7 Prehospital Management of Spinal Injuries

2009 ◽  
Keyword(s):  
Spinal Injuries ◽  
Prehospital Management

scholarly journals A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment

2020 ◽  
Vol 35 (5) ◽  
pp. 538-545
Author(s):  
Eric S. Weinstein ◽  
Joseph L. Cuthbertson ◽  
Luca Ragazzoni ◽  
Manuela Verde
Keyword(s):  
Focus Group ◽  
Spinal Injuries ◽  
Translational Science ◽  
Spinal Motion ◽  
Conflict Zones ◽  
The Third ◽  
Modified Delphi ◽  
Low Middle Income Countries ◽  
Prehospital Management ◽  
The Creation

AbstractIntroduction:Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments (RREs), whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSEs), such as: mass-casualty incidents (MCIs); low-middle income countries; complex humanitarian emergencies; conflict zones; and prolonged transport times. The application of Translational Science (TS) in the Disaster Medicine (DM) context was used to develop this study, leading to statements that can be used in the creation of evidence-based clinical guidelines (CGs).Objective:What is appropriate SMR in RSEs?Methods:The first round of this modified Delphi (mD) study was a structured focus group conducted at the World Association for Disaster and Emergency Medicine (WADEM) Congress in Brisbane Australia on May 9, 2019. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the second mD round questionnaire.Academic researchers and educators, operational first responders, or first receivers of patients with suspected spinal injuries were identified to be mD experts. Experts rated their agreement with each statement on a seven-point linear numeric scale. Consensus amongst experts was defined as a standard deviation ≤1.0. Statements that were in agreement reaching consensus were included in the final report; those that were not in agreement but reached consensus were removed from further consideration. Those not reaching consensus advanced to the third mD round.For subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement.Results:Twenty-two experts agreed to participate with 19 completing the second mD round and 16 completing the third mD round. Eleven statements reached consensus. Nine statements did not reach consensus.Conclusions:Experts reached consensus offering 11 statements to be incorporated into the creation of SMR CGs in RSEs. The nine statements that did not reach consensus can be further studied and potentially modified to determine if these can be considered in SMR CGs in RSEs.

SPINAL INJURIES

The Lancet ◽  
1963 ◽  
Vol 282 (7304) ◽  
pp. 409
Author(s):  
T.R. Beatson ◽  
F.W. Holdsworth
Keyword(s):  
Spinal Injuries

scholarly journals Spinal injuries in Rangoon, Burma

Spinal Cord ◽  
1978 ◽  
Vol 16 (1) ◽  
pp. 118-120 ◽  
Author(s):  
Than Toe
Keyword(s):  
Spinal Injuries

scholarly journals Epidemiology and outcomes from severe hypoglycemia in Kuwait: a prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dalal Al Hasan ◽  
Ameen Yaseen ◽  
Mohammad Al Roudan ◽  
Lee Wallis
Keyword(s):  
Severe Hypoglycaemia ◽  
Management Strategies ◽  
Severe Hypoglycemia ◽  
Inclusion Criteria ◽  
Initial Management ◽  
Scene Management ◽  
Prehospital Management ◽  
Improve Patient Management ◽  
Current Guidelines ◽  
Improve Patient

Abstract Background The objective of this study was to describe the epidemiology of severe hypoglycaemia in Kuwait, aiming to provide a preliminary background to update the current guidelines and improve patient management. Method This was a prospective analysis of severe hypoglycaemia cases retrieved from emergency medical services (EMS) archived data between 1 January and 30 June 2020. The severe hypoglycaemia cases were then sub-grouped based on EMS personal initial management and compared in terms of scene time, transportation rate, complications and outcomes. The primary outcomes were GCS within 10–30 min and normal random blood glucose (RBS) within 10–30 min. Results A total of 167 cases met the inclusion criteria. The incidence of severe hypoglycaemia in the national EMS was 11 per 100,000. Intramuscular glucagon was used on scene in 89% of the hypoglycaemic events. Most of the severe hypoglycaemia patients regained normal GCS on scene (76.5%). When we compared the two scene management strategies for severe hypoglycaemia cases, parenteral glucose administration prolonged the on-scene time (P = .002) but was associated with more favourable scene outcomes than intramuscular glucagon, with normal GCS within 10–30 min (P = .05) and normal RBS within 10–30 min (P = .006). Conclusion: Severe hypoglycaemia is not uncommon during EMS calls. Appropriate management by EMS personals is fruitful, resulting in favourable scene outcomes and reducing the hospital transportation rate. More research should be invested in improving and structuring the prehospital management of severe hypoglycaemia. One goal is to clarify the superiority of parenteral glucose over intramuscular glucagon in the prehospital setting.

scholarly journals A Prospective Study of Posterior (Transpedicular) Approach versus Anterior (Transthoracic/Thoracoabdominal) Approach for Posttraumatic Compression Fracture of Thoracolumbar Vertebra in a Tertiary Care Center: Comparison of Clinical and Radiological Outcomes

2020 ◽  
Author(s):  
Rahul Varshney ◽  
Parthasarathi Datta ◽  
Pulak Deb ◽  
Santanu Ghosh
Keyword(s):  
Prospective Study ◽  
Posterior Approach ◽  
Spinal Injuries ◽  
Anterolateral Approach ◽  
Kyphotic Angle ◽  
Posterior Group ◽  
Thoracoabdominal Approach ◽  
A Prospective Study ◽  
Anterior Group

Abstract Objective The aim of this article was to analyze the clinical and radiological outcomes of transpedicular decompression (posterior approach) and anterolateral approach in patients with traumatic thoracolumbar spinal injuries. Methods  It was a prospective study of patients with fractures of dorsolumbar spine from December 2011 to December 2013. A total of 60 patients with traumatic spinal injuries were admitted during the study period (December 2011–2013), of which 51 cases were finally selected and taken for operations while 3 were eventually lost in follow-up. Twenty patients were operated by anterolateral approach, titanium mesh cage, and fixation with bicortical screws. Twenty-eight patients were treated with posterior approach and transpedicular screw fixation. Clinical and radiographic evaluations were performed on all 48 patients before and after surgery. Results There were 48 patients of thoracolumbar burst fractures with 40 male and 8 female patients. Range of follow-up was from 1 month to 20 months, with a mean of 7.4. Preoperatively in anterior group, 65% of the patients were bed ridden, 20% patients were able to walk with support, and 15% of the patients were able to walk without support. In posterior group, 78.57% patients were bed ridden, 10.71% were able to walk with support, and 10.71% patients were able to walk without support. Kyphotic angle changes were seen in 16 patients out of 18 in anterior group and 20 patients in posterior group out of 25. Out of 18 patients in anterior group, 14 showed reduction in kyphotic angle of 10 to 100 (improvement), with mean improvement of 4.070. In posterior group, 7 patients showed improvement of 10 to 80 (reduction in kyphotic angle) whereas 13 patients showed deterioration of 1 to 120. The mean improvement was 2.140 in 7 patients and mean deterioration was 4.920. No statistical difference was found (p > 0.05) regarding improvement in urinary incontinence during the follow-up period. Conclusion There are significant differences in anterior and posterior approaches in terms of clinical improvement. Compared with posterior approach, the anterolateral approach can reduce fusion segment and well maintain the kyphosis correction. The selection of treatment should be based on clinical and radiological findings, including neurological deficit.

Spinal Injuries

2021 ◽  
pp. 181-209
Author(s):  
Mark J. Spoonamore ◽  
Demetrios Demetriades
Keyword(s):  
Spinal Injuries

scholarly journals Prehospital management of exertional heat stroke at sports competitions: International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020

2021 ◽  
pp. bjsports-2020-103854
Author(s):  
Yuri Hosokawa ◽  
Sebastien Racinais ◽  
Takao Akama ◽  
David Zideman ◽  
Richard Budgett ◽  
...  
Keyword(s):  
Rectal Temperature ◽  
Working Group ◽  
Olympic Games ◽  
Heat Stroke ◽  
International Olympic Committee ◽  
Exertional Heat Stroke ◽  
Weather Impact ◽  
Prehospital Management ◽  
Adverse Weather ◽  
Expert Working Group

ObjectivesThis document aimed to summarise the key components of exertional heat stroke (EHS) prehospital management.MethodsMembers of the International Olympic Committee Adverse Weather Impact Expert Working Group for the Olympic Games Tokyo 2020 summarised the current best practice regarding the EHS prehospital management.ResultsSports competitions that are scheduled under high environmental heat stress or those that include events with high metabolic demands should implement and adopt policy and procedures for EHS prehospital management. The basic principles of EHS prehospital care are: early recognition, early diagnosis, rapid, on-site cooling and advanced clinical care. In order to achieve these principles, medical organisers must establish an area called the heat deck within or adjacent to the main medical tent that is optimised for EHS diagnosis, treatment and monitoring. Once admitted to the heat deck, the rectal temperature of the athlete with suspected EHS is assessed to confirm an elevated core body temperature. After EHS is diagnosed, the athlete must be cooled on-site until the rectal temperature is below 39°C. While cooling the athlete, medical providers are recommended to conduct a blood analysis to rule out exercise-associated hyponatraemia or hypoglycaemia, provided that this can be safely performed without interrupting cooling. The athlete is transported to advanced care for a full medical evaluation only after the treatment has been provided on-site.ConclusionsA coordination of care among all medical stakeholders at the sports venue, during transport, and at the hospital is warranted to ensure effective management is provided to the EHS athlete.

scholarly journals Outcomes of Patients Treated with Prehospital Noninvasive Ventilation: Observational Retrospective Multicenter Study in the Northern French Alps

2021 ◽  
Vol 10 (7) ◽  
pp. 1359
Author(s):  
Julie Pinczon ◽  
Nicolas Terzi ◽  
Pascal Usseglio-Polatera ◽  
Gaël Gheno ◽  
Dominique Savary ◽  
...  
Keyword(s):  
Noninvasive Ventilation ◽  
Medical Emergency ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Cardiogenic Pulmonary Edema ◽  
Prehospital Management ◽  
Medical Emergency Teams ◽  
Prehospital Diagnosis ◽  
Current Guidelines ◽  
Retrospective Multicenter Study

Noninvasive ventilation (NIV) improves the outcome of acute cardiogenic pulmonary edema (AcPE) and acute exacerbation of chronic obstructive pulmonary disease (aeCOPD) but is not recommended in pneumonia. The aim of this study was to assess the appropriateness of the use of NIV in a prehospital setting, where etiological diagnostics rely mainly on clinical examination. This observational multicenter retrospective study included all the patients treated with NIV by three mobile medical emergency teams in 2015. Prehospital diagnoses and hospital diagnoses were extracted from the medical charts. The appropriateness of NIV was determined by matching the hospital diagnosis to the current guidelines. Among the 14,067 patients screened, 172 (1.2%) were treated with NIV. The more frequent prehospital diagnoses were AcPE (n = 102, 59%), acute respiratory failure of undetermined cause (n = 46, 28%) and aeCOPD (n = 17, 10%). An accurate prehospital diagnosis was more frequent for AcPE (83/88, 94%) than for aeCOPD (14/32, 44%; p < 0.01). Only two of the 25 (8%) pneumonia cases were diagnosed during prehospital management. Prehospital NIV was inappropriate for 32 (21%) patients. Patients with inappropriate NIV had a higher rate of in-hospital intubation than patients with appropriate NIV (38% vs. 8%; p < 0.001). This high frequency of inappropriate NIV could be reduced by an improvement in the prehospital detection of aeCOPD and pneumonia.

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