Combat Application Tourniquet fares well in a chemical, biological, radiological or nuclear dress state

2020 ◽  
pp. jramc-2019-001261
Author(s):  
Alastair Beaven ◽  
E Sellon ◽  
M Ballard ◽  
P Parker
Keyword(s):  
Pain Score ◽  
Control Group ◽  
Published Data ◽  
Imaging Data ◽  
Pain Scores ◽  
British Military ◽  
Significant Difference ◽  
The Mean ◽  
Control Pain ◽  
Threat Environment

IntroductionThere is a need for a military tourniquet to control catastrophic haemorrhage in a chemical, biological, radiological or nuclear (CBRN) threat environment. No published data exist as to the efficacy of tourniquets while wearing British military CBRN individual protective equipment (IPE).Methods12 volunteers from the counter CBRN instructors’ course allowed testing on 24 legs. A Combat Application Tourniquet (C-A-T) was applied to all volunteers at the level of the midthigh. 12 legs were tested while wearing CBRN IPE (both operator and simulated casualty), and the control group of 12 legs was tested while wearing conventional combat dress state (both operator and simulated casualty). The order of leg laterality and dress state were sequenced according to a prerandomised system. Efficacy was measured via use of an ultrasound probe at the popliteal artery. Tourniquets were considered effective if arterial flow was completely occluded on ultrasound imaging. Data were collected on time to successful application, failure of tourniquets and pain scores as rated by the visual analogue scale (1–10).ResultsThere were no failures of tourniquet application in the CBRN group, and two failures (17%) in the control group. Failures were pain threshold exceeded (n=1) and tourniquet internal strap failure (n=1). The mean application time for the CBRN group was 28.5 s (SD 11.7) and 23.7 s (SD 9.8) for the conventional combat group. There was no statistically significant difference (p=0.27). The median CBRN pain score was 2.0 (IQR 2.0–3.5). The median control pain score was 4.0 (IQR 3–6). This was a statistically significant difference (p=0.002).ConclusionC-A-Ts applied to simulated casualties in CBRN IPE at the midthigh are at least as efficacious as those applied to the midthigh in a conventional combat dress state. The pain experienced was less in CBRN IPE than when in a conventional combat dress state.

The Use of Paravertebral Analgesia in the Management of Pain in the Elderly Patient With Rib Fractures

2020 ◽  
pp. 000313482093355
Author(s):  
Tarik Wasfie ◽  
Adam Howell ◽  
N Cwalina ◽  
Raquel Yapchai ◽  
Jennifer Hille ◽  
...  
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Rib Fractures ◽  
Morbidity Rate ◽  
Control Group ◽  
High Morbidity ◽  
Pain Scores ◽  
High Morbidity Rate ◽  
Significant Difference ◽  
The Mean

Background Elderly patients with rib fractures carry a high morbidity rate, particularly due to pulmonary complications as decreased respiratory efforts ensue secondary to pain. Risk of bleeds in the elderly on anticoagulant therapy is high. The effort to reduce narcotic use in patients is now a health care priority. We propose that the use of paravertebral analgesia (PVA) pumps is an alternative pain control method with less risk and easy placement. Methods Two hundred and seventy-nine patients were admitted with multiple fractured ribs to the Trauma Center of Community Hospital and treated with the application of continuous PVA via a pump (72 patients). Pain scores were recorded before and after the initiation of the pump. These patients were compared with a group of the remaining 207 patients who received intravenous narcotics only. Results The mean change from baseline in pain scores for all patients was 1.43 (SD = 2.75). The mean change in pain for the treatment group was 1.93 (SD = 2.60), and the change in pain for the control group was 1.24 (SD = 2.79). Change in pain differed between groups (1.3 vs 1.8; P = .01) although it was a small difference. After adjusting for age, gender, Injury Severity Score, Glasgow Coma Scale, number of fractures, and comorbid conditions, there was no significant difference in pain post-procedure (odds ratio = 0.75; P = 0.39) with an effect size of 30% and total sample size of 279. Conclusion The PVA pump using bupivacaine is an effective safe and alternative method for managing elderly patients with rib fractures eliminating the serious side effects associated with narcotics.

P91 Post-operative pain in neurosurgery

2019 ◽  
Vol 90 (3) ◽  
pp. e46.1-e46
Author(s):  
PM Haigh ◽  
F Al-Hatimi ◽  
H Stewart ◽  
S Rajagopal ◽  
S Khalifa ◽  
...  
Keyword(s):  
Pain Score ◽  
Spinal Surgery ◽  
Foramen Magnum ◽  
P Value ◽  
Inflammatory Agent ◽  
Pain Scores ◽  
Post Operative Period ◽  
Post Operative Pain ◽  
Significant Difference ◽  
The Mean

ObjectivesAre the analgesic guidelines for those neurosurgical operations associated with major and complex major pain consistently followed? Is there a correlation between adherence and post-operative pain?DesignPatients undergoing spinal surgery and foramen magnum decompressions were visited on the first post-operative day (D1). They provided their pain score subjectively (0=nil; 10=worst ever experienced); objectively we recorded whether they could move in/out of bed without pain limitation.Subjectsn=57 consecutive patients undergoing elective major and complex major pain neurosurgery between April and June 2018 at the NHNN, Queen Square.MethodsA proforma was completed on D1. The patients consented to take part and answered three questions. We examined what (if any) analgesics they were admitted on, and what had been prescribed to cover the post-operative period. This was compared against the appropriate guideline for that category of operation.ResultsGuidelines were only followed in 16/57 (28.1%) cases; not followed in 41/57 (71.9%). On an unpaired T-test: 2-tailed P value=0.0195. Where guidelines were followed, the mean pain score reported was: 3.75 (SD 2.72) Where not followed, the mean pain score was 5.46 (SD 2.29). So with a 95% confidence interval −3.41 to −0.29, there is a significant difference between the pain in those prescribed according to the guidelines and those that were not.ConclusionsThe pain guidelines are not routinely followed. Most commonly this was due to no prescription for a non-steroidal anti-inflammatory agent. We suggest regular sessions of education of the guidelines. Cycle 2 closed the loop of the audit. We re-reviewed adherence and pain scores and found guidelines were followed in 34% of cases, which represented a 6% improvement. On a paired two-tailed P value=0.0794. The mean pain score where guidelines were followed=3.42 (SD1.62) against a mean=4.74 (SD 1.89) where guidelines were not followed.

scholarly journals Influence of demographic profiles and spinal anaesthesia procedures on patients with treated and untreated coffee related to post dural puncture headache pain score

2021 ◽  
Vol 8 (3) ◽  
pp. 363-370
Author(s):  
Jyotsana ◽  
Sreeja L
Keyword(s):  
Pain Score ◽  
Spinal Anaesthesia ◽  
Dural Puncture ◽  
Control Group ◽  
Post Dural Puncture Headache ◽  
Demographic Profiles ◽  
Pain Scores ◽  
Significant Difference ◽  
And Control ◽  
Interventional Group

Post Dural Puncture Headache (PDPH) is an iatrogenic complication of spinal anaesthesia (SP) and has devastating consequences. To assess the effect of Coffee on occurrence of PDPH in post-operative patients of Interventional and control groups by comparing the mean PDPH pain scores related to demographic profiles and spinal anaesthesia procedures. An experimental approach in which 60 patients were recruited from the accessible population and was further allocated randomly to Interventional (30) and Control (30) groups. The patients were compared the demographical profiles viz. age, education and marital status and spinal anaesthesia procedures viz. surgery types, needle size and amount of fluid intake related to PDPH pain scores by Numerical Rating Scale after administration of three doses (130mg caffeine in 150ml) of coffee at intervals of 12hrs in Interventional group and only routine care in control group. The main findings in this study were that the incidence of PDPH is lower in Interventional group compared to control group with statistically significant difference (P<0.001) but it is not influenced by demographic profiles as well as SP procedures in Interventional group compared to control group without statistically significant observation after 24 hrs, 48hrs and 72hrs NRS pain score, respectively.The use coffee is an effective, safe, non-invasive treatment for prevention of PDPH.

scholarly journals Virtual reality distraction decreases pain during daily dressing changes following haemorrhoid surgery

2019 ◽  
Vol 47 (9) ◽  
pp. 4380-4388 ◽  
Author(s):  
Jie Ding ◽  
Yanyan He ◽  
Lishan Chen ◽  
Bili Zhu ◽  
Qiuping Cai ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Control Group ◽  
Control Groups ◽  
Open Label ◽  
Pain Scores ◽  
Significant Difference ◽  
The Mean ◽  
Baseline Characteristics ◽  
Dressing Change ◽  
And Control

Objective To investigate whether immersive virtual reality (VR) distraction could decrease pain during postoperative dressing changes. Methods This was a prospective, open-label randomized clinical trial that enrolled patients that had undergone haemorrhoidectomy. Patients were randomly assigned to one of two groups: a control group that received the standard pharmacological analgesic intervention during dressing change and a VR group that received VR distraction during dressing change plus standard pharmacological analgesic intervention. Pain scores and physiological measurements were collected before, during and after the first postoperative dressing change. Results A total of 182 patients were randomly assigned to the control and VR groups. The baseline characteristics of the VR and control groups were comparable. There was no significant difference in mean pain scores prior to and after the dressing change procedure between the two groups. The mean pain scores at the 5-, 10-, 15- and 20-min time-points during the first dressing change were significantly lower in the VR group compared with the control group. Heart rates and oxygen saturation were not significantly different between the two groups. Conclusion Immersive VR was effective as a pain distraction tool in combination with standard pharmacological analgesia during dressing change in patients that had undergone haemorrhoidectomy.

Controlled, non-inferiority trial of bupivacaine liposome injectable suspension

2019 ◽  
Vol 22 (10) ◽  
pp. 916-921
Author(s):  
Wanda J Gordon-Evans ◽  
Hanah Y Suh ◽  
Alonso G Guedes
Keyword(s):  
Body Wall ◽  
Pain Scale ◽  
Control Group ◽  
Multiple Time ◽  
Double Blind ◽  
Time Points ◽  
Pain Scores ◽  
The Mean ◽  
Multiple Time Points ◽  
Control Pain

Objectives Recently, a bupivacaine liposome injectable suspension (BLIS) became commercially available in the veterinary market that may provide local analgesia for 72 h. The purpose of this study was to compare a BLIS incisional block with a control protocol in cats after ovariohysterectomy (OHE). The hypothesis was that a BLIS block would provide equivalent pain relief. Methods This study was designed as a randomized, double-blind, non-inferiority trial. Students performed an OHE followed by a two-layer incisional and body wall block with either standard bupivacaine (control) or BLIS. Postoperatively, cats in the control group received robenacoxib, whereas the BLIS cats received saline. All cats were evaluated using the feline Glasgow Composite Measure Pain Scale (GCMPS) at multiple time points postoperatively. Results There were 24 control cats and 23 BLIS cats. One cat from each group required rescue medication. The mean GCMPS scores were low and the groups were equivalent at all time points ( P <0.05). This study showed that BLIS was equivalent to the control group up to 42 h and pain scores remained low up to 68 h after surgery. Conclusions and relevance BLIS incisional block is equivalent to a control pain protocol and reduces the need for continued postoperative drug administration.

scholarly journals Comparison of Visual Analog Pain Score Reported to Physician vs. Nurse, Part II

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0033
Author(s):  
Kevin Martin ◽  
Trevor McBride ◽  
Jeffrey Wake ◽  
Jeffrey Van Buren ◽  
Cuyler Dewar
Keyword(s):  
Pain Score ◽  
Nursing Staff ◽  
Patient Reported Outcome Measures ◽  
Mean Difference ◽  
Surgical Patients ◽  
Vas Score ◽  
Pain Scores ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean

Category: Ankle Introduction/Purpose: Patient reported outcome measures (PROMs) are taking a more prominent role in Orthopedics as researchers and health care networks seek to define treatment outcomes. However, interpretation and clinical applications of PROMs are still under investigation. The visual analogue scale (VAS) is considered a reliable and validated measure of acute pain. In a previous study, it was found that in surgical candidates the VAS pain score was significantly higher when reporting to the surgeon as opposed to the nurse. The aim of this current study is to examine whether this phenomenon occurs in patients that do not ultimately go on to have a surgical procedure. We hypothesize that there will be no difference in patient reporting to the surgeon versus the nursing staff. Methods: This study is a retrospective cohort of 201 consecutive non-surgical foot and ankle patients treated by a single surgeon. The patients were asked to rate their pain intensity by the nursing staff and then by the surgeon using a standard horizontal VAS 0 to 10, from “no pain” to worst pain.” Differences in reported pain levels were analyzed. Results: The mean VAS score reported to the nurse was 3.2 whereas the mean VAS score reported to the Surgeon was 4.2 (p<.001). Contrary to our hypothesis, there was a statistically significant difference in pain scores reported to the surgeon compared to the nurse. We then analyzed the mean difference of pain scores reported to surgeon and nurse for surgical versus non-surgical patients. The mean difference in VAS scores reported to physician and nurse for surgical patients was 2.87 whereas the mean difference for non-surgical patients was 1.00 (p < .001). Conclusion: The current study found statistically significant differences between VAS pain scores reported to the surgeon versus the nurse in non-surgical patients. These results support the trend found in our previous study which demonstrated discrepancies in patient pain reporting, with surgical patients reporting significantly higher pain scores to the surgeon versus the nurse. However, the mean difference between reported pain scores, to the providers, is significantly higher for surgical patients as compared to non-surgical patients. The cause of this phenomenon remains unclear, however, this study provides more information regarding patient reported VAS pain scores in an outpatient clinical setting.

Determination some Immunological Aspects in Pulmonary Tuberculosis Patients in Qadisiyah Province

2018 ◽  
Vol 9 (2) ◽  
Author(s):  
Syoof Khowman Alramahy ◽  
Akram Hadi Hamza
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Pulmonary Tuberculosis ◽  
Statistical Difference ◽  
Positive Culture ◽  
Control Group ◽  
Tuberculosis Patients ◽  
Significant Difference ◽  
Lowenstein Jensen ◽  
The Mean ◽  
Igg Level

This study was carried out to study of some immunological aspects among the pulmonary Tuberculosis patients infected with causative agent, Mycobacterium tuberculosis. A Total of 200 sputum samples were collected from patients attending the consultant Clinic for Chest and Respiratory disease center, Diwaniya. Control group (No=15) also included. According to acid fast stain of sputum, the patients were classified as positive (No=91,45.5%) and negative (No=109,54.5, Lowenstein Jensen medium used for the cultivation of samples, on which 70% of sputum samples where positive culture for this microorganism. The grown microorganism were identified as M. tuberculosis, based on positive A.F.B, Niacin producers ,negative for catlase at 68c. The mean IgG level was l184.053±76.684 mg/100 ml in tuberculosis group compared with 1016.533 ± 44.882 mg/100ml in control group, rendering the statistical difference significant. For IgA and IgM levels, they were at mean of 315.880±38.552 mg/100 ml and 119.527±8.464 mg/100 ml in control group compared with 396.358±38.776 mg/100 ml and 134.207±11.696 mg/100 ml in patients group respectively with significant difference

The analgesic efficacy of liposomal bupivacaine compared with bupivacaine hydrochloride for the prevention of postoperative pain: a systematic review and meta-analysis with trial sequential analysis

2021 ◽  
pp. rapm-2020-102427
Author(s):  
Hanns-Christian Dinges ◽  
Thomas Wiesmann ◽  
Berit Otremba ◽  
Hinnerk Wulf ◽  
Leopold H Eberhart ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Pain Score ◽  
Meta Analysis ◽  
End Points ◽  
Liposomal Bupivacaine ◽  
Bupivacaine Hydrochloride ◽  
Pain Scores ◽  
Score Difference ◽  
The Mean

Background/ImportanceLiposomal bupivacaine (LB) is a prolonged release formulation of conventional bupivacaine designed for prolonging local or peripheral regional single injection anesthesia. To this day, the benefit of the new substance on relevant end points is discussed controversial.ObjectiveThe objective was to determine whether there is a difference in postoperative pain scores and morphine consumption between patients treated with LB and bupivacaine hydrochloride in a systematic review and meta-analysis.Evidence reviewRandomized controlled trials (RCT) were identified in Embase, CENTRAL, MEDLINE and Web of Science up to May 2020. Risk of bias was assessed using Cochrane methodology. Primary end points were the mean pain score difference and the relative morphine equivalent (MEQ) consumption expressed as the ratio of means (ROM) 24 and 72 hours postoperatively.Findings23 RCTs including 1867 patients were eligible for meta-analysis. The mean pain score difference at 24 hours postoperatively was significantly lower in the LB group, at −0.37 (95% CI −0.56 to −0.19). The relative MEQ consumption after 24 hours was also significantly lower in the LB group, at 0.85 (0.82 to 0.89). At 72 hours, the pain score difference was not significant at −0.25 (−0.71 to 0.20) and the MEQ ratio was 0.85 (0.77 to 0.95).ConclusionThe beneficial effect on pain scores and opioid consumption was small but not clinically relevant, despite statistical significance. The effect was stable among all studies, indicating that it is independent of the application modality.

scholarly journals Complex Regional Pain Syndrome: Current Practice Management and Referral Trends in a Closed Healthcare System

Osteology ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 39-47
Author(s):  
Connor Zale ◽  
Joshua Hansen ◽  
Paul Ryan
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Complex Regional Pain Syndrome ◽  
Healthcare System ◽  
Pain Syndrome ◽  
Occupational Outcomes ◽  
Mean Delay ◽  
Significant Difference ◽  
The Mean ◽  
Over Time

Background: Complex regional pain syndrome (CRPS) is a neurologic condition that can present with severe pain and dysfunction. Delay in treatment adversely affects outcomes. The purpose of this study is to evaluate patient outcomes as they relate to the time from diagnosis to pain management referral once the diagnosis of CRPS has been made in a closed healthcare system. Methods: A retrospective record review from a closed healthcare system was utilized for CRPS cases from 2010–2019. Demographics, injury pattern, surgeries, pain score, treatment modalities, occupational outcomes, and time to pain management referral were recorded. Results: There were 26 cases of CRPS that met inclusion criteria. The mean time from diagnosis to treatment was 55 days. 16/26 (61.5%) were medically discharged from the military. 23/26 (88.5%) were unable to return to full duty due to CRPS. There was no significant difference in the reported pain scores over time regardless of treatment (p = 0.76). A linear regression demonstrated a significantly higher Visual Analog Scale Pain Score (VAS) over time in patients that were medically discharged (p = 0.022). Conclusions: The mean delay in referral to the pain service was 55 days. The majority of patients (88.5%) did not return to full duty secondary to the diagnosis of CRPS, and 61.5% of patients required medical separation from active duty. Due to the negative impact that the diagnosis of CRPS has on occupational outcomes with a mean delay in referral of 55 days, clinics and providers should set up referral criteria and establish early pain pathways for patients diagnosed with CRPS.

The Baby Shark (Songs Heard Affecting Resuscitation Kinetics) study

2020 ◽  
pp. bmjstel-2020-000657
Author(s):  
Rebecca Singer ◽  
Grace Leo ◽  
Tessa Davis ◽  
Ben Lawton ◽  
Henry Goldstein ◽  
...  
Keyword(s):  
Control Group ◽  
Control Groups ◽  
Target Zone ◽  
Compression Depth ◽  
Significant Difference ◽  
Overall Performance ◽  
The Mean ◽  
Training Exercises ◽  
And Control ◽  
Musical Cues

Previous research has examined the utilisation of musical cues to improve the performance of cardiopulmonary resuscitation (CPR) delivered in training environments. We postulated a musical cue that is both contemporary and transcends cultures may improve CPR performance. Our aim was to establish whether chest compressions are performed with improved rate and depth if a song of a fixed beat (PinkFong’s ‘Baby Shark’ with a tempo of 115 beats per minute (bpm) and 15 beats in each verse) is played to a healthcare professional immediately before undertaking CPR compared to whale noises (a non-metronomic rhythm). 58 Participants of a paediatric conference (majority doctors) were randomly assigned to listen to a minute of Baby Shark (28) or whale song (30) and then undertake a minute of CPR. There was no significant difference in the mean compression rate between the Baby Shark and control groups, with the groups achieving 121 and 125 bpm, respectively (p=0.18). In relation to compression depth within the target zone, the Baby Shark group had more compressions completed within the target zone (55%) than the control group (39%) although this difference was not significant (p=0.08). Listening to Baby Shark prior to undertaking simulated CPR does not improve overall performance, but there is a potential tendency to improve adequate compression depth which may be beneficial in training exercises.

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