Prehospital life support in trauma patients should be questioned

BMJ ◽  
2003 ◽  
Vol 327 (7414) ◽  
pp. 0-d-0
Keyword(s):  
Life Support ◽  
Trauma Patients

Case Report: FAST Ultrasound Interpretation in Trauma Resuscitation

POCUS Journal ◽  
2016 ◽  
Vol 1 (3) ◽  
pp. 13-14
Author(s):  
Stuart Douglas, PGY4 ◽  
Joseph Newbigging, MD ◽  
David Robertson, MD
Keyword(s):  
Case Report ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Life Support ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Ultrasound Probe ◽  
Trauma Resuscitation ◽  
Highly Sensitive ◽  
Pouch Of Douglas

FAST Background: Focused Assessment with Sonography for Trauma (FAST) is an integral adjunct to primary survey in trauma patients (1-4) and is incorporated into Advanced Trauma Life Support (ATLS) algorithms (4). A collection of four discrete ultrasound probe examinations (pericardial sac, hepatorenal fossa (Morison’s pouch), splenorenal fossa, and pelvis/pouch of Douglas), it has been shown to be highly sensitive for detection of as little as 100cm3 of intraabdominal fluid (4,5), with a sensitivity quoted between 60-98%, specificity of 84-98%, and negative predictive value of 97-99% (3).

AP091 Advanced life support versus basic life support is not associated with increased survival in trauma patients: A meta-analysis

Resuscitation ◽  
2011 ◽  
Vol 82 ◽  
pp. S30 ◽  
Author(s):  
George Bakalos ◽  
Christos Komninos ◽  
Apostolis Tsantilas ◽  
Theophilos Rosenberg
Keyword(s):  
Basic Life Support ◽  
Life Support ◽  
Meta Analysis ◽  
Advanced Life Support ◽  
Trauma Patients

scholarly journals Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

2021 ◽  
Author(s):  
Adel Hamed Elbaih ◽  
Maged El-Setouhy ◽  
Jon Mark Hirshon ◽  
Hazem Mohamed El-Hariri ◽  
Mohamed El-Shinawi
Keyword(s):  
Low Income ◽  
Life Support ◽  
University Hospital ◽  
Low Income Countries ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Education Programs ◽  
Missed Injuries ◽  
Polytrauma Patients ◽  
Trauma Education

Abstract IntroductionTrauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.AimImprove the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.MethodsThis interventional training study was conducted in the SCUH ED that adheres to CONSORT guidelines. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.ResultsOverall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.ConclusionSTEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.Trial RegistrationProject manager for the Pan African Clinical Trial Registry (www.pactr.org) database has been accepted with the date of approval:18/11/2020. Current Controlled Trials number for the registry is PACTR202011853914203. Please note that the article state Retrospectively registered that my study adheres to CONSORT guidelines.

scholarly journals Pitfalls when using extracorporeal life support in trauma patients

2019 ◽  
Vol 4 (1) ◽  
pp. e000298 ◽  
Author(s):  
Shokei Matsumoto ◽  
Masahi Morizane ◽  
Kiyokuni Matsuo ◽  
Motoyasu Yamazaki ◽  
Mitsuhide Kitano
Keyword(s):  
Life Support ◽  
Extracorporeal Life Support ◽  
Trauma Patients

scholarly journals Medical and surgical devices in the emergency and trauma patient: what the radiologist should know, and how they can add value

2020 ◽  
pp. 20200530
Author(s):  
Marcela De La Hoz Polo ◽  
Amandeep Sandhu ◽  
Elika Kashef ◽  
Christopher Aylwin ◽  
Duncan Bew ◽  
...  
Keyword(s):  
Medical Devices ◽  
Life Support ◽  
Formal Training ◽  
Trauma Patients ◽  
Acute Setting ◽  
Endotracheal Tubes ◽  
Acute Trauma ◽  
Radiological Appearance ◽  
Surgical Devices ◽  
Limited Experience

A variety of different external and internal medical devices are used in the acute setting to maintain life support and manage severely injured and unstable trauma or emergency patients. These devices are inserted into the acutely ill patient with the specific purpose of improving outcome, but misplacement can cause additional morbidity and mortality. Consequently, meaningful interpretation of the position of devices can affect acute management. Some devices such as nasopharyngeal, nasogastric and endotracheal tubes and chest and surgical drains are well known to most clinicians, however, little formal training exists for radiologists in composing their report on the imaging of these devices. The novice radiologist often relies on tips and phrases handed down in an aural tradition or resorts to phrases such as: “position as shown”. Furthermore, radiologists with limited experience in trauma might not be familiar with the radiological appearance of other more specific devices. This review will focus on the most common medical devices used in acute trauma patients, indications, radiological appearance and their correct and suboptimal positioning.

Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study

2018 ◽  
Vol 33 (3) ◽  
pp. 230-236 ◽  
Author(s):  
Felicia M. Mix ◽  
Martin D. Zielinski ◽  
Lucas A. Myers ◽  
Kathy S. Berns ◽  
Anurahda Luke ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Patient Care ◽  
Blood Product ◽  
Life Support ◽  
Descriptive Study ◽  
Blood Product Transfusion ◽  
Trauma Patients ◽  
Blood Products ◽  
Total Patient ◽  
Significant Difference

AbstractIntroductionHemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).MethodsThis was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).ResultsA total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.ConclusionsIn this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.MixFM, ZielinskiMD, MyersLA, BernsKS, LukeA, StubbsJR, ZietlowSP, JenkinsDH, SztajnkrycerMD. Prehospital blood product administration opportunities in ground transport ALS EMS – a descriptive study. Prehosp Disaster Med. 2018;33(3):230–236.

Extracorporeal cardiopulmonary life support with heparinbonded circuitry in the resuscitation of massively injured trauma patients

Resuscitation ◽  
1996 ◽  
Vol 31 (2) ◽  
pp. 166
Author(s):  
MJ Perchinsky ◽  
WB Long ◽  
JG Hill ◽  
JA Parsons ◽  
JB Bennett
Keyword(s):  
Life Support ◽  
Trauma Patients

Managing the Monitors: An Analysis of Alarm Silencing Activities during an Anesthetic Procedure

2000 ◽  
Vol 44 (26) ◽  
pp. 250-253 ◽  
Author(s):  
Yan Xiao ◽  
Colin F. Mackenzie ◽  
F. Jacob Seagull ◽  
Mahmood Jaberi
Keyword(s):  
Critical Care ◽  
Airway Management ◽  
Patient Monitoring ◽  
Life Support ◽  
Attention Allocation ◽  
Trauma Patients ◽  
Care Providers ◽  
The Real ◽  
Patient Status ◽  
Monitoring Devices

Patient monitoring devices are designed to assist users in obtaining information on the patient and life-support equipment status. Most of the these devices have built-in visual and auditory alarms, which are to help the user to manage attention allocation. In this presentation we describe an analysis of the interaction between care providers and the monitoring devices during an anesthetic procedure (airway management) for trauma patients in the real environment. The videotapes of 47 cases were analyzed by coding the activities in silencing auditory alarms. In majority of the cases (87%) alarms could be heard yet only a small portion of the cases (6%) contained patient status events that signified by the alarm conditions. Care providers were frequently forced to interrupt clinical tasks to silence alarms. The differences in silencing frequency and rapidity among different monitoring devices suggest that alarms could be designed to be less intrusive and more tolerable, thus making the monitors easier to manage in critical care settings

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

2013 ◽  
Vol 33 (6) ◽  
pp. 18-24 ◽  
Author(s):  
Stavros Gourgiotis ◽  
George Gemenetzis ◽  
Hemant M. Kocher ◽  
Stavros Aloizos ◽  
Nikolaos S. Salemis ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Life Support ◽  
Operative Management ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Permissive Hypotension ◽  
Randomized Controlled Clinical Trials ◽  
Resuscitation Fluid ◽  
Crystalloid Solutions ◽  
Prehospital Trauma Life Support

Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient’s current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary.

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