scholarly journals P058: Paramedic recognition and management of anaphylaxis in the prehospital setting

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S77-S77
Author(s):  
M. Welsford ◽  
R. Gupta ◽  
K. Samoraj ◽  
S. Sandhanwalia ◽  
M. Kerslake ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Prehospital Treatment ◽  
Case Identification ◽  
System Involvement ◽  
Service Areas ◽  
Before And After ◽  
Threatening Condition ◽  
Life Threatening ◽  
Definition Of ◽  
Treatment Priorities

Introduction: Anaphylaxis is a life-threatening condition that paramedics are equipped to treat effectively in the field. Current literature suggests improvements in paramedic recognition and treatment of anaphylaxis could be made. The aim of this study was to compare the proportion of cases of anaphylaxis appropriately treated with epinephrine by paramedics before and after a targeted educational intervention. Methods: This was a retrospective medical records review of patients with anaphylaxis managed by primary or advanced care paramedics in five Emergency Medical Service areas in Ontario, before and after an educational module was introduced. This module included education on anaphylaxis diagnosis, recognition, treatment priorities, and feedback on the recognition and management from the before period. All paramedic call records (PCRs) coded as local allergic reaction or anaphylaxis during 12-month periods before and after the intervention were reviewed by trained data abstractors to determine if patients met an international definition of anaphylaxis. The details of interventions performed by the paramedics were used to determine primary and secondary outcomes. Results: Of the 600 PCRs reviewed, 99/120 PCRs in the before and 300/480 in the after period were included. Of the charts included, 63/99 (63.6%) in the before and 136/300 (45.3%) in the after period met criteria for anaphylaxis (p=0.002). Of the cases meeting anaphylaxis criteria, 41/63 (65.1%) in the before and 88/136 (64.7%) in the after period were correctly identified as anaphylaxis (p=0.96). Epinephrine was administered in 37/63 (58.7%) of anaphylaxis cases in the before period and 76/136 (55.9%) in the after period (p=0.70). Anaphylactic patients with only two-system involvement received epinephrine in 20/40 (50.0%) cases in the before period and 45/93 (48.4%) in the after period (p=0.86). Conclusion: There are gaps in paramedic recognition and management of anaphylaxis, particularly in cases of two-system involvement. These gaps persisted after the implementation of an educational intervention. Other quality interventions and periodic refreshers may be necessary to improve prehospital treatment of anaphylaxis. Limitations include an increase in overall cases and decrease in rate of true anaphylaxis in the after period, which may relate to better case identification after electronic PCR implementation and changes in paramedic recognition.

scholarly journals Blunt Traumatic Aortic Injury

2021 ◽  
Author(s):  
Domenico Calcaterra
Keyword(s):  
Trauma Team ◽  
Aortic Injury ◽  
Complex Patients ◽  
Key Factor ◽  
Threatening Condition ◽  
Life Threatening ◽  
Aortic Injuries ◽  
Definition Of ◽  
Blunt Traumatic Aortic Injury ◽  
Treatment Priorities

Traumatic aortic injuries represent a leading cause of death following motor-vehicular accidents. These injuries curry a very high mortality rate even though a significant number of patients reaches the hospital alive. These injuries are identified in the contest of a polytrauma work up and are almost always associated with multiple other severe traumatic injuries which makes the management of these patients very challenging. The technology advancements seen in recent years with radiologic imaging and the progress of the therapeutic options brought up by the uprise of endovascular therapy, along with the sophistication of the techniques of trauma resuscitation and intensive care management, have improved significantly the overall prognosis of these patients. Although traumatic aortic injuries need to be generally considered a life-threatening condition, their degree of severity may differ significantly from case to case requiring immediate repair in some patients, whereas their repair can be delayed in cases when the severity of the aortic injury does not represent an immediate threat to the patient life. Therefore, the challenge of treatment of the polytrauma patients with an aortic injury is to identify the best strategy of therapy able to prioritize the treatment of the injuries based on their lethal potential. In this contest, the ability of properly defining the severity of the aortic injury is the key-factor to allow the appropriate definition of a treatment strategy able to identify treatment priorities. In our experience, radiologic assessment of the aortic injury in correlation with the evaluation of clinical parameters and a comprehensive polytrauma assessment allows to optimize the ability of the trauma team to establish the most appropriate strategy for the care of this complex patients’ group.

scholarly journals PEMBERDAYAAN KELUARGA DALAM PENGONTROLAN TEKANAN DARAH PASIEN HIPERTENSI PADA MASA PANDEMIK COVID-19 DI PUSKESMAS LIMO DEPOK

2021 ◽  
pp. 51
Author(s):  
Mila Citrawati ◽  
Citra Ayu Aprilia ◽  
Yanti Harjono ◽  
Diana Agustini
Keyword(s):  
Blood Pressure ◽  
Community Service ◽  
Hypertensive Patients ◽  
Family Empowerment ◽  
Before And After ◽  
Service Activity ◽  
Life Threatening ◽  
To Come ◽  
Definition Of ◽  
Level Of Understanding

The definition of hypertension or high blood pressure is a condition when blood pressure reaches a value of ≥ 140/90 mmHg. If not treated immediately, hypertension can cause serious life-threatening diseases, such as heart failure, kidney disease, and stroke. During the Covid-19 pandemic which has been going on since the beginning of 2020, most government health facilities have become centers for handling Covid 19 patients. So it is difficult for patients other than Covid 19 to come for treatment. Depok has a fairly high number of hypertensive patients and is currently having problems with regular check-ups at the puskesmas. This can make it difficult to control the condition of hypertension patients, apart from the puskesmas being the first service center for Covid-19 patients, the risk of contracting Covid-19 is also high if the patient comes to the puskesmas for control. Various studies on family empowerment in treating hypertensive patients have become one of the basics for our community service team to educate respondents who have family members with hypertension. This community service activity aims to increase knowledge about hypertension and how to control it in respondents so that family empowerment in treating hypertension patients can be improved. To determine the level of understanding of respondents on educational materials, questionnaires were filled out before and after education. The results achieved in this activity is an increase in respondents' knowledge about hypertension and how to control it with family participation. Hipertensi (tekanan darah tinggi) adalah kondisi tekanan darah mencapai nilai ≥ 140/90 mmHg. Hipertensi dapat mengakibatkan beberapa penyakit yang mengancam nyawa, seperti gagal jantung, penyakit ginjal, dan stroke, jika tidak segera ditangani. Pandemi Covid-19 yang sudah berlangsung sejak awal tahun 2020 memaksa sebagian besar fasilitas kesehatan milik pemerintah menjadi pusat penanganan pasien Covid-19. Sehingga menjadi masalah bagi pasien selain Covid-19 untuk datang berobat. Depok memiliki angka pasien hipertensi yang cukup tinggi dan saat ini terkendala untuk kontrol rutin ke puskesmas. Hal ini dapat mengakibatkan sulitnya mengontrol kondisi pasien hipertensi selain puskesmas menjadi pusat layanan pertama untuk pasien Covid-19, risiko tertular Covid-19 juga tinggi apabila pasien datang ke puskesmas untuk kontrol. Berbagai penelitian mengenai pemberdayaan keluarga dalam merawat pasien hipertensi menjadi salah satu dasar tim pengabdi untuk melakukan edukasi kepada responden yang mempunyai anggota keluarga penderita hipertensi. Kegiatan pengabdian kepada masyarakat ini mempunyai tujuan meningkatkan pengetahuan tentang penyakit hipertensi dan cara mengendalikannya pada responden sehingga pemberdayaan keluarga dalam merawat pasien hipertensi dapat ditingkatkan. Untuk mengetahui tingkat pemahaman responden atas materi edukasi dilakukan pengisian kuesioner sebelum dan sesudah edukasi. Hasil yang dicapai pada kegiatan ini adalah peningkatan pengetahuan responden tentang penyakit hipertensi dan cara pengendaliannya dengan peran serta keluarga.

scholarly journals BIOMARKERS OF SEPSIS

JMS SKIMS ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 2-4
Author(s):  
Bashir Ahmad Fomda
Keyword(s):  
Altered Mental Status ◽  
Respiratory Alkalosis ◽  
Blood Stream ◽  
Rapid Progression ◽  
Microbial Invasion ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Definition Of ◽  
Infectious Source

“Sepsis is a state caused by microbial invasion from a local infectious source into the blood stream which leads to signs of systemic illness in remote organs,” this was the first scientific definition of sepsis proposed by Dr. Schottmuller in 1914.Sepsis is among the most common causes of death in hospitalized patients. Its death toll is in the same range as that of myocardial infarction. 1 Early and reliable diagnosis is imperative, because of the remarkably rapid progression of sepsis into a life-threatening condition.2 Findings in a patient with suspected or proven infection include fever or hypothermia, tachypnea, tachycardia, leukocytosis or leucopenia, acutely altered mental status, thrombocytopenia, an elevated blood lactate level, respiratory alkalosis, or hypotensions. 3  JMS 2017; 20(1):2-4

The essence of a helpless state of a person as an important component in the investigation of crimes

2021 ◽  
Vol 28 (2) ◽  
pp. 269-276
Author(s):  
Oleh V. Kravchuk ◽  
Volodymyr M. Atamanchuk ◽  
Yurii M. Turovets ◽  
Serhii H. Volkotrub ◽  
Oleksandr Ye. Ostapenko
Keyword(s):  
Mental State ◽  
Physiological State ◽  
Legal Framework ◽  
Legal Analysis ◽  
State Identification ◽  
Original Definition ◽  
Threatening Condition ◽  
Life Threatening ◽  
Definition Of

The modern legal framework, despite the definition of a helpless state in the corresponding provisions of criminal, administrative, and civil legislation, does not answer the question of what exactly should be understood by such a state due to the lack of any definitions or interpretations of this concept. This determines the relevance of this study. The purpose of this study is to develop an interpretation of a helpless or other life-threatening condition, with the subsequent possibility of the corresponding improvement of the current legislation of Ukraine. The leading method of research is the method of comparative legal analysis. The study analyses the definitions of the concept of a helpless state of a person available in legal and scientific sources. Based on the results of the study, the author’s position on the essence of the concept of a helpless state is presented. The causes that can act as factors of a helpless state are identified. It is noted that the helpless state of a person, under certain conditions, can transform into a dangerous state of a person, as a result of which there is a threat of violation of citizens’ rights. The authors conclude that a helpless state is not only a physical or mental state in which a person can be located, but also a physiological state (psychophysiological), as its factor, acts as a component of the content of a helpless state. Identification of the scope and content of the rights of citizens in need of external security due to the presence of the relevant citizens, owners of these rights in a helpless or other life-threatening state, another task of solving which requires prior clarification of the essence of the helpless state or related states. Based on the analysis, the authors propose an original definition of the helpless state, as well as determine its features

scholarly journals The Knowledge of Nursing Internship Program Students about Early Detection of Sepsis

2021 ◽  
Vol 9 (T6) ◽  
pp. 116-121
Author(s):  
Stefani Stefani ◽  
Yanny Trisyani ◽  
Anita Setyawati
Keyword(s):  
Early Detection ◽  
Sampling Technique ◽  
Knowledge Score ◽  
Clinical Criteria ◽  
Knowledge Deficit ◽  
Threatening Condition ◽  
Life Threatening ◽  
Definition Of ◽  
Almost All ◽  
Sepsis Care

Background: Sepsis is a life-threatening condition due to the failure of the body’s regulation of infection. Knowledge deficit is one of the barriers to early detection and initiation of sepsis care. Nursing internship program students as future nurses need to have sufficient knowledge about early detection of sepsis to support their behavior. Thus, the purpose of this study was to describe the knowledge of nursing internship program students regarding the early detection of sepsis and the demographic factor related to the knowledge.      Methods: The study design was a quantitative study. Through the proportionate stratified non-random sampling technique, the researcher involved 143 nursing internship program students of Universitas Padjadjaran. Data collection used a questionnaire based on the Sepsis-3 guidelines to measure nursing internship program students’ knowledge about early detection of sepsis. The data was carried out in July-August 2021.   Results: The average knowledge score of the respondents was 70.4 (SD=11.9). More than half of the respondents (56.6%) got a score below the average. Almost all respondents do not know the current definition of sepsis and still use the SIRS definition as clinical criteria for sepsis. However, respondents could identify clinical criteria for sepsis based on qSOFA and analyse sepsis indicators based on case scenarios. Meanwhile, based on its characteristics, the information is a factor that significantly affects the knowledge score (p < 0.05).          Conclusion: In conclusion, there is still a gap in the knowledge of the nursing internship program students regarding the update of the Sepsis-3 guidelines. Besides, information is identified as the factor that influences knowledge. Therefore, it suggested that the institution provide further effective educational methods to update students’ knowledge about the early detection of sepsis.

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

Severe Alveolar Hemorrhage – What’s in it for the Gastroenterologist?

2016 ◽  
Vol 25 (4) ◽  
pp. 555-558
Author(s):  
Alina Popp
Keyword(s):  
Celiac Disease ◽  
International Normalized Ratio ◽  
Gluten Free Diet ◽  
Alveolar Hemorrhage ◽  
Severe Anemia ◽  
Gluten Free ◽  
Pulmonary Infiltrates ◽  
Pulmonary Hemosiderosis ◽  
Threatening Condition ◽  
Life Threatening

Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet. Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

2019 ◽  
Author(s):  
Madan Goyal ◽  
R K Goel
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Critical View Of Safety ◽  
Recent Onset ◽  
Conversion To Open Cholecystectomy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Collections ◽  
A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

PRO–CF–MED, Clinical Proof of concept for a RNA–targeting Oligonucleotide for a Cystic fibrosis–F508del MEDication, Horizon2020

Impact ◽  
2018 ◽  
Vol 2018 (3) ◽  
pp. 52-54
Author(s):  
Nicolas Lamontagne
Keyword(s):  
Cystic Fibrosis ◽  
Transmembrane Conductance Regulator ◽  
Transmembrane Conductance ◽  
Rna Targeting ◽  
Threatening Condition ◽  
Life Threatening ◽  
Cftr Protein ◽  
Disease Modifying ◽  
Cystic Fibrosis Transmembrane ◽  
Specific Challenge

Cystic fibrosis (CF) is a progressive life–shortening disease caused by a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene leading to a dysfunctional CFTR protein. The disease affects over 70,000 patients worldwide and while many mutations are known, the F508del mutation affects 90% of all patients. The absence of CFTR in the plasma membrane leads to a dramatic decrease in chloride efflux, resulting in viscous mucus that causes severe symptoms in vital organs like the lungs and intestines. For CF patients that suffer from the life threatening F508del mutation only palliative treatment exist. PRO–CF–MED addresses the specific challenge of this call by introducing the first disease modifying medication for the treatment of the CF patients with F508del mutation. The PRO–CF–MED project has been designed to assess the potential clinical efficacy of QR–010, an innovative disease modifying oligonucleotide–based treatment for F508del patients. Partners within PRO–CF–MED have generated very promising preclinical evidence for QR–010 which allows for further clinical assessment of QR–010 in clinical trials. PRO–CF–MED will enable the fast translation of QR–010 towards clinical practice and market authorisation. PRO–CF–MED has the potential to transform this life–threatening condition into a manageable one.

Advanced care planning: thinking ahead for parents, carers, children, and young people

2018 ◽  
Author(s):  
Angela Thompson
Keyword(s):  
Spiritual Needs ◽  
Care Planning ◽  
Best Interest ◽  
Social Emotional ◽  
Children And Young People ◽  
Adult Services ◽  
Active Approach ◽  
Threatening Condition ◽  
Life Threatening ◽  
Advance Care

Advance care planning (ACP) in paediatrics applies from the diagnosis of a life-limiting/life-threatening condition onwards. It encompasses the management of intermittent potentially reversible episodes through to end-of-life care in keeping with the child’s best interest. It is an active approach to managing care and acknowledges the child’s and family’s broader social, emotional, and spiritual needs and keeps the child central and paramount to all planning. It requires transparent discussions and effectively documented agreements that are well communicated, readily accessible, and immediately identifiable. It is essential to regularly review and amend as necessary. They describe the care agreed at that point in time in the child’s best interest, in line with RCPCH guidance. Challenges may particularly occur at the time of transition to adult services.

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