Vacuum mattress or long spine board: which method of spinal stabilisation in trauma patients is more time consuming? A simulation study

Abstract Background Spinal stabilisation is recommended for prehospital trauma treatment. In Germany, vacuum mattresses are traditionally used for spinal stabilisation, whereas in anglo-american countries, long spine boards are preferred. While it is recommended that the on-scene time is as short as possible, even less than 10 minutes for unstable patients, spinal stabilisation is a time-consuming procedure. For this reason, the time needed for spinal stabilisation may prevent the on-scene time from being brief. The aim of this simulation study was to compare the time required for spinal stabilisation between a scoop stretcher in conjunction with a vacuum mattress and a long spine board. Methods Medical personnel of different professions were asked to perform spinal immobilizations with both methods. A total of 172 volunteers were immobilized under ideal conditions as well as under realistic conditions. A vacuum mattress was used for 78 spinal stabilisations, and a long spinal board was used for 94. The duration of the procedures were measured by video analysis. Results Under ideal conditions, spinal stabilisation on a vacuum mattress and a spine board required 254.4 s (95 % CI 235.6–273.2 s) and 83.4 s (95 % CI 77.5–89.3 s), respectively (p < 0.01). Under realistic conditions, the vacuum mattress and spine board required 358.3 s (95 % CI 316.0–400.6 s) and 112.6 s (95 % CI 102.6–122.6 s), respectively (p < 0.01). Conclusions Spinal stabilisation for trauma patients is significantly more time consuming on a vacuum mattress than on a long spine board. Considering that the prehospital time of EMS should not exceed 60 minutes and the on-scene time should not exceed 30 minutes or even 10 minutes if the patient is in extremis, based on our results, spinal stabilisation on a vacuum mattress may consume more than 20 % of the recommended on-scene time. In contrast, stabilisation on a spine board requires only one third of the time required for that on a vacuum mattress. We conclude that a long spine board may be feasible for spinal stabilisation for critical trauma patients with timesensitive life threatening ABCDE-problems to ensure the shortest possible on-scene time for prehospital trauma treatment, not least if a patient has to be rescued from an open or inaccessible terrain, especially that with uneven overgrown land.

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Scalp injury management by a maxillofacial surgeon in a low-resource hospital

Maxillofacial Plastic and Reconstructive Surgery ◽

10.1186/s40902-020-00283-2 ◽

2020 ◽

Vol 42 (1) ◽

Author(s):

Paul Frimpong ◽

Truc Thi Hoang Nguyen ◽

Edinam Salia Nimatu ◽

Emmanuel Kofi Amponsah ◽

Soung Min Kim

Keyword(s):

Medical Knowledge ◽

Clinical Information ◽

Medical Personnel ◽

Trauma Treatment ◽

Trauma Patients ◽

Case Presentation ◽

Low Resource ◽

Life Threatening ◽

Human Injury ◽

Scalp Injury

Abstract Background Head or scalp injury is a life-threatening and typically accidental human injury. Most medical departments require immediate medical treatment and proper treatment with specialized medical personnel and facilities. However, in low-resource environments, such as the rural region of West Africa, the authors have treated emergency trauma patients and provided immediate treatment despite lack of resources. Case presentation We reviewed three cases of scalp injury patients, with representative clinical information, and used these cases to outline feedback on scalp trauma treatment based on the specialty knowledge of general and emergency surgeon. Conclusions Oral and maxillofacial surgeons are medical specialists that can immediately diagnose and treat these scalp injuries based on their medical knowledge and experience with the maxillofacial region.

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Sophistry and Circumstance at the End of Life

Communication & Medicine ◽

10.1558/cam.v5i1.81 ◽

2008 ◽

Vol 5 (1) ◽

pp. 81-88

Author(s):

Philip Berry

Keyword(s):

Liver Failure ◽

Medical Personnel ◽

Medical Decision ◽

Loss Of Consciousness ◽

Supportive Treatment ◽

Medical Decisions ◽

Life Threatening Illness ◽

Two Factors ◽

Life Threatening ◽

Counselling Process

When life-threatening illness robs a patient of the ability to express their desires, medical personnel must work through the issues of management and prognosis with relatives. Management decisions are guided by medical judgement and the relatives’ account of the patient’s wishes, but difficulties occur when distance grows between these two factors. In these circumstances the counselling process may turn into a doctor-led justification of the medical decision. This article presents two strands of dialogue, in which a doctor, counselling for and against continuation of supportive treatment in two patients with liver failure, demonstrates selectivity and inconsistency in constructing an argument. The specific issues of loss of consciousness (with obscuration of personal identity), statistical ‘futility’ and removal of autonomy are explored and used to bolster diametrically opposed medical decisions. By examining the doctor’s ability to interpret these issues according to circumstance, the author demonstrates how it is possible to shade medical facts depending on the desired outcome.

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Lung ultrasound in blunt chest trauma: A clinical review

Ultrasound ◽

10.1177/1742271x21994604 ◽

2021 ◽

pp. 1742271X2199460

Author(s):

Serena Rovida ◽

Daniele Orso ◽

Salman Naeem ◽

Luigi Vetrugno ◽

Giovanni Volpicelli

Keyword(s):

Blunt Chest Trauma ◽

Chest Trauma ◽

Lung Ultrasound ◽

Lung Parenchyma ◽

Trauma Patients ◽

Minor Trauma ◽

Major Life ◽

Diagnostic Modality ◽

Life Threatening ◽

Sternal Fractures

Introduction Bedside lung sonography is recognized as a reliable diagnostic modality in trauma settings due to its ability to detect alterations both in lung parenchyma and in pleural cavities. In severe blunt chest trauma, lung ultrasound can identify promptly life-threatening conditions which may need direct intervention, whereas in minor trauma, lung ultrasound contributes to detection of acute pathologies which are often initially radio-occult and helps in the selection of those patients that might need further investigation. Topic Description We did a literature search on databases EMBASE, PubMed, SCOPUS and Google Scholar using the terms ‘trauma’, ‘lung contusion’, ‘pneumothorax’, ‘hemothorax’ and ‘lung ultrasound’. The latest articles were reviewed and this article was written using the most current and validated information. Discussion Lung ultrasound is quite accurate in diagnosing pneumothorax by using a combination of four sonographic signs; absence of lung sliding, B-lines, lung pulse and presence of lung point. It provides a rapid diagnosis in hemodynamically unstable patients. Lung contusions and hemothorax can be diagnosed and assessed with lung ultrasound. Ultrasound is also very useful for evaluating rib and sternal fractures and for imaging the pericardium for effusion and tamponade. Conclusion Bedside lung ultrasound can lead to rapid and accurate diagnosis of major life-threatening pathologies in blunt chest trauma patients.

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Radiographic Reread Protocols to Identify Clinically Relevant Errors in Initial Trauma Evaluations

The American Surgeon ◽

10.1177/0003134821998676 ◽

2021 ◽

pp. 000313482199867

Author(s):

Madison E. Morgan ◽

Catherine T. Brown ◽

Tawnya M. Vernon ◽

Brian W. Gross ◽

Daniel Wu ◽

...

Keyword(s):

Trauma Patients ◽

Radiological Imaging ◽

Major Life ◽

Temporal Bone Fracture ◽

Level Ii ◽

Activation Level ◽

Life Threatening ◽

Trauma Activation ◽

Original Interpretation ◽

Missed Diagnoses

Introduction Diagnostic radiology interpretive errors in trauma patients can lead to missed diagnoses, compromising patient care. Due to this, our level II trauma center implemented a reread protocol of all radiographic imaging within 24 hours on our highest trauma activation level (Code T). We sought to determine the efficacy of this reread protocol in identifying missed diagnoses in Code T patients. We hypothesized that a few, but clinically relevant errors, would be identified upon reread. Methods All radiographic study findings (initial read and reread) performed for Code T admissions from July 2015 to May 2016 were queried. The reviewed radiological imaging was given one of four designations: agree with interpretation, minor (non-life threatening) nonclinically relevant error(s)—addendum/correction required or clinically relevant error(s) (major [life threatening] and minor)—addendum/correction required, and trauma surgeon notified. The results were compiled, and the number of each type of error was calculated. Results Of the 752 radiological imaging studies reviewed on the 121 Code T patients during this period, 3 (0.40%) contained minor clinically relevant errors, 11 (1.46%) contained errors that were not clinically relevant, and 738 (98.1%) agreed with the original interpretation. The three clinically relevant errors included a right mandibular fracture found on X-ray and a temporal bone fracture that crossed the clivus and bilateral rib fractures found on computerized tomography. Discussion Clinically relevant errors, although minimal, were discovered during rereads for Code T patients. Although the clinical errors were significant, none affected patient outcomes. We propose that the implementation of reread protocols should be based upon institution-specific practices.

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MAINTAINING IMMOBILISATION DEVICES ON TRAUMA PATIENTS DURING CHEST AND PELVIC X-RAY: A FEASIBILITY STUDY

10.21203/rs.2.11154/v1 ◽

2019 ◽

Author(s):

Pål Johan Stokkeland

Keyword(s):

Clinical Judgment ◽

Conventional Radiography ◽

Kappa Coefficient ◽

Whole Body ◽

Trauma Patients ◽

Technical Quality ◽

Substantial Agreement ◽

X Ray ◽

Initial Resuscitation ◽

Vacuum Mattress

Abstract BACKGROUND The aim of our study was to investigate the effect of different vacuum mattresses on standard resuscitation bay conventional radiography of chest and pelvis, especially regarding artefacts. METHODS We used a mobile X-ray machine to perform chest and pelvic conventional radiography on an anthropomorphic whole body phantom with a trauma transfer board, three different vacuum mattresses and without any stabilization device. The vacuum mattresses were investigated in activated, deactivated and stretched after deactivated states. Two radiologists assessed the artefacts independently. Agreement was measured using kappa coefficient. RESULTS All radiographs were of good technical quality and fully diagnostic. With the exception of one disagreed occurrence, artefacts were seen to hamper clinical judgement exclusively with activated vacuum mattresses. There was substantial agreement between the two radiologists on artefact assessment. The observed agreement was 0,82 with a kappa coefficient of 0,71. The first vacuum mattress caused no artefacts hampering with clinical judgment. CONCLUSION Our study concludes that it is feasible to maintain some vacuum mattresses through resuscitation bay conventional radiography of chest and pelvis. They do not result in artefacts hampering with clinical judgment. Our vacuum mattress nr 1 is recommendable for this purpose. Together with our previous findings our present results indicate that some vacuum mattresses may be used throughout the initial resuscitation bay assessment and CT examination.

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Fractures Involving the Orbit

Surgery of the Eyelid, Lacrimal System, and Orbit ◽

10.1093/oso/9780195340211.003.0023 ◽

2011 ◽

Author(s):

Don O. Kikkawa ◽

Christine C. Annunziata

Keyword(s):

Lateral Wall ◽

Medial Wall ◽

Orbital Floor ◽

Trauma Patients ◽

Posterior Aspect ◽

Orbital Roof ◽

Life Threatening ◽

Interior Walls ◽

Anterior Support ◽

Orbital Rim

Orbital and periorbital injury can occur with localized trauma to the eye or in the setting of multiple trauma associated with injury to other vital organs. A reported 16% of major trauma patients have ocular or orbital injury, and 55% of patients with facial injury have associated ocular or orbital injury. In general, the amount of ocular, soft tissue, and bony damage is related to the amount, duration, and direction of force applied to the orbit and face. Nevertheless, orbital injury is common and can be a subtle finding in the context of other facial or life-threatening injuries. Geometrically, the bony orbit most closely resembles a four-sided pyramid consisting of an apex, a base, and four sides: roof, floor, medial wall, and lateral wall. The absence of the orbital floor posteriorly and the inclination of the lateral wall toward the medial wall changes the geometric shape from a four-sided pyramid to a three-sided pyramid at the orbital apex. The bony margin circumscribes the orbital entrance and provides anterior support for the thin bones of the interior walls of the orbit. Rounding of the orbital walls blends demarcation of the superior, medial, inferior, and lateral walls. The entrance measures 40 mm horizontally and 32 mm vertically. The widest portion of the orbital margin lies about 1 cm behind the anterior orbital rim. In adults, the depth from orbital rim to apex varies from 40 to 45 mm. Safe subperiosteal dissection may be accomplished along the lateral wall and orbital floor for 22 mm and along the medial wall and orbital roof for 30 mm. The volume of the orbit is approximately 30 cc. The triangular floor of the orbit serves as the roof of the maxillary sinus. Several areas of thin bone create weak points in the orbital floor that are susceptible to fracture. The thinnest portion is medial to the infraorbital groove and canal, particularly posteriorly, where the medial wall has no bony support. In the posterior aspect of the floor, the infraorbital fissure extends as the infraorbital canal.

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Efficacy of Amflow®, a Real-Time-Portable Feedback Device for Delivering Appropriate Ventilation in Critically Ill Patients: A Randomised, Controlled, Cross-Over Simulation Study

Emergency Medicine International ◽

10.1155/2020/5296519 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Jong Won Kim ◽

Sang O Park ◽

Kyeong Ryong Lee ◽

Dae Young Hong ◽

Kwang Je Baek

Keyword(s):

Head Trauma ◽

Simulation Study ◽

Gas Flow ◽

Distress Syndrome ◽

Trauma Patients ◽

Feedback Group ◽

Clinical Scenarios ◽

Significant Difference ◽

Adult Head ◽

Randomised Controlled

Objective. The aim of this study was to test whether Amflow® (a newly designed portable ventilation feedback device) can assist rescuers in delivering target tidal volume (VT) and respiration rate (RR) during self-inflating bag (SB) ventilations in various clinical scenarios. Method. This was a simulation study with a prospective cross-over design. A total of 40 trained participants who underwent training for SB ventilation were recruited. Using a SB with or without Amflow® alternately, participants delivered ventilations to test lungs connected to a gas flow analyser in each of three different scenarios: acute respiratory distress syndrome (ARDS; 315–385 ml ranges for 350 ml target VT, with 20 breaths/min); cardiopulmonary resuscitation (CPR; 450–550 ml ranges for 500 ml target VT with 10 breaths/min); and adult head trauma (630–770 ml ranges for 700 ml target VT with 15 breaths/min). Results. The feedback group (SB with Amflow®) demonstrated a significantly higher percentage of delivering the appropriate VT ranges than the no-feedback group for both ARDS (58.6% versus 23.5%, respectively) and CPR (85.4% versus 41.0%, respectively) (all p<0.05). However, there was no significant difference between the two groups in the percentage of delivering the appropriate VT ranges in head trauma patients (65.9% versus 68.3%, respectively; p=0.092). In all three scenarios, a higher percentage of target RR delivered was achieved in the feedback group (88.3%, 99.2%, and 96.3%, respectively) compared with the no-feedback group (5.8%, 12.5%, and 10.0%, respectively) (all p<0.05). Conclusion. The Amflow® device could be useful for rescuers in delivering SB ventilation with appropriate VT and RR simultaneously in various critical situations, except for clinical cases that demand greater delivered VT.

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Investigation of an Ultra Wideband Noise Sensor for Health Monitoring

Sensors ◽

10.3390/s20041034 ◽

2020 ◽

Vol 20 (4) ◽

pp. 1034

Author(s):

Xuezhi Zeng ◽

Joakim Robakowski ◽

Mikael Persson ◽

Albert Monteith ◽

Andreas Fhager

Keyword(s):

Low Cost ◽

Medical Personnel ◽

Medical Diagnostics ◽

Ultra Wideband ◽

Trauma Patients ◽

Wideband Noise ◽

Heartbeat Rate ◽

Additional Support ◽

Electrocardiogram Ecg ◽

Monitoring Devices

Quick on-scene assessment and early intervention is the key to reduce the mortality of stroke and trauma patients, and it is highly desirable to develop ambulance-based diagnostic and monitoring devices in order to provide additional support to the medical personnel. We developed a compact and low cost ultra wideband noise sensor for medical diagnostics and vital sign monitoring in pre-hospital settings. In this work, we demonstrated the functionality of the sensor for respiration and heartbeat monitoring. In the test, metronome was used to manipulate the breathing pattern and the heartbeat rate reference was obtained with a commercial electrocardiogram (ECG) device. With seventeen tests performed for respiration rate detection, sixteen of them were successfully detected. The results also show that it is possible to detect the heartbeat rate accurately with the developed sensor.

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Remaining Cervical Spine Movement Under Different Immobilization Techniques

Prehospital and Disaster Medicine ◽

10.1017/s1049023x2000059x ◽

2020 ◽

Vol 35 (4) ◽

pp. 382-387 ◽

Cited By ~ 2

Author(s):

Davut D. Uzun ◽

Matthias K. Jung ◽

Jeronimo Weerts ◽

Matthias Münzberg ◽

Paul A. Grützner ◽

...

Keyword(s):

Cervical Spine ◽

Standard Procedure ◽

Human Motion ◽

Cervical Collar ◽

Vacuum Mattress ◽

Flexion Extension ◽

Immobilization Techniques ◽

Spine Board ◽

Spine Movement ◽

Belt System

AbstractBackground:Immobilization of the cervical spine by Emergency Medical Services (EMS) personnel is a standard procedure. In most EMS, multiple immobilization tools are available.The aim of this study is the analysis of residual spine motion under different types of cervical spine immobilization.Methods:In this explorative biomechanical study, different immobilization techniques were performed on three healthy subjects. The test subjects’ heads were then passively moved to cause standardized spinal motion. The primary endpoints were the remaining range of motion for flexion, extension, bending, and rotation measured with a wireless human motion detector.Results:In the case of immobilization of the test person (TP) on a straight (0°) vacuum mattress, the remaining rotation of the cervical spine could be reduced from 7° to 3° by additional headblocks. Also, the remaining flexion and extension were reduced from 14° to 3° and from 15° to 6°, respectively. The subjects’ immobilization was best on a spine board using a headlock system and the Spider Strap belt system (MIH-Medical; Georgsmarienhütte, Germany). However, the remaining cervical spine extension increased from 1° to 9° if a Speedclip belt system was used (Laerdal; Stavanger, Norway). The additional use of a cervical collar was not advantageous in reducing cervical spine movement with a spine board or vacuum mattress.Conclusions:The remaining movement of the cervical spine is minimal when the patient is immobilized on a spine board with a headlock system and a Spider Strap harness system or on a vacuum mattress with additional headblocks. The remaining movement of the cervical spine could not be reduced by the additional use of a cervical collar.

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Considerations for Continuing Semielective and Emergency Otolaryngological Procedures During the COVID-19 Pandemic

Ear Nose & Throat Journal ◽

10.1177/0145561320952506 ◽

2020 ◽

Vol 100 (1) ◽

pp. 19-25

Author(s):

Sarina K. Mueller ◽

Maximilian Traxdorf ◽

Konstantinos Mantsopoulos ◽

Antoniu-Oreste Gostian ◽

Matti Sievert ◽

...

Keyword(s):

Quality Of Life ◽

Emergency Surgery ◽

Transmission Rate ◽

Medical Personnel ◽

Human Beings ◽

Threatening Condition ◽

Long Time ◽

Life Threatening

Introduction: During the COVID-19 pandemic, worldwide over 600,000 human beings died due to the cause of the disease. In order to deescalate the transmission rate and to avoid crush loading the countries medical health systems social distancing, face masks, and lockdowns have been considered essential by the majority of governments. Whereas some countries have highly reduced or completely stopped otorhinolaryngological procedures, other countries have continued selected surgeries. The objective of this study was to analyze procedures and outcomes of continuing semielective and emergency surgeries during the COVID-19 pandemic. Methods: Retrospective analysis of n = 750 patients who received semi-elective or emergency surgery between March 26 and June 16, 2020, in the Otolaryngology Department of the Friedrich-Alexander-University of Erlangen-Nürnberg. All patients were screened for COVID symptoms and swabbed for SARS-CoV-2 prior to surgery. Results: Of the n = 750 patients, n = 699 patients received semielective surgery and n = 51 emergency surgery. For 27 patients, the swab result could not be awaited due to a life-threatening condition. In these cases, surgery was performed in full protective equipment. No patient was tested positive during or after the surgery (follow-up 45 to 127 days). No member of the medical personnel showed symptoms or was tested positive after contact with patients. Due to the continuation of surgeries, patients’ lives were saved and improvement of long-term quality-of-life and outcomes is anticipated. Conclusions: Continuing selected otorhinolaryngological surgeries is crucial for patients’ health, survival, and long-time quality of life, yet, the protection of the medical personnel has to be granted.

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