
Tympanic Temperature ◽  
World Health ◽  
Who Criteria ◽  
Laboratory Confirmation ◽  
Patient Groups ◽  
Mode Of Transportation ◽  
Time Urgency

Abstract Background There is a lack of knowledge how patients with COVID-19 disease differ from patients with similar signs or symptoms (but who will have a diagnosis other than COVID-19) in the prehospital setting. The aim of this study was to compare the characteristics of these two patient groups met by the emergency medical services. Methods All prehospital patients after the World Health Organisation (WHO) pandemic declaration 11.3.2020 until 30.6.2020 were recruited for the study. The patients were screened using modified WHO criteria for suspected COVID-19. Data from the electronic prehospital patient reporting system were linked with hospital laboratory results to check the laboratory confirmation for COVID-19. For comparison, we divided the patients into two groups: screening- and laboratory-positive patients with a hospital diagnosis of COVID-19 and screening-positive but laboratory-negative patients who eventually received a different diagnosis in hospital. Results A total of 4157 prehospital patients fulfilled the criteria for suspected COVID-19 infection during the study period. Five-hundred-thirty-six (12.9%) of the suspected cases received a laboratory confirmation for COVID-19. The proportion of positive cases in relation to suspected ones peaked during the first 2 weeks after the declaration of the pandemic. In the comparison of laboratory-positive and laboratory-negative cases, there were clinically insignificant differences between the groups in age, tympanic temperature, systolic blood pressure, heart rate, on-scene time, urgency category of the call and mode of transportation. Foreign-language-speakers were overrepresented amongst the positive cases over native language speakers (26,6% vs. 7,4%, p < 0,001). The number of cases in which no signs or symptoms of COVID-19 disease were reported, but patients turned out to have a positive test result was 125 (0,3% of the whole EMS patient population and 11,9% of all verified COVID-19 patients encountered by the EMS). Conclusions In a sample of suspected COVID-19 patients, the laboratory-positive and laboratory-negative patients were clinically indistinguishable from each other during the prehospital assessment. Foreign-language-speakers had a high likelihood of having Covid-19. The modified WHO criteria still form the basis of screening of suspected COVID-19 patients in the prehospital setting.

scholarly journals Efficacy of tracheal tube introducers and stylets for endotracheal intubation in the prehospital setting: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Jaden Tollman ◽  
Zubair Ahmed
Keyword(s):  
Systematic Review ◽  
Endotracheal Intubation ◽  
Tracheal Tube ◽  
Meta Analysis ◽  
Prehospital Setting ◽  
Cochrane Central Register ◽  
Success Rates ◽  
Video Technology ◽  
Summary Estimate ◽  
First Pass

Abstract Purpose Tracheal tube introducers and stylets remain some of the most widely used devices for aiding practitioners in performing endotracheal intubation (ETI). The purpose of this systematic review is to evaluate the efficacy of tracheal tube introducers and stylets for ETI in the prehospital setting. Methods A literature search was conducted on the 2nd of March 2021 across PubMed, Embase (Ovid) and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify relevant studies. Included studies had their data extracted and both a quality assessment and statistical analysis were performed. Results The summary estimate of prehospital studies with video technology showed a statistically significant increase in first pass ETI success in favour of bougies (RR 1.15, CI 1.10–1.21, p < 0.0001). The summary estimates of prehospital studies without video technology and simulation studies with and without video technology showed no statistical difference between methods for first pass or overall ETI success. Some of the highest success rates were recorded by devices that incorporated video technology. Stylets lead to a shorter time to ETI while bougies were easier to use. Neither device was associated with a higher rate of ETI complications than the other. Conclusion Both tracheal tube introducers and stylets function as efficacious aids to intubation in the prehospital environment. Where video technology is available, bougies could offer a statistically significant advantage in terms of first pass ETI success. Where video technology is unavailable, a combination of clinical scenario, practitioner expertise and personal preference might ultimately guide the choice of device.

scholarly journals A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Tim Nutbeam ◽  
Rob Fenwick ◽  
Jason Smith ◽  
Omar Bouamra ◽  
Lee Wallis ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Blood Loss ◽  
Injury Severity ◽  
Spinal Cord Injuries ◽  
Motor Vehicle ◽  
Tension Pneumothorax ◽  
Research Network ◽  
Motor Vehicle Collisions ◽  
Vehicle Collisions ◽  
Time Critical

Abstract Background Motor vehicle collisions (MVCs) are a common cause of major trauma and death. Following an MVC, up to 40% of patients will be trapped in their vehicle. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation. This approach is time consuming and patients may have time-critical injuries. The purpose of this study is to describe the outcomes and injuries of those trapped following an MVC: this will help guide meaningful patient-focused interventions and future extrication strategies. Methods We undertook a retrospective database study using the Trauma Audit and Research Network database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2018. Patients were excluded when their outcomes were not known or if they were secondary transfers. Results This analysis identified 426,135 cases of which 63,625 patients were included: 6983 trapped and 56,642 not trapped. Trapped patients had a higher mortality (8.9% vs 5.0%, p < 0.001). Spinal cord injuries were rare (0.71% of all extrications) but frequently (50.1%) associated with other severe injuries. Spinal cord injuries were more common in patients who were trapped (p < 0.001). Injury Severity Score (ISS) was higher in the trapped group 18 (IQR 10–29) vs 13 (IQR 9–22). Trapped patients had more deranged physiology with lower blood pressures, lower oxygen saturations and lower Glasgow Coma Scale, GCS (all p < 0.001). Trapped patients had more significant injuries of the head chest, abdomen and spine (all p < 0.001) and an increased rate of pelvic injures with significant blood loss, blood loss from other areas or tension pneumothorax (all p < 0.001). Conclusion Trapped patients are more likely to die than those who are not trapped. The frequency of spinal cord injuries is low, accounting for < 0.7% of all patients extricated. Patients who are trapped are more likely to have time-critical injuries requiring intervention. Extrication takes time and when considering the frequency, type and severity of injuries reported here, the benefit of movement minimisation may be outweighed by the additional time taken. Improved extrication strategies should be developed which are evidence-based and allow for the expedient management of other life-threatening injuries.

Ready for Children Part II: Increasing Pediatric Care Coordination and Psychomotor Skills Evaluation in the Prehospital Setting

2021 ◽  
pp. 1-10
Author(s):  
Hilary A. Hewes ◽  
Andrea L. Genovesi ◽  
Rachel Codden ◽  
Michael Ely ◽  
Lorah Ludwig ◽  
...  
Keyword(s):  
Care Coordination ◽  
Prehospital Setting ◽  
Pediatric Care ◽  
Psychomotor Skills

Glucose as an additional parameter to National Early Warning Score (NEWS) in prehospital setting enhances identification of patients at risk of death: an observational cohort study

2020 ◽  
pp. emermed-2018-208309
Author(s):  
Hanna Vihonen ◽  
Mitja Lääperi ◽  
Markku Kuisma ◽  
Jussi Pirneskoski ◽  
Jouni Nurmi
Keyword(s):  
At Risk ◽  
Blood Glucose ◽  
Regression Model ◽  
Early Warning ◽  
Prehospital Setting ◽  
Early Warning Score ◽  
Calibration Model ◽  
Risk Of Death ◽  
Patients At Risk ◽  
National Early Warning Score

BackgroundTo determine if prehospital blood glucose could be added to National Early Warning Score (NEWS) for improved identification of risk of short-term mortality.MethodsRetrospective observational study (2008–2015) of adult patients seen by emergency medical services in Helsinki metropolitan area for whom all variables for calculation of NEWS and a blood glucose value were available. Survival of 24 hours and 30 days were determined. The NEWS parameters and glucose were tested by multivariate logistic regression model. Based on ORs we formed NEWSgluc model with hypoglycaemia (≤3.0 mmol/L) 3, normoglycaemia 0 and hyperglycaemia (≥11.1 mmol/L) 1 points. The scores from NEWS and NEWSgluc were compared using discrimination (area under the curve), calibration (Hosmer-Lemeshow test), likelihood ratio tests and reclassification (continuous net reclassification index (cNRI)).ResultsData of 27 141 patients were included in the study. Multivariable regression model for NEWSgluc parameters revealed a strong association with glucose disturbances and 24-hour and 30-day mortality. Likelihood ratios (LRs) for mortality at 24 hours using a cut-off point of 15 were for NEWSgluc: LR+ 17.78 and LR− 0.96 and for NEWS: LR+ 13.50 and LR− 0.92. Results were similar at 30 days. Risks per score point estimation and calibration model showed glucose added benefit to NEWS at 24 hours and at 30 days. Although areas under the curve were similar, reclassification test (cNRI) showed overall improvement of classification of survivors and non-survivors at 24 days and 30 days with NEWSgluc.ConclusionsIncluding glucose in NEWS in the prehospital setting seems to improve identification of patients at risk of death.

Comparison of a Colorimetric End-Tidal CO2 Detector and an Esophageal Aspiration Device for Verifying Endotracheal Tube Placement in the Prehospital Setting: A Six-Month Experience

1997 ◽  
Vol 12 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Richard J. Schaller ◽  
J. Stephen Huff ◽  
Allan Zahn
Keyword(s):  
Cardiac Arrest ◽  
Endotracheal Tube ◽  
Sensitivity And Specificity ◽  
Nasotracheal Intubation ◽  
Prehospital Setting ◽  
Tube Placement ◽  
Emergency Department Physician ◽  
Significant Difference ◽  
End Tidal ◽  
Chi Square Analysis

AbstractIntroduction:Hand held, colorimetric, end-tidal CO2 detector devices are being used to verify correct endotracheal tube (ETT) placement. The accuracy of these devices has been questioned in situations of cardiac arrest. The use of the esophageal detector device (EDD) is an easy alternative for detection of ETT placement, and may be more accurate in situations of cardiac arrest.Hypothesis:The use of the esophageal aspiration device in comparison with a colorimetric end-tidal CO2 detector is more accurate in detecting proper ETT placement and easier to use in the prehospital setting than is the colorimetric end-tidal CO2 detection device.Methods:This was a prospective alternating weeks, 6-month study in a prehospital setting. Participants included all patients older than 18 years who were intubated by the Portsmouth, Virginia Emergency Medical Services (EMS) personnel from 01 July 1993 through 31 December 1993. The aspiration device used, also known as an esophageal detector device (EDD), was a 60 ml, luer-lock syringe attached to a 15 mm ETT adapter. Its efficacy was compared with an already accepted method of ETT position detection, the colorimetric endtidal CO2 detector. Each device was used on alternating weeks, and correct ETT placement was determined by the receiving emergency department physician using standard techniques. Chi-square analysis and Fisher's Exact test were used to compare parameters, time of device use, and ease of use. Sensitivity and specificity were calculated, and provider preference was assessed using a survey instrument administered following completion of the study.Results:There were 49 patients who met the inclusion criteria, but six were excluded because of situational circumstances rendering use of the device a possible compromise of patient care. Twenty-five patients were in the EDD group, and 18 were in the endtidal CO2 detector group. There was no statistically significant difference detected between groups for the gender ratio, underlying condition, CPR in progress, perceived difficulty of intubation, or percentage of nasotracheal intubation. The EDD was significantly easier to use (p<0.005). There was no statistically significant difference in time required for use of end-tidal CO2 detector device versus the EDD. The sensitivity and specificity for correct tracheal placement using the EDD was 100%, and the sensitivity for correct tracheal placement using the end-tidal CO2 detector device was 78%. Use of the EDD was preferred over use of the end-tidal CO2 detector device by 75% of participating EMS providers. One case of nasotracheal intubation with an ETT placement above the cords raised the question of accuracy of this device in situations where direct visualization is not utilized.Conclusion:The EDD was accurate in all cases of orotracheal intubation, and was easier to use than was end-tidal CO2 detector device. It was preferred by 75% of participating EMS providers. In cases in which the ETT may be above the vocal cords, caution must be used with interpreting the results obtained by use of the EDD.

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