scholarly journals Prehospital resuscitation

2021 ◽  
Vol 6 (1) ◽  
pp. e000729
Author(s):  
Alexandra M P Brito ◽  
Martin Schreiber
Keyword(s):  
Young People ◽  
Tranexamic Acid ◽  
New Technologies ◽  
Blood Product ◽  
Traumatic Injury ◽  
Trauma Patients ◽  
Blood Products ◽  
Front Line ◽  
The Usa ◽  
Review Current

Traumatic injury is the leading cause of death in young people in the USA. Our knowledge of prehospital resuscitation is constantly evolving and is often informed by research based on military experience. A move toward balanced blood product resuscitation and away from excessive crystalloid use has led to improvements in outcomes for trauma patients. This has been facilitated by new technologies allowing more front-line use of blood products as well as use of tranexamic acid in the prehospital setting. In this article, we review current practices in prehospital resuscitation and the studies that have informed these practices.

Effect of tranexamic acid administration time on blood product use in urban trauma patients

2020 ◽  
Vol 77 (Supplement_2) ◽  
pp. S46-S53 ◽  
Author(s):  
Elizabeth Tencza ◽  
Andrew J Harrell ◽  
Preeyaporn Sarangarm
Keyword(s):  
Tranexamic Acid ◽  
Blood Product ◽  
Trauma Patients ◽  
Loading Dose ◽  
Blood Products ◽  
Ambulance Personnel ◽  
Product Usage ◽  
Packed Red Blood Cells ◽  
Product Use ◽  
Acid Administration

Abstract Purpose To evaluate the effect of time to tranexamic acid administration on blood product usage in trauma patients and to assess the potential benefit of initiating a protocol for field administration by ground ambulance personnel. Methods Adult patients with traumatic injuries who received 1 g of tranexamic acid during the period January 2014 through June 2016 were retrospectively identified via review of automated dispensing cabinet and electronic medical record data and cross-referencing with the New Mexico Trauma Registry. Exclusion criteria included tranexamic acid use for nontrauma indications, previous admission for trauma during the study period, and a lack of pertinent information regarding the time, type, or severity of trauma in available records. The primary outcome was blood product use (aggregate of units of platelets, packed red blood cells [pRBCs], and fresh frozen plasma [FFP]) in the first 24 hours of hospital admission. Results The analysis included 107 patient cases, with a median transport time of 20 minutes (range, 7-103 minutes); 73% of reported transport times were less than 30 minutes. All patients received a loading dose of tranexamic acid in the hospital, with the exception of 2 patients who received tranexamic acid in the field. Administration of a tranexamic acid loading dose was documented within 3 hours for 90.7% of patients, with a mean time to administration of 91.9 minutes. A mean (SD) total of 14.8 (16.0) units of blood products (range, 0-91 units) were administered, consisting of a mean (SD) of 8.0 (8.4) units of pRBCs (range, 0-48 units), 5.6 (7.5) units of FFP (range, 0-38 units), and 1.2 (1.7) units of platelets (range, 0-7 units). Time to tranexamic acid administration did not affect blood product usage in the first 24 hours of admission after adjusting for potential confounders. Conclusion Earlier administration of tranexamic acid was not associated with a decrease in use of blood products. This finding, paired with the relatively short ground transport times typical for our institution, makes it unlikely that field administration of tranexamic acid would benefit the evaluated patient population.

Tranexamic Acid Treatment for Trauma Victims

2021 ◽  
Author(s):  
Ian Roberts ◽  
Amy Brenner ◽  
Haleema Shakur-Still
Keyword(s):  
Tranexamic Acid ◽  
Traumatic Injury ◽  
Low Risk ◽  
Baseline Risk ◽  
Trauma Patients ◽  
Wide Range ◽  
Risk Patients ◽  
Polytrauma Patients ◽  
Time Critical ◽  
Proportional Reduction

AbstractWorldwide, traumatic injury is responsible for over 5 million deaths per year, the majority due to exsanguination and head injury. The antifibrinolytic drug tranexamic acid is the only drug proven to reduce deaths after traumatic injury. Several large randomized controlled trials have provided high-quality evidence of its effectiveness and safety in trauma patients. Early tranexamic acid reduces deaths on the day of the injury in polytrauma patients and patients with isolated traumatic brain injury by around 20%. Treatment is time critical; for patients to benefit, tranexamic acid must be given as soon as possible after injury. Intramuscular administration is well tolerated and rapidly absorbed, with the potential to reduce time to treatment. Because the proportional reduction in bleeding death with tranexamic acid does not vary by baseline risk, a wide range of trauma patients stands to benefit. There are far more low-risk trauma patients than high-risk patients, with a substantial proportion of bleeding deaths in the low-risk group. As such, treatment should not be limited to patients with severe traumatic hemorrhage. We must give paramedics and physicians the confidence to treat a far wider range of trauma patients while emphasizing the importance of early treatment.

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.

scholarly journals Prehospital Plasma Transfusion: What Does the Literature Show?

2021 ◽  
pp. 1-8
Author(s):  
Bryon P. Jackson ◽  
Jason L. Sperry ◽  
Mark H. Yazer
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Traumatic Injury ◽  
Limited Resource ◽  
Trauma Patients ◽  
Blood Products ◽  
Mortality Benefit ◽  
Transport Time ◽  
Cytokine Expression Profile ◽  
Transfusion Requirements

<b><i>Background:</i></b> Early initiation of blood products transfusion after injury has been associated with improved patient outcomes following traumatic injury. The ability to transfuse patients’ plasma in the prehospital setting provides a prime opportunity to begin resuscitation with blood products earlier and with a more balanced plasma:RBC ratio than what has traditionally been done. Published studies on the use of prehospital plasma show a complex relationship between its use and improved survival. <b><i>Summary:</i></b> Examination of the literature shows that there may be a mortality benefit from the use of prehospital plasma, but that it may be limited to certain subgroups of trauma patients. The likelihood of realizing these survival benefits appears to be predicted by several factors including the type of injury, length of transport time, presence of traumatic brain injury, and total number of blood products transfused, whether the patient required only a few products or a massive transfusion. When taken as a whole the evidence appears to show that prehospital plasma may have a mortality benefit that is most clearly demonstrated in patients with blunt injuries, moderate transfusion requirements, traumatic brain injury, and/or transport time greater than 20 min, as well as those who demonstrate a certain cytokine expression profile. <b><i>Key Messages:</i></b> The evidence suggests that a targeted use of prehospital plasma will most likely maximize the benefits from the use of this limited resource. It is also possible that prehospital plasma may best be provided through whole blood as survival benefits were greatest in patients who received both prehospital plasma and RBCs.

Influence of Tranexamic Acid on Inflammatory Signaling in Trauma

2020 ◽  
Vol 46 (02) ◽  
pp. 183-188
Author(s):  
Christopher D. Barrett ◽  
Yi Wen Kong ◽  
Michael B. Yaffe
Keyword(s):  
Tranexamic Acid ◽  
Inflammatory Responses ◽  
Traumatic Injury ◽  
Essential Medicines ◽  
World Health ◽  
Trauma Patients ◽  
Inflammatory Signaling ◽  
Inflammatory Signals ◽  
The World ◽  
Available Lysine

AbstractPlasmin generation in trauma patients has wide-ranging effects, from breakdown of clots to remodeling the extracellular matrix. An evolving recognition of plasmin as a critical effector molecule in various inflammatory signals and pathways has rendered the study of plasmin(ogen) and its regulation by upstream activators and downstream targets and inhibitors key to understanding the inflammatory responses to trauma. Tranexamic acid, a widely available lysine analogue medication on the World Health Organization's list of essential medicines, has rapidly become one of the most commonly implemented adjunct treatments for bleeding after traumatic injury in clinical practice. In this article, we review the effects, both anti- and proinflammatory, of tranexamic acid, with a focus on the injured trauma patient.

Perceptions of Marginalized Youth on Learning through Technologies

2011 ◽  
pp. 180-203
Author(s):  
Jean Johnson ◽  
Jonny Dyer ◽  
Ben Lockyer
Keyword(s):  
Online Learning ◽  
Young People ◽  
Information And Communication Technologies ◽  
School System ◽  
Large Scale ◽  
Formal Education ◽  
New Technologies ◽  
The Usa ◽  
Information And Communication ◽  
The Uk

This chapter examines students’ views of learning with technologies through four related case studies that utilized online learning with marginalized young people. The studies were carried out in the UK, Austria, Ireland, Sweden and the USA with young people aged 14-21 who had dropped out of formal education. Ethnographic research was used but quantitative data was also gathered to contextualize the qualitative approach. The views and opinions of these young people were used to aid the development of online learning platforms and their content for use both with static computers and mobile devices. The results suggested that the young people embrace new technologies in such a way that they evidence deep thinking and deep learning. However, use of technologies in this way is not possible on a large scale within the existing school system. Further research should examine how the school system can better embrace the way that young people use Information and Communication Technologies (ICT) tools into their learning.

ТЕЛЕВІЗІЙНА КОМУНІКАЦІЯ В КОНТЕКСТІ РОЗВИТКУ СУСПІЛЬСТВА

2020 ◽  
pp. 68
Author(s):  
O. Yatchuk ◽  
N. Kodatska
Keyword(s):  
Public Opinion ◽  
Mobile Communications ◽  
Mass Communication ◽  
New Technologies ◽  
Modern World ◽  
Digital Television ◽  
Broadband Internet ◽  
Television Content ◽  
The Usa ◽  
Traditional Technologies

<div><p><em>The article presents the dynamics of the main factors for the development of modern television, the transition from traditional technologies of television broadcasting to the latest technologies. The process of developing digital television and broadband has been technically determined to address the challenge of integrating new technologies into traditional TV content. Ways of expanding the possibilities of interaction between the viewer and the television producer in the context of overcoming the crisis of traditional technologies are analyzed. It is determined that integration, development of mobile communications and Internet technologies are a hallmark of the modern world media space and have a significant influence on the formation of public opinion. The analysis of actual media researches concerning problems of the theory of mass communication is carried out. The phenomenon of «social television», which combines watching TV with simultaneous communication in social networks, is considered. The author draws attention to the disclosure of the determining factors of media communication, the study of the process of feedback from viewers on television. It is stated that the development of modern technologies, namely digital broadcasting and introduction of broadband Internet access to create a multimedia platform that combines Internet communication services and television content, contributes to improving the mechanism of interaction between the TV and the viewer. The theory of the conceptualization of journalism based on identity construction is examined: journalists understand their audience and, as members of that audience, connect with their communities. An analysis of integrated journalistic activity is conducted, which consists of three stages: gathering, editing and disseminating information. It is determined that the influence of the Internet allows the consumer to play his or her role at each stage, thus helping the journalist determine the degree of relevance of the story to himself and to the potential audience. The common features of modern telecontent were singled out and a comparative analysis of the trend of development of interactive TV programs of the USA, UK and Ukraine was made.</em></p></div><p><strong><em>Key words:</em></strong><em> public opinion, two-vector communication, feedback, communication methods, television audience, country telephony.</em></p>

PSYCHOLOGICAL APPROACHES TO PREVENTION OF EXTREMISM IN THE HIGHER EDUCATION SYSTEM

2020 ◽  
Vol 22 (12) ◽  
pp. 5-9
Author(s):  
Livak N.S. ◽  
Klimova I.V. ◽  
Lebedikhin V.V.
Keyword(s):  
Young People ◽  
Moral Education ◽  
Social Life ◽  
New Technologies ◽  
Value Orientations ◽  
Educational Process ◽  
Educational Work ◽  
Higher Education System ◽  
Student Community ◽  
And Behavior

Modern youth and the student community today play a key role in the development of social and social life. Due to the peculiarities of the university space, the student community is in constant interaction and communication, both in the framework of the educational process and events of various formats, and in social and everyday conditions. In the context of interactions, this social group, which is most at risk of spreading negative ideologies that threaten not only the personal security of everyone, but also peaceful coexistence in the conditions of a multinational society in Russia. In the absence of educational measures as a prevention, an unfavorable environment arises in which it is very easy to influence the thinking of young people, their involvement in nationalist movements, extremist activities, etc. Hence the concept of «youth extremism» appears, which is manifested in the views and behavior of young people based on the manifestation of aggression and non-acceptance of dissenters. The search for new technologies of psychological support that allow to form cultural tolerance, value orientations and prevent the spread of extremist ideologies becomes relevant. The authors consider a set of measures that contribute to the generalization, dissemination, as well as the introduction into the student environment of the best practices of spiritual and moral education, the development of interethnic and interreligious dialogue, and the prevention of negative ideologies. To implement these tasks, it is necessary to form a pool of specialists in the prevention of extremism in the student environment, hold seminars and meetings for vice-rectors of universities on security and educational work, as well as educational seminars for managers of student organizations. This will make it possible to form leadership student associations that broadcast the values of cultural tolerance to the youth environment.

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