scholarly journals Trajectory of the Victims of Overland Transport Accidents: From Prehospital to Hospital Care

2020 ◽  
Vol 6 ◽  
pp. 237796082091963
Author(s):  
Neiliane M. Alencar ◽  
Daiane S. Mota ◽  
Flávia Emília Cavalcante Valença Fernandes ◽  
Rachel Mola
Keyword(s):  
Glasgow Coma Scale ◽  
Hospital Care ◽  
Prehospital Care ◽  
Seat Belt ◽  
Significance Level ◽  
Coma Scale ◽  
The Difference ◽  
Occurrence Type ◽  
Transportation Accident ◽  
Transport Accidents

Objective The aim is to evaluate the trajectory of the victims of ground transportation accidents from the prehospital care to the hospital. Methods The sample consisted of 1,264 patients collected from the prehospital care, from June 2015 to June 2016. The trajectory was analyzed by the difference in the average time elapsed between the call and the hospital entrance. The Mann–Whitney and Kruskal–Wallis tests were used, adopting a significance level of 5% and 95% confidence. Results Patients had a mean age of 31.2 years, Glasgow Coma Scale of 14.8 points, and 24.8 days of hospitalization. It is characterized predominantly masculine, conductive of the vehicle, being the motorcycle prevalent; most of them wore a helmet/seat belt and no alcohol. The association between the average time of care and the characteristics related to the victim was significant: the use of the belt/helmet, alcoholism, and type of discharge and relative to the accident: area of occurrence, period of the week, shift of occurrence, type of prehospital care, and other party involved. Conclusion The characteristics related to ground transportation accident interfere in the time of prehospital care to the hospital, which can influence the prognosis.

scholarly journals Prevalência e fatores associados aos acidentes por motocicleta segundo zona de ocorrência

2020 ◽  
Vol 19 (3) ◽  
pp. 93-134
Author(s):  
Isa Gabriela Oliveira Ramos Cavalcanti ◽  
Flávia Emília Cavalcante Valença Fernandes ◽  
Rachel Mola
Keyword(s):  
Glasgow Coma Scale ◽  
Urban Area ◽  
Rural Areas ◽  
Traffic Accidents ◽  
Prehospital Care ◽  
Night Shift ◽  
Bivariate Analysis ◽  
Coma Scale ◽  
Significant Difference ◽  
The Mean

Investigación descriptiva, analítica y documental que analiza la prevalencia y los factores asociados a los accidentes de motocicleta según el área de ocurrencia. Los datos provienen de registros de atención prehospitalaria. Se realizaron estadísticas descriptivas e inferenciales, y los factores asociados se analizaron mediante regresión logística binaria, adoptando una significación del 5% y 95% de confianza. La muestra totalizó 1.039 víctimas. La mayoría de los registros ocurrieron en el área urbana, que involucraban al hombre, donde la víctima era el conductor del vehículo, no había ingerido alcohol y usado el casco. La mayoría de las asistencias fueron realizadas por el Servicio de Asistencia Móvil de Emergencia, al final de la semana y en el turno de noche. La puntuación media de la escala de coma de Glasgow para el área urbana fue ligeramente superior a la rural, con una diferencia significativa. El tiempo medio entre la solicitud de atención y la llegada al lugar del suceso, así como entre la solicitud de atención y el ingreso hospitalario fueron significativos, prevaleciendo en las zonas rurales. En el análisis bivariado de la asociación de accidentes de tráfico en motocicleta con la zona de ocurrencia, las variables que mostraron una asociación significativa fueron: la escala de coma de Glasgow, el tiempo entre la solicitud y la llegada del servicio, el tiempo entre la solicitud del servicio y la admisión hospital, sexo, consumo de alcohol, uso de casco, otra parte involucrada, período de ocurrencia, giro del accidente, tipo de atención y tipo de alta de la víctima. Descriptive, analytical and documentary research that analyzed the prevalence and factors associated with motorcycle accidents according to the area of occurrence. The data came from prehospital care records. Descriptive and inferential statistics were performed, and the associated factors were analyzed using binary logistic regression, adopting a significance of 5% and 95% confidence. The sample totaled 1,039 victims. Most of the records occurred in the urban area, involving the male, where the victim was the driver of the vehicle, had not ingested alcohol and used the helmet. Most of the attendances were performed by the Emergency Mobile Attendance Service, at the end of the week and at night shift. The mean score of the Glasgow Coma Scale for the urban area was slightly higher than the rural one, with a significant difference. The mean time between the request for care and the arrival at the place of occurrence, as well as between the request for care and hospital admission were significant, being prevalent for rural areas. In the bivariate analysis of the association of traffic accidents by motorcycle with the occurrence zone, the variables that showed a significant association were: Glasgow coma scale, time between request and arrival of the service, time between request of service and admission hospital, sex, alcohol intake, helmet use, other party involved, period of occurrence, accident turn, type of care and discharge type of the victim.

scholarly journals Assessment of Nurse’s Knowledge About Glasgow Coma Scale at al Dhafra Hospitals, Abu Dhabi, United Arab Emirates 2018

2018 ◽  
Vol 3 (7) ◽  
Keyword(s):  
Glasgow Coma Scale ◽  
United Arab Emirates ◽  
Neurological Examination ◽  
Abu Dhabi ◽  
Patient Specific ◽  
P Value ◽  
Cross Sectional ◽  
Coma Scale ◽  
Level Of Consciousness ◽  
The Difference

Background: The most important assessment in the neurological examination is to assess the level of consciousness (LOC), which is considered as the first step in neurological examination. Detecting the changes in level of consciousness depends on the accuracy of nursing assessment. The nurses should be knowledgeable, confident, and quick in performing this task. Purpose: of this study is to assess UAE nurses’ knowledge about GCS working in Al Dhafer Hospitals, Abu Dhabi, United Arab Emirates. Methodology: This study was carried out in the Dhafra hospitals, Abu Dhabi, United Arab Emirates in April 2018. It is a cross-sectional, descriptive study. Eighty-five nurses met the inclusion criteria, the survey was sent to 165 nurses (Respondent rate 51%). Data collection was carried out using a survey monkey instru¬ment called “Glasgow Coma Scale”. Data coding, entry and analysis has been conducted using SPSS 20 software. The difference has been tested at 95% level of significance, and the difference that has P-value < 0.05 was considered significant. Results: The study revealed that the knowledge percentages mean of correct answers about GCS is 56.1 % {SD: ±11.7; 95% CI: [26.67-100]}. On the other hand, it revealed also that the percentages of nurses who have a good knowledge about GCS were 50.6% and staffs whom have poor knowledge were 49.4 %. Moreover, the results revealed significant relation between gender and GCS training with level of GCS knowledge. Conclusion and recommendations: The present study showed that the nurses in Al-Dhafra hospitals reflect inadequate knowledge. This finding raises concerns about the importance of knowledge and skill in assessing GCS. Continuing education and practice on the use of the GCS tool are important. A Brochure and booklet should be designated and distributed to all nurses who working in critical care units and dealing with an unconscious patient. Specific and advanced courses about GCS should be conducted in Al-Dhafra hospitals.

Diffuse cerebral swelling following head injuries in children: the syndrome of “malignant brain edema”

1981 ◽  
Vol 54 (2) ◽  
pp. 170-178 ◽  
Author(s):  
Derek A. Bruce ◽  
Abass Alavi ◽  
Larissa Bilaniuk ◽  
Carol Dolinskas ◽  
Walter Obrist ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Head Injuries ◽  
Clinical History ◽  
Complete Recovery ◽  
Ct Scans ◽  
Content Type ◽  
Coma Scale ◽  
The Difference ◽  
Ct Density

✓ The commonest initial computerized tomography (CT) finding in head-injured children is bilateral diffuse cerebral swelling. Cerebral blood flow and CT density studies suggest that this swelling is due to cerebral hyperemia and increased blood volume, not to edema. The clinical history, course, and outcome of 63 children with this CT pattern are reviewed. Fourteen children had a Glasgow Coma Scale score of greater than 8; all made a complete recovery and follow-up CT scans were normal. Forty-nine children had Glasgow Coma Scale scores of 8 or less. Fifteen had a history of a lucid period following the initial unconsciousness. One of these children died of delayed brain swelling, the others recovered well with minimal neurological deficit. Thirty-four children were rendered immediately and continuously unconscious. There was a high incidence of second lesions on the CT scan, 50% of this group developed intracranial hypertension and five died. All of the others were in coma for periods ranging from weeks to months. Follow-up CT scans showed an extracerebral collection with a density of cerebrospinal fluid in 27% of the patients, and ventriculomegaly with large sulci in 35%, whereas this pattern was seen only once in those with a lucid period. The difference between those with and without a lucid period is related to the degree of primary diffuse impact injury to the white matter.

scholarly journals Teaching Glasgow Coma Scale Assessment by Videos: A Prospective Interventional Study among Surgical Residents

2020 ◽  
Vol 11 (03) ◽  
pp. 381-384
Author(s):  
Jitin Bajaj ◽  
Sanjay Rathore ◽  
Vijay Parihar ◽  
Pawan Agarwal ◽  
Yad Ram Yadav ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
General Surgery ◽  
P Value ◽  
Chi Square ◽  
Coma Scale ◽  
Maximum Benefit ◽  
Before And After ◽  
Chi Square Test ◽  
The Difference ◽  
A Prospective Study

Abstract Objective Glasgow Coma Scale (GCS) assessment is vital for the management of various neurological, neurosurgical, and critical care disorders. Learning GCS scoring needs good training and practice. Due to limitation of teachers, the new entrants of the clinical team find it difficult to learn and use it correctly. Training through videos is being increasingly utilized in the medical field. This study aimed to evaluate the efficiency of video teaching of GCS scoring among general surgery residents. Materials and Methods A prospective study was done utilizing the freely available video at glasgowcomascale.org. The participants (general surgery residents, 1st–3rd year) were asked to assess and record their responses related to GCS both before and after watching the video. A blinded neurosurgeon recorded the correct responses separately. Statistical Analysis The difference between correct responses of the residents before and after watching the video was calculated using the “chi-square test.” p-Value ≤ 0.05 was taken as significant. Results There was a significant improvement in GCS scoring by residents after watching the videos (p < 0.05). On estimating the responses separately, all the three responses (eye, verbal, and motor) improved significantly for 1st-year residents while only the motor response improved significantly for 2nd- and 3rd-year residents. The mode subjective improvement for the 1st-, 2nd-, and 3rd-year residents was 5, 4, and 3, respectively. Conclusion Training GCS scoring through videos is an effective way of teaching the surgery residents with maximum benefit to the junior-most ones.

scholarly journals Study of Glasgow Coma Scale Score and QTc Interval in Prognosis of Organophosphate Compound Poisoning

2012 ◽  
Vol 3 ◽  
pp. IJCM.S9807
Author(s):  
Archana Deshpande ◽  
Nitin Gaikwad ◽  
Sanjay Deshpande
Keyword(s):  
Respiratory Failure ◽  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Qt Interval ◽  
Hospital Care ◽  
Hospital Setting ◽  
Qtc Interval ◽  
Coma Scale ◽  
Gcs Score ◽  
Complications And Mortality

We assessed the applicability of the Glasgow Coma Scale (GCS) and the QT interval (QTc) to predicting outcomes in patients with organophosphate (OP) poisoning. In the hospital setting, QTc and GCS were monitored in each patient at admission. Patients with respiratory failure were compared to patients without these complications, and mortality was compared between groups. We found that the group with complications had a significantly longer QTc and a lower GCS score, a higher number of intubations, and worse outcomes ( P < 0.05). GCS score and QTc have been shown to be equally good in predicting respiratory failure and hospital mortality in patients with OP poisoning. These results suggest that during initial out-of-hospital care of patients with OP poisoning, it is essential to monitor the QTc and the GCS score. The simplicity and promptness of these methods will allow providers to perform early and effective triage.

scholarly journals Hubungan Kadar Laminin Serum dengan Klasifikasi CT Marshall dan GCS pada Pasien Cedera Otak akibat Trauma

e-CliniC ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ferry Sudarsono ◽  
Eko Prasetyo ◽  
Maximillian Ch. Oley ◽  
Fima L. F. G. Langi
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Venous Blood ◽  
Elevated Serum ◽  
Cross Sectional ◽  
Coma Scale ◽  
The Difference ◽  
And Gender ◽  
The Individual

 Abstract: Elevated serum laminin levels in patients with traumatic brain injury (TBI) have been documented, but studies on its ability to predict outcomes based on the CT Marshall and Glasgow Coma Scale (GCS) classification are still unclear. This study was aimed to evaluate the relationship between serum laminin levels and Marshall CT as well as GCS classification in COT patients. This was an observational and analytical study with a cross-sectional design. A scan was used to determine the CT Marshall and GCS classification in order to obtain the level of consciousness. Venous blood samples for laminin were drawn less than 24 hours post-trauma. Age and gender were recorded, and the variable selection was carried out gradually. Proportional regression models were used to assess changes in the CT Marshall and GCS classification associated with laminin levels. The result showed that the 32 patients with COT had a mean laminin level of 818.4 pg/mL. Patients were distributed almost uniformly in the six categories of the CT Marshall classification. Furthermore, the final regression model consisted of patients with the CT Marshall IV-VI classification having a serum laminin level of 316.74 pg/mL (95% CI 206.88; 426.60 pg/mL; p<0.001) higher than that of I-III. Meanwhile, after controlling for a number of other variables, the difference increased to 401.06 pg/mL (95% CI 264.84; 563.28 pg/ mL; p<0.001). The individual consciousness levels were measured by using GCS which consist of an inverse relationship with serum laminin levels. Each increase in the mean of GCS rate decreased the laminin value to about 49.10 pg/mL (95% CI 23.33; 74.96 pg/mL; p<0.001). In conclusion, laminin has a significant correlation with the CT Marshall and GCS classifications in patients with COT.Keywords: laminin, traumatic brain injury (TBI)  Abstrak: Peningkatan kadar serum laminin pada pasien dengan cedera otak akibat trauma (COT) telah didokumentasikan, namun studi tentang kemampuannya untuk memrediksi hasil berdasarkan klasifikasi CT Marshall dan GCS (Glasgow Coma Scale) masih terbatas. Penelitian ini bertujuan untuk mengevaluasi hubungan antara kadar laminin serum dengan klasifikasi CT Marshall dan GCS pada pasien COT. Jenis penelitian ialah analitik observasional dengan desain potong lintang. Pemeriksaan CT-scan digunakan untuk menentukan klasifikasi CT Marshall dan GCS digunakan untuk menentukan tingkat kesadaran. Sampel darah vena untuk laminin diambil kurang dari 24 jam pasca trauma. Usia dan jenis kelamin juga dicatat. Seleksi variabel dilakukan secara bertahap. Digunakan model regresi proporsional untuk menilai perubahan klasifikasi CT Marshall dan GCS terkait dengan kadar laminin. Hasil penelitian mendapatkan 32 pasien dengan COT yang masuk ke Instalasi Rawat Darurat Bedah (IRDB). Kadar rerata laminin ialah 818,4 pg/mL. Pasien didistribusikan hampir seragam dalam enam kategori dari klasifikasi CT Marshall. Model regresi akhir terdiri dari penderita dengan klasifikasi CT Marshall IV-VI rata-rata memiliki kadar laminin serum 316,74 pg/mL (95% CI 206,88; 426,60 pg/mL; p<0,001) lebih tinggi daripada mereka dengan kategori I-III. Setelah sejumlah variabel lain dikontrol, selisih tersebut bahkan naik menjadi 401,06 pg/mL (95% CI 264,84; 563,28 pg/mL; p<0,001). Tingkat kesadaran individu, diukur menggunakan GCS, sebaliknya memiliki hubungan terbalik dengan kadar laminin serum. Setiap kenaikan angka GCS rata-rata menurunkan nilai laminin hingga sekitar 49,10 pg/mL (95% CI 23,33; 74,96 pg/mL; p<0,001). Simpulan penelitian ini ialah laminin mempunyai korelasi bermakna dengan klasifikasi CT Marshall dan GCS pada pasien dengan COT.Kata kunci: laminin, cedera otak akibat trauma (COT)

Naloxon – Medizinische Grundlagen und internationale Erfahrungen

2019 ◽  
Vol 65 (5) ◽  
pp. 335-342
Author(s):  
Norbert Wodarz ◽  
Jörg Wolstein ◽  
Heike Wodarz-von Essen ◽  
Oliver Pogarell
Keyword(s):  
Randomized Controlled Trial ◽  
Glasgow Coma Scale ◽  
Controlled Trial ◽  
Cochrane Library ◽  
Coma Scale ◽  
International Standard ◽  
Trial Number ◽  
Randomized Controlled ◽  
Opioid Crisis ◽  
Lebensrettende Basismaßnahmen

Zusammenfassung. Hintergrund: Die Abhängigkeit von Opioiden ist mit erheblichen gesundheitlichen Gefährdungen der Betroffenen und einer hohen Mortalität assoziiert. Derzeit werden insbesondere die dramatisch gestiegenen Mortalitätsraten in den USA diskutiert (‚opioid crisis‘), aber auch in Deutschland war in den letzten Jahren ein kontinuierlicher Anstieg der Drogentoten, überwiegend verursacht durch Opioide, zu verzeichnen. Die Risiken einer Opioid Überdosierung bzw. Intoxikation resultiert vor allem aus der hemmenden Wirkung der Opioide auf den Atemantrieb, die durch andere gleichzeitig konsumierte Substanzen noch verstärkt werden kann. Neben Erstmaßnahmen (Notruf, lebensrettende Basismaßnahmen der Ersten Hilfe) kommt auch der Einsatz des Opioidantagonisten Naloxon in Betracht. Methode: Literaturrecherche in PubMed, Cochrane Library und im International Standard Randomized Controlled Trial Number (ISRCTN) Register. Ergebnisse: Auch aus ethischen Gründen liegen bislang eher wenig systematische Untersuchungen zum nicht-ärztlichen Einsatz von Naloxon bei Opioidüberdosierung vor. Trotzdem kann nach aktuellem Stand geschlussfolgert werden, dass die intranasale Verabreichung vergleichbar wirksam mit einer intramuskulären Anwendung zu sein scheint. Bei Überdosierten, die nach erfolgreichem Naloxon-Einsatz aus unterschiedlichen Gründen nicht in einer Klinik gebracht wurden, wurden in ca. 1 %. Todesfälle dokumentiert. Falls 60 min nach Naloxongabe unauffällige Vitalparameter und auf der Glasgow Coma Scale mind. 15 Punkte erreicht werden, besteht wohl ein sehr niedriges Rebound-Risiko. Im Vergleich dazu ist das Auftreten von Naloxon-induzierten Entzugssyndromen deutlich häufiger, hängen jedoch von der Dosis und dem konsumierten Opioid ab, wie auch von der verabreichten Naloxon-Dosis. Schlussfolgerungen: Naloxon kann mittlerweile auch in Deutschland als zugelassenes Nasalspray verabreicht werden und ist daher im Prinzip auch für den Einsatz durch Ersthelfer geeignet. Verbesserte Rahmenbedingungen, wie z. B. spezifische Schulungen könnten dazu beitragen, Take-Home Naloxon als erfolgreichen Baustein zur Reduktion von Drogentod zu implementieren.

Results of studying the dimensional accuracy of the bases of complete removable prostheses made using 3D printing and traditional technologies

2020 ◽  
pp. 34-39
Author(s):  
Vokulova Yu.A. Vokulova ◽  
E.N. Zhulev
Keyword(s):  
3D Printing ◽  
Traditional Method ◽  
Laser Scanning ◽  
Laser Scanner ◽  
Digital Technologies ◽  
Dimensional Accuracy ◽  
3D Printer ◽  
Significance Level ◽  
Average Value ◽  
The Difference

This article presents the results of studying the dimensional accuracy of the bases of complete removable prostheses made using a 3D printer and the traditional method. Bases of complete removable prostheses were made using an intraoral laser scanner iTero Cadent (USA) and a 3D printer Asiga Max UV (Australia). To study the dimensional accuracy of the bases of complete removable prostheses, we used the DentalCAD 2.2 Valletta software. The Nonparametric Wilcoxon W-test was used for statistical analysis of the obtained data. We found that the average value of the difference with the standard for bases made using digital technologies is 0.08744±0.0484 mm. The average value of the difference with the standard for bases made by the traditional method is 0.5654±0.1611 mm. Based on these data, we concluded that the bases of complete removable prostheses made using modern digital technologies (intraoral laser scanning and 3D printer) have a higher dimensional accuracy compared to the bases of complete removable prostheses made using the traditional method with a significance level of p<0.05 (Wilcoxon's W-test=0, p=0.031). Keywords: digital technologies in dentistry, digital impressions, intraoral scanner, 3D printing, ExoCAD, complete removable dentures.

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