Analysis of the paramedic administration of fentanyl

2018 ◽  
Vol 7 (3) ◽  
pp. 229-234
Author(s):  
Jocelyn Freeman Garrick, MD, FACEP ◽  
Senai Kidane, MD, EMS Fellow ◽  
James E. Pointer, MD ◽  
William Sugiyama, MA, RN, NREMT-P ◽  
Christopher Van Luen, EMT-P ◽  
...  
Keyword(s):  
Side Effects ◽  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Adverse Outcomes ◽  
Secondary Outcome ◽  
Onset Of Action ◽  
Time Period ◽  
Subjective Pain ◽  
Reduction Of Pain ◽  
Fentanyl Administration

Introduction: Pain is a common complaint among emergency medical services patients. When compared with the most commonly used morphine, fentanyl has a shorter onset of action, shorter duration, and far fewer side effects making it an appealing candidate for prehospital pain management. This study’s intent is to prospectively assess the feasibility and safety of fentanyl for pain in prehospital patients in comparison with morphine.Methods: Observational trial to evaluate select characteristics of fentanyl administration. The primary outcome measure was the reduction of pain from time of initial patient assessment to transfer of care (TOC) to emergency department (ED) staff. Secondary outcome measures included the development of adverse outcomes and side effects related to fentanyl administration. Additionally, data obtained were compared with morphine retrospectively from an identical prior time period, ie, 1 year earlier.Results: About 16.6 percent of the patients who received fentanyl reported subjective pain relief in less than 1 minute, 47 percent in 1-2 minutes, 19.9 percent in 2-3 minutes, and 16.6 percent at greater than 3 minutes. The reduction of pain after fentanyl administration, on a scale of 1-10, was 3.82 points in TOC at the ED. No significant adverse clinical outcomes or incidents of diversion were reported during the trial period.Conclusions: Fentanyl can be used safely and effectively for pain control in the prehospital setting.

Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology

2021 ◽  
pp. neurintsurg-2021-017341
Author(s):  
Devin V Bageac ◽  
Blake S Gershon ◽  
Jan Vargas ◽  
Maxim Mokin ◽  
Zeguang Ren ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Control Group ◽  
Anterior Circulation ◽  
Guide Catheter ◽  
Catheter Failure ◽  
Catheter Technology ◽  
Intracranial Vasculature

BackgroundMost conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation.MethodsThis is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement.ResultsEach study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0–2%, and 10.26% were deceased.ConclusionsTracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.

scholarly journals Randomized controlled trial of convalescent plasma therapy against standard therapy in patients with severe COVID-19 disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Manaf AlQahtani ◽  
Abdulkarim Abdulrahman ◽  
Abdulrahman Almadani ◽  
Salman Yousif Alali ◽  
Alaa Mahmood Al Zamrooni ◽  
...  
Keyword(s):  
Standard Therapy ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Severe Disease ◽  
Pilot Trial ◽  
Standard Of Care ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Open Label ◽  
Plasma Therapy

AbstractConvalescent plasma (CP) therapy in COVID-19 disease may improve clinical outcome in severe disease. This pilot study was undertaken to inform feasibility and safety of further definitive studies. This was a prospective, interventional and randomized open label pilot trial in patients with severe COVID-19. Twenty COVID-19 patients received two 200 ml transfusions of convalescent patient CP over 24-h compared with 20 who received standard of care. The primary outcome was the requirement for ventilation (non-invasive or mechanical ventilation). The secondary outcomes were biochemical parameters and mortality at 28 days. The CP group were a higher risk group with higher ferritin levels (p < 0.05) though respiratory indices did not differ. The primary outcome measure was required in 6 controls and 4 patients on CP (risk ratio 0.67, 95% CI 0.22–2.0, p = 0.72); mean time on ventilation (NIV or MV) did not differ. There were no differences in secondary measures at the end of the study. Two patients died in the control and one patient in the CP arm. There were no significant differences in the primary or secondary outcome measures between CP and standard therapy, although a larger definitive study is needed for confirmation. However, the study did show that CP therapy appears to be safe in hospitalized COVID-19 patients with hypoxia.Clinical trials registration NCT04356534: 22/04/2020.

Reducing surgical site infections following craniotomy: examination of the use of topical vancomycin

2015 ◽  
Vol 123 (6) ◽  
pp. 1600-1604 ◽  
Author(s):  
Kalil G. Abdullah ◽  
Mark A. Attiah ◽  
Andrew S. Olsen ◽  
Andrew Richardson ◽  
Timothy H. Lucas
Keyword(s):  
Primary Outcome ◽  
Surgical Site Infections ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Time Interval ◽  
Infection Rates ◽  
Skin Flora ◽  
Vancomycin Powder ◽  
Subgaleal Space ◽  
Typical Skin

OBJECT Although the use of topical vancomycin has been shown to be safe and effective for reducing postoperative infection rates in patients after spine surgery, its use in cranial wounds has not been studied systematically. The authors hypothesized that topical vancomycin, applied in powder form directly to the subgaleal space during closure, would reduce cranial wound infection rates. METHODS A cohort of 150 consecutive patients who underwent craniotomy was studied retrospectively. Seventy-five patients received 1 g of vancomycin powder applied in the subgaleal space at the time of closure. This group was compared with 75 matched-control patients who were accrued over the same time interval and did not receive vancomycin. The primary outcome measure was the presence of surgical site infection within 3 months. Secondary outcome measures included tissue pH from a subgaleal drain and vancomycin levels from the subgaleal space and serum. RESULTS Vancomycin was associated with significantly fewer surgical site infections (1 of 75) than was standard antibiotic prophylaxis alone (5 of 75; p < 0.05). Cultures were positive for typical skin flora species. As expected, local measured vancomycin concentrations peaked immediately after surgery (mean ± SD 499 ± 37 μg/ml) and gradually decreased over 12 hours. Vancomycin in the circulating serum remained undetectable. Subgaleal topical vancomycin was associated with a lower incidence of surgical site infections after craniotomy. The authors attribute this reduction in the infection rate to local vancomycin concentrations well above the minimum inhibitory concentration for antimicrobial efficacy. CONCLUSIONS Topical vancomycin is safe and effective for reducing surgical site infections after craniotomy. These data support the need for a prospective randomized examination of topical vancomycin in the setting of cranial surgery.

A phase III trial of intramuscular recombinant interferon beta as treatment for exacerbating-remitting multiple sclerosis: design and conduct of study and baseline characteristics of patients

1995 ◽  
Vol 1 (2) ◽  
pp. 118-135 ◽  
Author(s):  
LD Jacobs ◽  
DL Cookfair ◽  
RA Rudick ◽  
RM Herndon ◽  
J R Richert ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Interferon Beta ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Phase Iii ◽  
Secondary Outcome ◽  
Recombinant Interferon ◽  
Study Population ◽  
The Mean ◽  
Baseline Characteristics

The design and conduct of a randomized, double-blinded, placebo-controlled, multicenter, phase III study of recombinant interferon beta-1a (IFN-β-1a) as treatment for exacerbating-remitting MS are described, as are baseline characteristics of the study population. The purpose of the study was to determine if 6.0 × 106 IU (30 μg) of IFN-β-1a, administered by weekly intramuscular (i.m.) injections, was effective in delaying the onset of sustained disability. The primary outcome measure was time to onset of treatment failure, defined as a worsening on the Kurtzke Expanded Disability Status Scale (EDSS) of greater than or equal to 1.0 point compared with baseline, persisting for at least 6 months. An intent-to-treat design was used. The primary outcome measure was analyzed using the Mantel-Cox log-rank statistic and Kaplan-Meier survival curves. Secondary outcomes included quantitative measures of upper and lower extremity function, neuropsychological test performance, functional and quality of life assessments and several measures derived from annual brain MRI studies. Entry criteria included prestudy exacerbation rates of at least 0.67 per year and EDSS scores of 1.0–3.5. A total of 301 MS patients were randomly assigned to receive weekly i.m. injections of IFN-β-1a or placebo. The average age of the study population at entry was 37 years; 92% were Caucasian and 73% were women. The mean prestudy disease duration was 6.5 years, mean prestudy exacerbation rate was 1.2 per year and the mean EDSS score was 2.3. The randomization yielded well-balanced treatment arms. Various aspects of the study are discussed, including: (1) the decision to focus study design on sustained disability; (2) the rationale for the treatment regimen; (3) measures taken to assure the reliability of the primary outcome measure; and (4) a description of the secondary outcome measures.

scholarly journals Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals

2017 ◽  
Vol 25 (4) ◽  
pp. 385-392 ◽  
Author(s):  
Willem van der Veen ◽  
Patricia MLA van den Bemt ◽  
Hans Wouters ◽  
David W Bates ◽  
Jos WR Twisk ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Medication Administration ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Bar Code ◽  
Implementation Evaluation ◽  
Medication Administration Errors ◽  
Large Numbers

Abstract Objective To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. Materials and Methods A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. Results We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Discussion Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. Conclusion In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.

Aspirin Use and Post-operative Bleeding from Dental Extractions

2008 ◽  
Vol 87 (8) ◽  
pp. 740-744 ◽  
Author(s):  
M.T. Brennan ◽  
M.A. Valerin ◽  
J.L. Noll ◽  
J.J. Napeñas ◽  
M.L. Kent ◽  
...  
Keyword(s):  
Tooth Extraction ◽  
Primary Outcome ◽  
Preventive Treatment ◽  
Primary Outcome Measure ◽  
Bleeding Complications ◽  
Secondary Outcome ◽  
Dental Procedures ◽  
Secondary Bleeding ◽  
Single Tooth ◽  
To Receive

Aspirin is a common, chronically administered preventive treatment for cardiovascular disease, but is often discontinued prior to invasive dental procedures because of concern for bleeding complications. We hypothesized that aspirin does not cause increased bleeding following a single tooth extraction. Thirty-six healthy persons requiring a tooth extraction were randomized to receive 325 mg/day aspirin or placebo for 4 days. Cutaneous bleeding time (BT) and platelet aggregation tests were obtained prior to extraction. The primary outcome measure, oral BT, and secondary bleeding outcomes were evaluated during and following extraction. No significant baseline differences, except for diastolic blood pressure, were found between groups. There were no differences in oral BT, cutaneous BT, secondary outcome measures, or compliance. Whole-blood aggregation results were significantly different between the aspirin and placebo groups. These findings suggest that there is no indication to discontinue aspirin for persons requiring single-tooth extraction.

Efficacy and safety of intra-articular versus intravenous tranexamic acid in reducing perioperative blood loss in total knee arthroplasty

2018 ◽  
Vol 100-B (2) ◽  
pp. 152-160 ◽  
Author(s):  
K. N. Subramanyam ◽  
P. Khanchandani ◽  
P. V. Tulajaprasad ◽  
J. Jaipuria ◽  
A. V. Mundargi
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Efficacy And Safety ◽  
Perioperative Blood Loss ◽  
Total Knee

Aims The aims of this study were to compare the efficacy and safety of intra-articular and intravenous (IV) tranexamic acid (TXA) in controlling perioperative blood loss in total knee arthroplasty (TKA) using a randomized, double-blinded equivalence trial. Patients and Methods A total of 182 patients aged between 45 and 75 years undergoing unilateral TKA at a tertiary centre were randomized to receive TXA, either 1.5 g intra-articularly after closure of the wound (n = 91) or two doses of 10 mg/kg IV (n = 91). The primary outcome measure was the reduction in the level of haemoglobin (Hb) in the blood on the fifth postoperative day. Secondary outcome measures were the total, visible, and hidden blood losses (TBL, VBL, HBL). We assumed equivalence of the primary outcome in both routes with a margin of ± 0.35gm/dl. Block randomization using computer-generated random numbers was used. The patients and the assessor of outcome were blinded. Results All patients completed the study. The mean difference in the reduction of the level of Hb between the two groups was -0.0055 gm/dl, with two-sided 95% confidence interval (CI) being -0.29 to 0.27, well within the predefined equivalence margin of ± 0.35gm/dl. The groups were comparable with regard to TBL, VBL, HBL, and complications. No patient needed a blood transfusion. Conclusion A single intra-articular dose and two IV doses of TXA give equivalent efficacy and safety in the management of blood loss at TKA. Cite this article: Bone Joint J 2018;100-B:152–60.

scholarly journals A Sternum-Disk Distance Method to Identify the Skin Level for Approaching a Surgical Segment without Fluoroscopy Guidance during Anterior Cervical Discectomy And Fusion

2017 ◽  
Vol 11 (1) ◽  
pp. 50-56
Author(s):  
Gun Woo Lee ◽  
Myun-Whan Ahn ◽  
Ji-Hoon Shin ◽  
Jae Woo Park ◽  
Jae-Hyung Uh ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Kappa Coefficient ◽  
Anterior Cervical Discectomy ◽  
Secondary Outcome ◽  
Distance Method ◽  
Cervical Discectomy ◽  
Observer Reliability ◽  
The Mean

<sec><title>Study Design</title><p>A retrospective review of prospectively collected data.</p></sec><sec><title>Purpose</title><p>To introduce the sternum-disk distance (SDD) method for approaching the exact surgical level without C-arm guidance during anterior cervical discectomy and fusion (ACDF) surgery and to evaluate its accuracy and reliability.</p></sec><sec><title>Overview of Literature</title><p>Although spine surgeons have tried to optimize methods for identifying the skin level for accessing the operative disk level without C-arm guidance during ACDF, success has rarely been reported.</p></sec><sec><title>Methods</title><p>In total, 103 patients who underwent single-level ACDF surgery with the SDD method were enrolled. The primary outcome measure was the accuracy of the SDD method. The secondary outcome measures were the mean SDD value at each cervical level from the cranial margin of the sternum in the neutral and extension positions of the cervical spine and the inter- and intra-observer reliability of the SDD outcome determined using repeated measurements by three orthopedic spine surgeons.</p></sec><sec><title>Results</title><p>The SDD accuracy (primary outcome measure) was indicated in 99% of the patients (102/103). The mean SDD values in the neutral-position magnetic resonance imaging (MRI) were 108.8 mm at C3–C4, 85.3 mm at C4–C5, 64.4 mm at C5–C6, 44.3 mm at C6–C7, and 24.1 mm at C7–T1; and those in the extension-position MRI were 112.9 mm at C3–C4, 88.7 mm at C4–C5, 67.3 mm at C5–C6, 46.5 mm at C6–C7, and 24.3 mm at C7–T1. The Cohen kappa coefficient value for intra-observer reliability was 0.88 (excellent reliability), and the Fleiss kappa coefficient value for inter-observer reliability as reported by three surgeons was 0.89 (excellent reliability).</p></sec><sec><title>Conclusions</title><p>Based on the results of the present study, we recommend performing ACDF surgery using the SDD method to determine the skin level for approaching the surgical cervical segment without fluoroscopic guidance.</p></sec>

scholarly journals Therapeutic Effect of Tetrax based Visual Biofeedback Training for Balance Dysfunction in a Child with Ataxic Cerebral Palsy- A Case Report

2021 ◽  
Vol 11 (9) ◽  
pp. 101-107
Author(s):  
Somya Prasad
Keyword(s):  
Cerebral Palsy ◽  
Primary Outcome ◽  
Stability Index ◽  
Berg Balance Scale ◽  
Primary Outcome Measure ◽  
Biofeedback Training ◽  
Secondary Outcome ◽  
Visual Biofeedback ◽  
Distribution Index ◽  
The Stability

Background and Purpose: The study investigated the effectiveness of Tetrax biofeedback training on balance of a child with ataxic Cerebral Palsy (ACP). Both Tetrax and conventional Occupational Therapy (COT) were performed. Each session of Tetrax and COT was carried out for 30 minutes, 3 times per week for 4 weeks. Primary outcome measure was Berg balance Scale (BBS) and fall index (FI). Secondary outcome measures were the stability index (ST) and the weight distribution index (WDI). Tetrax training has effectively aided in the recovery of balance when used in addition to the COT treatment, however further studies with larger populations are required for evidence of its effectiveness. Key words: Ataxia, Tetrax, Balance, Biofeedback, Rehabilitation.

scholarly journals Side Effects of Intravenous Patient-Controlled Analgesia with Remifentanil Compared with Intermittent Epidural Bolus for Labour Analgesia – A Randomized Controlled Trial

PRILOZI ◽  
2019 ◽  
Vol 40 (3) ◽  
pp. 99-108
Author(s):  
Dafina Karadjova ◽  
Mirjana Shosholcheva ◽  
Еmilija Ivanov ◽  
Аtanas Sivevski ◽  
Ivo Kjaev ◽  
...  
Keyword(s):  
Side Effects ◽  
Epidural Analgesia ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Patient Controlled Analgesia ◽  
Obstetric Anaesthesia ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Remifentanil Group

Abstract Introduction: Epidural analgesia is considered a gold standard in obstetric anaesthesia and analgesia. However, in situation when it is contraindicated, unwanted by the patient or simply unavailable, remifentanil can be an excellent alternative. The goal of our study is to analyse the side effects of intravenous patient-controlled analgesia (IV PCA) with remifentanil compared with epidural analgesia during delivery. Material and methods: This study included 155 pregnant women in term for birth, divided into 2 groups: a remifentanil group (RG), and an epidural group (EG). Patients in the RG received intravenous PCA with remifentanil, while patients in the ЕG received epidural analgesia with programmed intermittent bolus dosing. Our primary outcome was maternal safety; the secondary outcome was neonatal safety. Results: The results present a significantly lower SaO2 value of the parturients in the RG (96.95 ± 1.4 vs 98.22 ± 0.6), and a significantly higher respiratory rate per minute in the EG at all time points after the onset of analgesia (20.85 ± 1.4 vs 18.67 ± 0.9). There was more frequent sedation, nausea and vomiting in the RG, while in the EG there was a more elevated temperature, itching and irregularities in the CTG record. Regarding the newborn, there was no significant difference between the two groups in the Apgar scores, pH, pCO2, pO2, and bicarbonate, while there was a significantly lower value of the base excess in the RG group. Conclusion: PCA with remifentanil is safe for the mother, foetus and the newborn, with minimal side effects. Continuous respiratory monitoring, oxygen supply and following of all consensus recommendations are mandatory.

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