THỰC TRẠNG CẤP CỨU CHẤN THƯƠNG TRƯỚC VIỆN QUA CÁC TRƯỜNG HỢP CHẤN THƯƠNG SỌ NÃO NẶNG DO TAI NẠN GIAO THÔNG CẤP CỨU TẠI BỆNH VIỆN VIỆT ĐỨC

Đặt vấn đề: Cấp cứu trước viên (prehospital care), đặc biệt cấp cứu chấn thương quan trọng góp phần giảm nguy cơ biến chứng và tử vong, nhất là những trường hợp chấn thương sọ não (CTSN) do tai nạn giao thông (TNGT). Chúng tôi thực hiện nghiên cứu đánh giá thực trạng cấp cứu trước viện để đề ra khuyến nghị. Đối tượng và phương pháp nghiên cứu: Tất cả bệnh nhân CTSN do TNGT được cấp cứu tại bệnh viện Việt Đức trong thời gian từ 31/12/2020 đến 31/3/2021, không phân biệt giới, tuổi, địa phương và nghề, có hồ sơ đầy đủ, bao gồm cả các ca nặng về và tử vong. Số liệu được xử lý phần mềm SPSS 20.0. Kết quả: Tổng số 200 trường hợp cấp cứu CTSN nặng do TNGT, tuổi từ 21 – 60 chiếm 67,5%, nam giới chiếm đa số 88,5%; Thương tổn phối hợp: hàm mặt chiếm 44%, chấn thương chi chiếm 23,5%, chấn thương ngực kín 22%. Được cấp cứu ban đầu tại cơ sở y tế chiếm tỷ lệ 96,5%; Vận chuyển bằng xe cứu thương chiếm 98%; nhân viên y tế đi cùng chiếm 97%. Kỹ thuật đã làm: Ven truyền chiếm 97,5%, NKQ và khai thông đường thở 85% và 84,5%, nẹp cổ 37,5%. Xử trí tại viện: phẫu thuật cấp cứu chiếm 42%. Kết quả xử lý: nặng xin về chiếm 24,5%, tử vong chung chiếm 25%. Kết luận và khuyến nghị: Các trường hợp cấp cứu CTSN do TNGT tại bệnh viện Việt Đức thời gian gần đây được tiếp cận cấp cứu trước viện, hầu hết bệnh nhân được xử trí ban đầu tại cơ sở y tế và được vận chuyển xe cứu thương. Tuy nhiên tỷ lệ tử vong còn cao, chúng tôi khuyến nghị cần tăng cường chất lượng cấp cứu trước viện nhất là với chấn thương sọ não.

Clinical outcomes of fibrinolytic therapy for prehospital treatment of acute myocardial infarction

Fibrinolytic Therapy (FT) is an important form of treatment for cases of Acute Myocardial Infarction (AMI), especially in those places where Primary Percutaneous Coronary Intervention (PPCI) is not available, which is the main form of treatment and can be used even in the prehospital care. Aimed to describe the clinical outcomes of the use of FT in prehospital care for treating patients with AMI. This research covered a total of 53 patients and was carried out from march to october 2017, referring to the care provided from january 2015 to december 2016 in two stages, in which the first occurred with the Mobile Emergency Service (SAMU) and Walk-in Emergency Care Units (UPA), and the second in the referenced hospital services as gateways to those units. Data were collected from secondary sources. The clinical outcomes of FT considered in the form of absolute and relative frequencies and measures of central tendency were considered. The main signs and symptoms at admission were chest pain (84.62%), sweating (36.54%), dyspnea (26.92%), hypertension (19.23%), nausea (17.31%), malaise (17.31%) and emesis (13.46%). The main characteristic of chest discomfort was chest pain (70.45%). The FT drug administered in all patients was tenecteplase. The median time from symptom-to-door was 180 minutes, while symptom-reperfusion was 300 minutes and door-to-needle 160 minutes. Regarding the outcome, 74.47% had clinical improvement, 19.15% died, 4.25% had refractory AMI and 2.13% had reinfarction. The main characteristic of clinical improvement was the reversal of chest pain (68.57%), characterized as myocardial reperfusion criteria. The present study presented the main outcomes of FT use with improvement of those patients who were treated with it, and shorter times related to chest discomfort and the administration of FT were responsible for increasing the outcomes of clinical improvement and decreasing the outcome of death.

System Management Software for Emergency Call

Present the experience of the development of a system as an effective communication strategy between the user/requester and the mobile prehospital care service. Approach: It is a methodological study, fragmented into five stages, developed by health and technology professionals and students. Result: The five stages were followed to reach the final product. Conclusion: The app is groundbreaking and contributes to the safe and efficient communication with healthcare professionals and users.

Beyond STEMI: paramedics' views on how to improve their ability to interpret ECGs

Background: Internationally, the paramedic scope of practice is developing. Bypassing emergency departments in favour of direct access to primary percutaneous coronary intervention laboratories has been limited largely to cases of ST-elevation myocardial infarction and new-onset left bundle branch block, but updates to international guidelines suggest that enhancing paramedics' skills in interpreting electrocardiograms (ECGs) and widening the bypass criteria could be beneficial. Aim: The aim of the study is to explore paramedics' views on ways to improve their ECG interpretation abilities. Method: A two-arm design was used with an online questionnaire (quantitative) and one-to-one interviews (qualitative). The questionnaire results were used to inform the interview guide. Findings: One hundred and eighteen paramedics completed the survey, and 11 took part in interviews. The major themes identified from the template analysis of the interviews were ‘a profession in transition’, ‘lagging professional development’ and ‘supporting the frontline’. Self-directed learning resources before, during and after action were proposed. Conclusion: Paramedicine is evolving in Ireland and practitioners have reported undertaking self-directed learning activities. The resulting heterogeneity in skills such as ECG interpretation, and perceived barriers to education, can cause feelings of vulnerability within the profession. Supporting the frontline by introducing some Group-Orchestrated Self-Directed Learning resources could empower practitioners and contribute to the evolution of prehospital care in Ireland.

Assessment and management of issues in early pregnancy

Approximately 5% of the workload of UK emergency ambulance services involves managing obstetric patients. This places pregnancy firmly within the scope of prehospital care but training often focuses on critical illness during pregnancy rather than the range of presentations seen. This clinical review aims to discuss the implications of early pregnancy with a focus on ectopic pregnancy, rhesus incompatibility, miscarriage and hyperemesis gravidarum. Normal presentations of pregnancy and alternative management strategies, including early pregnancy units, are also discussed.

EFFICIENCY OF IMPLEMENTATION OF ELECTRONIC DOCUMENT CIRCULATION IN A MULTIDISCIPLINE HOSPITAL AT THE PREHOSPITAL STAGE

Статья посвящена анализу эффективности электронного документооборота в многопрофильном стационаре на догоспитальном этапе (в условиях приемного отделения). Исследование, проводимое в 2020-2021 гг в БУЗ ВО ВОКБ №1, можно считать актуальным, в виду того, что в последние годы в нашей стране в сфере здравоохранения продолжается ряд реформ, направленных на оптимизацию и модернизацию. Этот процесс был бы невозможен без повсеместно проводимой информатизации и цифрофизации. В настоящее время в Воронежской областной клинической больнице №1 происходит внедрение электронного документооборота и специализированных компьютерных программ, изучение эффективности которых и стала целью работы. Объектами исследования послужило 400 пациентов, мужчин и женщин в возрасте от 18 до 79 лет и их истории болезни. Все больные были разделены на 2 группы по 200 человек, в зависимости от того, использовались ли элементы электронного документооборота и специализированные компьютерные программы при их оформлении и при оказании им диагностических мероприятий (не использовались в 1 группе и использовались во 2). В дальнейшем пациенты каждой группы были также подразделены на 2 подгруппы, в зависимости от профиля (хирургия и терапия). В основу исследования лег анализ времени, затраченного на разные этапы догоспитальной помощи - от первичного осмотра и заполнения первичной документации врачами приемного отделения, до выполнения основного спектра лабораторных и инструментальных методов диагностики. Интересной особенностью работы стало выделение в каждой диагностической процедуре нескольких основных этапов, включающих, в том числе и этапы «доставки» пациента к врачу - диагносту, а также временные рамки ознакомления лечащих врачей (терапевта или хирурга приемного отделения или узких специалистов) с результатами исследования. Представленные в статье данные позволяют судить о существенном уменьшении времени, затрачиваемого на оформление и основные диагностические процедуры, благодаря внедрению электронного документооборота. Полученные в работе данные представляют существенный интерес как для практикующих врачей различного профиля и врачей, участвующих в разработке специализированного медицинского программного обеспечения, так и для организаторов здравоохранения The article is devoted to the analysis of the effectiveness of electronic document management in a multidisciplinary hospital at the prehospital stage (in the conditions of the admission department). The research carried out in 2020-2021 at BUZ VO VOKB № 1 can be considered relevant, in view of the fact that in recent years in our country a number of reforms aimed at optimization and modernization have been continuing in our country. This process would not have been possible without the widespread informatization and digitalization. Currently, the Voronezh Regional Clinical Hospital № 1 is introducing electronic document management and specialized computer programs, the study of the effectiveness of which has become the purpose of the work. The objects of the study were 400 patients, men and women, aged 18 to 79 years and their medical history. All patients were divided into 2 groups of 200 people, depending on whether the elements of electronic document management and specialized computer programs were used in their design and in providing them with diagnostic measures (were not used in group 1 and were used in 2). Subsequently, the patients of each group were also subdivided into 2 subgroups, depending on the profile (surgery and therapy). The study was based on the analysis of the time spent on different stages of prehospital care - from the initial examination and filling out the primary documentation by the doctors of the admission department, to the implementation of the main spectrum of laboratory and instrumental diagnostic methods. An interesting feature of the work was the identification of several main stages in each diagnostic procedure, including the stages of "delivery" of the patient to the doctor - diagnostician, as well as the time frame for familiarizing the attending physicians (therapist or surgeon of the admission department or narrow specialists) with the results of the study. The data presented in the article make it possible to judge a significant reduction in the time spent on registration and basic diagnostic procedures due to the introduction of electronic document management. The data obtained in this work are of significant interest both for practicing doctors of various profiles and doctors involved in the development of specialized medical software, and for healthcare organizers

Treatment approaches of electrical injuries

Background: The purpose of this study was to explore the differences in prehospital care, admission characteristics, burn intensive care, surgery and outcomes in patients requiring admission to a burn intensive care unit. Material and methods: The study was conducted on a group of 31 patients, who were hospitalized within the Clinical Hospital of Orthopedics and Traumatology in the period 2015-2019. The data analysis was carried out on the applied method of surgical treatment, the associated postoperative complications, antibiotic therapy applied, etc. Results: 27 out of the total number of patients underwent necrectomy and extensive wound debridement surgery in the first hours upon admission. 14 patients required additional decompression incisions in the underlying skin and fascia. 4 patients out of the total number presented visible signs of carbonization on the affected areas upon admission, therefore they were subjected to an emergency amputation. Out of 27 patients classified as “delayed emergency” cases, 13 patients were subjected to amputation of the corresponding segments. Conclusions: Electrical injuries are a severe cause of disability, as well as a challenging issue for reconstructive surgery, which is concerned with restoring the damaged structures with prosthetic amputation abutments, therefore improving the aesthetic and psychological appearance of the patients.

A systematic review of ePCR systems on reducing the response time of prehospital medical care

Background Poor communication at the time of patient handover is recognized as a root cause of a considerable proportion of preventable deaths. Despite several advantages, the Patient Care Report (PCR) implementation may include insufficient details for demonstrating the functional status of the patients during the actual response which can further prolong the response time. Healthcare entities have been emphasizing the need to implement e-PCR systems. This systematic review aimed to examine the impact of e-PCR systems on reducing response time of prehospital care. Methods Literature search was carried out using the relevant search terms and keywords with inclusion and exclusion criteria. N=6 researchers that focused on the impact of e-PCR systems on reducing response time of prehospital medical care were included within this review. Results The findings indicated that ePCR implementation led to prominent improvements in the quality of the care services provided by the healthcare organisation. Additionally, ePCR reduces the response rate by data standardization. Conclusion The implementation of e-PCR systems ensures the availability of records and automates reporting on given quality metrics. Moreover, the implementation of e-PCR systems also improved response time and increased the out of hospital rates of survival. However, fear of increasing the ambulance run time, compromise on the availability of ambulance, and challenges in integration with the existing information systems implemented within the hospitals, were some of the most common challenging situations associated with implementing e-PCR systems.